Phospholipase A2 (PLA2) injured lymphatic endothelial cells leading to progression of secondary lymphoedema.

Secondary lymphoedema is one of the common complications after lymph node dissection for gynecologic malignancies and breast cancer. In this study, the relationship between PLA2 and postoperative lymphoedema in cancer at the molecular level has been explored through transcriptomics and metabolomic assays. Transcriptome sequencing technology, as well as metabolomic assays, were utilized to explore the expression of PLA2 in lymphoedema patients, and search for potential pathways in the pathogenesis and exacerbation mechanism of lymphoedema. The effect of sPLA2 on human lymphatic endothelial cells was investigated by culturing human lymphatic endothelial cells. Secretory phospholipases A2 (sPLA2) showed high expression levels in lymphoedema tissues, however, cytoplasmic phospholipases A2 (cPLA2), showed low expression in lymphoedema, as demonstrated by RT-qPCR. By culturing human lymphatic vascular endothelial cells, the study found that sPLA2 causes HLEC vacuolization and has an inhibitory effect on HLEC proliferation and migration. By detecting sPLA2 in the serum of lymphoedema patients and analyzing clinical data, it was found that sPLA2 was positively correlated with the severity of lymphoedema. Secretory Phospholipase A2 (sPLA2) is highly expressed in lymphoedema tissue, damages lymphatic vessel endothelial cells, is strongly associated with disease severity, and can be used as a potential predictor of disease severity.Abbreviations: PLA2: Phospholipase A2; DEGs: differentially expressed genes; DMP: differential metabolic production.

Bioinformatics analysis of inflammation and oncology in pulmonary lymphangioleiomyomatosis.

This study investigates the molecular markers and biological pathways of pulmonary lymphangioleiomyomatosis. We analyzed 2 gene expression profiles in the gene expression omnibus Gene Expression Omnibus database for normal lung tissue and lymphangioleiomyomatosis and identified differential expressed genes in pulmonary lymphangioleiomyomatosis. Ninety-one differentially expressed genes were identified, including 36 upregulated genes and 55 downregulated genes. Hub genes and pathogenic pathways associated with disease development were subsequently identified by enrichment analysis and protein-protein interaction network. Analysis showed that differential expressed genes are mainly involved in the biological behavior of tumor cell proliferation and invasion as well as the inflammatory response. We have identified 10 hub genes in the protein-protein interaction network. Hub genes play an important role in the proliferation and inflammatory response involved in tumor cell proliferation. This study deepens the understanding of lymphangioleiomyomatosis disease and provides a biological basis for further clinical diagnosis and treatment.

Safety analysis of natural orifice specimen extraction surgery for colorectal cancer.

SUMMARY: This study investigated the safety, feasibility, and clinical outcomes of natural orifice specimen extraction surgery (NOSES) by collecting clinical from patients who underwent complete laparoscopic radical resection for colorectal cancer versus those who underwent conventional laparoscopic radical resection for colorectal cancer. Patients with colorectal cancer were selected as the study sample and grouped according to the different surgical methods. A total of 182 patients were eligible for enrollment in the study, including 92 patients who underwent NOSES (NOSES group) and 90 patients who underwent conventional laparoscopic radical colorectal cancer surgery. In the NOSES group, a total of 14 cases were observed to have a postoperative abdominal infection, and the remaining 78 cases did not have an abdominal infection, which we refer to as the infected and uninfected groups in this paper for further analysis. There was no difference in surgical outcome between NOSES surgery and conventional laparoscopic surgery. Diabetes mellitus, prolonged drain retention, and prolonged operative time were risk factors for the development of abdominal infection in NOSES. In contrast, intraoperative use of specimen retrieval bags, use of transanal endoscopic operations, and intraoperative flushing of the abdominal cavity with dilute iodophenol were protective factors for the development of postoperative abdominal infections. NOSES for colorectal cancer is worth promoting because of its small trauma and quick postoperative recovery.

Analysis of the Clinical Effect of Natural Orifice Specimen Extraction Surgery Combined with Transanal Endoscopic Operations.

Background: To explore the clinical efficacy of natural orifice specimen extraction surgery (NOSES) combined with transanal endoscopic operations (TEOs) to remove specimens from the anus for laparoscopic radical resection of colorectal cancer. Methods: From January 2014 to May 2020, 120 colorectal cancer patients were selected as study samples, including 60 cases who underwent NOSES laparoscopic radical resection of colorectal cancer (experimental group) and 60 cases who underwent traditional laparoscopic radical resection of colorectal cancer (control group). The basic preoperative conditions, operative time, intraoperative blood loss, lymph node dissection, postoperative hospitalization time, postoperative exhaust and defecation time, postoperative anal function, and postoperative complications were analyzed retrospectively. Results: Sleep quality score (6.26 ± 1.16), pain score (2.95 ± 0.79), and hospitalization time (11.55 ± 3.79 days) were better than those for the control group (P < .05). There were no positive cases of incisal margin in both groups. Gastrointestinal function recovery time, blood loss, lymph node dissection, and postoperative complications were not statistically significant (P > .05). Conclusion: NOSES combined with TEOs has the advantages of less trauma, quick postoperative recovery, and low psychological pressure, so it is worth popularizing.

Retrospective Study of Natural Orifice Specimen Extraction Surgery in Resection of Sigmoid and Rectal Tumors.

Background: With the development of surgical technology, surgeons are paying more and more attention to minimally invasive procedures such as injury reduction, pain reduction, and beautiful incisions to ensure the effectiveness of surgical treatment. This article discusses the safety, feasibility, and clinical outcomes of laparoscopic resection of sigmoid colon and rectal tumors via natural orifice specimen extraction surgery (NOSES). Materials and Methods: The clinical data of 39 patients who underwent complete laparoscopic resection of sigmoid colon tumor or rectal tumor at Chengde Medical College Hospital between 2018 and 2020, including general patient data (gender, age, body mass index [BMI], etc.), surgery-related data, general postoperative conditions, and postoperative pathological data, were retrospectively analyzed to explore the feasibility and safety of NOSES. Results: The specimens were all removed through the anorectal resection drag out type. The average age of 39 patients was 61.3 ± 10.2 years, the average BMI was 24.0 ± 3.1 kg/m2, the average postoperative hospital stay was 11.2 ± 4.4 days, 12 patients with sigmoid colon tumors, including 11 malignant tumors and 1 schwannoma, 27 rectal tumors, including 1 rectal villous tubular adenoma, among the 37 patients with malignant tumors, ulcer type 32 cases of adenocarcinoma and 5 cases of mass adenocarcinoma, mean number of lymph nodes detected intraoperatively (11.9 ± 3.9), mean operative time (162.9 ± 43.0 minutes), mean operative bleeding (36.9 ± 13.0 mL), mean time of initial exhaust (4.3 ± 3.0) days, mean time of laparoscopic drainage tube removal (9.8 ± 1.4) days, mean time of postoperative feeding (4.4 ± 3.0) days, the average maximum tumor diameter (3.7 ± 1.4 cm), and the average distance of the tumor from the anal margin (14.1 ± 6.1 cm); after surgery, there were two cases of anastomotic fistula. Conclusion: Laparoscopic resection of sigmoid colon and rectal tumors via natural orifice specimen extraction has the advantages of less pain, reduced incisional complications, good safety, and accurate efficacy in clinical applications.

Ovarian Solid Pseudopapillary Tumor Resembling Benign Hemorrhagic Cyst on Rapid Frozen Section.

Solid pseudopapillary tumors are rare, with the majority of described cases originating in the pancreas. To date, there are only 10 documented reports of primary ovarian solid pseudopapillary tumors. Here, we describe the case of a 24-year-old woman who presented with worsening pelvic pain and dysmenorrhea. Workup demonstrated a right ovarian solid mass on ultrasound and an elevated serum LDH, which raised concerns for dysgerminoma due to her relatively young age. Therefore, she was taken to the operating room and underwent laparoscopic right salpingo-oophorectomy. On initial rapid frozen section, her ovarian cyst had a grossly hemorrhagic appearance with multiple hemosiderin deposits noted microscopically, which suggested a benign hemorrhagic cyst. However, the final pathology was reported as solid pseudopapillary tumor based on several defining histologic characteristics. Most importantly, immunostaining was positive for ß-catenin and negative for E-cadherin. This report presents a brief review of the current literature on primary ovarian solid pseudopapillary tumors, including a discussion of expected prognosis after surgical resection, as well as a discussion of the role of immunohistochemistry (IHC) in differentiating ovarian neoplasms in young premenopausal women.

Fine Needle Aspiration Cytology of Diffuse-Type Tenosynovial Giant Cell Tumors.

BACKGROUND: Tenosynovial giant cell tumor (TSGCT), also known as giant cell tumor of tendon sheath or pigmented villonodular synovitis, is the most common benign tumor of the tendon and synovium. The intra-articular diffuse type can present as a large infiltrative mass involving adjacent soft tissue and sometimes causes secondary destruction of bone, which leads to radiographic and clinical concern for malignancy. The tumor may also be purely extra-articular. CASE: Here, we report the fine needle aspiration cytology findings of 2 cases of diffuse-type TSGCT with large mononuclear cells with eccentric nuclei, finely granular cytoplasm, and a peripheral well-defined cytoplasmic rim of hemosiderin ("ladybird cells"). CONCLUSION: Although the presence of ladybird cells has been described in tissue sections of TSGCT, their identification in cytological specimens has not been reported to our knowledge. When observed, their presence may aid in differentiating TSGCT from other lesions with multinucleated osteoclast-type giant cells occurring at or near joints.

IgG4-Associated Cholangitis Can Mimic Hilar Cholangiocarcinoma.

IgG4-associated cholangitis can mimic hilar cholangiocarcinoma. Previously reported patients with IgG4-associated cholangitis mimicking cholangiocarcinoma had elevated serum IgG4 levels and long-segment biliary strictures. However, in the absence of other diagnostic criteria for malignancy, IgG4-associated cholangitis should remain a consideration among patients with normal serum IgG4 and a hilar mass suspicious for cholangiocarcinoma. The presence of a hilar mass and a malignant-appearing biliary stricture in two patients with normal serum IgG4 prompted further evaluation and subsequent concomitant liver and bile duct resection and reconstruction. The diagnosis of IgG4-associated cholangitis was established during the pathologic evaluation of the resected specimens. IgG4-associated cholangitis is a known imitator of hilar cholangiocarcinoma and should be considered in the differential diagnosis even among serologically IgG4-negative patients with a hilar mass prior to operative resection.

Adjunct p16(INK4a) immunohistochemistry aids the detection of high-grade squamous intraepithelial lesions in endocervical curettage specimens.

OBJECTIVES: We questioned whether the use of p16(INK4a) immunohistochemistry in endocervical curettage (ECC) specimens would improve the detection of high-grade squamous intraepithelial lesions (HSIL) in a high-risk patient population. METHODS: Papanicolaou test results were retrieved in 58 consecutive ECC specimens that were previously diagnosed as no histopathologic abnormality in patients with antecedent HSIL or atypical squamous cells, cannot exclude HSIL. An H&E recut and immunohistochemistry for p16(INK4a) were performed on all cases. RESULTS: HSIL were found in 18 (31%) ECC specimens originally interpreted as negative. Of these 18 cases, three had moderate-sized fragments of ectocervical epithelium with HSIL seen on the recut H&E with concurrent positivity for p16(INK4a). Fourteen cases had rare to occasional clusters of atypical cells with strong immunoreactivity for p16(INK4a). A single case showed a medium-sized fragment of HSIL on the p16(INK4a)-stained section. CONCLUSIONS: The use of recuts and adjunct p16(INK4a) should be considered when evaluating ECC specimens in high-risk patient populations.

Maspin retards cell detachment via a novel interaction with the urokinase-type plasminogen activator/urokinase-type plasminogen activator receptor system.

It is well documented that tumor suppressive maspin inhibits tumor cell invasion and extracellular matrix remodeling. Maspin is a cytosolic, cell surface-associated, and secreted protein in the serine protease inhibitor superfamily. Although several molecules have been identified as candidate intracellular maspin targets, the extracellular maspin target(s) remains elusive. Although maspin does not directly inhibit urokinase-type plasminogen activator (uPA) activity, we have shown evidence that maspin may block the pericellular proteolysis mediated by cell surface-associated uPA. In the current study, maspin significantly inhibited the Ca2+ reduction-induced detachment of DU145 cells. This maspin effect was associated with increased and sustained levels of mature focal adhesion contacts (FAC). We noted that maspin (a) colocalized with uPA and uPA receptor (uPAR), (b) enhanced the interaction between uPAR and low-density lipoprotein receptor related protein, and (c) induced rapid internalization of uPA and uPAR. The maspin effects on surface-associated uPA and uPAR required the interaction between uPA and uPAR. Further biochemical and biophysical analyses revealed that maspin specifically bound to pro-uPA with a deduced K(d) of 270 nmol/L and inhibited the plasmin-mediated pro-uPA cleavage. Interestingly, substitution of maspin p1' site Arg340 in the reactive site loop (RSL) with alanine not only abolished the binding to pro-uPA but also diminished the maspin effects on pro-uPA cleavage and cell detachment. These data show an important role of maspin RSL in regulating the uPA/uPAR-dependent cell detachment. Together, our data led to a new hypothesis that maspin may stabilize mature FACs by quenching localized uPA/uPAR complex before uPA activation.