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Objective: To analyze clinicopathological features of circumferential superficial esophageal squamous cell carcinoma and precancerous lesions and investigate the risk factors for deep submucosal invasion and angiolymphatic invasion retrospectively. Methods: A total of 116 cases of esophageal squamous epithelial high-grade intraepithelial neoplasia or squamous cell carcinoma diagnosed by gastroscopy, biopsy pathology and endoscopic resection pathology during November 2013 to October 2021 were collected, and their clinicopathological features were analyzed. The independent risk factors of deep submucosal invasion and angiolymphatic invasion were analyzed by logistic regression model. Results: The multivariate logistic regression analysis showed that drinking history (OR=3.090, 95% CI: 1.165-8.200; P<0.05), The AB type of intrapapillary capillary loop (IPCL) (OR=11.215, 95% CI: 3.955-31.797; P<0.05) were the independent risk factors for the depth of invasion. The smoking history (OR=5.824, 95% CI: 1.704-19.899; P<0.05), the presence of avascular area (AVA) (OR=3.393, 95% CI: 1.285-12.072; P<0.05) were the independent factors for the angiolymphatic invasion. Conclusions: The risk of deep submucosal infiltration is greater for circumferential superficial esophageal squamous cell carcinoma patients with drinking history and IPCL type B2-B3 observed by magnifying endoscopy, while the risk of angiolymphatic invasion should be vigilant for circumferential superficial esophageal squamous cell carcinoma patients with smoking history and the presence of AVA observed by magnifying endoscopy. Ultrasound endoscopy combined with narrowband imagingand magnification endoscopy can improve the accuracy of preoperative assessment of the depth of infiltration of superficial squamous cell carcinoma and precancerous lesions and angiolymphaticinvasion in the whole perimeter of the esophagus, and help endoscopists to reasonably grasp the indications for endoscopic treatment.
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Humans , Esophageal Squamous Cell Carcinoma/pathology , Esophageal Neoplasms/pathology , Retrospective Studies , Esophagoscopy , Carcinoma, Squamous Cell/pathology , Precancerous Conditions/surgery , Margins of Excision , Risk FactorsABSTRACT
【Objective】 To explore the different expressions of TP53, P16 and K-ras in gallbladder high-grade intraepithelial neoplasia and early carcinoma, and establish their mutation random forest prediction model. 【Methods】 We retrospectively analyzed the clinicopathological data of 71 patients who underwent cholecystectomy at The First Affiliated Hospital of Xi’an Jiaotong University from January 2013 to December 2018, including 20 cases of chronic cholecystitis, 28 cases of gallbladder high-grade intraepithelial neoplasia, and 23 cases of early gallbladder carcinoma. The immunohistochemical SP method was conducted to detect the expressions of TP53, P16 and K-ras in the gallbladder pathological tissues; the correlation between the above genes and clinicopathological data was analyzed. A random forest prediction model of each gene mutation was established based on the clinicopathological data and gene expression. 【Results】 The positive expressions of TP53, P16 and K-ras were related to the gallbladder with cholecystolithiasis or polyps and gallbladder pathological tissue type. The positive rates of the three genes in the gallbladder polyps were significantly higher than those in the cholecystolithiasis group (P<0.05). The positive rates of the three genes in the latter two groups of gallbladder high-grade intraepithelial neoplasia and early gallbladder carcinoma were significantly higher than those in the chronic cholecystitis (P<0.05), while there was no statistical difference between the latter two groups (P>0.05). The mutations of TP53, P16 and K-ras had a certain correlation (χ2=6.285, 19.595, 4.070, r=0.298, 0.525, 0.239, P<0.05). TP53, P16 and K-ras mutation prediction models based on random forest had good accuracy (AUC=77.42%, 80.06%, 71.75%, accuracy=76.06%, 76.06%, 67.61%). 【Conclusion】 TP53, P16 and K-ras gene mutations promote the transformation of chronic cholecystitis to gallbladder carcinoma. The mutation prediction model based on random forest has a good accuracy, which can provide an important reference for carcinogenesis and early diagnosis of gallbladder carcinoma.
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Objective: To investigate the clinicopathological characteristics and relevance of main and minor lesions of synchronous multiple gastric cancer and gastric high-grade intraepithelial neoplasia. Methods: We retrospectively reviewed 56 patients with synchronous multiple gastric cancer and gastric high-grade intraepithelial neoplasia who had been treated with operation and endoscopic submucosal dissection. Their clinicopathologic characteristics were summarized, and the correlation between main and minor lesions were analyzed. Results: Among the 56 patients, with a mean age of (63.82±11.88) years, 75% were men whereas 25% were women. Twenty-five (44.64%) patients had mucosal atrophy. The depth of tumor invasion in main and minor lesions was mainly stage T1. The size of main and minor lesions showed a positive correlation (r=0.797, P<0.001). The pathologic type of main and minor lesions demonstrated a moderately significant positive correlation (P=0.007). The endoscopic classification between major and minor lesions had a statistically significant consistency (P<0.001). The comparison of location between main and minor lesions showed a correlation: the correlation coefficient of the vertical position was 0.484 (P=0.002) and that of the horizontal position was 0.535 (P=0.007). Main lesions in multifocal gastric cancer or high-grade gastric intraepithelial neoplasia differed from single-focal gastric cancer or high-grade gastric intraepithelial neoplasia in terms of lymphatic metastasis, the TNM stage, and mucosal atrophy. Conclusions: Old men who had lesions combined with mucosal atrophy were considered as the high-risk group among patients with synchronous multiple gastric cancer and gastric high-grade intraepithelial neoplasia. Therefore, clinicians must keep a high grade of suspicion and make careful observations during the endoscopic examination, considering the correlation between main and minor lesions, in order to avoid any misdiagnosis.
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Objective To investigate the expression of serum platelet factor 4 (CXCL4) in high-grade intraepithelial neoplasia (HGIN) of gastric cardia and its clinical significance. Methods Sixty-four HGIN patients and 29 patients with advanced cardiac cancer (ACC) from January 2010 to December 2011 in the Fourth Hospital of Hebei Medical University were selected as the research objects. Forty healthy people treated with endoscope screening were chosen as the control group. Enzyme linked immunosorbent assay (ELISA) was used to detect the expression of CXCL4 in serum. The expression differences were compared by using variance analysis and LSD-t. Results The CXCL4 detection showed that the expression levels of CXCL4 were(0.75±0.37)ng/ml,(0.87±0.33)ng/ml,(1.13±0.51)ng/ml respectively in HGIN group,ACC group and the control group (F = 10.77, P < 0.05). The CXCL4 expression levels in HGIN and ACC group were lower than that in the control group (t = 4.80, t = 2.67, both P < 0.05). There was no difference between the CXCL4 expression levels in HGIN and ACC group(t =1.27,P >0.05).Conclusions The expression level of CXCL4 in HGIN patients with gastric cardia is significantly decreased. CXCL4 may be related with the occurrence and angiogenesis of gastric cardia cancer, which can be considered as an important serum marker for early screening of gastric cardia cancer.
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Objective To investigate the clinicopathologic characteristics and relevance of main and minor lesions of synchronous multiple early gastric cancers ( SMEGC) and gastric high grade intraepithelial neoplasia ( GHGIN) . Methods Thirty-two patients with SMEGC or/and GHGIN who were diagnosed and treated with endoscopic submucosal dissection in Nanjing Drum Tower Hospital from July 2012 to September 2016 were enrolled in this study. Their clinicopathologic characteristics were summed up, and the correlation between main and minor lesions on the size, location, endoscopic classification, pathologic type, invasion depth and vascular invasion were analyzed. Results Among the 32 patients, with mean age of 66. 19±7. 46 years, 90. 62％(29/32) were male, 17 cases (53. 3％) had family history of gastric cancer, 25 (78. 13％) had smoking history, and 22 ( 68. 75％) were alcohol users. There were 30 cases ( 93. 75％) and 31 cases ( 96. 88％) with mucosal atrophy and intestinal metaplasia, respectively. The size of main and minor lesions showed a positive correlation (r=0. 4167, P=0. 018). The endoscopic classification of major and minor lesions had no statistical significant consistency ( P=0. 314 ) , but the pathologic type and invasion depth between major and minor lesions demonstrated a moderate significant positive correlation ( P<0. 05 ) . The comparison of location between the main and minor lesions did not show correlation. However, it showed a significant correlation between major lesion which on the upper 1/3 of stomach and minor lesion on the lower 1/3 of stomach ( r=0. 463,P=0. 003) . Further more, when the main lesion was at posterior gastric wall, the minor lesions on lesser curvature were increased, which showed a positive correlation( r=0. 417,P=0. 009) . Conclusion Old-age male with long-term smoking and alcohol history whose lesions combined with surrounding mucosa merger atrophy and intestinal metaplasia are considered as a high risk group in patients with SMEGC or/and GHGIN. Therefore, clinicians must keep high vigilant and make carefully observations on this group of patients during endoscopic examination, and consider the correlation between main and minor lesions to avoid misdiagnosis.
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Objective To analyze colonoscopic appearances,computed tomography (CT) imaging features and their correlation with postoperative pathology in patients with colorectal high grade intraepithelial neoplasia (HGIN) diagnosed by colonoscopic biopsy.Methods From October 2009 to October 2015,patients diagnosed as colorectal HGIN by colonoscopic biopsy who received endoscopic resection or operation,and had complete postoperative pathological data were enrolled.The results of CT imaging before operation,postoperative pathological type,the maximum diameter of lesions,sessile lesions or pedunculated lesions and enlarged lymph nodes were analyzed.Chi-square test were performed for statistical analysis.Sensitivity and specificity of CT imaging before operation in the detection of invasive colorectal cancer were calculated.Results Among the 76 patients,21.1％ (16/76) patients were HGIN,and 78.9％ (60/76) were invasive cancer confirmed by postoperative pathology.The incidence rate of invasive carcinoma in patients aged ≤50 years (3/14) was significantly lower than that of patients aged ＞50 years (91.9％,57/62),and the difference was statistically significant (x2 =30.05,P＜0.01).The incidence rate of invasive carcinoma in protruding lesions with maximum diameter ≥ 3.0 cm was 98.3％ (57/58),which was higher than that of lesions with maximum diameter ＜3.0 cm(2/16),and the difference was statistically significant (x2 =51.91,P＜0.01).The incidence rate of invasive carcinoma in pedicle polyps group (2/13) was lower than that of sessile lesions (93.4％,57/61),and the difference was statistically significant (x2 =35.72,P＜0.01).The sensitivity and specificity of CT in the diagnosis of invasive colorectal cancer was 95.0％ and 84.6％,respectively.The incidence rate of invasive carcinoma in patients with enlarged lymph nodes detected by CT (93.3 ％,42/45) was significantly higher than that of patients without enlarged lymph nodes (64.3％,18/28),and the difference was statistically significant (x2=9.95,P =0.002).Conclusions CT examination can compensate for the diagnostic deficiency of colonoscopic biopsy which inadequately diagnosed some invasive carcinoma as HGIN.The incidence of invasive cancer is high in patients with age over 50 years,large lesions,sessile lesions,CT indicating colorectal neoplasms and with enlarged lymph nodes.
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Objective To explore the experience in nursing the patients with esophageal high-grade intraepithelial neoplasia lesions treated with endoscopic submucosal dissection. Method A retrospective analysis was carried out among the patients with esophageal high-grade intraepithelial neoplasia lesions to look into the nursing care to the patients. Results Thirty patients were successfully stripped, and no surgical complication occurred. After intensive care, they were cured and discharged. Conclusion Professional and meticulous care can effectively improve the success rate of endoscopic submucosal dissection and reduce the incidence of complications, and promote the rehabilitation of patients.
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Objective To evaluate the feasibility,safety and efficacy of ESD for precancerous lesions and early cancer of remnant stomach after partial gastrectomy.Methods ESD was performed in 11 cases of high grade intraepithelial neoplasia/early cancer of remnant stomach.The short-term and long-term indices including time of procedure,complication,En Bloc resection rate,R0resection rate,local recurrence rate as well as lymph node metastasis were recorded and analysed.Results ESD was completed in all patients with only one case of delayed massive bleeding which was controlled by endoscopy successfully.Average procedure time,En Bloc resection rate,R0 resection rate were 85.5 minutes,100％ and 90％,respectively.No local recurrence or lymph node metastasis was detected during post-ESD surveillance (15 ～ 51 months).Conclusion High grade intraepithelial neoplasia and early cancer of remnant stomach after partial gastrectomy might be indication for ESD because of its safety and definite effect.Additionally,careful management of the fibre tissue is the key to procedure success.
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Objective To investigate the efficacy and safety of multi-band mucosectomy (MBM) for the treatment of high-grade intraepithelial neoplasia.Methods The clinical data of 24 patients with high-grade esophageal intraepithelial neoplasia who were admitted to the Henan Honliv Hospital from April 2011 to October 2012 were retrospectively analyzed.All the 24 patients received MBM,and the operation time,resection of the lesion and complications were observed.All the patients were followed up with gastroscopy at postoperative 1,3,6,12 months.The follow-up was ended in April 2013.Results A total of 26 lesions in 24 patients were resected successfully by MBM (2 patients received MBM twice).The mean operation time was 42 minutes.The mean length of the lesions was 3.1 cm (range,0.8-6.0 cm),and it occupied 3/4 of the circumference of the esophagus to the maximum.The mean number of the band used was 4 (range,1-6).During the operation,bleeding was occurred in 4 patients,and they were cured by hot biopsy forceps.No perforation of the esophagus was detected.The results of post-MBM pathological examination showed that 22 patients were with severe atypical hyperplasia,and 2 were with carcinoma in situ.During the follow-up of 6-24 months,22 patients were cured,and esophageal stricture occurred in 1 patient at post-MBM 1 month,and the symptoms were successfully relieved by endoscopic balloon dilatation.Neoplasia recurrence was observed in 1 patient (2 lesions were resected twice) at post-MBM 3 months,and he received surgical treatment.Histopathological diagnosis showed that he had esophageal squamous cell carcinoma.No stricture or neoplasia was detected by gastroscopy at postoperative month 12.Conclusions MBM is a relatively safe and effective endoscopic technique for the treatment of high-grade esophageal intraepithelial neoplasia.The resection range should not be blindly extended.For patients whose lesions are beyond 3/4 of the circumference of the esophagus in width or with multiple lesions which can not be resected by MBM at one time,MBM should be applied cautiously to avoid esophageal stricture and recurrence.
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Objective To analyze the clinical and pathological characteristics and its surgical management strategy for colorectal high-grade intraepithelial neoplasia (HGIN).Methods Eighty-two cases with colorectal tumors diagnosed as colorectal HGIN based on colonoscopic biopsy between January 2005 and December 2012 were enrolled in the study.The clinicopathological data of all the patients was collected and analyzed.Of the 82 cases,71 cases had radical colorectal surgery,1 cases had Miles operation after previous transanal excisions,3 had transanal local excisions,8 cases had palliative surgery.The surgical specimens were all examined pathologically and compared with the preoperative diagnosis of colonoscopic biopsy of all the patients.Results Three cases (3.7％) were pathologically diagnosed as high-grade intraepithelial neoplasia,their average diameter was 1.5 cm.The other 79 (96.3％) cases were diagnosed as adenocarcinoma,with an average diameter of 4.7 cm.The difference in tumor size was statistically significant (P ＜ 0.01).Comparison of pre-and post-operative specimens showed poor consistency,the Kappa value was O.104.Significant analysis showed a correlation between cancerous change to tumor size and depth of invasion.In the 79 cases confirmed as adenocarcinoma,liver metastasis occurred in 8 cases,regional lymph nodes metastasis in 31 cases (39.2％).Of the 33 cases with rectal tumors,30 cases (90.9％) were pathologically diagnosed as adenocarcinoma after operation.Conclusions Much attention should be payed to the pathological diagnosis in colorectal intraepithelial neoplasia,especially in the HGIN.We have found that of the cases first diagnosed as HGIN,approximately 96.3％ already have invasion adenocarcinoma.Most cases had reginonal lymph nodes metastasis.Liver metastasis had been occurred.thus active surgical measures should be taken.If the location of the tumor was not involved to anal sphincter,or cases with tumors larger than 3 cm was diagnosed,in highly suspected cases with malignant potiential,radical surgery is recommended.For tumors located at the lower rectum,the final decision should be made only after repeated endoscopic or transanal biopsy.
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Objective To investigate the pathological features of gastro-esophageal high-grade intraepithelial neoplasia (HGIEN) confirmed by biopsy and to compare the differences of its diagnosis after endoscopic resection. Methods Data of 147 patients with gastro-esophageal HGIEN confirmed by biopsy, who underwent EMR or ESD in recent 4 years were analyzed for the pathological findings of pre- and post- procedures. Results Among 147 cases of HGIEN diagnosed by endoscopic biopsy, 106 lesions were in esophagus and 41 in stomach. After endoscopic resection, intraepithelial neoplasia was confirmed in 97 (66%), and cancer was diagnosed in 50 (34%), of which submucosal layer was involved in 11. There were 34 cases of adenocarcinoma and 16 squamous cell carcinomas, in which 22 cases (44%) were poorly or moderately differentiated. Conclusion More than one third cases of biopsy diagnosed HGIEN are confirmed to be carcinoma after endoscopic resection, which needs active therapeutic measures.
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Objective To investigate the pathological diagnosis of high-grade intraepithelial neoplasia in gastric biopsy.MethodsOne hundred and forty-three cases diagnosed by gastric biopsy as high-grade intraepithelial neoplasia were analyzed by light microscopy,and were compared with the pathological findings of surgical specimens in 60 cases and a second biopsy in 13 cases.Results Among the sixty cases treated surgically following the gastric biopsies,no carcinoma was found in 6,while the other 54 were diagnosed as gastric adenocarcinoma,27 in advanced stage and 27 in early stage,respectively.Fifteen cases were well-differentiated,24 moderately-differentiated,12 poorly-differentiated and 3 were of mucinous type.Four of the 13 cases with a second biopsy were diagnosed as well-differentiated adenocarcinoma,8 low-grade intraepithelial neoplasia and 1 chronic inflammation.The colorectal adenomas-like changes were morphologically found in 6 surgically-treated cases without carcinoma,5 of whom mucous muscles were not found by biopsy.Fibroblastic reactions were found in 9 cases,all of which were diagnosed as adenocarcinoma in surgical specimens.Conclusion Ninety percent of the cases who are diagnosed as high-grade intraepithelial neoplasia by biopsy may have already been complicated with adenocarcinoma.The location and depth of the specimen in gastric biopsy have a considerable influence on pathological diagnosis.The fibroblastic reaction may be considered as an important marker for gastric adenocarcinoma in pathological diagnosis of gastric biopsy.
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Objective To detect the microsatellite instability (MSI) of D9S166,D9S171,D9S941, D9S942 and IFNA located at chromosome 9p21 in gastric carcinoma with high-grade intraepithelial neoplasia and normal tissue,and investigate the correlation of p14,p15,p16 gene and the gastric carcinogenesis. Methods 55 cases of gastric carcinoma with high-grade intraepithelial neoplasia and normal tissue were se- lected to detect MSI by microdissection,polymerase chain reaction,denaturing polyaerylamide gel elec- trophoresis and silver nitrate staining technology of five microsatellite markers on 9p21.Results In the infor- mative cases,total ratio of MSI in gastric carcinoma was 27 % (64/233) and it was 18% (42/233) in high- grade intraepithelial neoplasia.The ratio of MSI was significantly higher in gastric carcinoma than that in high-grade intraepithelial neoplasia (P