MRP-1/CD9 and KAI1/CD82 expression in normal and various cancer tissues

As part of our evaluation of MRP-1/CD9 and KAI1/CD82 as prognostic predictors among patients with cancer, we have extended our studies to solid tumors of a variety of anatomical sites. Normal tissues were included for comparison. Immunohistochemical techniques were used throughout. Our results indicate that MRP-1/CD9 was strongly expressed by many normal tissues, including the epithelium of the gastrointestinal tract, alveolar epithelium of the lung, urothelium and smooth muscle. Expression was weak in the pituitary gland, spleen and hepatocytes, and absent in testes and spinal cord. KAI1/CD82 was also expressed by many normal tissues, but was absent in some MRP-1/CD9-positive tissues (e.g., smooth muscle, adrenal cortex, urothelium, myelin of peripheral nerves, epithelium of amnion). On the other hand, KAI1/CD82 was strongly expressed in spinal cord gray matter, which was MRP-1/CD9-negative. Expression of these glycoproteins was detected in almost all types of tumors examined. In certain cancers, MRP-1/CD9 and KAI1/CD82 positivity was inversely related to lymph node involvement. Whereas lymph node metastases were present in 22.2% of lung cancer patients whose tumors were MRP-1/CD9 and KAI1/CD82-positive, 65.5% of patients with MRP-1/CD9 and KAI1/CD82-reduced/negative tumors had lymph node metastases. A similar inverse relationship was seen in colon cancer and breast cancer patients with respect to MRP-1/CD9 expression. The present data, together with our previous results suggest that evaluating the MRP1/CD9 and KAI1/CD82 status of cancers of the lung, breast and colon may provide useful information on the metastatic potential of the tumors.

Mixed-lineage-leukemia (MLL) fusion protein collaborates with Ras to induce acute leukemia through aberrant Hox expression and Raf activation

Mixed-lineage-leukemia (MLL) fusion oncogenes are closely involved in infant acute leukemia, which is frequently accompanied by mutations or overexpression of FMS-like receptor tyrosine kinase 3 (FLT3). Earlier studies have shown that MLL fusion proteins induced acute leukemia together with another mutation, such as an FLT3 mutant, in mouse models. However, little has hitherto been elucidated regarding the molecular mechanism of the cooperativity in leukemogenesis. Using murine model systems of the MLL-fusion-mediated leukemogenesis leading to oncogenic transformation in vitro and acute leukemia in vivo, this study characterized the molecular network in the cooperative leukemogenesis. This research revealed that MLL fusion proteins cooperated with activation of Ras in vivo, which was substitutable for Raf in vitro, synergistically, but not with activation of signal transducer and activator of transcription 5 (STAT5), to induce acute leukemia in vivo as well as oncogenic transformation in vitro. Furthermore, Hoxa9, one of the MLL-targeted critical molecules, and activation of Ras in vivo, which was replaceable with Raf in vitro, were identified as fundamental components sufficient for mimicking MLL-fusion-mediated leukemogenesis. These findings suggest that the molecular crosstalk between aberrant expression of Hox molecule(s) and activated Raf may have a key role in the MLL-fusion-mediated-leukemogenesis, and may thus help develop the novel molecularly targeted therapy against MLL-related leukemia.

Neuroendoscopically assisted cyst-cisternal shunting for a quadrigeminal arachnoid cyst causing typical trigeminal neuralgia

A quadrigeminal cistern arachnoid cyst is a very rare cause of typical trigeminal neuralgia. A 62-year-old woman presented with right facial pain of 8 years duration. Neuroradiological findings revealed a cystic mass in the quadrigeminal region that compressed the cerebellum downward and the brainstem anteriorly and was associated with hydrocephalus. She had neuroendoscopically-assisted cyst-cisternal shunting via a small craniotomy. Postoperatively, the trigeminal neuralgia disappeared. The origin of the trigeminal neuralgia may have either been a marked distortion of the pons that caused stretching of the trigeminal nerve and irregular demyelination within the root entry zone, or there was contact between the root entry zone and a vascular structure. Neuroendoscopy is useful for treating arachnoid cysts; however, in order to safely relieve symptoms, the procedure needs to be appropriately adapted depending on the pathogenesis. In this paper, we review the literature and discuss the pathophysiology and treatment of our case.

EC-IC bypass using the distal stump of the superficial temporal artery as an additional collateral source of blood flow in patients with Moyamoya disease

BACKGROUND

To establish multiple bypass flow in an adult Moyamoya disease patient, the distal stump of the parietal superficial temporal artery (dsPSTA) was used as an additional donor.

METHODS

Its potential as the donor was first evaluated by measuring the arterial pressure directly in three patients, revealing about 80% in mean arterial pressure of those measured at the proximal stump and radial artery. The anastomosis was performed just as conventionally except an additional anastomosis between the dsPSTA and frontal branch of the middle cerebral artery in 10 hemispheres of 7 patients.

RESULTS

The patency of the dsPSTA bypass was confirmed on postoperative angiography in 5 patients. The comparison of pre- and post-operative single photon emission computed tomography was feasible in 8 hemispheres of 6 patients of which 7 demonstrated improvement of the cerebral blood flow. CONCLUSION; This technique provides a novel source of donor artery in the treatment of Moyamoya disease, in which multiple anastomoses are desirable.

Randomised study of adjuvant chemotherapy for completely resected p-stage I-IIIA non-small cell lung cancer

We evaluated the therapeutic usefulness of adjuvant chemotherapy in patients with completely resected non-small cell lung cancer (NSCLC). We also examined the relation between DNA ploidy pattern and the response to chemotherapy. A total of 267 patients with NSCLC (pathologically documented stage I, II, or IIIA) underwent complete resection, and DNA ploidy pattern was analysed. Patients with stage I disease (n=172) were randomly assigned to receive surgery alone (group A) or surgery followed by adjuvant chemotherapy (UFT (oral anti-cancer drug, a combination of Uracil and Tegaful) 400 mg day-1 for 1 year after surgery; group B). Stage II or IIIA disease patients (n=95) were randomly assigned to surgery alone (group C) or surgery followed by chemotherapy (two 28-day courses of cisplatin 80 mg m-2 on day 1 plus vindesine 3 mg m-2 on days 1 and 8, followed by UFT 400 mg day-1 for at least 1 year; group D). Eight-year overall survival rate in patients with stage I disease was 74.2% (95% confidence interval (CI): 64.4-84.0%) in group B and 57.6% (95% CI: 46.4-68.8%) in group A (P=0.045 by log-rank test). In patients with stage II and IIIA disease, no difference was found between groups C and D. Analysis according to DNA ploidy pattern revealed no difference between the groups. Postoperative chemotherapy with UFT was suggested to be useful in patients with completely resected stage I NSCLC. No difference was seen in relation to DNA pattern in any treatment group.

Weekly paclitaxel in Japanese women with metastatic or advanced breast cancer

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Background: Weekly administration of paclitaxel (WP) has been reported to be at least as well-tolerated and effective as conventional tri-weekly treatment (TP). The present study was to evaluate the efficacy and safety of weekly paclitaxel treatment for japanese women with metastatic or advanced breast cancer. Methods: Eligibility criteria included < 75 years of age, histologically-proven advanced or recurrent breast cancer, and performance status (PS) of 0 to 2. Patients were scheduled to receive at least one course of paclitaxel 100 mg/m2/week for 6 consecutive weeks followed by 1 week off. The present WP results were compared with the previous TP data generated by the same trial group in Japan. In the TP group, paclitaxel 210 mg/m2 was given every 3 weeks up to 3 cycles or more until tumor progression or severe toxicity was observed. Results: From December 2002 to July 2005, 69 patients were enrolled into the study of WP and 68 were eligible for evaluation. All were previously treated, and 51 of 69 patients (73.9%) had received anthracyclines prior to this study. The median age was 55 years (range 27–74), and 66 patients (95.7%) had PS of 0–1. Sixty nine patients have been analyzed for efficacy and toxicity by the evaluation committee. The median dose intensity was 81.25 mg/m2 per week. In total, 270 courses of WP were administered (median 3 courses; range 1–13). Three patients entered into complete remission (CR) and 28 achieved partial response (PR) by the WHO response criteria with a response rate (RR) of 44.9%, which is similar to RR in the historical TP group (RR of 33.9% in 62 Patients). Median duration of response was 238 days (range 91–631). Time to progression was 193 days. It is of note that grade 3–4 neutropenia was observed less frequently in WP as compared with TP (37.7 vs. 93.3%). Other major toxicities including peripheral neuropathy (PNP) appear to be similar between the two regimens through all toxicity grades of PNP (WP and TP group; 89.9% and 93.3%, respectively). Conclusion: WP appears to have similar or better efficacy with better toxicity profile as TP in patients with metastatic or advanced breast cancer.

No significant financial relationships to disclose.

Diagnostic strategy based on preoperative serum CEA levels in clinical stage IA NSCLC

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Background: Following surgery, clinical stage IA NSCLC diagnosed using non-interventional examinations is occasionally pathological stage III or IV. The level of carcinoembryonic antigen (CEA) in serum has been reported to be a predictor of up-staging to advanced stages, however, there are few multi-center studies of serum CEA that utilized a short accrual period. Methods: A multi-center retrospective study was performed to assess serum CEA level as a predictor of advanced stage in 862 consecutive patients with clinical stage IA NSCLC from 2002 to 2004. The subjects were 493 males with a mean age of 65.2 years old, 460 of whom were smokers, who had a total of 689 adenocarcinomas with a mean tumor size of 19.5 cm. They were divided into 4 groups by smoking status and adenocarcinoma histology, after which AUC was calculated using an ROC curve, which provided an estimate of the probability efficiency of pathological diagnosis of stage III or stage IV. When AUC was greater than 0.7, sensitivity, specificity, and positive predictive values were calculated, and multivariate Cox regression analysis was performed to confirm independence. Results: There were 72 cases (8.1%) in an advanced stage. AUC was greater than 0.7 in the group of non-smokers with an adenocarcinoma (n = 413), in which the sensitivity, specificity, and positive predictive values were 0.14, 0.97, and 0.64, respectively, with a CEA cut-off level of 20 ng/ml. Thus, serum CEA level was shown to be an independent predictive factor. Conclusions: In smokers with an adenocarcinoma, a high level of CEA in serum was frequently found in those with pathologically advanced disease, thus intervention should be mandated in such cases.

[Table: see text]

No significant financial relationships to disclose.

Endoscope Assisted Removal of Jugular Foramen Schwannoma; Report of 3 Cases

Removal of the intraforaminal portion of a jugular foramen schwannoma under direct vision requires resection of the adjacent bone. Extensive resection of the bone around the jugular foramen, however, involves a potential danger for cerebrospinal fluid (CSF) leakage and for damage to the adjacent cranial nerves as well as venous outflow. To avoid such bone resection, we applied the endoscope during the removal of a jugular foramen schwannoma through the lateral suboccipital approach. Three patients with schwannomas in the jugular foramen were treated using the lateral suboccipital approach with endoscopic assistance. After the intracranial portion was first removed under the microscope, the residual tumor in the jugular foramen was subsequently removed under the side-viewing endoscope. In all cases the tumor was removed successfully without major complications. The authors conclude that if the cases are selected properly, removal of the schwannoma extending into the jugular foramen is feasible through the conventional lateral suboccipital window under endoscopic assistance.

Applicability of anti-neovascular therapy to drug-resistant tumor: Suppression of drug-resistant P388 tumor growth with neovessel-targeted liposomal adriamycin

Anti-neovascular therapy, one of the effective anti-angiogenic chemotherapy, damages new blood vessels by cytotoxic agents delivered to angiogenic endothelial cells and results in indirect eradication of tumor cells. We previously reported that liposomes-modified with a pentapeptide, Ala-Pro-Arg-Pro-Gly (APRPG-Lip) homing to angiogenic site, highly accumulated in tumor tissue, and APRPG-Lip encapsulating adriamycin (APRPG-LipADM) effectively suppressed tumor growth in tumor-bearing mice. In the present study, we examined the topological distribution of fluorescence-labeled APRPG-LipADM as well as TUNEL-stained cells in an actual tumor specimen obtained from Colon 26 NL-17 carcinoma-bearing mice. The fluorescence-labeled APRPG-Lip dominantly localized to vessel-like structure: a part of which was also stained with anti-CD31 antibody. Furthermore, TUNEL-stained cells were co-localized to the same structure. These data indicated that APRPG-LipADM bound to angiogenic endothelial cells and induced apoptosis of them. We also investigated the applicability of anti-neovascular therapy using APRPG-LipADM to ADM-resistant P388 solid tumor. As a result, APRPG-LipADM significantly suppressed tumor growth in mice bearing the ADM-resistant tumor. These data suggest that APRPG-LipADM is applicable to various kinds of tumor including drug-resistant tumor since it targets angiogenic endothelial cells instead of tumor cells, and eradicates tumor cells through damaging the neovessels.

A Neuroendoscopic Approach to the Aqueduct via the Fourth Ventricle Combined with Suboccipital Craniectomy

OBJECTIVES

We have tried to approach the aqueduct less invasively with the endoscope in combination with a small suboccipital craniectomy, especially for lesions of the aqueduct close to the fourth ventricle.

METHODS

The patient is placed in the prone position and a small suboccipital craniectomy is performed. After elevating the bilateral tonsils with retractors, the sheath of the endoscope is inserted from a small skin incision made on the posterior midline of the neck, far from the craniectomy site. The skin incision for endoscopic insertion is planned on the linear extension connecting the aqueduct and the foramen of Magendi on the craniocervical MRI. A rigid endoscope is inserted through the fourth ventricle to the aqueduct for exploration and surgical manipulation.

RESULTS

Two cases with hydrocephalus due to aqueductal stenosis, with gait disturbance were operated. After exploration of the aqueduct via the fourth ventricle, endoscopic aqueductal plasty was performed. The postoperative courses were uneventful. The patients' symptoms disappeared.

CONCLUSIONS

This approach can be applied for less invasive endoscopic exploration and surgery around the aqueduct close to the fourth ventricle with a rigid endoscope, without overflexion of the neck, or a large craniectomy, or overretraction of the tonsils, or incision of the inferior vermis.

[Multimodality therapy for diffuse malignant pleural mesothelioma]

Despite the rising incidence of diffuse malignant pleural mesothelioma (MPM), there is still no standard treatment for this disease, and the prognosis for patients remains poor. Recently, long-term survival has been reported when multimodality therapy is used, combining extrapleural pneumonectomy with perioperative chemotherapy and/or radiotherapy in highly selected patients. We report a case of a patient who presented with MPM, accompanied by a large malignant pleural effusion and pneumothorax, who was successfully treated with combination therapy. After being diagnosed with epithelial type MPM using thoracoscopic surgery, the patient underwent extrapleural pneumonectomy. Examination of the surgical specimen revealed invasion of the chest wall muscle and fat, as well as several positive mediastinal lymph nodes. The patient received 2 courses of postoperative chemotherapy using cisplatin and gemcitabine. He is currently alive and has been disease-free for 2 years.

Clinical significance of transmembrane 4 superfamily in colon cancer

Cell motility is an important cellular function closely related to the processes of tumour progression and metastasis. Several members of transmembrane 4 superfamily (TM4SF) have been reported to be associated with cell motility and metastatic potential of solid tumour. The aim of this study is to clarify the clinical significance of the member of TM4SF (MRP-1/CD9, KAI1/CD82 and CD151) in human colon cancer. We studied 146 colon cancer patients who underwent curative surgery and studied the expression of MRP-1/CD9, KAI1/CD82 and CD151 using reverse transcriptase - polymerase chain reaction and immunohistochemistry. We found that 64 patients (43.8%) had MRP-1/CD9-positive tumours and that the overall survival rate of patients with MRP-1/CD9-positive tumours was much higher than that of patients with MRP-1/CD9-negative tumours (89.8 vs 50.8%, P<0.001). In contrast, 63 patients (43.2%) had KAI1/CD82-positive tumours and the overall survival rate of patients with KAI1/CD82-positive tumours was also higher than that of patients with KAI1/CD82-negative tumours (84.8 vs 54.9%, P=0.002). On the other hand, positive CD151 expression had a bad effect on the overall survival rate of patients with colon cancer (61.2 vs 74.9%, P=0.022). In a multivariate analysis, MRP-1/CD9 status was a good indicator of the overall survival (P=0.007). We have shown that the reduction of MRP-1/CD9 and KAI1/CD82 expression, and the increasing CD151 expression are indicators for a poor prognosis in patients with colon cancer. This is a first report describing about the relation between CD151 and colon cancer.

[Surgically treated mucoepidermoid carcinoma in a 6-year-old boy; report of a case]

A 6-year-old boy was admitted to our hospital with a history of recurrent obstructive pneumonia and hemoptysis. A chest computed tomography (CT) showed atelectasis in the left lower lobe. Angiograpy, which was performed for the suspicion of pulmonary sequestration, showed no feeding artery and revealed bleeding from the bronchial artery in the left lower lobe. As hemoptysis would not stop, an emergency left lower lobectomy was performed. Macroscopic examination of the resected specimen revealed a mass measuring 20 x 15 x 17 mm in the S8 proximal lung parenchyma, bronchiectasis, and an abscess in the distal lung parenchyma. Histopathologic examination determined the tumor was a mucoepidermoid carcinoma. Immunohistochemical staining revealed some tumor cells were positive for CA 19-9. The child has not had a recurrence 3 years postoperatively.

Treatment of oligoasthenozoospermia with tranilast, a mast cell blocker, after long-term administration

The authors retrospectively examined whether long-term administration of tranilast improves semen parameters in severe oligoasthenozoospermia. Fifty-two patients presenting with sperm concentration of less than 10 x 10(6) sperm/mL were enrolled. Subjects were partitioned into 3 groups as follows: patients displaying an atrophic testis with elevated (FSH) (group 1), patients exhibiting normal testicular volume with elevated FSH (group 2), and patients with normal testicular volume and normal FSH levels (group 3). Tranilast (300mg/day) was administered until pregnancy was achieved or for a period of up to 12 months. Sperm concentration was significantly increased at 3 months in 16 subjects (44%) in groups 1 and 3. In group 2, sperm concentration was increased at 12 months (5 of 16 subjects; 31%). Total sperm count was obviously elevated at 3 months in groups 1 and 2, and at 6 months in group 3. Six pregnancies were achieved via natural intercourse. Tranilast, a mast cell blocker, demonstrates a certain clinical benefit in terms of improvement of semen parameters involving severe oligoasthenozoospermia, but it does not appear to afford clinical benefit in long-term administration.

[Long-term outcome after extracorporeal shock wave lithotripsy for gallstones]

We retrospectively reviewed 289 cases followed for a long time after extracorporeal shock wave lithotripy (ESWL) for gallstones. Follow-up periods ranged from 0.5 years to 9.2 years, with a median of 4.1 years. The complete resolution rate was 45.6%. A solitary gallstone, non-calcified gallstones on CT, and Tsuchiya's sonographic type Ia and Ib gallstones were found to be statistically significant variable for resolution of the disease. With a maximum follow-up period of 9 years, the cumulative recurrence rate was 30.7%. Among the 156 patients whose gallstones did not resolve, 70 were symptomatic and the other 86 were asymptomatic. Thirty-eight of the symptomatic patients (54.3%) became symptom-free, while 23 asymptomatic patients (29.1%) became symptomatic. The cumulative rate of occurrence of colic attacks and/or acute cholecystitis was significantly higher in the cases with lithotripsy fragments 4 mm or more in size than in the cases wih fragments 3 mm or less in size (51.8% vs. 16.7%; p < 0.05). ESWL was followed by surgery in 23.1% because symptoms developed or became aggravated after ESWL in 58.3% of them. Gallbladder cancer was discovered in one case. Patients undergoing ESWL should be followed by focusing on postoperative recurrence, symptoms, and gallbladder cancer.