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OBJECTIVE@#To evaluate the pathological characteristics of endoscopic submucosal dissection (ESD) specimens for early gastric cancer and precancerous lesions, accumulating experience for clinical management and pathological analysis.@*METHODS@#A total of 411 cases of early gastric cancer or precancerous lesions underwent ESD. According to the Japanese guidelines for ESD treatment of early gastric cancer and classification of gastric carcinoma, the clinicopathological data, pathologic evaluation, concordance rate of pathological diagnosis between preoperative endoscopic forceps biopsies and their ESD specimens (in 400 cases), as well as the risk factors of non-curative resection of early gastric cancer, were analyzed retrospectively.@*RESULTS@#23.4% (96/411) of the 411 cases were adenoma/low-grade dysplasia and 76.6% (315/411) were early gastric cancer. The latter included 28.0% (115/411) non-invasive carcinoma/high-grade dysplasia and 48.7% (200/411) invasive carcinoma. The concordance rate of pathological diagnosis between endoscopic forceps biopsies and ESD specimens was 66.0% (264/400), correlating with pathological diagnosis and lesion location (P < 0.01). The rate of upgraded diagnosis and downgraded diagnosis after ESD was 29.8% (119/400) and 4.2% (17/400), respectively. Among the 315 cases of early gastric cancer, there were 277 cases (87.9%) of differentiated type and 38 cases (12.1%) of undifferentiated type. In the study, 262 cases (83.2%) met with absolute indication, while 53 cases (16.8%) met relative indication. En bloc and curative resection rates were 98.1% and 82.9%, respectively. Risk factors for non-curative resection included a long diameter >20 mm (OR=3.631, 95%CI: 1.170-11.270, P=0.026), tumor infiltration into submucosa (OR=69.761, 95%CI: 21.033-231.376, P < 0.001)and undifferentiated tumor histology (OR=16.950, 95%CI: 4.585-62.664, P < 0.001).@*CONCLUSION@#Several subjective and objective factors, such as the limitations of biopsy samples, the characteristics and distribution of the lesions, different pathological understanding, and the endoscopic sampling and observation, can lead to the differences between the preoperative and postoperative pathological diagnosis of ESD. In particular, the pathological upgrade of postoperative diagnosis was more significant and should receive more attention by endoscopists and pathologists. The curative resection rate of early gastric cancer in ESD was high. Non-curative resection was related to the long diameter, the depth of tumor invasion and histological classification. ESD can also be performed in undifferentiated early gastric cancer if meeting the indication criteria. The comprehensive and standardized pathological analysis of ESD specimens is clinically important to evaluate the curative effect of ESD operation and patient outcomes.
Subject(s)
Humans , Stomach Neoplasms/pathology , Endoscopic Mucosal Resection , Retrospective Studies , Endoscopy , Precancerous ConditionsABSTRACT
In the past, the use of neoadjuvant androgen deprivation therapy (ADT) for prostate cancer did not exhibit survival benefits and was not recommended by the practicing guidelines. In recent years, with the emergence of novel hormonal therapeutics such as Abiraterone, Enzalutamide, Apalutamide and Darolutamide, the interest for neoadjuvant therapy has been reignited. Here, we summarize the four categories of neoadjuvant therapy with new hormonal agents, and discuss how to evaluate the efficacy and explore the molecular mechanism after neoadjuvant therapy.
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Objective:To explore the effect of oxymatrine on the intestinal flora of mice with colorectal cancer and its related microbial mechanisms.Method:Based on azoxymethane (AOM)-dextran sulfate sodium (DSS) method, 16 5-week-old male BALB/c mice were performed to establish a orthotopic colorectal tumor mouse model. According to the stratified sampling method, mice were divided into the control group and oxymatrine intervention group, 8 in each group. From 5th week, mice in oxymatrine intervention group were given intraperitoneal injection of 10 mg/kg oxymatrine solution every other day; mice in the control group were given the same amount of 0.9% NaCl injection intraperitoneally until the end of the experiment at 81st d of modeling. The body weight of mice was measured every 3 days since the beginning of the modeling; before mice were sacrificed, mouse feces were collected for microbiological and 16S ribosome (rDNA) high-throughput sequencing. The tumor number of colorectal cancer was observed and tumor tissues were taken out. Hematoxylin and eosin (HE) staining was used to evaluate the differentiation degree, the percentage of tumor tissues with all differentiation degrees in the total tumor tissues was calculated, and immunohistochemistry staining was used to test the expression of Ki-67.Results:At the late of the experiment (d 49-d 81 of modeling), the body weight of mice in the control group was lower than that of mice in oxymatrine intervention group [modeling at 81st d: (22.9±0.5) g vs. (24.0±0.5) g, t=2.187, P < 0.05], and the tumor number of intestinal tract in oxymatrine intervention group was lower than that in the control group [(8.5±1.2) vs. (12.0±1.2), t = 2.824, P < 0.05] at the end of experiment. The percentage of well-differentiated tumors in mice intestinal tract in the oxymatrine intervention group was higher than that of mice in the control group [(62.5±3.7)% vs. (25.0±2.6)%], and the expression score of Ki-67 in oxymatrine intervention group was lower compared with that in the control group [(3.2±1.0) scores vs. (6.0±1.0) scores, t = 2.668, P < 0.05). At the phylum level, the abundance of Firmicutes and Proteobacteria in the intestine of mice in oxymatrine intervention group was higher than that in the control group (all P < 0.05), the abundance of Bacteroides in oxymatrine intervention group was lower than that in the control group ( P = 0.037). At the genus level, compared with the control group, the oxymatrine intervention group had a higher abundance of norank_f__Muribaculaceae ( P = 0.001). The abundance of Bacteroides, Odoribacter, Parabacteroides and alloprevotella in oxymatrine intervention group was lower than that in the control group (all P < 0.05). Conclusion:Oxymatrine can decrease the incidence of colorectal cancer in mice and delay development of colorectal cancer by regulating the gut microbiota and sustaining the stability of intestinal flora.
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Proper evaluation and management of surgical specimens of colorectal cancer,such as standardizing the macroscopic evaluation criteria of colorectal cancer specimens,standard processing procedure of specimens,decision criteria of routine histologic types,the method for determination of the resection specimen infiltration distance and curative degree,are of important clinical significance for surgical quality control,assessment of local lesion infiltration and diffusion,pathological classification and stage,which is able to predict prognosis and guide postoperative treatment.
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Objective: To evaluate whether clinical imaging findings of sarcomas after preoperative chemotherapy correlate with tumor responses by pathological evaluation using the rate of necrosis, so as to develop reliable and quantitative evaluation of clinical re-sponse. Methods: We retrospectively reviewed the medical records of 190 patients with high-grade sarcomas (mainly osteosarcomas and Ewing's sarcomas) that originated from the bone and who received neoadjuvant chemotherapy from June 1, 2014 to March 1, 2017 at Peking University People's Hospital. Finally, 157 lesions were evaluated by clinical imaging, including X-ray, computed tomogra-phy, magnetic resonance imaging, and bone scans or PET/CT. All patients underwent surgery at our center and pathological evaluation by tumor necrosis rates, which were graded by Huvos'classification, where gradeⅠis 0 to 49%, gradeⅡis 50% to 89%, gradeⅢis 90% to 99%, and gradeⅣis 100% necrosis. Statistical diversity analysis was performed by different pathological groups and receiver operating characteristic (ROC) curves. ROC curves were generated to determine the dividing clinical parameters (cut-off values) to dis-tinguish different pathological groups. Results: The cut-off values of the rate change in maximum diameters of tumors located in the extremities were 86%, 50.7%, and 0.02% for Huvos'Ⅳ,Ⅲ,Ⅱ, andⅠgroups, respectively. The differentiation was not obvious using bone scans to distinguish different pathological responses. The cut-off value for SUVmax for Huvos'Ⅲ,Ⅱ, andⅠgroups were 60.7% and 31.4%, respectively. We did not identify any valuable clinical parameters to evaluate the lesion restricted inside the bone. For sar-comas that originated from the axial skeleton, because of the small size of the sample, the differentiation was not so obvious. Conclu-sions: This study clearly defined the measuring methods for sarcomas primarily originating from the bone and attempted to determine meaningful cut-off values for multiple pathological response groups. A prospective multicenter trial is warranted to expand the sample size to make this clinical evaluation more precise and practical.
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The immune system is a complex system involving multiple organs,and it is vulnerable to age,gender,environment and other factors.For a variation normal physiological range,it is a great challenge to evaluate drug-induced immunotoxicity in preclinical safety study.Histomorphologic assessment of the immune system is a recognized cornerstone in the identification of immunotoxicity at present.In this paper,the principles of pathological evaluation for immune system,and pathological evaluation for important immune organs including thymus,spleen,lymph nodes are discussed briefly,so that it is intended to assist toxicity pathologists in the accurate and consistent characterization of intended and unintended drug-induced alterations of the immune system.
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In order to characterize their relationship through clinicopathological comparison between IgA nephropathy and Henoch-Schonlein purpura nephritis (HSPN), 31 children with IgA nephropathy aged between 3 to 15 years and 120 children with HSPN aged between 4 to 15 years were compared with each other in clinical manifestation, blood biochemistry, serum immunology and followup study. Renal pathological findings under light microscope, immunofluorescence and electronic microscope were analyzed and also compared between 31 children with IgA nephropathy and 32 biopsied children with HSPN. The results showed that the onset age was over 12 years in 25.8 %children with IgA nephropathy, but only 10 % in HSPN (P＜0.05). The clinical patterns of IgA nephropathy and HSPN were similar, but extra-renal manifestations were more often in HSPN, all of them had skin purpura, 59 % had gastrointestinal symptoms and 47 % suffered from arthralgia,compared with only abdominal pain in 3.2 % children with IgA nephropathy. The renal pathological investigation showed global sclerosis in 35.5 % of IgA nephropathy and 3.1% of HSPN, mesangial sclerosis in 41.9 % of IgA nephropathy and 6.3 % of HSPN, but endothelial proliferation in 65.6% of HSPN and 29 % of IgA nephropathy (all P＜0.01). Thin basement membrane nephropathy was only found in 6.5 % children with IgA nephropathy, no in HSPN. The electronic dense deposits in HSPN were sparse, loose and wildly spread in glomerular mesangium, subendothelial area and even intra basement membrane, but it was dense, lumpy and mostly limited in mesangium and paramesangium in IgA nephropathy. Predominant IgA deposits were found in 81.2 %of HSPN, and overwhelming IgG deposits in 12.5 % of HSPN with relatively weak IgA deposits,moreover 6.3 % of HSPN showed linear IgG deposits in glomerular capillary. Totally 71.9 % of HSPN had IgG deposits in glomeruli and only 19.4 % of IgA nephropathy showed glomerular IgG deposits (P＜0.01). No IgG deposit was observed in 81.6 % of IgA nephropathy, among them most showed IgA and IgM and/or C3 deposits, moreover overwhelming IgG deposits and linear IgG deposits couldn't be found in IgA nephropathy. Mean 20 months follow-up showed complete remission in 72.5 % of HSPN, but only 19.4 % in IgA nephropathy after 34 months follow-up. Moreover, 64.5 % of IgA nephropathy had consistent hematuria and proteinuria and 16.1% had active nephritides (P＜0.05). It was concluded that significant clinico-pathological difference was found between HSPN and IgA nephropathy, which didn't support the one disease entity hypothesis.HSPN and IgA nephropathy are probably two diseases with similar immune abnormalities.