Case report: A surgically treated case of diaphragmatic clear cell carcinoma without relation to endometriosis

INTRODUCTION AND IMPORTANCE

Diaphragmatic tumor is a rare neoplastic disease. Only three reports have revealed diaphragmatic primary clear cell carcinoma. On the other hand, secondary membranous nephropathy is sometimes triggered by the carcinoma. We describe a case of primary diaphragmatic clear cell carcinoma without relation to endometriosis or ovarian malignancies, and secondary membranous nephropathy was triggered by diaphragmatic primary clear cell carcinoma.

CASE PRESENTATION

A 67-year-old woman was found to have membranous nephropathy due to examination for renal dysfunction. A rare diaphragmatic tumor was identified on CT scan for rule out secondary membranous nephropathy. She had underwent resection of the right diaphragm tumor and reconstruction with expanded polyterafluoroethylene (e-PTFE).

CLINICAL DISCUSSION

Pathological examination revealed the presence of clear cells with papillary arrangement and no findings of the endometriosis. Immunohistochemistry revealed that the tumor was positive for CK7, p53, and HNF-1-beta. And there had been no evidence of ovarian malignancies. A diagnosed of clear cell carcinoma of the right diaphragm without relation to endometriosis or ovarian malignancies was made. After resection of the tumor, it was revealed that her renal function was improvement.

CONCLUSION

This is the first report of diaphragmatic clear cell carcinoma without relation to endometriosis or ovarian malignancies that caused secondary membranous nephropathy. One year after the resection of the tumor, she is being followed up and has shown no signs of recurrence.

Equation of State of Liquid Water Written by Simple Experimental Polynomials and the Liquid-Liquid Critical Point

Experimental and theoretical evidence has been accumulating to support the liquid-liquid critical point (LLCP) hypothesis for water. However, no agreement has yet been reached on the pressure and temperature of LLCP. Here we made simple experimental equations that reproduced the volume of liquid water measured over a wide pressure-temperature range. They were polynomials that calculate pressure using volume and temperature as variables, and coefficients were determined by the method of least-squares. We analyzed the polynomials by changing the volume data and the number of terms in the polynomials and extrapolated them slightly to low temperatures. Consequently, the available experimental volume of liquid water indicated (but did not prove) the existence of LLCP at low temperature. Representative polynomials suggested that LLCP locates around 105 ± ∼ 9 MPa, 207 ± ∼ 5 K, and 0.993 ± ∼ 0.009 cm³/g.

Simultaneous nodular lymphocyte-predominant Hodgkin lymphoma with papillary thyroid carcinoma: a case report

We herein report the case of a 48-year-old man diagnosed with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL, Stage IA) and papillary thyroid carcinoma (PTC, Stage I). Total thyroidectomy, left modified neck dissection and biopsy of the right cervical lymph node were performed. Postoperatively, NLPHL treatment was prioritized, and external radiation (30.6 Gy) was applied to the right neck. PTC was considered a high-risk category for recurrence due to extranodal invasion of lymph node metastasis, and radioactive iodine therapy (ablative dose, 1110 MBq) was administered. Both PTC and NLPHL showed no recurrence 18 months after surgery.

Angiomatoid fibrosis histiocytoma in the pulmonary artery: A case report

Angiomatoid fibrosis histiocytoma (AFH) is a rare neoplastic disease. Only one report has demonstrated an intraluminal tumor of the pulmonary artery (PA) corresponding to AFH to date. We describe the case of AFH with EWSR1-CREB1 fusion occurring in the ascending artery. A 42-year-old man exhibited an abnormal nodule on chest computed tomography (CT) during checkup. It revealed an intraluminal mass in the ascending artery with significant metabolic uptake in positron emission tomography (PET)/CT. Therefore, right upper lobectomy with wedge resection of the PA trunk was performed. Histologically, the tumor was multinodular and surrounded by a dense lymphoplasmacytic cuff. Each nodule was composed of myxoid stroma and comprised ovoid or spindle cell fascicles with mild atypia. Fluorescent in situ hybridization (FISH) analysis confirmed EWSR1-CREB1 fusion. A diagnosed as AFH was made. This report widens the spectrum of differential diagnoses of primary tumors occurring in the PA.

A case of anaplastic lymphoma kinase (ALK)-positive ciliated muconodular papillary tumor (CMPT) of the lung

Ciliated muconodular papillary tumor (CMPT) is a rare papillary tumor that arises in the peripheral lung fields and is associated with the proliferation of ciliate d and goblet cells and increased mucin production. We report a case of CMPT involving the rearrangement of the anaplastic lymphoma kinase (ALK) gene. The patient was an 84-year-old Japanese female who had exhibited a small nodular shadow on chest computed tomography during a regular checkup 10 years ago. She underwent a partial resection of segment S10 of the right lung. The cut surface of the surgical specimen revealed a well-circumscribed, jelly-like mass measuring 8 × 8 × 10 mm. Histologically, the tumor was composed of a mixture of ciliated, goblet, and basal cells arranged in a papillary pattern together with pools of mucin. A diagnosis of CMPT was made. The lung tumor cells were subjected to fluorescent in situ hybridization and highly sensitive immunohistochemical staining for the ALK protein, both of which produced positive results. CMPT usually follows a favorable course, but the exact nature of this tumor; i.e., whether it is benign or malignant, has not been established. This is the first reported case of an ALK-positive CMPT.

Effect of water polyamorphism on the molecular vibrations of glycerol in its glassy aqueous solutions

A glassy dilute glycerol-water solution undergoes a mutual polyamorphic transition relating to the transition between high- and low-density amorphous ices of solvent water. The polyamorphic transition behavior depends on the glycerol concentration, indicating that the glycerol affects the water polyamorphism. Here, we used the glassy dilute glycerol-water solution of the solute molar fraction of 0.07 and examined the effect of the polyamorphic change in solvent water on the molecular vibrations of glycerol via Raman spectroscopy. It is found that the molecular vibration of glycerol in high-density liquid like solvent water is different from that in the low-density liquid like solvent water and that the change in the molecular vibration of glycerol is synchronized with the polyamorphic transition of solvent water. The dynamical change of the solute molecule relates to the polyamorphic state of solvent water. This result suggests that the polyamorphic fluctuation of water structure emanated from the presumed liquid-liquid critical point plays an important role for the function of aqueous solution under an ambient condition such as the conformational stability of solute, the functional expression of solute, and so on.

Efficacy of alogliptin, a dipeptidyl peptidase-4 inhibitor, on glucose parameters, the activity of the advanced glycation end product (AGE) - receptor for AGE (RAGE) axis and albuminuria in Japanese type 2 diabetes

BACKGROUND

To examine the effects of alogliptin, a dipeptidyl peptidase-4 inhibitor, on glucose parameters, the advanced glycation end product (AGE)-receptor for AGE (RAGE) axis and albuminuria in Japanese type 2 diabetes patients.

METHODS

Sixty-one patients whose HbAlc  ≥ 6.1% (mean age 64.7 years; 67% men; mean HbAlc 7.4%; 57% were pharmacologically treated) underwent blood and urine sampling and analysis before and after 12 weeks of treatment with alogliptin (25 mg once daily).

RESULTS

Alogliptin treatment significantly reduced fasting glucose (160.3 mg/dL at baseline versus 138.0 mg/dL at 12 weeks), glycoalbumin (21.1% at baseline versus 18.9% at 12 weeks), HbAlc (7.4% at baseline versus 6.9% at 12 weeks), circulating soluble form of RAGE concentrations (847.3 pg/mL at baseline versus 791.4 pg/mL at 12 weeks) and urine albumin to creatinine ratio (31.6 mg/g Cr at baseline versus 26.5 mg/g Cr at 12 weeks), whereas 1,5-anhydroglucitol concentrations were significantly increased (7.5 µg/mL at baseline versus 11.6 µg/mL at 12 weeks; all P < 0.05). Circulating AGEs concentrations were reduced only in patients with baseline AGEs ≥7 U/mL (n = 33, from 8.2 U/mL to 7.2U /mL; p < 0.01) after alogliptin treatment. The treatment-induced change of soluble form of sRAGE concentrations was associated with changes of 1,5-anhydroglucitol and HbAlc concentrations (rho = -0.32 and 0.29, respectively). Meanwhile, the treatment-induced change of urine albumin to creatinine ratio was associated with a change in the fasting glucose concentration (rho = 0.25; all p < 0.05). During the intervention, alogliptin treatment was well tolerated without any hypoglycemia or side effects.

CONCLUSION

Alogliptin treatment improved the AGE-RAGE axis and reduced albuminuria in Japanese type 2 diabetes patients.

Sudden switchover between the polyamorphic phase separation and the glass-to-liquid transition in glassy LiCl aqueous solutions

Lithium chloride aqueous solutions (LiClaq solutions) below 10 mol.% are vitrified by cooling from room temperature to 77 K at 0.3 GPa. We examine the solvent state of the glassy sample and its transformation by heating at 1 atm using low-temperature differential scanning calorimetry and Raman spectroscopy. This experimental study suggests strongly that the solvent state of the glassy LiClaq solution closely relates to the state of high-density amorphous ice. Moreover, we reconfirm that the separation into the low-density amorphous ice and the glassy highly concentrated LiClaq solution occurs in the glassy dilute LiClaq solution at ∼130 K, not the glass-to-liquid transition which is commonly observed in the glassy LiClaq solution above ∼10 mol.%. In order to interpret the sudden switchover between the glass-to-liquid transition and the phase separation at ∼10 mol.%, we propose a state diagram of LiClaq solution which connects with a polyamorphic state diagram of pure water and discuss a possibility that the electric field induces a polyamorphic transition of water.

Melting of the precipitated ice IV in LiCl aqueous solution and polyamorphism of water

Melting of the precipitated ice IV in supercooled LiCl-H(2)O solution was studied in the range of 0-0.6 MPa and 160-270 K. Emulsified solution was used to detect this metastable transition. Ice IV was precipitated from the aqueous solution of 2.0 mol % LiCl (or 4.8 mol % LiCl) in each emulsion particle at low-temperature and high-pressure conditions, and the emulsion was decompressed at different temperatures. The melting of ice IV was detected from the temperature change of the emulsified sample during the decompression. There was an apparently sudden change in the slope of the ice IV melting curve (liquidus) in the pressure-temperature diagram. At the high-pressure and high-temperature side of the change, the solute-induced freezing point depression was observed. At the low-pressure and low-temperature side, ice IV transformed into ice Ih on the decompression, and the transition was almost unrelated to the concentration of LiCl. These experimental results were roughly explained by the presumed existence of two kinds of liquid water (low-density liquid water and high-density liquid water), or polyamorphism in water, and by the simple assumption that LiCl dissolved maily in high-density liquid water.

Metastable Melting Lines for H2O and the Liquid-Liquid Phase Transition Hypothesis

When ice Ih in an emulsion is compressed below 250 K, it melts to supercooled liquid water, avoiding the formation of other crystal phases. Here, we create emulsified high-pressure ices under high pressure and low temperature, and measure their temperature while these ices are decompressed at a constant rate at different temperatures. We detect metastable melting points of high-pressure ices, and identify their melting lines. We find what could be possibly two new ice phases, and discuss the relationship between decompression-induced melting and decompression-induced amorphization. Finally, we discuss briefly the analysis of experimental data and simulation results that are consistent with the hypothesized “second critical point” with temperature and pressure coordinates of approximately 200 K and 100 Mpa.

Intralobar pulmonary sequestration associated with marked elevation of serum carbohydrate antigen 19-9

This report describes a 62-year-old man who experienced elevated serum carbohydrate antigen 19-9 (CA19-9) levels (>500 U/mL) for 4 years, and was finally diagnosed with right intralobar pulmonary sequestration. Surgery confirmed the presence an aberrant artery arising from the descending thoracic aorta and entering the right lower lobe basal segment. Immunohistochemistry demonstrated markedly positive staining of CA19-9 in the ciliated cylindrical epithelia, alveoli, and mucus in the cysts. After pulmonary resection, CA19-9 levels decreased to within a normal range. Therefore, the cause of the elevated serum CA19-9 levels in this case was almost certainly due to intralobar pulmonary sequestration.

Polyamorphism in water

Water, the most common and important liquid, has peculiar properties like the density maximum at 4 degrees C. Such properties are thought to stem from complex changes in the bonding-network structure of water molecules. And yet we cannot understand water. The discovery of the high-density amorphous ice (HDA) in 1984 and the discovery of the apparently discontinuous change in volume of amorphous ice in 1985 indicated experimentally clearly the existence of two kinds of disordered structure (polyamorphism) in a one-component condensed-matter system. This fact has changed our viewpoint concerning water and provided a basis for a new explanation; when cooled under pressure, water would separate into two liquids. The peculiar properties of water would be explained by the existence of the separation point: the liquid-liquid critical point (LLCP). Presently, accumulating evidences support this hypothesis. Here, I describe the process of my experimental studies from the discovery of HDA to the search for LLCP together with my thoughts which induced these experiments.

Differences between pressure-induced densification of LiCl-H(2)O glass and polyamorphic transition of H(2)O

We perform volumetric measurements of LiCl aqueous solution up to 1.00 GPa in the 100-170 K range, examine the pressure-induced vitrification and densification, and draw the pressure-temperature-volume surface. The pressure-induced vitrification of the solution corresponds to the cooling-induced vitrification of the liquid. We found that the volumetric decrease of glassy solution during the densification is continuous and this behavior depends on the glassy state before the compression. Raman profiles of the glassy solutions before and after the densification are similar. In contrast, the polyamorphic transition from low-density amorphous ice (LDA) to high-density amorphous ice (HDA) is discontinuous and their Raman profile before and after the transition is distinct. These results suggest that the densification relates to the structural relaxation and differs intrinsically from the polyamorphic transition. Furthermore, the densification of HDA is observed under high pressure, suggesting that very high-density amorphous ice (VHDA) may be the densified HDA. In order to recognize a polyamorphic transition under a non-equilibrium condition correctly, evidence of not only large volume change but also some distinct structural changes in glassy state is necessary.

Phase separation in dilute LiCl-H2O solution related to the polyamorphism of liquid water

When an emulsified 4.8 mol % LiCl-H2O solution was cooled under a pressure of 0.35 or 0.45 GPa and decompressed to 0.1 GPa at 142 K, slightly above its glass transition temperature (approximately 140 K at 0.1 GPa), its volume increased suddenly. This was regarded as an appearance of the low-density amorphous ice in the liquid solution as suggested by x-ray and Raman measurements, and this appearance corresponded to the high-to-low-density polyamorphic transition of pure H2O. Hysteresis was considered to accompany this volumetric change. The hysteresis of the liquid transition proves its first-order nature and, as for the solution, this suggests that the transition is a polyamorphic phase separation.

Application of polyamorphism in water to spontaneous crystallization of emulsified LiCl‐H2O solution

Aqueous solutions are widely explained by the hydration or the bound waterfree water notion. Amorphous polymorphism (polyamorphism) in pure water, which is presently under vigorous discussion, may provide a different view over the solutions. Here, I changed pressure, P, temperature, T, and concentration, C, of emulsified LiCl-H2O solutions and studied their freezing by detecting its heat evolution. It was experimentally indicated that the homogeneous nucleation of low-density crystalline ice I (phase Ih or Ic), in pure water and in solutions, connects to the polyamorphic transition of high-density amorphous ice (HDA) to low-density amorphous ice (LDA). Thus, the polyamorphism of water relates to the phase behavior of aqueous solution. In accordance with the recent simulation result, the nucleation was thought to occur in two stages: the appearance of the LDA-like state and the crystallization. Usefulness of the polyamorphic point of view about the solutions was seen.

The glass-to-liquid transition of the emulsified high-density amorphous ice made by pressure-induced amorphization

Emulsified high-density amorphous ice, made by pressure-induced amorphization of emulsified ice Ih, was decompressed at about 160 K. The onset of an endothermic event was observed around 0.4 GPa during the decompression. This is consistent with existence of the glass transition to a liquid state, implying the close relationship between melting and amorphization.

Inguinal herniation in two patients with continuous ambulatory peritoneal dialysis

We report two cases of subacute inguinal swelling in uremic patients on continuous ambulatory peritoneal dialysis (CAPD). Computed tomography, scintigraphy demonstrated a mass in the right groin. Surgical repair of an inguinal hernia resulted in complete resolution of the inguinal swelling. Both patients could restart continuous ambulatory peritoneal dialysis, without complication.

Propagation of the polyamorphic transition of ice and the liquid-liquid critical point

Water has a rich metastable phase behaviour that includes transitions between high- and low-density amorphous ices, and between high- and low-density supercooled liquids. Because the transitions occur under conditions where crystalline ice is the stable phase, they are challenging to probe directly. In the case of the liquids, it remains unclear whether their mutual transformation at low temperatures is continuous, or discontinuous and terminating at a postulated second critical point of water that is metastable with respect to crystallization. The amorphous ices are more amenable to experiments, which have shown that their mutual transformation is sharp and reversible. But the non-equilibrium conditions of these studies make a firm thermodynamic interpretation of the results difficult. Here we use Raman spectroscopy and visual inspection to show that the transformation of high-density to low-density amorphous ices involves the propagation of a phase boundary-a region containing a mixture of both ices. We find that the boundary region becomes narrower as the transformation progresses, and at higher transformation temperatures. These findings strongly suggest that the polyamorphic ice transition is discontinuous; a continuous transformation should occur uniformly over the entire sample. Because the amorphous ices are structurally similar to their supercooled liquid counterparts, our results also imply that the liquids transform discontinuously at low temperatures and thus support the liquid-liquid critical-point theory.

Two distinct raman profiles of glassy dilute LiCl solution

We make glass of dilute LiCl aqueous solution by cooling micrometer-sized droplets of the solution extremely quickly and measure the Raman spectra of the glass. It is found that the OH stretching vibration mode of the glass of dilute solution is composed of the OH stretching vibration mode of pure glassy water and that of the glass of solvent water in the highly concentrated solution. This is consistent with the possibility of the existence of two distinct glassy states of water in dilute LiCL solution at low temperature.

Liquid-liquid critical point in heavy water

According to the liquid-liquid critical-point hypothesis about water, two liquid waters exist at low temperatures and are supposed to be merged at a critical point. The low-temperature metastable melting curves of D2O ices have been measured. It is found that the melting curve of D2O ice III is smoothly curved around 25 MPa and 238 K, whereas the melting curve of D2O ice IV undergoes an abrupt change of slope at 100 MPa and 220 K. This is consistent with the existence of a liquid-liquid critical point in the region between the melting curve of D2O ice III and the melting curve of D2O ice IV.

[The two cases of examination of chemotherapy in advanced gallbladder carcinoma]

Two cases of advanced carcinoma of gallbladder were treated by combination chemotherapy consisting of 5-FU, leucovorin and continuous administration of etoposide. One of the cases was a male 61 years old and another was a female 64 years old, both of whom were diagnosed as inoperable cases by imaging studies. When combination chemotherapy consisting of 5-FU (750mg/day or 1,000mg/day infusion) was given, leucovorin (30mg/day) and etoposide (25mg/day oral or 33mg/day continuous infusion), angiography or other imaging studies pointed out a reduction in their lesions of over 50%, and their QOL was markedly improved.

Visual Observations of the Amorphous-Amorphous Transition in H2O Under Pressure

The vapor-deposited low-density amorphous phase of H(2)O was directly compressed at 77 kelvin with a diamond-anvil cell, and the boundary between the low-density amorphous phase and the high-density amorphous phase was observed while the sample was warmed under compression. The transition from the low-density amorphous phase to the high-density amorphous phase was distinct and reversible in an apparently narrow pressure range at approximately 130 to approximately 150 kelvin, which provided experimental evidence for polymorphism in amorphous H(2)O.

High-Temperature Cubic Boron Nitride P-N Junction Diode Made at High Pressure

A p-n junction diode of cubic boron nitride was made by growing an n-type crystal epitaxially on a p-type seed crystal at a pressure of 55 kilobars and a temperature of about 1700 degrees C. A temperature-difference solvent method was used for the crystal growth, and beryllium and silicon were doped as acceptors and donors, respectively. Formation of the p-n junction was clearly confirmed at 1 bar by rectification characteristics and by existence of a space charge layer of the junction as observed by electron beam induced current measurement. This diode operated at 530 degrees C.