Undifferentiated high-grade pleomorphic sarcoma of the common bile duct: A case report and review of literature.

BACKGROUND: Undifferentiated pleomorphic sarcoma (UPS) is a rare malignant mesenchymal tumor with a poor prognosis. It mainly occurs in the extremities, trunk, head and neck, and retroperitoneum regions. Owing to the lack of specific clinical manifestations and imaging features, UPS diagnosis mainly depends on pathological and immunohistochemical examinations for exclusive diagnosis. Here we report an extremely rare case of high-grade UPS in the common bile duct (CBD). There are limited available data on such cases. CASE SUMMARY: A 70-year-old woman was admitted to our department with yellow eyes and urine accompanied by upper abdominal distending pain for 2 wk. Her laboratory data suggested significantly elevated hepatorenal function levels. The imaging data revealed calculous cholecystitis, intrahepatic and extrahepatic bile duct dilation with extrahepatic bile duct calculi, and a space-occupying lesion at the distal CBD. After endoscopic biliary stenting and symptomatic support therapy, CBD exploration and biopsy were performed. The frozen section indicated malignant spindle cell tumor of the CBD mass, and further radical pancreaticoduodenectomy was performed. Finally, the neoplasm was diagnosed as a high-grade UPS combined with the light-microscopic morphology and immunohistochemical results. CONCLUSION: This extremely rare case highlighted the need for increasing physicians' vigilance, reducing the odds of misdiagnosis, and providing appropriate treatment strategies.

Anastomosing hemangioma arising from the left renal vein: A case report.

BACKGROUND: Anastomosing hemangioma (AH) is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract. Due to the lack of specific clinical and radiologic manifestations, it is easily misdiagnosed preoperatively. Here, we report a case of AH arising from the left renal vein that was discovered incidentally and confirmed pathologically, and then describe its imaging characteristics from a radiologic point of view and review its clinicopathologic features and treatment. CASE SUMMARY: A 74-year-old woman was admitted to our department for a left retroperitoneal neoplasm measuring 2.6 cm × 2.0 cm. Her laboratory data showed no significant abnormalities. A non-contrast-enhanced computed tomography (CT) scan showed a heterogeneous density in the neoplasm. Non-contrast-enhanced magnetic resonance imaging (MRI) revealed a heterogeneous hypointensity on T1-weighed images and a heterogeneous hyperintensity on T2-weighed images. On contrast-enhanced CT and MRI scans, the neoplasm presented marked septal enhancement in the arterial phase and persistent enhancement in the portal phase, and its boundary with the left renal vein was ill-defined. Based on these clinical and radiological manifestations, the neoplasm was initially considered to be a neurogenic neoplasm in the left retroperitoneum. Finally, the neoplasm was completely resected and pathologically diagnosed as AH. CONCLUSION: AH is an uncommon benign hemangioma. Preoperative misdiagnoses are common not only because of a lack of specific clinical and radiologic manifestations but also because clinicians lack vigilance and diagnostic experience in identifying AH. AH is not exclusive to the urogenital parenchyma. We report the first case of this neoplasm in the left renal vein. Recognition of this entity in the left renal vein can be helpful in its diagnosis and distinction from other neoplasms.

Bladder perforation caused by long-term catheterization misdiagnosed as digestive tract perforation: A case report.

BACKGROUND: Spontaneous bladder rupture is relatively rare, and common causes of spontaneous bladder rupture include bladder diverticulum, neurogenic bladder dysfunction, gonorrhea infection, pelvic radiotherapy, etc. Urinary bladder perforation caused by urinary catheterization mostly occurs during the intubation process. CASE SUMMARY: Here, we describe an 83-year-old male who was admitted with 26 h of middle and upper abdominal pain and a history of long-term catheterization. Physical examination and computed tomography of the abdomen supported the diagnosis of diffuse peritonitis, most likely from a perforated digestive tract organ. Laparoscopic exploration revealed a possible digestive tract perforation. Finally, a perforation of approximately 5 mm in diameter was found in the bladder wall during laparotomy. After reviewing the patient's previous medical records, we found that 1 year prior the patient underwent an ultrasound examination showing that the end of the catheter was embedded into the mucosal layer of the bladder. Therefore, the bladder perforation in this patient may have been caused by the chronic compression of the urinary catheter against the bladder wall. CONCLUSION: For patients with long-term indwelling catheters, there is a possibility of bladder perforation, which needs to be dealt with quickly.

Radiological aspects of giant hepatocellular adenoma of the left liver: A case report.

BACKGROUND: Hepatocellular adenoma (HCA) is very rare and has a high misdiagnosis rate through clinical and imaging examinations. We report a case of giant HCA of the left liver in a young woman that was diagnosed by medical imaging and pathology. CASE SUMMARY: A 21-year-old woman was admitted to our department for a giant hepatic tumor measuring 22 cm × 20 cm × 10 cm that completely replaced the left hepatic lobe. Her laboratory data only suggested mildly elevated liver function parameters and C-reactive protein levels. A computed tomography (CT) scan showed mixed density in the tumor. Magnetic resonance imaging (MRI) of the tumor revealed a heterogeneous hypointensity on T1-weighed MR images and heterogeneous hyperintensity on T2-weighed MR images. On dynamic contrast CT and MRI scans, the tumor presented marked enhancement and the subcapsular feeding arteries were clearly visible in the arterial phase, with persistent enhancement in the portal and delayed phases. Moreover, the tumor capsule was especially prominent on T1-weighted MR images and showed marked enhancement in the delayed phase. Based on these imaging manifestations, the tumor was initially considered to be an HCA. Subsequently, the tumor was completely resected and pathologically diagnosed as an HCA. CONCLUSION: HCA is an extremely rare hepatic tumor. Preoperative misdiagnoses were common not only due to the absence of special clinical manifestations and laboratory examination findings, but also due to the clinicians' lack of practical diagnostic experience and vigilance in identifying HCA on medical images. Our case highlights the importance of the combination of contrast-enhanced CT and MRI in the preoperative diagnosis of HCA.

[Preparation of immunomagnetic nanoparticles for tumor targeting therapy with herceptin].

OBJECTIVE: To prepare immunomagnetic nanoparticles (IMNs) for HER2/neu-targeted radioimmunotherapy with herceptin, a humanized anti-p185-HER-2/neu monoclonal antibody targeting the extracellular domain of HER-2/neu receptor. METHODS: The magnetic nanoparticles were synthesized by partial reductive precipitation method and the surface of the particles was chemically modified using silane coupling agent. Herceptin and histidine were covalently linked to the amine group upon the silica-coated magnetic nanoparticles modified by N-[3-(trimethoxysilyl) propyl]-ethylenediamine using glutaraldehyde method to prepare the IMNs. The nanoparticles were evaluated by diffraction (XRD), scanning electron microscope (SEM) and X- ray energy spectrometry (EDS), and the immunoreactivity of IMN was determined. RESULTS: The average diameter of the decanoic acid-coated Fe(3)O(4) nanoparticle was about 20 nm with a magnetic saturation of 65 emu/g. The surface amino group was 0.5 µmol/mg after modification with the amid functional group, and the mean size of Herceptin-loaded IMNs was about 60 nm. The IMN retained good immunoreactivity of Herceptin. CONCLUSION: The IMNs exhibit good properties for potential application in tumor targeting therapy using Herceptin against HER-2/nue proto-oncogene.

[Value of carcinoembryonec antigen in biochemotherapy response monitoring in patients with Her-2-positive advanced breast cancer].

OBJECTIVE: To assess the value of serum carcinoembryonec antigen (CEA) in monitoring the response to biochemotherapy by Herceptin plus taxol (TAX) in patients with Her-2-positive advanced breast cancer. METHODS: The changes in serum CEA level were investigated retrospectively after two cycles of biochemotherapy in 83 patients with Her-2-positive advanced breast cancer. The correlations between the changes and radiological objective response were analyzed. RESULTS: After two cycles of biochemotherapy, the clinical benefit rate (CBR) was 81.9%. In the 60 patients with lowered CEA level, the CBR was 85.0% (51/60), with a non-response rate of 15.0% (9/60); in contrast, the CBR was only 34.8% in 23 patients with elevated CEA, with a non-response rate of 65.2%, showing significant difference between the two groups (P<0.05). CONCLUSION: Serum CEA level can be used to monitor the therapeutic effect of biochemotherapy in patients with Her-2-positive advanced breast cancer.

[Expression and prognostic value of Polo-like kinase 1, E-cadherin in the patients with hepatocellular carcinoma].

OBJECTIVES: To study the expression of Polo-like kinase 1 (PLK1) and E-cadherin in the tissues of hepatocellular carcinoma, and to discuss the relationship between them and clinical-pathological features, and to evaluate their prognostic value of hepatocellular carcinoma after liver transplantation. METHODS: mRNA and protein expression of PLK1, E-cadherin were detected by RT-PCR and immunohistochemistry method respectively, the correlations of them with clinical-pathological data, tumor free time, recurrence rate were compared and analyzed. RESULTS: The mRNA expression was observed in 90.0% for PLK1 and 96.0% for E-cadherin, and higher in cancerous' tissues than paracancerous' of all cases for PLK1 but no trend for E-cadherin. The positive and decreased expression rate for PLK1 and E-cadherin was observed in 60.0% and 50.0% respectively, the positive PLK1 expression was correlated with preoperative serum alpha-fetoprotein (AFP) only (chi2 = 4.433, P = 0.035), while E-cadherin expression was associated with none of the clinical-pathological features. There was a correlation between the positive PLK1 and decreased E-cadherin expression (chi2 = 5.333, P = 0.021). PLK1 (P = 0.006), E-cadherin (P = 0.019) and larger tumor (P = 0.019), portal vein tumor thrombi (P = 0.030), Edmondson grading (P = 0.019), preoperative serum AFP (P = 0.020) were all correlated with recurrence rate under Kaplan-Meier analysis, while only PLK1 (RR = 3.104, P = 0.009) had significant difference under Cox regression analysis. CONCLUSIONS: The positive PLK1 expression and the decreased E-cadherin expression indicate higher recurrence rate of HCC after liver transplantation, and PLK1 is a independent risk factor.

[Randomized control study of medical adhesive products decreasing postoperative abdominal effusion in patients with gastric cancer].

OBJECTIVE: To determine the value of medical adhesive products for decreasing abdominal effusion after clearing up lymph nodes in patients with gastric cancer. METHODS: Seventy patients with gastric cancer and undergoing D(2 ) or D(2 )(+) radical excision were randomly divided into group A and B based on envelope method from June 2002 to December 2003. In group A (n=35),medical adhesive products was dripped on the retroperitoneal regions where perigastric lymph nodes were cleared up, while not in group B(n=35). Four items including the volume of intraperitoneal drainage, the loss of protein, erythrocyte and hemoglobin were compared between group A and B from the first day to the 5th day after operation. RESULTS: No patients died in group A and B. The volume of intraperitoneal drainage and loss of protein in group A were less than those in group B (P< 0.01) from the first day to the 3th day after operation,but there was no significant difference at the 4th day and 5th day after operation(P > 0.05). The total volume of intraperitoneal drainage and loss of protein in group A were less than those in group B (P< 0.01) from the first day to the 5th day after operation. The loss of erythrocyte and hemoglobin reached the peak at the first day after operation both in group A and B, then gradually decreased, so there was no significant difference between group A and B later. CONCLUSION: The medical adhesive products can decrease abdominal effusion effectively after clearing up perigastric lymph nodes and facilitate patients' recovery from operation.