Giant submucosal lipoma located in the descending colon: A case report and review of the literature

Colonic lipoma is an uncommon tumor of the gastrointestinal tract. Most cases are asymptomatic, with a small tumor size, and do not need any special treatment. However, we encountered one patient with a giant submucosal lipoma, with a maximum diameter of 8.5 cm, which exhibited symptoms such as intermittent lower abdominal pain, changes in bowel habits with passage of fresh blood and mucus per rectum, abdominal distension, anorexia and weight loss. Unfortunately, the possibility of colonic malignancy could not be precluded and leffc hemicolectomy was planned. The exact diagnosis of this special case was accomplished by intraoperative pathology. In the end, local resection was performed instead of left hemicolectomy. To the best of our knowledge, colonic lipoma exceeding 8 cm in diameter has not been previously reported. We, therefore, present this case and discuss age and sex factors, clinical and histopathological findings, diagnostic methods and treatment by reviewing the available literature, to serve as a reminder that colonic lipoma can also exist in patients with significant symptoms. In addition, intraoperative pathology should be investigated in those doubtful cases, so as to guide the exact diagnosis and treatment plan.

Study on the Relationship between Expression of LGR5 and Clinicopathological Characteristics in Gastric Cancer Patients

The aim of the study was to clarify the role of LGR5 in the process of formation and development of gastric cancer. The expression of LGR5 in gastric cancer and corresponding non-cancerous gastric tissues of 52 gastric cancer patients was assessed with the real-time fluorescence quantitative polymerase chain reaction (RT-PCR) and immunohistochemistry. We also analyzed the relationship between the expression level and clinicopathological characteristics. LGR5 gene and protein expression in gastric cancer tissues was in both cases significantly higher than in corresponding non-cancerous gastric tissues (both P 0.05, respectively). Furthermore, LGR5 gene expression was markedly higher in gastric cancer tissues of Helicobacter pylori (HP)-positive patients than negative ones (P < 0.05). The result of the study showed that LGR5 might play a significant role in the process of formation and development of gastric cancer as an oncogene. Its effect might be strengthened by HP infection.

Management of granulomatous lobular mastitis: an international multidisciplinary consensus(2021 edition)

Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.

EXPRESSION OF E-CADHERIN/CATENIN COMPLEX IN BREAST CANCER

Objective： To detect the expressions of E-cadherin, α-catenin and β-catenin and analyze the relationship between Ecadherin-catenin adhesion complex and clinicopathological features in breast cancer. Methods： The expressions of E-cadherin, α-cadherin and β-catenin in specimens of 54 breast cancer, 21 normal breast tissues around tumor, 15 breast hyperplasia of usual type and 15 breast atypical hyperplasia were detected by immunohistochemical method. Results： In 21 normal breast tissues, E-cadherin and α-catenin were expressed on cell membrane of ductal and acinic cells, showing cellular contour and border among cells. The staining character of the three proteins in breast hyperplasia of usual type was the same as that in normal breast tissue. In breast atypical hyperplasia, the abnormal expression rates of E-cadherin, α-catenin and β-catenin were 6.7%, 13.3% and 26.7%, respectively. The total abnormal expression rate of E-cadherin-catenin complex was 33.3%. In breast cancer, the abnormal expression rates of E-cadherin, α＋catenin and β-catenin were 51.9%, 63.0% and 61.1%, respectively. The total abnormal expression rate of E-cadherin-catenin complex was 88.9%. Abnormal expression of E-cadherin and α-catenin were significantly correlated with histological grade. Abnormal expressions of α-catenin and β-catenin were significantly correlated with TNM staging, axillary lymph nodes metastasis and postoperative distant metastasis. Abnormal expression of E-cadherin-catenin complex was correlated with TNM staging, histological grade and axillary lymph nodes. Abnormal expression of β-catenin was negatively correlated with expression of HER-2. COX multiple factor analysis showed that E-cadherin or α-catenin or β-catenin was not independent prognostic indicator. Conclusion： Abnormal expressions of E-cadherin, α-catenin and β-catenin frequently occur in breast cancer. Abnormal expression of E-cadherin-catenin complex is correlated with differentiation disturbance and metastasis. Combined measurement of E-caherin, α-catenin and β-catenin may improve accuracy and sensitivity of predicting metastasis and prognosis of breast cancer.

Study on the Relationship between Stromal Cell-Derived Factor-1 (SDF-1) and Gastric Cancer

Whether SDF-1 is related to the occurrence and development of gastric cancer, we collected gastric cancer tissues and corresponding non-cancerous gastric tissues from 52 patients with gastric cancer, and detected the expression of SDF-1 by real-time fluorescence quantitative polymerase chain reaction (RT-PCR) and immunohistochemistry. We also analyzed the relationship between the expression level and clinicopathological characteristics. In both cases SDF-1 gene and protein expression in gastric cancer tissues were significantly higher than in corresponding non-cancerous gastric tissues (both P 0.05, respectively). Also, there were no significant relations hip in gastric cancer tissues of Helicobacter pylori (HP)-positive patients and negative ones (P > 0.05). The result of the study showed that SDF-1 might play a significant role in the process of formation and development of gastric cancer as an oncogene, but could not be used as an index to judge prognosis and predict recurrence.

Relationship between expression of Aurka and clinicopathological characteristics in gastric cancer patients

The aim of the study was to clarify the role of Aurka in the process of formation and development of gastric cancer. The expression of Aurka in gastric cancer and corresponding non-cancerous gastric tissues of 52 gastric cancer patients was assessed with the real-time fluorescence quantitative polymerase chain reaction (RT-PCR) and immunohistochemistry. We also analyzed the relationship between the expression level and clinicopathological characteristics. Aurka gene and protein expression in gastric cancer tissues in both cases were significantly higher than in corresponding non-cancerous gastric tissues (both P < 0.01), but no significant relationship was found with clinicopathological parameters including tumor location, depth of invasion, differentiation, lymph node metastasis, stage, gender, age and carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) level in peripheral blood preoperation of patients (P > 0.05, respectively). Furthermore, Aurka gene expression was markedly higher in gastric cancer tissues of Helicobacter pylori (HP)-positive patients than negative ones (P < 0.05). The result of the study showed that Aurka might play a significant role in the process of formation and development of gastric cancer as an oncogene. Its effect might be strengthened by HP infection.

Effects of long non-coding RNA GAS5 on proliferation and apoptosis of hepatocellular carcinoma cells through miR-26a-5p action

Objective Long non-coding RNAs(lncRNAs)regulate tumor development and progression by promoting tumor proliferation,invasion,and metastasis.The aim of the study was to investigate the effects of lncRNA growth arrest-special 5(GAS5)on proliferation and apoptosis of hepatocellular carcinoma(HCC)cells through miR-26a-5p action.Methods Expression levels of GAS5 were detected in cancerous and paracancerous tissue of 80 HCC patients by RT-qPCR.The starBase tool predicted that GAS5 had binding sites for the miRNA miR-26a-5p,which was also highly expressed in HCC tissue.The relationship between GAS5 and miR-26a-5p was confirmed using a luciferase reporter assay.The role of these lncRNAs was further explored by transfecting plasmids into SMMC-7721 cells and classifying the cells as follows:NC group,GAS5 group,anti-miR-26a-5p group,and GAS5+miR-26a-5p group.Cell proliferation,cell cycle,and apoptosis were detected in each group.The relationship between miR-26a-5p and phosphatase and tensin homolog deleted on chromosome 10(PTEN)was analyzed by TargetScan database prediction and luciferase reporter assay.Western blotting was used to quantify PTEN,phosphatidylinositol 3-kinase(PI3K),phosphorylated protein kinase B(p-Akt),cyclin D1,and human P27 protein(P27).Results GAS5 was downregulated,while miR-26a-5p was upregulated in HCC tissue compared to in paracancerous tissue.High GAS5 levels and low miR-26a-5p levels inhibited cell proliferation,increased the number of G0/G1 phase cells,promoted cell apoptosis,promoted PTEN and P27 expression,and inhibited PI3K,P-Akt,and cyclin D1 expression at the protein level.Upregulation of miR-26a-5p attenuated the effects of GAS5 upregulation on the proliferation,cell cycle,and apoptosis of HCC cells and on the expression of PTNE/PI3K/Akt signaling pathway-related proteins.Conclusion Low GAS5 levels regulate the proliferation and apoptosis of HCC cells via the PTNE/PI3K/Akt signaling pathway and are linked to upregulation of miR-26a-5p.

Association of Pringle maneuver with postoperative recurrence and survival following hepatectomy for hepatocellular carcinoma: a multicenter propensity score and competing-risks regression analysis

Background:The application of Pringle maneuver(PM)during hepatectomy reduces intraoperative blood loss and the need for perioperative transfusion,but its effect on long-term recurrence and survival for patients with hepatocellular carcinoma(HCC)remains controversial.We sought to determine the association between the application of PM and post-hepatectomy oncologic outcomes for patients with HCC.Methods:Patients who underwent curative hepatectomy for HCC at 9 Chinese hospitals from January 2010 to December 2018 were identified.Using two propensity score methods[propensity score matching(PSM)and inverse probability of treatment weight(IPTW)],cumulative recurrence rate and cancer-specific mortality(CSM)were compared between the patients in the PM and non-PM groups.Multivariate competing-risks regression models were performed to adjust for the effect of non-cancer-specific mortality and other prognostic risk factors.Results:Of the 2,798 included patients,2,404 and 394 did and did not adopt PM(the PM and non-PM groups),respectively.The rates of intraoperative blood transfusion,postoperative 30-day mortality and morbidity were comparable between the two groups(all P>0.05).In the PSM cohort by the 1:3 ratio,compared to 382 patients in the non-PM group,1,146 patients in the PM group also had the higher cumulative 5-year recurrence rate and CSM(63.9%and 39.1%vs.55.3%and 31.6%,both P<0.05).Similar results were also yielded in the entire cohort and the IPTW cohort.Multivariate competing-risks regression analyses demonstrated that no application of the PM was independently associated with lower recurrence rate and CSM based on various analytical cohorts[hazard ratio(HR),0.82 and 0.77 in the adjusted entire cohort,HR 0.80 and 0.73 in the PSM cohort,and HR 0.80 and 0.76 in the IPTW cohort,respectively].Conclusions:The findings suggested that no application of PM during hepatectomy for patients with HCC reduced the risk of postoperative recurrence and cancer-specific death by approximately 20–25%.

Ileal duplication mimicking intestinal intussusception:A congenital condition rarely reported in adult

Intestinal duplication is an uncommon congenital condition in young adults.A 25-year-old man complained of chronic,intermittent abdominal pain for 3 years following previous appendectomy for the treatment of suspected appendicitis.Abdominal discomfort and pain,suggestive of intestinal obstruction,recurred after operation.A tubular mass was palpable in the right lower quadrant.Computed tomography enterography scan identified suspicious intestinal intussusception,while Tc-99m pertechnetate scintigraphy revealed a cluster of strip-like abnormal radioactivity in the right lower quadrant.On exploratory laparotomy,a tubular-shaped ileal duplication cyst was found arising from the mesenteric margin of the native ileal segment located 15 cm proximal to the ileocecal valve.Ileectomy was performed along with the removal of the duplication disease,and the end-to-end anastomosis was done to restore the gastrointestinal tract continuity.Pathological examination showed ileal duplication with ectopic gastric mucosa.The patient experienced an eventless postoperative recovery and remained asymptomatic within 2 years of postoperative follow-up.

Krüppel-like factor 7 attenuates hippocampal neuronal injury after traumatic brain injury

Our previous study has shown that the transcription factor Krüppel-like factor 7(KLF7) promotes peripheral nerve regeneration and motor function recovery after spinal cord injury.KLF7 also participates in traumatic brain injury,but its regulatory mechanisms remain poorly understood.In the present study,an HT22 cell model of traumatic brain injury was established by stretch injury and oxygenglucose deprivation.These cells were then transfected with an adeno-associated virus carrying KLF7(AAV-KLF7).The results revealed that,after stretch injury and oxygen-glucose deprivation,KLF7 greatly reduced apoptosis,activated caspase-3 and lactate dehydrogenase,downregulated the expression of the apoptotic markers B-cell lymphoma 2(Bcl-2)-associated X protein(Bax) and cleaved caspase-3,and increased the expression of βIII-tubulin and the antiapoptotic marker Bcl-2.Furthermore,KLF7 overexpression upregulated Janus kinase 2(JAK2) and signal transducer and activator of transcription 3(STAT3) phosphorylation in HT22 cells treated by stretch injury and oxygenglucose deprivation.Immunoprecipitation assays revealed that KLF7 directly participated in the phosphorylation of STAT3.In addition,treatment with AG490,a selective inhibitor of JAK2/STAT3,weakened the protective effects of KLF7.A mouse controlled cortical impact model of traumatic brain injury was then established.At 30 minutes before modeling,AAV-KLF7 was injected into the ipsilateral lateral ventricle.The protein and m RNA levels of KLF7 in the hippocampus were increased at 1 day after injury and recovered to normal levels at 3 days after injury.KLF7 reduced ipsilateral hippocampal atrophy,decreased the injured cortex volume,downregulated Bax and cleaved caspase-3 expression,and increased the number of 5-bromo-2'-deoxyuridine-positive neurons and Bcl-2 protein expression.Moreover,KLF7 transfection greatly enhanced the phosphorylation of JAK2 and STAT3 in the ipsilateral hippocampus.These results suggest that KLF7 may protect hippocampal neurons after traumatic brain injury through activation of the JAK2/STAT3 signaling pathway.The study was approved by the Institutional Review Board of Mudanjiang Medical University,China(approval No.mdjyxy-2018-0012) on March 6,2018.

Predictors and long-term prognosis of early and late recurrence for patients undergoing hepatic resection of hepatocellular carcinoma: a large-scale multicenter study

Recurrence is common among patients undergoing hepatic resection for hepatocellular carcinoma(HCC),which greatly limits long-term survival.We aimed to identify predictors and long-term prognosis of early and late recurrence after HCC resection.Methods:Multicenter data of patients who underwent HCC resection between 2002 and 2016 were analyzed.Recurrence was divided into early(≤2 years)and late recurrence(>2 years after surgery).Predictors of early and late recurrence,and prognostic factors of post-recurrence survival(PRS)were identified by univariate and multivariate analyses.Results:Among 1,426 patients,554(38.8%)and 348(24.4%)developed early and late recurrence,respectively.Independent predictors associated with early recurrence included preoperative alpha-fetoprotein level>400μg/L,resection margin<1 cm,and tumor size>5.0 cm,multiplicity,macrovascular and microvascular invasion,and satellites of the initial tumor at the first diagnosis of HCC;independent predictors associated with late recurrence included male,cirrhosis,and tumor size>5.0 cm,multiplicity,macrovascular and microvascular invasion,and satellites of the initial tumor.Patients with early recurrence had a lower likelihood of undergoing potentially curative treatments for recurrence(37.2%vs.48.0%,P<0.001)and a worse median PRS(13.5 vs.36.6 months,P<0.001)vs.patients who had late recurrence.Multivariate analysis revealed that early recurrence and irregular postoperative surveillance were independently associated with worse PRS[hazard ratio(HR)=1.250,95%CI:1.016-1.538,P=0.035;and HR=1.983,95%CI:1.677-2.345,P<0.001].Conclusions:Predictors associated with early and late recurrence after curative resection for patients with HCC were generally same,although several did differ.Patients with late recurrence had better long-term survival than patients with early recurrence.

Association of tumor morphology with long-term prognosis after liver resection for patients with a solitary huge hepatocellular carcinoma-a multicenter propensity score matching analysis

Background:A solitary hepatocellular carcinoma(HCC)without macrovascular invasion and distant metastasis,regardless of tumor size,is currently classified as early-stage disease by the latest Barcelona Clinic Liver Cancer(BCLC)staging system.While the preferred treatment is surgical resection,the association of tumor morphology with long-term survival outcomes after liver resection for a solitary huge HCC of≥10 cm has not been defined.Methods:Patients who underwent curative liver resection for a solitary huge HCC were identified from a multicenter database.Preoperative imaging findings were used to define spherical-or ellipsoidal-shaped lesions with smooth edges as balloon-shaped HCCs(BS-HCCs);out-of-shape lesions or lesions of any shape with matt edges were defined as non-balloon-shaped HCCs(NBS-HCCs).The two groups of patients with BS-HCCs and NBS-HCCs were matched in a 1:1 ratio using propensity score matching(PSM).Clinicopathologic characteristics,long-term overall survival(OS)and recurrence-free survival(RFS)were assessed.Results:Among patients with a solitary huge HCC,74 pairs of patients with BS-HCC and NBS-HCC were matched.Tumor pathological features including proportions of microvascular invasion,satellite nodules,and incomplete tumor encapsulation in the BS-HCC group were lower than the NBS-HCC group.At a median follow-up of 50.7 months,median OS and RFS of all patients with a solitary huge HCC after PSM were 27.8 and 10.1 months,respectively.The BS-HCC group had better median OS and RFS than the NBS-HCC group(31.9 vs.21.0 months,P=0.01;and 19.7 vs.6.4 months,P=0.015).Multivariate analyses identified BS-HCC as independently associated with better OS(HR=0.592,P=0.009)and RFS(HR=0.633,P=0.013).Conclusions:For a solitary huge HCC,preoperative imaging on tumor morphology was associated with prognosis following resection.In particular,patients with BS-HCCs had better long-term survival following liver resection versus patients with large NBS-HCCs.