Pituitary abscess: a descriptive analysis of a series of 19 patients-a multi-center experience.

OBJECTIVES: Pituitary abscess (PA) accounts for only 0.3-0.5% of sellar masses, and the lack of specific clinical symptoms makes diagnosing PA difficult without a surgical biopsy. In clinical practice, PA is often mistaken for cystic pituitary adenoma, craniopharyngioma, and Rathke's cyst. Thus, this study aims to investigate challenges in diagnosing PA and evaluate the importance of combining intraoperative surgery with postoperative antibiotic treatment. METHODS: We conducted a retrospective analysis of 19 patients diagnosed with PA through histopathology. All patients underwent transsphenoidal surgery (TSS) for pituitary adenomas after undergoing comprehensive preoperative evaluations, including routine tests, endocrine assay, and imaging examination. Furthermore, we compared different treatments for pituitary abscess (PA) to determine the most effective approach for achieving a favorable prognosis. RESULTS: The most prevalent symptom of PA was headache, especially in the frontal-temporal and vertex regions, ranging from mild to moderate severity. Hypopituitarism-related symptoms were also frequently observed, including hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea. Twelve patients exhibited abnormalities in endocrinology examinations. Diagnosing PA correctly is challenging. In our study, none of the patients were correctly diagnosed with PA prior to surgery, and many sellar lesions were misdiagnosed. The favorable prognosis was largely attributed to surgical intervention and active postoperative antibiotic therapy. CONCLUSIONS: Given the lack of clarity in preoperative diagnosis, typical intraoperative findings and effective antibiotics treatment are more indicative of the correct diagnosis than other tests. In terms of therapy, optimal surgical intervention and active postoperative antibiotic treatment contribute to resolving the challenges posed by PA.

MST4 as a novel therapeutic target for autophagy and radiosensitivity in gastric cancer.

BACKGROUND: Mammalian ste20-like kinase 4 (MST4) and autophagy have been implicated in ailments such as inflammatory and cancers. METHODS: In this study, the expression of MST4 data was extracted from TCGA, GTEx, and GEPIA. The infiltration of immune cells and methylation level of MST4 in tumor and normal tissues were extracted from GEPIA 2021, TISIDB, UALCAN, EWAS, MethSurv, and MEXPRESS database. We also predict the efficacy of outcome prediction with receiver operating characteristic curve (ROC). All proteins expressions of MST4, P62, and LC3 were detected by immunohistochemistry (IHC) in paired Gastric cancer (GC) and para-cancerous normal tissue samples. We verify the effects of MST4 on irradiation-induced gastric death, and also investigate effects of MST4 activating autophagy in GC cell lines with various in vitro assays using western blotting. RESULTS: We have confirmed the high transcription level of MST4 from TCGA, USLCAN, HPA, and other portals, but a rapid decrease in protein level. More, MST4 can be considered as an independent prognostic molecule, which has significant prognostic significance in tumor grade, anti-tumor treatment, histological type, and time-dependent ROC curve. The methylation degree of MST4 promoter region in tumor is much lower than that in normal tissue, which may be the main reason for the remarkably high transcription level of MST4. In addition, MST4 transcription level was significantly inversely proportional to the infiltration level of most immune cells. The MST4 up-regulation and the positive association of MST4 with autophagy expression were cross-validated in open-access datasets. CONCLUSIONS: MST4, as an autophagy-associated protein, plays a potential role in inducing cell death by increasing protein content in radiotherapy.

Safety of Anlotinib Capsules Combined with PD-1 Inhibitor Camrelizumab in the Third-Line Treatment of Advanced Non-Small-Cell Lung Cancer and Their Effect on Serum Tumor Markers.

Objective: To explore the safety of anlotinib capsules combined with the PD-1 inhibitor (camrelizumab) in the third-line treatment of advanced non-small-cell lung cancer (NSCLC) and their effect on serum tumor markers. Methods: 88 patients with advanced NSCLC treated in the Oncology Department of our hospital from December 2018 to December 2019 were selected as research subjects and randomly and equally split into the single treatment group (STG) and combined treatment group (CTG). The levels of serum tumor markers after treatment were detected in both groups, and the incidence of adverse reactions during treatment was recorded. Results: Compared with the STG, CTG achieved obviously higher total effective rate (P < 0.05), lower total incidence of adverse reactions (P < 0.05), lower levels of serum tumor markers and average CFS score (P < 0.001), and higher average KPS score (P < 0.001). Conclusion: Application of anlotinib capsules combined with the PD-1 inhibitor (camrelizumab) in the third-line treatment of advanced NSCLC can effectively reduce the levels of serum tumor markers and cancer fatigue degree of patients, with a better effect than that of simple anlotinib treatment. In addition, further research of the combined treatment is helpful to establish a better therapeutic regimen for patients with advanced NSCLC.

Clinicopathological Characteristics of Breast Ductal Carcinoma In Situ: An Analysis of Chinese Population of 617 Patients.

BACKGROUND: The purpose of this study was to describe the clinicopathological characteristics of breast DCIS in Chinese women and compare with that of patients in western countries. METHOD: From December 2005 to December 2015, 617 women diagnosed with pure DCIS after surgery at our institution were enrolled, and the clinicopathological characteristics were described. RESULTS: In this study, the percentage of patients detected on screening, diagnosed at ≤50 years of age, with tumor size ≤2.0 cm, and with low-intermediate grade was 39.4%, 56.7%, 72.6%, and 77.4%, respectively, as compared to 50-80%, 20-30%, 70-90%, and 40-60% in published reports from western countries. The percentage of ER-positive patients was 76.3% in this study, which is similar to the mean expression rate of ER (mean: 68.7%, range: 49-96.6%) reported previously. CONCLUSIONS: The clinicopathological characteristics of Chinese DCIS patients include less detection on screening, younger age at diagnosis, and more low-intermediate nuclear grade.

Endovascular Management of May-Thurner Syndrome: A Case Report.

May-Thurner syndrome (MTS) is caused by venous occlusion because of compression of the iliac vein by the iliac artery and vertebral body, leading to left lower extremity deep venous thrombosis, eventually resulting in a series of symptoms. Endovascular treatment has now become the most preferred method of treatment of MTS. The authors report a 66-year-old woman who was hospitalized because of increasing swelling in her left lower limb for almost 2 weeks. Ultrasonography performed upon admission indicated MTS, and venography revealed occlusion of the left common iliac vein and massive thrombosis in the left external iliac and femoral veins. The left lower extremity venous blood flow returned to normal after the patient underwent manual aspiration thrombectomy using a guide catheter, followed by balloon angioplasty and stent placement. The patient achieved complete remission after 1 week and had no in-stent restenosis during the 1-year follow-up. Endovascular treatment is a safe and effective treatment of MTS.

Up-regulation of USP2a and FASN in gliomas correlates strongly with glioma grade.

Gliomas are the most common neoplasms in the central nervous system. The lack of efficacy of glioma therapies necessitates in-depth studies of glioma pathology, especially of the underlying molecular mechanisms that transform normal glial cells into tumor cells. Here we report that a deubiquitinating enzyme, ubiquitin-specific protease 2a (USP2a), and its substrate, fatty acid synthase (FASN), are over-expressed in glioma tissue. Using real-time quantitative polymerase chain reaction (PCR), Western blot and immunohistochemistry, we examined the expression and cellular distribution of USP2a and FASN in human glioma tissues. The expression patterns of USP2a and FASN correlated with the pathologic and clinical characteristics of the patients. Real-time PCR analysis showed that the expression levels of USP2a and its substrate FASN were higher in high-grade (World Health Organization [WHO] grades III and IV) glioma tissues than in low-grade (WHO grades I and II) glioma tissues. Western blot analysis indicated that the average optical densitometry ratio of USP2a and its substrate FASN in high-grade gliomas was higher than in low-grade gliomas. Moreover, statistical analysis of grade-classified glioma samples showed that the level of USP2a and FASN expression increased with the elevation of the WHO grade of glioma. USP2a protein expression was detected in the nucleus of glioma tissues and an increase in expression was significantly associated with the elevation of the WHO grade of glioma by immunohistochemistry. These findings expand our understanding of the molecular profiling of glioma and could shed light on new diagnostic criteria for gliomas.

Assessing the value of bilateral inferior petrosal sinus sampling in the diagnosis and treatment of a complex case of Cushing's disease.

A 41-year-old female visited Ruijin Hospital because her face was swollen for more than 2 months. The patient was initially diagnosed with Cushing's disease (CD). Several examinations, including a dexamethasone suppression test (DST) at 2 mg and 8 mg, pituitary MRI, abdominal CT, punch biopsy of adrenal masses, and bilateral inferior petrosal sinus sampling (BIPSS), were performed, but the findings were not consistent with the clinical presentation. Ultimately, the patient underwent surgery and recovered. In this case, BIPSS was a useful way to diagnosis CD and suggested the exact location of a pituitary adenoma to Neurosurgery. BIPSS should be a required test for cases of CD that cannot be definitively diagnosed with just an MRI and 8 mg DST before surgery.

MicroRNAs-based network: a novel therapeutic agent in pituitary adenoma.

Pituitary adenomas are common benign intracranial neoplasms representing about 10-25% of all intracranial neoplasm. Significant morbidity can occur along with pituitary adenomas due to hormonal dysfunction and mass effects. The pathogenesis of pituitary adenoma is unclear, however, etiologic factors include genetic events, hormonal stimulation, and growth factors [1], all of which promote cell proliferation and transformation in the tumor. However, genetic events play the most important role in tumorigenesis. MicroRNAs (miRNAs), a class of non-coding RNAs, not only have function in pituitary cell proliferation and apoptosis but also in neoplastic transformation. It has been shown that miRNAs are differentially expressed in pituitary adenoma when compared with the normal pituitary gland; moreover, miRNAs have been identified as a predictive signature of pituitary adenoma and can be used to predict the histotype. The expression of miRNAs can be used not only to differentiate microadenomas from macroadenomas, but to also distinguish samples of treated patients from samples of non-treated patients. Therefore, we hypothesized that a miRNA-based network may be involved in pituitary tumorigenesis and it can potentially serve as useful diagnostic markers to improve the classification of pituitary adenomas. Here, we reviewed the therapeutic potential that different types of miRNAs may play in tumorigenesis. Moreover, miRNAs may emerge as potential therapeutic targets. We speculated the mechanism of miR-21 is involved in tumorigenesis, leading to improvements in therapies and prevention of metastasis.

Assessment of bilateral inferior petrosal sinus sampling in the diagnosis and surgical treatment of the ACTH-dependent Cushing's syndrome: a comparison with other tests.

BACKGROUND: Bilateral inferior petrosal sinus sampling (BIPSS), currently, is the gold standard test for the differential diagnosis of Cushing's syndrome (CS), but few data are available on the efficacy and accuracy of BIPSS in the qualitative diagnosis of ACTH-dependent CS and lateralization of Cushing's disease (CD); especially, the evaluation of BIPSS in all CD patients with transsphenoidal surgery (TSS). As a result, we investigated whether such invasive test compared other noninvasive tests may affect the efficacy and accuracy of diagnosis and TSS treatment in ACTH-dependent CS. OBJECTIVE: We investigated the efficacy and lateralized accuracy of diagnostic and therapeutic of BIPSS in ACTH-dependent CS. SETTINGS: A retrospective analysis was conducted at a single care center in Ruijin Hospital, Shanghai City. PARTICIPANTS: CD was confirmed by histopathology in one hundred and nineteen patients, include sixty-four patients with BIPSS procedure; and ectopic ACTH syndrome (EAS) also was histological confirmed in five patients. MAIN INTERVENTIONS AND OUTCOMES: Sixty-nine patients were all administrated with BIPSS test. Additionally, other noninvasive tests included endocrine examinations, low and high dose dexamethasone suppression test (LDDST and HDDST); imagine examinations include magnetic resonance imaging (MRI) and positron emission tomography and computerized tomography (PET-CT).Gradients of inferior petrosal sinus (IPS) to peripheral (IPS/P) ACTH were calculated before and after BIPSS procedure completed five minutes. RESULTS: In patients with proven pituitary cases, stringent response criteria in MRI and HDDST testing were fully by 51.6% and 60.3% respectively. While BIPSS, gave direct evidence of CD in 90.6% of these cases. The sensitivity for a basal IPS/P gradient greater than 2 was 89.1%, with 100% specificity and a diagnostic accuracy of 87.5%. A subgroup of 14 patients (all were CD) had contradictory responses to routine test with HDDST; while the sensitivity, specificity and accuracy of BIPSS were 100% respectively. Compared with the MRI and DST, we accepted Receiver Operating Characteristic (ROC) curve analysis showed that BIPSS performance is the best efficacy diagnosis tool in CS. In total, 57 of 64 patients with CD had an IPS/P gradient greater than 2, resulting in the sensitivity, specificity and diagnostic accuracy are 90.5%, 100%, 95.2% respectively. Additionally, the accuracy value of BIPSS in indicating dominant side should also be stressed in adenoma lateralization of CD. Finally, BIPSS test contributed most in the remission efficacy of TSS; then remission rate of underwent BIPSS group is 92.2% compared to the rate of 80% in without BIPSS group (p<0.01), Compared with other noninvasive tests, turn out the highest accuracy rate in remission. CONCLUSIONS: The application of BIPSS is associated with efficacy and accuracy of ACTH-dependent CS and lateralization of CD, what's more, all above, we can conclude that BIPSS is associated with the surgical therapy in CD patients. Therefore, BIPSS dedicate to the diagnosis, treatment and intraoperation administration of ACTH-dependent CS.