The Wnt/β-catenin signaling is abnormally activated in the progression of hepatocellular carcinoma (HCC). BCL9 is an essential co-activator in the Wnt/β-catenin signaling. Importantly, BCL9 is absent from tumors originating from normal cellular counterparts and overexpressed in many cancers including HCC. But the mechanism for BCL9 overexpression remains unknown. Ample evidence indicates that hypoxia inducible factors (HIFs) play a role in the development of HCC. It was found in our study that BCL9 was overexpressed in both primary HCC and bone metastasis specimens; loss of BCL9 inhibited the proliferation, migration and angiogenesis of HCC; and that that hypoxia mechanically induced the expression of BCL9. BCL9 induction under the hypoxic condition was predominantly mediated by HIF-1α but not HIF2α. In vitro evidence from xenograft models indicated that BCL9 promoter/gene knockout inhibited HCC tumor growth and angiogenesis. Notably, we found that BCL9 and HIF-1α were coordinately regulated in human HCC specimen. The above findings suggest that hypoxia may promote the expression of BCL9 and associate with the development of HCC. Specific regulation of BCL9 expression by HIF-1α may prove to be an underlying crosstalk between Wnt/β-catenin signaling and hypoxia signaling pathways.

Total spondylectomy, by either en bloc or piecemeal method, could significantly reduce LRFS for spinal chordoma. Location of C3-L5 is a favorable factor for LRFS, while dedifferentiated subtype and preoperative Frankel scores A-C are adverse prognostic factors. In addition, total en bloc spondylectomy and KPS ≥ 80% significantly improve overall survival of patients with spinal chordoma.

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Malignant giant cell tumor (MGCT) in the spine is extremely rare and there is little published information regarding this subject in the literature. We attempted to correlate different treatment options and outcomes over time. A retrospective study of patients with spinal MGCT who were surgically treated in our center between 2006 and 2012 was performed. Overall, three surgical management strategies, including subtotal resection, piecemeal total resection, and total en bloc spondylectomy were applied. Postoperative radiotherapy was carried out in 4 cases. Clinical data and efficacy of surgical treatment strategy were analyzed via chart review. A total of 14 patients with spinal MGCT were included in the study. Three cases were diagnosed as primary MGCT (PMGCT), while the other 11 patients were secondary MGCT (SMGCT). The mean follow-up period was 41 (range 3-75) months. Recurrence was found in 7 patients after surgery in our center, while distant metastasis and death occurred in 4 and 6 cases, respectively. MGCT of bone is always a high-grade sarcoma with a poor prognosis and complete excision, while also preserving neural function, is recommended. In our study, patients who underwent total en bloc spondylectomy had significantly lower local recurrence rate for MGCT in the spine.

Although mesenteric vasculitis due to Henoch-Schönlein purpura (HSP) is relatively uncommon, it is the most life-threatening manifestation associated with high mortality. We describe a 15-year-old boy with HSP who had massive gastrointestinal bleeding and ileus but delayed onset of the purpuric rash. Abdominal ultrasonography revealed thickening of both small and large intestinal walls, and CT found prominent mesenteric vessels with comb sign and double wall of the bowel. These findings were consistent with mesenteric vasculitis and bowel ischaemia. The ischaemic intestine recovered after methylprednisolone pulse therapy and surgical intervention was avoided. Our report suggests that corticosteroid pulse therapy may help controlling HSP with massive gastrointestinal haemorrhage and ischaemic bowel due to widespread mesenteric vasculitis.