AIM:To evaluate the demographics,clinical characteristics,treatments,and outcomes of patients with ocular surface squamous neoplasia(OSSN)at the Philippine General Hospital.METHODS:This was a single-center,11-year ret...AIM:To evaluate the demographics,clinical characteristics,treatments,and outcomes of patients with ocular surface squamous neoplasia(OSSN)at the Philippine General Hospital.METHODS:This was a single-center,11-year retrospective,cross sectional case series on 18 cases of OSSN seen between January 2012 to June 2023.The patient’s demographics,presenting symptoms,tumor characteristics,histopathologic diagnosis,treatment,outcomes,and duration of follow-up were reviewed.RESULTS:Out of 33 identified cases of OSSN,only 18 were eligible for inclusion in the study.Mean age was 60.78y(range 31 to 80),with male predominance(66.67%).The left eye was most commonly affected(61.11%)with most presenting with fleshy mass(83.33%).Most tumors were located nasally(66.67%)and were predominantly papilliform(44.44%)in morphology with associated hyperpigmentation(38.89%).Squamous cell carcinoma(SCCA)was the most common histopathologic diagnosis(72.22%).The main primary treatment was surgical excision(94.44%)with or without adjunctive therapy,with only 1 patient undergoing first-line topical chemotherapy.Only 3 recurrences(16.67%)were noted with a median followup of 7.5mo.A statistically significant recurrence-free odds leaning towards the utilization of cryotherapy was noted.CONCLUSION:OSSN seen at the Philippine General Hospital is presented as a limbal papilliform mass,most commonly affecting elderly males.Surgical excision with adjuvant cryotherapy and/or chemotherapy is the preferred mode of treatment.展开更多
BACKGROUND Gastric cancer is one of the most common cancers worldwide,especially in East Asia.AIM To explore the clinical outcomes and progression-related factors of low-grade intraepithelial neoplasia(LGIN)in the gas...BACKGROUND Gastric cancer is one of the most common cancers worldwide,especially in East Asia.AIM To explore the clinical outcomes and progression-related factors of low-grade intraepithelial neoplasia(LGIN)in the gastric mucosa and provide valuable guidance for improving treatment efficacy.METHODS A total of 357 patients diagnosed with LGIN based on initial pathological examination in Anhui Provincial Hospital or three other medical consortium units between January 2022 and June 2024 were included.Among them,296 patients were followed up with endoscopic and biopsy pathology.Logistic regression was utilized to analyze the relevant risk factors for LGIN progression in the gastric mucosa.RESULTS The distribution sites of LGIN among the 357 patients were as follows:Gastric antrum(54.6%),gastric cardia(24.1%),gastric angulus(8.7%),gastric body(4.8%),gastric fundus(4.8%),and multiple sites(3.1%).Additionally,of the 357 patients with LGIN,112(31.4%)developed ulceration and 59(16.5%)experienced gastric polyps.Furthermore,231 of the 357(64.71%)patients with LGIN tested positive for Helicobacter pylori(H.pylori)infection.The H.pylori infection rates of the patients with LGIN with accompanying atrophy,intestinal metaplasia,and gastric ulcer were 51.95%,59.31%,and 28.57%,respectively.Multivariate logistic regression analysis showed that age≥60 years[odds ratio(OR)=3.063,95%confidence interval(CI):1.351-6.945,P=0.007],H.pylori infection(OR=3.560,95%CI:1.158-10.949,P=0.027),multiple locations(OR=10.136,95%CI:2.045-50.237,P=0.005),lesion size≥2 cm(OR=3.921,95%CI:1.664-9.237,P=0.002),and gastric ulcer(OR=2.730,95%CI:1.197-6.223,P=0.017)were predictive factors for LGIN progression.CONCLUSION LGIN progression is closely related to age,H.pylori positivity,multiple locations,lesion size≥2 cm,and gastric ulcer.Thus,actively identifying these risk factors in patients with LGIN may have certain clinical significance in preventing further tumor progression.展开更多
BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To ...BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.展开更多
High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatograph...High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.展开更多
In this manuscript,we comment on a recent publication by Yuan et al.This article provides a detailed scientific diagnostic process for a multiple endocrine neo-plasia type 1 patient,thus offering strong guidance for c...In this manuscript,we comment on a recent publication by Yuan et al.This article provides a detailed scientific diagnostic process for a multiple endocrine neo-plasia type 1 patient,thus offering strong guidance for clinical practice.However,we believe that the authors should also provide information on the patient's long-term prognosis.展开更多
Topical chemotherapy is increasingly used to treat ocular surface tumors as a primary therapy and an adjuvant treatment after surgical excision.The most employed topical agents include mitomycin C(MMC),5-fluorouracil(...Topical chemotherapy is increasingly used to treat ocular surface tumors as a primary therapy and an adjuvant treatment after surgical excision.The most employed topical agents include mitomycin C(MMC),5-fluorouracil(5-FU),and interferon alpha-2b(IFNα2b),each with distinctmechanisms of action,efficacy profiles,and toxicity risks.Although these agents offer effective tumor control and allow for a non-invasive approach in many cases,ocular surface complications requiring medical or surgical management can occur.This summarizes the adverse effect and outilines practical strategies for their prevention and treatment.MMC is the most potent agent but also the most toxic,with reported complications such as limbal stemcell deficiency,punctal stenosis,and persistent epithelial defects.5-FU demonstrates a more favorable safety profile,although rare cases of corneal ulceration have been described.IFNα2b is well tolerated and associated primarily with mild,reversible reactions.The choice of the proper agent should be tailored according to patient’s clinical presentation,ocular surface status,and ability to adhere to therapy and followup.Timely recognition and management of complications are essential to minimize long-term sequelae.Reliance on compounded formulations highlights the need for stable,standardized,and commercially available topical agents specifically designed for ocular use to ensure safety,reproducibility,and global accessibility.展开更多
BACKGROUND Ulcerative colitis(UC)increases the risk of colorectal dysplasia.While colectomy was once standard,advances in polypectomy,endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),and endosco...BACKGROUND Ulcerative colitis(UC)increases the risk of colorectal dysplasia.While colectomy was once standard,advances in polypectomy,endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),and endoscopic full-thickness resection(EFTR)now allow organ-sparing management in selected cases.AIM To summarize current evidence on the feasibility,safety,and outcomes of these techniques in UC-associated neoplasia.METHODS A scoping review was conducted using PubMed and EMBASE(1975-May 2025)with the search:(“endoscopic submucosal dissection”/exp OR“endoscopic mucosal resection”OR“full thickness resection”OR“polypectomy”)AND(“ulcerative colitis”/exp OR“ulcerative colitis”OR“pouch”).Screening followed PRISMA guidelines.Eligible studies included those reporting outcomes,feasibility,or novel techniques in the endoscopic management of UC-associated dysplasia.RESULTS Of 1075 identified records,754 were screened after duplicate removal,and 48 studies were included.Polypectomy was safe and effective for well-demarcated,lifting lesions without adjacent dysplasia.EMR has excellent outcomes for small,polypoid,or right-sided lesions that demonstrated adequate lifting.ESD is ind icated for flat,large,non-polypoid,or fibrotic lesions,particularly in the left colon.ESD achieved en bloc resection in 88%-100%and R0 resection in 73%-96%of cases.The overall complication rate with ESD was approximately 2%-10%,primarily bleeding or perforation.Local recurrence occurred in 0%-6.8%,and metachronous lesions developed in up to 31%of cases over follow-up durations of up to 15 years.Surgical intervention after ESD was required in 10%-20%of patients,typically for non-curative resection or new lesions.Submucosal fibrosis,a common obstacle in UC,limited lifting and increased procedural difficulty.Adjunctive strategies-such as water pressure-assisted dissection,pocket-creation method,self-assembling peptide injectables,and traction systems-enhanced technical success.EFTR,though limited to case series,was effective for non-lifting or anatomically complex lesions,particularly in post-surgical or pouch anatomy,but carried higher procedural risk including rare but serious adverse events.CONCLUSION Endoscopic resection offers a spectrum of curative,minimally invasive options for managing dysplasia in UC.EMR remains appropriate for simple,lifting lesions,while ESD and EFTR broaden the therapeutic landscape for complex or fibrotic pathology.Lesion morphology,lifting characteristics,and operator experience should guide technique selection.Long-term outcomes are favorable with appropriate surveillance,though the risk of metachronous neoplasia necessitates continued monitoring.展开更多
Multiple endocrine neoplasia type 1(MEN1)is an autosomal-inherited syndrome involving multiple endocrine tumors.It is characterized by multiple mutations in the tumor suppressor gene MEN1,which is located on chromosom...Multiple endocrine neoplasia type 1(MEN1)is an autosomal-inherited syndrome involving multiple endocrine tumors.It is characterized by multiple mutations in the tumor suppressor gene MEN1,which is located on chromosome 11q13.As main etiology of MEN1 is genetic mutations,clinical symptoms may vary.In this editorial,we comment on the article by Yuan et al.This article describes a case of(MEN1)characterized by low incidence and diagnostic complexity.MEN1 co-mmonly presents as parathyroid,pancreatic,and pituitary tumors.Diagnosis requires a combination of serologic tests,magnetic resonance imaging,computed tomography,endoscopic ultrasonography,immunologic and pathology.The diagnosis is unique depending on the site of disease.Surgical resection is the treatment of choice for MEN1.The prognosis depends on the site of origin,but early detection and intervention is the most effective.展开更多
This editorial discusses an article by Liu et al,which focuses on the development and evaluation of a modified scoring model incorporating the waist-to-hip ratio for predicting advanced colorectal neoplasia(ACN).This ...This editorial discusses an article by Liu et al,which focuses on the development and evaluation of a modified scoring model incorporating the waist-to-hip ratio for predicting advanced colorectal neoplasia(ACN).This editorial provides an overview of the study,including the background of ACN risk prediction,the study design,key findings,and the significance and limitations of the new model.The study identified independent risk factors for ACN and developed a 7-point scoring model with better predictive performance than existing models.However,challenges,such as generalizability across ethnic groups and selection bias,exist.Further research involving multi-ethnic cohorts and the integration of novel biomarkers is needed to improve the model and its clinical application.展开更多
BACKGROUND Designing a feasible risk prediction model for advanced colorectal neoplasia(ACN)can enhance colonoscopy screening efficiency.Abdominal obesity is associated with colorectal cancer development.AIM To propos...BACKGROUND Designing a feasible risk prediction model for advanced colorectal neoplasia(ACN)can enhance colonoscopy screening efficiency.Abdominal obesity is associated with colorectal cancer development.AIM To propose and evaluate a modified scoring model incorporating waist-hip ratio for the prediction of ACN.METHODS A total of 6483 patients who underwent their first screening or diagnostic colonoscopy in our center between 2020 and 2023 were recruited,in which 4592 were in the derivation cohort and 1891 formed a validation cohort.Multivariate logistic regression was used to investigate the risk factors of ACN in the derivation cohort based on endoscopic findings,and a new scoring model for ACN prediction was developed.The discriminatory capability of the scoring model was validated by the validation cohort.RESULTS Age,male gender,smoking,and wait-to-hip ratio were identified as independent risk factors for ACN,and a 7-point scoring model was developed.The prevalence of ACN was 3.3%,9.3%and 18.5%in participants with scores of 0-2[low risk(LR)],3–4[moderate risk(MR)],and 5–7[high risk(HR)],respectively,in the derivation cohort.With the scoring model,49.9%,38.4%,and 11.7%of patients in the validation cohort were categorized as LR,MR,and HR,respectively.The corresponding prevalence rates of ACN were 5.0%,10.3%,and 17.6%,respectively.The C-statistic of the new scoring model was 0.66,which was higher than that of the Asia-Pacific Colorectal Screening model(0.63).CONCLUSION A modified scoring model incorporating waist-hip ratio has an improved predictive performance in the prediction of ACN.展开更多
BACKGROUND Recent advancements in artificial intelligence(AI)have significantly enhanced the capabilities of endoscopic-assisted diagnosis for gastrointestinal diseases.AI has shown great promise in clinical practice,...BACKGROUND Recent advancements in artificial intelligence(AI)have significantly enhanced the capabilities of endoscopic-assisted diagnosis for gastrointestinal diseases.AI has shown great promise in clinical practice,particularly for diagnostic support,offering real-time insights into complex conditions such as esophageal squamous cell carcinoma.CASE SUMMARY In this study,we introduce a multimodal AI system that successfully identified and delineated a small and flat carcinoma during esophagogastroduodenoscopy,highlighting its potential for early detection of malignancies.The lesion was confirmed as high-grade squamous intraepithelial neoplasia,with pathology results supporting the AI system’s accuracy.The multimodal AI system offers an integrated solution that provides real-time,accurate diagnostic information directly within the endoscopic device interface,allowing for single-monitor use without disrupting endoscopist’s workflow.CONCLUSION This work underscores the transformative potential of AI to enhance endoscopic diagnosis by enabling earlier,more accurate interventions.展开更多
The urgent necessity for enhanced risk stratification to improve the efficiency of colonoscopy screening is underscored by the fact that colorectal cancer(CRC)continues to be a primary cause of global cancer mortality...The urgent necessity for enhanced risk stratification to improve the efficiency of colonoscopy screening is underscored by the fact that colorectal cancer(CRC)continues to be a primary cause of global cancer mortality.Conventional models mostly rely on generalized obesity markers including body mass index(BMI),which does not effectively represent oncogenic risk linked with abdominal obesity.Liu et al undertook a large-scale case-control study comprising 6484 firsttime colonoscopy patients at a prominent Chinese hospital between 2020 and 2023 to overcome this restriction.Age,male sex,smoking status,and raised waist-hip ratio(WHR)were found by multivariate logistic regression as independent predictors of advanced colorectal neoplasia(ACN).In a validation cohort of 1891 individuals,a new 7-point risk scoring model was created and stratified into low-(5.0%)ACN prevalence,moderate-(10.3%)and high-risk(17.6%).With C-statistic=0.66 the model showed better discriminating ability than the Asia-Pacific Colorectal Screening(APCS)score(C-statistic=0.63)and the BMI-modified APCS model.These results fit newly published data showing central obesity as a major carcinogenic driver via pro-inflammatory visceral adipokine channels.With the use of WHR,patient risk classification is greatly improved,providing a practical tool to make the most of screening resources in the face of rising CRC incidence rates.Finally,multi-ethnic validation is necessary for the WHR-based scoring model to be considered for integration into global CRC preventive frameworks,since it improves the accuracy of ACN risk prediction.展开更多
BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Curren...BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Currently,it is difficult to accurately diagnose LGIN and HGIN through imaging,and clinical diagnosis depends on postoperative histopathological diagnosis.A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.AIM To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.METHODS We selected 84 older patients diagnosed with HGIN as the HGIN group(n=95 colonic polyps)and 112 older patients diagnosed with LGIN as the LGIN group(n=132 colonic polyps)from Shandong Provincial Hospital Affiliated to Shandong First Medical University.The endoscopic features,demographic characteristics,and clinical manifestations of the two patient groups were compared,and a logistic regression model was used to analyze the risk factors for HGIN in these patients.RESULTS The HGIN group was older and had a higher number of sigmoid colon polyps,rectal polyps,pedunculated polyps,polyps≥1.0 cm in size,polyps with surface congestion,polyps with surface depression,and polyps with villous/tubular adenomas,a higher proportion of patients with diabetes and a family history of colorectal cancer,patients who experienced rectal bleeding or occult blood,patients with elevated carcinoembryonic antigen(CEA)and cancer antigen 199(CA199),and lower nutritional levels and higher frailty levels.The polyp location(in the sigmoid colon or rectum),polyp diameter(≥1.0 cm),pathological diagnosis of(villous/tubular adenoma),family history of colorectal cancer,rectal bleeding or occult blood,elevated serum CEA and CA199 levels,lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.CONCLUSION The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location,size,villous/tubular characteristics,family history,elevated levels of tumor markers,and lower nutritional levels and higher frailty levels.展开更多
BACKGROUND Multiple endocrine neoplasias(MENs)are a group of hereditary diseases invol-ving multiple endocrine glands,and their prevalence is low.MEN type 1(MEN1)has diverse clinical manifestations,mainly involving th...BACKGROUND Multiple endocrine neoplasias(MENs)are a group of hereditary diseases invol-ving multiple endocrine glands,and their prevalence is low.MEN type 1(MEN1)has diverse clinical manifestations,mainly involving the parathyroid glands,gastrointestinal tract,pancreas and pituitary gland,making it easy to miss the clinical diagnosis.CASE SUMMARY We present the case of a patient in whom MEN1 was detected early.A middle-aged male with recurrent abdominal pain and diarrhea was admitted to the hos-pital.Blood tests at admission revealed hypercalcemia and hypophosphatemia,and emission computed tomography of the parathyroid glands revealed a hy-perfunctioning parathyroid lesion.Gastroscopy findings suggested a duodenal bulge and ulceration.Ultrasound endoscopy revealed a hypoechoic lesion in the duodenal bulb.Further blood tests revealed elevated levels of serum gastrin.Surgery was performed,and pathological analysis of the surgical specimens revealed a parathyroid adenoma after parathyroidectomy and a neuroendocrine tumor after duodenal bulbectomy.The time from onset to the definitive diagnosis of MEN1 was only approximately 1 year.CONCLUSION For patients who present with gastrointestinal symptoms accompanied by hyper-calcemia and hypophosphatemia,clinicians need to be alert to the possibility of MEN1.展开更多
BACKGROUND Multiple endocrine neoplasia type 2(MEN2)is a rare,autosomal dominant endocrine disease.Currently,the RET proto-oncogene is the only gene implicated in MEN2A pathogenesis.Once an RET carrier is detected,fam...BACKGROUND Multiple endocrine neoplasia type 2(MEN2)is a rare,autosomal dominant endocrine disease.Currently,the RET proto-oncogene is the only gene implicated in MEN2A pathogenesis.Once an RET carrier is detected,family members should be screened to enable early detection of medullary thyroid carcinoma,pheochromocytoma,and hyperparatitity.Among these,medullary thyroid carcinoma is the main factor responsible for patient mortality.Accordingly,delineating strategies to inform clinical follow-up and treatment plans based on genes is paramount for clinical practitioners.CASE SUMMARY Herein,we present RET proto-oncogene mutations,clinical characteristics,and treatment strategies in a family with MEN2A.A family study was conducted on patients diagnosed with MEN2A.DNA was extracted from the peripheral blood of family members,and first-generation exon sequencing of the RET protooncogene was conducted.The C634Y mutation was identified in three family members spanning three generations.Two patients were sequentially diagnosed with pheochromocytomas and bilateral medullary thyroid carcinomas.A 9-yearold child harboring the gene mutation was diagnosed with medullary thyroid carcinoma.Surgical resection of the tumors was performed.All family members were advised to undergo complete genetic testing related to the C634Y mutation,and the corresponding treatments administered based on test results and associated clinical guidelines.CONCLUSION Advancements in MEN2A research are important for familial management,assessment of medullary thyroid cancer invasive risk,and deciding surgical timing.展开更多
Despite advancements in the field,early diagnosis of multiple endocrine neoplasia type 1(MEN1)remains unachievable.This letter to the editor highlighted the importance of carefully assessing gastrointestinal symptoms,...Despite advancements in the field,early diagnosis of multiple endocrine neoplasia type 1(MEN1)remains unachievable.This letter to the editor highlighted the importance of carefully assessing gastrointestinal symptoms,hypercalcemia,and elevated serum gastrin levels,as suggested by Yuan et al in their paper.They focused on a patient with recurrent abdominal pain and diarrhea whose diagnostic path led to establishing a MEN1 diagnosis within a year.This emphasized the need for clinicians to consider MEN1 in patients with similar presentations,particularly when gastrointestinal symptoms persist or recur after discontinuation of proton pump inhibitors,especially knowing that early recognition and intervention are crucial for improving patient outcomes.展开更多
Different types of neuroendocrine cancer,including medullary thyroid cancer(MTC)and thyroid C-cell hyperplasia,are part of multiple endocrine neoplasia type 2(MEN2).A proto-oncogene mutation of the rearranged during t...Different types of neuroendocrine cancer,including medullary thyroid cancer(MTC)and thyroid C-cell hyperplasia,are part of multiple endocrine neoplasia type 2(MEN2).A proto-oncogene mutation of the rearranged during transfection(RET)gene changes the way that receptor tyrosine kinases work.Multiple endocrine neoplasia,a pathological condition,involves these kinases.When the RET protooncogene changes,it can cause endocrine adenomas and hyperplasia to happen at the same time or one after the other.Pheochromocytoma,medullary thyroid carcinoma,and hyperparathyroidism,alone or in combination,are present in MEN2A patients.Some patients may also have skin lichen amyloidosis or Hirschsprung's disease.Patients with MEN2A often present with MTC.MTC is aggressive and has the worst prognosis,as most patients exhibit lymph node metastasis.MTC is one of the important causes of death in patients with MEN2A.RET mutation analysis aids in identifying MEN2A symptoms and monitoring levels of calcium,thyroid hormones,calcitonin,normetanephrine,fractionated metanephrines,and parathyroid hormone.The earlier diagnosis of MTC significantly improves survival and prompts better management of MEN2A.In this editorial,we will discuss the significance of molecular diagnostic approaches in detecting RET oncogene mutations in MEN2A.展开更多
Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who...Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.展开更多
Objective: In Cameroon, more than 80% of women suffering from cervical intraepithelial neoplasia (CIN) are within the reproductive age. This study intended to analyze the pregnancy outcomes following cervical treatmen...Objective: In Cameroon, more than 80% of women suffering from cervical intraepithelial neoplasia (CIN) are within the reproductive age. This study intended to analyze the pregnancy outcomes following cervical treatment in Cameroon. Methods: This was a cohort study with two years retrospective data collection involving 82 women who underwent cervical treatment for CIN in two Cameroonian hospitals from January 2015 to December 2017. Data were collected from CIN treatment to end of pregnancy where applicable. Data analysis was done using Epi Info software version 3.5.4. Results: We collected data from 82 patients aged 27 to 48 years, with a mean age of 36.5 (SD: 5.3) years. During the study period, 33 out of 82 participants became pregnant 40.2 [29.56 - 51.66]%. The factor associated with pregnancy occurrence after treatment was age less than 35 years (Odds ratio = 4.37 [1.7 - 11.2]. From the 33 pregnancies recorded, 17 (51.5%) ended in a delivery, amongst which 15 (88.2%) were vaginal. Conclusion: Pregnancy frequency over two years following cervical treatment for CIN was relatively good, and younger women (age 35 years) were significantly more like to have conceived compared to their older counterparts. Post-treatment delivery outcomes seem to be similar to those in the general population.展开更多
AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:...AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:Eligible patients with suspected gastric IN lesions previously diagnosed by endoscopy in secondary hospitals and scheduled for further diagnosis and tratment were recruited for this study. Excluded from the study were patients who had liver cirrhosis, impaired renal function, acute gastrointestinal (GI) bleeding, coagulopathy, esophageal varices, jaundice, and GI post-surgery. Also excluded were those who were pregnant, breastfeeding, were younger than 18 years old, or were unable to provide informed consent. All patients had all mucus and bile cleared from their stom-achs. They then received upper GI endoscopy. When a mucosal lesion is found during observation with whitelight imaging, the lesion is visualized using maximal magnification, employing gradual movement of the tip of the endoscope to bring the image into focus. Saved images are analyzed. Confocal images were evaluated by two endoscopists (Huang J and Li MY), who were familiar with CLE, blinded to the related information about the lesions, and asked to classify each lesion as either a low grade dysplasia (LGD) or high grade dysplasia (HGD) according to given criteria. The results were compared with the final histopathologic diagnosis. ME-NBI images were evaluated by two endoscopists (Lu ZS and Ling-Hu EQ) who were familiar with NBI, blinded to the related information about the lesions and CLE images, and were asked to classify each lesion as a LGD or HGD according to the "microvascular pattern and surface pattern" classification system. The results were compared with the final histopathologic diagnosis. RESULTS: The study included 32 pathology-proven low grade gastric IN and 26 pathology-proven high grade gastric IN that were detected with any of the modalities. CLE and ME-NBI enabled clear visualization of the vascular microsurface patterns and microvascular structures of the gastric mucosa. The accuracy of the CLE and the ME-NBI diagnosis was 88% (95% CI:78%-98%) and 81% (95% CI: 69%-93%), respectively. The kappa coefficient of agreement between the histopathology and the in vivo CLE imaging was 0.755; between the histopathology and the in vivo CLE imaging was 0.615. McNemar's test (binomial distribution used) indicated that the agreement was significant (P < 0.05). When patients were diagnosed by MENBI with CLE, the overall accuracy of the diagnosis was 86.21% (95% CI:73%-96%), and the kappa coefficient of agreement was 0.713, according to McNemar's test (P < 0.05). CONCLUSION:Higher diagnostic accuracy, sensitivityand specificity of CLE over ME-NBI indicate the feasibility of these two techniques for the efficacious diagnostic classification of gastric IN.展开更多
文摘AIM:To evaluate the demographics,clinical characteristics,treatments,and outcomes of patients with ocular surface squamous neoplasia(OSSN)at the Philippine General Hospital.METHODS:This was a single-center,11-year retrospective,cross sectional case series on 18 cases of OSSN seen between January 2012 to June 2023.The patient’s demographics,presenting symptoms,tumor characteristics,histopathologic diagnosis,treatment,outcomes,and duration of follow-up were reviewed.RESULTS:Out of 33 identified cases of OSSN,only 18 were eligible for inclusion in the study.Mean age was 60.78y(range 31 to 80),with male predominance(66.67%).The left eye was most commonly affected(61.11%)with most presenting with fleshy mass(83.33%).Most tumors were located nasally(66.67%)and were predominantly papilliform(44.44%)in morphology with associated hyperpigmentation(38.89%).Squamous cell carcinoma(SCCA)was the most common histopathologic diagnosis(72.22%).The main primary treatment was surgical excision(94.44%)with or without adjunctive therapy,with only 1 patient undergoing first-line topical chemotherapy.Only 3 recurrences(16.67%)were noted with a median followup of 7.5mo.A statistically significant recurrence-free odds leaning towards the utilization of cryotherapy was noted.CONCLUSION:OSSN seen at the Philippine General Hospital is presented as a limbal papilliform mass,most commonly affecting elderly males.Surgical excision with adjuvant cryotherapy and/or chemotherapy is the preferred mode of treatment.
基金the Research Project of the Chinese Digestive Early Cancer Physicians’Joint Growth Program,No.GTCZ-2021-AH-34-0012.
文摘BACKGROUND Gastric cancer is one of the most common cancers worldwide,especially in East Asia.AIM To explore the clinical outcomes and progression-related factors of low-grade intraepithelial neoplasia(LGIN)in the gastric mucosa and provide valuable guidance for improving treatment efficacy.METHODS A total of 357 patients diagnosed with LGIN based on initial pathological examination in Anhui Provincial Hospital or three other medical consortium units between January 2022 and June 2024 were included.Among them,296 patients were followed up with endoscopic and biopsy pathology.Logistic regression was utilized to analyze the relevant risk factors for LGIN progression in the gastric mucosa.RESULTS The distribution sites of LGIN among the 357 patients were as follows:Gastric antrum(54.6%),gastric cardia(24.1%),gastric angulus(8.7%),gastric body(4.8%),gastric fundus(4.8%),and multiple sites(3.1%).Additionally,of the 357 patients with LGIN,112(31.4%)developed ulceration and 59(16.5%)experienced gastric polyps.Furthermore,231 of the 357(64.71%)patients with LGIN tested positive for Helicobacter pylori(H.pylori)infection.The H.pylori infection rates of the patients with LGIN with accompanying atrophy,intestinal metaplasia,and gastric ulcer were 51.95%,59.31%,and 28.57%,respectively.Multivariate logistic regression analysis showed that age≥60 years[odds ratio(OR)=3.063,95%confidence interval(CI):1.351-6.945,P=0.007],H.pylori infection(OR=3.560,95%CI:1.158-10.949,P=0.027),multiple locations(OR=10.136,95%CI:2.045-50.237,P=0.005),lesion size≥2 cm(OR=3.921,95%CI:1.664-9.237,P=0.002),and gastric ulcer(OR=2.730,95%CI:1.197-6.223,P=0.017)were predictive factors for LGIN progression.CONCLUSION LGIN progression is closely related to age,H.pylori positivity,multiple locations,lesion size≥2 cm,and gastric ulcer.Thus,actively identifying these risk factors in patients with LGIN may have certain clinical significance in preventing further tumor progression.
基金Supported by the National Key Research and Development Program of China,No.2022YFC2503600。
文摘BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.
文摘High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.
基金Supported by National Natural Science Foundation of China,No.821706751·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYJC21011.
文摘In this manuscript,we comment on a recent publication by Yuan et al.This article provides a detailed scientific diagnostic process for a multiple endocrine neo-plasia type 1 patient,thus offering strong guidance for clinical practice.However,we believe that the authors should also provide information on the patient's long-term prognosis.
文摘Topical chemotherapy is increasingly used to treat ocular surface tumors as a primary therapy and an adjuvant treatment after surgical excision.The most employed topical agents include mitomycin C(MMC),5-fluorouracil(5-FU),and interferon alpha-2b(IFNα2b),each with distinctmechanisms of action,efficacy profiles,and toxicity risks.Although these agents offer effective tumor control and allow for a non-invasive approach in many cases,ocular surface complications requiring medical or surgical management can occur.This summarizes the adverse effect and outilines practical strategies for their prevention and treatment.MMC is the most potent agent but also the most toxic,with reported complications such as limbal stemcell deficiency,punctal stenosis,and persistent epithelial defects.5-FU demonstrates a more favorable safety profile,although rare cases of corneal ulceration have been described.IFNα2b is well tolerated and associated primarily with mild,reversible reactions.The choice of the proper agent should be tailored according to patient’s clinical presentation,ocular surface status,and ability to adhere to therapy and followup.Timely recognition and management of complications are essential to minimize long-term sequelae.Reliance on compounded formulations highlights the need for stable,standardized,and commercially available topical agents specifically designed for ocular use to ensure safety,reproducibility,and global accessibility.
文摘BACKGROUND Ulcerative colitis(UC)increases the risk of colorectal dysplasia.While colectomy was once standard,advances in polypectomy,endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),and endoscopic full-thickness resection(EFTR)now allow organ-sparing management in selected cases.AIM To summarize current evidence on the feasibility,safety,and outcomes of these techniques in UC-associated neoplasia.METHODS A scoping review was conducted using PubMed and EMBASE(1975-May 2025)with the search:(“endoscopic submucosal dissection”/exp OR“endoscopic mucosal resection”OR“full thickness resection”OR“polypectomy”)AND(“ulcerative colitis”/exp OR“ulcerative colitis”OR“pouch”).Screening followed PRISMA guidelines.Eligible studies included those reporting outcomes,feasibility,or novel techniques in the endoscopic management of UC-associated dysplasia.RESULTS Of 1075 identified records,754 were screened after duplicate removal,and 48 studies were included.Polypectomy was safe and effective for well-demarcated,lifting lesions without adjacent dysplasia.EMR has excellent outcomes for small,polypoid,or right-sided lesions that demonstrated adequate lifting.ESD is ind icated for flat,large,non-polypoid,or fibrotic lesions,particularly in the left colon.ESD achieved en bloc resection in 88%-100%and R0 resection in 73%-96%of cases.The overall complication rate with ESD was approximately 2%-10%,primarily bleeding or perforation.Local recurrence occurred in 0%-6.8%,and metachronous lesions developed in up to 31%of cases over follow-up durations of up to 15 years.Surgical intervention after ESD was required in 10%-20%of patients,typically for non-curative resection or new lesions.Submucosal fibrosis,a common obstacle in UC,limited lifting and increased procedural difficulty.Adjunctive strategies-such as water pressure-assisted dissection,pocket-creation method,self-assembling peptide injectables,and traction systems-enhanced technical success.EFTR,though limited to case series,was effective for non-lifting or anatomically complex lesions,particularly in post-surgical or pouch anatomy,but carried higher procedural risk including rare but serious adverse events.CONCLUSION Endoscopic resection offers a spectrum of curative,minimally invasive options for managing dysplasia in UC.EMR remains appropriate for simple,lifting lesions,while ESD and EFTR broaden the therapeutic landscape for complex or fibrotic pathology.Lesion morphology,lifting characteristics,and operator experience should guide technique selection.Long-term outcomes are favorable with appropriate surveillance,though the risk of metachronous neoplasia necessitates continued monitoring.
文摘Multiple endocrine neoplasia type 1(MEN1)is an autosomal-inherited syndrome involving multiple endocrine tumors.It is characterized by multiple mutations in the tumor suppressor gene MEN1,which is located on chromosome 11q13.As main etiology of MEN1 is genetic mutations,clinical symptoms may vary.In this editorial,we comment on the article by Yuan et al.This article describes a case of(MEN1)characterized by low incidence and diagnostic complexity.MEN1 co-mmonly presents as parathyroid,pancreatic,and pituitary tumors.Diagnosis requires a combination of serologic tests,magnetic resonance imaging,computed tomography,endoscopic ultrasonography,immunologic and pathology.The diagnosis is unique depending on the site of disease.Surgical resection is the treatment of choice for MEN1.The prognosis depends on the site of origin,but early detection and intervention is the most effective.
文摘This editorial discusses an article by Liu et al,which focuses on the development and evaluation of a modified scoring model incorporating the waist-to-hip ratio for predicting advanced colorectal neoplasia(ACN).This editorial provides an overview of the study,including the background of ACN risk prediction,the study design,key findings,and the significance and limitations of the new model.The study identified independent risk factors for ACN and developed a 7-point scoring model with better predictive performance than existing models.However,challenges,such as generalizability across ethnic groups and selection bias,exist.Further research involving multi-ethnic cohorts and the integration of novel biomarkers is needed to improve the model and its clinical application.
基金Supported by The Guangdong Medical Research Foundation of China,No.A2020603.
文摘BACKGROUND Designing a feasible risk prediction model for advanced colorectal neoplasia(ACN)can enhance colonoscopy screening efficiency.Abdominal obesity is associated with colorectal cancer development.AIM To propose and evaluate a modified scoring model incorporating waist-hip ratio for the prediction of ACN.METHODS A total of 6483 patients who underwent their first screening or diagnostic colonoscopy in our center between 2020 and 2023 were recruited,in which 4592 were in the derivation cohort and 1891 formed a validation cohort.Multivariate logistic regression was used to investigate the risk factors of ACN in the derivation cohort based on endoscopic findings,and a new scoring model for ACN prediction was developed.The discriminatory capability of the scoring model was validated by the validation cohort.RESULTS Age,male gender,smoking,and wait-to-hip ratio were identified as independent risk factors for ACN,and a 7-point scoring model was developed.The prevalence of ACN was 3.3%,9.3%and 18.5%in participants with scores of 0-2[low risk(LR)],3–4[moderate risk(MR)],and 5–7[high risk(HR)],respectively,in the derivation cohort.With the scoring model,49.9%,38.4%,and 11.7%of patients in the validation cohort were categorized as LR,MR,and HR,respectively.The corresponding prevalence rates of ACN were 5.0%,10.3%,and 17.6%,respectively.The C-statistic of the new scoring model was 0.66,which was higher than that of the Asia-Pacific Colorectal Screening model(0.63).CONCLUSION A modified scoring model incorporating waist-hip ratio has an improved predictive performance in the prediction of ACN.
基金Supported by the 135 High-end Talent Project of West China Hospital,Sichuan University,No.ZYDG23029.
文摘BACKGROUND Recent advancements in artificial intelligence(AI)have significantly enhanced the capabilities of endoscopic-assisted diagnosis for gastrointestinal diseases.AI has shown great promise in clinical practice,particularly for diagnostic support,offering real-time insights into complex conditions such as esophageal squamous cell carcinoma.CASE SUMMARY In this study,we introduce a multimodal AI system that successfully identified and delineated a small and flat carcinoma during esophagogastroduodenoscopy,highlighting its potential for early detection of malignancies.The lesion was confirmed as high-grade squamous intraepithelial neoplasia,with pathology results supporting the AI system’s accuracy.The multimodal AI system offers an integrated solution that provides real-time,accurate diagnostic information directly within the endoscopic device interface,allowing for single-monitor use without disrupting endoscopist’s workflow.CONCLUSION This work underscores the transformative potential of AI to enhance endoscopic diagnosis by enabling earlier,more accurate interventions.
文摘The urgent necessity for enhanced risk stratification to improve the efficiency of colonoscopy screening is underscored by the fact that colorectal cancer(CRC)continues to be a primary cause of global cancer mortality.Conventional models mostly rely on generalized obesity markers including body mass index(BMI),which does not effectively represent oncogenic risk linked with abdominal obesity.Liu et al undertook a large-scale case-control study comprising 6484 firsttime colonoscopy patients at a prominent Chinese hospital between 2020 and 2023 to overcome this restriction.Age,male sex,smoking status,and raised waist-hip ratio(WHR)were found by multivariate logistic regression as independent predictors of advanced colorectal neoplasia(ACN).In a validation cohort of 1891 individuals,a new 7-point risk scoring model was created and stratified into low-(5.0%)ACN prevalence,moderate-(10.3%)and high-risk(17.6%).With C-statistic=0.66 the model showed better discriminating ability than the Asia-Pacific Colorectal Screening(APCS)score(C-statistic=0.63)and the BMI-modified APCS model.These results fit newly published data showing central obesity as a major carcinogenic driver via pro-inflammatory visceral adipokine channels.With the use of WHR,patient risk classification is greatly improved,providing a practical tool to make the most of screening resources in the face of rising CRC incidence rates.Finally,multi-ethnic validation is necessary for the WHR-based scoring model to be considered for integration into global CRC preventive frameworks,since it improves the accuracy of ACN risk prediction.
基金the Science and Research Office of Shandong First Medical University Affiliated Provincial Hospital(approved number SWYX:No.2024-294).
文摘BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Currently,it is difficult to accurately diagnose LGIN and HGIN through imaging,and clinical diagnosis depends on postoperative histopathological diagnosis.A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.AIM To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.METHODS We selected 84 older patients diagnosed with HGIN as the HGIN group(n=95 colonic polyps)and 112 older patients diagnosed with LGIN as the LGIN group(n=132 colonic polyps)from Shandong Provincial Hospital Affiliated to Shandong First Medical University.The endoscopic features,demographic characteristics,and clinical manifestations of the two patient groups were compared,and a logistic regression model was used to analyze the risk factors for HGIN in these patients.RESULTS The HGIN group was older and had a higher number of sigmoid colon polyps,rectal polyps,pedunculated polyps,polyps≥1.0 cm in size,polyps with surface congestion,polyps with surface depression,and polyps with villous/tubular adenomas,a higher proportion of patients with diabetes and a family history of colorectal cancer,patients who experienced rectal bleeding or occult blood,patients with elevated carcinoembryonic antigen(CEA)and cancer antigen 199(CA199),and lower nutritional levels and higher frailty levels.The polyp location(in the sigmoid colon or rectum),polyp diameter(≥1.0 cm),pathological diagnosis of(villous/tubular adenoma),family history of colorectal cancer,rectal bleeding or occult blood,elevated serum CEA and CA199 levels,lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.CONCLUSION The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location,size,villous/tubular characteristics,family history,elevated levels of tumor markers,and lower nutritional levels and higher frailty levels.
基金Supported by Sanming Project of Medicine in Shenzhen,No.SZSM202211029。
文摘BACKGROUND Multiple endocrine neoplasias(MENs)are a group of hereditary diseases invol-ving multiple endocrine glands,and their prevalence is low.MEN type 1(MEN1)has diverse clinical manifestations,mainly involving the parathyroid glands,gastrointestinal tract,pancreas and pituitary gland,making it easy to miss the clinical diagnosis.CASE SUMMARY We present the case of a patient in whom MEN1 was detected early.A middle-aged male with recurrent abdominal pain and diarrhea was admitted to the hos-pital.Blood tests at admission revealed hypercalcemia and hypophosphatemia,and emission computed tomography of the parathyroid glands revealed a hy-perfunctioning parathyroid lesion.Gastroscopy findings suggested a duodenal bulge and ulceration.Ultrasound endoscopy revealed a hypoechoic lesion in the duodenal bulb.Further blood tests revealed elevated levels of serum gastrin.Surgery was performed,and pathological analysis of the surgical specimens revealed a parathyroid adenoma after parathyroidectomy and a neuroendocrine tumor after duodenal bulbectomy.The time from onset to the definitive diagnosis of MEN1 was only approximately 1 year.CONCLUSION For patients who present with gastrointestinal symptoms accompanied by hyper-calcemia and hypophosphatemia,clinicians need to be alert to the possibility of MEN1.
基金Supported by The Finance Bureau of Dongguan City,Guangdong Province.
文摘BACKGROUND Multiple endocrine neoplasia type 2(MEN2)is a rare,autosomal dominant endocrine disease.Currently,the RET proto-oncogene is the only gene implicated in MEN2A pathogenesis.Once an RET carrier is detected,family members should be screened to enable early detection of medullary thyroid carcinoma,pheochromocytoma,and hyperparatitity.Among these,medullary thyroid carcinoma is the main factor responsible for patient mortality.Accordingly,delineating strategies to inform clinical follow-up and treatment plans based on genes is paramount for clinical practitioners.CASE SUMMARY Herein,we present RET proto-oncogene mutations,clinical characteristics,and treatment strategies in a family with MEN2A.A family study was conducted on patients diagnosed with MEN2A.DNA was extracted from the peripheral blood of family members,and first-generation exon sequencing of the RET protooncogene was conducted.The C634Y mutation was identified in three family members spanning three generations.Two patients were sequentially diagnosed with pheochromocytomas and bilateral medullary thyroid carcinomas.A 9-yearold child harboring the gene mutation was diagnosed with medullary thyroid carcinoma.Surgical resection of the tumors was performed.All family members were advised to undergo complete genetic testing related to the C634Y mutation,and the corresponding treatments administered based on test results and associated clinical guidelines.CONCLUSION Advancements in MEN2A research are important for familial management,assessment of medullary thyroid cancer invasive risk,and deciding surgical timing.
基金Supported by the European Union-Next Generation EU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008.
文摘Despite advancements in the field,early diagnosis of multiple endocrine neoplasia type 1(MEN1)remains unachievable.This letter to the editor highlighted the importance of carefully assessing gastrointestinal symptoms,hypercalcemia,and elevated serum gastrin levels,as suggested by Yuan et al in their paper.They focused on a patient with recurrent abdominal pain and diarrhea whose diagnostic path led to establishing a MEN1 diagnosis within a year.This emphasized the need for clinicians to consider MEN1 in patients with similar presentations,particularly when gastrointestinal symptoms persist or recur after discontinuation of proton pump inhibitors,especially knowing that early recognition and intervention are crucial for improving patient outcomes.
文摘Different types of neuroendocrine cancer,including medullary thyroid cancer(MTC)and thyroid C-cell hyperplasia,are part of multiple endocrine neoplasia type 2(MEN2).A proto-oncogene mutation of the rearranged during transfection(RET)gene changes the way that receptor tyrosine kinases work.Multiple endocrine neoplasia,a pathological condition,involves these kinases.When the RET protooncogene changes,it can cause endocrine adenomas and hyperplasia to happen at the same time or one after the other.Pheochromocytoma,medullary thyroid carcinoma,and hyperparathyroidism,alone or in combination,are present in MEN2A patients.Some patients may also have skin lichen amyloidosis or Hirschsprung's disease.Patients with MEN2A often present with MTC.MTC is aggressive and has the worst prognosis,as most patients exhibit lymph node metastasis.MTC is one of the important causes of death in patients with MEN2A.RET mutation analysis aids in identifying MEN2A symptoms and monitoring levels of calcium,thyroid hormones,calcitonin,normetanephrine,fractionated metanephrines,and parathyroid hormone.The earlier diagnosis of MTC significantly improves survival and prompts better management of MEN2A.In this editorial,we will discuss the significance of molecular diagnostic approaches in detecting RET oncogene mutations in MEN2A.
文摘Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.
文摘Objective: In Cameroon, more than 80% of women suffering from cervical intraepithelial neoplasia (CIN) are within the reproductive age. This study intended to analyze the pregnancy outcomes following cervical treatment in Cameroon. Methods: This was a cohort study with two years retrospective data collection involving 82 women who underwent cervical treatment for CIN in two Cameroonian hospitals from January 2015 to December 2017. Data were collected from CIN treatment to end of pregnancy where applicable. Data analysis was done using Epi Info software version 3.5.4. Results: We collected data from 82 patients aged 27 to 48 years, with a mean age of 36.5 (SD: 5.3) years. During the study period, 33 out of 82 participants became pregnant 40.2 [29.56 - 51.66]%. The factor associated with pregnancy occurrence after treatment was age less than 35 years (Odds ratio = 4.37 [1.7 - 11.2]. From the 33 pregnancies recorded, 17 (51.5%) ended in a delivery, amongst which 15 (88.2%) were vaginal. Conclusion: Pregnancy frequency over two years following cervical treatment for CIN was relatively good, and younger women (age 35 years) were significantly more like to have conceived compared to their older counterparts. Post-treatment delivery outcomes seem to be similar to those in the general population.
文摘AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:Eligible patients with suspected gastric IN lesions previously diagnosed by endoscopy in secondary hospitals and scheduled for further diagnosis and tratment were recruited for this study. Excluded from the study were patients who had liver cirrhosis, impaired renal function, acute gastrointestinal (GI) bleeding, coagulopathy, esophageal varices, jaundice, and GI post-surgery. Also excluded were those who were pregnant, breastfeeding, were younger than 18 years old, or were unable to provide informed consent. All patients had all mucus and bile cleared from their stom-achs. They then received upper GI endoscopy. When a mucosal lesion is found during observation with whitelight imaging, the lesion is visualized using maximal magnification, employing gradual movement of the tip of the endoscope to bring the image into focus. Saved images are analyzed. Confocal images were evaluated by two endoscopists (Huang J and Li MY), who were familiar with CLE, blinded to the related information about the lesions, and asked to classify each lesion as either a low grade dysplasia (LGD) or high grade dysplasia (HGD) according to given criteria. The results were compared with the final histopathologic diagnosis. ME-NBI images were evaluated by two endoscopists (Lu ZS and Ling-Hu EQ) who were familiar with NBI, blinded to the related information about the lesions and CLE images, and were asked to classify each lesion as a LGD or HGD according to the "microvascular pattern and surface pattern" classification system. The results were compared with the final histopathologic diagnosis. RESULTS: The study included 32 pathology-proven low grade gastric IN and 26 pathology-proven high grade gastric IN that were detected with any of the modalities. CLE and ME-NBI enabled clear visualization of the vascular microsurface patterns and microvascular structures of the gastric mucosa. The accuracy of the CLE and the ME-NBI diagnosis was 88% (95% CI:78%-98%) and 81% (95% CI: 69%-93%), respectively. The kappa coefficient of agreement between the histopathology and the in vivo CLE imaging was 0.755; between the histopathology and the in vivo CLE imaging was 0.615. McNemar's test (binomial distribution used) indicated that the agreement was significant (P < 0.05). When patients were diagnosed by MENBI with CLE, the overall accuracy of the diagnosis was 86.21% (95% CI:73%-96%), and the kappa coefficient of agreement was 0.713, according to McNemar's test (P < 0.05). CONCLUSION:Higher diagnostic accuracy, sensitivityand specificity of CLE over ME-NBI indicate the feasibility of these two techniques for the efficacious diagnostic classification of gastric IN.
