Primary invasive micropapillary carcinoma of the colon

AIMS

Invasive micropapillary carcinoma (IMPC) is associated with frequent lymph node metastasis and adverse clinical outcome. IMPC has been reported in breast, urinary bladder, ureter, lung and parotid gland but not in colon. We present the clinicopathological features of three cases of primary IMPC of the colon with a review of the literature.

METHODS AND RESULTS

The patients (one man and two women) were 53, 67 and 68 years old, respectively. The size of the tumour ranged from 20 to 100 mm in diameter. Histologically, all cases were composed predominantly of papillary tumour cell clusters with spaces in a background of fine fibrocollagenous stroma. One of the tumours (case 1) was nearly completely composed of IMPC, but the other two were associated with foci of adenocarcinoma and concurrent mucinous carcinoma, respectively. MUC1 was positive in all cases, suggestive of reverse cell orientation which is responsible for its unique histological features.

CONCLUSIONS

We report three cases of primary IMPC of the colon. Its clinical significance remains undetermined but the presence of this component may represent a poor prognostic factor.

Primary ependymoma of the ovary: a case report and literature review

Ependymoma is a glioma with differentiation toward ependymal cells that usually arises in the central nervous system. Ovarian ependymoma is extremely rare, and the treatment strategies for this disease have not been established. This is the first report of a patient with advanced ovarian ependymoma who received fertility-sparing surgery and is now alive without disease. A 23-year-old Japanese woman, gravida 0, presented with a chief complaint of lower abdominal distension and weight loss. She underwent left salpingo-oophorectomy for suspected ovarian cancer. Microscopic examination revealed a highly cellular tumor composed of small cells with hyperchromatic, round-to-oval nuclei and scanty cytoplasm. Perivascular pseudorosettes, ependymal rosettes, and extensive necrosis were observed. After thorough pathologic examination, she was diagnosed as having stage IIIC ovarian ependymoma. Postoperatively, she received adjuvant chemotherapy and underwent secondary cytoreductive surgery that preserved the uterus and right ovary. Her menstrual cycle has resumed, and she is alive without evidence of disease 16 months after the start of treatment. Although rare, primary ovarian ependymoma must be kept in mind in the differential diagnosis of ovarian tumors, especially in young women. Administration of etoposide-based chemotherapy along with cytoreductive surgery is a potential standard treatment for advanced ovarian ependymoma.

Rapid Onset of Quetiapine-Induced Diabetic Ketoacidosis in an Elderly Patient

New onset diabetes mellitus (DM) and diabetic ketoacidosis (DKA) among patients using atypical antipsychotics is of clinical importance [1,2,5,7-10]. Recently, atypical antipsychotics have been more widely used in the treatment of behavioral and psychological symptoms with dementia (BPSD) than conventional neuroleptics because of a reduced tendency for movement disorders and psychomotor retardation. We report a case of reversible DKA and new-onset DM that developed in a demented patient who was treated with quetiapine for 14 days.

Immunophenotypic alteration of the stromal component in minimal deviation adenocarcinoma ('adenoma malignum') and endocervical glandular hyperplasia: a study using oestrogen receptor and alpha-smooth muscle actin double immunostaining

AIMS

To define the phenotypic alteration of the stromal component in association with destructive invasion which is a crucial feature in distinguishing minimal deviation adenocarcinoma (MDA) from benign endocervical glandular lesions.

METHODS AND RESULTS

We studied endocervical glandular hyperplasias including non-specific-type (NEGH) (n = 3) and lobular-type (LEGH) (n = 8), and minimal deviation adenocarcinoma (MDA) (n = 11), well-differentiated endocervical adenocarcinoma of usual-type (WDA) (n = 11), and adenocarcinoma in situ (AIS) (n = 6) of the cervix, by double immunostaining for oestrogen receptor (ER) and alpha-smooth muscle actin (alpha-SMA) using peroxidase- and alkaline phosphatase-polymer methods, respectively. Glands in NEGH invariably showed nuclear staining for ER, with surrounding ER+/alpha-SMA- stromal cells, whereas LEGH also harboured ER+/alpha-SMA- spindle cells, but lacked nuclear staining for ER in constituent glands. In contrast, both WDA and MDA displayed accompanying stroma rich in alpha-SMA+ spindle cells in close vicinity to the infiltrating neoplastic glands, with only occasional weakly ER+ stromal cells. WDA tended to contain more alpha-SMA+ cells. The distribution of alpha-SMA+ cells was periglandular (6/11), patchy (6/11), and/or diffuse (4/11) in WDA, whereas in MDA it was periglandular (11/11) and/or patchy (8/11). AIS was surrounded by ER+/alpha-SMA- stromal cells. All cases of WDA, MDA, and AIS lacked nuclear staining for ER.

CONCLUSIONS

Both MDA and WDA can be distinguished from LEGH and NEGH by identifying surrounding alpha-SMA+ stromal cells and the absence or decreased number of ER+ cells, possibly as a result of the desmoplastic reaction with myofibroblasts replacing pre-existing ER+ stromal cells. In particular, the periglandular distribution of these alpha-SMA+ stromal cells can be a clue suggesting destructive stromal invasion in cases of MDA, although occasional glands may lack these cells.

Measurements of the response functions of a large size NE213 organic liquid scintillator for neutrons up to 800 MeV

The response functions of 25.4 cm (length) x 25.4 cm (diameter) NE213 organic liquid scintillator have been measured for neutrons in the energy range from 20 to 800 MeV at the Heavy-Ion Medical Accelerator in Chiba (HIMAC) and at the Research Center for Nuclear Physics (RCNP) of Osaka University. At HIMAC, white (continuous) energy spectrum neutrons were produced by the 400 MeV per nucleon carbon ion bombardment on a thick graphite target, whose energy spectrum has already been measured by Kurosawa et al., [Nucl. Sci. Eng. 132, 30 (1999)] and the response functions of the time-of-flight-gated monoenergetic neutrons in a wide energy range from 20 to 800 MeV were simultaneously measured. At RCNP, the quasi-monoenergetic neutrons were produced via 7Li(p,n)7Be reaction by 250 MeV proton beam bombardment on a thin 7Li target, and the TOF-gated 245 MeV peak neutrons were measured. The absolute peak neutron yield was obtained by the measurement of 478 keV gamma rays from the 7Be nuclei produced in a Li target. The measured results show that the response functions for monoenergetic neutrons < 250 MeV have a recoil proton plateau and an edge around the maximum light output, which increases with increasing incident neutron energy, on the other hand > 250 MeV, the plateau and the edge become unclear because the proton range becomes longer than the detector size and the escaping protons increase. It can be found that the efficiency of the 24.5 cm (diameter) x 25.4 cm (length) NE213 for the 250 MeV neutrons is -10 times larger than the 12.7 cm (length) x 12.7 cm (diameter) NE213, which is widely used as a neutron spectrometer.

Small cell carcinoma of the endometrium: report of three cases and literature review

BACKGROUND

Small cell carcinoma of the endometrium is extremely rare. Aim. We reported three cases of this rare tumor and reviewed the literature.

CASES

Case 1 was a 54-year-old woman and case 3 was a 58-year-old woman. Both patients presented with vaginal bleeding. Case 2, a 53-year-old woman, had no symptoms and had a vaginal-cervical smear suspicious for malignancy. All patients underwent surgery and their tumors originated in the endometrium. In all three cases, pathological examination revealed small cell carcinoma of endometrium, and immunohistochemical reactivity for one or more neuroendocrine markers was found in all cases. Under electron microscopy in case 2 and case 3, dense core granules in the cytoplasm of tumor cells were found only in case 3. Case 3 was stage IIIA and died of her disease 12 months after surgery. Both cases 1 and 2 were stage IB and alive with no evidence of disease for 28 months and 9 years, respectively.

CONCLUSION

Although the prognosis of small cell carcinoma of endometrium is poor, early detection of this disease may contribute to an improved prognosis.

Night-time restricted feeding normalises clock genes and Pai-1 gene expression in the db/db mouse liver

AIMS/HYPOTHESIS

An increase in PAI-1 activity is thought to be a key factor underlying myocardial infarction. Mouse Pai-1 (mPai-1) activity shows a daily rhythm in vivo, and its transcription seems to be controlled not only by clock genes but also by humoral factors such as insulin and triglycerides. Thus, we investigated daily clock genes and mPai-1 mRNA expression in the liver of db/db mice exhibiting high levels of glucose, insulin and triglycerides.

METHODS

Locomotor activity was measured using an infrared detection system. RT-PCR or in situ hybridisation methods were applied to measure gene expression. Humoral factors were measured using measurement kits.

RESULTS

The db/ db mice showed attenuated locomotor activity rhythms. The rhythmic expression of mPer2 mRNA was severely diminished and the phase of mBmal1 oscillation was advanced in the db/db mouse liver, whereas mPai-1 mRNA was highly and constitutively expressed. Night-time restricted feeding led to a recovery not only from the diminished locomotor activity, but also from the diminished Per2 and advanced mBmal1 mRNA rhythms. Expression of mPai-1 mRNA in db/db mice was reduced to levels far below normal. Pioglitazone treatment slightly normalised glucose and insulin levels, with a slight reduction in mPai-1 gene expression.

CONCLUSIONS/INTERPRETATION

We demonstrated that Type 2 diabetes impairs the oscillation of the peripheral oscillator. Night-time restricted feeding rather than pioglitazone injection led to a recovery from the diminished locomotor activity, and altered oscillation of the peripheral clock and mPai-1 mRNA rhythm. Thus, we conclude that scheduled restricted food intake may be a useful form of treatment for diabetes.

Small cell carcinoma of the endometrium: report of three cases and literature review

Background

Small cell carcinoma of the endometrium is extremely rare.

Aim

We reported three cases of this rare tumor and reviewed the literature.

Cases

Case 1 was a 54-year-old woman and case 3 was a 58-year-old woman. Both patients presented with vaginal bleeding. Case 2, a 53-year-old woman, had no symptoms and had a vaginal-cervical smear suspicious for malignancy. All patients underwent surgery and their tumors originated in the endometrium. In all three cases, pathological examination revealed small cell carcinoma of endometrium, and immunohistochemical reactivity for one or more neuroendocrine markers was found in all cases. Under electron microscopy in case 2 and case 3, dense core granules in the cytoplasm of tumor cells were found only in case 3. Case 3 was stage IIIA and died of her disease 12 months after surgery. Both cases 1 and 2 were stage IB and alive with no evidence of disease for 28 months and 9 years, respectively.

Conclusion

Although the prognosis of small cell carcinoma of endometrium is poor, early detection of this disease may contribute to an improved prognosis.

Expression of EBAG9/RCAS1 is associated with advanced disease in human epithelial ovarian cancer

Oestrogen receptor-binding fragment associated gene 9, EBAG9, is an oestrogen-responsive gene that was identified in MCF-7 human breast carcinoma cell line. It is identical to RCAS 1, a cancer cell surface antigen possibly involved in immune escape. In the present study, we examined the expression of EBAG9/RCAS1 in human epithelial ovarian cancer using immunohistochemistry, immunoblotting and reverse transcription–polymerase chain reaction (RT–PCR). A total of 90 epithelial ovarian cancer cases were examined immunohistochemically by means of the antibodies for EBAG9 and ERα. The correlation between EBAG9 immunoreactivity and clinicopathological parameters was examined. mRNA expression of EBAG9 and ERα were evaluated by RT–PCR in 22 cases. The expression for EBAG9 and ERα was examined by immunoblotting in 12 ovarian cancer cell lines. EBAG9 immunoreactivity was detected in the surface and cytoplasm of carcinoma cells in 46 out of 90 cases (51.1%). EBAG9 expression was significantly higher in serous histology (P=0.0402) and advanced disease (P=0.0206). No significant relationship was detected between EBAG9 immunoreactivity and overall survival (P=0.689). There was a highly significant correlation between EBAG9 and ER immunoreactivity (P<0.0001). The EBAG9 mRNA was detected in 20 out of 22 cases. In all of the cases that were positive for ERα mRNA, they were also positive for EBAG9 mRNA. Immunoreactive band corresponding to EBAG9 was detected in 11 out of 12 of ovarian cancer cell lines, and was consistent with ERα expression. In conclusion, the wide distribution of EBAG9 and its relation to advanced disease suggest that this protein may play important roles in epithelial ovarian cancer.

Constant light housing attenuates circadian rhythms of mPer2 mRNA AND mPER2 protein expression in the suprachiasmatic nucleus of mice

Constant light (LL) or constant dark (DD) environmental lighting conditions cause a free-running period and activity reduction in the rodent behavioral circadian rhythm. In order to understand the molecular process underlying behavioral rhythms in LL or DD housing conditions, we examined the circadian profile of mPer2 mRNA and mPER2 in the suprachiasmatic nucleus (SCN), a main oscillator, of free-running mice. The circadian expression rhythm of mPer2 in the SCN was dampened under 7-day LL conditions, whereas that of mPER2 protein was moderately attenuated and its expression peak delayed. The circadian expression of mPer2 and its product was slightly attenuated and advanced by 7-day DD conditions. With arrhythmic behavioral activity caused by long-term LL housing, mPER2 protein lost its rhythmicity in the SCN. On the other hand, LL or DD housing did not affect the mPer2 gene and its product in the cerebral cortex. The present results suggest that mPER2 circadian expression in the SCN corresponds well with behavioral circadian oscillation under LL or DD conditions. Thus, the behavioral circadian rhythm seems to correlate with molecular clock works in the SCN.

Feasibility of combination chemotherapy with cisplatin and etoposide for haemodialysis patients with lung cancer

Cancer chemotherapy for haemodialysis patients has never been established. To elucidate the feasibility of cisplatin-based combination chemotherapy for haemodialysis patients with lung cancer, a dose escalation study was conducted. Five haemodialysis patients with lung cancer were treated with cisplatin and etoposide. A starting dose of 40 mg m(-2) of cisplatin on day 1 and 50 mg m(-2) of etoposide on days 1, 3 and 5 were administered as the first course for the first patient. Membrane haemodialysis was regularly performed three times a week and soon after the completion of therapy. By monitoring toxicity and pharmacokinetics data, the dose was escalated course by course and patient by patient. Dose escalation was completed for the first two patients resulting in full-dose chemotherapy consisting of 80 mg m(-2) of cisplatin on day 1 and 100 mg m(-2) of etoposide on days 1, 3 and 5. Multiple courses of the full-dose chemotherapy were administered to the other three patients. Toxicity was manageable and tolerable for all. Pharmacokinetics data were comparable to those from patients with normal renal function, except for potential long-lasting higher levels of free platinum in the renal insufficiency group. In conclusion, this standard-dose combination chemotherapy was feasible even for haemodialysis patients.

Relation between brain oxygen metabolism and temperature gradient between brain and bladder

Brain temperature is slightly higher than systemic core temperature normally. Fluctuations of a temperature gradient between brain and core body have recently been reported after a severe brain insult. The pathophysiological significance of the gradient fluctuations is unclear. This study aims to identify the gradient fluctuations between brain and core temperatures after a brain insult. Temperature gradient (brain temperature minus bladder temperature: degrees C) was measured in 11 patients (125 points) with severe brain injury (4 patients with subarachnoid hemorrhage, 4 with cerebral hemorrhage. and 3 with traumatic brain injury). Cerebral perfusion pressure (CPP; mmHg) and jugular venous blood saturation (SjO2; %) was also measured. The average gradient was 0.29 +/- 0.285 degrees C when CPP was above 50 mmHg. SjO2 was inversely related to the temperature gradient in a significant manner (r = 0.472; P < 0.0001). Temperature gradients tended to increase and then decrease when CPP < 50 mmHg. This study demonstrates that increased temperature gradient has a significant inverse correlation with SjO2 at CPP > 50 mmHg. The current results suggest that the fluctuations in temperature gradient in critical conditions reflect brain ischemia.

Importance of hemodynamics management in patients with severe head injury and during hypothermia

OBJECTIVE

To evaluate the hemodynamics in patients with traumatic brain injury (TBI) during therapeutic hypothermia.

METHODS

Subjects were 25 patients with TBI (GCS; 8 or less). Mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), cardiac index (CI), systemic oxygen delivery (DO2), systemic vascular resistance index (SVRI), and pulmonary capillary wedge pressure (PCWP) were measured. Patients were retrospectively divided into 3 groups: normothermia (n = 5; NT), and survivors (n = 14; HT-S) and non-survivors (n = 6; HT-Non-S) after hypothermia. and hemodynamics were investigated for difference among groups at 24 hours from induction of normothermia or hypothermia.

RESULTS

CPP target was above 70 mmHg, however, HT-Non-S could not maintain CPP above 70 mmHg. The low CPP was the result of elevated ICP, low MAP (P < .05), or both during hypothermia. In HT-Non-S, significantly high SVRI and low CI (P < .05) causing dehydration were observed during cooling. DO2 could not be maintained in HT-Non-S during hypothermia.

CONCLUSIONS

These results suggest that patients run the risk of impairing hemodynamics during therapeutic hypothermia. Hemodynamic management is essential during hypothermia. If dehydration occurs during hypothermia. MAP may be reduced due to inadequate sedation, analgesia, and excess use of diuretic agents.

Changes in cerebrovascular response during brain hypothermia after traumatic brain injury

OBJECTIVE

Transcranial Doppler sonography (TCD) provides a rapid and noninvasive assessment of cerebral hemodynamics after traumatic brain injury. This study evaluates the change of cerebrovascular response at the rewarming stage of brain hypothermia using TCD.

MATERIAL AND METHODS

Seventeen patients who had suffered from closed brain injury were investigated with daily TCD recordings and the changes in flow velocities were evaluated to determine whether they reflected the temperature during brain hypothermia. All patients who had treated brain hypothermia underwent continuous monitoring of SjO2, mean arterial blood pressure, and intracranial pressure (ICP).

RESULTS

No significant changes in ICP and cerebral perfusion pressure (CPP) were recorded in all cases. Of 17 patients, 5 had a significant increase in SjO2 > 75% or more, retrospectively, with a robust increase in flow velocities of the middle cerebral artery (P < .01) at the rewarming stage. These cases marked a decrease in pulsatility index (P < .05) concomitant with an increase in SjO2 values. The CT scan revealed acute brain swelling in these cases.

CONCLUSION

These data suggest cerebral vasoactivity could be altered at the rewarming stage. Hypothermia runs a risk of hyperemia at the rewarming stage, which induced a decrease in cerebral vasoresistance.

Pituitary adenylate cyclase-activating polypeptide produces a phase shift associated with induction of mPer expression in the mouse suprachiasmatic nucleus

The main mammalian circadian pacemaker is located in the suprachiasmatic nucleus of the hypothalamus. Clock genes such as the mouse Period gene (mPer) play a role in this core clock mechanism in the mouse. With brief light exposure during the subjective night, the photic information, which is conveyed directly to the suprachiasmatic nucleus via the retinohypothalamic tract, results in mPer1 and mPer2 expression in the suprachiasmatic nucleus. Glutamate and pituitary adenylate cyclase-activating polypeptide (PACAP) are co-stored in the retinohypothalamic tract. Recent studies have suggested that not only glutamate but also PACAP are key players in the phase shift that occurs during subject night; however, research demonstrating a direct association between the PACAP-induced phase shift and mPer gene expression has yet to be conducted. In the present study, PACAP (200 pmol) injected into the lateral ventricle during subjective night (circadian time 16; circadian time 12, onset of locomotor activity) caused a moderate phase delay associated with moderate expression of mPer1 and only slight expression of mPer2 in the mouse suprachiasmatic nucleus. PACAP-induced mPer1 expression was also observed in the paraventricular nucleus and periventricular area of the hypothalamus. (+)MK-801 (0.5 mg/kg), an N-methyl-D-aspartate (NMDA) receptor antagonist, suppressed both the PACAP-induced phase delay and mPer1 expression. From these results we suggest that PACAP induces phase delays in the mouse circadian rhythm in association with an increase of mPer expression in the suprachiasmatic nucleus via the activation of NMDA receptors.

[Assessment of mode of recurrence after surgical treatment for thymic carcinoma]

In order to establish an appropriate treatment for thymic carcinoma, clinical courses of 15 patients with type C thymoma of WHO classification were reviewed. Five-years survival rate in all patients was 37.6%. In cases underwent complete resection, survival was 48.5%. The induction chemotherapy was done in 7 cases, and complete resection was possible in all these cases, suggested the possibility of improving the survival by the induction therapy. Upper mediastinal lymph node dissection each performed in 9 cases, and they showed significantly better survival than those without lymph node dissection. In conclusion, we have found that induction chemoradiotherapy and complete tumor resection with lymphnode dissection would contribute to improvement of the results in treatment for thymic carcinoma.

Comparison of the histological and histochemical properties of skeletal muscles between carbon dioxide and electrically stunned chickens

1. Histological and histochemical profiles of Musculus pectoralis (PT, type IIB fibres), M. iliotibialis lateralis (ITL, types IIA + IIB fibres) and M. puboischiofemoralis pars medialis (PIF, type I fibres) were compared in carbon dioxide (37%, 70 s) and electrically (14 V, 5 s) stunned male chickens. 2. Muscle materials were taken at 0, 4 and 24 h from carcases dressed and cooled with ice-water mixture for 30 min. Glycogen and fat contents, and adenosine triphosphatase and reduced nicotinamide adenine dinucleotide dehydrogenase activities of fibres were measured. 3. In PT muscle at 0 h, gas stunned chickens showed many fibres with high glycogen content but those electrically stunned contained few such fibres. Fibres from gas stunned birds had lost almost all their glycogen after 24 h of cold storage. 4. In the ITL muscle of gas stunned chickens at 0 h residual glycogen was observed in type IIB fibres. In contrast, in the electrically stunned birds it was in type IIA, showing the different effects of the stunning methods. During cold storage, glycogen disappeared earlier in type IIB than IIA fibres. 5. In PIF muscle with fibres of low glycogen content, the gas stunned chickens maintained a good fibre structure for 4 h or more, but the electrically stunned had already lost intact fibre structure at 4 h. 6. These results indicated that the carbon dioxide stunning was a better method for chicken welfare and meat quality than electrical stunning.

Effects of insulin-like growth factor on nitrogen balance during hypoxic exposure

Acute exacerbations of chronic obstructive pulmonary disease (COPD) accompanied with hypoxaemia may induce net protein catabolism and hypoxaemia could be an important trigger of a systemic catabolic response. The aim of this study was to examine the anabolic effects of recombinant human insulin-like growth factor-I (IGF-1) in rats exposed to hypoxia. Although acute hypoxia is usually accompanied with a decrease in dietary intake, the usual nitrogen intake was maintained in this study. Sprague-Dawley rats were maintained by continuous infusion of solution for total parenteral nutrition for 6 days. The animals were then randomly assigned to a normoxic (N) or a hypoxic (H) group. During the last 3 days of the experiment N and H rats were randomised to receive either IGF-I or vehicle. Exposure to hypoxia caused a decrease in body-weight gain accompanied by a negative nitrogen balance, which was mainly due to increased urinary nitrogen excretion. No effect of recombinant human IGF-I treatment on body weight was observed during exposure to hypoxia, although nitrogen balance normalised. The co-infusion of recombinant human insulin-like growth factor-1 and total parenteral nutrition has a significant net anabolic effect, as demonstrated by nitrogen retention and reduction in urine protein excretion observed in rats. Insulin-like growth factor-1 may help to ameliorate the protein catabolism observed under hypoxic conditions.

Glomerular structural changes and structural-functional relationships at early stage of diabetic nephropathy in Japanese type 2 diabetic patients

Details of renal structural changes and structural-functional relationships at the early stage of diabetic nephropathy (DN) in type 2 diabetes are not well known. The present review focuses on these topics from previous studies using light and electron microscopic morphometric analysis. Glomerular hypertrophy, one of the histological changes in DN, is present in type 2 as well as in type 1 diabetic patients. However, mechanisms of increased glomerular size might be different from those in type 1 diabetes. Other typical glomerular changes, glomerular basement membrane thickening and mesangial expansion, are present in normoalbuminuric type 2 diabetic patients as a group. However, these parameters are similar between normo- and microalbuminuric patients. Renal structural-functional relationships cannot be seen in type 2 diabetic patients and therefore urinary albumin might not be a reliable indicator for glomerular structural changes in type 2 diabetic patients. Although previous reports showed reversibility of advanced diabetic glomerulosclerosis in type 1 diabetes by 10 years of strict glycemic control, there is no report regarding histological reversibility by therapeutic interventions in type 2 diabetic patients. In addition, it is unclear whether DN lesions are concordant or discordant with diabetic retinopathy grade in type 2 diabetes. From this information, renal structural changes or structural-functional relationships in type 2 diabetic patients might be heterogeneous and different from those in type 1 diabetic patients. Careful longitudinal study of renal structure and function including serial renal biopsy at the early stage of DN in type 2 diabetes is necessary.