Primary papillary mucinous adenocarcinoma of the ureter: a case report / 中华泌尿外科杂志

The presence of adenocarcinoma in urothelium is rare and mucinous adenocarcinoma is even rarer. A case of primary ureteral papillary mucinous adenocarcinoma was reported. The patient was admitted to hospital due to dull pain in the left lumbar abdomen with abdominal distension for 2 years and aggravation with fever for 1 week. CT examination revealed left ureteral calculi, severe left renal hydronephrosis, and renal cortical atrophy. The diagnosis was left ureteral calculus with hydronephrosis and left renal dysfunction. Left kidney puncture and drainage were performed first, followed by laparoscopic nonfunctional nephrectomy and ureterolithotomy. The pathological diagnosis was left ureteral mucinous adenocarcinoma. The patient refused further adjuvant therapy and died 16 months after surgery due to extensive tumor metastasis.

Mucocele of the appendix: what to expect / Mucocele do apêndice: o que esperar

Abstract Mucoceles of the appendix are rare and can have quite variable imaging and clinical presentations, sometimes mimicking an adnexal mass. The underlying cause can be neoplastic or non-neoplastic. The typical imaging appearance of a mucocele of the appendix is that of a cystic structure with a tubular morphology. This structure is defined by having a blind-ending and being contiguous with the cecum. Radiologists should be familiar with key anatomical landmarks and with the various imaging features of mucoceles of the appendix, in order to provide a meaningful differential diagnosis of a lesion in the right lower abdominal quadrant. In addition, a neoplastic mucocele can rupture, resulting in pseudomyxoma peritonei, which will change the prognosis dramatically. Therefore, prompt diagnostic imaging is crucial.

Resumo Mucoceles do apêndice são raras e podem ter uma apresentação clínica e imagiológica bastante variável, por vezes mimetizando patologia anexial. As causas subjacentes podem ser neoplásicas ou não neoplásicas. O aspecto de imagem típico de mucoceles do apêndice é o de uma estrutura de natureza cística com morfologia tubular. Esta estrutura deverá terminar "em fundo cego" e ser contígua com o ceco. Os radiologistas devem estar familiarizados com os pontos anatômicos de referência e com as diferentes características imagiológicas de mucoceles do apêndice, de modo a fornecer um adequado diagnóstico diferencial de uma lesão localizada no quadrante abdominal inferior direito. Para além disso, uma mucocele neoplásica pode sofrer ruptura, resultando em pseudomixoma peritoneal, o que altera drasticamente o prognóstico. Assim, o diagnóstico por imagem em tempo útil é crucial.

Metastasis of mucinous breast carcinoma to the lower alveolus as initial presentation: a diagnostic dilemma

ABSTRACT Metastases in the oral cavity are rare and comprise approximately 1% of all oral malignancies. They usually involve the jaws but may also be found in the soft tissues and salivary glands. Women's most common metastatic malignancies are from primary breast cancers. However, metastasis of mucinous breast carcinoma to the lower alveolus mimicking an aggressive primary malignancy as the initial presentation is exceptionally uncommon. We describe the case of a 66-year-old lady with an ulceroproliferative growth in the right lower alveolus. The lesion eroded the mandible and involved the adjacent soft tissues with no prior history of lesion anywhere else. The lesion clinically mimicked a squamous cell carcinoma and masqueraded as a salivary gland mucinous adenocarcinoma on histopathology. The possibility of a metastatic lesion from the breast rather than a primary of the alveolus was also entertained, aided by the immunohistochemical findings of positivity of the tumor cells for GATA3. A positron emission tomography (PET) scan was undertaken to ascertain the primary site. It detected a hypermetabolic lesion in the left breast, which biopsy revealed mucinous breast carcinoma on histopathological evaluation. Metastasis of breast mucinous carcinoma by the hematogenous route is extremely rare; very few cases have been reported. This case illustrates the diagnostic challenges such a lesion can pose to the surgeon and the pathologist. In the advent of such lesions being the initial clinical presentation, a vigilant clinicopathological and radiological assessment is essential to detect the primary.

MicroPET imaging studies of 89Zr-labeled EGFR and HER2 antibodies in gastric mucinous adenocarcinoma / 中华核医学与分子影像杂志

Objective:To screen 89Zr-labeled anti-epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) monoclonal antibody molecular probes suitable for monitoring the gastric mucinous adenocarcinoma bearing mouse models with low glucose metabolism. Methods:The expression of EGFR and HER2 in the MGC803 gastric cancer cell line was verified by analyzing cell slides and xenograft tumor sections. 89Zr-Deferoxamine (DFO)-Cetuximab and 89Zr-DFO-Pertuzumab were prepared and the radiochemical purity was detected. Cell binding experiments and blocking experiments were performed to verify the binding ability and specificity of the probes. Twelve gastric mucinous adenocarcinoma bearing mouse models were divided into 3 groups ( n=4 in each group): 89Zr-DFO-Cetuximab group (7.4 MBq/mouse, 74 μg/mouse), 89Zr-DFO-Pertuzumab group (7.4 MBq/mouse, 70 μg/mouse) and 18F-fluorodeoxyglucose (FDG) group (7.4 MBq/mouse). MicroPET imaging was performed at 4, 24 and 48 h ( 18F-FDG group underwent imaging at 1 h only) post-injection. The biodistribution study of 89Zr-DFO-Cetuximab and 89Zr-DFO-Pertuzumab was conducted in 2 groups ( n=4 in each group) 48 h after the injection. The independent sample t test was used for data analysis. Results:The immunofluorescent staining demonstrated EGFR expression was significantly higher than HER2 expression in MGC803 gastric cancer cell line. The radiochemical purity of 89Zr-DFO-Cetuximab and 89Zr-DFO-Pertuzumab were both more than 95%, and the specific activities were 100 and 95 MBq/mg, respectively. The two probes had good stability in normal saline and fetal bovine serum, with the radiochemical purity higher than 80% at 72 h. MicroPET imaging showed that the uptake of 89Zr-DFO-Cetuximab in the MGC803 tumor was significantly higher than that of 18F-FDG and 89Zr-DFO-Pertuzumab. The biodistribution study demonstrated the 89Zr-DFO-Cetuximab uptake (percentage activity of injection dose per gram of tissue, %ID/g) of tumors at 48 h was significantly higher than that of 89Zr-DFO-Pertuzumab (56.3±12.0 vs 22.0±3.6; t=4.31, P<0.05). Conclusion:Compared with 89Zr-DFO-Pertuzumab, 89Zr-DFO-Cetuximab has a better potential for non-invasive monitoring of gastric mucinous adenocarcinoma with low glucose metabolism.

Mucinous adenocarcinoma of the appendix with inguinal node metastases

Mucinous adenocarcinoma of the appendix is a rare neoplasm with a low propensity for lymph node metastasis. The present case refers to an appendicular mucinous adenocarcinoma with inguinal lymph node metastasis. A 71-year-old woman underwent an appendectomy due to a clinical presentation of acute appendicitis. However, the histological examination of the surgical specimen revealed a mucinous adenocarcinoma of the appendix. After staging, the patient underwent a right hemicolectomy and was proposed for adjuvant chemotherapy. At the 3rd year of follow-up, inguinal lymphadenopathy was diagnosed, which biopsy confirmed inguinal node metastases from primary colorectal cancer, with areas of extracellular mucin. Restaging revealed liver and peritoneal metastasis, and the patient was proposed for palliative chemotherapy. Appendicular neoplasms, due to their rarity, represent a diagnostic and therapeutic challenge. This clinical case depicts an unusual metastasis pathway for an unusual neoplasm.

MRI differences between locally advanced rectal mucinous adenocarcinoma and non-mucinous adenocarcinoma before and after neoadjuvant chemoradiotherapy / 中华放射学杂志

Objective:To investigate the MRI differences between locally advanced rectal mucinous adenocarcinoma and non-mucinous adenocarcinoma before and after neoadjuvant chemoradiotherapy (NCR).Methods:A retrospective cohort study was conducted to collect the clinical and imaging data of 165 patients with locally advanced rectal adenocarcinoma treated by NCR combined with surgery from October 2016 to October 2019 in the Sixth Affiliated Hospital of Sun Yat-sen University, 36 cases were rectal mucinous adenocarcinoma and 129 cases were non-mucinous adenocarcinoma. The image features of the two groups before and after NCR were evaluated based on MRI, including the length and thickness of the tumor, the distance from the lower edge of the tumor to the anal edge, T stage, N stage, involvement of mesorectal fascia (MRF) and peritoneal reflux. The difference of NCR and the change of MRI characteristics after NCR were compared by independent sample t test, Mann-Whitney U test or χ 2 test. The accuracy of MRI re-staging after NCR was evaluated according by postoperative pathological staging results. Results:Before NCR, there was significant difference in length of tumor between mucinous adenocarcinoma and non-mucinous adenocarcinoma groups ( P=0.044), there was no significant difference in the distance from the lower edge of the tumor to the anal edge, thickness of the tumor, T stage, N stage, involvement of MRF and peritoneal reflux (all P>0.05). After NCR, in patients with non-mucinous adenocarcinoma, the distance reduction from the lower edge of the tumor to the anal edge, the length reduction of the tumor, the thickness reduction of the tumor, the T-stage decline rate were significantly higher than those in the mucinous adenocarcinoma group (all P<0.05). The N-stage decline rate of mucinous adenocarcinoma was higher than that in non-mucinous adenocarcinoma group ( P=0.008). After NCR, MRI overestimated T staging of patients with both mucinous adenocarcinoma and non-mucinous adenocarcinoma compared with pathological T-stage ( P<0.001). In patients with mucinous adenocarcinoma, MRI overstated the N-stage than pothology ( P=0.001). Conclusions:There is different sensitivity of mucinous adenocarcinoma and non-mucinous adenocarcinoma to NCR. Patients with non-mucinous adenocarcinoma benefit more from the efficacy of NCR. The accuracy of MRI in re-staging of rectal mucinous adenocarcinoma and non-mucinous adenocarcinoma after NCR needs to be improved.

Clinicopathological characteristics of primary ovarian mucinous adenocarcinoma / 中国医师进修杂志

Objective@#To investigate the clinicopathological characteristics of primary ovarian mucinous adenocarcinoma.@*Methods@#The clinical data of 28 patients with primary ovarian mucinous adenocarcinoma from April 2006 to December 2018 in Dalian Maternity Hospital Affiliated to Dalian Medical University were retrospectively analyzed. The pathological sections were reviewed, and the clinicopathological characteristics were analyzed by immunohistochemical staining.@*Results@#Among 28 patients, the average age of patients was 46.5 (22 to 64) years. Ten cases were found by health examination, 15 cases showed lower abdominal discomfort, and 3 cases had irregular vaginal bleeding. Pelvic ultrasound examination showed heterogeneous internal echoes in adnexal region, and serum tumor marker levels did not significantly increase. The diameters of tumors were 8 to 32 cm, with an average of 16.5 cm. The unilateral ovarian tumor was in 26 cases, and bilateral ovarian tumor was in 2 cases. Most of tumors were solid-cystic with viscous liquid or jelly-like substance inside the cystic, accompanied with solid papillae or nodules. Microscopically, tumors were composed with gastrointestinal epithelium. Eighteen cases had borderline mucinous tumors with focal fusion infiltrating carcinoma; 10 cases had fusion infiltrating carcinoma dominant, while there were 2 cases whose tumor exhibited focal invasive infiltration. Immunohistochemical result showed that the positive rates of cytokeratin (CK) 7, CK20 and tail-type homeobox gene (CDX) 2 were 100.0% (28/28), 71.4% (20/28) and 53.6% (15/28); the positive rates of paired box gene (PAX) 8 and special AT-rich sequence-binding protein (SATB) 2 were 14.3%(4/28) and 10.7% (3/28). According to the ovarian carcinoma stage standard of International Federation of Gynecology and Obstetrics (FIGO) 2014, Ⅰ stage was in 21 cases, Ⅱstage in 4 cases, Ⅲ stage in 2 cases, and Ⅳ stage in 1 case. The patients were followed up for 3 to 120 months, with an average of 55 months. No recurrence or metastasis was in 17 cases (FIGO Ⅰ stage 16 cases, FIGO Ⅱ stage 1 case); recurrent within 2 years was in 5 cases (FIGO Ⅱ stage 2 cases, Ⅲ stage 2 cases, Ⅳ stage 1 case), of which 4 cases died within 5 years (FIGO Ⅱ stage 1 case, Ⅲ stage 2 cases, Ⅳ stage 1 case); lost to follow-up was in 6 cases (FIGO Ⅰ stage 5 cases, FIGO Ⅱ stage 1 case).@*Conclusions@#Primary ovarian mucinous adenocarcinoma is rare, and it has no specific clinical symptoms. It is mainly characterized by fusion infiltration. Immunohistochemical result shows that CK7 is always positive, the expressions of CK20 and CDX2 are different degree, and SATB2 and PAX-8 are mostly negative. Prognosis is closely related with FIGO stage, and the patients with FIGO Ⅰ stage have good prognoses, Ⅲ and Ⅳ stage have poor prognoses. It should be distinguished from ovarian metastatic mucinous tumor.

Clinicopathological characteristics of primary ovarian mucinous adenocarcinoma / 中国医师进修杂志

Objective To investigate the clinicopathological characteristics of primary ovarian mucinous adenocarcinoma.Methods The clinical data of 28 patients with primary ovarian mucinous adenocarcinoma from April 2006 to December 2018 in Dalian Maternity Hospital Affiliated to Dalian Medical University were retrospectively analyzed.The pathological sections were reviewed,and the clinicopathological characteristics were analyzed by immunohistochemical staining.Results Among 28 patients,the average age of patients was 46.5 (22 to 64) years.Ten cases were found by health examination,15 cases showed lower abdominal discomfort,and 3 cases had irregular vaginal bleeding.Pelvic ultrasound examination showed heterogeneous internal echoes in adnexal region,and serum tumor marker levels did not significantly increase.The diameters of tumors were 8 to 32 cm,with an average of 16.5 cm.The unilateral ovarian tumor was in 26 cases,and bilateral ovarian tumor was in 2 cases.Most of tumors were solid-cystic with viscous liquid or jelly-like substance inside the cystic,accompanied with solid papillae or nodules.Microscopically,tumors were composed with gastrointestinal epithelium.Eighteen cases had borderline mucinous tumors with focal fusion infiltrating carcinoma;10 cases had fusion infiltrating carcinoma dominant,while there were 2 cases whose tumor exhibited focal invasive infiltration.Immunohistochemical result showed that the positive rates of cytokeratin (CK) 7,CK20 and tail-type homeobox gene (CDX) 2 were 100.0％ (28/28),71.4％ (20/28) and 53.6％ (15/28);the positive rates of paired box gene (PAX) 8 and special AT-rich sequence-binding protein (SATB) 2 were 14.3％ (4/28) and 10.7％ (3/28).According to the ovarian carcinoma stage standard of International Federation of Gynecology and Obstetrics (FIGO) 2014,Ⅰ stage was in 21 cases,Ⅱ stage in 4 cases,Ⅲ stage in 2 cases,and Ⅳ stage in 1 case.The patients were followed up for 3 to 120 months,with an average of 55 months.No recurrence or metastasis was in 17 cases (FIGO Ⅰ stage 16 cases,FIGO Ⅱ stage 1 case);recurrent within 2 years was in 5 cases (FIGO Ⅱ stage 2 cases,Ⅲ stage 2 cases,Ⅳ stage 1 case),of which 4 cases died within 5 years (FIGO Ⅱ stage 1 case,Ⅲ stage 2 cases,Ⅳ stage 1 case);lost to follow-up was in 6 cases (FIGO Ⅰ stage 5 cases,FIGO Ⅱ stage 1 case).Conclusions Primary ovarian mucinous adenocarcinoma is rare,and it has no specific clinical symptoms.It is mainly characterized by fusion infiltration.Immunohistochemical result shows that CK7 is always positive,the expressions of CK20 and CDX2 are different degree,and SATB2 and PAX-8 are mostly negative.Prognosis is closely related with FIGO stage,and the patients with FIGO Ⅰ stage have good prognoses,Ⅲ and Ⅳ stage have poor prognoses.It should be distinguished from ovarian metastatic mucinous tumor.

CT features of pneumonic-type pulmonary invasive mucinous adenocarcinoma / 中国医学影像技术

Objective: To observe CT features of pneumonic-type pulmonary invasive mucinous adenocarcinoma (PIMA). Methods: Clinical, imaging (plain and multi-phase enhanced CT) and pathological data of 30 patients with pathologically confirmed pneumonic-type PIMA were retrospectively analyzed. Results: Consolidation was found in all 30 cases, including 5 cases of pure consolidation and 25 cases of consolidation with multiple morphologies. The density of consolidation was lower than the same level muscles. Mild-to-moderate enhancement of consolidations were observed after administration of contrast media. CT angiogram sign and lobar distention sign were detected inside consolidations in 26 and 12 cases, respectively. Nine cases were diagnosed as lung cancer, while 21 cases were diagnosed as infection or other lesions with the first time CT examination. Conclusion: The consolidation of pneumonic-type PIMA has some characteristics, including low density, mild-to-moderate enhancement, angiogram sign and lobar distention sign. Consolidation combined with ground glass density, nodules and cystic transparent shadow are helpful to differential diagnosis of pneumonic-type PIMA, infectious lesions and infectious diseases or lymphoma.

Human Epidermal Growth Factor Receptor 2-positive Mucinous Carcinoma with Signet Ring Cell Differentiation, Which Showed Complete Response after Neoadjuvant Chemotherapy / 한국유방암학회지

Mucinous carcinoma (MC) is a rare subtype of breast cancer, which is composed of tumor cells floating in the abundant extracellular mucin. This form of cancer is usually estrogen receptor/progesterone receptor positive and human epidermal growth factor receptor 2 (HER2) negative. Here, we present a case of HER2-positive MC with an unusual signet ring cell differentiation. It is very rare that a breast tumor consists entirely of signet ring cells. The tumor showed pathologic complete response (pCR) after neoadjuvant chemotherapy with trastuzumab and pertuzumab. pCR of HER2-positive MC has rarely been described in literature. It is important to consider the biological heterogeneity of MCs for effective management.

Adenocarcinoma mucinoso de cérvix metastásico en la laringe: descripción de un caso y revisión de la literatura / Metastatic mucinous cervix adenocarcinoma in the larynx: case report and literature review

Introducción: el adenocarcinoma mucinoso endocervical de tipo gástrico es poco frecuente, presenta un comportamiento agresivo y tendencia a la diseminación a distancia. El tratamiento varía según el estadio inicial, y el manejo de las recaídas, según su presentación locorregional o a distancia (aislada o múltiple). Descripción: se presenta el caso de una paciente tratada que, luego de un período libre de enfermedad de 18 meses, presenta una metástasis única en la laringe. Revisión y discusión: se revisó la literatura disponible, exponiendo los aspectos clínicos y terapéuticos más relevantes. Conclusiones: el manejo oncológico debe ser individualizado y valorado en un comité interdisciplinar.

Introduction: the gastric-type mucinous adenocarcinoma of the cervix is infrequent, presents an aggressive behavior and tends to give distant metastasis. The treatment differs according to the initial stage, whereas the management of the relapses differs according to the locoregional or distant presentation (isolated or multiple). Description: it is analyzed the case of a treated patient who, after a period of 18 months disease-free, presented a single metastasis in the larynx. Review and discussion: we review the available literature, showing the most relevant clinical and therapeutic aspects. Conclusions: the oncological treatment must be individualized and valued within an interdisciplinary committee.

Enterovesical fistula caused by ileal primary adenocarcinoma / Fístula enterovesical causada por adenocarcinoma ileal primário

ABSTRACT Introduction: Small bowel neoplasms are rare entities, with only 3.2% of gastrointestinal tumors localized in this segment. Adenocarcinoma is the second most common histologic type among small bowel neoplasms. The disease's symptoms are non-specific, with abdominal pain being the most common. Among the complications, fistulas are a far rare condition. Case report: We present the case of an 86-year-old woman, hypertensive, diabetic, and former smoker, with lower abdominal pain, hematuria, fecaluria and fever associated with weight loss. Upon physical examination presented pale mucous membranes. Magnetic resonance imaging of the abdomen showed parietal thickening in the distal ileum segment with an anterior wall bladder fistula. Absence of metastases. Subjected to transurethral endoscopic biopsy of the bladder lesion, which anatomopathological study was compatible with invasive mucinous adenocarcinoma. An enterectomy was performed with primary enteroanastomosis, associated with partial cystectomy by videolaparoscopy. Anatomopathological study of the surgical specimens concluded mucinous adenocarcinoma with signet ring cells located in the small bowel and bladder. Immunohistochemical exam has identified findings compatible with mucinous adenocarcinoma of origin in the small bowel. The patient evolved well, being discharged, and returned to postoperative follow-up without signs of relapse of the disease. Conclusion: The relative inaccessibility of the small bowel and the malignant neoplasms' non-specific symptoms make an early diagnosis difficult. Discovery of the disease, often only at an advanced stage, results in complications and less effective therapy. The laparoscopic approach might be advantageous and effective in the treatment of advanced small bowel cancer with invasion of adjacent structures.

RESUMO Introdução: As neoplasias do intestino delgado são entidades raras com apenas 3,2% dos tumores gastrointestinais localizando-se neste segmento. O adenocarcinoma é o segundo tipo histológico mais comum entre as neoplasias do intestino delgado. Os sintomas da doença são inespecíficos, sendo a dor abdominal o mais comum, dificultando o diagnóstico precoce. Dentre as complicações, as fistulas são de ocorrência ainda mais rara. Relato de caso: Mulher de 86 anos, hipertensa, diabética e ex-tabagista. Quadro de dor em abdome inferior, hematúria, fecalúria, febre eventual e perda ponderal. Ao exame físico pele e mucosas hipocoradas. Ressonância Magnética de abdome evidenciou espessamento parietal em segmento do íleo distal com fístula para a parede vesical anterior. Ausência de metástases. Submetida à biopsia endoscópica transuretral da lesão vesical, cujo estudo anatomopatológico evidenciou adenocarcinoma mucinoso invasivo. Realizada enterectomia com enteroanastomose primária, associada à cistectomia parcial por videolaparoscopia. Estudo anatomopatológico das peças cirúrgicas concluiu adenocarcinoma mucinoso com células em anel de sinete localizado em intestino delgado e bexiga. A Imunohistoquímica identificou achados compatíveis com adenocarcinoma mucinoso de origem em intestino delgado. A paciente evoluiu bem no pós-operatório, recebendo alta e retornando para seguimento pós-operatório sem sinais de recidiva da doença. Conclusão: A relativa inacessibilidade do intestino delgado e os sintomas inespecíficos das neoplasias malignas deste sítio dificulta o diagnóstico precoce. O reconhecimento da doença, muitas vezes somente em estágio avançado, resulta em complicações e sequelas com terapêutica menos eficaz. A abordagem laparoscópica pode ser vantajosa no tratamento do câncer avançado do intestino delgado com invasão de estruturas adjacentes.

Outcomes of Non-High Grade Serous Carcinoma after Neoadjuvant Chemotherapy for Advanced-Stage Ovarian Cancer: Single-Institution Experience

PURPOSE: Outcomes in patients with ovarian high-grade serous carcinoma (HGSC) treated with neoadjuvant chemotherapy (NAC) have been widely studied; however, there is limited information on responses to chemotherapy among patients with non-HGSC. The aim of this study was to compare the survival outcomes of patients with advanced-stage non-HGSC and HGSC treated with NAC. MATERIALS AND METHODS: This study was a retrospective analysis of patients with advanced-stage ovarian cancer treated at Yonsei Cancer Hospital between 2006 and 2017. The demographics, chemotherapy response, and survival rates were compared between patients with non-HGSC and those with HGSC. RESULTS: Among 220 patients who underwent NAC, 25 (11.4%) patients had non-HGSC histologic subtypes, and all received a taxane-platinum combination regimen for NAC. Patients with non-HGSC had lower baseline cancer antigen-125 levels (p < 0.001), poorer response rates (p < 0.001), lower rates of optimal cytoreduction (p=0.003), and poorer progression-free survival (PFS) (median PFS 10.3 months vs. 18.3 months; p=0.009) and overall survival (OS) (median OS 25.5 months vs. 60.6 months; p < 0.001), compared to those with HGSC. In multivariate analysis, non-HGSC was a negative prognostic factor for both PFS [hazard ratio (HR), 3.19; 95% confidence interval (CI), 1.73–5.88] and OS (HR, 4.22; 95% CI, 2.07–8.58). CONCLUSION: In this study, poorer survival outcomes were observed in patients who underwent NAC for treatment of non-HGSC versus those treated for HGSC. Different treatment strategies are urgently required to improve survival outcomes for patients with non-HGSC undergoing NAC.

Synchronous mucinous metaplasia and neoplasia of the female genital tract / 中华病理学杂志

Objective@#To describe the clinicopathological features of synchronous mucinous metaplasia and neoplasia of the female genital tract (SMMN-FGT). @*Methods@#The sample consisted of 7 cases of SMMN-FGT recorded from November 2014 to September 2017 at Obstetrics and Gynecology Hospital, Fudan University.PAP method was used in immunohistochemistry.Clinical histories were retrieved and pathological slides were reviewed. @*Results@#The patients were 37 to 70 years old(mean 54 years old). All patients showed endometrial mucinous lesions associated with cervical lesions. Three cases were an admixture of minimal deviation adenocarcinoma(MDA) and gastrictype adenocarcinoma(GAS). Three cases were an admixture of lobular endocervical glandular hyperplasia (LEGH), atypical LEGH and focal gastrictype adenocarcinoma in situ, one of which had early invasive gastrictype adenocarcinoma.Endometrium showed a structure of LEGH in one patient with focal simple gastric mucinous metaplasia in her cervix. Gastric mucinous differentiation was found in unilateral fallopian tube in 6 patients. Ovarian mucinous lesions were found in 3 patients. p16 was negative staining in 6 cases and positive in 1 case. CK7 was diffusely positive in all lesions. CK20 and CDX2 were negative or only focally positive.The expression of MUC6 was strongly positive staining or focal staining. p53 in GAS and GAS in situ had mutant expression, but wild expression in MDA region. Patients were followed up for 2 to 34 months and no recurrence was found. @*Conclusions@#SMMN-FGT is a series of rare mucinous lesions involving multiple areas of the female genital tract, including benign or malignant lesions with gastric differentiation. It is not related to infection with high-risk human papilloma virus. When cervical gastrictype lesions are found, SMMN-FGT should be considered and should be differentiated from metastatic mucinous adenocarcinoma.

KRAS mutations analysis in mucinous epithelial lesions of the endometrium / 中华病理学杂志

Objective@#To investigate the frequency of KRAS mutation in mucinous epithelial lesions of the endometrium, and analyze the correlation between KRAS mutation and the clinicopathologic features.@*Methods@#The cohort included forty-three cases of mucinous epithelial lesions of the endometrium selected from July 2015 to October 2017 from Beijing Obstetrics and Gynecology Hospital, and 22 control cases. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue sections. Polymerase chain reaction amplification for KRAS exons 2 and 3 was performed, followed by sequencing using capillary electrophoresis. The Fisher exact test was used to compare the prevalence of KRAS mutation among the different groups.@*Results@#The patients′age ranged from 33 to 77 years [mean (55.12±9.34) years, median 55 years]. None of the eight cases of endometrial hyperplasia with mucinous differentiation without atypia showed KRAS mutation. The frequency of KRAS mutations was 1/10 in endometrial atypical hyperplasia, 1/12 in endometrioid carcinoma, 4/11 in endometrial atypical hyperplasia with mucinous differentiation (EAHMD), 6/15 in endometrioid carcinoma with mucinous differentiation (ECMD) and 8/9 in mucinous carcinoma (MC), respectively. The differences were statistically significant between MC versus EC (P<0.01) and MC versus ECMD (P<0.05).@*Conclusion@#The high frequency of KRAS mutation in EAHMD, ECMD and MC indicates that KRAS mutational activation is implicated in the pathogenesis of endometrial mucinous carcinoma.

Comparative study of the diagnostic value of ultrasonography and MRI in mucinous adenocarcinoma of breast / 中华超声影像学杂志

Objective@#To investigate ultrasonographic and magnetic resonance imaging features of pure mucinous adenocarcinoma of breast, and to discuss the diagnose value.@*Methods@#Eighty-eight patients with 92 breast lesions of pure mucinous adenocarcinoma had undergone ultrasonography and MRI. The imaging features were reviewed and the diagnostic values were compared between the two imaging examinations.@*Results@#On ultrasonography, tumors were mostly showed well-defined margins (77.2%), lobulated shape (60.9%), hypoechoic (51.1%), heterogeneous texture (63.0%), posterior echo enhancement (82.6%). Color Doppler imaging showed vascularity in 75% of these lesions.On magnetic resonance imaging, most tumors showed circumscribed mass with lobulated shape. Sixty-four lesions (69.6%) showed hypointensity on T1-wighted images.Hyperintensity and strongly hyperintensity on T2-weighted images were identified in 71 cases and 21 cases, respectively. After contrast, 54 cases showed rim enhancement and the other 38 cases showed heterogeneous enhancement. There was no significant difference in diagnostic accuracy between ultrasonography and MRI (72.8% vs 77.2%, P=0.481). Combined the two imaging examinations, the diagnostic accuracy was higher than that of ultrasonography (84.8% vs 72.8%, P=0.001) and MRI (84.8% vs 77.2%, P=0.016).@*Conclusions@#Pure mucinous adenocarcinoma of breast has some typical characteristics in ultrasonography and MRI, combination of the two imaging examinations can improve the diagnostic accuracy.

18F-FDG PET/CT imaging on a case of primary pulmonary mucinous adenocarcinoma / 天津医药

Primary pulmonary mucinous adenocarcinoma (PPMA) is a low incidence subtype of lung adenocarcinoma. Clinical data of a case with PPMA confirmed pathologically were retrospectively analyzed. The case of PPMA was found the primary lesion and lymph node and bone metastases by 18F-FDG PET/CT examination on May 2017 in People's Liberation Army No. 254 Hospital. We discussed the clinical application of PET/CT in the diagnosis, staging and efficacy evaluation of PPMA.

Analysis of ultrasonographic features of different pathological types of mucinous breast carcinomas / 肿瘤研究与临床

Objective To investigate ultrasonographic features of different pathological types of mucinous breast carcinomas (MBC), and to improve the diagnosis rate of MBC. Methods The ultrasonographic features of 42 MBC cases between January 2014 and December 2015 in Shanxi Provincial Cancer Hospital were retrospectively analyzed according to pathological types. Results There were 24 cases of simple type and 18 cases of mixed type in 42 MBC cases (46 lesions in total). The coincidence rate of preoperative ultrasound diagnosis for cancerous lesions was 93.5 % (43/46), including 24 cases of 27 simple type lesions with oval form or lobulated (20/27, 74.1 %), clear boundary (21/27, 77.8 %), uniform internal echo (17/27, 63.0 %), posterior echo enhancement (11/27, 40.7 %), and 18 cases of 19 mixed type lesions with irregular shape (14/19, 73.7 %), unclear border (16/19, 84.2 %), uneven internal echo (13/19, 68.4 %), posterior echo attenuation (13/19, 68.4 %). The differences between the two types of ultrasound images were statistically significant (both P＜0.05). Of 42 cases, 76 axillary lymph nodes were transferred in 13 cases. Preoperative ultrasonography showed that 32 axillary lymph nodes enlargement were abnormal in 12 cases, and the detection rate was 42.1 % (32/76). The positive rates of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) were 87.5 % (21/24), 79.2 % (19/24), 8.3 % (2/24) in simple type and 83.3 % (15/18), 88.9 % (16/18), 5.6 % (1/18) in mixed type respectively. There was no significant difference in the positive rates of 3 kinds of molecular markers among two types (all P＞0.05). Conclusions Due to the different tissue components in different types of MBC, ultrasonic features show several differences. Simple type is similar to benign masses, while mixed type shows the characteristics of invasive carcinomas.

The image performance of mucinous breast carcinoma on automated breast volume scanner and its pathologic features / 中华超声影像学杂志

Objective To explore the image performance of mucinous breast carcinoma( MBC) on automated breast volume scanner ( ABVS ) and its pathologic features ,for the purpose of improving the recognition of this disease on ABVS ,as well as diagnostic ability . Methods Retrospectively analyzed the sonogram and pathological data of 17 patients with 18 MBC lesions that included 9 PMBC ( pure mucinous breast carcinoma) and 9 MMBC( mixed mucinous breast carcinoma) ,all patients were examined by ABVS before operation and confirmed by pathology . Results Luminal A was the main molecular subtype of MBC ,as well as rarely lymph node metastases;The image of the MBC on ABVS mainly showed a round like or irregular mass ,isoechoic or slightly lower with posterior acoustic enhancement ,and clearly edge with microlobulated or angular ;While on the coronal plane ,it might presented unsmoothed contour ,retraction phenomenon and expansive growth pattern like a spherical nodular;The image characteristics of the PMBC and MMBC lesions on ABVS had no statistical difference( P > 0 .05) ,but the PMBC often performed isoechoic mass with clearly marge ,in contrast , the MMBC usually performed hypoechoic mass with indistinct and angular edge ,and the malignant image features on the coronal plane . Conclusions The three vertical sections of ABVS are beneficial to observe the morphological features of MBC completely ,which can help to identify it from the benign lesions ,reduce misdiagnosis ,and provide some guidance for MBC surgical treatment in the early stage .

CT findings of invasive mucinous adenocarcinoma of the lung / 中国医师进修杂志

Objective To analyze the CT findings of invasive mucinous adenocarcinoma of the lung.Methods The CT findings of 7 patients with invasive mucinous adenocarcinoma of the lung were retrospectively analyzed. Results Six cases manifested isolated pulmonary nodules or masses, among which circular/round shape was in 6 cases,clear tumor-lung parenchyma interface was in 6 cases,lobular sign was in 5 cases,specular sign was in 6 cases,calcifications was in 3 cases,angiogram sign of contrast enhancement was in 4 cases, and the CT value was close to the liquid density in 6 cases. One case showed consolidation of lung with multiple nodules or mass, and the lesions had angiographic signs calcification, unenhanced area with water density as well. The CT findings of angiography signs, calcification and consolidation of regional focal liquid opacity had significance for the diagnosis.One case was misdiagnosed as tuberculosis and 1 case as hamartomas. Factors which caused misdiagnosis were irregularly shaped calcifications and angiographic signs in lesion, and the enhanced CT value was less than 20 HU. Conclusions The invasive mucinous adenocarcinoma of the lung has characteristic CT findings. In addition to the malignant tumor features. When plain CT scan finds the watery density, calcifications and angiographic signs in the lesion, the invasive mucinous adenocarcinoma of the lung should be considered.The enhanced CT scan shows no enhancement or enhanced value less than 20 HU is also the characteristic of invasive mucinous adenocarcinoma of the lung. MRI check will help us to improve the diagnostic accuracy.