Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was co...Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.展开更多
Small intestinal villi are essential for nutrient absorption,and their impairment can lead to malabsorption.Small intestinal villous atrophy(VA)encompasses a heterogeneous group of disorders,including immune-mediated ...Small intestinal villi are essential for nutrient absorption,and their impairment can lead to malabsorption.Small intestinal villous atrophy(VA)encompasses a heterogeneous group of disorders,including immune-mediated conditions(e.g.,celiac disease,autoimmune enteropathy,inborn errors of immunity),lymphoproliferative disorders(e.g.,enteropathy-associated T-cell lymphoma),infectious causes(e.g.,tropical sprue,Whipple’s disease),iatrogenic factors(e.g.,Olmesartanassociated enteropathy,graft-vs-host disease),as well as inflammatory and idiopathic types.These disorders are often rare and challenging to distinguish due to overlapping clinical,serological,endoscopic,and histopathological features.Through a systematic literature search using keywords such as small intestinal VA,malabsorption,and specific enteropathies,this review provides a comprehensive overview of diagnostic clues for VA and malabsorption.We systematically summarize the pathological characteristics of each condition to assist pathologists and clinicians in accurately identifying the underlying etiologies.Current studies still have many limitations and lack broader and deeper investigations into these diseases.Therefore,future research should focus on the development of novel diagnostic tools,predictive models,therapeutic targets,and mechanistic molecular studies to refine both diagnosis and management strategies.展开更多
Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pat...Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pathological images.Methods:A total of 1,213 patients were divided into training and validation sets,an internal test set,a pooled external test set,and a pooled prospective test set at three centers.DMILS was constructed using a deep learningbased weakly supervised method based on multiscale WSIs at 10×,20×,and 40×magnifications.The performance of the DMILS was compared with that of a single magnification and validated in two pathologist-unidentified subsets.Results:The DMILS yielded good performance,with areas under the receiver operating characteristic curves(AUCs)of 0.848,0.857,0.810,and 0.787 in the training and validation sets,internal test set,pooled external test set,and pooled prospective test set,respectively.The AUC of the DMILS was higher than that of a single magnification,with 0.788 of 10×,0.824 of 20×,and 0.775 of 40×in the internal test set.Moreover,DMILS yielded satisfactory performance on the two pathologist-unidentified subsets.Furthermore,the most indicative region predicted by DMILS is the follicular epithelium.Conclusions:DMILS has good performance in differentiating thyroid follicular neoplasms on multiscale WSIs of intraoperative frozen pathological images.展开更多
BACKGROUND Pancreatic cancer remains one of the most lethal malignancies worldwide,with a poor prognosis often attributed to late diagnosis.Understanding the correlation between pathological type and imaging features ...BACKGROUND Pancreatic cancer remains one of the most lethal malignancies worldwide,with a poor prognosis often attributed to late diagnosis.Understanding the correlation between pathological type and imaging features is crucial for early detection and appropriate treatment planning.AIM To retrospectively analyze the relationship between different pathological types of pancreatic cancer and their corresponding imaging features.METHODS We retrospectively analyzed the data of 500 patients diagnosed with pancreatic cancer between January 2010 and December 2020 at our institution.Pathological types were determined by histopathological examination of the surgical spe-cimens or biopsy samples.The imaging features were assessed using computed tomography,magnetic resonance imaging,and endoscopic ultrasound.Statistical analyses were performed to identify significant associations between pathological types and specific imaging characteristics.RESULTS There were 320(64%)cases of pancreatic ductal adenocarcinoma,75(15%)of intraductal papillary mucinous neoplasms,50(10%)of neuroendocrine tumors,and 55(11%)of other rare types.Distinct imaging features were identified in each pathological type.Pancreatic ductal adenocarcinoma typically presents as a hypodense mass with poorly defined borders on computed tomography,whereas intraductal papillary mucinous neoplasms present as characteristic cystic lesions with mural nodules.Neuroendocrine tumors often appear as hypervascular lesions in contrast-enhanced imaging.Statistical analysis revealed significant correlations between specific imaging features and pathological types(P<0.001).CONCLUSION This study demonstrated a strong association between the pathological types of pancreatic cancer and imaging features.These findings can enhance the accuracy of noninvasive diagnosis and guide personalized treatment approaches.展开更多
BACKGROUND The microcystic,elongated,and fragmented(MELF)pattern of invasion in endometrioid endometrial carcinoma(EEC)is a special mode of myometrial invasion that has been recently recognized by the pathology commun...BACKGROUND The microcystic,elongated,and fragmented(MELF)pattern of invasion in endometrioid endometrial carcinoma(EEC)is a special mode of myometrial invasion that has been recently recognized by the pathology community.Overex-pression of CXC chemokine receptor 4(CXCR4)in tumor cells contributes to tumor growth,invasion,angiogenesis,metastasis,and recurrence.AIM To explore the correlation between CXCR4 expression in EEC and MELF invasion and clinicopathological features.METHODS A total of 205 EEC patients treated at Peking University People’s Hospital from June 2020 to December 2021 were selected(60 cases with MELF invasion,145 cases without).The clinicopathological features of the two groups were compared,and expression of CXCR4 protein,estrogen receptor,and progesterone receptor was detected and compared by immunohistochemistry.RESULTS EEC with MELF invasion was significantly associated with low tumor grade,lymphovascular space invasion,deep myometrial invasion,cervical stromal involvement,and lymph node metastasis.There was a difference in CXCR4 expression between the two groups,with the MELF group having a significantly higher expression than the non-MELF group.CONCLUSION CXCR4 expression is significantly increased in EEC with MELF invasion and in the MELF invasion area,which may promote tumor invasion and metastasis and has some value for prognostic assessment.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.How...BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.However,the uneven development of healthcare in China,especially in eastern and western China,creates challenges for sharing a standardized diagnostic process.AIM To optimize the process of ESD specimen sampling,embedding and slide production,and to provide complete and accurate pathological reports.METHODS We established a practical process of specimen sampling,created standardized reporting templates,and trained pathologists from neighboring hospitals and those in the western region.A training effectiveness survey was conducted,and the collected data were assessed by the corresponding percentages.RESULTS A total of 111 valid feedback forms have been received,among which 58%of the participants obtained photographs during specimen collection,whereas the percentage increased to 79%after training.Only 58%and 62%of the respondents ensured the mucosal tissue strips were flat and their order remained unchanged;after training,these two proportions increased to 95%and 92%,respectively.Approximately half the participants measured the depth of the submucosal infiltration,which significantly increased to 95%after training.The percentage of pathologists who did not evaluate lymphovascular invasion effectively reduced.Only 22%of the participants had fixed clinic-pathological meetings before training,which increased to 49%after training.The number of participants who had a thorough understanding of endoscopic diagnosis also significantly increased.CONCLUSION There have been significant improvements in the process of specimen collection,section quality,and pathology reporting in trained hospitals.Therefore,our study provides valuable insights for others facing similar challenges.展开更多
BACKGROUND Esophageal cancer is the sixth most common cancer worldwide,with a high mortality rate.Early prognosis of esophageal abnormalities can improve patient survival rates.The progression of esophageal cancer fol...BACKGROUND Esophageal cancer is the sixth most common cancer worldwide,with a high mortality rate.Early prognosis of esophageal abnormalities can improve patient survival rates.The progression of esophageal cancer follows a sequence from esophagitis to non-dysplastic Barrett’s esophagus,dysplastic Barrett’s esophagus,and eventually esophageal adenocarcinoma(EAC).This study explored the application of deep learning technology in the precise diagnosis of pathological classification and staging of EAC to enhance diagnostic accuracy and efficiency.AIM To explore the application of deep learning models,particularly Wave-Vision Transformer(Wave-ViT),in the pathological classification and staging of esophageal cancer to enhance diagnostic accuracy and efficiency.METHODS We applied several deep learning models,including multi-layer perceptron,residual network,transformer,and Wave-ViT,to a dataset of clinically validated esophageal pathology images.The models were trained to identify pathological features and assist in the classification and staging of different stages of esophageal cancer.The models were compared based on accuracy,computational complexity,and efficiency.RESULTS The Wave-ViT model demonstrated the highest accuracy at 88.97%,surpassing the transformer(87.65%),residual network(85.44%),and multi-layer perceptron(81.17%).Additionally,Wave-ViT exhibited low computational complexity with significantly reduced parameter size,making it highly efficient for real-time clinical applications.CONCLUSION Deep learning technology,particularly the Frequency-Domain Transformer model,shows promise in improving the precision of pathological classification and staging of EAC.The application of the Frequency-Domain Transformer model enhances the automation of the diagnostic process and may support early detection and treatment of EAC.Future research may further explore the potential of this model in broader medical image analysis applications,particularly in the field of precision medicine.展开更多
Liver metastases are a leading contributor to cancer-related illness and death,occurring far more frequently than primary liver tumors.Their management remains highly challenging due to the complexity of disease behav...Liver metastases are a leading contributor to cancer-related illness and death,occurring far more frequently than primary liver tumors.Their management remains highly challenging due to the complexity of disease behavior and the need for an individualized,multidisciplinary approach.Effective care increasingly relies on integrating sophisticated diagnostic techniques,advanced systemic and locoregional therapies,and molecularly tailored treatment strategies.This review provides an in-depth analysis of the current clinicopathological perspectives on liver metastases.It explores their epidemiology,mechanisms of spread,histological growth patterns,diagnostic imaging advancements,molecular characteristics,and therapeutic interventions.Additionally,it examines the broader implications for patient quality of life(QoL),healthcare costs,and the particular difficulties associated with managing liver metastases in pediatric patients and individuals with rare malignancies.The article outlines the diverse histopathological features and tumor–liver interface growth patterns,emphasizing their prognostic and therapeutic significance.It evaluates contemporary imaging modalities–including magnetic resonance imaging and computed tomography(CT)with hepatocyte-specific agents,positron emission tomography/CT,and contrast-enhanced ultrasound–and highlights the emerging importance of liquid biopsy and molecular profiling in shaping treatment decisions.The review discusses available treatment options such as chemotherapy,targeted agents,immunotherapies,surgical resection,liver transplantation,and various locoregional therapies.Furthermore,it addresses evolving fields like prognostic scoring systems,radiomics,artificial intelligence(AI)applications,and patient–derived organoid and xenograft models.A summary of current clinical trials and translational research initiatives reflects the fast-paced evolution of this field.The management of liver metastases is rapidly advancing,driven by precision oncology principles and collaborative,multidisciplinary care.The integration of molecular diagnostics,novel therapeutic approaches,and cutting–edge technologies–including AI and organoid-based personalized drug testing-is poised to enhance treatment selection,improve clinical outcomes,and support better QoL.These innovations hold the potential to transform the outlook for patients with liver metastases,moving toward more durable disease control in appropriately selected cases.展开更多
BACKGROUND Chronic hepatitis B virus(HBV)infection acquired in childhood frequently presents with mild or nonspecific symptoms,yet a distinct subset of pediatric patients develops rapid progression to liver cirrhosis(...BACKGROUND Chronic hepatitis B virus(HBV)infection acquired in childhood frequently presents with mild or nonspecific symptoms,yet a distinct subset of pediatric patients develops rapid progression to liver cirrhosis(LC)before adulthood.AIM To identify clinical and pathological characteristics of pediatric HBV-related LC.METHODS A total of 1332 pediatric patients with chronic HBV infection from the Fifth Medical Center of PLA General Hospital from January 2010 to January 2023 were included in this study.We identified 62 pediatric HBV-related LC by liver biopsy from the group.Subsequently,we described the clinical and pathological characteristics of pediatric LC.And 64 pediatric chronic hepatitis B(CHB;age and sex were matched with pediatric LC group)and 69 adult HBV-related LC(sex were matched with pediatric LC group)were enrolled to further demonstrate clinical and pathological differences between pediatric LC,pediatric CHB and adult LC.RESULTS We enrolled 62 pediatric LC,including 54(87.1%)males and 8(12.9%)females.The median age was 11(4-14)years old.The pediatric LC group showed significantly lower median quantitative HBV DNA loads(log10IU/mL:6.3 vs 17.4,P<0.001),reduced HBsAg titers(log10IU/mL:3.11 vs 8.956,P<0.0001),and diminished hepatitis B e antigen-positive positive rate(81.4%vs 93.8%,P<0.05)compared with pediatric CHB.A higher proportion of pediatric patients were asymptomatic(77.4%)compared to adult patients(11.6%)as they first diagnosed as LC,pediatric LC showed milder initial symptoms compared with adult patients such as fatigue(4.8%vs 27.5%),abdominal discomfort(9.7%vs 23.2%),nausea(0%vs 10.1%),and poor appetite(6.5%vs 8.7%;all P<0.0001).Notably,pediatric LC can achieve a significant percentage of functional cure compared with adult LC as 17.4%and 0%.The incidence of progression of LC in children after antiviral therapy continues to be much lower than that in adult LC(hazard ratio=6.102,95%confidence interval:1.72-21.65,P=0.00051).While the incidence of LC remission in children after antiviral therapy continues to be much higher than that in adult LC(hazard ratio=0.055,95%confidence interval:0.07128-0.2802,P<0.0001).CONCLUSION Pediatric patients with HBV-related cirrhosis exhibit elevated virological parameters and heightened transaminase levels than adult patients.However,the frequent paucity of overt clinical symptoms contributes to diagnostic challenges.Notably,early initiation of antiviral therapy in this population substantially improved clinical outcomes.展开更多
BACKGROUND Despite the promising prospects of using artificial intelligence and machine learning(ML)for disease classification and prediction purposes,the complexity and lack of explainability of this method make it d...BACKGROUND Despite the promising prospects of using artificial intelligence and machine learning(ML)for disease classification and prediction purposes,the complexity and lack of explainability of this method make it difficult to apply the constructed models in clinical practice.We developed and validated an interpretable ML model based on magnetic resonance imaging(MRI)radiomics and clinical features for the preoperative prediction of the pathological grades of hepatocellular carcinomas(HCCs).This model will help clinicians better understand the situation and develop personalized treatment plans.AIM To develop and validate an interpretable ML model for preoperative pathological grade prediction in HCC patients via a combination of multisequence MRI radiomics and clinical features.METHODS MRI and clinical data derived from 125 patients with HCCs confirmed by postoperative pathological examinations were retrospectively analyzed.The patients were randomly split into training and validation groups(7:3 ratio).Univariate and multivariate logistic regression analyses were performed to identify independent clinical predictors.The tumor lesions observed on axial fatsuppressed T2-weighted imaging(FS-T2WI),arterial phase(AP),and portal venous phase(PVP)images were delineated in a slice-by-slice manner using 3D-slicer to generate volumetric regions of interest,and radiomic features were extracted.Interclass correlation coefficients were calculated,and least absolute selection and shrinkage operator regression were conducted for feature selection purposes.Six predictive models were subsequently developed for pathological grade prediction:FS-T2WI,AP,PVP,integrated radiomics,clinical,and combined radiomics-clinical(RC)models.The effectiveness of these models was assessed by calculating their area under the receiver operating characteristic curve(AUC)values.The clinical applicability of the models was evaluated via decision curve analysis.Finally,the contributions of the different features contained in the model with optimal performance were interpreted via a SHapley Additive exPlanations analysis.RESULTS Among the 125 patients,87 were assigned to the training group,and 38 were assigned to the validation group.The maximum tumor diameter,hepatitis B virus status,and monocyte count were identified as independent predictors of pathological grade.Twelve optimal radiomic features were ultimately selected.The AUC values obtained for the FS-T2WI model,AP model,PVP model,radiomics model,clinical model,and combined RC model in the training group were 0.761[95%confidence interval(CI):0.562-0.857],0.870(95%CI:0.714-0.918),0.868(95%CI:0.714-0.959),0.917(95%CI:0.857-0.959),0.869(95%CI:0.643-0.973),and 0.941(95%CI:0.857-0.945),respectively;in the validation group,the AUC values were 0.724(95%CI:0.625-0.833),0.802(95%CI:0.686-1.000),0.797(95%CI:0.688-1.000),0.901(95%CI:0.833-0.906),0.865(95%CI:0.594-1.000),and 0.932(95%CI:0.812-1.000),respectively.The combined RC model demonstrated the best performance.Additionally,the decision curve analysis revealed that the combined RC model had satisfactory prediction efficiency,and the SHapley Additive exPlanations value analysis revealed that the“FS-T2WI-wavelet-HLL_gldm_Large Dependence High Gray Level Emphasis”feature contributed the most to the model,exhibiting a positive effect.CONCLUSION An interpretable ML model based on MRI radiomics provides a noninvasive tool for predicting the pathological grade of HCCs,which will help clinicians develop personalized treatment plans.展开更多
BACKGROUND Microvascular invasion(MVI)is a critical prognostic factor for postoperative hepatocellular carcinoma recurrence,but the reliability of its current pathological diagnosis remains uncertain.AIM To evaluate t...BACKGROUND Microvascular invasion(MVI)is a critical prognostic factor for postoperative hepatocellular carcinoma recurrence,but the reliability of its current pathological diagnosis remains uncertain.AIM To evaluate the accuracy of current 7-point sampling methods and propose an optimal pathological protocol using whole-mount slide imaging(WSI)for better MVI detection.METHODS We utilized 40 New Zealand white rabbits to establish VX2 liver tumor models.The entire tumor-containing liver lobe was subsequently obtained,following which five different sampling protocols(A-E)were employed to evaluate the detection rate,accuracy,quantity,and distribution of MVI,with the aim of identifying the optimal sampling method.RESULTS VX2 liver tumor models were successfully established in 37 rabbits,with an incidence of MVI of 81.1%(30/37).The detection rates[27%(10/37),43%(16/37),62%(23/37),68%(25/37),and 93%(14/15)]and quantity(15,36,107,125,and 395)of MVI increased significantly from protocols A to E.The distribution of MVI showed fewer MVIs farther away from the tumor,but the percentage of MVI detected quantity gradually increased from 6.7%to 48.3%in the distant nonneoplastic liver tissue from protocols A to E.Protocol C was identified as the optimal sampling method by comparing them in sequence.The sampling protocol of three consecutive interval WSIs at the tumor center(WSI3)was further screened to determine the optimal number of WSIs.Protocol A(7-point sampling method)exhibited only 46%accuracy and a high false-negative rate of 67%.Notably,the WSI3 protocol improved the accuracy to 78%and decreased the false-negative rate to 27%.CONCLUSION The current 7-point sampling method has a high false-negative rate in MVI detection.In contrast,the WSI3 protocol provides a practical and effective approach to improve MVI diagnostic accuracy,which is crucial for hepatocellular carcinoma diagnosis and treatment planning.展开更多
Objective:This study aimed to investigate the clinicopathological features and prognosis of small cell carcinoma of the urinary bladder(SCCUB).Methods:Clinicopathological data and prognosis of 24 patients with primary...Objective:This study aimed to investigate the clinicopathological features and prognosis of small cell carcinoma of the urinary bladder(SCCUB).Methods:Clinicopathological data and prognosis of 24 patients with primary SCCUB treated at the Affiliated Hospital of Qingdao University(from January 2016 to December 2021)were retrospectively collected and compared with 335 patients with primary high-grade urothelial carcinoma(HG-UC)during the same period.The study endpoints were disease-free survival(DFS)and overall survival(OS).Results:Of the 24 patients with SCCUB,19 were male and five were female.Eight(33%)cases were pure SCCUB(pSCCUB).Sixteen(67%)cases were mixed SCCUB(mSCCUB),all of which were mixed with urothelial carcinoma.All patients underwent surgery and 13(76%,13/17;seven patients were lost to follow-up)patients received postoperative adjuvant chemotherapy.We found no significant difference in clinicopathological features between pSCCUB and mSCCUB.However,compared to HG-UC,SCCUB had higher lymph node metastasis(p=0.014),more lymphovascular invasion(p=0.024),higher Ki-67 expression(p<0.001),and more disease progression events(p=0.001).Median DFS and OS for SCCUB were 22 months and 38 months,respectively.The Kaplan-Meier survival curve showed that the pathological type or surgical type did not affect DFS or OS of SCCUB.However,SCCUB patients had worse DFS and OS than HG-UC patients(both p<0.05).The multivariate Cox analysis showed that the tumor size(hazard ratio 1.44,95%CI 1.96–2.15,p=0.048)was an independent factor affecting DFS of SCCUB patients.Conclusion:Compared with the common HG-UC,SCCUB is rare with specific clinicopathological features and a worse prognosis.展开更多
Globally,approximately 10 million new tuberculosis(TB)cases are reported annually.Delayed diagnosis due to low detection rates is the primary cause of mortality.Although pathological examination is commonly used for d...Globally,approximately 10 million new tuberculosis(TB)cases are reported annually.Delayed diagnosis due to low detection rates is the primary cause of mortality.Although pathological examination is commonly used for diagnosing TB,5%-30%of cases remain undiagnosed,emphasizing the urgent need to establish quality control(QC)standards to reduce rates of misdiagnosis and missed diagnoses.To address this,we introduced a novel QC chip for detecting Mycobacterium tuberculosis(MTB).A quantitative pathological QC model was constructed by precisely and uniformly integrating MTB and HeLa cells into a photocurable hydrogel.This model was then sliced into uniform sections to create QC chips.It demonstrated that the QC chips exhibited no significant differences in intra-batch or inter-batch variation(coefficient of variation<5%),and remained stable at−80°C for one year.Furthermore,these chips were found to be 100%effective when tested with 240 clinical samples(200 with special staining and 40 with polymerase chain reaction).In addition to enhancing TB detection rates,this approach offers visualization,quantification,and sustainable production.Overall,this work provides a novel framework for developing QC chips for pathological testing,offering a reliable solution to enhance clinical diagnostic workflows.展开更多
BACKGROUND Crohn’s disease(CD)patients with intestinal involvement often require surgical intervention due to resistance to medical therapy.Postoperative recurrence remains a significant challenge,with the Rutgeerts ...BACKGROUND Crohn’s disease(CD)patients with intestinal involvement often require surgical intervention due to resistance to medical therapy.Postoperative recurrence remains a significant challenge,with the Rutgeerts score commonly used to predict endoscopic recurrence.AIM To evaluate the relationship between microscopic and macroscopic pathological findings in resected intestinal specimens and the Rutgeerts score to predict endoscopic recurrence in CD patients.METHODS This retrospective cohort study included 32 patients over 18 years of age with intestinal CD who underwent surgery at General Surgery Clinic of Ankara Bilkent City Hospital between November 2019 and October 2023.Resection specimens were histopathologically re-examined,and postoperative colonoscopy reports were classified according to the Rutgeerts score.The association between pathological findings and endoscopic recurrence was analyzed statistically.RESULTS No significant association was found between macroscopic findings and Rutgeerts scores or endoscopic recurrence(P>0.05).However,the presence and severity of neutrophilic cryptitis(P=0.035)and crypt abscesses(P=0.010)in microscopic findings were significantly associated with higher Rutgeerts scores,indicating a parallel increase with endoscopic recurrence.Other microscopic findings showed no significant correlation with Rutgeerts scores or endoscopic recurrence(P>0.05).CONCLUSION The presence of neutrophilic cryptitis and crypt abscesses in resected intestinal specimens of CD patients increases the likelihood of endoscopic recurrence.Early postoperative medical treatment and close endoscopic follow-up may benefit high-risk patients to prevent recurrence,with treatment decisions made by a weekly multidisciplinary council involving General Surgery,Gastroenterology,and Radiology.展开更多
BACKGROUND The decision to administer adjuvant chemotherapy to patients with local stage depends on specific high-risk features that are T4 tumor stage,presence of perineural invasion,lymphovascular invasion,poorly di...BACKGROUND The decision to administer adjuvant chemotherapy to patients with local stage depends on specific high-risk features that are T4 tumor stage,presence of perineural invasion,lymphovascular invasion,poorly differentiated tumor histology,inadequate lymph node sampling(fewer than 12 lymph nodes),and evidence of tumor perforation or obstruction.Tumor-stroma ratio,tumor infiltrating lymphocytes(TIL),Crohn-like reaction(CLR),desmoid reaction,poorly differentiated clusters(PDC)are new pathological markers that are being studied.AIM To examine the relationship between new pathological markers and defined high METHODS We evaluated 155 patients with the diagnosis stage I and II colorectal cancer between the years 2007 and 2021 who were treated at Trakya University Hospital,Department of Medical Oncology.We divided those with and without high-risk factors into two groups.We examined the relationship of new pathological markers with these groups and with pathological markers in risk factors.RESULTS There was no statistically significant correlation between presence of TIL,presence of PDC,presence of tumor budding,presence of CLR,presence of desmoid reaction and low and high-risk groups according to the degree of those with PDC(P=0.82,P=0.51,P=0.77,P=0.37,P=0.83,respectively).In addition,no statistically significant correlation was found between the tumor-stroma ratio and low and high risk groups(P=0.80).We found a statistically significant correlation between the presence of PDC and the presence of PDC grade 3 and T stage(P=0.001,P=0.001,respectively).It was determined that the presence of PDC and the frequency of grade 3 PDC increased with the advanced T stage.CONCLUSION No relationship was found between the presence of new pathological markers and high-low risk groups.When we examined the relationship between new and old pathological markers,only the frequency of detection of PDC and PDC grade 3 was found to be correlated with advanced T stage.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is one of the most prevalent and aggressive forms of liver cancer,with high morbidity and poor prognosis due to late diagnosis and limited treatment options.Despite advances in ...BACKGROUND Hepatocellular carcinoma(HCC)is one of the most prevalent and aggressive forms of liver cancer,with high morbidity and poor prognosis due to late diagnosis and limited treatment options.Despite advances in understanding its molecular mechanisms,effective biomarkers for early detection and targeted therapy remain scarce.Zinc finger protein 71(ZNF71),a zinc-finger protein,has been implicated in various cancers,yet its role in HCC remains largely unexplored.This gap in knowledge underscores the need for further investigation into the ZNF71 of potential as a diagnostic or therapeutic target in HCC.AIM To explore the expression levels,clinical relevance,and molecular mechanisms of ZNF71 in the progression of HCC.METHODS The study evaluated ZNF71 expression in 235 HCC specimens and 13 noncancerous liver tissue samples using immunohistochemistry.High-throughput datasets were employed to assess the differential expression of ZNF71 in HCC and its association with clinical and pathological features.The impact of ZNF71 on HCC cell line growth was examined through clustered regularly interspaced short palindromic repeat knockout screens.Co-expressed genes were identified and analyzed for enrichment using LinkedOmics and Sangerbox 3.0,focusing on significant correlations(P<0.01,correlation coefficient≥0.3).Furthermore,the relationship between ZNF71 expression and immune cell infiltration was quantified using TIMER2.0.RESULTS ZNF71 showed higher expression in HCC tissues vs non-tumorous tissues,with a significant statistical difference(P<0.05).Data from the UALCAN platform indicated increased ZNF71 levels across early to mid-stage HCC,correlating with disease severity(P<0.05).High-throughput analysis presented a standardized mean difference in ZNF71 expression of 0.55(95%confidence interval[CI]:0.34-0.75).The efficiency of ZNF71 mRNA was evaluated,yielding an area under the curve of 0.78(95%CI:0.75-0.82),a sensitivity of 0.63(95%CI:0.53-0.72),and a specificity of 0.82(95%CI:0.73-0.89).Diagnostic likelihood ratios were positive at 3.61(95%CI:2.41-5.41)and negative at 0.45(95%CI:0.36-0.56).LinkedOmics analysis identified strong positive correlations of ZNF71 with genes such as ZNF470,ZNF256,and ZNF285.Pathway enrichment analyses highlighted associations with herpes simplex virus type 1 infection,the cell cycle,and DNA replication.Negative correlations involved metabolic pathways,peroxisomes,and fatty acid degradation.TIMER2.0 analysis demonstrated positive correlations of high ZNF71 expression with various immune cell types,including CD4^(+)T cells,B cells,regulatory T cells,monocytes,macrophages,and myeloid dendritic cells.CONCLUSION ZNF71 is significantly upregulated in HCC,correlating with the disease’s clinical and pathological stages.It appears to promote HCC progression through mechanisms involving the cell cycle and metabolism and is associated with immune cell infiltration.These findings suggest that ZNF71 could be a novel target for diagnosing and treating HCC.展开更多
BACKGROUND Gastric adenocarcinoma with primitive phenotypes has recently attracted increasing attention due to its aggressive nature and challenging diagnosis.Gastric adenocarcinoma with enteroblastic differentiation(...BACKGROUND Gastric adenocarcinoma with primitive phenotypes has recently attracted increasing attention due to its aggressive nature and challenging diagnosis.Gastric adenocarcinoma with enteroblastic differentiation(GAED)and hepatoid adenocarcinoma(HAC)were previously regarded as gastric adenocarcinoma with primitive enterocyte phenotype(GAPEP).GAPEP is known for its poor prognosis,and the accurate diagnosis of GAPEP directly affects therapeutic decision-making.Despite their poor prognosis and morphological heterogeneity,the molecular drivers of GAPEP,particularly methylation-driven mechanisms,remain poorly explored.AIM To investigate the clinicopathological and molecular characteristics of GAPEP and establish an integrative diagnostic strategy to guide therapeutic decision-making.METHODS Based on the expression profile and morphology,patients were divided into three groups:GAPEP(including GAED and HAC),conventional gastric cancer(CGC),and CGC expressing primitive phenotypic markers.We analyzed clinicopathological features and overall survival.Data from The Cancer Genome Atlas were also analyzed,and functional enrichment analysis was conducted.RESULTS GAPEP showed diverse morphology,and immunohistochemical staining alone was not adequate for accurate diagnosis.Histologically,GAPEP was characterized by large,polygonal tumor cells with supranuclear or subnuclear vacuoles,a“piano keyboard-like”appearance,and clear or eosinophilic cytoplasms.Compared to CGC and CGC expressing primitive phenotypic markers,GAPEP displayed more aggressive clinical features.Molecular analysis showed significant differences in molecular subtypes,TP53 mutation,ERBB2 amplification,ARID1A mutation,MSI status,and CpG island methylator phenotype category.Genomic analysis revealed that TP53 mutations,APC mutations,and ERBB2 amplifications were more frequent in GAPEP.Genes involved in methylation processes were highly upregulated in GAPEP.HAC and GAED shared similar clinicopathological and genetic characteristics.Functional enrichment analysis highlighted the critical role of methylation in the development of GAPEP.CONCLUSION The diversity and aggressiveness of GAPEP are driven by deregulated methylation,necessitating the integration of morphological and immunohistochemical diagnosis.Targeting methylation can provide new therapeutic opportunities for treating this aggressive cancer.展开更多
BACKGROUND Epigenetic involvement of methyltransferase-like factor 14(METTL14)in tumor development has not been clearly defined.AIM To investigate METTL14 expression and its relationship with pathological stage in pat...BACKGROUND Epigenetic involvement of methyltransferase-like factor 14(METTL14)in tumor development has not been clearly defined.AIM To investigate METTL14 expression and its relationship with pathological stage in patients undergoing radical surgery for colorectal cancer(CRC).METHODS This retrospective study included 80 patients with CRC who were admitted to the Third Hospital of Hefei and the Western District of the First Affiliated Hospital of Anhui Medical University between June 2021 and June 2024.These patients were selected for treatment.Lesions and adjacent tissues were collected from these patients,and METTL14 expression was assessed using immunohistochemistry.Expression levels of METTL14 were compared across different tissue samples.Additionally,we evaluated METTL14 expression in patients with varying pa-thological characteristics using statistical methods such asχ2 tests and analysis of variance to identify significant differences.RESULTS The positivity rate of METTL14 in tumor tissues was significantly lower than that in adjacent tissues(30%vs 60%,P<0.05).Conversely,the negative expression rate of METTL14 was higher in tumor tissues compared to adjacent tissues(P<0.05).The positive expression of METTL14 mRNA did not differ by age,sex,tumor tissue classification,tumor diameter,or tumor location(P>0.05).However,the positive expression rate of METTL14 was significantly lower in patients with lymph node metastasis,invasion depth T3+T4,and tumor,node,and metastasis(TNM)stage III/IV compared to those without lymph node metastasis,invasion depth T1+T2,and TNM stage I(P<0.05).Specifically,METTL14 mRNA expression was significantly lower in patients with lymph node metastasis(0.51±0.12 vs 1.23±0.25,P<0.001),invasion depth T3+T4(0.48±0.15 vs 1.18±0.21,P<0.001),and TNM stage III/IV(0.45±0.13 vs 1.20±0.22,P<0.001)compared to those with no lymph node metastasis,invasion depth T1+T2,and TNM stage I,respectively.CONCLUSION In CRC,low positive METTL14 expression is closely correlated with lymph node metastasis,invasion depth T3+T4,and TNM stage,indicating the malignant biological behavior of rectal cancer.展开更多
BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrason...BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrasonography(EUS),but atypical EUS features have also been reported.Previous studies have found that atypical features of gastric IFPs observed under EUS have corresponding histological manifestations.At present,there is no study elaborating the EUS manifestations of gastric IFPs at different pathological stages.We hypothesize that gastric IFPs at different pathological stages may have different EUS features.AIM To describe EUS features of gastric IFPs and compare with their pathological characteristics.METHODS Clinical data of 53 inpatients with pathologically diagnosed gastric IFPs after endoscopic treatment were collected.All patients underwent preoperative EUS.We analyzed the EUS characteristics of the lesions and compared with the pathological characteristics and staging of the resected specimens.RESULTS Most gastric IFPs showed medium-low echo(67.9%),homogeneous echo(90.6%),and unclear boundaries(83%),and involved the second and third layers of the gastric wall(69.8%)under EUS.The echogenicity level and echo homogeneity were significantly correlated with the pathological stage of gastric IFP.Gastric IFPs in the nodular stage presented hypoechoic and homogeneous echo.Gastric IFPs in the fibrovascular stage mostly showed medium-low echo and homogeneous echo.Gastric IFPs in the sclerotic stage showed different echogenicity levels and echo homogeneity.The accuracy of EUS in diagnosing gastric IFPs was 66.0%(35/53),and the accuracy in determining the origin layer of gastric IFPs was 73.4%(39/53).CONCLUSION Gastric IFPs at different pathological stages have different EUS features.In order to improve the diagnostic rate,it is necessary to combine EUS with EUS-guided fine-needle aspiration or artificial intelligence.展开更多
BACKGROUND Esophageal submucosal gland duct adenoma(ESGDA)is very rare,and easily diagnosed as adenocarcinoma.CASE SUMMARY A 70-year-old man presented with abdominal discomfort and intermittent dull pain during swallo...BACKGROUND Esophageal submucosal gland duct adenoma(ESGDA)is very rare,and easily diagnosed as adenocarcinoma.CASE SUMMARY A 70-year-old man presented with abdominal discomfort and intermittent dull pain during swallowing for 10 days.Digestive endoscopy revealed a polypoid bulge at the esophago-gastric junction,which was resected by endoscopic submucosal dissection(ESD).Routine pathological examination showed intestinal metaplasia of the glandular epithelium on the mucosal surface,with serous tumor-like complex glands in the submucosa which showing significant hyperplasia.This initially diagnosis was early gastric adenocarcinoma.However,we still observed a few points that did not meet the criteria for cancer such as lack of malignant features.Following multidisciplinary discussion and consultation with the experienced specialist pathologists,we finally diagnosed the lesion as a rare ESGDA by further immunohistochemistry.The follow-up examination results for the patient were satisfactory,with no evidence of tumor recurrence.And we summarize the ESGDAs reported in the literature,aiming to enhance understanding of this tumor type.CONCLUSION ESGDA is a benign tumor that can be cured by ESD.Accurate diagnosis can prevent unnecessary extensive therapeutic interventions.展开更多
文摘Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.
基金Supported by National High-Level Hospital Clinical Research Funding,No.2022-PUMCH-B-022,and No.2022-PUMCH-D-002CAMS Innovation Fund for Medical Sciences,No.CIFMS 2021-1-I2M-003Undergraduate Innovation Program,No.2024dcxm025.
文摘Small intestinal villi are essential for nutrient absorption,and their impairment can lead to malabsorption.Small intestinal villous atrophy(VA)encompasses a heterogeneous group of disorders,including immune-mediated conditions(e.g.,celiac disease,autoimmune enteropathy,inborn errors of immunity),lymphoproliferative disorders(e.g.,enteropathy-associated T-cell lymphoma),infectious causes(e.g.,tropical sprue,Whipple’s disease),iatrogenic factors(e.g.,Olmesartanassociated enteropathy,graft-vs-host disease),as well as inflammatory and idiopathic types.These disorders are often rare and challenging to distinguish due to overlapping clinical,serological,endoscopic,and histopathological features.Through a systematic literature search using keywords such as small intestinal VA,malabsorption,and specific enteropathies,this review provides a comprehensive overview of diagnostic clues for VA and malabsorption.We systematically summarize the pathological characteristics of each condition to assist pathologists and clinicians in accurately identifying the underlying etiologies.Current studies still have many limitations and lack broader and deeper investigations into these diseases.Therefore,future research should focus on the development of novel diagnostic tools,predictive models,therapeutic targets,and mechanistic molecular studies to refine both diagnosis and management strategies.
基金supported by the Taishan Scholar Project(No.ts20190991,tsqn202211378)the Key R&D Project of Shandong Province(No.2022CXPT023)the General Program of National Natural Science Foundation of China(No.82371933)。
文摘Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pathological images.Methods:A total of 1,213 patients were divided into training and validation sets,an internal test set,a pooled external test set,and a pooled prospective test set at three centers.DMILS was constructed using a deep learningbased weakly supervised method based on multiscale WSIs at 10×,20×,and 40×magnifications.The performance of the DMILS was compared with that of a single magnification and validated in two pathologist-unidentified subsets.Results:The DMILS yielded good performance,with areas under the receiver operating characteristic curves(AUCs)of 0.848,0.857,0.810,and 0.787 in the training and validation sets,internal test set,pooled external test set,and pooled prospective test set,respectively.The AUC of the DMILS was higher than that of a single magnification,with 0.788 of 10×,0.824 of 20×,and 0.775 of 40×in the internal test set.Moreover,DMILS yielded satisfactory performance on the two pathologist-unidentified subsets.Furthermore,the most indicative region predicted by DMILS is the follicular epithelium.Conclusions:DMILS has good performance in differentiating thyroid follicular neoplasms on multiscale WSIs of intraoperative frozen pathological images.
文摘BACKGROUND Pancreatic cancer remains one of the most lethal malignancies worldwide,with a poor prognosis often attributed to late diagnosis.Understanding the correlation between pathological type and imaging features is crucial for early detection and appropriate treatment planning.AIM To retrospectively analyze the relationship between different pathological types of pancreatic cancer and their corresponding imaging features.METHODS We retrospectively analyzed the data of 500 patients diagnosed with pancreatic cancer between January 2010 and December 2020 at our institution.Pathological types were determined by histopathological examination of the surgical spe-cimens or biopsy samples.The imaging features were assessed using computed tomography,magnetic resonance imaging,and endoscopic ultrasound.Statistical analyses were performed to identify significant associations between pathological types and specific imaging characteristics.RESULTS There were 320(64%)cases of pancreatic ductal adenocarcinoma,75(15%)of intraductal papillary mucinous neoplasms,50(10%)of neuroendocrine tumors,and 55(11%)of other rare types.Distinct imaging features were identified in each pathological type.Pancreatic ductal adenocarcinoma typically presents as a hypodense mass with poorly defined borders on computed tomography,whereas intraductal papillary mucinous neoplasms present as characteristic cystic lesions with mural nodules.Neuroendocrine tumors often appear as hypervascular lesions in contrast-enhanced imaging.Statistical analysis revealed significant correlations between specific imaging features and pathological types(P<0.001).CONCLUSION This study demonstrated a strong association between the pathological types of pancreatic cancer and imaging features.These findings can enhance the accuracy of noninvasive diagnosis and guide personalized treatment approaches.
文摘BACKGROUND The microcystic,elongated,and fragmented(MELF)pattern of invasion in endometrioid endometrial carcinoma(EEC)is a special mode of myometrial invasion that has been recently recognized by the pathology community.Overex-pression of CXC chemokine receptor 4(CXCR4)in tumor cells contributes to tumor growth,invasion,angiogenesis,metastasis,and recurrence.AIM To explore the correlation between CXCR4 expression in EEC and MELF invasion and clinicopathological features.METHODS A total of 205 EEC patients treated at Peking University People’s Hospital from June 2020 to December 2021 were selected(60 cases with MELF invasion,145 cases without).The clinicopathological features of the two groups were compared,and expression of CXCR4 protein,estrogen receptor,and progesterone receptor was detected and compared by immunohistochemistry.RESULTS EEC with MELF invasion was significantly associated with low tumor grade,lymphovascular space invasion,deep myometrial invasion,cervical stromal involvement,and lymph node metastasis.There was a difference in CXCR4 expression between the two groups,with the MELF group having a significantly higher expression than the non-MELF group.CONCLUSION CXCR4 expression is significantly increased in EEC with MELF invasion and in the MELF invasion area,which may promote tumor invasion and metastasis and has some value for prognostic assessment.
基金Supported by the Medical Education Research Project from Nanjing Drum Tower Hospital,No.2021-7the Clinical Trials Fund from Nanjing Drum Tower Hospital,No.2022-YXZX-XH-04National Natural Science Foundation of China,No.82203063.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.However,the uneven development of healthcare in China,especially in eastern and western China,creates challenges for sharing a standardized diagnostic process.AIM To optimize the process of ESD specimen sampling,embedding and slide production,and to provide complete and accurate pathological reports.METHODS We established a practical process of specimen sampling,created standardized reporting templates,and trained pathologists from neighboring hospitals and those in the western region.A training effectiveness survey was conducted,and the collected data were assessed by the corresponding percentages.RESULTS A total of 111 valid feedback forms have been received,among which 58%of the participants obtained photographs during specimen collection,whereas the percentage increased to 79%after training.Only 58%and 62%of the respondents ensured the mucosal tissue strips were flat and their order remained unchanged;after training,these two proportions increased to 95%and 92%,respectively.Approximately half the participants measured the depth of the submucosal infiltration,which significantly increased to 95%after training.The percentage of pathologists who did not evaluate lymphovascular invasion effectively reduced.Only 22%of the participants had fixed clinic-pathological meetings before training,which increased to 49%after training.The number of participants who had a thorough understanding of endoscopic diagnosis also significantly increased.CONCLUSION There have been significant improvements in the process of specimen collection,section quality,and pathology reporting in trained hospitals.Therefore,our study provides valuable insights for others facing similar challenges.
文摘BACKGROUND Esophageal cancer is the sixth most common cancer worldwide,with a high mortality rate.Early prognosis of esophageal abnormalities can improve patient survival rates.The progression of esophageal cancer follows a sequence from esophagitis to non-dysplastic Barrett’s esophagus,dysplastic Barrett’s esophagus,and eventually esophageal adenocarcinoma(EAC).This study explored the application of deep learning technology in the precise diagnosis of pathological classification and staging of EAC to enhance diagnostic accuracy and efficiency.AIM To explore the application of deep learning models,particularly Wave-Vision Transformer(Wave-ViT),in the pathological classification and staging of esophageal cancer to enhance diagnostic accuracy and efficiency.METHODS We applied several deep learning models,including multi-layer perceptron,residual network,transformer,and Wave-ViT,to a dataset of clinically validated esophageal pathology images.The models were trained to identify pathological features and assist in the classification and staging of different stages of esophageal cancer.The models were compared based on accuracy,computational complexity,and efficiency.RESULTS The Wave-ViT model demonstrated the highest accuracy at 88.97%,surpassing the transformer(87.65%),residual network(85.44%),and multi-layer perceptron(81.17%).Additionally,Wave-ViT exhibited low computational complexity with significantly reduced parameter size,making it highly efficient for real-time clinical applications.CONCLUSION Deep learning technology,particularly the Frequency-Domain Transformer model,shows promise in improving the precision of pathological classification and staging of EAC.The application of the Frequency-Domain Transformer model enhances the automation of the diagnostic process and may support early detection and treatment of EAC.Future research may further explore the potential of this model in broader medical image analysis applications,particularly in the field of precision medicine.
基金Supported by UMM Al-Qura University,Saudi Arabia,No.25UQU4350477GSSR05.
文摘Liver metastases are a leading contributor to cancer-related illness and death,occurring far more frequently than primary liver tumors.Their management remains highly challenging due to the complexity of disease behavior and the need for an individualized,multidisciplinary approach.Effective care increasingly relies on integrating sophisticated diagnostic techniques,advanced systemic and locoregional therapies,and molecularly tailored treatment strategies.This review provides an in-depth analysis of the current clinicopathological perspectives on liver metastases.It explores their epidemiology,mechanisms of spread,histological growth patterns,diagnostic imaging advancements,molecular characteristics,and therapeutic interventions.Additionally,it examines the broader implications for patient quality of life(QoL),healthcare costs,and the particular difficulties associated with managing liver metastases in pediatric patients and individuals with rare malignancies.The article outlines the diverse histopathological features and tumor–liver interface growth patterns,emphasizing their prognostic and therapeutic significance.It evaluates contemporary imaging modalities–including magnetic resonance imaging and computed tomography(CT)with hepatocyte-specific agents,positron emission tomography/CT,and contrast-enhanced ultrasound–and highlights the emerging importance of liquid biopsy and molecular profiling in shaping treatment decisions.The review discusses available treatment options such as chemotherapy,targeted agents,immunotherapies,surgical resection,liver transplantation,and various locoregional therapies.Furthermore,it addresses evolving fields like prognostic scoring systems,radiomics,artificial intelligence(AI)applications,and patient–derived organoid and xenograft models.A summary of current clinical trials and translational research initiatives reflects the fast-paced evolution of this field.The management of liver metastases is rapidly advancing,driven by precision oncology principles and collaborative,multidisciplinary care.The integration of molecular diagnostics,novel therapeutic approaches,and cutting–edge technologies–including AI and organoid-based personalized drug testing-is poised to enhance treatment selection,improve clinical outcomes,and support better QoL.These innovations hold the potential to transform the outlook for patients with liver metastases,moving toward more durable disease control in appropriately selected cases.
基金Supported by National Key R&D Program of China,No.2023YFC2308104Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support,No.ZLRK202301National Natural Science Foundation of China,No.92159305.
文摘BACKGROUND Chronic hepatitis B virus(HBV)infection acquired in childhood frequently presents with mild or nonspecific symptoms,yet a distinct subset of pediatric patients develops rapid progression to liver cirrhosis(LC)before adulthood.AIM To identify clinical and pathological characteristics of pediatric HBV-related LC.METHODS A total of 1332 pediatric patients with chronic HBV infection from the Fifth Medical Center of PLA General Hospital from January 2010 to January 2023 were included in this study.We identified 62 pediatric HBV-related LC by liver biopsy from the group.Subsequently,we described the clinical and pathological characteristics of pediatric LC.And 64 pediatric chronic hepatitis B(CHB;age and sex were matched with pediatric LC group)and 69 adult HBV-related LC(sex were matched with pediatric LC group)were enrolled to further demonstrate clinical and pathological differences between pediatric LC,pediatric CHB and adult LC.RESULTS We enrolled 62 pediatric LC,including 54(87.1%)males and 8(12.9%)females.The median age was 11(4-14)years old.The pediatric LC group showed significantly lower median quantitative HBV DNA loads(log10IU/mL:6.3 vs 17.4,P<0.001),reduced HBsAg titers(log10IU/mL:3.11 vs 8.956,P<0.0001),and diminished hepatitis B e antigen-positive positive rate(81.4%vs 93.8%,P<0.05)compared with pediatric CHB.A higher proportion of pediatric patients were asymptomatic(77.4%)compared to adult patients(11.6%)as they first diagnosed as LC,pediatric LC showed milder initial symptoms compared with adult patients such as fatigue(4.8%vs 27.5%),abdominal discomfort(9.7%vs 23.2%),nausea(0%vs 10.1%),and poor appetite(6.5%vs 8.7%;all P<0.0001).Notably,pediatric LC can achieve a significant percentage of functional cure compared with adult LC as 17.4%and 0%.The incidence of progression of LC in children after antiviral therapy continues to be much lower than that in adult LC(hazard ratio=6.102,95%confidence interval:1.72-21.65,P=0.00051).While the incidence of LC remission in children after antiviral therapy continues to be much higher than that in adult LC(hazard ratio=0.055,95%confidence interval:0.07128-0.2802,P<0.0001).CONCLUSION Pediatric patients with HBV-related cirrhosis exhibit elevated virological parameters and heightened transaminase levels than adult patients.However,the frequent paucity of overt clinical symptoms contributes to diagnostic challenges.Notably,early initiation of antiviral therapy in this population substantially improved clinical outcomes.
文摘BACKGROUND Despite the promising prospects of using artificial intelligence and machine learning(ML)for disease classification and prediction purposes,the complexity and lack of explainability of this method make it difficult to apply the constructed models in clinical practice.We developed and validated an interpretable ML model based on magnetic resonance imaging(MRI)radiomics and clinical features for the preoperative prediction of the pathological grades of hepatocellular carcinomas(HCCs).This model will help clinicians better understand the situation and develop personalized treatment plans.AIM To develop and validate an interpretable ML model for preoperative pathological grade prediction in HCC patients via a combination of multisequence MRI radiomics and clinical features.METHODS MRI and clinical data derived from 125 patients with HCCs confirmed by postoperative pathological examinations were retrospectively analyzed.The patients were randomly split into training and validation groups(7:3 ratio).Univariate and multivariate logistic regression analyses were performed to identify independent clinical predictors.The tumor lesions observed on axial fatsuppressed T2-weighted imaging(FS-T2WI),arterial phase(AP),and portal venous phase(PVP)images were delineated in a slice-by-slice manner using 3D-slicer to generate volumetric regions of interest,and radiomic features were extracted.Interclass correlation coefficients were calculated,and least absolute selection and shrinkage operator regression were conducted for feature selection purposes.Six predictive models were subsequently developed for pathological grade prediction:FS-T2WI,AP,PVP,integrated radiomics,clinical,and combined radiomics-clinical(RC)models.The effectiveness of these models was assessed by calculating their area under the receiver operating characteristic curve(AUC)values.The clinical applicability of the models was evaluated via decision curve analysis.Finally,the contributions of the different features contained in the model with optimal performance were interpreted via a SHapley Additive exPlanations analysis.RESULTS Among the 125 patients,87 were assigned to the training group,and 38 were assigned to the validation group.The maximum tumor diameter,hepatitis B virus status,and monocyte count were identified as independent predictors of pathological grade.Twelve optimal radiomic features were ultimately selected.The AUC values obtained for the FS-T2WI model,AP model,PVP model,radiomics model,clinical model,and combined RC model in the training group were 0.761[95%confidence interval(CI):0.562-0.857],0.870(95%CI:0.714-0.918),0.868(95%CI:0.714-0.959),0.917(95%CI:0.857-0.959),0.869(95%CI:0.643-0.973),and 0.941(95%CI:0.857-0.945),respectively;in the validation group,the AUC values were 0.724(95%CI:0.625-0.833),0.802(95%CI:0.686-1.000),0.797(95%CI:0.688-1.000),0.901(95%CI:0.833-0.906),0.865(95%CI:0.594-1.000),and 0.932(95%CI:0.812-1.000),respectively.The combined RC model demonstrated the best performance.Additionally,the decision curve analysis revealed that the combined RC model had satisfactory prediction efficiency,and the SHapley Additive exPlanations value analysis revealed that the“FS-T2WI-wavelet-HLL_gldm_Large Dependence High Gray Level Emphasis”feature contributed the most to the model,exhibiting a positive effect.CONCLUSION An interpretable ML model based on MRI radiomics provides a noninvasive tool for predicting the pathological grade of HCCs,which will help clinicians develop personalized treatment plans.
基金Supported by the National Natural Science Foundation of China,No.82072038 and No.82371975.
文摘BACKGROUND Microvascular invasion(MVI)is a critical prognostic factor for postoperative hepatocellular carcinoma recurrence,but the reliability of its current pathological diagnosis remains uncertain.AIM To evaluate the accuracy of current 7-point sampling methods and propose an optimal pathological protocol using whole-mount slide imaging(WSI)for better MVI detection.METHODS We utilized 40 New Zealand white rabbits to establish VX2 liver tumor models.The entire tumor-containing liver lobe was subsequently obtained,following which five different sampling protocols(A-E)were employed to evaluate the detection rate,accuracy,quantity,and distribution of MVI,with the aim of identifying the optimal sampling method.RESULTS VX2 liver tumor models were successfully established in 37 rabbits,with an incidence of MVI of 81.1%(30/37).The detection rates[27%(10/37),43%(16/37),62%(23/37),68%(25/37),and 93%(14/15)]and quantity(15,36,107,125,and 395)of MVI increased significantly from protocols A to E.The distribution of MVI showed fewer MVIs farther away from the tumor,but the percentage of MVI detected quantity gradually increased from 6.7%to 48.3%in the distant nonneoplastic liver tissue from protocols A to E.Protocol C was identified as the optimal sampling method by comparing them in sequence.The sampling protocol of three consecutive interval WSIs at the tumor center(WSI3)was further screened to determine the optimal number of WSIs.Protocol A(7-point sampling method)exhibited only 46%accuracy and a high false-negative rate of 67%.Notably,the WSI3 protocol improved the accuracy to 78%and decreased the false-negative rate to 27%.CONCLUSION The current 7-point sampling method has a high false-negative rate in MVI detection.In contrast,the WSI3 protocol provides a practical and effective approach to improve MVI diagnostic accuracy,which is crucial for hepatocellular carcinoma diagnosis and treatment planning.
基金financially supported by the National Natural Science Foundation of China(82071750 and 81772713 to Niu H)Taishan Scholar Program of Shandong Province(tstp20221165 to Niu H).
文摘Objective:This study aimed to investigate the clinicopathological features and prognosis of small cell carcinoma of the urinary bladder(SCCUB).Methods:Clinicopathological data and prognosis of 24 patients with primary SCCUB treated at the Affiliated Hospital of Qingdao University(from January 2016 to December 2021)were retrospectively collected and compared with 335 patients with primary high-grade urothelial carcinoma(HG-UC)during the same period.The study endpoints were disease-free survival(DFS)and overall survival(OS).Results:Of the 24 patients with SCCUB,19 were male and five were female.Eight(33%)cases were pure SCCUB(pSCCUB).Sixteen(67%)cases were mixed SCCUB(mSCCUB),all of which were mixed with urothelial carcinoma.All patients underwent surgery and 13(76%,13/17;seven patients were lost to follow-up)patients received postoperative adjuvant chemotherapy.We found no significant difference in clinicopathological features between pSCCUB and mSCCUB.However,compared to HG-UC,SCCUB had higher lymph node metastasis(p=0.014),more lymphovascular invasion(p=0.024),higher Ki-67 expression(p<0.001),and more disease progression events(p=0.001).Median DFS and OS for SCCUB were 22 months and 38 months,respectively.The Kaplan-Meier survival curve showed that the pathological type or surgical type did not affect DFS or OS of SCCUB.However,SCCUB patients had worse DFS and OS than HG-UC patients(both p<0.05).The multivariate Cox analysis showed that the tumor size(hazard ratio 1.44,95%CI 1.96–2.15,p=0.048)was an independent factor affecting DFS of SCCUB patients.Conclusion:Compared with the common HG-UC,SCCUB is rare with specific clinicopathological features and a worse prognosis.
基金supported by the National Natural Science Foundation of China(Nos.52325504 and 52235007)the Basic Public Welfare Research Project of Zhejiang Province(No.LGY23H160089)the Science and Technology Plan Project of Taizhou City(No.24ywa08).
文摘Globally,approximately 10 million new tuberculosis(TB)cases are reported annually.Delayed diagnosis due to low detection rates is the primary cause of mortality.Although pathological examination is commonly used for diagnosing TB,5%-30%of cases remain undiagnosed,emphasizing the urgent need to establish quality control(QC)standards to reduce rates of misdiagnosis and missed diagnoses.To address this,we introduced a novel QC chip for detecting Mycobacterium tuberculosis(MTB).A quantitative pathological QC model was constructed by precisely and uniformly integrating MTB and HeLa cells into a photocurable hydrogel.This model was then sliced into uniform sections to create QC chips.It demonstrated that the QC chips exhibited no significant differences in intra-batch or inter-batch variation(coefficient of variation<5%),and remained stable at−80°C for one year.Furthermore,these chips were found to be 100%effective when tested with 240 clinical samples(200 with special staining and 40 with polymerase chain reaction).In addition to enhancing TB detection rates,this approach offers visualization,quantification,and sustainable production.Overall,this work provides a novel framework for developing QC chips for pathological testing,offering a reliable solution to enhance clinical diagnostic workflows.
文摘BACKGROUND Crohn’s disease(CD)patients with intestinal involvement often require surgical intervention due to resistance to medical therapy.Postoperative recurrence remains a significant challenge,with the Rutgeerts score commonly used to predict endoscopic recurrence.AIM To evaluate the relationship between microscopic and macroscopic pathological findings in resected intestinal specimens and the Rutgeerts score to predict endoscopic recurrence in CD patients.METHODS This retrospective cohort study included 32 patients over 18 years of age with intestinal CD who underwent surgery at General Surgery Clinic of Ankara Bilkent City Hospital between November 2019 and October 2023.Resection specimens were histopathologically re-examined,and postoperative colonoscopy reports were classified according to the Rutgeerts score.The association between pathological findings and endoscopic recurrence was analyzed statistically.RESULTS No significant association was found between macroscopic findings and Rutgeerts scores or endoscopic recurrence(P>0.05).However,the presence and severity of neutrophilic cryptitis(P=0.035)and crypt abscesses(P=0.010)in microscopic findings were significantly associated with higher Rutgeerts scores,indicating a parallel increase with endoscopic recurrence.Other microscopic findings showed no significant correlation with Rutgeerts scores or endoscopic recurrence(P>0.05).CONCLUSION The presence of neutrophilic cryptitis and crypt abscesses in resected intestinal specimens of CD patients increases the likelihood of endoscopic recurrence.Early postoperative medical treatment and close endoscopic follow-up may benefit high-risk patients to prevent recurrence,with treatment decisions made by a weekly multidisciplinary council involving General Surgery,Gastroenterology,and Radiology.
文摘BACKGROUND The decision to administer adjuvant chemotherapy to patients with local stage depends on specific high-risk features that are T4 tumor stage,presence of perineural invasion,lymphovascular invasion,poorly differentiated tumor histology,inadequate lymph node sampling(fewer than 12 lymph nodes),and evidence of tumor perforation or obstruction.Tumor-stroma ratio,tumor infiltrating lymphocytes(TIL),Crohn-like reaction(CLR),desmoid reaction,poorly differentiated clusters(PDC)are new pathological markers that are being studied.AIM To examine the relationship between new pathological markers and defined high METHODS We evaluated 155 patients with the diagnosis stage I and II colorectal cancer between the years 2007 and 2021 who were treated at Trakya University Hospital,Department of Medical Oncology.We divided those with and without high-risk factors into two groups.We examined the relationship of new pathological markers with these groups and with pathological markers in risk factors.RESULTS There was no statistically significant correlation between presence of TIL,presence of PDC,presence of tumor budding,presence of CLR,presence of desmoid reaction and low and high-risk groups according to the degree of those with PDC(P=0.82,P=0.51,P=0.77,P=0.37,P=0.83,respectively).In addition,no statistically significant correlation was found between the tumor-stroma ratio and low and high risk groups(P=0.80).We found a statistically significant correlation between the presence of PDC and the presence of PDC grade 3 and T stage(P=0.001,P=0.001,respectively).It was determined that the presence of PDC and the frequency of grade 3 PDC increased with the advanced T stage.CONCLUSION No relationship was found between the presence of new pathological markers and high-low risk groups.When we examined the relationship between new and old pathological markers,only the frequency of detection of PDC and PDC grade 3 was found to be correlated with advanced T stage.
基金Supported by Joint Project on Regional High Incidence Diseases Research of Guangxi Natural Science Foundation,No.2024GXNSFAA010057 and No.2024GXNSFAA010085Natural Science Foundation of Guangxi,China,No.2022GXNSFBA035657+2 种基金Guangxi Zhuang Autonomous Region Health Commission Self-Financed Scientific Research Project,No.Z20210764Guangxi Zhuang Autonomous Region Administration of Traditional Chinese Medicine Scientific Research Project,No.GXZYA20230270 and No.GXZYA20240305Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University(2022).
文摘BACKGROUND Hepatocellular carcinoma(HCC)is one of the most prevalent and aggressive forms of liver cancer,with high morbidity and poor prognosis due to late diagnosis and limited treatment options.Despite advances in understanding its molecular mechanisms,effective biomarkers for early detection and targeted therapy remain scarce.Zinc finger protein 71(ZNF71),a zinc-finger protein,has been implicated in various cancers,yet its role in HCC remains largely unexplored.This gap in knowledge underscores the need for further investigation into the ZNF71 of potential as a diagnostic or therapeutic target in HCC.AIM To explore the expression levels,clinical relevance,and molecular mechanisms of ZNF71 in the progression of HCC.METHODS The study evaluated ZNF71 expression in 235 HCC specimens and 13 noncancerous liver tissue samples using immunohistochemistry.High-throughput datasets were employed to assess the differential expression of ZNF71 in HCC and its association with clinical and pathological features.The impact of ZNF71 on HCC cell line growth was examined through clustered regularly interspaced short palindromic repeat knockout screens.Co-expressed genes were identified and analyzed for enrichment using LinkedOmics and Sangerbox 3.0,focusing on significant correlations(P<0.01,correlation coefficient≥0.3).Furthermore,the relationship between ZNF71 expression and immune cell infiltration was quantified using TIMER2.0.RESULTS ZNF71 showed higher expression in HCC tissues vs non-tumorous tissues,with a significant statistical difference(P<0.05).Data from the UALCAN platform indicated increased ZNF71 levels across early to mid-stage HCC,correlating with disease severity(P<0.05).High-throughput analysis presented a standardized mean difference in ZNF71 expression of 0.55(95%confidence interval[CI]:0.34-0.75).The efficiency of ZNF71 mRNA was evaluated,yielding an area under the curve of 0.78(95%CI:0.75-0.82),a sensitivity of 0.63(95%CI:0.53-0.72),and a specificity of 0.82(95%CI:0.73-0.89).Diagnostic likelihood ratios were positive at 3.61(95%CI:2.41-5.41)and negative at 0.45(95%CI:0.36-0.56).LinkedOmics analysis identified strong positive correlations of ZNF71 with genes such as ZNF470,ZNF256,and ZNF285.Pathway enrichment analyses highlighted associations with herpes simplex virus type 1 infection,the cell cycle,and DNA replication.Negative correlations involved metabolic pathways,peroxisomes,and fatty acid degradation.TIMER2.0 analysis demonstrated positive correlations of high ZNF71 expression with various immune cell types,including CD4^(+)T cells,B cells,regulatory T cells,monocytes,macrophages,and myeloid dendritic cells.CONCLUSION ZNF71 is significantly upregulated in HCC,correlating with the disease’s clinical and pathological stages.It appears to promote HCC progression through mechanisms involving the cell cycle and metabolism and is associated with immune cell infiltration.These findings suggest that ZNF71 could be a novel target for diagnosing and treating HCC.
基金Supported by the Startup Fund for Scientific Research,Fujian Medical University,No.2020QH1168Fujian Provincial Science and Technology Innovation Joint Funds,No.2024Y9023the Fujian Provincial Natural Science Foundation of China,No.2024J011644.
文摘BACKGROUND Gastric adenocarcinoma with primitive phenotypes has recently attracted increasing attention due to its aggressive nature and challenging diagnosis.Gastric adenocarcinoma with enteroblastic differentiation(GAED)and hepatoid adenocarcinoma(HAC)were previously regarded as gastric adenocarcinoma with primitive enterocyte phenotype(GAPEP).GAPEP is known for its poor prognosis,and the accurate diagnosis of GAPEP directly affects therapeutic decision-making.Despite their poor prognosis and morphological heterogeneity,the molecular drivers of GAPEP,particularly methylation-driven mechanisms,remain poorly explored.AIM To investigate the clinicopathological and molecular characteristics of GAPEP and establish an integrative diagnostic strategy to guide therapeutic decision-making.METHODS Based on the expression profile and morphology,patients were divided into three groups:GAPEP(including GAED and HAC),conventional gastric cancer(CGC),and CGC expressing primitive phenotypic markers.We analyzed clinicopathological features and overall survival.Data from The Cancer Genome Atlas were also analyzed,and functional enrichment analysis was conducted.RESULTS GAPEP showed diverse morphology,and immunohistochemical staining alone was not adequate for accurate diagnosis.Histologically,GAPEP was characterized by large,polygonal tumor cells with supranuclear or subnuclear vacuoles,a“piano keyboard-like”appearance,and clear or eosinophilic cytoplasms.Compared to CGC and CGC expressing primitive phenotypic markers,GAPEP displayed more aggressive clinical features.Molecular analysis showed significant differences in molecular subtypes,TP53 mutation,ERBB2 amplification,ARID1A mutation,MSI status,and CpG island methylator phenotype category.Genomic analysis revealed that TP53 mutations,APC mutations,and ERBB2 amplifications were more frequent in GAPEP.Genes involved in methylation processes were highly upregulated in GAPEP.HAC and GAED shared similar clinicopathological and genetic characteristics.Functional enrichment analysis highlighted the critical role of methylation in the development of GAPEP.CONCLUSION The diversity and aggressiveness of GAPEP are driven by deregulated methylation,necessitating the integration of morphological and immunohistochemical diagnosis.Targeting methylation can provide new therapeutic opportunities for treating this aggressive cancer.
文摘BACKGROUND Epigenetic involvement of methyltransferase-like factor 14(METTL14)in tumor development has not been clearly defined.AIM To investigate METTL14 expression and its relationship with pathological stage in patients undergoing radical surgery for colorectal cancer(CRC).METHODS This retrospective study included 80 patients with CRC who were admitted to the Third Hospital of Hefei and the Western District of the First Affiliated Hospital of Anhui Medical University between June 2021 and June 2024.These patients were selected for treatment.Lesions and adjacent tissues were collected from these patients,and METTL14 expression was assessed using immunohistochemistry.Expression levels of METTL14 were compared across different tissue samples.Additionally,we evaluated METTL14 expression in patients with varying pa-thological characteristics using statistical methods such asχ2 tests and analysis of variance to identify significant differences.RESULTS The positivity rate of METTL14 in tumor tissues was significantly lower than that in adjacent tissues(30%vs 60%,P<0.05).Conversely,the negative expression rate of METTL14 was higher in tumor tissues compared to adjacent tissues(P<0.05).The positive expression of METTL14 mRNA did not differ by age,sex,tumor tissue classification,tumor diameter,or tumor location(P>0.05).However,the positive expression rate of METTL14 was significantly lower in patients with lymph node metastasis,invasion depth T3+T4,and tumor,node,and metastasis(TNM)stage III/IV compared to those without lymph node metastasis,invasion depth T1+T2,and TNM stage I(P<0.05).Specifically,METTL14 mRNA expression was significantly lower in patients with lymph node metastasis(0.51±0.12 vs 1.23±0.25,P<0.001),invasion depth T3+T4(0.48±0.15 vs 1.18±0.21,P<0.001),and TNM stage III/IV(0.45±0.13 vs 1.20±0.22,P<0.001)compared to those with no lymph node metastasis,invasion depth T1+T2,and TNM stage I,respectively.CONCLUSION In CRC,low positive METTL14 expression is closely correlated with lymph node metastasis,invasion depth T3+T4,and TNM stage,indicating the malignant biological behavior of rectal cancer.
文摘BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrasonography(EUS),but atypical EUS features have also been reported.Previous studies have found that atypical features of gastric IFPs observed under EUS have corresponding histological manifestations.At present,there is no study elaborating the EUS manifestations of gastric IFPs at different pathological stages.We hypothesize that gastric IFPs at different pathological stages may have different EUS features.AIM To describe EUS features of gastric IFPs and compare with their pathological characteristics.METHODS Clinical data of 53 inpatients with pathologically diagnosed gastric IFPs after endoscopic treatment were collected.All patients underwent preoperative EUS.We analyzed the EUS characteristics of the lesions and compared with the pathological characteristics and staging of the resected specimens.RESULTS Most gastric IFPs showed medium-low echo(67.9%),homogeneous echo(90.6%),and unclear boundaries(83%),and involved the second and third layers of the gastric wall(69.8%)under EUS.The echogenicity level and echo homogeneity were significantly correlated with the pathological stage of gastric IFP.Gastric IFPs in the nodular stage presented hypoechoic and homogeneous echo.Gastric IFPs in the fibrovascular stage mostly showed medium-low echo and homogeneous echo.Gastric IFPs in the sclerotic stage showed different echogenicity levels and echo homogeneity.The accuracy of EUS in diagnosing gastric IFPs was 66.0%(35/53),and the accuracy in determining the origin layer of gastric IFPs was 73.4%(39/53).CONCLUSION Gastric IFPs at different pathological stages have different EUS features.In order to improve the diagnostic rate,it is necessary to combine EUS with EUS-guided fine-needle aspiration or artificial intelligence.
文摘BACKGROUND Esophageal submucosal gland duct adenoma(ESGDA)is very rare,and easily diagnosed as adenocarcinoma.CASE SUMMARY A 70-year-old man presented with abdominal discomfort and intermittent dull pain during swallowing for 10 days.Digestive endoscopy revealed a polypoid bulge at the esophago-gastric junction,which was resected by endoscopic submucosal dissection(ESD).Routine pathological examination showed intestinal metaplasia of the glandular epithelium on the mucosal surface,with serous tumor-like complex glands in the submucosa which showing significant hyperplasia.This initially diagnosis was early gastric adenocarcinoma.However,we still observed a few points that did not meet the criteria for cancer such as lack of malignant features.Following multidisciplinary discussion and consultation with the experienced specialist pathologists,we finally diagnosed the lesion as a rare ESGDA by further immunohistochemistry.The follow-up examination results for the patient were satisfactory,with no evidence of tumor recurrence.And we summarize the ESGDAs reported in the literature,aiming to enhance understanding of this tumor type.CONCLUSION ESGDA is a benign tumor that can be cured by ESD.Accurate diagnosis can prevent unnecessary extensive therapeutic interventions.
