Lei Shi

Clinicopathological findings in a case series of abdominopelvic solitary fibrous tumors

Solitary fibrous tumors (SFTs) represent a rare type of soft tissue tumor. Extrathoracic SFTs (ESFTs) in the soft tissues of the abdominopelvic cavity are extremely rare. Between January 2002 and January 2013, 10 patients were identified with abdominopelvic SFTs at the Northern Jiangsu People’s Hospital. The clinicopathological data, treatment and follow-up results were retrospectively analyzed in this study. Patients included four females and six males, whose age ranged between 21 and 75 years (mean, 53.3 years). The maximum diameter of the tumors was 2.5–28 cm (mean, 12.7 cm). Two cases were diagnosed as malignant variants of ESFTs. R0 resection was performed in eight patients, while one patient underwent R1 resection, and one patient received palliative chemotherapy for an inoperable mass. Follow-up time ranged between 6 and 126 months (mean, 50 months). The patient with R1 resection suffered a local relapse, and the patient receiving palliative chemotherapy succumbed to the disease. The remaining eight patients remained free of disease. Abdominopelvic SFTs usually reveal an indolent process, although the majority of tumors in the present study were of giant size when diagnosed. The risk of local recurrence and metastasis correlates with tumor size and the histological status of surgical margins. The preferred treatment is complete resection followed by extended follow-up surveillance.

Clinical experience and analysis of laparoscopic total mesorectal excision combined with improved Bacon for the treatment of lower rectal cancer.

This study is aimed at assessing the safety and feasibility of laparoscopic total mesorectal excision (LTME) combined with improved Bacon (IB) procedure in the treatment of lower rectal cancer. There were 347 patients undergoing sphincter-preserving operation at the authors hospital from 2003 to 2009. Of these, there were 201 cases with double stapler technique (DST) anastomosis in high-location group (range 6 to 12cm); 76 cases with DST anastomosis in low-location subgroup A (range 5 to 6cm); and 70 cases with IB anastomosis in low-location subgroup B (range 5 to 6cm). In high-location group vs. low-location subgroup A, anastomotic leak rate and covering stoma rate in low-location subgroup A were obviously higher (p=0.038 and p=0.040); in low-location subgroup A vs. low-location subgroup B, operative time in low-location subgroup B was a little longer (p=0.000). However, anastomotic leak rate and covering stoma rate were significantly higher in low-location subgroup A (p=0.043 and p=0.043). DST can be applied as the first choice if the inferior margin of tumor to anal verge is 6 to 12cm. For lower rectal cancer, 5 to 6cm from anal verge, when DST is not suitable for sphincter-preserving operation, IB anastomosis can be applied.

Ki67 is a biological marker of malignant risk of gastrointestinal stromal tumors: A systematic review and meta-analysis

Background: Ki67 is a good marker of cell proliferation in a variety of tumors. High ki67 levels are usually associated with poor prognosis. However, the relationship between Ki67 expression and the risk of malignancy of gastrointestinal stromal tumors (GISTs) is still poorly defined. The current meta-analysis was initiated to address this issue. Methods: Studies reporting Ki67 expression and the risk of malignancy in GIST were found by searching Cochrane Library, PubMed, Medline, and Embase until October 31, 2016. A total of 9 studies involving 982 patients were included. Pooled odds ratio (OR) estimates and 95% confidence intervals (CIs) were calculated using a fixed-effect model. Results: Meta-analysis showed no significant difference in the incidence of Ki67 overexpression between the very low NIH group and the low NIH group (OR: 0.66, 95% CI: 0.25–1.76; P = .41, Pheterogeneity = .25). However, the incidence of Ki67 overexpression gradually increased from the low NIH group to the high NIH group (OR: 0.46, 95% CI: 0.27–0.80; P = .005, Pheterogeneity = .13) and (OR: 0.22, 95% CI: 0.15–0.34; P < .00001, Pheterogeneity = .33). Conclusions: There were more GIST patients with Ki67 overexpression in the intermediate and high NIH groups than in the low NIH group. Ki67 overexpression may be a useful marker of the risk of malignant GIST transformation.

Squamous cell carcinoma arising from an unknown primary site metastasizing to the stomach: A case report

Primary squamous cell carcinoma (SCC) may originate elsewhere in the body, including the head, neck, lung, bronchus, cervix uteri, esophagus and cardia, and metastasize to the stomach. In the present report, a case is presented of an SCC, which arose from an unknown primary site and metastasized to the stomach of a 59-year-old male. The tumor was located in the interspace between the liver and the stomach. It involved the placenta percreta, lamina muscularis and submucosa, however, had already metastasized to a regional lymph node at the time of surgery. No SCC was observed in other organs on physical examination, which included positron emission tomography-computed tomography. In the follow-up period, there was no evidence of additional malignant tumors in the patient; therefore, the origin of the tumor was speculative. To the best of our knowledge, this is the first case report regarding a tumor of this type.

Cellular schwannoma arising from the gastric wall misdiagnosed as a gastric stromal tumor: A case report

Cellular schwannomas have been previously described at almost every anatomic location of the human body, but reports in the gastric wall are rare. The current study presents a rare case of cellular schwannoma originating from the gastric wall. Computed tomography revealed a 5.6×5.3×4.0-cm3 solid mass located in the posterior wall of the stomach. Open laparotomy confirmed its mesenchymal origin. Microscopically, the tissue was composed of spindle-shaped and fascicularly-arranged cells, but mitotic figures were rare. Immunohistochemical staining showed that the tumor was negative for cluster of differentiation (CD)117, CD34, smooth muscle actin and desmin, but positive for S-100 and Ki67. The patient presented no evidence of recurrence and metastasis during follow-up. Gastric cellular schwannomas may be diagnosed by clinical characteristics, histological observations and immunohistochemical markers.