Feasibility and surgery indications of endoscopic submucosal dissection for gastric cancers / 中华消化内镜杂志

Objective To evaluate the feasibility and indications of endoscopic submucosal dissection (ESD) by analyzing the early gastric cancer cases.Methods All the pathological materials of radical gastric resections in Huashan hospital from 2007 to 2011 were retrieved and the EGC cases were selected.All the cases in EGC group which met the extended ESD criteria were reviewed.Extended ESD criteria were cited from Treatment guidelines for gastric cancer in Japan edited by JGCA in 2001.The risk factors relevant with regional metastasis,such as invasive depth and differentiation degrees,were also analysed.Results In the recent five years,there were 1159 cases of gastric cancer undergoing radical gastrectomy in Huashan hospital including 210 EGC.According to the extended criteria of JGCA,151 cases could be candidates for ESD while 126 cases could be candidates for ESD according to the typical criteria for ESD.The local metastases of lymphatic or vascular involvement for mucosa cancer,muscularis mucosae cancer,sm1 and sm2 cancer were 6.75％,15.00％,23.25％,and 39.62％ respectively (P ＜0.05).Twenty-five cases had local metastases that met the extended criteria for ESD.Within the 210 EGC cases,the local metastases of differentiated type and undifferentiated type were 13.95％ and 47.37％ respectively (P ＜ 0.05).Conclusion Most EGC cases undergoing radical gastrectomy can be cured by ESD.Its metastases are highly correlated with invasion depth and differentiation,so indications of ESD should be assessed.

Pilomatricoma: a retrospective study of 399 cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinical and pathological features of pilomatricoma.@*METHOD@#The authors retrospectively investigated the clinical and pathological materials of 399 patients with pilomatricoma.@*RESULT@#Single lesion occurred in most patients (99%) and 56.39% of them were younger than 30 years. The male-female ratio was 1:1.33. The lesions which sizes average 1.22 cm were commonly emerged in the head, neck, and upper extremity.@*CONCLUSION@#Pilomatricoma is a slowly developed benign cutaneous tumour, but it can aggravate sometimes. It's manifestation is diversed and easily misdiagnosed. Early complete excision is recommended for hard or tenacious nodules on head, neck and upper extremity.

Clinicopathological characteristics of hypopharyngeal carcinosarcoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinicopathological characteristics, diagnosis and differential diagnosis of hypopharyngeal carcinosarcoma.@*METHOD@#Clinical data of one case with hypopharyngeal carcinosarcoma proved by pathology were analyzed retrospectively. The related literatures were reviewed.@*RESULT@#The masses were surgically removed,and the postoperative diagnosis was confirmed to be carcinosarcoma by histopathological examination. After radiotherapy and chemotherapy, the patient recovered well postoperatively without recurrence during 18-month follow-up.@*CONCLUSION@#Carcinosarcoma of the hypopharynx is an extremely rare malignant tumor with distinctive histological, clinical and immunohistochemical features. The final diagnosis depends on histopathology. This tumor should be differentiated from other tumors such as sarcomatoid carcinoma and the reaction of radiotherapy of carcinoma. Surgery is the proper treatment strategy for carcinosarcoma of the hypopharynx. The patients with locally advanced, postoperative residual tumor or tumor without clear safe surgical margin should undergo radiotherapy, and the postoperative follow up should be in time.

Distribution of metastatic lymph nodes in 150 patients who underwent radical resection for pancreatic head cancer / 中华肝胆外科杂志

ObjectiveTo study the characteristics and the impact of lymph node metastasis on radical resection for pancreatic head cancer to provide a theoretical basis for lymphadenectomy in radical resection.To study the reliability of using a surgical microscope to detect lymph nodes in radically resected specimens of pancreatic head cancer.MethodsLymph nodes in the specimens after radical pancreaticoduodeneetomy (pancreaticoduodenectomy + D2 regional lymphadenectomy) were identified using a surgical microscope and they were grouped using the JPS standard.The position and the frequency of the lymph nodes retrieved,and their association with other clinicopathologic factors were analysed.The results were compared with the data published in 2004 on 46 patients to evaluate the reliability of using a surgical microscope.ResultsLymph node metastasis was detected histopathologically in 101 patients (67.3％).The median number of lymph nodes retrieved in the specimens as detected using the surgical microscope was 38.2.The most commonly involved lymph node groups were No.13 (64.5％),No.14 (51.7％),No.17 (38.6％),No.12 (25.8％),No.16 (20.8％).Lymph node metastasis was significantly associated with tumour T stage,tumour invasion and differentiation,preoperative serum level of CA19-9 and CA72-4,but not with patient age,sex,or tumour location.There were no significant differences between the results and the data of the previous study in 2004.ConclusionsExtended lymphadenectomy is necessary because extensive lymph node metastasis was common.Surgical microscopy is an effective and reliable method to detect lymph nodes in resected specimens of pancreatic head cancer for accurate pathologic staging.

A study on the relationship between thyroid nodules with calcification and thyroid carcinoma / 中华普通外科杂志

Objective To investigate the relationship between thyroid nodules with calcification and thyroid carcinoma and its significance in the screening of thyroid carcinoma in high risk group.Methods The clinical data of 1771 patient undergoing surgery for thyroid nodules from March, 2006 to March, 2009 in Huashan Hospital, Fudan University were retrospectively analyzed. Results Among 1771 patients, 500 were finally identified as having malignant tumors. Incidence of calcification in thyroid carcinoma was 68. 4%, and that in benign thyroid nodules was 27.0% ( χ2 = 259. 5, P ＜ 0. 05 ). The specificity of microcalcification for the diagnosis of carcinoma was 89. 4%, and its positive predictive value was 66. 3% ( χ2 = 368.6, P ＜ 0. 01 ). The incidence of thyroid carcinoma in patients ＜ 45 years was 39.2%, while that in patients ≥ 45 years was 22.9% ( χ2 = 51.12, P ＜ 0. 05 ). The incidence of carcinoma in patients of single thyroid nodule was 31.7% and that in those with multiple nodules was 26. 4% (χ2 =4. 766,P ＜ 0. 05). Metastasis was pathologically diagnosed in 26. 8% of lymph nodes found by preoperative ultrasonography. Conclusions The specificity of thyroid nodule calcification, especially microcalcification is high for the diagnosis of thyroid carcinoma. High-risk index for carcinoma includes thyroid nodules with microcalcification, ＜ 45 years old and single thyroid nodule.

Clinical analysis of superficial parotidectomy with preservation of the Steven’s duct / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the results of superficial parotidectomy with preservation of the Steven’s duct. METHODS 27 cases of superficial parotidectomy with preservation of the Steven’s duct were reviewed retrospectively. Complications and treatment outcomes were analyzed. RESULTS Almost all cases investigated resulted in satisfactory outcomes. CONCLUSION Superficial parotidectomy with preservation of the Steven’s duct is a possible alternative for some patients, especially those with benign parotid tumour.

The pathological changes of nasopharyngeal carcinoma cases treated by stereotactic radiosurgery / 临床耳鼻咽喉头颈外科杂志

Objective:To study the pathological changes of nasopharyngeal carcinoma cases after the treat-ment of stereotactic radiosurgery. Method: 15 cases with recurrent or residual squamous cell carcinoma of na-sopharynx diagnosed as T1～4 N0M0 were selected,which had undergone previous radiotherapy. The patients weretreated by Gamma Knife while the isodose curve was 50％00 and the margin dose was 20 Gy. The nasopharynxbiopsy was performed before the treatment and 1,3,6,12 months after the treatment. The biopsy specimen wastaken to make a pathological examination. Result:①Before the Gamma Knife treatment, carcinoma cell could beseen in the tissue;②1～3 months after the treatment, cell necrosis and acute inflammation cell infiltration couldbe seen in the target ;③6～12 months after the treatment ,infiltration of chronic inflammation cell ,proliferation offibrous tissue and capillary could be found in the target. Conclusion:This research implies that the short-termpathological changes after the treatment of stereotactic radiosurgery can be defined as two phases ..The first phaseoccurs from 1 to 3 months after the treatment called necrosis period. The second phase occurs from 6 to 12months after the Gamma Knife treatment named as absorption period.