Sublingual Nodules: Diagnostic Markers of Metastatic Breast Cancer

Objective: To evaluate the diagnostic significance of sublingual nodules for metastasis of patients with breast cancer and further to explore the mechanisms of sublingual nodules. Methods: The image data of 117 in-patients with breast cancer in stage Ⅰ–Ⅳ in Tianjin Medical University Cancer Institute and Hospital from December 2009 to September 2011 were assessed retrospectively. All photos of patients' tongue were recorded by the digital camera of uniform type within 1 month after serological examination and regular re-examined by computed tomography(CT), magnetic resonance imaging and positron emission tomography CT. The presence of sublingual nodules was the positive standard. Chi square test and two-independent-sample test were used to determine the diagnostic value between the status of sublingual nodules and Clinico-pathological characteristics. The optimal cut-off of uric acid(UA) level to diagnose sublingual nodules was determined by receiver operating curve(ROC) analysis. Results: Breast cancer patients with sublingual nodules had a higher risk of recurrence and/or metastasis than patients without it(P0.001). Sublingual nodules was significantly correlated with increased serum UA level(P=0.001). The optimal cut-off value of UA level to diagnose sublingual nodules was 290 μmol/L. Furthermore, the elevated serum UA level( 290 μmol/L) was significantly related to breast cancer recurrence and/or metastasis(P0.001). Conclusions: Sublingual nodules were potential diagnostic markers for metastatic breast cancer. The formation of sublingual nodules was associated with elevated level of serum UA.     

The potential of carcinoembryonic antigen, p53, Ki-67 and glutathion Stransferase-π as clinico-histopathological markers for colorectal cancer

Objective： Colorectal cancer is one of the major contributors to cancer death worldwide. Lack of reliable colorectal cancer markers has hampered the management of these cancer patients. Our main purpose was to study the correlation between histopathological variables of colorectal adenocarcinomas and identify histopathological markers that are of prognostic value in patients with colorectal cancer. Methods： In the present study, we examined the expression of carcinoembryonic antigen （CEA）, p53, Ki-67 and glutathion Stransferase （GST） -n by using immunohistochemical staining methods in 126 colorectal carcinoma patients and evaluated the lymph node metastasis status in these patients by histopathological examination. Results： The positive rates of CEA, p53, Ki-67 and GST-π expression in the colorectal cancer tissue specimens examined were 95.23%, 55.56%, 53.38% and 82.30%, respectively. Expression of p53 and Ki-67 was significantly correlated with the Dukes stages of the tumor, with higher levels of these proteins in Dukes＇ C and D tumors than those in Dukes＇ A and B tumors. Furthermore, the expression of p53, GST-π and Ki-67 correlated with prognosis of patients with colorectal cancer. Additionally, the expression of p53 in colorectal cancer was closely related to the expression of Ki-67 and the expression of GST-π was directly correlated with that of p53. Conclusion： The expression of CEA, p53, Ki-67 and GST-π was correlated with various clinical features of patients with colorectal cancer. The combined use of these histopathological markers appeared to be a promising tool in predicting the prognosis of patients with this type of cancer.     

Cohort Study on the Effect of a Combined Treatment of Traditional Chinese Medicine and Western Medicine on the Relapse and Metastasis of 222 Patients with Stage Ⅱ and Ⅲ Colorectal Cancer after Radical Operation

Objective:To evaluate the effectiveness of a comprehensive therapy of traditional Chinese medicine(TCM)in reducing the relapse and metastasis of stageⅡandⅢcolorectal cancer based on conventional Western medicine(WM)therapy.Methods:Two hundred and twenty-two patients in total, diagnosed as stageⅡandⅢcolorectal cancer from February 2000 to March 2006,were recruited from Xiyuan Hospital,China Academy of Chinese Medical Sciences and the General Hospital of Beijing Military Area.They were followed-up once every 3-6 months.Twenty cases dropped out from the cohort.The remaining 202 patients were all treated with routine WM treatment [including R0 radical operation,or chemotherapy or/and radiotherapy according to national comprehensive cancer network(NCCN)clinical guidelines].These patients were assigned to two groups based on whether or not they were additionally treated with TCM comprehensive therapy(orally administered with a decoction according to syndrome differentiation,combined with a traditional patent drug over one year).Ninety-eight patients from Xiyuan Hospital were treated with WM and TCM(combined group),and 104 patients from the General Hospital of Beijing Military Area were treated with WM alone(WM group).The demographic data at baseline were comparable,including the operation times,age,sex,TNM staging,and pathological types.The patients were followed-up for one to five years.Up to now,there are 98,98,77,64,and 47 patients with 1,2,3, 4,and 5 years of follow-up in the combined group,respectively;and 104,104,97,81,and 55 patients in the WM group,respectively.The results of the 5-year follow-up of all the patients will be available in 2011. Results:The relapse/metastasis rate of 1-,2-,3-,4-,and 5-year were 0(0/98),2.04%(2/98),11.69% (9/77),14.06%(9/64),and 21.28%,(10/47)in the combined group,and were 4.80%(5/104),16.35% (17/104),21.65%(21/97),25.93%(21/81),and 38.18%(21/55)in the WM group,respectively.A significant difference was found in the second year between the two groups(χ~2=12.117,P = 0.000).Median relapse/ metastasis time was 26.5 months in the combined group and 16.0 months in the WM group.Conclusion: The combined therapy of TCM and WM may have great clinical value and a potential for decreasing the relapse or metastasis rate in stageⅡandⅢcolorectal cancer after conventional WM therapy.     

Clinical significance of B7-H3 expression on CD3 T cells in colorectal cancer

Background To investigate the expression of negative costimulatory molecule B7-H3 on CD3 T lymphocytes in colorectal cancer, and its relationship with clinic-pathological variables and patients’ prognosis. Methods The expression of B7-H3 was detected in 98 patients of colorectal cancer by using immunohistochemistry. Then the expression of B7-H3 was further conformed by flow cytometry on CD3 T lymphocytes isolated from the fresh cancer tissues of 12 colorectal cancer patients. Then analyzed the relationship between the expression of B7-H3 on CD3 T lymphocytes and patients’ clinic-pathological variables. Results The survival time of patients with more CD3 T cell infiltration are longer than those with less CD3 T cell infiltration(P<0.05), B7-H3 was highly expressed on the infiltrating CD3 T lymphocytes in colorectal cancer tissues. The expression of B7-H3 was found to be significantly related with the lymph node metastasis(P<0.05), but not with the patient's gender, age, tumor size, differentiation degree, depth of tumor invasion, Dukes' stage, distant metastasis and whether or not mucinous adenocarcinoma(P>0.05). Moreover, the survival time of patients with low expression of B7-H3 is longer than those of high B7-H3 expression patients, but the patients’ seven-year survival rate has no statistical difference between the high expression of B7-H3 and low expression of B7-H3(P>0.05). Conclusions The negative costimulatory molecule B7-H3 expresses on infiltrating CD3 T lymphocytes in colorectal cancer and plays an important role in lymph node metastasis and prognosis.     

Correlation between calcified liver metastases and histopathology of primary colorectal carcinoma in Chinese

The study examined the association between calcified liver metastases and the histopathology of the primary colorectal carcinoma in Chinese.The clinical,pathological and CT data were retrospectively analyzed in 210 patients (mean age:54.2 years) with liver metastases from colorectal carcinoma.Plain CT scanning and contrast-enhanced scanning were performed in all the patients.For the contrast-enhanced examination,iohexol was injected by using a high pressure syringe at a flow rate of 2.5-3.0 mL/s.The arterial phase lasted approximately 25 s and the portal venous phase about 60 s.All patients had no history of chronic liver diseases and had never received interventional treatments.χ 2-test was used to analyze the rate of calcification in the liver metastasis from colorectal cancer of different differentiation degrees.Among the 210 cases of liver metastases,22 patients (10.5%) were found to have calcified liver metastases on CT scan.Two patients with calcified liver metastasis received lumpectomy and developed calcification in recurrent tumors.Another two patients had calcification in newly developed tumor masses.And the calcification in the newly developed masses was similar to that of their primary counterparts in terms of morphology and distribution.On the enhanced CT scan,the tumors exhibited no enhancement during hepatic arterial phase and showed slight rim enhancement during portal venous scan in the 22 cases.The calcification became obscure on contrast-enhanced scans.Histopathologically,the primary tumors were well-differentiated adenocarcinoma in 6 cases,moderately-differentiated adenocarcinoma in 10,poorly-differentiated adenocarcinoma in 4 and mucinous adenocarcinoma in 2 among the 22 cases.No statistical correlation was noted between the incidence of calcified liver metastasis and the pathological subtypes and differentiation degrees of the primary colorectal carcinoma.It was concluded that calcified liver metastases may result from colorectal adenocarcinomata of different differentiation degrees or muc     

Effects of diabetes mellitus on prognosis of the patients with colorectal cancer undergoing resection: a cohort study with 945 patients

Background Diabetes mellitus plays an important role in cancer prevalence and outcomes. The aim of this study was to evaluate the influence of DM on stages and outcomes among patients with colorectal cancer.Methods The study enrolled 945 patients who were diagnosed as having colorectal carcinoma from August 1994 to December 2002. In the cohort, 26 patients were diagnosed as having DM. With a median follow-up of 45.8 months,differences in overall survival and disease-free survival between the diabetes and non-diabetes groups were analyzed.Results Kaplan and Meier analysis showed that there were no significant differences between the two groups in overall survival rates at 3 years or 5 years. At 5 years, patients with DM, compared with patients without diabetes, experienced a significantly lower disease-free survival rate （34.2% diabetics vs. 55.1% non-diabetics; P=0.025）.Conclusions DM was associated with an increased risk of recurrence in patients with colorectal cancer.     

Cohort Study on the Effect of a Combined Treatment of Traditional Chinese Medicine and Western Medicine on the Relapse and Metastasis of 222 Patients with Stage Ⅱ and Ⅲ Colorectal Cancer after Radical Operation

Objective： To evaluate the effectiveness of a comprehensive therapy of traditional Chinese medicine （TCM） in reducing the relapse and metastasis of stage Ⅱ and Ⅲ colorectal cancer based on conventional Western medicine （WM） therapy. Methods： Two hundred and twenty-two patients in total, diagnosed as stage Ⅱ and Ⅲ colorectal cancer from February 2000 to March 2006, were recruited from Xiyuan Hospital, China Academy of Chinese Medical Sciences and the General Hospital of Beijing Military Area. They were followed-up once every 3-6 months. Twenty cases dropped out from the cohort. The remaining 202 patients were all treated with routine WM treatment [including R0 radical operation, or chemotherapy or/and radiotherapy according to national comprehensive cancer network （NCCN） clinical guidelines]. These patients were assigned to two groups based on whether or not they were additionally treated with TCM comprehensive therapy （orally administered with a decoction according to syndrome differentiation, combined with a traditional patent drug over one year）. Ninety-eight patients from Xiyuan Hospital were treated with WM and TCM （combined group）, and 104 patients from the General Hospital of Beijing Military Area were treated with WM alone （WM group）. The demographic data at baseline were comparable, including the operation times, age, sex, TNM staging, and pathological types. The patients were followed-up for one to five years. Up to now, there are 98, 98, 77, 64, and 47 patients with 1, 2, 3, 4, and 5 years of follow-up in the combined group, respectively; and 104, 104, 97, 81, and 55 patients in the WM group, respectively. The results of the 5-year follow-up of all the patients will be available in 2011. Results： The relapse/metastasis rate of 1-, 2-, 3-, 4-, and 5-year were 0 （0/98）, 2.04% （2/98）, 11.69% （9/77）, 14.06% （9/64）, and 21.28% （10/47） in the combined group, and were 4.80%（5/104）, 16.35% （17/104）, 21.65% （21/97）, 25.93% （21/81）, and 38.     

Treatment outcomes of occult breast carcinoma and prognostic analyses

Background The surgical management of occult breast cancer is controversial.We compared the outcomes of different treatments of occult breast cancer and evaluated the potential prognostic factors for overall survival and recurrence.Methods We retrospectively reviewed 77 patients who presented to our hospital from 1968 to 2011 with a diagnosis of occult breast cancer.Patients were divided into three groups：42 patients （63％） were treated with modified radical mastectomy＋axillary lymph node dissection （ALND）,16 patients （24％） were treated with ALND＋postoperative radiotherapy,and 9 patients （13％） with only ALND.Survival analyses were undertaken to compare the efficacy of these three treatments.Results Of the 77 patients with occult breast cancer,2 patients were lost to follow-up and 8 patients refused surgical treatment：67 patients （90.4％） were included in this analysis.The median follow-up was 62.2 （0.6-328.0）months.Kaplan-Meier analyses showed no significant difference in overall survival and recurrence-free survival between the three groups （P=0.494 and 0.397,respectively）.The prevalence of local recurrence was 11.9％ for the mastectomy＋ALND,18.8％ for ALND＋radiotherapy,and 11.1％ for ALND-only groups,and those for distant recurrence were 2.4％,12.5％,and 11.1％,respectively.Compared with progesterone receptor-negative subjects,progesterone receptor-positive patients had better overall survival and lower recurrence rates （P=0.057 and 0.062,respectively）.Conclusions There was no significant difference in outcomes between mastectomy and breast-preserving surgery.Expression of the progesterone receptor should be taken into account when evaluating the prognosis of occult breast cancer.     

Breast

<正>209325 Clinical characteristics and survival in the operable breast cancer patients with different molecular subtypes/Zhang Huiming(张慧明,Dept Abdom Surg Oncol,Cancer Hosp(Inst),Chin Acad Med Sci Peking Union Med Col,Beijing 100021)…∥Chin J Oncol.-2009,31(6).-447～451Objective According to the immunohistochemical (IHC)test of ER,PR and HER-2,breast cancer can be divided into 4 different molecular subtypes:Luminal A subtype (ER or PR positive and HER-2 negative),Luminal B subtype (ER or PR positive and HER-2 positive),HER-2 sutype (ER and PR negative,HER-2 positive) and Basal-like subtype (ER,PR and HER-2 negative).This study was to analyze the clinical features of different breast cancer subtypes,and try to find the evidence of combined and individualized treatment for patients with breast cancer.Methods The data of 408 surgically treated breast cancer patients in the Cancer Hospital of Chinese Academy of Medical Sciences from January 1,2002 to December 31,2002 were collected and retrospectively analyzed.The clinicopathological features and recurrence,metastasis as well as survival of these four subtypes were compared.Results Of the 408 cases,Luminal A subtype accounted for 60.8% (248/408),Luminal Bsubtype 7.8% (32/408),HER-2 subtype 12.5%(51/408),and Basal-like subtype 18.9%(77/408).Basal-like subtype had less lymph mode metastases than other subtypes(P<0.05).HER-2 subtypes consisted of less patients aged 45 years or younger than other subtypes(P<0.05).Luminal B subtype contained less advanced cases than other subtypes(P<0.01).By August 2008,the median time of follow-up was 64 months (range,3-79 months).Fifty-eight cases presented local recurrence or metastasis,and 51 of them died of the disease.The 5-year overall survival rates (OS) for patients with Luminal A,Luminal B,Basal-like and HER-2 subtype were 89.83%,86.15%,79.85% and 86.70%,respectively.The 5-year disease-free survival (DFS) rates of the four subtypes were 83.52%,68.88% and 75.83%,respectively.The rate of local recur     

Proximal gastric cancer: lymph node metastatic patterns according to different T stages dictate surgical approach

Background As a common form of gastric cancer migration,lymph node metastasis largely affects the surgical treatment and prognosis of gastric cancer.Surgery is the fundamental curative option for gastric cancer that varies depending on different stages.The study aimed to compare the clinicopathological characteristics and lymph node metastatic patterns in patients of proximal gastric cancer with different T stages and investigate a reasonable radical gastrectomy approach in terms of the range of lymphadenectomy for proximal gastric cancer.Methods In our retrospective study,the data of 328 patients of proximal gastric cancer with different T stages were analyzed.By comparing the differences of lymph node metastatic rate and ratio,we investigated the clinicopathological characteristics and metastatic patterns of lymph nodes.Also,we were especially interested in the differences in survival rates between patients with and without No.5 and 6 group metastasis with the same TNM stage.Results The overall lymph node metastatic rate and ratio of advanced proximal gastric cancer were 73.4％ and 23.3％,respectively.The tumors of different T stages were statistically significant in size and differentiation degree （P ＜0.05）,multivariate analysis showed that the depth of tumor invasion was an independent risk factor for lymph node metastasis in proximal gastric cancer （RR,12.025; 95％ CI,2.326 to 62.157; P=0.003）.The overall survival rate of patients with No.5,6 group lymph node metastasis and those without was significantly different,but the differences in survival rates between patients with and without No.5 and 6 group metastasis with the same TNM stage were not statistically significant.Conclusions Different T stages in proximal gastric cancer showed different patterns and characteristics of lymph node metastasis.D2 lymphadenectomy in patients with early gastric cancer had little survival benefit because metastasis to level 2 nodes was rare.Therefore the range of the lymph node dissection in radical gastrectomy     

Ultrasound predictors of malignancy in indeterminate thyroid nodules

Background

Asymptomatic thyroid nodules are an increasingly common clinical problem. Lesions greater than a centimetre require cytological assessment. Indeterminate lesions often need surgical excision to establish a definitive diagnosis and plan further management. If a definitive diagnosis could be accurately predicted pre-operatively, the most appropriate surgical procedure could be performed at the initial operation.

Aim

The aim of this study was to identify whether specific thyroid ultrasound features could predict malignancy in indeterminate thyroid nodules.

Methods

A retrospective review of all patients undergoing surgery for an indeterminate thyroid lesion between 2006 and 2012 was performed. Demographic features, surgical intervention and final histological findings were determined. Pre-operative ultrasound findings and final histology were correlated and the ultrasonic markers predictive of malignancy were determined.

Results

A total of 40 patients were identified as having undergone surgical intervention for indeterminate thyroid nodules. The majority of patients were diagnosed with a follicular adenoma (n = 22; 55 %). Papillary thyroid carcinoma was identified in three patients (7.5 %) and follicular carcinoma in a further 3 (7.5 %). Ultrasound features associated with malignancy included poorly defined nodule borders and increased vascularity. The presence of malignancy was not related to nodule size, echogenicity or the presence of calcifications.

Conclusions

The majority of indeterminate thyroid lesions are benign on final histological assessment. High nodule vascularity associated with ill-defined borders is associated with malignancy. Further research is warranted to identify predictors of malignancy in indeterminate nodules in order to avoid unnecessary or repeated procedures.     

Prognostic implications of p53 and bcl-2 expression in 108 women with stage two breast cancer

Background

The mortality and morbidity of patients with breast cancer can vary even between individuals with similar histological stage at diagnosis. Identification of those individuals with prognostically poorer tumours is an essential prerequisite in planning adjuvant therapies. Some prognostic indices of tumour size, grade, oestrogen receptor status and nodal status are well established.

Aim

The aim of this study was to examine the prognostic role of information relating to proto-oncogene and tumour suppressor gene expression.

Methods

108 women with stage II breast cancer were studied. Tumour expression of p53 and bcl-2 were scored and then correlated with recurrence and mortality.

Results

We have shown that individuals poorly expressing bcl-2 in their tumours have a poorer disease-free and overall survival than those who express bcl-2. When p53 was strongly expressed, it was associated with poorer disease-free and overall survival.

Conclusion

The profiling of individual tumour genetic expression of proto-oncogenes may allow for more specific identification of patients at higher risk’ of recurrence in breast cancer.     

Pancreatic metastasectomy: experience of the Irish National Surgical Centre for Pancreatic Cancer

Background

Metastatic tumours of the pancreas are rare and the optimal management of these tumours remains unclear, given the paucity of data existing in the literature. We report our experience of pancreatic metastasectomy.

Methods

Data were reviewed on all patients who underwent pancreatic resection for pathologically confirmed metastatic lesions over a consecutive 7-year period.

Results

Seven patients (two men and five women) underwent a pancreatectomy for a metastatic pancreatic tumour. The primary tumours were renal cell carcinoma (n = 3), colorectal carcinoma (n = 2) and leiomyosarcoma (n = 2). There was no operative mortality. Postoperative morbidities occurred in two patients. The median follow-up was 49 months (range 17–76). Overall 1- and 2-year survivals were 100 and 86 %, respectively, with a 2-year disease-free survival of 72 %.

Conclusions

Our series further supports that pancreatic metastasectomy can be performed safely and achieves acceptable survival outcomes.     

Mid-term follow-up of stenting in chronic mesenteric ischaemia: a review of six cases

Background

Chronic mesenteric angina is a rare condition with high morbidity and mortality, which occurs due to stenosis or occlusion in the mesenteric vessels commonly due to atherosclerosis. Typically, patients present with worsening postprandial abdominal pain, chronic weight loss and fear of food. The condition can be treated by surgical bypass, but also by percutaneous transluminal angioplasty and stenting of the affected mesenteric arteries.

Aim

To assess the mid-term outcomes in patients treated by endovascular stenting for chronic mesenteric ischaemia (CMI).

Methods

Six patients were treated for symptomatic CMI. In total, six severely stenosed vessels were stented including the superior mesenteric artery (n = 5) and coeliac artery (n = 1). A retrospective review of these patients was performed with end points including symptom recurrence, major morbidity and mortality. The mean follow-up was 16.5 months (range 5–28 months).

Results

Initial clinical success was observed in all six patients. Four patients were clinically asymptomatic, but died within 18 months after the procedure from other conditions. One patient suffered from recurrence of symptoms. Only one patient died as a consequence of mesenteric artery re-stenosis.

Conclusion

Stenting of mesenteric vessels has shown excellent early and mid-term clinical success in selected patients. Though no direct comparison with open revascularization surgery was performed in this case series, technical and mid-term clinical success is promising.     

Clinical study on effect of shenbing mixture in reducing recurrence of simple nephrotic syndrome of children

Objective

To observe the effect of Shenbing Mixture (SBM) of the recurrence of simple nephrotic syndrome of children.

Methods

Sixty-eight patients treated with SBM combined with prednisone were observed and compared with those in the control group treated with prednisone alone.

Results

The 1-year recurrence rate of the treated group was 14. 3% , which was obviously lower than that in the control group (59.3%,P<0. 01). Serum level of Cortisol, IgG, IgA, CD₃, CD₄, CD₄/ CD₈ ratio and rosette formation rate of RBC-C₃b in patients before treatment were all significantly lower than normal range. After being treated with SBM combined with prednisone, the above-mentioned indexes were all improved significantly and close to normal.

Conclusion

SBM had obvious effect in reducing recurrence of nephrotic syndrome in children, the mechanism is closely related to multiple pathways, including adjustment of T-lym-phocyte dysfunction, improving humoral immunity and RBC immune function, and promoting the recovery of adrenal cortex function.     

Peripheral blood CD40–CD40L expression in human breast cancer

Background

Breast cancer is the most common cancer in women. T cell-based immunotherapy for cancer has attracted much attention recently. CD40 and CD40L occupy an important position of specific immune response. In this paper, we want to study the role of co-stimulatory molecules CD40/CD40L and their clinical significance in peripheral blood of patients with breast cancer.

Methods

Thirty breast cancer patients served as observation group, who were diagnosed as having infiltrating ductal breast cancer histopathologically, and 30 healthy as control group. Flow cytometric analysis was conducted to detect the expression of CD40 and CD40L on B and T lymphocytes in peripheral blood. The relationship between the CD40/CD40L expression levels and pathological grades was analyzed.

Results

The expression levels of CD40/CD40L on B cells and T cells in breast cancer patients were significantly higher than those in the controls (all P < 0.001), and CD40/CD40L levels had a significant positive relationship with pathological grades (all P < 0.001).

Conclusions

The upregulated levels of co-stimulators CD40/CD40L on B cells and T cells may play an important role in the immune pathogenesis of breast cancer.     

Life after the cancer strategy: analysis of surgical workload in the general hospital setting

Background

The National Cancer Strategy heralded a major reorganisation of the delivery of cancer services in Ireland. As a result of this policy, cancer care was centralised to eight centres. The impact of this strategy on hospitals no longer providing cancer services has not been analysed to date.

Aim

The aim of this study was to examine the impact of centralisation of cancer services on surgical workload at Mayo General Hospital.

Methods

Data pertaining to all surgical procedures performed in 2007 (prior to the introduction of the National Cancer Strategy) and 2011 were obtained using the Hospital Inpatient Enquiry system. Histopathology reports and theatre registers were also analysed to ensure accuracy of the data.

Results

The numbers of elective and emergency surgical admissions during 2007 and 2011 were broadly similar (2,581 vs. 2,662). One hundred and thirty-five oncological procedures (colorectal and breast) were carried out in 2007 compared with 50 (colorectal) in 2011. This represents a 63 % reduction in cancer surgery workload following the implementation of the National Cancer Strategy. There was a concomitant increase in surgery performed for benign conditions (laparoscopic cholecystectomy and hernia repair), which coincided with the innovative introduction of 43 ring-fenced surgical in-patient beds in June 2010.

Conclusion

This study demonstrates the impact of the centralisation of cancer services on surgical workload in a non-cancer centre. Our results show that there continues to be a role for general hospitals in the provision of elective surgical services. Hospital network arrangements have the potential to facilitate such developments.     

Laparoscopic adrenalectomy for a late solitary renal cell cancer metastasis to the ipsilateral adrenal gland

Background

Metastases to the adrenal gland are the second most common type of adrenal mass lesion after adrenocortical adenomas [1, 2]. However, less than 2% of those patients who develop a metachronous metastasis after resection of a primary renal tumour will present with a solitary adrenal tumour [3]. Most of these patients present within several years of the primary diagnosis [4].

Case report

A 66-year-old man with a history of left nephrectomy for renal cell carcinoma 18 years previously was investigated for recent weight loss. Computed tomography scanning identified a lesion in the ipsilateral adrenal gland. Hormonal investigations were consistent with a non-functioning mass. Magnetic resonance imaging and positron emission tomography scans suggested a malignant lesion. Laparoscopic adrenalectomy was performed without complication and histopathological examination confirmed metastatic renal cell carcinoma. The patient remains well with no evidence of recurrence at 6 months.

Conclusion

Laparoscopic adrenalectomy is a safe, effective treatment in the treatment of late solitary renal cell cancer metastasis to the ipsilateral adrenal gland.     

Second toe swelling: Nora’s lesion or glomus tumour, case report and literature review

Introduction

We report a rare case of bizarre parosteal osteochondromatous proliferation (BPOP, Nora??s lesion) of the right second toe in a 60-year-old man who presented with painful, bluish and bulbous swelling of the right second toe without any break in the skin.

Investigations

Physical examination, plain radiography and magnetic resonance imaging (MRI) scan of the foot, histology of the excised tissue.

Diagnosis

Bizarre parosteal osteochondromatous proliferation.

Management

Radiographs showed a calcified/ossified lesion adjacent to the tuft of the terminal phalanx of the second toe. MRI showed a small low signal nodule on T1- and T2-weighted images in a subungual position adjacent to the terminal phalanx with sclerosis. The second toe was excised and the histology from excised tissue was consistent with ??bizarre parosteal osteochondromatous proliferation??. There was no malignant change on histology. Local excision of the entire lesion was done and there has been no recurrence to date.

Conclusion

BPOP, although a benign lesion, behaves aggressively with rapid growth and has a high risk of local recurrence after local resection (Nora et al. in Am J Surg Pathol 7(3):245?C250, 1983; Meneses et al. in Am J Surg Pathol 17(7):691?C697, 1993). Its clinical presentation can be confused with glomus tumour, subungual exostosis and enchondroma. The distinguishing features of BPOP and several relevant different differential diagnoses are discussed in this case report.     

健脾解毒方可通过COX-2通路逆转大肠癌细胞P-糖蛋白介导的多重耐药性

Objective:To evaluate the underlying mechanism of Jianpi Jiedu Recipe(健脾解毒方,JJR)in the reversion of multidrug resistance concerning colorectal cancer in vitro and in vivo.Methods:Mice were treated orally with JJR at a daily 4.25 g/(kg-day)or injected with vinblastine(VCR)2.5 mg/(kg·day)for 3 weeks after having been inoculated with HCT8/V cells;tumor tissues were assayed by hematoxylin and eosin staining.Firstly,the effects of JJR on the expression of cyclooxygenase-2(COX-2)were tested by real-time polymerase chain reaction(PCR)technique and COX-2 gene silenced by siRNA.Secondly,the variation of intracellular concentration of oxaliplatin(L-OHP)was evaluated by the inductively coupled plasma mass spectroscopy(ICPMS)in HCT8/V and its COX-2 siRNA cells;the concentration of JJR combined with chemotherapeutic drugs and the reverse effect of multidrug resistance(MDR)in HCT8/V cells was evaluated by the MTT assay.Thirdly,real-time quantitative PCR and Western blot analysis were used to detect the multidrug resistance gene 1(MDR1)mRNA and P-gp expression.Results:JJR had an inhibitory effect on the growth of tumors in vivo,and it,in combination with chemotherapeutic drugs,could reverse the drug-resistance of HCT8/V cells and increase the sensitivity of HCT8/V cells to VCR,DDP,5-Fu,and THP.ICP-MS results showed that JJR could increase the concentration of drugs in HCT8/V cells(P0.01).Furthermore,it was shown that JJR could reverse drug resistance of colorectal cancer cells by decreasing MDR1 expression and P-gp level via downregulation of COX-2,which has been represented as one of the major mechanisms that contributes to the MDR phenotype(P0.01).Conclusion:JJR reversed multidrug resistance and enhanced the sensitivity to chemotherapy,which could be attributed to the down-regulation of COX-2 in MDR1/P-gp-mediated MDR colorectal cancer after chemotherapy.