Pulmonary pleomorphic carcinoma producing hCG

An 80-year-old woman with a pleomorphic carcinoma (PC) producing hCG was admitted to Nippon Steel Hirohata Hospital because of an abnormal shadow on CT seen during a follow-up examination after surgery for breast cancer. A right upper lobectomy was performed due to rapid growth of the shadow 3 months later. Macroscopically the tumor was a 4.8 x 4.0 cm well-circumscribed grayish-white mass. On histology the tumor consisted mostly of intermingled spindle and polygonal cells, while evidence of poorly differentiated adenocarcinoma was seen in a few areas. A diagnosis of PC was made due to hCG expression in approximately 20% of the spindle and polygonal cells on immunohistology. Six months after the operation metastasis to the liver and adrenal gland was seen on CT. The patient died due to metastases 1 year after the operation, even though the patient had been at stage 1B at the time of the operation and appropriate chemotherapy had been given. PC patients with immunohistochemical hCG expression have elevated risk of local recurrence and metastasis.

Poorly differentiated adenocarcinoma with signet-ring cell carcinoma in a hyperplastic polyp of the stomach: report of a case

Hyperplastic polyps (HPs) of the stomach have been reported to be mostly benign. However, in rare cases, carcinomas have been found in HPs. We treated a 59-year-old Japanese male who underwent a total gastrectomy, and a gross examination of the resected stomach revealed a 4.8 x 3.8-cm polyp on the greater curvature of the antrum and multiple small polyps in the whole gastric mucosa. Histologically, the large polyp consisted mainly of hyperplastic foveolar epithelium, while the presence of variously colored lobules demonstrated a poorly differentiated adenocarcinoma mixed with signet-ring cell carcinoma. Hyperplastic polyps should therefore be carefully examined microscopically as a polypectomy specimen and in resected stomach specimens.

An experimental comparison of flat-panel detector performance for direct and indirect systems (initial experiences and physical evaluation)

The purpose of this work was to compare direct and indirect detectors in terms of their system linearity, presampled modulation transfer function (MTF), Wiener spectrum (WS), noise equivalent quanta (NEQ), and power spectrum. Measurements were made on two flat-panel detectors, GE Revolution XR/d (indirect) and Shimadzu Safire (direct) radiographic techniques. The system linearity of the systems was measured using a time-scale method. The MTF of the systems was measured using an edge method. The WS of the systems was determined for a variable range of exposure levels by two-dimensional Fourier analysis. The NEQ was assessed from the measured MTF, WS, and estimated ideal signal-to-noise ratios. Power spectrum analyzed the chest phantom within artificial lesions. System linearity was excellent for the direct systems. For the direct system, the MTF was found to be significantly higher than that for the indirect systems. For the direct system, the WS was relatively uniform across all frequencies. In comparison, the indirect system exhibited a drop in the WS at high frequencies. At lower frequencies, the NEQ for the indirect system was noticeably higher than for the direct system. Power spectrum for the direct system was relatively flat and similar to that for white noise. The indirect system exhibited significant reduction at high spatial frequencies. In general, the direct systems exhibit improved image quality over indirect systems at comparable exposure dose.

Elevation of the post-translational modification of proteins by O-linked N-acetylglucosamine leads to deterioration of the glucose-stimulated insulin secretion in the pancreas of diabetic Goto-Kakizaki rats

Many nuclear and cytoplasmic proteins are O-glycosylated on serine or threonine residues with the monosaccharide beta-N-acetylglucosamine, which is then termed O-linked N-acetylglucosamine (O-GlcNAc). It has been shown that abnormal O-GlcNAc modification (O-GlcNAcylation) of proteins is one of the causes of insulin resistance and diabetic complications. In this study, in order to examine the relationship between O-GlcNAcylation of proteins and glucose-stimulated insulin secretion in noninsulin-dependent type (type 2) diabetes, we investigated the level of O-GlcNAcylation of proteins, especially that of PDX-1, and the expression of O-GlcNAc transferase in Goto-Kakizaki (GK) rats, which are an animal model of type-2 diabetes. By immunoblot and immunohistochemical analyses, the expression of O-GlcNAc transferase protein and O-GlcNAc-modified proteins in whole pancreas and islets of Langerhans of 15-week-old diabetic GK rats and nondiabetic Wistar rats was examined. The expression of O-GlcNAc transferase at the protein level and O-GlcNAc transferase activity were increased significantly in the diabetic pancreas and islets. The diabetic pancreas and islets also showed an increase in total cellular O-GlcNAc-modified proteins. O-GlcNAcylation of PDX-1 was also increased. In the diabetic GK rats, significant increases in the immunoreactivities of both O-GlcNAc and O-GlcNAc transferase were observed. PUGNAc, an inhibitor of O-GlcNAcase, induced an elevation of O-GlcNAc level and a decrease of glucose-stimulated insulin secretion in isolated islets. These results indicate that elevation of the O-GlcNAcylation of proteins leads to deterioration of insulin secretion in the pancreas of diabetic GK rats, further providing evidence for the role of O-GlcNAc in the insulin secretion.

Pulmonary Lymphangiectasis in an Asymptomatic Adult

Pulmonary lymphangiectasis is a rare anomaly in infancy that is characterized by dilatation of pulmonary lymphatic vessels resulting in fetal respiratory distress. Pulmonary lymphangiectasis is considered to occur exclusively in young children and neonates, and very few survive beyond an early age. We herein present an asymptomatic adult case of localized pulmonary lymphangiectasis with multiple nodules. A 27-year-old asymptomatic female presented with multiple nodules on chest computed tomogram images. An exploratory video-assisted thoracoscopy revealed multiple yellowish cysts on the visceral pleura, which were histologically diagnosed as lymphangiectasis. In the present study, the pathogenesis and clinical characteristics are discussed.

Experimental comparison of flat-panel detector performance for direct and indirect systems

The purpose of this study was to compare direct and indirect detectors in terms of their presampled modulation transfer function (MTF), Wiener spectrum (WS), and noise-equivalent quanta (NEQ). Measurements were made on two flat-panel detectors, the GE Revolution XR/d (indirect) and Shimadzu Safire (direct) radiographic techniques. The presampled MTFs of the systems were measured using an edge method. The WS calculated the difference in uniform images that changed exposure to radiation using the two-dimensional Fourier method. The NEQ were assessed from the measured MTF, WS, and estimated signal-to-noise ratios (SNR). The system linearity was excellent in the direct Safire system. Presampled MTF was notably higher for the direct Safire system. For the direct Safire system, the WS was relatively uniform across all frequencies. In comparison, the indirect Revolution XR/d system exhibited a drop in the WS at high frequencies. At lower frequencies, the NEQ for the indirect Revolution XR/d system was noticeably higher than the direct Safire system. For the direct Safire system, the NEQ at mid to high spatial frequencies were higher linearity.

Two different transposable elements inserted in flavonoid 3',5'-hydroxylase gene contribute to pink flower coloration in Gentiana scabra

Pink-flowered gentian plants (Gentiana scabra) have been bred from spontaneous mutations of blue-flowered gentian plants, but the formation mechanism(s) is unknown so far. To investigate the process, two independent pink-flowered gentian plant lines were analyzed by a molecular biological approach. HPLC analysis showed that petals of the blue-flowered cultivar contained a small amount of cyanidin derivatives and major delphinidin derivatives, whereas pink petals had only a small amount of cyanidin derivatives. To find the causal factor(s) of this change, we focused on flavonoid 3',5'-hydroxylase (F3',5'H), which is a key enzyme for delphinidin biosynthesis in the flavonoid biosynthetic pathway. Molecular analyses confirmed that the loss of delphinidin synthesis could be attributed to the insertions of different transposable elements in the F3',5'H gene in each independent pink-flowered gentian plant. Sequence analysis showed that these transposable elements were classified into an hAT superfamily and terminal-repeat retrotransposon in miniature (TRIM), by which normal F3',5'H transcripts were interrupted. Southern blot analysis indicated that they belong to high copy number elements and are also found in a related gentian species (G. triflora). These results suggest that the transposable elements inserted in F3',5'H are the source of the mutations and may also play a substantial role in the genomic evolution of the genus Gentiana.

Responses of transformed root culture of Atropa belladonna to salicylic acid stress

The effect of salicylic acid (SA) on tropane alkaloid production and the responses to SA stress of transformed root cultures of Atropa belladonna (belladonna) were investigated. Treatment of A. belladonna transformed roots with 0.2 mM SA did not have any effect on tropane alkaloid production, but two compounds were produced in the medium. These were identified as the SA derivatives methylsalicylate and methyl-o-methoxybenzoate by high-resolution mass spectrometry and UV spectrometry. In contrast, treatment with 2 mM salicylic acid stimulated tropane alkaloid release from the transformed roots into the medium by up to 35% of the total alkaloids after 24 h, and the SA derivatives were not observed in the medium. These results revealed that transformed root of A. belladonna exhibits distinct by different responses to SA stress depending on the SA concentration.

Consistent transcriptional silencing of 35S-driven transgenes in gentian

In this study, no transgenic gentian (Gentiana triflora x Gentiana scabra) plants produced via Agrobacterium-mediated transformation exhibited transgene (GtMADS, gentian-derived MADS-box genes or sGFP, green fluorescent protein) expression in their leaf tissues, despite the use of constitutive Cauliflower mosaic virus (CaMV) 35S promoter. Strikingly, no expression of the selectable marker gene (bar) used for bialaphos selection was observed. To investigate the possible cause of this drastic transgene silencing, methylation-specific sequences were analysed by bisulfite genomic sequencing using tobacco transformants as a control. Highly methylated cytosine residues of CpG and CpWpG (W contains A or T) sites were distinctively detected in the promoter and 5' coding regions of the transgenes 35S-bar and 35S-GtMADS in all gentian lines analysed. These lines also exhibited various degrees of cytosine methylation in asymmetrical sequences. The methylation frequencies in the other transgene, nopaline synthase (NOS) promoter-driven nptII, and the endogenous GtMADS gene coding region, were much lower and were variable compared with those in the 35S promoter regions. Transgene methylation was observed in the bialaphos-selected transgenic calluses expressing the transgenes, and methylation sequences were distributed preferentially around the as-1 element in the 35S promoter. Calluses derived from leaf tissues of silenced transgenic gentian also exhibited transgene suppression, but expression was recovered by treatment with the methylation inhibitor 5-aza-2'-deoxycytidine (aza-dC). These results indicated that cytosine methylation occurs exclusively in the 35S promoter regions of the expressed transgenes during selection of gentian transformants, causing transcriptional gene silencing.

O-GlcNAc modification of nucleocytoplasmic proteins and diabetes

Nuclear and cytosolic proteins are glycosylated on serine or threonine residues by O-linked beta-N-acetylglucosamine (O-GlcNAc). O-GlcNAc modification is one of various posttranslational modifications and seems to be involved in the modulation of transcription and signal transduction. Accumulating data suggest a role for O-GlcNAc-modified proteins in diabetes, acting as a glucose sensor. It has been suggested that the hexosamine biosynthetic pathway is involved in the mechanism causing insulin resistance and diabetic complications. Excess glucose entering into the hexosamine biosynthetic pathway might cause elevated O-GlcNAc modification of various proteins. In this article, we review the current data regarding the relationship between O-GlcNAc modification and diabetes.

Analysis of head movements coupled with trunk drift in healthy subjects

Accelerometers were used to measure sequential head tilt and trunk drift in 14 healthy young subjects while they performed three kinds of head task. First, maximum inclination angles in anterior, posterior, right and left directions were measured to estimate cervical ranges of motion for flexion-extension and lateral bending. The inclination angles measured (61.2 degrees on average for flexion, 51.7 degrees for extension, 42.7 degrees for right bending and 43.9 degrees for left bending) were consistent with previous findings. Secondly, cross-correlation analysis was applied to evaluate the degree of functional coupling between the head and trunk during flexion-extension and lateral bending. Significantly higher correlation coefficients were found between head tilt and trunk drift when these movements were in the same (iso-) directional condition than in a different (allo-) directional condition. The coupled trunk drift in flexion-extension for the iso-directional condition (10.3 degrees on average) was much larger than for the allodirectional condition (2.3 degrees). Finally, head turning was recorded as oval traces in a biaxial plane. In both clockwise and counter-clockwise head turning conditions, the maximum inclination angles of the traces were larger in the anterior-posterior direction (59.8 degrees anterior and 58.2 degrees posterior, in the clockwise condition, and 47.4 degrees and 47.4 degrees in the counter-clockwise condition) than in the right-left direction (36.3 degrees right and 39.0 degrees left, in the clockwise condition, and 40.5 degrees and 36.7 degrees in the counter-clockwise condition), and the angles in the four directions were almost equal to flexion-extension and lateral bending. The characteristics of the traces recorded and a possible application of the present recording system are discussed.

Analysis of gene expression in apoptosis of human lymphoma U937 cells induced by heat shock and the effects of α-phenyl N-tert-butylnitrone (PBN) and its derivatives

Hyperthermia, a modality of cancer therapy, has been known as a stress to induce apoptosis. However, the molecular mechanism of heat shock-induced apoptosis, especially on roles of intracellular oxidative stress, is not fully understood. First, when human lymphoma U937 cells were treated with heat shock (44 degrees C, 30 min), the fraction of apoptosis, revealed by phosphatidylserine externalization, increased gradually and peaked at 6 hr after the treatment. In contrast, intracellular superoxide formation increased early during the heat shock treatment and peaked at 30 min after the treatment. When the cells were treated with heat shock in the presence of alpha -phenyl-N-tert-butylnitrone (PBN) and its derivatives, which are potent antioxidants, the DNA fragmentation was inhibited in an order according to the agents' hydrophobicity. PBN showing the highest inhibitory effects suppressed not only intracellular superoxide formation but also various apoptosis indicators. cDNA microarray was employed to analyze gene expression associated with heat shock-induced apoptosis, and the time-course microarray analysis revealed 5 groups showing changes in their pattern of gene expression. Among these genes, c-jun mRNA expression showed more than 40 fold increase 2 hr after heat treatment. The expression level of c-jun mRNA verified by quantitative real-time PCR was about 20 fold increase, and c-jun expression was similarly suppressed by PBN and its derivatives. These results suggest that the change of c-jun expression is an excellent molecular marker for apoptosis mediated by intracellular oxidative stress induced by heat shock.

Head movement associated with performance of mandibular tasks

The present study was designed to examine the hypothesis that the motor system controlling phonation is functionally coupled with the motor system controlling posture of the head and neck, as previously suggested (U. Haddar, T.J. Steiner, E.C. Grant and F.C. Rose Human Movement Science 2: 35 and Language and Speech 26: 117). Head tilt and trunk drift in the antero-posterior and right-left directions were measured simultaneously for 20 s before and during three types of speech sounds (/pa/, /ta/ and /ka/) as well during a maximum jaw open-close task in 14 healthy young subjects. The major findings obtained in all of the four tasks were: (i) the trunk drift measured in both directions was negligible in comparison with the head tilt; (ii) the head tilt in the antero-posterior direction was much larger than in the right-left direction and (iii) the head tilt during performance of the four tasks consisted of 'initial' and 'sustained' phases. In the initial phase, the head tilted posteriorly in association with the start of individual tasks. In the sustained phase, the head tilted either anteriorly or posteriorly when the task progressed. The magnitude of the net head tilt in the sustained phase negatively correlated with that of the initial head tilt. These findings indicate that phonation, in the form of jaw open-close, accompanies head movement in two consecutive phases.

Thymic carcinoma with a large cystic lesion

A 59-year-old man presented with a large anterior mediastinal mass. A computed tomography (CT) and magnetic resonance imaging showed a well-circumscribed cystic mass, 12 cm in size adjacent to the heart border and superior vena cava (SVC). A CT guided needle biopsy was performed, and instead of detecting malignant tissues but finding that gray muddy fluid was suctioned, suggesting cystic teratoma. At surgery, the tumor was confirmed advanced thymic carcinoma with pleural dissemination, then the tumor was extirpated with resection of SVC, followed by 2 cycles of chemotherapy. Histologically, the cystic wall was lined with malignant cells. We herein present a diagnostic pitfall case of thymic carcinoma having a large cystic component with which rare association should be recognized.

Identification of ASK and clock-associated proteins as molecular partners of LKP2 (LOV kelch protein 2) in Arabidopsis

The ADO/FKF/LKP/ZTL family of proteins of Arabidopsis thaliana Heynh. have a LOV domain, an F-box motif, and a kelch repeat region. LKP2 is a member of this family and functions either within or very close to the circadian oscillator in Arabidopsis. Promoter-GUS fusion studies revealed that the LKP2 gene was highly active in rosette leaves. In CaMV 35S:LKP2-GFP plants, GFP-associated fluorescence was detected in nuclei, suggesting that LKP2 is a nuclear protein. Yeast two-hybrid analysis demonstrated that LKP2 interacted with some Arabidopsis Skp1-like proteins (ASK), as do other ADO/FKF/LKP/ZTL family proteins, suggesting that LKP2 can form an SCF (Skp1-Cullin-F-box protein) complex that functions as a ubiquitin E3 ligase. LKP2 interacted not only with itself but also with other members of the family, LKP1 and FKF1. The two-hybrid analysis also demonstrated that LKP2 interacted with TOC1, a clock component, but not with CCA1 or LHY, negative regulators of TOC1 gene expression. The LOV domain of LKP2 was shown to be necessary and sufficient for the interaction with TOC1. An interaction between LKP2 and APRR5, a paralogue of TOC1, was also observed, but LKP2 did not interact with APRR3, APRR7, or APRR9, other paralogues of TOC1.

Localization of HB9 homeodomain protein and characterization of its nuclear localization signal during chick embryonic skin development

We detected HB9 protein during tarsometatarsal scale skin and late feather development. Immunofluorescent analyses with N-terminal 14 amino acids antiserum revealed that HB9 was strongly expressed in epidermal basal cells of the outer scale face in tarsometatarsal scale skin. Specific expression was also detected in dermal cells at the root region of the feather and around the feather follicle. Furthermore, we observed precise distribution of HB9 protein by immunoelectron microscopy. We detected HB9 protein not only in the nucleus, but also in the cytoplasm in tarsometatarsal scale skin. However, in feather skin HB9 protein was found in the nucleus but not in the cytoplasm. Cytoplasmic localization of HB9 protein in tarsometatarsal scale skin was observed especially in the endoplasmic reticulum and the Golgi apparatus. To address the mechanism of nuclear-cytoplasmic translocation, we determined the nuclear localization signal (NLS) sequences by using eukaryotic green fluorescent protein fusion protein in primary keratinocyte culture. Chick HB9 homeoprotein has two types of the NLS sequences in its homeodomain. One of them is a bipartite type as representatively found in Xenopus nucleoplasmin. The other is very similar to hexapeptide NLS sequences identified in pancreatic duodenum homeobox 1 (PDX1). These sequences functioned not only in keratinocytes but also in dermal fibroblasts. They are conserved in Xenopus, mouse, and human HB9 ortholog. These results indicate that HB9 protein might be involved in chick tarsometatarsal scale and feather development and that nuclear import of HB9 protein might be regulated by these NLS sequences in the homeodomain.

Solitary Fibrous Tumor of the Spinal Cord: Case Report and Review of the Literature

OBJECTIVE AND IMPORTANCE:

A solitary fibrous tumor (SFT) is a rare neoplasm of probable mesenchymal origin that was first reported in the pleura but can occur in different sites. Only six cases of SFT arising from the spinal cord have been reported.

CLINICAL PRESENTATION:

We report a case of primary SFT occurring in the thoracic spinal cord in a 64-year-old man with Brown-Séquard syndrome. Magnetic resonance imaging revealed an intradural mass at the level of T2–T3.

INTERVENTION:

Total T2–T3 laminectomies were performed. The tumor appeared to be adherent to the right lateral aspect of the cord but not attached to the meninges. On histological examination, the tumor exhibited spindle cell proliferation with abundant dense collagen but without a hemangiopericytomatous pattern. Immunohistochemically, the tumor cells were reactive with CD34 and vimentin only.

CONCLUSION:

We report a rare case of SFT occurring in the thoracic spinal cord. Histologically and immunohistochemically, we confirmed the diagnosis of SFT. Low signal intensity on T1- and T2-weighted images corresponded to the histological findings. When a spinal cord tumor exhibits a signal pattern similar to this, SFT should be included in the differential diagnosis. Because of the rarity of reports on this condition, the clinical manifestations and course of SFT of the spinal cord are unknown, and careful long-term follow-up is recommended.

Thymic carcinoma. Clinical institutional experience with 15 patients

OBJECTIVE

We retrospectively evaluated 15 patients with thymic carcinoma treated with various modalities and investigated overall management of this disease.

METHODS

From 1983 to 2003, we treated 15 patients with thymic carcinoma (12 squamous cell carcinomas, 2 undifferentiated carcinomas and one adenocarcinoma). According to Masaoka's staging system, they consisted of 2 at stage II, 5 at stage III, 4 at stage IVa and 4 at stage IVb.

RESULTS

Ten patients were histologically diagnosed preoperatively, and 5 patients underwent an exploratory procedure under the diagnosis of thymoma or benign teratoma. Complete resection was performed in 9 patients (2 stage II, 5 stage III and 2 stage IVa), which included 4 patients who received induction therapy, 4 who received postoperative radiation therapy, and 1 who received postoperative chemotherapy. Six patients with unresectable tumors were treated by irradiation (40-60 Gy) with or without chemotherapy. The median survival was 13 months for patients without resection, and 57 months for patients with a complete resection. Total 3-year and 5-year survival rates were 51.9 and 39.0%, respectively.

CONCLUSIONS

We concluded that a complete resection is mainstay of therapy when possible, but chemoradiation therapy being potential benefit in the management of thymic carcinoma. However, considering the high prevalence of advanced stage patients, to establish the effective regimen of induction therapy in the additional multicenter trials should be mandatory.

Localized pleural malignant mesothelioma

The occurrence of pleural malignant mesothelioma (MM) is unusual and the cases that appear as a localized tumor are extremely rare. A case of localized pleural MM including immunohistochemical findings is presented. A 70-year-old man had an abnormal shadow found during a routine roentgenogram at an annual health checkup and was admitted to Toneyama National Hospital (Toyonaka, Osaka, Japan) for detailed examinations. Chest X-rays showed a 2 x 5 cm-sized nodule with relatively smooth margins in the right segment three. Computed tomography (CT) showed an extrapleural mass with a smooth surface and a thickened parietal pleura, and results of a biopsy performed under CT scanning yielded MM. Systematic examinations did not show any metastasis and the patient underwent surgery for removal of the mass. The resected tumor, measuring 3.2 x 3.1 cm, was firm, partially encapsulated, and irregularly shaped. Pathological examinations revealed that it consisted of large polygonal cells, partially showing myxoid patterns, which led to a diagnosis of localized pleural MM. Tumor recurrence was seen, and the duration between initial symptoms and death was 29 months. This case suggests that localized pleural MM has a high proliferative potential and aggressive course, and is considered an early stage of diffuse pleural MM.

Protein extraction from mature rice leaves for two-dimensional gel electrophoresis and its application in proteome analysis

Sample preparation is crucial for extraction and higher resolution of proteins by two-dimensional gel electrophoresis (2-DE). In this study, we present an efficient protocol to extract proteins from mature rice leaves by minimizing the presence of nonprotein contaminants and by maximizing contact between the sample and extraction buffer. A combination of chemical and physical processes remarkably improved protein extraction for 2-DE. The efficiency of this protocol was demonstrated by comparison of the rice proteome at two developmental stages.

Autopsy case of congenital pulmonary lymphangiectasis

Congenital pulmonary lymphangiectasis (CPL) is a rare anomaly. We report a female infant born at 39 weeks of gestation who was found to have CPL. Cyanosis and tachypnea were noted immediately after birth, and, at room air, PaO2 was 30.7 mmHg, PaCO2 was 82.5 mmHg and pH was 7.12. The infant's symptoms did not improve even with the initiation of artificial ventilation. Chest X-ray film showed cotton-like infiltrates in both lungs and an air-leak surrounding the cardiac shadow. Echocardiography study showed no abnormality. The neonate died 3 days after birth due to hypoxemic cardiac failure. At autopsy, the pleural surface contained numerous dilated vessels that had the appearance of lymphatics. Microscopic features of the lungs were marked lymphatic dilatation of the perivascular, subpleural and interlobular areas. Lymphangiectasis was found in the liver, kidney, pancreas, thyroid and alimentary canals, such as the esophagus, stomach and rectum. Patients with lymphatic dilatations in extrapulmonary organs have mild pulmonary involvement and symptoms and a better prognosis. However, a few cases of CPL with lymphatic dilatations in extrapulmonary organs and an aggressive course, such as the present case, have been reported. The clinical behavior and prognosis of CPL depend on the extent of pulmonary involvement of the lymphatic dilatations regardless of systemic lymphatic dilations.

Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study

BACKGROUND

Complete excision of nonsmall cell lung cancer is necessary during a limited resection procedure, as a malignant positive margin can lead to margin relapse. Because there is scant information available regarding the optimal size of a malignant negative margin, we conducted a multicenter, prospective study to more fully elucidate this area of concern.

METHODS

Two hundred five pulmonary tumors (22 nonsmall cell lung cancers and 183 undiagnosed lesions) were excised, of which 118 nonsmall cell lung cancer lesions were analyzed. Malignant status was considered positive when either a cytologic or histologic technique revealed the margin to be malignant. Maximum tumor diameter (from 4 to 45 mm with an average of 15.3 mm), margin distance (from 0 to 25 mm with an average of 9.3 mm), tumor location, extent of stapling carried out, and performance of a thoracotomy were the variables.

RESULTS

Seventy-two of the sample tissues (61%) were malignant negative. The negative group had smaller maximum tumor diameter, greater margin distance, lesions in more easily resectable regions, and more often required stapling only. Using a multivariate analysis, maximum tumor diameter and margin distance were found to be independent factors. The number of malignant negative margins was 7/7 (100%) when the margin distance was greater than 20 mm, and the number of malignant negative margins was 21 of 21 (100%) when the resected tumors had a margin distance greater than the maximum tumor diameter.

CONCLUSIONS

Malignant positive margins were not found when the margin distance was greater than the maximum tumor diameter, which was considered to be the optimal margin distance for prevention against margin relapse.

Induction of CD13 on T-lymphocytes by adhesive interaction with gingival fibroblasts

Lymphocytes in peripheral blood do not express CD13 (aminopeptidase N), a membrane alanyl metallopeptidase. However, it has been demonstrated that locally infiltrated lymphocytes in chronic inflammatory sites can be CD13-positive, and possible involvement of stromal cell adherence in the induction of CD13 has been suggested. In this study, we examined whether T-lymphocyte/gingival-fibroblast interaction can activate T-lymphocytes to express CD13. CD13 expression was induced on PMA-activated T-lymphocytes only when they adhered directly to human gingival fibroblasts (HGF) at 2 hrs after the co-culture began, while an increase in the enzyme activity of CD13 was also confirmed in activated T-lymphocytes that had been co-cultured with HGF. Furthermore, CD13-positive T-lymphocytes were detected in inflamed gingival tissues in vivo. Analysis of these results indicates that direct interaction with HGF is essential for the induction of CD13 expression on T-lymphocytes that was also observed in periodontitis lesions.

Desmoplastic malignant mesothelioma: two cases and a literature review

We present two cases of desmoplastic malignant mesothelioma (DMM) with pathological, immunohistochemical, and ultrastructural features. Each patient showed rapid progress and died within 1 year from appearance of the initial symptoms. Macroscopically, both showed a thickened pleura replaced by a tumor that encased the lung. Microscopic results of each showed that the tumors consisted of a dense fibrous area, with mild nuclear irregularities and hyperchromatism. In case 1, the tumor had invaded the diaphragm, chest wall, and cardiac sac; the mass in case 2 invaded the lung and diaphragm, and distal metastases were seen in the thoracic vertebrae, meninges, and liver. Ultrastructural findings in case 1 showed a few short blunt microvilli on the cell surfaces. DMM is occasionally difficult to distinguish from fibrous pleurisy and solitary fibrous tumor. Immunohistochemical examinations of the present cases showed the expression of cytokeratin and vimentin, and focal positive stainings of antihuman mesothelial cell antibody (HBME-1) in both, whereas CD34 and bcl2 were negative. Solitary fibrous tumor was excluded. Therefore, pathological, ultrastructural, and immunohistochemical findings led us a diagnosis of DMM in each case. The Ki-67 labeling index (Ki-67 LI) of cases 1 and 2 was 25.5 and 15.5, respectively, both high, which suggested malignancy. Widespread immunohistological panels of malignant mesothelioma were not evaluated; Immunohistological markers commonly used for the diagnosis of malignant mesothelioma were not evaluated; however, the high ki-67 LI results and positive HBME-1 staining were helpful factors for the diagnoses of DMM.

Clinico-pathological study of meningiomas with haemorrhagic onset

BACKGROUND

Haemorrhage from meningiomas is rare and the underlying pathophysiological mechanisms remain to be determined. We sought to identify these mechanisms by studying clinical and histological records of 6 meningioma patients treated at our institution.

PATIENTS AND METHODS

We retrospectively studied 6 patients with meningiomas whose acute onset was due to haemorrhage. We evaluated clinical features and imaging studies. The vascularity and proliferative nature of these tumours were examined immunohistochemically and tissue factor (TF) immunoreactivity was assessed. For comparison we evaluated 25 non-haemorrhagic meningiomas.

FINDINGS

At onset, the haemorrhages mimicked stroke in all 6 patients. On imaging studies, 3 of the haemorrhages were intra- and extratumoural, the other 3 were extratumoural only. Hyperintensity on T2-weighted MRI was a characteristic of these meningiomas. Histologically, they were of 3 subtypes, meningothelial (n=3), transitional (n=2), and anaplastic (n=1). The MIB-1 labelling index of the 5 WHO Grade I meningiomas was 5.8+/-2.2. The mean number of CD31-positive blood vessels did not differ in haemorrhagic and non-haemorrhagic meningiomas. The TF-positivity rate of haemorrhagic meningiomas was higher than of non-haemorrhagic meningiomas.

INTERPRETATION

The proliferative nature of the meningiomas and TF expression in tumour cells may have contributed to the eventual haemorrhage of the meningiomas in our series.

Elevated expression of O-GlcNAc-modified proteins and O-GlcNAc transferase in corneas of diabetic Goto-Kakizaki rats

PURPOSE

The hexosamine biosynthetic pathway is one of the possible mechanisms involved in diabetic keratopathy. The purpose of this study was to examine the role of O-glycoside-linked N-acetylglucosamine (O-GlcNAc) modification of proteins in the pathogenesis of diabetic keratopathy in the Goto-Kakizaki (GK) rat, which has spontaneous development of diabetes.

METHODS

An anti-O-GlcNAc antibody, an anti-O-GlcNAc transferase antibody, and digoxigenin (DIG)-labeled cRNA probes were used to examine the localization of O-GlcNAc-modified proteins, O-GlcNAc transferase protein and mRNA in the corneas of diabetic GK rats and in those of nondiabetic Wistar rats. The corneas from Wistar rats were organ cultured in control medium or in medium containing 100 micro M O-(2-acetamide-2-deoxy-D-glucopyranosylidene) amino-N-phenyl-carbamate (PUGNAc), an inhibitor of O-GlcNAcase, the enzyme that removes O-GlcNAc from proteins. The morphologic changes were examined by electron microscopy.

RESULTS

In normal corneas, immunoreactive O-GlcNAc and O-GlcNAc transferase were observed in the epithelial, endothelial, and stromal cells. In the diabetic corneas, their immunoreactivities in the epithelium were increased in intensity. Morphologically, the number of hemidesmosomes in the epithelial basal cells was lower than that in those cells from the nondiabetic rats. In some areas, the basement membrane had detached from the epithelial basal cells. The PUGNAc treatment of Wistar rat corneas increased the level of O-GlcNAc immunoreactivity and caused a decrease in the number of hemidesmosomes and the detachment of corneal epithelial cells from the basement membrane.

CONCLUSIONS

The elevated expression of O-GlcNAc-modified proteins and O-GlcNAc transferase may play a causative role in the corneal epithelial disorders of diabetic GK rats.

[Conservative therapy for recurrent bronchial stump fistula occurred after surgery for lung cancer with cerebrovascular disease]

BACKGROUND

Although pyrothorax caused by bronchial stump fistula is 1 of the most severe respiratory complications frequently encountered after surgery for lung cancers, it is very difficult to prevent the development of pyrothorax. However, conservative treatment for bronchial stump fistula occurred after surgery for lung cancer was successfully performed in 1 of our elderly lung cancer patients with a history of cerebrovascular events.

CASE

Patient was a 74-year-old man who developed cerebral infarction in October 2000, and was continuously undergoing rehabilitation for left hemiplegia. Chest computed tomography (CT) demonstrated a tumorous lesion in the right S6. Clinical diagnosis of stage IA squamous cell carcinoma was made. His performance status (PS) was degree IV, and he required complete assistance. In addition, since several abnormal florae were detected by preoperative examinations of sputum, the development of postoperative respiratory complications was suspected. In April 2001, thoracoscopy-assisted right inferior lobectomy and nodal dissection 1 (ND 1) were performed. Although the patient developed bronchial stump fistula on the 6th hospital day, it was successfully treated by conservative procedures after second surgery.

CONCLUSION

Conservative therapy under nutritional management mainly consisting of central venous nutrition may be useful for some surgically treated lung cancer patients with bronchial stump fistula when they have mild inflammation and the reduction of pyrothorax cavity can be expected by re-expansion of the residual lobes of the lung.

Immunohistochemical analysis of resected clinical stage I pulmonary adenocarcinomas with high preoperative levels of serum carcinoembryonic antigen

BACKGROUND

Clinical stage I pulmonary adenocarcinoma (AD) patients with persistently high serum carcinoembryonic antigen (CEA) levels after surgery have a poor prognosis. Although CEA staining pattern is reported to be a prognostic indicator for patients with colorectal cancer, the relationship with lung cancer is unclear.

METHODS

One hundred eighteen patients with clinical stage I AD underwent surgery from 1993 to 1997. Of them, 19 (16%) patients with a high preoperative serum level of CEA and 19 randomly selected control patients with preoperatively normal CEA were studied. CEA staining of tumor specimens from each of the 38 patients was performed, and the staining patterns were then classified into two types: apical and diffuse.

RESULTS

Patients with normal postoperative serum CEA levels (group HN, n = 13) had a 5-year survival rate higher than those with persistently high postoperative serum CEA (group HH, n = 6). In a comparison between the two groups, apical patterns (n = 10) were only seen in group HN, and those who demonstrated an apical CEA staining pattern had a 5-year survival rate (5-YSR) of 80% as compared with 13% for those HN patients with only a diffuse pattern (p = 0.01). In the control group, 16 (84%) patients had an apical staining pattern and the other 3 patients showed no staining.

CONCLUSIONS

Patients with normalized serum CEA levels had a high chance of showing an apical staining pattern, which may be a very good prognosis predictor for patients with high preoperative levels of CEA.

Detection of single nucleotide polymorphism (SNP) controlling the waxy character in wheat by using a derived cleaved amplified polymorphic sequence (dCAPS) marker

We investigated a single nucleotide polymorphism (SNP) in the Wx-D1 gene, which was found in a mutant waxy wheat, and which expressed the Wx-D1 protein (granule-bound starch synthase I) as shown by immunoblot analysis. We also assayed starch synthase activity of granule-bound proteins. Using 22 doubled-haploid (DH) lines and 172 F(5) lines derived from the wild type x the mutant, we detected SNP via a PCR-based (dCAPS) marker. Amplified PCR products from Wx-D1 gene-specific primers, followed by mismatched primers designed for dCAPS analysis, were digested with the appropriate restriction enzyme. The two alleles, and the heterozygote genotype were easily and rapidly discriminated by gel-electrophoresis resolution to reveal SNP. All progeny lines that have the SNP of the mutant allele were waxy. Integrating the results of dCAPS analysis, immunoblot analysis and assays of starch synthase activity of granule-bound proteins indicates that the SNP in the Wx-D1 gene was responsible for its waxy character. This dCAPS marker is therefore useful as a marker to introduce the mutant allele into elite breeding lines.

Prognostic significance of persistent mediastinal metastasis following induction therapy in large (> or = 2 cm) N2 or N3 non-small cell lung cancer

OBJECTIVE

It is controversial whether or not surgery is beneficial for patients with non-small cell lung cancer accompanied by persistent lymph node metastasis in the mediastinum following induction therapy. We have therefore conducted a retrospective study to assess this issue.

METHODS

Eligibility criteria were defined as follows: 1) the period of treatment was between January 1991 and April 1998, 2) the clinical stages were IIIA (N2) or IIB (N3) with large lymph nodes (> or = 2 cm), 3) induction therapy had been administered, 4) tumor was resected completely, 5) at least one mediastinal lymph node had necrosis or scar if the pathological N status was p-N0 or p-N1 and 6) the p-stage was not IV. Dichotomous variables included the radiographic response of the tumor, the T status, and the N status.

RESULTS

Thirty-nine patients were eligible. There were 29 males and 10 females aged from 27 to 74 years, and involved 20 cases of adenocarcinoma. The pathological N status was as follows: p-N0 in 18 patients, p-N1 in 3, p-N2 in 16, and p-N3 in the other 2. In overall survival, the median survival time (MST) was 34 months and the actuarial 5-year-survival rate (5-YSR) was 28%. The group of patients with either N0 or N1 (n = 21) had a 71-month MST and a 54% 5-YSR, and the group of patients with either N2 or N3 (n = 18) had a 13-month MST and a 5-YSR of 0% (p < 0.0001). On multivariate analysis, the pathological N factor was confirmed as an independently significant.

CONCLUSIONS

Our retrospective study found that the survival rate of patients with persistent mediastinal nodal metastasis was very poor. A prospective study is needed to investigate whether or not surgery is beneficial for these patients.

Localization of the O-GlcNAc transferase and O-GlcNAc-modified proteins in rat cerebellar cortex

O-linked N-acetylglucosamine (O-GlcNAc) is a ubiquitous nucleocytoplasmic protein modification that has a complex interplay with phosphorylation on cytoskeletal proteins, signaling proteins and transcription factors. O-GlcNAc is essential for life at the single cell level, and much indirect evidence suggests it plays an important role in nerve cell biology and neurodegenerative disease. Here we show the localization of O-GlcNAc Transferase (OGTase) mRNA, OGTase protein, and O-GlcNAc-modified proteins in the rat cerebellar cortex. The sites of OGTase mRNA expression were determined by in situ hybridization histochemistry. Intense hybridization signals were present in neurons, especially in the Purkinje cells. Fluorescent-tagged antibody against OGTase stained almost all of the neurons with especially intense reactivity in Purkinje cells, within which the nucleus, perikaryon, and dendrites were most intensely stained. Using immuno-electron microscopic labeling, OGTase was seen to be enriched in euchromatin, in the cytoplasmic matrix, at the nerve terminal, and around microtubules in dendrites. In nerve terminals, immuno-gold labeling was observed around synaptic vesicles, with the enzyme more densely localized in the presynaptic terminals than in the postsynaptic ones. Using an antibody to O-GlcNAc, we found the sugar localizations reflected results seen for OGTase. Collectively, these data support hypothesized roles for O-GlcNAc in key processes of brain cells, including the regulation of transcription, synaptic vesicle secretion, transport, and signal transduction. Thus, by modulating the phosphorylation or protein associations of key regulatory and cytoskeletal proteins, O-GlcNAc is likely important to many functions of the cerebellum.

Leiomyosarcoma arising from soft tissue tumor of the mediastinum

The occurrence of a leiomyosarcoma (LMS) in soft tissue of the mediastinum is rare. We report a 60-year-old woman with an LMS in mediastinal soft tissue who died 8 months after surgical removal. Pathological, immunohistochemical, and electron microscopic features of this rare tumor are described.

[Two cases of pulmonary eosinophilic granuloma with multiple nodular shadows]

We encountered two rare cases of pulmonary eosinophilic granuloma with multiple nodular shadows in both lungs. The patient in case 1 was a 54-year-old man complaining of dry cough and chest pain. He had smoked 20 cigarettes a day for 36 years. The patient in case 2 was a 37-year-old woman complaining of dry cough. She had smoked 15 cigarettes a day for 20 years. Chest radiography and CT revealed multiple nodular shadows in both lungs. Diagnosis was made by open lung biopsy in case 1 and by percutaneous lung biopsy in case 2. After smoking cessation, symptoms improved markedly and the shadows in the chest radiographs and CT disappeared. In cases of bilateral multiple nodular shadows, other than metastatic lung tumor cases, pulmonary eosinophilic granuloma should be considered.

Cytologically malignant margins of wedge resected stage I non-small cell lung cancer

BACKGROUND

We have developed a novel test for the surgical margin of pulmonary malignant tumor using a cytologic technique (the run-across method in which a glass slide is run across the staple site), and we have assessed whether this method is useful in predicting margin relapse and prognosis.

METHODS

From April 1996 to March 1999, 15 lesions of stage I non-small cell lung cancer (NSCLC) (maximum diameter ranged from 10 to 35 mm with a median of 20 mm) from 15 patients with cardiopulmonary impairment were excised without additional proximal resections. The surgical margin was examined using the run-across method. There were 8 male 7 female patients whose ages ranged from 51 to 80 years. One patient underwent video-assisted thoracic surgery and 14 underwent thoracotomy. The preoperative diagnoses of the patients were 13 adenocarcinomas, 2 squamous cell carcinomas, and 1 undiagnosed lesion (1 adenocarcinoma). The follow-up period ranged from 37 to 63 months.

RESULTS

The rate of positive cytology was 47% in comparison with the rate of positive histology of 20%. There were 4 patients with margin relapse (3 of them contained negative histology margins) at a rate of 57% among the positive cytology patients in comparison with 0% among the negative cytology patients (p = 0.03). In a comparison of survival between the negative cytology group and the positive cytology group, there were no statistically significant differences.

CONCLUSIONS

The run-across method is also useful in confirming complete resection. A positive cytology margin could lead to margin relapse even if a non-small cell lung cancer is resected with a negative histology margin.

Malignant mesothelioma of the pericardium: case reports and immunohistochemical studies including Ki-67 expression

Pericardial malignant mesothelioma (PMM) is extremely rare compared with pleural cases of mesothelioma. We present the clinical and pathological features of three autopsy cases with PMM. All three cases showed rapid progress and died of heart failure. Detailed examination was obtained from the autopsy. Macroscopic appearances of each case showed a thickened pericardium due to tumor invasion. Microscopic observations of all cases led to a diagnosis of epithelial-type malignant mesothelioma (MM). The results of immunohistochemical examinations were similar to the previous published work on pleural mesothelioma. To disclose the pathological characteristics of PMM, we analyzed Ki-67 labeling index (LI) of three cases of PMM and five cases of pleural MM that died within 2 years. The difference of Ki-67 LI between PMM and pleural MM was not significant (P > 0.05). The poor prognosis of patients with PMM must be caused by restricted cardiac wall motion due to tumor involvement, in addition to the tumor proliferation itself.

Anaplastic large-cell lymphoma (Ki-1 lymphoma): ultrastructural and immunohistochemical studies

We report an autopsy case of a malignant neutrophil-rich anaplastic large cell lymphoma (ALCL), which was reactive to the monoclonal antibody Ki-1 (CD30). This subtype of Ki-1 ALCL containing many neutrophils was named by Mann and colleagues in 1995, and its clinical and pathological characteristics have not been well described. In our case, the patient died 2 months after he first noticed an abdominal skin tumor. It was difficult to make the exact diagnosis of malignant lymphoma because the histological examination showed very poorly differentiated tumor cells. Ultrastructural observations revealed nuclei with convoluted contours and, sometimes, deep indentations, which suggested ALCL. Immunohistologically, most neoplastic cells were reactive with Ki-1 (CD30), leukocyte common antigen (LCA), and CD45RO (UCHL-1), and we confirmed Ki-1 ALCL. When we encounter poorly differentiated tumors on light microscopy, we should perform immunohistochemistry for hematological markers, such as LCA and Ki-1.

Salicylic acid carboxyl methyltransferase induced in hairy root cultures of Atropa belladonna after treatment with exogeneously added salicylic acid

In Atropa belladonna hairy roots, exogeneously added salicylic acid (SA) is converted to methyl salicylate (MSA) through the reaction, which might be catalysed by S-adenosyl-L-methionine: salicylic acid carboxyl methyltransferase (SAMT). Here we cloned a cDNA for A. belladonna SAMT (AbSAMT1), which consisted of 357 aa residues. It was expressed in E. coli, and the recombinant AbSAMT1 showed SAMT activity. When A. belladonna hairy roots were exposed to a high concentration of SA, AbSAMT1 mRNA begins to be expressed 12 h after the exposure, and steady expression continued over 144 h.

Immunolocalization of peripheral lymph node addressins in normal and neoplastic human thymuses

Peripheral lymph node addressin is a specific L-selectin ligand of the high endothelial venules that plays an important role in lymphocyte homing to lymph nodes. Tissue selective migration of lymphocytes through this pathway to the thymus has also been proposed. In this work, peripheral lymph node addressin expression was investigated immunohistochemically with a monoclonal antibody, clone MECA-79, in formaldehyde-fixed, paraffin-embedded tissue sections of 5 normal neonatal thymuses, 25 thymomas, 3 thymic carcinomas, and 2 thymic lymphoid hyperplasias. In normal thymuses, peripheral lymph node addressin expression was found in the endothelium of corticomedullary and medullary vessels surrounded by perivascular space. In type B thymomas and thymic lymphoid hyperplasias, peripheral lymph node addressin was detected in the vessels with perivascular spaces, at the medullary differentiation areas, and in paralymphoid follicles, respectively. However, in type A thymomas and thymic carcinomas, MECA-79-positive vessels were restricted to the remnants of pre-existing thymic tissue, and they were absent from the neoplastic areas. These findings suggest that in normal and most neoplastic thymuses, peripheral lymph node addressin is expressed by regions of vascular endothelium corresponding to postcapillary venules that may serve as a pathway for homing of recirculating lymphocytes to the thymus.

Distribution of sialoglycoconjugates in the rat cerebellum and its change with aging

We examined the distribution of sialoglycoconjugates in the cerebellum of 9-week-old and 30-month-old rats using light microscopy and electron microscopy in combination with two lectins, Maackia amurensis lectin (MAL) for Sia(alpha)2-3Gal and Sambucus sieboldiana agglutinin (SSA) for Sia(alpha)2-6Gal. Each lectin showed characteristic staining patterns. In young adult rats, MAL stained a strongly granular layer, a weakly molecular layer, and the medullary lamina, while SSA more strongly stained the medullary lamina than the molecular and granular layers. After aging, different staining patterns were obtained. Intense SSA reactivity was observed in the granular layer and intense MAL reactivity was observed in the medullary lamina of the aged groups. The reactivity of Purkinje cells with MAL was downregulated in the aged rats. These results indicated that Sia(alpha)2-3Gal and Sia(alpha)2-6Gal were expressed in distinct regions of the rat cerebellum and that their expression patterns changed in the aged brain.

Expression of Hex homeobox gene during skin development: Increase in epidermal cell proliferation by transfecting the Hex to the dermis

A number of homeobox genes have been found to be expressed in skin and its appendages, such as scale and feather, and appear to be candidates for the regulation of the development of these tissues. We report that the proline-rich divergent homeobox gene Hex is expressed during development of chick embryonic skin and its appendages (scale and feather). In situ hybridization analysis revealed that, during development of the skin, a transient expression of the Hex gene was observed. While the expression of Hex in the dermis was closely correlated with proliferation activity of epidermal basal cells, that in the epidermis was related to a suppression of epidermal differentiation. When dermal fibroblasts were transfected with Hex, stimulation of both DNA synthesis and proliferation of the epidermal cells followed by two-fold scale ridge elongation and increase in epidermal area was observed during culture of the skin, whereas epidemal keratinization was not affected. This is the first study to demonstrate that Hex is expressed during development of the skin and its appendages and that its expression in the dermal cells regulates epidermal cell proliferation through epithelial mesenchymal interaction.

Pulmonary dirofilariasis--clinicopathological study

Pulmonary dirofilariasis (PD), caused by Dirofilaria immitis (D. immitis), the dog heartworm, is not common in humans, though we recently encountered 4 cases. Chest X-ray images from annual health examinations showed a single spherical nodule in the inferior or middle portion of the right lung in each patient. None of the patients showed any clinical symptoms and had no contact with dogs. Hematological results in 3 of the cases were within normal limits, while mild eosinophilia was found in one. Serological tests for the Anti-Dirofilaria antibodies were not performed. There were no characteristic clinical manifestation of PD in any of the patients, however, we consider it important to keep a diagnosis of PD in mind, when we experienced these cases, they present no characteristic clinical manifestations. Pathologically, macroscopic findings showed well-circumscribed nodules that were round peripheral lesions in lungs. Histological results revealed coagulation necrosis with fibrosis and granulation in the nodule edge, which contained inflammatory cells. By means of silver staining, the worm structures in the nodules could be identified well, and the quadrant cells in the sections were numbered about 30. Immunohistochemically, the somatic muscle tissues were stained with anti-Dirofilaria antibody. These findings indicated that the pulmonary lesions in all 4 cases were due to D. immitis.