[Clinicopathological features of mixed cervical carcinoma with adenoid cystic pattern]

Objective: To investigate the clinicopathological characteristics, immunophenotype, molecular characteristics, differential diagnosis, clinical treatment and prognosis of mixed carcinoma of cervix with adenoid cystic pattern. Methods: Three cases of mixed cervical carcinoma with adenoid cystic pattern were collected at the Affiliated Hospital of Xuzhou University Medical School from 2018 to 2021.The clinicopathological characteristics were analyzed, immunohistochemistry (IHC) and in situ hybridization (ISH) were performed. The related literature was reviewed. Results: The three patients were postmenopausal women with a median age of 74.7 years. The clinical symptom was vaginal bleeding without obvious causes. One case was an endophytic tumor, and the others were exophytic. The median diameter of the three cases was 3.3 cm. Two patients underwent hysterectomy, the tumors infiltrated the external 1/3 and middle 1/3 of the cervix respectively. All the lymph nodes were negative. One patient had a previous biopsy. Microscopically, all three tumors were characterized by a cribriform structure, which were filled with basophilic myxoid substance and surrounded by tubules lined by two layers of cells. The tumor cells had scanty cytoplasm and showed the characteristics of cervical basal-like cells. All three cases were accompanied by high-grade squamous intraepithelial lesions and squamous cell carcinoma, and one also showed a non-specific spindle cell sarcomatoid component. Within the double-layered epithelial structure, the outer epithelium was positive for p63, CD117, p16^INK4a (clone E6H4) and MYB protein and negative for S-100 by IHC. The combined positive score of PD-L1 (clone 22C3) was less than 1 in all three cases. Human papillomavirus (HPV) types 16 and 18 were detected in one patient preoperatively, while high-risk HPV were positive in the other two patients by RNAscope ISH postoperatively. None of the three cases showed MYB gene rearrangement by FISH. The mean follow-up time was 23.3 months (36, 28 and 6 months, respectively). Two patients underwent hysterectomy and radiotherapy survived without disease. One patient survived with tumor just by radiotherapy and drug therapy. Conclusions: Mixed cervical carcinoma with adenoid cystic pattern is extremely rare. It is a high-grade malignancy with poor prognosis. The tumor is associated with high-risk HPV infection, without MYB gene rearrangement, and with low PD-L1 immunoreactivity. Radical surgery combined with radiotherapy and chemotherapy is the mainstay of treatment at present.

[Clinical analysis and laboratory diagnosis of three cases with infantile botulism caused by Clostridium botulinum type B]

Objective: To summarize the clinical characteristics and laboratory diagnostic methods of infant botulism caused by Clostridium botulinum type B. Methods: Clinical data of 3 infants with type B botulism who were admitted to Children's Hospital Affiliated to Capital Institute of Pediatrics from May to November 2018 were retrospectively analyzed. Botulinum toxin was detected in fecal samples or fecal enrichment solution of the patients, and Clostridium botulinum was cultured and isolated from fecal samples. Results: The age of onset of the patients (two boys and one girl) was 3, 3 and 8 months old, respectively. Two cases had the onset in May and one case had the onset in November. There were two cases with mixed feeding and one case with breast feeding. One case's family members engaged in meat processing. All of them were previously healthy. All the children presented with acute flaccid paralysis, cranial nerve involvement and difficult defecation. Two cases had secondary urinary tract infection. Electromyograms of two cases showed that action potential amplitude of the motor nerve were lower than those of their peers. After treatments including intravenous human immunoglobulin, respiratory tract management, urethral catheterization, nasal feeding, etc., three cases recovered completely 2 to 4 months later. Type B botulinum toxin was detected in the fecal diluent of one patient, and the TPGYT enrichment solution and cooked meet medium of the feces of 3 patients, respectively. Clostridium botulinum B was identified from the feces of 3 infants after culture, isolation and purification. Conclusions: Combined with typical clinical manifestations including acute flaccid paralysis, cranial nerve involvement symptoms and difficult defecation examination, infant botulism can be clinically diagnosed. The detection of fecal botulinum toxin and the culture and isolation of Clostridium botulinum are helpful for the diagnosis.

[Clinical effectiveness of pleural abrasion in video-assisted thoracic surgery for bullae resection]

Objective: To evaluate the efficacy of pleural abrasion in treatment of spontaneous pneumothorax with video-assisted thoracic surgery (VATS) for bullae resection. Methods: The clinical data of 158 patients with initial spontaneous pneumothorax who underwent video-assisted thoracic wedge resections with or without pleural abrasion in Henan Provincial People's Hospital from June 2010 to June 2015 were retrospectively analyzed. The patients were assigned to two equal groups according to whether pleural abrasion was applied or not: experimental group (with pleural abrasion) and control group (without pleural abrasion); and there were 79 patients in each group.There were 62 males and 17 females aged 15-60 years (mean age 34 years) in pleural abrasion group. And there were 70 males and 9 females aged 18-60 years (mean age 38 years) in non-pleural abrasion group.After surgery, all patients were evaluated for postoperative pain, chest tube removal time, hospital stay and other complications.Independent samples t test was used to compare the data between groups. Results: Surgeries for 158 patients were performed successfully.No mortality occurred.There was no conversion to thoracotomy.Postoperative pain, operation time, intraoperative blood loss, chest tube removal time, pleural canals flowand average hospital stay in non-pleural abrasion group was significantly lower for 4.4, 19 minutes, 10 ml, 21 hours, 87 ml and 1.4 days respectively when compared with those in pleural abrasion group (t=32.478, 7.140, 11.093, 7.288, 10.246, 8.070, all P<0.05). There was no missing case with a follow-up of 30 months.No complications, such as pneumothorax, was observed. Conclusions: Postoperative pain, chest tube removal time and hospital stay in non-pleural abrasion group are all lower than those in pleural abrasion group.And there is no significant difference in the recurrence of pneumothorax between the two groups after VATS bullae resection.

Magnetic resonance elastography of brain tumors: preliminary results

PURPOSE

To investigate the potential value of magnetic resonance elastography (MRE) in evaluating the consistency of brain tumors.

MATERIAL AND METHODS

Six patients with known solid brain tumor underwent brain MRE studies. Consistency of brain tumors was evaluated at surgery. Correspondence of MRE evaluation with operative result was studied.

RESULTS

The elasticity of tumors in six patients evaluated by MRE agreed with the tumor consistency given by the operative results.

CONCLUSION

MRE could be used as an imaging technique for noninvasive assessment of the consistency of brain tumor in vivo.

Magnetic resonance elastography of the human brain: a preliminary study

PURPOSE

To study the application of magnetic resonance elastography (MRE) in the human brain.

MATERIAL AND METHODS

An external force actuator was developed, which produced propagating shear waves in brain tissue. A modified phase-contrast gradient-echo sequence was developed. The propagating shear waves within the brain were directly imaged. The wave images were processed to obtain the elasticity image. Shear waves at 100 Hz, 150 Hz, and 200 Hz were applied.

RESULTS

The propagating shear waves in the brain were visualized on wave images. The elasticity image revealed the difference in tissue elasticity between gray and white matter of the brain.

CONCLUSION

MRE could be an imaging technique for assessing the elasticity of brain tissue.

Radon measurements in underground dwellings from two prefectures in China

Radon, an established lung carcinogen, remains the single most important environmental radiation exposure. Yet, an excess of lung cancer from breathing radon in homes has not been consistently demonstrated in studies conducted to date. To address several major problems that have hindered previous studies of lung cancer and radon in homes, we have embarked upon a lung cancer case-control study in Gansu Province, China, where a substantial proportion of the population live in underground dwellings. In this paper, we report on results of a pilot study in which radon measurements were made for 3 days in the summer in 40 homes under normal occupancy conditions using short-term E-PERM detectors and for 6 months from February through August in 49 homes using long-term alpha-track detectors. Useable E-PERM data were obtained from 38 homes and useable alpha-track data from 47 homes. For both types of detectors, measurements were approximately log-normally distributed. Arithmetic and geometric means were 233 and 185 Bq m-3 (range 74-1,590 Bq m-3) for E-PERM measurements and 165 and 158 Bq m-3 (range 74-592 Bq m-3) for alpha-track measurements, respectively; 68% of E-PERM measured homes and 55% of alpha-track measured homes exceeded 148 Bq m-3. Alpha-track measurements made at the entry, middle, and rear areas of the underground dwellings did not differ significantly (arithmetic means of 168, 162, and 165 Bq m-3 with standard deviations 63, 73, and 48, respectively), which suggests that air circulation may be minimal. The underground dwellings measured in the pilot study had high radon levels and the underground dwellers may provide an excellent population for studying indoor radon and risk of lung cancer.

Radiologic-pathologic correlation. Epidermoid tumor of the cerebellopontine angle

This case demonstrated the classic gross pathologic, CT, and MR appearances of epidermoid tumors. The imaging features and differential diagnosis are summarized.

[Magnetic resonance imaging of occult intracranial malformations]

11 patients with angiographically occult intracranial vascular malformations proved by surgery and pathology were studied by magnetic resonance imaging (MRI). The chief MRI findings were: On T1-weighted imaging, there was a homogeneous or heterogeneous hyperintensity or isointensity signal at the centre of the lesion with a surrounding rim of hypointensity signal; On T2-weighted imaging, there was a hyperintensity signal at the centre and hypointensity signal at the peripheral region. Differential diagnosis between hemorrhagic tumor and occult vascular malformation lies in that the latter has no edema and is often single. comparing with CT, the size of occult vascular malformation on MRI was equal to that on CT.

[Magnetic resonance imaging and CT diagnosis of small acoustic neuromas in the internal auditory canal]

The MRI findings of 6 small acoustic neuromas proved by surgery and pathology were analyzed in detail and compared with CT air cisternography. The MRI features of small acoustic neuromas include that small lesions produce thickening of the nerve or partial or entire filling of the internal auditory canal. In T1-weighted images, the tumor is of higher signal intensity than CSF, but is the same as the brain in T 2-weighted images, the tumor is brighter than the brain. MRI makes possible the diagnosis of small acoustic neuromas without subjecting the patients to invasive procedures or exposing them to X-radiation. Comparing MRI with CT air cisternography, we conclude that MRI is more convenient than CT and causes no postoperative complications.

[Intra-arterial digital subtraction angiography (IADSA) of intracranial lesions (an analysis of 600 cases)]

Intracranial vessels were evaluated in 600 patients with IADSA. Among them, 100 cases were studied with both conventional angiography and IADSA. The advantages of IADSA are: (1) Good image quality; (2) Examination time shortened; (3) Very useful for interventional neuroradiology, hence it can replace conventional cerebral angiography for preoperative evaluation in most cases.

[CT diagnosis of neuron migration anomalies]

CT findings of 17 patients with neuron migration anomalies, 5 with lissencephaly, 6 with schizencephaly and 6 with heterotopic gray matter were reviewed. Migratory anomalies are congenital malformations caused by insult to the neurons during the time of migration. CT is effective in detecting these malformations.