Prognostic factors of retroperitoneal soft tissue sarcomas: analysis of 132 cases.

BACKGROUND: Retroperitoneal sarcoma is a rare disease with poor prognosis. The aim of this study was to investigate the prognostic factors of the disease. METHODS: Between January 1988 and December 2003, 132 patients with retroperitoneal sarcoma were surgically treated in our hospital, 79 of them were followed up for 1 - 122 months (median: 19 months). Their clinicopathological data including tumor size, histological subtype, grade and resection margin status, were studied. The Kaplan-Meier method and log-rank test were used to analyze the disease-specific survival rates after the resection. RESULTS: Among the 132 patients, 98 (74.2%) received macroscopic complete resection, 29 (22.0%) incomplete resection, and 5 (3.8%) surgical biopsy. In the 79 patients who were followed up, macroscopic clear resection of retroperitoneal sarcoma (n = 49) was associated with a significantly higher survival rate compared with unclear resection (n = 30, P < 0.001). The median survival period was 31 months (95% CI, 20.09 - 41.91; actuarial 1-year survival, 85.7%) in the patients with the tumor completely resected and 11 months (95% CI, 6.71 - 15.29; actuarial 1-year survival, 46.7%) in those with incomplete resection. Patients with high-grade sarcomas had a significantly shorter survival time (n = 39; median: 24, 95% CI: 5.71 - 42.29) than those with low-grade sarcomas (n = 40; median: 15; 95% CI: 8.80 - 21.20; P < 0.01). Moreover, compared with the patients with the tumor sized < 15 cm in diameter (n = 53), the survival rate was lower in those with a sarcoma sized > 15 cm (n = 26). (Median: 12, 95% CI: 8.26 - 15.74 vs median: 24, 95% CI: 17.25 - 30.75; P < 0.05). Furthermore, the survival of the patients with liposarcomas (n = 29, median: 29, 95% CI: 12.84 - 45.16), leiomyosarcomas (n = 14, median: 11, 95% CI: 6.11 - 15.89), and others (n = 36, median: 22, 95% CI: 14.95 - 29.05) varied significantly (P < 0.05). CONCLUSION: Completeness of resection, tumor volume, grade, and subtype are prognostic factors of retroperitoneal soft tissue sarcomas.

[Primary diffuse large B-cell non-Hodgkin's lymphoma of the small intestine: clinicopathologic features, management, and prognosis in 24 patients].

OBJECTIVE: To investigate the clinicopathological features of primary diffuse large B-cell lymphomas (DLBCLs) of the small intestine, CD10 expression, and their relationship to prognosis. METHODS: Twenty-four cases of small intestinal DLBCLs were studied clinically and pathologically. All cases were staged according to the Ann Arbor classification of lymphoma. RESULTS: Fifteen cases (62.5%) were at stages I and II, and nine cases (37.5%) at stages III and IV. The Karnofsky performance status ranged from 40% to 100% (mean 75.5%). Twenty cases (83.3%) received surgical resection, sixteen cases (66.7%) received chemotherapy, and no patient received radiotherapy. Seven of 19 cases (36.8%) were CD10+. Although there was no statistically significant difference(P = 0.28) in therapy result between the CD10+ and CDO1--groups, patients with CD10+ lymphoma more frequently presented with stages I compared with those with CD10 - lymphoma (P = 0.013). Follow-up information was available in 19 cases ranging from 1 to 111 months (mean 32.7 months). Five cases died of the disease. The mortality rate was 26.3%. The analysis of survival rate showed a longer overall survival duration in the stage I and II group compared with that of the stage III and IV group ( P = 0.0197 ) , but there was no significant difference between CD10+ and CD1- groups. CONCLUSION: The primary small intestnal diffuse large B cell lymphoma patients at stage I and II respond better to therapy including surgical resection and chemotherapy than those at stage III and IV. CD10+ expression is more common in stage I lymphomas.

[Research of rat small intestinal mesentery lymphoid tissue stimulating allograft mixed lymphocyte reaction].

OBJECTIVE: To evaluate the effect of the small intestinal mesenteric lymphoid tissues stimulating mixed lymphocyte reaction with dendritic cells (DC) and peripheral blood monocyte cells (PBMC), and observe the changes of the MHC molecular expression on DC. METHODS: DC, PBMC and mixed lymphocyte were separated to culture from SD rats. Lymphoid tissue suspension was adopted from small intestinal mesentery of Wistar rats. In the mixed lymphocyte reaction (MLR), the cellular proliferation of small intestinal mesenteric lymphoid tissue antigen act on DC and PBMC was detected with cell counting of CCK-8 assay, the same assay used in small intestinal mesenteric lymphoid tissue antigen and ovalbumin (OVA) acting on DC. FACS analysis was performed after lymphoid tissue suspension stimulating DC to observe the MHC molecular expression. RESULTS: In the lymphoid tissue suspension, 91% of the cells was lymphocyte, others including granulocyte, plasmocyte, epithelium. The effect of stimulating mixed lymphocyte proliferation were higher in DC groups than in PBMC groups with the small intestinal mesenteric lymphoid tissue (P < 0.05). In the proportion of DC and mixed lymphocyte >or= 1:100 groups, the mixed lymphocyte proliferation were higher in the small intestinal mesenteric lymphoid tissues groups than in the OVA groups (P < 0.05). After stimulated by the small intestinal mesenteric lymphoid tissue, DC expressed higher MHC-I and -II molecules than control groups. CONCLUSIONS: The small intestinal mesenteric lymphoid tissue has high antigenicity; the antigen presenting ability of DC was much stronger than granulocytes; DC expresses high MHC-I and MHC-II molecules after stimulated by mixed lymphoid tissue suspension.

[Clinical analysis of infectious complications following abdominal cluster transplantation].

OBJECTIVE: To investigate the characteristic and management of postoperative infection in abdominal cluster transplantation. METHODS: Preliminary experience of two cases of abdominal cluster transplantation including small intestine was reviewed. RESULTS: Combination of five immunosuppressive agents based on tacrolimus was used. Severe Gram-negative bacillus infections occurred. The majority of invasive fungal infections was due to Candida species. Cytomegalovirus (CMV) infection increased monocytes and caused eosinopenia and an inversion of the CD4(+) to CD8(+) cell ratio in recipient I, and human CMV matrix proteins pp71 (CMV-pp71) was detected and identified in bile by PCR. Microabscesses in liver transplant biopsies were presented. CONCLUSIONS: Infectious complications after cluster transplantation were complicated. Strategies to optimize the immunity suppression protocol and early diagnosis and treatment will be important to reduce infection after abdominal cluster transplantation.

Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas.

BACKGROUND: Solid-pseudopapillary tumors (SPTs) of the pancreas have been reported as rare lesions with "low malignant potential" occurring mainly in young women. This study was designed to define the clinicopathological characteristics and the effect of surgical intervention. METHODS: A retrospective clinical analysis was made of 21 patients with solid-pseudopapillary tumor of the pancreas admitted from June 1994 to December 2004. RESULTS: Abdominal pain as the major complaint was found in 13 patients, and palpable abdominal mass in 7. Imaging examination showed the abdominal mass clearly, but diagnosis was not defined. In 12 patients, tumors were located in the pancreatic head and in 9 patients, in the pancreatic tail. The average diameter of the tumor was 9.5 cm (range, 3-20 cm). One patient had liver metastasis. The diagnosis of the tumor was proved pathologically during operation in 14 patients, and other 3 patients who had been diagnosed as having insulinoma and other malignant tumors were confirmed by paraffin section and enzyme labeling after operation. Eighteen patients (85.7%) were followed up with a median period of 24 months, 1-60 months without tumor recurrence. CONCLUSION: Huge pancreatic masses of the pancreas in young women are suggestive of solid-pseudopapillary tumors. Aggressive surgical therapy can result in good prognosis in these patients.

[Operative techniques and common complications of modified orthotopic intestinal transplantation in rats].

OBJECTIVE: To investigate operative techniques, treatment and precaution of common complications of orthotopic intestinal transplantation in the rats. METHODS: Orthotopic intestinal transplantation was performed in 120 rats by modified three cuffs method. The causes, treatment and precaution of common complications were analyzed retrospectively. RESULTS: The 7-day survival rate of recipients was 82.5% and the 30-day survival rate was 68.3%. The average volume of bleeding in the recipient operation was less than 1 ml. The result obtained from the above 99 recipients was satisfactory. The main reasons of final failure and death were as follows: anastomotic bleeding(5 rats), portal vein thrombus(2 rats), arterial thrombus(4 rats), air embolism(1 rat), infection of abdominal cavity(4 rats), aspiration pneumonitis (2 rats), anesthetic accident(2 rats) and kinking of graft intestine(1 rat). CONCLUSIONS: The sophisticated surgical technique and the delicate surgical manipulation are the prerequisite of preventing operational complication. Improving operative techniques and being familiar with the common complications can reduce the occurrence of complications and increase operative successful rate.

[Primary non-Hodgkin lymphoma of small bowel: a clinical analysis of 34 cases].

OBJECTIVE: To study the clinical characteristics,treatment and prognosis of primary non-Hodgkin's lymphoma of small bowel. METHODS: The records of 34 patients with a confirmed diagnosis of primary non-Hodgkin's lymphoma of small bowel, registered between Jan. 1996 and Dec. 2005 at our hospital, were retrieved and analysed retrospectively. RESULTS: Twenty-seven patients had B-cell lymphoma and 7 had T-cell lymphoma of the small bowel. The major symptoms included abdominal pain and intestinal obstruction. According to Ann Arbor staging classification, 22 patients belonged to stage I~II, including 20 cases of B-cell lymphoma and 2 cases of T-cell lymphoma, and 12 patients belonged to stage III~IV, including 7 cases of B-cell lymphoma and 5 cases of T-cell lymphoma. Compared with T-cell lymphoma patients, B-cell lymphoma patients had lower lymphoma stages (P<0.05). Twenty-seven patients were treated with surgical resection. Fourteen patients were treated with six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy, and 8 patients were treated with Rituximab at the same time. T-cell lymphoma patients were more often treated with emergent operation than B-cell lymphoma patients would (P<0.05). It happened more frequently that B-cell lymphoma patients reached complete remission and their accumulative survival rate was longer than T-cell lymphoma patients did (P<0.05). CONCLUSION: Patients with stages I and II B-cell lymphoma of small bowel respond well to surgery and chemotherapy, and the treatment and prognosis of patients with T-cell lymphoma of small bowel are unsatisfactory.