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Transcription factor ERG is a specific and sensitive diagnostic marker for hepatic angiosarcoma

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World Journal of Gastroenterology 2014年第13期20卷 3672-3679页

作者： Zhan-Bo Wang Jing Yuan Wei Chen Li-Xin Wei Department of Pathology Chinese People's Liberation Army General Hospital

AIM:To investigate the expression of ERG,CD34,CD31(PECAM-1,platelet/endothelial cell adhesion molecule 1)and factorⅧ-related antigen(FⅧRAg)in the diagnosis of hepatic angiosarcoma patients.METHODS:Patient samples were collected from January 1986 to December 2012 from the People’s Liberation Army General Hospital in Beijing,China.We obtained twenty-four samples of hepatic angiosarcoma(HAS)that were confirmed by two pathologist.The samples were the result of three autopsy cases,eight biopsy cases and 13 patients who underwent surgical tumor removal.The HAS cases accounted for 2.23%(24/1075)of all hepatic vascular tumors at the hospital during the same time period.Patient histories including age,gender,clinical manifestations,medical treatments,laboratory tests,radiological images,histological observations and outcomes for each case were analyzed in detail.All samples were evaluated histologically with hematoxylin and eosinstaining.Using immunohistochemistry,the expression and localization of ERG was examined in all HAS specimens and compared to the known endothelial markers CD34,CD31 and FⅧRAg.The endothelial markers were also evaluated in a panel of non-HAS tumors.RESULTS:This cohort of 24 HAS cases is,to the best of our knowledge,currently the largest cohort in the world in the publicly available literature.Hepatic angiosarcoma tissue samples were obtained from 14 males and 10 females with a mean age of 50.6 years(range:7-86 years).The patients presented with the following clinical manifestations:abdominal pain(16/24),back pain(3/24),heart palpitations(1/20),cough(1/24)or no clinical symptoms(3/24).Tumors were predominantly localized in the right hepatic lobe(15/24)or left hepatic lobe(6/24),or a diffuse growth on the right and left hepatic lobes(3/24).Eleven patients underwent surgical resection(45.8%),two patients received a liver transplant(8.3%),eight patients received interventional therapy(33.3%)and three patients received no treatment(lesions discovered at autopsy,12.5%).Postoperative follow-up of patients

关键词： Liver Angiosarcoma ERG Immunohisto-chemistry diagn

Nonalcoholic fatty liver disease:Updates in noninvasive diagnosis and correlation with cardiovascular disease

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World Journal of Gastroenterology 2014年第24期20卷 7718-7729页

作者： Kuang-Chun Hu Horng-Yuan Wang Sung-Chen Liu Chuan-Chuan Liu Chung-Lieh Hung Ming-Jong Bair Chun-Jen Liu Ming-Shiang Wu Shou-Chuan Shih Mackay Medical College Division of Gastroenterology Department of Internal MedicineHealth Evaluation CenterMackay Memorial Hospital Graduate Institute of Clinical Medicine National Taiwan University College of Medicine Division of Endocrine Department of Internal MedicineDM CenterMackay Memorial Hospital Division of Cardiology Department of Internal MedicineMackay Memorial Hospital Gastroenterology Division Department of Internal MedicineMackay Memorial HospitalTaitung Branch

Nonalcoholic fatty liver disease(NAFLD)refers to the accumulation of fat(mainly triglycerides)within hepatocytes.Approximately 20%-30%of adults in the general population in developed countries have NAFLD;this trend is increasing because of the pandemicity of obesity and diabetes,and is becoming a serious public health burden.Twenty percent of individuals with NAFLD develop chronic hepatic inflammation[nonalcoholic steatohepatitis(NASH)],which can be associated with the development of cirrhosis,portal hypertension,and hepatocellular carcinoma in a minority of patients.And thus,the detection and diagnosis of NAFLD is important for general practitioners.Liver biopsy is the gold standard for diagnosing NAFLD and confirming the presence of NASH.However,the invasiveness of this procedure limits its application to screening the general population or patients with contraindications for liver biopsy.The development of noninvasive diagnostic methods for NAFLD is of paramount importance.This review focuses on the updates of noninvasive diagnosis of NAFLD.Besides,we review clinical evidence supporting a strong association between NAFLD and the risk of cardiovascular disease because of the cross link between these two disorders.

关键词： Nonalcoholic fatty liver disease Noninvasive diagn

Endoscopic ultrasound-guided deep and large biopsy for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies

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World Journal of Gastroenterology 2015年第12期21卷 3607-3613页

作者： Xin-Xin Zhou Hang-Hai Pan Ali Usman Feng Ji Xi Jin Wei-Xiang Zhong Hong-Tan Chen Department of Gastroenterology The First Affiliated Hospital College of Medicine Zhejiang University Department of Gastroenterology Zhejiang Provincial People’s Hospital Department of Pathology The First Affiliated Hospital College of Medicine Zhejiang University

AIM: To assess the diagnostic yield and safety of adeep and large biopsy technique under the guidance of endoscopic ultrasound(EUS) for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies.METHODS: From January 2009 to March 2014, 36 patients in whom gastric infiltrating tumors had been diagnosed by EUS received negative results for malignancy after endoscopic biopsies. The deep and large biopsy technique combined bite-on-bite technique with or without endoscopic mucosal resection(EMR) to obtain submucosal tissue from lesions. EUS was used to select the appropriate biopsy sites. If the lesion protruded into the cavity, EMR was performed for removal of the overlying mucosa and then bite-onbite technique was conducted in the resected area to obtain submucosal tissue. If the lesion appeared to be flat or was difficult to lift by injection, the bite-on-bite technique was directly used.RESULTS: Twenty-eight of the 36 patients were treated by EMR followed by bite-on-bite technique, while 8 patients only underwent bite-on-bite technique. Histological results showed 23 of the 36 lesions were poorly differentiated adenocarcinomas, 2 diffuse large B cell lymphomas, 4 mucosa-associated lymphoid tissue-type lymphomas, and 7 undiagnosed. The deep and large biopsy technique provided a definitive and conclusive diagnosis in 29(80.6%) of the 36 patients. The 12 gastric linitis plastica and 6 lymphoma patients received chemotherapy and avoided surgery. Minor oozing of blood in 2 mucosal resection wounds was managed by argon plasma coagulation and in 5 cases after deep biopsies by epinephrine(0.001%). Neither severe hemorrhage nor perforation occurred in any patient.CONCLUSION: The deep and large biopsy technique is superior to ordinary endoscopic biopsy for achieving an accurate diagnosis of gastric infiltrating tumors.This procedure guided by EUS is an effective and safe diagnostic method for gastric infiltrating tumors in which endoscopic biopsy results were negative for malignancy.

关键词： Endoscopic ultrasonography Endoscopic biopsy diagn

Perceived risk as a barrier to appropriate diagnosis of irritable bowel syndrome

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World Journal of Gastroenterology 2014年第48期20卷 18360-18366页

作者： Eunmi Ahn Ki Young Son Dong Wook Shin Min Kyu Han Hyejin Lee Ah Reum An Eun Ho Kim Be Long Cho Department of Family Medicine Seoul National University Hospital Cancer Survivorship Clinic Seoul National University Cancer HospitalSeoul 110-744 South Korea

AIM:To evaluate perceived risk,diagnostic testing,and acceptance of a diagnosis of irritable bowel syndrome(IBS)among the Korean laypersons.METHODS:We designed a conceptual framework to evaluate the health-seeking behavior of subjects based on a knowledge,attitude,and practice model.We developed a vignette-based questionnaire about IBS based on a literature review and focused group interviews.The vignette described a 40-year-old woman who meets the RomeⅢcriteria for IBS without red-flag signs.It was followed by questions about demographic characteristics,health behaviors,IBS symptoms,risk perception,perceived need for diagnostic tests,and acceptance of a positive diagnosis of IBS.Weplanned a nationwide survey targeting laypersons without IBS and between the ages of 20 and 69 years.Survey participants were selected by quota sampling stratified by gender,age,and nationwide location.A multivariate logistic model was constructed based on literature reviews,univariate analysis,and a stepwise selection method to investigate correlations between the perceived risk,need for diagnostic tests,and acceptance of a positive diagnosis.RESULTS:Of 2354 eligible households,1000 subjects completed the survey and 983 subjects were analyzed,excluding those who met symptom criteria for IBS.After reading the IBS vignette,the majority of subjects(86.8%)responded that the patient was at increased risk of severe disease.The most frequent concern was colon cancer(59.8%),followed by surgical condition(51.5%).Most subjects responded the patient needs diagnostic tests(97.2%).Colonoscopy was the most commonly required test(79.5%).Less than half of the respondents requested a stool examination(45.0%),blood test(40.7%),abdominal ultrasound(36.0%),or computed tomography(20.2%).The subjects who felt increased risk were more likely to see a need for colonoscopy[adjusted odds ratio(a OR)=2.10,95%CI:1.38-3.18].When asked about the positive diagnosis,the most frequent response was that"the patient would not be reassured"(65.7%).The increased risk per

关键词： diagnostic testing Patient attitude Positive diagn