Mutant Allele Frequency-Based Intra-Tumoral Genetic Heterogeneity Related to the Tumor Shrinkage Mode After Neoadjuvant Chemotherapy in Breast Cancer Patients.

The shrinkage mode of tumor extent after neoadjuvant chemotherapy (NAC) is an important index to evaluate the odds of breast-conserving surgery. However, there is no sufficient measurement to predict the shrinkage mode after NAC. In this study, we analyzed 24 patients' formalin-fixed, paraffin-embedded samples before and after treatment and analyzed 456 cancer-related genes panel by using target next-generation sequencing. Meanwhile, the pathological shrinkage mode was reconstructed in three dimensions after surgery, and the genetic heterogeneity level was estimated by mutant-allele tumor heterogeneity (MATH). We measured the genetic intra-tumor heterogeneity and explored its correlation with the shrinkage mode after NAC. A total of 17 matched pair samples of primary tumor tissue and residual tumor tissue were successfully accessed. It was found that the most common mutated genes were TP53 and PIK3CA in both samples before and after NAC, and no recurrent mutations were significantly associated with the shrinkage mode. Besides, the MATH value of formalin-fixed, paraffin-embedded samples before and after NAC was analyzed by the area under the curve of the receiver operating characteristic, and it is feasible to classify patients into concentric shrinkage mode and non-concentric shrinkage mode in NAC based on the MATH threshold of 58. Our findings indicate that the MATH value was associated with the shrinkage mode of breast cancer in a non-linear model. Patients with the MATH value below the threshold of 58 before and after NAC displayed a concentric shrinkage mode. The area under the curve was 0.89, with a sensitivity of 0.69 and specificity of 1. Our study might provide a promising application of intra-tumor heterogeneity that is measured by MATH to make a choice of surgery.

Lymphoplasmacytic sclerosing pancreatitis with obstructive jaundice: a case report and review of the literature.

BACKGROUND: Lymphoplasmacytic sclerosing pancreatitis (LPSP) is a unique form of chronic pancreatitis and a tumor-like lesion simulating a carcinoma process clinically and radiographically. CASE REPORT: Herein, we presented a case of a patient with LPSP mimicking pancreatic carcinoma, who was admitted to our institution and subsequently treated with a Whipple procedure. This case typifies the growing awareness of this new clinicopathologic entity and the importance for LPSP to be included in the differential diagnosis of pancreaticobiliary disease. CONCLUSION: LPSP represents a diagnostic challenge which deserves more attention in the clinical management. An accurate preoperative diagnosis of LPSP can avoid pancreaticoduodenectomy in these patients.