OBJECTIVE: There is currently no comprehensive genome-wide description of the primary ghost cell odontogenic carcinoma (GCOC), hindering our understanding of pathogenesis. We herein present a case with comprehensive clinical, genome and transcriptomic analysis. These will serve as the first comprehensive molecular atlas for primary GCOC. A 58-year-old male underwent subtotal resection with prosthetic restoration. Genome sequencing (WGS) detected previously identified CTNNB1 mutation with novel alterations of MAP3K, EP300, and 22q11.21 region. Transcriptome results showed significant involvement of cytokine-cytokine receptor interaction and PI3K-Akt signaling pathway. These results need to be compared with more GCOCs for more accurate clinical guidance.

BACKGROUND: There are different surgical strategies that can treat synchronous colorectal cancer (SCRC) involving separate segments, namely extensive resection (EXT) and left hemicolon-sparing resection (LHS). We aim to comparatively analyze short-term surgical results, bowel function, and long-term oncological outcomes between SCRC patients treated with the two different surgical strategies.
METHODS: One hundred thirty-eight patients with SCRC lesions located in the right hemicolon and rectum or sigmoid colon were collected at the Cancer Hospital, Chinese Academy of Medical Sciences, and the Peking University First Hospital from January 2010 to August 2021 and divided into EXT group (n = 35) and LHS group (n = 103), depending on their surgical strategies. These two groups of patients were compared for postoperative complications, bowel function, the incidence of metachronous cancers, and prognosis.
RESULTS: The operative time for the LHS group was markedly shorter compared with the EXT group (268.6 vs. 316.9 min, P = 0.015). The post-surgery incidences of total Clavien-Dindo grade ≥ II complications and anastomotic leakage (AL) were 8.7 vs. 11.4% (P = 0.892) and 4.9 vs. 5.7% (P = 1.000) for the LHS and EXT groups, respectively. The mean number of daily bowel movements was significantly lower for the LHS group than for the EXT group (1.3 vs. 3.8, P < 0.001). The proportions of no low anterior resection syndrome (LARS), minor LARS, and major LARS for the LHS and EXT groups were 86.5 vs. 80.0%, 9.6 vs. 0%, and 3.8 vs. 20.0%, respectively (P = 0.037). No metachronous cancer was found in the residual left colon during the 51-month (median duration) follow-up period. The overall and disease-free survival rates at 5 years were 78.8% and 77.5% for the LHS group and 81.7% and 78.6% for the EXT group (P = 0.565, P = 0.712), respectively. Multivariate analysis further confirmed N stage, but not surgical strategy, as the risk factor that independently affected the patients\' survival.
CONCLUSIONS: LHS appears to be a more appropriate surgical strategy for SCRC involving separate segments because it exhibited shorter operative time, no increase in the risk of AL and metachronous cancer, and no adverse long-term survival outcomes. More importantly, it could better retain bowel function and tended to reduce the severity of LARS and therefore improve the post-surgery life quality of SCRC patients.

UNASSIGNED: Anorectal melanoma is a rare tumor with a dismal prognosis. The only promising treatment for anorectal melanoma is surgery, either extensive resection (ER) or local excision (LE). However, the optimal extent of resection is still controversial. The purpose of this study was to investigate whether the survival outcomes of anorectal melanoma at different stages are influenced by the surgical approaches (LE or ER) using the National Institute of Health\'s Surveillance, Epidemiology, and End Results Program (SEER) database.
UNASSIGNED: The Surveillance, Epidemiology and End Results (SEER) database was queried to identify patients treated for anorectal melanoma (2000-2018). Overall survival (OS) and disease-specific survival (DSS) outcomes were compared for the two surgical approaches (ER or LE) stratified by stage (localized, regional and distant).
UNASSIGNED: A total of 736 patients were included in the study. Details of previous surgical procedures were available for 548 of the study patients: 360 (65.7%) underwent LE, and 188 (34.3%) underwent ER. In localized cases, 199 underwent LE, and 48 underwent ER. The OS (median 45 vs. 29 months, 5-year rate 41.7% vs. 23.4%) and DSS (median 66 vs. 34 months, 5-year rate 51% vs. 30.7%) of patients undergoing ER were significantly better (p = 0.009 and 0.041, respectively) than those who received LE. Multivariate analysis showed that the type of surgery was an independent prognostic factor for both OS and DSS. Among the regional cases, 89 cases had LE, and 96 cases had ER. Patients with regional disease who underwent ER had no significant differences in OS (23 vs. 21 months; p = 0.866) or DSS (24 vs. 24 months; p = 0. 907) compared to patients who underwent LE. In distant cases, 72 cases had LE, and 44 cases had ER. Patients with metastatic disease who had ER also had similar OS (median 11 vs. 8 months; p = 0.36) and DSS (median 11 vs. 8 months; p = 0.593) to those who underwent LE.
UNASSIGNED: Extensive resection can improve the long-term prognosis of localized anorectal melanoma compared to local excision, but the prognosis of the two surgical techniques is comparable in both regional patients and distant patients.

A standard treatment for osteoradionecrosis (ORN) has not yet been established because of the diversity. Therefore, identifying the risk factors for a poor prognosis is essential. This study retrospectively investigated the factors associated with the prognosis of ORN in 68 patients. Relevant clinical data of all patients were obtained. Of the patients, 16 who underwent extensive surgery underwent histopathological analysis. The necrotic changes of the anterior and posterior margins in the cortical and cancellous bones were investigated. Multivariate analyses showed statistically significant associations between poor prognosis in patients with ORN and high radiation dose (hazard ratio [HR] 1.15), orocutaneous fistula (HR 2.93), and absence of sequestration (HR 2.49). Histopathological analysis showed a viable anterior margin of the middle portion of the cortical bone for all recovered cases; in contrast, most cases (75%) with a poor prognosis showed necrotic changes. The anterior margin of the cancellous bone was viable and resilient to high irradiation, regardless of the prognosis. These results suggest that patients with orocutaneous fistula should receive early surgical intervention, even if the affected area is limited or asymptomatic. In extensive surgery, a sufficient safety margin of necrotic bone, particularly in the anterior region, is required to improve the prognosis.

BACKGROUND: Nonocclusive mesenteric ischemia (NOMI) is defined as acute intestinal ischemia because of decreased blood flow in mesenteric vessels. Only a few cases of NOMI that occur secondary to aortic dissection (AD) have been reported, resulting in the lack of sufficient knowledge of diagnosis and treatment.
METHODS: We aimed to report a case of NOMI caused by type B Aortic Dissection. A 26-year-old male patient was transferred to our hospital with the diagnose of NOMI and aortic dissection in April 2018. The abdominal computed tomography (CT) assists the diagnosis of paralytic intestinal obstruction, intestinal wall pneumatosis, and perforation. Emergency laparotomy revealed that the bowel wall supplied by the superior mesenteric artery (SMA) was pale with the palpable but weak pulsation of the parietal artery. The small intestine was extremely dilated with a paper-thin, fragile wall that was ruptured easily and could not be sutured. In this case, extensive resection and segmental drainage were done. Postoperatively, the digestive tract was reconstructed. However, the patient suffered from iron deficiency anemia and short bowel syndrome eight months later, and unfortunately died from long-term complications.
CONCLUSIONS: Aortic dissection leads to continuous decrease in blood pressure and blood flow to the SMA, considering as a predisposing factor for NOMI. During the treatment, extensive resection and segmental drainage are the optimal surgical strategy, which can make benefit in emergencies especially.

Background : Appendectomy can be challenging and occasionally converted to extensive resection for complicated appendicitis. However, optimal treatment strategies can be developed using preoperative risk assessment. Thus, we aimed to investigate the preoperative predictors of extensive resection in complicated appendicitis patients undergoing surgery. Materials and methods : In total, 173 complicated appendicitis patients undergoing surgery between 2014 and 2019 were classified into the appendectomy (n = 153) or extensive resection (n = 20) groups. Clinicopathological factors and surgical outcomes were compared between groups. Results : Extensive resection was performed in 20 of 173 complicated appendicitis patients (11.5%). The rates of having defects in the wall structure at the appendix root on computed tomography images were significantly higher, and the duration from onset to surgery was significantly longer in the extensive resection group. Significant differences were found in operative duration, blood loss and postoperative hospitalization, but none in the incidence of postoperative complications between groups. Multivariate analyses showed that defects in the wall structure at the appendix root and five days or longer from onset were identified as independent predictors of extensive resection. Conclusions : Defects in the wall structure at the appendix root and five days or longer from onset predict extensive resection performance in complicated appendicitis patients. J. Med. Invest. 68 : 334-341, August, 2021.

We present the case of a giant bronchogenic cyst (BC) that appeared just within the right diaphragm. A 51-year-old man was referred to our hospital with a chief complaint of pain from the lumbar area to the right shoulder. Computed tomography images showed a cystic mass measuring 18.0 × 17.5 × 12.8 cm in the right thoracic cavity. Right posterolateral thoracotomy from the eighth intercostal space was performed, and the cyst wall and diaphragm were resected together. The defect of the diaphragm was repaired using a 2-mm-thick Gore-Tex™ expanded polytetrafluoroethylene patch. It is embryologically rare for a giant BC to develop within the right diaphragm. As BCs may be associated with malignant tumours or infection, complete resection of the cyst wall is required. Literature review revealed no consensus on the best surgical procedure. Therefore, it is important to consider the appropriate surgical procedure for each case.

OBJECTIVE: We describe the operative techniques and perioperative morbidity of intestinal autotransplantation (IATx) for neoplasms originating in the pancreatic head with involvement of the superior mesenteric artery (SMA), particularly focusing on oncological outcomes of patients with ductal adenocarcinoma.
METHODS: Six patients with pancreatic head neoplasms aged 20 to 67 years underwent IATx in our center from January 2012 to January 2016. The operative procedure involves (1) selection and procurement of a segment of small intestine as the autograft, (2) completion of an en bloc resection of the tumor along with involved organs, and (3) autotransplantation of the autograft.
RESULTS: In all six patients, the median operative time was 12.1 h (range, 9.5-16.5) with a median blood transfusion of 7 units (range, 4-10). All patients had margin-negative resections. Complications occurred in three of six patients with no perioperative mortality. The median duration of hospital stay was 19 days (range, 15-26). These six patients have had a well-functioning autograft and have not required any intravenous fluid hydration since discharge. At 5.9-, 10.9-, and 12.4-month follow-ups, serum levels of CA19-9 remained normal in two and elevated in one of three patients with ductal adenocarcinoma. At a median follow-up of 12.1 months (range, 4.9-42.9), all patients have remained alive without evidence of local recurrence and gross metastatic disease.
CONCLUSIONS: IATx combined with extensive pancreaticoduodenectomy and SMA resection can be performed in highly selected patients with an acceptable morbidity and mortality. Careful preoperative assessment and planning are the keys to the success of this aggressive operation.