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We present a rare case of a 36 year old man who presented with recurrent fever but no other symptoms. Laboratory data provided no specific information for diagnosis. Abdominal ultrasonography revealed splenomegaly with multiple small hypoechoic lesions within the spleen. Computed tomography of abdomen showed a hypodense diffuse lesion. A diagnosis of isolated splenic tuberculosis was confirmed after a splenic puncture and histopathological examination.

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OBJECTIVE: To explore significance of high-risk human papillomavirus (HR-HPV) testing in atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion (ASC-H). METHODS: Presence of HR-HPV DNA was examined in 45 patients with ASC-H using hybrid capture II (HC-II) test. Colposcopic examination and biopsy were taken all results were evaluated. RESULTS: Overall, 33 of 45 (73.3%) ASC-H cases were biopsy proven cervical intraepithelial lesion (CIN). 36 of 45 ASC-H cases were HPV-DNA positive, including 19 cases of HSIL and over lesion; whereas no HSIL or over was found in 9 HR-HPV negative cases. Sensitivity and negativity predictive value of HR-HPV in ASC-H with HSIL and over lesion were both 100%. CONCLUSIONS: ASC-H strongly predicts the presence of HSIL, HR-HPV may serve as a predict select whether a patient with ASC-H should take colposcopic examination immediately, patients with positive HR-HPV should undergo immediate colposcopic examination, while negative HR-HPV is an excellent predictor of the absence of HSIL.

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OBJECTIVE: To assess the sensitivity and positive predictive value (PPV) of intraoperative frozen section diagnosis of the borderline tumor of ovary (BTO). METHODS: A retrospective analysis and comparison were done respectively between the accuracies of diagnoses made by using frozen and paraffin sections from the same tissue blocks for BTO from March 1995 to May 2008 achieved in the Department of Pathology, Guangdong General Hospital. Univariate and multivariate regression models were used to assess the influence of patient and tumor characteristics on the likelihood of underdiagnosis and overdiagnosis. RESULTS: Of the 73 patients analyzed, 39 cases (53.42%) were histologically serous tumors, 32 (43.84%) were mucinous and 2 (2.74%) were endometrioid tumors. Diagnoses identical in those made by using either frozen or routine paraffin sections were 55/73 (75.34%). The sensitivity and positive predictive value of frozen section diagnosis were 87.30% and 85.94%, respectively. Underdiagnosis of frozen section were 18/73 (24.66%). There was no overdiagnosis cases obtained. Univariate analysis showed that tumor diameter and tumor histology were the predictors of underdiagnosis in frozen section analysis. And in multivariate analysis, only tumor diameter, rather than patient age, tumor histology and stage, bilateral side tumor, serum CA-125 and concurrent presence of endometriosis was a predictor of underdiagnosis. CONCLUSIONS: Intraoperative frozen section diagnosis of BTO has a low sensitivity and PPV. Underdiagnosis is not uncommon. Surgical management based on intraoperative frozen section diagnosis should be used with caution.

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AIM: To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS: Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People's Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma. RESULTS: Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients (12.5%), and was significantly associated with family history (c2=3.929, P=0.047), high CEA level (c2=4.964, P=0.026), cancerous perforation (c2=8.503, P=0.004), tumor differentiation (c2=9.315, P=0.009) and vessel cancerous emboli (c2=11.879, P=0.001). In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age (c2=0.506, P=0.477), gender (c2=0.102, c2=0.749), tumor diameter (c2=0.421, P=0.516), tumor infiltration (c2=5.052, P=0.168), depth of tumor invasion (c2=4.588, P=0.101), lymph node metastases (c2=3.688, P=0.055) and TNM staging system (c2=3.765, P=0.152). The local recurrence rate of middle and lower rectal carcinoma was 33.3% (4/12) in patients with positive circumferential resection margin and 6.8% (3/44) in those with negative circumferential resection margin. There was a significant difference between the two groups (c2=6.061, P=0.014). Local recurrence of rectal carcinoma occurred in 6 of 36 patients (16.7%) with mesorectal metastasis, and in 1 of 20 patients (5.0%) without mesorectal metastasis. However, there was no significant difference between the two groups (c2=1.600, P=0.206). CONCLUSION: Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.

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AIM: To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benefit from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer. METHODS: A total of 96 consecutive patients who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identified. RESULTS: Lateral lymph node metastasis was observed in 14.6% (14/96) of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 (25.0%) of 40 patients with tumor diameter >or= 5 cm and in 4 (7.1%) of 56 patients with tumor diameter < 5 cm. The difference between the two groups was statistically significant (c2 = 5.973, P = 0.015). Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration (7 of 10 cases, 70.0%), compared with patients with 3/4, 2/4 and 1/4 diameter of tumor infiltration (3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%) (c2 = 27.944, P = 0.0001). The lateral lymph node metastasis rate was 30.0% (9 of 30 cases), 9.1% (4 of 44 cases) and 4.5% (1 of 22 cases) for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant (c2 = 8.569, P = 0.014). Local recurrence was 18.8% (18 of 96 cases), 64.3% (9 of 14 cases), and 11.0% (9 of 82 cases) in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically significant (c2 = 22.308, P = 0.0001). Kaplan-Meier survival analysis showed significant improvements in median survival (80.9 +/- 2.1 m, 95% CI: 76.7-85.1 m vs 38 +/- 6.7 m, 95% CI: 24.8-51.2 m) of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis (log-rank, P = 0.0001). CONCLUSION: Tumor diameter, infiltration and differentiation are significant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter >or= 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.

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AIM: To clarify the relationship between circumferential resection margin status and local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma. The relationship between circumferential resection margin status and clinicopathologic characteristics of middle and lower rectal carcinoma was also evaluated. METHODS: Cancer specimens from 56 patients with middle and lower rectal carcinoma who received total mesorectal excision at the Department of General Surgery of Guangdong Provincial People's Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. RESULTS: Local recurrence occurred in 12.5% (7 of 56 cases) of patients with middle and lower rectal carcinoma. Distant recurrence occurred in 25% (14 of 56 cases) of patients with middle and lower rectal carcinoma. Twelve patients (21.4%) had positive circumferential resection margin. Local recurrence rate of patients with positive circumferential resection margin was 33.3% (4/12), whereas it was 6.8% (3/44) in those with negative circumferential resection margin (P = 0.014). Distant recurrence was observed in 50% (6/12) of patients with positive circumferential resection margin; conversely, it was 18.2% (8/44) in those with negative circumferential resection margin (P = 0.024). Kaplan-Meier survival analysis showed significant improvements in median survival (32.2 +/- 4.1 mo, 95% CI: 24.1-40.4 mo vs 23.0 +/- 3.5 mo, 95% CI: 16.2-29.8 mo) for circumferential resection margin-negative patients over circumferential resection margin-positive patients (log-rank, P < 0.05). 37% T(3) tumors examined were positive for circumferential resection margin, while only 0% T(1) tumors and 8.7% T(2) tumors were examined as circumferential resection margin. The difference between these three groups was statistically significant (P = 0.021). In 18 cancer specimens with tumor diameter >= 5 cm 7 (38.9%) were detected as positive circumferential resection margin, while in 38 cancer specimens with a tumor diameter of < 5 cm only 5 (13.2%) were positive for circumferential resection margin (P = 0.028). CONCLUSION: Our findings indicate that circumferential resection margin involvement is significantly associated with depth of tumor invasion and tumor diameter. The circumferential resection margin status is an important predictor of local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma.

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OBJECTIVE: To detect mesorectal metastasis of middle and lower rectal cancer and to evaluate its relationship with clinicopathologic characteristics. METHODS: Cancer specimens resected from 56 patients with middle and lower rectal cancer who received total mesorectal excision were examined by routine pathologic observation. The relationship between mesorectal metastasis and clinicopathologic characteristics of middle and lower rectal cancer was also investigated. RESULTS: Mesorectal metastasis was detected in 36 (64.3%) of 56 cancer specimens. In 18 cancer specimens with tumor diameter > or = 5 cm, 15 (83.3%) were detected mesorectal metastasis, while in 38 cancer specimens with tumor diameter < 5 cm only 21 (55.3%) were detected mesorectal metastasis (P = 0.041). Mesorectal metastasis was more frequent in T(3) cancer specimens (81.5%) and T(2) cancer specimens (56.6%), compared with T(1) cancer specimens (1/6) (P = 0.007). 85.7% poorly differentiated cancer specimens were detected mesorectal metastasis, while moderate and well-differentiated cancer specimens were only 63.2% and 1/5 respectively (P = 0.028). Mesorectal metastasis was more frequent in stage III cancer specimens (100%), compared with stage II and I cancer specimens (27.3% and 1/5 respectively, P = 0.000). No significant correlations were found between mesorectal metastasis and other variables such as age, gender and Ming classification (P > 0.05). CONCLUSION: Mesorectal metastasis of middle and lower rectal cancer has significant correlation with tumor diameter, tumor invasion, tumor differentiation and TNM stage. Total mesorectal excision or > or = 5 cm mesorectal distal to the rectal tumor should be followed in the management of middle and lower rectal cancer.

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OBJECTIVE: To examine the expression of matrix metalloproteinase-2 (MMP-2) and to evaluate its correlation with mesorectal metastasis in middle and lower rectal cancer. METHODS: The resected primary tumors from 56 patients with middle and lower rectal cancer who received total mesorectal excision were studied from Dec. 2001 to Jul. 2003. RESULTS: The MMP-2 expression was positive in 42 (75%) cases. The positive rate of MMP-2 expression was 88.9% in T3 tumors and 69.6 % in T2 tumors respectively, while only 33.3% in T1 tumors (P=0.013). MMP-2 was positive in 91.2% (31/34) infiltrative rectal carcinomas while 40.0% (6/15) expansive rectal carcinomas (P=0.001). Mesorectal metastasis was detected in 36 (64.3%) of 56 cases. The expression of MMP-2 was positive in 31 (86.1%) of the 36 patients with mesorectal metastasis, while in 11(55%) of the 20 patients without mesorectal metastasis (P=0.01). CONCLUSIONS: The expression of MMP-2 in middle and lower rectal cancer is significantly associated with depth of tumor invasion and Ming classifications. The high expression of MMP-2 may play an important role in the development of mesorectal metastasis in middle and lower rectal cancer.

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BACKGROUND & OBJECTIVE: Both transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) are the most important and popular procedures of interventional treatment for hepatocellular carcinoma (HCC). Although the improvement of the short-term efficacy of the combination of TACE and PEI has been proved, the long-term efficacy is seldom reported so far. The purpose of this study was to evaluate the long-term efficacy of the combination of TACE and PEI for treatment of HCC. METHODS: Six hundred and seventy-five patients with HCC from 2 cm to 15 cm in the greatest diameter (average 9.6 cm) were enrolled in this study. Among them, 179 were treated by a combination of TACE using the emulsion of lipiodol and anti-cancer drugs and PEI (TACE/PEI group) and 496 patients by TACE alone (TACE group). Ten patients in each group underwent resection after the final interventional treatment and the resected specimens were detected by histopathology method. The unresected patients had been followed up for 5-7 years and the 1-, 3-, 5 -, and 7-year survival rates were evaluated. The clinical data of the patients in two groups before intervention were comparable. RESULTS: Pathological data of two groups showed that remarkable differences were found in the mean necrosis rates (100.0+/-0.0% vs 91.5+/-7.1%, P< 0.05) and the complete necrosis rates of tumors (100% vs 20%, P = 0.0007), while there were no statistical significances in the extent of shrinkage of tumors after treatment between two groups. The results of follow-up showed that the 1-, 3-, 5-, and 7-year survival rates were 80.5%, 58.6%, 29.6%, 16.5% in TACE-PEI group, and 68.5%, 27.8%, 7.2%, 5.2% in TACE group, respectively. Significant differences were found between two groups (P< 0.01). CONCLUSION: The combination of TACE and PEI is a valuable remedy for HCC to prolong long-term survival rate.

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