Axillary Paget disease with a visible satellite: a case report and literature review.

BACKGROUND: Extramammary Paget disease (EMPD) is an uncommon malignancy affecting apocrine gland-bearing skin, such as vulvar, perianal, axillary and penoscrotal areas. Paget cells are sometimes detected outside clinical border in a phenomenon called subclinical extension. Satellite is one of the patterns of subclinical extension which is likely to be invisible. The standard management strategy for EMPD without distant metastasis is a complete surgical removal, sometimes called wide local excision. However, there is no consensus regarding surgical margin width to decrease the high recurrence rate. Here we describe the first macroscopically visible satellite of axillary EMPD and wide local excision of both main lesion and the satellite lesion with only 0.5 cm margin, succeeded by a short review of the literature. CASE PRESENTATION: A 48-year-old female with a red macule in the right axilla was presented to our clinic. A well-demarcated 4 cm × 3 cm erythematous plaque was observed in the right axilla, and a similar lesion measuring 0.5 cm × 0.3 cm was found 3.5 cm away from the primary site. Breast and axillary node examination was unremarkable. Biopsy of the large plaque revealed Paget disease, then we performed a local extended excision of both lesions with a 0.5 cm margin, all margins negative indicated, by frozen pathology. Pathology revealed the nature of the satellite beside the main lesion also as Paget disease. The patient is currently followed-up for 20 months and has shown no signs of recurrence, with normal shoulder motor function. CONCLUSION: We have report the first visible satellite of extramammary Paget disease, indicating the necessity of an extended local resection of both the main leision and the satellite lesion. Considering the anatomical structure of axillary Paget disease, a 0.5 cm negative surgical margin indicated by frozen pathology might be sufficient to sustain the shoulder motor function.

Expression and clinicopathological significance of Bcl - 2 and Bax genes in colorectal cancer patients complicated with schistosomiasis / 中国血吸虫病防治杂志

Objective To investigate the expression and clinicopathological significance of Bcl-2 and Bax genes in colorectal cancer (CRC) patients complicated with schistosomiasis. Methods The CRC patients receiving surgical treatment in the First Affiliated Hospital of Dali University from June 2016 to June 2020 were recruited as the study subjects, and 30 subjects were randomly sampled from the CRC patients complicated with schistosomiasis (CRC-S group) and 30 subjects were randomly sampled from the CRC patients without schistosomiasis (CRC group) using a random number table method. The cancer specimens were sampled from subjects in the CRC-S and CRC groups, and the peri-cancer specimens were sampled from subjects in the CRC group. The Bcl-2 and Bax expression was quantified in cancer and peri-cancer specimens using a real-time fluorescent quantitative PCR (qPCR) assay and immunohistochemistry at transcriptional and translational levels, and the cell apoptosis was detected in cancer specimens using HE staining. Results A total of 60 subjects were enrolled, including 30 cases in the CRC group and 30 cases in the CRC-S group. There were no significant differences between the two groups in terms of gender distribution (χ2 = 0.271, P > 0.05), mean age (t = -0.596, P > 0.05), tumor growth pattern (χ2 = 0.275, P > 0.05), tumor location (χ2 = 4.008, P > 0.05), tumor invasion depth (χ2 = 0.608, P > 0.05), degree of tumor differentiation (χ2 = 0.364, P > 0.05), or presence of vascular metastasis (χ2 = 1.111, P > 0.05), while significant differences were seen between the two groups in terms of histological type, presence of lymph node metastasis and TMN staging (χ2 = 5.963, 8.297 and 5.711, all P values < 0.05). qPCR assay and immunohistochemistry quantified significantly higher Bcl-2 and Bax expression in cancer specimens from the CRC and CRC-S groups than in the peri-cancer specimens from the CRC group at both translational and transcriptional levels (all P values < 0.05), and higher Bcl-2 and lower Bax expression were seen in the cancer specimens from the CSC-S group than that from the CRC group (all P values < 0.05). In addition, the cell apoptotic rate was significantly greater in the cancer specimens in the CRC group than in the CRC-S group (42.00% vs. 23.35%; χ2 = 41.500, P = 0.000). Conclusion Schistosomiasis may be involved in the development and progression of CRC through affecting Bcl-2 and Bax gene expression in the apoptosis signaling pathway.

Prognostic Superiority of Log Odds of Positive Lymph Nodes in Stage 3 Colorectal Cancer.

Objective To evaluate the prognostic value of the log odds of positive lymph nodes (LODDS) in stage 3 colorectal cancer (CRC) patients who have undergone curative resection. Methods We performed a retrospective review of 175 stage 3 CRC patients who underwent curative resection in Peking Union Medical College Hospital from 2005 to 2012. Patients were categorized respectively according to the AJCC/UICC N grade,the metastatic lymph node ratio (LNR),and the ratio of their LODDS. The relationship between the N grade,LNR,LODDS,and overall survival (OS) rates were assessed.Results The five-year disease-free survival (DFS) was significantly different among stage 3 CRC patients in different N grade (Χ(2)=33.1,P=0.000),LNR (Χ(2)=14.3,P=0.001),and LODDS (Χ(2)=14.9,P=0.001). Univariate analysis showed that TNM stage (Χ(2)=27.0,P=0.000),cancerous node(Χ(2)=3.6,P=0.040),N grade (Χ(2)=33.1,P=0.000),LNR (Χ(2)=14.3,P=0.001),and LODDS (Χ(2)=30.4,P=0.000) were related to OS. Multivariate analysis indicated that TNM stage (HR:1.84,95%CI:1.59～6.29,P=0.001) and LODDS classification (HR:1.34,95%CI:1.01～1.80,P=0.047) were independent prognostic factors for OS in stage 3 CRC patients. Conclusion LODDS is a good prognostic indicator in stage 3 CRC patients who have undergone curative resection.

Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer.

We report on a patient diagnosed with Peutz-Jeghers syndrome (PJS) with synchronous rectal cancer who was treated with laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). PJS is an autosomal dominant syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract, mucocutaneous pigmentation, and increased risks of gastrointestinal and nongastrointestinal cancer. This report presents a patient with a 20-year history of intermittent bloody stool, mucocutaneous pigmentation and a family history of PJS, which together led to a diagnosis of PJS. Moreover, colonoscopy and biopsy revealed the presence of multiple serried giant pedunculated polyps and rectal adenocarcinoma. Currently, few options exist for the therapeutic management of PJS with synchronous rectal cancer. For this case, we adopted an unconventional surgical strategy and ultimately performed laparoscopic restorative proctocolectomy with IPAA. This procedure is widely considered to be the first-line treatment option for patients with ulcerative colitis or familial adenomatous polyposis. However, there are no previous reports of treating PJS patients with laparoscopic IPAA. Since the operation, the patient has experienced no further episodes of gastrointestinal bleeding and has demonstrated satisfactory bowel control. Laparoscopic restorative proctocolectomy with IPAA may be a safe and effective treatment for patients with PJS with synchronous rectal cancer.

Esophageal manometry and 24-hour pH monitoring in the remnant esophagus after esophagectomy and esophagogastric anastomosis following esophageal bed / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the motility function of remnant esophagus and stomach, and the gastroesophageal reflux after esophagectomy and esophagogastric anastomosis following esophageal bed.</p><p><b>METHODS</b>Esophageal manometry and 24-hour pH monitoring were performed in 10 healthy volunteers and 20 patients who underwent esophagectomy and esophagogastric anastomosis through esophageal bed as a treatment for mid-esophageal carcinoma. These 20 patients, received examinations within 3 to 6 months after operations, were defined as study group, and 10 healthy volunteers as control group.</p><p><b>RESULTS</b>(1) All the pH monitoring indexes in study group were significantly higher than those in control group (P<0.01). (2) Rest pressures of stomach, remnant esophagus and upper esophageal sphincter significantly increased in comparison with control group(P<0.01). (3) The contracting pressure, amplitude of primary peristalsis and amplitude of swallow peristalsis of remnant esophagus were reduced as compared to control group(P<0.01). (4) The contraction pressure of upper esophageal sphincter was obviously higher than that of control group (P<0.01). (5) There were no significant differences among stomach rest pressure, anastomosis rest pressure and remnant esophagus rest pressure in study group (F=3.08, P>0.05).</p><p><b>CONCLUSION</b>After esophagectomy and esophagogastric anastomosis through esophageal bed in upper aortic site, the peristalsis function of remnant esophagus is poor, the function of acid clearance is reduced, no high pressure zone at the anastomosis orifice is found, the anastomosis orifice has no anti-reflux effect, and gastroesophageal reflux exists in the postoperative patients prevalently.</p>

Effects of XinShu Parenteral Solution on the function of platelet,the changes of fibrinolysis system after intima denudation of rabbits / 中国康复理论与实践

@#ObjectiveTo observe the effects of XinShu parenteral solution (XSPS) on the activation of platelet, the activity of fibrinolysis system after intima denudation of rabbits.Methods20 male Japanese white rabbits (2.5±0.5)kg were randomly divided into the control group and XSPS group .The celiac arterial endothelium of all rabbits were denuded with balloon. Before the operation and 3d, 7d, after balloon denudation, vein blood samples were obtained from each group rabbits for measurement of α granule membrane protein of platelets(GMP-140), tissue-type plasminogen activator(t-PA) and plasminogen activator inhibitor-type Ⅰ(PAI-1).ResultsPlasma GMP-140 and PAI-1 activity obviously elevated after balloon injury, and there was a little elevation in plasma t-PA activity in control group. Activity of plasma GMP-140 in XSPS group remained bottom level after balloon injury, and there was a significant increase in plasma t-PA activity and a marked reduce in PAI-1 activity in XSPS group. There was a notable difference between group B and group C (P<0.05). ConclusionXSPS obviously inhibits platelet activation, and improves fibrinolysis activity after balloon injury.