Multiple myeloma(MM)remains an incurable disease,with most patients experiencing multiple relapses before ultimately progressing to refractory stage.Extramedullary infiltration is a common manifestation of relapse.However,distinguishing synchronous multifocal extramedullary infiltration from secondary malignancies poses significant diagnostic challenges.This study presents a case of relapsed refractory MM with multifocal extramedullary infiltration,diagnosed as coexistence of multiple myeloma extramedullary infiltration and pulmonary adenocarcinoma through multidisciplinary team(MDT)collaboration.Such coexistence is exceedingly rare in clinical practice and introduces substantial complexity in diagnosis and treatment planning.Through a comprehensive case report and literature review,this paper explores the diagnostic and therapeutic approaches to managing multifocal extramedullary infiltration coexisting with secondary malignancies in MM,highlighting the pivotal role of MDT in achieving precise diagnosis and optimizing patient outcomes.

Multiple myeloma(MM)remains an incurable disease,with most patients experiencing multiple relapses before ultimately progressing to refractory stage.Extramedullary infiltration is a common manifestation of relapse.However,distinguishing synchronous multifocal extramedullary infiltration from secondary malignancies poses significant diagnostic challenges.This study presents a case of relapsed refractory MM with multifocal extramedullary infiltration,diagnosed as coexistence of multiple myeloma extramedullary infiltration and pulmonary adenocarcinoma through multidisciplinary team(MDT)collaboration.Such coexistence is exceedingly rare in clinical practice and introduces substantial complexity in diagnosis and treatment planning.Through a comprehensive case report and literature review,this paper explores the diagnostic and therapeutic approaches to managing multifocal extramedullary infiltration coexisting with secondary malignancies in MM,highlighting the pivotal role of MDT in achieving precise diagnosis and optimizing patient outcomes.

Objective To investigate epigenetic inactivation of SPOCK2 gene in the malignant transformation of ovarian endometriosis ( EM ) by comparing the methylation status and protein expression of SPOCK2 gene in the malignant tissues,ectopic endometria and the eutopic endometria of endometriosis.Methods From Jan.2005 to Jan.2011,22 paraffin-embedded specimens diagnosed as malignant transformation of ovarian endometriosis ( EAOC ) including 11 cases with ovarian endometrioid carcinoma,8 cases with clear cell carcinoma,2 cases with serous cystadenocarcinoma and 1 case with mucous cystoadenocarcinoma matched with 22 cases with ovarian endometriosis and 16 cases with normal endometrium form cervical intraepithelial neoplasia(CIN) patients as controls in Department of Obstetrics and Gynecology of Shengjing Hospital.Twenty-two malignant tissues,15 ectopic endometria and 10 eutopic endometria were captured by microdissection in EAOC group; 22 eetopic endometria and 17 eutopic endometria were captured in EM group; 22 endometrium were captured in the NE group.The methylation statue of SPOCK2 was determined by combined bisulfite restriction analysis,and the protein expression of SPOCK2 was evaluated by immunohistochemistry.Results ( 1 ) Methylation of SPOCK2:in the EAOC group,the frequency of SPOCK2 hypermethylation in malignant tissue was 45％ (10/22),which was significantly higher than 1/15 in the ectopic endometrium (P＜0.05).There was no statistical difference of the frequency of SPOCK2 hypermethylation in ectopic endometrium in the EAOC group(1/15) and EM group (5％,1/22) (P＞0.05).(2) SPOCK2 protein:the loss rate of SPOCK2 was 44％ (11/22) in malignant tissue in EAOC group,which were significantly higher than 2/15 of in ectopic endometrium of EAOC (P ＜ 0.05).However,there was no remarkable difference in loss rate of SPOCK2 protein between ectopic endeometrium of EAOC and endometrium of EM [ 2/15 vs.5％ ( 1/22 ),P ＞ 0.05 ].No significantly difference in loss rate of SPOCK2 in eutopic endometrium was observed among three groups ( P ＞ 0.05 ).(3) The abnormal methylation of SPOCK2 could lead to loss expression of protein ( P ＜ 0.05 ).Conclusion Epigenetic inactivation of SPOCK2 gene is involved in the malignant transformation of ovarian endometriosis.

Objective To compare the clinical features and results between transperitoneal laparoscopic radical prostatectomy and extraperitoneal laparoscopic radical prostatectomy.Methods Thirty-three prostate cancer patients treated with laparoscopic radical prostatectomy. Among them,21 cases had been done transperitoneally and 12 cases had been done extroperitoneally. The two different approaches were evaluated and compared in respects of operating time, estimated blood loss, complications during surgery, postoperative complications, intestinal function recovery time, catheterization time and length of hospital stay.Results All the surgeries had completed successfully without conversion to open surgery. For transperitoneal approach and extraperitoneal approach, the operating time was (299±46)min and (309±64)min, blood loss was (618±448)ml and (677±469)ml. There were 3 cases with severe blood loss, 2 cases with bladder injuries and 1 case with ureteral injury in transperitoneal approach group. There were 1 case with severe blood loss, 1 case with obturator never injury, 1 case with cysto-ureteral injury and 1 case with peritoneum injury in extraperitoneal approach group. For transperitoneal approach and extraperitoneal approach,the catheterization time was(14.6±3.8)d and (12.3±2.9)d, intestinal function recovery time was (2.7±0.7)d and (2.1±0.5)d, length of hospital stay was (17.0±3.6)d and (11.2±3.5)d, respectively.Conclusions Laparoscopic radical prostatectomy is feasible and safe in clinical practice. Extraperitoneal approach has better vision, less impact on abdominal organs, faster recovery and shorter hospital stay comparing to transperitoneal approach.

OBJECTIVETo evaluate the value of percutaneous vasography in the diagnosis of the disorders of the seminal duct system.

METHODSPercutaneous vasography was performed successfully in 63 male patients (24 cases of infertility, and 21 hemospermia, 16 chronic prostatitis, and prostate carcinoma) from November 1974 to December 2003.

RESULTSVasography revealed abnormal ducts in 28 and disorders in 38 (60.3%), including 8 cases of sterility, 13 seminal vesiculitis, 16 chronic prostatitis 5 seminal vesical cyst, and 2 prostate carcinoma.

CONCLUSIONPercutaneous vasography is an effective method to identify diseases of the seminal vesical and ductal system.

Adult ; Aged ; Ejaculatory Ducts ; diagnostic imaging ; Genital Diseases, Male ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Radiography ; methods ; Seminal Vesicles ; diagnostic imaging ; Vas Deferens ; diagnostic imaging

Objective To study the feasibility of transperitoneal laparoscopic radical prostatectomy. Methods Laparoscopic radical prostatectomy was performed according to Montsouris technique. Results All the operations were successfully completed. The operating time was 330~540 min (mean, 433 min) and the estimated blood loss was 100~550 ml (mean, 274 ml). No patients required a blood transfusion. Bladder injury was found in 1 patient and was sutured promptly during the operation. The postoperative hospital stay was 15~23 days (mean, 17 days). The catheterization time was 14~23 days (mean, 16 days). In 2 patients presenting with urinary leakage, the catheter was removed at 20 and 23 days after surgery respectively, while in the remaining 8 patients, at 2 weeks after operation. Mild urinary incontinence occurred in 3 patients and disappeared after 4 weeks of supportive treatment. Pathological examinations revealed stage pT_ 1c) in 3 patients, stage pT_2 in 6, and stage pT_3 in 1. A follow-up for 3~21 months (mean, 7.5 months) was carried out. The postoperative prostate-specific antigen (PSA) level was 0~2.70 ?g/L(mean,0.05 ?g/L). Two patients returned a normal sexual function. Conclusions Strict following surgical indications, adequate preoperative preparation, improvement of surgical techniques, and proper application of surgical instruments and devices make transperitoneal laparoscopic radical prostatectomy feasible.