Objective: To explore the feasibility and application value of intraoperative direct immunohistochemical (IHC) staining in improving the diagnosis accuracy in difficult cases of bronchiolar adenoma (BA). Methods: Nineteen cases with single or multiple pulmonary ground-glass nodules or solid nodules indicated by imaging in Cancer Hospital of Chinese Academy of Medical Sciences from January to July 2021 and with difficulty in differential diagnosis at frozen HE sections were selected. In the experimental group, direct IHC staining of cytokeratin 5/6 (CK5/6) and p63 was performed on frozen sections to assist the differentiation of BA from in situ/micro-invasive adenocarcinoma/adenocarcinoma/invasive mucinous adenocarcinoma. In the control group, two pathologists performed routine frozen HE section diagnosis on these 19 cases. The diagnostic results of paraffin sections were used as the gold standard. The sensitivity and specificity of BA diagnosis, consistency with paraffin diagnosis and time used for frozen diagnosis were compared between the experimental group and the control group. Results: The basal cells of BA were highlighted by CK5/6 and p63 staining. There were no basal cells in the in situ/microinvasive adenocarcinoma/adenocarcinoma/invasive mucinous adenocarcinoma. In the experimental group, the sensitivity and specificity with aid of direct IHC staining for BA were 100% and 86.7%, respectively, and the Kappa value of frozen and paraffin diagnosis was 0.732, and these were significantly higher than those in the control group (P<0.05). The average time consumption in the experimental group (32.4 min) was only 7 min longer than that in the control group (25.4 min). Conclusions: Direct IHC staining can improve the accuracy of BA diagnosis intraoperatively and reduce the risk of misdiagnosis, but require significantly longer time. Thus frozen direct IHC staining should be restricted to cases with difficulty in differentiating benign from malignant diseases, especially when the surgical modalities differ based on the frozen diagnosis.
Humans ; Paraffin ; Sensitivity and Specificity ; Adenocarcinoma in Situ ; Adenoma/diagnosis* ; Adenocarcinoma, Mucinous/surgery* ; Frozen Sections/methods*

Objective: To investigate the clinicopathological features, surgical methods and prognosis of primary appendiceal neoplasms. Methods: A descriptive case series study was performed. Clinical data of patients diagnosed with primary appendiceal neoplasms in Peking University First Hospital from 2006 to 2017 were retrospectively analyzed. Patients who underwent surgery and were confirmed as appendiceal neoplasms by postoperative pathology were included. Cases of cecal tumor invading the appendix and other organ tumors implanting in the appendix and cases of recurrent appendix tumors were excluded Pathological classification was based on the 4th edition of the WHO classification of digestive tract tumors (2010 edition), and the efficacy of operation methods of low grade appendiceal mucinous neoplasm (LAMN) were analyzed. Results: A total of 115 patients were enrolled, including 52 males and 63 females with a median age of 59 (51, 71) years. Clinical symptoms usually manifested as dormant pain in the right lower quadrant, migrating right lower abdominal pain, fever and bloating. Twenty-four cases were accidentally discovered during surgery, and 21 cases were found by physical examination. The preoperative diagnosis rate of CT and ultrasound was 40.2% (43/107) and 25.5% (24/94) respectively. The postoperative pathological types contained 83 cases of LAMN, 12 cases of mucinous adenocarcinoma, 9 cases of appendiceal neuroendocrine neoplasms (aNEN), 2 cases of mucinous adenocarcinoma with signet ring cells, 3 cases of serrated adenoma, 2 cases of goblet cell carcinoid, 2 cases of lymphoma, 1 case of leiomyoma and 1 case of schwannomas. All the patients underwent surgical resection, including 41 cases of appendectomy, 21 cases of partial cecectomy, 48 cases of right hemicolectomy, and 5 cases of combined organ resection due to appendiceal tumor infiltration or dissemination. Eighteen cases were diagnosed with pseudomyxoma peritonei (PMP) during operation. A total of 98 patients were enrolled for follow-up. The median follow-up time was 58 (5-172) months. The 5-year disease-free survival (DFS) rate was 84.5% and 5-year overall survival (OS) was 88.2%. Multivariate analysis revealed that high-grade malignancy tumors (HR=25.881, 95% CI: 2.827-236.935, P=0.004) and PMP formation (HR=42.166, 95% CI: 3.470-512.439,P=0.003) were independent risk factors for prognosis. Patients undergoing right hemicolectomy presented longer operation time, more blood loss and higher morbidity of complication as compared to those undergoing appendectomy and partial cecectomy (all P<0.05), while no significant differences in 5-year DFS (P=0.627) and 5-year OS (P=0.718) were found. Conclusions: Primary appendiceal neoplasms usually have no typical features, accompanied with low preoperative diagnosis rate. The common pathological types are LAMN, mucinous adenocarcinoma and aNEN. Appendectomy or partial cecectomy for LAMN may achieve satisfactory prognosis. High-grade malignancy tumors and PMP formation are independent risk factors for prognosis.
Adenocarcinoma, Mucinous/surgery* ; Appendectomy ; Appendiceal Neoplasms/surgery* ; Humans ; Male ; Neoplasm Recurrence, Local ; Retrospective Studies

Primary mucinous carcinoma of the skin is a rare adnexal neoplasm with sweat gland differentiation. Mucinous carcinoma can occur in noncutaneous visceral sites and may metastasize in the skin. Thus it is important to exclude the possibility of a noncutaneous visceral primary tumor before diagnosing primary mucinous carcinoma of the skin. This tumor has a tendency for slow growth, local recurrence, and infrequent metastasis. To decrease local recurrence, Mohs micrographic surgery can be used to treat primary mucinous carcinoma of the skin. We describe a case of primary mucinous carcinoma of the skin which was resected by Mohs micrographic surgery.
Adenocarcinoma, Mucinous* ; Mohs Surgery ; Mucins* ; Neoplasm Metastasis ; Recurrence ; Skin* ; Sweat Glands

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare sub-type of renal cell carcinoma (RCC). It has been considered to be a kind of "indolent" tumor with low-grade fashion, weak invasive capacity and relatively favorable prognosis. However, in the current case, a 3.7 cm×2.8 cm spherical mass with contrast enhancement was found in the left kidney incidentally by computed tomography (CT) in a 60-year-old male patient. A lesion in the right humerus (2.1 cm×1.6 cm×3.1 cm) was found at the same time without any symptoms or sign of pathological fracture by magnetic resonance (MR) imaging. Further positron emission tomography (PET)/CT scan which was ordered immediately after admission suggested multiple bone destruction including skull, pelvis, sternum, right humerus and femur, left scapula, multiple vertebrae and libs. Pathological examination after radical nephrectomy and palliative resection with internal fixation of the lesion in the right humerus indicated that both renal (3.0 cm×3.0 cm×2.5 cm) and bone lesions were MTSCC with the features of high-grade ovoid epithelioid cells, cord-like spindle cells and mucinous matrix under light microscope. The diagnosis of renal MTSCC concurrent with multiple bone metastasis was made. This case report suggested the necessity of general evaluation, especially bone scan for possible distant metastasis, as MTSCC might present unexpected advanced behaviors without any orthopedic symptoms. The behavior of bone metastasis might be associated with male and elderly age. MTSCC has similar enhancement features to papillary RCC on CT scan. As results, attentions are needed to differentiate MTSCC from papillary RCC as they both tend to show lesser enhancement degrees than cortex. Rather than exhibiting a dedifferentiating appearance, the pathological characteristics of bone metastasis lesion were close to those of primary renal lesion. The reason of distant metastasis to the bone remained unclear, negative expression of cytokeratin (CK) 7 might be attributed to. Though immunotherapy, chemotherapy and target therapy could all be methods for systematic therapies, procedures to remove renal lesions and prevent skeletal related events are still highly recommended.
Adenocarcinoma, Mucinous/surgery* ; Bone Neoplasms/secondary* ; Carcinoma, Renal Cell ; Humans ; Kidney ; Kidney Neoplasms/surgery* ; Male ; Middle Aged ; Nephrectomy

PURPOSE: Although laparoscopic surgery is widely accepted in the treatment of colorectal cancer, conversion to open surgery is associated with the rate of unfavorable outcomes. The aim of this study was to determine the factors associated with open conversion from laparoscopic surgery for colorectal cancer.METHODS: A total of 3,002 patients who underwent laparoscopic colectomy as an initial plan for the treatment of colorectal cancer located from the sigmoid colon to the rectum were retrospectively evaluated between January 2009 and December 2018 at Samsung Medical Center in Korea. Risk factors significantly associated with open conversion were determined using univariate and multivariate regression models.RESULTS: Among the 3,002 patients, open conversion was performed in 120 patients (4%). Age >60 years (adjusted odds ratio [AOR], 2.370), preoperative bowel obstruction (AOR, 2.348), clinical T4 stage (AOR, 2.201), and serum carcinoembryonic antigen level >5 ng/mL (AOR, 2.289) were significantly associated with open conversion. Moreover, mucinous carcinoma was a significantly more frequent histopathologic type than adenocarcinoma (10.0% vs. 3.2%, P<0.001) in the open conversion group with an AOR of 2.549 (confidence interval, 1.259–5.159; P=0.009).CONCLUSION: The present study presented a novel finding, i.e. mucinous carcinoma as the histopathologic type could be an independent predictive factor for conversion from laparoscopic colectomy to open surgery. Identifying patients with mucinous carcinoma will help stratify the risk of open conversion preoperatively.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Carcinoembryonic Antigen ; Colectomy ; Colon, Sigmoid ; Colorectal Neoplasms ; Conversion to Open Surgery ; Humans ; Korea ; Laparoscopy ; Mucins ; Odds Ratio ; Rectum ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: Intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms are included in mucin-producing pancreatic tumors. The reports about IPMN are not uncommon but those about the mucinous cystic neoplasms are relatively few. The aims of this study were to define the natural history of resected mucinous cystic neoplasms of the pancreas and to identify the findings which suggest malignancy. METHODS: The authors retrospectively evaluated the clinical outcomes of 41 patients with mucinous cystic neoplasms who were surgically resected at Asan Medical Center between 1995 and 2004. RESULTS: Women (n=33) were more frequently affected than men (n=8). Thirty three patients (80.6%) had adenoma, 1 (2.4%) borderline malignancy, 1 (2.4%) carcinoma in situ, and 6 (14.6%) invasive mucinous cystadenocarcinoma. The most frequent symptom was abdominal pain (39%). About half of the enrolled patients were asymptomatic. Unilocular type (79%) was more frequent than the multilocular type (21%) on gross morphology. The tumor size of invasive mucinous cystic neopolasms was larger than that of non-invasive mucinous cystic neoplalsms (p=0.01). Abdominal pain was more frequent in invasive mucinous cystic neoplasms (p=0.026). On gross morphology, mural nodules were detected in 4 of 6 patients with invasive mucinous cystic neoplasms. However, they were not detected in any patients with non-invasive mucinous cystic neoplasms. Recurrence developed in none of the 35 patients with non-invasive mucinous cystic neoplasms, however 2 of the 6 patients with invasive mucinous cystic neoplasms died within 5 years. CONCLUSIONS: Clinical predictors of invasive mucinous cystic neoplasms are suggested to be tumor size and abdominal pain. The prognosis of the non-invasive mucinous cystic neoplasms is excellent when curative resection is performed.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Adult ; Aged ; Carcinoma, Pancreatic Ductal/diagnosis/pathology/surgery ; Cystadenocarcinoma, Mucinous/diagnosis/pathology ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Retrospective Studies ; Survival Analysis

OBJECTIVETo discuss the rationality and clinical significance of total mesorectal excision (TME) assessed by the pattern of local recurrence of rectal cancer.

METHODS207 rectal cancer patients treated by surgery from 1975 to 2001 who developed local recurrence were retrospectively studied as to the option of treatment based on their outcome. 172 of these 207 patients had complete record of follow-up with a follow-up rate of 83.0%.

RESULTSThe local recurrent sites of 207 patients were: anastomotic stoma 71, mesorectum 65, perineum 50, lymph nodes 59, multiple recurrences 89 and others sites rare. Among 81 patients who had been first treated by anterior resection (AR), 58 were again treated by abdomino-perineal resection (APR). Among 102 patients who had been treated by APR, 38 were treated by perineal tumor resection, 15 were treated by total and posterior pelvic organ resection, and 18 were supplemented with lymph node resection. By all modalities, the resection rate was 66.1% (137/207), in which the curable resection rate was 46% (63/137). The 5-year survival rate of patients with tumor resection was 23.3% (32/137), those treated by curable resection was 34.9% (22/63).

CONCLUSIONFrom the pattern of local recurrence, the operation for middle-lower rectal cancer must follow the principle of total mesorectum excision (TME). Patients with local recurrence should be energetically treated in the second operation if tolerable.

Adenocarcinoma ; secondary ; surgery ; Adenocarcinoma, Mucinous ; secondary ; surgery ; Anastomosis, Surgical ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Neoplasm Recurrence, Local ; surgery ; Neoplasm Staging ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo discuss surgical treatment of right colon carcinoma of hepatic flexure invading the duodenum.

METHODSSixty-five patients with right colon carcinoma of hepatic flexure invading the duodenum, treated in our department from 1987 to 2007, were included in this study. Their clinicopathological data were retrospectively reviewed and analyzed. All the cases were divided into three types (local invasion, regional invasion, and cancer with internal fistula) according to duodenal defect, including local invasion (< 2.0 cm), wide invasion (> 2.0 cm) and the presence of internal fistula.

RESULTS25 patients with local invasion underwent en bloc resection of the duodenal wall. Pedicled ileal flap was used to cover the large duodenal defect measuring 2.0 - 3.0 cm in 5 patients. Dudenojejunostomy was used to reconstruct the large defect measuring more than 5 cm in 3 patients. Conservative resection of right-sided colon was performed in 18 patients with wide invasion. 4 patients underwent pancreaticoduodenectomy combined with right hemicolectomy for colon cancer involving the pancreatic head. 10 underwent duodenal diverticularization. One patient with anastomotic leakage healed within 3 weeks. Other patients were cured without postoperative complications. The total 3-year and 5-year survival rates after surgery were 53.8% and 9.2%, respectively.

CONCLUSIONThe surgical procedure to be performed is usually decided according to the cancer location, extent, and duodenal defect and invasion, which are important for prolonging life time, improving of quality of life and prognosis in these patients.

Adenocarcinoma ; pathology ; surgery ; Adenocarcinoma, Mucinous ; pathology ; surgery ; Adult ; Aged ; Colectomy ; methods ; Colon, Ascending ; pathology ; surgery ; Colonic Neoplasms ; pathology ; surgery ; Duodenum ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pancreaticoduodenectomy ; Quality of Life ; Retrospective Studies ; Survival Rate

Compared with other types of cancers, pancreatic cancer is one of the most dreadful malignancies and is fifth leading cause of cancer-related death in Korea. It is difficult to expect early diagnosis or improvement in prognosis due to lack of specific early symptoms and effective diagnostic methods. Whereas cystic neoplasm of the pancreas is a rare type of pancreatic tumor, surgical resection provides good prognosis because of its low possibility of local invasion or distant metastasis. In case of pancreatic cystic tumor, radiologic differentiation between benign and malignant lesions is crucial for the selection of appropriate treatment and the prediction of prognosis. And ductal adenocarcinoma of pancreas presenting in cystic form is an uncommon type of cystic tumor, making it extremely rare among all pancreatic malignancies. We report two cases of atypical pancreatic ductal adenocarcinoma presenting as solid pseudopapillary tumor and intraductal papillary mucinous neoplasm, respectively.
Adenocarcinoma, Mucinous/*diagnosis/surgery ; Adenocarcinoma, Papillary/*diagnosis/surgery ; Adult ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Adenocarcinoma, Mucinous ; diagnosis ; pathology ; surgery ; Adult ; Aged ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; surgery ; Cholecystectomy ; methods ; Female ; Follow-Up Studies ; Gallbladder Neoplasms ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Survival Rate