Similar usage of T-cell receptor ß-chain between tumor and adjacent normal tissue in hepatocellular carcinoma.

BACKGROUND: In this study, we comprehensively profiled the T-cell receptor (TCR) repertoire of the tumor and adjacent normal tissue in patients with HBV-associated hepatocellular carcinoma (HCC) and determined the baseline characteristics and clinical significance of TCR. METHODS: High-throughput sequencing was used to determine the profile of complementarity-determining region 3 (CDR3) of the TCR-ß chain variable (TRBV) in the tumor and normal tissue samples of 14 HCC patients. At the same time, TRBV diversity and differences in expression between tumor and normal tissues were investigated. The cumulative frequency of top 100 CDR3 (CF100), clonality, and Shannon entropy as indices to evaluate diversity, RESULTS: The diversity of TRBV CDR3 showed no significant difference between tumor and normal tissues. Of the 58 V gene segments in TRBV, TRBV16 and TRBV7-6 had a significantly higher frequency in the tumor group than in the normal group (p < 0.05). The frequency of 14 J gene segments showed no significant difference between tumor and normal tissues. In contrast, the frequency of 22 TRBVx/BJx combinations was significantly higher in the tumor than in the normal tissue. In addition, the length and type of TRBV CDR3 were similar in tumor and normal tissues, and a Gaussian distribution was observed in both groups. CONCLUSION: This study provided a large amount of information about the TCR lineage in HBV-associated HCC, laying the foundation for further research. In addition, the fact that the immune repertoire (TRBV CDR3) hardly differs between tumor and adjacent normal tissue provides a new clue for exploring the mechanism of the liver as an organ with immune privileges.

Antimicrobial Substances and Mechanisms of Lactobacillus rhamnosus against Gardnerella vaginalis.

Bacterial vaginosis (BV) is a common vaginal disease associated with abnormal changes in the vaginal microbiome. Our previous study found that Lactobacillus rhamnosus has a good therapeutic effect on bacterial vaginosis by inhibiting the most prominent bacterium associated with BV, Gardnerella vaginalis. In this study, we show that acetic acid and lactic acid are the main substances in the cell-free supernatant (CFS) of L. rhamnosus that inhibit the growth of G. vaginalis. Further study on the mechanism showed that acetic acid and lactic acid alter the morphology of the G. vaginalis cells, eventually causing the cells to shrink or burst, resulting in exudation of their intracellular contents. In addition, these two organic acids also dissipate the membrane potential of bacterial cells, affecting their synthesis of ATP. A reduced activity of the Na+/K+-ATPase leads to abnormal ATP metabolism, and ultimately inhibits the growth and reproduction of G. vaginalis. Our study provides valuable information for the widespread application of L. rhamnosus in the treatment of bacterial vaginosis.

Successful treatment of pancreatic accessory splenic hamartoma by laparoscopic spleen-preserving distal pancreatectomy: A case report.

BACKGROUND: Pancreatic accessory spleen (PAS) is an uncommon congenital abnormality of the spleen. Spleen hamartoma (SH) is also rare. Moreover, hamartoma in the PAS has not been reported thus far. We report the first case here. CASE SUMMARY: A 26-year-old male presented with a one-month history of left upper quadrant abdominal pain, and computerized tomography (CT) examination suggested a mass in the pancreas tail. The patient then attended our hospital for diagnosis and treatment. Ultrasonography, CT, and magnetic resonance imaging revealed a solid mass with cystic degeneration growing from the tail of the pancreas. The tumor marker carbohydrate antigen 19-9 (CA19-9) increased to 96.7 U/mL (normal range 0-37 U/mL). An epidermoid cyst in a PAS was considered preoperatively. However, a malignant tumor cannot be ruled out. We performed laparoscopic surgery, and two pancreatic masses were found growing from the pancreatic tail. The two masses were so closely connected that preoperative imaging examinations suggested only one mass. We carefully isolated the masses from the splenic artery and vein. A laparoscopic spleen-preserving distal pancreatectomy was successfully performed. On pathological examination, the masses were well-defined, homogeneous red-tan, 4 × 3, and 4.5 × 1.5 in size, respectively. One of them was cystically degenerated. On microscopical examination, the mass contained unorganized small slit-like vascular channels enclosing red blood cells and lined with plump endothelial cells. No area of cytologic atypia was identified. Focal lymphoid aggregates were found in the intravascular areas. White pulp or fibrosis was not observed. The final diagnosis was pancreatic accessory SH with cystic degeneration. After the operation, CA19-9 was reduced to normal. The patient recovered well, and the 34-mo follow-up period was uneventful. CONCLUSION: Here, we report the first case of pancreatic accessory SH. A laparoscopic spleen-preserving distal pancreatectomy was successfully performed. The patient recovered well and had a good prognosis.

Successful treatment of pancreatic schwannoma by enucleation: A case report.

RATIONALE: Pancreatic schwannomas are extremely rare and are difficult to diagnose preoperatively. Over the past 50 years, only 96 cases of pancreatic schwannoma have been reported in English literature. Herein, we report a case of pancreatic schwannoma treated with enucleation. PATIENT CONCERNS: A 66-year-old woman visited a local hospital due to ventosities. Ultrasonography and computed tomography revealed a pancreatic mass. She visited our hospital for further diagnosis and treatment. DIAGNOSIS AND INTERVENTIONS: Magnetic resonance imaging revealed a tumor in the pancreatic body, and a solid pseudopapillary tumor was considered preoperatively. During the surgery, a pancreatic mass was found growing in the pancreatic body and tail. A successful tumor enucleation was performed. The mass was 7 × 6 × 3 cm in size with a thin capsule. Pathological examination revealed that the tumor was mainly composed of spindle-shaped cells with a palisading arrangement and no atypia. Both hypercellular and hypocellular areas were visible. Immunohistochemical staining showed that protein S-100 was strongly positive. The tumor was diagnosed as a benign schwannoma originating from the pancreatic body and tail. OUTCOMES: Postoperatively, the patient showed good recovery. During the 24-month follow-up period, the patient remained well and free of complications. LESSONS: Pancreatic schwannomas are extremely rare and difficult to diagnose using imaging examinations. Enucleation is a safe and efficacious treatment for exophytic pancreatic schwannomas.

Successful treatment of a giant ossified benign mesenteric schwannoma.

Primary benign schwannoma of the mesentery is extremely rare. To date, only 9 cases have been reported in the English literature, while mesenteric schwannoma with ossified degeneration has not been reported thus far. In the present study, we present the first giant ossified benign mesenteric schwannoma in a 58-year-old female. Ultrasound, computed tomography and magnetic resonance imaging were used, but it was still difficult to determine the definitive location and diagnose the mass. By laparotomy, a 10.0 cm × 9.0 cm × 9.0 cm giant mass was found in the mesentery and was then completely resected. Microscopically, the tumour located in the mesentery mainly consisted of spindle-shaped cells with a palisading arrangement. Some areas of the tumour were ossified, and a true metaplastic bone formation was observed, with the presence of bone lamellae and osteoblasts. Immunohistochemical investigation of the tumour located in the mesentery showed that the staining for the S-100 protein was strongly positive, while the stainings of SMA, CD34, CD117 and DOG-1 were negative. The cell proliferation index, measured with Ki67 staining, was less than 3%. Finally, a giant ossified benign mesenteric schwannoma was diagnosed. After surgery, the patient was followed up for a period of 43 mo, during which she remained well, with no evidence of tumour recurrence.

Accessory spleen located in the right parietal peritoneum: The first case report.

RATIONALE: Accessory spleen is a congenital abnormality caused by failure of the splenic anlage to fuse during embryology. The presence of an accessory spleen located in the parietal peritoneum has not been reported so far, and an accessory spleen situated on the right side is extremely rare. In the present study, we describe the first case of an accessory spleen located in the right parietal peritoneum. PATIENTS CONCERNS: A 65-year-old man, presented with pain in his left abdomen for 1 month. DIAGNOSES: With ultrasonography and computed tomography, it was difficult to determine the accurate location and diagnosis, and an abdominal fibroma was preoperatively considered. INTERVENTIONS: By laparotomy, we found a mass connected to the right parietal peritoneum by a vascular pedicle. We resected it completely, and the gross specimen measured 5.0 × 3.0 × 2.5 cm and was a localized tumor with a capsule. OUTCOMES: Microscopically, sinusoids were visible, as well as scattered lymphoid follicles, eosinophils, histiocytes, plasma cells, neutrophils, and red blood cells, indicative of splenic tissue. Finally, the lesion was diagnosed as an accessory spleen located in the right parietal peritoneum. Postoperatively, he recovered well and was followed up for a 31 months, during which he was well with no complication. LESSONS: We present the first accessory spleen located in the right parietal peritoneum. Awareness of the accessory spleen and familiarity with typical imaging findings are necessary for surgeons to make a precise preoperative diagnosis.

Successful treatment of a pancreatic schwannoma by spleen-preserving distal pancreatectomy.

Schwannomas are neurogenic tumors that arise from the neural sheaths of peripheral nerves. These tumors can be located in any area of the human body; the most common locations are the head, neck, trunk and extremities. Pancreatic schwannomas are very rare. Over the past 40 years, only 67 cases of pancreatic schwannomas have been reported in the English literature. Here we present a case of pancreatic schwannoma in a 62-year-old male. The tumor was revealed by ultrasound and computed tomography in the neck and body of the pancreas. An accurate diagnosis was difficult to obtain preoperatively. The patient consented to the performance of a laparotomy, and the mass was found in the neck and body of the pancreas and successfully treated using a spleen-preserving distal pancreatectomy with splenic artery and vein preservation. The procedure has only been reported in one other case of pancreatic schwannoma; here we present the second reported case. Macroscopically, the tumor was well circumscribed, gray-white in color and 3.3 cm × 2.8 cm in size. Microscopically, the tumor cells were spindle-shaped and had a palisading arrangement with no atypia, which are results compatible with a benign tumor. Both hypercellular and hypocellular areas were visible. Immunohistochemically, the tumor cells were strongly positive for S-100 protein. The tumor was definitively diagnosed as a schwannoma of the pancreatic neck and body. The patient was followed for 72 mo and has been doing well without any complications.

Synchronous occurrence of a hepatic myelolipoma and two hepatocellular carcinomas.

Myelolipoma is a rare tumor composed of fat and bone marrow components, most of which are located in the adrenal gland. Myelolipoma in the liver is extremely rare. To date, only 10 cases have been reported in the English-language medical literature. In one of these cases, the hepatic myelolipoma was found within a hepatocellular carcinoma (HCC). In the present study, we report the first case of the synchronous occurrence of hepatic myelolipoma and HCCs in different liver sections of one patient, a 26-year-old female who was admitted to our hospital because of a 4-d history of upper abdominal pain. The unenhanced computed tomography (CT) images showed a well-defined low-density mass with adipose components in the right liver lobe, 4.2 cm × 4.1 cm in size. Two inhomogeneous low-density masses were found in the left liver lobe, 8.6 cm × 7.7 cm and 2.6 cm × 2.6 cm in size. The masses in both the right and left liver lobes were heterogeneously enhanced in the contrast-enhanced CT images. Based on the results of the imaging examination, the mass in the right liver lobe was preliminarily considered to be a hamartoma, and the two masses in the left liver were preliminarily considered to be HCCs. We performed a right hepatectomy, a left hepatic lobectomy, and a cholecystectomy. Microscopic and immunohistochemical results revealed that the tumor in the right liver lobe was a hepatic myelolipoma, and that the two tumors in the left liver lobe were HCCs.

Schwannoma in the hepatoduodenal ligament: A case report and literature review.

Schwannomas are mesenchymal neoplasms with low malignant potential that arise from Schwann cells. They can occur almost anywhere, although the most common locations are the head, neck and extremities. Primary benign schwannoma of the hepatoduodenal ligament is rare. To date, only three cases have been reported in the English literature. In the present study, we report a case of hepatoduodenal ligament schwannoma in a 43-year-old male, who was admitted to our hospital because of a abdominal mass found by physical examination. It was hard to determine the definitive location and diagnosis of the mass using ultrasound, computed tomography and magnetic resonance cholangiopancreatography. During laparotomy, the mass was found in the hepatoduodenal ligament and close to the cholecystic duct, so we resected the gallbladder and cholecystic duct along with the mass. The gross specimen revealed an 8.5 cm × 5.5 cm × 3.0 cm localized tumor. Microscopic examination showed that the tumor was mainly composed of spindle-shaped cells. Immunohistochemical staining showed a strong positive S-100 protein reaction. Finally, the lesion was diagnosed as a benign schwannoma in the hepatoduodenal ligament. However, one month later, the patient was readmitted to our hospital because of skin and sclera jaundice caused by common bile duct stenosis without common bile duct stone or tumor. The patient recovered well after implantation of a common bile duct stent under endoscopic retrograde cholangiopancreatography. He was followed up for a period of 17 mo, during which he was well with no complications.

Central pancreatectomy for pancreatic schwannoma: A case report and literature review.

Schwannomas are mesenchymal tumors originating from Schwann cells in peripheral nerve sheaths. Although the tumor can be located in any part of the human body, the most common locations are the head, neck, trunk and extremities. Pancreatic schwannomas are rare. To our knowledge, only 64 cases of pancreatic schwannoma have been reported in the English literature over the past 40 years. In this paper, we present a pancreatic schwannoma in a 59-year-old female. Ultrasound, computed tomography and magnetic resonance imaging revealed the tumor located in the pancreatic body; however, accurate diagnosis was hard to obtain preoperatively and a pancreatic cystadenoma was preliminarily considered. During laparotomy, the mass was found in the body of the pancreas. An enlarged gallbladder with multiple stones was also observed. We performed central pancreatectomy, end-to-side pancreaticojejunostomy and cholecystectomy. Notably, central pancreatectomy has been reported in only one case prior to this report. The gross specimen showed a mass with a thin capsule, 1.6 cm × 1.1 cm × 1.1 cm in size. Microscopic examination showed that the tumor was mainly composed of spindle-shaped cells with palisading arrangement and no atypia, which is consistent with a benign tumor. Both hypercellular and hypocellular areas were visible. Immunohistochemical staining revealed strongly positive results for protein S-100. Finally, the tumor was diagnosed as a schwannoma of the pancreatic body. Postoperatively, the patient recovered well and left the hospital 6 d later. During the 53-mo follow-up period, the patient remained well and free of complications.

Multiple schwannomas synchronously occurring in the porta hepatis, liver, and gallbladder: first case report.

BACKGROUND: Schwannomas are mesenchymal neoplasms that arise from Schwann cells with low malignant potential. Schwannomas originating from the porta hepatis or intra-abdominal organs are extremely rare. To our knowledge, multiple schwannomas synchronously occurring in the porta hepatis, liver, and gallbladder have not been reported so far and we first report one in the present case. CASE SUMMARY: A 31-year-old female was referred to our hospital because of repeated abdomen discomfort, slight abdominal distension, and occasional abdominal pain for seven years. Ultrasound and computed tomography and magnetic resonance cholangiopancreatography found multiple intrahepatic and extrahepatic cystic lesions with the dilation of intrahepatic and extrahepatic bile ducts. By exploratory laparotomy, multiple tumors were found in the porta hepatis, liver, and gallbladder, the biggest one was 11 × 6 cm in size. We completely resected these tumors combined with the left lateral liver lobe, gallbladder, and the invaded left and right hepatic arteries, and then severed vessels were reconstructed. Microscopically, the tumor cells were spindle shaped and palisading arrangement. Atypical cells or signs of malignancy were not found. Immunohistochemical investigation showed the protein S-100 was positive, while SMA, CD34, and CD117 negative. Finally, these tumors were diagnosed as schwannomas in the porta hepatis, liver, and gallbladder. The patient is followed-up for 70 months and has been doing well without any complications. CONCLUSION: We report the first patient with multiple schwannomas synchronously occurring in the porta hepatis, liver, and gallbladder. Accurate preoperative diagnosis of these tumors is difficult. Due to closely adhering to the surrounding important tissues, complete removal is challenging.

Hemorrhagic, calcified, and ossified benign retroperitoneal schwannoma: First case report.

BACKGROUND: Schwannomas are mesenchymal tumors arising from the neural sheaths of peripheral nerves. They can almost develop in any part of the body, while head, neck and extremities are the most common sites. Occurrence in the retroperitoneum is rare. Schwannomas can show secondary degenerative changes including cyst formation, hyalinization, hemorrhage, and calcification, whereas the ossified retroperitoneal schwannoma was only reported in a malignant one. CASE SUMMARY: We first present a benign ossified retroperitoneal schwannoma in a 61-year-old female. The mass was found by a routine health examination. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a well-defined mass in the area among duodenum, right liver, and kidney. Definitive preoperative diagnosis of the mass was difficult. By laparotomy, the mass was found in the retroperitoneum. We completely removed the tumor and gross specimen showed a mass with a capsule and 6 × 6 × 4.8 cm in size. Microscopic examination showed the tumor is composed of spindle-shaped cells with degenerative changes of hemorrhage, calcification, and ossification. Immunohistochemically, S-100 protein was strongly positive. Finally, the mass was diagnosed as a hemorrhagic, calcified, and ossified benign schwannoma in the retroperitoneum. The patient was followed up for a period of 21 months, during which she was well with no evidence of recurrence. CONCLUSION: We report the first case of a benign retroperitoneal schwannoma with secondary degenerative changes including hemorrhage, calcification, and ossification. Precise preoperative diagnosis of the tumor is challenging even with multiple preoperative imaging modalities. After complete resection, patients with benign retroperitoneal schwanommas generally have good prognosis.