Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
-
Haihong Liao
and
Yulong Liu
Abstract
Multiple primary malignancies in a single patient are relatively rare; however, the frequency of this has increased significantly in recent decades. Here, we retrospectively reported an unusual case of a 70-year-old man who was admitted to the hospital with mantle cell lymphoma (MCL) and colon cancer and aimed to explore measures to reduce missed diagnosis. Based on the data, the investigation of the related literatures, colonoscopy examination, and abdominal computed tomography (CT) scan were conducted for the detection of colon cancer. Following this, a precise diagnosis of MCL was confirmed by immunohistochemistry and bone marrow biopsy, which were performed to analyze the clinical characteristics and essentials for the diagnosis and differential of the disease. The results of colonoscopy showed that the patient had colon cancer, while the abdominal CT scan demonstrated colon cancer accompanied by multiple lymphadenopathy throughout the entire body. Besides, the results of immunohistochemistry confirmed that the patient suffered from MCL. The bone marrow biopsy revealed the active hematopoietic tissue hyperplasia but no tumor issue involvement in the bone marrow. In conclusion, our study combined the analysis and summary of the diagnosis and treatment of the colon cancer with MCL to provide clinical guidance for the rare multiple primary malignancy.
1 Introduction
Multiple primary malignancies are defined as the occurrence of two or more malignancies without subordinate relationship in different organs of an individual patient, while the underlying mechanism remains unclear [1]. The incidence of multiple primary malignancy is rare although the prevalence rate is increasing recently [2]. Mantle cell lymphoma (MCL) is a unique B-cell lymphoma that accounts for 3–10% of non-Hodgkin’s lymphoma (NHL) with a median survival of 3–4 years [3]. It is more common in the elderly, which is often diagnosed at an advanced stage [4]. Lymph node metastasis in colon cancer and extralateral lymphoma in gastrointestinal tract are common, whereas conventional lymph node biopsy during the operation of colon cancer and partial enlarged lymph nodes that are found in MCL are rare [5]. Only one case reported that a patient developed NHL after curative resection of colon cancer in recent decades, but no report was found about synchronous primary malignancy, including the colon cancer and lymphoma [6]. Herein, we present such an unusual case of colon cancer and MCL. To our knowledge, this is the first article that has been reported on double primary malignancies associated with MCL in a patient with colon cancer. We report the following case according to the CARE reporting checklist.
2 Case presentation
A 70-year-old man was admitted to our hospital in March 2017 due to upper abdominal pain for more than 2 weeks. He had no obvious nausea, vomiting, chills, fever, black stools, and other discomforts. The patient was previously healthy and had no family history of colon cancer or malignant lymphoma, and social history was noncontributory.
The colonoscopy revealed colon cancer, and the abdominal computed tomography (CT) indicated colon cancer and systemic multiple lymphadenopathy that might be malignant lymphoma (Figure 1). On March 17, 2017, the pathological diagnoses were as follows: (descending colon) uplifted moderately differentiated adenocarcinoma with a maximum mass diameter of 4.5 cm infiltrating into the serosal layer; the peripheral lymph node metastases were 3/10 perienteric group, 2 cancer nodules, and 0/5 mesenteric group; the upper and lower cutting edges were negative (Figure 2a). The immunohistochemical results showed P53 (3+), Ki-67 (+, about 70%), CEA (+), E-cadherin (+), Topo-II (2+), and CDX-2 (+) (Figure 2b). Fourteen retroperitoneal lymph nodes with a maximum diameter of 0.3–6 cm were found: NHL (Figure 2c). Immunohistochemical results showed LCA (+), CD3 (−), CD20 (+), PAX-5 (+), CD10 (−), Bcl-6 (−), Mum-1 (+), Bcl-2 (+), Ki-67 (+, about 50%), and cyclin D1 (+) (Figure 2d). Finally, the patient was diagnosed as NHL [MCL at stage IIIA, CD20+ with International Prognostic Index (IPI) score of 4 points, postoperative colon cancer (pT3N1M0, stage IIIB)]. During the course of the disease, the patient had no fever, night sweats, or significant weight loss. The bone marrow biopsy on April 10, 2017, revealed that bone marrow hematopoietic tissue hyperplasia was active, and the hematopoietic tissue accounted for about 40% with the degree of hyperplasia (++). Besides, granulocytes proliferate actively, protocells were observed, and the proportion of mature granulocytes was normal. Furthermore, red blood cell lines were hyperproliferative, and clusters of juvenile red blood cells were visible, which were distributed in the trabecular region, and the proportion of the megakaryocytes was normal. The bone marrow biopsy revealed that bone marrow hematopoietic hyperplasia was active and no tumor involving bone marrow was found. Bone marrow routine examination showed that the smear had an active proliferation of nuclear cells without obvious abnormal cells on April 12, 2017. After admission to our department, the patient went to a hospital in Shanghai for pathological consultation based on the data and pathological sections to confirm the diagnosis of the double primary tumor. The result of consultation was the same as that of our hospital. The patient presented significant abdominal pain while waiting for the result of pathological consultation after surgery. CT scan showed obvious abdominal lymphadenopathy, indicating the progression of lymphoma (no CT images because of many enlarged lymph nodes).
Abdominal CT indicating a mass lesion of the colon before surgery.
(a) HE staining of postoperative intestinal cancer specimen, original magnification ×100. (b) Positive with CDX-2 (×100). (c) HE staining of postoperative MCL specimen (×100). (d) Positive with cyclin D1 (×200).
According to the principle of dual primary tumor treatment, this patient underwent a radical resection of a tumor in the descending colon cancer in our hospital on March 7, 2017, and postoperative adjuvant chemotherapy was performed to reduce the risk of recurrence and metastasis. Patients with NHL at stage III were mainly treated with internal medicine, and chemotherapy was required because of obvious clinical symptoms. However, there is no chemotherapy scheme for both tumors. In addition, the side effects of two chemotherapy regimens on bilateral tumors are too severe to be tolerated by elderly patients. After discussing the multidisciplinary diagnosis and treatment model (MDT), and actively communicating with the patient’s family, MCL with clinical symptoms was treated. R-CHOP chemotherapy regimen was performed for five times, including metrology (600 mg, day 1), dexamethasone (10 mg, days 2–6), pharmorubicin (80 mg, day 2), cyclophosphamide (0.8 g, day 2), and vindesine (4 mg, day 2 q3w). IV degree of the bone marrow was suppressed, and granulocytes were lacking after the first chemotherapy. Following the subsequent chemotherapy, PEGylated recombinant human granulocyte colony-stimulating factor needle was used to prevent leukopenia, and no obvious bone marrow suppression occurred. Abdominal pain was relieved, and abdominal lymph nodes became smaller upon the first chemotherapy. On June 6, 2017, abdominal CT indicated no obvious occupying lesion in hepatic segment IV (Figure 3a). After the fifth course of chemotherapy, abdominal CT was performed on August 30, 2017, and the result showed the hepatic segment IV occupation and metastasis may occur (Figure 3b). Enhanced MRI was performed on September 5, 2017, because the abdominal CT was not clear and the results revealed obvious occupying lesion in segment IV of the liver and the occurrence of metastasis, but the specific nature and source remain unclear (Figure 3c).
(a) Abdominal enhanced CT revealing no obvious occupying lesion in the hepatic segment IV on June 6, 2017. (b) Abdominal enhanced CT revealing hepatic segment IV occupation and metastasis may occur on August 30, 2017. (c) Abdominal enhanced MRI showing obvious occupying lesion in the hepatic segment IV, and metastasis may occur on September 5, 2017. (d) Abdominal enhanced CT suggesting enlarged hepatic segment IV lesions.
Intrahepatic lesion biopsy, surgery, radiofrequency ablation (RF), stereotactic body radiation therapy (SBRT) and other local treatments were not performed because of the old age of the patient. According to the probability of metastasis of the two tumors to the liver, colon cancer was more likely to metastasize to the liver. In addition, MCL was in remission, and hence, the protocol was made based on the hepatic metastasis of colorectal cancer. Capecitabine tablets (1.5 g, bid, d1–14) were given orally twice (chemotherapy), and the abdominal CT taken on November 21, 2017, revealed that the lesion was enlarged in the liver (Figure 3d). The patient was recommended to undergo liver mass puncture for pathology, but the family requested to continue with the original chemotherapy. However, xeloda was not taken orally for the third time because of the low platelet level of the patient and the presence of chemotherapy taboos. Then, the treatment was terminated because of the economic reason.
In July 2018, the patient was admitted to our department due to neck swelling, tracheal compression, and dyspnea. The neck ultrasound revealed goiter and compression of trachea and esophagus. Needle biopsy indicated that thyroid was invaded by lymphoma. Furthermore, the immunohistochemical results showed CD3 (−), CD20 (+), PAX-5 (+), CD5 (+), Cyclin D1 (+), BCL-2 (+), CD10 (−), CD56 (−), and Ki-67 (+, about 90%), which are consistent with MCL (Figure 4). R-CHOP chemotherapy regimen was not performed because of the costs. Thus, the patient was treated with glucocorticoids and was discharged after improvement in dyspnea. After that, the patient did not receive any treatment. During the follow-up, we found that the patient died at home in January 2019, and the cause of death was unknown.
(a) HE staining of fine needle aspiration sample of thyroid (×100). (b) Positive with PAX-5 (×100).
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Ethical statement: The research related to human use has been complied with all the relevant national regulations, institutional policies, and in accordance the tenets of the Helsinki Declaration, and has been approved by the Ethics Committee of Huzhou Central Hospital (20191210-01).
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Informed consent: Written informed consent was obtained from the patient for publication of this study and any accompanying images.
3 Discussion
The diagnosis of multiple primary malignancies in the study was performed according to the criteria previously described: each tumor is malignant and has its own unique pathological features; two or more tumors need to be spaced at a normal interval or occur at different sites, but the two are not continuous; and recurrence and metastasis must be excluded [7]. This case showed a combination of colon cancer and MCL, which are two different types occurred simultaneously, thus meeting the criteria for multiple primary malignancy.
In terms of treatment, there is no chemotherapy scheme for both tumors. Currently, the treatment for colon cancer is mostly surgical resection followed by adjuvant chemotherapy [8]. Previous studies have reported that although the first-line treatment for MCL patients is generally considered too toxic for elderly patients, moderate intensive chemotherapy, such as R-CHOP, still remained the best induction regimen for elderly patients with MCL [9]. In this case, according to the principle of dual primary tumor treatment, radical resection of colon cancer and postoperative adjuvant chemotherapy were performed, whereas patients with MCL were mainly treated with internal medicine, and R-CHOP chemotherapy was required because of obvious clinical symptoms. Moreover, oral chemotherapy was also adopted in the patient for the treatment of hepatic and thyroid metastasis.
The pathogenesis of multiple primary malignancies remains unclear. Several researches have reported that risk factors, including low immunity, the existence of tumor-susceptibility genes, mutual signal channels and continuous exposure to toxic and harmful carcinogens, are related with multiple primary malignancy [10,11,12]. Colon cancer is often associated with endometrial, gastric, and ovarian cancers, but little is reported to its correlations with blood malignancies [13]. It has been reported that the patients underwent secondary breast, ovarian, and uterine cancers after colorectal cancer in Korea [14]. Liu et al. reported a case with male breast cancer and coexisting MCL in 2017 [7]. Besides, Hu et al. reported that a 74-year-old woman had a history of colon cancer and developed multiple primary malignancies including stomach, lung, breast, and liver cancers [15]. In our study, two types of malignant tumor components (colon cancer and MCL) were noticed simultaneously in the patient, followed by invasion of thyroid by lymphoma. Multiple primary tumor is usually found in the same system or in different parts of the same organ [16]. Colon cancer and coexisting MCL in this case are rare because colon belongs to the parenchymal organ, whereas MCL is a disease of the lymphatic hematopoietic system. The patient was admitted to the hospital because of digestive symptoms, and the colonoscopy revealed colon cancer. Furthermore, abdominal CT showed lymphadenectasis. Lymph node metastasis of colon malignant tumor generally occurs through lymphatic circulation path [17]. Therefore, colon cancer with lymph node metastasis rather than the second primary tumor would be considered when the swollen lymph nodes were observed in imagological diagnosis, resulting in missed diagnosis. In addition, the lymph nodes submitted for examination in the case were colorectal cancer metastasis, and retroperitoneal lymph nodes were MCL. Thus, pathological diagnosis should be performed for the specimens of the lymph node to avoid missed diagnosis. Moreover, auxiliary examination including regional lymph nodes and puncture of mass should be completed before treatment because the liver lesions were not examined for pathology with the unknown nature. As for therapeutic effect, the prognosis of dual primary tumors is worse than that of the corresponding single primary tumors, which may be related to the low immunity of patients and the failure of treatment of both tumors [18,19,20,21].
The synchronous of MCL and colonic carcinoma in one patient is rare. Liao et al. [22] previously reported a case of advanced sigmoid adenomcarcinoma and duodenal MCL with the involvement of lymph nodes. This case was considered as extremely rare because the location of MCL was identified 20 months after the chemoradiotherapy of adenocarcinoma. In the case described by Sztarkier et al. [23], there was also a case of adenocarcinoma; however, the MCL was present in tubular adenoma with polyp formation. One polyp was infiltered by the lymphoid cell, whereas two regional lymph nodes were partially replaced by MCL. Handra-Luca [24] has described a patient with intestinal tumors of adenoma-lymphoma without compromising the lymph nodes. All three patients described earlier received R-CHOP regimen after the diagnosis of MCL, which is consistent with our case. Yet, the used drugs and its dosage in R-CHOP regimen were different, which may depend on the patients’ clinical situation. Besides, compared with other studies, our study is the first one that has not only introduced a rare case of synchronous of colon cancer and MCL but also provided a clinical guidance of composite tumors to reduce the probability of misdiagnosis.
In conclusion, colon cancer with multiple lymphadenopathy throughout the body (malignant lymphoma was considered) was detected through abdominal CT. Combined with the immunohistochemical results, the patient was diagnosed as synchronous primary malignancy colon cancer and MCL, avoiding missed diagnosis. The diagnosis rate of dual primary tumors is high due to the medical advancements. Doctors require detailed analysis ability and rich clinical experience from multiple disciplines to discuss together before making best choice to formulate the most effective treatment regimen, prolong the survival time of the patients, and improve the quality of life needs to be solved in the future.
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Funding information: This work was supported by the Young Talents of Zhejiang Provincial Medical and Health Science and Technology Project [grant number 2019RC285].
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Conflict of interest: The authors have no conflicts of interest to declare.
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Data availability statement: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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© 2021 Haihong Liao et al., published by De Gruyter
This work is licensed under the Creative Commons Attribution 4.0 International License.
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- Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
- Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
- miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
- Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
- The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
- Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
- No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
- circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
- Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
- Educational program for orthopedic surgeons’ influences for osteoporosis
- Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
- GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
- lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
- Anticoagulation is the answer in treating noncritical COVID-19 patients
- Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
- Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
- VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
- Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
- Treatment of osteoporosis with teriparatide: The Slovenian experience
- New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
- Superenhancer–transcription factor regulatory network in malignant tumors
- β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
- Clinical features of atypical tuberculosis mimicking bacterial pneumonia
- Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
- Effect of electromagnetic field on abortion: A systematic review and meta-analysis
- miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
- MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
- Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
- miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
- Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
- MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
- Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
- circATP2A2 promotes osteosarcoma progression by upregulating MYH9
- Prognostic role of oxytocin receptor in colon adenocarcinoma
- Review Articles
- The function of non-coding RNAs in idiopathic pulmonary fibrosis
- Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
- Role of cesarean section in the development of neonatal gut microbiota: A systematic review
- Small cell lung cancer transformation during antitumor therapies: A systematic review
- Research progress of gut microbiota and frailty syndrome
- Recommendations for outpatient activity in COVID-19 pandemic
- Rapid Communication
- Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
- Use of microspheres in embolization for unruptured renal angiomyolipomas
- COVID-19 cases with delayed absorption of lung lesion
- A triple combination of treatments on moderate COVID-19
- Social networks and eating disorders during the Covid-19 pandemic
- Letter
- COVID-19, WHO guidelines, pedagogy, and respite
- Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
- COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
- What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
- Case Report
- Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
- CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
- Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
- Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
- Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
- Pulmonary parenchymal involvement caused by Tropheryma whipplei
- Mediastinal mixed germ cell tumor: A case report and literature review
- Ovarian female adnexal tumor of probable Wolffian origin – Case report
- Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
- Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
- Primary orbital ganglioneuroblastoma: A case report
- Primary aortic intimal sarcoma masquerading as intramural hematoma
- Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
- Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
- Chondroblastoma of mandibular condyle: Case report and literature review
- Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
- Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
- Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
- High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
- Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
- Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
- Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
- Retraction
- Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
- Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
- An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
- Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
Articles in the same Issue
- Research Articles
- Identification of ZG16B as a prognostic biomarker in breast cancer
- Behçet’s disease with latent Mycobacterium tuberculosis infection
- Erratum
- Erratum to “Suffering from Cerebral Small Vessel Disease with and without Metabolic Syndrome”
- Research Articles
- GPR37 promotes the malignancy of lung adenocarcinoma via TGF-β/Smad pathway
- Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
- Additional baricitinib loading dose improves clinical outcome in COVID-19
- The co-treatment of rosuvastatin with dapagliflozin synergistically inhibited apoptosis via activating the PI3K/AKt/mTOR signaling pathway in myocardial ischemia/reperfusion injury rats
- SLC12A8 plays a key role in bladder cancer progression and EMT
- LncRNA ATXN8OS enhances tamoxifen resistance in breast cancer
- Case Report
- Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy
- Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background
- Research Articles
- TRIM25 contributes to the malignancy of acute myeloid leukemia and is negatively regulated by microRNA-137
- CircRNA circ_0004370 promotes cell proliferation, migration, and invasion and inhibits cell apoptosis of esophageal cancer via miR-1301-3p/COL1A1 axis
- LncRNA XIST regulates atherosclerosis progression in ox-LDL-induced HUVECs
- Potential role of IFN-γ and IL-5 in sepsis prediction of preterm neonates
- Rapid Communication
- COVID-19 vaccine: Call for employees in international transportation industries and international travelers as the first priority in global distribution
- Case Report
- Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature
- An infertile female delivered a baby after removal of primary renal carcinoid tumor
- Research Articles
- Hypertension, BMI, and cardiovascular and cerebrovascular diseases
- Case Report
- Coexistence of bilateral macular edema and pale optic disc in the patient with Cohen syndrome
- Research Articles
- Correlation between kinematic sagittal parameters of the cervical lordosis or head posture and disc degeneration in patients with posterior neck pain
- Review Articles
- Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database
- Research Articles
- Thermography in the diagnosis of carpal tunnel syndrome
- Pemetrexed-based first-line chemotherapy had particularly prominent objective response rate for advanced NSCLC: A network meta-analysis
- Comparison of single and double autologous stem cell transplantation in multiple myeloma patients
- The influence of smoking in minimally invasive spinal fusion surgery
- Impact of body mass index on left atrial dimension in HOCM patients
- Expression and clinical significance of CMTM1 in hepatocellular carcinoma
- miR-142-5p promotes cervical cancer progression by targeting LMX1A through Wnt/β-catenin pathway
- Comparison of multiple flatfoot indicators in 5–8-year-old children
- Early MRI imaging and follow-up study in cerebral amyloid angiopathy
- Intestinal fatty acid-binding protein as a biomarker for the diagnosis of strangulated intestinal obstruction: A meta-analysis
- miR-128-3p inhibits apoptosis and inflammation in LPS-induced sepsis by targeting TGFBR2
- Dynamic perfusion CT – A promising tool to diagnose pancreatic ductal adenocarcinoma
- Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches
- Review Articles
- The ambiguous role of mannose-binding lectin (MBL) in human immunity
- Case Report
- Membranous nephropathy with pulmonary cryptococcosis with improved 1-year follow-up results: A case report
- Fertility problems in males carrying an inversion of chromosome 10
- Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature
- Metastatic renal Ewing’s sarcoma in adult woman: Case report and review of the literature
- Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review
- Skull hemophilia pseudotumor: A case report
- Judicious use of low-dosage corticosteroids for non-severe COVID-19: A case report
- Adult-onset citrullinaemia type II with liver cirrhosis: A rare cause of hyperammonaemia
- Clinicopathologic features of Good’s syndrome: Two cases and literature review
- Fatal immune-related hepatitis with intrahepatic cholestasis and pneumonia associated with camrelizumab: A case report and literature review
- Research Articles
- Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study
- Significance of nucleic acid positive anal swab in COVID-19 patients
- circAPLP2 promotes colorectal cancer progression by upregulating HELLS by targeting miR-335-5p
- Ratios between circulating myeloid cells and lymphocytes are associated with mortality in severe COVID-19 patients
- Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation
- Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China
- Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
- Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
- FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
- Platelet-rich fibrin: Basics of biological actions and protocol modifications
- Accurate diagnosis of prostate cancer using logistic regression
- miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
- Prognostic significance of TRIM28 expression in patients with breast carcinoma
- Integrative bioinformatics analysis of KPNA2 in six major human cancers
- Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
- A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
- Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
- Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
- Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
- COVID-19 severity in relation to sociodemographics and vitamin D use
- Clinical analysis of 11 cases of nocardiosis
- Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
- Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
- Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
- Relation between IL-8 level and obstructive sleep apnea syndrome
- circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
- Nomogram prediction model for renal anaemia in IgA nephropathy patients
- Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
- NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
- A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
- Clinical and prognostic features of MMP-2 and VEGF in AEG patients
- The value of miR-510 in the prognosis and development of colon cancer
- Functional implications of PABPC1 in the development of ovarian cancer
- Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
- Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
- Prediction of improvement after anterior cruciate ligament reconstruction
- Effluent Osteopontin levels reflect the peritoneal solute transport rate
- circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
- Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
- Association between hair cortisol concentration and metabolic syndrome
- Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
- Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
- Knee alterations in rheumatoid arthritis: Comparison of US and MRI
- Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
- lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
- Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
- Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
- Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
- Travelers’ vaccines and their adverse events in Nara, Japan
- Association between Tfh and PGA in children with Henoch–Schönlein purpura
- Can exchange transfusion be replaced by double-LED phototherapy?
- circ_0005962 functions as an oncogene to aggravate NSCLC progression
- Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
- Serum intact fibroblast growth factor 23 in healthy paediatric population
- Algorithm of rational approach to reconstruction in Fournier’s disease
- A meta-analysis of exosome in the treatment of spinal cord injury
- Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
- Dexmedetomidine may decrease the bupivacaine toxicity to heart
- Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
- Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
- External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
- miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
- HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
- Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
- Cell population data in identifying active tuberculosis and community-acquired pneumonia
- Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
- Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
- 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
- Association of gene polymorphisms with women urinary incontinence
- Influence of COVID-19 pandemic on stress levels of urologic patients
- miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
- miR-519d downregulates LEP expression to inhibit preeclampsia development
- Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
- Fluorescent light energy modulates healing in skin grafted mouse model
- Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
- Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
- Severe postoperative hyperbilirubinemia in congenital heart disease
- Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
- Clinical factors predicting ureteral stent failure in patients with external ureteral compression
- Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
- Triple-Endobutton and clavicular hook: A propensity score matching analysis
- Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
- Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
- miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
- Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
- The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
- Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
- No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
- circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
- Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
- Educational program for orthopedic surgeons’ influences for osteoporosis
- Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
- GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
- lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
- Anticoagulation is the answer in treating noncritical COVID-19 patients
- Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
- Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
- VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
- Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
- Treatment of osteoporosis with teriparatide: The Slovenian experience
- New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
- Superenhancer–transcription factor regulatory network in malignant tumors
- β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
- Clinical features of atypical tuberculosis mimicking bacterial pneumonia
- Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
- Effect of electromagnetic field on abortion: A systematic review and meta-analysis
- miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
- MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
- Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
- miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
- Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
- MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
- Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
- circATP2A2 promotes osteosarcoma progression by upregulating MYH9
- Prognostic role of oxytocin receptor in colon adenocarcinoma
- Review Articles
- The function of non-coding RNAs in idiopathic pulmonary fibrosis
- Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
- Role of cesarean section in the development of neonatal gut microbiota: A systematic review
- Small cell lung cancer transformation during antitumor therapies: A systematic review
- Research progress of gut microbiota and frailty syndrome
- Recommendations for outpatient activity in COVID-19 pandemic
- Rapid Communication
- Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
- Use of microspheres in embolization for unruptured renal angiomyolipomas
- COVID-19 cases with delayed absorption of lung lesion
- A triple combination of treatments on moderate COVID-19
- Social networks and eating disorders during the Covid-19 pandemic
- Letter
- COVID-19, WHO guidelines, pedagogy, and respite
- Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
- COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
- What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
- Case Report
- Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
- CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
- Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
- Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
- Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
- Pulmonary parenchymal involvement caused by Tropheryma whipplei
- Mediastinal mixed germ cell tumor: A case report and literature review
- Ovarian female adnexal tumor of probable Wolffian origin – Case report
- Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
- Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
- Primary orbital ganglioneuroblastoma: A case report
- Primary aortic intimal sarcoma masquerading as intramural hematoma
- Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
- Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
- Chondroblastoma of mandibular condyle: Case report and literature review
- Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
- Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
- Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
- High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
- Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
- Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
- Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
- Retraction
- Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
- Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
- An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
- Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
