Serous Cavity Effusion Research Articles

Weakly supervised multiple instance learning model with generalization ability for clinical adenocarcinoma screening on serous cavity effusion pathology

Accurate and rapid screening of adenocarcinoma cells in serous cavity effusion is vital in diagnosing the stage of metastatic tumors and providing prompt medical treatment. However, it is often difficult for pathologists to screen serous cavity effusion. Fixed agglutination cell block can help to improve diagnostic sensitivity in malignant tumor cells through analyzing larger volumes of serous cavity effusion, though it could accordingly lead to screening on more cells for pathologists. With the advent of whole slide imaging and development of artificial intelligence, advanced deep learning models are expected to assist pathologists in improving the diagnostic efficiency and accuracy. In this study, so far as we known, it is the first time to use cell block technology combined with a proposed weakly supervised deep learning model with multiple instance learning method to screen serous adenocarcinoma. The comparative experiments were implemented through five-fold cross-validation, and the results demonstrated that our proposed model not only achieves state-of-the-art performance under weak supervision while balancing the number of learnable parameters and computational costs and reduces the workload of pathologists, but also presents a quantitative and interpretable cellular pathological scene of serous adenocarcinoma with superior interpretability and strong generalization capability. The performances and features of the model indicate its effectiveness in the rapid screening and diagnosis of serous cavity effusion and its potential in broad clinical application prospects, e.g., in precision medical applications. Moreover, the constructed two real-world pathological datasets would be the first public WSI datasets of serous cavity effusion with adenocarcinoma based on cell block sections, which can help to assist colleagues.

Analysis of the prevalence characteristics and risk factors of pulmonary tuberculosis combined with extrapulmonary tuberculosis in elderly patients

To analyze the clinical features, epidemiological characteristics, risk factors, and complication characteristics of pulmonary tuberculosis (PTB) combined with extrapulmonary tuberculosis (EPTB) in elderly patients (aged > 60 years). Clinical data were collected from pathogen positive elderly patients with PTB hospitalized in a teaching hospital in Zhejiang from 2017 to 2023. We retrospectively analyzed the risk factors for complications of EPTB in elderly patients with PTB by univariate and multivariate logistic regression models. We also described the characteristics of complications in PTB with EPTB. A total of 781 PTB elderly patients were enrolled, of whom 86 (11.01%) had complicated EPTB. The most commonly invasive sites for EPTB were thoracic spine (17.53%), cervical lymph nodes (13.40%), and meninges (12.37%). 60 < aged < 80 years (OR = 2.876, 95%CI 1.290–6.412; P = 0.010), anaemia (OR = 2.212, 95%CI 1.135–3.967; P = 0.018) and osteoporosis (OR = 4.925, 95%CI 1.501–16.160; P = 0.009) were the independent risk factors for PTB with EPTB infection. PTB with EPTB had a higher proportion of multiple serous cavity effusion (19.8% vs. 12.2%) and longer hospitalisation (17 vs. 15, P = 0.004). 60 < aged < 80 years, anaemia and osteoporosis were found to be independent risk factors for PTB with EPTB in elderly patients. We compared the epidemiological and clinical characteristics of PTB with EPTB. These results are important for improving the diagnosis of EPTB, reducing complications, and improving prognosis.

Clinicopathological features of metastatic melanoma in effusion cytology of serosal cavity

Objective: To investigate the clinical, cytomorphology, immunocytochemical and molecular features of metastatic melanoma in serosal cavity effusion. Methods: Cytological specimens of 14 patients with melanoma in the chest and abdomen were collected from 2017 to 2023, at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. SOX10, S-100 protein, PRAME, BRAF V600E, HMB45, and Melan A were detected by immunocytochemical methods. Fourteen cases were tested for routine antibody combinations, including Claudin4, HEG1, Calretinin, CD68, etc. Four of the patients had biopsy or surgical samples of metastatic solid lesions of primary sites, and further next-generation sequencing (NGS) or amplification refractory mutation system (ARMS)-PCR molecular test was performed. In addition, 30 cases of serosal effusion samples were collected as control groups (10 cases of benign mesothelial cell reactive hyperplasia, 10 cases of mesothelioma, and 10 cases of metastatic lung adenocarcinoma). Results: Among the 14 cases of melanoma, there were 7 males and 7 females, with ages ranging from 35 to 86 years, and an average age of 57 years, there 10 cases aged ≥50 years. The tumor cells in the serosal effusion varied in morphology and degree of atypia. SOX10 was positive in all 14 cases (14/14), S-100 protein was positive in 10 cases (10/14), PRAME was positive in 12 cases (12/14), BRAF V600E was positive in 10 cases (10/14), HMB45 was positive in 12 cases (12/14), and Melan A was positive in 13 cases (13/14). In 4 patients with histological correlation, the cytological and histological expression of SOX10, BRAF V600E, and PRAME was positive in all 4 cases (4/4); S-100 protein was positive in 2 cases (2/4); and HMB45 and Melan A were positive in 3 cases (3/4). Using NGS or ARMS-PCR, missense mutations of BRAF V600E were detected in all 4 patients; TERT promoter mutations was detected in 1 case; and CDKN2A terminating mutations and MSI1 deletion mutations were detected in the other case. SOX10, S-100, HMB45, Melan A, PRAME and BRAF V600E were all negative in 30 control samples of serosal cavity effusion. Conclusion: By observing the morphology of tumor cells, immunocytochemical test of several combination markers, especially the expression of SOX10, BRAF V600E and PRAME, can help to improve the positive diagnosis rate of melanoma in serous cavity effusion.

Multiple serous cavity effusion screening based on smear images using vision transformer

Serous cavity effusion is a prevalent pathological condition encountered in clinical settings. Fluid samples obtained from these effusions are vital for diagnostic and therapeutic purposes. Traditionally, cytological examination of smears is a common method for diagnosing serous cavity effusion, renowned for its convenience. However, this technique presents limitations that can compromise its efficiency and diagnostic accuracy. This study aims to overcome these challenges and introduce an improved method for the precise detection of malignant cells in serous cavity effusions. We have developed a transformer-based classification framework, specifically employing the vision transformer (ViT) model, to fulfill this objective. Our research involved collecting smear images and corresponding cytological reports from 161 patients who underwent serous cavity drainage. We meticulously annotated 4836 patches from these images, identifying regions with and without malignant cells, thus creating a unique dataset for smear image classification. The findings of our study reveal that deep learning models, particularly the ViT model, exhibit remarkable accuracy in classifying patches as malignant or non-malignant. The ViT model achieved an impressive area under the receiver operating characteristic curve (AUROC) of 0.99, surpassing the performance of the convolutional neural network (CNN) model, which recorded an AUROC of 0.86. Additionally, we validated our models using an external cohort of 127 patients. The ViT model sustained its high-level screening performance, achieving an AUROC of 0.98 at the patient level, compared to the CNN model’s AUROC of 0.84. The visualization of our ViT models confirmed their capability to precisely identify regions containing malignant cells in multiple serous cavity effusion smear images. In summary, our study demonstrates the potential of deep learning models, particularly the ViT model, in automating the screening process for serous cavity effusions. These models offer significant assistance to cytologists in enhancing diagnostic accuracy and efficiency. The ViT model stands out for its advanced self-attention mechanism, making it exceptionally suitable for tasks that necessitate detailed analysis of small, sparsely distributed targets like cellular clusters in serous cavity effusions.

18F-FDG PET/CT features of Meigs syndrome induced by ovarian sex cord stromal tumors: a retrospective clinical study

The objective of this study was retrospectively to analyze the clinical characteristics and 18F-FDG PET/CT findings in Meigs syndrome (MS) patients. A total of 21 patients with MS induced by ovarian stromal tumors and 69 patients with pseudo-MS caused by ovarian cancer (OC-PMS) were subjected to evaluation using 18F-FDG PET/CT. Visual and semi-quantitative methods were employed to analyze the PET/CT findings. Visual analysis included recording whether the density of the primary tumor was uniform, whether there were cystic changes and calcifications, and the location of serous fluid accumulation. Semi-quantitative analysis involved the measurement of the tumor size, SUVmax, and SUVmean. No significant difference was observed in the size and density of primary tumors between the MS group and the OC-PMS group. However, the SUVmax and SUVmean of tumors in the MS group were found to be significantly lower than those in the OC-PMS group. The amount of serous cavity effusion caused by ovarian sex cord stromal tumors was found to be unrelated to the size of the tumor, SUVmax, and SUVmean but was positively correlated with the level of Ca125. MS patients have both benign ovarian tumors and ascites and/or pleural effusion, which may be accompanied by elevated Ca125 levels. This should be considered as one of the differential diagnoses for ovarian cancer. Understanding the PET/CT features of MS can facilitate the attainment of an accurate diagnosis before surgery.

CORRELATION BETWEEN SOMATIC MUTATIONS AND PROGNOSIS IN PEDIATRIC MATURE B‐CELL LYMPHOMA

Introduction: To investigate the prognostic factors of childhood mature B-cell lymphoma (MBL), especially the significance of somatic mutations in the clinical features and prognosis, by analyzing the clinical chartacteristics, genetic mutation results and prognosis of 133 children with MBL. Methods: Children and adolescents (≤18 years old) with MBL who were admitted from November 2017 to February 2023 were enrolled, and patients with somatic mutations were detected using next-generation sequencing (NGS). The diagnosis includes the completion of pathological examination and center consultation, and the staging is based on the international children's St. Jude staging system, primary patients were treated with the modified LMB89/96 protocol. Refractory or recurrent (r/r) patients were treated with second-line chemotherapy based on ICE and/or CAR-T-cell sequential therapy with different B-cell targets. The factors related to curative effect and prognosis, especially the correlation between the gene mutation spectrum and prognosis, were analyzed. Results: The mutant gene spectrum of 133 patients is shown in Fig.a. According to the time of specimen collection, there were 77 cases of initial diagnosis (initial treatment group) and 56 cases of r/r patients (r/r group). The clinical feature and survival of the 133 patients are summarized in Figure b, c, d, e (P < 0.001) and g. The results showed that patients with a large tumor focus, serous cavity effusion and delayed chemotherapy during treatment had significant difference in prognosis and significantly shortened survival. The top three genes in the initial treatment group were ID3 (53%), TP53 (47%), and CCND3 (30%) (Figure h). The top three genes in the r/r group were TP53 (82%), ID3 (58%), and ARID1A (40%) (Figure j). TP53 was significantly different between the initial treatment group and r/r patients (P < 0.001). Of the 133 patients grouped by efficacy, 70 progressed/relapsed, and 59/70 received CAR T therapy, with an overall response rate (ORR) of 83%. Survival analysis is shown in the figure f. A total of 11/70 patients received second-line chemotherapy, and only 1 patient survived to receive treatment. Compared with second-line chemotherapy, CAR T-cell treatment significantly improved the survival rate (P = 0.008). ARID1Awas significant in patients with poor prognosis after CAR T therapy (P = 0.00081) (Figure k). Keywords: Chemotherapy, Diagnostic and Prognostic Biomarkers, Non-Hodgkin (Pediatric, Adolescent, and Young Adult) No conflicts of interests pertinent to the abstract.

Возможности цитологического исследования экссудатов серозных полостей в диагностике онкопатологии в условиях многопрофильного стационара

Cytological criteria of tumors in exudate fluids are associated with certain subjective difficulties, one of which is the differential diagnosis of proliferating mesothelial and malignant neoplasm cells. The study aimed to show the possibilities of cytological examination of exudates from serous cavities in the diagnosis of oncopathology. Material and methods. From 2018 to 2021, 10,082 serous cavity effusions (pleural – 8,166 (81%), abdominal cavity – 1,512 (15%), pericardial – 404 (4%)) were included in the cytological examination. Microscopic examination of traditional preparations was carried out, and immunocytochemical (ICC) examination was carried out in difficult diagnostic situations. Results. Analysis of the study showed that by the traditional cytological method in effusion fluids in women, metastatic lesions of the serous cavities were diagnosed in 672 cases (58%), mainly due to the progression of breast cancer (26%). In men, pleurisy was mainly due to metastasis of adenocarcinoma of the lung – 266 cases (23%). ICC research increased the diagnostic accuracy of cytological examination by 62–93% and the specificity – by 95–99%. Conclusions. An algorithm has been developed for conducting ICS studies, differing in the number of monoclonal antibodies used, to determine the histological form of a malignant tumor and the source organ of metastasis. In specific cases, conducting ICR studies with 2–3 monoclonal antibodies may be quite enough to confirm the histological form of the tumor and, where necessary, perform additional ICR studies without significant loss of time for obtaining results.

Cytopathological characterization of ascites for the diagnosis of serous ovarian carcinoma

Objective: To investigate the cytomorphological and immunocytochemical features of tumor cells in the ascites of ovarian plasmacytoma (SOC). Methods: Specimens of serous cavity effusions were collected from 61 tumor patients admitted to the Affiliated Wuxi People's Hospital of Nanjing Medical University from January 2015 to July 2021, including ascites from 32 SOC, 10 gastrointestinal adenocarcinomas, 5 pancreatic ductal adenocarcinomas, 6 lung adenocarcinomas, 4 benign mesothelial hyperplasia and 1 malignant mesothelioma patients, pleural effusions from 2 malignant mesothelioma patients and pericardial effusion from 1 malignant mesothelioma. Serous cavity effusion samples of all patients were collected, conventional smears were made through centrifugation, and cell paraffin blocks were made through centrifugation of remaining effusion samples. Conventional HE staining and immunocytochemical staining were applied to observe and summarize cytomorphological characteristics and immunocytochemical characteristics. The levels of serum tumor markers carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were detected. Results: Of the 32 SOC patients, 5 had low-grade serous ovarian carcinoma (LGSOC) and 27 had high-grade serous ovarian carcinoma (HGSOC). 29 (90.6%) SOC patients had elevated serum CA125, but the difference was not statistically significant between them and patients with non-ovarian primary lesions included in the study (P>0.05); The serum CEA was positive in 9 patients with gastrointestinal adenocarcinoma and 5 patients with lung adenocarcinoma, and the positive rate was higher than that in SOC patients (P<0.001); The serum CA19-9 was positive in 5 patients with gastrointestinal adenocarcinoma and 5 patients with pancreatic ductal adenocarcinoma, and the positive rate was higher than that in SOC patients (P<0.05). The serum CA125, CEA and CA19-9 were within the normal range in 4 patients with benign mesothelial hyperplasia. LGSOC tumor cells were less heterogeneous and aggregated into small clusters or papillary pattern, and psammoma bodies could be observed in some LGSOC cases. The background cells were fewer and lymphocytes were predominant; the papillary structure was more obvious after making cell wax blocks. HGSOC tumor cells were highly heterogeneous, with significantly enlarged nuclei and varying sizes, which could be more than 3-fold different, and nucleoli and nuclear schizophrenia could be observed in some cases; tumor cells were mostly clustered into nested clusters, papillae and prune shapes; there were more background cells, mainly histiocytes. Immunocytochemical staining showed that AE1/AE3, CK7, PAX-8, CA125, and WT1 were diffusely positively expressed in 32 SOC cases. P53 was focally positive in all 5 LGSOCs, diffusely positive in 23 HGSOCs, and negative in the other 4 HGSOCs. Most of adenocarcinomas of the gastrointestinal tract and lung had a history of surgery, and tumor cells of pancreatic ductal adenocarcinoma tend to form small cell nests. Immunocytochemistry can assist in the differential diagnosis of mesothelial-derived lesions with characteristic "open window" phenomenon. Conclusion: Combining the clinical manifestations of the patient, the morphological characteristics of the cells in the smear and cell block of the ascites can provide important clues for the diagnosis of SOC, and the immunocytochemical tests can further improve the accuracy of the diagnosis.

Claudin18.2 expression and clinicopathological features in cytology effusion specimens from gastric adenocarcinoma: Acomparative study with tissue specimens.

Zolbetuximab (IMAB362) is under investigation for treating advanced gastrointestinal tumors because it targets Claudin18.2 (CLDN18.2). CLDN18.2 is a promising molecule along with the presence of human epidermal growth factor receptor 2 in gastric cancer. This study evaluated cell block (CB) preparations of serous cavity effusions for the feasibility for CLDN18.2 protein expression and compared the results with those of biopsy or resection specimens. The association of CLDN18.2 expression in effusion samples and the clinicopathological features were also investigated. Cytological effusion specimens and matched surgical pathology biopsy or resection specimens of 43 gastric and gastroesophageal junctional cancer cases were stained for CLDN18.2 expression and quantified using immunohistochemistry based on the manufacturer's instructions. Positive staining was detected in 34 (79.1%) tissue and 27 (62.8%) effusion CB samples in this study. When "positivity" was defined as moderate-to-strong staining in ≥40% viable tumor cells, CLDN18.2 expression was observed in 24 (55.8%) tissue and 22 (51.2%) effusion CB samples. A cutoff of 40% for CLDN18.2 positivity was used to demonstrate high concordance (83.7%) between cytology CB and tissue specimens. The results showed that CLDN18.2 expression in effusion specimens correlated with tumor size (p=.021) but not with sex, age at diagnosis, primary tumor location, staging, Lauren phenotype, cytomorphologic features, or Epstein-Barr virus infection. Cytological effusions with or without CLDN18.2 expression did not significantly affect overall survival. This study's results show that serous body cavity effusions may be suitable for CLDN18.2 biomarker testing; however, discordant cases should be interpreted cautiously.

Clinical features of cancer with unknown primary site (clinical features, treatment, prognosis of cancer with unknown primary site)

Cancer of unknown primary site(CUPs) is a metastatic syndrome with an unidentifiable primary tumor, even after extensive workup to seek the primary site. CUPs accounts for about 3%-5% of the total number of all cancer diagnoses worldwide. The current precision medicine era has reclassified patients with CUPs into the favorable and unfavorable prognostic subset. In this study clinical characteristics and treatment of patients of CUPs were retropactively analysed. Thirty-two patients treated from July 2016 to October 2021 were included in the Affiliated Tumor Hospital of Tianjin Medical University(Tianjin, China).Common symptoms were anemia, fever, enlarged lymph nodes, abdominal pain, edema/multiple serous cavity effusion. Patients with good prognostic factors achieved good outcomes with treatment, conversely, patients with poor prognosis were generally treated empirically and had poorer outcomes. After anti-tumor treatment, the total effective rate was 41 percent(41% was the percentage of patients who achievedtumour respons). To the end of follow-up, after anti-tumor treatment, the median Overall Survival(OS) of patients was 5.4 months.

STAGES OF CYTOLOGICAL EXAMINATION&#x0D; (USING IMMUNOCYTOCHEMICAL EXAMINATION) OF EFFUSION FLUIDS

Relevance: Cytological criteria of tumors in exudate fluids are associated with certain subjective difficulties, one of which is the differential&#x0D; diagnosis of proliferating mesothelial and adenocarci-noma cells.&#x0D; The study aimed to increase the informational value of cytological diagnostics in a multidisciplinary hospital.&#x0D; Methods: From 2018 to 2021, 10,082 serous cavity effusions (pleural – 8,166 (81%), abdominal cavity – 1,512 (15%), pericardial – 404 (4%))&#x0D; were included in the cytological examination. Micro-scopic examination of traditional preparations was carried out, and immunocytochemical&#x0D; (ICC) ex-amination was carried out in difficult diagnostic situations.&#x0D; Results: Analysis of the study showed that by the traditional cytological method in effusion fluids in women, metastatic lesions of the serous&#x0D; cavities were diagnosed in 672 cases (58%), mainly due to the progression of breast cancer (26%). In men, pleurisy was mainly due to metastasis&#x0D; of adenocar-cinoma of the lung – 266 cases (23%). ICC research increased the diagnostic accuracy of cytological examination by 62-93% and the&#x0D; specificity – by 95-99%.&#x0D; Conclusions: An algorithm for conducting ICH studies, differing in the number of panels of mono-clonal antibodies used to determine the&#x0D; histological form and organ - the source of the tumor, has been developed. In specific cases, conducting ICR studies with 2-3 monoclonal antibodies&#x0D; may be quite enough to confirm the histological form of the tumor and, where necessary, perform additional ICR studies without significant loss&#x0D; of time for obtaining results.

STAGES OF CYTOLOGICAL EXAMINATION (USING IMMUNOCYTOCHEMICAL EXAMINATION) OF EFFUSION FLUIDS

Relevance: Cytological criteria of tumors in exudate fluids are associated with specific subjective difficulties, one of which is the differential diagnosis of proliferating mesothelial and adenocarcinoma cells.&#x0D; The study aimed to: increase the informational value of cytological diagnostics in a multidisciplinary hospital.&#x0D; Methods: From 2018 to 2021, 10,082 serous cavity effusions (pleural – 8,166 (81%), abdominal cavity – 1,512 (15%), pericardial – 404 (4%)) were included in the cytological examination. Microscopic examination of traditional preparations was carried out, and immunocytochemical (ICC) examination was carried out in difficult diagnostic situations.&#x0D; Results: In this study, in women, the traditional cytological examination of effusion fluids revealed metastatic lesions of the serous cavities in 672 cases (58%), mainly due to breast cancer progression (26%). In men, pleurisy was primarily due to metastasis of adenocarcinoma of the lung – 266 cases (23%). ICC research increased the diagnostic accuracy of cytological examination by 62-93% and the specificity – by 95-99%.&#x0D; Conclusion: An algorithm for conducting ICH studies, differing in the number of panels of monoclonal antibodies used to determine the histological form and organ — the source of the tumor, has been developed. In specific cases, conducting ICR studies with 2-3 monoclonal antibodies may be enough to confirm the histological form of cancer and, where necessary, perform additional ICR studies without significant loss of time for obtaining results.

EpCAM and MUC-1 Flow Cytometry for Detection of Malignant Epithelial Cells in Serous Cavity Effusions in Cases with Suspicious/Atypical Morphology

EpCAM and MUC-1 Flow Cytometry for Detection of Malignant Epithelial Cells in Serous Cavity Effusions in Cases with Suspicious/Atypical Morphology

Nursing Countermeasures of Continuous Renal Replacement Treatment in End-Stage Renal Disease with Refractory Hypotension in the Context of Smart Health.

This work is aimed at exploring the nursing strategies and effects of continuous renal replacement therapy (CRRT) for end-stage renal disease (ESRD) with refractory hypotension under the background of smart health. 40 ESRD patients with refractory hypotension who received CRRT treatment were enrolled as the research objects and were randomly rolled into the intervention group and the control group, with 20 cases in each group. Patients in the control group received routine nursing, and those in the intervention group received individualized nursing. The incidence of hypotension, dry body weight, serous cavity effusion, renal function indicators (blood urea nitrogen (BUN) and creatinine (Cre)), and patient satisfaction were compared between the two groups. The results showed that the probability of hypotension in the intervention group was 9.38%, which was lower than that in the control group (34.38%). The probability of early termination of dialysis in the intervention group was 0%, which was lower than that in the control group (18.75%), and the difference was statistically significant (P < 0.05). The decreases of BUN and Cre in the intervention group were significantly greater than those in the control group, and the differences were statistically significant (P < 0.05). The proportion of water growth less than 10% during dialysis in the intervention group was 98.44%, which was greater than that in the control group (93.45%), and the difference was statistically significant (P < 0.05). The ultrafiltration volume after dialysis in the intervention group was 2850 ± 400 mL, which was greater than that in the control group 2350 ± 350 mL. After intervention, the proportion of patients with pleural effusion in the intervention group was 10% less than that in the control group (20%), and the difference was statistically significant (P < 0.05). The satisfaction rate of the intervention group was 97.66%, which was higher than that of the control group (65.63%). In conclusion, individualized nursing was more helpful to the recovery of ESRD patients with refractory hypotension treated with CRRT than routine nursing.

Systemic Therapy in Patients With Metastatic Xp11.2 Translocation Renal Cell Carcinoma.

Xp11.2 translocation renal cell carcinoma (Xp11.2 tRCC) is a unique subtype with poor prognosis, its response to systemic therapy is not fully understood, we evaluated the benefit of systemic therapy in these patients. Between May 2006 and December 2019, patients diagnosed with Xp11.2 tRCC from Peking university cancer hospital were collected. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS) distributions. Metastatic Xp11.2 tRCC was found in 45 patients. The median PFS and median OS was 7.4 months (4.5-8.8) and 17.9 months (12.4-24.4), respectively. First-line treatment mainly included sunitinib (n=14), sorafenib (n=15), axitinib (n=6), and pazopanib (n=5), and the median PFS of these regimens were 7.4 months, 5.4 months, 9.4 months, 8.9 months, respectively. Two patients who received Vascular endothelial growth factor receptor - tyrosine kinase inhibitor (VEGFR-TKI) plus immune checkpoint inhibitor (ICI) as first line therapy had a PFS of more than 16.6 months and more than 25.6 months, respectively. Twenty-four patients received subsequent therapies, which included VEGFR-TKI/ICI, VEGFR-TKI and mTOR inhibitor. The ORR and median PFS was 33% and 7.1 months, 7.7% and 4.3 months, 0% and 2.1 months for these treatments, respectively. The estimated median OS was 17.3 months (95% CI, 11.2 to not reached) in patients with TKI/ICI treatment and 11.0 months (95% CI, 6.1 to not reached) without TKI/ICI treatment in subsequent therapies (P=.04). Patients with serous cavity effusion or IMDC poor risk groups had significantly shorter median PFS and median OS. Metastatic Xp11.2 tRCC is an aggressive disease. VEGFR-TKI agents appeared to demonstrate some efficacy, VEGFR-TKI /ICI combination might be a useful tool for the treatment of metastatic Xp11.2 tRCC.

Tuberculous polyserositis in endemic areas with an emphasis on empiric therapy

Abstract Rationale: Polyserositis describes contemporaneous inflammation of multiple serous membranes accompanied by effusions in serous cavities. It has been associated with different aetiologies, including autoimmune diseases, endocrine diseases, neoplasia, drug-associated cases, and infectious diseases, such as tuberculosis. Patient concerns: We report the case of a 34-year-old woman who presented with abdominal swelling for 8 months, fatigability, and shortness of breath for 2 months. She denied a history of lower-limb swelling, orthopnea, paroxysmal nocturnal dyspnoea, or right upper quadrant pain. She had no history of cigarette smoking, prior treatment for tuberculosis, malignancy, or contact with someone known to have tuberculosis (TB). On examination, she had a weak pulse, muffled heart sounds, and ascites. Diagnosis: Polyserositis was suspected following visualization of fluid in the peritoneal, pleural, and pericardial cavities on imaging. Interventions: The patient underwent pericardiocentesis and ascitic taps. The patient also received spironolactone, prednisolone, and paracetamol. Despite repeated ascitic tapping and use of diuretics, fluid continued to accumulate until the initiation of empiric anti-TB drugs (rifampicin, isoniazid, pyrazinamide, and ethambutol), as noted from the elevated levels of adenosine deaminase (pleural fluid-46.30U/L) and living in an endemic area for tuberculosis (Kenya). Outcomes: Three weeks after the initiation of anti-TB drugs, the ascites and pericardial and pleural effusions resolved. Two months after discharge, the patient showed marked improvement, with no residual fluid noted in the serous cavities on imaging. Lessons learnt: We report a case of extrapulmonary TB presenting with polyserositis (pericardial, pleural, and ascitic fluid) with elevated adenosine deaminase levels when the traditional Ziehl Neelsen staining yielded negative results. Good clinical judgment and more novel diagnostic tools are necessary to avoid unnecessary delays in initiating definitive management.

AL amyloidosis with primary presentation of multiple serous cavity effusion and severe cholestasis: a case report and review of literature

BackgroundImmunoglobulin light chain (AL) amyloidosis commonly affects the kidney or heart, but may also involve the liver at a histopathological level. Early diagnosis of AL amyloidosis is important for proper management with desirable outcome. We reported here an unusual case of AL amyloidosis, presenting primarily with multiple serous cavity effusion, accompanied with rapidly progressive cholestasis.Case presentationA previously healthy 63-year-old man presented with dysuria, frequent urination, oliguria and oedema of lower extremities for one month, accompanied with jaundice and hypoproteinemia. CT demonstrated multiple serous cavity effusion, focal hypodense lesions in the liver, and focal low-density in the spleen. Laparoscopy with liver biopsy revealed liver and spleen fibrosis with congestion, no visceral rupture, following haemorrhagic ascites from abdominocentesis. This patient was transferred to our (tertiary) hospital. The diagnosis of amyloidosis was confirmed with histopathology/immunohistochemistry. Haematopoietic stem cell transplantation was not applicable, however chemotherapy was advised, due to the patient’s Mayo score 3. The patient declined chemotherapy and was self-discharged back to his hometown hospital with palliative care, however only lasted a further one-month.DiscussionThe lesson we have learnt from this case that any patients with multiple serous cavity effusion and isolated hepatic involvement, primary amyloidosis should be considered. Multiple serous cavity effusion may serve as an indicator for poor prognosis of hepatic AL amyloidosis.

Systemic therapy in patients with metastatic Xp11.2 translocation renal cell carcinoma.

341 Background: Xp11.2 translocation renal cell carcinoma (RCC) is a unique RCC subtype with high malignant potential and poor prognosis, its natural course and response to systemic therapy are not fully understood. We analyzed the clinic features of this distinct entity and the benefit of systemic therapy in these patients. Methods: Between May 2006 and December 2019, 1113 consecutive patients diagnosed with RCC from Peking university cancer hospital (Beijing, China) were reviewed, data of the clinical characteristics and outcome of patients with metastatic Xp11.2 RCC were retrospectively collected. Tumor response to systemic therapy was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) criteria. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS) distributions. Results: Metastatic Xp11.2 tRCC was found in 45 patients. The median PFS and median OS was 7.4 months (4.5 - 8.8) and 17.9 months (12.4 - 24.4), respectively. First-line treatment mainly included sunitinib (n = 14), sorafenib (n = 15), axitinib (n = 6), and pazopanib (n = 5), and the median PFS of these regimens were 7.4 months, 5.4 months, 9.4 months, 8.9 months, respectively. Two patients who received Vascular endothelial growth factor receptor - tyrosine kinase inhibitor (VEGFR-TKI) plus immune checkpoint inhibitor (ICI) as first line therapy had a PFS of more than 16.6 months and more than 25.6 months, respectively. Twenty-four patients received subsequent therapies, which included VEGFR-TKI/ICI, axitinib and mTOR inhibitor, the median PFS for these regimens was 8.5, 7.2 and 2.0 months, respectively. Patients with serous cavity effusion or IMDC poor risk groups had significantly shorter median PFS and median OS. Conclusions: Metastatic Xp11.2 tRCC is an aggressive disease. VEGFR-TKI agents appeared to demonstrate some efficacy, VEGFR-TKI/ICI combination might be a useful tool for the treatment of metastatic Xp11.2 tRCC.

Exosomes in Pathogenesis, Diagnosis, and Treatment of Hepatocellular Carcinoma.

Exosomes are extracellular vesicles with a diameter of 30-150 nm that are released by most types of cells and have been confirmed to be involved in many physical and pathological processes, especially in cell to cell communication. Compared with other vesicles, exosomes have a unique double-layer saclike structure that allows them to be present stably in various body fluids, including blood, cerebrospinal fluid, urine, saliva, and serous cavity effusion. The cargoes of exosomes reflect the characteristics of host cells. Due to the nature of hepatocellular carcinoma (HCC) cells, heterogeneity in the bioactive substances usually exist in exosomes. In addition, exosomes can efficiently deliver cargoes to the target cells to exert pathological functions, playing important role in tumor occurrence, development, metastasis, immune regulation, and drug resistance. Previous studies have been shown that exosomes have wide applications in diagnosis and treatment of HCC. In this review, we discuss these recent findings and highlight the significant roles of exosomes in HCC, focusing on the effect and underlying mechanisms of exosomes to regulate HCC progression and the potential clinical value of exosomes as biomarkers and therapeutic targets.

Clone Selection Artificial Intelligence Algorithm-Based Positron Emission Tomography-Computed Tomography Image Information Data Analysis for the Qualitative Diagnosis of Serous Cavity Effusion in Patients with Malignant Tumors.

This study aimed to investigate the application of positron emission tomography- (PET-) computed tomography (CT) image information data combined with serous cavity effusion based on clone selection artificial intelligence algorithm in the diagnosis of patients with malignant tumors. A total of 97 patients with PET-CT scanning and empirically confirmed as serous cavity effusion were retrospectively analyzed in this study. The clone selection artificial intelligence algorithm was applied to register the PET-CT images, and the patients were rolled into a benign effusion group and a malignant effusion group according to the benign and malignant conditions of the serous cavity effusion. Besides, the causes of patients from the two groups were analyzed, and there was a comparison of their physiological conditions. Subsequently, CT values of different KeV, lipid/water, water/iodine, and water/calcium concentrations were measured, and the differences of the above quantitative parameters between benign and malignant serous cavity effusion were compared, as well as the registration results of the clone algorithm. The results showed that the registration time and misalignment times of clonal selection algorithm (13.88, 0) were lower than those of genetic algorithm (18.72, 8). There were marked differences in CT values of 40–60 keV and 130–140 keV between the two groups. The concentrations of lipid/water, water/iodine, and water/calcium in basal substances of the malignant effusion group were obviously higher than the concentrations of the benign effusion group (P < 0.05). Benign and malignant effusions presented different manifestations in PET-CT, which was conducive to the further diagnosis of malignant tumors. Based on clone selection artificial intelligence algorithm, PET-CT could provide a new multiparameter method for the identification of benign and malignant serous cavity effusions and benign and malignant tumors.