Background: Up to 30% colorectal carcinoma (CRC) are inherited tendency. Lynch syndrome (LS) which is caused by mismatch repair (MMR) genes germline mutation, is the most prevalent form of hereditary CRC. Ethnical and regional differences would lead to diverse characteristics of LS. However, Studies of LS from China are few and with relatively small sample sizes.
Method: Immunohistochemistry (IHC) testing for MMR deficiency (dMMR) is advocated to preliminarily screen LS in recent guidelines. This single center retrospective study from central China performed IHC to prescreen dMMR and analyze the patterns and characteristics of dMMR CRCs.
Results: 12.0% (180/1505) CRCs had dMMR status in this study, they had the universal features such as younger diagnostic age, more proximal colon location, more poorly differentiated with an excess of mucinous type, advanced pT stage and lower pN stage (all P < 0.05), but had larger tumor size and less perineural invasion (all P < 0.05) compared with proficiency MMR CRCs, which were not reported before. Moreover, PMS2 deficiency (8.7%) was common in this study which was different from studies in Western. MLH1/PMS2, isolated PMS2, MSH2/MSH6 and isolated MSH6 were the most common deficiency patterns, and the MSH2/MSH6 subtype had the most often family history.
Conclusion: This study demonstrated dMMR CRCs from central China had the similar general characteristics as reported studies, but had larger tumor size and less perineural invasion which were not reported before. What’s more, PMS2 deficiency (8.7%) was common in this study which was different from studies in Western.
Objective
The repair of great toe donor site defect after wrap‐around flap transfer is still controversial. The bilobed superficial circumflex iliac artery perforator (SCIP) flap can improve the aesthetics of the great toe while maintaining its function. Thus, this study aimed to report our experience in the reconstruction of big toe donor site defects with the bilobed SCIP flap and describe the clinical outcomes.
Methods
This study was a retrospective trial. From May 2017 to May 2020, 13 patients with the great toe donor site defect after wrap‐around flap transfer were included in this study. The average age of the patients was 44 years (range, 23–60 years). All patients received free bilobed SCIP flaps to reconstruct the donor site defect of the great toe. Relevant clinical features were recorded preoperatively. The thickness and design of the SCIP flap and the harvesting layer of the flap were measured during the operation. The survival rate of flaps and skin grafts and the incidence of infection were recorded after operation. At follow‐up, donor site complications and postoperative outcomes were evaluated.
Results
In all cases, the SCIP flap covering the donor site of the great toe survived. All patients were followed up for 24–40 months (mean, 30.5 months). The average thickness of the SCIP flap was 0.38cm. All SCIP flaps were harvested from the superficial fascial layer except for three obese patients. The thin SCIP flap had a bilobed design with no further defatting procedures. Postoperatively, the great toe‐nail flap donor site regained its original appearance without bloating or flap necrosis. There was a hidden linear scar in the groin donor site, which did not affect hip joint movement. All patients were satisfied with the aesthetics of the surgical site.
Conclusion
The SCIP flap with bilobed design for repairing the donor defect of the great toe after wrap‐around flap transfer is a kind of surgical method with excellent contour, meeting the requirements of function and aesthetics.
Background
Endoscopy biopsy (EB) is the standard diagnostic method for colorectal cancer (CRC), whereas its accuracy and efficiency in mucinous adenocarcinoma (MAC) initial diagnosis is unclear.
Methods
The initial EB and postoperative specimen (PS) pathological diagnosis of MAC from two centers were retrospectively collected and analyzed. The accuracy and efficiency of initial EB compared with PS pathological diagnosis were analyzed. The potential factors which would affect the initial EB diagnosis of MAC were analyzed.
Results
280 and 78 eligible cases were enrolled in this study from two centers respectively. The initial EB diagnosis accuracy for MAC were 84.62% and 83.33%. However, among the cases of PS diagnosis with MAC, the diagnostic efficiency of initial EB was only 36.49% and 32.50% respectively. Lower tumor differentiation and more EB number were associated with an increased probability for the EB diagnosis of MAC, but only tumor differentiation was an independent diagnositic factor for EB in the two cohorts.
Conclusions
The accuracy of initial EB with MAC is high, but the diagnostic efficiency was extremely low. Tumor differentiation and EB number were associated with the diagnosis efficiency of MAC before surgery.
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