Humans ; Lymphatic Metastasis

Villous tumor of the duodenum are rare, only 89 cases having been reported and reviewed in several recent publication. Malignancy is discovered in approximately 30-45% leading to the recommandation that all such tumors be excised regardless of the endoscopic findings. Two cases of villous tumor of the duodenum were reported and locally excised. The pathologic specimens showed carcinoma in situ, no evidence of hematogenous and lymphatic metastasis.
Carcinoma in Situ ; Duodenum* ; Lymphatic Metastasis ; Publications

To investigate the effects of different wavelet filters on correlation and diagnostic performance of radiomics features.
 Methods: A total of 143 colorectal cancer (CRC) patients (64 positive in lymph node metastasis and 79 negative) with contrast-enhanced CT examination were recruited. After labeling the tumor area by experienced radiologists, radiomics wavelets features based on 48 different wavelets were extracted using in-house software coded by Matlab. The correlation coefficients of the features with same names between different wavelets were calculated and got the distribution of high-correlation features between each wavelet. The least absolute shrinkage and selection operator (LASSO) was used to build signatures between lymph node metastasis and wavelet features data set based on different wavelets. The numbers of features in signatures and diagnostic performance were compared using Delong's test.
 Results: With the difference of wavelet order increased, the number of high-correlation features between two wavelets decreased. Some features were prone to high correlation between different wavelets. When building radiomics signature based on single wavelet, signatures built from 'rbio2.2', 'sym7' and 'db7' did well in predicting lymph node metastasis. The signature based on Daubechies wavelet feature set had the highest performance in predicting lymph node metastasis, while the signature from Biorthogonal wavelet features was worst. Improvement was significant in diagnostic performance after excluding the high-correlation features in the whole features set (P=0.004).
 Conclusion: In order to reduce the data redundancy of features, it is recommended to select wavelets with large differences in wavelet orders when calculating radiomics wavelet features. It is necessary to remove high correlation features for improving the diagnostic performance of radiomics signature.
Colorectal Neoplasms ; Humans ; Lymphatic Metastasis ; Retrospective Studies

For a potentially malignant lymphadenopathy, it is clinically important to distinguish between metastasis of a primary tumor and a benign lesion such as systemic sarcoidosis or sarcoid reaction. We describe here a case of systemic sarcoidosis that was associated with early gastric cancer. A patient was found to have early gastric cancer (EGC) during routine clinical examination. The chest radiography demonstrated bilateral hilar lymphadenopathy and further examination showed that he had multiple lymphadenopathies. We diagnosed systemic sarcoidosis with EGC because of the elevated serum ACE-I, the chest CT findings and the pathological analysis. We performed endoscopic submucosal dissection (ESD) for EGC, and there was no local recurrence and distant metastasis for eighteen months. These findings suggest that the possibility of systemic sarcoidosis should be considered in cases with established malignancy and multiple lymphadenopathies.
Humans ; Lymphatic Diseases ; Neoplasm Metastasis ; Recurrence ; Sarcoidosis ; Stomach Neoplasms ; Thorax

BACKGROUND/AIMS: Endoscopic mucosal resection can cure early gastric cancer. The risk of lymphatic metastasis is related to the depth of submucosal invasion by the mucosal malignancy, with a resection depth of 500 micrometer generally accepted as a safe cut-off. However, excessive thinning induced by stretching of the resected tissue sometimes preventing a precise diagnosis. We studied the effects of stretching on different layers and sites of gastric tissue. METHODS: Porcine stomachs were cut into 2.0x2.0 cm pieces, and pieces from body were stretched to 2.5, 3.0, and 3.5 cm. Pieces from the cardia, body, and antrum were also stretched to 3.0 cm. The thickness of each layer was measured and analyzed statistically. RESULTS: Whole gastric wall and submucosal layers showed gradual thinning, with stretching to 3.5 cm tearing the tissues and resulting in imperfect extension. The submucosa was thinner in body tissue than in cardia and antrum tissues. Stretching to 3.0 cm induced a consistent decrease in submucosal thickness (30-70%). The change in thickness varied widely between individual samples. CONCLUSIONS: A resection margin of 500 micrometer might be insufficient for the complete removal of malignancy. Moreover, the thickness of the submucosal layer differs with the gastric site and between individuals. Future studies are needed to confirm the findings in human tissue.
Cardia ; Gastric Mucosa ; Gastroscopy ; Humans ; Lymphatic Metastasis ; Stomach ; Stomach Neoplasms

Primary malignant melanoma of the esophagus is a rare, but aggressive tumor with a fatal prognosis. Hematogenous and lymphatic metastasis are common. The tumor has multiple black and pigmented lesions. Resection of the tumor with an anastomotic procedure is the treatment of choice. Despite this operation, the prognosis is quite poor with the mean life expectancy being less than 1 year. We describe here a case of a 54-year-old man with esophageal malignant melanoma, and we also include a review of the relevant literature.
Esophagus ; Humans ; Life Expectancy ; Lymphatic Metastasis ; Melanoma ; Middle Aged ; Prognosis

To determine the value of radiomics in identifying lymph node (LN) metastasis in patients with rectal nonmucinous adenocarcinoma.
 Methods: Imaging data of 91 patients were retrospectively analyzed (61 in the training set and 30 in the test set). A total of 1 301 radiomics features were extracted from high-resolution T2-weighted images of the whole primary tumor. The least absolute shrinkage and selection operator (LASSO) logistic regression was performed to choose the optimal features and construct a radiomics classifier in the training set. Its discrimination performance was compared with that of morphological criteria by receiver operating characteristic (ROC) curve analysis, which was validated in the test set.
 Results: The radiomics classifier combined with five key features was significantly associated with LN metastasis, which distinguished LN metastasis with an area under curve (AUC) at 0.874 (95% CI 0.787 to 0.960) in the training set, and the performance was similar in the test set (AUC 0.878, 95% CI 0.727 to 1.000). The AUCs according to the morphological criteria in the training set and test set were 0.619 (95% CI 0.487 to 0.752) and 0.556 (95% CI 0.355 to 0.756), respectively. Discrimination of the radiomics classifier was superior to that of morphological criteria in both the two datasets (both P <0.05).
 Conclusion: The radiomics classifier provides individualized risk estimation for LN metastasis in rectal nonmucinous adenocarcinoma patients and it has the advantage over the morphological criteria.
Adenocarcinoma ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Rectal Neoplasms ; Retrospective Studies

OBJECTIVETo demonstrate the association of tumor budding with clinicopathological features and prognosis in T2 rectal cancer.

METHODSClinicopathological data of 123 patients who underwent potentially curative resection for T2 rectal carcinoma between 2001 and 2005 at the Changhai Hospital were collected. All pathology slides were stained with hematoxylin and eosin for microscopic examinations. The maximum value of tumor buds(MV) and average value of tumor buds(AV) were calculated, which were classified as low value (≤5), median value (5 < bud value < 10), and high value (≥10).

RESULTSUnivariate analysis and multivariate analysis revealed that MV(P=0.000), AV(P=0.001), and lymphatic invasion (P=0.006) were independent predictors for lymph node metastasis in T2 rectal cancer. Neural invasion and poorly differentiation were significantly associated with MV(P<0.05). Neural invasion, vascular invasion and poorly differentiation were were significantly associated to AV (P<0.01). Disease-free survival (DFS) of patients with low AV, median AV and high AV was 110.5 months, 95.8 months, and 60.0 months respectively. There were significance differences in DFS of low AV with median and high AV(P<0.05). DFS of patients with low MV, median MV and high MV was 115.1 months, 98.5 months, and 86.0 months respectively. There were significance differences in DFS between low and high AV, and median and high MV(P<0.01 and P<0.05), while no significant difference existed between low and median MV.

CONCLUSIONTumor budding is a useful marker to indicate high invasiveness of rectal cancer and a valuable prognostic predictor.

The precondition of accurate gastric cancer surgery is precise assessment of lymph node metastasis. To date, no imaging modality achieves both high sensitivity and high specificity in detecting lymph node metastasis in gastric cancer. Intraoperative sentinel node tracing and biopsy are the most popular method to identify the localization of tumor cell, but is limited to early gastric cancer. Nano-composite materials, designed for tumor imaging and tracing, show us a newly emerging domain for tumor detection in gastric cancer. The function of these nano-composite materials to detect lymph node metastasis in gastric cancer relies on the effective backflow of lymph system. However, the lymph vessels can be obstructed by tumor cells in advanced gastric cancer, which may restrain the application of these nanoparticles. Therefore, more methods to detect lymph node metastasis in gastric cancer should be explored. This review summarizes the characteristic of the targeted nanosphere. Based on the reported studies, a novel idea is conceived that targeted multifunctional nanosphere may be a potential method to achieve precise assessment of lymph node metastasis in gastric cancer.
Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Stomach Neoplasms ; pathology

OBJECTIVETo analyze the association between the response of primary tumor to neoadjuvant chemoradiotherapy (CRT) and lymph node status in mid and low rectal cancer.

METHODSSeventy-one patients with locally advanced mid and low rectal cancer underwent preoperative CRT followed by surgery. Surgical specimens were examined by surgeons and pathologists to obtain more lymph nodes and the histological sections were examined. Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and tumor regression. Statistical analyses were performed to investigate the relationship between tumor regression and lymph node status.

RESULTSAll the patients completed the neoadjuvant CRT. Twelve patients achieved pathological complete response, of whom one was not operated and on surveillance. Pathological examination of the remaining 70 patients showed that the tumor was downstaged to T 0-2 group in 39 patients, among whom 5 patients (12.8%) had positive lymph nodes. Tumor was not downstaged in 31 patients, of whom 10 patients (32.3%) had positive nodes. The difference between the two groups was statistically significant (P=0.029).

CONCLUSIONTumor regression is consistent with the reduction of lymph node metastasis after preoperative CRT.