To investigate the effects and associated factors of extended pelvic lymph node dissection (ePLND) on urinary control (UC) and sexual function recovery following bilateral nerve-sparing radical prostatectomy. From June 2016 to December 2023, our institution treated and followed 341 patients who underwent bilateral nerve-sparing RP for over a year. These patients were divided into two groups: ePLND (n = 185) and no PLND (n = 246). To minimize potential biases, 1:1 propensity score matching (PSM) was utilized to compare functional outcomes, and complications between the groups. After adjusting for propensity scores, a total of 240 patients (120 in each group) were included for further analysis. There was no significant difference between the two groups (p > 0.05) in terms of complete UC (0 pad) at 3, 6, and 12 months postoperatively. Regarding sexual function recovery, 21.7

Purpose: This study aimed to compare and analyze the feasibility and long-term efficacy of prostatic capsule-sparing (PCS) and nerve-sparing (NS) radical cystectomy in the treatment of bladder cancer.Methods: From June 2004 to December 2021, our institution treated and followed 145 patients who underwent radical cystectomy with neobladder reconstruction for over a year. These patients were divided into 2 groups: PCS (n=74) and NS (n=71). To minimize potential biases, 1:1 propensity score matching was utilized to compare oncological outcomes, functional outcomes, and complications between the groups. Additionally, Kaplan-Meier analysis and the log-rank test were used to evaluate survival differences between the PCS and NS groups.Results: The median follow-up durations for PCS and NS were 155 and 122 months, respectively. After adjusting for propensity scores, a total of 96 patients (48 in each group) were included for further analysis. Kaplan-Meier curves showed no statistically significant differences in metastasis-free probability (P=0.206), cancer-specific survival (P=0.091), and overall survival (P=0.208). The daytime urinary control (UC) rate at 3, 6, and 12 months postoperatively was 72.9%, 91.7%, and 97.9% in the PCS group and 47.9%, 79.2%, and 91.7% in the NS group, respectively (P=0.012, P=0.083, and P=0.362). The nocturnal UC rate was 54.2%, 85.4%, and 95.8% in the PCS group, and 31.3%, 60.4%, and 83.3% in the NS group, respectively (P=0.023, P=0.006, and P=0.091). Regarding erectile function recovery, 62.5% of patients in the PCS group and 22.9% in the NS group returned to preoperative levels (P<0.001).Conclusions: PCS outperformed NS in restoring UC and sexual function and did not affect oncological outcomes. However, PCS was associated with a higher risk of complications linked to bladder-neck obstruction.

The brachytherapy (BT) and radical prostatectomy (RP) are two methods recommended in current guidelines for the treatment of localized prostate cancer (PCa). It is difficult to compare the oncological results of these two treatments because of differences in baseline characteristics and treatment selection.we sought to compare the efficacy of BT and RP after propensity score matching(PSM)analysis. Between January 2009 and December 2021, our institution treated 657 patients with localized PCa (BT: n = 198; RP: n = 459)and followed up for > 2 years. Biochemical recurrence was defined as prostate-specific antigen (PSA) levels of nadir plus 2 ng/ml or higher (Phoenix definition) for BT, and as PSA0.2 ng/ml or greater for RP. PSM was applied based on the age, body mass index, PSA, prostate volume, clinical T-stage, Gleason grade, percentage of positive puncture needles ≥ 1/2, maximum tumor diameter ≥ 5 mm, and follow-up period. Median follow-up was 63 months for BT and 52 months for RP. After propensity score adjustment, a total of 294 (147 each) patients remained for further analysis.Kaplan–Meier curves showed no statistically significant difference in clinical relapse-free survivals (cRFS) (p = 0.637),overall survival (OS) (p = 0.726),and cancer-specific survival (CSS) (p = 0.505).BT was associated with improved biochemical relapse-free survivals (bRFS) compared to RP (p = 0.022), Logistic multivariate analysis based on the whole cohort revealed that clinical T stage ≥ T2b (p = 0.043) and tumor maximum diameter ≥ 5 mm (p = 0.044) were associated with significantly bRFS. The BT and RP group patients exhibited similar cRFS, OS, and CSS. However, patients in the BT groups exhibited better bRFS than those in the RP group.Clinical T stage ≥ T2b and a maximum tumor diameter ≥ 5 mm were independent prognostic factors.

Objective. The present study aims to explore the clinicopathological characteristics of EpsteinReport. The case involved a 32-year-old woman who underwent surgical resection of a splenic nodule. Histological examination and immunohistochemistry were performed using cluster of differentiation (CD) markers, and in-situ hybridization was conducted to detect EBV-encoded RNA (EBER). Results. A microscopic analysis revealed neoplastic cells with various morphologies, including round, ovoid, or spindled shapes, dispersed within a prominent lymphoplasmacytic infiltrate. The tumor cells exhibited nuclear atypia, with some resembling Reed-Sternberg cells. The immunohistochemistry demonstrated focal positivity for follicular dendritic cell markers, such as CD21, CD23 and CD35, and focal negativity for other markers, including CD3, CD34, CD20, CD79a, myeloperoxidase and HMB45. Additionally, the EBER staining showed strongly positive results. The patient showed no local recurrence or metastasis during the 13-month follow-up. Conclusion. A comprehensive understanding of EBV+IFDCS, including its clinicopathological features and immunohistochemical characteristics, is crucial for accurate diagnosis and differential diagnosis of this rare tumor.

BACKGROUND Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and clinically aggressive hematologic malignancy originating from the precursors of plasmacytoid dendritic cells. BPDCN often involves the skin, lymph nodes, and bone marrow, with rapid clinical progression and a poor prognosis. The BPDCN diagnosis is mainly based on the immunophenotype. CASE SUMMARY In this paper, we retrospectively analyzed 2 cases of BPDCN. Both patients were elderly males. The lesions manifested as skin masses. Morphological manifestations included diffuse and dense tumor cell infiltration of the dermis and subcutaneous tissues. Immunohistochemistry staining showed that cluster of differentiation CD4, CD56, CD43, and CD123 were positive. CONCLUSION In this paper, we retrospectively analyzed 2 cases of BPDCN. Both patients were elderly males. The lesions manifested as skin masses. Morphological manifestations included diffuse and dense tumor cell infiltration of the dermis and subcutaneous tissues. Immunohistochemistry staining showed that cluster of differentiation CD4, CD56, CD43, and CD123 were positive.

ObjectiveThis study aims to investigate and analyze the feasibility, oncological outcomes, functional efficacy, and complications with the prostatic capsule sparing (PCS) as well as the nerve sparing (NS) in radical cystectomy for bladder cancer.Patients and methodsBetween January 2007 and December 2021, 67 total cystectomies with PCS and 54 with NS were performed at our institution. The inclusion criteria for PCS were as follows: proactive, fully informed patient consent; negative transurethral resection of the bladder neck; normal prostate-specific antigen (PSA) level < 4 ng/dL; and normal transrectal ultrasonography with biopsy of any suspicious nodes. Patients received complete oncological and functional follow-ups. The Kaplan-Meier method was utilized to characterize survival outcomes after surgery.ResultsThe median follow-up times for PCS and NS were 144 and 122 months, respectively. Cumulative survival estimated the 5- and 10-years cancer-specific survival were 93.0% and 88.7% for the PCS group and 79.7% and 79.6% for the NS group, respectively (p = 0.123). In terms of function, the daytime urinary control at 3, 6, and 12 months postoperatively was 80.60%, 97.01%, and 100% in the PCS group, and 53.70%, 85.19%, and 94.44% in the NS group, respectively (p = 0.002, 0.023, and 0.100); and nocturnal urinary control was 62.69%, 94.03%, and 98.51% in the PCS group, and 40.74%, 72.22%, and 87.04% in the NS group, respectively (p = 0.016, 0.001, and 0.022). The erectile function recovery revealed that 62.69% and 40.74% of patients returned to preoperative levels (International Index of Erectile Function (IIEF)-5 score ≥ 15) in the PCS and NS groups, respectively (p = 0.016). Considering complications within 30 days after surgery, 4.48% and 7.69% patients had Clavien ≥ III complications in the PCS and NS groups, respectively (p = 0.700).ConclusionThe PCS provides better restored urinary control and sexual function than the NS technique and does not affect oncological outcomes. However, PCS is prone to bladder-neck obstruction complications and requires closer long-term follow-up.

Background:Allied disorders of Hirschsprung's disease (ADHD) exhibit symptoms akin to those of Hirschsprung's disease, primarily characterized by intestinal obstruction, bowel dilatation, and chronic constipation. The occurrence of amyloid complications in patients with ADHD is infrequent. In this report, we present a case of ADHD with intestinal ulcers as the initial gastrointestinal manifestation, and subsequent pathological examination revealed the presence of amyloid deposits in the colonic mucosa.Case Report:A male patient, aged 20, exhibited recurring abdominal distension and intestinal obstruction for a duration of three years. Multiple colonoscopies revealed the presence of recurrent colonic ulcers, with pathological examination indicating the existence of amyloid deposits within the mucosal layer of the colon. Abdominal CT scans suggested colonic dilatation. Following a multidisciplinary consultation, a subtotal resection of the colon was performed, and subsequent postoperative pathology confirmed a decrease and absence of myenteric plexus ganglion cells. Considering the patient's symptoms and the findings from the postoperative pathology, a diagnosis of ADHD was made. The patient's symptoms resolved postoperatively and he was discharged from the hospital and followed up for 1 year in stable condition.Conclusion:Our study highlights the potential association between ADHD and the initial presentation of recurrent colonic ulcers, accompanied by amyloid deposition in the intestinal mucosa. This finding suggests a possible pathogenic mechanism for ADHD and offers a novel perspective on its diagnosis.

目的 探讨保留耻骨膀胱复合体的前列腺癌根治术后尿失禁恢复情况.方法 2017 年6 月～2020 年6 月,将局限性前列腺癌行腹腔镜根治性前列腺切除(laparoscopic radical prostatectomy,LRP)的患者按住院号分为保留耻骨膀胱复合体的观察组(n =53)和未保留的对照组(n =51).2 组年龄、体重指数、前列腺特异性抗原、穿刺活检Gleason评分、前列腺体积等差异无显著性(P>0.05).均行保留神经的LRP.根据每天使用尿垫数量评估尿失禁恢复情况.尿失禁完全恢复定义:每天使用尿垫0 个.拔除导尿管后至少随访12 个月.结果 拔除导尿管当天(24 h),1、3、6 和12 个月尿失禁完全恢复率观察组均明显高于对照组[39.6%(21/53)vs.17.6%(9/51),P =0.013;66.0%(35/53)vs.35.3%(18/51),P =0.002;84.9%(45/53)vs.56.9%(29/51),P = 0.002;92.5%(49/53)vs.70.6%(36/51),P = 0.004;98.1%(52/53)vs.84.3%(43/51),P =0.031].结论 在LRP手术时,保留耻骨膀胱复合体技术能早期快速改善术后尿失禁,并显著减少远期(术后12 个月)尿失禁.

Objective: Preoperative chemoradiotherapy (CRT) is a standard option for patients with advanced rectal cancer (RC) located in the lower part of the rectum. Besides, some early stage RC patients may be over-treated, due to imprecise preoperative staging. The aim this study was to explore the value of hypoxia-inducible factor 1 alpha (HIF-1 alpha) as a predictor of benefit from preoperative CRT for locally advanced RC patients in terms of pathologic complete response (pCR) and clinical outcomes.Methods: Colonoscopic biopsy specimens from 114 RC patients were subjected to immunohistochemistry method for analysis of HIF-1 alpha expression, followed by analyzing clinicopathological characteristics. Independent factors associated with pCR were analyzed using univariate and logistic multivariate regression. Cox proportional hazard models were utilized to analyze param-eters independently related to overall survival (OS) and recurrence-free survival (RFS) of RC patients.Results: HIF-1 alpha was observed to be highly expressed in 52.6% patients (60/114). Tumor size was significantly larger in the HIF-1 alpha high expression group than in the low expression group (p = 0.027). The proportion of patients who achieved pCR in the high expression group, was significantly lower than the low expression group (p = 0.001). Besides, HIF-1 alpha was identified as the only predictor of pCR in the multivariate regression analysis (p = 0.006). In terms of prognosis, the 3-year RFS rate and OS rate were significantly lower in the high-expression HIF-1 alpha group than those in the low-expression HIF-1 alpha group (p = 0.015 & p = 0.027). HIF-1 alpha level was significantly related to RFS and OS based on univariate and multivariate analyses.Conclusions: HIF-1 alpha expression is a potential predictor for pCR and an independent prognostic factor for RC patients with preoperative CRT.

Objective To investigate the expression of the double tree-like gene 4（SALL4）, SALL4,GPC3,AFP,and Hepatocyte in liver metastatic hepatoid adenocarcinoma（HAC） and hepatocellular carcinoma（HCC）. Methods To collect52 cases of HAC with liver metastasis and 56 cases of primary HCC confirmed from January 2012-December 2021, the expression of immunohistochemical antibodies of SALL4,GPC3, Hepatocyte and AFP in HAC and the significance of HCC.Results GPC3, Hepatocyte,and AFP were expressed to varying degrees in both groups of tumors, while SALL4 was highly positive and specific in metastatic HAC, but not in HCC. Conclusion SALL4 is a HAC-specific marker that can be used to identify HAC from HCC.

目的 探讨原发性肾浆细胞瘤(primary renal plasmacy-toma,PRP)的临床病理学特征、诊断、鉴别诊断及预后.方法 回顾性分析1例PRP的临床病理学及免疫表型特征,并复习相关文献.结果 患者以右侧腰部疼痛为首发症状,CTU增强提示右肾占位.穿刺活检组织镜下可见肿瘤组织由密集的细胞簇组成,几乎没有细胞间质,少量瘤细胞形态似正常浆细胞,体积小,胞质少,核圆偏位,染色质凝集成块,无核仁;大部分肿瘤细胞体积较大,胞质丰富,嗜碱性,核大居中,染色质疏松,核仁明显,可见病理性核分裂.免疫表型:瘤细胞CD138、MUM1及轻链κ均(+),Cyclin D1(10％+),CK、CD3、CD19、CD20、CD79a、CD15、CD30、Syn、S-100、HMB-45、EBER和轻链 λ均(-),Ki-67增殖指数为90％.结论 PRP是一种罕见的发生于髓外的浆细胞单克隆增生性肿瘤,及时行病理及影像学检查有助于确诊,尽早规范治疗及长期随访对疾病的预后至关重要.

例1男性,47岁,因中上腹腹胀半个月余就诊,全腹增强CT示:左侧腹膜后见含脂混杂密度影,内见分隔及软组织密度影,增强扫描呈轻度强化,左肾受压下移(图1),影像学提示腹膜后脂肪肉瘤.术中探查见瘤体位于左侧腹膜后、胰腺及脾脏下极,瘤体下缘位于左肾上方,大小20 cm×15 cm,边界清.例2女性,71岁,无自觉症状,体检发现腹膜后肿物就诊.腹部增强CT示:左侧腹膜后占位,内见脂肪密度影,增强扫描呈不均匀强化,左输尿管受压推移(图2);上腹部增强MR示:腹膜后结节状、团状混杂信号影,T2呈高低混杂信号,局部同反相位信号减低(图3),CT及MR均诊断为脂肪肉瘤.术中见左侧腹膜后一巨大占位,大小10 cm×8 cm,前方为肠系膜下血管,外侧方为肾脏,内侧为脊柱,后方为腰大肌.2例均行手术完整切除肿物.

背景:颗粒细胞瘤(GCT)少见,消化道GCT更少见.目的:探讨消化道GCT的临床病理学特点及其治疗和预后.方法:收集2017年1月—2021年6月联勤保障部队第903医院和金华市中心医院医疗集团(医学中心)收治的9例消化道GCT患者,回顾性分析患者的临床资料、病理学特征及其治疗方案和预后.结果:9例消化道GCT患者中,男女之比为2:1;发病年龄为19～60岁,中位年龄52岁;发生于食管6例,结直肠2例,肛管1例.内镜示黏膜下隆起或无蒂息肉,肿瘤直径2～12 mm,中位直径5 mm.组织病理学检查示肿瘤位于黏膜层和(或)黏膜下层,呈实性团片状或巢状排列,周边呈浸润性生长;间质有炎性细胞浸润;瘤细胞呈胖梭形或多边形,胞质丰富,内含大量嗜酸性颗粒;核小、核质比极低,核分裂象罕见.免疫组化示所有患者均表达S100和CD68,部分表达SOX10、CD56、Calretinin和Syn,不表达CKp、Desmin、SMA、CD117、CD34、Dog1和α-inhibin.食管和结直肠GCT均行内镜下黏膜切除术(EMR)或内镜黏膜下剥离术(ESD),肛管GCT行局部切除术.所有患者随访9～53个月,均未见肿瘤复发或转移.结论:消化道GCT少见,临床症状无特异性,内镜下多呈黏膜下隆起或无蒂息肉,有特征性病理形态和免疫表型.病变小且浅表者行EMR或ESD治疗,效果好,术后需长期随访.

目的 探讨伴复发性肛瘘的骶部囊肿型肠重复畸形的临床和病理特点.方法 回顾性分析2例以"长期复发性肛瘘"为临床表现的骶部囊肿型肠重复畸形的临床资料并复习相关文献.结果 2例均因"长期复发性肛瘘"就诊,核磁共振显示骶前囊性肿物,手术完整切除肿物;镜下见肿物囊壁由胃黏膜、复层鳞状上皮、纤毛柱状上皮构成,2例均可见胰腺组织.术后分别随访9、39个月,肿物均无复发.结论 囊肿型肠重复畸形是一种罕见的先天性疾病,以"复发性肛瘘"为首发症状者更为罕见,当患者表现为长期反复肛瘘、肛周脓肿时应结合影像学和病理检查作出正确诊断,以免误诊.

目的 探讨位于前列腺及其周围区域盆筋膜层内的神经网络较确切解剖定位和神经纤维的数目分布.方法 使用6具盆腔结构正常的男性尸体,每具尸体取10处邻近前列腺周围的盆筋膜组织样本,每个样本1 cm×1 cm大小,按时钟的点位编号并分区.分布如下:前列腺尖部(与膜部尿道交界)区域:1区1点钟,2区11点钟;前列腺中部区域:3区2点钟(右侧骨盆侧面),4区10点钟(左侧骨盆侧面),5区4点钟,6区8点钟;前列腺基底部(与膀胱颈交界):7区5点钟,8区7点钟;9区(位于前列腺尖部尿道后背侧)6点钟,10区(位于前列腺基底部腹侧)12点钟.比较这10个解剖区域单位面积(1 cm2)内的神经数目和直径大小.结果 共获得60个盆筋膜组织样本.神经数目平均为(13.4±13.3)束.前列腺基底腹侧12点钟10区(平均5.3束)与前列腺中部8点钟侧6区(平均9.8束)神经数目分布较少,两区之间差异无统计学意义(P＞0.05);10区与其他8个区均有统计学差异(P＜0.05);剩余各区之间分布均衡(P＞0.05).神经纤维直径平均为(90.4±61.8) μm.前列腺尖部1点钟1区(平均119.2 μm)和中部2点钟3区(平均101.3 μm)神经纤维较粗,1区与中部10点钟4区(平均77.7 μm)、尖部背侧6点钟9区(平均81.1 μm)、基底部腹侧12点钟10区(平均79.4 μm)之间差异有统计学意义(P＜0.05);4区(平均77.7 μm)与对侧2点钟3区之间(平均101.3 μm)差异也有统计学意义(P＜0.05);其他各区之间分布均衡(P＞0.05).结论 前列腺周围盆筋膜内神经网分布表现为在前列腺基底部(与膀胱颈交界)腹侧12点钟区域神经纤维数目较少,其他区域均匀分布;神经纤维直径在尖部腹侧区域朝向顶点较粗,左右不对称分布.骨盆筋膜是根治性前列腺切除术中保留神经的关键性解剖标志.

目的 探讨肝脏原发性胆管淋巴上皮瘤样癌(LEL-ICC)的临床病理学特征.方法 收集2009年至2018年该院诊治的3例肝脏原发性LEL-ICC患者的临床病理资料,采用免疫组织化学标记肿瘤细胞,并与其他疾病进行鉴别诊断.结果 3例肝脏原发性LEL-ICC患者均因体检发现肝脏肿块就诊,临床无明显不适.组织病理学显示具有不同级别腺体分化的腺癌和淋巴细胞浸润的特征.其中2例肿瘤细胞免疫组织化学表达肌酸激酶(CK)7、CK19,1例只表达CK19;原位杂交EB病毒编码RNA染色癌细胞2例阳性,1例阴性;3例患者手术后目前均生存良好.结论 肝脏原发性LEL-ICC是一种罕见的恶性肿瘤,临床预后好于一般的胆管细胞癌,诊断主要依靠术后的病理组织学及免疫组化标记.

本文对2例分别就诊于浙江省金华市中心医院和武汉大学人民医院的 SMARCB1（ INI-1）缺陷型鼻腔鼻窦癌[ SMARCB1（ INI-1）-deficient sinonasal carcinoma，SDSC]病例进行回顾性分析，探讨其临床特征、组织病理学形态及免疫表型、诊断及鉴别诊断、治疗及随访情况。本研究提示SDSC是一种罕见的高侵袭性恶性肿瘤，组织形态谱广，但具有特征性基因学改变，熟悉这些特点有助于正确的诊断和鉴别诊断。

This article reports the pathologic features and malignant biological behavior of a perivascular epithelioid cell neoplasm (PEComa) with the clinical manifestation being endometrial polyps. The case was cured with curettage in a local hospital one year ago. The postoperative diagnosis was "endometrial polyps". This time, due to "irregular bleeding", we carried out another curettage in our hospital. After the operation, 3 pieces of polyps were inspected with diameters of 0.3 cm, 0.5 cm and 0.6 cm, respectively. The tumor consisted of epithelioid cells with alveolar and nesting pattern and showed a diffuse strong expression of HMB45, Melan-A and TFE3. The patient then underwent a hysterectomy and the "polyps" were sent for pathological examination. The result showed that tumor cells infiltrated the deep muscle layer, close to the outer membrane, suggesting a malignant biologic behavior. TFE3-related PEComa is different from general PEComa. This neoplasm and Melanotic Xp11 renal carcinoma have similar clinicopathologic features, histology, immunity and molecular phenotypes, belonging to the same type of tumor. It has been suggested in the literature naming this neoplasm as 'Xp11 neoplasm with melanocytic differentiation' or 'melanotic Xp11 neoplasm'. Our case has expanded our understanding of PEComa characteristics and increased data for TFE3 translocation-related PEComa, reminding us to avoid misdiagnosis when PEComa manifests as small polyps.

Background Pelvic lymph node dissection (PLND) is one of the most important steps in radical prostatectomy (RP). Not only can PLND provide accurate clinical staging to guide treatment after prostatectomy but PLND can also improve the prognosis of patients by eradicating micro-metastases. However, reports of the number of pelvic lymph nodes have generally come from incomplete dissection during surgery, there is no anatomic study that assesses the number and variability of lymph nodes. Our objective is to assess the utility of adopting the lymph node count as a metric of surgical quality for the extent of lymph node dissection during RP for prostate cancer by conducting a dissection study of pelvic lymph nodes in adult male cadavers.Methods All 30 adult male cadavers underwent pelvic lymph node dissection (PLND), and the lymph nodes in each of the 9 dissection zones were enumerated and analyzed.Results A total of 1267 lymph nodes were obtained. The number of lymph nodes obtained by local PLND was 4-22 (14.1±4.5), the number obtained by standard PLND was 16-35 (25.9±5.6), the number obtained by extended PLND was 17-44 (30.0±7.0), and the number obtained by super-extended PLDN was 24-60 (42.2±9.7).Conclusions There are substantial inter-individual differences in the number of lymph nodes in the pelvic cavity. These results have demonstrated the rationality and feasibility of adopting lymph node count as a surrogate for evaluating the utility of PLND in radical prostatectomy, but these results need to be further explored.