[Clinical analysis of lung adenocarcinoma with epidermal growth factor receptor mutation transformed into sarcoma].

Objective: To analyze the clinical data of a case of lung adenocarcinoma with Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) resistance transforming into sarcoma, and to conduct a literature review to improve the understanding of the resistance mechanism. Histological transformation is a unique form of acquired resistance of EGFR-TKIs in non-small cell lung cancer (NSCLC). Thereinto, the transformation of small cell carcinoma is more common, and the transformation of sarcoma is rarely reported. Methods: Clinicopathological data on the treatment process, pathological features, and clinical outcome of the patient with EGFR-TKIs-resistance lung adenocarcinoma transforming into sarcoma were collected. The literature was reviewed to analyze the pathogenetic mechanism for sarcomatoid carcinoma or sarcoma transformation after drug resistance of adenocarcinoma, as well as the clinical characteristics of the patients and the corresponding therapeutic schemes. Results: We reported a patient with lung adenocarcinoma who developed EGFR-T790M mutation after first-line treatment with icotinib and sarcoma transformation after second-line treatment with almonertinib. Chemotherapy, radioactive particle implantation, antiangiogenic therapy and immunotherapy were followed, but the results were unsatisfactory. There was no report of EGFR-TKIs-resistant lung adenocarcinoma transforming into sarcoma. Among the 14 reports of adenocarcinoma transforming into sarcomatoid carcinoma, 8 cases had EGFR mutation, 3 cases had ALK mutation, 2 cases had ROS1 mutation, and 1 case had no asscoiated sensitive mutation. The median survival of 14 patients with adenocarcinoma transforming to sarcomatoid carcinoma was only 3 months. Conclusions: Sarcoma transformation can be one of the forms of drug resistance in patients with lung adenocarcinoma with EGFR-TKIs. The prognosis of patients with adenocarcinoma after transformation into sarcoma is poor.

[Clinicopathological features of esophageal carcinoma with ductal differentiation of esophageal gland].

Objective: To investigate the clinicopathological characteristics of esophageal carcinoma with gland duct differentiation. Methods: The clinical, morphologic and immunohistochemical (IHC) features of eight cases of esophageal carcinoma with gland duct differentiation diagnosed from 2012 to 2022 at the First Affiliated Hospital of Soochow University were summarized. Results: There were four males and four females, with a mean age of 68.5 (range 59-82) years. Two tumors were located in middle esophagus, five in the lower esophagus, and one in the cardia. The mean diameter was 2.4 cm (range 0.6-4.5 cm). The tumor had a bilayer epithelial structure, including the inner luminal epithelium and the outer basal epithelium. Immunohistochemistry showed that CK7 (8/8) and CK18 (8/8) were positive in the inner epithelium. p40 (8/8), p63 (8/8) and CK5/6 (8/8) were positive in the outer epithelium. SMA, calponin and CD117 were all negative. p53 mutants were found in all eight cases (strong and diffuse positivity in 6/8; complete loss of expression in 2/8). No columnar metaplasia, intestinal metaplasia and ectopic gastric mucosa were observed in the surface squamous epithelium in the cases. The mean follow-up time was 21.5 months (range 5-51 months). Seven patients survived and one patient died 31 months after surgery due to recurrence and liver metastasis. Conclusion: Esophageal carcinoma with esophageal gland duct differentiation is a rare tumor with unique histologic and IHC characteristics.

[The effect of chronic endometritis on the clinical outcomes of patients with failure of first embryo transfer].

Objective: To investigate the effect of chronic endometritis (CE) on the clinical outcomes of patients with failure of first embryo transfer. Methods: A total of 5 605 cycles of frozen-thawed single blastocyst transfer in the reproductive center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to June 2021 were retrospectively collected. After the failure of first embryo transfer, all patients underwent hysteroscopy, and when necessary, endometrial pathology and immunohistochemistry were combined to diagnose CE. Patients were divided into two groups: non-CE group (5 033 cycles) and CE treatment group (572 cycles). The main outcome was live birth rate and the secondary outcomes included clinical pregnancy rate and early abortion rate. The quantitative data were represented by Median (Q1, Q3). The rank sum test was used for comparison between groups. The factors related to live birth rate were analyzed by binary logistic regression model. Results: The incidence of CE was 10.21% (572 cycles) in patients with the failure of first embryo transfer. The maternal age in the non-CE group was 31.0 (29.0, 34.0) years old, and that in the CE treatment group was 31.0 (29.0, 34.0) years old (P<0.001). There was a statistically significant difference in endometrial preparation between the two groups (P=0.010). The endometrial thickness in the CE group was 9.0 (8.2, 10.3) mm on progesterone transformation day, which was higher than that of [9.5 (8.6, 11.0) mm] in the non-CE group (P<0.001). There was no significant difference in clinical pregnancy rate (60.3% (3 035 cycles) vs 63.1% (361 cycles), P=0.193), early abortion rate (17.1% (520 cycles) vs 20.5% (74 cycles), P=0.112) and live birth rate (49.2% (2 477 cycles) vs 49.3% (282 cycles), P=0.969) between the non-CE group and the CE treatment group. The maternal age, endometrial thickness on progesterone transformation day and blastocyst grade were related factors of the live birth rate, and the OR(95%CI) were 0.94 (0.93-0.96), 1.10 (1.06-1.14) and 2.07 (1.84-2.32)), respectively (all P<0.001). Compared with the non-CE group, the CE treatment group did not affect the live birth rate after transplantation, the aOR (95%CI) was 0.99 (0.82-1.18), P=0.882. Conclusions: For patients who underwent the failure of first embryo transfer, hysteroscopy is recommended before single frozen blastocyst transfer, and if necessary, combined with immunohistochemical screening for CE. After standardized treatment, CE patients could obtain similar clinical pregnancy rate, early miscarriage rate and live birth rate as non-CE patients.

[The effect of human chorionic gonadotropin day serum progesterone level on the live birth rate of fresh embryo transfer with GnRH antagonist protocols].

Objective: To investigate the effect of human chorionic gonadotropin (HCG)day serum progesterone (P) level on the live birth rate (LBR) of fresh embryo transfer with GnRH antagonist protocols. Methods: Patients who underwent the first IVF/ICSI in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 were included for analysis. The patients with normal ovarian response with GnRH antagonist protocols were included (n=765). The receiver operating characteristic curve (ROC) was used to select the optimal cut-off value of serum P on HCG day (0.83 µg/L), and the included cycles were divided into two groups: P<0.83 µg/L (n=444) and P≥0.83 µg/L (n=321). The primary outcome measure was LBR. Secondary outcome measures included clinical pregnancy rate (CPR) and early miscarriage rate. The difference of the above indexes between the two groups was compared. Multivariate logistic regression model was used to analyze the effect of serum P level on LBR in fresh embryo transfer cycles. Results: The maternal ages in P<0.83 µg/L group and P≥0.83 µg/L group were (32.40±5.49) years and (32.53±5.51) yeas, respectively. The paternal ages were (33.35±6.34) years and (33.43±6.38) years, respectively of which, the difference was not statistically significant (P>0.05). The CPR in the P<0.83 µg/L group was 45.9% (n=204), which was significantly higher than that in the P≥0.83 µg/L group (37.1%) (n=119) (P=0.014). There was no significant difference in the early miscarriage rate between the two groups [14.2% (n=29) vs 14.3% (n=17), P=0.986]. The LBR in the P<0.83 µg/L group was significantly higher than that in the P≥0.83 µg/L group [36.3% (n=161) vs 28.0% (n=90), P=0.017]. By multivariate logistic regression model analysis, the maternal age, type of embryo transferred, number of embryos transferred, endometrial thickness on HCG day and serum P level on HCG day were independent risk factors of LBR. The adjust OR(95%CI) were 0.91(0.88-0.94), 2.36(1.04-5.35), 1.84(1.14-2.95), 1.16(1.07-1.25)and 0.63(0.44-0.89), all P<0.05. Conclusion: When the GnRH antagonist protocol is applied in the normal ovarian response population, as the serum P on the HCG trigger day≥0.83 µg/L, the CPR and LBR of fresh embryo transfer are decreased.