Mixed adenoneuroendocrine carcinoma of the gallbladder.

A 58-year-old woman presented with a 1-day history of abdominal pain. Abdominal CT showed an oval soft tissue density mass in the fundus of the gallbladder (red arrow), approximately 4.0 cm × 3.0 cm in size. The level of cancer antigen 199 was elevated (275.80 U/mL; normal level, 0.0-27.0 U/mL). Other tumor markers were normal including alpha fetoprotein, carcinoembryonic antigen. Abdominal magnetic resonance imaging demonstrated the mass with characteristic of mixed signals, containing marked enhanced ingredient (yellow arrow) and poor blood supply ingredient (blue arrow). Radical cholecystectomy, partial liver resection, and regional lymphadenectomy were performed. Pathological examination indicated mixed adenoneuroendocrine carcinoma, with the following immunohistochemistry results: CD56 (+) (Figure 1F), Syn (+) (Figure 1G), CK19 (+) (Figure 1H), CgA (+), MLHL (+), PMS2 (+), MSH2 (+), MSH6 (+), Ki-67 (60%+).

Imaging findings and clinical features of atypical retroperitoneal abscess caused by duodenal perforation: a case report and review of the literature.

INTRODUCTION: A retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the head of the retroperitoneal pancreas. CASE PRESENTATION: A 28-year-old Chinese man presented with fever and abdominal pain after overeating and heavy drinking. On physical examination, he had mild tenderness in his upper abdomen. Laboratory examination results showed a white blood cell count of 24.06 109/L and a neutrophil absolute value of 18.81 109/L, and a computed tomography scan showed an irregular soft tissue mass with uneven enhancement of the cystic wall in the retroperitoneal space. Gastroscopy showed that there was a fistula in the anterior wall of the duodenal bulb. Endoscopic anastomosis clip system (over-the-scope clip) of the duodenal fistula was performed successfully. After the operation, nasal feeding was provided with a nutrition tube, and empiric anti-infection, acid-inhibiting, and stomach-protecting treatments were administered. Our patient's body temperature gradually returned to normal, and his abdominal pain decreased. CONCLUSIONS: A retroperitoneal abscess caused by duodenal perforation can be diagnosed by clinical symptoms and abdominal computed tomography imaging. The choice of treatment should be based on accurate and timely clinical and imaging data.

Aberrant expression of B7­H4 may contribute to the development of hepatocellular carcinoma.

In order to determine the effect of B7­H4 on the development of human hepatocellular carcinoma (HCC), the expression levels of B7­H4 were evaluated using reverse transcription­polymerase chain reaction and flow cytometry in HL­7702 and Huh7 cells. B7­H4 protein expression levels were analyzed using western blotting and immunohistochemistry in HCC tissues collected from patients and from a mouse tumor model. Soluble B7­H4 (sB7­H4), interferon­Î³ (IFN­Î³), and interleukin­4 (IL­4) in blood serum were assessed using ELISA in patients with HCC and mice injected with tumor cells. B7­H4 was expressed in HCC cell lines, mouse tumor tissues and HCC patient tissues. However, B7­H4 was not detected in HL­7702 cells or normal human liver tissues. The expression level of B7­H4 was positively correlated with tumor­node­metastasis (TNM) stage, lymph node metastasis, and differentiation degree in patients with HCC. sB7­H4 levels in blood serum samples collected from patients with HCC and tumorigenic mice were higher compared with healthy controls. Expression levels of IFN­Î³ were reduced, and IL­4 levels were increased in blood serum samples of patients with HCC and tumorigenic mice compared with healthy controls. sB7­H4 expression levels were negatively correlated with IFN­Î³ levels, and with the ratio of IFN­Î³ to IL­4. Additionally, sB7­H4 was positively correlated with IL­4 levels in mouse tumor tissues, serum samples obtained from tumorigenic mice and human HCC patients. Notably, the levels of sB7­H4 and IL­4 were positively correlated and IFN­Î³ was negatively correlated with the TNM stage of patients with HCC. In addition, sB7­H4 and IL­4 expression levels increased and levels of IFN­Î³ and the ratio of IFN­Î³/IL­4 decreased as a function of time post tumor implantation in the mouse model. The present study determined that aberrant expression of B7­H4 contributed to HCC development. B7­H4 may be a potential target for therapy and diagnosis of HCC.

[Comparative study of identification of pulmonary perfusion with dual source computed tomography in diagnosing pulmonary embolism].

OBJECTIVE: To explore the diagnostic value of dual source computed tomography (CT) in the diagnosing acute pulmonary embolism (PE). METHODS: A total of 20 cases with suspected PE were scanned by dual source CT and the data were analyzed with the software packages of conventional 3D, pulmonary embolism detection (PED), lung vessels and lung PBV. The examination with the highest detection rate was used to screen for pulmonary segment of PE and verify the diagnostic consistency with dual-energy perfusion imaging (DEPI) on pulmonary segment of PE. RESULTS: The detection rates for PE in pulmonary artery branches were all 30% for CTPA, lung vessels and PED. There were no statistical difference. The detection rates for PE in pulmonary lobar arteries were 47.0%, 49% and 50% for CTPA, lung vessels and PED. There were no statistical difference. The detection rates for PE in pulmonary segment arteries were 14.2%, 19.7% and 26.1% for CTPA, lung vessels and PED. Statistical differences existed among CTPA, lung vessels and PED. The detection rates for PE in pulmonary subsegment arteries were 3.7%, 4.5% and 7.0% for CTPA, lung vessels and PED. Statistical differences existed between PED, CTPA and lung vessels. No statistical difference existed between CTPA and lung vessels. PED had the higher clinical value on the diagnosis of PE of pulmonary segmental artery and inferior segmental artery. The sensitivity of DEPI for PE was 85.7%, specificity 94.1% and kappa 0.789. The diagnosis on PE of DEPI and PED image had a higher consistency. CONCLUSION: The dual-energy scanning of dual source CT has higher practical values in the diagnosis of PE. And PED can visualize the pulmonary artery segment and a downstream segment of PE. Pulmonary perfusion imaging may show the perfusion abnormalities due to pulmonary blood flow changes. A combination of both increases the diagnostic rate of PE.