neoplasm

摘要： 成年人中有8%胰腺囊性病变(pancreatic cystic lesions, PCLs)。PCLs是一组无症状、异质性强的良性肿瘤,其中一部分导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm, IPMN)最终会演变为胰腺导管腺癌(pancreatic ductal adenocarcinoma, PDAC)。胰腺癌素有"癌症之王"的称号,确诊后5年生存率约为10%,预后极差。由于没有办法鉴别哪些PCLs可能发展为胰腺癌,保守监测还是手术干预是临床一大难题。因此,寻找此类囊肿发展为癌的分子机制,对于高危PCLs和PDAC的治疗极为重要。

摘要： BACKGROUND Ovarian cancer is one of the three most common malignant tumors of the female reproductive tract and ranks first in terms of mortality among gynecological tumors.Epithelial ovarian carcinoma(EOC)is the most common ovarian malignancy,accounting for 90%of all primary ovarian tumors.The clinical value of cytoreductive surgery in patients with platinum-resistant recurrent EOC remains largely unclear.AIM To evaluate the feasibility of secondary cytoreductive surgery for treating platinum-resistant recurrent EOC.METHODS This was a retrospective study of the clinical data of patients with platinumresistant EOC admitted to the Cancer Hospital of the University of Chinese Academy of Sciences between September 2012 and June 2018.Patient baseline data were obtained from clinical records.Routine follow-up of disease progression was performed as follows.CA125 assessment and physical examination were performed every 3 wk during treatment,including gynecological examination.Imaging assessment was carried out every 12 wk by B-mode ultrasound,computed tomography,or magnetic resonance imaging.The primary outcome was progression-free survival(PFS).Secondary outcomes included overall survival(OS),chemotherapy-free interval(CFI),and complications.Follow-up ended on April 15,2019.RESULTS A total of 38 patients were included.R0 resection was achieved in 25(65.8%) patients and R1/2 in 13 (34.2%). Twenty-five (65.8%) patients required organ resection. Nine(23.7%) patients had operative complications, 36 (94.7%) received chemotherapy, and five (13.2%)had targeted therapy. Median PFS and OS were 10 (95%CI: 8.27-11.73) months and 28 (95%CI:12.75-43.25) months, respectively;median CFI was 9 (95%CI: 8.06-9.94) months. R0 resection andpostoperative chemotherapy significantly prolonged PFS and OS (all P < 0.05), and R0 resectionalso significantly prolonged CFI (P < 0.05). Grade ≥ 3 complications were observed, includingrectovaginal fistula (n = 1), intestinal and urinary fistulas (n = 1), and renal failure-associated death(n = 1). Except for the patient who died after surgery, all other patients with complications weresuccessfully managed. Two patients developed intestinal obstruction and showed improvementafter conservative treatment.CONCLUSIONSecondary cytoreductive surgery is feasible for treating platinum-resistant recurrent EOC. Thesefindings provide important references for the selection of clinical therapeutic regimens.

摘要： Cardiac myxomas are common primary neoplasms of the heart.They are biologically benign but“functionally malignant”because of the potential for embolization.They arise most commonly from the left atrium,but no chambers of the heart are immune.They may be sporadic in the majority but also familial as a part of the Carney complex.Two morphological forms exist:polypoid and papillary.Polypoid myxomas often present with obstructive features,while the papillary forms are more prone to embolization.Histogenesis is still controversial;the current view centres around origin from the primitive pluripotent mesenchymal cells.They may be of giant proportion,be calcified or get infected.Clinical presentation typically involves the triad of intracardiac obstruction,embolic events and constitutional symptoms.Precordial examination findings may simulate those of mitral or tricuspid stenosis.The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two.Echocardiography is the investigation of choice.Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features.Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value.Histopathological examination reveals abundant loose myxoid stroma with scattered round,polygonal or stellate cells with dense irregular nuclei.Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma,i.e.the Carney complex.Surgical excision is the mainstay of treatment with low operative mortality,excellent postoperative survival and low recurrence rate.The current trend favours minimal-access surgery with or without robotic assistance.Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.

摘要： 神经内分泌肿瘤(neuroendocrine neoplasm,NEN)是起源于神经内分泌细胞的肿瘤,发病率较低,其临床表现多种多样,较易误诊,影像学、内镜及核医学的发展使其检出率越来越高。1一般资料患者,男,54岁,以“腹痛伴腹泻”入院。自诉胰腺炎病史。既往发病时于当地医院保守治疗后恢复,本次发病考虑慢性胰腺炎急性发作。体格检查:血压127/85mmHg,脉搏92次/min,体温正常,全腹叩诊呈鼓音,疼痛以左上腹为著,向腰背部放散。移动性浊音阳性。

摘要： BACKGROUND Endoscopic ultrasound(EUS)can detect small lesions throughout the digestive tract;however,it remains challenging to accurately identify malignancies with this approach.EUS elastography measures tissue hardness,by which malignant and nonmalignant pancreatic masses(PMs)and lymph nodes(LNs)can be differentiated.However,there is currently little information regarding the strain ratio(SR)cutoff in Hispanic populations.AIM To determine the diagnostic accuracy of EUS elastography for PMs and LNs with an SR cutoff value in Hispanics.METHODS A retrospective study of patients who underwent EUS elastography for PMs between December 2013 and December 2014.A qualitative(analysis of color maps)and quantitative(SR)analysis of PMs and their associated LNs was performed.The accuracy of EUS elastography in identifying malignant PMs and LNs and cutoff value for SR were analyzed.A PM and/or its associated LNs were considered malignant based on histopathological findings from fine-needle aspiration biopsy samples.RESULTS A sample of 121 patients was included,45.4%of whom were female.69(57.0%)PMs were histologically malignant,with a median SR of 50.4 vs 33.0 for malignant vs nonmalignant masses(P21.5 yielded a sensitivity of 94.2%,while a cutoff value of>121 yielded a specificity of 96.2.2%.There were significant differences in the Giovannini scores,a previously established elastic score system,between the patients grouped by their final histology results(P14.0 and>155 yielded a sensitivity of 90.9%and a specificity of 95.2%,respectively,in detecting malignancy.CONCLUSION EUS elastography is a helpful technique for the diagnosis of solid PMs and their associated LNs.The proposed SR cutoff values have a high sensitivity and specificity for the detection of malignancy.

摘要： BACKGROUND Few studies compared the oncological and biological characteristics between ampullary carcinoma(AC)and cancer of the second portion of the duodenum(DC-II),although both tumors arise from anatomically close locations.AIM To elucidate differences in clinicopathological characteristics,especially the patterns of lymph node metastasis(LNM),between AC and DC-II.METHODS This was a retrospective cohort study of 80 patients with AC and 27 patients with DC-II who underwent pancreaticoduodenectomy between January 1998 and December 2018 in two institutions.Clinicopathological factors,LNM patterns,and prognosis were compared between the two groups.RESULTS The patients with AC and DC-II did not exhibit significant differences in 5-year overall survival(66.0%and 67.1%,respectively)and 5-year relapse-free survival(63.5%and 62.2%,respectively).Compared to the patients with DC-II,the rate of preoperative biliary drainage was higher(P=0.042)and the rates of digestive symptoms(P=0.0158),ulcerative-type cancer(P<0.0001),large tumor diameter(P<0.0001),and advanced tumor stage(P=0.0019)were lower in the patients with AC.The LNM rates were 27.5%and 40.7%in patients with AC and DC-II,respectively,without significant difference(P=0.23).The rates of LNM to hepatic nodes(N-He)and pyloric nodes(N-Py)were significantly higher in patients with DC-II than in those with AC(metastasis to N-HE:18.5%and 5%in patients with DC-II and AC,respectively;P=0.0432;metastasis to N-Py:11.1%and 0%in patients with DC-II and AC,respectively;P=0.0186)CONCLUSION Although there were no significant differences in the prognosis and recurrence rates between the two groups,metastases to N-He and N-Py were more frequent in patients with DC-II than in those with AC.

摘要： BACKGROUND Hepatectomy is the first choice for treating neuroendocrine tumor liver metastases.However,most patients with neuroendocrine tumor liver metastases are not suitable for hepatectomy.Ablation combined with hepatectomy can be an alternative to liver resection.AIM To explore the clinical effect of microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases.METHODS In this study,the data of patients who underwent microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases from June 2015 to January 2018 were reviewed.Before the operation,the patients did not receive any treatment for liver neuroendocrine tumors.After a multidisciplinary expert group discussion,all patients were deemed unsuitable for liver resection.All patients were diagnosed with neuroendocrine tumors by pathology.The overall survival time and progression-free survival time were followed by telephone calls and outpatient visits after surgery.RESULTS Eleven patients with neuroendocrine tumor liver metastases were treated by microwave ablation combined with hepatectomy between June 2015 and January 2018.The median number of liver metastatic nodules was 4(range,2 to 43).The median number of lesions resected was 1(range,1 to 18),and the median number of lesions ablated was 3(range,1 to 38).The mean operation time was 405.6(±39.4)min.The median intraoperative blood loss was 600 mL(range,50 to 3000).Ten patients had a fever after surgery.The median duration of fever was 3 d(range,0 to 21).Elevated bilirubin levels occurred in all patients after surgery.The median bilirubin on the first day after surgery was 28.5(range,10.7 to 98.9)μmol/L.One patient developed respiratory failure,renal insufficiency,and pneumonia after the operation.No patient died postoperatively during hospitalization.The mean overall survival time after surgery was 34.1(±3.7)mo,and the median progression-free survival time was 8(range,2 to 51)mo.One year after surgery,ten patients survived and five patients survived without progression.Three year after surgery,eight patients survived and two patients survived without progression.CONCLUSION Microwave ablation combined with hepatectomy not only makes the patients obtain a survival rate similar to that of patients undergoing hepatectomy,but also has a low incidence of postoperative complications.

摘要： Plexiform fibromyxoma(PF)is a very rare mesenchymal neoplasm of the stomach that was first described in 2007 and was officially recognized as a subtype of gastric mesenchymal neoplasm by World Health Organization(WHO)in 2010.Histologically,PF is characterized by a plexiform growth of bland spindle to ovoid cells embedded in a myxoid stroma that is rich in small vessels.The lesion is usually paucicellular.While mucosal and vascular invasion have been documented,no metastasis or malignant transformation has been reported.Its pathogenesis is largely unknown and defining molecular alterations are not currently available.There are other mesenchymal tumors arising in the gastrointestinal tract that need to be differentiated from PF given their differing biologic behaviors and malignant potential.Histologic mimics with spindle cells include gastrointestinal stromal tumor,smooth muscle tumor,and nerve sheath tumor.Histologic mimics with myxoid stroma include myxoma and aggressive angiomyxoma.Molecular alterations that have been described in a subset of PF may be seen in gastroblastoma and malignant epithelioid tumor with gliomaassociated oncogene homologue 1(GLI1)rearrangement.The recent increase in publications on PF reflects growing recognition of this entity with expansion of clinical and pathologic findings in these cases.Herein we provide a review of PF in comparison to other mesenchymal tumors with histologic and molecular resemblance to raise the awareness of this enigmatic neoplasm.Also,we highlight the challenges pathologists face when the sample is small,or such rare entity is encountered intraoperatively.

摘要： Approximately 17%-40%of para-aortic lymph node(PAN)metastasis occurs in patients with advanced gastric cancer.As the third tier of lymphatic drainage of the stomach and the final station in front of the systemic circulation,PAN infiltration is defined as distant metastasis and plays a key role in the evaluation of the prognosis of advanced gastric cancer.Many clinical factors including tumor size≥5 cm,pT3 or pT4 depth of tumor invasion,pN2 and pN3 stages,the macroscopic type of Borrmann Ⅲ/Ⅳ,and the diffuse/mixed Lauren classification are indicators of PAN metastasis.Whether PAN dissection(PAND)should be performed on patients with or without the macroscopic PAN invasion remains unascertained,regardless of the numerous retrospective comparative studies reported on the improved prognosis over D2 alone.Another paradoxical result from many other studies showed no significant difference in the overall survival between these two lymphadenectomies.A phase Ⅱ trial launched by the Japan Clinical Oncology Group indicated that two or three courses of S-1 and cisplatin preoperatively followed by radical surgery with D2+PAND and postoperative S-1 is the current standard strategy for the treatment of patients with extensive lymph node metastasis,and this regimen could be substituted by a promising strategy with effective combination chemotherapy or suitable chemotherapy duration.This review focuses on the advances in radical gastrectomy plus PAND with or without chemotherapy for patients with advanced gastric cancer.

摘要： BACKGROUND Tumors located in the pylorus are technically more complex to resect by endoscopic resection,as the anatomical characteristics of this region can affect the adequate assessment of margins and performance of the procedure.We reported the results of underwater endoscopic mucosal resection(UEMR)of benign mucosal neoplasms located in the pyloric ring.CASE SUMMARY This case series describes 4 patients with 4 mucosal neoplasms located in the pyloric ring.The diameter of each neoplasm was less than 15 mm.We performed UEMR for the lesions.Water immersion enabled slight floating of the lesions,resulting in easy identification.We achieved en bloc resection with a snare and electrosurgical unit.All procedure were performed within 3 min without adverse events.Pathologic examination showed low-grade dysplasia with clear resection margins in one case and hyperplastic polyps in three cases.CONCLUSION UEMR can be an effective and safe treatment method for neoplasms in the gastric pyloric ring.