Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection.

BACKGROUND: Gastric cancer is a common malignant tumor of the digestive tract, and endoscopic submucosal dissection (ESD) is the preferred treatment for early-stage gastric cancer. The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD. AIM: To analyze the features of gastric mucosal tumors at different differentiation levels, and to explore the prognostic factors of ESD. METHODS: We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021, according to the latest Japanese guidelines (sixth edition), and divided them into low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), and differentiated and undifferentiated early carcinoma. They are followed up by endoscopy, chest and abdominal computed tomography at 3, 6 and 12 months after ESD. We compared clinicopathologic characteristics, ESD efficacy, and complications with different degrees of differentiation, and analyzed the related factors associated with ESD. RESULTS: HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients (P < 0.001) and accounted for more 0-IIc (P < 0.001), atrophic gastritis was common (P < 0.001), and irregular microvascular patterns (IMVPs) and demarcation lines (DLs) were more obvious (P < 0.001). There was more infiltration in the undifferentiated carcinoma tissue (P < 0.001), more abnormal folds and poorer mucosal peristalsis (P < 0.001), and more obvious IMVPs, irregular microsurface patterns and DLs (P < 0.05) than in the LGIN and HGIN tissues. The disease-free survival rates at 2, 5, and 8 years after ESD were 95.0%, 90.1%, and 86.9%, respectively. Undifferentiated lesions (HR 5.066), white moss (HR 7.187), incomplete resection (HR 3.658), and multiple primary cancers (HR 2.462) were significantly associated with poor prognosis. CONCLUSION: Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics, which are closely related to the safety and efficacy of ESD.

Shifting patterns in fine root distribution of four xerophytic species across soil structural gradients and years of growth.

Fine root (diameter < 2 mm) distribution influences the potential for resource acquisition in soil profiles, which defines how plants interact with local soil environments; however, a deep understanding of how fine root vertical distribution varies with soil structural variations and across growth years is lacking. We subjected four xerophytic species native to an arid valley of China, Artemisia vestita, Bauhinia brachycarpa, Sophora davidii, and Cotinus szechuanensis, to increasing rock fragment content (RFC) treatments (0%, 25%, 50%, and 75%, v v-1) in an arid environment and measured fine root vertical profiles over 4 years of growth. Fine root depth and biomass of woody species increased with increasing RFC, but the extent of increase declined with growth years. Increasing RFC also increased the degree of interannual decreases in fine root diameter. The limited supply of soil resources in coarse soils explained the increases in rooting depth and variations in the pattern of fine root profiles across RFC. Fine root depth and biomass of the non-woody species (A. vestita) in soil profiles decreased with the increase in RFC and growth years, showing an opposite pattern from the other three woody species. Within woody species, the annual increase in fine root biomass varied with RFC, which led to large interannual differences in the patterns of fine root profiles. Younger or non-woody plants were more susceptible to soil environmental changes than the older or woody plants. These results reveal the limitations of dry and rocky environments on the growth of different plants, with woody and non-woody plants adjusting their root vertical distribution through opposite pathways to cope with resource constraints, which has management implications for degraded agroforest ecosystems.

A trade-off between leaf hydraulic efficiency and safety across three xerophytic species in response to increased rock fragment content.

Limited information is available on the variation of plant leaf hydraulic traits in relation to soil rock fragment content (RFC), particularly for xerophytes native to rocky mountain areas. In this study, we conducted a field experiment with four gradients of RFC (0, 25, 50 and 75% ν ν-1) on three different xerophytic species (Sophora davidii, Cotinus szechuanensis and Bauhinia brachycarpa). We measured predawn and midday leaf water potential (Ψleaf), leaf hydraulic conductance (Kleaf), Ψleaf induced 50% loss of Kleaf (P50), pressure-volume curve traits and leaf structure. A consistent response of hydraulic traits to increased RFC was observed in three species. Kleaf showed a decrease, whereas P50 and turgor loss point (Ψtlp) became increasingly negative with increasing RFC. Thus, a clear trade-off between hydraulic efficiency and safety was observed in the xerophytic species. In all three species, the reduction in Kleaf was associated with an increase in leaf mass per area. In S. davidii, alterations in Kleaf and P50 were driven by leaf vein density (VLA) and Ψtlp. In C. szechuanensis, Ψtlp and VLA drove the changes in Kleaf and P50, respectively. In B. brachycarpa, changes in P50 were driven by VLA, whereas changes in both Kleaf and P50 were simultaneously influenced by Ψtlp. Our findings suggest that adaptation to increased rockiness necessarily implies a trade-off between leaf hydraulic efficiency and safety in xerophytic species. Additionally, the trade-off between leaf hydraulic efficiency and safety among xerophytic species is likely to result from processes occurring in the xylem and the outside-xylem hydraulic pathways. These findings contribute to a better understanding of the survival strategies and mechanisms of xerophytes in rocky soils, and provide a theoretical basis for the persistence of xerophytic species in areas with stony substrates.

Within leaf nitrogen allocation regulates the photosynthetic behavior of xerophytes in response to increased soil rock fragment content.

There is limited information on how plant functional traits vary with soil rock fragment content (RFC), especially for xerophytes growing in stony soils. We examined leaf functional traits of three xerophytes (Sophora davidii; Cotinus szechuanensi; and Artemisia vestita) grown under an RFC gradient in a heavy loamy soil. Our results show that photosynthetic capacity increased linearly with RFC in S. davidii, whereas unimodal patterns were observed for the other two species. The RFC that maximized photosynthetic capacity (Asat) and photosynthetic N use efficiency (PNUE) were achieved by allocating more N to photosynthetic apparatus at the expense of cell walls. For C. szechuanensis, the increased fraction of photosynthetic N allocated to carboxylation (PC) bioenergetics (PB), and thylakoid light-harvesting components (PL) together contributed to the higher Asat and PNUE values. As for S. davidii, both PC and PB mainly contributed to higher Asat and PNUE, whereas for A. vestita only PB was the main contributor. Our results suggest that increased non-capillary porosity of high RFC soil conditions through promoting the root growth of S. davidii and C. szechuanensis ensures sufficient water and N supply for photosynthetic capacity. In shallow-rooted species A. vestita, low RFC soil maintained higher nitrate N in the topsoil, enhancing leaf photosynthetic capacity. We conclude that rock fragments promoted leaf photosynthetic capacity in the studied loamy soil system, but the promoting effect was species-specific. The results highlight the relevance of consideration of soil rock fraction in evaluation of photosynthetic behavior of xerophytes in heterogeneous rocky soils.

Regulation of glucolipid metabolism and gut microbiota by green and black teas in hyperglycemic mice.

A high-sugar and -fat diet (HSFD) has become a primary risk factor for diabetes, and dietary intervention shows a substantial effect on the prevention and management of hyperglycemia. In this study, the chemical compositions of the aqueous extracts of stir-fried green tea (GT) and congou black tea (BT) were compared. Moreover, their potential mechanisms and regulatory effects on hepatic glycolipid metabolism and gut microbiota disorders in hyperglycemic mice were further explored. Our results show that GT or BT intervention had a prominent regulatory effect on glycolipid metabolism. Moreover, they could significantly regulate the levels of serum metabolic signatures, the activities of key enzymes in liver glucose metabolism, and the expression of genes or proteins related to glycolipid metabolism via activating the IRS-1-PI3K/AKT-GLUT2 signaling pathway. Significantly, GT or BT administration adjusted the composition and diversity of the gut microbiota, mainly reflecting a significant increase in the abundance of beneficial bacteria (including Allobaculum, Lactobacillus, and Turicibacter) and reducing the abundance of harmful or conditionally pathogenic bacteria (mainly including Clostridiales and Bacteroides). Our results suggest that dietary supplementation with GT or BT could exert a practical anti-diabetic effect. Meanwhile, BT intervention showed a better regulation effect on glycolipid metabolism. This study reveals that GT and BT have excellent potential for developing anti-diabetic food.

Selenium-Enriched and Ordinary Black Teas Regulate the Metabolism of Glucose and Lipid and Intestinal Flora of Hyperglycemic Mice.

Black tea is one of the six major tea categories and has a variety of bioactivities. However, little is known about its comprehensive evaluation of hypoglycemic effects and potential mechanisms. In this study, we investigated the in vivo hypoglycemic activity and potential mechanism for aqueous extracts of ordinary black tea (BT) and selenium-enriched black tea (Se-BT) by using an established high-fat diet together with streptozotocin (STZ)-induced hyperglycemic mouse model. Additionally, we also explored their α-glucosidase inhibition activity. The results show that both BT and Se-BT had a favorable glycosidase inhibitory activity. Moreover, the intervention of BT and Se-BT could regulate the mRNA expression and the level of serum parameters related to glucose and lipid metabolisms. Accordingly, they could activate the phosphoinositide-3-kinase/protein kinase B (PI3K/Akt) signaling pathway and alleviate insulin resistance (IR) and hyperglycemia. Moreover, supplementation of BT and Se-BT increased the richness and diversity of intestinal flora and altered the abundance of beneficial and harmful bacteria. Both BT and Se-BT could regulate glucose metabolism, alleviate tissue damage, and restore intestinal flora dysbiosis, suggesting that they could be used as a natural functional food for preventing hyperglycemia.

Colonic Castleman Disease on FDG PET/CT.

ABSTRACT: Colonic Castleman disease is very rare. We report FDG PET/CT findings of colonic Castleman disease in a 72-year-old man. On FDG PET/CT, it presented as a colonic soft tissue mass with intense FDG uptake. The final pathology supported a diagnosis of Castleman disease, plasma cell variant. This case hints us, although rare, Castleman disease should be considered as a differential diagnosis when we notice a hypermetabolic colon mass on PET/CT.

Regulation of fungal community and the quality formation and safety control of Pu-erh tea.

Pu-erh tea belongs to dark tea among six major teas in China. As an important kind of post-fermented tea with complex microbial composition, Pu-erh tea is highly praised by many consumers owing to its unique and rich flavor and taste. In recent years, Pu-erh tea has exhibited various physiological activities to prevent and treat metabolic diseases. This review focuses on the fungi in Pu-erh tea and introduces the sources, types, and functions of fungi in Pu-erh tea, as well as the influence on the quality of Pu-erh tea and potential safety risks. During the process of fermentation and aging of Pu-erh tea, fungi contribute to complex chemical changes in bioactive components of tea. Therefore, we examine the important role that fungi play in the quality formation of Pu-erh tea. The associations among the microbial composition, chemicals excreted, and potential food hazards are discussed during the pile-fermentation of Pu-erh tea. The quality of Pu-erh tea has exhibited profound changes during the process of pile-fermentation, including color, aroma, taste, and the bottom of the leaves, which are inseparable from the fungus in the pile-fermentation of Pu-erh tea. Specifically, the application prospects of various detection methods of mycotoxins in assessing the safety of Pu-erh tea are proposed. This review aims to fully understand the importance of fungi in the production of Pu-erh tea and further provides new insights into subtly regulating the piling process to improve the nutritional properties and guarantee the safety of Pu-erh tea.

Green and Oolong Tea Extracts With Different Phytochemical Compositions Prevent Hypertension and Modulate the Intestinal Flora in a High-Salt Diet Fed Wistar Rats.

Green tea (GT) and oolong tea (OLT) are widely consumed beverages, and their preventive and regulatory effects on hypertension have been reported. However, the interventional effects of GT and OLT on hypertension induced by a high-salt diet and its mechanism have not been fully explored. This study evaluated the anti-hypertensive effects of GT and OLT and their underlying mechanisms. The in vivo anti-hypertensive effects of GT and OLT and their capability to prevent hypertension and regulate the intestinal microbiota in Wistar rats fed with a high-salt diet were evaluated. Our results show that GT and OLT supplementations could regulate oxidative stress, inflammation, gene expression, and parameter levels related to blood pressure (BP) and prevent the increase in BP induced by a high-salt diet. Furthermore, both GT and OLT boosted the richness and diversity of intestinal microbiota, increased the abundance of beneficial bacteria and reduced the abundance of harmful bacteria and conditionally pathogenic bacteria, and regulated the intestinal microbial metabolism pathway related to BP. Among them, OLT presented better effects than GT. These findings indicate that GT and OLT can prevent hypertension caused by high-salt diets, which may be due to the regulation of intestinal flora by GT and OLT.

Preparation, Physicochemical and Hypoglycemic Properties of Natural Selenium-Enriched Coarse Tea Glycoproteins.

Various functional components in tea have been well developed, but less research has been explored on glycoproteins in tea. In this paper, three types of glycoprotein fractions, namely tea selenium-binding glycoprotein1-1 (TSBGP1-1), TSBGP2-1, and TSBGP3-1, respectively, were extracted and purified from selenium-enriched coarse green tea. Chemical analysis revealed that three fractions were glycoproteins, but their selenium content, molecular weight, and monosaccharide composition were significantly different. Fourier transforms infrared (FT-IR) analysis indicated that three fractions contained characteristic absorption peaks of glycoproteins but differed in secondary structural composition. Thermogravimetric (TG) analysis showed that the thermal stability of the three fractions was dramatically distinct. The in vitro hypoglycemic activity showed that TSBGPs significantly activated the insulin receptor substrate 2 (IRS2)/protein kinase B (Akt) pathway in LO2 cells, then enhanced glucose metabolism and inhibited gluconeogenesis, and finally ameliorated insulin resistance (IR) and glucose metabolism disorders. Furthermore, Pearson correlation analysis reveals that the hypoglycemic activity was significantly correlated with Se, protein, monosaccharide composition (especially glucose), molecular weight, and secondary structure. Our results show that Se-enriched tea glycoprotein is a desirable candidate for developing anti-diabetic food, and TSBGP-2 and TSBGP-3 had a better regulation effect. Our results can provide a research reference for the extraction, physicochemical property, and function of selenium-enriched plant glycoproteins.

Extranodal natural killer/T-cell lymphoma of the breast: a retrospective clinicopathological analysis of a consecutive 11-year case series.

BACKGROUND: Extranodal NK/T-cell lymphoma of the breast (ENKTL-Breast) is rarely detected in clinical practice, and its clinicopathological features remain unclear. RESULTS: A consecutive 11-year (2010-2020) ENKTL-Breast case series was retrospectively analyzed. Eight cases of ENKTL-Breast were selected, with three primary and five secondary lesions, accounting for 3.5% (8/228) of all breast lymphomas. All patients were female with a median age of 46 years. Lesions presented as solid breast masses (8/8, 100%) and were usually located in the upper outer quadrant of the breast (7/8, 87.5%). B-symptoms were observed in seven (7/8, 87.5%) cases. Two primary ENKTL-Breast cases showed concomitant diseases (IgA nephropathy and chronic active hepatitis B). Histological and immunohistochemical features of ENKTL-Breast were similar to those of ENKTL at other sites. T-cell receptor rearrangement revealed clonality in all examined primary cases (2/2, 100%), but only in one secondary case (1/5, 20%). The disease progressed rapidly in two primary cases and both patients died within 3 and 9 months. For secondary cases, the disease manifested as a disseminated disease, with a median survival time of 6 months. CONCLUSIONS: Our data suggested that ENKTL-Breast clinically mimics breast cancer to some extent, though B-symptoms might serve as a distinguishing factor. ENKTL-Breast is highly aggressive and patients with this disease exhibit a short survival time. Primary ENKTL-Breast tends to originate from activated cytotoxic T-cells, and immune-related diseases may be involved in its pathogenesis and development.

Valorization of Polysaccharides Obtained from Dark Tea: Preparation, Physicochemical, Antioxidant, and Hypoglycemic Properties.

The structure and hypoglycemic activity of tea polysaccharides has been extensively studied, while there are few reports on the characterization and hypoglycemic activity of dark tea polysaccharides. The crude dark tea polysaccharide (CDTPS) was optimally extracted from Fuzhuan dark tea. Six polysaccharide fractions (namely DTPS-1, DTPS-2, DTPS-3, DTPS-4, DTPS-5, and DTPS-6) were isolated from CDTPS, and their physicochemical, structural, and biological properties were compared and analyzed. The results revealed that the compositions, structural characteristics, and biological properties of the six DTPSs were different. Therein, DTPS-4 and DTPS-6 had looser morphology, faster solubility, and a more stable structure. Additionally, DTPS-4 had the optimum in vitro antioxidant capabilities, and DTPS-6 had the strongest in vitro hypoglycemic capabilities. In addition, a correlation analysis revealed that the molecular weight and uronic acid content were significantly related to their antioxidant and hypoglycemic activities. Our results indicated that DTPS-4 and DTPS-6 could be further developed into functional foods or additives, respectively.

Unusual unilateral renal mass with pulmonary multiple nodules as the initial presentation of granulomatosis with polyangiitis.

We report a case of a 32-year-old man with recurrent fever, cough and left lumbago for more than one month. Computed tomography (CT) and magnetic resonance imaging (MRI) found bilateral multiple pulmonary nodules and a tumor-like mass in the left kidney. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed increased uptake in the right pharyngeal recess along with pulmonary and renal hypermetabolic lesions. The pathologic findings of pulmonary and renal specimens were suggestive of granulomatous inflammatory changes. Further laboratory examinations showed an elevated level of serum cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and serum proteinase 3-ANCA (PR3-ANCA). Clinical symptoms were significantly improved, and the size of pulmonary and renal lesions reduced following the use of steroids and cyclophosphamide together. Therefore, a final diagnosis of granulomatosis with polyangiitis (GPA) was made.

A low-grade bone angiosarcoma presented as low to mild 18F-FDG uptake mimicking multiple myeloma.

Angiosarcoma is a rare and aggressive malignancy disease. It constitutes less than 1% of all sarcomas. According to previous reports, angiosarcoma usually shows hypermetabolic features on fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) and therefore 18F-FDG PET/CT may be helpful to staging and assessing therapeutic efficacy. We report a rare case of multicentric bone angiosarcoma in a 51-year-old female patient showing low to mild 18F-FDG uptake, mimicking multiple myeloma, which often presents mild 18F-FDG avid lesions.

[The Application Value of True Whole-body PET/CT Scanning Protocol in Patients of Extranodal NK/T Cell Lymphoma].

OBJECTIVE: To assess the staging, restaging, and treatment strategy determination of extranodal NK/T cell lymphoma (ENKT) by PET/CT real body (true whole-body, TWB) imaging, which is superior to PET/CT limitation of the whole body (limited whole-body, LWB, from skull vertex to upper thighs) by adding 'distal lower extremity' images. METHODS: TWB 18F-FDG PET/CT studies performed for staging and follow-up of ENKTL patients between January 2012 and September 2017 were retrospectively reviewed. Patients in staging group received TWB PET/CT evaluation for staging at the first diagnosis. In follow-up group, patients received follow-up evalution with TWB PET/CT and progressive disease (PD) in the LWB range with or without clinical diagnosis or suspicion before follow-up examination, and then divided into four subgroups: staging (+) PD (－), staging (+) PD (+), staging (－) PD (－), staging (－) PD (+). Then the percentage of unexpected ENKTL lesions found at the distal extremity (outside the LWB range) (P1), and the percentage of changes in the staging, restaging/outcome evaluation (P2) in each group were recorded. RESULTS: Among the 225 patients in the staging group, 200 (88.9%) had tumors confined to LWB, while P1 was 11.1% (25 cases) and P2 was 0.4% (1 case). In the follow-up group, the P1 in staging (+) PD (－)( n=85), staging (+) PD (+)( n=4), staging (－) PD (－)( n=43), staging (－) PD (+) goups ( n=15) were 1.2%, 75.0%, 0%, 26.7%, and P2 were 1.2%, 0%, 0%, 13.3%, respectively. In the follow-up group, regardless of whether the TWB PET/CT examination was performed at the initial diagnosis stage, P1 in PD (－) group and PD (+) group was 0.8 vs. 36.8% ( P<0.000 1), and P2 was 0.8% vs. 10.5% ( P<0.000 1). CONCLUSION: It is not recommended that the TWB PET/CT imaging from the top of the head to the bottom of the foot use for the first diagnosis of ENKTL patients. And for follow-up patients with no clinical evidence of tumor progression or with evidence of tumor progression but whose lesions were limited to LWB at the initial diagnosis of TWB PET/CT staging, LWB PET/CT from the top of the head to the middle of the thigh is recommended for routine follow-up. For ENKTL patients, TWB PET/CT was not performed at the initial stage of diagnosis to detect the condition of lower limbs. If the evidence of tumor progression in the LWB range appeared before the follow-up examination, TWB PET/CT was recommended for the follow-up evaluation to evaluate the systemic tumor involvement.

Linking leaf hydraulic properties, photosynthetic rates, and leaf lifespan in xerophytic species: a test of global hypotheses.

PREMISE OF THE STUDY: Leaf venation and its hierarchal traits are crucial to the hydraulic and mechanical properties of leaves, reflecting plant life-history strategies. However, there is an extremely limited understanding of how variation in leaf hydraulics affects the leaf economic spectrum (LES) or whether venation correlates more strongly with hydraulic conductance or biomechanical support among hierarchal orders. METHODS: We examined correlations of leaf hydraulics, indicated by vein density, conduit diameter, and stomatal density with light-saturated photosynthetic rates, leaf lifespan (LLS), and leaf morpho-anatomical traits of 39 xerophytic species grown in a common garden. KEY RESULTS: We found positive relationships between light-saturated, area-based photosynthetic rates, and vein densities, regardless of vein orders. Densities of leaf veins had positive correlations with stomatal density. We also found positive relationships between LLS and vein densities. Leaf area was negatively correlated with the density of major veins but not with minor veins. Most anatomical traits were not related to vein densities. CONCLUSIONS: We developed a network diagram of the correlations among leaf hydraulics and leaf economics, which suggests functional trade-offs between hydraulic costs and lifetime carbon gain. Leaf hydraulics efficiency and carbon assimilation were coupled across species. Vein construction costs directly coordinated with the LLS. Our findings indicate that hierarchal orders of leaf veins did not differ in the strength of their correlations between hydraulic conductance and biomechanical support. These findings clarify how leaf hydraulics contributes to the LES and provide new insight into life-history strategies of these xerophytic species.

[Comparison Study of Left Ventricular Function Assessment by 18F-FDG PET, Gated SPECT and 2D-Echocardiography in Patients with Myocardial Infarction].

The aim of this study is to analyze the concordance between EDV, ESV and LVEF values derived from 18F-FDG PET, GSPECT and ECHO in patients with myocardial infarction. Sixty-four patients with coronary artery disease (CAD) and myocardial infarction were enrolled in the study. Each patient underwent at least two of the above mentioned studies within 2 weeks. LVEF, EDV and ESV values were analyzed with dedicated software. Statistical evaluation of correlation and agreement was carried out EDV was overestimated by 18F-FDG PET compared with GSPECT [(137.98 ± 61.71) mL and (125.35 ± 59.34) mL]; ESV was overestimated by 18F-FDG PET (85.89 ± 55.21) mL and GSPECT (82.39 ± 55.56) mL compared with ECHO (68.22 ± 41.37) mL; EF was overestimated by 18F-FDG PET (41.96% ± 15.08%) and ECHO (52.18% ± 13.87%) compared with GSPECT (39.75% ± 15.64%), and EF was also overestimated by 18F-FDG PET compared with GSPECT. The results of linear regression analysis showed good correlation between EDV, ESV and LVEF values derived from 18F-FDG PET, GSPECT and ECHO (r = 0.643-0.873, P = 0.000). Bland-Altman analysis indicated that 18F-FDG PET correlated well with ECHO in the Left ventricular function parameters. While GSPECT correlated well with 18F-FDG PET in ESV, GSPECT had good correlation with Echo in respect of EDV and EF; whereas GSPECT had poor correlation with PET/ECHO in the remaining left ventricular function parameters. Therefore, the clinical physicians should decide whether they would use the method according to the patients' situation and diagnostic requirements.

Risk factors for N2 metastasis in patients with non-small-cell lung cancer: multivariate analyses of 18F-FDG PET/CT data.

OBJECTIVES: N staging is a key factor when considering the choice of treatment for non-small-lung cancer. It is possible that there is a correlation between N2 metastasis and some risk factors. The objective of the present study was to evaluate associations between several risk factors and N(2) metastasis using univariate and multivariate analyses, which may assist clinicians in therapeutic planning. MATERIALS AND METHODS: The enrolled patients were divided into two groups on the basis of histopathological results after surgery: those with pN(2) disease (N(2) group) and those without (N(2) group). Sex, age, location, size, maximum standardized uptake value (SUV(max)) on fluorine-18 fluorodeoxyglucose PET, histopathological type, and tumor cell grade were compared between N(2) and N(2) groups. Correlations between each significant factor and groups were analyzed using univariate analyses. Independent risk factors were finally identified with multivariate analyses. RESULTS: A total of 258 patients met the inclusion criteria. Univariate analyses showed significant correlation between size, SUV(max), tumor cell grade, and N(2) status (P<0.05). Multivariate logistic regression showed that both SUV(max) and tumor cell grade were independent risk factors and had predictive value for N(2) disease (P<0.05). There were no N(2) node metastases when tumor SUV(max) was up to 2.5 and the tumor cell grade was low. However, the likelihood of metastasis increased to 0.29 and 0.28 when tumor SUV(max) was greater than 7.5 and when the tumor cell grade was high. CONCLUSION: SUV(max) and tumor cell grade are independent risk factors for N(2) metastasis.

Lingual tonsillar metastasis from rectal carcinoma: a rare occurrence.

A 66-year-old man presenting with sacral pain 18 months after radical transabdominal resection of rectal mucinous adenocarcinoma underwent F-FDG PET/CT cancer surveillance. Detection of multiple nodules in lingual tonsil and left neck by imaging initially suggested tonsillar squamous carcinoma (as a second primary) with spread to cervical nodes, given the rarity with which rectal carcinoma metastasizes to the head and neck. Ultimately, the tonsillar neoplasm proved to be adenocarcinoma of colorectal origin based on its shared histologic features and compatible immunostaining profile.

Therapeutic status-dependent thymic changes on 18F-FDG PET/CT in an adult patient with lymphoma who underwent 2 phases of chemotherapy.

A 31-year-old woman who underwent 2 phases of chemotherapy for Hodgkin lymphoma subsequently underwent 8 F-FDG PET/CT scans for staging and treatment response evaluation. The images revealed that the Hounsfield unit and SUV of the thymus changed with the therapeutic status; both decreased to the lowest level 0.5 months after chemotherapy and increased to the highest level 8 to 12 months after the end of treatment. Interestingly, we found a positive correlation between the thymic Hounsfield unit and SUV, with a Spearman correlation coefficient of 0.946 (P < 0.001).