AIM: Expression of heat shock proteins (HSPs) is frequently up-regulated in hepatocellular carcinoma (HCC), which evolves from dysplastic nodule (DN) and early HCC to advanced HCC. However, little is known about the d...AIM: Expression of heat shock proteins (HSPs) is frequently up-regulated in hepatocellular carcinoma (HCC), which evolves from dysplastic nodule (DN) and early HCC to advanced HCC. However, little is known about the differential expression of HSPs in multistep hepatocarcinogenesis. It was the purpose of this study to monitor the expression of HSPs in multistep hepatocarcinogenesis and to evaluate their prognostic significance in hepatitis B virus (HBV)related HCC.METHODS: Thirty-eight HCC and 19 DN samples were obtained from 52 hepatitis B surface antigen-positive Korean patients. Immunohistochemical and dot immunoblot analyses of HSP27, HSP60, HSP70, HSP90, glucoseregulated protein (GRP)78, and GRP94 were performed and their expression at different stages of HCC development was statistically analyzed.RESULTS: Expression of HSP27, HSP70, HSP90, GRP78, and GRP94 increased along with the stepwise progression of hepatocarcinogenesis. Strong correlation was found only in GRP78 (Spearman's r= 0.802). There was a positive correlation between the expressions of GRP78, GRP94, HSP90, or HSP70 and prognostic factors of HCC. Specifically, the expression of GRP78, GRP94, or HSP90 was associated significantly with vascular invasion and intrahepatic metastasis.CONCLUSION: The expressions of HSPs are commonly up-regulated in HBV-related HCCs and GRP78 might play an important role in the stepwise progression of HBVrelated hepatocarcinogenesis. GRP78, GRP94, and HSP90 may be important prognostic markers of HBV-related HCC, strongly suggesting vascular invasion and intrahepatic metastasis.展开更多
AIM:To elucidate the variety of ways early-stage hepatocellular carcinoma(HCC)can appear on magnetic resonance(MR)imaging by analyzing T1-weighted,T2-weighted,and gadolinium-enhanced dynamic studies.METHODS:Seventy-th...AIM:To elucidate the variety of ways early-stage hepatocellular carcinoma(HCC)can appear on magnetic resonance(MR)imaging by analyzing T1-weighted,T2-weighted,and gadolinium-enhanced dynamic studies.METHODS:Seventy-three patients with well-differentiated HCC(wHCC)or dysplastic nodules were retrospectively identified from medical records,and new histological sections were prepared and reviewed.The tumor nodules were categorized into three groups:dysplastic nodule(DN),wHCC compatible with Edmondson-Steiner grade I HCC(w1-HCC),and wHCC compatible with Edmondson-Steiner gradeⅡHCC(w2-HCC).The signal intensity on pre-contrast MR imaging and the enhancing pattern for each tumor were recorded and compared between the three tumor groups.RESULTS:Among the 73 patients,14 were diagnosed as having DN,40 were diagnosed as having w1-HCC,and 19 were diagnosed as having w2-HCC.Hyperintensity measurements on T2-weighted axial images(T2WI)were statistically significant between DNs and wHCC(P=0.006)and between DN and w1-HCC(P=0.02).The other imaging features revealed no significant differences between DN and wHCC or between DN and w1-HCC.Hyperintensity on both T1W out-phase imaging(P=0.007)and arterial enhancement on dynamic study(P=0.005)showed statistically significant differences between w1-HCC and w2-HCC.The other imaging features revealed no significant differences between w1-HCC and w2-HCC.CONCLUSION:In the follow-up for a cirrhotic nodule,increased signal intensity on T2WI may be a sign of malignant transformation.Furthermore,a noted loss of hyperintensity on T1WI and the detection of arterial enhancement might indicate further progression of the histological grade.展开更多
We describe a rare case of the transformation of a dysplastic nodule into well-differentiated hepato- cellular carcinoma (HCC) in a 56-year-old man with alcoholrelated liver cirrhosis. Ultrasound (US) disclosed a 10 m...We describe a rare case of the transformation of a dysplastic nodule into well-differentiated hepato- cellular carcinoma (HCC) in a 56-year-old man with alcoholrelated liver cirrhosis. Ultrasound (US) disclosed a 10 mm hypoechoic nodule and contrast enhanced US revealed a hypovascular nodule, both in segment seven. US-guided biopsy revealed a high-grade dysplastic nodule characterized by enhanced cellularity with a high N/C ratio, increased cytoplasmic eosinophilia, and slight cell atypia. One year later, the US pattern of the nodule changed from hypoechoic to hyperechoic without any change in size or hypovascularity. US-guided biopsy revealed well-differentiated HCC of the same features as shown in the first biopsy, but with additional pseudoglandular formation and moderate cell atypia. Moreover, immunohistochemical staining of cyclase- associated protein 2, a new molecular marker of well- differentiated HCC, turned positive. This is the first case of multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated HCC within one year in alcohol-related liver cirrhosis.展开更多
AIM： To design a classification tool for the histological assessment of hepatocellular carcinoma （HCC）, dysplastic nodules （DN）, and macroregenerative nodules （MRN） in cirrhotic liver. METHODS： Two hundred and...AIM： To design a classification tool for the histological assessment of hepatocellular carcinoma （HCC）, dysplastic nodules （DN）, and macroregenerative nodules （MRN） in cirrhotic liver. METHODS： Two hundred and twelve hepatocellular nodules （106 HCC; 74 IRN, 32 DN） were assessed systematically, quantitatively, and semiquantitatively as appropriate for 10 histological features that have been described as helpful in distinguishing small HCC, DN, and MRN in cirrhotic livers. The data were analyzed by multiple correspondence analysis （MCA）. RESULTS： HCA distributed HCC, DN, and HRN as defined by traditional histological evaluation as well as the individual histological variables, in a ＂malignancy scale＂. Based on the MCA data representation, we created a classification tool, which categorizes an individual nodular lesion as MRN, DN, or HCC based on the balance of all histological features （i.e., vascular invasion, capsular invasion, tumor necrosis, tumor heterogeneity, reticulin loss, capillarization of sinusoids, trabecular thickness, nuclear atypia, and mitotic activity）. The classification tool classified most （83%） of a validation set of 47 nodules in the same way as the routine histological assessment. No discrepandes were present for DN and MRN between the routine histological assignment and the dassification tool. Of 25 HCC assigned by routine assessment in the validation set, 8 were assigned to the DN category by the classification tool. CONCLUSION： We have designed a classification tool for the histological assessment of HCC and its putative precursors in cirrhotic liver. Application of this toolsystematically records histological features of diagnostic importance in the evaluation of small HCC.展开更多
Fourty-three cases of globoid dysplasia and signet ring cell carcinoma were stained by mucin and CEA (ABC method). It was found that there were three kinds of mucins (neutral, sialo and sulphomucin in both globoid dys...Fourty-three cases of globoid dysplasia and signet ring cell carcinoma were stained by mucin and CEA (ABC method). It was found that there were three kinds of mucins (neutral, sialo and sulphomucin in both globoid dysplastic cells and signet ring cells. The percentages of the three kinds of mucins seen in the two kinds of cells were not much different. It was indicated that the altered mucins in the gastric epithelial cells must be a sign of dedifferentiation of the cells and the results of malfunction. The globoid dysplasia type I mainly contained neutral mucin, whereas type II, the acid mucin was predominant, especially the sulphomucin. The CEA positive reaction became stronger as the atypia being remarkable, and the characteristics of distribution of CEA positive particles were similar in the two kinds of cells namely, randomly or disorderly in the cells. Based on the analysis of the results, a conclusion can be made that the variety of mucins in globoid dysplastic cells can be used as a reference point in classification and is not much significant in grading, but the amount of CEA positive matter can be a reference point in grading. The globoid dysplasia is such a lesion with special features in morphology and function manifested in the process of de-differentiation towards signet ring cell carcinoma following the successive action of carcinogens upon the cells of gastric epithelium.展开更多
<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Objective:</strong> To describe the histological and immunohistochemical findings observed when ...<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Objective:</strong> To describe the histological and immunohistochemical findings observed when studying a dysplastic cerebellar gangliocytoma observed in a 33-year-old man with a history of Thyroid Cancer. <strong>Material and Methods:</strong> Radiological images (MRI) and histological and immunohistochemical preparations obtained from the cerebellar tissue were received in our laboratory. <strong>Results:</strong> A neoplasm constituted by aberrant-looking mature neurons was observed that showed negativity for the immunohistochemical markers of the PTEN protein, expression of the activity of the PTEN gene. <strong>Conclusions:</strong> Verify the diagnosis of a rare entity, clearly related in scientific publications with Cowden’s Syndrome.</span> </div>展开更多
Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the cerebellum is a rare benign lesion of uncertain pathogenesis characterized by overgrowth of cerebellar ganglion cells which replace granular cells and ...Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the cerebellum is a rare benign lesion of uncertain pathogenesis characterized by overgrowth of cerebellar ganglion cells which replace granular cells and Purkinje cells;this results in gross thickening of the cerebellar folia. It is revealed by symptoms of raised intracranial pressure, cerebellar impairment and obstructive hydrocephalus. We reported the case of a 41-year-old male who presented with symptoms of acute raised intracranial pressure. Brain computed tomography (CT) scan revealed hydrocephalus due to compression of the 4th ventricle by a large non-enhancing left cerebellar mass. Magnetic resonance imaging (MRI) showed a space-occupying lesion within the left cerebellar hemisphere with unusual striation. Radical surgery was retained though the margins with normal cerebellar tissue were not distinct. Clinical complications after gross total or partial removal of Lhermitte-Duclos lesions have been rarely reported in the literature;herein we stress the importance of extreme caution in removing these lesions in cerebellar areas that have no distinct margins between the lesion and normal tissue.展开更多
To introduce the osteotomy of acetabular medial wall as a technique to facilitate anatomical implantation and secure fit of acetabular cups for dysplastic hips.Methods Eighteen hip replacements were performed with use...To introduce the osteotomy of acetabular medial wall as a technique to facilitate anatomical implantation and secure fit of acetabular cups for dysplastic hips.Methods Eighteen hip replacements were performed with use of an osteotomy of acetabular medial wall to stabilize the cups in 17 dysplastic patients.The patients were aged from 35～70 years,with an average of 51.4 year.Among all the dysplastic hips,4 were of type Ⅰ,7 of type Ⅱ,4 of type Ⅲ,and 3 of type Ⅳ according to the Crowe criteria.A Ranawat triangle was drawn on the X-ray film,and a supposed optimal rotating center was located.Both of the horizontal and vertical distances between femoral head and supposed rotating center was decreased significantly after operation.Results With medial wall osteotomy,all the acetabular components were placed in the true acetabulum.The diameters of the implanted cups were 44～56 mm with an average of 50.78 mm.Medial bony wall was preserved with an average thickness of 9.5 mm.The horizontal distance was 21.09 mm(12～40 mm) preoperatively and 3.73 mm(-3～10.1 mm)postoperatively,there was statistical difference (t=7.95,P<0.01);whereas the vertical distance was 15.39 mm(5～32 mm)preoperatively and 4.98 mm(-18～26.3 mm)postoperatively,there was also statistical difference (t=3.42,P<0.01).13 acetabular cups were implanted with the medial aspect of their dome beyond the Kohler line.In the cases followed-up more than 3 months,the osteomized site all achieved bony union.Conclusion The medial wall osteotomy technique is a predictable,reproducible procedure for optimal rotating center reconstruction and it may obtain fixation of an uncemented hemispheric acetabular component in a dysplastic hip.11 refs,3 figs.展开更多
BACKGROUND Metachronous multiple esophageal squamous cell carcinomas(ESCCs)may occur in some patients after endoscopic resection.Multiple dysplastic lesions in the esophagus increase risk of multiple squamous cell car...BACKGROUND Metachronous multiple esophageal squamous cell carcinomas(ESCCs)may occur in some patients after endoscopic resection.Multiple dysplastic lesions in the esophagus increase risk of multiple squamous cell carcinomas(SCCs).Endoscopic imaging technology such as narrow band imaging(NBI),can detect early SCC.Lugol chromoendoscopy is also the conventional standard technique for detecting superficial ESCC.However,little is known about the interval from the first SCC to the metachronous SCC.Effective methods to prevent multiple metachronous SCCs are needed in survivors of esophageal SCC.CASE SUMMARY A 56-year-old man showed a slightly elevated reddish area in the middle thoracic esophagus at 30 cm from the incisors on gastroscopy for routine examination.Esophageal mucosa lesion was about 2.5 cm.NBI and magnifying gastroscopy confirmed intra-epithelial papillary loop type B-1 according to the Japan Esophageal Society Classification.Lugol chromoendoscopy was used to evaluate the dysplastic squamous epithelium in the esophagus.Biopsy pathology revealed severe dysplastic squamous epithelium.Computed tomography showed no lymph node metastasis.His complete blood test and tumor markers were within reference values.He had no history of alcohol consumption and smoking.Mucosal lesion was dissected by endoscopic submucosal dissection(ESD).Postoperative pathological results showed moderately differentiated squamous carcinoma.No cancer thrombus was seen in the vasculature,and the surrounding cut edge was not involved.The patient underwent radiotherapy within 2 months after ESD.The multiple Lugol-voiding lesions disappeared,and enhanced chest computed tomography revealed no lymph node metastasis.CONCLUSION This is the first case of multiple dysplastic lesions of esophagus cured by radiotherapy.Radiotherapy after minimally invasive endoscopic treatment might be a safe and effective optional therapeutic strategy to prevent metachronous multiple esophageal SCCs.展开更多
Dear Editor,Myelodysplastic syndromes(MDSs)are a group of clonal myeloid stem cell disorders characterized by varying degrees of cytopenias,cytogenetic and molecular genetic abnormalities,and a predisposition to acute...Dear Editor,Myelodysplastic syndromes(MDSs)are a group of clonal myeloid stem cell disorders characterized by varying degrees of cytopenias,cytogenetic and molecular genetic abnormalities,and a predisposition to acute myeloid leukemia(AML).The treatments for MDS mainly consist of cytoreductive treatment,such as traditional AML-like chemotherapy,hypomethylating agents(HMAs),allogeneic hematopoietic stem cell transplantation(alio-HSCT)and immunoregulation according to risk stratification.展开更多
Objective To detect the expression level of growth differentiation factor 11(GDF11)in patients with myelodysplastic syndrome(MDS),and to evaluate the relationship between GDF11 level and erythropoiesis functions.Metho...Objective To detect the expression level of growth differentiation factor 11(GDF11)in patients with myelodysplastic syndrome(MDS),and to evaluate the relationship between GDF11 level and erythropoiesis functions.Methods A total of 44 MDS patients(18 low-risk group patients and 26 high-risk group patients)in the Department of Hematology in Tianjin Medical展开更多
假性Kaposi肉瘤(Pseudo-Kaposi’s Sarcoma以下简称PKS)是1974年Earhari等命名的,具有与Kaposi肉瘤相似皮损的动静脉瘘的一种疾病。本病在60～70年代的皮肤科文献上曾应用过多种病名,如皮肤及其下组织的先天性发育不良性血管病(Congenit...假性Kaposi肉瘤(Pseudo-Kaposi’s Sarcoma以下简称PKS)是1974年Earhari等命名的,具有与Kaposi肉瘤相似皮损的动静脉瘘的一种疾病。本病在60～70年代的皮肤科文献上曾应用过多种病名,如皮肤及其下组织的先天性发育不良性血管病(Congenital dysplastic angiopathy of the skin and underlying tissue);足部肢端血管性皮炎(Acroangiodermatitis of the foot);展开更多
Contrast-enhanced ultrasound(CEUS)using microbubble contrast agents are useful for the diagnosis of the nodules in liver cirrhosis.CEUS can be used as a problem-solving method for indeterminate nodules on computed tom...Contrast-enhanced ultrasound(CEUS)using microbubble contrast agents are useful for the diagnosis of the nodules in liver cirrhosis.CEUS can be used as a problem-solving method for indeterminate nodules on computed tomography(CT)or magnetic resonance imaging(MRI)or as an initial diagnostic test for small newly detected liver nodules.CEUS has unique advantages over CT and MRI including no renal excretion of contrast,real-time imaging capability,and purely intravascular contrast.Hepatocellular carcinoma(HCC)is characterized by arterial-phase hypervascularity and later washout(negative enhancement).Benign nodules such as regenerative nodules or dysplastic nodules are usually isoechoic or slightly hypoechoic in the arterial phase and isoechoic in the late phase.However,there are occasional HCC lesions with atypical enhancement including hypovascular HCC and hypervascular HCC without washout.Cholangiocarcinomas are infrequently detected during HCC surveillance and mostly show rimlike or diffuse hypervascularity followed by rapid washout.Hemangiomas are often found at HCC surveillance and are easily diagnosed by CEUS.CEUS can be effectively used in the diagnostic work-up of small nodules detected at HCC surveillance.CEUS is also useful to differentiate malignant and benign venous thrombosis and to guide and monitor the local ablation therapy for HCC.展开更多
Hepatocarcinogenesis in human chronic liver diseases is a multi-step process in which hepatic precancerous lesions progress into early hepatocellular carcinoma(HCC) and progressed HCC, and the close surveillance and t...Hepatocarcinogenesis in human chronic liver diseases is a multi-step process in which hepatic precancerous lesions progress into early hepatocellular carcinoma(HCC) and progressed HCC, and the close surveillance and treatment of these lesions will help improve the survival rates of patients with HCC. The rapid development and extensive application of imaging technology have facilitated the discovery of nodular lesions of ambiguous significance, such as dysplastic nodules. Further investigations showed that these nodules may be hepatic precancerous lesions, and they often appear in patients with liver cirrhosis. Although the morphology of these nodules is not sufficient to support a diagnosis of malignant tumor, these nodules are closely correlated with the occurrence of HCC, as indicated by long-term follow-up studies. In recent years, the rapid development and wide application of pathology, molecular genetics and imaging technology have elucidated the characteristics of precancerous lesions. Based on our extensive review of the relevant literature, this article focuses on evidence indicating that high-grade dysplastic nodules are more likely to transform into HCC than low-grade dysplastic nodules based on clinical, pathological, molecular genetic and radiological assessments. In addition, evidence supporting the precancerous nature of large cell change in hepatitis B virus-related HCC is discussed.展开更多
Congenital abnormalities of the kidney and urinary tract(CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis(bilateral). Many of them are detected ...Congenital abnormalities of the kidney and urinary tract(CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis(bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number(agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography(US) is typically the first imaging performed as it is easily available, noninvasive and radiation free used both antenatally and postnatally. Computed tomography(CT) and magnetic resonance imaging(MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management.展开更多
Noninvasive imaging has become the standard for hepatocellular carcinoma(HCC) diagnosis in cirrhotic livers. In this review paper, we go over the basics of MR imaging in cirrhotic livers and describe the imaging appea...Noninvasive imaging has become the standard for hepatocellular carcinoma(HCC) diagnosis in cirrhotic livers. In this review paper, we go over the basics of MR imaging in cirrhotic livers and describe the imaging appearance of a spectrum of hepatic nodules marking the progression from regenerative nodules to low- and high-grade dysplastic nodules, and ultimately to HCCs. We detail and illustrate the typical imaging appearancesof different types of HCC including focal, multifocal, massive, diffuse/infiltrative, and intra-hepatic metastases; with emphasis on the diagnostic value of MR in imaging these lesions. We also shed some light on liver imaging reporting and data system, and the role of different magnetic resonance imaging(MRI) contrast agents and future MRI techniques including the use of advanced MR pulse sequences and utilization of hepatocyte-specific MRI contrast agents, and how they might contribute to improving the diagnostic performance of MRI in early stage HCC diagnosis.展开更多
BACKGROUND Patients with atypical mole syndrome(AMS)have a 3-to 20-fold higher risk of developing malignant melanoma(MM)than individuals without.The most modifiable risk factor for developing MM is the ongoing ultravi...BACKGROUND Patients with atypical mole syndrome(AMS)have a 3-to 20-fold higher risk of developing malignant melanoma(MM)than individuals without.The most modifiable risk factor for developing MM is the ongoing ultraviolet exposure.AIM To assess awareness,knowledge,and attitudes towards sun protection among patients with MM and AMS.METHODS From January 2020 till December 2021,a written survey was administered to patients with MM and AMS and a control group who attended a specialist mole clinic at the Dermatology Department of the University Hospital of Heraklion in Heraklion,Crete,Greece.Demographic data and photoprotective practices,knowledge,and perceived barriers were collected.Relevant statistical analyses were performed using SPSS IBM 25.RESULTS In total,121 subjects consented and participated in the survey.Their mean age was 43.92±12.55 years.There were 66(54.4%)females and 55(45.4%)males.Forty-seven(38.8%)patients had AMS,26(21.5%)had a past medical history of MM,and 48(39.7%)attended the clinic for a full skin checkup for their naevi without having AMS or MM.Although 104(86%)participants reported using sunscreen with the majority of them(59/121=48.8%)wearing sunscreen with a sun protection factor of>50,only 22(18.2%)patients did so every day and only 20(16.5%)all year round.Approximately 74.4%of patients recalled having received advice on how to protect their skin from sunlight,and 73%were interested in receiving education about sun protection.The most mentioned barriers in photoprotection were concerns over adequate vitamin D and lack of time.CONCLUSION Despite mentioning having received adequate education in photoprotection,adherence to photoprotection practices is suboptimal in patients with MM and AMS.展开更多
With the increasing use of ultrasonography,congenital anomalies are often picked in utero.Antenatally detected hydronephrosis is amongst the most commonly detected abnormality.The management of this condition has rais...With the increasing use of ultrasonography,congenital anomalies are often picked in utero.Antenatally detected hydronephrosis is amongst the most commonly detected abnormality.The management of this condition has raised considerable debate amongst clinicians dealing with it.This article is written with an idea to provide comprehensive information regarding the postnatal management of antenatally detected hydronephrosis.A detailed review of the current literature on this topic is provided.Also,guidelines have been given to facilitate the management of this condition.展开更多
基金Supported by the fund from the Korea Science and Engineering Foundation (Grant No. R01-2001-00098). Seung Oe Lim was supported by BK21 Research Fellowship from the Ministry of Education and Human Resources Development
文摘AIM: Expression of heat shock proteins (HSPs) is frequently up-regulated in hepatocellular carcinoma (HCC), which evolves from dysplastic nodule (DN) and early HCC to advanced HCC. However, little is known about the differential expression of HSPs in multistep hepatocarcinogenesis. It was the purpose of this study to monitor the expression of HSPs in multistep hepatocarcinogenesis and to evaluate their prognostic significance in hepatitis B virus (HBV)related HCC.METHODS: Thirty-eight HCC and 19 DN samples were obtained from 52 hepatitis B surface antigen-positive Korean patients. Immunohistochemical and dot immunoblot analyses of HSP27, HSP60, HSP70, HSP90, glucoseregulated protein (GRP)78, and GRP94 were performed and their expression at different stages of HCC development was statistically analyzed.RESULTS: Expression of HSP27, HSP70, HSP90, GRP78, and GRP94 increased along with the stepwise progression of hepatocarcinogenesis. Strong correlation was found only in GRP78 (Spearman's r= 0.802). There was a positive correlation between the expressions of GRP78, GRP94, HSP90, or HSP70 and prognostic factors of HCC. Specifically, the expression of GRP78, GRP94, or HSP90 was associated significantly with vascular invasion and intrahepatic metastasis.CONCLUSION: The expressions of HSPs are commonly up-regulated in HBV-related HCCs and GRP78 might play an important role in the stepwise progression of HBVrelated hepatocarcinogenesis. GRP78, GRP94, and HSP90 may be important prognostic markers of HBV-related HCC, strongly suggesting vascular invasion and intrahepatic metastasis.
文摘AIM:To elucidate the variety of ways early-stage hepatocellular carcinoma(HCC)can appear on magnetic resonance(MR)imaging by analyzing T1-weighted,T2-weighted,and gadolinium-enhanced dynamic studies.METHODS:Seventy-three patients with well-differentiated HCC(wHCC)or dysplastic nodules were retrospectively identified from medical records,and new histological sections were prepared and reviewed.The tumor nodules were categorized into three groups:dysplastic nodule(DN),wHCC compatible with Edmondson-Steiner grade I HCC(w1-HCC),and wHCC compatible with Edmondson-Steiner gradeⅡHCC(w2-HCC).The signal intensity on pre-contrast MR imaging and the enhancing pattern for each tumor were recorded and compared between the three tumor groups.RESULTS:Among the 73 patients,14 were diagnosed as having DN,40 were diagnosed as having w1-HCC,and 19 were diagnosed as having w2-HCC.Hyperintensity measurements on T2-weighted axial images(T2WI)were statistically significant between DNs and wHCC(P=0.006)and between DN and w1-HCC(P=0.02).The other imaging features revealed no significant differences between DN and wHCC or between DN and w1-HCC.Hyperintensity on both T1W out-phase imaging(P=0.007)and arterial enhancement on dynamic study(P=0.005)showed statistically significant differences between w1-HCC and w2-HCC.The other imaging features revealed no significant differences between w1-HCC and w2-HCC.CONCLUSION:In the follow-up for a cirrhotic nodule,increased signal intensity on T2WI may be a sign of malignant transformation.Furthermore,a noted loss of hyperintensity on T1WI and the detection of arterial enhancement might indicate further progression of the histological grade.
文摘We describe a rare case of the transformation of a dysplastic nodule into well-differentiated hepato- cellular carcinoma (HCC) in a 56-year-old man with alcoholrelated liver cirrhosis. Ultrasound (US) disclosed a 10 mm hypoechoic nodule and contrast enhanced US revealed a hypovascular nodule, both in segment seven. US-guided biopsy revealed a high-grade dysplastic nodule characterized by enhanced cellularity with a high N/C ratio, increased cytoplasmic eosinophilia, and slight cell atypia. One year later, the US pattern of the nodule changed from hypoechoic to hyperechoic without any change in size or hypovascularity. US-guided biopsy revealed well-differentiated HCC of the same features as shown in the first biopsy, but with additional pseudoglandular formation and moderate cell atypia. Moreover, immunohistochemical staining of cyclase- associated protein 2, a new molecular marker of well- differentiated HCC, turned positive. This is the first case of multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated HCC within one year in alcohol-related liver cirrhosis.
文摘AIM： To design a classification tool for the histological assessment of hepatocellular carcinoma （HCC）, dysplastic nodules （DN）, and macroregenerative nodules （MRN） in cirrhotic liver. METHODS： Two hundred and twelve hepatocellular nodules （106 HCC; 74 IRN, 32 DN） were assessed systematically, quantitatively, and semiquantitatively as appropriate for 10 histological features that have been described as helpful in distinguishing small HCC, DN, and MRN in cirrhotic livers. The data were analyzed by multiple correspondence analysis （MCA）. RESULTS： HCA distributed HCC, DN, and HRN as defined by traditional histological evaluation as well as the individual histological variables, in a ＂malignancy scale＂. Based on the MCA data representation, we created a classification tool, which categorizes an individual nodular lesion as MRN, DN, or HCC based on the balance of all histological features （i.e., vascular invasion, capsular invasion, tumor necrosis, tumor heterogeneity, reticulin loss, capillarization of sinusoids, trabecular thickness, nuclear atypia, and mitotic activity）. The classification tool classified most （83%） of a validation set of 47 nodules in the same way as the routine histological assessment. No discrepandes were present for DN and MRN between the routine histological assignment and the dassification tool. Of 25 HCC assigned by routine assessment in the validation set, 8 were assigned to the DN category by the classification tool. CONCLUSION： We have designed a classification tool for the histological assessment of HCC and its putative precursors in cirrhotic liver. Application of this toolsystematically records histological features of diagnostic importance in the evaluation of small HCC.
文摘Fourty-three cases of globoid dysplasia and signet ring cell carcinoma were stained by mucin and CEA (ABC method). It was found that there were three kinds of mucins (neutral, sialo and sulphomucin in both globoid dysplastic cells and signet ring cells. The percentages of the three kinds of mucins seen in the two kinds of cells were not much different. It was indicated that the altered mucins in the gastric epithelial cells must be a sign of dedifferentiation of the cells and the results of malfunction. The globoid dysplasia type I mainly contained neutral mucin, whereas type II, the acid mucin was predominant, especially the sulphomucin. The CEA positive reaction became stronger as the atypia being remarkable, and the characteristics of distribution of CEA positive particles were similar in the two kinds of cells namely, randomly or disorderly in the cells. Based on the analysis of the results, a conclusion can be made that the variety of mucins in globoid dysplastic cells can be used as a reference point in classification and is not much significant in grading, but the amount of CEA positive matter can be a reference point in grading. The globoid dysplasia is such a lesion with special features in morphology and function manifested in the process of de-differentiation towards signet ring cell carcinoma following the successive action of carcinogens upon the cells of gastric epithelium.
文摘<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Objective:</strong> To describe the histological and immunohistochemical findings observed when studying a dysplastic cerebellar gangliocytoma observed in a 33-year-old man with a history of Thyroid Cancer. <strong>Material and Methods:</strong> Radiological images (MRI) and histological and immunohistochemical preparations obtained from the cerebellar tissue were received in our laboratory. <strong>Results:</strong> A neoplasm constituted by aberrant-looking mature neurons was observed that showed negativity for the immunohistochemical markers of the PTEN protein, expression of the activity of the PTEN gene. <strong>Conclusions:</strong> Verify the diagnosis of a rare entity, clearly related in scientific publications with Cowden’s Syndrome.</span> </div>
文摘Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the cerebellum is a rare benign lesion of uncertain pathogenesis characterized by overgrowth of cerebellar ganglion cells which replace granular cells and Purkinje cells;this results in gross thickening of the cerebellar folia. It is revealed by symptoms of raised intracranial pressure, cerebellar impairment and obstructive hydrocephalus. We reported the case of a 41-year-old male who presented with symptoms of acute raised intracranial pressure. Brain computed tomography (CT) scan revealed hydrocephalus due to compression of the 4th ventricle by a large non-enhancing left cerebellar mass. Magnetic resonance imaging (MRI) showed a space-occupying lesion within the left cerebellar hemisphere with unusual striation. Radical surgery was retained though the margins with normal cerebellar tissue were not distinct. Clinical complications after gross total or partial removal of Lhermitte-Duclos lesions have been rarely reported in the literature;herein we stress the importance of extreme caution in removing these lesions in cerebellar areas that have no distinct margins between the lesion and normal tissue.
文摘To introduce the osteotomy of acetabular medial wall as a technique to facilitate anatomical implantation and secure fit of acetabular cups for dysplastic hips.Methods Eighteen hip replacements were performed with use of an osteotomy of acetabular medial wall to stabilize the cups in 17 dysplastic patients.The patients were aged from 35～70 years,with an average of 51.4 year.Among all the dysplastic hips,4 were of type Ⅰ,7 of type Ⅱ,4 of type Ⅲ,and 3 of type Ⅳ according to the Crowe criteria.A Ranawat triangle was drawn on the X-ray film,and a supposed optimal rotating center was located.Both of the horizontal and vertical distances between femoral head and supposed rotating center was decreased significantly after operation.Results With medial wall osteotomy,all the acetabular components were placed in the true acetabulum.The diameters of the implanted cups were 44～56 mm with an average of 50.78 mm.Medial bony wall was preserved with an average thickness of 9.5 mm.The horizontal distance was 21.09 mm(12～40 mm) preoperatively and 3.73 mm(-3～10.1 mm)postoperatively,there was statistical difference (t=7.95,P<0.01);whereas the vertical distance was 15.39 mm(5～32 mm)preoperatively and 4.98 mm(-18～26.3 mm)postoperatively,there was also statistical difference (t=3.42,P<0.01).13 acetabular cups were implanted with the medial aspect of their dome beyond the Kohler line.In the cases followed-up more than 3 months,the osteomized site all achieved bony union.Conclusion The medial wall osteotomy technique is a predictable,reproducible procedure for optimal rotating center reconstruction and it may obtain fixation of an uncemented hemispheric acetabular component in a dysplastic hip.11 refs,3 figs.
基金Supported by Jinhua City Science and Technology Plan Projects,No.2022-4-145.
文摘BACKGROUND Metachronous multiple esophageal squamous cell carcinomas(ESCCs)may occur in some patients after endoscopic resection.Multiple dysplastic lesions in the esophagus increase risk of multiple squamous cell carcinomas(SCCs).Endoscopic imaging technology such as narrow band imaging(NBI),can detect early SCC.Lugol chromoendoscopy is also the conventional standard technique for detecting superficial ESCC.However,little is known about the interval from the first SCC to the metachronous SCC.Effective methods to prevent multiple metachronous SCCs are needed in survivors of esophageal SCC.CASE SUMMARY A 56-year-old man showed a slightly elevated reddish area in the middle thoracic esophagus at 30 cm from the incisors on gastroscopy for routine examination.Esophageal mucosa lesion was about 2.5 cm.NBI and magnifying gastroscopy confirmed intra-epithelial papillary loop type B-1 according to the Japan Esophageal Society Classification.Lugol chromoendoscopy was used to evaluate the dysplastic squamous epithelium in the esophagus.Biopsy pathology revealed severe dysplastic squamous epithelium.Computed tomography showed no lymph node metastasis.His complete blood test and tumor markers were within reference values.He had no history of alcohol consumption and smoking.Mucosal lesion was dissected by endoscopic submucosal dissection(ESD).Postoperative pathological results showed moderately differentiated squamous carcinoma.No cancer thrombus was seen in the vasculature,and the surrounding cut edge was not involved.The patient underwent radiotherapy within 2 months after ESD.The multiple Lugol-voiding lesions disappeared,and enhanced chest computed tomography revealed no lymph node metastasis.CONCLUSION This is the first case of multiple dysplastic lesions of esophagus cured by radiotherapy.Radiotherapy after minimally invasive endoscopic treatment might be a safe and effective optional therapeutic strategy to prevent metachronous multiple esophageal SCCs.
基金This work was supported by the National Key Research and Development Projects(Grant Nos.2017YFA0105500,2017YFA105504)the National Natural Science Foundation of China(Grant Nos.81770190,81970161,81500149)R&D projects in key areas of Guangdong Province(Grant No.2019B020236004).
文摘Dear Editor,Myelodysplastic syndromes(MDSs)are a group of clonal myeloid stem cell disorders characterized by varying degrees of cytopenias,cytogenetic and molecular genetic abnormalities,and a predisposition to acute myeloid leukemia(AML).The treatments for MDS mainly consist of cytoreductive treatment,such as traditional AML-like chemotherapy,hypomethylating agents(HMAs),allogeneic hematopoietic stem cell transplantation(alio-HSCT)and immunoregulation according to risk stratification.
文摘Objective To detect the expression level of growth differentiation factor 11(GDF11)in patients with myelodysplastic syndrome(MDS),and to evaluate the relationship between GDF11 level and erythropoiesis functions.Methods A total of 44 MDS patients(18 low-risk group patients and 26 high-risk group patients)in the Department of Hematology in Tianjin Medical
文摘假性Kaposi肉瘤(Pseudo-Kaposi’s Sarcoma以下简称PKS)是1974年Earhari等命名的,具有与Kaposi肉瘤相似皮损的动静脉瘘的一种疾病。本病在60～70年代的皮肤科文献上曾应用过多种病名,如皮肤及其下组织的先天性发育不良性血管病(Congenital dysplastic angiopathy of the skin and underlying tissue);足部肢端血管性皮炎(Acroangiodermatitis of the foot);
文摘Contrast-enhanced ultrasound(CEUS)using microbubble contrast agents are useful for the diagnosis of the nodules in liver cirrhosis.CEUS can be used as a problem-solving method for indeterminate nodules on computed tomography(CT)or magnetic resonance imaging(MRI)or as an initial diagnostic test for small newly detected liver nodules.CEUS has unique advantages over CT and MRI including no renal excretion of contrast,real-time imaging capability,and purely intravascular contrast.Hepatocellular carcinoma(HCC)is characterized by arterial-phase hypervascularity and later washout(negative enhancement).Benign nodules such as regenerative nodules or dysplastic nodules are usually isoechoic or slightly hypoechoic in the arterial phase and isoechoic in the late phase.However,there are occasional HCC lesions with atypical enhancement including hypovascular HCC and hypervascular HCC without washout.Cholangiocarcinomas are infrequently detected during HCC surveillance and mostly show rimlike or diffuse hypervascularity followed by rapid washout.Hemangiomas are often found at HCC surveillance and are easily diagnosed by CEUS.CEUS can be effectively used in the diagnostic work-up of small nodules detected at HCC surveillance.CEUS is also useful to differentiate malignant and benign venous thrombosis and to guide and monitor the local ablation therapy for HCC.
文摘Hepatocarcinogenesis in human chronic liver diseases is a multi-step process in which hepatic precancerous lesions progress into early hepatocellular carcinoma(HCC) and progressed HCC, and the close surveillance and treatment of these lesions will help improve the survival rates of patients with HCC. The rapid development and extensive application of imaging technology have facilitated the discovery of nodular lesions of ambiguous significance, such as dysplastic nodules. Further investigations showed that these nodules may be hepatic precancerous lesions, and they often appear in patients with liver cirrhosis. Although the morphology of these nodules is not sufficient to support a diagnosis of malignant tumor, these nodules are closely correlated with the occurrence of HCC, as indicated by long-term follow-up studies. In recent years, the rapid development and wide application of pathology, molecular genetics and imaging technology have elucidated the characteristics of precancerous lesions. Based on our extensive review of the relevant literature, this article focuses on evidence indicating that high-grade dysplastic nodules are more likely to transform into HCC than low-grade dysplastic nodules based on clinical, pathological, molecular genetic and radiological assessments. In addition, evidence supporting the precancerous nature of large cell change in hepatitis B virus-related HCC is discussed.
文摘Congenital abnormalities of the kidney and urinary tract(CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis(bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number(agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography(US) is typically the first imaging performed as it is easily available, noninvasive and radiation free used both antenatally and postnatally. Computed tomography(CT) and magnetic resonance imaging(MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management.
文摘Noninvasive imaging has become the standard for hepatocellular carcinoma(HCC) diagnosis in cirrhotic livers. In this review paper, we go over the basics of MR imaging in cirrhotic livers and describe the imaging appearance of a spectrum of hepatic nodules marking the progression from regenerative nodules to low- and high-grade dysplastic nodules, and ultimately to HCCs. We detail and illustrate the typical imaging appearancesof different types of HCC including focal, multifocal, massive, diffuse/infiltrative, and intra-hepatic metastases; with emphasis on the diagnostic value of MR in imaging these lesions. We also shed some light on liver imaging reporting and data system, and the role of different magnetic resonance imaging(MRI) contrast agents and future MRI techniques including the use of advanced MR pulse sequences and utilization of hepatocyte-specific MRI contrast agents, and how they might contribute to improving the diagnostic performance of MRI in early stage HCC diagnosis.
文摘BACKGROUND Patients with atypical mole syndrome(AMS)have a 3-to 20-fold higher risk of developing malignant melanoma(MM)than individuals without.The most modifiable risk factor for developing MM is the ongoing ultraviolet exposure.AIM To assess awareness,knowledge,and attitudes towards sun protection among patients with MM and AMS.METHODS From January 2020 till December 2021,a written survey was administered to patients with MM and AMS and a control group who attended a specialist mole clinic at the Dermatology Department of the University Hospital of Heraklion in Heraklion,Crete,Greece.Demographic data and photoprotective practices,knowledge,and perceived barriers were collected.Relevant statistical analyses were performed using SPSS IBM 25.RESULTS In total,121 subjects consented and participated in the survey.Their mean age was 43.92±12.55 years.There were 66(54.4%)females and 55(45.4%)males.Forty-seven(38.8%)patients had AMS,26(21.5%)had a past medical history of MM,and 48(39.7%)attended the clinic for a full skin checkup for their naevi without having AMS or MM.Although 104(86%)participants reported using sunscreen with the majority of them(59/121=48.8%)wearing sunscreen with a sun protection factor of>50,only 22(18.2%)patients did so every day and only 20(16.5%)all year round.Approximately 74.4%of patients recalled having received advice on how to protect their skin from sunlight,and 73%were interested in receiving education about sun protection.The most mentioned barriers in photoprotection were concerns over adequate vitamin D and lack of time.CONCLUSION Despite mentioning having received adequate education in photoprotection,adherence to photoprotection practices is suboptimal in patients with MM and AMS.
文摘With the increasing use of ultrasonography,congenital anomalies are often picked in utero.Antenatally detected hydronephrosis is amongst the most commonly detected abnormality.The management of this condition has raised considerable debate amongst clinicians dealing with it.This article is written with an idea to provide comprehensive information regarding the postnatal management of antenatally detected hydronephrosis.A detailed review of the current literature on this topic is provided.Also,guidelines have been given to facilitate the management of this condition.
