[Renal eosinophilic vacuolated tumor: a clinicopathological analysis of seven cases].

Objective: To investigate the clinicopathological features and differential diagnosis of eosinophilic vacuolated tumor (EVT). Methods: Seven cases of EVT with characteristic morphology and unequivocal diagnosis from the Affiliated Hospital of Qingdao University (6 cases), Qingdao, China and the 971 Hospital of PLA Navy (1 case), Qingdao, China between January 2010 and December 2021 were subject to morphological and immunohistochemical analyses. Additionally, whole exome sequencing (WES) was performed in two cases. Twenty-two cases of renal oncocytoma (RO) and 17 cases of eosinophilic chromophobe renal cell carcinoma (eChRCC) diagnosed at the same time were used as controls. Results: Four males and three females with a mean age of 42 years (range: 29-61 years) were included in the study. The tumors were nodular and well-circumscribed, with sizes ranging from 1.5 to 4.5 cm. On cross-section, they appeared gray-red or gray-white, solid, and soft. Tumor cells were arranged in nests, solid sheets, and acinar or small vesicular structures. These cells exhibited eosinophilic cytoplasm with large, prominent clear vacuoles and round nuclei with prominent nucleoli. Perinuclear halos were focally present in four cases, while small tumor cells with sparse cytoplasm and hyperchromatic nuclei were seen in one case. No necrosis or mitosis was noted. Edematous stroma was detected in three cases. All tumors were positive for CD117 and Cathepsin K, but negative for vimentin and CK7. CK20 was positive in scattered individual cells, and Ki-67 positivity ranged from 1% to 4%. Point mutations in MTOR were identified in both patients who were subject to the molecular analysis. Statistical differences in the expression of Cathepsin K, CD10, S-100A1, and Cyclin D1 between EVT and RO (P<0.05) were significant, so were the differences in the expression of Cathepsin K, CD10, CK7 and claudin 7 between EVT and eChRCC (P<0.001). Seven patients were followed up for 4 to 96 months (mean, 50 months), with no recurrences or metastases. Conclusions: EVT is a rare renal tumor that shares morphological and immunophenotypic features with RO and eChRCC, and it is closely linked to the TSC/MTOR pathway. The presence of large prominent transparent vacuoles in eosinophilic cytoplasm along with conspicuous nucleoli is its key morphological characteristics. The use of combined immunohistochemical stains greatly aids in its diagnosis. Typically, the tumor exhibits indolent biological behaviors with a favorable prognosis.

[Clinicopathological features and differential diagnosis of eosionphilic chromophobe renal cell carcinoma].

Objective: To investigate the clinicopathological characteristics of eosionphilic Chromophobe renal cell carcinoma (eChRCC), and differences in morphology, immunophenotype and clinical prognosis betweeneChRCC, renal oncocytoma(RO) and classic Chromophobe renal cell carcinoma (cChRCC). Methods: The clinicopathologic data of 17 patients diagnosed as eChRCC from the Affiliated Hospital of Qingdao University (13 cases) and 971 Hospital of PLA Navy (4 cases) from October 2006 to February 2019 were collected. Immunohistochemical analysis was carried out to compare the immunophenotypes between 17 cases with ChRCC, 27 cases with RO and 30 cases with cChRCC. Resuls: Among the 17 patients, seven were males and ten were females, and the age ranged from 40 to 75 years (median 54 years). Clinically, 15 cases of 17 were found accidentally by physical examination. The tumor size ranged from 1.8 cm to 10.0 cm (average 5.7 cm) and the cut surface of 15 cases were solid, one case was solicl and cystic, and one was cystic. Most showed gray to red, and partially soft, gray to yellow appearances. Microscopically, most tumors presented solid growth pattern with vary number of alveolar structures (12 cases). Some were predominately characterized by cystic structure (3 cases), alveolar structure(1 case) and microcapsule structure (1 case). There were boundaries with varying degrees of clarity between tumor cells in 16 cases. The cytoplasm of tumor cells was eosinophilic and the nuclei were small round or irregular with focal perinuclear haloes in 14 cases. Large polygonal cells with light-stained cytoplasm appeared focally in 9 cases, and edematous areas with scarce tumor cells were found in 4 cases. Among 7 cases, 4 cases focally invaded peripheral renal parenchyma, 2 cases invaded adipose tissues outside the renal capsule, and 1 case presented invasion of renal sinus. Immunohistochemically, all cases were moderate to strong positive for EMA and claudin-7. CK7, CD117 and Ksp-cad were highly expressed with the expression rates of 12/17, 15/17, 14/17, respectively. Cyclin D1, AMACR, CD10, S100A1, and RCC were rarely expressed with the expression rates of 4/17, 3/17, 4/17, 1/17 and 1/17, respectively. On the contrary, all cases were negative for vimentin, CAⅨ, HMB45 and Melan A. The Ki-67 proliferation index of the 17 cases was 1%‒5%. Follow-up data were available for all 17 patients from 7 to 154 months. Among them, 15 patients were alive without tumor recurrence or metastasis, one patient died of pulmonary metastasis after 31 months of surgery and one patient died of hepatic metastasis after 38 months of surgery. Conclusion: eChRCC has overlapping morphology and immunophenotype with RO. eChRCC is characterized by solid nest or alveolar structure, distinct border between tumor cells, perinuclear halos and lacking of interstitial looseness and edema. Scattered large polygonal cells with light-stained cytoplasm in tumor tissue play a significant role in the diagnosis of eChRCC. The positive expression of CK7, CD117, claudin-7 and Ksp-cad, and negative expression of cyclin D1, S100A1 are helpful to the diagnosis and differential diagnosis of eChRCC. The prognosis of eChRCC after complete surgical resection is excellent and few cases may have long-term metastasis. There is no significant difference in prognosis between eChRCC and cChRCC, but eChRCC shows better outcome than RO.

[Clinicopathological characteristics of fumarate hydratase-deficient renal cell carcinoma].

Objective: To investigate the clinicopathologic characteristics, molecular and genetic features, differential diagnoses and prognosis of fumarate hydratase-deficient renal cell carcinoma (FH-RCC). Methods: The immunohistochemical (IHC) expression of FH in 391 renal neoplasms in tissue chips collected from the Affiliated Hospital of Qingdao University and 971 Hospital of PLA Navy from January 2011 to December 2017 was evaluated. The clinicopathologic data of eight FH negative cases were collected.Polymerase chain reaction (PCR) and sequencing were used to detect the changes in FH gene in three cases. Interphase FISH with a dual color and break-apart probe was applied to detect the TFE3 gene alteration in the cases showing TFE3 protein expression. Results: Among the eight patients, seven were male and one was female, and age ranged from 28 to 50 years (mean 39 years). Tumor size ranged from 3.5 cm to 12.0 cm (mean 7.9 cm). Renal pelvis invasion was identified in six cases, and the tumor emboli in renal vein and inferior vena cava were found in four patients. The cut surface of most tumors was solid, colorful, grayish white or yellow with no clear border showing invasive growth pattern. Microscopically, the tumors showed different proportions of papillary, tubular cystic, cribriform and solid structures. The tumor cells were rounded or polygonal with eosinophilic or amphotropic cytoplasm, round or oval nuclei, and focal large and prominent nucleoli (WHO/ISUP grade 3-4). Two cases had sarcomatoid or rhabdoid components. Intravascular tumor emboli were found in five cases. IHC staining showed most tumors expressed PAX8(7/8), CK19(7/8), vimentin (6/8) and P504s(8/8). However, other immunomarkers including CK7, CD10, CD117, RCC, 34ßE12, HMB45 and Melan A were all negative. Sequencing showed all three cases had FH gene mutations in exon 1. FISH revealed no TFE3 gene translocation or amplification in the two cases with TFE3 IHC expression. Follow-up data were available in seven patients with the follow-up period from 11 to 66 months. Among them, five patients died between 11 to 31 months after the surgery because of extensive distant metastases of the tumor to the lung, liver and lymph nodes. The other two patients were alive at the 36th and 66th month after the surgery. Conclusions: Morphologically, FH-RCC overlaps with papillary RCC, collecting duct carcinoma and tubular-cystic RCC, showing a mixture of papillary, tubular cystic, cribriform or tubular papillary structures with at least focal large and prominent nucleoli. The negative expression of FH and the detection of FH gene mutation could facilitate the diagnosis of the tumor. FH-RCC is a high aggressive tumor, prone to metastasize, and is associated with poor prognosis. The timely diagnosis of FH-RCC could benefit the patients and their relatives as well.

[Intestinal perforation caused by severe electrical burn: report of 5 cases].

In recent 11 years, 5 cases of severe high voltage electrical burn with intestinal perforations were successfully treated. They showed obvious whole layer necrosis of abdominal wall, exudation, intestinal prolapse and peritonitis. On the basis of antishock therapy and protection of renal function, acute laparotomy was done early. Resection of the small intestine with necrosis and perforation and end-to-end anastomosis were done in 4 cases (5 regions). Colon resection and colostomy were done in 2 cases, and immediate end-to-end anastomosis in 2 cases. Bowel segment with external fistulae was left in 1 case (2 regions). If the abdominal wall defect could not be sutured directly, skin grafting on the residual tissue and omentum may be temporarily effective. And myocutaneous pedicle flap should be repaired secondarily. After operation, parenteral nutrition and anti-infection are important for patient recovery. No complication occurred in this group.

[Median thoracic flap with cartilage for repair of large tracheal defect].

Large defect of the tracheal wall is very difficult to repair without support of cartilage. Two patients with large defect of the tracheal anterior wall (2.5-3.0 x 6.0 cm) were treated successfully. For the patients with much scar in neck a median thoracic flap (3.5 x 4.0 x 7.0 cm) was designed as follow: The flap was elevated, and 3 autocartilage bows (0.5 x 0.4 x 0.4 cm) were implanted into the separated tunnels just beneath the subdermal vascular plexus of the flap. The flap was sutured at the border of tracheal wall defect. The cartilage bows were fixed and covered with a combined cervico-thoracic and cervico-acromial bilobate flap. 13 cadavers showed that 1-2 stem vessels (n = 9) or 4-5 vascular branches (n = 4) developed in the flap.

[Biliogenic liver abscess caused by acute obstructive suppurative cholangitis].

Biliogenic liver abscess was found by autopsy in 52 of 61 (85.2%) cases died of acute obstructive suppurative cholangitis (AOSC) at our hospital from 1957 to 1980. Of the 52 cases with liver abscess, 44 (84.6%) had multiple abscesses and 47 (90.4%) suffered complications of the rupture of liver abscess. Liver abscess was clinically diagnosed in only 7 of 52 cases who underwent emergency operation, with the predeath definite diagnosis of 13.5% (7/52). The authors considered biliogenic liver abscess an inevitable outcome not an accidental complication of AOSC when the high pressure in bile duct could not be relieved, and emphasized the importance of prevention, early diagnosis and treatment of liver abscess in order to decrease the mortality of AOSC.

Anticancer gelatin microspheres with multiple functions.

Biodegradable, hydrophilic gelatin microspheres (GM) with an average diameter of 70 microns were prepared by cross-linking gelatin with glutaraldehyde for hepatic intra-arterial infusion. An anticancer agent, mitomycin C (MMC), together with a radioisotope, 131I, were bound to the GM for chemotherapy and local internal radiotherapy. The 131I-labelled MMC-GM (131I-MMC-GM) could accumulate in the specific site and embolize the hepatic arteries after the hepatic intra-arterial infusion, while it caused various effects to the liver cells. The 131I-MMC-GM remained within the hepatic arteries for at least one month. In vitro release of drugs from the GM was also quantified using a dynamic dialysis method.

[Effect of porto-azygous disconnection with or without low esophageal transection on esophageal varices and portal pressure].

73 cases of cirrhotic portal hypertension treated in 4 years period (1982-1986) were followed by endoscope. Varices showed very little chance to disappear completely, and little difference in results between porto-azygous disconnection and that in combination with lower esophageal transection. The pressure of disconnected coronary vein on stomach side showed considerable elevation than that before and also in combination with lower esophageal transection. Continuous observation of portal pressure changes during and after operation for 4 days showed variations of amplitude suggesting redistribution of portal circulation. Judging from the series of postoperative events in follow-up, particularly rebleeding from recurrence of varices, there was renewed collateral circulation developed in the area of porto-azygous connection irrespective of the means of interruptions.