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Takeguchi-Kikuchi S, Hayasaka T, Katayama T, Kano K, Takahashi K, Saito T, Sawada J, Minoshima A, Sakamoto N, Akasaka K, Miyokawa N, Nishino I, Ishibashi-Ueda H, Hasebe N. Anti-signal Recognition Particle Antibody-positive Necrotizing Myopathy with Secondary Cardiomyopathy: The First Myocardial Biopsy- and Multimodal Imaging-proven Case. Intern Med 2019; 58:3189-3194. [PMID: 31292376 PMCID: PMC6875452 DOI: 10.2169/internalmedicine.2564-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
A 69-year-old Japanese woman was admitted to our hospital with progressive muscle weakness and dysphagia. She was taking pitavastatin for dyslipidemia. Her serum creatine kinase was 6,300 U/L. Pitavastatin was stopped, but her symptoms deteriorated, and cardiac congestion appeared. A muscle biopsy showed necrotizing myopathy (NM), and anti-signal recognition particle (SRP) antibody was positive. 18F-fluorodeoxyglucose-positron emission tomography showed an abnormal uptake, and magnetic resonance imaging showed abnormal gadolinium enhancement in the left ventricular wall. An endomyocardial biopsy revealed inflammatory cardiomyopathy. Steroid, tacrolimus, and intravenous immunoglobulins were effective against the symptoms. This is the first case of biopsy-proven secondary cardiomyopathy due to anti-SRP-positive NM.
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Affiliation(s)
- Shiori Takeguchi-Kikuchi
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Taiki Hayasaka
- Division of Cardiology, First Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Takayuki Katayama
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Kohei Kano
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Kae Takahashi
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Tsukasa Saito
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Jun Sawada
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Akiho Minoshima
- Division of Cardiology, First Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Naka Sakamoto
- Division of Cardiology, First Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Kazumi Akasaka
- Division of Cardiology, First Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Naoyuki Miyokawa
- Department of Clinical Pathology, Asahikawa Medical University, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Japan
| | | | - Naoyuki Hasebe
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Japan
- Division of Cardiology, First Department of Internal Medicine, Asahikawa Medical University, Japan
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Abstract
Birch pollen is a very common cause of nasal allergy (pollinosis) not only in Scandinavia, Europe, Canada, and the northern part of the United States but also in Hokkaido, Japan. Although there are many papers describing the association of HLA antigens and pollinosis caused by many other allergens, there is no report about the association of HLA antigens and birch pollen allergy. In this paper, we performed an HLA population study of birch pollen-allergic patients in Japan and their pattern analysis of HLA-DRB and HLA-DQB gene by the Southern blot hybridization technique. Our population study data indicated that the HLA-DR9 and HLA-DQw3 phenotypes strongly associated with the development of birch pollen allergy in Japanese subjects. By restriction fragment length polymorphism pattern analysis, some restriction fragments of the HLA-DQB gene were detected only in the patient group. These data suggested that there was a significant association between HLA class II antigens and the development of birch pollen allergy in Japanese subjects.
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Affiliation(s)
- Megumi Kumai
- Department of Otolaryngology, Asahikawa Medical School, Asahikawa, Japan
| | - Naoyuki Miyokawa
- Department of Pathology, Asahikawa Medical School, Asahikawa, Japan
| | - Toshihide Adachi
- Department of Otolaryngology, Asahikawa Medical School, Asahikawa, Japan
| | - Makoto Katagiri
- Department of Pathology, Asahikawa Medical School, Asahikawa, Japan
| | - Tokuji Unno
- Department of Otolaryngology, Asahikawa Medical School, Asahikawa, Japan
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Hayashi S, Abe M, Takahashi N, Okazaki S, Ishibashi K, Kitada M, Miyokawa N. [Intrapulmonary Thymoma Suspected of Malignancy]. Kyobu Geka 2017; 70:1079-1082. [PMID: 29249786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 68-year-old woman was found a nodule of the right lower lobe. Malignancy was suspected by positive positron emission tomography-computed tomography finding. Wedge resection was performed to establish the diagnosis, and the pathological diagnosis was a type AB thymoma. At 13 months after operation, no recurrence was observed.
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Affiliation(s)
- Satoshi Hayashi
- Respiratory Center, Asahikawa Medical University, Asahikawa, Japan
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Yamamoto M, Xin B, Watanabe K, Ooshio T, Fujii K, Chen X, Okada Y, Abe H, Taguchi Y, Miyokawa N, Furukawa H, Nishikawa Y. Oncogenic Determination of a Broad Spectrum of Phenotypes of Hepatocyte-Derived Mouse Liver Tumors. Am J Pathol 2017; 187:2711-2725. [PMID: 28964793 DOI: 10.1016/j.ajpath.2017.07.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/27/2017] [Accepted: 07/28/2017] [Indexed: 12/11/2022]
Abstract
Activation of the phosphoinositide 3-kinase-AKT, Yes-associated protein (YAP), and MYC pathways is involved in human liver cancers, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). However, the nature of the interactions among these pathways has remained poorly understood. Herein, we demonstrate the coordination of these pathways during the formation of mouse liver tumors induced by hepatocyte-specific somatic integration of myristoylated AKT, mutant YAP, Myc, or their combinations. Although the introduction of YAP or Myc alone was inefficient in inducing tumors, these proteins accelerated tumorigenesis induced by AKT. The generated tumors demonstrated various histological features: low-grade HCC by AKT/Myc, CC by AKT/YAP, and high-grade HCC by AKT/Myc/YAP. CC induced by AKT/YAP was associated with activation of the Notch pathway. Interestingly, the combination of Myc and YAP generated tumors composed of hepatoblast/stem-like cells expressing mRNA for Afp, Dlk1, Nanog, and Sox2 and occasionally forming immature ducts. Finally, immunohistochemical analysis revealed that human HCC and CC were predominantly associated with phosphorylation of S6 and glycogen synthase kinase-3β, respectively, and >60% of CC cases were positive for both phosphorylated glycogen synthase kinase--3β and YAP. Our study suggests that hepatocyte-derived tumors demonstrate a wide spectrum of tumor phenotypes, including HCC, CC, and hepatoblastoma-like, through the combinatory effects of the oncogenic pathways and that the state of the phosphoinositide 3-kinase-AKT pathway is a key determinant of differentiation.
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Affiliation(s)
- Masahiro Yamamoto
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Bing Xin
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Kenji Watanabe
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan; Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Takako Ooshio
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Kiyonaga Fujii
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Xi Chen
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Yoko Okada
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroaki Abe
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Yoshimitsu Taguchi
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Naoyuki Miyokawa
- Department of Surgical Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Furukawa
- Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yuji Nishikawa
- Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Asahikawa, Japan.
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Yoshida R, Sasaki T, Minami Y, Hibino Y, Okumura S, Sado M, Miyokawa N, Hayashi S, Kitada M, Ohsaki Y. Activation of Src signaling mediates acquired resistance to ALK inhibition in lung cancer. Int J Oncol 2017; 51:1533-1540. [DOI: 10.3892/ijo.2017.4140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/04/2017] [Indexed: 11/06/2022] Open
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Hayashi S, Yasuda S, Takahashi N, Okazaki S, Ishibashi K, Kitada M, Miyokawa N. Nodular fasciitis of the breast clinically resembling breast cancer in an elderly woman: a case report. J Med Case Rep 2017; 11:57. [PMID: 28253912 PMCID: PMC5335820 DOI: 10.1186/s13256-017-1219-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nodular fasciitis is a benign reactive proliferative lesion of fibroblast cells, which can occur throughout the body. However, it has rarely been reported in the breast of an elderly woman. CASE PRESENTATION Our patient was an 88-year-old Asian woman who had noticed a mass in her right breast for 1 month before presentation to our hospital. The mass was elastic-hard and 20 mm in size. No qualitative diagnosis was made by core needle biopsy. Because of potentially malignant findings on mammography and ultrasonography, she underwent an excisional biopsy. Microscopically, spindle cell proliferation with abundant elastic fibers were observed. The tumor cells were positive for α-smooth muscle actin and negative for pancytokeratin, β-catenin, and cluster of differentiation 34. Based on these morphological and immunohistochemical features, a diagnosis of nodular fasciitis was made. All resection margins in the specimen were tumor-free. The patient has been disease-free for over 12 months. CONCLUSIONS Nodular fasciitis shows clinical features and imaging findings similar to those of breast cancer. To avoid unnecessary surgery, nodular fasciitis should be taken into consideration when there is spindle cell proliferation found by biopsy.
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Affiliation(s)
- Satoshi Hayashi
- Breast Center, Asahikawa Medical University Hospital, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Shunsuke Yasuda
- Breast Center, Asahikawa Medical University Hospital, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Nana Takahashi
- Breast Center, Asahikawa Medical University Hospital, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Satoshi Okazaki
- Breast Center, Asahikawa Medical University Hospital, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kei Ishibashi
- Breast Center, Asahikawa Medical University Hospital, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Masahiro Kitada
- Breast Center, Asahikawa Medical University Hospital, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Naoyuki Miyokawa
- Department of Pathology, Asahikawa Medical University Hospital, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
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Kano K, Katayama T, Takeguchi S, Asanome A, Takahashi K, Saito T, Sawada J, Saito M, Anei R, Kamada K, Miyokawa N, Nishihara H, Hasebe N. Biopsy-proven case of Epstein-Barr virus (EBV)-associated vasculitis of the central nervous system. Neuropathology 2016; 37:259-264. [PMID: 28004435 DOI: 10.1111/neup.12356] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 01/29/2023]
Abstract
A 75-year-old woman was admitted to our hospital with rapidly deteriorating consciousness disturbance. She had a 7-year history of rheumatoid arthritis (RA), which had been treated with methotrexate (MTX) and prednisolone. Brain T2-weighted MRI showed diffuse high-intensity lesions in the cerebral subcortical and deep white matter, bilateral basal ganglia and thalamus. A cerebrospinal fluid examination revealed elevated protein levels and positive Epstein-Barr virus (EBV) DNA. Human immunodeficiency virus was negative. Brain biopsy showed perivascular lymphocytic infiltration in the parenchyma and meninx with EBV-encoded small RNA (EBER). Since this case did not fulfill the criteria for chronic active EBV infection (CAEBV), she was diagnosed with Epstein-Barr virus (EBV)-associated vasculitis of the central nervous system. High-dose methylprednisolone, acyclovir, ganciclovir and foscarnet were not effective. Although EBV is a causative agent of infectious mononucleosis (IM), lymphomas and nasopharyngeal carcinomas, vasculitic pathology of the central nervous system with EBV reactivation in the elderly is rare. Immunosuppressive drugs such as steroids and MTX are widely used to treat autoimmune disorders, but may exacerbate the reactivation of EBV. This is the first case of biopsy-proven EBV-positive/HIV-negative vasculitis during the treatment of RA with MTX and steroids. This case indicates that EBV-associated vasculitis needs to be considered as a differential diagnosis of CNS vasculitis.
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Affiliation(s)
- Kohei Kano
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Takayuki Katayama
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Shiori Takeguchi
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Asuka Asanome
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kae Takahashi
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Tsukasa Saito
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Jun Sawada
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Masato Saito
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Ryogo Anei
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Kyousuke Kamada
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naoyuki Miyokawa
- Department of Clinical Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroshi Nishihara
- Department of Translational Pathology, Hokkaido University School of Medicine, Sapporo, Japan
| | - Naoyuki Hasebe
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
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Kitada M, Yasuda S, Takahashi N, Okazaki S, Ishibashi K, Hayashi S, Ohsaki Y, Miyokawa N. Non-islet cell tumor hypoglycemia caused by intrathoracic solitary fibrous tumor: a case report. J Cardiothorac Surg 2016; 11:49. [PMID: 27061182 PMCID: PMC4826510 DOI: 10.1186/s13019-016-0463-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 04/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Non-islet cell tumor hypoglycemia (NICTH) is defined as a form of hypoglycemia caused by an extrapancreatic tumor. Solitary fibrous tumor (SFT) associated with hypoglycemia is rare. Case presentation A 76-year-old woman, who had frequently experienced hypoglycemic symptoms such as presyncope for the prior 6 months, visited our hospital to undergo detailed examinations. Her fasting glucose level was low at 49 mg/dl. The blood levels of IRI and C-peptide were also low at 0.2 μU/ml and 0.21 ng/ml, respectively. Chest computed tomography revealed a mass measuring 15 cm in the left thoracic cavity. Percutaneous needle biopsy yielded a diagnosis of intrathoracic SFT associated with NICTH. The tumor was removed by video-assisted thoracoscopic surgery. Histological examination showed a tumor composed of simple spindle-shaped cells with an irregular arrangement. Immunohistochemical staining was positive for CD34, bcl-2, and vimentin and negative for alpha SMA and mesothelin. These results confirmed the diagnosis of SFT. Her hypoglycemic symptoms resolved rapidly after surgery. The clinical course has since remained favorable with no signs of recurrence. Conclusion We report a case of non-islet cell tumor hypoglycemia caused by intrathoracic SFT. The high-molecular-weight IGF-II produced by the tumor has been regarded as the cause of NICTH.
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Affiliation(s)
- Masahiro Kitada
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Shunsuke Yasuda
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Nana Takahashi
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Satoshi Okazaki
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kei Ishibashi
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Satoshi Hayashi
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yoshinobu Ohsaki
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Naoyuki Miyokawa
- Department of Clinical Pathology, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, Japan
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Hanada K, Nishikawa N, Miyokawa N, Yoshida A. Long-term outcome of amniotic membrane transplantation combined with mitomycin C for conjunctival reconstruction after ocular surface squamous neoplasia excision. Int Ophthalmol 2016; 37:71-78. [DOI: 10.1007/s10792-016-0231-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/04/2016] [Indexed: 11/30/2022]
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Affiliation(s)
- Hidetoshi Takahashi
- Department of Dermatology, Asahikawa Medical University, Midorigaokahigashi, Asahikawa, Japan
| | - Masako Hori
- Department of Dermatology, Asahikawa Medical University, Midorigaokahigashi, Asahikawa, Japan
| | - Naoyuki Miyokawa
- Department of Clinical Pathology, Asahikawa Medical University, Midorigaokahigashi, Asahikawa, Japan. E-mail:
| | - Hajime Iizuka
- Department of Dermatology, Asahikawa Medical University, Midorigaokahigashi, Asahikawa, Japan
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Kitada M, Yasuda S, Ishibashi K, Hayashi S, Matuda Y, Ohsaki Y, Miyokawa N. Leiomyoma of the Trachea: a case report. J Cardiothorac Surg 2015; 10:78. [PMID: 26026331 PMCID: PMC4459451 DOI: 10.1186/s13019-015-0283-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
We present a surgical case of a rare primary tracheal tumor. In a 44-year-old asymptomatic man, computed tomography (CT), performed as part of health check-up, revealed a tumor measuring 1.5 cm in diameter in the mediastinal trachea. Biopsy failed to yield a definitive diagnosis, but the tumor tended to grow rapidly; therefore, surgery was performed. Five tracheal rings were resected through median sternotomy, followed by interrupted suture with 3-0 absorbable thread. The postoperative course has been favorable with no evidence of recurrence. The pathological diagnosis was leiomyoma. We report this case with literature review.
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Affiliation(s)
- Masahiro Kitada
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Shunsuke Yasuda
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Kei Ishibashi
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Satoshi Hayashi
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Yoshinari Matuda
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Yoshinobu Ohsaki
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Naoyuki Miyokawa
- Department of Clinical Pathology, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan.
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12
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Makino Y, Tani C, Miyokawa N, Yoshimoto R, Mizumoto K, Eguchi K, Fujishiro D, Kodama S, Kobayashi A, Komura K, Okamoto K, Furukawa H, Haneda M. Multiple Intestinal Ulcers Associated with Primary Epstein-Barr Virus Infection in a Patient with Rheumatoid Arthritis Undergoing Methotrexate Therapy. Intern Med 2015; 54:2851-5. [PMID: 26567997 DOI: 10.2169/internalmedicine.54.4735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 47-year-old woman with a 2-year history of rheumatoid arthritis (RA) undergoing methotrexate treatment developed a perforated ulcer in the ileum for which she underwent emergency surgery. A histological analysis of the extirpated specimen presented a possible Epstein-Barr virus (EBV) infection in the ulcerative lesion without a feature of lymphoproliferative disorder. Interestingly, the patient's serological tests with a paired serum diagnosed a primary EBV infection. The present case emphasizes the importance of being aware of severe enteritis as a possibility for patients with RA, for an accurate diagnosis.
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Affiliation(s)
- Yuichi Makino
- Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Japan
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Furukori M, Imai K, Karasaki H, Watanabe K, Oikawa K, Miyokawa N, Taniguchi M, Furukawa H. Clinicopathological features of small nonfunctioning pancreatic neuroendocrine tumors. World J Gastroenterol 2014; 20:17949-17954. [PMID: 25548493 PMCID: PMC4273145 DOI: 10.3748/wjg.v20.i47.17949] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 05/09/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To present our experiences in studying the clinicopathological features of small nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs).
METHODS: The subjects included 9 patients with NF-pNETs who underwent pancreatectomy between April 1996 and September 2012. The surgical procedure, histopathological findings, and prognosis were assessed.
RESULTS: All tumors were incidentally detected by computed tomography. The median diameter was 10 mm (5-32 mm). One patient was diagnosed with von Hippel-Lindau disease, and the others were sporadic cases. For the histopathological findings, 7 patients were G1; 1 patient was G2; and 1 patient, whose tumor was 22 mm, had neuroendocrine carcinoma (NEC). One patient who had a tumor that was 32 mm had direct invasion to a regional lymph node and 1 patient with NEC, had regional lymph node metastases. Six of the 7 patients with sporadic NF-pNETs, excluding the patient with NEC, had tumors that were smaller than 10 mm. Tumors smaller than 10 mm showed no malignancy and lacked lymph node metastasis.
CONCLUSION: Sporadic NF-pNETs smaller than 10 mm tend to have less malignant potential. These findings suggest that lymphadenectomy may be omitted for small NF-pNETs after further investigation.
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Taniguchi M, Okizaki A, Watanabe K, Imai K, Uchida K, Einama T, Shuke N, Miyokawa N, Furukawa H. Hepatic clearance measured with 99mTc-GSA single-photon emission computed tomography to estimate liver fibrosis. World J Gastroenterol 2014; 20:16714-20. [PMID: 25469042 PMCID: PMC4248217 DOI: 10.3748/wjg.v20.i44.16714] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/03/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical utility of hepatic clearance (HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin (99mTc-GSA) single-photon emission computed tomography (SPECT) to estimate the degree of liver fibrosis.
METHODS: Seventy-eight consecutive patients who underwent initial hepatectomy due to hepatocellular carcinoma were enrolled in this study. Indocyanine green clearance (ICG R15), quantitative indices estimated by 99mTc-GSA [the receptor index (LHL15 and HH15) and HC via SPECT analysis], and conventional liver function tests were performed before hepatectomy. Correlations among the quantitative indices for liver functional reserve, conventional liver function tests, and the degree of liver fibrosis were evaluated.
RESULTS: The degree of liver fibrosis was correlated with ICG R15, HH15, LHL15, and HC. HC showed the best correlation with conventional liver function tests. According to multivariate analysis, HC and LHL15 were significant independent predictors of severe fibrosis. HC was the most valuable index for predicting severe fibrosis.
CONCLUSION: HC measured with 99mTc-GSA SPECT is a reliable index for assessing liver fibrosis before hepatectomy.
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Einama T, Uchida K, Taniguchi M, Ota Y, Watanabe K, Imai K, Karasaki H, Chiba A, Oikawa K, Miyokawa N, Furukawa H. Successful curative resection of gallbladder cancer following S-1 chemotherapy: A case report and review of the literature. Oncol Lett 2014; 8:2443-2447. [PMID: 25360167 PMCID: PMC4214413 DOI: 10.3892/ol.2014.2565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 08/01/2014] [Indexed: 11/05/2022] Open
Abstract
The symptoms of gallbladder cancer (GBC) are vague and non-specific. Therefore, GBC is often detected at an advanced or metastatic stage. The most effective treatment for GBC is surgical resection, however the majority of GBC cases are unresectable at the time of diagnosis. Therefore, numerous GBC patients undergo chemotherapy. This study reports the case of a 60-year-old female with GBC who underwent successful surgical curative resection following a single dose of the chemotherapeutic agent, S-1, twice daily for 4 weeks followed by a 14-day rest period for 36 months. S-1 is a novel orally administered drug composed of a combination of the 5-fluorouracil (5-FU) prodrug, tegafur, 5-chloro-2,4-dihydroxypyridine (CDHP) and oteracil potassium in a 1:0.4:1 molar concentration ratio. The focus of the present study was the candidate factors that affect the therapeutic efficacy of S-1-based chemotherapy. In particular, the gene expression involved in the S-1 metabolic pathway was investigated by assessing the intratumoral dihydropyrimidine dehydrogenase (DPD), thymidylate synthase (TS) and orotate phosphoribosyltransferase gene expression. The surgical specimen exhibited high intratumoral DPD gene expression levels compared with those observed in previously reported non S-1 responsive cases of biliary tract cancer. Due to the results obtained in the current study, we hypothesize that CDHP enhanced the antitumor efficacy of 5-FU by inhibiting the excess DPD protein produced by the tumor.
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Affiliation(s)
- Takahiro Einama
- Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan ; Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805, Japan
| | - Koichiro Uchida
- Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Masahiko Taniguchi
- Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Yu Ota
- Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Kenji Watanabe
- Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Koji Imai
- Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Hidenori Karasaki
- Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Atsushi Chiba
- Digestive Disease Center, Asahikawa City Hospital, Hokkaido 070-8610, Japan
| | - Kensuke Oikawa
- Department of Surgical Pathology, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Naoyuki Miyokawa
- Department of Surgical Pathology, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Hiroyuki Furukawa
- Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
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Kitada M, Hayashi S, Matsuda Y, Ishibashi K, Oikawa K, Miyokawa N. Spindle cell carcinoma of the breast as complex cystic lesion: a case report. Cancer Biol Med 2014; 11:130-3. [PMID: 25009755 PMCID: PMC4069803 DOI: 10.7497/j.issn.2095-3941.2014.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/26/2014] [Indexed: 11/23/2022] Open
Abstract
Spindle cell carcinoma of the breast is a rare tumor. This tumor can proliferate rapidly and cause cystic changes because of internal tissue necrosis. We evaluated a 54-year-old woman with right breast lump. Mammography showed a category four mass with a diameter of 2.5 cm. Ultrasonography (US) revealed a complex cystic lesion, and fine-needle aspiration (FNA) cytology demonstrated bloody fluid and malignant cells. Partial breast resection and sentinel lymph node biopsy were performed. Immunohistology revealed spindle cells with positive results for cytokeratin (AE1/AE3) and vimentin, partially positive results for s-100, and negative results for desmin and α-actin. The pathological stage was IIA, and biochemical characterization showed that the tumor was triple negative. Six courses of FEC-100 chemotherapy (5-fluorouracil 500 mg/m2, epirubicin 100 mg/m2, and cyclophosphamide 500 mg/m2) were administered. Radiotherapy was performed. This case is discussed with reference to the literature.
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Affiliation(s)
- Masahiro Kitada
- 1 Department of Surgery, 2 Department of Clinical Pathology, Asahikawa Medical University, Asahikawa Hokkaido 078-8510, Japan
| | - Satoshi Hayashi
- 1 Department of Surgery, 2 Department of Clinical Pathology, Asahikawa Medical University, Asahikawa Hokkaido 078-8510, Japan
| | - Yoshinari Matsuda
- 1 Department of Surgery, 2 Department of Clinical Pathology, Asahikawa Medical University, Asahikawa Hokkaido 078-8510, Japan
| | - Kei Ishibashi
- 1 Department of Surgery, 2 Department of Clinical Pathology, Asahikawa Medical University, Asahikawa Hokkaido 078-8510, Japan
| | - Keisuke Oikawa
- 1 Department of Surgery, 2 Department of Clinical Pathology, Asahikawa Medical University, Asahikawa Hokkaido 078-8510, Japan
| | - Naoyuki Miyokawa
- 1 Department of Surgery, 2 Department of Clinical Pathology, Asahikawa Medical University, Asahikawa Hokkaido 078-8510, Japan
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Kanno K, Minami-Hori M, Ishida-Yamamoto A, Komura K, Oikawa K, Miyokawa N, Iizuka H. Cutaneous lesions of Kikuchi's disease: Evolution of histopathological findings. J Dermatol 2014; 41:736-8. [DOI: 10.1111/1346-8138.12557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 06/05/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Kyoko Kanno
- Department of Dermatology; Asahikawa Medical University; Asahikawa Japan
| | - Masako Minami-Hori
- Department of Dermatology; Asahikawa Medical University; Asahikawa Japan
| | | | - Keiji Komura
- Department of Internal Medicine; Asahikawa Medical University; Asahikawa Japan
| | - Kensuke Oikawa
- Department of Pathology; Asahikawa Medical University; Asahikawa Japan
| | - Naoyuki Miyokawa
- Department of Pathology; Asahikawa Medical University; Asahikawa Japan
| | - Hajime Iizuka
- Department of Dermatology; Asahikawa Medical University; Asahikawa Japan
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18
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Sawada J, Orimoto R, Misu T, Katayama T, Aizawa H, Asanome A, Takahashi K, Saito T, Anei R, Kamada K, Miyokawa N, Takahashi T, Fujihara K, Hasebe N. A case of pathology-proven neuromyelitis optica spectrum disorder with Sjögren syndrome manifesting aphasia and apraxia due to a localized cerebral white matter lesion. Mult Scler 2014; 20:1413-6. [PMID: 24986696 DOI: 10.1177/1352458514540834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A woman with Sjögren syndrome manifesting as aphasia with a left deep cerebral white matter lesion tested positive for anti-aquaporin 4 (AQP4) antibody. Open biopsy of the lesion revealed active demyelination with edematous changes and the preservation of most axons, indicating a non-necrotic demyelinating lesion. Immunostaining for AQP4 was diffusely lost, whereas the loss of glial fibrillary acidic protein immunostaining was limited but with highly degenerated astrocytic foot processes in perivascular areas. These results suggested neuromyelitis optica spectrum disorder (NMOSD) pathology rather than Sjögren-related vasculitis. Only cerebral cortical symptoms with a cerebral white matter lesion could be observed in NMOSDs.
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Affiliation(s)
- Jun Sawada
- Division of Neurology, Asahikawa Medical University, Japan
| | | | - Tatsuro Misu
- Tohoku University Graduate School of Medicine, Japan
| | | | | | - Asuka Asanome
- Division of Neurology, Asahikawa Medical University, Japan
| | - Kae Takahashi
- Division of Neurology, Asahikawa Medical University, Japan
| | - Tsukasa Saito
- Division of Neurology, Asahikawa Medical University, Japan
| | | | | | | | | | | | - Naoyuki Hasebe
- Division of Neurology, Asahikawa Medical University, Japan
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Takahashi F, Miura E, Shibukawa K, Chinda J, Miyokawa N, Imamoto C, Kikuchi K, Hasebe N. Monitoring with serum SP-A, SP-D, and KL-6 in a patient with interstitial pneumonia complicated with ANCA-associated glomerulonephritis. CEN Case Rep 2014; 3:5-9. [PMID: 28509235 DOI: 10.1007/s13730-013-0074-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 03/01/2013] [Indexed: 11/26/2022] Open
Abstract
A 69-year-old woman was admitted to hospital, complaining of fatigue and dry cough. Her renal function deteriorated rapidly, and the laboratory findings showed elevated myeloperoxidase-specific anti-neutrophil cytoplasmic antibody (ANCA). Renal biopsy examination revealed crescentic glomerulonephritis (pauci-immune type), and linear opacities and a honeycomb appearance in both lower lobes was evident on the chest computed tomography scan. The patient was diagnosed as having ANCA-associated glomerulonephritis complicated with mild interstitial pneumonia (IP). Treatment with methylprednisolone pulse therapy improved both her renal function and IP, but her lung lesions worsened during the course of tapering the prednisolone doses. After careful observation, her IP improved gradually without specific treatment. Worsening or improvement of her lung lesions was accompanied by changes in the serological markers of IP, namely, surfactant protein-A, surfactant protein-D, and KL-6. We found that monitoring these markers was helpful in diagnosing and managing IP in our patient with ANCA-associated vasculitis.
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Affiliation(s)
- Fumihiko Takahashi
- Cardiovascular, Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
- Department of Cardiovascular Medicine, Rumoi City Hospital, 2-16, Shinonome-cho, Rumoi, 077-8511, Japan.
| | - Eriko Miura
- Cardiovascular, Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kiyoko Shibukawa
- Cardiovascular, Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Junko Chinda
- Cardiovascular, Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Naoyuki Miyokawa
- Department of Surgical Pathology, Asahikawa Medical University, Asahikawa, Japan
| | | | - Kenjiro Kikuchi
- Cardiovascular, Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Naoyuki Hasebe
- Cardiovascular, Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
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20
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Hayashi S, Kitada M, Ishibashi K, Matsuda Y, Miyokawa N. Combined large cell neuroendocrine carcinoma with giant cell carcinoma of the lungs: a case report. World J Surg Oncol 2013; 11:205. [PMID: 23957954 PMCID: PMC3751810 DOI: 10.1186/1477-7819-11-205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 08/07/2013] [Indexed: 11/10/2022] Open
Abstract
Combined large cell neuroendocrine carcinoma of the lungs (combined LCNEC) with giant cell carcinoma is extremely rare. A 65-year-old man was found to have an abnormal shadow in his left lung field. Computed tomography revealed a solid, round mass measuring 2.8 × 2.2 cm that was located in the left S9. The patient underwent left lower lobectomy and mediastinal lymph node dissection. Histopathological examination revealed an LCNEC, combined with giant cell carcinoma. The patient received by S-1 (TS-1, an oral fluoropyrimidine) chemotherapy, and he has been disease-free for over 8 months. Combined LCNEC with giant cell carcinoma is an extremely rare tumor with high malignant potential, and thus, multidisciplinary therapy and close follow-up are advised.
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Affiliation(s)
- Satoshi Hayashi
- Respiratory Center, Asahikawa Medical University Hospital, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, Japan.
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21
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Kitada M, Matuda Y, Hayashi S, Ishibashi K, Oikawa K, Miyokawa N, Ohsaki Y. IgG4-related lung disease showing high standardized uptake values on FDG-PET: report of two cases. J Cardiothorac Surg 2013; 8:160. [PMID: 23800259 PMCID: PMC3717047 DOI: 10.1186/1749-8090-8-160] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/21/2013] [Indexed: 01/06/2023] Open
Abstract
Immunoglobulin G4 (IgG4)-related lung disease is a disease in which IgG4-positive plasma cells and lymphocytes infiltrate lung tissues along with immunohistochemically evident fibrous interstitial proliferation in the background, in addition to hyper-IgG4 disease. The diagnosis of this disease can be difficult. Here, we report 2 cases with IgG4-related lung disease that was difficult to differentiate from malignant tumors because both cases had pulmonary lesions showing high standardized uptake values (SUV) on positron emission tomography (PET). Case 1: A 75-year-old man under treatment for autoimmune pancreatitis and diabetes mellitus was noted to have multiple nodular opacities in both lungs and a mass density in the right paravertebral region on computed tomography (CT). As high SUVmax was noted for both lesions on exploration by fluorodeoxyglucose (FDG)-PET/CT, an advanced malignant tumor was diagnosed and a video-assisted thoracoscopic (VATS) biopsy was performed and diagnosed IgG4-related lung disease. Case 2: A 48-year-old woman consulted our clinic with a chief complaint of bloody sputum. Chest CT revealed a mass density with 12-, 13-, and 16-mm spiculations in the S2 segment of the right upper lobe and irregular thickening of the pleura including the paravertebral region. The lesion was a mass showing high SUV in the S2 segment on FDG-PET. Malignancy was suspected from the imaging findings, and a VATS biopsy was performed and diagnosed IgG4-related lung disease. Actively undertaking VATS biopsy in cases with this disease is valuable for making the differential diagnosis between malignant tumors and IgG4-related lung disease, since the diagnosis can be difficult in some patients showing high SUV.
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Affiliation(s)
- Masahiro Kitada
- Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido 078-8510, Japan.
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22
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Hirai N, Takaaki S, Minami Y, Kitada M, Miyokawa N, Ohsaki Y. Abstract 4209: Genotypic agreement between histological specimen and preoperative cytology in small lung adenocarcinoma. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-4209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Histological subtype and genotype is critical for making treatment decisions and improving patient outcomes in non-small cell lung cancer (NSCLC). Approximately 70% of lung cancers are diagnosed in advanced stages where small biopsies and cytological specimens are the only source of material for both diagnosis and genotyping. Patients with specific gene alterations in epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) likely receive more benefit from EGFR TKI or ALK TKI therapy, respectively. Although, genotyping agreement from cytological and histological samples is critical, more investigational studies need to be explored to assess the concordance of genotype. Purpose. We performed a comparing investigation on concordance rate for pathological diagnosis and EGFR gene mutation status between surgical specimen and preoperative cytological specimen in small lung cancer. Additionally we reviewed immunohistochemical (IHC) staining with two different ALK specific antibodies. Materials and Methods. 55 patients who had surgically resected small (≦3cm) lung adenocarcinoma with known preoperative bronchial brushing cytology were examined retrospectively. IHC staining was conducted by mutation-specific antibodies using E746-A750 deletion and L858R for EGFR or 5A4 and D5F3 for ALK. DNA analysis was performed by PNA-RNA PCR clamp assay. Results. 1) Diagnostic concordance rate between cytological and histological specimen was 90.9%. Disagreement cases were included one case of squamous cell carcinoma, two cases of small cell carcinoma, one case of melanoma and one case of mucoepidermoid carcinoma by cytology. 2) In IHC positive for mutation-specific EGFR antibodies, the sensitivity was 83% in E746-A750 and 100% in L858R, respectively. In EGFR IHC positive cases, well to moderate differentiation were dominant. 3) In ALK IHC, one case was observed stronger cytoplasmic staining in D5F3 than 5A4. Furthermore, the cribriform pattern was observed in H&E staining. Distinctive cytological feature was not observed. Conclusion. Our results showed that high genotype concordance rates of histology and cytology agreement in small lung adenocarcinoma.
Citation Format: Noriko Hirai, Sasaki Takaaki, Yoshinori Minami, Masahiro Kitada, Naoyuki Miyokawa, Yoshinobu Ohsaki. Genotypic agreement between histological specimen and preoperative cytology in small lung adenocarcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4209. doi:10.1158/1538-7445.AM2013-4209
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Ogino J, Asanuma H, Hatanaka Y, Matsuno Y, Gotoda H, Muraoka S, Tsuji T, Fukazawa Y, Yamashiro K, Kondo N, Iwaki H, Miyokawa N, Hasegawa T. Validity and reproducibility of Ki-67 assessment in gastrointestinal stromal tumors and leiomyosarcomas. Pathol Int 2013; 63:102-7. [PMID: 23464967 DOI: 10.1111/pin.12038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 01/21/2013] [Indexed: 12/16/2022]
Abstract
With the aim of standardizing Ki-67 immunohistochemistry, we assessed interobserver and interlaboratory variability of the Ki-67 labeling index and Ki-67 score among eight general pathologists for 24 gastrointestinal stromal tumors (GISTs) and 12 leiomyosarcomas, which were predominantly of the gastrointestinal (GI) tract, mesentery and retroperitoneum, based on a review of a tissue microarrays subjected to immunohistochemistry with antibodies for Ki-67. For Ki-67 immunostaining of mesenchymal tumors of the GI tract, including GISTs, differences were seen in the scores given by regional hospitals. Conversely, for two categories of the Ki-67 labeling index, namely <10% and ≥10%, concordance of the Ki-67 score between microscopic observation and image analysis, and between the observers, was good, but it was not good for the other four categories of the index for <5%, 5-9%, 10-29%, and ≥30%. The concordance of the Ki-67 scores between the observers in two categories was higher using the Ki-67 pre-stained tissue microarrays (TMAs) within each participating institute than that using the Ki-67 stained TMAs between the participating institutes. The reproducibility of a 10% cut-off value for the Ki-67 labeling index to predict the prognosis of GISTs was relatively high, but there is an urgent need to standardize the staining technique.
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Affiliation(s)
- Jiro Ogino
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
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24
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Akasaka K, Saito E, Higuchi T, Yanagiya T, Nakamori R, Kawabata N, Tokusashi Y, Miyokawa N, Hasebe N. Aortic regurgitation caused by fibrous strand rupture in a fenestrated aortic valve. J Echocardiogr 2012; 10:151-3. [PMID: 27278355 DOI: 10.1007/s12574-012-0148-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/08/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
Fibrous strand rupture in a fenestrated aortic valve can cause acute severe aortic regurgitation. We report the case of a 56-year-old woman with severe aortic regurgitation. Transesophageal echocardiography showed an abnormal fibrous strand echo on the prolapsed left coronary cusp (LCC). The operative finding revealed one ruptured fibrous strand attached to the LCC at the commissure between the left and noncoronary cusps. Pathologic examination of the aortic valve revealed myxomatous degeneration.
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Affiliation(s)
- Kazumi Akasaka
- Medical Laboratory and Blood Center, Asahikawa Medical University Hospital, 2-1-1-1 Midori-ga-oka Higashi, Asahikawa, 078-8510, Japan.
| | - Erika Saito
- Department of Internal Medicine, Cardiovascular Respiratory and Neurology Division, Asahikawa Medical University, 2-1-1-1 Midori-ga-oka Higashi, Asahikawa, 078-8510, Japan
| | - Takaya Higuchi
- Medical Laboratory and Blood Center, Asahikawa Medical University Hospital, 2-1-1-1 Midori-ga-oka Higashi, Asahikawa, 078-8510, Japan
| | - Takako Yanagiya
- Medical Laboratory and Blood Center, Asahikawa Medical University Hospital, 2-1-1-1 Midori-ga-oka Higashi, Asahikawa, 078-8510, Japan
| | - Rie Nakamori
- Medical Laboratory and Blood Center, Asahikawa Medical University Hospital, 2-1-1-1 Midori-ga-oka Higashi, Asahikawa, 078-8510, Japan
| | - Naoko Kawabata
- Department of Internal Medicine, Cardiovascular Respiratory and Neurology Division, Asahikawa Medical University, 2-1-1-1 Midori-ga-oka Higashi, Asahikawa, 078-8510, Japan
| | - Yoshihiko Tokusashi
- Department of Pathology, Asahikawa Medical University Hospital, 2-1-1-1 Midori-ga-oka Higashi, Asahikawa, 078-8510, Japan
| | - Naoyuki Miyokawa
- Department of Pathology, Asahikawa Medical University Hospital, 2-1-1-1 Midori-ga-oka Higashi, Asahikawa, 078-8510, Japan
| | - Naoyuki Hasebe
- Department of Internal Medicine, Cardiovascular Respiratory and Neurology Division, Asahikawa Medical University, 2-1-1-1 Midori-ga-oka Higashi, Asahikawa, 078-8510, Japan
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25
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Hanada K, Miyokawa N, Sano A, Igarashi S, Yoshida A. [Fungal dacryocystitis with cacosmia after penetrating keratoplasty--taxonomy and identification of pathogenic fungi based on DNA sequence analysis]. Nippon Ganka Gakkai Zasshi 2012; 116:1144-1149. [PMID: 23379204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CASE A 76-year-old woman with a history of penetrating keratoplasty had cacosmia associated with dacryocystitis. Two species of yeast-like fungi were isolated from the contents of her lacrimal sac. Each cultured fungus had a unique, distinctive odor. Althogh treated with an oral antifungal agent and washing of the nasolacrimal duct, the cacosmia was not improved. The continuous dacryocystitis with cacosmia was treated by dacryocystectomy. Two yeast-like fungi were again isolated from the contents of the lacrimal sac. Pathological examination confirmed a diagnosis of fungal dacryocystitis based on the fungal hyphae observed on the excised lacrimal sac wall. The cacosmia promptly disappeared. The fungi isolated from the contents of lacrimal sac were identified by DNA sequencing as Wickerhamomyces anamalus (Pichia anomala-Candida pelliculosa) and Galactomyces geotrichum (Geotrichum candidum). CONCLUSION The cause of cacosmia in the present case was fungal dacryocystitis. Antibiotic eye drops and steroid eye drops for the treatment of penetrating keratoplasty can cause atypical fungal presentation in the inconsistently treated lacrimal system and can induce dacryocystitis. Careful usage and consideration is necessary in the long-term use of antibiotics and steroids following corneal transplantation.
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Affiliation(s)
- Kazuomi Hanada
- Department of Medicine and Engineering Combined Research Institute, Asahikawa Medical University, Hokkaido, Japan.
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Ando K, Fujiya M, Ito T, Sugiyama R, Nata T, Nomura Y, Ueno N, Kashima S, Ishikawa C, Inaba Y, Moriichi K, Okamoto K, Ikuta K, Tanabe H, Tokusashi Y, Miyokawa N, Watari J, Mizukami Y, Kohgo Y. A pseudosarcomatous lesion resembling a malignant tumor of the esophagocardiac junction, diagnosed by a total biopsy with endoscopic surgery. Endoscopy 2012; 44 Suppl 2 UCTN:E21-2. [PMID: 22396258 DOI: 10.1055/s-0031-1291502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- K Ando
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Ota Y, Aso K, Watanabe K, Einama T, Imai K, Karasaki H, Sudo R, Tamaki Y, Okada M, Tokusashi Y, Kono T, Miyokawa N, Haneda M, Taniguchi M, Furukawa H. Hepatic schwannoma: Imaging findings on CT, MRI and contrast-enhanced ultrasonography. World J Gastroenterol 2012; 18:4967-72. [PMID: 23002371 PMCID: PMC3447281 DOI: 10.3748/wjg.v18.i35.4967] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/12/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
A primary benign schwannoma of the liver is extremely rare and is difficult to preoperatively discriminate from a malignant tumor. We compared the imaging and pathological findings, and examined the possibility of preoperatively diagnosing a benign liver schwannoma. A 72-year-old woman was admitted to our hospital because of a 4.6-cm mass in the liver. A malignant tumor was suspected, and a right hepatectomy was performed. After this, the diagnosis of a primary benign schwannoma of the liver was made through pathological examination. Contrast-enhanced ultrasonography (CEUS) with Sonazoid showed minute blood flows into the septum and solid areas of the tumor in the vascular phase; most likely due to increased arterial flow associated with infiltration of chronic inflammatory cells. In the postvascular phase, CEUS showed contrast defect of cystic areas and delayed enhancement of solid areas; most likely due to aggregation of siderophores. Because discriminating between a benign and malignant schwannoma of the liver is difficult, surgery is generally recommended. However, the two key findings from CEUS may be useful in discriminating ancient schwannoma by recognizing the hemorrhage involved in the secondary degeneration and aggregation of siderophores.
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Hayashi S, Kitada M, Sato K, Matsuda Y, Ishibashi K, Oikawa K, Miyokawa N, Hirata S. Histological grade as an alternative to the Ki67 labeling index is only available for luminal-type breast cancers. Breast Cancer 2012; 21:47-51. [PMID: 22467403 DOI: 10.1007/s12282-012-0353-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The 2011 St. Gallen Consensus Statement advocated using histological grade (HG) as a proliferation marker of breast cancer (BC) if reliable Ki67 labeling index (Ki67-LI) assessment is not available. However, it has been difficult to evaluate tumor aggressiveness in case of HG2. METHODS A total of 259 cases of BC were assessed for HG, Ki67-LI and other clinicopathological features. The cut point for Ki67-LI was interpreted as low and high using a 14% threshold. RESULTS The average age at diagnosis was 58.2 years (range 28-86); 64.9% of the patients were postmenopausal. Of the 259 cases, 151 were stage I, 78 were stage II, 29 were stage III, and 1 was stage IV. The subtypes based on immunohistochemical staining were 60 cases of luminal A (LA) type (23.2%), 37 cases of luminal B (LB) (HER2-) type (14.3%), 91 cases of LB (HER2+) type (35.1%), 40 cases of human epidermal growth factor receptor 2 (HER2) type (15.4%) and 31 cases of triple negative (TN) type (12%). HG was 1 (89 cases, 34.4 %), 2 (117 cases, 45.2%) and 3 (53 cases, 20.5%). High Ki67-LI cases were observed in HG1 (37.1%), HG2 (56.4%) and HG3 (96.2%). Especially in cases of HG2, high Ki67-LI cases were observed in 0 % of LA type, 100% of LB (HER2-) type, 71.2% of LB (HER2+) type, 68.8% of HER2 type and 40.0% of TN type. The average Ki67-LI was 6.0 ± 3.8 (LA type), 31.4 ± 15.7 [LB (HER2-) type], 20.2 ± 14.8 [LB (HER2+) type], 32.7 ± 21.9 (HER2 type) and 55.7 ± 32.2 (TN type). All LA-type cases and 66.7% of LB (HER2+)-type cases were low Ki67-LI. CONCLUSIONS Our study demonstrates that all LA-type cases and most HG1 of LB (HER2+)-type cases are low proliferative. However, HG was not informative enough for estimating tumor proliferation in cases of LB (HER2-), HER2 and TN types. It is necessary to add other proliferation tools such as the gene expression profiling tool and Ki67-LI except in LA and HG1 of LB (HER2+)-type cases.
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Affiliation(s)
- Satoshi Hayashi
- Breast Center, Asahikawa Medical University Hospital, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan,
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Kitada M, Matsuda Y, Sato K, Hayashi S, Ishibashi K, Miyokawa N, Sasajima T. Mucoepidermoid carcinoma of the lung: a case report. J Cardiothorac Surg 2011; 6:132. [PMID: 21985459 PMCID: PMC3207949 DOI: 10.1186/1749-8090-6-132] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 10/11/2011] [Indexed: 11/10/2022] Open
Abstract
Mucoepidermoid carcinoma of the lung (MEC) is a tumor of low malignant potential of bronchial gland origin. MEC and adenoid cystic carcinoma are both considered to be salivary gland-type neoplasms. MECs are comparatively rare with an incidence of all lung cancers. We recently encountered a case of this type of lung cancer. A 60-year-old man was found to have an abnormal shadow in the left lower lung field on a regular check-up for lung cancer at his company. Chest radiography and CT revealed a mass shadow measuring 30 mm in diameter in the left lower lung field. Bronchoscopy revealed a protuberant tumor in the S9 bronchus, leading to a diagnosis of low-grade MEC by transbronchial lung biopsy. He underwent left lower lobe resection and mediastinal lymph node dissection using VATS. Tumor cells had a scattering of mucus-producing epithelial components in papillary growth of stratified squamous epithelia with anisokaryosis and minimal pleomorphism, indicating a diagnosis of MEC. Because the postoperative course was good and the tumor was low-grade, no adjuvant treatment was administered. The patient has had no signs of tumor recurrence for 9 months, to date, since resection of the tumor.
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Affiliation(s)
- Masahiro Kitada
- Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yoshinari Matsuda
- Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Kazuhiro Sato
- Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Satoshi Hayashi
- Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Kei Ishibashi
- Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naoyuki Miyokawa
- Department of Clinical Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Tadahiro Sasajima
- Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
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Kitada M, Sato K, Matsuda Y, Hayashi S, Miyokawa N, Sasajima T. Role of treatment for solitary pulmonary nodule in breast cancer patients. World J Surg Oncol 2011; 9:124. [PMID: 21989021 PMCID: PMC3198949 DOI: 10.1186/1477-7819-9-124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 10/11/2011] [Indexed: 01/15/2023] Open
Abstract
Background Metastatic pulmonary tumors secondary to breast cancer detected either before or after surgery are predominantly multiple and bilateral. However, in cases detected to have a solitary pulmonary nodule (SPN), determining whether the lesion represents a primary cancer, metastasis, or a benign pulmonary lesion can be difficult. Materials and methods Between January 2000 and December 2009, we performed breast cancer surgery on 1,226 patients, of which 49 cases (3.9%) were detected to have pulmonary lesions before or after the surgery. In 14 of these patients, video-assisted thoracoscopic surgery was performed to remove a SPN. Result Pathological examination of the resected specimens in these 14 cases revealed metastatic pulmonary tumor in 8 cases, primary lung cancer in 3 cases, and benign disease in 3 cases. While lobectomy was performed in one of these patients with metastatic pulmonary tumor, the remaining 7 underwent partial resection of the lung. The primary lung cancer was an adenocarcinoma in all 3 patients, and lobectomy plus mediastinal lymph node dissection was performed in these patients. The tumor grading based on pathological diagnosis was T1N0M0, p-Stage 1A in all 3 patients. The prognosis was good in the breast cancer patients in whom the metastatic lung tumor was a SPN. Conclusion Evaluating the immunohistochemical cytokeratin profile and levels of the TTF-1 and GCDFP-15 of the lesion was useful when distinguishing between pulmonary cancer and metastatic pulmonary tumor. In addition, some patients exhibited changes in the biological properties of the metastatic tumor, and delete tumor resection by video-assisted thoracoscopic surgery can be useful for deciding the drug treatment strategy in some cases
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Affiliation(s)
- Masahiro Kitada
- Department of Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1 Asahikawa Hokkaido 078-8510, Japan.
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Kitada M, Hayashi S, Matsuda Y, Sato K, Miyokawa N, Sasajima T. Surgical treatment of intracystic carcinoma of the breast. World J Surg Oncol 2011; 9:116. [PMID: 21970587 PMCID: PMC3204257 DOI: 10.1186/1477-7819-9-116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 10/04/2011] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Intracystic carcinoma of the breast is a type of breast cancer with favorable prognosis where cancer arises from the cystic wall. However, it is a relatively rare disease, and no general consensus has been reached on its definition, including pathogenesis, extramural invasion, and lymph node metastasis. METHODS Six patients who underwent surgery at the Department of Surgery at Asahikawa Medical University are presented. In each patient, background factors, diagnosis, surgery, pathological diagnosis, and prognosis were investigated. RESULTS Fine needle aspiration showed class V disease in three patients and class III disease in the other three, and lumpectomy was performed for class III patients. Three patients underwent breast-conserving surgery While extramural invasion was seen in three patients, lymph node metastasis was absent in all patients. CONCLUSION When it is difficult to diagnose intracystic carcinoma of the breast by fine needle aspiration, active lumpectomy is necessary. Because extramural invasion and lymph node metastasis have been reported, it is necessary to carefully determine the range of excision and rationally perform lymph node dissection, such as sentinel node biopsy.
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Affiliation(s)
- Masahiro Kitada
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Satoshi Hayashi
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yoshinari Matsuda
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Kazuhiro Sato
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Naoyuki Miyokawa
- Department of Clinical Pathology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Tadahiro Sasajima
- Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Kashima S, Nata T, Fujiya M, Moriichi K, Nomura Y, Ueno N, Itabashi K, Ishikawa C, Inaba Y, Ito T, Okamoto K, Mizukami Y, Ebisawa Y, Chisato N, Kohno T, Tokusashi Y, Miyokawa N, Yamada M, Kohgo Y. Obscure gastrointestinal bleeding occurring 50 years after an appendectomy. Gut 2011; 60:1344, 1403. [PMID: 20542871 DOI: 10.1136/gut.2009.205526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- Shin Kashima
- Department of Medicine, Asahikawa Medical College, Asahikawa, Hokkaido, Japan
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Nishikawa N, Hanada K, Miyokawa N, Tokusashi Y, Yoshida A. Pigmented squamous cell carcinoma in situ of the conjunctiva. Jpn J Ophthalmol 2011; 55:583-584. [DOI: 10.1007/s10384-011-0067-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 05/23/2011] [Indexed: 11/30/2022]
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Sako K, Kimura T, Sawamura A, Yonemasu Y, Takahashi M, Miyokawa N. Prevention of CSF Leakage by Staged Operation for Clival Metastatic Tumor. Skull Base Surg 2011; 7:159-62. [PMID: 17171026 PMCID: PMC1656631 DOI: 10.1055/s-2008-1058608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The transoral approach is a direct route to the clivus. However, application of this approach is infrequent because of the risk of cerebrospinal fluid (CSF) fistula and subsequent meningitis. We report a case of clival metastatic tumor treated by staged operation without CSF leakage. A 39-year-old man was found to have a tumor in clivus extending to the intradural space. Two-staged resection through the lateral suboccipital and transoral approach was performed and the dural defect was replaced by a fascia in the first operation. CSF leakage was prevented by this procedure. The patient received radiotherapy postoperatively.
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Kitada M, Ozawa K, Sato K, Matsuda Y, Hayashi S, Tokusashi Y, Miyokawa N, Sasajima T. Alpha-fetoprotein-producing primary lung carcinoma: a case report. World J Surg Oncol 2011; 9:47. [PMID: 21554678 PMCID: PMC3103442 DOI: 10.1186/1477-7819-9-47] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 05/09/2011] [Indexed: 01/15/2023] Open
Abstract
Alpha-fetoprotein (AFP)-producing lung adenocarcinoma is a rare type of lung cancer, with its characteristics not yet fully clarified. We recently encountered a case of this type of lung cancer. The patient was a 69-year-old man who consulted an internist with the chief complaint of epigastric pain. Chest X-ray and CT revealed a lobulated mass measuring 70 mm in diameter in the right lower lung field and a metastasis in the right hilar lymph nodes. Of the tumor markers, the serum AFP was elevated (4620 ng/ml), and the serum carcinoembryonic antigen and carbohydrate antigen 19-9 were also slightly elevated. Transbronchial lung biopsy revealed the diagnosis of lung cancer. Under thoracoscopic assistance, right lower lobectomy + mediastinal lymph node dissection was carried out. Immunostaining showed the tumor cells to be AFP-positive. The tumor was thus diagnosed as an AFP-producing lung adenocarcinoma. The patient followed an uneventful clinical course after the surgery, with serum AFP decreasing to the normal range by about 2 weeks after the surgery. As of this writing, no sign of tumor recurrence has been noted. This case is presented here with a review of the literature.
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Ando K, Fujiya M, Ito T, Sugiyama R, Nata T, Nomura Y, Ueno N, Kashima S, Ishikawa C, Inaba Y, Moriichi K, Okamoto K, Ikuta K, Mizukami Y, Tokusashi Y, Miyokawa N, Watari J, Kohgo Y. Atypical tumour-like involvement of the colon in secondary systemic amyloidosis which vanished after 1 month of observation. BMJ Case Rep 2011; 2011:2011/mar16_1/bcr0120113775. [PMID: 22699464 DOI: 10.1136/bcr.01.2011.3775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Amyloidosis occurs as a result of the extracellular deposition of protein fibrils in organs and tissues, thus causing mild to severe pathophysiological changes. The gastrointestinal tract is a common site of amyloid deposition. While intestinal amyloidosis frequently results in polypoid lesions, ulcerations, nodules and petechial mucosal haemorrhage, tumour-like lesions are rarely developed and infrequently diagnosed before the resection because of the difficulty in differentiating them from colon cancer. The authors herein reported a case of intestinal amyloid A amyloidosis with a complication of a tumour-like lesion endoscopically resembling a malignant lesion, which was completely diminished after 1 month of observation with bowel rest. Such conservative treatment is a feasible option to cure intestinal tumour-like lesions in patients with intestinal amyloidosis when no neoplastic change is histologically detected, possibly decreasing the need for surgery of the fragile mucosa.
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Affiliation(s)
- Katuyoshi Ando
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
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Kitada M, Ozawa K, Sato K, Hayashi S, Tokusashi Y, Miyokawa N, Sasajima T. Adenoid cystic carcinoma of the peripheral lung: a case report. World J Surg Oncol 2010; 8:74. [PMID: 20796281 PMCID: PMC2936894 DOI: 10.1186/1477-7819-8-74] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 08/26/2010] [Indexed: 11/10/2022] Open
Abstract
Adenoid cystic carcinoma of the peripheral lung is a rare entity. We recently encountered a patient with adenoid cystic carcinoma. A 75-year-old woman showed a nodular lesion with 10 mm in diameter in the right upper lung field on chest radiography. The diagnosis was unclear, but lung cancer could not be ruled out. Thoracoscopic biopsy was performed, and intraoperative pathological diagnosis revealed the carcinoma of the lung. We enforced upper lobectomy and mediastinal lymph node dissection to the patient. Histopathological examination revealed adenoid cystic carcinoma with a characteristic cribriform structure. Immunohistochemical examination revealed that the tumor cells were positive for thyroid transcription factor 1 (TTF-1), this tumor was diagnosed primary ACC of the lung.
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Affiliation(s)
- Masahiro Kitada
- Department of Surgery, Asahikawa Medical University, Asahikawa Hokkaido 078-8510, Japan.
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Ogino J, Asanuma H, Sakurai S, Matsuno Y, Miyokawa N, Yamashiro K, Fukazawa Y, Muraoka S, Iwaki Y, Kondo N, Hasegawa T. Use of tissue microarrays and immunohistochemistry to standardize the diagnosis of gastrointestinal stromal tumors. Pathol Int 2010; 60:707-13. [DOI: 10.1111/j.1440-1827.2010.02585.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yamashita T, Katayama H, Kato Y, Nishiwaki K, Hayashi H, Miyokawa N, Sengoku K. Management of pelvic lymph nodes by sentinel node navigation surgery in the treatment of invasive cervical cancer. Int J Gynecol Cancer 2009; 19:1113-8. [PMID: 19820378 DOI: 10.1111/igc.0b013e3181a83d65] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Diagnosis of lymph node metastasis is a critical issue in the treatment of cervical cancer. Many studies describing sentinel node navigation surgery (SNNS) for examination of node status have been reported in the past decade. In this study, the feasibility of node status diagnosis by SNNS, including intraoperative frozen section diagnosis, in patients with early and advanced cervical cancer was evaluated. PATIENTS AND METHODS Fifty-eight cervical cancer patients with early and advanced stage disease were enrolled. All patients were treated with backup pelvic lymphadenectomy after SNNS. To detect sentinel lymph nodes (SLNs), radioactive material and/or blue dye were used as tracers. Lymph nodes confirmed as SLNs were immediately sent to pathologists and diagnosed by frozen section intraoperatively. RESULTS A total of 118 and 16 SLNs were pathologically investigated in early and advanced stage cervical cancer, respectively. The detection rate of SLNs in the early and advanced stages was 94.7% and 66.7%, respectively, whereas the detection rate using 1 or 2 tracers was 62.5% and 90%, respectively. The false-negative rate and negative predictive value was 0% and 100% for all stages. Pathological diagnosis by frozen section was completed within 30 minutes in all cases. CONCLUSIONS Our data demonstrate that SNNS in cervical cancer is a promising procedure for patients with early stage (up to Ib1) disease, especially patients with small tumor diameter (<2.0 cm). However, SNNS raises several points for discussion before it can be established as a practical clinical procedure or as part of a subsequent radical hysterectomy.
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Affiliation(s)
- Tsuyoshi Yamashita
- Department of Obstetrics and Gynecology, Asahikawa Medical College, Midorigaoka-higashi 2-1-1-1, Asahikawa, Japan.
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Hayashi S, Kitada M, Ozawa K, Sato K, Hirata S, Tokusashi Y, Miyokawa N, Sasajima T. [Solitary fibrous tumor of the visceral pleura being suspected of chest wall origin: report of a case]. Kyobu Geka 2009; 62:1097-1100. [PMID: 19894579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report a case of a solitary fibrous tumor (SFT) of the pleura which is suspected of chest wall tumor. A 52-year-old female was admitted to our hospital because of epigastralgia and body weight loss. Chest X-ray and computed tomography showed a circumscribed mass of 35 x 22 mm in diameter arising from the parietal pleura. Positron emission tomography showed uptake valve of 1.5. SFT of chest wall origin was suspected and performed video-assisted thoracic surgery. The pedunculated tumor attached to the visceral pleura. The tumor was diagnosed as a benign SFT in intraoperative diagnosis. Long term clinical follow-up is recommended for patients with SFT, because the tumor recurrence and malignant transformation may occur in tumors with benign histological features.
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Affiliation(s)
- S Hayashi
- Department of Surgery, Asahikawa Medical College, Asahikawa, Japan
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Shibukawa K, Miyokawa N, Tokusashi Y, Sasaki T, Osanai S, Ohsaki Y. High incidence of chromosomal abnormalities at 1p36 and 9p21 in early-stage central type squamous cell carcinoma and squamous dysplasia of bronchus detected by autofluorescence bronchoscopy. Oncol Rep 2009; 22:81-7. [PMID: 19513508 DOI: 10.3892/or_00000409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Heavy smokers with central type squamous cell carcinoma (SCC) frequently have multiple cancerous lesions in the bronchus. Autofluorescence bronchoscopy (AFB) is useful in the detection of early bronchogenic cancer and dysplastic lesions. We investigated the loss of heterozygosity (LOH) and microsatellite instability (MSI) and expression of four proteins in 13 early stage SCC (early SCC) and 9 squamous dysplasia detected by AFB and 19 cases of surgically resected invasive SCC (invasive SCC). In early SCC and squamous dysplasia, LOH/MSI of chromosome 1p36 was found in 62 and 33%, respectively, and of 9p21 in 54 and 63%, respectively. TAp73 expression of early SCC and squamous dysplasia was lower than that of normal bronchial epithelium, and p16 expression was not detectable in these lesions. These results suggested that the genetic abnormalities had already developed in the early stage of carcinogenesis of SCC, including squamous dysplasia. The AFB system was able to reveal abnormal autofluorescence in these precancerous lesions, including squamous dysplasia.
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Affiliation(s)
- Kiyoko Shibukawa
- Respiratory Center, Asahikawa Medical College, Midorigaoka Higashi, Asahikawa, Japan
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42
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Ishikawa C, Watari J, Ueno N, Konno Y, Sato R, Moriichi K, Okamoto K, Tanabe H, Fujiya M, Tokusashi Y, Miyokawa N, Kohgo Y. [A case report of ball valve syndrome caused by the gastrointestinal stromal tumor arising from the muscularis mucosae in gastric fornix]. Nihon Shokakibyo Gakkai Zasshi 2008; 105:1337-1343. [PMID: 18772574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
An 83-year-old woman who was admitted to other hospital, was consulted us because of continuous tarry stool and abdominal fullness. On upper endoscopy, the submucosal tumor from greater curvature of gastric fornix invaginated into the duodenal bulbus, showing so-called "ball valve syndrome (BVS)". As the tumor incarcerted again on the following endoscoopy, she underwent laparoscopic partial gastrectomy. The submucosal tumor was diagnosed histologically as gastrointestinal stromal tumor (GIST) arising from the muscularis mucosae. This is the first report that GIST arising from the muscularis mucosae in gastric fornix showed a BVS.
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Affiliation(s)
- Chisato Ishikawa
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, Japan
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Karasaki H, Ishizaki A, Yanagawa N, Nakano Y, Sasajima J, Mizukami Y, Tanno S, Tokusashi Y, Miyokawa N, Obara M, Goto J, Kino S, Kono T, Kasai S. [Two cases of pancreatic tumor with von Hippel-Lindau disease]. Nihon Shokakibyo Gakkai Zasshi 2008; 105:725-731. [PMID: 18460863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Von Hippel-Lindau disease (VHL disease) is an inherited neoplasia syndrome. VHL disease which frequently complicates pancreatic lesions is rarely diagnosed by existence of pancreatic involvements. We report two cases of VHL disease with pancreatic lesions. The first patient was a 40-year-old woman. Adrenal pheochromocytoma, spinal hemangioblastoma and pancreatic endocrine tumor were resected. The second case was a 68-year-old woman with past surgical histories included cerebellar and spinal hemangioblastoma. Subtotal pancreatectomy was performed for multiple serous cystadenoma. IPMN which has been never reported as pancreatic involvement of VHL disease were documented by imaging diagnosis in the first case, and by histological examination in the second case. We considered VHL disease from coexistent multiple tumors include pancreatic involvements and finally diagnosed by genetic examination in both cases. Care should be taken regarding the patient's right for treatment against for the genetic disease. We hold a genetic conference composed of multidisciplinary team. Consequently we detected another VHL disease patient from patient's family.
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Affiliation(s)
- Hidenori Karasaki
- Division of Gastroenterologic and General Surgery, Asahikawa Medical College
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Nakanishi K, Ohsaki Y, Kurihara M, Nakao S, Fujita Y, Takeyama K, Osanai S, Miyokawa N, Nakajima S. Color auto-fluorescence from cancer lesions: Improved detection of central type lung cancer. Lung Cancer 2007; 58:214-9. [PMID: 17659811 DOI: 10.1016/j.lungcan.2007.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 01/16/2007] [Accepted: 06/14/2007] [Indexed: 10/23/2022]
Abstract
A fluorescence endoscopic system, PDS-2000, enabled observation of color auto-fluorescence from the human body. We performed a clinical study to determine whether color auto-fluorescence bronchoscopy using PDS-2000 improved the accuracy of central type lung cancer diagnosis, as compared to white light bronchoscopy. White light bronchoscopy followed by auto-fluorescence bronchoscopy was performed in 71 subjects with either bronchogenic cancer, previous lung cancer, bloody sputum or who were at a high risk of developing lung cancer. Findings of white light bronchoscopy and auto-fluorescence bronchoscopy were classified into three categories. Two hundred eighty-eight biopsy specimens were taken from all sites which were considered to be abnormal by white light bronchoscopy as well as by auto-fluorescence bronchoscopy. The pathological findings were classified into nine categories. The sensitivity of only white light bronchoscopy (WLB) regarding the detection of severe dysplasia and cancer was compared with that of only auto-fluorescence bronchoscopy (AFB) and that of WLB+AFB. We quantified color endoscopic fluorescence images and compared the red/green signal intensity ratio (R/G ratio) according to the pathological diagnosis. The pathological diagnosis was normal in 123, inflammation, hyperplasia or metaplasia in 120, mild or moderate dysplasia in 8, severe dysplasia in 14 and cancer in 23. The sensitivity of WLB, AFB and WLB+AFB regarding the detection of severe dysplasia or cancer was 54.1%, 81.1% and 89.2%, respectively. The R/G ratio was significantly increased in the areas with severe dysplasia and cancer.
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Affiliation(s)
- Kyoko Nakanishi
- Respiratory Medicine, Department of Medicine, Asahikawa Medical College, Asahikawa City 078-8510, Japan
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Inagaki M, Obara M, Suzuki S, Ishizaki A, Takahashi K, Matsumoto K, Haneda M, Tokusashi Y, Miyokawa N, Kasai S. Mucinous carcinoma of Vater's ampulla with a unique extension along the main pancreatic duct. J Hepatobiliary Pancreat Surg 2007; 14:518-21. [PMID: 17909724 DOI: 10.1007/s00534-006-1205-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 09/20/2006] [Indexed: 01/13/2023]
Abstract
We report a case of mucinous carcinoma of Vater's ampulla with a unique extension along only the main pancreatic duct (MPD) and microinvasion to the pancreas. A 52-year-old man was referred to our hospital for the evaluation and treatment of acute pancreatitis. Abdominal computed tomography (CT) demonstrated swelling in the head of the pancreas with a mass in the duodenum. Hypotonic duodenography and endoscopic examination revealed a well-defined mass, measuring about 25 mm in size, in Vater's ampulla. A biopsy specimen of the tumor showed moderately differentiated adenocarcinoma. A pylorus-preserving pancreaticoduodenectomy with a regional lymphadenectomy was performed, under a preoperative diagnosis of adenocarcinoma of Vater's ampulla with direct invasion into the head of the pancreas. The resected specimen of the duodenum confirmed the presence of the mass, which measured 22 x 15 mm in size, in Vater's ampulla. Microscopically, the tumor consisted of two components: moderately differentiated adenocarcinoma in the peripheral region of the tumor Vater's papilla and mucinous carcinoma in the central region of the tumor. The mucinous carcinoma component uniquely extended along only the MPD with microinvasion to the pancreas. Immunohistochemically, both the moderately differentiated adenocarcinoma and the mucinous carcinoma were positive for cytokeratin 20 (CK20) and negative for cytokeratin 7 (CK7) which is the pattern of intestinal-type carcinoma of Vater's ampulla. We concluded that the original site of this tumor may have been the duodenal epithelium of Vater's ampulla originally moderately differentiated adenocarcinoma-which subsequently changed to mucinous carcinoma that extended along only the MPD with microinvasion to the pancreas.
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Affiliation(s)
- Mitsuhiro Inagaki
- Department of Surgery, Asahikawa Medical College, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, 078-8510, Japan
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Inagaki M, Goto J, Suzuki S, Ishizaki A, Tanno S, Kohgo Y, Tokusashi Y, Miyokawa N, Kasai S. Gallbladder carcinoma associated with occult pancreatobiliary reflux in the absence of pancreaticobiliary maljunction. ACTA ACUST UNITED AC 2007; 14:529-33. [PMID: 17909727 DOI: 10.1007/s00534-006-1217-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 12/27/2006] [Indexed: 10/22/2022]
Abstract
We herein report a case of gallbladder carcinoma associated with occult pancreatobiliary reflux (PR) in the absence of pancreatobiliary maljunction. A 67-year-old woman was referred to our hospital for the evaluation and treatment of a gallbladder tumor. Ultrasonography and computed tomography showed a nodular lesion in the fundus of the gallbladder, indicating the possibility of a gallbladder carcinoma. Endoscopic ultrasonography showed the nodular tumor and thickness of the surrounding epithelium. Endoscopic retrograde cholangiopancreatography revealed a normal pancreaticobiliary junction without the common channel and a slight dilatation of the common bile duct (15 mm in diameter). An open cholecystectomy and partial resection of the liver bed of the gallbladder with regional lymphadenectomy was performed. A C-tube was inserted from the cut end of the cystic duct into the common bile duct to prevent bile stasis. Biliary amylase and lipase levels sampled in the gallbladder were 2604 IU/l and 775 IU/l, respectively. Biliary amylase level in the bile collected from the C-tube in the common bile duct was 119 550 IU/l on postoperative day (POD) 6 and 22 265 IU/l on POD 12. These observations suggested that PR was present in this patient. The histopathological findings of the resected specimen showed a well-differentiated adenocarcinoma of the gallbladder with invasion to the muscle layer and no metastasis of the resected lymph nodes. A high index of nuclear staining for MIB-I in the cancer cells (about 10%) was exhibited, and a few cells in the normal epithelium also stained positive.
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Affiliation(s)
- Mitsuhiro Inagaki
- Department of Surgery, Asahikawa Medical College, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, 078-8510, Japan
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Ogino T, Moriai S, Ishida Y, Ishii H, Katayama A, Miyokawa N, Harabuchi Y, Ferrone S. Association of immunoescape mechanisms with Epstein-Barr virus infection in nasopharyngeal carcinoma. Int J Cancer 2007; 120:2401-10. [PMID: 17315195 DOI: 10.1002/ijc.22334] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We have investigated the association of immunoescape mechanisms in nasopharyngeal carcinoma (NPC) lesions with Epstein-Barr virus (EBV) infection and clinical course of the disease. Tumor biopsy specimens obtained from 36 Japanese NPC patients were examined for antigen processing machinery component and HLA class I antigen expression, CD8(+) T cell infiltration, and Fas, Fas ligand (FasL) and IL-10 expression using immunohistochemical staining. The results were correlated with the histopathological characteristics of the lesions, the clinical course of the disease and EBV infection. LMP2, TAP1, tapasin and HLA class I antigens were downregulated in more than 65% of the lesions tested, while FasL, Fas and IL-10 were expressed in at least 60% of the lesions. Statistical analysis showed that (i) HLA class I antigen expression was significantly correlated with LMP2 and tapasin expression (r = 0.39 and 0.45, respectively); (ii) CD8(+) T cell infiltration into tumor lesions was significantly correlated with HLA class I antigen, LMP2 and Fas expression (r = 0.34, 0.49 and 0.44, respectively); (iii) LMP2 and FasL expression was significantly correlated with IL-10 expression (r = 0.49 and 0.52, respectively); (iv) IL-10 expression was significantly associated with EBERs and EBV oncoprotein LMP1 expression (p = 0.00078 and 0.015, respectively) and (v) FasL overexpression was significantly associated with reduced patients' survival (p = 0.033). Multivariate analysis identified FasL overexpression as an independent unfavorable prognostic marker. These results suggest that NPC cells may utilize multiple immunoescape mechanisms, including dysfunction of HLA class I antigens and Fas/FasL apoptosis pathways. Furthermore, FasL expression appears to be associated with IL-10 upregulation in EBV positive NPC cells.
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Affiliation(s)
- Takeshi Ogino
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical College, Asahikawa, Japan
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Inagaki M, Obara M, Kino S, Goto J, Suzuki S, Ishizaki A, Tanno S, Kohgo Y, Tokusashi Y, Miyokawa N, Kasai S. Pylorus-preserving total pancreatectomy for an intraductal papillary-mucinous neoplasm of the pancreas. ACTA ACUST UNITED AC 2007; 14:264-9. [PMID: 17520201 DOI: 10.1007/s00534-006-1146-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 06/30/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE Total pancreatectomy (TP) is rarely performed to treat invasive ductal carcinoma of the pancreas, due to the associated markedly impaired quality of life and poor prognosis after the resection. Intraductal papillary-mucinous neoplasm (IPMN) of the pancreas is characterized by extensive intraductal spread and a favorable outcome even when presenting at an invasive stage. We herein reappraise the role of pylorus-preserving total pancreatectomy (PPTP) as a viable alternative pancreatic resection modality for borderline and malignant IPMN. METHODS A total of five patients with IPMN underwent PPTP and their clinical follow-up data were reviewed. RESULTS TP was performed due to recurrent IPMN in the remnant pancreas after distal pancreatectomy in three patients and due to massive involvement of the entire pancreas in the others. All patients were treated by the pylorus-preserving method, while the spleen was also preserved in one patient. The surgical margins were negative and no metastasis to the resected lymph nodes was evident, based on histological examinations. One patient underwent a re-operation due to postoperative intraabdominal bleeding, while another patient required tubedrainage for left pleural effusion. Three of the four patients who underwent PPTP with a splenectomy experienced postoperative gastric ulcer, which were controlled by medication. One patient died due to suicide 16 months after the PPTP. All the others were doing well without recurrence at periods of 62 to 127 months after the PPTP. CONCLUSIONS PPTP is therefore considered to be indicated as an effective treatment for borderline or malignant IPMN with extensive involvement, when the patient's condition permits, in order to achieve complete resection of the IPMN.
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Affiliation(s)
- Mitsuhiro Inagaki
- Department of Surgery, Asahikawa Medical College, 2-1-1-1 Midorigaoka-Higashi, Asahikawa 078-8510, Japan
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Inagaki M, Watanabe K, Yoshikawa D, Suzuki S, Ishizaki A, Matsumoto K, Haneda M, Tokusashi Y, Miyokawa N, Sato S, Kasai S. A malignant nonfunctioning pancreatic endocrine tumor with a unique pattern of intraductal growth. ACTA ACUST UNITED AC 2007; 14:318-23. [PMID: 17520210 DOI: 10.1007/s00534-006-1140-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 06/02/2006] [Indexed: 12/18/2022]
Abstract
The intraductal growth of nonfunctioning pancreatic endocrine tumors (NFPTs) is considered to be rare, and in our survey of the English-language literature, we found only three cases to have been described previously. We herein report the case of a 36-year-old man with a malignant NFPT that uniquely grew within the lumen of the main pancreatic duct (MPD) and completely obstructed the MPD, as shown by endoscopic retrograde pancreatography (ERP). Endoscopic ultrasonography clearly detected the tumor with intraductal growth. In addition, positron emission tomography (PET), using 18F-fluorodeoxyglucose (FDG) and computed tomography (CT) with the same scanner (FDG-PET/CT) showed enhanced uptake of FDG in the tumor. A pylorus-preserving pancreaticoduodenectomy and regional lymphadenectomy were performed under the preoperative diagnosis of an NFPT. Microscopically, positive immunoreactions for synaptophisin and vasoactive intestinal peptide indicated neuroendocrine differentiation of the tumor, while in addition, metastasis to a lymph node along the common hepatic artery was also observed. The patient has survived for 6 months after the surgery without any evidence of recurrence or metastasis. Both ERP and FDG-PET/CT were thus found to be useful for predicting the malignant potential of an NFPT in the preoperative diagnosis.
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Affiliation(s)
- Mitsuhiro Inagaki
- Department of Surgery, Asahikawa Medical College, 2-1-1-1 Midorigaoka-Higashi, Asahikawa 078-8510, Japan
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Inaoka T, Takahashi K, Miyokawa N, Ohsaki Y, Aburano T. Solitary fibrous tumor of the pleura: Apparent diffusion coefficient (ADC) value and ADC map to predict malignant transformation. J Magn Reson Imaging 2007; 26:155-8. [PMID: 17659560 DOI: 10.1002/jmri.20942] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Solitary fibrous tumors (SFTs) of the pleura are rare soft-tissue tumors that are presumed to be of mesenchymal origin. Most SFTs are histologically benign, but up to 20% of SFTs may be malignant. In addition, malignant transformation may occur within histologically benign SFTs, though it is rare. However, it is difficult to diagnose malignant SFTs of the pleura by means of conventional computed tomography and magnetic resonance imaging (MRI). In this article we present the first case of malignant SFT of the pleura in an 81-year-old man in which the apparent diffusion coefficient (ADC) value and ADC map based on diffusion-weighted MRI were very useful for identifying malignant transformation.
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Affiliation(s)
- Tsutomu Inaoka
- Department of Radiology, Asahikawa Medical College, Asahikawa, Japan.
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