Unicentric Castleman disease was misdiagnosed as pancreatic mass: A case report

BACKGROUND

Castleman’s disease (CD) is a lymphatic proliferative disorder of unknown cause and is rarely seen clinically. It has been divided into unicentric and multicentric types. Unicentric CD (UCD) occurs as a solitary enlarged mass and mediastinal lymph nodes are the most common site. Surgical excision has proven to be curative for UCD. Multicentric CD (MCD) appears as a systemic disease with peripheral lymphadenopathy. MCD had a poor response to surgery and monoclonal antibodies with rituximab have become a research hotspot.

CASE SUMMARY

A 44-year-old woman presented with a pancreatic mass during routine physical examination. She had no obvious symptoms, such as fever, abdominal pain, abdominal distension, or jaundice. Ultrasound examination indicated a hypoechoic mass between the body of the pancreas, left lobe of the liver and stomach. It had a clear boundary, irregular shape, uneven echo, and no obvious blood flow signals. To clarify the diagnosis, contrast-enhanced ultrasound examination was performed, which showed a benign pancreatic lesion. Neuroendocrine or solid pseudopapillary tumor was a possible diagnosis. The patient underwent further contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging, which were suggestive of solid pseudopapillary tumor or neuroendocrine tumor. All the examinations failed to give a definitive diagnosis, and the patient underwent surgery. The final pathological and immunohistochemical results showed that the mass was CD.

CONCLUSION

This case highlights when lymphadenopathy is encountered clinically, CD should be considered and a biopsy should be performed.

Hepatic Microwave Ablation-Induced Tumor Destruction and Animal End Point Survival Can Be Improved by Suppression of Heat Shock Protein 90

OBJECTIVES

To investigate the effect of heat shock protein 90 (HSP90) modulation on tumor necrosis, apoptosis, tumor growth delay, and end point survival by combining microwave ablation (MWA) with an HSP90 inhibitor in a nude mouse model.

METHODS

This study was approved by the Ethics Committee. Forty mice with HepG2 subcutaneous xenograft tumors (10 ± 1 mm) were randomized into 4 groups: (1) no treatment, (2) MWA only, (3) the HSP90 inhibitor ganetespib only, and (4) ganetespib combined with MWA. Tumors were harvested 24 hours after treatment, and gross coagulation diameters were measured. The effect of ganetespib on HSP90 and caspase 3 expression in the periablational rim was assessed. Another 40 mice with the same tumors and groupings were observed after treatment. Tumor growth curve and Kaplan-Meier survival analyses were performed with a tumor diameter of 2.2 cm and 40 days of survival as the defined survival end points.

RESULTS

Combination treatment significantly increased the coagulation size compared to tumors treated with MWA or ganetespib alone (P < 0.05). The combination of MWA and ganetespib decreased HSP90 expression and increased cleaved caspase 3 expression 24 hours after treatment. Compared with MWA or ganetespib only, combination treatment could lengthen the end point survival and reduce the tumor growth rate.

CONCLUSIONS

Modulation of HSP production can improve MWA-induced tumor apoptosis and destruction, reduce residual tumor growth rates, and prolong end point survival.

Comparison of Sonazoid and SonoVue in the Diagnosis of Focal Liver Lesions: A Preliminary Study

OBJECTIVE

This study aimed to compare the efficacy of Sonazoid and SonoVue in subjects with focal liver lesions.

METHODS

The patients who had untreated focal solid liver lesions confirmed by B-mode ultrasonography were eligible for the study. The target lesion and whole liver were scanned by gray scale ultrasonography; then, contrast-enhanced ultrasonography was performed, and the results were evaluated blindly. The main end point was accuracy improvement with postcontrast versus precontrast ultrasound examination for diagnosis of the target lesion of interest as malignant or benign against the reference standard.

RESULTS

There were 65 patients with 65 hepatic tumors enrolled in the study. The improvement of diagnostic accuracy was 0.30 in the Sonazoid group and 0.16 in the SonoVue group (95% confidence interval, -0.828-0.168; P = .24). Using 20% as the noninferiority margin, the upper limit of the 95% confidence interval (0.168) was less than 0.20. The number of lesions detected during the whole-liver scanning in the Sonazoid group was significantly more than that detected in the SonoVue group (P = .024).

CONCLUSION

The diagnosis value of Sonazoid is noninferior to SonoVue, and this new contrast agent can improves the whole-liver image quality.

LncRNA BCAR4 up-regulates EGFR and thus promotes human thyrocyte proliferation

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[Removal of Algal Organic Matter and Control of Disinfection By-products by Powder Activated Carbon]

The removal efficiencies of algal organic matter (AOM) and typical nitrogenous and non-nitrogenous disinfection by-products (DBPs) through adsorption with powder activated carbon (PAC) were investigated. Three-dimensional fluorescence spectroscopy confirmed that PAC adsorption changed the composition of AOM. PAC adsorption showed high removal efficiency for humus-like substances in AOM, but limited removal efficiency for aromatic protein-like substances. When the dosage of PAC was 20 mg·L^-1 and the adsorption time ranged from 10 to 30 min, the removal rates of 3.30 mg·L^-1 dissolved organic carbon were 20.7%-31.9% for intracellular organic matter (IOM) and 12.6%-19.0% for extracellular organic matter (EOM). The highest removal rates of trihalomethanes by PAC in the chlorination of IOM and EOM were 26.6% and 35.8%, respectively. The highest removal rates of haloacetonitriles were 49.6% and 53.6% in the chlorination of IOM and EOM. The removal of dibromoacetonitrile precursors by PAC was significant. In summary, the PAC had a higher efficiency in reducing the generation of DBPs in EOM chlorination than in IOM chlorination.

Aspergillus niger bloodstream infection in gastric cancer after common hepatic artery embolization: A case report

The present case study reported on a 62-year-old male patient with gastric cancer-associated Aspergillus (A.) niger bloodstream infection. The patient presented with massive hemorrhage in the gastrointestinal tract 3 months after total gastrectomy for gastric cancer. Conservative treatment consisting of blood transfusion to supplement blood volume loss was ineffective. Digital subtraction angiography indicated gastroduodenal artery bleeding. The first attempt of performing arterial embolization using gelatin sponges failed, while the second attempt of performing common hepatic artery embolization using gelatin sponges and micro-coil springs stopped the bleeding. Four weeks after angiography, the patient presented with the complication of A. niger bloodstream infection, which was cured using intravenous and oral voriconazole. Clinicians should be aware of the possibility of A. niger bloodstream infection after invasive operations in immunocompromised patients and apply timely antifungal treatment.

[Mechanism for Effects of High Free Ammonia Loadings on Biological Nitrification]

Wastewater treatment plants treating industrial wastewater and municipal wastewater may suffer from unexpected shock loads of high ammonia concentrations,which can lead to inhibition of biological nitrification and failure to meet the wastewater discharge standards.In order to solve the problem of failure to meet the standards,the effects of high loadings of free ammonia (FA) on the nitrification process were investigated in this work using a sequencing batch reactor (SBR).For such purpose,maximum specific degradation rates of ammonia,maximum specific formation rates of nitrate,specific oxygen uptake rates and abundances of nitrifying bacteria were monitored.The results showed that FA promoted nitrification activities at low concentrations and inhibited the activities when the FA concentration exceeded a certain value.In addition,high loading concentrations of FA resulted in long recovery times.When the FA concentration increased from 3.6 mg·L^-1 to 8.1 mg·L^-1,the abundances of ammonia-oxidizing bacteria (AOB) and nitrite-oxidizing bacteria (NOB) increased slightly,as shown by the fluorescence in situ hybridization tests.However,there were apparent decreases in the abundances of AOB and NOB when the concentration of FA was higher than 8.1 mg·L^-1.The critical FA inhibitory concentrations for AOB and NOB were 8.1 mg·L^-1 and 6.6 mg·L^-1.It was found that the NOB flora were more sensitive than AOB to FA inhibition.

[Long-term effects of ultrasound-guided microwave ablation in the treatment of small renal cell carcinoma]

OBJECTIVE

To evaluate the long-term efficacy of microwave ablation in the treatment of small renal cell carcinoma (RCC).

METHODS

We retrospectively analyzed 140 cases of small cell renal carcinoma (151 lesions with a mean diameter of 2.8±0.8 cm) treated between April, 2006 and October, 2015 with ultrasound-guided microwave ablation with cooled-shaft needle antenna. One microwave ablation antenna was used for tumors less than 2 cm in diameter and 2 antennas were used for larger tumors. The patients received enhanced ultrasound and CT/MRI examinations at 1, 3, and 6 months after the operation and every 6 months thereafter. The overall survival, disease-free survival, and local tumor progression rate of the patients were evaluated.

RESULTS

The response rate of treatment (complete ablation at one month on enhanced images) was 100% in these patients. The local tumor progression rates at 1, 3, and 5 years were 0.9%, 2.0%, and 7.1%, respectively, and the 1-, 3-, and 5-year distant metastasis rates were 1.6%, 2.5%, and 7.9%, respectively. The overall survival rates of the patients at 1, 3, and 5 years were 98.4%, 94.8%, 89.5%, respectively, with disease-free survival rates of 98.4%, 93.0%, and 83.1%, respectively. No major complications occurred in these cases, and multivariate analysis showed that the tumor number (P=0.015) and tumor growth patterns (P=0.049) were independent risk factors that adversely affected the long-term outcome after surgery.

CONCLUSION

Our data show that microwave ablation is a safe and effective modality for treatment of renal cell carcinoma.

Diagnostic value of two-dimensional shear wave elastography in papillary thyroid microcarcinoma

Objective

The purpose of this study was to evaluate the predictability of two-dimensional shear wave elastography (2D-SWE) for papillary thyroid microcarcinoma (PTMC).

Materials and methods

One hundred and eighteen patients with 137 thyroid nodules (46 benign nodules, 91 malignant nodules) were included in this study who received conventional ultrasound (US) and 2D-SWE before fine-needle aspiration or surgery. The diagnostic performance was compared between US findings only and the combined use of US findings with 2D-SWE, which were correlated with pathology results.

Results

Receiver-operating characteristic curve analysis was performed to assess the diagnostic performance of 2D-SWE. Conventional US findings and 2D-SWE values were analyzed and compared between benign and malignant thyroid nodules. The mean values of SWE_mean, SWE_min, and SWE_max were 46.6±16.7, 26.2±9.5, and 73.6±18.1 kPa, respectively, in PTMC, which were significantly higher than those in benign tumors (27.8±12.4, 15.8±8.6, and 50.3±22.6 kPa, P<0.001). The optimal cut-off values of SWE_mean, SWE_min, and SWE_max for predicting malignancy were 34.5, 21.8, and 53.2 kPa, respectively. Taller than wide, micro-calcification, and SWE_mean were found to be independent risk factors for predicting PTMC. The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of combined conventional US features with 2D-SWE parameters were 95.7%, 94.5%, 94.9%, 89.8%, and 97.7%, respectively; these were superior to those of conventional US (89.1%, 90.1%, 89.9%, 82.0%, and 93.2%).

Conclusion

The study indicates that the quantitative parameters of 2D-SWE are an independent predictive factor for diagnosing PTMC, which could provide valuable information when conventional US cannot give determinate results.

[Analysis of trace elements in chrysanthemum from different habitats with ICP-MS]

OBJECTIVE

To establish a method for determination of trace elements in chrysanthemum and analyze trace elements in chrysanthemum from different habitats.

METHODS

The preprocessing for determination of trace elements in chrysanthemum was carried out by microwave digestion,the content of trace elements in chrysanthemum was determined by ICP-MS.

RESULTS

The content of trace elements of chryscmthemum varied with the habitats.

CONCLUSION

The contents of trace elements as well as heavy metals of Chrysanthemum relate to its species and habitats to a certain degree.