The poor prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) is associated with the invasion and metastasis of tumor cells. Epithelial cell transforming 2 (ECT2) is a guanine nucleotide exchange factor (GEF) of the Rho family of GTPases. It has also been reported that upregulation of ECT2 in pancreatic cancer, but the role and mechanism of ECT2 have not been previously determined. We found that ECT2 was significantly elevated in PDAC tissues and cells, correlated with more advanced AJCC stage, distant metastases, and overall survival of patients with PDAC. Inhibition and overexpression tests showed that ECT2 promoted proliferation, migration and invasion in vitro, and promoted tumor growth and metastasis in vivo. We determined that ECT2 was involved in the post-translational regulation of Grb2. ECT2 inhibited the degradation of Grb2 through deubiquitination. Furthermore, knockdown of ECT2 downregulated EGFR levels by accelerating EGFR degradation. EGF stimulation facilitated the formation of ECT2-Grb2 complex. Overall, our findings indicated that ECT2 could be used as a promising new therapeutic candidate for PDAC.Doxorubicin (DOX) is a cytotoxic drug used for the treatment of breast cancer (BC). However, the rapid emergence of resistance toward doxorubicin threatens its clinical application, thus the need for combination therapy. Here, we interrogate the role of Emodin, a chemical compound with tumor inhibitory properties, in the resistance of BC to Doxorubicin. We first evaluated the efficacy of Emodin in the treatment of BC cells. We then used γH2A to examine doxorubicin-induced DNA damage in BC cells, with or without Emodin. Data from CCK-8, flow cytometry, and tumor xenograft assays showed that Emodin suppresses the growth of BC cells. Further, we demonstrated that Emodin enhances γH2A levels in BC cells. Moreover, bioinformatics analysis and western blot assays indicated that Emodin down-regulates the AKT1 expression, and marginally decreases the levels of DNA damage proteins (XRCC1, PARP1, and RAD51) as well as increased p53 expression in BC cells. Taken together, our data demonstrates that Emodin affects cell proliferation, and DNA damage pathways in BC cells, thus increasing the sensitivity of BC cells to doxorubicin. Besides, we confirmed that Emodin confers sensitization of BC to doxorubicin through AKT1-mediated DNA.

To investigate the role of interleukin-33 (IL-33) in head and neck squamous cell carcinoma (HNSCC).

RNA-seq data of 520 cases of HNSCC were retrieved from The Cancer Genome Atlas. The tumor microenvironment was deconstructed by xCell using bulk RNA-seq data. The cohort was dichotomized by the median IL-33 expression level. Immune cell components and molecular markers were compared between the high and low IL-33 groups. The prognostic value of IL-33 was evaluated by the log-rank test. Differential gene expression analysis and KEGG pathway enrichment analysis were also conducted. The relationship between the IL-33 expression level and the abundance of its potential cellular sources was evaluated by Pearson’s partial correlation test. Subgroup analysis was conducted in laryngeal, oropharyngeal, and oral cavity squamous cell carcinoma (LSCC, OPSCC, and OCSCC).

The role of IL-33 in HNSCC was heterogeneous among tumors at different sites. In LSCC, IL-33 may increase the extent of malignancy of tumor cells and act as a pro-tumor factor. In OCSCC, IL-33 may play a role in orchestrating the immune responses against tumor cells and act as an antitumor factor. The role of IL-33 in OPSCC was undetermined. IL-33 in LSCC was mainly derived from endothelial cells, while IL-33 in OCSCC was mainly derived from endothelial and epithelial cells.

According to the different sources of IL-33 in LSCC and OCSCC, we propose a hypothesis that stroma-derived IL-33 could favor tumor progression, while epithelial-derived IL-33 could favor antitumor immune responses in HNSCC.

According to the different sources of IL-33 in LSCC and OCSCC, we propose a hypothesis that stroma-derived IL-33 could favor tumor progression, while epithelial-derived IL-33 could favor antitumor immune responses in HNSCC.Long non-coding RNAs (lncRNAs) are reported to participate in tumor development. It has been manifested in previous researches that lncRNA ELFN1-AS1 is involved in early-stage colon adenocarcinoma with potential diagnostic value. However, no studies have revealed the specific mechanism of ELFN1-AS1 in colon cancer, and there are no other studies on whether ELFN1-AS1 is associated with tumorigenesis. In our study, ELFN1-AS1 with high expression in colon cancer was selected by TCGA analysis, and the survival analysis was carried out to verify it. Subsequently, qRT-PCR was adopted for validating the results in tissues and cell lines. Cell counting kit-8 (CCK8), 5-ethynyl-2′-deoxyuridine (EdU), cell colon, cell apoptosis, cell cycle, cell migration, and invasion assays were utilized to assess the role of ELFN1-AS1 in colon cancer. Results uncovered that ELFN1-AS1 expression was prominently raised in colon cancer cells and tissues. ELFN1-AS1 decrement restrained cells to grow through interfering with distribution of cell cycle and promoting apoptosis. Meanwhile, ELFN1-AS1 decrement weakened the capacity of cells to migrate and invade. What’s more, ELFN1-AS1 was uncovered to act as a competing endogenous RNA (ceRNA) to decrease miR-191-5p expression, thus raising special AT-rich sequence-binding protein 1 (SATB1), a downstream target of ceRNA. To sum up, ELFN1-AS1 drives colon cancer cells to proliferate and invade through adjusting the miR-191-5p/SATB1 axis. The above results disclose that lncRNA ELFN1-AS1 is possibly a novel treatment target for colon cancer cases.Endocrine treatment plus CDK4/6 inhibitors have become standard of care for estrogen receptor positive (ER+) breast cancer. Although immune checkpoint inhibitors (ICIs) have shown promising antitumor activity in a variety of cancer types, only limited success has been achieved for metastatic breast cancer (mBC) patients, especially the ER+ subtype, which usually exhibit lower tumor mutation burden (TMB) compared with other subtypes and therefore perceived as immunologically quiescent. Here we present a case of an ER+/HER2- but TMB-high mBC patient who had significant response to combination therapy with anti-PD-1 antibody camrelizumab and vinorelbine and obtained partial response (PR) with a progression-free survival (PFS) of 5 months after failure of multiple lines of therapy. Our case indicates that TMB may serve as a potential biomarker in immunotherapy selection for normally immunologically „cold” tumors such as ER+ mBC, also molecular monitoring during the whole treatment course plays an important role in patient management.

To investigate the tumor volume and its change on short-term outcome in esophageal squamous cell carcinoma (ESCC) patients who underwent definitive radiotherapy or chemoradiotherapy.

All data were retrospectively collected from 418 ESCC patients who received radiotherapy or chemoradiotherapy at our institution between 2015 and 2019. Short-term outcome using the treatment response evaluation was assessed according to the RECIST 1.1. The tumor volume change rate (TVCR) was defined as follows TVCR

1

[gross tumor volume (GTV) at shrinking irradiation field planning)]/(GTV at the initial treatment planning) ×100%. Chi square test was used to compare the clinic characteristics in different TVCR groups, and the difference between initial GTV (GTVi) and shrinking GTV (GTVs) was compared using Wilcoxon’s sign rank test. Logistic regression analysis and Spearman correlation was performed.

There was a significant decrease in GTVi compared to GTVs (

< 0.001). In univariate analysis, age, cT-stage, TNM stage, treatment modality, GTVi, and TVCR were associated with short-term outcome (all

0.05). In multivariate analysis, gender and TVCR were statistically significant (

= 0.010, <0.001) with short-term outcome, and the combined predictive value of gender and TVCR exceeded that of TVCR (AUC, 0.876

0.855).

TVCR could serve to forecast short-term outcome of radiotherapy or chemoradiotherapy in ESCC. It was of great significance to guide the individualized treatment of ESCC.

TVCR could serve to forecast short-term outcome of radiotherapy or chemoradiotherapy in ESCC. It was of great significance to guide the individualized treatment of ESCC.Identification of novel tumor-specific targets is important for the future development of immunotherapeutic strategies using genetically engineered T cells or vaccines. In this study, we characterized the expression of VCX2, a member of the VCX/Y cancer/testis antigen family, in a large panel of normal tissues and tumors from multiple cancer types using immunohistochemical staining and RNA expression data. In normal tissues, VCX2 was detected in the germ cells of the testis at all stages of maturation but not in any somatic tissues. Among malignancies, VCX2 was only found in tumors of a small subset of melanoma patients and thus rarely expressed compared to other cancer/testis antigens such as GAGE and MAGE-A. The expression of VCX2 correlated with that of other VCX/Y genes. Importantly, we found that expression of VCX2 was inversely correlated with promoter methylation and could be activated by treatment with a DNA methyltransferase inhibitor in multiple breast cancer and melanoma cell lines and a breast cancer patient-derived xenograft. The effect could be further potentiated by combining the DNA methyltransferase inhibitor with a histone deacetylase inhibitor. Our results show that the expression of VCX2 can be epigenetically induced in cancer cells and therefore could be an attractive target for immunotherapy of cancer.

The prognostic value of programmed cell death-ligand 1 (PD-L1) in gynecological cancers has been explored previously, but the conclusion remains controversial due to limited evidence. This study aimed to conduct an updated meta-analysis to re-investigate the predictive significance of PD-L1 expression.

PubMed, EMBASE and Cochrane Library databases were searched. The associations between PD-L1 expression status and prognosis [overall survival (OS), progression-free survival (PFS), recurrence-free survival (RFS), cancer-specific survival (CSS) or disease-free survival (DFS)], clinical parameters [FIGO stage, lymph node metastasis (LNM), tumor size, infiltration depth, lymphovascular space invasion (LVSI) or grade] and response to anti-PD-1/PD-L1 treatment [objective response rate (ORR)] were analyzed by hazard ratios (HR) or relative risks (RR).

Fifty-five studies were enrolled. Overall, high PD-L1 expression was not significantly associated with OS, PFS, RFS, CSS and DFS of gynecological cancers. Howevercancer expressed on TICs). Patients with PD-L1-positivity may obtain more benefit from anti-PD-1/PD-L1 treatment than the negative group, showing a higher ORR (RR = 1.98), longer OS (HR = 0.34) and PFS (HR = 0.61).

Our findings suggest high PD-L1 expression may be a suitable biomarker for predicting the clinical outcomes in patients with gynecological cancers.

Our findings suggest high PD-L1 expression may be a suitable biomarker for predicting the clinical outcomes in patients with gynecological cancers.Programmed death 1(PD-1) blockade has shown promising efficacy in advanced gastric cancer. Here, we performed a retrospective analysis of three patients with locally advanced gastric cancer who received adjuvant PD-1 plus chemoradiotherapy as neoadjuvant treatment. Neoadjuvant sintilimab plus concurrent chemoradiotherapy had an acceptable side-effect profile. All three patients underwent surgical gastrectomy after a median of 3.9 months. A major pathological response occurred in two resected tumors and a pathologic complete response was observed in one patient. Our results suggest that PD-1 blockade combined with chemoradiotherapy is a promising strategy as a neoadjuvant therapy in patients with unresectable locally advanced gastric cancer.

Tumor mutational burden (TMB) could be a measure of response to immune checkpoint inhibitors therapy for patients with colorectal cancer (CRC). MicroRNAs (miRNAs) participate in anticancer immune responses. In the present study, we determined miRNA expression patterns in patients with CRC and built a signature that predicts TMB.

Next generation sequencing (NGS) on formalin-fixed paraffin-embedded samples from CRC patients was performed to measure TMB levels. We used datasets from The Cancer Genome Atlas to compare miRNA expression patterns in samples with high and low TMB from patients with CRC. We created an miRNA-based signature index using the selection operator (LASSO) and least absolute shrinkage method from the training set. We used an independent test set as internal validation. We used real-time polymerase chain reaction (RT-PCR) to validate the miRNA-based signature classifier.

Twenty-seven samples from CRC patients underwent NGS to determine the TMB level. We identified four miRNA candidates in the training set for predicting TMB (N = 311). We used the test set (N = 204) for internal validation. The four-miRNA-based signature classifier was an accurate predictor of TMB, with accuracy 0.963 in the training set. In the test set, it was 0.902; and it was 0.946 in the total set. The classifier was superior to microsatellite instability (MSI) for predicting TMB in TCGA dataset. In the validation cohort, MSI status more positively correlated with TMB levels than did the classifier. Validation from RT-qPCR showed good target discrimination of the classifier for TMB prediction.

To our knowledge, this is the first miRNA-based signature classifier validated using high quality clinical data to accurately predict TMB level in patients with CRC.

To our knowledge, this is the first miRNA-based signature classifier validated using high quality clinical data to accurately predict TMB level in patients with CRC.Cancer care in the United States is unquestionably expensive. In 2017, annual costs related to cancer-related treatment reached $180 billion. There is clear evidence that the increased cost of cancer care translates to financial hardship. This hardship is widespread, impacting as many as 75% of patients and their families with associated adverse sequelae. Growing recognition of the negative impact of cancer-related treatment costs on patients and their families led to the creation of the term „financial toxicity”. The present editorial is borne out of the need to bring this problem to the attention of practicing surgeons, as to the best of our knowledge is still underreported in our specialties.Contralateral prophylactic mastectomy (CPM) rates have continued to rise in the United States, impacting all stakeholders including plastic and reconstructive surgeons. Multiple factors may be influencing this trend, including patient decision-making characteristics, knowledge about breast cancer disease and prognosis, advances in genetic testing and enhanced imaging capabilities, sociodemographic factors, and access to specialty surgical services such as breast reconstruction. In this review, the authors shed light on the current state of CPM and summarize the literature analyzing its increasing prevalence in the United States, as well as outline future directions for study and dissemination of knowledge from providers to patients surrounding this important and complex treatment decision.Breast sensation has recently become an integral aspect of the reconstructive goal after mastectomy and is an important consideration for many patients. Neurotization techniques using primary coaptation, autograft, allograft, or nerve conduit have been used for autologous flaps, such as the deep inferior epigastric perforator (DIEP) flap. Outcomes have shown improved sensation and faster sensory recovery in the flap skin in immediate neurotized DIEP flap breast reconstructions compared to delayed reconstruction. Breast flap neurotization during reconstruction is a rapid and simple procedure with minimal morbidity. An improved understanding of breast anatomy and innovative modifications to breast reconstruction have made the restoration of breast sensation achievable, and promising results have been obtained with respect to sensory return and patient satisfaction.The procedural volume of autologous fat grafting (AFG) has risen over the past several years, specifically in the setting of breast reconstruction, despite controversy surrounding its oncologic safety. While some in vitro and animal models have cast doubt on the oncologic safety of AFG, there is no clinical evidence that AFG in breast reconstruction is associated with an increased risk of cancer development or recurrence or an inability to adequately assess changes in the breast. That being said, recommendations regarding surveillance and follow-up after AFG in breast reconstruction are largely surgeon directed and differ across practices. The purpose of this review is to summarize the current literature and provide evidence-based recommendations.Breast reconstruction is an important part of the cancer treatment paradigm and the psychosocial benefits are well described in the literature. Notably, breast reconstruction restores both the functional and emotional losses patients experience due to tumor resection. Post-cancer quality of life is an important benchmark of successful treatment; therefore, breast reconstruction is an essential component that should be offered whenever possible. Over time, reconstructive techniques and outcomes have improved dramatically resulting in better patient safety and decreased operative morbidity. When counseling a patient for surgery, the provider must consider all aspects of a patient’s health. Ideally, breast cancer patients should be physically, emotionally, and oncologically appropriate candidates for reconstruction. However, in concerted effort to provide opportunities for as many patients as possible, the definition of who is a good candidate for reconstruction has evolved to include higher risk patients. These patients include those with advanced age, nicotine use, obesity, and significant ptosis. With improvements in surgical procedures and perioperative care, this population may also benefit from restorative surgery. However, the exact risk of complications and necessary counseling has gone largely undefined in this population. This article examines particular „high-risk” groups that may be challenging for extirpative and reconstructive surgeons and offers current guidelines for practice.The rising popularity of robotic surgery has enabled surgeons to continue to expand the uses of robotic surgery. Robotic surgery offers minimally invasive approaches coupled with tremor elimination, up to seven degrees of freedom, ergonomic positioning, 3D magnified vision and improved resolution. We describe robotic surgery techniques for nipple-sparing mastectomies, latissimus dorsi muscle flap harvest, deep inferior epigastric perforator (DIEP) flap pedicle harvest, and robotic microsurgical anastomoses. By using a robotic system the surgeon is able to offer not only a minimally invasive approach to the patient but the surgeon’s ability can be improved upon as well. This improved ability is best characterized in the robotic supermicrosurgical anastomosis where even the faintest surgeon’s tremor is exploited. However, within the robotic system tremor is eliminated. We are now able to offer patients a completely minimally invasive approach to ablative breast surgery and breast reconstruction. A patient could have a robotic nipple-sparing mastectomy, followed by a robotic DIEP reconstruction with a robotic microsurgical anastomosis. The patient could even have robotic lymphovenous bypass to address lymphedema that could have arisen after an axillary dissection. A completely robotic surgical approach maximizes both utilization of the robotic system and patient benefit. By using robotic techniques in flap harvest the morbidity of traditional open surgeries is minimized and the use of robotic anastomoses expands the limits of human precision.For survivors of breast cancer lymphedema is their greatest survivorship burden. Modern surgical techniques to treat lymphedema are effective at reducing limb volume, symptoms of lymphedema, episodes of cellulitis, and improving patient quality of life. Physiologic procedures, including lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT), restore physiological lymphatic function within the affected extremity. In patients with post-mastectomy breast cancer-related upper extremity lymphedema that desire breast reconstruction, microvascular abdominal flap breast reconstruction can be combined with superficial inguinal (groin) VLNT to provide breast reconstruction and treatment of lymphedema in a single operation. This article reviews the indications, preoperative assessment, surgical technique, outcomes, and tips and pearls for performing this procedure.The gold standard for autologous reconstruction in the post-mastectomy patient remains the deep inferior epigastric artery perforator flap, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap) and trunk (lumbar artery perforator flap, superior and inferior gluteal artery perforator flaps). This study will review the history, relevant anatomy, surgical technique and outcomes for alternative flaps in autologous reconstruction. Additionally, preoperative imaging (CTA, MRA) and novel applications (stacking flaps, neurotization) in breast reconstructive microsurgery will be discussed.Recently, the term breast implant illness has become popularized in social media to describe a constellation of symptoms which have been attributed to a patient’s breast implants. These symptoms include fatigue, chest pain, hair loss, headaches, chills, photosensitivity, rash, and chronic pain amongst others. While physicians aim to treat these physical symptoms, currently the evidence supports the safety of silicone breast implants. This article entitled „Breast implant illness a topic in review” presents an up-to-date review focusing on the safety of silicone breast implants. Patients retain the right to decide to keep or remove their breast implants and for those who choose to pursue explantation, they should be advised to seek the care of a board-certified plastic surgeon. As a scientific community is our duty to continue to conduct well-designed scientific studies to gain more insight into the safety of breast implants as it related to cancer detection, autoimmune disease, and other health concerns to improve patient safety, awareness, and education. This review article aims to delineate both the content and timing of all research and evidence as it pertains to the newly coined phrase „breast implant illness”. The authors of this study support that currently there have not been any concrete or evidence-based studies which support the formation of a new syndrome „silicone implant illness”.The United States Food and Drug Administration (FDA) recently recognized the necessity for improved patient education and public awareness of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). BIA-ALCL is an uncommon T-cell lymphoma that can arise years after placement of a textured breast implant or tissue expander. Patients and providers would greatly benefit from a broader awareness of BIA-ALCL and how it presents with both common and rare symptoms. Disease awareness can be improved with specific steps moving forward. This includes improved counseling about annual recommendations from the FDA, standard of care guidelines, current estimates of disease prevalence, and manufacturer-specific risk for developing the malignancy. Informed consent for implant-based breast surgery should include a discussion of BIA-ALCL, symptoms, inherent risks and alternatives. Consideration should be given for reasonable efforts to retroactively contact patients with textured implants to inform them of recent regulatory actions as well as the risk of developing the disease and the signs and symptoms to watch for. Where risk can be reduced, all steps should be taken to ensure patient safety. In keeping with our commitment to patient safety, the strategies moving forward for implant-based breast surgery should be marked by patient awareness, physician vigilance, and defined by evidence-based diagnosis and treatment.Prepectoral breast reconstruction after mastectomy is a more commonly performed technique in recent years due to its numerous advantages over subpectoral breast reconstruction. This study reviews the current state of clinical outcomes for patients undergoing postmastectomy radiation therapy (PMRT) after prepectoral breast reconstruction. A comprehensive search of the literature was performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify all relevant studies. Outcome measures included demographics, mean follow-up, and complication measures. Three studies for a total of 175 breasts were identified. Average age was 49.3 years and BMI was 27.7 kg/m2. Mean follow up was 18.1 months. A total of 3 (1.7%) hematomas and 4 (2%) seromas were reported. Surgical site infection was the most common complication reported with an overall reported 32 breasts with infections (18%). A total of 9 (5.1%) cases of wound dehiscence were reported. Mastectomy flap necrosis was found in 10 (5.7%) breasts. A total of 22 (12.6%) tissue expanders or implants required explantation. The review of the literature suggests that prepectoral breast reconstruction with acellular dermal matrices in the setting of post mastectomy radiation therapy is a safe and successful surgical option resulting in excellent clinical outcomes. Furthermore, there may be a reduction of capsular contracture and implant migration in this setting, relative to traditional submuscular techniques with PMRT.Immediate oncoplastic breast reconstruction performed at the time of breast conserving surgery for the treatment of breast cancer merges the therapeutic goals of complete oncologic extirpation with preservation of breast form and function. A constellation of surgical techniques that employs breast volume displacement and/or replacement methods of varying complexity levels have emerged, thus broadening the potential applications for breast conservation therapy to include cases with increased tumor-to-native breast-volume ratios, multicentric or multifocal disease, and/or previous margin-positive resections. This review describes the various reconstructive methods, including the use of local tissue rearrangement, oncoplastic reduction-mastopexy, and locoregional flaps. Classification of the surgical options into levels I and II volume-displacement and volume-replacing techniques is made. Additionally, we explore the oncologic safety and effectiveness of this treatment paradigm by summarizing existing supportive evidence regarding associated risk of surgical complications, rate of margin-positive resection, implications for radiographic surveillance, local recurrence rates, and patient-reported outcomes. In conclusion, surgeons may use a wide variety of oncoplastic techniques for partial breast reconstruction at the time of segmental mastectomy to deliver effective breast conserving treatment for women with breast cancer. A growing body of literature affirms the oncologic safety of this approach. Future directions for research include long-term follow-up data with emphasis on outcomes from patient perspectives.We report 2 cases of rare thyroid malignancy angiosarcoma and myoepithelial carcinoma (MC). Thyroid angiosarcomas (TAS) is extremely rare and comprises less than 1% of primary thyroid cancer worldwide. MC usually presents as a slow-growing painless mass arising in the salivary glands. It has not been reported in the thyroid gland. The first case describes a 59-year-old patient who was admitted to hospital with the discovery of thyroid nodule for 1 month. The tumor thrombus was found in the left internal jugular vein and superior thyroid artery during the operation. Diagnosis of angiosarcoma of the thyroid was based on positive endothelial markers such as thrombomodulin and CD31 after total thyroidectomy. The left internal jugular vein, left recurrent laryngeal nerve and anterior cervical banding muscle were invaded by thyroid tumor. No lymph node metastasis was observed. The patient died after 4 years. The second case describes a 55-year-old woman who presented with the discovery of thyroid nodule for 1 month. Right thyroid lobectomy and right neck lymph node functional dissection were carried out. The results from postoperative pathology revealed that papillary carcinoma in right lobe of thyroid and MC next to thyroid were found. Besides, the metastasis of MC was observed at right II-IV level and right VI level. Five years later, the patient was re-admitted to hospital, primarily due to the discovery of anterior cervical tumor for one year. Then, she underwent left thyroid lobectomy and right tumor resection. Postoperative routine pathology showed recurrent MC in the right thyroid. After surgery and radiotherapy, the patient was followed up for 2 years. Angiosarcoma and myoepithelioma should be kept in mind in diagnosis of thyroid malignant tumor.Although ectopic thyroid can be found in thoracic locations, the discovery of abdominal ectopic thyroid is often an accidental event. Moreover, abdominal ectopic thyroid is easily misdiagnosed due to the rarity of these cases and the difficulties in the preoperative diagnosis process. Thus, we aimed to assess the prevalence and features of abdominal ectopic thyroid and to highlight the current knowledge about the clinical characteristics and management of this condition by analyzing a case report of abdominal ectopic thyroid and reviewing the literature. A 70-year-old woman with a 3-year history of gradually increasing abdominal distension in the right lower quadrant of the abdomen was admitted to the hospital. Contrast-enhanced computed tomography (CT) of the abdomen revealed a retroperitoneal mass. The patient underwent Da Vinci robotic surgery, and the retroperitoneal mass was completely resected. Subsequently, the pathologic diagnosis of the mass was ET. The patient had no discomfort or symptoms when she was discharged from the hospital and at the postoperative 1, 3, 6, 9 and 12 months follow-up. The summary of literature review suggested that abdominal ectopic thyroid is still rare although there are some reports. Nonetheless, the cause of abdominal ectopic thyroid is unclear, and abdominal ectopic thyroid has the following characteristics more common in women than in men, asymptomatic in the majority of the cases, difficult to diagnose, and found by excluding metastasis. Most ectopic thyroid is treated with surgery, and minimally invasive techniques have been increasingly performed. This is the first report on Da Vinci robotic resection for large rare retroperitoneal ET, and this case highlights that ET should be considered when patients present with similar imaging findings in the abdomen.Phyllodes tumor of the breast (PTB) is a rare fibroepithelial breast neoplasm that accounts for less than 1% of breast tumors. Only a few cases related to pregnancy have been reported. It is not known how pregnancy affects the diagnosis, treatment and prognosis of breast tumors. Here we report a case of a 38-year-old female patient with a small, mobile palpable lump in the left breast for about 15 years. it was considered a benign lesion and no surgical treatment was performed at the beginning. The left breast mass became larger suddenly during pregnancy, However, she did not see the doctor and receive any treatment in time. The lump was resected one year after labor and confirmed to be malignant phyllodes of the breast by histopathology and immunohistochemistry. Unfortunately, local recurrence occurred within six months after the first operation, and lung metastasis occurred eight months later. And this patient finally died 13 months after the operation due to tumor progression. This is the first report of pregnancy-related malignant PTB, with local recurrence and distant metastasis in a short period. This case report highlights a situation the patient should be diagnosed early and treated in time when she has a previous breast fibroadenoma, but suddenly increased during pregnancy.Pituitary apoplexy is a life-threatening syndrome caused by acute infarction of the pituitary gland. The most common symptoms associated with pituitary apoplexy are headache, nausea, vomiting, visual symptoms, hypopituitarism, and altered mental status. Both oculomotor nerve palsy and hyponatremia are relatively rare complications of pituitary apoplexy. The treatment of pituitary apoplexy is controversial. We report a case of a 72-year-old man with severe headache, nausea, vomiting, confusion and left oculomotor nerve palsy, who was initially considered as posterior communicating artery aneurysm (PCOAA) based on the presenting symptoms. Initial biochemical evaluation showed severe hyponatremia, hormonal evaluation identified multiple pituitary hormone deficiency and enhanced magnetic resonance imaging showed a large pituitary adenoma with signs of hemorrhage. A diagnosis of pituitary apoplexy and secondary hypopituitarism was finally made. The patient was treated with intravenous hydrocortisone 100 mg twice daily and oral levothyroxine 100 mg once daily. Appropriate venous transfusion with sodium was also used concomitantly to correct hyponatremia. After seven days of treatment, the patient’s serum electrolytes normalized and he gradually recovered alertness. Then, the patient underwent transsphenoidal surgery for tumor removal. Left ptosis and oculomotor nerve palsy completely recovered three months after surgery. Postoperatively, hormone replacement therapy was essential for the patient with 20 mg hydrocortisone and 50 mg levothyroxine once daily. During the last follow up 4 years later, the patient was still on hormonal replacement and in good condition. So, for patients with pituitary apoplexy, we have shown that a semi-elective surgery after conservative treatment when the patient becomes clinically stable and hypopituitarism has been corrected is a good approach.

High-risk histologic endometrioid carcinomas include poorly differentiated endometrial carcinoma (PDEC), uterine clear cell carcinoma (UCCC), uterine carcinosarcoma (UCS), and uterine papillary serous carcinomas (UPCS). The purpose of this study was to investigate and compare the effect of open surgery and minimally invasive surgery on the prognosis of patients with high-risk endometrial cancer tissue types.

A retrospective analysis was conducted to investigate 57 UCS or UPCS, 53 UCCC, and 110 PDEC patients receiving initial treatment at the Department of Gynecology in Shaanxi Provincial Tumor hospital and the Affiliated Hospital of Medical College of Xi’an Jiaotong University between February 2010 and January 2015. Prognostic factors were determined using univariate/multivariate analysis, and survival rates were assessed using the Kaplan-Meier method. The Cox regression model was adopted to assess the independent prognostic factors.

Two hundred and twenty patients who met the criteria were included in and UPCS.

To analyze the atypical enhanced computed tomography (CT) signs of pancreatic cancer (PC) and compare them with those of autoimmune pancreatitis (AIP) to explore the differential diagnosis value of CT.

The clinical data of 36 AIP (AIP group) and 38 PC patients (PC group), who were admitted to our hospital from January 2013 to June 2020 and confirmed by surgical biopsy or hormone therapy, were retrospectively analyzed. Participants in both groups were examined by CT, the imaging signs of the 2 groups were analyzed, and the results of CT examination were compared.

In the PC group, the density of the lesions on the CT scan was mostly reduced, the pancreas was not swollen, and the kidneys were not involved. The bile duct wall was thickened with a sausage-like appearance, enveloped edges were rare, blood vessels were invaded, lymph nodes were enlarged, and the pancreatic duct was truncated. The findings of the AIP group were the opposite. The difference in the proportion of participants with the above-mentioial diagnosis between AIP and PC. Familiarity with and mastery of the CT signs of AIP and PC can help to improve the accuracy of clinical diagnosis and provide a reliable basis for patients’ follow-up treatment.

This study investigated the relationship between thyroid diseases and the risk of breast cancer (BC). Clarifying this issue can help medical staff perform of early prevention, diagnosis and treatment for breast cancer patients.

The meta-analysis combined data from cohort studies and case-control to obtain a comprehensive result of the relationship between thyroid diseases and risk of BC. We comprehensively searched PubMed, EMbase, Web of Science, and the Cochrane Library. The search period was from the establishment of the databases to August 2020. Literature was collected and screened individually by two reviewers. There was English language restriction on the search and unpublished literature was excluded. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the selected studies prior to data extraction. The data collected included country, author, year of publication, research type, and number of cases. In cases where the data and study heterogeneity permitted, meta-analyses were performed, and odd ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated. Data were analyzed using the STATA 15.1 software.

A total of 21 articles were included in this study. Hyperthyroidism, thyroid cancer, thyroglobulin antibody (TGAb) levels, and thyroid microsomal antibody (TPOAb) levels were all significantly associated with an increased risk of BC, while hypothyroidism was associated with a reduced risk of BC.

This study demonstrated that hyperthyroidism, autoimmune thyroiditis (AITD), and thyroid cancer are significantly associated with an increased risk of BC, while hypothyroidism is associated with a reduced risk of BC.

This study demonstrated that hyperthyroidism, autoimmune thyroiditis (AITD), and thyroid cancer are significantly associated with an increased risk of BC, while hypothyroidism is associated with a reduced risk of BC.

Our study aims to test the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with the detection of serine/threonine-protein kinase V600E (

) in nodules of unclear significance by thyroid fine-needle aspiration (FNA).

From January 2015 to December 2019, 244 patients were subjected to ultrasonic strain imaging and elastography, CEUS, and

gene detection at Lishui Hospital of Zhejiang University. Thyroid FNA does not confirm the benignancy and malignancy of the thyroid nodules. With postoperative pathology as the gold standard, the diagnostic value of CEUS,

detection, and the combination in differentiating benign and malignant thyroid nodules were evaluated. The negative predictive value (NPV) and accuracy of CEUS,

detection, and the combination were calculated along with sensitivity, specificity, and positive predictive value (PPV).

In this study, the sensitivity, specificity, PPV, NPV, accuracy, and AUC of CEUS alone in predicting benign and malignant thyroid nodules were 69.8%, 94.9%, 98.6%, 37.4%, 73.8% and 0.884, respectively. The sensitivity, specificity, PPV, NPV, accuracy and AUC of

detection alone were 65.4%, 100%, 100%, 35.5%, 70.9% and 0.827, respectively. The sensitivity, specificity, PPV, NPV, accuracy and AUC of the combination were 73.2%, 94.9%, 98.7%, 40.2%, 76.6% and 0.923, respectively.

Therefore, compared with CEUS or

gene detection alone, the combination of CEUS and

gene detection has a higher sensitivity, NPV, and accuracy in the diagnosis of thyroid nodules.

Therefore, compared with CEUS or BRAF V600E gene detection alone, the combination of CEUS and BRAF V600E gene detection has a higher sensitivity, NPV, and accuracy in the diagnosis of thyroid nodules.

Distinguishing aggressive pT1 papillary thyroid carcinomas (PTCs) from indolent PTCs before or during surgery is important. To the best of our knowledge, few reports in the literature have examined the value of the cytomorphologic features of PTC as predictors of aggressiveness.

This retrospective study included 226 pT1 PTC patients who underwent preoperative fine-needle aspiration cytology (FNAC) and surgery at Peking University Cancer Hospital between January 2018 and December 2019. Data on the clinical characteristics and pathological results were obtained from the electronic medical record database. All FNAC smears were blindly reviewed by two independent cytopathologists, and the associations between nine cytomorphologic features (lymphocytes, multinucleated giant cells, cellularity, cellular adhesiveness, nuclear size, nuclear pleomorphism, nuclear membrane regularity, intranuclear pseudoinclusions and the amount of cytoplasm) and clinicopathological parameters were statistically analyzed.

Univariate analysis showed that cellularity, intranuclear pseudoinclusions, cellular adhesiveness, nuclear size, and nuclear pleomorphism were strong predictors of some clinicopathological parameters such as extracapsular invasion (ECI) and lymph node metastasis (LNM). Multivariate analysis confirmed that cellular adhesiveness was a strong independent predictor of ECI (P=0.001) and LNM (P<0.001), and the amount of cytoplasm can also predict LNM (P=0.024).

Cytomorphologic features including cellular adhesiveness and the amount of cytoplasm in preoperative FNAC smears could be a valuable tool for predicting ECI or LNM and may be predictors of aggressiveness in patients with pT1 PTC.

Cytomorphologic features including cellular adhesiveness and the amount of cytoplasm in preoperative FNAC smears could be a valuable tool for predicting ECI or LNM and may be predictors of aggressiveness in patients with pT1 PTC.

The terminology „non-invasive follicular thyroid neoplasm with papillary-like nuclear features” (NIFTP) was introduced to reduce overtreatment of thyroid carcinomas with indolent behavior. However, limited literature discussed the sonographic features of the entity in depth. The objective of this study is to summarize sonographic subtypes of NIFTP for precise diagnosis.

From January 2017 to June 2020, 13,531 consecutive patients underwent surgery for thyroid nodules were reviewed; 30 patients (0.22%) with 30 NIFTP were eligible for this retrospective observational study. We evaluated ultrasound features of all the lesions and distributed them into 3 major types of ultrasound appearance using pattern recognition. Systemic literature review concerning ultrasonography of NIFTP was also performed.

At sonography, all the NIFTP lesions were classified into three types 19 (63.3%) were categorized into type A-oval and solid nodule without other high-suspicion features, 7 (23.3%) into type B-partially cystic mass without high-suspicion features, 4 (13.3%) into type C-hypoechoic solid nodule with high-suspicion features including irregular margins, microcalcifications, taller-than-wide shape.

Three ultrasound patterns were proposed by us for ultrasound-cytopathology correlation analysis.

Three ultrasound patterns were proposed by us for ultrasound-cytopathology correlation analysis.

Determination of appropriate operative methods for primary hyperparathyroidism (PHPT) is difficult when localisation results are discordant between imaging studies. The aim of this study was to compare the efficacy of focused parathyroidectomy (FP) and bilateral neck exploration (BNE) according to the concordance in localisation results.

One hundred and ninety-one patients who underwent a PHPT operation at Asan Medical Center between 2000 and 2010 were divided into two groups according to the concordance in findings between neck ultrasonography (USG) and sestamibi (MIBI) scan. Differences in clinicopathological features and surgical outcomes between the concordant (n=137) and discordant (n=54) groups were analysed.

FP and BNE did not show significant differences in postoperative persistent hyperparathyroidism rates. Although intraoperative parathyroid hormone (IOPTH) monitoring was not performed in this study, the cure rates of PHPT using only USG and MIBI scans were satisfactorily high, at 98.5% in thearathyroidectomy methods according to the concordance in USG and MIBI scans might produce good results without any difference in recurrence.

Since the introduction of skin-sparing mastectomy (SSM), more breast surgeons have been preserving the areola and often nipple areolar complex (NAC) entirely. For better outcomes, more studies are necessary to analyze whether preserving the areola or NAC is unfavorable in breast reconstruction. The aim of this study was to assess the potential risk of areola or NAC preservation in direct-to-implant (DTI) breast reconstruction after SSM.

We retrospectively reviewed the medical records of patients who underwent immediate breast reconstruction from May 2011 to July 2017. Immediate breast reconstruction was performed with DTI procedure in all cases. In total, 213 breasts met the inclusion criteria and were divided into 3 groups nipple-sparing mastectomy (NSM), aerola-sparing mastectomy (ASM) which only nipple is excised, and skin-sparing mastectomy (SSM) which whole NAC was excised. Complications including infection, capsular contracture, skin necrosis and explantation were measured.

The mean patient age was 45.3 years, with a range of 27-62 years; the mean follow-up was 3.08 years. NSM, ASM and SSM groups consisted of 121, 30 and 62 breasts, respectively. The Infection rates were statistically lower in SSM group (4.8%) compared with NSM group (15.7%) (P=0.033) but not statistically different from ASM group (13.3%) (P=0.210). SSM group showed significantly lower rate of overall complication compared with both NSM and ASM groups (P=0.005, 0.025 respectively).

Our research suggests that preservation of the NAC increases the rate of infection and skin necrosis in DTI breast reconstruction.

Our research suggests that preservation of the NAC increases the rate of infection and skin necrosis in DTI breast reconstruction.

Surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC). However, most of patients lose the chance of surgery due to the unresectable disease at the time of diagnosis. Despite the improvement of radiological imaging, a portion of patients intended for radical resection were proven to be unresectable at surgical exploration due to occult metastasis.

Patients who were aimed to undergo radical pancreatectomy for PDAC from 2010 to 2019 were reviewed retrospectively. All patients included underwent diagnostic laparoscopic exploration. Patients were divided into two groups depending on whether distant metastasis were encountered during exploration. Univariate and multivariate logistic regression analyses were used to identify risk factors for occult metastasis. A nomogram to predict occult metastasis of PDAC on exploration was developed and evaluated.

A total of 273 patients who underwent diagnostic laparoscopic exploration were included in this study. Nineteen (7.0%) patients were found with distant metastasis during exploration. Multivariate logistic regression analysis showed that ALT>40U/L, CA19-9, CA125 and regional nodes enlargement were independent predictors for occult metastasis. Incorporating these four factors, the nomogram achieved concordance index of 0.799, with a well-fitted calibration curve.

Occult metastasis is not unusual during surgical exploration in patients with resectable or borderline resectable PDAC. The nomogram could achieve a personal prediction of unexpected distant metastasis on exploration. It may help to sift through patients with PDAC who would benefit from laparoscopic exploration.

Occult metastasis is not unusual during surgical exploration in patients with resectable or borderline resectable PDAC. The nomogram could achieve a personal prediction of unexpected distant metastasis on exploration. It may help to sift through patients with PDAC who would benefit from laparoscopic exploration.

Although the origin of the multifocality of papillary thyroid carcinoma (PTC) is unclear, it is not unusual and has not been considered as an independent prognostic factor from several tumor staging systems. This study aims to evaluate whether the presence of multifocality is associated with PTC recurrence.

We reviewed retrospectively detailed histological reports of PTC patients who underwent thyroidectomy from January 2000 through December 2010 at a single institution. We assessed the relationship between multifocality and other possible prognostic factors using binary logistic regression analysis. We compared recurrence by the Kaplan-Meier method (the log-rank test). We analyzed a prognostic factor for recurrence using Cox’s proportional hazard model (the stepwise forward method).

We enrolled a total of 434 PTC patients (380 women and 54 men; mean age, 48 years). The median follow-up period was 10.2 years. Of all PTC patients enrolled, 135 patients (31%) had multifocal PTC. There was a significant association between multifocality and cervical lymph node (CLN) metastasis (P=0.01). Multivariate analyses showed a significant association between multifocality and CLN metastasis (P<0.001). Multifocal PTC patients had higher CLN metastasis and tumor recurrence than those with single PTC. There was a significant association between multifocality and tumor recurrence (P=0.03 by log-rank test), but it disappeared in multivariate analysis.

Multifocality of PTC might be related to CLN metastasis and tumor recurrence.

Multifocality of PTC might be related to CLN metastasis and tumor recurrence.

To determine the histopathological and MRI features of BRCA1/2 mutation-associated familial breast cancers compared with those of BRCA1/2 mutation-negative and sporadic breast cancers and to further compare the imaging features of cancers from BRCA1 and BRCA2 mutation carriers according to lesion type on MRI.

A retrospective review of medical records was conducted to determine tumour clinicopathologic features and MRI characteristics between June 2011 and July 2017, and 93 lesions with BRCA mutations, 93 lesions without BRCA mutations from familial breast cancers and 93 lesions from sporadic breast cancers were included. Histopathologic data, including immunohistochemistry findings and MRI data according to the BI-RADS lexicon, were reviewed. The association between MRI or histopathologic findings and BRCA mutations was analysed.

BRCA-positive familial breast cancers had a higher number of IDCs with high nuclear grade and lymph node metastasis (all P<0.05), while the BRCA-negative group had a significantly lower Ki-67 index (P<0.