[Polypoid ganglioneuroma combined with juvenile polyp: case report and literature review].
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Biomedical subjects
Publications and source records attributed to Dai-yun Chen.
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OBJECTIVE: To study lymph node involvement and micro-metastasis of rectal cancer with large slice technique and tissue microarray. METHODS: Large slice technique, combined with tissue microarray,was used in pathologic study of 31 patients after total mesorectal excision (TME) for rectal cancer. RESULTS: Nine hundred and ninety- two lymph nodes were harvested and 148 were positive. More than 40% of positive lymph nodes were located in the outer layer of the mesorectum and in the same side of the mesorectum as the primary tumor was. Circumferential margin involvement was observed in 12 cases and correlated with the numbers of metastatic lymph nodes (Beta =1.166, P=0.041). Micrometastasis was found in 9 cases with negative pathological lymph nodes, but not correlated with tumor differentiation and stage (P> 0.05). CONCLUSION: Large slice technique combined with tissue microarray facilitates the detection of lymph node involvement and micrometastasis. There is a predominance of lymph node metastasis in the outer layer and the same side of the mesorectum. Micrometastasis can be discovered in different stages of rectal cancer.
OBJECTIVE: To investigate the clinicopathologic features of small intestinal hemangioma and vascular malformation. METHODS: A retrospective analysis was performed on 51 cases of hemangioma and vascular malformation involving the duodenum, jejunum and ileum in the past 30 years. RESULTS: The patient's age ranged from 1.4 to 75.0 years, with an average/median age of 40 years for the 51 cases. The ratio of male and female was almost equal. In most cases, the lesions were located in the ileum (18 cases) and jejunum (16 cases) accounting for 66.7%. The predominant symptoms and signs were either intestinal hemorrhage or obstruction. Grossly, the lesions appeared as polyp-like, ulcerative, varices, solitary mass, diffuse infiltration or in an occult status. Histologically, arteriovenous hemangioma also called arteriovenous malformation was more common seen accounting for 86.3%. Other less common vascular lesions included cavernous hemangioma, capillary hemangioma, Rendu-Osler-Weber syndrome and Dieulafoy disease. CONCLUSIONS: Histologic classification and denomination for hemangioma and vascular malformation of small intestine are still controversial. It is very important to correlate clinical manifestations with arteriography findings in histologic diagnosis of hemanigoma and vascular malformation of the small intestine.
PURPOSE: To investigate the relationship between root resorption related to fixed appliance and the variables including sex, age. METHODS: 44 patients were divided into four groups according to sex and age: juvenile males, juvenile females, adult males, adult females. The length of incisors was calculated according to orthopantomograph and study models of pre- and post-treatment, and the relationship between patients' sex and age and root absorption pre- and post-treatment was analyzed by paired t test. RESULTS: Root absorption occurred in every patient. There was no significant difference between the same-age groups of males and females (P<0.05); However, there was significant difference between adult groups (both males and females) and juvenile groups (P<0.01). CONCLUSION: Root absorption occurs in every fixed-appliance case. Fixed-appliance-caused root absorption has no significant correlation with sex;however, absorption of adult groups is of higher level than that of juvenile groups.
OBJECTIVE: To investigate the relationship of the expression of GRalpha and GRbeta in the colonic mucosal cell of patients with ulcerative colitis to the efficacy of glucocorticoid (GC) therapy and the intensity of inflammation. METHODS: GRalpha expression and GRbeta expression in the colonic mucosal specimens were assessed by means of immunohistochemistry. Then comparative analyses were made on the GRalpha and GRbeta expression between the GC resistant group and GC sensitive group at various levels of inflammation. A normal response group was observed for comparison. RESULTS: The staining intensities of both GRalpha and GRbeta in colonic mucosal specimens showed significant differences between the GC resistant group, GC sensitive group and normal response group. No association between the expression of GRalpha and GRbeta and the degree of inflammation was found. CONCLUSION: These findings suggest that both GRalpha and GRbeta play an important role in the mechanism of the action of GC, and GRbeta functions as a dominant negative inhibitor of GRalpha in there. The expression of GRalpha and GRbeta in the colonic mucosal cell of patients with ulcerative colitis may serve as predictors of glucocorticoid response, but cannot be used as the markers of the severity of inflammation.
OBJECTIVE: To provide the mode of cancer distribution in the mesorectum and circumferential resection margin. METHODS: Large slice technique was used in the pathologic study of 62 specimens operated on following the principles of total mesorectal excision (TME). RESULTS: More than 40% of all the observed neoplastic foci were located in the outer layer of the mesorectum in Stage III patients. Further analysis of the foci's localities with respect to the primary tumor's locality showed that ipsolateral neoplastic foci (44.44%) were significantly more than the contralateral neoplastic foci (13.33%) in the mesorectum (P<0.05). Extramural distal spread was found in 8 cases with the maximum extent of 3.5 cm. No significant difference in occurrence of circumferential margin involvement (CMI) was observed among tumors of different location, but tumors of poorer differentiation were noted to have a higher risk of CMI. CONCLUSION: Large slice technique offers a whole image of rectum, mesorectum, together with the position of neoplastic foci. There are outer preponderance and lateral discrepancy of neoplastic foci distribution in the mesorectum. A distal clearance margin of 4 cm would be mandatory. We advocate the adoption of TME as the baisc surgical principles in treating patients with rectal cancer and in avoiding surgery-related circumferential margin involvement.
OBJECTIVE: The aim of this study involving general pathologists was to assess interobserver reproducibility in the pathologic diagnosis of borderline ductal proliferative breast diseases. METHODS: Ten general pathologists independently reviewed 43 specimens chosen to represent the spectrum of borderline ductal proliferative breast lesions. All slides were blindly reviewed without given standardized criteria, and were classified as either mild usual hyperplasia, moderate-severe usual hyperplasia, mild atypical hyperplasia, moderate-severe atypical hyperplasia, ductal carcinoma in situ, or ductal carcinoma in situ with invasion. According to the years of training, these 10 general pathologists were divided into the experienced group and the less trained group. Interobserver agreement was statistically analyzed using Kappa statistic. Then, by comparing all the diagnoses of individual pathologist with the consensus opinion confirmed by two breast pathologists in terms of Page standard, we acquired the diagnostic accuracy and ascertained the undue diagnosis. RESULTS: The ten general pathologists' interobserver reproducibility in the diagnosis of borderline ductal proliferative breast diseases was rather low, especially that in their diagnosis of atypical hyperplasia. The reproducibility and accuracy were slightly higher in the experienced pathologists than in the less trained pathologists. Some pathologists made over-diagnosis or under-diagnosis of the lesions to different degrees. However, when the categories of diagnostic terms were simplified, the interobserver reproducibility increased. CONCLUSION: The use of standardized criteria is an important approach to increasing the diagnostic reproducibility and accuracy.
OBJECTIVE: To determine the general markers for the diagnosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma and select optimal cases to be interfered in early stage. METHODS: To investigate the changes of histology, Ki-67 expression, monoclonality of IgH gene rearrangement in gastric lymphoid hyperplasia (GLH) cases before and after Helicobacter pylori (Hp) eradication treatment. Histological changes were classified according to Isaacson's criteria of GLH; L26, UCHL-1, anti-Kappa, anti-Lambda and Ki-67 were applied for immunohistochemical staining; semi-nest PCR was used to detect IgH gene rearrangement. RESULTS: Thirty-one cases of GLH with predominant chronic gastritis and gastric ulcer were studied. The ratio of male to female in the 31 cases was 1.8 and the mean course 6.8 years. Twenty-nine cases had Hp infection. Most of the cases belonged to histological grade II and III. Only 1 case had lambda light chain restriction and 10 cases had monoclonal IgH gene rearrangement. Expression of Ki-67 and monoclonal IgH gene rearrangement were significantly increased with the crescendo of lymphoid hyperplasia grading (P < 0.05). 28 cases were given antibiotics with eradication of Hp in 24 cases and 2 cases had to be given another course of treatment. These cases were followed-up on average for 4.6 months. 18 cases showed complete regression both histologically and endoscopically, 4 cases partial regression and 6 cases no change. Four cases with histological grade II, III had the decrease of expression of Ki-67 and reversed to polyclonal IgH gene rearrangement, while there was no change in 4 cases with histological grade IV. CONCLUSIONS: General considerations of histology, expression of Ki-67 and combined clonality of IgH gene rearrangement help to screen cases which need intervention early and make a diagnosis of gastric MALT lymphoma in early stage. Monoclonal IgH gene rearrangement in cases with histological grade III or IV appears to carry more clinical significance.