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Cutaneous diffuse large B-cell lymphoma (DLBCL) usually manifests as papules, nodules, or plaques. A rare case of a patient with a chronic skin ulcer and signs and symptoms of infection, including fever and large amounts of yellow wound exudate, is presented. Fifteen (15) months before diagnosis, a 43-year-old otherwise healthy man noted soreness without apparent cause in his upper chest and a palpable 2 cm x 2 cm focal lump. The patient developed frequent fevers, and the lump enlarged over time, producing purulent exudate. For 14 months, the patient was examined and treated at 5 hospitals, but biopsies, smears, cultures, and various types of nucleic acid testing were negative. Antibiotics to treat the suspected but nonclassified infection were ineffective. Ultimately, debridement and pathological examination of necrotic tissue from the deep sinus revealed DLBCL. The patient was provided chemotherapy, surgical debridement, and negative pressure wound therapy. Wounds started to reduce in size once chemotherapy was initiated. The wound was surgically closed with a split-skin graft, and the patient was discharged 93 days following admission to the authors' facility. This case illustrates the possibility of cutaneous DLBCL in patients with chronic skin ulcers and infectious manifestation that do not respond to antibiotic therapy. Prompt deep tissue debridement and pathological examination of deep tissue will help confirm the presence of cutaneous DLBCL and guide required chemotherapy.

The phenomenon of losing a green signal in synovial sarcoma (SS) using the SS18 break-apart probe by fluorescence in situ hybridization (FISH) has been poorly described. In this study, 12 SS with missing a green signal were identified. This series included 7 males and 5 females, aged 17 to 69 years (median, 38.5 years). The tumors involved the extremities (50%), mediastinum (16.7%), hypopharynx (8.3%), neck (8.3%), thyroid (8.3%), and retroperitoneum (8.3%). The tumors were classified as monophasic SS (58.3%) and poorly differentiated SS (41.7%). An anaplastic SS showing features of pleomorphic sarcoma was observed. Immunostaining for TLE1, BCL2, CD99, epithelial membrane antigen, cytokeratin (AE1/AE3), cytokeratin 7, S-100 protein, and CD34 was consistent with typical SS. In FISH, all the tumors showed the pattern of 1 to 3 fused signal(s) with 1 to 3 red signal(s), without corresponding a green signal. The fusion transcripts included SS18-SSX1 (8/10, 80%) and SS18-SSX2 (2/10, 20%) fusions. Median and 5-year overall survival were 19.1 months and 43.6%, respectively. In conclusion, we reported a series of SS losing a green signal in the SS18 FISH assay. We propose that this variant FISH pattern should be interpreted as a peculiar unbalanced rearrangement of the SS18 gene and subsequent SS18-SSX fusion test should be recommended. The cases in this study seem to show some unusual clinicopathological features, including unusual locations, higher proportions of poorly differentiated SS, and aggressive clinical course. However, whether this variant FISH pattern is associated with peculiar clinicopathologic features awaits larger series.

The aim of this study was to explore HER2 status and characteristics in biopsy specimens of gastric cancer (GC) in Chinese population.A total of 27,787 biopsy specimens of GC from 103 hospitals were obtained. Immunohistochemistry (IHC) staining of HER2 was performed. Overall HER2 IHC positive rate was 11.2 %. HER2 positive rate elevated with the increase of age in total patients and both genders. The rates were 7.1 %, 8.1 %, 9.0 %, 10.9 %, 11.8 %, 12.6 %, and 12.1 % when patient age was ≤30, 31-40, 41-50, 51-60, 61-70, 71-80, and80, respectively (P 0.001). In male, the rates were 6.5 %, 8.4 %, 9.6 %, 11.5 %, 12.4 %, 13.3 %, and 12.1 % (P 0.001). In female, the rates were 7.4 %, 7.9 %, 8.0 %, 9.0 %, 9.6 %, 10.6 %, and 11.9 % (P = 0.128). The changes in male were more dramatic than in female (P 0.001). Furthermore, the proportion of the intestinal type GCs increased with age in total patients and both genders (P 0.001), and in male the changes were more dramatic (P 0.001). While the proportion of the diffuse type showed the opposite tendency to that of the intestinal type (P 0.001). HER2 IHC positive rate showed a positive correlation with the proportion of the intestinal type (r=0.986, P 0.001), and a negative correlation with the proportion of the diffuse type (r=0.984, P 0.001).The HER2 IHC positive rate showed age variation in biopsy specimens of GC. In male the variation was more dramatic than in female. The variation of HER2 positive rate can be attributed to the age variation of the Lauren subtypes.

The purpose of this study was to assess real-time contrast-enhanced ultrasound in patients with hepatic angiomyolipomas with respect to contrast-enhancing kinetics and enhancement patterns. Nonlinear, low mechanical index (mechanical index less than 0.2), real-time contrast-enhanced ultrasonography was performed in 18 patients with 19 tumors after 2.4 mL bolus injection of contrast agent SonoVue. All the 19 tumors were surgically resected and immunohistochemically proven sporadic hepatic angiomyolipomas. Inhomogeneous hyperenhancing pattern was detected 16 tumors (84.2%) and homogeneous hyperenhancing pattern in 1 tumor (0.5%) in arterial phase and portal phase, 16 lesions remained hyperenhancement but one lesion became isoenhancement in late phase. Two lesions (10.5%) were detected inhomogeneously hypoenhancement compared to liver parenchyma during arterial, portal, and late phases, with only punctiform internal enhancement. The margin of all the lesions were smooth and well defined on contrast-enhanced ultrasonography, whereas no peripheral nodular arterial enhancement, centripetal filling, or spoke-wheel like enhancement pattern were depicted. Early strong enhancement in arterial phase, rapid washout of contrast agent, and appear hypoechoic to surrounding liver tissue during portal or late phase was not at all observed. Real-time contrast-enhanced ultrasonography can demonstrate typical imaging characteristics of hepatic angiomyolipomas in most cases, that is, inhomogeneous hyperenhancing pattern in arterial phase, prolonged hyperenhancement during portal and late phase with smooth and well-defined margin. This real-time dynamic imaging technique may therefore improve noninvasive characterization and differentiation of this rare, benign, hepatic mesenchymal neoplasm.

Objective The purposes of this study were to confirm the definite metastasis and micrometastasis rate of upward and lateral lymph nodes of mid-to-low rectal cancer at stage II and stage III, and to evaluate the feasibility and safety of laparoscopic radical correction combined with extensive lymphadenectomy and pelvic autonomic nerve preservation (PANP). Methods The study was performed in 68 patients who were diagnosed with mid-to-low rectal cancer at stage II or stage III and received laparoscopic radical correction combined with extensive lymphadenectomy and PANP from June 2006 to June 2008 in the General Surgery Department of Southwest Hospital. All lymph nodes resected in the surgeries were examined by hematoxylin and eosin (H & E) stain and immunohistochemistry with an antibody against cytokeratin 20 (CK20) to confirm the conditions of metastasis and micrometastasis. We compared the postoperative complications with those of traditional surgeries. Results In 1571 lymph nodes, 16 lymph nodes were found to have definite metastasis in 6 patients (8.8%) and in 41 lymph nodes we found micrometastasis in 12 patients (17.6%). The total metastasis rate of upward and lateral lymph nodes was 19.1%. Compared with traditional surgeries, the new surgery had less blood loss and short convalescence and postoperative complications were not increased. Conclusion The total metastasis rate of upward and lateral lymph nodes is 19.1%. The laparoscopic radical correction combined with extensive lymphadenectomy and PANP is feasible and safe.