Objective To investigate the clinical features of cryptogenic multifocal ulcerous stenosing enteritis(CMUSE),and to improve the diagnosis of this rare disease.Methods From 2010 to 2015,clinical data of 10 patients with CMUSE were retrospectively analyzed,including clinical features,laboratory examination,imaging examination,appearance under endoscopy,pathologic characteristics,location of lesions,treatment and prognosis.Results Among the 10 patients with CMUSE (male six,female four),the mean age was (35.1±14.8) years.The predominant clinical manifestation was melena (eight cases),abdominal pain (eight cases) and anemia (nine cases).The results of laboratory examination showed normal in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).Among seven patients,hypersensitive C reactive protein (hsCRP) of two patients increased.Imaging examination showed intestinal stricture and appearance under endoscopic examination was intestinal ulcers and stenosis.Pathologic finding was superficial ulcers at mucosal and submucosal layers.Lesions mostly involved small intestine,and one case involving ileocecal valves and rectum.Among the 10 patients,seven patients received combination of surgical resection and prednisone treatment,and three patients were only administrated with medications.After treatment,seven patients remainedremission and three patients relapsed after remission.Immunosuppressors and enteral nutrition was effective in two of them and glucocorticoid resistance happened in one patient.Conclusions The diagnosis of CMUSE should he considered in patients with unexplained recurrent bowel obstruction,melena,anemia and concomitant intestinal ulcer and stricture.Endoscopy plays an important role in the diagnosis.Glueocorticoid is effective but easy to relapse.Immunomodulators and enteral nutrition may be considered as second-line therapy.

Objective To assess the fecal immunochemical test (FIT) followed by colonoscopy in opportunistic screenings for colorectal neoplasm.Methods Total 6 193 patients, who underwent opportunistic colorectal cancer (CRC) screening, were classified into four groups: 3 812 patients underwent direct colonoscopy (group 1), 1 244 patients received one FIT followed by colonoscopy (group 2), 341 patients received two FITs followed by colonoscopy (group 3), and 796 patients received three FITs followed by colonoscopy (group 4).Results Total 97 (1.6%) patients with CRC and 1 038 (16.8%) with colorectal adenoma were detected.The positive predictive value of 1, 2 and 3 positive tests out of three FITs for CRC were 4.53%, 5.62% and 8.94%, respectively, which was higher than that of direct colonoscopy (1.52%).One or more positive tests out of three FIT had the largest area under receiver operating characteristic curve (0.743).For colorectal adenoma, detection rate of direct colonoscopy (17 581.25/105) was higher than all FIT strategies (3 732.30/105-13 127.41/105).Conclusions Single or repeated FIT and colonoscopy have different screening utility.One or more positive tests out of three FIT followed by colonoscopy is preferred to screen CRC, and direct colonoscopy is better for detection of colorectal adenoma.

Objective Placental transmogrification of the lung(PTL) is rare;summarizes the reported cases and add our two cases, to explore the best diagnosis and treatment strategy.Methods Review of the cases reported in the literature, combined with the 2 cases described in this article, summarizes the characteristics of PTL and analyzed the best diagnosis and treatment strategy.Results We reported two cases of placental transmogrification of the lung, both presented in the right lower lobe, imaging performance as a giant bulla with a cystic nodule.VATS lobectomy was performed in both cases, no complication after operation.Combined with literature review of 34 cases of patients to analyze the best diagnosis and treatment strategy.Conclusion Grossly and microscopically, the lesion resembles placental tissue, with formation of placental villus-like papillary structures covered by epithelial cells.The most common imaging manifestation of PTL is a bullous emphysema pattern or with a mixed pattern of thin-walled cystic lesions and nodules.Early diagnosis and surgical operation should be performed as soon as possible, these lesions are best treated by minimally invasive surgery, leaving as much normal lung tissue and avoiding pneumonectomy if possible.Surgical treatment is usually curable and leads to successful improvement of symptoms and quality of life.

Objective Tumor size discrepancy in measurement between real-time ultrasonic elastography and conventional uItrasound(US) was found in some breast lesions.The study was designed to investigate the value of the feature in the diagnosis of breast cancer,and its relationship with the margin features on gray-scale US.Methods Both US and real-time elastogram using a Hitachi EUB-8500 US system were performed in 308 consecutive Datients.The margin features on US and the size measured on both methods were documented.A lesion was defined as a significant size discrepancy when a larger size measured at elastogram.Sensitivity,specificity,and overall accuracy of feature to diagnosis malignancy were determined by surgical pathology as gold standard.Results There were total 166 benign,163 malignant and 3 borderline lesions.of 99 lesions with larger measurement on elastography,there were 91 malignant lesions and 8 benign lesions.By the feature of size discrepancY,the sensitivity,specificity and accuracy was achieved 55.8%,96.9%,75.7%,respectively.The size measured on elastogram was statistically larger than that on gray scale US(t=-11.0,P＜0.05).The ratio of indistinct,angular and spiculated margin characteristics were significantly higher in breast cancers with larger size measurement than those with unchanged or decreased size measurement(P＜0.05).Conclusions The increased size-measurement at elastography is helpful to diagnosis breast cancers.And it is more likely to be present in breast cancers with indistinct,angular or spiculated margin.

Objective To study the diagnostic value of magnifying chromoendoscopy combined with narrow band imaging (NBI) for screening inflammatory bowel disease (IBD) and colorectal cancer(CRC).Methods In colonoscopic examinations of long-term IBD patients,magnifying colonoscopy was used to make the consecutive observation with white light,NBI,and indigo carmine spraying.Targeted biopsies or endoscopic resections were performed for histological diagnosis as the golden standard of this study.Results Sixteen cases (17 lesions) with dysplasia or colorectal cancer in 45 long-term IBD patients were detected,including 12 (26.7％) cases of low-grade dysplasia (LGD),4 (8.9％) cases of high-grade dysplasia (HGD),and 1 (2.2％) case of CRC.Targeted biopsy yielded a positive rate of 13.2％ (17/129).Detection rates of NICE and Kudo classification were 81.3％ (13/16) and 75.0％ (12/16),respectively,and were 100.0％ when combined together.Age (P =0.027) and prolonged disease course (P =0.013)were associated with advanced histology in those with dysplasia or CRC.Lesions of HGD and CRC have larger diameters (2.5 ± 1.4 cm) than LGD (0.6 ± 0.4 cm) (P =0.003).Conclusion Magnifying chromoendoscopy with NBI is effective to detect and differentiate colitis-related neoplastic lesions,thus allowing rational therapeutic plans.

Objective:Summarize and analyze the clinical features of immune checkpoint inhibitor (ICI)-related colitis.Methods:From January 2019 to September 2020, the clinical data of 8 patients with ICI-related colitis from Peking Union Medical College Hospital were retrospectively collected and including the onset of ICI-related colitis, clinical symptoms, endoscopic and pathological findings, treatment, comorbidities and resuming of ICI. Independent sample t test was used for statistical analysis. Results:Eight patients were all male, and the median age (range) was 66 years old (55 to 74 years old), 7 cases were diagnosed with stage Ⅳ lung cancer and 1 case was diagnosed with stage Ⅲc pyelo-carcinoma. Among 8 patients, 4 cases of ICI-related colitis occurred during combination of anti-programmed death-1 (PD-1) treatment and chemotherapy, 2 cases occurred during anti-PD-1 monotherapy after combination of anti-PD-1 treatment and chemotherapy, and 2 cases occurred after anti-PD-1 monotherapy. The median time (range) was 44 d (27 to 128 d) from initial anti-PD-1 treatment to the onset of ICI-related colitis and the median time (range) was 8 d (6 to 35 d) from last anti-PD-1 treatment to onset of ICI-related colitis. The ICI efficacy of 4 patients had partial response, 2 patients had stable disease, 1 patient had disease progression, and 1 patient′s condition was not assessed. All 8 patients had moderate to severe extensive colitis. The main clinical manifestation was diarrhea (5/8), 3 patients accompanied by abdominal pain. The endoscopic findings were diffuse mucosal erosion, accompanied by ulcer in 2 patients. The main pathologic findings were cryptitis or crypt abscess, accompanied by apoptosis in 2 patients. Eight patients were all treated with glucocorticoids, among them 2 patients were further treated with biologics, due to the insufficient efficacy of glucocorticoid treatment, 4 patients had opportunistic infections. The initial prednisone dose for patients with opportunistic infections and patients without opportunistic infections was (85.00±52.60) and (60.00±23.09) mg, respectively. The prednisone treatment course was (8.75±4.03) and (7.50±3.11) weeks, respectively, and the differences were not statistically significant (both P>0.05). The colitis relapsed in all 3 patients after resuming of ICI. Conclusions:ICI-related colitis had corresponding ICI treatment history and clinical, endoscopic, and histopathological features. Glucocorticoid is the main treatment, and it is prone to relapse after resuming of ICI.

Objective To evaluate magnifying endoscopy combined with narrow-band imaging ( ME-NBI) for diagnosis of early gastric cancer (EGC).Methods A total of 150 focal lesions from 143 patients over 35 years old identified by white light endoscopy (WLE) from March 2010 to December 2010 in our tertiary referential institution were recruited in the prospective study with written informed consent.Focal lesions were defined as any small local mucosa with abnormal shape or color based on an assessment of findings of WLE without any specified criteria, including superficial, depressed and elevated lesions.The patients with local advanced gastric cancer, submucosal lesions and history of gastrectomy were excluded from the study.All the patients received ME-NBI.Based on literature, national criteria of early diagnosis with ME-NBI were established.All the lesions underwent biopsy and pathological examination.Diagnostic accuracy of ME-NBI for EGC was assessed with reference to histopathology.Results In 150 focal lesions, 19 were pathologically diagnosed as EGC, 8 of which were treated by endoscopic resection and 11 were resected surgically.The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of conventional WLE for diagnosing EGC were 94.7%, 53.4%, 22.8%, 98.6% and 58.7%, respectively.The counterparts of ME-NBI for diagnosing EGC were 73.7%, 99.2%, 93.3%, 96.3% and 96.0%, respectively.The diagnostic accuracy of ME-NBI was significantly better than that of conventional WLE (96.0% vs.58.7%, P＜0.05).With regard to the findings of EGC on ME-NBI, irregular or absent microsurface pattern and microvascular pattern were characteristic features of EGC.Conclusion Conventional WLE is still an important and mandatory screening modality, which is significant for further procedures of suspected lesions, preferably accompanied with biopsy.ME-NBI achieved superior accuracy in the differential diagnosis of focal lesions detected with conventional WLE, but needs further verification.

Objective:To determine the clinical features and genetic characters of patients with chronic enteropathy associated SLCO2A1 gene (CEAS). Methods:Five CEAS patients diagnosed at Peking Union Medical College Hospital from January 2012 to December 2019 were enrolled in this study. The clinical manifestations, laboratory test, radiological and endoscopic findings, gene detections, treatments and prognosis of these patients were reviewed and analyzed.Results:Five male patients presented gastrointestinal symptoms after puberty, including abdominal pain, diarrhea, intermittent melena or hematochezia, incomplete bowel obstruction, anemia, hypoalbuminemia and hypokalemia. The whole gastrointestinal tract except esophagus could be involved, especially the stomach and ileum. Intestinal lesions were characterized by multiple shallow ulcers with stenosis in the layers of mucosa and submucosa. Five patients were all accompanied with primary hypertrophic osteoarthropathy (PHO), and 1 with myelofibrosis and thoracic duct dysplasia. All patients were homozygous or compound heterozygous mutations of SLCO2A1 gene. Conventional treatment of inflammatory bowel disease and COX-2 inhibitors were ineffective. Conclusions:CEAS is an autosomal recessive genetic disease which widely involves the gastrointestinal tract, and can be associated with skin and bone involvement. There is no effective treatment for CEAS at present. CEAS is a different entity from other inflammatory gastrointestinal diseases.

OBJECTIVETo discuss the clinicopathological characteristics and differential diagnosis of nodular regenerative hyperplasia of the liver (NRH).

METHODS9 cases of NRH were collected and their clinical and pathological features were reviewed.

RESULTSNRH is an important cause of non-cirrhotic portal hypertension which is frequently associated with autoimmune disease, malignant tumors and administration of certain drugs. Clinically NRH presents portal hypertension, but with almost normal liver function. Pathological examinations found diffuse nodules of hyperplastic hepatocytes in liver without fibrous septa in between. The obliteration of portal veins are frequently seen. This suggests that ischemia caused by alteration of portal veins may play an important role in the development of nodular regenerative hyperplasia of the liver.

CONCLUSIONHistopathology of NRH is characteristic and it should be differentiated from cirrhosis, focal nodular hyperplasia and hepatocellular adenoma.

Adult ; Female ; Humans ; Hyperplasia ; pathology ; Liver ; pathology ; Liver Diseases ; pathology ; Liver Regeneration ; Male ; Middle Aged