Peptidylarginine Deiminase Type 2 Predicts Tumor Progression and Poor Prognosis in Patients with Curatively Resected Biliary Tract Cancer.

(1) Background: PADI2 is a post-translational modification (PTM) enzyme that catalyzes citrullination, which then triggers autoimmune disease and cancer. This study aimed to evaluate the prognostic value of peptidylarginine deiminase 2 (PADI2) protein expression in biliary tract cancer (BTC) patients. (2) Methods: Using immunohistochemistry, the PADI2 protein expression in BTC tissues was analyzed. The correlations between PADI2 protein expression and clinicopathologic characteristics were analyzed using Chi-square tests. The Kaplan-Meier procedure was used for comparing survival distributions. We used Cox proportional hazards regression for univariate and multivariate analyses. From 2014 to 2020, 30 resected BTC patients were enrolled in this study. (3) Results: Patients with high PADI2 protein expression were associated with shorter progress-free survival (PFS; p = 0.041), disease-specific survival (DSS; p = 0.025), and overall survival (OS; p = 0.017) than patients with low PADI2 protein expression. (4) Conclusions: The results indicated that PADI2 protein expression was an independent poor prognostic factor for BTC patients regarding PFS, DSS, and OS.

Long-term follow-up of central hepatocellular carcinoma in comparison with non-central hepatocellular carcinoma.

BACKGROUND/AIMS: Multiple hepatic vessels and portal vessels are distributed in the central segments of the liver (segments IV, V and VIII). Due to its anatomical complexity, in centrally-located hepatocellular carcinoma (cHCC) it is theoretically not easy to reach a wide margin, as it is in non-central hepatocellular carcinoma (ncHCC) (segments II, III, VII and VIII). We compared their outcomes to see if cHCC has an inferior result than ncHCC. METHODOLOGY: From August 2000 to July 2008, 213 HCC patients received curative-intended resection. Sixty-nine cHCC (group A) and 64 ncHCC (group B) received trisegmentectomy (include mesohepatectomy), bi-segmentectomy, mono-segmentectomy or subsegmentectomy. The outcomes were retrospectively analyzed. RESULTS: The in-hospital mortality was 0% and 3.12% in groups A and B, respectively (p=0.55). The morbidity was 27.5% and 28.1% in groups A and B, respectively (p=0.23). The 1- and 3-year disease-free survival were 68%, 50% and 62%, 33% in groups A and B, respectively (p=0.39). The 1- and 3-year overall survival rates were 83%, 75% and 89%, 70% in groups A and B, respectively (p=0.91). Tumor size and numbers were significant factors for disease-free and overall survival. CONCLUSIONS: cHCC treated by partial hepatectomy and mesohepatectomy has a comparable result to ncHCC. Mesohepatectomy is needed only in some selected patients.

Association of Chinese herbal medicine use with the depression risk among the long-term breast cancer survivors: A longitudinal follow-up study.

Background: Breast cancer patients are at elevated risk of depression during treatment, thus provoking the chance of poor clinical outcomes. This retrospective cohort study aimed to investigate whether integrating Chinese herbal medicines citation(CHM) into conventional cancer therapy could decrease the risk of depression in the long-term breast cancer survivors. Methods: A cohort of patients aged 20-70 years and with newly diagnosed breast cancer during 2000-2008 was identified from a nationwide claims database. In this study, we focused solely on survivors of breast cancer at least1 year after diagnosis. After one-to-one matching for age, sex, and baseline comorbidities, breast cancer patients who received (n = 1,450) and did not receive (n = 1,450) CHM treatment were enrolled. The incidence rate and hazard ratio citation(HR) for depression between the two groups was estimated at the end of 2012. A Cox proportional hazard model was constructed to examine the impact of the CHM use on the risk of depression. Results: During the study period, the incidence rate of depression was significantly lower in the treated cohort than in the untreated cohort [8.57 compared with 11.01 per 1,000 person-years citation(PYs)], and the adjusted HR remained significant at 0.74 (95% CI 0.58-0.94) in a Cox proportional hazards regression model. The corresponding risk further decreasing to 43% among those using CHM for more than 1 year. Conclusion: Finding from this investigation indicated that the lower risk of depression observed in breast cancer patients treated with CHM, suggesting that CHM treatment should be considered for disease management toward breast cancer. Yet, the optimal administered dose should be determined in further clinical trials.

Diagnostic value of I-131 NP-59 SPECT/CT scintigraphy in patients with subclinical or atypical features of primary aldosteronism.

Accumulating evidence has shown the adverse effect of long-term hyperaldosteronism on cardiovascular morbidity that is independent of blood pressure. However, the diagnosis of primary aldosteronism (PA) remains a challenge for patients who present with subtle or atypical features or have chronic kidney disease (CKD). SPECT/CT has proven valuable in the diagnosis of a number of conditions. The aim of this study was to determine the usefulness of I-131 NP-59 SPECT/CT in patients with atypical presentations of PA and in those with CKD. The records of 15 patients with PA were retrospectively analyzed. NP-59 SPECT/CT was able to identify adrenal lesion(s) in CKD patients with suspected PA. Patients using NP-59 SPECT/CT imaging, compared with those not performing this procedure, significantly featured nearly normal serum potassium levels, normal aldosterone-renin ratio, and smaller adrenal size on CT and pathological examination and tended to feature stage 1 hypertension and non-suppressed plasma renin activity. These findings show that noninvasive NP-59 SPECT/CT is a useful tool for diagnosis in patients with subclinical or atypical features of PA and those with CKD.

Relationship between the use of Chinese herbal medicines and Sjögren syndrome risk among women with menopause: a retrospective cohort study.

OBJECTIVE: Menopausal women appear to report a higher risk of Sjögren syndrome (SS). Although Chinese herbal medicines (CHMs) are proven to lower SS risk, the scientific evidence of whether it can lessen the occurrence of SS among menopausal women is limited. This longitudinal cohort study aimed to clarify the relationship between CHMs use and SS risk in menopausal women. METHODS: Using a nationwide claims data, we enrolled 31,917 women with first-time diagnosed menopause who simultaneously were free of SS between 2000 and 2007. Among them, we randomly selected 12,757 CHMs users and 12,757 non-CHMs users using propensity scores matching. All participants were followed until the end of 2012 to record SS incidence. The hazard ratio of SS with regard to CHMs use was estimated using the Cox proportional hazards regression model. RESULTS: In the follow-up period, 589 CHMs users and 644 non-CHMs users developed SS, representing incidence rates of 5.12 and 6.40, respectively, per 1,000 person-years. CHMs use was associated with a 21% lower subsequent risk of SS (adjusted hazard ratio, 0.79; 95% CI, 0.71-0.89). Six commonly prescribed CHMs were discovered to be associated with lower SS risk: Ge-Gen-Tang, Zhi-Gan-Cao-Tag, Da-Huang, Ye-Jiao-Teng, Tian-Hua-Fen, and Bo-Zi-Ren. CONCLUSIONS: A statistically significant association was found between CHMs use and lower risk of SS onset in menopausal women, suggesting that CHMs could be considered to integrate it into conventional therapy to reduce subsequent SS risk for menopausal women.

The cytology of a thyroid granular cell tumor.

Granular cell tumor (GCT) of the thyroid is rare. Before this report, only four cases of thyroid GCT have been reported, none of which presented a cytopathological examination. In this paper, we report the fine needle aspiration cytology and pathological analysis of a thyroid GCT from a 12-year-old girl who presented with a painless neck mass. The tumor cells were single, in syncytial clusters, or pseudofollicles, contained small round, oval, or spindle nuclei, indistinct nucleoli, and a large amount of grayish, granular fragile cytoplasm. The background contained granular debris and naked nuclei. A differential diagnosis of thyroid GCT with more frequent thyroid lesions containing cytoplasmic granules, including Hurthle cells, macrophages, follicular cells, and cells of black thyroid syndrome, was also performed.

Open colectomy versus laparoscopic-assisted colectomy supported by hand-assisted laparoscopic colectomy for resectable colorectal cancer: a comparative study with minimum follow-up of three years.

BACKGROUND/AIMS: Although laparoscopic colorectal cancer surgery is not widely used for several reasons especially for concerning inadequate resection, recent data showed equivalent oncologic outcomes between open colectomy (OC) and laparoscopic-assisted colectomy (LAC). However, there is no clinical trial for the LAC supported by hand-assisted laparoscopic colectomy (HALC), named as LAC/HALC. METHODOLOGY: Patients were assigned to either OC or LAC/HALC group. Clinical data, operation times, conversion rates from LAC to HALC, complications, early results, and long-term results were analyzed retrospectively. RESULTS: The short-term outcomes including pain, ambulation, oral resumption, wound infections, and hospital stays were favorable for LAC/HALC group. HALC was subsequently required in seven LAC cases but none of them required open colectomies. Functional recovery was the benchmark for early discharge for LAC/HALC group. Specimen size and number of lymph nodes harvested were similar. Local recurrence, disease-free and overall survival rates were comparable. CONCLUSION: The current study demonstrated that LAC/HALC was associated with favorable recoveries even in oncologic clearance in the long-term follow-up. HALC reduces the conversion rate from LAC to OC and maintains the benefits of minimal invasive surgery. Therefore, we suggest LAC/HALC is a suitable surgical hybrid for the treatment of resectable colorectal cancers.

Delayed-Onset Chylous Ascites After a Living-Donor Liver Transplant: First Case Successfully Treated With Conservative Treatment?

Chylous ascites is a rare complication in liver transplant. Few cases have been reported to date. In most cases, chylous ascites is diagnosed within 1 month after surgery because of intraoperative injury of the hilar lymphatic system. Preoperative massive ascites and use of a LigaSure vessel sealing system for hilar dissection have been reported as risk factors. We report a case of chylous ascites after a living-donor liver transplant that was diagnosed after 6 months of uneventful follow-up. Sirolimus was added to cyclosporine early (2 wk after the operation) owing to poor renal function and it was found to be high (> 22 ng/mL) when the chylous ascites occurred. The patient was treated with total parenteral nutrition in combination with Sandostatin and rapid tapering of sirolimus after the failed initial conservative treatment. Residual abdominal fullness after meals and lymphedema of the legs disappeared 1 month after discontinuing sirolimus. This is the first case of delayed-onset chylous ascites after a liver transplant that was successfully treated conservatively.

Myoepithelial carcinoma of the stomach: a diagnostic pitfall.

Myoepithelioma/myoepithelial carcinomas are not commonly found in soft tissues and are especially rare at visceral sites. This report describes a case of a rare low-grade myoepithelial carcinoma of the stomach. A 61-year-old female patient presented with postprandial abdominal discomfort. Endoscopy revealed a 1.1 cm submucosal lesion. Local excision was performed after malignancy was confirmed by biopsy. The resection margin is free of tumor and she received no adjuvant therapy. The tumor was characterized by multinodular growth with biphasic epithelioid and spindle components. Infiltrative margin and nuclear pleomorphism are seen. Tumor cells were positive for both epithelial and myoepithelial markers. Evidence of epithelial differentiation was confirmed by electron microscopy. No EWSR1 rearrangement was detected. The final diagnosis was low-grade myoepithelial gastric carcinoma. The patient is currently well, and no evidence of recurrence or metastasis was found after ten-month of follow-up. Myoepithelial carcinoma should be considered in the differential diagnosis of a biphasic gastric tumor.

The safety and adequacy of resection on hepatocellular carcinoma larger than 10 cm: A retrospective study over 10 years.

BACKGROUND/PURPOSE: Current treatment options for HCC≥10 cm (huge HCC) are limited. Otherwise, the margin status is known as a prognostic factor. Our aim was to determine the safety, effectiveness, and risk factors for overall survival and disease-free survival for these patients. METHODS: A total of 211 consecutive patients from 2000/08 to 2010/12 were enrolled. Characteristics of patients, tumors, and treatment were compared between the huge group (HCCs; ≥10 cm, n = 23; 11%) and those with smaller group (HCC; <10 cm n = 188; 89%). Disease-free survival (DFS), overall survival (OS), and risk factors were analyzed. RESULTS: Median follow up was 37 months. Patients with huge HCC were more likely to be symptomatic, positive for preoperative portal vein thrombosis, longer surgical time, more blood loss and transfusions, and significantly shorter median OS and DFS. Both groups had similar postoperative mortality and morbidity rates. In the huge HCC, multivariate analysis identified two significant determinants of DFS (preoperative portal vein thrombosis on imaging and tumor-free margin less than 1 mm) and two significant determinants of OS (age over 80 and preoperative portal vein thrombosis). Even with positive margins, it still had no impact on OS. For DFS, 1 mm free margins appeared to be adequate. CONCLUSION: Tumor-free margin is an independent risk factor for recurrence but has no impact on OS. Surgical margin >1 mm is adequate in patients with tumors ≥10 cm. Postoperative close follow up, especially of distant metastasis, and appropriate treatment of recurrence by a multidisciplinary approach may improve prognosis.

Vascular invasion affects survival in early hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is an aggressive malignant tumor with a high mortality rate. The optimal therapeutic choice for early HCC is surgical resection. However, the rate of intrahepatic recurrence is high. The objective of this study was to evaluate the effect of various factors on the survival of patients with early HCC. Between January 1st, 2006 and December 31st, 2013, a total of 89 patients who underwent surgery for HCC were retrospectively enrolled. The analysis was conducted using the Student's t-test, Chi-square test, Kaplan-Meier method and Cox proportional hazard regression model to assess potential confounding and predictive variables. The 3-year overall survival (OS) rate was 71%. The 3-year OS rates in patients with and those without vascular invasion were 62.1 and 92.8%, respectively (P<0.003). Based on the multivariate analysis, postoperative pathological vascular invasion (hazard ratio = 4.96; 95% confidence interval: 1.55-15.9) remained an independent predictor of adverse long-term outcome. Furthermore, vascular invasion was significantly associated with intrahepatic metastasis. These data emphasize the need for effective adjuvant therapy in selected high-risk patients with early HCC. Further studies are required to determine the optimal approach to further improving the prognosis of early HCC.

Acute appendicitis in organ transplantation patients: a report of two cases and a literature review.

BACKGROUND: Abdominal surgery on patients with previous organ transplantation, especially in the early postoperative period, is a challenging problem. Due to high risk of complications in transplant patients, we usually tend to treat such patients more conservatively rather compared to the more aggressive attitude in diagnosis and surgery of non-transplant patients. Delayed diagnosis, delayed surgery, and high morbidity and mortality are more common in transplant patients with GI disease. While appendicitis is one of the most common surgical diseases, with an estimated lifetime risk of 8.6% for males and 6.7% for females, there are relatively few reports of appendicitis in solid organ transplant recipients, and the condition has rarely been reported after liver transplantation. CASE REPORT: We have performed surgery on 2 cases of presumed acute appendicitis among 75 cases of kidney and liver transplantation in our series in the last 10 years. Laparoscopic technique was used for exploration of presumed acute appendicitis with atypical clinical and image presentation in a deceased donor liver transplantation (DDLT) and a deceased donor kidney transplantation (DDKT). CONCLUSIONS: Acute appendicitis in both patients was highly suspected preoperatively in computed tomography, and early exploration with laparoscopic technique prompted early diagnosis and treatment, with excellent surgical outcomes.

Donor-derived Cryptococcus infection in liver transplant: case report and literature review.

Cryptococcosis occurring within 30 days after transplant is unusual. We present a case of cryptococcosis diagnosed within 2 weeks of liver transplant and cryptococcal infection transmitted by liver transplant is considered as the cause. A 63-year-old woman with hepatitis C virus-related cirrhosis and hepatocellular carcinoma had an orthotopic liver transplant from a 45-year-old donor. The immediate postoperative course was smooth, although she was confused with a fever, tachycardia, respiratory failure of 1 week's duration after the orthotopic liver transplant. A liver biopsy was performed for hyperbilirubinemia 2 weeks after the orthotopic liver transplant that showed a Cryptococcus-like yeast. Her blood culture was reexamined, and it was confirmed as Cryptococcus neoformans that had been misinterpreted as candida initially. At the time of the re-examination, her sputum was clear. We checked her preoperative blood sample, retrospectively, for serum cryptococcal antigen with negative result. She was on liposomal amphotericin treatment for 1 month when her blood culture became negative. She was discharged home, with good liver function and a low antigen titer for cryptococcal infection. Cryptococcal disease usually develops at a mean of 5.6 months after transplant. However an early occurrence is rare. Apart from that, its variable clinical presentations make early detection difficult. It might be an early reactivation or a donor-derived infection. The latter usually occurs in unusual sites (eg, the transplanted organ as the sole site of involvement). Our case presented as cryptococcoma and liver involvement was diagnosed by an unintentional liver biopsy.

Undifferentiated embryonal sarcoma of the liver with focal osteoid picture-a case report.

Undifferentiated embryonal sarcoma of the liver (UESL) is a rare primary liver tumor. Less than 100 adult cases were reported. It has female and right lobe preponderance. In pathological features, focal osteoid picture in UESL is never reported. We present a 63-year-old male patient with left lobe UESL with focal osteoid picture. He was admitted for a palpable solid mass, with left upper quadrant abdominal pain for 4 months. Abdominal computed tomography showed a huge well-circumscribed mass at left upper quadrant, 21.3 × 13 × 27.9 cm(3) in size, with multiple septa in delayed phase. En bloc resection including lateral segmentectomy, splenectomy, and cholecystectomy were performed, but tumor rupture was noted. The pathologic diagnosis was ruptured UESL. The postoperative course was uneventful, and adjuvant radiotherapy without chemotherapy was performed. Peritoneal seeding with massive ascites was noted in the 9(th) month after operation. Even after receiving salvage chemotherapy, he died 1 year after operation. Early complete surgical resection with adjuvant chemotherapy may improve prognosis of UESL. But the overall survival of UESL did not improve until recently. We present this case along with a literature review of the clinical pictures, diagnosis, pathology presentation, pathologicogenesis of focal osteoid picture, treatment, and prognosis for UESL of another 23 new reported cases since 2007.

Clinical and pathologic factors affecting lymph node yields in colorectal cancer.

OBJECTIVE: Lymph node yield is recommended as a benchmark of quality care in colorectal cancer. The objective of this study was to evaluate the impact of various factors upon lymph node yield and to identify independent factors associated with lymph node harvest. MATERIALS AND METHODS: The records of 162 patients with Stage I to Stage III colorectal cancers seen in one institution were reviewed. These patients underwent radical surgery as definitive therapy; high-risk patients then received adjuvant treatment. Pathologic and demographic data were recorded and analyzed. The subgroup analysis of lymph node yields was determined using a t-test and analysis of variants. Linear regression model and multivariable analysis were used to perform potential confounding and predicting variables. RESULTS: Five variables had significant association with lymph node yield after adjustment for other factors in a multiple linear regression model. These variables were: tumor size, surgical method, specimen length, and individual surgeon and pathologist. The model with these five significant variables interpreted 44.4% of the variation. CONCLUSIONS: Patients, tumor characteristics and surgical variables all influence the number of lymph nodes retrieved. Physicians are the main gatekeepers. Adequate training and optimized guidelines could greatly improve the quality of lymph node yields.

The association of socioeconomic status and access to low-volume service providers in breast cancer.

BACKGROUND: No large-scale study has explored the combined effect of patients' individual and neighborhood socioeconomic status (SES) on their access to a low-volume provider for breast cancer surgery. The purpose of this study was to explore under a nationwide universal health insurance system whether breast cancer patients from a lower individual and neighborhood SES are disproportionately receiving breast cancer surgery from low-volume providers. METHODS: 5,750 patients who underwent breast cancer surgery in 2006 were identified from the Taiwan National Health Insurance Research Database. The Cox proportional hazards model was used to compare the access to a low-volume provider between the different individual and neighborhood SES groups after adjusting for possible confounding and risk factors. Hosmer-Lemeshow goodness-of-fit statistic was used to determine how well the model fit the data. RESULTS: Univariate analysis data shows that patients in disadvantaged neighborhood were more likely to receive breast cancer surgery at low-volume hospitals; and lower-SES patients were more likely to receive surgery from low-volume surgeons. In multivariate analysis, after adjusting for patient characteristics, the odds ratios of moderate- and low-SES patients in disadvantaged neighborhood receiving surgery at low-volume hospitals was 1.47 (95% confidence interval=1.19-1.81) and 1.31 (95% confidence interval=1.05-1.64) respectively compared with high-SES patients in advantaged neighborhood. Moderate- and low-SES patients from either advantaged or disadvantaged neighborhood had an odds ratios ranging from 1.51 to 1.80 (p<0.001) to receiving surgery from low-volume surgeons. In Hosmer-Lemeshow goodness-of-fit test, p>0.05 that shows the model has a good fit. CONCLUSIONS: In this population-based cross-sectional study, even under a nationwide universal health insurance system, disparities in access to healthcare existed. Breast cancer patients from a lower individual and neighborhood SES are more likely to receive breast cancer surgery from low-volume providers. The authorities and public health policies should keep focusing on these vulnerable groups.

Postoperative retroperitoneal desmoid tumor mimics recurrent gastrointestinal stromal tumor: a case report.

Desmoid tumor is a locally invasive, myofibroblastic, nonmetastatic tumor. Its pathogenesis remains unclear and it may involve genetic abnormalities, sex hormones and traumatic injury, including surgery. Postoperative intra-abdominal desmoid tumor is rare, especially in the retroperitoneum. We report a case of postoperative retroperitoneal desmoid tumor that developed 29 mo after the first excision of a gastrointestinal stromal tumor. Sporadic trauma-related intra-abdominal desmoid tumors reported in the English literature are also reviewed. Despite an extremely low incidence, postoperative desmoid tumor should be considered in the differential diagnosis when a recurrent neoplasm is found at least one year after operation. However, it is a clinical challenge to distinguish recurrent malignant neoplasms from desmoid tumors, and surgical resection is the treatment option depending on the anatomic location.

Solitary concomitant endocrine tumor and ductal adenocarcinoma of pancreas.

Pancreatic tumors with combined exocrine and endocrine features are rare. Most reported cases are classified as mixed exocrine and endocrine carcinoma of the pancreas. We report the first case of solitary concomitant endocrine tumor and ductal adenocarcinoma of the pancreas. A 58-year-old patient was admitted for uncontrolled diabetes mellitus and body weight loss. The tumor was fortuitously discovered in the pancreatic tail after a tumor survey panel. Grossly, the solitary tumor had a central fibrous band that clearly divided it into two parts. On microscopic examination, the tumor contained both endocrine and exocrine components distinctly separated by the central fibrous band. The exocrine part showed a poorly-differentiated adenocarcinoma. The endocrine part was strongly immunoreactive to chromogranin, synaptophysin and glucagon. We reviewed the literature on pancreatic tumors with combined exocrine and endocrine features. A simple classification for this group of neoplasms is suggested, including five types: amphicrine, mixed, collision, solitary concomitant and multiple concomitant.

Classification of the thyroid nodules based on characteristic sonographic textural feature and correlated histopathology using hierarchical support vector machines.

In this study, the ultrasound images of thyroid nodules were classified to facilitate clinical diagnosis and management. The hierarchical support vector machines (SVM) classification system was used to select the characteristic sonographic textural feature that represents the major histopathologic components of the thyroid nodules. Two ultrasound systems (LA39 and i12L mentioned in the Materials and Methods section) were used for comparison. Seventy-six thyroid nodular lesions and 157 regions-of-interest thyroid ultrasound image from each system were recruited in the study. The parameters affecting image acquisition were kept in the same condition for all lesions. Commonly used texture analysis methods were applied to characterize thyroid ultrasound images. Image features were classified according to the corresponding pathologic findings. To estimate their relevance and performance to classification, SVMs were used as a feature selector and a classifier. The thyroid nodules are first categorized as two main types, i.e., follicle base and fibrosis base nodule, by sum average. The follicle base nodules can be further and completely classified into follicles with few cells, follicles with follicular cells and follicles with papillary cancer cells by run length nonuniformity (RLNU). The fibrosis base nodules are further classified by sum square into fibrosis with few cells and fibrosis with dominant cells. The fibrosis base neoplasm with dominant cells can be separated into fibrosis with follicular cells and fibrosis with papillary cancer cells by entropy. The hierarchical SVM classification system achieves a diagnostic accuracy between 96.34% and 100%. Besides, the best sonographic textural feature can be selected by the system for the differentiation between the follicle and fibrosis base thyroid nodules or the cell types mixed in them. In follicle base thyroid nodules, papillary cancers show higher sonographic textural RLNU but less than follicular cells. In fibrosis base thyroid nodules, papillary cancers show increased sonographic textural variance and entropy.