Node Swelling Research Articles

Validating the efficacy of interval appendectomy for acute appendicitis: representative three cases with different etiologies

BackgroundAppendectomy for acute appendicitis (AA) is considered one of the most common emergency surgeries. However, emergency appendectomy accompanied with complex lesions such as extensive abscess formation is not recommended in most cases. Therefore, non-operative management followed by interval appendectomy (IA) for AA has been tried. Herein, we present three AA cases with specific etiology that underwent interval appendectomy.Case presentationCase 1: A 68-year-old man was diagnosed AA with intestinal malrotation and intra-abdominal abscesses. He initially treated with conservative therapy and underwent laparoscopic IA after detailed preoperative examination.Case 2: A 22-year-old man had been under treatment for pancolitis-type ulcerative colitis (UC), also bothered by right-lower abdominal pain several times a year. The appendix always appeared swollen on every CT taken during symptoms. He underwent laparoscopic IA; pathological finding revealed typical UC histological features in the resected appendix. After the surgery, he never suffered from terrible right lower abdominal pain.Case 3: A 69-year-old woman complaining a right lower abdominal pain had undergone CT examination, which revealed AA with appendiceal mass, irregular wall thickness of the cecum, and mediastinal and para-aortic lymph node swelling. The operation was carried out after conservative therapy. The pathological diagnosis revealed BRAF mutated colorectal carcinoma. She had received systematic chemotherapy after the surgery, and all metastatic lesions have completely disappeared.ConclusionInterval appendectomy provided us with much clearer anatomical information and precise therapeutic strategies, avoiding technical and general operative complications, and also induced fast recovery and short length of hospital stay. Interval appendectomy is a reasonable procedure and could be recommended in case of AA with some different etiology.

Malignant peripheral nerve sheath tumour of the oesophagus: a case report

BackgroundMalignant peripheral nerve sheath tumour (MPNST) is a very rare disease, and its pathogenesis is unknown. There are few reports of MPNST of the oesophagus. We report a case of an MPNST that was diagnosed and resected.Case presentationA 30-year-old female presented with dysphagia. She had been aware of the dysphagia approximately 6 months before presentation. The chest X-ray showed shadows in the right mediastinum. Barium fluoroscopy revealed a semicircular raised lesion in the lower oesophagus. Upper gastrointestinal endoscopy revealed a type 1 oesophageal tumour centred on the posterior wall 26–35 cm from the incisors. The surface was ulcerated, and the tumour was exposed. The affected area showed no iodine uptake. The EUS showed an isoechoic mass. The CT scan showed a mass of 71 × 61 × 55 mm in the beginning of the lower oesophagus with low density mass and swelling of the right recurrent nerve lymph node to 12 mm. On FDG-PET, the tumour showed an SUVmax of 11.05, and no abnormal accumulation was found in lymph nodes or other organs. The MRI showed a hyperintense mass on the T2WI, which had prolonged contrast enhancement, and no findings of invasion into surrounding tissue were found. The patient underwent right thoracotomy and open thoracic oesophagectomy. The affected lymph node was tumour negative by rapid pathological diagnosis during the operation. Histologically, spindle cells with different-sized nuclei were mixed throughout the tissue. Some regions showed nuclear polymorphism or a storiform pattern, and locally, there were approximately 7 mitoses/10 HPFs. The margin was relatively clear, but spindle-shaped tumour cells infiltrated the surrounding interstitium and basal myoepithelium, and the patient was diagnosed with MPNST. In this case, the postoperative course was good, and 16 months after the operation, the patient is currently under observation at the outpatient stage without recurrence.ConclusionsMPNST in the oesophagus is a relatively rare disease. Diagnosis before treatment is sometimes difficult, but the prognosis is good if radical resection is possible.

Fine Needle Aspiration Biopsy of Peripheral Lymph Nodes in Children: Practical Experience in a Tertiary Hospital.

Peripheral lymphadenopathy occurs often in children; fine needle aspiration biopsy (FNAB) is a commonly performed diagnostic procedure. We describe FNAB use and outcome for peripheral lymphadenopathy in children in a routine clinical setting. A retrospective study done at Tygerberg Hospital, Cape Town of children (<13 years) who had an FNAB for lymphadenopathy from July 2012 to June 2014. Demographic, clinical, treatment and follow-up data were retrieved from patient folders; FNAB and special investigation results were obtained from the laboratory database. Of the 173 children, the median age was 37 (interquartile range 13-75) months; 20 (11.5%) were HIV positive. Most FNABs were done in the neck (131; 76%) and axillary areas (34; 20%). FNAB provided a result in 165 (95%) cases; in 8 (5%) children FNAB was insufficient for diagnosis. Mycobacterial aetiology was diagnosed in 84 (49%); 49 (58%) were culture-confirmed (37 Mycobacterium tuberculosis, 10 Mycobacterium bovis BCG, 1 both and 1 non-tuberculous mycobacterium). Reactive lymphadenopathy was diagnosed in 56 (32%), neoplastic disease in 6 (3.5%) and other pathology in 19 (11%) cases. Additional special investigations changed FNAB diagnosis or led to an additional diagnosis in 8 (5%) children. Overall, 70/84 (83%) with mycobacterial aetiology and all neoplastic disease cases received the correct treatment. Follow-up appointments were arranged in 144 (83%) patients. In a high tuberculosis burden area, a single FNAB provided a diagnosis in most cases in a routine referral setting; FNAB remains a safe and useful investigation. Follow-up of children to initiate appropriate treatment could improve. Large swollen lymph nodes, especially in the neck, are a common finding in children. Fine needle aspiration biopsy (FNAB) is a commonly used diagnostic procedure and we looked at how well this procedure works in everyday hospital practice. We identified all children <13 years of age over a 2-year period (2012-2014) who had an FNAB done at Tygerberg Hospital, Cape Town, South Africa, and looked how well this procedure performed and what the doctors did with these children. We found 173 children who had an FNAB done. They were generally young children of around 3 years old. With a single FNAB, we could make a diagnosis in 95% of these children. About half of the children had tuberculosis or complications of a BCG vaccine (both caused by mycobacteria), only 4% had a malignancy of some kind, about a third had reactive lymph nodes (usually other mainly local infectious causes) and the rest had other pathology like abscesses. All malignancies and >80% of the mycobacterial pathology cases were correctly managed; the latter could definitely improve.

Study of fine needle aspiration cytology of cervical Lymph nodes in tertiary care Hospital

AIM: To evaluate the Cytomorphological patterns in cervical lymph nodes by using fine needle aspiration cytology, and analyze the usefulness of the fancy procedure.Materials and methods: In this study total 100 patients with cervical lymph node swelling were included in the study, who had presented to the department of pathology in our tertiary care center.Results: Out of 100 clerical lymphadenopathy cases majority were Tuberculous lymphadenitis 32 (32%), Reactive lymph adenitis 30(30%), Granulomatous lymphadenitis 22(22%), Nonspecific lymph adenitis 7(7%), Necrotizing Lymph adenitis (5%), Metastatic Deposits 2(2%), Lymphoma 2(2%).Conclusion: FNAC is a cheap, reliable, easy procedure for the early detection of disease pathology in lymph nodes.

Health Related Quality of Life of Thyroid Cancer Patients

Background: Having the longevity of thyroid cancer patients, any impairment in health-related quality of life (HRQOL) during the follow-up period is of great importance.&#x0D; Objective: The study was conducted to determine the health related quality of life of thyroid cancer patients. Material and methods: This cross sectional study was conducted among 246thyroid cancer patients. Data were collected by face-to-face interview and reviewing medical records with semi-structured questionnaire and checklist with validated scale. The subjects were purposively selected following specific selection criteria and maintaining ethical issues.&#x0D; Place and period of study: The study was conducted during the period from July 2018-June 2019 in two tertiary hospitals of Dhaka city: Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital, Dhaka.&#x0D; Results: This study revealed that majority (74.4%) of respondents was female, married (72%), housewife (61.4%), rural respondent (41.1%) and had primary education (69%). Mean (± SD) age of the respondent was 37.85(±12.20) years (range 14-70 years) and mean (± SD) monthly family income was Tk.17681(±10602). Out of 246 cases, 204 (82.9%) was papillary and 42 (17.1%) was follicular carcinoma. Main presenting features were neck swelling (91.5%), swollen lymph node (41.9%), dysphonia (57.3%) and dysphagia (35.4%). Mean (± SD) of total HRQOL score was 73.7 ± 8.39. HRQOL score of students and higher educated patients were better among the respective groups (p &lt;.001). The study showed the association of HRQOL with clinical condition of thyroid cancer patients (R2=.025). HRQOL revealed the strong prediction with education (β=-0.888, p&lt;.05), family income (β=0.05, p&lt;.05), marital status (β=-0.1.384, p&lt;.05), clinical condition (β=-0.522, p&lt;.05) and perceived stress (β=-0.632, p&lt;.001).&#x0D; Conclusion: The overall HRQOL score was considerably good in this study. Timely detection, regular motivation and attending clinical condition may significantly improve the HRQOL of thyroid cancer patients&#x0D; JOPSOM 2019; 38(2): 1-8

Besnoitia besnoiti natural infection in a crossbred cow in India

Besnoitia besnoiti is an obligate intracellular parasite that causesbesnoitiosis in cattle, goats, and equids.Acute besnoitiosis is characterized bypyrexia, enlargement of the lymph nodes, anorexia, ruminal atony, and necrosis of the epidermis. A crossbred Jersey cow was referred for respiratory distress, swollen lymph nodes, patchy dermis, pyrexia, and anorexia. Skin histopathology revealed Besnoitia cysts. The animal was treated with oxytetracycline (10 mg/kg body weight, IV) for a week and with ivermectin (200 μg/kg, SC) once a week for 75 days with supportive therapy. Chronic bovine besnoitiosis was diagnosed, and the author concluded that no therapeutic plan would be successful. This case is unusual because besnoitiosis is not commonly reported in India

Development of diffuse large B-cell lymphoma after sofosbuvir-ledipasvir treatment for chronic hepatitis C: A case report and literature review.

Recently, treatments for chronic hepatitis C virus (HCV) infection have significantly improved by the development of direct-acting antiviral agents (DAAs) and almost all patients with HCV can complete antiviral treatment without apparent adverse events. Malignant lymphoma, particularly B-cell non-Hodgkin's lymphoma, is one of the extrahepatic manifestations associated with chronic HCV infection. The effectiveness of anti-HCV therapy with DAAs for B-cell non-Hodgkin's lymphoma has been demonstrated in recent reports, whereas late-onset B-cell non-Hodgkin's lymphoma after HCV eradication with DAAs has occasionally been reported. In the present study, a 77-year-old man with chronic hepatitis C and intermediate liver cancer risk received sofosbuvir-ledipasvir treatment for 12 weeks. Two months following the end of antiviral therapy, he had achieved sustained virologic response for 8 weeks. However, the patient occasionally found swelling of the right cervical lymph nodes without any subjective symptoms. Lymph node biopsy revealed diffuse large B-cell lymphoma and whole-body 18F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography showed increased FDG uptake in the right cervical, right submandibular, mediastinal and mesenteric lymph nodes. The patient received six courses of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy and achieved complete response at 8 months after chemotherapy initiation. Thus, the development of lymphoid malignancies may arise, even after HCV eradication with DAAs. Therefore, clinicians should be aware of such risks during and after antiviral treatment with DAAs.

ME/CFS in Adolescents — Study Review

Chronic Fatigue Syndrome (CFS), also called myalgic encephalomyelitis (ME), is a condition characterized by long-term fatigue that is not significantly alleviated during rest and is not caused by previous medical conditions or continuous exercise. Symptoms are quite diverse, but not specific to this disease entity. The most common are: concentration and memory problems, sore throat, swollen lymph nodes, joint pain, sleep disturbances, headache. Moreover, autonomic nervous system functioning and post-exertional malaise examination is considered to be important in diagnosis of adolescent patients with ME/CFS. The presented analysis of research shows that adolescents with ME/CFS urge to be understood and believed regarding an illness that few understood. Continuing education and remaining the social activity in young ME/CFS patients seems to be crucial in maintaining quality of life. ME/CFS in adolescents might lead to significant problems related to the school absenteeism, poorer quality of life at school, school and academic achievement compared to healthy adolescents. Anxiety might co-occur with ME/CFS in adolescents. Supportive therapy for comorbidities could be considered, if needed. However, there is no established effective treatment for ME/CFS, for which there is urgent need. (JNNN 2020;9(2):76–79)

The utility of serum C-C chemokine ligand 1 in sarcoidosis: A comparison to IgG4-related disease

We previously reported higher levels of C-C chemokine ligand (CCL) 1 in the bronchoalveolar lavage (BAL) fluid (BALF) of patients with sarcoidosis than in BALF of patients with immunoglobulin G4 (IgG4)-related disease (IgG4-RD), indicating that CCL1 might act as a marker of disease activity in sarcoidosis. Notably, less invasive sampling sources are desirable, as BAL cannot always be performed due to its inherent risk. In this study, we sought to decipher the correlation between serum levels of CCL1 and clinical characteristics of sarcoidosis. Serum samples were obtained from 44 patients with clinically confirmed sarcoidosis, 14 patients with IgG4-RD, and 14 healthy controls. The clinical and radiological findings were retrospectively evaluated. Serum levels of CCL1 were measured using a sandwich enzyme-linked immunosorbent assay. Serum levels of other 17 cytokines and chemokines were measured using a MILLIPLEX® MAP KIT and Luminex® magnetic beads. Serum levels of CCL1 were significantly higher in patients with sarcoidosis than in patients with IgG4-RD and healthy controls. Serum CCL1 was positively correlated with the degree of hilar lymph node swelling on chest computed tomography and serum levels of soluble interleukin 2 receptor. Positive correlations were also observed between serum CCL1 and total cell counts, lymphocyte counts in BALF, and serum T helper 1 mediators such as IP-10 and TNF-α in patients with sarcoidosis. Serum CCL1 levels were significantly elevated in sarcoidosis and correlated with clinical parameters of the disease. In addition, serum and BALF levels of CCL1 were positively correlated in a statistically significant manner. Although further research in this field is necessary, CCL1 might have the potential to be a reliable serological marker of disease activity in sarcoidosis.

Blackfly fever and dermatitis caused by Simulium kiritshenkoi: a human case report in Iran

BackgroundBesides the considerable role of blackflies to the transmission of many disease agents, these flies considered as annoying biting pests of wildlife, livestock, poultry, and humans. There are few literature reports of blackfly fever following Simulium spp. This study describes a case of blackfly fever and dermatitis following blackflies numerous bites in Iran.Case presentationThe present report describes a 25-year-old man that was attacked by numerous flies while fishing and camping near Namrood river in Firuzkuh County, Tehran Province, Iran. Pruritic dermatitis with marked edema appeared mainly on the hands and legs and subsequently, the patient’s condition worsened with swollen lymph nodes, joints aching, and 40 °C fever. The patient’s clinical signs and symptoms were alleviated by injection of intramuscular Dexamethasone Phosphate (DEXADIC®) 8 mg/2 ml after 24 h.ConclusionsThis study reported a human case with blackfly fever and dermatitis following numerous bites of Simulium kiritshenkoi, for the first time in Iran.

Critical analysis of head and neck swelling with respect to cytomorphological diagnosis: A retrospective study

Head and neck lesions are common as compared to other body lesions. In head and neck swellings- cervical lymph node swellings, thyroid swellings and salivary gland enlargement are included. Fine needle aspiration cytology ( FNAC)is less invasive, cost effective, safe and satisfactory OPD procedure. To study the spectrum of lesions in head and neck in our semi urban area. And also assess the role of fine needle aspiration cytology in diagnosing the palpable head and neck swelling. This retrospective study was conducted in department of pathology over a duration of 6 months on all age group patients in both sex male, female. This study had included total number of 392 patients with neck swelling in both kind of patients either indoor or outdoor. The fine needle aspiration cytology (FNAC) procedure was done in these patients with using 23 gauge needle and 20 ml disposable syringe for aspiration. The study included total number of 392 cases. FNAC revealed 247 cases (63.01%) of cervical lymph node in which non neoplastic lesions were in 146(59.11%) and malignant lesions were in 85(34.41%) cases in which metastatic carcinoma was common. Fine needle aspiration cytology will be more helpful in neck swelling because of safe, cost effective and less painful comparatively biopsy. It can be easily performed in children and old age patients without giving anaesthesia.

Clinicopathologic Significance of False-Positive Lymph Node Status on FDG-PET in Lung Cancer

Introduction2-[18F] Fluoro-d-deoxyglucose (FDG) positron emission tomography (PET) is a relevant diagnostic procedure for staging lung cancer. However, accurate evaluation of lymph node metastases by PET is controversial because of false-positive FDG uptake. Patients and MethodsA total of 245 patients with lung cancer were retrospectively analyzed. Standardized maximum uptake values (SUVmax) of the primary tumor and lymph nodes were compared to pathologic lymph node metastases to correlate PET findings with clinicopathologic variables and patient outcomes. ResultsThe SUVmax values of metastatic lymph nodes were significantly higher than those of lymph nodes without metastases (P = .0036). When SUVmax ≥ 4 was defined as PET positive for metastasis, the sensitivity, specificity, and accuracy were 48.1%, 79.8%, and 73.1%, respectively. Multivariate logistic regression analysis showed that age > 75 years, bilateral hilar FDG uptake, and no lymph node swelling were significant factors related to false-positive lymph node metastases. Smoking status, FDG uptake in the primary tumor, and concurrent lung diseases were not significant factors. ConclusionMetastatic lymph nodes show higher FDG uptake than false-positive lymph nodes, and older patient age, bilateral hilar FDG uptake, and no swollen nodes are associated with no metastases. Patients with lymph node metastases have worse survival than those with false-positive FDG-PET findings. However, abnormal FDG uptake in the lymph node is an important prognostic factor.

Actinobacillosis outbreak in cattle with clinical manifestation of hippopotamus-like face

ABSTRACT: Actinobacillosis outbreak with clinical manifestation of hippopotamus-like face observed in a property located in the municipality of Capão do Leão, Southern Brazil, in September 2016, is described. The cattle herd remained for most of the year in rice stubble. When these areas were occupied with new crops, they were transferred to areas where there were small native forests. Three cattle were affected. They presented a volume increase in the nasolabial and maxillary region, and there was also regional lymph node swelling. The evolution of the disease occurred in approximately six months. In tissue fragments collected for culture, Actinobacillus lignieresii was isolated. The diagnosis was based on clinical findings, histopathological evaluation characterized by the presence of piogranulomas with Splendore Hoepli reaction in its center, bacterial isolation, and identification of A. lignieresii by polymerase chain reaction (PRC) and genetic sequencing.

Abstract A19: Conditional inactivation of SHOC2 in adult mice to study its role in tissue homeostasis

Abstract The RAS-RAF-MEK-ERK signaling pathway plays an important role throughout mammalian development, from embryogenesis to tissue-specific cellular homeostasis, and its aberrant activation is a major driver of human cancer. Mouse models have highly improved our current understanding of the RAS-ERK pathway in physiologic and pathologic contexts. RAF activation is a complex process that involves multiple regulatory steps in addition to RAS binding. Key among them is the dephosphorylation of a conserved inhibitory site (S259-RAF1, S365-BRAF) by a phosphatase complex comprising SHOC2, MRAS and PP1 (SHOC2 complex). Work from our lab has proposed the SHOC2 complex has properties of an attractive therapeutic target against RAS-driven tumors that may help overcome the main problems associated with pharmacologic inhibition of the pathway in the clinic, namely, drug resistance and toxicity. In order to study the role of SHOC2 in vivo/in tissue homeostasis we have generated 2 mouse models of conditional SHOC2 inactivation. A knock-out model (KO) was generated by flanking exon 4 with loxP sites. A knock-in (KI) model was generated using a minigene strategy, where wild-type SHOC2 is expressed in a cDNA configuration under its endogenous promoter and replaced after Cre-mediated recombination by a mutant SHOC2 D175N allele that is defective for interaction with MRAS and PP1. SHOC2 KO and KI mice are embryonic lethal, indicating SHOC2 function is required during mouse development. To study SHOC2 function in adult tissue homeostasis, SHOC2 KO and KI mice were crossed with animals carrying an inducible ubiquitously expressed CreERT2 recombinase (R26-CreERT2). Treatment with tamoxifen leads to efficient recombination (&amp;gt;80%) in all tissues examined except brain. Significantly, SHOC2 inactivation is tolerated well in the short term as mice appear normal up to ~10 weeks post-treatment. However, at later times KO female mice start to lose weight and have to be sacrificed after ~14 weeks. Male KO mice do not lose weight but instead develop skin lesions and have to be culled at ~15 weeks. Postmortem studies show both sexes have splenomegaly and swollen lymph nodes consistent with an immune phenotype that is under study. Male KO mice also have swollen bladders, suggesting a sexually dymorphic role for SHOC2 in urinary function. Our mouse studies reveal that SHOC2 inactivation in adult mice appears well tolerated in the short term and thus help validate SHOC2 as a good therapeutic target. However, our studies also reveal new roles for SHOC2 in tissue homeostasis and suggest pleiotropic phenotypes likely to emerge after sustained inhibition. Citation Format: Sibel Sari, Isabel Boned del Rio, Greg Jones, Jake Henry, Maria De Las Nieves Amalia Peltzer, York Posor, Sergio Quezada, Pablo Rodriguez-Viciana. Conditional inactivation of SHOC2 in adult mice to study its role in tissue homeostasis [abstract]. In: Proceedings of the AACR Special Conference on Targeting RAS-Driven Cancers; 2018 Dec 9-12; San Diego, CA. Philadelphia (PA): AACR; Mol Cancer Res 2020;18(5_Suppl):Abstract nr A19.

LYMPHADENOPATHY IN DOGS AT A GLANCE

Lymphadenopathy defined as swelling of lymph nodes which are elements of the immune system and in dogs located in the submandibular, prescapular, axillar, inguinal and popliteal regions. Lymphadenopathy

Point-of-Care Ultrasound for Evaluating Lymphadenopathy in the Pediatric Emergency Department: Case Series and Review of Literature.

Children present to the pediatric emergency department (ED) with enlarged lymph nodes due to a broad spectrum of conditions ranging from benign causes like reactive lymph nodes to adverse conditions like malignancy. Identifying sonographic features typical of infection, inflammation, and neoplasms will help assist clinicians in deciding the disposition of the patients from the ED. Point-of-care ultrasound has become an essential adjunct for diagnostic assessment in pediatric emergency medicine. The wider accessibility of ultrasound along with greater resolution using high-frequency probes places this noninvasive, nonradiation-based bedside examination, an ideal tool for real-time examination of the lymph nodes in the EDs. We present a series of cases in which the point-of-care ultrasound examination proved valuable in the timely diagnosis and expedited care of lymph node pathologies secondary to reactive, infectious, and malignant processes. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Point-of-care ultrasound will facilitate diagnosis in children with lymph node swelling and should be considered in children of all ages. While assessing the lymph node pathology at the bedside, describe the shape, size, internal echotexture, borders, vascularity, and the pattern of the perinodal soft tissue to differentiate between a normal, reactive, infectious, inflammatory, or malignant underlying pathology.

Targeting the Tumor Microenvironment with Fluorescence-Activatable Bispecific Endoglin/Fibroblast Activation Protein Targeting Liposomes.

Liposomes are biocompatible nanocarriers with promising features for targeted delivery of contrast agents and drugs into the tumor microenvironment, for imaging and therapy purposes. Liposome-based simultaneous targeting of tumor associated fibroblast and the vasculature is promising, but the heterogeneity of tumors entails a thorough validation of suitable markers for targeted delivery. Thus, we elucidated the potential of bispecific liposomes targeting the fibroblast activation protein (FAP) on tumor stromal fibroblasts, together with endoglin which is overexpressed on tumor neovascular cells and some neoplastic cells. Fluorescence-quenched liposomes were prepared by hydrating a lipid film with a high concentration of the self-quenching near-infrared fluorescent dye, DY-676-COOH, to enable fluorescence detection exclusively upon liposomal degradation and subsequent activation. A non-quenched green fluorescent phospholipid was embedded in the liposomal surface to fluorescence-track intact liposomes. FAP- and murine endoglin-specific single chain antibody fragments were coupled to the liposomal surface, and the liposomal potentials validated in tumor cells and mice models. The bispecific liposomes revealed strong fluorescence quenching, activatability, and selectivity for target cells and delivered the encapsulated dye selectively into tumor vessels and tumor associated fibroblasts in xenografted mice models and enabled their fluorescence imaging. Furthermore, detection of swollen lymph nodes during intra-operative simulations was possible. Thus, the bispecific liposomes have potentials for targeted delivery into the tumor microenvironment and for image-guided surgery.

Efficacy of medicinal penetration on acupoint as adjunctive therapy on histiocytic necrotizing lymphadenitis of heat-toxin syndrome: a randomized controlled trial

To evaluate the clinical efficacy of medicinal penetration on acupoint combined with medication for histiocytic necrotizing lymphadenitis (HNL) of heat-toxin syndrome, and to explore the methods of improving the clinical effect. A total of 72 cases with HNL with heat-toxin syndrome were randomly divided into an observation group and a control group, 36 cases in each group. The patients in the control group were treated with oral administration of prednisone tablets for 40 days (first 5 days: 10 mg, three times a day; since then, reduced by 5 mg every 7 days). In the observation group, on the basis of the medication in the control group, the patients were treated with acupoint application and ultrasonic drug penetration therapy, once a day for 14 days. The acupoints of Waiguan (TE 5), Fengchi (GB 20) of affected side and ashi points were selected. The changes of target lymph node swelling, visual analogue score (VAS), axillary temperature and total score of symptoms and signs were evaluated before treatment and 7, 14, 28 and 40 d into treatment; the changes of white blood cell (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and lactic dehydrogenase (LDH) were evaluated on 14 d and 40 d into treatment; the patients were followed-up for half a year. ① Fourteen days into treatment, the clinical cured rate in the observation group was 38.9% (14/36), which was superior to 16.7% (6/36) in the control group (P<0.01); the clinical cured rates were both 100% in the two groups on 40 d into treatment. ② The VAS score, axillary temperature and the total score 7 d into treatment, as well as node swelling, VAS score, axillary temperature and the total score 14, 28 and 40 d into treatment in the two groups were significantly improved (P<0.01); the total score and VAS score of 7 d into treatment, target lymph node swelling, VAS score and total score of 14 d into treatment in the observation group were significantly improved than those in the control group (P<0.01). ③ Compared before treatment, WBC, CRP, ESR in the two groups were significantly improved 14 d and 40 d into treatment (P<0.01), and LDH in the two groups were decreased 40 d into treatment (P<0.01), but there was no significant difference between the two groups (P>0.05). ④ The recurrence rate in the observation group was 5.6% (2/36), which was similar to 16.7% (6/36) in the control group (P>0.05). The medicinal penetration on acupoint as adjunctive treatment could effectively relieve the discomfort symptoms of HNL patients with syndrome of heat and toxin, improve the clinical cured rate, and provide the research direction for shortening the course of medication.

Intramural metastasis to the appendix from ascending colon cancer: a case report

BackgroundIntramural metastasis is rare in colorectal cancer, especially metastasis of ascending colon cancer to the appendix.Case presentationA 64-year-old man was admitted to our hospital for surgery for ascending colon cancer detected by medical examination. Colonoscopy identified a type-2 tumor in the ascending colon, which was diagnosed as adenocarcinoma. Abdominal computed tomography revealed focal thickening of the ascending colon and middle of the appendix and swelling of the lymph nodes around the ileocolic artery. The patient underwent laparoscopic right hemi-colectomy with D3 lymph node dissection. Histopathological findings revealed that the ascending colon cancer was moderately differentiated adenocarcinoma with lymphatic and vascular invasion (stage IIIB; pT3N2M0). Additionally, moderately differentiated adenocarcinoma was observed mainly in the submucosa and muscularis propria of the appendix, which was approximately 10 cm proximal to the ascending colon cancer. These findings indicated intramural metastasis to the appendix from the ascending colon cancer. The patient experienced recurrence with lung metastasis 2.5 years after the first surgery.ConclusionsIntramural metastasis of ascending colon cancer to the appendix is extremely rare. Because the risk of recurrence and the prognosis for intramural metastasis has not been clarified, careful follow-up is recommended.

Clinical Characteristics and Prognostic Factors of Children with Non-Hodgkin's Lymphoma of Different Pathological Subtypes

To investigate the clinical characteristics and prognostic factors of children with non-Hodgkin's lymphoma of different pathological subtypes. Ninety-three patients with newly-diagnosed childhood NHL in Fujian Medical University Union Hospital from March 2011 to September 2017 were salected. The diagnosis of patients was performed according to the World Health Organization classification of tumors 2008 ys. The chemotherapy regimens were based on immune phenotype, pathological type and clinical stages. The 5-years event-free survival rate (EFS) were calculated and analyzed by Kaplan-Meier method, and difference of survival rate between groups were compared. The possible factors influencing 5-years EFS was analyzed using Cox proportional hazards model. Among the 93 patients, male to female ratio was 2.88:1, the median age at diagnosis was 6 (0.9 to 13) years old. According to pathological types, Burkitt's lymphoma was the most common, follow by ALK+ anaplastic large-cell lymphoma (ALCL) and lymphoblastic lymphoma (LBL). Clinically, the most common initial symptoms observed at diagnosis were swelling of superficial lymph node, and abdominal pain and abdominal mass in mature B-cell neoplasms, and the swelling of mediastinal lymph nodes in LBL, and hemophagocytic syndrome (HPS) in mature T-cell and natural killer cell NHL. Seventy-nine cases completed 2 courses of induction chemotherapy, and 64 cases (81.01%) reached complete remission (CR). In a median follow up for 32.5(1.0-88.5) months, ten patients (11.90%) relapsed, the median relapsed time was 5.7(3.4-15.7) months. 5-year EFS rate in 84 patients received standardized treatments were (77.1±4.9)%. As compared with lymphoblastic lymphoma and extranodal NK/T cell lymphoma, there was a trend towards better outcomes in B-LBL, and mature B-cell neoplasms and ALK+ ALCL showing 5-year EFS was (86.2±5.2)% and (93.8±6.1)% vs (53.3%±16.1)% and (28.6±17.1)%. Univariate analysis showed that B symptoms, LDH level, secondary HLH, immunophenotype, pathological subtypes, clinical stage and whether reached CR after induction chemotherapy significantly correlated with prognosis. Cox regression analysis showed that no CR after 2 courses was an independent unfavorable prognostic factor (HR0.001, 95%CI: 0.000-0.122). The clinical characteristics and prognosis of patients with NHL of different pathological types are different. Whether reached CR after induction chemotherapy is the imdependent risk factor affecting the prognosis.