A 69-year-old male patient presented with a gradually enlarging mass in the left inner upper thigh for more than 2 months,and pigmented patches in the left medial leg for more than 20 years.Physical examination revealed a painless mass measuring 3 cm × 2 cm × 2 cm in size in the left inner upper thigh.Several pigmented patches were observed in the left medial leg,and the largest pigmented patch measured 2 cm× 2 cm in size with an irregular border and uneven pigmentation.The mass in the left inner upper thigh was resected and subjected to histopathological examination,which showed proliferative epithelioid neoplastic cells with mucous matrix,round and spindle cells of varying sizes separated by mucous matrix.The immunohistochemical study of tumor cells showed positive staining for vimentin,S100 and Melan-A,but negative staining for actin,desmin,CD56,epithelial membrane antigen,cytokeratin,leukocyte common antigen,CD99,chromogranin A and synaptophysin.Hematoxylin-eosin staining of pigmented patches on the left medial leg revealed squamous epithelium covering the surface of lesions with no superficial ulceration or atypia in epithelial cells,unevenly distributed melanophages,fibroplasia accompanied by collagen formation,obviously decreased skin appendages,infiltration of a few inflammatory cells in the dermis.AB-PAS staining was negative.The immunohistochemical study of pigmented patches showed positive staining for vimentin and Melan-A.The patient was pathologically diagnosed with metastatic myxoid melanoma with partial regression of the primary lesion.

Objective To describe the clinicopathologic features of two cases of mucoepidermoid carcinoma of the skin.Methods Two cases of mucoepidermoid carcinoma of the skin were analyzed histopathologically using hematoxylin and eosin (HE) staining,alcian blue-periodic acid Schiff (AB-PAS) staining and immunohistochemical staining.Relavant literature was reviewed.Results Histopathological examination showed that the tumor was subcutaneously located in both cases,with epidermoid cells and intermediate cells arranged in sheets or nests,as well as different sizes of glandular structures lined by mucinous columnar epithelium in some areas.Both tumors had a relatively clear boundary with peripheral invasive growth and no obvious capsules.Immunohistochemical examination showed positive staining for carcinoembryonic antigen (CEA),high and low molecular weight cytokeratin (CK(H) and CK(L)).The cytoplasm of mucous cells was stained blue with,and mucus was visualized after,AB-PAS staining.Conclusions Primary mucoepidermoid carcinoma of the skin is a kind of malignant tumor arising from skin appendages,whose diagnosis depends on histological and immunohistochemical examination.

Objective To develop an immunohistochemical assay for the diagnosis of cutaneous malignant melanoma (CMM) micrometastasis via blood and lymphatic vessels,and to evaluate its clinical significance.Methods Fifty-three patients (32 males and 21 females) histopathologically diagnosed as CMM were enrolled in this study.The patients were aged (61.2 ± 8.4) years (range,52-72 years).Tissue specimens were obtained from the central area of tumor in each case,and also from removed lymph nodes in some cases.The average duration of follow-up was (65.00 ± 5.68) months.During the follow-up,17 patients died of the recurrence or metastasis of CMM,and 6 patients were lost to follow-up.The expressions of D2-40,S100 and CD34 antigens in 53 tissue specimens were examined by immunohistochemical staining with three individual monoclonal antibodies,or by an immunohistochemical method using 2 two-antibody cocktails (D2-40/S 100 and CD34/S100) and double-color chromogens in single tissue sections.Results Of the 53 patients,30.19％ (16/53) were positive for hematoxylin-eosin (HE) staining combined with immunohistochemical staining with individual monoclonal antibodies,and 49.06％ (26/53) for the immunohistochemical method using two-antibody cocktails and double-color chromogens.Statistical differences were found in the positive rate between the two methods (x2 =3.94,P＜ 0.05).Compared with patients without blood/lymph vessel tumor emboli,those with blood/lymph vessel tumor emboli showed higher lymph node metastasis rate (80.77％ (21/26) vs.37.04％ (10/27),x2 =10.43,P ＜ 0.001),but lower five-year survival rate (42.31％ (11/26) vs.70.37％ (19/27),x2 =4.25,P ＜ 0.05).Conclusions The immunohistochemical method with two-antibody cocktails is superior to HE staining combined with immunohistochemical staining with individual monoclonal antibodies in the detection of blood/lymph vessel tumor emboli.And blood/lymph vessel tumor emboli may be an important prognostic factor in patients with CMM.

Objective To explore the feasibility and significance of hand-assisted laparoscopic splenectomy (HALS) for ruptured spleen. Methods We conducted HALS in 18 cases of ruptured spleen between January 2002 and January 2003. According to the Buntain classification of CT-graded splenic injury, 7 cases were classified as “type Ⅱ” and 11 cases, “type Ⅲ”. Ruptured spleen was complicated by other organ injuries in 12 cases. Results The operation was completed successfully in 16 cases, the operation time being 75～115 min (mean, 92.5 min). A conversion to open surgery was made in 2 cases, which were suspected of having injuries of other major vessels. Postoperative time to normal activities was 20～30 days in 6 cases of simple ruptured spleen and 30～100 days in 10 cases of ruptured spleen complicating other injuries. Conclusions HASL is feasible for “type Ⅱ or Ⅲ” ruptured spleen without severe complicating injuries.

Objective To explore the feasibility and clinical efficacy of hand assisted laparoscopic splenectomy (HALS) for ruptured spleen. Methods From January 2002 to October 2002, HALS was performed in 12 cases, among whom were 8 cases combined with other viceral trauma. Results HALS was accomplished successfully in 10 cases and laparotomy in 2. In 10 cases, the operation time of HALS averaged 102.5 minutes. The mean post operative hospitalization was 5.8 days in 4 cases with only spleen trauma and 15.5 days in 6 combined with other viceral trauma. Conclusions HALS is a feasible, effective and safe surgical procedure for the cases with Buntain CT scalingⅡ or Ⅲ spleen trauma with no severe combined trauma.

Objective To investigate and eompare the diagnostic values of linear reference region model (LRRM) and Extended Tofts model in quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) analysis of benign and malignant breast lesions under different temporal resolutions.Methods Eight five suspicious breast cancer women underwent bilateral DCE-MRI exam, 37 patients were benigns and 48 patients were malignants.Among those, 31 patients(15 malignant, 16 benign) were scanned with 18 s per phase, and 54 patients(33 malignant, 21 benign) were scanned with 7 s per phase, and they were assigned into breast cancer group, benign lesion group and healthy gland group proven by surgery or biopsies.For the same model, Ktrans values of the three groups under different time resolution were first analyzed using Kruskal-Wallis H rank sum test.Receiver operator curve (ROC) was used to analyse the diagnostic efficiency of K values.Results Under high and low temporal resolutions, K values of the healthy group were (0.048 ±0.022) and (0.090±0.040)/min for extended Tofts model,(0.301 ±0.197) and (0.287±0.225)/min for LRRM model respectively.K values of the benign group were (0.289±0.163) and (0.211 ± 0.080)/min for extended Tofts,(0.624 ± 0.358) and (0.593 ± 0.165)/min for LRRM respectively.K values of the malignant group were (0.959±0.451) and (0.524±0.285)/min for extended Tofts,(1.576±0.935) and (0.956±0.180)/min for LRRM respectively.There were significant differences among the three different groups(P＜0.05).Area under the ROC to differentiate benign and malignant breast lesions for Extended Tofts in high temporal, LRRM in high temporal, Tofts in low temporal and LRRM in low temporal were 0.941, 0.876, 0.850 and 0.933, with Ktrans cutoff values of 0.304, 0.917, 0.252 and 0.789/min,and sensitivity of 93.9％, 80.0％,80.0％, 80.0％;specificity of 85.7％, 90.5％, 81.2％, 87.5％ respectively.Conclusion Under low temporal resolutions, Ktrans of LRRM model had better sensitivities and specificities in differentiation of benign and malignant breast lesions than Extended Tofts model, which was the opposite in high temporal resolutions.

Objective To evaluate comparability of two different assay system for detecting CRP.Methods Following the profile of Clinical and Laboratory Standard Institute (CLSI)document EP9-A2,50 blood samples with anti-coagulant ED-TA-2K were collected from emergency patients at Changhai Hospital.The test result of samples by the i-CHROMA Reader was compared and evaluated with those by Beckman Immage 800.Results The linear regression equation for plasma CRP was:Y=1.076 5X-3.031 5,R2=0.986.The linear regression equation for whole blood CRP was:Y=0.882 6X-1.180 8, R2=0.931 1.For whole blood samples with low HCT (<30.45%).Used correction equation:CRP (after corrected)=CRP (before corrected)/(1-HCT).The regression equation (after corrected)was:Y=1.006 8X-3.612 2,R2=0.950 9.Con-clusion CRP concentration detected by i-CHROMA showed good correlation and comparability compared to laboratory ref-erence system by using plasma samples.Results form whole blood samples with low HCT should be corrected to improve comparability.

Proton pump inhibitors are H+ /K+-ATPase inhibitors, which can efficiently inhibit gastric acid secretion for a long time. As the latest inhibitory gastric acid drugs, proton pump inhibitors are the best choices for acid-related diseases such as gastroe-sophageal reflux disease, peptic ulcer and gastrointestinal lesions caused by nonsteroidal anti-inflammatory drugs. Proton pump inhibi-tors have significant inhibition to basal gastric acid, night gastric acid and gastric acid secretion caused by gastrin and food stimulation. This article reviewed the pharmacokinetic characteristics of five proton pump inhibitors in domestic market.

Objective To retrospectively analyze the treatment outcomes and failure patterns in patients with head?and?neck cancer of unknown primary head?and?neck cancer of unknown primary, and to compare the efficacy between elective mucosal irradiation and ipsilateral neck treatment. Methods The clinical data of patients with head?and?neck cancer of unknown primary who were admitted from January 2007 to December 2013 were retrospectively collected. Thirty?one patients received elective pharyngeal mucosal irradiation and 61 patients only received ipsilateral neck treatment. The SPSS 19. 0 software was used for comparison of the survival and local control between the two groups. Results In the 92 patients, the median age was 57 years;79. 3% had metastasis to level Ⅱ lymph nodes;the median follow?up time was 36. 5 months;the 3?year overall survival, mucosal control, and neck control rates were 89. 0%, 86. 6%, and 82. 4%, respectively. Primary sites were found in 15 patients, containing nasopharynx in 4 patients, oropharynx in 3 patients, oral cavity in 3 patients, throat and hypopharyngeal part in 3 patients, maxillary sinus in 1 patient, and esophagus in 1 patient. The patients undergoing elective pharyngeal mucosal irradiation had significantly higher 3?year mucosal control and neck control rates than those undergoing ipsilateral neck treatment ( 100% vs. 74. 9%, P= 0. 040;87. 5% vs. 62. 2%, P= 0. 037 ) . There was no difference in the 3?year overall survival rate between the two groups ( 83. 5% vs. 88. 7%, P= 0. 910 ) . Conclusions For patients with head?and?neck cancer of unknown primary, elective pharyngeal mucosal irradiation can reduce the incidence of primary site and increase the neck control rate. A new standard for target volume delineation should be established as soon as possible for elective prophylactic pharyngeal mucosal irradiation.

Objective To investigate the value of quantitative dynamic contrast-enhanced MRI (DCE-MRI)in diagnosis of breast adenosis.Methods 54 patients with breast glandular lesions diagnosed as 4th or 5th grade in BI-RADS and proved by pathology un-derwent routine 3.0T quantitative DCE-MRI.Quantitative parameters including volume transfer constant (Ktrans ),plasma volume fraction (Vp )were measured.According to the pathological findings and MRI morphological characteristics,the lesions were divided into breast cancer group,adenosis group and control group.The contralateral healthy side of the adenosis group was regarded as control group.The quantitative parameters of the three groups were statistically analyzed.Results Pharmacokinetic parameters of Ktrans and Vp were (0.289±0.1 63)min-1 and 0.042 8±0.045 respectively in adenosis group (n=21),(0.959±0.45 1)min-1 and 0.057±0.079 in breast cancer group (n=33),and (0.048±0.022)min-1 and 0.01 6 ±0.01 9 in control group (n=21).Ktrans and Vp between adenosis and control group had statistical significance(Z =-5.733,-2.844,all P <0.05),Ktrans between breast cancer group and adenosis group had statistical difference (Z =-5.421,P =0.000 ).Vp between breast cancer and adenosis group had no statistical difference (Z=-0.009,P =0.993).Area under curve (AUC)of the receiver operator curve (ROC)to differentiate benign and malignant lesions of Ktrans were 0.941.When the cutoff were 0.304 min-1 ,the sensitivities and specificities were 93.9%,85.7%. Conclusion Quantitative DCE-MRI shows good diagnostic value in differentiation of breast glandular lesions and cancer.