Table of Content

20 December 2022, Volume 22 Issue 06

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Original Articles and Clinical Research

Pathological and pathogenesis analysis of tumor-splenic sclerosing angiomatoid nodular transformation syndrome

JIANG Han-wen, WAN Huan, FU Li-na, CHEN Fei-long, CHEN Rui-zhong, ZHONG Xiao-jing

2022, 22(06):  531-536.  DOI: 10.3969/j.issn.1009-976X.2022.06.001

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Objective To investigate the clinical manifestations, pathological features and pathogenesis of tumor-splenic sclerosing angiomatoid nodular transformation （SANT） syndrome. Methods The cases of spleen Sant cases with tumor in the Department of Pathology of Guangzhou Panyu Maternal and Child Health Hospital, Sun Yat Sen Memorial Hospital of Sun Yat sen University and the Department of Pathology of Guangzhou Huayin Medical Laboratory Center Co., Ltd. were retrospectively analyzed. The clinical data, pathological paraffin sections, immunohistochemistry and in situ hybridization sections were collected. A total of 22 case reports from 20 related articles in Wanfang database and PubMed medical database were searched and reviewed. Results Among the 8 cases of SANT, 4 had tumor-splenic SANT syndrome, which was found incidentally during the examination before tumor resection. The pathological features include the appearance of the SANT as a circular nodule with clear boundary and easy separation from the surrounding normal splenic tissue. There are a large number of mature sclerosing collagen fibers inside, forming segmented fibrous septa. Microscopically, the remnant red pulp tissue was surrounded by sclerosing fibrous collagen as an island, which was scattered with macrophages, lymphocytes, plasma cells and hemosiderin cells. There were different expression patterns of CD8, CD31 and CD34 in the three types of blood vessels. CD68 showed that macrophages in the residual red medullary were functionally active. Conclusion Both clinicians and pathologists need to consider the possibility of tumor-splenic SANT syndrome when diagnosing patients with SANT or malignant tumors with splenic mass.

The blood supply to the nipple areola complex （NAC） based on dynamic contrast-enhanced MRI exams

WANG Zun, ZHU Ye-feng, LI Lu, JIANG Min, GAO Ying-fei, FU Shi-xin

2022, 22(06):  537-541.  DOI: 10.3969/j.issn.1009-976X.2022.06.002

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Objective The aim of this study was to evaluate the blood supply characteristics of the nipple-areolar complex （NAC） with dynamic contrast-enhanced MRI, and to provide an anatomical basis for the design of surgical incisions and intraoperative NAC vascular protection. Methods From January 2020 to December 2021, the breast magnetic resonance imaging data of 396 breasts in 198 female patients in Shenzhen Baoan Women's and Children's Hospital were collected retrospectively. The axial, coronal and sagittal maximum intensity projection （MIP） images were assessed, all the arteries supplying the NAC were identified by 3D MIP images. The blood supply sources of NAC were divided into 9 zones： superomedial, medial, inferomedial, superolateral, lateral, inferolateral, central, inferior, and superior. Results Of the 396 breasts（diseased breasts 221 and healthy breasts 185）, 84 （21.2%） were supplied by single region, 207（52.3%） by double region, and 105（26.5%） by three regions and above. The characteristics of the blood supply to the NAC did not differ significantly between diseased breasts and healthy breasts （P>0.05）. A total of 830 blood vessels were found, of which 346 （41.7%） were from superomedial, 102（12.3%） from medial, 66（8.0%） from inferomedial, 7（0.8%） from superior, and 9（1.1%） from central, 17（2.0%） from Inferior, 251（30.2%） from superolateral, 8 （1.0%） from lateral, 24（2.9%） from inferolateral. There was no significant difference in the number of NAC perfusion zones （P>0.05） and the distribution of source vessels （P>0.05）. Conclusion Preoperative breast MRI can dedicate clear information of blood supply to NAC. Blood vessels from the superomedial and superolateral zones were the predominant sources of blood supplying the NAC. Most NACs have dual-zone blood supply and above.

Application of pure wave linear array probe in the diagnosis of early breast cancer and the localization of tumor margin before breast conserving resection

YAO Gong-zhi, JIANG Hui-yue, LIN Jia-li, SUN Lu

2022, 22(06):  542-546.  DOI: 10.3969/j.issn.1009-976X.2022.06.003

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Objective To explore the value of pure wave linear array probe in the diagnosis of early breast cancer and the localization of tumor margin before breast conserving resection. Methods 200 patients with suspected early breast cancer were selected and divided into observation group （n=100） and control group （n=100）, the observation group was given pure wave linear array probe, and the control group was given ordinary linear array probe,The diagnosis, ultrasonic features and related surgical indexes of breast conserving resectionl of the two groups were observed. Results The diagnostic accuracy of early breast cancer in the observation group was 80.00%, which was significantly higher than that in the control group （P<0.05）. The ultrasonic features of breast cancer in the observation group： unclear boundary, microcalcification and the proportion of blood flow grade Ⅱ ~ Ⅲ were 62.50%, 70.00% and 73.75% respectively, which were significantly higher than those in the control group （P<0.05）; In the observation group, the proportion of cutting edge >2 cm and the rate of positive cutting edge requiring secondary dilatation were 12.50% and 8.33% respectively, which were significantly lower than those in the control group （P<0.05）. In the observation group, the preoperative prediction of tumor size and tissue resection area and postoperative anastomosis ratio were 61.76% higher than those in the control group. Conclusion The pure wave linear array probe has higher coincidence rate and sensitivity in the diagnosis of early breast cancer, and has higher diagnostic efficacy. The pure wave linear array probe has higher evaluation value for the location of surgical margin and the size and resection range of mass after mastectomy, and has higher clinical reference value.

The expression of miR-130b-3p in the blood of patients with non-small cell lung cancer and its potential significance

LI Jing-xiao, LI Guo-sheng, XU Yang, HE Rong-quan, ZHOU Hua-fu, KONG Jin-liang, CHEN Gang

2022, 22(06):  547-554.  DOI: 10.3969/j.issn.1009-976X.2022.06.004

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Objective This research aims to explore the expression and potential clinical significance of miR-130b-3p in the blood of NSCLC patients. Methods The Cancer Genome Atlas, Gene Expression Omnibus, and Sequence Read Archive were used to download NSCLC-associated miRNAs expression data, then the expression data of miR-130b-3p was extracted from included datasets. Estimating standardized mean difference （SMD） to comprehensively present the expression level of miR-130b-3p in the blood of NSCLC patients. A diagnostic test was performed to explore the discriminated potential of differentially expressed miR-130b-3p between NSCLC patients and healthy people. By making an interaction for predicted results from 12 databases in miRwalk 2.0, we screened out the downstream target genes of miR-130b-3p. Enrichment analysis was used to find potential signaling pathways of miR-130b-3p downstream target genes in regulating NSCLC development. Results A total of 300 blood samples from seven studies were included. MiR-130b-3p is downregulated in blood of NSCLC patients, including both LUAD （SMD=-1.45,95%CI： -2.66~-0.23） and LUSC （SMD=-0.46, 95%CI：-0.84~-0.09）. The diagnostic test indicated miR-130b-3p has a good potential to discriminate NSCLC patients from healthy people AUC=0.85,95%CI：0.82~0.88）. Forty-seven genes are identified as miR-130b-3p downstream targets, they significantly enrich in Renin-angiotensin system pathway. Conclusion MiR-130b-3p is downregulated in the blood of NSCLC patients and is expected to be used for early screening of NSCLC.

Analysis of perioperative risk factors associated with prolonged length of stay in patients who underwent radical resection of colon cancer

WU Jia-yao, WANG Cheng-li, ZHOU Sheng-ning, WANG Kan

2022, 22(06):  555-559.  DOI: 10.3969/j.issn.1009-976X.2022.06.005

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Objective To investigate perioperative risk factors associated with prolonged length of stay in patients who underwent radical resection of colon cancer. Methods We organized a retrospective study of all patients who underwent radical resection of colon cancer from 2019.01 to 2021.06 in Sun Yat-sen Memorial Hospital. All patients were divided into two groups based on their length of stay. Univariate and multivariate logistic regression analyses were conducted. Results 426 patients were enrolled in this study. Univariate study showed that age >64 y, ASA Ⅲ~Ⅴ, Tumor stage Ⅳ, diabetes mellitus, cardiac disease, preoperative （preop） lymphocyte <1.565×10⁹, preop albumin <36 g/L, preop D-dimer >0.49 U/L, preop CRP>3.46, duration of surgery >196 min, non-laparoscope, crystalloid infusion >1000 ml, amount of bleeding >50 ml, postoperative （postop）complications occurrence, postop ICU stay, postop albumin <29 g/L, postop lymphocyte <0.81×10⁹, postop defecating time >4 days and blood transfusion were associated with prolonged length of stay （P<0.05, OR>1）. Multivariate study showed that duration of surgery >196 min， postop defecating time >4 days and postop complications occurrence were associated with prolonged length of stay （P<0.05， OR>1）. Conclusion Duration of surgery >196 min， postop defecating time >4 days and postop complications occurrence were independent risk factors associated with prolonged length of stay in patients who underwent radical resection of colon cancer.

Clinical observation of video-assisted thoracoscopic mitral valve surgery

QIANG Yong-jia, ZENG Kuan, LIU Zhu-xuan, XU Hao-hua, YANG yan-qi

2022, 22(06):  560-564.  DOI: 10.3969/j.issn.1009-976X.2022.06.006

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Objective To investigate the surgical efficacy and skill of video-assisted thoracic surgery for mitral valve disease. Methods Nineteen patients with mitral valve disease were randomly selected and treated by video-assisted thoracoscopic approach in our hospital from November 2020 to November 2021, including 7 males and 12 females. The age range was 24-76 years, with an average of 55 years. Preoperative echocardiography showed mitral insufficiency in 13 cases, including 12 cases of severe mitral insufficiency and 1 case of moderate mitral insufficiency. There were 6 cases of mitral stenosis with insufficiency, including 5 cases of severe mitral stenosis and 1 case of moderate mitral stenosis. All cases were established cardiopulmonary bypass using superior vena cava and femoral arteriovenous cannulation under general anesthesia. Mitral surgery was performed with the assistance of video-assisted thoracoscopy, in which 17 patients underwent mitral valve replacement and 2 patients underwent mitral valvuloplasty.Results All the 19 cases were successful, and no one was converted to open surgery. The operation time ranged from 4.45 h to 10.45 h, with an average of 6.9 h; The postoperative hospital stay ranged from 8 days to 20 days, with an average of 14 days. The patients were followed up for 1 month.The volume of left atrium and left ventricular end diastolic volume were significantly reduced （P < 0.05）, and cardiac function （NYHA grade） and quality of life （Minnesota Heart Failure Quality of life questionnaire） were significantly improved. Conclusion Video-assisted thoracic surgery for mitral valve disease is less trauma but considerable safety, curative efficacy, and it will become the main cardiac surgical modality in the near future.

Outcome and influence factors of acute cerebral infarction combined with isolated distal deep vein thrombosis during hospitalization

CHEN Zhi-qiang, LIN Chun-ming, HUANG Xin, WU Quan-hui, ZHUANG Pei-pei, GUO Jin-ming, LI Xiao-hu, WANG Geng

2022, 22(06):  565-569.  DOI: 10.3969/j.issn.1009-976X.2022.06.007

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Objective To explore the risk factors for the progression of acute cerebral infarction combined with isolated distal deep vein thrombosis （IDDVT） to pulmonary embolism during hospitalization Methods Patients with acute cerebral infarction combined with IDDVT who were admitted to the Traditional Chinese Medical Hospital of Zhongshan from January 2019 to December 2021 were enrolled. The case data and outcome information were collected, and the risk factors for the progression of IDDVT to pulmonary embolism were analyzed. Results A total of 141 patients were included in the study. The length of hospital stay was 6-64 （21.9±10.1） days, 2 patients （1.4%） developed into proximal deep vein thrombosis （PDVT）. Thirteen patients （9.2%） developed into pulmonary embolism, of which 1 case was high-risk pulmonary embolism, and 12 were low-risk pulmonary embolism. Univariate analysis and multivariate logistic regression analysis showed that the length of hospital stay （OR=1.036, 95%CI： 1.034~1.164, P=0.002）, thrombosis involving bilateral lower extremities （OR=6.163, 95%CI： 1.269~29.931, P=0.024）, increased D-dimer （OR=1.122, 95%CI： 1.020-1.233, P=0.017） were independent risk factors of acute cerebral infarction combined with IDDVT developing into pulmonary embolism. Conclusion The incidence of acute cerebral infarction combined with IDDVT developing into PDVT during hospitalization is low, and the incidence of developing into pulmonary embolism is high, which may lead to high-risk pulmonary embolism. Length of hospital stay, thrombosis involving bilateral lower extremities, and increased D-dimer are independent risk factors of acute cerebral infarction combined with IDDVT developing into pulmonary embolism

Effect of intraoperative ICG angiography on surgery for hemorrhagic cerebral arteriovenous malformation

YANG Yu-min, HAn Yang-yun, LONG Xiao-dong, LI Ai-guo, LIANG Xiao-long, YE Feng, ZOU Lin-bo, LIU Zhi-yi

2022, 22(06):  570-572.  DOI: 10.3969/j.issn.1009-976X.2022.06.008

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Objective To investigate the effect of intraoperative ICG angiography on surgery for hemorrhagic cerebral arteriovenous malformation（AVM）. Methods Eight patients with hemorrhagic AVM were underwent craniotomy in our hospital from January 2010 to December 2021.Intraoperative ICG fluorescence angiography, preoperative CTA and postoperative DSA vascular imaging data were retrospective analyzed in 8 patients. The role of ICG fluorescence angiography in operation was evaluated by comparing intraoperative ICG fluorescence angiography with preoperative CTA and postoperative DSA angiography. Results Of 8 cases, the AVM was clearly developed by intraoperative ICG angiography. The images of feeding arteries and draining veins were consistent with preoperative CTA images. No vascular malformation was found on ICG fluorescence angiography after operation, which was consistent with DSA vascular imaging. Conclusion Intraoperative ICG angiography can show the scope of AVM, and clarify the feeders and drainers, which has guiding significance in the resection of hemorrhagic AVM.

Myxoifibroma of jaw bone： clinico-pathological analysis of 7 cases

LIU Huo-lian, BIAN Li-juan

2022, 22(06):  573-577.  DOI: 10.3969/j.issn.1009-976X.2022.06.009

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Objective To investigate the clinicopathological features and diagnosis of myxoifibroma of jaw bone. Methods We collected 7 cases of maxillary myxoifibroma from July 2018 to March 2022 in the Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The clinical data, imaging, morphology, immunohistochemical results and treatments of the patients were analyzed. Results There were 3 males and 4 females in 7 cases of maxillary myxoifibroma, aged from 5 to 50 years old, with a median age of 36 years and an average age of 29.286±18.382 years. All patients underwent surgical treatment. Both imaging and microscopy showed bone destruction. The tumor showed a loose mesh structure, matrix myxedema. Spindle or star-axed tumor cells were few and scattered, with oval nuclei and rare nuclear mitosis. Vimentin was consistently expressed in tumor cells （4/4） and Actin was expressed in some cases （2/5）, while Desmin, S-100, CD34 and β-catenin were totally negative. Ki67 positive index was 2% ~ 5%. Conclusion Maxillary myxoifibroma is a rare and benign otogenic tumor, but it is locally invasive and has a high recurrence rate, requiring follow-up. Preoperative imaging is tend to be confused with other jaw tumors, and histopathological and immunohistochemical inspections are required to confirm the diagnosis. Surgical excision is the main treatment method at present.

Case Report

A case of colon cancer complicated with malignant mesothelioma and the literature review

FENG Chun-bao, LU Rui-lin, WANG Ding-ping, WANG Dong, CHEN Huan-xin

2022, 22(06):  578-581.  DOI: 10.3969/j.issn.1009-976X.2022.06.010

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Malignant mesothelioma is a class of rare malignant tumor with a poor prognosis, which originates in the serosal surface. Due to the insidious onset and nonspecific clinical manifestation, it is not unusual for the missed diagnosis of malignant mesothelioma clinically. Pathology and immunohistological techniques have so far been the major diagnostic approach, owning the high sensitivity and specificity. This article reported a case of colon cancer complicated with malignant peritoneal mesothelioma, and summarized a literature review about it's pathogenesisas, diagnosis and treatment as well, trying to promote the clinical cognition of the disease.

Effective treatment of recurrent cholangiocarcinoma with Arotinib combined with Sintilimab injection： a case report and literature review

WANG Zhong-hui, CHEN Gou-lin, SU Shu-ying

2022, 22(06):  582-587.  DOI: 10.3969/j.issn.1009-976X.2022.06.011

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A patient with cholangiocarcinoma was found to have tumor recurrencemultiple intrahepatic metastasis and hilar lymph node metastasis 5 months after radical resection. She was treated with Arotinib combined with 9 courses of treatment with Sintilimab injection. Imaging examination showed that the tumor gradually shrank, necrotized and absorbed, and CA19-9 gradually decreases to normal value, achieve clinical cure. suggesting that arotinib combined with xindili monoclonal antibody in the treatment of cholangiocarcinoma can reduce the tumor load, prolong the survival time and improve the quality of life; However, its therapeutic mechanism and safety need to be further confirmed.

A case of primary malignant melanoma of liver

FU Jian, KUANG Yuan-li

2022, 22(06):  588-591.  DOI: 10.3969/j.issn.1009-976X.2022.06.012

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Objective To improve the understanding of primary malignant melanoma of the liver,and summarize the experience of diagnosis and treatment of this disease. Methods Clinical data of 1 patient with primary malignant melanoma of the liver was retrospectively analyzed and related literature was reviewed. Results Primary malignant melanoma of the liverwhich lack specific clinical features are uncommon and difficult to be diagnosed. The diagnosis is mainly based on pathology, MRI is of great value in the diagnosis of this disease. Surgical treatment is the main treatment,In combination with Rational application of chemoradiotherapy and immunotherapy. Conclusion The preoperative diagnosis of primary malignant melanoma of the liver requires rich experience combined with MRI and other imaging examinations. The treatment is mainly surgical treatment combined with radiotherapy, chemotherapy and immunotherapy, which is of great significance for prolonging life and improving the quality of life.

A case of breast cancer with nipple hemorrhage as the only clinical manifestation

WANG Yong-nan, YAN shan-shan

2022, 22(06):  592-594.  DOI: 10.3969/j.issn.1009-976X.2022.06.013

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A case of breast cancer with nipple hemorrhage as the only clinical manifestation has been treated. After preoperative mammography, breast ultrasound, duct endoscopy, and MRI examinations, selective duct excision were performed. Frozen suggested breast cancer, and finally successful breast-conserving surgery was performed. For breast cancer with pathologic nipple discharge （PND）, even if breast ultrasound and mammography are negative, ductoscopy and MRI should be continued to avoid missed diagnosis. Breast-conserving surgery is also an option for patients with no nipple-areola complex （NAC） involvement and limited lesions.

Review

Progress in diagnosis and treatment of focal nodular hyperplasia of the liver

LI Tian-wei, YANG Zong-rui, TAI Sheng

2022, 22(06):  595-599.  DOI: 10.3969/j.issn.1009-976X.2022.06.014

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In recent years, the incidence of focal nodular hyperplasia （FNH） in the liver has gradually increased, and it has become the second most common benign liver disease after hepatic hemangioma. Its course is slow, and complications such as bleeding and rupture are rare, almost no possibility of malignant transformation. The imaging features of typical FNH include central scars and other characteristics. The imaging manifestations of atypical FNH are different and should be diagnosed and differentiated by combining medical history, laboratory examinations, and comprehensive imaging techniques. The surgical indications for FNH should be strictly controlled. The author reviewed the progress of diagnosis and treatment of FNH based on relevant domestic and foreign literature.

Mechanisms and effects of platelet changes in liver cirrhosis

LIAO Xiao-hui, YANG Chang-qing, WEI Zi-bai

2022, 22(06):  600-605.  DOI: 10.3969/j.issn.1009-976X.2022.06.015

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Liver cirrhosis can cause changes in the number and function of platelets. Platelet changes, especially the decrease of platelet number, can increase the risk of bleeding in patients with liver cirrhosis. Thrombocytopenia is closely related to bleeding after invasive procedures. Treatment of thrombocytopenia is essential to improve the prognosis of patients. This article reviews the mechanism and influence of thrombocytopenia in liver cirrhosis, providing basis for clinical diagnosis and treatment and disease evaluation of such patients.