Primary hepatic neuroendocrine tumor - 18F-fluorodeoxyglucose positron emission tomography/computed tomography findings: A case report.

BACKGROUND: Primary hepatic neuroendocrine tumors (PHNETs) are rare hepatic tumors. Their diagnosis, which is based on radiological findings, is difficult. CASE SUMMARY: We present a case of PHNET in a 79-year-old man with no clinical symptoms. Computed tomography (CT) and 2-Deoxy-2-[fluorine-18] fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) were performed for further evaluation. A hypoattenuating mass with rim-like enhancement in segment 6 of the liver was detected on contrast-enhanced CT imaging. Increased uptake was also observed on 18F-FDG PET/CT. Histopathological and immunohistochemical examinations, which revealed a grade 2 neuroendocrine tumor (NET), confirmed the diagnosis. CONCLUSION: Diagnosing PHNET is challenging, and must be distinguished from other liver tumors. Metastatic NETs should be excluded.

Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China.

BACKGROUND: Functional dyspepsia (FD) has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma (ESCC). This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia (OD) in such a population. METHODS: A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC. All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire, and they underwent gastroscopy. After exclusion of gastroesophageal reflux disease, uninvestigated dyspepsia (UID) was divided into OD and FD for further analyses. RESULTS: A total of 2916 participants were enrolled from July 2013 to March 2014 in China. We detected 166 UID cases with questionnaires, in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy. OD cases presented as reflux esophagitis (RE), ESCC, and duodenal ulcer. Heartburn (52.94%) and reflux (29.41%) were common in OD, but no symptomatic differences were found between FD and OD. Male sex, low education level, and liquid food were the risk factors for OD, while frequent fresh vegetable consumption was a protective factor. FD included 56 (37.58%) cases of postprandial distress syndrome (PDS), 52 (34.89%) of epigastric pain syndrome (EPS), nine (6.04%) of PDS + EPS, and 32 (21.48%) of FD + functional esophageal disorders. The Helicobacter pylori infection rate in FD patients was not higher than that in the control group (34.23% vs. 42.26%, P = 0.240). Frequent spicy food consumption was associated with PDS (odds ratio [OR]: 2.088, 95% confidence interval [CI]: 1.028-4.243), while consumption of deep well water was protective for PDS (OR: 0.431, 95% CI: 0.251-0.741). CONCLUSIONS: The prevalence of FD was 5.11% in the studied population. Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01688908; https://clinicaltrials.gov/ct2/show/record/NCT01688908.

Cellular stress and redox activity proteins are involved in gastric carcinogenesis associated with Helicobacter pylori infection expressing high levels of thioredoxin-1.

Helicobacter pylori infection is related to the development of gastric diseases. Our previous studies showed that high thioredoxin-1 (Trx1) expression in H. pylori can promote gastric carcinogenesis. To explore the underlying molecular mechanisms, we performed an isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative proteomic analysis of stomach tissues from Mongolian gerbil infected with H. pylori expressing high and low Trx1. Differences in the profiles of the expressed proteins were analyzed by bioinformatics and verified using Western blot analysis. We found three candidate proteins, 14-3-3α/ß, glutathione-S-transferase (GST), and heat shock protein 70 (HSP70), in high Trx1 tissues compared with low Trx1 tissues and concluded that cellular stress and redox activity-related proteins were involved in the pathogenesis of gastric cancer associated with H. pylori Trx1.

Helicobacter pylori with high thioredoxin-1 expression promotes stomach carcinogenesis in Mongolian gerbils.

OBJECTIVE: Previous studies by this group have shown that Helicobacter pylori with high thioredoxin-1 (Trx1) expression might be involved in stomach carcinogenesis in vitro. To study histopathological changes of the stomach mucosa in vivo, a Mongolian gerbil model infected with H. pylori with high Trx1 expression was established. METHODS: Healthy, male Mongolian gerbils (n=75) were randomly divided into 3 groups: controls (n=15), which were not infected with H. pylori, high Trx1 (n=30) which were infected with H. pylori with high Trx1 expression and low Trx1 (n=30) which were infected with low Trx1 expression H. pylori. The animals were sacrificed at 4, 20, 34, 48, 70 and 90 weeks after inoculation. RESULTS: The Mongolian gerbil model of H. pylori infection was successfully established. Three animals died during the study, leaving 72 animals (controls, n=14; low Trx1, n=29; high Trx1, n=29) examined on schedule. Histopathological analysis of the stomach mucosa showed gradually increased aggravation over time in the high and low Trx1 groups. Compared with control and low Trx1, the histopathological changes were more serious in the high Trx1 group. At 90 weeks, no abnormal changes were found in the controls, but 62.5% of the high Trx1 group and 33.3% of the low Trx1 showed adenocarcinomas. The H. pylori Trx1 level in gastric cancer tissue was significantly higher than that from gastritis tissue. Within gastric cancer cells, high Trx1 expression in H. pylori significantly upregulated cyclin D1. CONCLUSIONS: High Trx1 expression in H. pylori promoted stomach carcinogenesis. More studies are needed to confirm this finding.

Accuracy of diagnosing gastroesophageal reflux disease by GerdQ, esophageal impedance monitoring and histology.

OBJECTIVE: To assess the performance of self-assessment gastroesophageal reflux disease questionnaire (GerdQ), 24-h impedance monitoring, proton pump inhibitor (PPI) test and intercellular space of esophageal mucosal epithelial cells in the diagnosis of gastroesophageal reflux disease (GERD). METHODS: Patients with symptoms suspected of GERD were administered the GerdQ and underwent endoscopy (measurement of intercellular space in the biopsy specimen sampling at 2 cm above the Z-line) and 24-h impedance pH monitoring, together with a 2-week experimental treatment with esomeprazole. RESULTS: A total of 636 patients were included for the final analysis, including 352 with GERD. The sensitivity and specificity of GerdQ and 24-h impedance monitoring for diagnosing GERD were 57.7% and 48.9%, and 66.4% and 43.3%, respectively. The sensitivity of 24-h impedance pH monitoring increased to 93.7%. The sensitivity and specificity of dilated intercellular spaces (DIS) (≥0.9 µm) for diagnosing GERD were 61.2% and 56.1%, respectively, whereas those for PPI test were 70.5% and 44.4%. CONCLUSIONS: GerdQ score or PPI test alone cannot accurately diagnose GERD in a Chinese population suspected of GERD. A definitive diagnosis of GERD still depends on endoscopy or 24-h pH monitoring. 24-h impedance pH monitoring may increase the sensitivity for diagnosing GERD by 20%; however, when used alone, it results in poor specificity in patients without acid suppressive therapy.

[Predicative value of expression of TrkB and TRIM29 in biopsy tissues from preoperative gastroscopy in lymph node metastasis of gastric cancer].

OBJECTIVE: To analyze the expressions of TrkB and TRIM29 in biopsy tissues from preoperative gastroscopy in patients with gastric cancer and investigate the relationship between their expression and rate of lymph node metastasis. METHODS: Through immunohistochemistry, the authors analyzed the expression status of TRIM29 and TrkB in biopsy tissues from preoperative gastroscopy in 67 patients with a diagnosis of gastric cancer undergoing radical operations during 2005 - 2009 at Peking University Third Hospital. There were 39 males and 28 females. Then the relationship was explored between the expression of both proteins and lymph node metastasis and other clinical pathological factors. Image pro Plus 6.0 software was used for image analysis. The data underwent a logarithmic process and were analyzed through SPSS 17.0 statistical software. RESULTS: The expression of TrkB in lymph node metastasis (n = 42) was higher than that in without lymph node metastasis (n = 25) (lgA 4.79 ± 0.42 vs 3.98 ± 0.71, t = -5.873, P = 0.003), while the expression of TRIM29 with lymph node metastasis (n = 36) was also higher than that in without lymph node metastasis (n = 24) (5.21 ± 0.27 vs 5.02 ± 0.37, t = -2.257, P = 0.040). Logistic regression analysis showed that the TrkB expression was an independent predictor for lymph node metastasis. A discriminant was set based on the result (discriminant value = 1.705 × TrkB lgA+ 1.803 × TRIM29 lgA-16.880, cutoff value = 0). This discriminant achieved a prediction accuracy of 80.0% (48/60), a positive likelihood ratio 3.332 and a negative likelihood ratio 0.223. Patients with a high expression of TrkB showed a worse survival rate than those with a low TrkB expression [36.0% (9/25) vs 66.7% (16/24), P = 0.047). Patients with a high TRIM 29 expression showed a worse survival rate than those with a low TRIM29 expression [38.1% (8/21) vs 66.7% (14/21), P = 0.044]. CONCLUSION: The expressions of TrkB and TRIM29 are correlated with lymph node metastasis in gastric cancer, and discriminant based on the expressions of TrkB and TRIM29 had important values for preoperative prediction of lymph node metastasis in gastric cancer.

[Relationship among pathological change of gastric mucous, body mass index and the serum levels of ghrelin and leptin].

OBJECTIVE: To investigate serum ghrelin and leptin levels in relation to pathology change of gastric mucous membrane and body mass index (BMI). METHODS: A total of 156 patients were studied from Apr. 2009 to Jul. 2009. Blood serum ghrelin and leptin levels were assessed by ELISA method. All patients underwent gastroscopy with biopsies from gastric antrum and gastric body in order to evaluate pathology change of gastric mucous membrane. RESULTS: Serum ghrelin levels (250.14 ng/L vs 386.65 ng/L) and leptin levels (4.12 µg/L vs 4.31 µg/L) in male subjects were lower than in female ones. There was significant difference in ghrelin levels (P=0.003), but not in leptin levels (P=0.681). ghrelin levels in ≤35-year-old group, 36 to 54-year-old group and ≥55-year-old group were 408.93 ng/L, 309.16 ng/L and 236.76 ng/L respectively, with significant difference (P=0.007). While leptin levels in ≤35-year-old group, 36 to 54-year-old group and ≥55-year-old group were 4.26 µg/L, 4.41 µg/L and 3.86 µg/L respectively, without significant difference (P=0.549). Serum ghrelin levels (308.40 ng/L vs 344.88 ng/L) and leptin levels (4.17 µg/L vs 4.35 µg/L) were both lower in chronic superficial gastritis patients than in chronic atrophy gastritis patients. But no statistically significant difference of ghrelin and leptin levels emerged either in chronic superficial gastritis group or in chronic atrophy gastritis group (P=0.870 and 0.436, respectively). There was a negative correlation between ghrelin and BMI (P=0.000), but a positive correlation between leptin and BMI (P=0.000). CONCLUSION: Gender and age have influence on serum ghrelin levels. Meanwhile, serum ghrelin and leptin levels were associated with neither chronic superficial gastritis nor chronic atrophy gastritis. Serum ghrelin levels decrease and leptin levels increase with the increase of BMI.

[A case report of collagenous gastritis in a young Chinese woman and literatures review].

OBJECTIVE: Collagenous gastritis is a rare entity, characterized by the deposition of a subepithelial collagen band with an inflammatory infiltrate in the mucosa. This report describes the first case of collagenous gastritis occurring in a young Chinese woman and reviews the literatures. METHODS: The patient underwent the gastroscopy screening, and the biopsy specimens were treated with HE staining, Masson staining, Congo red staining and Warthin-Starry staining.Patients' clinical data was discussed and followed up. RESULTS: A twenty-year-old girl had intermittent epigastric pain for 4 years, abdominal distention, hiccup and weight loss for two months. The gastric endoscopy revealed diffuse white nodular appearance of the mucosa in angular incisura and antrum. Pathologic examination of the gastric biopsies from the antrum and angular showed a subepithelial collagen deposition with moderate infiltrates of lymph plasma cells and eosinophils of the lamina propria. The collagen band measured up to 120.3 µm (mean 43.8 µm). Prednisone 20 mg/d for 4 weeks led to clinical remission and weight gain. CONCLUSION: There are about 40 cases in literatures to date, and the cause and pathogenesis of collagenous gastritis remain unknown. According to the clinical and pathological characteristics, the patient in this article is the subtype of collagenous gastritis that occurring in children and young adults. Specific therapy has not been established, the gluten-free diet and glucocorticosteroid may be helpful to relieve symptoms in collagenous gastritis patients.

Genetic and epigenetic alterations of LTF at 3p21.3 in nasopharyngeal carcinoma.

To investigate the roles of lactotransferrin gene (LTF, also referred to as the lactoferrin gene, LF), located at 3p21.3 within the common minimal deletion region, in the pathogenesis of nasopharyngeal carcinoma (NPC), we first detected its expression level in 33 primary NPC tissues and 15 chronic nasopharyngitis tissues. Absent expression or downregulation of LTF were observed in 76% (25 of 33) of primary NPC tissues. We further found that 25% (5 of 20) of NPC specimens had loss of heterozygosity (LOH) at the LTF locus. LTF mutation assessed by polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) and DNA sequencing was noted in 30% (6 of 20) of primary NPC tissues. In addition, hyper-methylation of LTF promoter region was found in 63.6% (21 of 33) of primary NPC samples but not in chronic nasopharyngitis tissues. The LTF transcripts in NPC cell lines increased upon treatment with the demethylation compound, 5-aza-2-deoxycytidine. In conclusion, our data indicate that two-hit silencing of LTF through genetic and epigenetic changes may be a common and important event in the carcinogenesis of NPC.