Objective:To discusse the clinical features of sarcomatoid hepatocellular carcinoma to improve the understanding of diagnosis and treatment for sarcomatoid hepatocellular carcinoma. Methods:Data including clinical features and follow-up from 8 pa-tients admitted in Tianjin Medical University Cancer Institute and Hospital from January 2009 to April 2014 were retrospectively ana-lyzed. Results: The average age of all patients was 56.6 years old, and the male-to-female ratio was 3:1. Preoperative CT or MRI showed specific characteristics but it was difficult to confirm diagnosis. Pathological and immunohistochemical examination revealed an expressed epithelial-like phenotype. All 8 patients had advanced local tumor invasion and high lymph node metastasis rates. These patients received surgery, and the median survival time was 10.8 months (3 months to 35 months). Conclusion:Diagnosis of sarcoma-toid hepatocellular carcinoma mainly depended on postoperative pathological examination. Immunohistochemistry was beneficial for sarcomatoid hepatocellular carcinoma diagnosis and differential diagnosis. Surgical treatment prolonged survival time, but the overall prognosis remained poor.

Objective:To investigate the effect of pancreaticojejunostomy on the occurrence of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. Methods:Data from 145 patients with periampullary tumor who underwent pancreaticoduode-nectomy in Tianjin Medical University Cancer Institute and Hospital between October 2008 and August 2013 were reviewed. Factors potentially associated with POPF were analyzed by Pearson chi-square test and Logistic regression analysis. Results:Among the 145 patients, 27 were diagnosed with POPF, including 5 grade A, 17 grade B and 5 grade C. Neither duct to mucosa nor Blumgart pancreati-cojejunostomy was correlated with POPF in grade C. The univariate analysis showed that gender, pancreatic cancer, portal vein involve-ment, type of pancreaticojejunostomy, texture of pancreas, and diameter of the main pancreatic duct were closely correlated with POPF. The multivariate analysis using Logistic regression showed that different pancreaticojejunal anastomoses and genders were independent predictors of POPF. Conclusion:Different types of pancreatic anastomoses are a risk factor for POPF after pancreaticoduodenectomy.

ObjectiveTo investigate the treatment strategies and factors influencing the prognosis of patients with primary gallbladder carcinoma.MethodsThe clinical data of 135 patients with primary gallbladder cancer who were admitted to the Cancer Hospital of Tianjin Medical University from January 2000 to December 2009 were retrospectively analyzed.The survival curve was drawn by the Kaplan-Meier method,and the survival rates were analyzed by using the Log-rank test.Factors which may have influences on the prognosis were analyzed by univariate analysis and COX multivariate analysis.ResultsThe overall 1-,3-,5-year survival rates of the 135 patients were 46.7％,10.4％ and 5.2％,respectively.The 1-,3-,5-year survival rates of 74 patients who received radical resection of gallbladder cancer were 68.9％,18.9％ and 9.5％,respectively.The 1-,3-,5-year survival rates of 50 patients who received palliative treatment were 24.0％,0 and 0,respectively.The 1-,3-,5-year survival rates of 11 patients who received conservative treatment were 0,0 and 0,respectively.There was no significant difference in the survival rates among patients who received different treatment methods (x2 =5.642,P ＜ 0.05 ). Of the 9 patients with gallbladder cancer who received reoperation after laparoscopic choledochotomy,the survival time of 1 patient in stage Ⅰ and 1 of the 3 patients in stage Ⅱ who received radical surgery exceeded 5 years,while the survival time of 5 patients in stage Ⅱ who received palliative treatment was shorter than 5 years.There was a significant difference in the survival time among the 3 groups of patients ( x2 =5.642,P＜0.05).Under the condition of same TNM stages ( Ⅱ,ⅢA,ⅢB,ⅣA,ⅣB),the survival rates of patients who received radical resection of gallbladder cancer were significantly higher than those who received palliative or conservative treatment ( x2 =8.971,21.250,44.153,6.696,21.722,P ＜ 0.05 ).The results of univariate analysis showed that age,CA19-9,TNM stages and treatment methods were risk factors influencing the median survival time ( x2 =8.466,3.977,9.837,5.642,P ＜ 0.05 ).The results of multivariate analysis showed that age,TNM stages and treatment methods were the independent risk factors influencing the median survival time ( Wald=5.779,14.724,11.640,P＜0.05).ConclusionThe prognosis of primary gallbladder cancer is poor.Age,TNM stages and treatment methods are the independent factors influencing the prognosis of patients with gallbladder cancer,and patients who receive radical resection have relatively good prognosis.

Liver is the most common metastatic organ in patients with advanced colorectal cancer. Once colorectal cancer liver metastasis (CRLM) occurs, the prognosis will be poor. Therefore early detection of CRLM has a great clinical significance for improving the prognosis of CRLM patients. Surgical resection of primary and metastatic lesion is the only possible curable option for CRLM, translational therapy, interventional therapy and multidisciplinary team also provide more treatment ideas. Long non-coding RNA, cancer stem cells and phosphatidylinositide-3-kinases/protein kinase B signaling pathway reveal the main mechanism of CRLM from different aspects. This article reviews the recent advances in the early diagnosis, treatments and main mechanisms of CRLM.

OBJECTIVETo evaluate the efficacy and safety of high-dose dexamethasone-based regiments in newly diagnosed multiple myeloma patients with renal impairment.

METHODSThe clinical data of 22 patients with newly diagnosed multiple myeloma patients with renal impairment who received high-dose dexamethasone-based regiments from August 2006 to August 2008 in Peking Union Medical College Hospital were retrospectively reviewed.

RESULTSAfter receiving a median 4 cycles of high-dose dexamethasone-based regiments, renal impairment was reversed in 7 patients (31.8%) with a median time to reversal of 31 days. Sixteen patients (72.7%) achieved overall response, including 7 patients (31.8%) had complete remission / near complete remission. The grade 3 or 4 adverse events included neutropenia (13.6%), infections (22.7%), peripheral neuropathy (9.1%), and ileus (4.5%).

CONCLUSIONThe high-dose dexamethasone-based regiments are safe and effective for newly diagnosed multiple myeloma patients with renal impairment.

Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Dexamethasone ; administration & dosage ; Female ; Humans ; Male ; Middle Aged ; Multiple Myeloma ; complications ; drug therapy ; Prognosis ; Renal Insufficiency ; complications ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo explore the clinical value of blood concentration monitoring during high-dose methotrexate (MTX) treatment.

METHODSHigh-dose MTX (1.5-9.0 g) was infused to 105 patients with acute lymphoblastic leukemia or lymphoma, and then the blood MTX concentration was measured by fluorescence polarization immune assay (FPIA) 44 hours after the start of administration. The procedure was repeated every 6-12 hours until the concentration was less than 0.1 micromol/L.

RESULTSForty-four hours after the start of administration, the blood MTX concentration (C(MTX/44h)) was > or = 5 micromol/L in 6 patients (2.8%) and was between 1 and 5 micromol/L in 23 patients (10.6%). C(MTX/44h) > or = 1 micromol/L was more common in patients received 5.0 g MTX. No severe adverse event was observed in all patients.

CONCLUSIONSBlood MTX concentration is different after high-dose MTX treatment due to individual metabolic differences, and therefore it is clinically important to monitor blood concentration of MTX. Elimination delay is more common in patients receive 5.0 g MTX. Application of high-dose MTX therapy under the monitoring of blood MTX concentration is safe and feasible.

Adolescent ; Adult ; Aged ; Antimetabolites, Antineoplastic ; administration & dosage ; blood ; therapeutic use ; Drug Monitoring ; Female ; Humans ; Lymphoma ; drug therapy ; Male ; Methotrexate ; administration & dosage ; blood ; therapeutic use ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; Young Adult

OBJECTIVETo describe the clinical and pathological features, treatment and prognosis of dendritic cell sarcoma (DCS).

METHODSA group of DCS was described, including two cases of follicular dendritic cell sarcoma (FDCS), one each of interdigitating dendritic cell sarcoma (IDCS) and langerhans cell sarcoma (LCS). The related English literatures were reviewed.

RESULTSTwo patients with IDCS were a 19-year-old man and a 45-year-old woman respectively, both exhibited fever of unknown origin and painless lymphadenopathy. Pathological diagnosis of lymph node biopsy was FDCS with positive CD21 and CD35. Both patients achieved complete remission (CR) after 6 cycles of chemotherapy (CHOP: cyclophosphamide, epirubicin, vindesine, and prednisolone). However, the male patient relapsed 5 months later and another patient was still in CR at 5 months follow-up. One case of IDCS was a 42-year-old man, who manifested as paraneoplastic pemphigus. Biopsy of mediastinal lymph node demonstrated IDCS and immunohistochemistry showed positive S-100 staining. This patient died of pneumonia after two cycles of CHOP. One patient of LCS was a 54-years-old woman with fever, painless lymphadenopathy and diffused pulmonary nodules. The diagnosis of LCS was established after excisional biopsy was taken from inguinal lymph node. Positive staining of CD1a and S-100 was displayed by immunohistochemistry. Electron microscope examination confirmed the presence of Birbeck granule in tumor cells. Four cycles of chemotherapy (including ECHOP, FND) were administered, but the disease progressed.

CONCLUSIONDCS is a group of very rare sarcoma, FDCS, IDCS and LCS have different characteristic clinical features, immunophenotype and prognosis. The prognosis of most patients is poor.

Adult ; Dendritic Cell Sarcoma, Interdigitating ; pathology ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; Young Adult

OBJECTIVETo investigate the in vitro effect of erythropoietin (EPO) on hepcidin of monocytes and its molecular mechanisms.

METHODSHepcidin and signaling molecules including C/EBPalpha, Smad1/5/8, p-Smad1/5/8 and p-STAT3 were detected by real time PCR and Western blot. THP-1 monocytes were stimulated by interleukin-6 (IL-6) or lipopolysaccharide (LPS). EPO receptor (EPOR) antibody was added to observe its antagonistic effect on EPO and impact on the signaling proteins.

RESULTSEPO suppressed mRNA expression of THP-1 hepcidin of monocytes induced by 20 ng/ml IL-6 or 1 microg/ml LPS in both dose and time dependent manner. The most decrease of hepcidin expression was observed at 2 IU/ml EPO for 6 hours. EPO also down-regulated hepcidin protein induced by 20 ng/ml IL-6. At 2 IU/ml EPO for 6 hours hepcidin protein was down-regulated, as was C/EBPalpha, p-Smad1/5/8 and p-STAT3. Antibody to EPOR antagonized the down-regulation of EPO on hepcidin and signaling proteins.

CONCLUSIONSMonocytes hepcidin can be reduced by EPO when stimulated by IL-6 or LPS. The mechanism of which may be at least in part, via suppression of C/EBPalpha, p-Smad1/5/8 and p-STAT3 signaling.

Antimicrobial Cationic Peptides ; metabolism ; Cells, Cultured ; Erythropoietin ; pharmacology ; Hepcidins ; Humans ; Interleukin-6 ; pharmacology ; Lipopolysaccharides ; pharmacology ; Monocytes ; drug effects ; metabolism ; Signal Transduction

Disorders of iron utilization caused by abnormal elevation of hepcidin levels are the main mechanism of anemia of chronic disease. Hepcidin is mainly produced by the liver. Recently it has been found that monocytes are another source of hepcidin. The increased hepcidin in serum and urine of multiple myeloma patients may be one cause of anemia of chronic disease (ACD). However it is unclear whether the peripheral blood monocyte hepcidin is involved in the pathogenesis of anemia of chronic disease. This study was purposed to investigate the role of monocyte hepcidin in multiple myeloma patients with anemia of chronic disease. The clinical data and peripheral venous blood of multiple myeloma patients were collected.Serum concentration of IL-6 and TNF-α was detected by ELISA. Peripheral blood monocytes were isolated by CD14(+) magnetic beads. Hepcidin, IL-6 and TNF-α mRNA of monocytes were detected by real time quantitative PCR. The results showed that the expression level of monocyte hepcidin mRNA in myeloma patients was higher than that in normal controls. In untreated patients, the expression level of monocyte hepcidin mRNA was negatively correlated with hemoglobin, and positively correlated with serum ferritin and IL-6 levels, but unrelated with TNF-α levels.It is concluded that the increased monocyte hepcidin levels in multiple myeloma patients may play an etiologic role in ACD.
Adult ; Aged ; Anemia ; etiology ; Case-Control Studies ; Chronic Disease ; Female ; Ferritins ; blood ; Hepcidins ; blood ; Humans ; Interleukin-6 ; blood ; Leukocytes, Mononuclear ; metabolism ; Male ; Middle Aged ; Monocytes ; metabolism ; Multiple Myeloma ; blood ; complications ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo explore the feasible age limits in Chinese elderly patients with non-Hodgkin's lymphoma (NHL).

METHODSThe clinical data of 507 patients with NHL who were admitted to Peking Union Medical College Hospital (PUMCH) from January 1990 to December 2007 were retrospectively analyzed. They were further followed up by reviewing medical records or by phone. The deadline of follow-up was October 2008.

RESULTSThe 5-year/8-year overall survival (OS) rates were 64.6%/45.7%, 53.0%/ 44.1%, 32.8%/17.5%, 40.0%/22.8%, and 19.8%/0, respectively, in patients aged < 60 years, 60-64 years, 65-69 years, 70-74 years, and > or = 75 years. The OS rate was significantly different between patients aged > or = 75 years and other age groups, and between patients aged 65-70 years and patients younger than 60 years (P < 0.05). Only age, serum albumin, and hemoglobin affected the survival status in elderly NHL patients.

CONCLUSIONSixty-five years can be regarded as the age limit in Chinese NHL patients.

Age Factors ; Aged ; Aged, 80 and over ; China ; epidemiology ; Female ; Follow-Up Studies ; Humans ; Lymphoma, Non-Hodgkin ; mortality ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Rate