BACKGROUND

Early-stage endometrial cancer often presents with favorable survival rates, but high-risk factors, including TP53 mutations and high-grade serous pathology, can lead to recurrence and poor prognosis. The standard primary treatment for endometrial cancer is surgical staging, and lymph node metastases significantly impact adjuvant therapy decisions. The subgroup of p53-abnormal (p53abn) indicates the worst prognosis and potential benefits from adjuvant chemotherapy. Molecular classification, while recommended, faces practical challenges due to resource constraints.

OBJECTIVES

The study aimed to assess the incidence of p53 abnormal expression in clinical stage 1 endometrial cancer cases that underwent surgery at a government tertiary hospital, and assess its relationship with clinicopathologic factors and pelvic and paraaortic lymph node metastasis (LNM).

METHODS

A cross-sectional retrospective analysis was conducted on clinical early-stage endometrial cancer cases that underwent surgical primary treatment between January 2018 and December 2022. Patient records were reviewed to gather demographics, surgical information, and pathological evaluations. Preoperative clinical staging was determined through imaging, and surgical staging involved comprehensive lymphadenectomy. Immunohistochemistry studies for p53 were carried out on formalin-fixed paraffin-embedded tissue samples.

RESULTS

A total of 233 endometrial cancer cases were included. The mean age at diagnosis was 53.7 years. Common comorbidities included hypertension (47.2%) and dyslipidemia (20.6%). Most cases were endometrioid histology (82.8%) and low-grade tumors (85.8%). Tumor grade (p=0.010), myometrial invasion (pCONCLUSION

Tumor grade, myometrial invasion, and LVSI were all significantly associated with lymph node involvement. While p53 immunohistochemical stains show promise in predicting metastasis and has been associated with tumor aggressiveness, this should still be correlated with clinicopathological parameters to carry out a more accurate risk stratification of early-stage patients.

Therapeutics ; Survival Rate ; Risk Factors ; Recurrence ; Prognosis ; Pathology ; Endometrial Neoplasms ; Immunohistochemistry ; Tumor Suppressor Protein P53 ; Lymph Node Excision ; Risk Assessment

BACKGROUND

Early-stage endometrial cancer often presents with favorable survival rates, but high-risk factors, including TP53 mutations and high-grade serous pathology, can lead to recurrence and poor prognosis. The standard primary treatment for endometrial cancer is surgical staging, and lymph node metastases significantly impact adjuvant therapy decisions. The subgroup of p53-abnormal (p53abn) indicates the worst prognosis and potential benefits from adjuvant chemotherapy. Molecular classification, while recommended, faces practical challenges due to resource constraints.

OBJECTIVES

The study aimed to assess the incidence of p53 abnormal expression in clinical stage 1 endometrial cancer cases that underwent surgery at a government tertiary hospital, and assess its relationship with clinicopathologic factors and pelvic and paraaortic lymph node metastasis (LNM).

METHODS

A cross-sectional retrospective analysis was conducted on clinical early-stage endometrial cancer cases that underwent surgical primary treatment between January 2018 and December 2022. Patient records were reviewed to gather demographics, surgical information, and pathological evaluations. Preoperative clinical staging was determined through imaging, and surgical staging involved comprehensive lymphadenectomy. Immunohistochemistry studies for p53 were carried out on formalin-fixed paraffin-embedded tissue samples.

RESULTS

A total of 233 endometrial cancer cases were included. The mean age at diagnosis was 53.7 years. Common comorbidities included hypertension (47.2%) and dyslipidemia (20.6%). Most cases were endometrioid histology (82.8%) and low-grade tumors (85.8%). Tumor grade (p=0.010), myometrial invasion (pCONCLUSION

Tumor grade, myometrial invasion, and LVSI were all significantly associated with lymph node involvement. While p53 immunohistochemical stains show promise in predicting metastasis and has been associated with tumor aggressiveness, this should still be correlated with clinicopathological parameters to carry out a more accurate risk stratification of early-stage patients.

Therapeutics ; Survival Rate ; Risk Factors ; Recurrence ; Prognosis ; Pathology ; Endometrial Neoplasms ; Immunohistochemistry ; Tumor Suppressor Protein P53 ; Lymph Node Excision ; Risk Assessment

OBJECTIVES

To present a case of a 59-year-old male with bilateral symmetrical lipomatosis consistent with Madelung disease.

METHODS

Design:Case Report

Setting:Tertiary Government Training Hospital

Patient: One

RESULTS

A 59-year-old alcoholic man presented with progressive, bilaterally symmetrical masses in the supraclavicular and anterior neck regions over a 12-month period. Computed tomography revealed diffuse, non-enhancing, symmetrical subcutaneous fatty deposits without delineated solid or cystic masses. The masses were surgically excised, and histopathologic analysis confirmed lipoma. Post-operative recovery was unremarkable, with significant cosmetic improvement and no recurrence in the 2 years of regular follow-up.

CONCLUSION

This case highlights the pathognomonic clinical presentation of Madelung disease in a middle-aged Filipino man with a long history of alcohol consumption and no familial predisposition. Recognition of its characteristic features—symmetry, fat distribution, association with alcoholism, and radiologic profile—is essential to avoid misdiagnosis and unnecessary interventions. Lipectomy achieved excellent cosmetic and clinical outcomes in this patient, underlining its role as the primary treatment modality.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Alcohol Drinking ; Lipoma ; Lipectomy ; Diagnostic Errors ; Recurrence ; Therapeutics ; History ; Hospitals ; Alcoholism

Wunderlich Syndrome is a rare potentially life-threatening phenomenon that involves spontaneous non-traumatic retroperitoneal hemorrhage. At present, identifying the course of conservative management in these patients, especially in pregnancy, has not been clinically established. Presented here is a known case of Tuberous Sclerosis Complex with a Bilateral, 10cm Angiomyolipoma in a 31-year-old female, initially managed with active surveillance. At 27 weeks of pregnancy, she presented with a sudden onset of left flank pain with a hematocrit of 22%. Anemia was corrected with blood transfusions. A contrast-enhanced MRI of the abdomen showed a large subcapsular perirenal hematoma of the left kidney. Renal angioembolization of the bleeding segmental renal artery was done. The patient was conservatized until 37 weeks of pregnancy and underwent cesarean section delivery.

Four months after angioembolization, she had a recurrence of the left flank pain associated with gross hematuria and hypovolemic shock. The patient underwent emergency renal exploration of the left kidney via a transabdominal approach. Three liters of hemoperitoneum and a large expanding left retroperitoneal hematoma were noted intraoperatively. Early vascular control before nephrectomy of the left kidney was done. The postoperative course was unremarkable and the patient was discharged with improved condition.

This case displays a unique course in the management of a bleeding angiomyolipoma especially during pregnancy. Renal angioembolization can aid in achieving the age of viability in pregnancy. However, close monitoring for rebleeding should be kept in mind. A lower threshold for conservative management should be utilized when patients have a previous history of bleeding.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdomen ; Anemia ; Angiomyolipoma ; Arteries ; Blood ; Blood Transfusion ; Cesarean Section ; Conservative Treatment ; Emergencies ; Female ; Flank Pain ; Hematocrit ; Hematoma ; Hematuria ; Hemoperitoneum ; Hemorrhage ; History ; Hypovolemia ; Insemination, Artificial, Heterologous ; Kidney ; Life ; Nephrectomy ; Pain ; Patients ; Pregnancy ; Recurrence ; Renal Artery ; Research Report ; Sclerosis ; Shock ; Syndrome ; Tuberous Sclerosis ; Watchful Waiting

Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is a mesenchymal tumor which lies along the spectrum of smooth muscle neoplasm of the uterus. This type of neoplasm has morphologic features intermediate between the benign leiomyoma and the malignant leiomyosarcoma but is characterized by distinct pathologic findings. STUMPs are rare and standardized treatment for these neoplasms remains to be controversial as its behavior and clinical course is unpredictable and response to various treatments remains to be challenging up to this time. Due to the rarity of these cases, consensus on the standardized treatment on the best surgical approach and adjuvant therapy has not been reached. This study presents a 40-year-old nulligravida who had initial surgical resection of uterine mass but had recurrence of a suprapubic mass with complete treatment of eight cycles of doxorubicin and now presenting with stable disease.

Human ; Doxorubicin ; Prognosis ; Recurrence

OBJECTIVES: The overall survival of pediatric acute leukemia improved to >90% in developed countries with chemotherapy but relapse rates still remain at 10% to 20% in developed countries. This study aim to determine the risk factors for relapse in pediatric Standard Risk B Cell ALL. Specifically to describe and compare the socioclinical profile of patients under the relapse and non relapse group.

MATERIALS AND METHODS: Medical records of all children diagnosed with B Cell ALL were reviewed. Demographics and clinical data of patients who relapsed were compared to those who did not. The timing, site and outcome of patients who relapsed were noted. Risk factors for relapse were determined by logistic regression analysis to identify risk prognostic factors of relapse.

RESULTS: A total of 226 patients were included with 58 patients who relapsed and 168 who did not relapse. The mean age of diagnosis in both groups were 4y/o. Majority of the relapsed patients were male 35 (60%) and from outside NCR 35 (60%). Among the risk factors evaluated only the duration of chemotherapy induced agranulocytopenia of > 7 days was identified to be significant risk factor
for relapse, p value 0.001.

CONCLUSIONS: The present study determined that > 7 days duration of chemotherapy induced agranulocytopenia is a significant risk for relapse. Future studies with a larger population should be conducted to determine the factors for prolonged chemotherapy induced agranulocytopenia resulting to therapy interruptions that compromises treatment outcome. Cytogenetic and molecular approaches for relapsed ALL would help improve treatment strategies for these patients.

Human ; Male ; Female ; Child Preschool: 2-5 Yrs Old ; Bone Marrow ; Recurrence ; Drug Therapy ; Leukemia ; Diagnosis ; Survival

Objective:To retrospectively analyze the clinical features and surgical efficacy of congenital cholesteatoma （CC） and acquired cholesteatoma （AC） in children. Methods:Clinical data of 169 children with middle ear cholesteatoma were reviewed in the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University from January 2010 to July 2020. The clinical characteristics, stages, surgical methods, and postoperative recurrence rates were analyzed and summarized. Results:The age distribution of enrolled children ranged from 2 to 14 years. The mean age of the CC group was （5.60±2.48） years compared with （6.45±2.48） years in the AC group, and the difference was statistically significant （P<0.05）. Preoperative hearing in the CC group was （40.06±13.52） dB HL, which was better than in the AC group at （48.40±13.84） dB HL （P<0.05）. The proportion of stage Ⅰ in the CC group was lower than that in the AC group according to EAONO/JOS staging （P<0.05）. The recurrence rate after primary surgery was 19.23% （10/52） in the CC group compared with 36.29% （45/124） in the AC group （P<0.05）. The mastoid retention rates after all operations were 28.85% （15/52） in the CC group and 5.65% （7/124） in the AC group （P<0.05）. Conclusion:Compared with congenital cholesteatoma, acquired cholesteatoma in children is more aggressive and has more complications, higher postoperative recurrence rate, and less possibility of mastoid retention. Early clinical detection and treatment are required, and canal wall-down tympanoplasty should be considered in surgery.
Humans ; Cholesteatoma, Middle Ear/congenital* ; Child ; Retrospective Studies ; Child, Preschool ; Adolescent ; Male ; Female ; Recurrence ; Cholesteatoma/congenital* ; Tympanoplasty ; Treatment Outcome

Objective:To explore relevant factors to accurately diagnose BPPV in vertigo children. Methods:A retrospective study was conducted on the proportion of BPPV in children（<18 years） with vertigo who visited the Hearing and Vertigo Diagnosis and Treatment Center of Tianjin Medical University General Hospital from September 2017 to August 2023. The clinical characteristics of BPPV children, including general demographics, medical history, first visit department, comorbidities, canal involvement, response to treatment, and incidence of recurrence, were analyzed. Data analysis was conducted using SPSS 25.0 software. Results:BPPV was diagnosed in 22.8% of patients seen for vertigo during the study period. There are differences in the proportion of BPPV diagnosis among children with dizziness in different age groups（P<0.05）, and the diagnosis of BPPV in the 7-12-year-old group has a longer disease course than in the 13-17-year-old group（P<0.05）. 72.3%（47/65） of patients or their families were able to provide a typical history of positional vertigo. 49.2%（32/65） of BPPV patients had comorbidities, and there were differences in the proportion of comorbidities among different age groups of BPPV patients（P<0.05）. With the progress of study, the proportion of BPPV in children with vertigo has shown an upward trend, and the proportion of children with otolaryngology as the first diagnosis department has also increased（P<0.05）. The proportion of horizontal semicircular canals in children with BPPV has increased. All BPPV patients underwent canalith repositioning maneuvers, with good treatment outcomes and a recurrence rate of 12.3%（8/65）. The recurrence rate in the group of BPPV patients with comorbidities was 21.9%, which was higher than that in the group without comorbidities（P<0.05）. Conclusion:Childhood BPPV has clinical characteristics such as unclear medical history, high proportion of comorbidities, easy recurrence in BPPV children with comorbidities and high proportion of horizontal semicircular canal involvement. For children diagnosed with other vertigo diseases, do not ignore the BPPV diagnostic test. It is recommended to perform routine position tests on children with vertigo if conditions permit to reduce missed diagnosis of BPPV in children.
Humans ; Benign Paroxysmal Positional Vertigo/diagnosis* ; Child ; Retrospective Studies ; Adolescent ; Female ; Male ; Recurrence ; Vertigo/diagnosis* ; Comorbidity ; Child, Preschool

The patient, a 10-year-old and 4-month-old boy, was admitted to the hospital "with a history of 19 days since tonsil surgery and 11 days of recurrent hematemesis". 19 days ago, bilateral endoscopic tonsil + adenoid plasma melting and bilateral tonsil fossa inferior pole suture were performed in the outer hospital, and recurrent hematemesis occurred 11 days ago, accompanied by transient fatigue and abdominal pain, diagnosis: ①Hematemesis to be investigated: postoperative tonsil bleeding? Upper gastrointestinal bleeding?②Acute moderate hemorrhagic anemia. On the first and third days of admission, the child had two sudden episodes of massive hematemesis, both of which were more than 1 000 mL, with pale lips, fatigue, and hemorrhagic shock. Bleeding was rapid and can terminate spontaneously, and emergency physical examination does not reveal a clear point of bleeding. Bilateral inferior pole sutures in the tonsillar fossa are in place. There were no obvious abnormalities in the emergency digestive endoscopy, no obvious bleeding points were detected in the tonsils and adenoids surgical area, and no obvious abnormalities were found in the neck CT angiography（CTA）. Emergency DSA-guided percutaneous selective external carotid artery intervention was performed, during which about 5 mm contrast agent overflowed at the origin of the facial artery, and a coil was implanted. The child had no active bleeding after the operation, and his life was as usual at 2 months of follow-up.
Humans ; Male ; Child ; Tonsillectomy/adverse effects* ; Postoperative Hemorrhage/therapy* ; Palatine Tonsil/surgery* ; Recurrence

Objective:To explore the clinical manifestations, recurrence factors, and outcomes of revision surgery for recurrent thyroglossal duct cysts and fistulas in children. Methods:A retrospective study was conducted on the clinical manifestations, the relationship between cysts/ fistulas and residual hyoid bone of 10 patients with recurrent thyroglossal cysts and fistulas admitted to our hospital from July 2015 to July 2023, as well as the methods and effects of revision surgery. Results:The recurrence time after the initial surgery was between 7 months and 6 years, with an average of 2 years and 1 month.Clinical manifestations: 50%（5 cases） of patients have recurrent cysts near the incision, 40%（4 cases） had recurrent infections at the incision and eventually form fistulas, and 10%（1 case） experienced sleep snoring and pharyngeal trouble, were diagnosed with lingual thyroglossal duct cyst through laryngoscopy. All cysts or fistulas are connected to residual hyoid bodies, and three cases have intact hyoid bodies.Revision surgery: Nine cases underwent modified Sistrunk surgery, removing cysts, fistulas, and residual hyoid bodies. Suspension laryngoscopy and coblation were employed to treat the lingual thyroglossal duct cyst. After the revision surgery, follow-up was conducted for 8 months to 3 years, and no recurrence was found. Conclusion:All recurrences of thyroglossal duct cysts in this study were associated with residual hyoid bodies. Therefore, for thyroglossal duct cysts or fistulas, whether it is the first surgery or a revision surgery, it is recommended to choose the optimized Sistrunk operation, with the key point being complete resection of the hyoid body. Cases with lingual thyroglossal duct cyst can be treated with suspension laryngoscopy by coblation. Whether to remove the residual hyoid body requires further observation.
Humans ; Thyroglossal Cyst/surgery* ; Retrospective Studies ; Recurrence ; Reoperation ; Fistula/surgery* ; Child ; Hyoid Bone/surgery* ; Male ; Female ; Treatment Outcome ; Laryngoscopy ; Child, Preschool