Lobulated Research Articles

Bright lobulated tumor on the face in a newborn.

Bright lobulated tumor on the face in a newborn.

A New Pressure-Regulated, Partial Resuscitative Endovascular Balloon Occlusion of the Aorta Device Achieves Targeted Distal Perfusion

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) reduces blood loss and improves hemodynamics. Complete occlusion results in distal ischemia, limiting its use for prolonged care. This study evaluated two next-generation partial REBOA (pREBOA) catheters and their ability to achieve targeted distal aortic flow. Materials and methodsSwine underwent hemorrhagic shock, complete aortic occlusion, controlled continuous balloon deflation, and targeted distal perfusion (TDP; 300-mL/min) phases. They were randomized into three groups (n = 6/group), one managed with the current ER-REBOA (ER), and two with the new pREBOA technologies: a bilobed (BL) device and a semicompliant pREBOA-PRO (PRP). Hemodynamics including flow rates and mean arterial pressures at the carotid artery and infrarenal aorta were recorded. ResultsHemodynamics were comparable between groups during hemorrhage and complete occlusion phases. During the controlled continuous balloon deflation phase, the distal aortic flow rate strongly correlated with percent balloon volume in BL and PRP groups, suggesting a precise control of distal perfusion. The slope of flow-balloon-volume curves was greater in the ER group than BL and PRP groups, indicating the change in distal aortic flow rate was more sensitive to the balloon volume (less titratable) when using ER. During the TDP phase, variation in distal aortic flow and mean arterial pressure with respect to the target flow was lower in ER and PRP groups, than the BL group. ConclusionsPressure-regulated occlusion using the next-generation pREBOA catheters is more controlled than the first-generation ER-REBOA catheter and allow for targeted and precise distal perfusion.

HRCT features differentiate synchronous multiple primary lung adenocarcinomas from intrapulmonary metastases

Objective: To investigate the high resolution CT (HRCT) features of lung adenocarcinoma for differentiating synchronous multiple lung adenocarcinoma from lung adenocarcinoma with intrapulmonary metastasis. Methods: The clinical and imaging features of 131 lesions from 62 patients of synchronous multiple primary lung adenocarcinoma (primary group) and 67 lesions from 31 patients of lung adenocarcinoma with intrapulmonary metastases (metastasis group) were retrospectively analyzed. According to the types of lesion, including pure ground glass nodule (pGGN), mixed ground glass nodule (mGGN) and solid nodule (SN), the image feature matching types of patients were divided into 7 types. The differences of image feature matching types between the primary group and the metastasis group were compared. Multiple lesions in the lung of patients were classified into the main lesion and the concomitant lesions according to their size. The differences including the size of the main lesion and the concomitant lesion (long diameter of nodule, long diameter of solid component in nodule), whether it contains ground glass components in nodule, shape, lobulation, margin, spiculation, bubble-like lucency, pleural retraction and pleural attachment were recorded and analyzed. The differences of image features of main lesion and the concomitant lesion in the primary group and the metastasis group were compared. Results: The image feature matching types of pGGN + mGGN and mGGN + mGGN were more common in the primary group, and the ground glass component contained pGGN or mGGN was accounted for 62.9%(39/62). At least one lesion containing the ground glass component was accounted for 96.8% (60/62). There were two types in metastatic groups, mGGN+ SN and SN+ SN accounting for 6.5% (2/31) and 93.5% (29/31), respectively. There were significant differences in image feature matching types between the primary group and metastatic group (P<0.01). Univariate analysis of the main lesions between the two groups showed that the gender, smoking history, long diameter of the main lesion, long diameter of the solid component, the ground glass component and pleural attachment were statistically different (P<0.05). Further analysis by multivariate logistic regression showed that the male (OR=5.742, P=0.010), SN (OR=41.291, P<0.01) and pleural attachment (OR=9.288, P=0.001) were the three significant risk factors associated with the main lesions in metastasis group.The most common concomitant lesions in primary group were pGGN, containing the ground glass component. However, all of the concomitant lesions in the metastatic group were SN (P<0.01), showing round lesions with well-defined margin, attaching the pleura (P<0.05). Conclusions: The HRCT features of lung adenocarcinoma can differentiate synchronous multiple lung adenocarcinoma from lung adenocarcinoma with intrapulmonary metastasis. At least one lesion contains ground glass components (pGGN or mGGN) in synchronous multiple primary lung adenocarcinoma, while SN is more common in lung adenocarcinoma with lung metastasis. Lung cancer with intrapulmonary metastasis can be considered when the main lesion is SN with pleural attachment and the intrapulmonary accompanying lesion is also solid nodules without lobular, speculation and bubble-like lucency.

An analysis of CT and MRI features of 16 patients with primary hepatic sarcomatoid carcinoma

Objective To analyze the CT and MRI features of primary hepatic sarcomatoid carcinoma. Methods A retrospective study was conducted on 16 patients with primary hepatic sarcomatoid carcinoma who presented to Wenzhou People's Hospital of Zhejiang Province and the Second Affiliated Hospital of Wenzhou Medical University from January 2009 to June 2019. There were 8 males and 8 females, with age ranging from 35 to 71 years (average 56.8 years). The site, size, shape, margin, density of signal, adjacent tissue changes and degree enhancement of tumor were analyzed. Results Tumors in the liver in the 16 patients were all solitary, with 11 in the right and 5 in the left liver. The maximum diameter of tumor ranged from 3 to 16cm (average 8.5cm). On plain CT scanning (n=16), the tumors were round or oval in 6, and lobulated or irregular in 10 patients. The margins of the tumors were clear in 10 and unclear in 6 patients. All tumors showed low density, with 15 tumors showing uneven density, with necrosis and liquefaction of different sizes in the center, while 1 tumor showing uniform density. On plain MRI scanning (n=4), four tumors had clear margins, with necrosis and liquefaction seen in the center of the tumors. The solid part showed a slightly lower signal on T1 weighted imaging and a slightly higher signal on T2 weighted imaging. The liquefaction focus of central necrosis showed higher signal intensity on T2 weighted imaging. Enhanced scanning (n=12 on CT enhancement and n=4 on MRI enhancement), the margins of the tumors were enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 7 patients. Strip septate and margin enhancement in the tumor were enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 7 patients. Inhomogeneous strengthening in the tumor was enhanced in the arterial phase. The enhancement was continued into the portal venous and delayed phases in 1 patient. Inhomogeneous strengthening in the tumor was enhanced in the arterial phase. The enhancement was continued into the portal venous phase. In the delayed phase, enhancement in the tumor decreased, but there was continuous enhancement of the margin and interval of the tumor in 1 patient. Conclusions Hepatic sarcomatoid carcinoma showed dual imaging characteristics of sarcoma and cancer. The imaging features of hepatic sarcomatoid carcinoma depended on the proportion of sarcomatoid components. Large intrahepatic tumors showed necrotic cystic degeneration, moderate or significant persistent enhancement in striped septum and margin of tumor. Key words: Liver neoplasms; Sarcomatoid carcinoma; Tomography, X-ray computers; Magnetic resonance imaging

Application value of 16-slice spiral CT multi-planar reconstruction, surface occlusion display and other image post-processing techniques in the diagnosis of peripheral lung cancer

Objective To explore the application value of 16-slice spiral CT multi-planar reconstruction(MPR), surface occlusion display and other image post-processing techniques in the diagnosis of peripheral lung cancer. Methods From April 2017 to April 2019, a total of 98 patients with peripheral lung cancer admitted to the Affiliated Hospital of Hangzhou Normal University and the First People's Hospital of Jiashan County were selected.The detection rates of various signs of MPR, surface occlusion display and other image post-processing techniques in the diagnosis of peripheral lung cancer were analyzed and compared. Results MPR in the diagnosis of peripheral lung cancer, the lobulated sign was 94.9%(93/98), the vascular bundle sign was 85.7%(84/98), the fine and short burr was 93.9%(92/98). The detection rate of vascular bundle sign and fine burr sign was higher than that of thin layer scan (χ2=5.351, 5.023, 5.777, all P 0.05). The surface occlusion in the diagnosis of peripheral lung cancer, showed 90.8%(89/98) lobulated sign and 74.5%(73/98) pleural indentation.The detection rates of lobulated sign and pleural sag were higher than those of thin layer scanning (χ2=5.450, 6.002, all P 0.05). Conclusion In the diagnosis of various signs of peripheral lung cancer, the detection rate of 16-slice spiral CT MPR technique is high and worthy of application. Key words: Tomography, spiral computed; Lung neoplasms; Image processing, computer-assisted; Multi-plane reconstruction technology; Surface occlusion display

The CT imaging features of hepatoblastoma in term neonates

Objective To investigate the CT features of hepatoblastoma in term neonates. Methods The clinical data and abdominal CT features of 7 children with neonatal hepatoblastoma confirmed by surgical pathology from January 2015 to January 2019 in Hunan Children′s Hospital were retrospectively analyzed, focusing on the position, size, shape, density and dynamic enhancement characteristics of the mass. Results All 7 cases were solitary intrahepatic mass, which affected the liver SⅥ in 2 cases, SⅦ in 2 cases, SⅤ+Ⅵ in 1 case, SⅡ+Ⅲ in 1 case, SⅣa+Ⅴ+Ⅷ in 1 case. The maximum diameters were 2.9-10.2 cm (median maximum diameter 4.7 cm). Four cases tumors were spherical shape, while 3 cases were irregular lobulation and extended to the outside of live. The boundary was clear in 6 cases and fuzzy in 1 case. Necrosis, calcification, patchy hemorrhage was shown in 4 cases, 1 case, 5 cases, respectively. All 7 cases tumors showed heterogeneous enhancement, with multiple nodular and lamellar obvious enhancement at the center and edge of the tumor in arterial phase, and gradually filling-in, presented as multiple bands and island-like enhancement, with prominent edge enhanced but no enhancement in the necrotic area in portal venous and delayed phase. The tumor invaded portal vein and bile duct in hilar area in 1 case, with the intra-hepatic bile duct dilation. The caliber of the abdominal aorta below celiac trunk became thinner in 3 cases. 6 cases were epithelial fetal type and 1 case was mixed type with pathological confirmed. Conclusion The main CT manifestations of neonatal hepatoblastoma are spherical or lobulated, with varied degrees of necrotic, hemorrhage and calcification, and heterogeneous enhancement with gradually regional expansion. Key words: Neonates; Hepatoblastoma; Tomomography, X-ray computed; Alpha fetoprotein

Characteristics of primary mediastinal large B-cell lymphoma in 18F-FDG PET/CT imaging

Objective To investigate the characteristics of primary mediastinal large B-cell lymphoma (PMBL) in 18F-fluorodeoxyglucose (FDG) PET/CT imaging. Methods From July 2010 to April 2019, 18F-FDG PET/CT images of 27 patients (10 males, 17 females, median age 31 (19-57) years) with pathologically confirmed PMBL from the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The location, shape, density, presence of necrosis and calcification, and invasion around or beyond the lesions were observed. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured by automatic segmentation algorithm method. Spearman correlation analysis was used to evaluate the correlation between SUVmax or MTV or TLG and the maximum diameter or Ann Arbor staging. Results The lesions appeared as anterior mediastinal huge masses in 27 patients, and grew in the anterior mediastinal cross-regionally in 25 patients, lobulated at the edge in 24 patients. Low-density necrosis lesions were found in 18 patients. The lesions were surrounded by large blood vessels in 15 patients and tracheae were compressed in 12 patients. Lung tissues were invaded in 3 patients, abdominal lymph nodes and bone marrow were invaded in 1 patient, and no splenomegaly was found in 27 patients. The maximum diameter, SUVmax, MTV and TLG were (11.6±3.7) cm, 21.07 (15.78, 25.09), 190.43 (130.14, 350.75) cm3 and 2 165.54 (1 465.86, 4 185.21) g, respectively. There was no correlation between SUVmax and the maximum diameter of lesions (rs=-0.305, P=0.122), while MTV and TLG were positively correlated with the maximum diameter (rs values: 0.741, 0.532, both P 0.05). Conclusions PMBL mostly presents as large anterior mediastinal mass with the high 18F-FDG uptake in 18F-FDG PET/CT imaging, and the focal necrosis is common, while abdominal lymph nodes, spleen and bone marrow invasion are rare. MTV and TLG of lesions positively correlate with Ann Arbor staging. Key words: Lymphoma, large B-cell, diffuse; Mediastinum; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

Grey based Taguchi optimization for multi-lobe bearing

Multi lobe bearing have been widely used to support high speed rotating machinery because of their superior durability and load carrying capacity. Therefore, the bearings are important machine elements for enhancing the quality of the rotating machinery. The performance of rotor bearings is mainly depending upon two factors pressure and oil film thickness. Therefore, an optimum film thickness needed to be maintained. In this presented work a Grey based Taguchi optimization method has been proposed for multi-lobe bearing. Experimental runs have been planned as per Taguchi’s principle with three input variables such as speed, Load and attitude angle have been taken for the study. The results show that the angle plays maximum contribution in performance of the bearings.

3D-CTA assisted anterolateral thigh lobulated perforator flap in repairing soft tissue defect of limb: 11 cases report

Objective To investigate the effectiveness of preoperative 3D-CTA in assisting the preparation of free thinned anterolateral thigh lobulated perforator flap with nerve in repairing soft tissue defect of limb. Methods Between February, 2010 and May, 2018, free super-thin anterolateral thigh lobulated perforator flap with nerve was transferred to repair soft tissue defect of limbs in 11 cases. There were 8 males and 3 females with an average age of 35 (range, 22-56) years. The defect area was 8.0 cm×11.0 cm-9.0 cm×23.0 cm. Preoperation CT scan of the free flap donor site was performed to obtain 3D images of the region with arterial blood supply by digital 3D reconstruction CT, and to determine the origin, direction, classification, length, diameter and the position of pedicle perforator. Postoperative regular followed-up was carried according to the Upper Limb Function Evaluation Trial Standards of Chinese Medical Association of Hand Surgery and Enneking Evaluation System. Results All 11 flaps survived. No vascular crisis happened. All 11 cases were followed-up for 3 to 12 (average, 5) months. The flaps were supple and elastic with near normal color. There was no bulkiness. Sensory function was recovered well and two point discrimination was 3.0-6.0 mm. According to the Upper Limb Function Evaluation of Upper Limb of Chinese Medical Association of Hand Surgery, the results were excellent in 1 case, good in 3 cases and fair in 1 case. The Enneking system was used to assesse the lower limbs recovery. The average score was 21, an average of 70% of limb function restored. Conclusion The free super-thin anterolateral thigh lobulated perforator flap with nerve offers advantages to the traditional anterolateral thigh flap. The survived flaps are ideal in terms of covering limb defects and restoring functions. Preoperative 3D-CTA in the anterolateral thigh perforator flap transplantation is an accurate and useful method. It helps a safer and successful operation with optimal outcome. Key words: 3D-CTA; Anterolateral thigh perforator flap; Lobulated flap; Repair; Limb

Applied anatomied study in bilobed micro-flap of second dorsal metacarpal artery and dorsal digital artery

Objective To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal digital artery. Methods From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected. The radial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed. Results The distal 1/3 segment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface. The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries. The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6±0.4 cm and the diameter was 0.2±0.1 mm. Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches. Conclusion The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue defect on the thumb and purlicue. Key words: Second dorsal metacarpal artery; Finger web artery; Dorsal digital artery; Bilobed flap; Applied anatomy

Correlation between CT-feature of lobulation and epidermal growth factor receptor gene mutations in advanced pulmonary adenocarcinoma

Objective To investigate the correlation between the feature of lobulation, degree of lobulation on CT images and epidermal growth factor receptor gene (EGFR) mutations in advanced pulmonary adenocarcinoma. Methods Two hundred and one patients who were diagnosed with advanced pulmonary adenocarcinoma between January and December 2017 and had undergone a chest CT and EGFR mutation testing at Shanghai Pulmonary Hospital were enrolled in this retrospective study. The clinical and imaging data of the patients were analyzed. The patients were classified into EGFR mutations group (107 cases) and wild type group (94 cases) according to whether EGFR gene mutation occurred. The feature of lobulation (described as presence of lobulation, absence of lobulation, or obscured margin), degree of lobulation (including deep lobulation, shallow lobulation, no lobulation, and obscured) on CT images were statistically compared between the two groups. Results Based on the presence or absence of lobulation sign, there were 99, 0, 8 cases with lobulation, no lobulation, obscured margin in the EGFR mutations group and 80, 1, 13 cases in the wild type group, respectively. There was no significant difference in lobulation sign between the EGFR mutations group and wild type group (P=0.152). According to the degree of lobulation, there were 32, 67, 0, 8 cases of deep lobulation, shallow lobulation, no lobulation, obscured margin in EGFR mutations group and 60, 20, 1, 13 cases in wild type group. Significant differences of frequency were found regarding deep lobulation and shallow lobulation between the two groups (P 0.05). Conclusions EGFR mutations are significantly associated with shallow lobulation in advanced pulmonary adenocarcinoma. Conversely, deep lobulation is more likely to appear in advanced pulmonary adenocarcinoma with wild-type EGFR. However, there is no association between EGFR mutation status and the presence of lobulation. Key words: Lung neoplasms; Receptor, epidermal growth factor; Gene expression; Tomography, X-ray computed

The ultrasonic appearances of primary testicular lymphoma

Objective To explore the sonographic features of primary testicular lymphoma(PLT). Methods The sonographic features of 16 PLT patients confirmed by surgery and pathology were retrospectively analyzed. Results Sixteen PLT patients were typed into 3 ultrasonic patterns: ①The diffuse homogeneous echo type: 2 cases, the ultrasonic features were homogeneous sieve-like hypoechoic echo, the blood flow signal was rich and radially distributed, with interstisial fibrosis inapparently under-microscope. ②The diffuse uneven homogeneous echo type: 9 cases, the ultrasonic features lobulated or map-like heterogeneous hypoechoic features, the blood flow signal was rich in linear distribution, and interstisial fibrosis proliferated to form fibrous septa under-microscope. ③The focal nodular pattern echo type: 5 cases, the ultrasonic features were homogeneous hypoechoic nodules, the blood flow signal was few, interstisial fibrosis hyperplasia surrounding the tumor under-microscope. Conclusions Ultrasonic appearances of primary testicular lymphoma are closely related to its pathologic characteristics, the recognization of their relations contributes to improve the diagnostic value of ultrasound. Key words: Ultrasonograghy; Lymphoma, testis, primary

Transplantation of lobulated free latissimus dorsi flap for repairing irregular soft tissue defect of shank

Objective To investigate the feasibility and clinical effects of lobulated free latissimus dorsi flap in repairing severe shank trauma with irregular soft tissue defect. Methods Eight patients with soft tissue defect of shank due to trauma were treated from February, 2013 to November, 2018, which were 5 males and 3 females. All wounds were irregular. The size of soft tissue defect ranged from 11.0 cm×15.0 cm to 15.0 cm×23.0 cm, with different degrees exposure of deep tissue such as bone and tendon. Five cases out of 8 were infected wound, 3 cases of which had internal fixation bracket exposed. Five infected wounds were firstly treated with negative pressure after debridement, then repaired with flap transplantation until the infection were completely controlled. Other wounds were repaired directly after debridement. The free lobulated latissimus dorsi flap was designed and applied to repair the irregular soft tissue defect of shank. The lobulated latissimus dorsi flap with the outer branch of the thoracodorsal artery ranged from 14.0 cm×7.0 cm to 24.0 cm×8.5 cm. The lobulated latissimus dorsi flap with the inner branch of the thoracodorsal artery ranged from 10.0 cm×5.0 cm to 15.0 cm×7.0 cm. When cutting the flap, the branch vessels should be protected to insure the continuity of the thoracodorsal artery. After spliced the 2 lobulated flaps, the thoracodorsal arteriovenous was anastomosed with the recipient region arteriovenous. All the donor sites were sutured directly. All patients were followed-up by outpatient and telephone regularly. Results Seven flaps survived well. Only 1 case of partial necrosis appeared at the distal edge of the lobulated flap and healed after wound care. All patients were followed-up from 3 to 30 months, averaged of 14 months. The texture of flap was flexible and the appearance was well. Only a linear scar was left in the donor site. The shoulder joint retained good mobility. Conclusion The lobulated latissimus dorsi flap has rich blood supply, concealed donor area and high survival rate after transplantation, which can flexibly repair the irregular soft tissue defect of the shank, and effectively prettify the appearance of the recipient area. This strategy has little effect on the appearance and function of the donor area, and worthy of promoting in clinic. Key words: Lobulated, latissimus dorsi flap; Transplantation; Shank; Microsurgical technique

Application of local flaps in repair of defects after resection of nasal skin tumors

Objective To evaluate the effect of local flaps on repair of defects after surgical removal of nasal skin tumors. Methods A total of 65 patients with nasal skin tumors were enrolled from Department of Dermatology, People′s Hospital of Xinjiang Uygur Autonomous Region between March 2015 and August 2016, and subjected to surgical removal of the nasal skin tumors. According to the location, size, shape and surrounding skin of the nasal defects, nasolabial fold flaps, modified rhomboid flaps, bilobed flaps or frontal nasal flaps were chosen to repair skin and soft tissue defects. Results Of the 65 patients with nasal skin tumors, 38 had basal cell carcinoma, 20 pigmented nevus, 5 keratoacanthoma, and 2 had squamous cell carcinoma. The lengths of the defects after resection were all below 2.5 cm. Nasolabial fold flaps were used in 32 cases, modified rhomboid flaps in 16, bilobed flaps in 12, and frontal nasal flaps in 5. All the flaps survived after the surgery, and no obvious deformation of the nose was observed. No recurrence was observed during 1 year of follow-up. Conclusion For skin defects with the length ≤ 2.5 cm after resection of nasal skin tumors, nasolabial fold flaps, modified rhomboid flaps, bilobed flaps and frontal nasal flaps can be used to repair wounds, with satisfactory efficacy. Key words: Skin neoplasms; Nasal surgical procedures; Surgical flaps; Local flaps

Clinical application of single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot

Objective To explore the clinical efficacy of single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot. Methods From January 2014 to March 2018, 18 patients with dorsal skin and tendon defects of hand and foot were repaired with single or bilobed free anterolateral thigh flaps with fascia lata, including 14 cases of dorsal hand wound and 4 cases of dorsal foot wound. Among them, 1 case was accompanied with 1 tendon defect, 5 cases with 2 tendon defects, 8 cases with 3 tendon defects, 3 cases with 4 tendon defects, and 1 case with 5 tendon defects. There were 12 cases of single lobed flaps and 6 cases of bilobed flaps. 6 cases underwent secondary flap plastic surgery and tenolysis after operation. Results All the 18 flaps survived and the wound achieved primary healing. The donor site of thigh healed well with only linear scar. The follow-up period was 6 to 24 months with an average of 13 months. 14 cases of dorsal skin defects in hand were evaluated according to the criteria issued by the Hand Surgery Society of the Chinese Medical Association with the results being excellent in 6 cases, good in 7 cases, poor in 1 case. 4 cases of dorsal skin defects in foot had good functional recovery, no toe droop and no limitation of walking function. The appearance and texture of the flaps were excellent in 11 cases. No re-rupture or adhesion of extensor tendon occurred. 6 cases underwent second operation to thin the skin flaps 3 months after operation because of unsatisfactory shape. 4 of them had tendon adhesion after hand wound repair. The tenolysis was performed at the same time of skin flaps thinning. The appearance and function of the flaps recovered satisfactorily. Conclusion The single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot have little damage to donor site. It is an ideal method for repairing such injuries for good recovery of hand and foot function. Key words: Surgical flaps; Treatment outcome; Fascia lata; Skin defects; Tendon defects

The classification and clinicopathological analysis of hepatocellular adenoma based on immunohistochemistry

Objective The subtypes of hepatocellular adenoma (HCA) were classified by immunohistochemical study, and the clinicopathological characteristics of each subtype were analyzed. Methods From December 2003 to March 2018, 31 cases with HCA were retrieved from the archive files of the Department of Pathology, Peking Union Medical College Hospital, including 16 male patients and 15 female patients. The age ranged from 16 to 63 years. Hematoxylin and eosin (HE) and immunohistochemical staining were performed with HCA samples. The subtypes were classified by immunohistochemical staining, and the clinicopathological characteristics of each subtype were analyzed. Results The HCA patients had no obvious and specific clinical symptoms, and most of them were diagnosed during the routine health checkup. All of the 31 patients were treated with surgery, and the complete resection was achieved in 26 cases. The adenomas were mainly in the right lobe of the liver (51.6%, 16/31), and the solitary adenoma accounted for 54.8% (17/31). 8 HCA were classified as H-HCA, 14 as I-HCA, 7 as β-HCA, and 2 as U-HCA by immunohistochemistry. H-HCA was characterized histologically by marked steatosis and lobulated contours, lacking L-FABP staining. I-HCA exhibited inflammatory infiltrate, telangiectasia, thickened arteries, more or less obvious ductular reaction, with the positive L-FABP/SAA/CRP staining. β-HCA all showed fibrous capsules, some of adenomas exhibited pseudoglandular structure and nodules in nodule. A strong homogeneous cytoplasmic overexpression of GS and nuclear β-catenin were observed in all β-HCA cases. The staining of SAA/CRP/GS was lacking in the U-HCA. Conclusions HCA is rare and difficult to diagnose in clinic. Final diagnosis relies on histological features, and immunohistochemical examinations need to be used for subtyping classification. Each of the four subtypes has characteristic pathological features. Key words: Adenoma; Pathology; Diagnosis; Immunohistochemistry; Classification

Karakteristik Pasteurella multocida Penyebab Pasteurellosis pada Babi di Kota Kupang Provinsi Nusa Tengggara Timur

The number of commercial pigs in East Nusa Tenggara has grown fast with a population of 1,739,481, and has become more potential. However, the mixed farming model has become one of the factor of potentially high in the transmission of disease-causing pathogenic microorganisms. One of the microorganism is Pasteurella multocida which causes pasteurellosis, has been identified in 25% of slaughtered pigs (Maes et al., 2001). One of the clinical symptom due to pasteurellosis in pigs is the occurrence of bronchopneumonia in pulmo and inflammation in various visceral organs, such as the heart and kidneys. the phenotypic characteristization of this bacteria, will be very helpful in designing a comprehensive prevention and treatment programs of pig pasteurellosis.&#x0D; The aim of the research was to determine the characteristics of P. multocida related to pasteurellosis and recording of the disease in Kupang, NTT. This research also find out the phenotipyc characteristics of P. multocida species from pigs and the possibility of transmission among sensitive species.&#x0D; A total of 30 swine lung samples of pulmo were obtained from slaughterhouse in Kupang to carry out this study. Pulmo taken from slaughtered pigs that showed clinical respiratoric symptoms such as dyspnoea and the presence of serous to mucopurulent nasal exudates, and the specific lesions of gray hepatization in pulmo. The collected samples were then processed for histopathological and microbiological studies.&#x0D; Out of the total 30 sample, 15 samples were found to be suspected for pasteurellosis, and 3 samples were successfully confirmed to be positive for Pasteurella multocida. Varied macroscopic changes showed pathognomonic lesions as multifocal hemorrhage and congestion of the pulmonary lobes. Serous to mucopurulent exudate were found in lumen bronchus. Multi lobes grayed hepatization and multifocal hemorrhage were observed in the pulmo. Histopatologic analysis showed three types of pneumonia that were multifocal suppurative bronchopneumonia with neutrophil infiltration into alveoli and bronchioles; non-suppurative pneumonia as fibrinous bronchopneumonia with severe congestion, and chronic bronchiolitis with infiltration of mononuclear cell and thickening of fibrous tissue on bronchioles. Bacterial culture from the samples showed circular, convex and non hemolytic colony on blood agar base. Gram staining’s showed Gram negative microorganism with coccoid bipolar structure, which are some of the characteristic of the microorganism..&#x0D; It was concluded that the samples is having P. multocida infection. Although, some isolate on MacConkey showed lactose fermentation and tolerance to bile salts that were not the nature of the microorganism, isolation and identification from other organs needed to be done, for example from the heart and kidneys, are needed.&#x0D;

Ultrasonographic features of different pathological types of breast phyllodes tumors

Objective To investigate the ultrasonographic features of different pathological types of phyllodes tumors (PT) of breast. Methods The clinical manifestations and sonographic findings were analyzed retrospectively in 132 patients with 136 different subtype PTs. Ultrasonographic features of benign, borderline and malignant types were compared. Results All the lesions were classified into benign (46/136, 33.8%), borderline (62/136, 45.6%) and malignant (28/136, 20.6%). On sonography, most tumors were shown as oval or lobulated (77.9%), well-defined margins (70.6%), and posterior echo enhancement (72.1%). Cystic areas were observed in 36 lesions (26.5%). No significant difference was observed in age, lesion shape, echo patterns, posterior acoustic features or cystic area (P>0.05). Large size, indistinct margins and grade Ⅱ-Ⅲ vascularity were more frequent in borderline and malignant tumors (P=0.002, P=0.028, P<0.001, respectively). Conclusions Phyllodes tumors of breast have certain characteristics on ultrasonography.Large size, unclear margins and rich blood flow signals may indicate malignancy. Key words: Ultrasonography; Breast neoplasms; Phyllodes tumor

(18)F-fluorodeoxy glucose positron emission tomography/computed tomography manifestation and clinical characteristics of primary salivary gland-type lung cancer

Objective: To explore the imaging manifestation and clinical characteristics of primary salivary gland-type lung cancer using (18)F-fluorodeoxy glucose ((18)F-FDG) positron emission tomography/computed tomography (PET-CT). Methods: From March 2009 to January 2017, 12 patients with pathologically confirmed primary salivary gland-type lung cancer were enrolled in First Affiliated Hospital of Nanjing Medical University. Their images and clinicopathological data were retrospectively analyzed. Results: Six out of 12 patients had mucoepidermoid carcinoma (MEC), and the other six patients had adenoid cystic carcinoma (ACC). Five MEC were located in the main bronchus, and the other one was in segmental bronchus. Intrabronchial nodule or mass with smooth or lobulated margin and calcification(n=3) was the main (18)F-FDG PET-CT features of MEC. Two ACC involved trachea, two involved the main bronchi, and the other two involved lobular bronchi. The main (18)F-FDG PET-CT features of ACC were diffuse or circumferential irregular thickness of the bronchial wall, distorted lumen, and the longitudinal extent of the tumor was greater than its transverse axis. The (18)F-FDG uptake of all lesions was increased in varying degree. The median (25th percentile, 75th percentile) value of maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were 5.1(3.1, 8.1), 5.7(1.2, 21.4)cm(3) and 18.6(0.6, 93.7), respectively. All of them were related to pathological grading and nodal tumor involvement( all P<0.05), but not associated with tumor location or pathological type( all P>0.05). MTV and TLG were also related to clinical stage( all P<0.05). Tumor size was correlated with MTV, TLG of primary lesions(r=0.607, P=0.036; r=0.579, P=0.049), but not with SUVmax(r=0.568, P=0.054). Conclusions: Primary salivary gland-type lung cancer mainly occurs in segmental bronchus. The MTV and TLG of the tumor calculated by (18)F-FDG PET-CT are correlated with clinicopathological characteristics, and are helpful for clinical diagnosis and treatment.

Application of double-leaf perforator free flap of posterolateral calf peroneal artery in repairing facial through-and-through defect after oral cancer oblation

Objective To evaluate the effect of double-leaf perforator free flap pedicled with posterolateral calf peroneal artery on repairing facial through-and-through defect after oral cancer oblation. Methods Nine patients with facial through-and-through defects after oblation of oral and maxillofacial malignancies, including 4 cases of buccal mucosa carcinoma, 2 cases of maxilla osteosarcoma, 1 case of carcinoma of the maxillary sinus and 2 cases of parotid duct carcinoma, were recruited from May, 2016 to May, 2018. The flap was used to repair the facial defect of recruited patients. The area of the bigger leaf of bilobed perforator flap was 7.0 cm×8.0 cm-6.0 cm×7.0 cm and the small leaf was 4.5 cm×4.5 cm-4.0 cm×4.0 cm, respectively. The intraoral and facial defects needed to be reconstructed contained the oral mucosal of the upper palate, the skin, subcutaneous tissue and mucosa of the cheek. The radiotherapy was performed 1.0-1.5 months after the operation. The prognosis including appearance, mouth opening, and the functions of deglutition, and language were assessed. Results Through 3-18 months outpatient followed-up, all 9 cases of transplanted flaps survived well and the incisions of the donor and recipient areas healed by first intention. The patients were satisfied with the facial appearance, mouth opening, and the functions of deglutition and language at the 6 months follow-up. The radiotherapy had no damage on the survival of the bilobed perforator flap. There was no recurrence or metastasis in follow-up. Conclusion The double-leaf perforator free flap pedicled with posterolateral calf peroneal artery is an ideal free tissue for repairing the facial perforating defect after oral cancer oblation because of its constant blood vessel, abundant tissues, flexible design and operating methods. Key words: Oral cancer; Through-and-through defect; Double-leaf perforator free flap; Peroneal artery; Repair