Feasibility study on expanded indication for endoscopic submucosal dissection of intramucosal poorly differentiated early gastric cancer.

AIM: To identify clinicopathological factors predictive of lymph node metastasis (LNM) in intramucosal poorly differentiated early gastric cancer (EGC), and further to expand the possibility of using endoscopic submucosal dissection (ESD) for the treatment of intramucosal poorly differentiated EGC. METHODS: Data for 81 surgically treated patients with intramucosal poorly differentiated EGC were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Several clinicopathologic factors were investigated to identify predictive factors for lymph nodes metastasis, including gender, age, family history of gastric cancer, number of tumors, tumor location, ulceration, tumor size, macroscopic type, lymphatic vessel involvement, and signet-ring-cell component. RESULTS: Tumor size (OR = 7.273, 95%CI: 1.246-29.918, P = 0.042), lymphatic vessel involvement (OR = 42.219, 95%CI: 1.923-97.052, P = 0.018) and signet-ring-cell component (OR = 17.513, 95%CI: 1.647-77.469, P = 0.034) that were significantly associated with LNM by univariate analysis, were found to be significant and independent risk factors for LNM by multivariate analysis. However, gender, age, family history of gastric cancer, number, location, ulceration and macroscopic type of tumor were found not to be associated with LNM. Of these 81 patients diagnosed with intramucosal poorly differentiated EGC, 7 (8.6%) had LNM. The LNM rates were 9.1%, 22.2% and 57.1%, respectively, in cases with one, two and three of the risk factors. There was no LNM in 54 patients without the three risk clinicopathological factors. CONCLUSION: Tumor size, lymphatic vessel involvement and signet-ring-cell component are independently associated with the presence of LNM in intramucosal poorly differentiated EGC. Thus, these three risk factors may be used as a simple criterion to expand the possibility of using ESD for the treatment of intramucosal poorly differentiated EGC.

Histological and developmental study of prehierarchical follicles in geese.

The development of the follicular wall and apoptosis of corresponding cells are dependent upon the stage of follicle growth and levels of endogenous hormones. However, the development and apoptosis of prehierarchical follicles in geese is insufficiently known. In order to obtain an understanding about the microstructure, development and apoptosis of prehierarchical follicles in geese, firstly, a histological method was used to investigate the morphological structure of prehierarchical follicles. Results showed that the thickness of granulosa cell layers of the follicular wall increased first, then decreased to the lowest when follicles grew to 9-10 mm in diameter, and the theca layers also thinned to the lowest thickness at the same stage. Moreover, the expression of follicle-stimulating hormone receptor (FSHR) mRNA and the enzyme activity of caspase-3 were analyzed and the results showed that the expression of FSHR was highest when follicles grew to 8-9 mm in diameter (p < 0.05); the enzyme activity of caspae-3 was the highest when follicles grew to 6-8 mm in diameter (p < 0.05). These collective findings suggested that follicles 6-10 mm in diameter were especially significant, and perhaps represent a turning point from growing follicles to dominant follicles to be selected into a hierarchical sequence or to other follicles to be degenerated during prehierarchical follicle development.