Appendiceal mucinous neoplasms(AMNs)are rare tumors originating from mucin-producing epithelial cells of the appendix.They can exhibit both benign and malignant behavior.They are often incidentally discovered during a...Appendiceal mucinous neoplasms(AMNs)are rare tumors originating from mucin-producing epithelial cells of the appendix.They can exhibit both benign and malignant behavior.They are often incidentally discovered during appendectomy.Clinical presentation ranges from asymptomatic to mimicking acute appendicitis.Histologically,noninvasive AMNs are classified as low-grade AMNs(LAMNs)or high-grade AMNs(HAMNs),whereas invasive tumors are categorized as mucinous adenocarcinomas.Although LAMNs and HAMNs are generally nonmalignant,rupture can lead to pseudomyxoma peritonei(PMP).Surgical resection is the primary diagnostic and therapeutic approach,with intraoperative assessment to prevent rupture.Treatment strategies vary based on findings and include appendectomy,right hemicolectomy,and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.Histological diagnosis relies on mucin detection,and immunohistochemical markers such as cytokeratin 20(diffusely positive),cytokeratin 7(often negative),mucin 5AC,and special ATrich sequence-binding protein 2 assist in characterization.Molecular profiling frequently identifies KRAS,GNAS,and TP53 mutations.KRAS mutations are generally associated with a favorable prognosis,whereas GNAS and TP53 mutations correlate with poorer survival outcomes.These findings highlight the potential role of molecular profiling in guiding treatment strategies for AMN and PMP.展开更多
BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to p...BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to premalignant and malignant,posing a diagnostic challenge.Accurate differentiation is critical,as premalignant and malignant PCNs often require surgical intervention,while benign cysts may only need monitoring unless symptomatic.Current diagnostic methods,including cross-sectional imaging,endoscopic ultrasonography,and endoscopic ultrasonography-guided fine-needle aspiration/biopsy,are specialized,not universally available,and have variable accuracy.Clinical and laboratory parameters such as carbohydrate antigen 19-9(CA 19-9),neutrophillymphocyte ratio,platelet-lymphocyte ratio,and red cell distribution width(RDW)have been associated with malignancy risk,though only CA 19-9 is guideline-supported.AIM To assess the malignancy risk of PCNs using preoperative clinical and routine laboratory parameters.METHODS A retrospective cohort study analyzed 70 patients who underwent surgery for PCNs at Ankara Bilkent City Hospital between February 2019 and March 2023.Patients were categorized into group A(benign or low-grade dysplasia,n=40)and group B(malignancy or high-grade dysplasia,n=30)based on postoperative pathology.Preoperative demographic and laboratory parameters,including age,RDW,albumin,and CA 19-9,were compared.Univariate and multivariate logistic regression analyses identified independent predictors of malignancy.Receiver operating characteristic curve analysis evaluated predictive performance,with internal validation using bootstrapping.RESULTS Group B patients were older(69.86±9.58 years vs 52.74±16.85 years,P<0.001)and had a higher incidence of diabetes mellitus(57.1%vs 21.4%,P=0.002).RDW(16.2%vs 13.7%,P<0.001),platelet-lymphocyte ratio(178 vs 126,P=0.008),and CA 19-9(21.7 U/mL vs 9.3 U/mL,P=0.009)were significantly higher in group B,while albumin was lower(41 g/L vs 45 g/L,P=0.008).Multivariate analysis identified age[odds ratio=1.067,95%confidence interval(CI):1.014-1.122,P=0.012]and RDW(odds ratio=1.784,95%CI:1.172-2.715,P=0.007)as independent predictors.The area under the curve for age,RDW,and their combination was 0.798(95%CI:0.695-0.900),0.801(95%CI:0.692-0.911),and 0.858(95%CI:0.771-0.944),respectively,with bootstrapped validation confirming stability.Cut-off values of age≥60 years and RDW≥15.5%balanced sensitivity and specificity,increasing malignancy risk 15.3-fold and 22.6-fold,respectively.CONCLUSION Age and RDW are independent predictors of malignancy in PCNs,aiding in patient selection for advanced diagnostics and surgery.Larger,multicenter studies are needed to validate these findings.展开更多
To the Editor,We have read the article by Gener-Ricos et al.titled"NPM1-mutated myeloid neoplasms are a unique entity not defined by bone marrow blast percentage",published in Cancer[1].This retrospective,cr...To the Editor,We have read the article by Gener-Ricos et al.titled"NPM1-mutated myeloid neoplasms are a unique entity not defined by bone marrow blast percentage",published in Cancer[1].This retrospective,cross-sectional pilot study provides valuable insights into the clinicopathological features and treatment outcomes of patients with NPM1-mutated myeloid neoplasms(MNs)with less than 20%bone marrow blasts[1].展开更多
Neuroendocrine neoplasms(NENs)are highly heterogeneous and potentially malignant tumors arising from secretory cells of the neuroendocrine system.Gastroenteropancreatic NENs(GEP-NENs)are the most common subtype of NEN...Neuroendocrine neoplasms(NENs)are highly heterogeneous and potentially malignant tumors arising from secretory cells of the neuroendocrine system.Gastroenteropancreatic NENs(GEP-NENs)are the most common subtype of NENs.Historically,GEP-NENs have been regarded as infrequent and slow-growing malignancies;however,recent data have demonstrated that the worldwide prevalence and incidence of GEP-NENs have increased exponentially over the last three decades.In addition,an increasing number of studies have proven that GEP-NENs result in a limited life expectancy.These findings suggested that the natural biology of GEP-NENs is more aggressive than commonly assumed.Therefore,there is an urgent need for advanced researches focusing on the diagnosis and management of patients with GEP-NENs.In this review,we have summarized the limitations and recent advancements in our comprehension of the epidemiology,clinical presentations,pathology,molecular biology,diagnosis,and treatment of GEP-NETs to identify factors contributing to delays in diagnosis and timely treatment of these patients.展开更多
Pancreatic cystic neoplasms(PCNs) are a diverse group of neoplasms in the pancreas,and are more increasingly encountered with widespread abdominal screening and improved imaging techniques.The most common types of PCN...Pancreatic cystic neoplasms(PCNs) are a diverse group of neoplasms in the pancreas,and are more increasingly encountered with widespread abdominal screening and improved imaging techniques.The most common types of PCNs are serous cystic neoplasms(SCNs),mucinous cystic neoplasms(MCNs),and intraductal papillary mucinous neoplasms(IPMNs).Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas,which may lead to overtreatment or delayed treatment.The current review provides recent developments in the understanding of the three most common types of PCNs,the latest modalities used in preoperative diagnosis and differential diagnosis,as well as the most up to date management.Suggestions for diagnosis and differential diagnosis of SCNs,MCNs,and IPMNs are also provided for young surgeons.Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.展开更多
BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particu...BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.展开更多
Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in...Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in the digestive system.NENs consist of a range of tumor types and the biological behaviors exhibit significant differences.NENs are classified into well-differentiated neuroendocrine tumors(NETs)and poorly differentiated neuroendocrine carcinomas(NECs).NETs can be further classified and graded into the following three categories:low-grade NETs,grade 1(NET G1);intermediate-grade NET G2;and high-grade NET G3.NECs include large cell-type NEC(LCNEC)and small cell-type NEC(SCNEC),both of which are considered high grade.Currently,the main treatments for advanced NENs are biological treatments,targeted therapy,chemotherapy,and newer treatments that are still under development,such as immunotherapy and peptide receptor radionuclide therapy(PRRT).However,owing to the rarity of NENs,pharmaceutical company investment is limited and few phase Ⅲ studies have targeted advanced NENs.Most current research consists of investigator-initiated phase Ⅰ and Ⅱ clinical trials or largescale retrospective studies.NEN treatment should be chosen carefully because it is cumbersome and complicated,as indicated above.Herein,we comprehensively summarize the clinical application status and research progress for advanced NEN treatment regimens,especially for advanced NETs,which may help to create awareness on NENs among medical professionals across specialties.展开更多
Mixed neuroendocrine non-neuroendocrine neoplasms constitute rare tumors that are located mainly in the gastrointestinal(GI)tract and have high degrees of malignancy,and the frequency of these tumors has been increasi...Mixed neuroendocrine non-neuroendocrine neoplasms constitute rare tumors that are located mainly in the gastrointestinal(GI)tract and have high degrees of malignancy,and the frequency of these tumors has been increasing.They consist of a neuroendocrine neoplastic component with another component of adenocarcinoma usually and have a dismal prognosis.The rare GI pure neuroendocrine carcinoma is highly aggressive and requires complex and extensive management since a genetic distinction exists between it and GI non-neuroendocrine neoplasms,which are generally slow-growing lesions.The most common GI-mixed neuroendocrine non-neuroendocrine neoplasms are colorectal,followed by gastric,mainly in the gastroesophageal junction.Current imaging modalities of nuclear medicine and radiology play important roles in the accuracy of diagnosis.Liquid biopsy may contribute to early detection and timely diagnosis.Ultrasonography,either endoscopic or abdominal,is a technique that contributes to a diagnosis;additionally,contrast-enhanced ultrasonography is very helpful in followup appointments.Histopathology establishes a definite diagnosis and stage by evaluating the cell differentiation grade and the cell proliferation index Ki67.The genetic profile can be valuable in diagnosis and gene therapy.Surgical resection with wide lymphadenectomy,whenever possible,and adjuvant chemotherapy constitute the main therapeutic management strategies.Targeted therapy and immunotherapy achieve encouraging results.展开更多
BACKGROUND Pancreatic neuroendocrine neoplasms(pNENs)are rare,heterogeneous tumors accounting for 1%-2%of pancreatic tumors,with significant malignant potential.Intraductal papillary mucinous neoplasm of the bile duct...BACKGROUND Pancreatic neuroendocrine neoplasms(pNENs)are rare,heterogeneous tumors accounting for 1%-2%of pancreatic tumors,with significant malignant potential.Intraductal papillary mucinous neoplasm of the bile duct(IPMN-B)is a rare precancerous lesion in the bile duct system,with potential for malignancy.The combination of pNENs and IPMN-B is exceptionally rare and often leads to misdiagnosis.This study aims to report a rare case of pNENs combined with IPMN-B treated at Yanbian University Hospital to improve understanding and management of this unusual tumor combination.CASE SUMMARY We retrospectively analyzed a case from Yanbian University Hospital.We re-viewed clinical records,imaging findings,endoscopic retrograde cholangiopan-creatography,surgical exploration,and histopathological examination.The pa-tient was diagnosed with pNENs and IPMN-B.Surgical treatment was performed,with follow-up showing effective management and no significant recurrence.CONCLUSION This case represents the first report of pNENs combined with IPMN-B.It high-lights the need for thorough diagnostic evaluation to prevent misdiagnosis and improve treatment strategies.展开更多
BACKGROUND The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection(ESD).There are few studies that analyze the influence of tumor location ...BACKGROUND The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection(ESD).There are few studies that analyze the influence of tumor location in the stomach on ESD outcomes.AIM To compare the clinical efficacy and safety of ESD in the proximal vs distal stomach.METHODS A retrospective analysis was conducted on patients admitted in chronological order who received gastric ESD between 2009 and 2024.Patients were stratified into two groups based on tumor location:Group 1 included patients with tumors in the lower third of the stomach,while Group 2 included those with tumors in the middle or upper third.The following parameters were evaluated for each group:procedure duration,curative resection rate,en bloc resection rate,complete resection rate,incidence of complications,and depth of neoplastic invasion.RESULTS The mean procedure time was 97.07 minutes for lesions located in the distal stomach and 129.08 minutes for those in the proximal stomach(P=0.0011).En bloc resection rates for ESD in the distal and proximal stomach were 97.9%and 85.7%,respectively(P=0.0016),while complete resection rates were 93.9%and 73.4%,respectively(P=0.0002).Curative resection was achieved in 90.9%of distal lesions compared to 65.3%of proximal lesions(P=0.0001).Submucosal invasion was identified in 4.0%of distal lesions and 14.2%of proximal lesions(P=0.013).CONCLUSION ESD performed in the proximal stomach requires a longer procedural time compared to ESD in the distal stomach,independent of lesion size and histopathological characteristics.Additionally,proximal gastric ESD is associated with reduced clinical efficacy and increased incidence of submucosal invasion.展开更多
BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognos...BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognostic nomogram for PDGNEN patients.METHODS We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023.Overall survival(OS)differences were assessed with the Log-rank test and Kaplan-Meier survival curves.Cox regression analysis identified independent risk factors for prognosis.Model performance was evaluated using Harrell’s concordance index,receiver operating characteristic analysis,area under the curve,calibration curves,and decision curve analysis(UDC),including the area under the UDC.RESULTS The study included 336 patients(227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma).The average age was 62.7 years.The cohort comprised 80(24.7%)patients in stage I,146(42.9%)in stage II,62(18.1%)in stage III,and 48(14.3%)in stage IV.Significant differences in OS were observed across tumor-node-metastasis stages(P<0.001).Multivariate analysis showed age,Ki-67 index,invasion depth,lymph node metastasis,distant metastasis,and platelet-to-lymphocyte ratio as independent risk factors.We developed a nomogram with a concordance index of 0.779(95%confidence interval:0.743-0.858).Receiver operating characteristic analysis showed area under the curves for 1-year,3-year,and 5-year OS predictions of 0.865,0.850,and 0.890,respectively.The calibration curve demonstrated good agreement with actual outcomes.The area under the UDC for the nomogram vs the 8th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027,0.291 vs 0.179,and 0.376 vs 0.216 for 1-year,3-year,and 5-year OS,respectively.CONCLUSION PDGNENs are predominantly found in older men,often in advanced stages at diagnosis,resulting in poor prognosis.The established nomogram demonstrates strong predictive capability and clinical utility.展开更多
Pancreatic cystic neoplasms(PCNs)represent a spectrum of heterogeneous lesions with diverse biological behaviors and malignant potential.This category encompasses relatively common subtypes,such as intraductal papilla...Pancreatic cystic neoplasms(PCNs)represent a spectrum of heterogeneous lesions with diverse biological behaviors and malignant potential.This category encompasses relatively common subtypes,such as intraductal papillary mucinous neoplasms,serous cystic neoplasms,and mucinous cystic neoplasms,alongside relatively rarer entities,including cystic degeneration of solid pancreatic tumors.The widespread use of cross-sectional imaging has led to increased incidental detection of PCNs,subsequently driving a surge in PCN-related medical consultations and interventions;thus,standardized management of PCNs demands heightened attention.Continuous advancements in endoscopic techno-logies,particularly endoscopic ultrasound(EUS)and EUS-guided procedures,now offer diversified diagnostic and therapeutic options,establishing EUS as a pivotal tool for diagnosing,surveillance,and treating PCNs.This review synthesizes current evidence and evolving clinical practices in the endoscopic management of PCNs,emphasizing optimizing preoperative diagnostic accuracy,standardizing endoscopic protocols,implementing subtype-specific risk strati-fication,promoting multidisciplinary team approaches,and addressing challenges in emerging technologies.展开更多
BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized ...BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.展开更多
Background:The JAK2^(V617F)mutation plays a crucial part in the pathogenesis of myeloproliferative neoplasms(MPN),which includes polycythemia vera(PV),essential thrombocythemia(ET),and primary myelofibrosis(PMF)leadin...Background:The JAK2^(V617F)mutation plays a crucial part in the pathogenesis of myeloproliferative neoplasms(MPN),which includes polycythemia vera(PV),essential thrombocythemia(ET),and primary myelofibrosis(PMF)leading to aberrant proliferation and survival of hematopoietic cells.Alongside the challenges of drug resistance and side effects,identifying novel compounds that selectively target JAK2^(V617F)could provide more effective and safer therapeutic options for patients with MPNs.Materials and Methods:We employed computational approaches like high-throughput virtual screening,molecular dynamics simulations(MDS),and binding free energy calculations to identify inhibitors targeting wild and mutant JAK2 kinases.JAK2^(V617F)positive HEL,wild type JAK2 positive TF-1,and non-cancerous Vero cells were used for in vitro validations.Results:SBLJ23 emerged as a top candidate inhibitor with specificity for JAK2^(V617F).Protein-ligand interaction studies and MDS revealed stable interactions and binding of SBLJ23 over the simulation period,with Root Mean Square Deviation(RMSD)indicating consistent binding after 1t15ns.SBLJ23 displayed a half maximal inhibitory concentration(IC_(50))value of 522.4 nM against the JAK2 enzyme.The compound exhibited inhibition of cell proliferation in HEL and TF-1 cells,with half maximal cell growth inhibitory concentration(GI 50)values of 2.51 and 15.87μM,respectively.Moreover,SBLJ23 induced G 2/M cell cycle arrest in HEL cells to facilitate apoptosis in these cell lines.The compound significantly reduced the percentage of phospho JAK2 and phospho STAT3 in HEL cells.Conclusion:High binding affinity,stable interaction profile,favorable binding free energy,and in vitro validations claim SBLJ23 as a potential lead compound against JAK2^(V617F)and suggest further development and optimization towards clinical application in managing myeloproliferative neoplasms.展开更多
Tumors of the pancreas,the ampulla of Vater,and the extrahepatic and intrahepatic bile ducts have significant histological similarities due to the common embryonic origin of the pancreatobiliary system.This obviates t...Tumors of the pancreas,the ampulla of Vater,and the extrahepatic and intrahepatic bile ducts have significant histological similarities due to the common embryonic origin of the pancreatobiliary system.This obviates the need for discovery of biomarkers with diagnostic and prognostic value for these tumors.Mucins,especially MUC-1,-2,-4 and-5AC,are important candidates for developing into such reliable biomarkers.Increased expression of MUC1 occurs in pancreatic ductal adenocarcinomas and is associated with increased degrees of dysplasia in pancreatic intraepithelial neoplasia(Pan IN).Positive expression of MUC2 in intraductal papillary mucinus neoplasms(IPMN) of the intestinal type indicates high potential progression to invasive carcinoma with de novo expression of MUC1,while absence of MUC2 expression in IPMNs of gastric type implies low potential to malignant evolution.De novo MUC4 expression correlates to the severity of dysplasia in Pan IN and is associated with a poor prognosis in patients with pancreatic ductal adenocarcinomas.In biliary intraepithelial neoplasia(Bil IN),increased expression of MUC1 is associated with higher degrees of dysplasia.Intrahepatic cholangiocarcinomas(ICC) are characterized by increased expression of all glycoforms of MUC1.Positive MUC2 expression in intraductal papillary neoplasm of the bile ducts(IPNB) of the intestinal type indicates high malignant potential with de novo expression of MUC1 in the invasive element.Absent MUC2 expression in any degree of Bil IN may prove useful in differentiating them from IPNB.De novo expression of MUC4 is associated with poor prognosis in patients with ICC or carcinoma of the extrahepatic bile ducts(EHBDC).High de novo expression of MUC5 AC is found in all degrees of Bil IN and all types of IPNB and ICC.The MUC5 AC is useful in the detection of neoplastic lesions of the bile duct at an early stage.Increased expression of mucin MUC1 in carcinoma of the ampulla of Vater associated with unfavorable behavior of the tumor,such as lymph node metastasis,infiltration of the pancreas and duodenum,advanced TNM classification and worse prognosis.Patients withintra-ampullary papillary-tubular neoplasm(IAPN) of the pancreatobiliary immunophenotype did not show MUC2,while those of the intestinal immunophenotype are MUC2 positive.The expression of MUC4 is associated with poor prognosis in patients with carcinoma of the ampulla of Vater favoring metastasis and making them resistant to apoptosis.Moreover,it appears that MUC4 positivity correlates with recurrence of the tumor.Expression of MUC5 AC is associated with the invasive potential of the tumor.展开更多
Objective： To study the characteristics and clinical features of uterine neoplasms developed after radiation therapy for cervical carcinoma. Methods： Clinical data of 47 cases of uterine neoplasms occurred following...Objective： To study the characteristics and clinical features of uterine neoplasms developed after radiation therapy for cervical carcinoma. Methods： Clinical data of 47 cases of uterine neoplasms occurred following radiation therapy for cervical carcinoma were retrospectively reviewed. Results： The median age at uterine neoplasms diagnosis was 62 years （range： 38-77 years）, and the median latency period from initial therapy to development of uterine neoplasms was 14 years （range： 5-35 years）. Thirty of 47 cases were endometrial carcinoma, of which 3 were uterine papillary serous carcinoma （UPSC）. Seventeen of 47 patients were uterine sarcoma, all of those were carcinosarcoma. The distribution by stage, grade, and histology of 30 cases of endometrial carcinoma was as follows： stage Ⅰb, 1 case; stage Ⅰc, 2 cases; stage Ⅱ, 6; stage Ⅲa, 4; stage Ⅲb, 2; stage Ⅲc, 11; stage Ⅳ, 4 cases; grade 1, two cases; grade 2, nine; grade 3 （include 3 UPSC patients）, seventeen; unknown grade, two; endometriod, 27; UPSC, 3 cases; 7 of 30 cases of endometrial carcinoma had recurrences （23.3%）, at median time to recurrence was 24 months, and their median survival time was 26 months. The overall 3- and 5-year survival rates were 60% and 38%, respectively. Of the 17 cases of uterine sarcoma, the median survival was 10 months, 6 patients occurred recurrence （35.9%）, at a median time to recurrence was 9 months, and their median survival was 6 months. The overall 3- and 5-year survival rates were 12% and 0, respectively. Conclusion： The main uterine neoplasms development after radiation therapy for cervical carcinoma is endometrial carcinomas, of which there is a preponderance of high-risk histological subtypes and a poor prognosis. Most of the uterine sarcomas occurred following radiation therapy for cervical carcinoma are carcinosarcomas and the prognosis is very poor.展开更多
Background: Biliary mucinous cystic neoplasms(BMCNs) are rare hepatobiliary cystic tumors, which can be divided into noninvasive and invasive types. This study aimed to investigate the diagnosis, treatment, and progno...Background: Biliary mucinous cystic neoplasms(BMCNs) are rare hepatobiliary cystic tumors, which can be divided into noninvasive and invasive types. This study aimed to investigate the diagnosis, treatment, and prognosis of BMCNs in a large single center. Methods: We analyzed 49 patients with BMCNs confirmed by postoperative pathology at the First Afflliated Hospital, Zhejiang University School of Medicine between January 2007 and December 2021. Results: Among the 49 patients, 37 were female(75.5%), and the average age was 57.04 years. Common symptoms included abdominal discomfort, jaundice and fever, while 22 patients(44.9%) had no symptoms. Serum carbohydrate antigen(CA) 19-9 and CA125 concentrations were elevated in 34.8% and 19.6% of patients, respectively. Forty-eight patients had tumors in the intrahepatic bile ducts and only one had a tumor in the extrahepatic bile duct. Forty-eight patients with noninvasive intrahepatic BMCNs were further analyzed in terms of pathological features: 34(70.8%) had low-grade intraepithelial neoplasms(LGINs), and 14(29.2%) had high-grade intraepithelial neoplasms(HGINs). The potential immunohistochemical markers of BMCNs were cytokeratin(CK) 19, CK7, estrogen receptor and progesterone receptor. Follow-up data for 37 patients with intrahepatic BMCNs were obtained. The median overall survival(OS) of BMCNs was not reached. The longest survival time was 137 months.The 5-and 10-year OS rates were 100% and 85.4%, respectively. The 5-and 10-year recurrence-free survival(RFS) rates were 93.9% and 80.2%, respectively. Conclusions: BMCNs are rare cystic neoplasms that commonly occur in middle-aged females. BMCNs can only be diagnosed and classified by postoperative pathology, as there are no specific clinical presentations, serological indicators or imaging modalities for preoperative diagnosis. Complete surgical resection is necessary for BMCNs, and the postoperative prognosis is favorable.展开更多
Mucinous cystic neoplasms of the liver(MCN-L)are rare cystic lesions characterized by mucin-producing epithelium and ovarian-like stroma.Although they constitute fewer than 5%of hepatic cystic lesions,MCN-L poses sign...Mucinous cystic neoplasms of the liver(MCN-L)are rare cystic lesions characterized by mucin-producing epithelium and ovarian-like stroma.Although they constitute fewer than 5%of hepatic cystic lesions,MCN-L poses significant diagnostic challenges due to overlapping features with other cystic lesions and their potential for malignant transformation.Early recognition and definitive surgical intervention are therefore critical to ensure optimal patient outcomes.A literature review was conducted to summarize epidemiology,clinical presentation,diagnostic modalities,and management strategies for MCN-L.Additionally,from 2019 to 2025,9 patients with MCN-L were identified at our center.Clinical data and outcomes were retrospectively analyzed.MCN-L predominantly affects middle-aged women and presents as large,multiloculated cystic lesions without biliary communication.The revised 2010 World Health Organization classification emphasizes the presence of ovarian-like stroma for definitive diagnosis.Contrast-enhanced computed tomography or magnetic resonance imaging are often suggestive but not pathognomonic,reinforcing the need for histopathological confirmation.MCN-L remains a diagnostic and therapeutic challenge due to its resemblance to other cystic liver lesions.Complete surgical resection is the treatment of choice to prevent recurrence and malignant transformation,reinforcing the importance of early intervention.Further research is needed to improve diagnostic accuracy and refine management strategies.展开更多
Compared with colorectal adenocarcinoma,neuroendocrine neoplasms(NENs),which affect the colon and rectum,are uncommon tumor conditions that have received relatively limited attention in basic research.Furthermore,the ...Compared with colorectal adenocarcinoma,neuroendocrine neoplasms(NENs),which affect the colon and rectum,are uncommon tumor conditions that have received relatively limited attention in basic research.Furthermore,the scarcity of these NENs has hindered extensive clinical investigations,thereby leading to a dearth of robust evidence for guiding clinical practice and impeding the establishment of standardized approaches for diagnosis and treatment.However,with the increasing awareness of population screening,as well as the increasing popularity of colonoscopy screening programs,the incidence of colorectal NENs has gradually increased.Moreover,some high-grade NENs are highly malignant and invasive,thereby leading to poor treatment outcomes and prognoses.These challenges have elicited increased attention from clinical physicians,thus prompting researchers to explore relevant studies using limited specimens and clinical data.This scenario has resulted in preliminary findings that provide evidence for addressing diagnostic and therapeutic challenges associated with NENs of the colon and rectum.In this article,we review recent literature reports and summarize the advances regarding the diagnosis and treatment of colorectal NENs.展开更多
BACKGROUND Gamma-glutamyl transferase(GGT)is a known surrogate marker of hepatic dysfunction and oxidative stress.It has recently been reported to be associated with metabolic diseases,cardiovascular diseases,and mali...BACKGROUND Gamma-glutamyl transferase(GGT)is a known surrogate marker of hepatic dysfunction and oxidative stress.It has recently been reported to be associated with metabolic diseases,cardiovascular diseases,and malignancies including pancreatic cancer.However,data on its association with pancreatic cystic neo-plasm(PCN),is unknown.AIM To investigate the association of GGT with the incidence of PCN.METHODS In this nationwide retrospective cohort study,participants who received general health checkup by National Health Insurance Service in 2009 were included.Newly diagnosed PCNs from one year after the checkup to 2020 were identified.Participants were divided into quartiles based on GGT levels.Multivariable cox proportional hazard models estimated the risk of PCNs according to GGT quartiles(Q1-Q4).Subgroup analyses by age,sex,and comorbidities,and sensitivity analyses varying lag periods and GGT categorizations were performed.RESULTS There were 28940 cases of PCNs among 2655665 eligible participants.The incidence rate was 1.09 cases per 1000 person-years,with a median follow-up of 10.32(interquartile range:10.09-10.58)years.In multivariate regression analysis,adjusted hazard ratios for GGT quartiles using Q1 group as a reference were:1.04[95%confidence interval(CI):1.005-1.075]for Q2,1.065(95%CI:1.03-1.102)for Q3,and 1.109(95%CI:1.07-1.15)for Q4.Subgroup analysis showed consistent results across age,sex,and comorbidities.In sensitivity analyses,the association remained robust even at 3-year and 5-year lag periods.A clear dose-response relationship was also observed when using GGT deciles(All P for trend<0.001).CONCLUSION Higher GGT level is associated with increased risk of PCNs.Therefore,serum GGT levels might have a role as a biomarker for the development of PCNs.展开更多
文摘Appendiceal mucinous neoplasms(AMNs)are rare tumors originating from mucin-producing epithelial cells of the appendix.They can exhibit both benign and malignant behavior.They are often incidentally discovered during appendectomy.Clinical presentation ranges from asymptomatic to mimicking acute appendicitis.Histologically,noninvasive AMNs are classified as low-grade AMNs(LAMNs)or high-grade AMNs(HAMNs),whereas invasive tumors are categorized as mucinous adenocarcinomas.Although LAMNs and HAMNs are generally nonmalignant,rupture can lead to pseudomyxoma peritonei(PMP).Surgical resection is the primary diagnostic and therapeutic approach,with intraoperative assessment to prevent rupture.Treatment strategies vary based on findings and include appendectomy,right hemicolectomy,and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.Histological diagnosis relies on mucin detection,and immunohistochemical markers such as cytokeratin 20(diffusely positive),cytokeratin 7(often negative),mucin 5AC,and special ATrich sequence-binding protein 2 assist in characterization.Molecular profiling frequently identifies KRAS,GNAS,and TP53 mutations.KRAS mutations are generally associated with a favorable prognosis,whereas GNAS and TP53 mutations correlate with poorer survival outcomes.These findings highlight the potential role of molecular profiling in guiding treatment strategies for AMN and PMP.
文摘BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to premalignant and malignant,posing a diagnostic challenge.Accurate differentiation is critical,as premalignant and malignant PCNs often require surgical intervention,while benign cysts may only need monitoring unless symptomatic.Current diagnostic methods,including cross-sectional imaging,endoscopic ultrasonography,and endoscopic ultrasonography-guided fine-needle aspiration/biopsy,are specialized,not universally available,and have variable accuracy.Clinical and laboratory parameters such as carbohydrate antigen 19-9(CA 19-9),neutrophillymphocyte ratio,platelet-lymphocyte ratio,and red cell distribution width(RDW)have been associated with malignancy risk,though only CA 19-9 is guideline-supported.AIM To assess the malignancy risk of PCNs using preoperative clinical and routine laboratory parameters.METHODS A retrospective cohort study analyzed 70 patients who underwent surgery for PCNs at Ankara Bilkent City Hospital between February 2019 and March 2023.Patients were categorized into group A(benign or low-grade dysplasia,n=40)and group B(malignancy or high-grade dysplasia,n=30)based on postoperative pathology.Preoperative demographic and laboratory parameters,including age,RDW,albumin,and CA 19-9,were compared.Univariate and multivariate logistic regression analyses identified independent predictors of malignancy.Receiver operating characteristic curve analysis evaluated predictive performance,with internal validation using bootstrapping.RESULTS Group B patients were older(69.86±9.58 years vs 52.74±16.85 years,P<0.001)and had a higher incidence of diabetes mellitus(57.1%vs 21.4%,P=0.002).RDW(16.2%vs 13.7%,P<0.001),platelet-lymphocyte ratio(178 vs 126,P=0.008),and CA 19-9(21.7 U/mL vs 9.3 U/mL,P=0.009)were significantly higher in group B,while albumin was lower(41 g/L vs 45 g/L,P=0.008).Multivariate analysis identified age[odds ratio=1.067,95%confidence interval(CI):1.014-1.122,P=0.012]and RDW(odds ratio=1.784,95%CI:1.172-2.715,P=0.007)as independent predictors.The area under the curve for age,RDW,and their combination was 0.798(95%CI:0.695-0.900),0.801(95%CI:0.692-0.911),and 0.858(95%CI:0.771-0.944),respectively,with bootstrapped validation confirming stability.Cut-off values of age≥60 years and RDW≥15.5%balanced sensitivity and specificity,increasing malignancy risk 15.3-fold and 22.6-fold,respectively.CONCLUSION Age and RDW are independent predictors of malignancy in PCNs,aiding in patient selection for advanced diagnostics and surgery.Larger,multicenter studies are needed to validate these findings.
文摘To the Editor,We have read the article by Gener-Ricos et al.titled"NPM1-mutated myeloid neoplasms are a unique entity not defined by bone marrow blast percentage",published in Cancer[1].This retrospective,cross-sectional pilot study provides valuable insights into the clinicopathological features and treatment outcomes of patients with NPM1-mutated myeloid neoplasms(MNs)with less than 20%bone marrow blasts[1].
基金supported by the National Natural Science Foundation of China(82104596)the Shenzhen Key Medical Discipline Construction Fund&Sanming Project of Medicine in Shenzhen(SZSM202111002)+1 种基金the Medicine-Engineering Interdisciplinary Research Foundation of Shenzhen University(2023YG019)the Shenzhen Science and Technology Program(GJHZ20220913143005010)。
文摘Neuroendocrine neoplasms(NENs)are highly heterogeneous and potentially malignant tumors arising from secretory cells of the neuroendocrine system.Gastroenteropancreatic NENs(GEP-NENs)are the most common subtype of NENs.Historically,GEP-NENs have been regarded as infrequent and slow-growing malignancies;however,recent data have demonstrated that the worldwide prevalence and incidence of GEP-NENs have increased exponentially over the last three decades.In addition,an increasing number of studies have proven that GEP-NENs result in a limited life expectancy.These findings suggested that the natural biology of GEP-NENs is more aggressive than commonly assumed.Therefore,there is an urgent need for advanced researches focusing on the diagnosis and management of patients with GEP-NENs.In this review,we have summarized the limitations and recent advancements in our comprehension of the epidemiology,clinical presentations,pathology,molecular biology,diagnosis,and treatment of GEP-NETs to identify factors contributing to delays in diagnosis and timely treatment of these patients.
基金supported by the National Natural Science Foundation of China (Nos.30925033,30801101,and 81171884)the Innovation and High-Level Talent Training Program of Department of Health of Zhejiang Province,China
文摘Pancreatic cystic neoplasms(PCNs) are a diverse group of neoplasms in the pancreas,and are more increasingly encountered with widespread abdominal screening and improved imaging techniques.The most common types of PCNs are serous cystic neoplasms(SCNs),mucinous cystic neoplasms(MCNs),and intraductal papillary mucinous neoplasms(IPMNs).Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas,which may lead to overtreatment or delayed treatment.The current review provides recent developments in the understanding of the three most common types of PCNs,the latest modalities used in preoperative diagnosis and differential diagnosis,as well as the most up to date management.Suggestions for diagnosis and differential diagnosis of SCNs,MCNs,and IPMNs are also provided for young surgeons.Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.
基金Supported by National Natural Science Foundation of China,No.82004298Jiangsu Graduate Research and Practice Innovation Program,China,No.KYCX23_2090.
文摘BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.
文摘Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in the digestive system.NENs consist of a range of tumor types and the biological behaviors exhibit significant differences.NENs are classified into well-differentiated neuroendocrine tumors(NETs)and poorly differentiated neuroendocrine carcinomas(NECs).NETs can be further classified and graded into the following three categories:low-grade NETs,grade 1(NET G1);intermediate-grade NET G2;and high-grade NET G3.NECs include large cell-type NEC(LCNEC)and small cell-type NEC(SCNEC),both of which are considered high grade.Currently,the main treatments for advanced NENs are biological treatments,targeted therapy,chemotherapy,and newer treatments that are still under development,such as immunotherapy and peptide receptor radionuclide therapy(PRRT).However,owing to the rarity of NENs,pharmaceutical company investment is limited and few phase Ⅲ studies have targeted advanced NENs.Most current research consists of investigator-initiated phase Ⅰ and Ⅱ clinical trials or largescale retrospective studies.NEN treatment should be chosen carefully because it is cumbersome and complicated,as indicated above.Herein,we comprehensively summarize the clinical application status and research progress for advanced NEN treatment regimens,especially for advanced NETs,which may help to create awareness on NENs among medical professionals across specialties.
文摘Mixed neuroendocrine non-neuroendocrine neoplasms constitute rare tumors that are located mainly in the gastrointestinal(GI)tract and have high degrees of malignancy,and the frequency of these tumors has been increasing.They consist of a neuroendocrine neoplastic component with another component of adenocarcinoma usually and have a dismal prognosis.The rare GI pure neuroendocrine carcinoma is highly aggressive and requires complex and extensive management since a genetic distinction exists between it and GI non-neuroendocrine neoplasms,which are generally slow-growing lesions.The most common GI-mixed neuroendocrine non-neuroendocrine neoplasms are colorectal,followed by gastric,mainly in the gastroesophageal junction.Current imaging modalities of nuclear medicine and radiology play important roles in the accuracy of diagnosis.Liquid biopsy may contribute to early detection and timely diagnosis.Ultrasonography,either endoscopic or abdominal,is a technique that contributes to a diagnosis;additionally,contrast-enhanced ultrasonography is very helpful in followup appointments.Histopathology establishes a definite diagnosis and stage by evaluating the cell differentiation grade and the cell proliferation index Ki67.The genetic profile can be valuable in diagnosis and gene therapy.Surgical resection with wide lymphadenectomy,whenever possible,and adjuvant chemotherapy constitute the main therapeutic management strategies.Targeted therapy and immunotherapy achieve encouraging results.
文摘BACKGROUND Pancreatic neuroendocrine neoplasms(pNENs)are rare,heterogeneous tumors accounting for 1%-2%of pancreatic tumors,with significant malignant potential.Intraductal papillary mucinous neoplasm of the bile duct(IPMN-B)is a rare precancerous lesion in the bile duct system,with potential for malignancy.The combination of pNENs and IPMN-B is exceptionally rare and often leads to misdiagnosis.This study aims to report a rare case of pNENs combined with IPMN-B treated at Yanbian University Hospital to improve understanding and management of this unusual tumor combination.CASE SUMMARY We retrospectively analyzed a case from Yanbian University Hospital.We re-viewed clinical records,imaging findings,endoscopic retrograde cholangiopan-creatography,surgical exploration,and histopathological examination.The pa-tient was diagnosed with pNENs and IPMN-B.Surgical treatment was performed,with follow-up showing effective management and no significant recurrence.CONCLUSION This case represents the first report of pNENs combined with IPMN-B.It high-lights the need for thorough diagnostic evaluation to prevent misdiagnosis and improve treatment strategies.
文摘BACKGROUND The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection(ESD).There are few studies that analyze the influence of tumor location in the stomach on ESD outcomes.AIM To compare the clinical efficacy and safety of ESD in the proximal vs distal stomach.METHODS A retrospective analysis was conducted on patients admitted in chronological order who received gastric ESD between 2009 and 2024.Patients were stratified into two groups based on tumor location:Group 1 included patients with tumors in the lower third of the stomach,while Group 2 included those with tumors in the middle or upper third.The following parameters were evaluated for each group:procedure duration,curative resection rate,en bloc resection rate,complete resection rate,incidence of complications,and depth of neoplastic invasion.RESULTS The mean procedure time was 97.07 minutes for lesions located in the distal stomach and 129.08 minutes for those in the proximal stomach(P=0.0011).En bloc resection rates for ESD in the distal and proximal stomach were 97.9%and 85.7%,respectively(P=0.0016),while complete resection rates were 93.9%and 73.4%,respectively(P=0.0002).Curative resection was achieved in 90.9%of distal lesions compared to 65.3%of proximal lesions(P=0.0001).Submucosal invasion was identified in 4.0%of distal lesions and 14.2%of proximal lesions(P=0.013).CONCLUSION ESD performed in the proximal stomach requires a longer procedural time compared to ESD in the distal stomach,independent of lesion size and histopathological characteristics.Additionally,proximal gastric ESD is associated with reduced clinical efficacy and increased incidence of submucosal invasion.
文摘BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognostic nomogram for PDGNEN patients.METHODS We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023.Overall survival(OS)differences were assessed with the Log-rank test and Kaplan-Meier survival curves.Cox regression analysis identified independent risk factors for prognosis.Model performance was evaluated using Harrell’s concordance index,receiver operating characteristic analysis,area under the curve,calibration curves,and decision curve analysis(UDC),including the area under the UDC.RESULTS The study included 336 patients(227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma).The average age was 62.7 years.The cohort comprised 80(24.7%)patients in stage I,146(42.9%)in stage II,62(18.1%)in stage III,and 48(14.3%)in stage IV.Significant differences in OS were observed across tumor-node-metastasis stages(P<0.001).Multivariate analysis showed age,Ki-67 index,invasion depth,lymph node metastasis,distant metastasis,and platelet-to-lymphocyte ratio as independent risk factors.We developed a nomogram with a concordance index of 0.779(95%confidence interval:0.743-0.858).Receiver operating characteristic analysis showed area under the curves for 1-year,3-year,and 5-year OS predictions of 0.865,0.850,and 0.890,respectively.The calibration curve demonstrated good agreement with actual outcomes.The area under the UDC for the nomogram vs the 8th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027,0.291 vs 0.179,and 0.376 vs 0.216 for 1-year,3-year,and 5-year OS,respectively.CONCLUSION PDGNENs are predominantly found in older men,often in advanced stages at diagnosis,resulting in poor prognosis.The established nomogram demonstrates strong predictive capability and clinical utility.
基金Supported by the Education and Teaching Reform Project of the First Clinical College of Chongqing Medical University,No.CMER202305Natural Science Foundation of Tibet Autonomous Region,No.XZ2024ZR-ZY100(Z)Program for Youth Innovation in Future Medicine,Chongqing Medical University,No.W0138.
文摘Pancreatic cystic neoplasms(PCNs)represent a spectrum of heterogeneous lesions with diverse biological behaviors and malignant potential.This category encompasses relatively common subtypes,such as intraductal papillary mucinous neoplasms,serous cystic neoplasms,and mucinous cystic neoplasms,alongside relatively rarer entities,including cystic degeneration of solid pancreatic tumors.The widespread use of cross-sectional imaging has led to increased incidental detection of PCNs,subsequently driving a surge in PCN-related medical consultations and interventions;thus,standardized management of PCNs demands heightened attention.Continuous advancements in endoscopic techno-logies,particularly endoscopic ultrasound(EUS)and EUS-guided procedures,now offer diversified diagnostic and therapeutic options,establishing EUS as a pivotal tool for diagnosing,surveillance,and treating PCNs.This review synthesizes current evidence and evolving clinical practices in the endoscopic management of PCNs,emphasizing optimizing preoperative diagnostic accuracy,standardizing endoscopic protocols,implementing subtype-specific risk strati-fication,promoting multidisciplinary team approaches,and addressing challenges in emerging technologies.
文摘BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.
文摘Background:The JAK2^(V617F)mutation plays a crucial part in the pathogenesis of myeloproliferative neoplasms(MPN),which includes polycythemia vera(PV),essential thrombocythemia(ET),and primary myelofibrosis(PMF)leading to aberrant proliferation and survival of hematopoietic cells.Alongside the challenges of drug resistance and side effects,identifying novel compounds that selectively target JAK2^(V617F)could provide more effective and safer therapeutic options for patients with MPNs.Materials and Methods:We employed computational approaches like high-throughput virtual screening,molecular dynamics simulations(MDS),and binding free energy calculations to identify inhibitors targeting wild and mutant JAK2 kinases.JAK2^(V617F)positive HEL,wild type JAK2 positive TF-1,and non-cancerous Vero cells were used for in vitro validations.Results:SBLJ23 emerged as a top candidate inhibitor with specificity for JAK2^(V617F).Protein-ligand interaction studies and MDS revealed stable interactions and binding of SBLJ23 over the simulation period,with Root Mean Square Deviation(RMSD)indicating consistent binding after 1t15ns.SBLJ23 displayed a half maximal inhibitory concentration(IC_(50))value of 522.4 nM against the JAK2 enzyme.The compound exhibited inhibition of cell proliferation in HEL and TF-1 cells,with half maximal cell growth inhibitory concentration(GI 50)values of 2.51 and 15.87μM,respectively.Moreover,SBLJ23 induced G 2/M cell cycle arrest in HEL cells to facilitate apoptosis in these cell lines.The compound significantly reduced the percentage of phospho JAK2 and phospho STAT3 in HEL cells.Conclusion:High binding affinity,stable interaction profile,favorable binding free energy,and in vitro validations claim SBLJ23 as a potential lead compound against JAK2^(V617F)and suggest further development and optimization towards clinical application in managing myeloproliferative neoplasms.
文摘Tumors of the pancreas,the ampulla of Vater,and the extrahepatic and intrahepatic bile ducts have significant histological similarities due to the common embryonic origin of the pancreatobiliary system.This obviates the need for discovery of biomarkers with diagnostic and prognostic value for these tumors.Mucins,especially MUC-1,-2,-4 and-5AC,are important candidates for developing into such reliable biomarkers.Increased expression of MUC1 occurs in pancreatic ductal adenocarcinomas and is associated with increased degrees of dysplasia in pancreatic intraepithelial neoplasia(Pan IN).Positive expression of MUC2 in intraductal papillary mucinus neoplasms(IPMN) of the intestinal type indicates high potential progression to invasive carcinoma with de novo expression of MUC1,while absence of MUC2 expression in IPMNs of gastric type implies low potential to malignant evolution.De novo MUC4 expression correlates to the severity of dysplasia in Pan IN and is associated with a poor prognosis in patients with pancreatic ductal adenocarcinomas.In biliary intraepithelial neoplasia(Bil IN),increased expression of MUC1 is associated with higher degrees of dysplasia.Intrahepatic cholangiocarcinomas(ICC) are characterized by increased expression of all glycoforms of MUC1.Positive MUC2 expression in intraductal papillary neoplasm of the bile ducts(IPNB) of the intestinal type indicates high malignant potential with de novo expression of MUC1 in the invasive element.Absent MUC2 expression in any degree of Bil IN may prove useful in differentiating them from IPNB.De novo expression of MUC4 is associated with poor prognosis in patients with ICC or carcinoma of the extrahepatic bile ducts(EHBDC).High de novo expression of MUC5 AC is found in all degrees of Bil IN and all types of IPNB and ICC.The MUC5 AC is useful in the detection of neoplastic lesions of the bile duct at an early stage.Increased expression of mucin MUC1 in carcinoma of the ampulla of Vater associated with unfavorable behavior of the tumor,such as lymph node metastasis,infiltration of the pancreas and duodenum,advanced TNM classification and worse prognosis.Patients withintra-ampullary papillary-tubular neoplasm(IAPN) of the pancreatobiliary immunophenotype did not show MUC2,while those of the intestinal immunophenotype are MUC2 positive.The expression of MUC4 is associated with poor prognosis in patients with carcinoma of the ampulla of Vater favoring metastasis and making them resistant to apoptosis.Moreover,it appears that MUC4 positivity correlates with recurrence of the tumor.Expression of MUC5 AC is associated with the invasive potential of the tumor.
文摘Objective： To study the characteristics and clinical features of uterine neoplasms developed after radiation therapy for cervical carcinoma. Methods： Clinical data of 47 cases of uterine neoplasms occurred following radiation therapy for cervical carcinoma were retrospectively reviewed. Results： The median age at uterine neoplasms diagnosis was 62 years （range： 38-77 years）, and the median latency period from initial therapy to development of uterine neoplasms was 14 years （range： 5-35 years）. Thirty of 47 cases were endometrial carcinoma, of which 3 were uterine papillary serous carcinoma （UPSC）. Seventeen of 47 patients were uterine sarcoma, all of those were carcinosarcoma. The distribution by stage, grade, and histology of 30 cases of endometrial carcinoma was as follows： stage Ⅰb, 1 case; stage Ⅰc, 2 cases; stage Ⅱ, 6; stage Ⅲa, 4; stage Ⅲb, 2; stage Ⅲc, 11; stage Ⅳ, 4 cases; grade 1, two cases; grade 2, nine; grade 3 （include 3 UPSC patients）, seventeen; unknown grade, two; endometriod, 27; UPSC, 3 cases; 7 of 30 cases of endometrial carcinoma had recurrences （23.3%）, at median time to recurrence was 24 months, and their median survival time was 26 months. The overall 3- and 5-year survival rates were 60% and 38%, respectively. Of the 17 cases of uterine sarcoma, the median survival was 10 months, 6 patients occurred recurrence （35.9%）, at a median time to recurrence was 9 months, and their median survival was 6 months. The overall 3- and 5-year survival rates were 12% and 0, respectively. Conclusion： The main uterine neoplasms development after radiation therapy for cervical carcinoma is endometrial carcinomas, of which there is a preponderance of high-risk histological subtypes and a poor prognosis. Most of the uterine sarcomas occurred following radiation therapy for cervical carcinoma are carcinosarcomas and the prognosis is very poor.
基金supported by grants from Zhejiang Natural Science Foundation (GF21H030024)the General Scientific Re-search Project of Zhejiang Provincial Department of Education (Y202146219)the Postgraduate Education Research Project of Zhejiang University (20220326)。
文摘Background: Biliary mucinous cystic neoplasms(BMCNs) are rare hepatobiliary cystic tumors, which can be divided into noninvasive and invasive types. This study aimed to investigate the diagnosis, treatment, and prognosis of BMCNs in a large single center. Methods: We analyzed 49 patients with BMCNs confirmed by postoperative pathology at the First Afflliated Hospital, Zhejiang University School of Medicine between January 2007 and December 2021. Results: Among the 49 patients, 37 were female(75.5%), and the average age was 57.04 years. Common symptoms included abdominal discomfort, jaundice and fever, while 22 patients(44.9%) had no symptoms. Serum carbohydrate antigen(CA) 19-9 and CA125 concentrations were elevated in 34.8% and 19.6% of patients, respectively. Forty-eight patients had tumors in the intrahepatic bile ducts and only one had a tumor in the extrahepatic bile duct. Forty-eight patients with noninvasive intrahepatic BMCNs were further analyzed in terms of pathological features: 34(70.8%) had low-grade intraepithelial neoplasms(LGINs), and 14(29.2%) had high-grade intraepithelial neoplasms(HGINs). The potential immunohistochemical markers of BMCNs were cytokeratin(CK) 19, CK7, estrogen receptor and progesterone receptor. Follow-up data for 37 patients with intrahepatic BMCNs were obtained. The median overall survival(OS) of BMCNs was not reached. The longest survival time was 137 months.The 5-and 10-year OS rates were 100% and 85.4%, respectively. The 5-and 10-year recurrence-free survival(RFS) rates were 93.9% and 80.2%, respectively. Conclusions: BMCNs are rare cystic neoplasms that commonly occur in middle-aged females. BMCNs can only be diagnosed and classified by postoperative pathology, as there are no specific clinical presentations, serological indicators or imaging modalities for preoperative diagnosis. Complete surgical resection is necessary for BMCNs, and the postoperative prognosis is favorable.
文摘Mucinous cystic neoplasms of the liver(MCN-L)are rare cystic lesions characterized by mucin-producing epithelium and ovarian-like stroma.Although they constitute fewer than 5%of hepatic cystic lesions,MCN-L poses significant diagnostic challenges due to overlapping features with other cystic lesions and their potential for malignant transformation.Early recognition and definitive surgical intervention are therefore critical to ensure optimal patient outcomes.A literature review was conducted to summarize epidemiology,clinical presentation,diagnostic modalities,and management strategies for MCN-L.Additionally,from 2019 to 2025,9 patients with MCN-L were identified at our center.Clinical data and outcomes were retrospectively analyzed.MCN-L predominantly affects middle-aged women and presents as large,multiloculated cystic lesions without biliary communication.The revised 2010 World Health Organization classification emphasizes the presence of ovarian-like stroma for definitive diagnosis.Contrast-enhanced computed tomography or magnetic resonance imaging are often suggestive but not pathognomonic,reinforcing the need for histopathological confirmation.MCN-L remains a diagnostic and therapeutic challenge due to its resemblance to other cystic liver lesions.Complete surgical resection is the treatment of choice to prevent recurrence and malignant transformation,reinforcing the importance of early intervention.Further research is needed to improve diagnostic accuracy and refine management strategies.
文摘Compared with colorectal adenocarcinoma,neuroendocrine neoplasms(NENs),which affect the colon and rectum,are uncommon tumor conditions that have received relatively limited attention in basic research.Furthermore,the scarcity of these NENs has hindered extensive clinical investigations,thereby leading to a dearth of robust evidence for guiding clinical practice and impeding the establishment of standardized approaches for diagnosis and treatment.However,with the increasing awareness of population screening,as well as the increasing popularity of colonoscopy screening programs,the incidence of colorectal NENs has gradually increased.Moreover,some high-grade NENs are highly malignant and invasive,thereby leading to poor treatment outcomes and prognoses.These challenges have elicited increased attention from clinical physicians,thus prompting researchers to explore relevant studies using limited specimens and clinical data.This scenario has resulted in preliminary findings that provide evidence for addressing diagnostic and therapeutic challenges associated with NENs of the colon and rectum.In this article,we review recent literature reports and summarize the advances regarding the diagnosis and treatment of colorectal NENs.
文摘BACKGROUND Gamma-glutamyl transferase(GGT)is a known surrogate marker of hepatic dysfunction and oxidative stress.It has recently been reported to be associated with metabolic diseases,cardiovascular diseases,and malignancies including pancreatic cancer.However,data on its association with pancreatic cystic neo-plasm(PCN),is unknown.AIM To investigate the association of GGT with the incidence of PCN.METHODS In this nationwide retrospective cohort study,participants who received general health checkup by National Health Insurance Service in 2009 were included.Newly diagnosed PCNs from one year after the checkup to 2020 were identified.Participants were divided into quartiles based on GGT levels.Multivariable cox proportional hazard models estimated the risk of PCNs according to GGT quartiles(Q1-Q4).Subgroup analyses by age,sex,and comorbidities,and sensitivity analyses varying lag periods and GGT categorizations were performed.RESULTS There were 28940 cases of PCNs among 2655665 eligible participants.The incidence rate was 1.09 cases per 1000 person-years,with a median follow-up of 10.32(interquartile range:10.09-10.58)years.In multivariate regression analysis,adjusted hazard ratios for GGT quartiles using Q1 group as a reference were:1.04[95%confidence interval(CI):1.005-1.075]for Q2,1.065(95%CI:1.03-1.102)for Q3,and 1.109(95%CI:1.07-1.15)for Q4.Subgroup analysis showed consistent results across age,sex,and comorbidities.In sensitivity analyses,the association remained robust even at 3-year and 5-year lag periods.A clear dose-response relationship was also observed when using GGT deciles(All P for trend<0.001).CONCLUSION Higher GGT level is associated with increased risk of PCNs.Therefore,serum GGT levels might have a role as a biomarker for the development of PCNs.
