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The incidence of thyroid cancer continues to increase, among which differentiated thyroid cancer occupies the main position. Development of molecular biology has facilitated early diagnosis and precise treatment of thyroid carcinoma, and hopefully provided potential options for certain subtypes with poor prognosis, such as radioactive iodine-refractory differentiated thyroid carcinoma. This review summarizes the gene variants of high frequency and the mechanism of such gene variants, application of molecular biological detection in clinical diagnosis, as well as the correlation of specific gene variants with clinicopathological characteristics and prognosis for differentiated thyroid carcinoma.
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Objective:To analyze and summarize the clinical manifestations, imaging and colonoscopy characteristics, treatment and prognosis of idiopathic mesenteric phlebosclerosis(IMP), so as to raise clinicians' awareness of this rare disease.Methods:One case of IMP admitted into the Department of Gastroenterology, Beijing Hospital, was reported.The patient was admitted primarily due to abdominal pain, distension, and obstructed defecation and flatulence for 3 months, and recurrent vomiting for 2 days.Combining the patient's medical history, symptoms, physical signs, imaging and colonoscopy results, IMP was suspected to be the most likely cause for incomplete intestinal obstruction in this case.The literatures on IMP published before April 2021, including case reports, reviews and articles, were collected and analyzed.Based upon information mentioned above, the epidemiological characteristics, pathogenesis, clinical manifestations, diagnosis, treatment and prognosis of IMP were systematically reviewed.Results:A total of 206 cases of idiopathic mesenteric vein sclerosing enteritis had been reported up to April 2021 in the literature, with a male to female ratio of about 2.75∶1.Age was clearly mentioned in 111 case reports, with a median age of 59 years and 36 patients(32.4%)≥65 years old.Common clinical manifestations include abdominal pain, distension, diarrhea, hematochezia, nausea and vomiting, obstructed defecation and flatulence, among others.The lesion is usually at the right side of the colon, including the cecum, ascending colon and transverse colon, with the ascending colon as the most commonly involved site.Imaging characteristics include linear, serrated or tortuous calcification of vessels inside the involved colon segments and adjacent mesenterium, edema and thickening of the intestinal wall, and reactive hyperplasia of lymph nodes, etc.Endoscopic features include edema and thickening of the intestinal wall, discoloration of the mucosa, and tortuous and dilated submucosal vessels.Complications include intestinal obstruction, perforation and necrosis.In most cases, symptoms subside after patients stop taking herbal medicines and go through conservative treatment for microcirculation improvement, anti-inflammation, anti-coagulation, anti-infection, etc.Overall, the prognosis of IMP is satisfactory.Conclusions:IMP is a type of non-obstructive, non-thrombotic and non-inflammatory mesenteric phlebosclerosis that causes intestinal ischemia.The pathogenesis of the disease is still unclear.Combination of characteristic clinical manifestations, imaging especially CT findings, endoscopic and histopathological examinations will help the diagnosis of IMP.
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Objective:To explore the effectiveness of the treatment modality among western localized extranodal NK/T-cell lymphoma (ENKTCL) patients based on the Surveillance, Epidemiology and End Result (SEER) database.Methods:A total of 448 cases of early stage ENKTCL, diagnosed from 2000 to 2016, were identified from the SEER database: 108 received chemotherapy alone, 100 received radiation alone, and 240 had combined chemoradiotherapy. Overall survival (OS) were compared between different modalities using univariate, multivariate and propensity-score matched (PSM) method.Results:The median overall survival (OS) and 5-year OS rate were 59.0 months and 49.0% for the whole cohort, respectively. Different treatment modalities were significantly associated with OS of patients with localized ENKTCL. Patients who received chemoradiotherapy had the highest 5-year OS rate followed by those who received radiation alone and chemotherapy alone (62.1% vs. 41.5% vs. 28.5%, χ2=41.727, P<0.001). Patients who received radiation with/without chemotherapy had significant superior survival outcome compared with those who received chemotherapy alone (5-year OS rate, 55.9% vs. 28.5%, χ2=10.823, P<0.001). Furthermore, compared with radiation alone, additional chemother-apy to radiation provided survival benefit and reduced death hazard for localized ENKTCL ( HR 0.578, 95% CI: 0.413~0.808, P=0.001). After baseline prognostic factors adjustment using PSM method, similar survival benefit was still observed among patients treated with chemoradiotherapy over those treated with radiation alone (5-year OS, 61.3% vs. 40.5%, HR 0.592, 95% CI: 0.369~0.885, P=0.012). Conclusions:These results based on SEER database indicate that compared with radiation or chemotherapy alone, chemoradiotherapy is more preferable treatment option for patients with early stage ENKTCL.