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

World Journal of Gastrointestinal Oncology 2024年第5期16卷 2253-2260页

作者： Li-Ping Zheng Wen-Yan Shen Chun-Dong Hu Chun-Hua Wang Xu-Jian Chen Jing Wang Yi-Yu Shen department of General Surgery The Second Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina department of pathology The Second Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina

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

关键词： Undifferentiated pleomorphic sarcoma Soft tissue sarcoma Common bile duct Extrahepatic bile duct Immunohistochemistry Case report

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Roles and application of exosomes in the development,diagnosis and treatment of gastric cancer

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 630-642页

作者： Xiao-Li Guan Xiao-Ying Guan Zheng-Yi Zhang department of General Medicine The Second Hospital of Lanzhou UniversityLanzhou 730030Gansu ProvinceChina department of pathology The Second Hospital of Lanzhou UniversityLanzhou 730030Gansu ProvinceChina

As important messengers of intercellular communication,exosomes can regulate local and distant cellular communication by transporting specific exosomal con-tents and can also promote or suppress the development and progression of gas-tric cancer(GC)by regulating the growth and proliferation of tumor cells,the tumor-related immune response and tumor *** transport bioactive molecules including DNA,proteins,and RNA(coding and noncoding)from donor cells to recipient cells,causing reprogramming of the target *** this review,we will describe how exosomes regulate the cellular immune respon-se,tumor angiogenesis,proliferation and metastasis of GC cells,and the role and mechanism of exosome-based therapy in human *** will also discuss the potential application value of exosomes as biomarkers in the diagnosis and treat-ment of GC and their relationship with drug resistance.

关键词： Exosomes Gastric cancer Immune regulation Diagnosis Cancer therapy

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Endoscopic detection and diagnostic strategies for minute gastric cancer:A real-world observational study

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World Journal of Gastrointestinal Oncology 2024年第8期16卷 3529-3538页

作者： Xiao-Wei Ji Jie Lin Yan-Ting Wang Jing-Jing Ruan Jing-Hong Xu Kai Song Jian-Shan Mao department of Gastroenterology The Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310009Zhejiang ProvinceChina department of pathology The Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310009Zhejiang ProvinceChina

BACKGROUND Minute gastric cancers(MGCs)have a favorable prognosis,but they are too small to be detected by endoscopy,with a maximum diameter≤5 *** To explore endoscopic detection and diagnostic strategies for *** This was a real-world observational *** endoscopic and clinicopathological parameters of 191 MGCs between January 2015 and December 2022 were retrospectively *** discoverable opportunity and typical neoplastic features were emphatically *** All MGCs in our study were of a single pathological type,97.38%(186/191)of which were differentiated-type *** light endoscopy(WLE)detected 84.29%(161/191)of MGCs,and the most common morphology of MGCs found by WLE was ***-band imaging(NBI)secondary observation detected 14.14%(27/191)of MGCs,and the most common morphology of MGCs found by NBI was *** three MGCs were detected by indigo carmine third *** a well-demarcated border lesion exhibited a typical neoplastic color,such as yellowish-red or whitish under WLE and brownish under NBI,MGCs should be *** proportion with high diagnostic confidence by magnifying endoscopy with NBI(ME-NBI)was significantly higher than the proportion with low diagnostic confidence and the only visible groups(94.19%>56.92%>32.50%,P<0.001).CONCLUSION WLE combined with NBI and indigo carmine are helpful for detection of MGCs.A clear demarcation line combined with a typical neoplastic color using nonmagnifying observation is sufficient for diagnosis of *** improves the endoscopic diagnostic confidence of MGCs.

关键词： Minute gastric cancer White light endoscopy Narrow-band imaging endoscopy Indigo carmine Magnifying endoscopy Detection Diagnosis

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Different lymph node staging systems for predicting the prognosis of colorectal neuroendocrine neoplasms

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 1745-1755页

作者： Yuan-Yi Zhang Yue-Wei Cai Xia Zhang department of pathology Zhaoqing Medical CollegeZhaoqing 526020Guangdong ProvinceChina department of Emergency Zhaoqing Second People’s HospitalZhaoqing 526020Guangdong ProvinceChina department of pathology and Physiology Zhaoqing Medical CollegeZhaoqing 526020Guangdong ProvinceChina

BACKGROUND Colorectal neuroendocrine neoplasms(NENs)are a rare malignancy that primarily arises from the diffuse distribution of neuroendocrine cells in the colon and *** studies have pointed out that the status of lymph node may be used to predict the *** To investigate the predictive values of lymph node ratio(LNR),positive lymph node(PLN),and log odds of PLNs(LODDS)staging systems on the prognosis of colorectal NENs treated surgically,and compare their predictive *** This cohort study included 895 patients with colorectal NENs treated surgically from the Surveillance,Epidemiology,and End Results *** endpoint was mortality of patients with colorectal NENs treated surgically.X-tile software was utilized to identify most suitable thresholds for categorizing the LNR,PLN,and *** were selected in a random manner to form training and testing *** prognosis of surgically treating colorectal NENs was examined using multivariate cox analysis to assess the associations of LNR,PLN,and LODDS with the prognosis of colorectal NENs.C-index was used for assessing the predictive *** conducted a subgroup analysis to explore the different lymph node staging systems’predictive *** After adjusting all confounding factors,PLN,LNR and LODDS staging systems were linked with mortality in patients with colorectal NENs treated surgically(P<0.05).We found that LODDS staging had a higher prognostic value for patients with colorectal NENs treated surgically than PLN and LNR staging *** results were obtained in the different G staging subgroup ***,the area under the receiver operating characteristic curve values for LODDS staging system remained consistently higher than those of PLN or LNR,even at the 1-,2-,3-,4-,5-and 6-year follow-up *** LNR,PLN,and LODDS were found to significantly predict the prognosis of patients with colorectal NENs treated surgically.

关键词： Positive lymph node Lymph node ratio Log odds of positive lymph nodes Prognosis Colorectal neuroendocrine neoplasms

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Three cancers in the renal pelvis,bladder,and colon:A case report

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World Journal of Clinical Cases 2024年第2期12卷 392-398页

作者： Jing Chen Hua-Yan Huang Hui-Chun Zhou Lin-Xiao Liu Chuang-Fan Kong Quan Zhou Jian-Ming Fei Yuan-Ming Zhu Hu Liu Ye-Chen Tang Cheng-Zhong Zhou department of General Surgery The Second Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina department of pathology The Second Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina department of Medical Imaging The Second Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina department of Urology The Second Affiliated Hospital of Jiaxing UniversityJiaxing 31400Zhejiang ProvinceChina

BACKGROUND Multiple primary cancers are rare occurrences that can involve either metachronous or synchronous *** is particularly rare for an individual to have more than two primary *** this report,we present a case study of an elderly man who was diagnosed with three heterochronous cancers in the renal pelvis,bladder,and *** SUMMARY On December 30,2014,a 51-year-old Chinese man was admitted to our hospital with complaints of intermittent painless gross hematuria for the preceding week.A computed tomography(CT)scan revealed wall thickening in the left ureter’s upper segment,while a CT urography revealed a left renal pelvis tumor.A successful laparoscopic radical resection of the left renal pelvis tumor was subsequently performed at Shanghai Zhongshan Hospital in January *** pathological findings after the surgery revealed a low-grade papillary urothelial carcinoma of the renal *** final pathological tumor stage was *** surgery,this patient received 6 cycles of intravenous chemotherapy with gemcitabine and carboplatin,as well as bladder infusion therapy with *** December 18,2017,the patient was admitted once again to our hospital with a one-day history of painless gross hematuria.A CT scan showed the presence of a space-occupying lesion on the posterior wall of *** examination revealed multiple tumors in the bladder and right cutaneous ureterostomy was performed under general anesthesia on December 29,*** postoperative pathological findings disclosed multifocal papillary urothelial carcinoma of the bladder(maximum size 3.7 cm×2.6 cm).The bladder cancer was considered a metastasis of the renal pelvis cancer after *** pathological tumor stage was *** patient refused chemotherapy after *** another six years,the patient returned on February 28,2023,complaining of periumbilical pain that had lasted six *** time,a CT scan of the abdomen showed a tumor in the ascen

关键词： Metachronous primary carcinoma Renal pelvis carcinoma Bladder carcinoma Colon carcinoma Case report

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PRaG 3.0 therapy for human epidermal growth factor receptor 2-positive metastatic pancreatic ductal adenocarcinoma:A case report

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World Journal of Gastroenterology 2024年第9期30卷 1237-1249页

作者： Yue-Hong Kong Mei-Ling Xu Jun-Jun Zhang Guang-Qiang Chen Zhi-Hui Hong Hong Zhang Xiao-Xiao Dai Yi-Fu Ma Xiang-Rong Zhao Chen-Yang Zhang Rong-Zheng Chen Peng-Fei Xing Li-Yuan Zhang Center for Cancer Diagnosis and Treatment The Second Affiliated Hospital of Soochow UniversitySuzhou 215000Jiangsu ProvinceChina department of Radiotherapy&Oncology The Second Affiliated Hospital of Soochow UniversitySuzhou 215000Jiangsu ProvinceChina Institution of Radiotherapy&Oncology Soochow UniversitySuzhou 215000Jiangsu ProvinceChina department of Radiology The Second Affiliated Hospital of Soochow UniversitySuzhou 215000Jiangsu ProvinceChina department of Nuclear Medicine The Second Affiliated Hospital of Soochow UniversitySuzhou 215000Jiangsu ProvinceChina department of Clinical Laboratory The Second Affiliated Hospital of Soochow UniversitySuzhou 215000Jiangsu ProvinceChina department of pathology The Second Affiliated Hospital of Soochow UniversitySuzhou 215000Jiangsu ProvinceChina

BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a highly fatal disease with limited effective treatment especially after first-line *** human epidermal growth factor receptor 2(HER-2)immunohistochemistry(IHC)positive is associated with more aggressive clinical behavior and shorter overall survival in *** SUMMARY We present a case of multiple metastatic PDAC with IHC mismatch repair proficient but HER-2 IHC weakly positive at diagnosis that didn’t have tumor regression after first-line nab-paclitaxel plus gemcitabine and PD-1 inhibitor treatment.A novel combination therapy PRaG 3.0 of RC48(HER2-antibody-drug conjugate),radio-therapy,PD-1 inhibitor,granulocyte-macrophage colony-stimulating factor and interleukin-2 was then applied as second-line therapy and the patient had confirmed good partial response with progress-free-survival of 6.5 months and overall survival of 14.2 *** had not developed any grade 2 or above treatment-related adverse events at any *** of peripheral CD8^(+) Temra and CD4^(+) Temra were increased during first two activation cycles of PRaG 3.0 treatment containing radiotherapy but deceased to the baseline during the maintenance cycles containing no *** PRaG 3.0 might be a novel strategy for HER2-positive metastatic PDAC patients who failed from previous first-line approach and even PD-1 immunotherapy but needs more data in prospective trials.

关键词： Pancreatic ductal adenocarcinoma PRaG 3.0 therapy Human epidermal growth factor receptor 2 Novel combination therapy Case report

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Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection

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World Journal of Gastroenterology 2024年第14期30卷 1990-2005页

作者： Hong-Yi Zhu Jie Wu Yuan-Miao Zhang Fang-Lan Li Jin Yang Bin Qin Jiong Jiang Ning Zhu Meng-Yao Chen Bai-Cang Zou department of Gastroenterology The Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710004Shaanxi ProvinceChina department of pathology The Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710004Shaanxi ProvinceChina department of Gastroenterology Xianyang Hospital of Yan'an UniversityXianyang 712000Shaanxi ProvinceChina department of Gastroenterology The First Hospital of Xi'anXi'an 710000Shaanxi ProvinceChina

BACKGROUND Gastric cancer is a common malignant tumor of the digestive tract,and endosco-pic submucosal dissection(ESD)is the preferred treatment for early-stage gastric *** analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and *** To analyze the features of gastric mucosal tumors at different differentiation levels,and to explore the prognostic factors of *** We retrospectively studied 301 lesions in 285 patients at The second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021,according to the latest Japanese guidelines(sixth edition),and divided them into low-grade intrae-pithelial neoplasia(LGIN),high-grade intraepithelial neoplasia(HGIN),and computed tomography at 3,6 and 12 months after *** compared clinicopathologic characteristics,ESD efficacy,and complications with different degrees of differentiation,and analyzed the related factors associated with *** HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients(P<0.001)and accounted for more 0-IIc(P<0.001),atrophic gastritis was common(P<0.001),and irregular microvascular patterns(IMVPs)and demarcation lines(DLs)were more obvious(P<0.001).There was more infiltration in the undifferentiated carcinoma tissue(P<0.001),more abnormal folds and poorer mucosal peristalsis(P<0.001),and more obvious IMVPs,irregular microsurface patterns and DLs(P<0.05)than in the LGIN and HGIN *** disease-free survival rates at 2,5,and 8 years after ESD were 95.0%,90.1%,and 86.9%,***-tiated lesions(HR 5.066),white moss(HR 7.187),incomplete resection(HR 3.658),and multiple primary cancers(HR 2.462)were significantly associated with poor *** Differentiations of gastric mucosal tumors have different epidemiological and

关键词： Gastric mucosal epithelial neoplasia Differentiated early gastric cancer Undifferentiated early gastric cancer Endoscopic submucosal dissection Long-term outcomes

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New roles of tumor-derived exosomes in tumor microenvironment

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Chinese Journal of Cancer Research 2024年第2期36卷 151-166页

作者： Shiqian Chen Jinzhe Sun Huan Zhou Hongbin Lei Dan Zang Jun Chen department of Oncology the Second Hospital of Dalian Medical UniversityDalian 116023China department of Radiotherapy the Second Hospital of Dalian Medical UniversityDalian 116023China

Throughout tumorigenesis, the co-evolution of tumor cells and their surrounding microenvironment leads to the development of malignant phenotypes. Cellular communication within the tumor microenvironment(TME) plays a critical role in influencing various aspects of tumor progression, including invasion and metastasis. The release of exosomes, a type of extracellular vesicle, by most cell types in the body, is an essential mediator of intercellular communication. A growing body of research indicates that tumor-derived exosomes(TDEs) significantly expedite tumor progression through multiple mechanisms, inducing epithelial-mesenchymal transition and macrophage polarization, enhancing angiogenesis, and aiding in the immune evasion of tumor cells. Herein, we describe the formation and characteristics of the TME, and summarize the contents of TDEs and their diverse functions in modulating tumor development. Furthermore, we explore potential applications of TDEs in tumor diagnosis and treatment.

关键词： Tumor-derived exosomes tumorigenesis tumor microenvironment diagnosis treatment

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Neuroendocrine carcinoma of the common hepatic duct coexisting with distal cholangiocarcinoma:A case report and review of literature

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1449-1460页

作者： Fei Chen Wei-Wei Li Juan-Fen Mo Min-Jie Chen Su-Hang Wang Shu-Ying Yang Zheng-Wei Song department of Hepatobiliary Surgery The Second Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina Graduate School Bengbu Medical CollegeBengbu 233000Anhui ProvinceChina The Key Laboratory The Second Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina department of pathology The Second Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina department of Intensive Medicine The Second Affiliated Hospital of Jiaxing UniversityJiaxing 314000Zhejiang ProvinceChina

BACKGROUND Neuroendocrine carcinoma(NEC)of the extrahepatic bile duct is very rare,and the treatment and prognosis are ***,we report the case of a middleaged female with primary large cell NEC(LCNEC)of the common hepatic duct combined with distal cholangiocarcinoma(dCCA).Additionally,after a review of the relevant literature,we summarize and compare mixed neuroendocrine-nonneuroendocrine neoplasm(MiNEN)and pure NEC to provide a reference for selecting the appropriate treatment and predicting the prognosis of this rare *** SUMMARY A 62-year-old female presented to the hospital due to recurrent abdominal pain for 2 *** examination showed mild tenderness in the upper abdomen and a positive Courvoisier *** tests showed elevated liver transaminase and carbohydrate antigen 199 *** examination revealed node dissection was performed,and hepatic duct tumours were unexpectedly found during *** suggested poorly differentiated LCNEC(approximately 0.5 cm×0.5 cm×0.4 cm),Ki-67(50%),synaptophysin+,and chromogranin A+.dCCA pathology suggested moderately differentiated *** patient eventually developed lymph node metastasis in the liver,bone,peritoneum,and abdominal cavity and died 24 months after *** sequencing methods were used to compare gene mutations in the two primary bile duct *** The prognosis of MiNEN and pure NEC alone is different,and the selection of treatment options needs to be differentiated.

关键词： Neuroendocrine carcinoma Mixed neuroendocrine-non-neuroendocrine neoplasm Cholangiocarcinoma Extrahepatic bile duct Case report

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Pyrotinib is effective in both trastuzumab-sensitive and primary resistant HER2-positive breast tumors

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Chinese Journal of Cancer Research 2024年第2期36卷 124-137页

作者： Jialin Zhang Gengshen Yin Chunmiao Ye Man Feng Changhua Ji Wenzhong Zhou Fei Wang Lixiang Yu Shuya Huang Zhigang Yu department of Breast Surgery the Second Hospital of Shandong UniversityJinan 250033China Institute of Translational Medicine of Breast Disease Prevention and Treatment Shandong UniversityJinan 250033China Shandong Provincial Engineering Laboratory of Translational Research on Prevention and Treatment of Breast Disease Jinan 250033China department of pathology the Third Affiliated Hospital of Shandong First Medical University(Affiliated Hospital of Shandong Academy of Medical Sciences)Jinan 250031China department of pathology the Second Hospital of Shandong UniversityJinan 250033China

Objective: Primary resistance to trastuzumab frequently occurs in human epidermal growth factor receptor 2(HER2)-positive(+) breast cancer patients and remains a clinical challenge. Pyrotinib is a novel tyrosine kinase inhibitor that has shown efficacy in the treatment of HER2+ breast cancer. However, the efficacy of pyrotinib in HER2+ breast cancer with primary trastuzumab resistance is ***: HER2+ breast cancer cells sensitive or primarily resistant to trastuzumab were treated with trastuzumab, pyrotinib, or the combination. Cell proliferation, migration, invasion, and HER2 downstream signal pathways were analyzed. The effects of pyrotinib plus trastuzumab and pertuzumab plus trastuzumab were compared in breast cancer cells in vitro and a xenograft mouse model with primary resistance to ***: Pyrotinib had a therapeutic effect on trastuzumab-sensitive HER2+ breast cancer cells by inhibiting phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT) and rat sarcoma virus(RAS)/rapidly accelerated fibrosarcoma(RAF)/mitogen-activated protein kinase(MAPK)/extracellular-signal regulated kinase(ERK)pathways. In primary trastuzumab-resistant cells, pyrotinib inhibited cell growth, migration, invasion, and HER2 downstream pathways, whereas trastuzumab had no effects. The combination with trastuzumab did not show increased effects compared with pyrotinib alone. Compared with pertuzumab plus trastuzumab, pyrotinib plus trastuzumab was more effective in inhibiting cell proliferation and HER2 downstream pathways in breast cancer cells and tumor growth in a trastuzumab-resistant HER2+ breast cancer xenograft ***: Pyrotinib-containing treatments exhibited anti-cancer effects in HER2+ breast cancer cells sensitive and with primary resistance to trastuzumab. Notably, pyrotinib plus trastuzumab was more effective than trastuzumab plus pertuzumab in inhibiting tumor growth and HER2 downstream pathways in HER2+ breast cancer with primary resistance

关键词： Breast cancer HER2 pyrotinib trastuzumab primary resistance pertuzumab

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