ABSTRACT
Objective: To investigate the clinicopathological features and treatment of gastric alpha-fetoprotein (AFP)-producing adenocarcinoma with SWI/SNF complex deletion. Methods: Four cases of gastric AFP-producing adenocarcinoma with SWI/SNF complex deletion diagnosed in Zhongshan Hospital of Fudan University from January 2021 to December 2022 were collected, and their histomorphological characteristics, immunohistochemical (IHC), in situ hybridization of Epstein-Barr virus-encoded RNA (EBER), next-generation sequencing results, clinicopathological features and treatment were summarized, and literature review was conducted. Results: Among the 4 patients, there were three males and one female. They presented with abdominal pain, belching and melena. Serum AFP was significantly elevated in three patients, and endoscopy showed ulcerative lesions. Microscopically, the tumor cells showed mainly diffuse flaky or nest-like growth and typical characteristics of hepatoid adenocarcinoma. In two cases there were adenoid growth, and the tumor cells in these areas possessed clear cytoplasm, suggesting enteroblastic differentiation. The tumor cell nuclei were pleomorphic with large nucleoli and brisk mitoses. The IHC results showed that the tumor cells expressed AFP, GPC3 and SALL4, and there was retained expression of broad-spectrum keratin (CKpan) and E-cadherin. IHC detection of SWI/SNF complex subunits, namely INI1 (SMARCB1), BRG1 (SMARCA4), BRM (SMARCA2), ARID1A protein was performed. In all four cases the hepatoid adenocarcinoma region and enteroblastic differentiation region showed SMARCA2 deletion, and one case with enteroblastic differentiation also showed ARID1A deletion. SMARCB1 and SMARCA4 deletions were not seen. All the four cases were diffusely positive for p53 protein, and the Ki-67 proliferation index was 80%-90%. There were no mismatch repair deletion detected; one cases showed HER2 was strongly positive (3+), and EBER was negative. None of the four cases had mutations in the SWI/SNF complex-related subunits detected by next-generation sequencing. Among the four patients, two underwent palliative surgery due to distant metastasis at the time of surgery, two underwent radical resection. Postoperative adjuvant chemotherapy was given to three patients. Conclusions: AFP-producing adenocarcinoma is a rare subtype of gastric cancer, which can be combined with SWI/SNF complex deletion, and the pathomorphological manifestations are different from the classical SWI/SNF complex deletion of undifferentiated carcinoma with rhabdoid phenotype.
Subject(s)
Male , Humans , Female , alpha-Fetoproteins , Stomach Neoplasms/genetics , Epstein-Barr Virus Infections , Herpesvirus 4, Human , Adenocarcinoma/pathology , Biomarkers, Tumor/genetics , DNA Helicases/genetics , Nuclear Proteins , Transcription Factors/genetics , GlypicansABSTRACT
Objective:To observe the effect of acupuncture plus medium-frequency electric stimulation on bladder function after radical hysterectomy for cervical cancer. Methods:A total of 170 patients confirmed by biopsy and surgical pathology and treated with radical hysterectomy for cervical cancer were randomly divided into an acupuncture group, an observation group and a control group by random digital table. Fifty-six cases in the acupuncture group were treated with acupuncture after surgery, one session each day, till the extubation day; 58 cases in the observation group were treated with acupuncture plus medium-frequency electric stimulation after surgery, one session each day, till the extubation day; and 56 cases in the control group didn't receive any intervention, and the catheter was retained till the extubation day. On the postoperative day 14, all groups were dealt with catheterization to determine the residual urine volume, in order to observe the occurrence rate of urinary retention and the recovery of bladder function and to compare the differences of the therapeutic effects among the groups. Results:The occurrence rates of urinary retention were respectively 16.1%, 20.7% and 46.4% in the acupuncture group, observation group and control group, with significant differences (P<0.05). When comparing the acupuncture group and the observation group with the control group, there were significant differences (bothP<0.05). In comparison between the acupuncture group and the observation group, there was no significant difference (P>0.05). The recovery rates of bladder function in the three group were respectively 42.9%, 60.3% and 41.1% without significant differences (P>0.05). Moreover, there were no significant between-group differences (P>0.05), but acupuncture plus medium-frequency electric stimulation showed a better tendency. Conclusion: The single application of acupuncture therapy is effective and able to prevent urinary retention after radical hysterectomy for cervical cancer. Acupuncture plus medium-frequency electric stimulation can effectively enhance the recovery of bladder function and reduce the residual urine volume in the bladder to the maximum.
ABSTRACT
Objective:To observe the effect of acupuncture plus medium-frequency electric stimulation on bladder function after radical hysterectomy for cervical cancer. Methods:A total of 170 patients confirmed by biopsy and surgical pathology and treated with radical hysterectomy for cervical cancer were randomly divided into an acupuncture group, an observation group and a control group by random digital table. Fifty-six cases in the acupuncture group were treated with acupuncture after surgery, one session each day, till the extubation day; 58 cases in the observation group were treated with acupuncture plus medium-frequency electric stimulation after surgery, one session each day, till the extubation day; and 56 cases in the control group didn't receive any intervention, and the catheter was retained till the extubation day. On the postoperative day 14, all groups were dealt with catheterization to determine the residual urine volume, in order to observe the occurrence rate of urinary retention and the recovery of bladder function and to compare the differences of the therapeutic effects among the groups. Results:The occurrence rates of urinary retention were respectively 16.1%, 20.7% and 46.4% in the acupuncture group, observation group and control group, with significant differences (P<0.05). When comparing the acupuncture group and the observation group with the control group, there were significant differences (bothP<0.05). In comparison between the acupuncture group and the observation group, there was no significant difference (P>0.05). The recovery rates of bladder function in the three group were respectively 42.9%, 60.3% and 41.1% without significant differences (P>0.05). Moreover, there were no significant between-group differences (P>0.05), but acupuncture plus medium-frequency electric stimulation showed a better tendency. Conclusion: The single application of acupuncture therapy is effective and able to prevent urinary retention after radical hysterectomy for cervical cancer. Acupuncture plus medium-frequency electric stimulation can effectively enhance the recovery of bladder function and reduce the residual urine volume in the bladder to the maximum.