Primary Signet Ring Cell Carcinoma of the Duodenum: Case Report

Introduction: Primary carcinoma of the duodenum is an infrequent malignancy; it represents 0.3-0.5% of all carcinomas of the GI tract and 33-45% of all carcinomas of the small intestine. Clinical case: A 57-year-old female patient with nonspecific GI symptoms and unintentional weight loss was diagnosed with diffuse, infiltrating, and ulcerated adenocarcinoma in the duodenum. Surgical management with duodenopancreatectomy was considered; however, it could not be performed due to deteriorating nutritional status. She later died due to abdominal sepsis. Conclusion: The clinical manifestations of adenocarcinoma of the duodenum are variable and nonspecific. It is a challenge to make an early diagnosis. We recommend considering the diagnostic possibility in patients with nausea, emesis, abdominal pain, and weight loss, which requires esophagogastroduodenoscopy and histological and immunohistochemical confirmation.

Introducción: el carcinoma primario de duodeno es una neoplasia maligna infrecuente; representa el 0,3%-0,5% de todos los carcinomas del tracto gastrointestinal y el 33%-45% de todos los carcinomas de intestino delgado. Caso clínico: paciente de sexo femenino de 57 años, con sintomatología gastrointestinal inespecífica y pérdida de peso no intencional a quien se le diagnosticó un adenocarcinoma difuso, infiltrante y ulcerado en el duodeno. Se planteó el manejo quirúrgico con duodenopancreatectomía; sin embargo, no pudo realizarse debido al deterioro del estado nutricional y posteriormente falleció como consecuencia de una sepsis abdominal. Conclusión: las manifestaciones clínicas del adenocarcinoma de duodeno son variables e inespecíficas, es un reto realizar un diagnóstico precoz. Se recomienda considerar la posibilidad diagnóstica en pacientes con síntomas de náuseas, emesis, dolor abdominal y pérdida de peso, que requiere la realización de esofagogastroduodenoscopia y confirmación histológica e inmunohistoquímica.

Uterine POLE mutant endometrioid carcinoma combined with human papilloma virus-associated cervical adenocarcinoma: A case report and literature review / 北京大学学报(医学版)

Independent primary uterine and cervical adenocarcinoma are rare and difficult to identify their origins, which makes treatment decision difficult. A 46-year-old female with endometrioid carcinoma and adenocarcinoma, human papilloma virus (HPV)-associated of the uterine cervix was reported. The patient presented with increased menstrual flow, contact bleeding and watery leucorrhea for more than one year, and the imaging findings showed abnormal uterine morphology, irregular margins, and multiple abnormal signals in uterine cavity and myometrium, which suggested multiple leiomyomas of the uterus. The signal intensity in the right muscle layer was markedly enhanced, suggesting a smooth muscle tumor of uncertain malignant potential. A large number of cystic hypointensity was seen in the cervix, and multiple cysts were considered. The initial preoperative diagnosis was multiple leiomyoma of the uterus, and a hysterectomy operation was planned. During the operation, the uterus was sent for frozen sections. There was a mass in the endometrium of the fundus, with a soft grayish-red cut surface and a clear border with the myometrium, and there was a grayish-white nodule in the cervix with a hard grayish-white cut surface. The two masses were well demarcated from each other, and the distance between them was 30 mm. The result of the frozen sections indicated the malignant tumor of the endometrium, and the extended hysterectomy+pelvic lymphadenectomy+partial resection of the greater omentum was performed. After the operation, the paraffin sections were sent to the Department of Pathology of the Peking University Third Hospital for histochemistry, POLE gene sequencing and HPV RNAscope tests, and the final diagnosis was a synchronous endometrioid carcinoma (POLE-mutant according to the WHO classification) and an adenocarcinoma, HPV-associated of the uterine cervix. Now the patient had been treated with 2 cycles of chemotherapy and her condition was fine. Through the analysis of the histological, immunohistochemical and molecular detection results of this case, the importance of applying HPV RNAscope and TCGA molecular typing in the diagnosis of cervical adenocarcinomas and endometrial carcinomas was emphasized. At the same time, gynecologists should not blindly rely on intraoperative frozen sections, and should pay attention to preoperative pathological examination, and make appropriate operation methods according to the results in order to prevent passivity in the surgery.

Mucinous tubular and spindle cell carcinoma of kidney: Clinicopathology and prognosis / 北京大学学报(医学版)

OBJECTIVE@#To investigate and summarize the clinicopathological features, immunophenotype, differential diagnosis and prognosis analysis of mucinous tubular and spindle cell carcinoma (MTSCC).@*METHODS@#The data of thirteen cases of MTSCC were retrospectively analyzed, the clinical and pathological characteristics and immunohistochemical expression were summarized, and fluorescence in situ hybridization was detected.@*RESULTS@#Among the thirteen patients, four were males and nine females, with a male-to-female ratio of 1 ∶2.25. The average age was 57.1 years, ranging from 39 to 78 years. The maximum diameter of the tumor was 2-12 cm. All cases had no symptoms, and were accidentally discovered, 3 cases underwent partial renal resection, 10 cases underwent radical renal resection, 9 cases were located in the left kidney, and 4 cases were located in the right kidney. Most of the cases showed the classical morphological changes, with 11 cases of nuclear grading [World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading system] being G2 and 2 cases being G3. There were 6 cases of stage PT1a, 3 cases of PT1b, 2 cases of PT2a, and 1 case of PT2b and 1 case of PT3a. The positive rates of immunohistochemical staining were: vimentin, AE1/AE3, α-methylacyl-CoA racemase (αMACR) and cytokeratin (CK) 8/18, 100% (13/13); CK7, 92.3% (12/13); epithelial membrane antigen (EMA), 92.3% (12/13); CK20, 46.2% (6/13); CD10, 30.8% (4/13); synaptophysin (Syn), 7.7% (1/13); chromogranin A (CgA), CD57, WT1 and Ki-67, 0 (0/13), and fluorescence in situ hybridization showed that no trisomy of chromosomes 7 and 17 were observed in any of the cases. The follow-up period was 6 months to 7 years and 6 months, 2 cases died after lung metastasis (one with ISUP/WHO grade G3, one with necrosis), and the remaining 11 cases had no recurrence and metastasis.@*CONCLUSION@#MTSCC is a unique type of low-grade malignancy kidney tumor, occurs predominantly in females, widely distributed in age, the current treatment method is surgical resection, and cases with necrosis and high-grade morphology are prone to recurrence and metastasis, although most cases have a good prognosis, but they still need close follow-up after surgery.

Advances in the Study of Invasive Non-mucinous Adenocarcinoma with Different Pathological Subtypes / 中国肺癌杂志

Lung cancer is the leading cause of cancer death in the world today, and adenocarcinoma is the most common histopathological type of lung cancer. In May 2021, World Health Organization (WHO) released the 5th edition of the WHO classification of thoracic tumors, which classifies invasive non-mucinous adenocarcinoma (INMA) into lepidic adenocarcinoma, acinar adenocarcinoma, papillary adenocarcinoma, solid adenocarcinoma, and micropapillary adenocarcinoma based on its histological characteristics. These five pathological subtypes differ in clinical features, treatment and prognosis. A complete understanding of the characteristics of these subtypes is essential for the clinical diagnosis, treatment options, and prognosis predictions of patients with lung adenocarcinoma, including recurrence and progression. This article will review the grading system, morphology, imaging prediction, lymph node metastasis, surgery, chemotherapy, targeted therapy and immunotherapy of different pathological subtypes of INMA.
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Diagnóstico fortuito de neoplasia mucinosa de apéndice establecido durante la cesárea / Incidental diagnosis of mucinous neoplasm of appendix established during caesarean section

Resumen ANTECEDENTES: Los tumores del apéndice son bastante excepcionales y el adenocarcinoma mucinoso es el más frecuente de estos tumores. Esta patología es aún más infrecuente en pacientes embarazadas. CASO CLÍNICO: Paciente de 43 años, en curso de las 38.1 semanas del primer embarazo. Antecedentes: diabetes gestacional y obesidad mórbida. Se hospitalizó para practicarle la cesárea de urgencia, indicada por restricción del crecimiento intrauterino, sin posibilidad de una conducta expectante. En la ecografía de control prenatal del primer trimestre se describió la existencia de una masa quística, tabicada, de aproximadamente 12 x 12 cm. En la resonancia magnética nuclear de abdomen se encontró una lesión quística en el flanco derecho, de probable origen de masa anexial derecha de 12 x 9 cm. El estudio histopatológico reportó el hallazgo de una neoplasia mucinosa de bajo grado, asociada con extravasación extramural de mucina del apéndice cecal y un pseudomixoma peritoneal. CONCLUSIÓN: El hallazgo de una neoplasia mucinosa del apéndice en una paciente embarazada es sumamente raro. Su diagnóstico supone un reto, sobre todo en quienes no tienen síntomas. Aunque hay padecimientos más frecuentes en las mujeres, como los tumores de ovario o la apendicitis, vale la pena tener en cuenta este cuadro clínico en futuras pacientes. Se requiere mayor investigación de esta neoplasia en embarazadas para optimizar los métodos diagnósticos y poder tratarla de manera oportuna y evitar dañar al feto o la madre.

Abstract BACKGROUND: Tumours of the appendix are quite rare, with mucinous adenocarcinoma being the most frequent of these tumours. This pathology is even rarer in pregnant patients. CLINICAL CASE: 43-year-old patient, in the course of 38.1 weeks of her first pregnancy. History: gestational diabetes and morbid obesity. She was hospitalised for emergency caesarean section, indicated for intrauterine growth restriction, with no possibility of expectant management. The first trimester prenatal ultrasound scan showed a cystic mass, septate, measuring approximately 12 x 12 cm. Magnetic resonance imaging of the abdomen revealed a cystic lesion in the right flank, probably caused by a right adnexal mass measuring 12 x 9 cm. Histopathological study reported the finding of a low-grade mucinous neoplasm associated with extramural extravasation of mucin from the cecal appendix and a peritoneal pseudomyxoma. CONCLUSION: The finding of a mucinous neoplasm of the appendix in a pregnant patient is extremely rare. It is challenging to diagnose, especially in those without symptoms. Although there are more common conditions in women, such as ovarian tumours or appendicitis, this condition is worth considering in future patients. Further investigation of this neoplasm in pregnant women is needed to optimise diagnostic methods to treat it in a timely manner and to avoid harm to the foetus or the mother.

A case report of prostate mucinous adenocarcinoma / 中华泌尿外科杂志

Mucinous adenocarcinoma of the prostate is a rare pathological type of prostate cancer. We reported one case. The patient went to see a doctor because of intermittent hematuria. He was diagnosed as prostate adenocarcinoma before operation. He underwent laparoscopic radical prostatectomy. Postoperative pathological examination showed mucinous adenocarcinoma of the prostate. The patient was followed up for six months. Imaging showed no signs of recurrence and metastasis with normal tPSA.

Clinical status and research progress of primary pulmonary mucinous adenocarcinoma / 中国综合临床

Primary pulmonary mucinous adenocarcinoma is a subtype of lung adenocarcinoma, and its epidemiology is similar to other pulmonary adenocarcinoma. Because of its low incidence rate, the survival data of patients with pulmonary mucinous adenocarcinoma are few and often contradictory. KRAS mutations often occur in pulmonary mucinous adenocarcinoma, but EGFR mutations are rare. The expression of PD-L1 in pulmonary mucinous adenocarcinoma is very low. Patients with early pulmonary mucinous adenocarcinoma can benefit from surgery. Lobectomy is still the standard operation at present, but sub lobectomy may also be effective for early pulmonary mucinous adenocarcinoma. Other treatment options include platinum based dual drug chemotherapy, targeted therapy targeting driving genes, and the recent rise of immunotherapy. Future new targets and corresponding treatments should require more research to confirm.

Interpretation of CT images of pulmonary mucinous adenocarcinoma / 中国综合临床

Pulmonary mucinous adenocarcinoma (PMA) is relatively rare. On chest CT, it can be divided into two types: mass type and pneumonia type. Mass type PMA is more common and is difficult to distinguish from other nonsmall cell lung cancer. It is a solid or partial solid nodule or mass, predominantly located in the peripheral field of the lung with lobulation, spiculation, and more prone “vacuole sign”. Pneumonia type PMA has a poor prognosis and is more likely to develop into diffuse, multifocal and multilobular lesions similar to inflammatory manifestations, indicating dissemination along the airway. Typical signs include large areas of low density, low enhancement consolidation, and “dead tree sign”.

Pathological diagnosis and molecular alternations of pulmonary mucinous adenocarcinoma / 中国综合临床

Primary pulmonary mucinous adenocarcinoma is a rare subtype of lung adenocarcinoma. It differs from non-mucinous adenocarcinoma in etiology, pathogenesis, clinical, imaging, histological, immunophenotypic and genotypic features, prognosis and treatment. pulmonary mucinous adenocarcinoma mainly originates from bronchial basal cells and mucous cells. Tumor cells show a goblet and/or columnar cell morphology with abundant intracytoplasmic mucin and basally oriented nuclei, with a typical lepidic-predominant growth, the commonest molecular alterations are KRAS mutations.

Prospect on medical treatment of pulmonary mucinous adenocarcinoma / 中国综合临床

Pulmonary mucinous adenocarcinoma is a subtype of lung adenocarcinoma, among which invasive mucinous adenocarcinoma (IMA) is the most common subtype and is easily misdiagnosed as pneumonia. Its etiology and pathogenesis are unclear and may be related to gene mutations and other factors. Due to its relative rarity and few related studies, guidelines do not provide advices on its treatment. KRAS mutations are common in IMA patients, and Sotorasib may be effective against KRAS G12C mutated IMA. NRG1 fusion is considered to be an important driver of IMA, and afatinib may be effective in treating IMA with NRG1 fusion/rearrangement. PD-L1 expression is very low in IMA patients, while B7-H3 expression is high, so B7-H3 may be a potential immunotherapeutic target.

Absceso del psoas ilíaco secundario a un tumor de colon izquierdo fistulizado al retroperitoneo: caso clínico y análisis de la literatura / Iliopsoas abscess resulting from penetrating left colon cancer to the retroperitoneum: case report and literature review / Abscesso do iliopsoas secundário a tumor de cólon esquerdo fistulizado para o retroperitônio: caso clínico e análise da literatura

Los abscesos del psoas ilíaco secundarios a un tumor de colon fistulizado son excepcionales y potencialmente graves. La mayoría son adenocarcinomas de tipo mucinoso. Su tratamiento es complejo ya que, para lograr una resección oncológica pretendidamente curativa, es necesario realizar una resección ampliada con mayor morbimortalidad. Presentamos el caso de una paciente con un adenocarcinoma mucinoso de colon izquierdo fistulizado al músculo ilíaco y la pared anterolateral del abdomen en la que se realizó una resección multivisceral que incluyó el colon izquierdo, el músculo y la cresta ilíaca y parte de la pared anterolateral del abdomen.

Iliopsoas abscess secondary to perforation of colon cancer is an extremely rare and potentially life-threatening condition. Most tumors are mucinous adenocarcinomas. Its treatment its complex, as most patients need radical extended resections to achieve good oncological results, which are in turn, graved with higher morbidity and mortality. We present the case of a patient with a left colon mucinous adenocarcinoma penetrating to the iliopsoas muscle and the anterolateral abdominal wall that required a multivisceral resection including left colon, iliac muscle and crest and part of the anterolateral abdominal wall.

Abscessos do iliopsoas secundários a um tumor de cólon fistulizado são raros e potencialmente graves. A maioria são adenocarcinomas do tipo mucinoso. Seu tratamento é complexo, pois, para se obter uma ressecção oncológica supostamente curativa, é necessário realizar uma ressecção ampliada com maior morbimortalidade. Apresentamos o caso de um paciente com adenocarcinoma mucinoso de cólon esquerdo fistulizado para o músculo ilíaco e parede ântero-lateral do abdome no qual foi realizada ressecção multivisceral que incluiu cólon esquerdo, músculo e crista ilíaca e parte do a parede anterolateral do abdome.

A CASE REPORT ON PROSTATIC ADENOCARCINOMA WITH MUCINOUS FEATURES

We present a case of primary adenocarcinoma of the prostate with mucinous feature. Mucinous adenocarcinoma (MC) of the pros¬tate gland is rare morphological variant of Prostate carcinoma characterized by pools of extracellular mucin in >25% of tumor. A 72-year-old male presented to our hospital with urinary frequency, nocturia and voiding difficulties;on digital rectal examination enlarged prostate was observed without any palpable nodule. on Ultrasonography hypoechoic lesion was observed in left lobe of prostate suggestive of prostate tumor. A transurethral resection of prostate confirmed the diagnosis of Prostatic adenocarcinoma with mucinous features and Gleasons score 9(4+5). We report the cases due to the aggressive beahviour and uncommon diagnosis of mucinous variant of adenocarcinoma of the prostate. But it is seen that its proper diagnosis and treatment significantly contribute to favourable prognosis

COLORECTAL CANCER IN YOUNG ADULTS: A CASE SERIES

Introduction & Background: Colorectal cancer (CRC) is a frequent tumor in adults, it rarely occurs before the age of 25 years, with an annual incidence of only 1-2 cases per 10,00,000 people, accounting for only about 80 cases per year worldwide. Overall incidence of CRC involving hepatic ?exure is 2%, ascending colon is 5%, sigmoid colon is 21% which is very rare in young age group. Herein we report a 3 rare cases of CRC in young adults less than 25 years of age involving hepatic ?exure, ascending colon and sigmoid colon respectively. Case Description: Case 1: A 20 year-old male presented with complaints of abdominal distension and constipation for 1 week and loss of weight for 1 month. Patient had no comorbities and no family history of malignancy. CECT done showed an asymmetric wall thickening involving proximal transverse colon with signi?cant luminal narrowing. He underwent emergency laparotomy and intra operatively patient had a growth at hepatic ?exure of colon with dilated ascending colon, caecum and distal ileum and multiple enlarged mesenteric lymph nodes. He was proceeded with right hemicolectomy with ileo transverse anastomosis. Post operative histopathology revealed mucinous adenocarcinoma involving hepatic ?exure. Case 2: A 25 year-old female was hospitalized due to com plaint s of abdominal pain for 3 months, lower abdomen mass for 1 month and melena for the past 15 days and loss of weight and appetite. Patient had no comorbities and no family history of malignancy. CECT done showed a suspicious wall thickening involving ascending colon. The patient was taken up for laparotomy and per operative ?ndings showed a ulceroproliferative growth involving ascending colon. Patient was proceeded with right hemicolectomy with ileo transverse anastomosis. Post operative histopathology revealed mucinous adenocarcinoma involving ascending colon.Case 3: A 22 year-old male was admitted for comp laint s of lower abdominal pain for 4 months, bleeding per rectum on and off for 1 month and abdomen distension and constipation for 5 days and loss of weight and appetite. Patient had no comorbities and no family history of malignancy. CECT done showed a circumferential wall thickening involving sigmoid colon. Hence the patient was proceeded for emergency laparotomy and per operative ?ndings showed a stenosing growth involving sigmoid colon. Patient was proceeded with Hartmann's procedure. Post operative histopathology revealed adenocarcinoma involving sigmoid colon. Conclusion: Within a young group, CRC is usually diagnosed later andpotentially associated with worst prognosis. Detecting CRC at an early, more treatable stage is important for cure and survival. This report suggest a greater suspicion rate and early screening that necessary when evaluating young patients with common symptoms

Neoplasias apendiculares incidentales / Incidental appendicular neoplasms

Las neoplasias apendiculares se presentan hasta en el 50 % de los casos como un episodio de apendicitis aguda. Existen características demográficas, clínicas y radiológicas que aumentan las posibilidades de un tumor apendicular subyacente, sin embargo, en la mayoría de los casos, son los hallazgos intraoperatorios los que alertan al cirujano. A pesar de que el tipo histológico determina la radicalidad del manejo quirúrgico de estos pacientes, algunas características macroscópicas pueden orientar a las patologías específicas y a una conducta adecuada. En general, los objetivos del manejo quirúrgico inicial se cumplen con una resección limitada al apéndice cecal, asociada a la citología de mucina y biopsia de los implantes peritoneales si están presentes, reservando las resecciones extendidas, como hemicolectomía derecha oncológica, para los pacientes con compromiso extenso de la base o del mesenterio apendicular ante la sospecha de neoplasias neuroendocrinas o adenocarcinoma del apéndice cecal.

Appendicular neoplasms present in up to 50% of cases as an episode of acute appendicitis. There are demographic, clinical and radiological characteristics that increase the chances of an underlying appendicular tumor; however, in most cases are the intraoperative findings that alert the surgeon. Although the histological type determines the radical nature of the surgical management of these patients, some macroscopic characteristics can guide specific pathologies and appropriate behavior. In general, the objectives of initial surgical management are met with a limited resection of the cecal appendix, associated with mucin cytology and biopsy of peritoneal implants if present, reserving extended resections such as oncological right hemicolectomy for patients with extensive compromise of the base or appendicular mesentery when neuroendocrine neoplasms or adenocarcinoma of the cecal appendix are suspected.

A rare case of mucinous adenocarcinoma of the bladder: A case report

@#Adenocarcinoma represents 0.5 to 2% of all malignant tumors of the bladder, and the mucinous subtype is extremely rare as a primary vesical lesion. This is the case of a 50-year-old male who presented with dysuria with occasional hematuria, underwent cystoscopy, transurethral resection of the bladder tumor, with the subsequent diagnosis of Mucinous adenocarcinoma of the bladder. He then completed neoadjuvant chemotherapy but eventually underwent cystoprostatectomy, urethrotomy with extended bilateral pelvic lymph node dissection due to tumor progression.

Adenocarcinoma mucinoso uracal / Urachal mucinous adenocarcinoma

Introducción: El uraco o conducto onfalomesentérico es una estructura embrionaria que conecta el intestino medio y el saco vitelino, que involuciona antes del tercer trimestre de embarazo. Objetivo: Presentar un caso con diagnóstico de adenocarcinoma uracal, neoplasia maligna rara. Desarrollo: Paciente de 50 años de edad sin antecedentes patológicos, con cuadro clínico inicial de ascitis y dolor abdominal, al examen físico masa palpable en hipocondrio-fosa iliaca izquierda que en la tomografía abdominal se observa una masa adyacente a la cúpula vesical y pared anterior del abdomen. El resultado de la biopsia reportó un adenocarcinoma mucinoso del conducto onfalomesentérico (uracal). Al momento del diagnóstico, el paciente se encontró en un estadio IVB según el sistema Sheldon y otros y un IV según sistema Mayo, etapa avanzada de la enfermedad que determina mal pronóstico. Se instauró tratamiento con quimioterapia neoadyuvante, quirúrgico y continuación con quimioterapia adyuvante, el cual continúa, actualmente, con una evolución estable. Conclusiones: Esta es una neoplasia rara. Sospechar su diagnóstico llevará a un diagnóstico temprano, lo que mejorará el pronóstico y sobrevida de los pacientes afectados(AU)

Introduction: The urachus or omphalomesenteric duct is an embryonic structure connecting the midgut and the yolk sac, which regresses before the third trimester of pregnancy. Objective: To report a case with a diagnosis of urachal adenocarcinoma, a rare malignant neoplasm. Case report: A 50-year-old patient with no pathological history, who had an initial clinical condition of ascites and abdominal pain. At physical examination, we found a palpable mass in the left hypochondrium - iliac fossa, which revealed a mass next to the bladder dome and anterior wall on the abdominal tomography of the abdomen. The biopsy result reported a mucinous adenocarcinoma of the omphalomesenteric duct (urachal). At the time of diagnosis, the patient was in stage IVB according to the Sheldon et al system and IV according to the Mayo system, an advanced stage of the disease that determines poor prognosis. Treatment with neoadjuvant and surgical chemotherapy was established and adjuvant chemotherapy to follow, which currently continues with a stable evolution. Conclusions: This is a rare neoplasm. Suspecting its diagnosis will lead to an early diagnosis, which will improve the prognosis and survival of affected patients(AU)

A rare case of mucinous adenocarcinoma of the bladder: A case report

@#Adenocarcinoma represents 0.5 to 2% of all malignant tumors of the bladder, and the mucinous subtype is extremely rare as a primary vesical lesion. The patient is a case of a 50-year-old male who initially presented with dysuria with occasional hematuria. A CT scan was done and showed bladder new growth. Cystoscopy Transurethral Resection of the bladder tumor was done revealing mucinous adenocarcinoma of the bladder. He then completed neoadjuvant chemotherapy with Pacitaxel and Cisplatin for 4 cycles, however repeat CT scan with contrast post chemotherapy showed progression of the adenocarcinoma. Due to the possibility of a primary lesion in the gastrointestinal tract, colonoscopy was performed revealing sessile serrated adenoma, as were tumor markers CA 19-9, CA 125, alpha-fetoprotein, and CEA, all of which without any abnormal results. He eventually underwent cystoprostatectomy and urethrectomy with extended bilateral pelvic lymph node dissection. The margins and lymph nodes were negative for tumor invasion. Adenocarcinoma is diagnosed mainly on histopathology and with the help of Immunohistochemistry (IHC). Once the diagnosis is confirmed, the radical surgery should be advised which could improve survival and disease progression.

Survival and prognosis of 60 cases with appendix-derived high-grade mucinous adenocarcinoma / 中国肿瘤临床

Objective: To investigate the clinical characteristics and prognostic factors associated with appendix-derived high-grade mucinous adenocarcinoma. Methods: A retrospective analysis of clinical and follow-up data of 60 patients with appendix-derived high-grade mucinous adenocarcinoma admitted to Aerospace Central Hospital between January 2013 and December 2017 was carried out. Results: Of the patients, 48% (29 cases) were men and 52% (31 cases) were women. The median age of the patients at admission was 57 (38-74) years. CEA levels increased in serum in 65% patients (39 cases) before operation, and hyperthermic intraperitoneal chemotherapy after operation accounted for 80% of the patients (48 cases). The 1-, 2- and 3-year survival rates were 80%, 58%, and 30%, respectively. The median survival time was 29 months. Univariate analysis showed that a lower peritoneal cancer index (PCI) score (P= 0.039) and a lesser degree of completeness of cytoreduction (CC) (P=0.002) were statistically significant in prolonging survival time. Multivariate analysis showed that the degree of CC could be an independent prognostic factor for overall survival (P=0.037). Conclusions: Appendix-derived high-grade mucinous adenocarcinoma is highly invasive and features a poor prognosis, but radical tumor reduction has a positive effect on prolonging the survival of patients. Early detection and early intervention are of great significance for the prognostic outcome.

Invasive mucinous adenocarcinoma of lung: A case report and literature review / 吉林大学学报(医学版)

Objective: To investigate the clinical characteristics and diagnosis and treatment process of a patient with invasive mucinous adenocarcinoma (IMAs) of lung, and to improve the clinician's understanding of IMAs. Methods: The general materials, imaging manifestations and treatment plan of a patient with IMAs were collected, and the related literature review was conducted. Results: A 42-year-old female patient was admitted to hospital due to cough and expectoration, the CT examination results showed the bilateral lung patchy shadows∗ the patient was suspected of having pneumonia. After anti-infective treatment, the patient' s symptoms did not improve. The pathological findings of transbronchial lung biopsy (TBLB) and the examination of exfoliated cells of pleural fluid all showed inflammation, and the pathological result of percutaneous biopsy was IMAs. The result of gene detection was 2-point mutation in exon of KRAS. After chemotherapy with paclitaxel plus carboplatin combined with bevacizumab, the symptoms of the patients were improved significantly, and the changes of imaging manifestations were obvious. Conclusion: IMAs is a special pathological type of lung adenocarcinomas (ADCs) with various imaging manifestations and specific gene expression. The treatment principles are different from those of the other types of ADCs.

Adenocarcinoma mucinoso bien diferenciado de tipo gástrico (adenoma maligno): un reto diagnóstico / Gastric-type mucinous well differentiated adenocarcinoma (adenoma malignum): a diagnostic challenge

Resumen ANTECEDENTES: El adenocarcinoma mucinoso bien diferenciado de tipo gástrico (adenoma maligno) es una variante histológica poco frecuente de adenocarcinoma mucinoso cervical. La hidrorrea, el sangrado vaginal persistente y las formaciones quísticas cervicales son manifestaciones sugerentes de la enfermedad. CASO CLÍNICO: Paciente de 52 años, que acudió a consulta por hidrorrea y sangrado genital persistente. Después de la exploración física se tomaron muestras de: exudado vaginal, citología cervical, biopsia endometrial e identificación de virus del papiloma humano. También se practicaron estudios de: colposcopia, legrado endocervical, ecografía transvaginal, histeroscopia y resonancia magnética. Se visualizaron múltiples quistes de Naboth, menores de 2 cm; líquido en la cavidad uterina y el canal endocervical, sin hallazgos patológicos adicionales. Por la persistencia de los síntomas se decidió efectuar la histerectomía total simple con doble anexectomía, por laparotomía. El reporte anatomopatológico fue: adenocarcinoma mucinoso bien diferenciado de tipo gástrico, estadio IB2 (FIGO). Se prescribieron: tratamiento coadyuvante, radioterapia externa y braquiterapia. Después de 12 esquemas de tratamiento no se identificaron signos de recidiva. CONCLUSIONES: Establecer el diagnóstico anatomopatológico preoperatorio es decisivo para disminuir la morbilidad y mortalidad por adenocarcinoma mucinoso. Es importante establecer el diagnóstico diferencial exhaustivo con lesiones benignas cervicales.

Abstract BACKGROUND: Gastric-type mucinous well differentiated adenocarcinoma (adenoma malignum) is an infrequent cervical mucinous adenocarcinoma. It must be suspected if persistent hydrorrhea or vaginal bleeding are present, as well as multiple cervical cysts. CLINICAL CASE: A case of a 52-year-old woman with persistent hydrorrhea and vaginal bleeding. The study was completed with vaginal culture, cervical cytology and HPV (Human Papiloma Virus), colposcopy, endocervical curettage, transvaginal ultrasound, endometrial biopsy, hysteroscopy and magnetic resonance imaging. Multiple Nabothian cysts <2 cm and fluid in the uterine cavity and the endocervical canal were observed, with no other pathological findings. Due to the symptom persistence and severity, surgical treatment was decided, revealing the diagnosis of gastric-type mucinous well differentiated adenocarcinoma, stage IB2 (FIGO). Adjuvant treatment consisted in external radiotherapy and brachytherapy. After one year of follow-up, the patient did not show any sign of relapse. CONCLUSIONS: Reaching a pathological diagnosis prior to surgery has a crucial importance to decrease morbi-mortality. A thorough differential diagnosis including benign cervical lesions is essential.