Objective:To investigate the clinical, pathological and immunophenotypic features, and differential diagnosis of angioimmunoblastic T-cell lymphoma (AITL) with B-cell proliferation or neoplasms.Methods:Eight qualified cases were collected from the Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China from January 2019 to July 2023. One case was diagnosed with AITL and diffuse large B-cell lymphoma (DLBCL) and the other seven cases were diagnosed with AITL and B-cell proliferation. Clinical characteristics and pathological morphology were summarized. Immunohistochemical analysis, fluorescence in situ hybridization and gene rearrangement detection were performed.Results:The patients′ average age was 58 years. Five of them were male. Biopsies of the enlarged cervical lymph nodes showed structural destruction and exhibited various histologic patterns. Some cases revealed Burkitt-like morphology, a moderate tumor volume and slightly irregular nuclei. Some cases showed prominent nucleoli. High endothelial venules and expanded follicular dendritic cells were detected. Tumor cells derived from T-follicular helper (TFH) cells were positive for two or more TFH biomarkers. Nodular or diffuse patchy proliferation of B cells was noted around the tumor tissue, which was initially considered as B-cell lymphoma. All of the 8 cases showed monoclonal rearrangements of the T-cell receptor genes while 5 of them also showed clonal rearrangements of the Ig genes. Seven of the 8 cases were subject to the detection of C-MYC gene breakage and were all negative. EBV-positive cells were seen in 6 cases. Neoplastic B cells were positive for C-MYC (>40%), while proliferative B cells were negative for C-MYC (<40%).Conclusions:The histological morphology of AITL with B-cell proliferation or lymphoma may be different from AITL. An integrated analysis, incorporating clinical, morphologic, immunophenotypic, and molecular assessment, helps reach an accurate diagnosis. This group of cases demonstrated the clinical and pathological characteristics of AITL accompanied by B-cell proliferation and B-cell lymphoma. The findings suggest that C-MYC maybe a feasible indicator for distinguishing B-cell proliferation from B-cell lymphoma, and provide a simple and feasible immunohistochemical marker for the diagnosis and research of composite lymphoma.

Objective To investigate the prevalence and endoscopic detection rate of proximal serrated polyps and to screen the risk factors. Methods The data of 9010 colonoscopies performed by 22 endoscopists between September 2016 and September 2017 were reviewed. The adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSDR) were calculated, and the correlation between ADR and PSDR was estimated by Pearson correlation coefficients. Multivariate logistic regression was used to analyze PSDR among endoscopists. Results For all subjects, the mean ADR was 30. 07％ ( ranged from 20. 00％ to 40. 78％) and mean PSDR was 4. 70％ ( ranged from 1. 52％ to 9. 28％) . PSDR of males was 1. 38 times of that of females ( OR=1. 38, 95％CI:1. 13-1. 69, P<0. 01) . For 3560 cases ( 39. 51％) of 50 years and older subjects, the mean ADR was 45. 01％ ( 28. 99％-57. 78％) and mean PSDR was 6. 08％(2. 07％-10. 56％). PSDR was moderately correlated with ADR (r=0. 48, P=0. 02). PSDR of males was 1. 36 times of that of females (OR=1. 36, 95％CI: 1. 04-1. 80, P=0. 03). Endoscopist was a significant risk factor for detection of proximal serrated polyps ( P<0. 01) . Compared with endoscopist with the highest PSDR, odds ratio of other endoscopists ranged from 0. 16 (95％CI:0. 06-0. 40, P<0. 01) to 0. 83 (95％CI:0. 53-1. 32, P=0. 44) . Conclusion Proximal serrated polyps are more common in males, who are over 50 years old. The PSDR is highly variable and dependent on endoscopists. It is possible that a certain proportion of proximal serrated polyps are missed during colonoscopy.

Objective To assess the clinical effects of simethicone emulsion combined with polyethylene glycol on bowel preparation for colonoscopy. Methods Two hundred out-patients, who underwent colonoscopy,were randomly divided into the study group and the control group. The study group was given simethicone in addition with polyethylene glycol, and the control group was given polyethylene glycol only. The differences on bowel preparation scores, air bubble reduction rate, colon lens sharpness, ileocecal region arrival time, colon polyp detection rate, the number of colon poly detection, and adverse event rate between the two groups were compared. Results The air bubble reduction rate, colon lens sharpness score and ileocecal region arrival time of the study group was 1(0-3)score,1.0(0-2)score,and 9(5-21)min,respectively,which was 2(1-3)score,1.5(0-2)score and 12(6-22)min, respectively in the control group. Differences between the two groups were statistically significant(Z=-9.490,P=0.000;Z=-6.768,P=0.000;Z=-5.521,P=0.000). For the bowel preparation score, colonoscopy polyp detection rate,the detection rate of colon polyp of diameter less than 5 mm, and number of colonoscopy polyp detection,there was no statistical difference between the two groups(P>0.05). No adverse events were observed in the both two groups. Conclusion The bowel preparation using simethicone combined with polyethylene glycol could effectively decrease the number of air bubble, enhance colon lens sharpness and shorten operation time,which contributes significant improvement for colonoscopy quality.

Purpose To identify the role of tyrosine kinase receptor Axl for anti-apoptosis which was induced by cisplatin (DDP) and methotrexate (MTX) chemotherapy and to analyze the relationship between P-Axl and apoptosis-related proteins in osteosarcoma.Methods Osteosarcoma cell lines MG63,143B and U2OS were used in apoptosis assays,Axl siRNA transfection,cytotoxicity assays,cell cycle analysis,etc.A total of 41 cases of osteosarcom patients were included for immunohistochemistry of EnVision two-step staining and clinico-pathological relative analysis.TUNEL assay was performed in ten cases for apoptosis detection.Results Among the osteosarcoma cell lines,Gas6/Axl could obviously protect tumor cells from apoptosis induced by DDP and MTX (P ＜ 0.05).Axl siRNA transfection enhanced cell apoptosis,whereas Gas6 prone to function upon previous knockdown by Axl siRNA.Among the 41 cases,the positive rate of P-Axl,BCL-2,and Bax was 85.4％,70.7％,and 36.6％,respectively.In contrast,the positive rate of them was 22.2％,11.1％,and 11.1％ in osteofibrous dysplasia,respectively.The expression levels of these apoptosisrelated factors were significantly higher in osteosarcoma than in osteofibrous dysplasia (P ＜ 0.05).Through clinico-pathological analysis,there were significant relationships between the survival status and BCL-2 or Bax expression (P ＜ 0.05).Pearson correlation analysis demonstrated that BCL-2 was positively correlated to P-Axl with statistical significance (r =0.842,P ＜ 0.0001).By Cox univariate analysis,BCL-2 or Bax was correlated with the patients' prognosis.TUNEL assay also demonstrated that P-Axl high expression inhibited apoptosis in osteosarcoma tissues.Conclusion Gas6/Axl protects osteosarcoma cells from the apoptosis induced by DDP and MTX chemotherapy and inhibits apoptosis in osteosarcoma tissue,possibly through the regulation of apoptosis-related protein BCL-2.

Objective To investigate the clinicopathologic characteristics and relevance of main and minor lesions of synchronous multiple early gastric cancers ( SMEGC) and gastric high grade intraepithelial neoplasia ( GHGIN) . Methods Thirty-two patients with SMEGC or/and GHGIN who were diagnosed and treated with endoscopic submucosal dissection in Nanjing Drum Tower Hospital from July 2012 to September 2016 were enrolled in this study. Their clinicopathologic characteristics were summed up, and the correlation between main and minor lesions on the size, location, endoscopic classification, pathologic type, invasion depth and vascular invasion were analyzed. Results Among the 32 patients, with mean age of 66. 19±7. 46 years, 90. 62％(29/32) were male, 17 cases (53. 3％) had family history of gastric cancer, 25 (78. 13％) had smoking history, and 22 ( 68. 75％) were alcohol users. There were 30 cases ( 93. 75％) and 31 cases ( 96. 88％) with mucosal atrophy and intestinal metaplasia, respectively. The size of main and minor lesions showed a positive correlation (r=0. 4167, P=0. 018). The endoscopic classification of major and minor lesions had no statistical significant consistency ( P=0. 314 ) , but the pathologic type and invasion depth between major and minor lesions demonstrated a moderate significant positive correlation ( P<0. 05 ) . The comparison of location between the main and minor lesions did not show correlation. However, it showed a significant correlation between major lesion which on the upper 1/3 of stomach and minor lesion on the lower 1/3 of stomach ( r=0. 463,P=0. 003) . Further more, when the main lesion was at posterior gastric wall, the minor lesions on lesser curvature were increased, which showed a positive correlation( r=0. 417,P=0. 009) . Conclusion Old-age male with long-term smoking and alcohol history whose lesions combined with surrounding mucosa merger atrophy and intestinal metaplasia are considered as a high risk group in patients with SMEGC or/and GHGIN. Therefore, clinicians must keep high vigilant and make carefully observations on this group of patients during endoscopic examination, and consider the correlation between main and minor lesions to avoid misdiagnosis.

Objective To study the risk factors for pathological upgrading after diagnosis of esophageal low?grade intra?epithelial neoplasia with ESD preoperative biopsy. Methods The endoscopic and pathological data of 85 lesions with ESD preoperative biopsy were analyzed, and grouped based on pathological upgrading after ESD. The risk factors for pathological upgrading after ESD was studied through single and multiple factor analysis. Results Pathological upgrading occurred in 45(52?94%) lesions after ESD, among whom 38 lesions developed up to high?grade intra?epithelial neoplasia and 7 lesions developed to esophageal early cancer. NBI?ME was performed on 37 patients and the accuracy of detecting the pathological invasion was 83?8%(31/37).Multi?factor analysis showed that reddish surface(OR=9?478, 95%CI:2?775?32?368, P = 0?000 3 ) and nodular lesion ( OR = 15?628, 95%CI:1?475?165?617, P =0?022 5) were independent factors for pathological upgrading after ESD. Conclusion Pathological upgrading of low?grade intra?epithelial neoplasia was common, especially esophageal mucosa with red surface and nodular lesion.Biopsy combined with NBI?ME is of significant importance to improve diagnostic accuracy.

Objective To identify the risk factors for positive resection residues after endoscopic submucosal dissection ( ESD ) of early esophageal squamous carcinomas and precancerous lesions. Methods A retrospective analysis was performed in 315 patients with early esophageal squamous cancer and precancerous lesion who underwent ESD. The pathological features of all resection margins in the specimen and the follow?up outcome of the patients with positive resection margin were evaluated. Univariate and multi?variate analysis were used to determine the risk factors for resection margin residues after ESD. Results In 315 lesions,there were 290 lesions with negative resection margins and 25 with positive resection margins.The number of lesions with positive lateral, basal, or both resection margins was 13, 8, and 4, respectively. Multivariate analysis showed that the depth of invasion( submucosal layer invasion, P=0?048) was the only independent risk factor for positive basal resection margin. The proportion of circumferential extension (≥3/4,P=0?014) and the depth of invasion( exceeding muscularis mucosa, P=0?007) were independent risk factors for positive lateral resection margin. Conclusion The diameter of the lesions and the depth of tumor invasion are independent risk factors for esophageal ESD positive resection margins. Accurate evaluation of lesion extension and invasive depth is critical to avoid residual or recurrent tumor after esophageal ESD.

Objective To evaluate the feasibility, efficacy, and safty of endoscopic submucosal dissection (ESD) in treatment of uppergastrointestinal ectopic pancreas. Methods 36 uppergastrointestinal ectopic pancreas were treated with ESD from January 1 2012 to November 30 2014. The definitive histological diagnosis of ectopic pancreas was made after the endoscopic treatment. We analyzed the operation method, dissected tissue, complication, retrospec-tively. Results 34 cases were located in stomach, the other 2 in duodenum. All cases underwent ESD, the mean op-erating time was 66 min. The mean dissected tissue diameter was 21 mm × 16 mm in the 36 cases. The curative re-section rate was 100.00 %. Bleeding rate of ESD was 2.77 %(1/36). Perferation rate of ESD was 2.77 %(1/36). 2 cases suffered from low grade fever. None need surgical intervention. Recurrence rate was 0.00%. Conclusions ESD is a minimally invasive technique that allows resection of whole lesions and provides precise histological information, which is particularly suitable for uppergastrointestinal ectopic pancreas.

Objective To investigate the clinical significance of the expression of microvessel density and adhesion molecules in the tissue of chronic gastritis and gastric cancer. Methods Fifty-six patients with chronic superficial gastritis (chronic superficial gastritis group), 55 cases of gastric cancer without lymph node metastasis (gastric cancer without lymph node metastasis group) and 57 patients with gastric cancer and lymph node metastasis (gastric cancer with lymph node metastasis group) were included in this study. Gastric pathology paraffin blocks was studied using immunohistochemical Envision method. Microvessel density CD34 and cell adhesion molecule Syndecan-1 expression was examined. In 112 gastric cancer patients, 47 patients were highly differentiated, and 65 patients were poorly differentiated. Results Microvessel density CD34 results:in chronic superficial gastritis group was (13 ± 10)/HP,in gastric cancer without lymph node metastasis group was (27 ± 11 VHP, in gastric cancer with lymph node metastasis group was (28 ± 10)/HP. There were significant differences between chronic superficial gastritis group and gastric cancer without lymph node metastasis group,and between chronic superficial gastritis group and gastric cancer with lymph node metastasis group (t = 7.044,7.908, P ＜0.05), but there was no significant difference between gastric cancer without lymph node metastasis group and gastric cancer with lymph node metastasis group (t = 0.506,P ＞ 0.05). In chronic superficial gastritis group, gastric cancer without lymph node metastasis group and gastric cancer with lymph node metastasis group, Syndecan-1 positive expression ratewas 96.43%(54/56),45.45%(25/55),24.56%(14/57),and there was significant difference between chronic superficial gastritis group and gastric cancer without lymph node metastasis group,and between chronic superficial gastritis group and gastric cancer with lymph node metastasis group (x2 = 163.560,17.197,P＜ 0.01). There was significant difference between gastric cancer without lymph node metastasis group and gastric cancer with lymph node metastasis group (x2 = 5.340, P ＜ 0.05). Conclusions Microvessel density is related with the occurrence of gastric cancer;adhesion molecule Syndecan-1 expression reduces the incidence of gastric cancer development, and might further promote the metastasis of gastric cancer. Detecting the expression changes of microvessel density CD34 and cell adhesion molecule Syndecan-1 facilitates the diagnosis and prognosis of gastric cancer.

Objective To investigate the expression of CD44v3 and VEGF-C in human gastric cancers and the clinical significance. Methods The expression of CD44v3 and VEGF-C was detected by immunohistochemistry SP method in 92 gastric cancer tissues. Results Positive immunohistochemical stain for CD44v3 was identified in 27.2% of gastric cancer tissues. There was no correlation found among the expression of CD44v3 with sex, location,depth of invasion, WHO type, Lauren type as well as distant metastasis (all P ＞ 0. 05 ). The expression of CD44v3 was positively correlated with lymph node metastasis and tumor differentiation( all P ＜ 0. 05 ). Positive immunohistochemical stain for VEGF-C was identified in 48.9% of gastric cancer tissues. There was no correlation found among the expression of VEGF-C with sex,location, tumor differentiation, depth of invasion, WHO type, as well as distant metastasis ( all P ＞ 0. 05 ). The expression of VEGF-C was positively correlated with lymph node metastasis and Lauren type ( all P ＜0. 05). Cox-Regression reflected that only the lymphatic metastasis situation correlated with the life ratio( P =0. 015). Conclusion The expression of CD44v3 and VEGF-C could suggest the progression and metastatic potential value of gastric cancer,but didnt correlate with the life ratio. There was no cooperation between CD44v3 and VEGF-C in promoting gastric cancer metastasis.