Background: Functional adrenal tumors (FATs) are mainly diagnosed by biochemical analysis. Traditional imaging tests have limitations and cannot be used alone to diagnose FATs. In this study, we aimed to establish an artificially intelligent diagnostic model based on computed tomography (CT) images to distinguish different types of FATs. Methods: A cohort study of 375 patients diagnosed with hyperaldosteronism (HA), Cushing's syndrome (CS), and pheochromocytoma in our center between March 2015 and June 2020 was conducted. Retrospectively, patients were randomly divided into three data sets: the training set (270 cases), the testing set (60 cases), and the retrospective trial set (45 cases). An artificially intelligent diagnostic model based on CT images was established by transferring data from the training set into the deep learning network. The testing set was then used to evaluate the accuracy of the model compared to that of physicians' judgments. The retrospective trial set was used to evaluate the quantification and distinction performance. Results: The deep learning model achieved an average area under the receiver operating characteristic (ROC) curve (AUC) of 0.915, and the AUCs in all three FAT types were greater than 0.882. The AUC of the model tested on the retrospective dataset reached above 0.849. In the quantitative evaluation of tumor lesion area recognition, the diagnostic model also obtained a segmentation Dice coefficient of 0.69. With the help of the proposed model, clinicians reached 92.5% accuracy in distinguishing FATs, compared to 80.6% accuracy when using only their judgment (P<0.05). Conclusions: The result of our study shows that the diagnostic model based on a deep learning network can distinguish and quantify three common FAT types based on texture features of contrast-enhanced CT images. The model can quantify and distinguish functional tumors without any endocrine tests and can assist clinicians in the diagnostic procedure.
Background: Adrenocortical carcinoma (ACC) is an extremely rare malignant tumor with poor prognosis.Existing treatment options have limited effects, and new therapeutic targets urgently need to be discovered. TNFSF13B has been reported to be associated with the prognosis of clear cell renal cell carcinoma, but it has not been studied in ACC.Methods: TNFSF13B expression was analyzed and compared between ACC tumors and normal tissues by using public datasets from TCGA and GTEx. Kaplan-Meier analysis was employed to evaluate survival, and Cox regression was employed to evaluate clinicopathologic features. The upstream and downstream regulatory mechanisms of TNFSF13B were also analyzed. GSEA was performed to explore the mechanisms of TNFSF13B in ACC. Finally, 14 ACC clinical samples were used to verify the relationships between TNFSF13B expression and disease-free survival (DFS) and overall survival (OS).Results: TNFSF13B expression was significantly higher in ACC tissues than in normal tissues. The prognosis of ACC patients with high TNFSF13B expression was worse than that of patients with low TNFSF13B expression. High TNFSF13B expression was strongly correlated with poor prognosis, and TNFSF13B was a prognostic factor. TNFSF13B expression is modified by upstream miRNAs, methylation and ubiquitination, and downstream, it interacts with other proteins. GSEA showed that regulation of cholesterol biosynthesis by SREBP and SREBF, downstream signaling events of the B cell receptor (BCR) and activation of gene expression by SREBF and SREBP were significantly enriched in the TNFSF13B highexpression phenotype. Clinical samples confirmed that TNFSF13B expression was significantly associated with DFS but not with OS.Conclusions: TNFSF13B may be a potential prognostic molecular marker of poor survival in ACC patients, offering a new therapeutic target.
ObjectiveOur previous work found COX4I2 was associated with angiogenesis in pheochromocytoma. The purpose of this study was to explore the role of COX4I2 in regulating angiogenesis in pheochromocytoma.MethodsDistribution of COX4I2 was evaluated by scRNA-seq in one case of pheochromocytoma and the findings were verified by immunostaining. COX4I2 was further knocked down in target cells. Changes of angiogenesis-related genes were evaluated by qPCR in target cells.ResultsThe scRNA-seq revealed high mRNA expression of COX4I2 in fibroblasts rather than tumor cells. Immunostaining of COX4I2 confirmed its distribution in fibroblasts. Knocking down COX4I2 in NIH3T3 cell line led to significant reduction of angiogenesis-related genes, especially ANG1 and HGF.ConclusionsFibroblasts mediate the angiogenesis of pheochromocytoma by increasing COX4I2 expression, possibly by affecting ANG1 and HGF.
Background As the development of various imaging techniques, the incidental detection of renal masses is increasing. Laparoscopic partial nephrectomy (LPN) is the current standard of treatment for renal carcinoma. Though the retroperitoneal laparoscopic partial nephrectomy (RLPN) become the prior choice, the edge of lateroconal fascia blocks the sight and make operation more challenging. Methods Between October 2018 and December 2020, the clinical data of 28 cases diagnosed with renal cell carcinoma (RCC) in our hospital was collected and analyzed retrospectively. All patients underwent RLPN and for management of curtain effect, we performed lateroconal fascia suspension (LFS) procedure in all cases with prepared Hem-o-lock clip which bound with 2-0 suture. Results RLPN for renal tumor was successfully performed in all cases with no conversions to open surgery and other interruptions. In all cases, the free edge of lateroconal fascia and peritoneum partially blocked the sight of surgeon. We managed the curtain effect successfully and got a satisfying field of view for subsequent surgical procedure. The median operation time was 142 [interquartile range (IQR), 110–164] min, median estimated blood loss was 93 (IQR, 50–100) mL. Median warm ischemia time was 29 (IQR, 22–30) min. Conclusions LFS is useful for management of curtain effect. It is a simple, economical and less invasive technique and we can get better efficiency with little consumption.
The occurrence of pregnancy with Cushing syndrome (CS) is rare but with high risks, posing a great challenge to the clinical diagnosis and treatment of the disease.
Background: to discuss the diagnosis, treatment and mechanism of leukemoid reaction in bladder cancer. Methods: to present and analyze the clinical data of a patient who had urothelial carcinoma complicated with leukemoid reaction Result: The patient had years of smoking history. He underwent six TURBT operations during the time of 31st Aug 2015 to 26th Oct 2022. Pathological diagnosis deteriorated from low-grade papillary urothelial carcinoma to high-grade. The patient did not keep to regular bladder perforation or routine follow-up cystoscopy. He also refused radical resection intervention. Last CT results show the following: multiple tumors in the bladder, bilateral ureter bladder entrance invasion, bilateral renal pelvis and ureter dilatation , multiple lymphadenopathy in the pelvis and along the right iliac artery. After cystoscopy examination and urethral catheter was placed, creatinine level gradually decreased. However, body temperature raised from 38 oC to 40o C. White blood cell count increased from 67.83*109/L (neutrophils being 64.5*109/L) to 72.17*109/L (neutrophils being 70.27*109/L). The patient was considered to have leukemoid reaction complicated with bladder cancer. The patient refused to have bone marrow biopsy, palliative care was provided instead. The patient passed away on 28th Oct 2022. Conclusion: Bladder cancer patients complicated with leukemoid reactions are rarely reported clinically. Even after surgical resection, the outcome was poor. Monitoring of G-CSF level in blood can help to make predictions of the patient’s health condition. Blocking the G-CSF signaling pathway might work as a future therapeutic target for bladder cancer complicated with leukemia reaction.
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