Rare adipose disorders (RADs) masquerading as obesity

Rare adipose disorders (RADs) including multiple symmetric lipomatosis (MSL), lipedema and Dercum''s disease (DD) may be misdiagnosed as obesity. Lifestyle changes, such as reduced caloric intake and increased physical activity are standard care for obesity. Although lifestyle changes and bariatric surgery work effectively for the obesity component of RADs, these treatments do not routinely reduce the abnormal subcutaneous adipose tissue (SAT) of RADs. RAD SAT likely results from the growth of a brown stem cell population with secondary lymphatic dysfunction in MSL, or by primary vascular and lymphatic dysfunction in lipedema and DD. People with RADs do not lose SAT from caloric limitation and increased energy expenditure alone. In order to improve recognition of RADs apart from obesity, the diagnostic criteria, histology and pathophysiology of RADs are presented and contrasted to familial partial lipodystrophies, acquired partial lipodystrophies and obesity with which they may be confused. Treatment recommendations focus on evidence-based data and include lymphatic decongestive therapy, medications and supplements that support loss of RAD SAT. Associated RAD conditions including depression, anxiety and pain will improve as healthcare providers learn to identify and adopt alternative treatment regimens for the abnormal SAT component of RADs. Effective dietary and exercise regimens are needed in RAD populations to improve quality of life and construct advanced treatment regimens for future generations.     

Efflux of Prostaglandins in Right Lymphatic Duct Lymph Following Induced Intravascular Coagulation and Inhibited Fibrinolysis in the Dog

Intravascular coagulation and inhibited fibrinolysis were induced in 10 dogs by infusion of thrombin and tranexamic acid (AMCA). Lymph fluid from the right lymphatic duct, draining the main parts of the lungs, was examined for the presence of smooth-muscle-stimulating activity. The treatment was followed by increased lymph flow due to interstitial pulmonary oedema and efflux of smooth-muscle-stimulating material. The presence of prostaglandin E₁ and E₂ (PGE₁ and E₂) and prostaglandin F-compounds as well as ‘slow reacting substance’ (SRS) in the lymph fluid was demonstrated by bioassay in combination with chromatography. Histamine was not detected in the lymph fluid.     

腔镜辅助下行分化型甲状腺癌功能性颈淋巴结清扫术（附7例）

目的：研究腔镜辅助下行分化型甲状腺癌颈淋巴结清扫术的可行性,探索手术治疗分化型甲状腺癌的新方法。方法：为7名分化型甲状腺癌患者行腔镜辅助下功能性颈淋巴结清扫术,其中4例为甲状腺癌联合根治术。就手术的清扫范围、手术时长、术中失血量、术后病理结果、并发症、患者满意度等多方面进行分析。结果：全部病例手术顺利,清扫范围可以达到传统开放式手术范围。整体手术时长平均214分钟,平均失血量约137ml。病理显示颈部各区清扫组织均可见数目不等的淋巴结,并有部分癌转移。伤口愈合良好,无并发症,患者满意度100%。结论：在腔镜辅助下行颈淋巴结清扫术是安全可行的,较完全腔镜式和传统开放式手术,在美容、微创、疗效三方面互有补裨,相得益彰。该技术可用于分化型甲状腺癌的手术治疗。     

Sentinel lymph node detection in early stage cervical cancer: a prospective study comparing preoperative lymphoscintigraphy, intraoperative gamma probe, and blue dye

OBJECTIVE: The objective of this prospective study was to determine the feasibility of sentinel lymph node (SLN) detection in patients with cervical cancer using lymphoscintigraphy (LS), gamma probe, and blue dye. METHODS: A total of 32 patients with early stage cervical cancer (FIGO IA2-IIA) who were treated with total abdominal hysterectomy and bilateral pelvic and paraortic lymphadenectomy underwent SLN biopsy. LS was performed on all the patients following the injection of 74 MBq technetium-99m-nanocolloid pericervically. The first appearing persistent focal accumulation on either dynamic or static images of LS was considered to be an SLN. Blue dye was injected just prior to surgical incision in 16 patients (50%) at the same locations as the radioactive isotope injection. During the operation, blue-stained node(s) were excised as SLNs. For gamma probe, a lymph node was accepted as an SLN, if its ex vivo radioactive counts were at least 10-fold above background radioactivity. SLNs, which were negative by routine hematoxylin and eosin (H&E) examination, were histopathologically reevaluated for the presence of micrometastases by step sectioning and immunohistochemical staining with pancytokeratin. RESULTS: At least one SLN was identified for each patient by gamma probe. Intraoperative gamma probe was the most sensitive method with a technical success rate of SLN detection of 100% (32/32), followed by LS 87.5% (28/32) and blue dye 68.8% (11/16), respectively. The average number of SLNs per patient detected by gamma probe was 2.09 (range 1-5). The localizations of the SLNs were external iliac 47.8%, obturatory 32.8%, common iliac 9%, paraaortic 4.4%, and paracervical 6%. Micrometastases, not detected by routine H&E were found by immunohistochemistry in one patient. On the basis of the histopathological analysis, the negative predictive value for predicting metastases was 100%, and there were no false-negative results. CONCLUSIONS: Preoperative LS with radiocolloids, intraoperative lymphatic mapping with blue dye and gamma probe are all feasible methods comparable with each other for SLN detection in early stage cervical cancer patients, but gamma probe is the most useful method in terms of technical success.     

术前体检联合超声检查预测腋窝淋巴结转移与前哨淋巴结预测结果分析

目的：比较术前联合检查与前哨淋巴结检查技术对腋窝淋巴结转移情况判断能力差异。方法对2012年8月—2014年8月该院收治的57例乳腺癌患者分别行术前联合检查及前哨淋巴结活检,统计结果并分析。结果57例患者中联合检查的敏感性为58.3%,特异性为97.0%,准确性为80.7%。结论术前联合检查能够提高单独检查的诊断及预测腋窝淋巴结转移的能力,但是其比较前哨淋巴结活检技术仍存在差距。     

支气管内超声引导针吸活检术对肺门、纵隔淋巴结肿瘤和结核的诊断价值

目的探讨支气管内超声引导针吸活检术（EBUS-TBNA）在肺门、纵膈淋巴结恶性肿瘤和结核诊断中的应用价值。方法回顾性分析2013年1月至2016年9月在四川大学华西医院呼吸内镜中心接受EBUS-TBNA检查的553例患者的临床及病理资料,统计EBUS-TBNA对肺门、纵膈淋巴结肿瘤和结核的诊断敏感性、特异性和准确率。结果EBUS-TBNA诊断肺门、纵膈淋巴结恶性肿瘤的敏感性、特异性和准确率分别为89.2%（263/295）、100.0%（247/247）和94.1%（510/542）。针吸活检组织查见肉芽肿诊断结核的敏感性、特异性和准确率分别为65.0%（76/117）、97.2%（385/396）和89.9%（461/513）。标本组织行抗酸染色和TB-PCR的102例中,查见抗酸杆菌或TB-PCR任一项阳性诊断结核的敏感性、特异性和诊断准确率为63.7%（58/91）、90.9%（10/11）和66.7%（68/102）。结论EBUS-TBNA诊断肺门和纵膈肿瘤具有较高的敏感性和特异性,并可联合抗酸染色和TB-PCR联合诊断肺门和纵膈淋巴结结核。     

前哨淋巴结活检与乳腺癌分子分型的关系

目的 探讨前哨淋巴结活检结果与乳腺癌分子分型的关系。方法 选取2015 年1 月—2018 年 12 月于东莞市松山湖中心医院接受全乳切除术或保乳术加前哨淋巴结活检的302 例早期乳腺癌患者作为 研究对象,采用免疫组织化学法检测肿瘤组织中雌激素受体（ER）、孕激素受体（PR）、人体表皮生长因 子受体-2（Her-2）、Ki-67 的表达,并将患者划分为Luminal A 型、Luminal B 型、HER-2 阳性型及三阴 性型。分析前哨淋巴结转移与患者分型的关系。结果 患者中Luminal A 型134 例、Luminal B 型91 例、 Her-2 阳性型32 例及三阴性型45 例,各亚型中前哨淋巴结阳性者分别有31、37、7 及6 例。前哨淋巴结 阳性组年龄≤ 52 岁、T2 期、Luminal B 型占比均高于阴性组（P <0.05）,TNM 分期是前哨淋巴结阳性的危 险因素[Ol ^ R=3.531（95% CI ：1.936,6.438）,P =0.000],Luminal A 型[Ol ^ R=0.242（95% CI ：0.121,0.483）, P =0.000]、年龄[Ol ^ R=0.202（95% CI ：0.101,0.405）,P =0.000] 是其保护因素。前哨淋巴结阳性组年龄≤ 52 岁、T2 期、Luminal B 型占比均高于阴性组（P <0.05）, 年龄[Ol ^ R=0.250（95% CI ：0.063,0.987）, P =0.000] 是前哨淋巴结阳性数的保护因素。检出组年龄≤ 52 岁、T2 期、阳性前哨淋巴结数量≥ 2 枚、前哨 淋巴结宏转移者占比均高于未检出组（P <0.05）,前哨淋巴结阳性数量≥ 2 枚[Ol ^ R=27.926（95% CI ：6.433, 121.222）,P =0.000]、前哨淋巴结宏转移[Ol ^ R=10.662（95% CI ：1.620,70.177）,P =0.014] 是非前哨淋巴结转 移的危险因素。结论 分子分型与前哨淋巴结阳性有一定关系,其中Luminal A 型患者前哨淋巴结阳性风险 低于Luminal B 型患者,但分子分型与是否伴非前哨淋巴结转移无关。     

Dukes‘B期大肠癌淋巴结微转移的检测及其临床意义

目的探讨免疫组化测定CEA检测Dukes'B期大肠癌淋巴结微转移的可行性及其临床意义.方法应用以CEA为目标抗原的免疫组化技术来检测42例Dukes'B期大肠癌的淋巴结微转移;并分析其对术后3年肿瘤复发转移的影响.结果在42例(330枚淋巴结)中;共有10例(16枚淋巴结)为微转移阳性,阳性率23.81%(10/42);微转移阳性组的3年肿瘤复发转移率为40%(4/10),明显高于阴性组的9.4%(3/32)(P=0.032).结论通过免疫组化测定CEA可以检测到Dukes'B期大肠癌淋巴结的微转移;微转移阳性者肿瘤容易复发转移;预后不良,应加强术后辅助治疗和随访.     

乳腺癌前哨淋巴结活检技术

目的 探讨不同方法检测乳腺癌前哨淋巴结（sentinel lymph node,SLN)的可行性及其临床意义。方法 71例经细针穿刺或术中冰冻切片诊断为乳腺癌而临床无腋窝淋巴结肿大的女性患者,随机分为4组,其中亚甲蓝淋巴示踪24例,活性染料异硫蓝示踪29例,核素^99m锝－硫胶体示踪8例,染料与核素联合示踪10例,确认并切除前哨淋巴结,将其单独送病理,随后行乳腺癌手术,包括传统的腋窝淋巴结清扫术。结果 71例患者中有60例成功确定前哨淋巴结,检出率84．5％,其中亚甲蓝组75．0％（18／24）,异硫蓝组86．2％（25／29）,核素组检出7例,联合组全部检出;该技术总的敏感性83．3％,4组分别为70．0％、90．0％、100％、100％;假阴性率各组分别为30．0％、10．0％、0、0;总的准确率93．3％,各组分别为83％、96．0％、100％、100％。各组寻找前哨淋巴结平均花费时间分别为29、22、7、6min。结论 前哨淋巴结活检技术在临床是可行的。绝大多数前哨淋巴结可以比较准确地反映其余腋窝淋巴结的组织学特点。活性染料与核素联合示踪既直观又准确,是最佳的选择方法。     

Peripheral small-sized (2 cm or less) non-small cell lung cancer with mediastinal lymph node metastasis; clinicopathologic features and patterns of nodal spread

Objective: The diagnosis of small-sized (2 cm or less) non-small cell lung cancer (NSCLC) has increased with the development of computed tomography (CT), whereas unexpected extensive multiple-level mediastinal involvement has been occasionally detected in this small-sized lung cancer. To establish the optimal surgical strategy, we retrospectively analyzed the clinicopathologic features, efficacy of preoperative investigations and lobe specific patterns of nodal spread in small-sized NSCLC with mediastinal involvement. Methods: Among 1550 resected lung cancer cases between 1981 and 2000, 267 (17.2%) had peripheral small-sized NSCLC. Of these, 29 patients (10.8%) with mediastinal lymph node involvement who underwent pulmonary resection and systematic nodal dissection were reviewed. Results: Among 29 patients, 27 patients (93.1%) were adenocarcinoma, and 51.7% (15/29) showed no lymph node enlargement on CT (cN0). Surgical pathology revealed multiple-level mediastinal involvement in 65.5% (19/29) of all patients and 60.0% (9/15) of cN0 patients. All of right upper lobe tumors (n=11) showed multiple-level involvement. Thallium-201 single photon emission computed tomography (201Tl-SPECT) was positive for increased focal uptake in the mediastinum in 72.7% (8/11) of patients. Conclusions: The vast majority of cases were adenocarcinoma, and two thirds of them showed multiple-level mediastinal involvement, even in cN0 patients. We thus recommend to perform systematic nodal dissection or meticulous sampling for accurate intrathoracic staging, especially for right upper lobe tumor. 201Tl-SPECT appears to be more sensitive preoperative investigation for mediastinal metastasis compared with CT scan.