The evaluation of MR imaging in the diagnosis of primary duodenal adenocarcinoma / 实用放射学杂志

Objective To study the imaging features and the diagnostic value of conventional and enhanced MRI,DWI and magnetic resonance cholangiopancreatography (MRCP)in primary duodenal adenocarcinoma.Methods 12 cases with duodenal adenocarcinoma confirmed by pathological results were analyzed by conventional and enhanced MRI,DWI (3.0T,b＝0 and 800 s/mm2 )and MRCP.Results 11 cases out of twelve cases of duodenal adenocarcinoma demonstrated uneven thickening of intestinal wall,while mass shadow was observed in 1 case.Slight hypointensity of T1 WI and slight hyperintensity of T2 WI were demonstrated in all the twelve cases .DWI demonstrated mild increase in signal in 3 cases,while hyperintensity was observed in 9 cases.On MRCP,ampullary obstructions were observed in 1 1 cases,of which 6 were accompanied with the dilatation of common bile duct (CBD),and 5 with dilatation of CBD and pancreatic duct, while no dilatation of CBD or pancreatic duct was observed in 1 case.The tumors showed moderate enhancement after intravenous administration of contrast material.No normal layered intestinal walls were observed.Conclusion Conventional and enhanced MRI combined with DWI can clearly demonstrate the features of duodenal adenocarcinoma.Additionally,MRCP is instrumental in assessing the lesions involved in the duodenal papilla.

Total omentectomy in gastric cancer surgery: is it always necessary? / Omentectomia total na cirurgia do câncer gástrico: é ela sempre necessária?

ABSTRACT Background: Traditionally, total omentectomy is performed along with gastric resection and extended lymphadenectomy in gastric cancer (GC) surgery. However, solid evidences regarding its oncologic benefit is still scarce. Aim: To evaluate the incidence of metastatic omental lymph nodes (LN) in patients undergoing curative gastrectomy for GC, as well as its risk factors and patients' outcomes. Methods: All consecutive patients submitted to D2/modified D2 gastrectomy due to gastric adenocarcinoma from March 2009 to April 2016 were retrospectively reviewed from a prospective collected database. Results: Of 284 patients included, five (1.8%) patients had metastatic omental LN (one: pT3N3bM0; two: pT4aN3bM0; one: pT4aN2M0 and one pT4bN3bM0). Four of them deceased and one was under palliative chemotherapy due relapse. LN metastases in the greater omentum significantly correlated with tumor's size (p=0.018), N stage (p<0.001), clinical stage (p=0.022), venous invasion growth (p=0.003), recurrence (p=0.006), site of recurrence (peritoneum: p=0.008; liver: p=0.023; ovary: p=0.035) and death (p=0.008). Conclusion: The incidence of metastatic omental LN of patients undergoing radical gastrectomy due to GC is extremely low. Total omentectomy may be avoided in tumors smaller than 5.25 cm and T1/T2 tumors. However, the presence of lymph node metastases in the greater omentum is associated with recurrence in the peritoneum, liver, ovary and death.

RESUMO Racional: Tradicionalmente a omentectomia total é realizada juntamente com a ressecção gástrica associada à linfadenectomia na cirurgia do câncer gástrico. No entanto, evidências sólidas em relação ao seu benefício oncológico são escassas . Objetivo: Avaliar a incidência de metástases em linfonodos do omento maior em pacientes submetidos à gastrectomia potencialmente curativa por câncer gástrico, assim como, avaliar os fatores de risco para a ocorrência e a evolução dos pacientes. Métodos: Pacientes consecutivos submetidos à gastrectomia D2/D2 modificada devido ao adenocarcinoma gástrico foram analisados retrospectivamente a partir de um banco de dados. Resultados: Dos 284 pacientes, cinco (1,8%) tinham linfonodos metastáticos no omento maior (um pT3N3bM0; dois pT4aN3bM0; um pT4aN2M0 e um pT4bN3bM0). Quatro faleceram e um estava em tratamento paliativo com quimioterapia devido à recidiva da doença. Os linfonodos metastáticos no omento maior tiveram correlação significativa com o tamanho do tumor (p=0,018), estádio N (p<0,001), estádio clínico (p=0,022), invasão venosa (p=0,003), recorrência (p=0,006), local de recorrência (peritônio p=0,008; fígado p=0,023; ovário p=0,035) e óbito (p=0,008). Conclusão: A incidência de linfonodos metastático no omento maior de pacientes submetidos à gastrectomia radical por câncer gástrico é baixa. A omentectomia total pode ser evitada em tumores menores que 5,25 cm e estádios T1/T2. Entretanto, a presença de metástases linfonodais no omento maior está associada à recidiva no peritônio, fígado, ovário e óbito.

Pulmonary alveolar proteinosis with peripheral adenocarcinom.

Background: Pulmonary alveolar proteinosis (PAP) is a rare interstitial lung disease classified into congenital form, autoimmune form and secondary form. Secondary PAP is caused by underlying conditions including solid malignancies. Few cases reported PAP associated with lung cancers. Objective: To show the clinical features of PAP with adenocarcinom, tried to seek for possible mechanism to explain whole clinical course. Methods: Reported a case of PAP associated with lung adenocarcinom, and also reviewed the relevant literature on PAP. Results: The patient suffered from intermittent cough, fever, shortness of breath, thoracalgia or hemoptysis. Blood gas analysis showed hyoxemia. Spirometric abnormality is mildly restrictive defect. High-resolution computed tomography (HRCT) showed patchy, ground-glass opacities with interlobular septal thickening called as "crazy-paving" pattern. Positron emission tomography/computed tomography (PET/CT) revealed a nodule with characteristics of lobulation and spiculation in the right lung apex section and diffuse consolidation shadow spreading over rest of lung field. Bronchoalveolar lavage fluid (BALF) showed a large amount of amorphous red-dyed materials and a few alveolar macrophages scattered in endoalveolar space with PAS positive. Transbronchial lung biopsy found adenocarcinoma. Wedge resection with mediastinal lymphnode and then 2 cycles of postoperative chemotherapy was carried out. No ground-glass opacities were found in his chest CT pictures in the next nine months. This result may support the theory that lung cancer cells cause quantitative or functional damage to alveolar macrophages, which trend to secondary PAP. Conclusions: The patient had typical clinical features of PAP. PAP may be secondary to lung cancer. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 390-394).

Expression and clinnical significance of NF-κB and CD147 in lung adenocarcinoma / 实用医学杂志

Objective To investigate the expression of NF-κB and CD147 in lung adenocarcinoma.Methods The expressions of NF-κB and CD147 protein were detected on 80 lung adenocarcinoma tissue by S-P immunohistochemical method.The positive units(PUs) of NF-κB and CD147 were assessed quantitatively using Imagepro Plus image analysis softwore.Results NF-κB and CD147 protein positive intensity in lung adenocarcinoma was significantly higher than that in the non lung carcinoma (P =0.000,respectively).The positive rates of NF-κB and CD147 were 68.75％ (55/80) and 81.25％ (65/80) respectively.The expressions of NF-κB and CD147 were positively correlated with the degree of histologic differentiation,lymph node metastasis status and TNM stage (P =0.000,respectively).Both of them were not associated with sex,age,patients with history smoking,and tumor located in the central (P ＞ 0.05,respectively).NF-κB was correlated positively with CD147 expression (rp =0.498,P =0.000).Conclusions The high expression of NF-κB in lung adenocarcinoma may promote the high expression of CD147,and promote the tumor invasion and metastasis.

Inductions of Caspase-, MAPK- and ROS-dependent Apoptosis and Chemotherapeutic Effects Caused by an Ethanol Extract of Scutellaria barbata D. Don in Human Gastric Adenocarcinom Cells.

OBJECTIVES: The crude extracts of Scutellaria barbata D. Don (SB) have traditionally demonstrated inhibitory effects on numerous human cancers both in vitro and in vivo. Gastric cancer is one of the most common types of cancer on world. The authors investigated the effects of an ethanol extract of Scutellaria barbata D. Don (ESB) on the growth and survival of MKN-45 cells (a human gastric adenocarcinoma cell line). METHODS: The MKN-45 cells were treated with different concentrations of ESB, and cell death was examined using an MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay. Analyses of sub-G1 peaks, caspase-3 and -9 activities, and mitochondrial membrane depolarizations were conducted to determine the anti-cancer effects of SB on MKN-45 cells. Also, intracellular reactive oxygen species (ROS) generation was investigated. RESULTS: ESB inhibited the growth of MKN-45 cells, caused cell cycle arrest, and increased the sub-G1 population. In addition, ESB markedly increased mitochondrial membrane depolarization and the activities of caspase-3 and -9. ESB exerted anti-proliferative effects on MKN-45 cells by modulating the mitogen-activated protein kinase (MAPK) signaling pathway and by increasing the generation of ROS. Furthermore, combinations of anti-cancer drugs plus ESB suppressed cell growth more than treatments with an agent or ESB, and this was especially true for cisplatin, etoposide, and doxorubicin. CONCLUSION: ESB has a dose-dependent cytotoxic effect on MKN-45 cells and this is closely associated with the induction of apoptosis. ESB-induced apoptosis is mediated by mitochondria- , caspase- and MAPK dependent pathways. In addition, ESB enhances ROS generation and increases the chemosensitivity of MKN-45 cells. These results suggest that treatment with ESB can inhibit the proliferation and promote the apoptosis of human gastric adenocarcinoma cells by modulating the caspase-, MAPK- and ROS-dependent pathway.

A study of radiosensitizing effect of PKM2 silencing in lung adenocarcinoma cells and xenografts / 中华放射肿瘤学杂志

Objective To investigate the impacts of pyruvate kinase M2 isoform (PKM2) silencing on the radiosensitivity of lung adenocarcinoma cell line (A549 cells) and the radiation synergy of xenografts, and to explore their mechanisms. Methods Plasmid pshRNA?PKM2 for interference with PKM2 expression was transfected into A549 cells, and empty vector?transfected cells and untransfected cells were set as con?trols. The silencing efficiency of pshRNA?PKM2 and the expression level of microtubule?associated protein 1 light chain 3(LC3) were measured by Western blot assay. The radiosensitizing effects in A549 cells and xen?ografts after PKM2 silencing were determined by colony?forming assay and xenografts growth curves. Autoph?agy formation in A549 cells and xenografts was analyzed by transmission electron microscopy, and the ex?pression level of PKM2 in xenografts was measured by immunohistochemistry. Comparison between groups was made by Student′s t?test, and the body weights of nude mice and xenograft volumes were subjected to a?nalysis of variance for continuous variables. Results Stable A549 cell lines transfected with pshRNA?PKM2 were successfully produced. Transfection with pshRNA?PKM2 significantly down?regulated PKM2 expression in A549 cells and xenografts (P= 0?? 001;P= 0?? 000). The sensitizer enhancement ratios for A549 cells and xenografts were 1?? 47 and 2?? 00, respectively. Interference with PKM2 expression enhanced radiation?in duced autophagy formation and significantly increased the ratio of LC 3 ? II / I ( P= 0.000 1 ) . Conclusions Silencing of PKM2 expression may enhance the radiosensitivity of A549 cells and xenografts by regulation of autophagy, which holds promise for becoming an effective radiosensitizing target for non?small cell lung canc?er, but still needs to be confirmed by further studies.

Muscular metastasis from gastric cancer.

The association between gastric cancer and muscle metastasis is extremely rare. Few cases have been reported in the literature. We report a case of a 68-year-old man, with a diagnosis of gastric adenocarcinoma by endoscopy and biopsy. A painful nodule on the right thigh became noticeable during chemotherapy sessions, where positron emission tomography and percutaneous biopsy diagnosed a muscle metastasis of gastric adenocarcinoma. This report demonstrates the importance of further investigation of muscle lesion in patients with gastrointestinal cancer and how we can diagnose and treat these lesions.

Jejunostomy-Site Adenocarcinoma: A case report

Malignant tumors of the small bowel are uncommon by comparison with those in other parts of the gastrointestinal tract. Adenocarcinomas account for about half of the malignant tumors of the small intestine, which account for 1% to 2% of the gastrointestinal neoplasma. Small-bowel tumors are often asymptomatic and without clinical significance, and later became symptomatic and are eventually fatal. Patient's with regional enteritis, especially those who have had segments of the intestine surgically by passed, have an increased incidence of small-bowel cancer. The author experienced a case of an adenocarcinoma at the jejunostomy site (Braun anastomosis) which was treated by using a B II type subtotal gastrectomy for stomach cancer. That case of a jejunostomy site adenocarcinoma is reported and the literature on small-bowel malignancy is reviewed.

Total mesorectal excision with double mastomosis instruments in lower rectal carcinoma / 中国普通外科杂志

ObjectiveTo determine the effect of total mesorectal excision with double anastomosis instruments(DAIs) in lower rectal carcinoma. MethodsFrom 1995 to 1998,57 cases of middle and lower segement rectal carcinoma were treated by total mesorectal excision with DAIs, and were followed for 3 years. Results No operative death and no anastomotic leakage were noted. Two patients suffered from anastomotic stenosis,but no dysuria and sexual dysfunction occurred. Local recurrence rate was 5.3%(3/57)in the follow-up period. ConclusionsTotal mesorectal excision with DAIs is not only an effective method to maintain pelvic organ function in lower rectal cancer, but also able to improve the living quality of patients and reduce local reccurence.

Clinical significance of level of serum transforming growth factor-? in colorectal cancer / 中国普通外科杂志

Objective To observe the level of serum transforming growth factor ?(TGF ?) in patients with colorectal cancer and study its clinical significance. Methods Serum TGF ? was measured with radioimmunoassay in 54 patients with colorectal cancer and 25 healthy subjects,compared with 42 patients with colorectal cancer before and after the operation. Results The levels of serum TGF ? were significantly higher in patients with colorectal cancer than those in healthy controls(P