Metastatic renal cell carcinoma involving colon with unusual histologic features and diagnostic challenges: A case report

Introduction and importanceRenal cell carcinoma (RCC) accounts for 3% of all malignancies in adults, on its own being the 3rd most common urologic malignancy. Commonly RCC metastasizes to lung, bone, liver, brain but rarely to colorectum. Here we present the metastasis of RCC to colon with unusual histologic features.Case presentationA 40-year-old woman presented with abdominal pain and constipation. Colonoscopy showed an ulcerative mass 30 cm from anal verge. Subsequently, she underwent abdominoperineal resection of the involved portion of colon and the biopsy was sent to us for histopathological analysis. Grossly, it was a large fungating mass. Microscopic examination revealed a malignant neoplasm with polygonal cells, abundant eosinophilic cytoplasm, eccentric nuclei and prominent nucleoli. Immunohistochemistry confirmed the diagnosis of RCC.Clinical discussionColon rarely infiltrated by metastasis from RCC and so far, around 25 of such cases have been reported in the literature. Most common metastatic type of RCC to gastrointestinal tract is clear cell type. In our patient, the type of the metastatic RCC to colon was RCC with rhabdoid features. RCC with rhabdoid features is rare (3–5% of all RCC), but it is highly aggressive with higher chance of metastasis, extra renal invasion and poorer prognosis.ConclusionRCC should be considered as one of the differential diagnosis of colorectal cancers. Appropriate immunohistochemical workup would then reveal the correct diagnosis.     

前次妊娠期糖尿病临床特征对再次妊娠复发性糖尿病影响

目的:分析前次妊娠期糖尿病(GDM)的临床特征对再次妊娠糖尿病复发影响。方法:回顾性收集2017年1月-2019年10月本院产科常规产前检查且前次妊娠诊断为GDM的306例产妇临床资料,根据本次妊娠GDM诊断标准分为复发性GDM组与血糖正常组,再根据葡萄糖耐量试验(OGTT)各时间点血糖水平将复发性GDM组分为复发性GDM A组(单纯FPG异常)、复发性GDM B组(FPG正常但1hPG或/和2hPG异常)、复发性GDM C组(FPG异常,同时合并1hPG或/和2hPG异常)。比较各组前次妊娠临床特点与复发关系。结果:复发性GDM组与血糖正常组年龄、产次间隔≥5年比例、前次妊娠FPG、1hPG、2hPG值及OGTT异常类型比例、前次妊娠应用胰岛素比例均有差异(P<0.05),而前次妊娠前体质指数、妊娠期增重及早产发生情况无差异(P>0.05);年龄≥35岁、前次妊娠2hPG>9.10mmol/L、1hPG或(和)2hPG异常及FPG+1hPG或(和)2hPG异常是复发性GDM的危险因素(P<0.05),而产次间隔≥5年、前次妊娠OGTT FPG>5.35mmol/L、1hPG>10.59mmol/L、前次妊娠应用胰岛素与复发性GDM无相关性(P>0.05);复发性GDM C组与A组年龄、前次妊娠OGTT 1hPG、2hPG值有差异(P<0.05),而复发性GDM C组与B组、B组与A组比较无差异(P>0.05);复发性GDM A组、B组、C组前次妊娠OGTT异常类型构成比有差异(P<0.001),产次间隔时间≥5年、前次妊娠早产、应用胰岛素比例无差异(P>0.05);年龄≥35岁及前次妊娠FPG+1hPG或(和)2hPG异常是GDM复发时血糖异常类型高等级的危险因素(P<0.05),前次妊娠OGTT 1hPG>10.59mmol/L、2hPG>9.10mmol/L、前次妊娠1hPG或(和)2hPG异常与复发性GDM孕妇OGTT异常类型无相关性(P>0.05)。结论:孕妇年龄、前次妊娠OGTT 2hPG值及异常类型可能会影响再妊娠复发性GDM的发生率及严重程度。     

穿心莲内酯对TBHP诱导的椎间盘髓核细胞凋亡的作用及机制研究

目的：探讨穿心莲内酯（andrographolide,ANDRO）对叔丁基过氧化氢（tert-butyl hydroperoxide,TBHP）诱导的椎间盘髓核细胞（nucleus pulposus cells,NPC）凋亡的作用及其机制。方法：用TBHP诱导NPC建立细胞模型。将NPC分为5组：对照组、模型组（100μmol/L TBHP）、ANDRO低剂量组（100μmol/L TBHP+9μmol/L ANDRO）、ANDRO中剂量组（100μmol/L TBHP+18μmol/L ANDRO）和ANDRO高剂量组（100μmol/L TBHP+36μmol/L ANDRO）。流式细胞术检测细胞凋亡和活性氧（reactive oxygen species,ROS）水平,ELISA试剂盒检测氧化应激相关指标超氧化物歧化酶（superoxide dismutase,SOD）、谷胱甘肽过氧化物酶（glutathione peroxidase,GSH-PX）和过氧化氢酶（catalase,CAT）水平,JC-1探针法检测线粒体膜电位,Western blot检测动力相关蛋白1(dynam...     

The concept of distinct but voluminous groups of bipolar and unipolar diseases

Summary One hundred and six affective (76 unipolar and 30 bipolar) and 101 schizoaffective patients (45 unipolar and 56 bipolar) were investigated after a long-term course of illness, evaluating sociodemographic and general data, the long-term course of illness, disability and psychosocial alterations according to WHO/DAS, WHO/PIRS and GAS, as well as several social consequences of the illness (living situation at the end of the observation time, downward occupational drift, downward social drift, premature retirement, achievement of the expected social development). Comparing the 30 bipolar affective and 56 bipolar schizoaffective disorders, no differences were found regarding (a) sociodemographic and general data (i.e. sex distribution, age at onset, education and occupation at onset, stable heterosexual relationship, premorbid personality and social interactions, mental illness in the family, broken home, life events, season of birth and social classes) and (b) relevant patterns of the long-term course. Regarding long-term out-come the only difference found concerned the more favourable outcome of the bipolar affective disorders according to WHO/DAS, while using GAS the difference was not statistically significant. No difference was found either between the two bipolar groups in the social consequences of the illness. The combining of both bipolar groups as bipolar diseases is discussed, as well as the use of the terms bipolar disease, affective subtype and bipolar disease, schizoaffective subtype.     

Adenocarcinoma arising in Barrett's esophagus

A review of nine adenocarcinomas of the esophagus arising in Barrett's epithelium was undertaken. We found the disease among white males disproportionately. Risk factors and incidence rate remain to be clarified. Only one patient was in a surveillance program and only he had carcinoma discovered "early." He still survives while only one of the eight whose diagnosis followed investigation of symptoms remains alive.     

结直肠间质瘤临床病理特征及预后分析

目的 探究结直肠间质瘤预后相关因素,并通过列线图预测该肿瘤生存概率,为指导临床评估预后提供依据.方法: 通过监测流行病学和最终结果(surveillance, epidemiology, and end results, SEER)数据库获取1992年1月至2015年12月结直肠间质瘤临床病理及预后相关资料,对入组患者进行生存分析,将分析得到的独立预后因素绘制成列线图,之后采用校准曲线评估列线图预测生存准确性.结果: 546例结直肠间质瘤患者被纳入研究.中位发病年龄64岁,区域淋巴结转移率9.4%.546例患者多因素生存分析显示发病年龄 > 64岁,未婚/离婚,结肠间质瘤(与直肠间质瘤相比),非手术治疗,组织分化级别高,区域淋巴结转移及远处转移具有更差的肿瘤特异性生存和总生存(P均<0.05), 美国东部地区诊治患者比西部地区患者具有更长的总生存时间(P = 0.027),以上独立预后因素预测肿瘤特异性生存率和总生存率的C指数分别为0.76(95%CI: 0.72-0.80)和0.75(95%CI: 0.72-0.78).在174例组织分化级别和肿瘤部位明确的患者中,影响肿瘤特异性生存和总生存的独立预后因素为年龄,组织分化级别和是否行手术治疗(P均<0.05),而肿瘤部位仅与肿瘤特异性生存显著相关(P = 0.041),未证实与总生存显著相关(P = 0.057),采用这4个预后影响因素预测546例患者肿瘤特异性生存率和总生存率的C指数分别是0.71(95%CI: 0.66-0.75)和0.73(95%CI: 0.70-0.77), 能较准确预测结直肠间质瘤患者总生存率.结论: 结直肠间质瘤预后受多个临床病理因素影响,列线图能为预测结直肠间质瘤患者生存率提供依据.     

中医内科急症概论(上)

论述了急症的基本特点为大实大虚,邪正消长多变;多脏同病,但有主次先后;多病证,但又同中有异。急症的病机要点为：①内外合邪,因果夹杂;②病理因素责之风火（热）痰瘀,常可转化并见;③邪盛酿毒,有外受、内生之别;④邪实机闭是急症阴竭阳脱、气血消亡的基础;⑤病性多实,但常虑实夹杂;⑥病机之间的演变转化,可致多证相关。     

Dementia lacking distinctive histopathology: clinicopathological evaluation of 32 cases

We report the neuropathological findings in 32 patients, aged 46–86 years, with demential lacking distinctive histopathology. All of the patients were classified clinically as having Pick's or atypical Pick's disease, but the routine neuropathological evaluation showed no specific histopathological changes such as Pick bodies, senile plaques, neurofibrillary tangles or Lewy bodies. In 50% of the cases the first symptoms appeared before 65 years of age. However, there were 9 patients with onset in the eighth decade. Positive family history was found only in 6 presenile cases. The retrospective evaluation of the clinical records revealed the consistent presence of frontal symptomatology, including loss of personal awareness, inappropriate euphoria and stereotyped behavior. Speech disorders were observed in 80% of the cases, whereas temporospatial disorientation and memory impairment were less frequent. Praxis and gnosis were strikingly preserved in most of the cases. The macroscopic neuropathological examination revealed frontal or temporopolar atrophy in 97% of the cases, while the hippocampus and subcortical structures were relatively spared in the majority of the cases. Histologically, four groups were recognized. Group A showed moderate to severe neuron loss and gliosis in the frontal and/or temporopolar cortex without subcortical involvement. In group B, the neocortical cell loss was widespread, and the striatum and substantia nigra displayed differential degrees of gliosis but no neuron loss. Group C patients showed a lesion distribution comparable to that observed in group B but with severe neuron loss in at least one subcortical region. Four cases formed group D, which was characterized by the preservation of the pyramidal neurons in the neocortex and variable subcortical changes. Despite these differences in the topography of pathological changes, all of the cases shared a similar clinical profile. These findings further demonstrate the epidemiological and neuropathological heterogeneity of dementia lacking distinctive histopathology. Furthermore, they suggest that the same clinical manifestations may correspond to several distinct pathological processes in this condition.     

A study of comparison between the nationwide epidemiological survey in 1991 and previous surveys on behçet’s disease in Japan

The 4th nationwide epidemiological survey on Behçet disease (BD), which included all patients with BD at 1,200 hospitals selected at random from 10,081 hospitals in Japan, was carried out by the BD Research Committee of the Ministry of Health and Welfare in 1991 to examine the epidemiological features of BD in Japan by comparing with previous surveys. 3,938 patients from these hospitals were examined by the Japanese diagnostic criteria of BD (JCBD) revised in 1987 and the International criteria for classification of BD (ICBD). Among these 3,938 patients, 622 patients were only suspected of having BD or clinical signs of the disease were unknown, and most of these patients were incompatible with the ICBD. So these patients were excluded from the study of epidemiological features. The average patients age has risen 7–8 years over the last 20 years and the average age of onset in both sexes increased by about 3 years from 1972 to 1991. While a decrease in the sex ratio was seen in the complete-type and the incomplete-type BD without ocular symptoms, a sustained high sex ratio was shown in incomplete-type BD with ocular symptoms. The positive rate of HLA-B51 antigen was 54.9% (men: 56.9%, women: 52.2%) significantly higher than die 15–16% in healthy subjects but it might have been gradually decreasing. Also the clinical course of BD has become too mild for prognosis. According to diese epidemiological features of BD, the clinical manifestation of BD in Japan might have become the Western type of BD.