neoplasms

摘要： BACKGROUND Atypical spindle cell lipomatous tumor(ASLT)is a rare soft tissue neoplasm with a low potential for malignancy.ASLT frequently occurs in the limb and limb girdles.However,large retroperitoneal ASLTs are extremely rare.There was no concrete case report of retroperitoneal ASLTs.CASE SUMMARY An 18-year-old woman presented with abdominal pain and a palpable mass.Abdominal computed tomography revealed a large fatty mass that was approximately 30 cm in size and filled the entire abdominal cavity.Surgical excision was indicated.The tumor did not invade the adjacent organs.The pelvic cavity was then too narrow to dissect smoothly.The mass was successfully excised without tumor rupture or adjacent organ injury.Microscopically,the neoplasm was a well-differentiated adipocytic neoplasm.Immunohistochemical staining showed that the spindle cells were positive for CD34 and desmin,in addition to multifocal positivity for S100 protein.These histological features were consistent with an ASLT.The patient’s postoperative course was uneventful.At the 12-mo followup,no evidence of recurrence or metastasis was observed.CONCLUSION To the best of our knowledge,our study is the first concrete report of a large retroperitoneal ASLT in the English literature.In the large retroperitoneal ASLT located in the pelvic cavity,which made it too narrow and tight to dissect,complete excision is difficult but very important because of recurrence risk.Although large retroperitoneal ASLTs are considered extremely rare,their detection is important for accurate evaluation and management.Owing to their significant rarity,retrospective multicenter case studies are required to determine the clinicopathologic characteristics.

摘要： BACKGROUND Laparoscopic pancreaticoenteric anastomosis is one of the technically challenging steps of minimally invasive pancreaticoduodenectomy(PD),especially during the learning curve.Despite multiple randomized controlled trials and meta-analyses,the type of pancreatico-enteric anastomosis as a risk factor for post-pancreatectomy complications is debatable.Also,the ideal technique of pancreatic reconstruction during the learning curve of laparoscopic PD has not been well studied.AIM To compare the short-term outcomes of modified binding pancreaticogastrostomy(PG)and Blumgart pancreaticojejunostomy(PJ)during learning curve of laparoscopic PD.METHODS The first 25 patients with resectable pancreatic or periampullary tumors who underwent laparoscopic PD with modified binding PG or modified Blumgart PJ between January 2015 and May 2020 were retrospectively analyzed to compare perioperative outcomes during the same learning curve.A single layer of the fullthickness purse-string suture was placed around the posterior gastrotomy in the modified binding PG.In the modified Blumgart technique,only a single transpancreatic horizontal mattress suture was placed on either side of the pancreatic duct(total two sutures)to secure the pancreatic parenchyma to the jejunum.Also,on the ventral surface,the knot is tied on the jejunal wall without going through the pancreatic parenchyma.Post pancreatectomy complications are graded as per the RESULTS During the study period,modified binding PG was performed in 27 patients and modified Blumgart PJ in 29 patients.The demographic and clinical parameters of the first 25 patients included in both groups were comparable.Lower end cholangiocarcinoma and ampullary adenocarcinoma were the primary indications for laparoscopic PD in both groups(32/50,64%).The median operative time for pancreatic reconstruction was significantly lower in the binding PG group(42 vs 58 min,P=0.01).The clinically relevant(Grade B/C)postoperative pancreatic fistula(POPF)was significantly more in the modified PJ group(28%vs 4%,P=0.04).In contrast,intraluminal postpancreatectomy hemorrhage(PPH)was more in the binding PG group(32%vs 4%,P=0.02).There was no significant difference in the incidence of delayed gastric emptying between the two groups.CONCLUSION During the learning curve of laparoscopic PD,modified binding PG reduces POPF but is associated with increased intraluminal PPH compared to PJ using the modified Blumgart technique.

摘要： Background Abnormal growth of cell called as cancer or malignancy.Although it may be seen in any age,more commonly seen in patients more than 50 years of age.where epithelial ovarian cancer has been commonly seen[1].Approximately 70%of ovarian cancers have been diagnosed at progressive stage where only 30%of women suffering from this cancer,expect to survive up to 5 years.Ovarian malignancy constitutes about 15-20 percent of genital malignancy.In India the incidence of ovarian carcinoma(age adjustable to range from 1.7 to 15.2 from 2012 to 2014)in various population-based registers of cancer.Approximately 59,276 have been estimated as new ovarian cancer causes by the end of 2020 and twenty percent of neoplasms are malignant.It is the fourth most common cause of cancer death in women exceeded only by breast,colon and lung malignancies.Again,the recurrent ovarian cancer is a fatal disease with few survivors.Despite the fact that most patients have uniform surgery and chemotherapy,the status of recurring disease varies.The location of recurrence and the periods between recurrences are likewise widely dispersed.After recurrence,approximately 70%of advanced stage ovarian cancer patients relapse,and even in stage I or II patients,the relapse rate is 20%-25%.Because the survival curve following recurrence never plateaus,the goal of treatment for recurrent ovarian cancer is to control the disease and its symptoms,limit treatment-related damage,and preserve or improve quality of life[2].There seems to be no doubt that Ayurveda,with its holistic approach,is the finest way to limit the adverse treatment outcomes while also enhancing the patient’s quality of life.

摘要： BACKGROUND The commonly used predictors of clinically relevant postoperative pancreatic fistula(CR-POPF)following pancreaticoduodenectomy(PD)have subjective assessment components and can be used only in the postoperative setting.Also,the available objective predictors based on preoperative cross-sectional imaging were not prospectively studied.AIM To evaluate the accuracy of the pancreatic attenuation index(PAI)and pancreatic enhancement ratio(PER)for predicting CR-POPF following PD and its correlation with pancreatic fat fraction and fibrosis.METHODS A prospective observational study included patients who underwent PD for benign and malignant pathology of the periampullary region or pancreatic head between February 2019 and February 2021.Patients undergoing extended or total pancreatectomy and those with severe atrophy of pancreatic tissue or extensive parenchymal calcifications in the pancreatic head and neck precluding calculation of PAI and PER were excluded from the study.Preoperatively PAI was measured in the neck of the pancreas by marking regions of interest(ROI)in the non-contrast computed tomography(CT),and PER was measured during the contrast phase of the CT abdomen.Also,the fibrosis score and fat fraction of the pancreatic neck were assessed during the histopathological examination.Demographic,clinical and preoperative radiological indices(PAI,PER)were evaluated to predict CR-POPF.Preoperative pancreatic neck CT indices were correlated with the histopathological assessment of fat fraction and fibrosis.RESULTS Of the 70 patients who underwent PD,61 patients fulfilling the inclusion criteria were included in the analysis.The incidence of CR-POPF was 29.5%(18/61).PAI had no association with the development of CR-POPF.Of the preoperative parameters,PER(mean±standard deviation[SD])was significantly lower in patients developing CR-POPF(0.58±0.20 vs 0.81±0.44,P=0.006).The area under the curve for the PER was 0.661(95%CI:0.517-0.804),which was significant(P=0.049).PER cut-off of 0.673 predicts CR-POPF with 77.8%sensitivity and 55.8%specificity.PAI and PER had a weak negative correlation(Strength-0.26,P=0.037).Also,PER showed a moderately positive correlation with fibrosis(Strength 0.50,P<0.001).Patients with CR-POPF had a significantly higher incidence of the intraabdominal abscess(50%vs 2.3%,P<0.001),delayed gastric emptying(83.3%vs 30.2,P<0.001),and prolonged mean(±SD)postoperative hospital stay(26.8±13.9 vs 9.6±3.6,P=0.001).CONCLUSION PER exhibited good accuracy in predicting the development of CR-POPF.PER additionally showed a good correlation with PAI and fibrosis scores and may be used as an objective preoperative surrogate for assessing pancreatic texture.However,ROI-based PAI did not show any association with CR-POPF and pancreatic fat fraction.

摘要： Introduction: With the advent of multiparametric MRI (mpMRI), clinicians added an important tool for helping to decide whether a man should undergo a prostate biopsy. The MRI PI-RADS system stratifies the risk of finding cancer on prostate biopsy. PI-RADS 3 lesions often prove to be a diagnostic challenge, and many men are advised not to proceed with a biopsy based on this finding. The goal of our paper was to evaluate the likelihood of finding cancer of clinical significance in this group. Methods: A retrospective 4-year data and quality analysis was performed of 312 evaluable men undergoing prostate MRI. Of the subset with scores of PI-RADS 3 who underwent biopsy (N = 32), 100 percent were biopsied using an MRI-guided fusion technique, greatly raising the likelihood that the MRI lesion was, in fact, the area sampled. Results: A total of 34% of the men with PI-RADS 3 lesions were found to have Grade Group ≥ 1, with 15.6 % demonstrating Grade Group ≥ 2. In the men with cancer, we analyzed and report the relationship to age, ethnicity, PSA density, and the presence or absence of cribriform findings. Conclusions: We found that many men with PI-RADS 3 findings on multiparametric MRI do, in fact, have clinically significant prostate cancer. We suggest that many factors (such as rate of rise of PSA over time, family history, and rectal examination findings) be considered in addition to the MRI PI-RADS score to advise whether or not to proceed with a biopsy of the prostate. Our findings, from a single, large, community hospital with a diverse ethnic makeup, parallel the findings of large trials done at academic centers of excellence. This demonstrates that comparable diagnostic mpMRI/biopsy quality may be found in the community setting.

摘要： Objective:This study aims to offer an update assessment of the knowledge of Chinese oncologists on female fertility preservation,and identify the determinants that influence the implementation of fertility preservation.Methods:A total of 713 Chinese oncologists with different specialties completed the online self-report questionnaire to assess their understanding of fertility risks in cancer treatment,knowledge on female fertility preservation,and perceptions on the barriers in referring patients for fertility preservation.Results:Although most oncologists were familiar with fertility risk in cancer treatment,half of them lacked the knowledge for reproduction and preservation methods.In the multivariable model,oncologists in a hospital with a specialized reproductive institution,positive precaution for fertility risk,and fertility preservation discussion with patients were significantly correlated with the possibility of fertility preservation referral.Conclusions:The intervention targets based on the update evaluation and identified influencing determinants will be helpful for all the oncofertility researchers,oncologists and institutions in future efforts for well-established female fertility preservation services.

摘要： 胃肠胰神经内分泌肿瘤(gastroenteropancreatic neuroendocrine neoplasms,GEP-NENs)是一类起源于神经内分泌细胞且具有神经内分泌功能的肿瘤。由于GEP-NENs的临床症状和生物学行为缺乏特异性,因此早期误诊率和漏诊率极高。同时,原发部位和分级不同的GEP-NENs分子生物学特性差异较大,因此该类肿瘤具有高度的异质性。目前对于该类疾病的诊断主要依靠于影像学和组织活检等传统方法。

摘要： 胃肠胰神经内分泌肿瘤(gastroenteropancreatic neuroendocrine neoplasms,GEP-NENs)是一类起源于神经内分泌细胞且具有神经内分泌功能的肿瘤。由于GEP-NENs的临床症状和生物学行为缺乏特异性,因此早期误诊率和漏诊率极高。同时,原发部位和分级不同的GEP-NENs分子生物学特性差异较大,因此该类肿瘤具有高度的异质性。目前,对于该类疾病的诊断主要依靠于影像学和组织活检等传统方法。

摘要： BACKGROUND Despite being the most common intraocular malignancy among adults,choroidal melanoma is a rare cancer type,even more so when accompanied by lung cancer.We report a patient with synchronous choroid melanoma and lung cancer treated with carbon ion radiotherapy(CIRT).CASE SUMMARY A 41-year-old woman was transferred to our center with a diagnosis of choroidal melanoma in her right eye.During the examination,we found a right lung tumor that was histologically diagnosed as lung cancer.The patient was treated with CIRT for both malignant neoplasms.The CIRT dose was 70 photon equivalent doses(GyE)in five fractions for the right eye choroidal melanoma and 72 GyE in 16 fractions for the right lung cancer.At 3 mo after CIRT,the choroidal melanoma completely disappeared,as did the right lung cancer 7 mo after;the patient was in complete remission.CONCLUSION CIRT may be an effective treatment for double primary lung cancer and choroid melanoma.

摘要： Malnutrition reduces tolerance and effectiveness of anti-tumor treatment(ANT),increases the risk of complications,medical costs,and death(Arends et al.,2017).About 40%of patients with cancer die because of malnutrition rather than the disease itself(Barton,2017;Roeland et al.,2020).In order to set up a panorama for association among nutrition status,nutrition support treatment(NST),ANT and outcomes in patients with neoplasms,the Chinese Society of Nutritional Oncology(CSNO)conducted a multicenter prospective cohort program called Investigation on Nutrition Status and its Clinical Outcome of Common Cancers(INSCOC)from 2013.