AIM:To investigate the clinical characteristics and treatment outcomes,including visual function and overall survival(OS)of patients with ocular adnexal diffuse large B-cell lymphoma(OA-DLBCL).METHODS:This retrospecti...AIM:To investigate the clinical characteristics and treatment outcomes,including visual function and overall survival(OS)of patients with ocular adnexal diffuse large B-cell lymphoma(OA-DLBCL).METHODS:This retrospective cohort study enrolled 29 patients diagnosed with OA-DLBCL based on histopathological biopsy between 2006 and 2023.Patients were stratified into two subgroups:primary OA-DLBCL(no prior history of lymphoma)and secondary OA-DLBCL(history of DLBCL at non-ocular adnexal sites).OS was defined as the time interval from OA-DLBCL diagnosis to death from any cause.Survival analysis was performed using the Kaplan–Meier method,and prognostic factors affecting OS were identified using multivariate Cox proportional hazards regression with a stepwise selection approach.RESULTS:The cohort included 24 patients with primary OA-DLBCL(13 males,11 females;mean age:61.36±18.29y)and 5 patients with secondary OA-DLBCL(2 males,3 females;mean age:50.94±18.17y).Among the primary OA-DLBCL subgroup,12 patients(50%)presented with advanced disease(Ann Arbor stage IIIE–IV),and 16 patients(66%)were classified as T4 disease according to the tumor-node-metastasis(TNM)staging system.The mean final visual acuity was 1.72±1.10 in the primary group and 0.90±1.18 in the secondary group.The 5-year OS rate for the entire cohort was 27.7%.Multivariate analysis identified five factors significantly associated with poor survival outcomes:epiphora[adjusted hazard ratio(aHR),36.95],atherosclerotic cardiovascular disease(aHR,10.08),human immunodeficiency virus(HIV)infection(aHR,12.47),M1 stage(aHR,6.99),and secondary OA-DLBCL(aHR,6.03;all P<0.05).The median OS was 1.68y for primary OA-DLBCL and 1.12y for secondary OA-DLBCL.CONCLUSION:A substantial proportion of patients with primary OA-DLBCL present with advanced-stage disease at diagnosis.Epiphora,atherosclerotic cardiovascular disease,HIV infection,M1 stage,and secondary OA-DLBCL are independent prognostic factors for poor survival outcomes.These findings emphasize the urgent need for optimized therapeutic strategies and early screening protocols to improve the management of OA-DLBCL,particularly in developing countries.展开更多
AIM: To investigate the clinical features, treatment and prognosis of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma(POAML).METHODS: A retrospective analysis was performed on 64 patients with POAML ...AIM: To investigate the clinical features, treatment and prognosis of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma(POAML).METHODS: A retrospective analysis was performed on 64 patients with POAML who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2006 to December 2018.RESULTS: With a median follow-up of 61 mo(range, 2-156 mo), estimated overall survival(OS) rate and progressionfree survival(PFS) rate at 10 y reached 94.5% and 61.5%, respectively. Median OS time and PFS time were not reached. During this period, only 3 patients died, but none of them died directly due to disease progression. One patient(1.6%) developed transformation to diffuse large B-cell lymphoma(DLBCL). Of the 56 patients achieved complete remission after first-line treatment, 5(8.9%) developed local and/or systemic relapse eventually. Patients ≥60 y had significantly shorter PFS than younger patients(P=0.01). For patients with early stages(Ann Arbor stage I and stage II), univariate analysis confirmed that radiotherapydose lower than 32 Gy were independently associated with shorter PFS(P=0.04). Other factors including gender, bone marrow involvement, the initial location of the disease, and the laterality were not associated with PFS.CONCLUSION: The data from our center indicate that POAML has a slow clinical progression and has an excellent clinical outcome. Patients with POAML harbor a continual risk of relaps and transformation to aggressive subtype of lymphoma.展开更多
BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant tumor of the skin that is commonly found on the face.It grows slowly and has a low mortality rate.However,for various reasons,including strong histologi...BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant tumor of the skin that is commonly found on the face.It grows slowly and has a low mortality rate.However,for various reasons,including strong histological invasiveness,clinical inexperience and inadequate procedure design,immediate or permanent facial deformity may occur after surgical operations.CASE SUMMARY This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip.She declined the recommended treatment plan,which included two-stage reconstruction,skin grafting,or surgery that could have resulted in obvious facial dysfunction or esthetic deformity.We accurately designed a personalized procedure involving a“jigsaw puzzle advancement flap”for the patient based on the lesion location and the estimated area of skin loss.The procedure was successful;both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.CONCLUSION This study suggests that when treating facial MAC or other skin malignancies,a surgical team should have sufficient plastic surgery-related knowledge and skills.An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.展开更多
AIM：To investigate the expressions of metadherin（astrocyte elevated gene-1, AEG-1） and lymphoid enhancerbinding factor-1（LEF-1） in ocular adnexal mucosaassociated lymphoid tissue（MALT） lymphoma.METHODS：The exp...AIM：To investigate the expressions of metadherin（astrocyte elevated gene-1, AEG-1） and lymphoid enhancerbinding factor-1（LEF-1） in ocular adnexal mucosaassociated lymphoid tissue（MALT） lymphoma.METHODS：The expressions of AEG-1 and LEF-1 were detected on specimens harvested from patients suffering from MALT lymphoma and lymphadenosis of ocular adnexal in Ophthalmology Department, Affiliated Hospital of Qingdao University from 2000 to 2015 by immunohistochemical and polymerase chain reaction（PCR） analysis.RESULTS：AEG-1 and LEF-1 expressions in MALT lymphoma was respectively higher than that in lymphadenosis, both by immunohistochemical and PCR analysis（P〈0.05）. Diversity of AEG-1 and LEF-1 expressions in different Ann Arbor clinical stages showed a statistically significant result（P〈0.05）. A positive relevance between AEG-1 and LEF-1 was observed in MALT ocular adnexal lymphoma（r=0.435, P=0.016）.CONCLUSION：The over expressions of AEG-1 and LEF-1 at the level of protein and mR NA participates in the tumorigenesis of ocular adnexal MALT lymphoma. They should act as a new biological marker for pathological diagnosis in the future.展开更多
Objective To investigate the correlation between gynaecologic adnexal surgery history and pregnancy outcome of in vitro fertilization （IVF） treatment. Methods A total of 810 women who were proceeded 810 IVF; treatme...Objective To investigate the correlation between gynaecologic adnexal surgery history and pregnancy outcome of in vitro fertilization （IVF） treatment. Methods A total of 810 women who were proceeded 810 IVF; treatment cycles from October 2009 to March 2011 were recruited to this retrospective study, based on whether they had history of gynaecologic adnexal surgeries or not. Among 810 women, 587 women had no gynaecologic adnexal surgeries （group A）, 223 women had gynaecologic adnexal surgeries （group B）. Additionally, the group B was further divided into 4 subgroups based on their different gynaecologic adnexal surgery histories, such as tubal conservative surgery （group Bal）, unilateral salpingectomy （group Ba2）, ovarian cyst ablation （group Bbl） and unilateral adnexal resection （group Bb2）. The basal levels of FSH, antral follicle count （AFC）, clinical pregnancy rate （CPR）, embryos implantation rates （IR） and live birth rates （LBR） were compared.Results The levels of FSH and AFC were significantly different between groups A and B, respectively. Therefore, CPR, IR and LBR were significantly lower （P 〈0.05） in group B （30.9%, 17.8% and 25.1%） compared with group A （39.9%, 22.8% and 32.4%）. Meanwhile, there was no significant difference between the patients who had tubal conservation surgery （group Bal） and who had unilateral salpingectomy （group Ba2）. However, in contrast to unilateral adnexectomy, ovarian cystectomy surgery influenced FSH and AFC significant, even for the number of oocyte retrieved, but did not affect the IVF treatment outcome. Conclusion The previous history of gynaecologic adnexal surgeries may affect the subsequent ovarian function and also IVF outcomes. As for different operation methods, between tubal conservation surgery and unilateral salpingectomy, the IVF outcomes were not significantly different. The same result we found in different ovarian operation groups.展开更多
目的探讨基于简化流程图的O-RADS联合ADNEX模型评估中老年女性附件肿瘤良恶性的临床应用。方法选取2018年11月—2022年11月在桂林医学院附属医院行妇科超声检查发现附件肿瘤且行手术治疗的中老年患者95例。根据O-RADS及ADNEX模型对附件...目的探讨基于简化流程图的O-RADS联合ADNEX模型评估中老年女性附件肿瘤良恶性的临床应用。方法选取2018年11月—2022年11月在桂林医学院附属医院行妇科超声检查发现附件肿瘤且行手术治疗的中老年患者95例。根据O-RADS及ADNEX模型对附件肿瘤进行分类,以病理组织学作为金标准,计算出O-RADS、ADNEX模型及两者联合的诊断效能,绘制受试者工作特征(ROC)曲线。结果95例患者中,病理结果恶性46例、良性49例。O-RADS 4、5类诊断附件恶性肿瘤的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%(95%CI:0.811,0.983)、69.39%(95%CI:0.544,0.813)、74.14%、91.89%,ADNEX模型诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为89.13%(95%CI:0.756,0.959)、79.59%(95%CI:0.652,0.893)、80.39%、88.63%,两者联合诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%(95%CI:0.811,0.983)、83.67%(95%CI:0.698,0.922)、84.31%和93.18%。O-RADS、ADNEX模型及其联合诊断附件肿瘤良恶性的曲线下面积分别0.814、0.844、0.871。由2位超声医师运用O-RADS分类诊断的一致性好(κ=0.847,P=0.000),运用O-RADS简化流程图者较颜色编码计分表格者用时更短,分别为42 min 39 s和51 min 3 s。结论O-RADS联合ADNEX模型诊断中老年女性附件肿瘤良恶性的价值较单独使用O-RADS高,不同超声医师使用O-RADS有较高的一致性,且使用简化流程图者可更快速进行分类,值得推广。展开更多
AIM:To report CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease(IgG4-MALT lymphoma),a rare but clinically important complication of ocular adn...AIM:To report CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease(IgG4-MALT lymphoma),a rare but clinically important complication of ocular adnexal IgG4-related disease.METHODS:We retrospectively reviewed all cases of histologically confirmed ocular adnexal IgG4-related disease at three ter tiary and one secondary referral centers,between February 2003 and December 2016.Seven cases of histopathologically diagnosed IgG4-MALT lymphoma were identified.CT and MR images were analyzed by consensus of two experienced head and neck radiologists.RESULTS:Lacrimal glands were the main site of involvement in all seven patients.The lesions typically showed well-demarcated margins,iso-to hyperattenuation on precontrast CT,T2 hypo-to isointensity,T1 isointensity,and homogenous internal architecture with homogenous enhancement pattern.Lesions were mostly hyperdense and isointense to normal extraocular muscles on postcontrast CT and MR images,respectively.CONCLUSION:Unlike in typical ocular adnexal IgG4-related disease,T2 isointensity and hyperattenuation on precontrast CT images were noted in some IgG4-MALT lymphoma cases.Although the findings may be nonspecific,the possibility of accompanying MALT lymphoma may need to be considered,when ocular adnexal lesions in patients clinically suspected of having IgG4-related disease are refractory to glucocorticoids and show T2 isointensity and hyperattenuation on precontrast CT for the optimal management of the patients.However,this is a case series of a very rare complication of ocular adnexal IgG4-related disease,and thus caution is warranted to generalize the conclusion.展开更多
Ovarian cancer is one of the most common causes of cancerrelated death in women. Adnexal masses are frequently diagnosed during reproductive age and often require surgical removal. The risk of malignancy when dealing ...Ovarian cancer is one of the most common causes of cancerrelated death in women. Adnexal masses are frequently diagnosed during reproductive age and often require surgical removal. The risk of malignancy when dealing with a complex adnexal mass should be defned prior to surgery and several scoring systems may be useful for this purpose. Laparoscopic management of ovarian tumours allows a minimally invasive approach with respect to several oncological assumptions. In the last decade concerns have been raised regarding the risk of cyst rupture and tumour spillage as a con-sequence of the laparoscopic technique itself both in early and advanced stages of ovarian cancer. Although limited data have been reported in the literature on the use of minimally invasive techniques in ovarian cancer, the clear benefits of this approach must be balanced with the potential hazards in different clinical situations. Laparoscopic staging in borderline tumours and presumed early-stage ovarian cancer performed by a laparoscopic oncologist seems to be safe and effec-tive when compared to laparotomy. The precise role of laparoscopy in patients with more advanced cancer is still to be defned, and the risk of suboptimal surgery should never outweigh the potential benefits of mini-mally invasive surgery. Thus, a tailored prediction of optimal laparoscopic debulking is mandatory in these patients.展开更多
Aims and Objectives: The aim of this diagnostic observational study was to find an association of final diagnosis of adnexal masses suggested by MRI and compare it as an imaging modality in determining the origin, nat...Aims and Objectives: The aim of this diagnostic observational study was to find an association of final diagnosis of adnexal masses suggested by MRI and compare it as an imaging modality in determining the origin, nature (benign/malignant) & characteristics of adnexal masses by calculating sensitivity, specificity, and diagnostic accuracy. Materials and Methods: The present study was carried out in 90 patients in the department of radio diagnosis and imaging, institute of medical sciences, Banaras Hindu University (BHU). The patients were referred from department of obstetrics & gynecology, institute of medical sciences. Majority of the referred cases were those who had clinical features of abdominal pain, abdominal lump, menstrual irregularity, ascites, and anorexia or weight loss & in whom adnexal mass was suspected clinically. Magnetic resonance imaging was performed using 1.5 Tesla MR Scanner, Magnetom Avanto (Siemens Healthcare). Results: Out of 114 masses, 17 (14.9%) were malignant. The benign adnexal masses were maximum in the age group 20 - 39 years (56/97, 57.7%), while malignant masses were mainly found in women ≥60 years of age (11/17, 64.7%). CA-125 level was grossly elevated in association with 35.3% of the malignant masses. On MRI, the sensitivity for the mass of ovarian origin was (97.7%) and specificity was (73.1%). The diagnostic accuracy was (92.1%). The mass of uterine origin had a sensitivity of (73.1%) and diagnostic accuracy (99.1%). Conclusion: MRI, because of its accuracy in identifying the origin of adnexal mass and characterizing the solid, hemorrhagic, fatty and fibrous content, may obviate surgery or significantly contribute to preoperative planning for a sonographically indeterminate mass. MRI is the state of the art imaging modality for evaluation of adnexal masses with an overall high diagnostic accuracy.展开更多
Objective： The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant speciali...Objective： The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. Methods： Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index （PDI）, risk of malignancy index （RMI） and body mass index （BMI） were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. Results： The study included 689 women （112 malignant, 544 benignant, and 33 borderline tumors）. Malignant and borderline tumors were more frequent in postmenopausal women （P=0.000）. Women who had benignant tumors had the lowest BMI （P=0.000）. There were significant （P〈0.05） differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen （CEA） levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors （P=0.000）. Women with malignant tumors had highest values of RMI and PDI （P=0.000）. Conclusions： Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.展开更多
Objectives:To evaluate the safety and efficacy of conservative laparoscopic surgery for adnexal torsion and the feasibility of secondary operation.Methods:This is a retrospective study that consists of 17 patients wit...Objectives:To evaluate the safety and efficacy of conservative laparoscopic surgery for adnexal torsion and the feasibility of secondary operation.Methods:This is a retrospective study that consists of 17 patients with clinically diagnosed adnexal torsion who have a desire for pregnancy in the future.We performed conservative laparoscopic adnexal detorsion operations from January 2014 to June 2016 in Sir Run Run Shaw Hospital.The collected data,including age,onset time,maximum diameter of adnexal lesion,local blood flow signal,torsion degree,and recovery of local blood supply after detorsions,were analyzed.The blood flow of the lesion side,the antral follicles development,the basal endocrine hormone levels and the menstrual cycle were examined one-month and three-month post operation.Future fertility was investigated postoperatively.Results:All cases had no obvious clinical postoperative complications.There were no significant changes on menstrual cycle and ovarian function during the follow-up period.Conclusions:Adnexal torsion in young patients should be carefully treated and fertility reservation should be thoroughly considered.The decision to remove adnexa needs careful consideration.Conservative laparoscopic surgery is safe and does not increase the occurrence of serious complications.There is a higher possibility of a long delay between surgery and onset necrosis,but this is not always the case.Even if there is adnex thromboembolic infarction it does not result in serious complications such as pulmonary infarction.Conservative laparoscopic surgery can be performed first unless the clinician is certain it is already necrotic.We should do our best to reserve patients’fertility as much as possible.If necessary,a secondary surgery can be performed.展开更多
BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant cutaneous adnexal neoplasm,often presenting as a flesh-colored and slow-growing indurated plaque or cystic nodule in the mid-facial region.Its character...BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant cutaneous adnexal neoplasm,often presenting as a flesh-colored and slow-growing indurated plaque or cystic nodule in the mid-facial region.Its characteristic indolent presentation usually leads to initial misdiagnosis,resulting in tumor mismanagement and added morbidity due to increased propensity for local invasion.CASE SUMMARY A 63-year-old Chinese male patient with a long-term history of excessive ultraviolet irradiation had received two surgeries for an“epidermal cyst”on his glabella and was presented to our hospital’s Dermatology Department for further diagnosis and therapy of the lesion on his glabella.One month ago,his two 7 mm×7 mm subcutaneous nodules were diagnosed as"recurrent epidermal cysts",and he underwent local excision surgery.Additionally,he has post medical history of surgery for right clear cell renal carcinoma.According to his biopsy,the patient was diagnosed as MAC in our hospital,and a tumor remnant was found on his wound.He then underwent wide local excision to achieve negative margins and reconstruction of full-thickness flap transplantation for tissue coverage.He remained tumor-free after six months of follow-up.CONCLUSION This case highlights the importance of MAC’s possible pathogenic factor of excessive ultraviolet exposure,its differential diagnosis to avoid misdiagnosis and mismanagement to adverse prognosis,the patient’s particular medical history of clear cell renal carcinoma,the alert for any tumor recurrence in older patients,and his uncommon multiple nodules mess consisting of two 7 mm×7 mm subcutaneous nodules,that will enrich the existing knowledge of MAC’s clinical features.展开更多
Lymphomas are known as neoplasm’s caused by clone proliferation of B and T lymphocytes. Extranodal lymphoma arises from tissues other than lymph nodes or even from sites which normally doesn’t contain lymph tissues....Lymphomas are known as neoplasm’s caused by clone proliferation of B and T lymphocytes. Extranodal lymphoma arises from tissues other than lymph nodes or even from sites which normally doesn’t contain lymph tissues. Orbital adnexal lymphoma arises from eyelid, orbit, lacrimal glands or conjunctivae and it is totally different from intraocular lymphoma. Wide range of differential diagnosis including infectious inflammatory orbital disease, preseptal and orbital cellulitis, orbital idiopathic inflammatory disease-pseudotumors, especially dacryoadenitis and myositis and thyroid associate orbit disease makes the diagnosis of orbital adnexal lymphoma even more difficult. We represent the case of diagnostic delay of very aggressive form orbital non-Hodgkin lymphoma occurred because of the unspecific signs and symptoms as well as not indicative imaging investigation and laboratory tests.展开更多
基金Supported by the Faculty of Medicine,Prince of Songkla University.Wainipitapong S has received grants from the Faculty of Medicine,Prince of Songkla University。
文摘AIM:To investigate the clinical characteristics and treatment outcomes,including visual function and overall survival(OS)of patients with ocular adnexal diffuse large B-cell lymphoma(OA-DLBCL).METHODS:This retrospective cohort study enrolled 29 patients diagnosed with OA-DLBCL based on histopathological biopsy between 2006 and 2023.Patients were stratified into two subgroups:primary OA-DLBCL(no prior history of lymphoma)and secondary OA-DLBCL(history of DLBCL at non-ocular adnexal sites).OS was defined as the time interval from OA-DLBCL diagnosis to death from any cause.Survival analysis was performed using the Kaplan–Meier method,and prognostic factors affecting OS were identified using multivariate Cox proportional hazards regression with a stepwise selection approach.RESULTS:The cohort included 24 patients with primary OA-DLBCL(13 males,11 females;mean age:61.36±18.29y)and 5 patients with secondary OA-DLBCL(2 males,3 females;mean age:50.94±18.17y).Among the primary OA-DLBCL subgroup,12 patients(50%)presented with advanced disease(Ann Arbor stage IIIE–IV),and 16 patients(66%)were classified as T4 disease according to the tumor-node-metastasis(TNM)staging system.The mean final visual acuity was 1.72±1.10 in the primary group and 0.90±1.18 in the secondary group.The 5-year OS rate for the entire cohort was 27.7%.Multivariate analysis identified five factors significantly associated with poor survival outcomes:epiphora[adjusted hazard ratio(aHR),36.95],atherosclerotic cardiovascular disease(aHR,10.08),human immunodeficiency virus(HIV)infection(aHR,12.47),M1 stage(aHR,6.99),and secondary OA-DLBCL(aHR,6.03;all P<0.05).The median OS was 1.68y for primary OA-DLBCL and 1.12y for secondary OA-DLBCL.CONCLUSION:A substantial proportion of patients with primary OA-DLBCL present with advanced-stage disease at diagnosis.Epiphora,atherosclerotic cardiovascular disease,HIV infection,M1 stage,and secondary OA-DLBCL are independent prognostic factors for poor survival outcomes.These findings emphasize the urgent need for optimized therapeutic strategies and early screening protocols to improve the management of OA-DLBCL,particularly in developing countries.
基金Supported by the National Natural Science Foundation of China (Henan Joint Fund, No.U1404308)
文摘AIM: To investigate the clinical features, treatment and prognosis of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma(POAML).METHODS: A retrospective analysis was performed on 64 patients with POAML who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2006 to December 2018.RESULTS: With a median follow-up of 61 mo(range, 2-156 mo), estimated overall survival(OS) rate and progressionfree survival(PFS) rate at 10 y reached 94.5% and 61.5%, respectively. Median OS time and PFS time were not reached. During this period, only 3 patients died, but none of them died directly due to disease progression. One patient(1.6%) developed transformation to diffuse large B-cell lymphoma(DLBCL). Of the 56 patients achieved complete remission after first-line treatment, 5(8.9%) developed local and/or systemic relapse eventually. Patients ≥60 y had significantly shorter PFS than younger patients(P=0.01). For patients with early stages(Ann Arbor stage I and stage II), univariate analysis confirmed that radiotherapydose lower than 32 Gy were independently associated with shorter PFS(P=0.04). Other factors including gender, bone marrow involvement, the initial location of the disease, and the laterality were not associated with PFS.CONCLUSION: The data from our center indicate that POAML has a slow clinical progression and has an excellent clinical outcome. Patients with POAML harbor a continual risk of relaps and transformation to aggressive subtype of lymphoma.
文摘BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant tumor of the skin that is commonly found on the face.It grows slowly and has a low mortality rate.However,for various reasons,including strong histological invasiveness,clinical inexperience and inadequate procedure design,immediate or permanent facial deformity may occur after surgical operations.CASE SUMMARY This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip.She declined the recommended treatment plan,which included two-stage reconstruction,skin grafting,or surgery that could have resulted in obvious facial dysfunction or esthetic deformity.We accurately designed a personalized procedure involving a“jigsaw puzzle advancement flap”for the patient based on the lesion location and the estimated area of skin loss.The procedure was successful;both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.CONCLUSION This study suggests that when treating facial MAC or other skin malignancies,a surgical team should have sufficient plastic surgery-related knowledge and skills.An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.
基金Supported by Public Domain of Science and Technology Project of Qingdao,Shandong Province,China(NO.2012-1-3-2-14-snh)
文摘AIM：To investigate the expressions of metadherin（astrocyte elevated gene-1, AEG-1） and lymphoid enhancerbinding factor-1（LEF-1） in ocular adnexal mucosaassociated lymphoid tissue（MALT） lymphoma.METHODS：The expressions of AEG-1 and LEF-1 were detected on specimens harvested from patients suffering from MALT lymphoma and lymphadenosis of ocular adnexal in Ophthalmology Department, Affiliated Hospital of Qingdao University from 2000 to 2015 by immunohistochemical and polymerase chain reaction（PCR） analysis.RESULTS：AEG-1 and LEF-1 expressions in MALT lymphoma was respectively higher than that in lymphadenosis, both by immunohistochemical and PCR analysis（P〈0.05）. Diversity of AEG-1 and LEF-1 expressions in different Ann Arbor clinical stages showed a statistically significant result（P〈0.05）. A positive relevance between AEG-1 and LEF-1 was observed in MALT ocular adnexal lymphoma（r=0.435, P=0.016）.CONCLUSION：The over expressions of AEG-1 and LEF-1 at the level of protein and mR NA participates in the tumorigenesis of ocular adnexal MALT lymphoma. They should act as a new biological marker for pathological diagnosis in the future.
基金supported by the National Natural Science Foundation of China(Grant No.81370762)the Key Program for Basic Research of the Science and Technology Commission of Shanghai Municipality,China(Grant No.12JC1405800)
文摘Objective To investigate the correlation between gynaecologic adnexal surgery history and pregnancy outcome of in vitro fertilization （IVF） treatment. Methods A total of 810 women who were proceeded 810 IVF; treatment cycles from October 2009 to March 2011 were recruited to this retrospective study, based on whether they had history of gynaecologic adnexal surgeries or not. Among 810 women, 587 women had no gynaecologic adnexal surgeries （group A）, 223 women had gynaecologic adnexal surgeries （group B）. Additionally, the group B was further divided into 4 subgroups based on their different gynaecologic adnexal surgery histories, such as tubal conservative surgery （group Bal）, unilateral salpingectomy （group Ba2）, ovarian cyst ablation （group Bbl） and unilateral adnexal resection （group Bb2）. The basal levels of FSH, antral follicle count （AFC）, clinical pregnancy rate （CPR）, embryos implantation rates （IR） and live birth rates （LBR） were compared.Results The levels of FSH and AFC were significantly different between groups A and B, respectively. Therefore, CPR, IR and LBR were significantly lower （P 〈0.05） in group B （30.9%, 17.8% and 25.1%） compared with group A （39.9%, 22.8% and 32.4%）. Meanwhile, there was no significant difference between the patients who had tubal conservation surgery （group Bal） and who had unilateral salpingectomy （group Ba2）. However, in contrast to unilateral adnexectomy, ovarian cystectomy surgery influenced FSH and AFC significant, even for the number of oocyte retrieved, but did not affect the IVF treatment outcome. Conclusion The previous history of gynaecologic adnexal surgeries may affect the subsequent ovarian function and also IVF outcomes. As for different operation methods, between tubal conservation surgery and unilateral salpingectomy, the IVF outcomes were not significantly different. The same result we found in different ovarian operation groups.
文摘目的探讨基于简化流程图的O-RADS联合ADNEX模型评估中老年女性附件肿瘤良恶性的临床应用。方法选取2018年11月—2022年11月在桂林医学院附属医院行妇科超声检查发现附件肿瘤且行手术治疗的中老年患者95例。根据O-RADS及ADNEX模型对附件肿瘤进行分类,以病理组织学作为金标准,计算出O-RADS、ADNEX模型及两者联合的诊断效能,绘制受试者工作特征(ROC)曲线。结果95例患者中,病理结果恶性46例、良性49例。O-RADS 4、5类诊断附件恶性肿瘤的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%(95%CI:0.811,0.983)、69.39%(95%CI:0.544,0.813)、74.14%、91.89%,ADNEX模型诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为89.13%(95%CI:0.756,0.959)、79.59%(95%CI:0.652,0.893)、80.39%、88.63%,两者联合诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%(95%CI:0.811,0.983)、83.67%(95%CI:0.698,0.922)、84.31%和93.18%。O-RADS、ADNEX模型及其联合诊断附件肿瘤良恶性的曲线下面积分别0.814、0.844、0.871。由2位超声医师运用O-RADS分类诊断的一致性好(κ=0.847,P=0.000),运用O-RADS简化流程图者较颜色编码计分表格者用时更短,分别为42 min 39 s和51 min 3 s。结论O-RADS联合ADNEX模型诊断中老年女性附件肿瘤良恶性的价值较单独使用O-RADS高,不同超声医师使用O-RADS有较高的一致性,且使用简化流程图者可更快速进行分类,值得推广。
文摘AIM:To report CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease(IgG4-MALT lymphoma),a rare but clinically important complication of ocular adnexal IgG4-related disease.METHODS:We retrospectively reviewed all cases of histologically confirmed ocular adnexal IgG4-related disease at three ter tiary and one secondary referral centers,between February 2003 and December 2016.Seven cases of histopathologically diagnosed IgG4-MALT lymphoma were identified.CT and MR images were analyzed by consensus of two experienced head and neck radiologists.RESULTS:Lacrimal glands were the main site of involvement in all seven patients.The lesions typically showed well-demarcated margins,iso-to hyperattenuation on precontrast CT,T2 hypo-to isointensity,T1 isointensity,and homogenous internal architecture with homogenous enhancement pattern.Lesions were mostly hyperdense and isointense to normal extraocular muscles on postcontrast CT and MR images,respectively.CONCLUSION:Unlike in typical ocular adnexal IgG4-related disease,T2 isointensity and hyperattenuation on precontrast CT images were noted in some IgG4-MALT lymphoma cases.Although the findings may be nonspecific,the possibility of accompanying MALT lymphoma may need to be considered,when ocular adnexal lesions in patients clinically suspected of having IgG4-related disease are refractory to glucocorticoids and show T2 isointensity and hyperattenuation on precontrast CT for the optimal management of the patients.However,this is a case series of a very rare complication of ocular adnexal IgG4-related disease,and thus caution is warranted to generalize the conclusion.
文摘Ovarian cancer is one of the most common causes of cancerrelated death in women. Adnexal masses are frequently diagnosed during reproductive age and often require surgical removal. The risk of malignancy when dealing with a complex adnexal mass should be defned prior to surgery and several scoring systems may be useful for this purpose. Laparoscopic management of ovarian tumours allows a minimally invasive approach with respect to several oncological assumptions. In the last decade concerns have been raised regarding the risk of cyst rupture and tumour spillage as a con-sequence of the laparoscopic technique itself both in early and advanced stages of ovarian cancer. Although limited data have been reported in the literature on the use of minimally invasive techniques in ovarian cancer, the clear benefits of this approach must be balanced with the potential hazards in different clinical situations. Laparoscopic staging in borderline tumours and presumed early-stage ovarian cancer performed by a laparoscopic oncologist seems to be safe and effec-tive when compared to laparotomy. The precise role of laparoscopy in patients with more advanced cancer is still to be defned, and the risk of suboptimal surgery should never outweigh the potential benefits of mini-mally invasive surgery. Thus, a tailored prediction of optimal laparoscopic debulking is mandatory in these patients.
文摘Aims and Objectives: The aim of this diagnostic observational study was to find an association of final diagnosis of adnexal masses suggested by MRI and compare it as an imaging modality in determining the origin, nature (benign/malignant) & characteristics of adnexal masses by calculating sensitivity, specificity, and diagnostic accuracy. Materials and Methods: The present study was carried out in 90 patients in the department of radio diagnosis and imaging, institute of medical sciences, Banaras Hindu University (BHU). The patients were referred from department of obstetrics & gynecology, institute of medical sciences. Majority of the referred cases were those who had clinical features of abdominal pain, abdominal lump, menstrual irregularity, ascites, and anorexia or weight loss & in whom adnexal mass was suspected clinically. Magnetic resonance imaging was performed using 1.5 Tesla MR Scanner, Magnetom Avanto (Siemens Healthcare). Results: Out of 114 masses, 17 (14.9%) were malignant. The benign adnexal masses were maximum in the age group 20 - 39 years (56/97, 57.7%), while malignant masses were mainly found in women ≥60 years of age (11/17, 64.7%). CA-125 level was grossly elevated in association with 35.3% of the malignant masses. On MRI, the sensitivity for the mass of ovarian origin was (97.7%) and specificity was (73.1%). The diagnostic accuracy was (92.1%). The mass of uterine origin had a sensitivity of (73.1%) and diagnostic accuracy (99.1%). Conclusion: MRI, because of its accuracy in identifying the origin of adnexal mass and characterizing the solid, hemorrhagic, fatty and fibrous content, may obviate surgery or significantly contribute to preoperative planning for a sonographically indeterminate mass. MRI is the state of the art imaging modality for evaluation of adnexal masses with an overall high diagnostic accuracy.
基金supported by Grant No 41021 from the Ministry of Science and Technological Development of the Republic of Serbia
文摘Objective： The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. Methods： Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index （PDI）, risk of malignancy index （RMI） and body mass index （BMI） were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. Results： The study included 689 women （112 malignant, 544 benignant, and 33 borderline tumors）. Malignant and borderline tumors were more frequent in postmenopausal women （P=0.000）. Women who had benignant tumors had the lowest BMI （P=0.000）. There were significant （P〈0.05） differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen （CEA） levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors （P=0.000）. Women with malignant tumors had highest values of RMI and PDI （P=0.000）. Conclusions： Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.
基金All the co-authors have made great contributions to this article.The author appreciates the support from Lingxiu Huang for assisting with data collection and Guanghui Song for technical support.This work was supported by the following foundation:Project of Soft Science Research Project of Primary Health Care in Zhejiang Province(2015jc11)Project of Hangzhou Health Planning Scientific Research Program(2015A55).
文摘Objectives:To evaluate the safety and efficacy of conservative laparoscopic surgery for adnexal torsion and the feasibility of secondary operation.Methods:This is a retrospective study that consists of 17 patients with clinically diagnosed adnexal torsion who have a desire for pregnancy in the future.We performed conservative laparoscopic adnexal detorsion operations from January 2014 to June 2016 in Sir Run Run Shaw Hospital.The collected data,including age,onset time,maximum diameter of adnexal lesion,local blood flow signal,torsion degree,and recovery of local blood supply after detorsions,were analyzed.The blood flow of the lesion side,the antral follicles development,the basal endocrine hormone levels and the menstrual cycle were examined one-month and three-month post operation.Future fertility was investigated postoperatively.Results:All cases had no obvious clinical postoperative complications.There were no significant changes on menstrual cycle and ovarian function during the follow-up period.Conclusions:Adnexal torsion in young patients should be carefully treated and fertility reservation should be thoroughly considered.The decision to remove adnexa needs careful consideration.Conservative laparoscopic surgery is safe and does not increase the occurrence of serious complications.There is a higher possibility of a long delay between surgery and onset necrosis,but this is not always the case.Even if there is adnex thromboembolic infarction it does not result in serious complications such as pulmonary infarction.Conservative laparoscopic surgery can be performed first unless the clinician is certain it is already necrotic.We should do our best to reserve patients’fertility as much as possible.If necessary,a secondary surgery can be performed.
文摘BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant cutaneous adnexal neoplasm,often presenting as a flesh-colored and slow-growing indurated plaque or cystic nodule in the mid-facial region.Its characteristic indolent presentation usually leads to initial misdiagnosis,resulting in tumor mismanagement and added morbidity due to increased propensity for local invasion.CASE SUMMARY A 63-year-old Chinese male patient with a long-term history of excessive ultraviolet irradiation had received two surgeries for an“epidermal cyst”on his glabella and was presented to our hospital’s Dermatology Department for further diagnosis and therapy of the lesion on his glabella.One month ago,his two 7 mm×7 mm subcutaneous nodules were diagnosed as"recurrent epidermal cysts",and he underwent local excision surgery.Additionally,he has post medical history of surgery for right clear cell renal carcinoma.According to his biopsy,the patient was diagnosed as MAC in our hospital,and a tumor remnant was found on his wound.He then underwent wide local excision to achieve negative margins and reconstruction of full-thickness flap transplantation for tissue coverage.He remained tumor-free after six months of follow-up.CONCLUSION This case highlights the importance of MAC’s possible pathogenic factor of excessive ultraviolet exposure,its differential diagnosis to avoid misdiagnosis and mismanagement to adverse prognosis,the patient’s particular medical history of clear cell renal carcinoma,the alert for any tumor recurrence in older patients,and his uncommon multiple nodules mess consisting of two 7 mm×7 mm subcutaneous nodules,that will enrich the existing knowledge of MAC’s clinical features.
文摘Lymphomas are known as neoplasm’s caused by clone proliferation of B and T lymphocytes. Extranodal lymphoma arises from tissues other than lymph nodes or even from sites which normally doesn’t contain lymph tissues. Orbital adnexal lymphoma arises from eyelid, orbit, lacrimal glands or conjunctivae and it is totally different from intraocular lymphoma. Wide range of differential diagnosis including infectious inflammatory orbital disease, preseptal and orbital cellulitis, orbital idiopathic inflammatory disease-pseudotumors, especially dacryoadenitis and myositis and thyroid associate orbit disease makes the diagnosis of orbital adnexal lymphoma even more difficult. We represent the case of diagnostic delay of very aggressive form orbital non-Hodgkin lymphoma occurred because of the unspecific signs and symptoms as well as not indicative imaging investigation and laboratory tests.
