Lanthanum Deposition in the Stomach: Usefulness of Scanning Electron Microscopy for Its Detection

After having been treated with lanthanum carbonate administration for 4 years for hyperphosphatemia, a 75-year-old Japanese woman undergoing hemodialysis was diagnosed with lanthanum phosphate deposition in the stomach. The deposition, seen as white microgranules, was observed using esophagogastroduodenoscopy with magnifying observation. To the best of our knowledge, these are the minutest endoscopy images of lanthanum phosphate deposition in the gastric mucosa. Scanning electron microscopy (SEM) observation enabled easier identification of the deposited material, which was visible as bright areas. The present case suggests the usefulness of SEM observation in the detection of lanthanum phosphate deposition in the gastrointestinal tract.

Disordered Route to the Coulomb Quantum Spin Liquid: Random Transverse Fields on Spin Ice in Pr_{2}Zr_{2}O_{7}

Inelastic neutron scattering reveals a broad continuum of excitations in Pr_{2}Zr_{2}O_{7}, the temperature and magnetic field dependence of which indicate a continuous distribution of quenched transverse fields (Δ) acting on the non-Kramers Pr^{3+} crystal field ground state doublets. Spin-ice correlations are apparent within 0.2 meV of the Zeeman energy. A random phase approximation provides an excellent account of the data with a transverse field distribution ρ(Δ)∝(Δ^{2}+Γ^{2})^{-1}, where Γ=0.27(1)  meV. Established during high temperature synthesis due to an underlying structural instability, it appears disorder in Pr_{2}Zr_{2}O_{7} actually induces a quantum spin liquid.

Abstract OT1-02-01: Phase II neoadjuvant trial of nanoparticle almumin-bound paclitaxel and trastuzumab in patients with node-negative, Her-2 positive breast cancer (OMC-BC04)

Background: Neoadjuvant chemotherapy plus trastuzumab results in a 30% to 50% pathologic complete response (pCR) rate in HER-2 positive breast cancer and has been associated with improved therapeutic outcomes. Thus, the pCR rate can be useful in evaluating novel agents in this patient population. Albumin-bound (nab)-paclitaxel can reduce the toxicity of Paclitaxel while maintaining its efficacy. We reported that neoadjuvant therapy using Anthracycline based regimens (EC,AC,FEC) followed by a combination with nab-Paclitaxel and Trastuzumab was effective and safe by OMC-BC01 Study (Tanaka et al. Clin Breast Cancer 15:191-196). The pCR rate was 36% and 71% in the patients with estrogen receptor-positive and negative cancer, respectively. In addition, Tolaney et al. showed that adjuvant Paclitaxel and Trastuzumab for node-negative, HER-2 positive tumors measuring up to 3 cm in greatest dimension was associated with patients outcomes that were better than expected on the basis of historical data (Tolaney et al. N Engl J MED.2015 Jan 8:372(2):134-141). We conducted a clinical Phase II, multicenter, neoadjuvant trial of combination with nanoparticle albumin-bound Paclitaxel and Trastuzumab in patients with node-negative, Her-2 positive, estrogen receptor-negative breast cancer measuring up to 3 cm in greatest dimension.

Patients and Methods: nab-Paclitaxel and Trastuzumab as neoadjuvant therapy in patients with Her-2 positive, node-negative, estrogen receptor-negative breast cancer measuring up to 3 cm in greatest dimension. Patients are treated with neoadjuvant nab-Paclitaxel (260mg/m2) and Trastuzumab q21d x 4, and undergo surgery 4-6 weeks later from completing chemotherapy. The primary endpoint, pCR is defined as no evidence of invasive tumors in the final surgical sample both in the breast and axillary lymph nodes. Secondary endpoints include objective clinical response rate, histological response rate, disease-free interval, rate of breast conserving surgery, and the safety of the treatment.

Accrual: Presently, a total number of 1 patient have been included since start of the study. The expected end of accrual of 30 patients will be the last quarter 2018.

Citation Format: Iwamoto M, Tanaka S, Koda C, Kawaguchi K, Terasawa R, Sato N, Fujioka H, Kimura K, Uchiyama K. Phase II neoadjuvant trial of nanoparticle almumin-bound paclitaxel and trastuzumab in patients with node-negative, Her-2 positive breast cancer (OMC-BC04) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-02-01.

A Rare Case of Diffuse Large B-cell Lymphoma in a Patient with IgG4-Related Autoimmune Pancreatitis

A 61-year-old Japanese man with IgG4-related autoimmune pancreatitis was referred to our hospital because of perspiration during food intake. Abdominal computed tomography (CT) with contrast media revealed multiple mesenteric lymphadenopathies. An open surgical abdominal biopsy and subsequent histopathological analysis revealed abnormally large lymphoid cells that were negative for CD3, CD5, and c-myc and positive for CD20 and bcl-2, leading to a diagnosis of diffuse large B-cell lymphoma. Here, we discuss the risk of malignancies, particularly malignant lymphoma in patients with IgG4-related disease. The importance of pathological analysis to reach the appropriate diagnosis in such cases should be emphasized.

Proliferative Enteropathy caused by Lawsonia intracellularis in Chickens

Proliferative enteropathy (PE) is an infectious disease caused by Lawsonia intracellularis (Li), an obligate intracellular bacterium. PE is endemic in swine herds and has been reported in a variety of mammals including horses, hamsters, rabbits, rats, guinea pigs, ferrets, foxes, dogs, sheep, deer and non-human primates. Avian cases are reported only in ratite birds, including emus and ostriches. Some studies show an absence of Lawsonia spp. infection in chickens. In this study, we performed morphological and bacteriological examinations on the intestines of two broiler chickens that had been condemned at a poultry slaughter plant in Japan due to intestinal haemorrhage, which was a result of focal coccidial enteritis. Histopathology revealed proliferation of the villous epithelium in the small and/or large intestines, especially the caeca, regardless of coccidial lesions. Warthin-Starry silver staining and immunohistochemistry using anti-Li monoclonal antibody revealed numerous bacteria and/or antigens in the villous epithelium. Scanning electron microscopy and transmission electron microscopy revealed the presence of curved rods, morphologically compatible with Li, in the apical cytoplasm of the epithelium. Polymerase chain reaction products specific for Li were amplified from DNA samples extracted from formalin-fixed and paraffin wax-embedded tissue. These results suggest that Li can cause PE, characterized by proliferation of the villous epithelium, in chickens.

Three-Dimensional Demonstration of Liver and Spleen by a Computer Graphics Technique

Three-dimensional demonstration of the liver and spleen has been developed using a computer graphics technique. Three-dimensional models were constructed from organ-surface information derived from computed tomographic images. Three-dimensional images could be displayed as wire-frame or solid models on a color display tube. After examining the accuracy of this technique using a liver phantom, this technique was applied to the human liver and spleen. The anatomic surface of the liver and spleen appeared realistic when viewed from any direction. In liver cirrhosis, abnormal configuration of the liver and spleen was vividly demonstrated. The liver was displayed as a wire-frame, while a hepatoma was presented as a solid form in the same image. This combined display clarified the intrahepatic location of the hepatoma together with its configuration. It is thus expected that this technique will prove clinically useful in the noninvasive evaluation of patho-morphologic changes in the liver and spleen.

Computer-Aided Interpretation of Coronary Cineangiograms

To accurately diagnose stenotic lesions on coronary cineangiograms, an automatic detection method using computer image processing was developed. We evaluated its accuracy by comparing the results of computer-aided interpretation (CAI) with those obtained independently by 3 observers. Evaluation was performed on 129 segments from 27 arteries visualized on angiograms obtained in 18 patients. The detection rates of stenosis of the 3 observers by pure visual interpretation were 7.0%, 27.9%, and 17.1%, and using CAI 40.0%, 42.6%, and 47.3%. By computer recognition alone, a detection rate of 51.9% was achieved. The agreement by at least 2 observers (consensus) on the sites with lesions was 41.1% while the consensus of computer recognition regarding the sites with lesion was 40.3%. Therefore, our findings indicated that computer recognition of cineangiograms is likely to result in overdetection of lesions. However, all 3 observers detected stenotic lesions better with CAI than with pure visual interpretation. Accordingly, CAI may improve the reliability of cineangiographic diagnosis.

Angiographic A-V Shunt during Interventional Thrombolysis for Acute Cerebral Embolism

In order to predict the post-therapeutic hemorrhagic complication of interventional thrombolysis, we retrospectively examined angiographic findings and other factors in 44 patients with acute cerebral embolism. All patients were super selectively catheterized within 5 hours of onset and received a fixed regimen of urokinase or t-PA, unless recanalization was achieved or deterioration was apparent before total infusion. Immediate post-therapeutic CT scan revealed hematoma within the basal ganglia in 10 patients (group 1) and no hemorrhage in the remaining 34 (group 2). A series of angiograms during the therapy showed A-V shunt from lenticulostriate arteries to thalamostriate vein in 7 of 10 cases in group 1; no case in group 2 was accompanied by such abnormal shunt.

Prognosis after the therapy was worse in group 1 than in group 2. No other factors, such as therapeutic timing after the disease onset or total doses of urokinase or t-PA infused, differed between the two groups. These findings indicate that angiographic A-V shunt during therapy is a predictive sign of a high incidence of hemorrhagic complication.

We recommend performing several angiographic controls during therapy and when A-V shunt is detected, the therapy should be discontinued to prevent hemorrhage which leads to a poor prognosis.

Increased Serum KL-6 Levels Induced by Pulmonary Mycobacterium Avium Complex Infection in a Patient with RA-associated Lung Disease

KL-6 is a glycoprotein found predominantly on type II pneumocytes and alveolar macrophages, and often shows increased serum levels in patients with interstitial pneumonia. We report a case of mycobacterium avium complex (MAC) infection whose disease activity was correlated with KL-6 levels in serum. During treatment of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) with prednisolone, chest image findings improved in association with decreased KL-6 levels. Following tapering of prednisolone, chest image findings deteriorated again as levels of KL-6 increased, suggesting recurrence of RA-ILD. Bronchoscopic examination revealed active MAC infection. Treatment of MAC infection not only improved chest image findings but also decreased KL-6 levels in serum, suggesting that KL-6 was increased by active MAC infection by itself, not by recurrence of RA-ILD. To the best of our knowledge, this is the first documentation of KL-6 elevation in serum in association with active MAC infection.

Long-term prognosis of IgA nephropathy presenting with minimal or no proteinuria: A single center experience

The long-term prognosis of patients with IgA nephropathy (IgAN) who present with preserved renal function and minimal proteinuria is not well described. We investigated the long-term outcomes of IgAN patients with an apparently benign presentation and evaluated prognostic factors for renal survival and clinical remission. We studied Japanese patients with biopsy-proven IgAN who had an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m² and proteinuria <0.5 g/day at the time of renal biopsy. The renal biopsies were reviewed using the Oxford classification. Twenty patients met the inclusion criteria. At diagnosis, the median eGFR (interquartile range) was 76.8 (65.2–91.1) mL/min/1.73 m², and the median proteinuria level was 0.31 (0.16–0.39) g/day. Only one patient had an increase in serum creatinine of over 50% and no patient progressed to end-stage renal disease. The 15-year renal survival rate was 93.8%. Clinical remission was observed in 9 (45%) patients. Baseline proteinuria was the only factor significantly associated with the absence of clinical remission. The long-term prognosis of Japanese patients with IgAN who presents with minor urinary abnormalities and preserved renal function is excellent.

Endoscopic detection of the gastric lesions of peripheral T-cell lymphoma

An 82-year-old Japanese man presented with a gastric involvement of peripheral T-cell lymphoma, not otherwise specified. Although gastrointestinal lesions were not detected on computed tomography, oesophagogastroduodenoscopy revealed a slight elevation of the gastric mucosa, with changes in mucosal colour and the presence of abnormal microvessels. This led to the prompt detection of gastric involvement in lymphoma. This case highlights the usefulness of detailed observation of the gastric mucosa for the endoscopic detection of gastric involvement of peripheral T-cell lymphoma.