Clinical outcomes of percutaneous radiofrequency ablation for small renal cancer

Partial nephrectomy is the treatment of choice for small renal cell carcinoma (RCC) from the perspective of cancer management and renal function. However, when patients with RCC are of advanced age, exhibit severe comorbidities, including cardiovascular and pulmonary diseases, or have hereditary RCC, ablative therapies, including radiofrequency ablation (RFA) and cryoablation are useful treatment options. In the present study, the clinical outcomes of percutaneous RFA for treating small RCC were evaluated. Between December 2005 and March 2015, 40 patients (41 renal tumors in total) underwent RFA and a total of 50 sessions of RFA were performed. The average tumor size was 2.5 cm. A total of 18 tumors were exophytic and 23 were parenchymal. Of the 41 tumors, 85.4% were completely ablated by initial RFA and the rate of complete ablation following reablation for residual viable lesions was 95.1%. Local recurrence-free survival following complete ablation was 84.2% at 3 years. A patient with a 4.7 cm RCC tumor rapidly progressed following four RFA treatments until complete ablation was achieved. The metastasis-free survival rate following initial RFA was 95.7% at 3 years. The RCC-specific survival was 100% (mean follow-up, 38 months). Adverse events occurred in five sessions (10%); however, only 1 patient with arteriovenous fistula required intervention (transarterial embolization). The mean hospital stay following RFA was 3.2 days. The mean decrease in estimated glomerular filtration rate following RFA was 2.7%. The results of the present study indicate that percutaneous RFA was an effective treatment for small RCCs with respect to management of cancer, minimal invasiveness and minimal loss of renal function, particularly in patients for whom surgery would be a high risk and those at increased risk of deterioration of renal function.

Epitope analysis of Japanese cedar pollen allergen Cry j2 with a human IgM class monoclonal antibody 404-117

Japanese cedar pollen allergen Cry j2 is a causal allergen of seasonal pollinosis in Japan. To analyze B cell epitopes of Cry j2, we established two human-mouse hybridomas secreting IgM class human monoclonal antibodies to Cry j2. A pin-peptide enzyme-linked immunosorbent assay with synthesized icosa peptides showed that 404-117 monoclonal antibody bound to peptides #11-13 with cry j2 amino acid sequence of 101F-L140. Detailed analysis with octa peptides and alanine substituted peptides indicated that an amino acid sequence of 118FKVD121 was an essential for antibody binding. When K119 (Asn) was substituted with alanine, 404-117 monoclonal antibody did not bind to the alanine substituted peptide. We concluded that the 118FKVD121 sequence might have a very important role in early recognition by Cry j2-specific B cells, which could act as antigen presenting cells.

Synchronous neuroendocrine tumors in both the pancreas and ileum: A case report

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This is the first case of synchronous pancreatic and ileal NET in a non-MEN 1 patient.

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Both morphologic and immunophenotypic findings were different.

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The synchronous occurrence of these tumors may be considered as a chance occurrence.

Introduction

Although it is well-known that in multiple endocrine neoplasia type 1 (MEN 1) disease, multiple endocrine lesions frequently occur, synchronous or metachronous neuroendocrine tumors (NETs) in non-MEN 1 patients are extremely rare.

Presentation of case

An asymptomatic 72-year-old woman with an ileal NET was referred to our hospital. Abdominal computed tomography revealed another circular tumor within the pancreatic head. She was classified as a non-MEN 1 patient. An operative procedure was performed with a preoperative diagnosis of synchronous NET, which was confirmed by pathological examination.

Discussion

Both morphologic and immunophenotypic findings were different between in the ileum and pancreas. Therefore, it was reasonable to consider that both tumors were primary tumors. The synchronous occurrence of these tumors is unusual, and it may be considered as a chance occurrence.

Conclusion

We here report the first case of synchronous pancreatic NET and ileal NET in a non-MEN 1 patient.

A pilot study of photoacoustic imaging system for improved real-time visualization of neurovascular bundle during radical prostatectomy

BACKGROUND

Photoacoustic imaging, a noninvasive imaging based on optical excitation and ultrasonic detection, enables one to visualize the distribution of hemoglobin and acquire a map of microvessels without using contrast agents. We examined whether it helps visualize periprostatic microvessels and improves visualization of the neurovascular bundle.

METHODS

We developed a photoacoustic imaging (PAI) system with a hand-held probe combining optical illumination and a conventional linear array ultrasound probe. In experiments with a phantom model, it was able to visualize vessels with diameters as small as 300 μm within a depth of 10 mm. We also developed a TRUS type probe for our photoacoustic imaging system and used it to intraoperatively monitor periprostatic tissues in seven patients with clinically organ-confined prostate cancer who were undergoing non-nerve-sparing retropubic radical prostatectomy. Images of periprostatic tissues from resected prostatectomy specimens were also obtained using the linear photoacoustic probe, and the consistency of the microvessel distribution and co-existence of nerve fibers was examined by double immunostaining of paraffin-embedded sections with anti-CD31 and anti-S-100 antibodies.

RESULTS

Intraoperative monitoring of periprostatic tissues with the TRUS photoacoustic probe showed substantial signals on the posterolateral surface of the prostate and clearly demonstrated the location and extent of the neurovascular bundle better than does TRUS alone. Photoacoustic images of the periprostatic tissues in resected specimens also showed substantial signals that were especially strong on the posterolateral surface of the prostate. Nerve fibers were closely co-localized with periprostatic microvessels and the pattern of their distribution was consistent with that of PAI signals.

CONCLUSIONS

The intraoperative photoacoustic imaging located the microvascular complex in the neurovascular bundle. Moreover, the neurovascular bundle was easier to identify by PAI than by TRUS alone, suggesting that PAI could be helpful in nerve-sparing radical prostatectomy.

Transarterial embolization for pediatric hepatocellular carcinoma with cardiac cirrhosis

We describe the case of a 15-year-old boy with a history of Fontan operation and multiple intrahepatic tumors. Computed tomography showed multiple hepatic nodules with arterial enhancement. Because hepatocellular carcinoma (HCC) was not detected on biopsies and tumor markers were normal, progress was monitored on imaging. One hepatic tumor increased greatly in size during follow up. At 15 years of age, tumor markers rose rapidly, and he had upper abdominal swelling. Therefore, transarterial embolization (TAE) was performed for the largest tumor, suspected to be a HCC due to cardiac cirrhosis. This tumor had not increased at follow up 4 months later. The patient died from hepatic failure at the age of 17 years, and HCC was diagnosed at autopsy. Although pediatric HCC is rare, its incidence is likely to increase. TAE, with or without anticancer agents, is a therapeutic option for unresectable pediatric HCC, as it is for adult HCC.

Magnetic resonance enterocolonography in detecting erosion and redness in intestinal mucosa of patients with Crohn's disease

BACKGROUND AND AIM

In Crohn's disease (CD), assessment of disease activity and extension is important for clinical management. Endoscopy is the most reliable tool for evaluating disease activity in these patients and it distinguishes between lesions based on ulcer, erosion, and redness. Magnetic resonance imaging (MRI) is less invasive than endoscopy; however, the sensitivity of MRI in detecting lesions is believed to be lower, and whether MRI can detect milder lesions has not been studied. The aim of this study was to compare the detection ability of magnetic resonance enterocolonography (MREC) with ileocolonic endoscopy in patients with CD.

METHODS

A total of 27 patients with CD underwent both MREC and ileocolonoscopy. There were 55 lesions (18 ileum and 37 colon) endoscopically detected, and the findings of MREC were compared with each ileocolonoscopic finding to determine sensitivity and specificity.

RESULTS

For a positive lesion defined as having at least one of the following: wall thickness, edema, diffusion-weighted imaging (DWI) high intensity and relative contrast enhancement (RCE) on MREC, the sensitivities were 100% for ulcer, 84.6% for erosion, and 52.9% for redness, suggesting an ability to detect milder lesions such as erosion or redness. Moreover, RCE values were well correlated with the severity of endoscopically identified active lesions.

CONCLUSION

MREC findings may be useful not only for evaluation of ulcers, but also for detection of endoscopically identified milder lesions in CD, suggesting a clinical usefulness of MREC for disease detection and monitoring.

Time course of osteonecrosis in rabbit articular intercalated bone: line scan spectroscopic imaging and correlation with histology

PURPOSE

Magnetic resonance (MR) imaging offers the highest sensitivity for detecting bone necrosis. We evaluated osteonecrosis in rabbit models by calculating the percentage of fat to (fat + water) [F/(F+W)] on MR spectroscopy (MRS) and compared MR spectroscopy and imaging findings with corresponding histological results.

METHODS

To model the natural course of articular osteonecrosis, we removed the fourth tarsal bone in 45 rabbits, froze it for 5 min in liquid nitrogen to produce complete cellular necrosis, and then replaced the bone into the knee joint. We performed Carr-Purcell-Meiboom-Gill proton spectroscopic imaging to assess necrotic bone at 3 days and one, 2, 3, 4, 8, 12, 16, and 20 weeks after osteonecrosis and calculated the percentage of F/(F+W) of each bone. We also performed conventional T1- and T2-weighted imaging and compared all data to histological findings to analyze the natural course of necrosis.

RESULTS

T1-weighted MR imaging demonstrated obvious low signal intensity at 2 to 8 weeks and recovery at 12 to 20 weeks, whereas T2-weighted imaging demonstrated inconsistent intensities throughout the period. The postoperative percentage of F/(F+W) measured using line scan MRS decreased to 8.88% at 3 weeks, 6.22% at 8 weeks, and 34.40% at 20 weeks results that were mostly consistent with MR imaging findings. Histological findings demonstrated complete absence of osteocyte nuclei and loss of osteoid-osteogenesis at 3 to 8 weeks. Recovery of bone marrow was identified as an increase in the area of fat after 12 weeks.

CONCLUSION

Osteonecrosis delineated by T1-weighted MR imaging demonstrated fat content in the bone marrow that correlated with histology. The present MRS modality can be used to calculate the percentage of F/(F+W) of osteonecrosis to enable objective assessment of recovery and quantification of osteonecrosis to provide a numerical value for osteonecrosis.

Mac1 Positive Cells Are Required for Enhancement of Splenocytes Proliferation Caused by Bisphenol A

We examined the effects of bisphenol A (BPA) on immune cells and it was shown that BPA upregulated the proliferation of murine splenocytes stimulated with Concanavalin A (ConA). The upregulating effects of BPA were removed with depleting Mac1+ cells from the splenocytes. This study provides evidence for the first time that Mac1+ cells were required for enhancement of splenocytes proliferation caused by bisphenol A.

Orally Administered Bisphenol A Disturbed Antigen Specific Immunoresponses in the Naïve Condition

Bisphenol A [2,2-bis(4-hydoxyphenyl)propane; BPA] is an endocrine disrupter widely used in polycarbonate plastics and epoxy resins. We investigated the effects of orally administered BPA on antigen-specific responses of the naïve immune system.BPA was orally administered to T cell receptor transgenic mice, and the antigen-specific responses of immune cells were investigated. Administered BPA moderately reduced interleukin (IL)-2, 4, and interferon (IFN)-gamma secretion and increases in IgA and IgG2a production.Additionally, it was found that orally administered BPA increased antigen-specific IFN-gamma production of T cells and modified whole antigen presenting cells (APCs) to suppress antigen-specific cytokine production from T cells. These findings suggest that BPA can augment the Th1-type responses of naïve immune systems, though the bioavailability of orally administered BPA was low in our experiments.

[The diagnostic value of pre-biopsy magnetic resonance imaging for precise detection of clinically localized prostate cancer compared to post-biopsy setting]

A total of 136 patients who underwent radical prostatectomy following histological diagnosis of prostate cancer by transrectal biopsy and 3-Tesla magnetic resonance imaging (MRI) were evaluated. MRI was performed on 26 patients before prostate biopsy (pre-biopsy group) and on 110 patients after prostate biopsy (post-biopsy group). We defined the largest tumor focus in a radical prostatectomy specimen as the index cancer. We compared the accuracy of MRI in detecting and localizing the index cancer in the groups. The sensitivity of detecting the index cancer by MRI was significantly (p = 0.012) higher in the pre-biopsy group (96.2%) than in the post-biopsy group (77. 3%). The negative predictive value of extracapsular invasion was 84.6% in the pre-biopsy group and 80.7% in the post-biopsy group. The average interval between biopsy and MRI was 42.8 days. Artifacts due to post-biopsy hemorrhage were observed in 32 (29.1%) of the patients in the post-biopsy group. The sensitivity of detecting the index cancer by MRI was significantly (p = 0.022) higher in 78 patients without artifacts due to hemorrhage (83.3%) than in the 32 patients with artifacts due to hemorrhage (62.5%). Even if MRI is delayed until after prostate biopsy,the artifact due to hemorrhage markedly interferes with the accuracy of MRI. Although pre-biopsy MRI is more accurate than post-biopsy MRI,there are some problems to be solved,such as cost effectiveness and the detectability of low-malignant and small cancers.

Diffusion kurtosis imaging study of prostate cancer: preliminary findings

PURPOSE

To evaluate the differences in parameters of diffusion kurtosis imaging (DKI) between prostate cancer, benign prostatic hyperplasia (BPH), and benign peripheral zone (PZ).

MATERIALS AND METHODS

Twenty-four foci of prostate cancer, 41 BPH nodules (14 stromal and 27 nonstromal hyperplasia), and 20 benign PZ from 20 patients who underwent radical prostatectomy were investigated. Diffusion-weighted imaging (DWI) was performed using 11 b-values (0-1500 s/mm(2) ). DKI model relates DWI signal decay to parameters that reflect non-Gaussian diffusion coefficient (D) and deviations from normal distribution (K). A mixed model analysis of variance and receiver operating characteristic (ROC) analyses were performed to assess the statistical significance of the metrics of DKI and apparent diffusion coefficient (ADC).

RESULTS

K was significantly higher in prostate cancer and stromal BPH than in benign PZ (1.19 ± 0.24 and 0.99 ± 0.28 versus 0.63 ± 0.23, P < 0.001 and P < 0.001, respectively). K showed a trend toward higher levels in prostate cancer than in stromal BPH (1.19 ± 0.24 versus 0.99 ± 0.28, P = 0.051). On the ROC analyses, a significant difference in area under the curve was not observed between K and ADC, however, K showed the highest sensitivity among three parameters.

CONCLUSION

DKI may contribute to the imaging diagnosis of prostate cancer, especially in the differential diagnosis of prostate cancer and BPH.

Superparamagnetic iron oxide-enhanced interstitial magnetic resonance lymphography to detect a sentinel lymph node in tongue cancer patients

CONCLUSION

This is the first report on human sentinel node (SN) detection by interstitial magnetic resonance (MR) lymphography with superparamagnetic iron oxide (SPIO) in tongue cancer patients who also underwent lymphoscintigraphy. Our results indicate that further studies are warranted, as this novel method may replace current scintigraphic techniques.

OBJECTIVES

To examine the feasibility of interstitial MR lymphography using SPIO for SN detection in the head and neck region.

METHODS

MR images were acquired sequentially at 10 min, 30 min, and 24 h after submucosally injecting 0.1 ml SPIO (ferucarbotran) around the tumor in three patients with tongue cancer without cervical lymph node metastasis (clinical T2N0M0).

RESULTS

The SNs were clearly visualized in the 10 min interstitial MR lymphography images and were completely concordant with those visualized by (99m)Tc-radiocolloid lymphoscintigraphy and a gamma probe in all cases. Iron incorporation into the SNs was confirmed by pathological examination.

Laparoscopic enucleation of macronodules in a patient with ACTH-independent macronodular adrenal hyperplasia 7 years after unilateral adrenalectomy: consideration of operative procedure

OBJECTIVES

We evaluated the technical feasibility and efficacy of laparoscopic enucleation of adrenal macronodules in a patient with ACTH-independent macronodular adrenal hyperplasia (AIMAH).

PATIENT AND METHODS

A 41-year-old female manifested Cushing's syndrome due to AIMAH in 1999 and underwent a right unilateral adrenalectomy in 2002. Although the patient's symptoms improved postoperatively, in 2005 they began to get worse as her urinary cortisol excretion increased. Computed tomography in 2008 showed four macronodules in the left adrenal gland, and we performed a laparoscopic enucleation of four adrenal nodules in hopes of avoiding the need for lifelong steroid replacement. In the operation we paid special attention to avoiding injuring major adrenal vessels. Nontumorous adrenal tissue was dissected just near the surfaces of the nodules by using a sealing system. The residual adrenal gland was at most left undissected from the surrounding tissues in order to preserve blood supply and preserve small drainage veins.

RESULTS

The operation could be performed with minimal blood loss. Plasma cortisol became measurable 22 months after the enucleation and returned to normal level 29 months after the enucleation.

CONCLUSIONS

The laparoscopic enucleation of hyperplastic nodules is technically feasible and a treatment of choice for AIMAH patients who already underwent unilateral adrenalectomy.

Importance of maintaining left gastric arterial flow at Appleby operation preserving whole stomach for central pancreatic cancer

The safety of whole stomach-preserving Appleby operation with resection of the left gastric artery (LGA) for pancreatic cancer cannot be assured. The anatomy of the celiac axis (CA) with special regard to the position of the origin of the LGA was examined. Using 3D images of the vascular architecture reconstructed from volume data of helical CT, the length of the CA and the position of the origin of the LGA from the CA were measured in 53 patients. Among 53 patients, 47 patients (89%) had classical anatomy of the CA branches. The mean length(2 standard deviation) of the CA and the distance from the root of the LGA to the bifurcation of the CA were 25.2mm (-4.9) (range 14.6-36.5) and 10.3mm (+4.5)(range 2.4-21.9), respectively. In 23 (45%) cases, the LGA arose farther than 10mm away from the bifurcation of the CA. Among six patients with anatomical variation of the arteries, two (4%) had the LGA directly arising from the aorta. Conservation of the LGA at modified Appleby operation would give complete cancer removal by en bloc resection of the nerve plexus, without risk of ischemic complications of the stomach and liver.

Epitope analysis of Japanese cedar pollen allergen Cry j1 with the human monoclonal antibody 4701-1

We obtained a stable human-mouse hybridoma clone 4701-1 secreting IgM class human monoclonal antibody to Japanese cedar pollen allergen Cry j1. A pin-peptide enzyme-linked immunosorbent assay (ELISA) with synthesized pentadeca peptides showed a peptide with an amino acid sequence of LYTVT NSDDD PVNPA was found to be positive. Detailed analysis with deca to tetra peptides indicated that an amino acid sequence of TVTN was an essential sequence for antibody binding. When N (Asn) was substituted with A (Ala) of the TVTN epitope, the resulting peptide did not have antibody binding ability. We concluded that the TVTN sequence might have a very important role in early recognition of Cry j1 allergen by Cry j1-specific B cells, which act as antigen presenting cells.

Stimulation of cell growth in the U-937 human myeloid cell line by honey royal jelly protein

Royal jelly was fractionated by ion-exchange chromatography and a protein (DIII protein) that had growth stimulating activity to the U-937 human myeloid cell line was obtained. The molecular weight of the DIII protein was 58 kDa on SDS-PAGE. The growth stimulating activity of the DIII protein was shown to be relatively heat and pH stable.