Metastatic hepatocellular carcinoma of the maxillary sinus: a rare autopsy case without lung metastasis and a review

A rare case of metastatic hepatocellular carcinoma (HCC) of the maxillary sinus in a 67-year-old man is reported along with the findings at autopsy. A fine needle aspiration biopsy specimen revealed a characteristic tumour structure resembling primary HCC. At autopsy, metastatic lesions were recognized in the bilateral adrenals, spleen, sternum, vertebrae and lymph node at the lesser curvature of the stomach, but not in the lung, suggesting that the HCC had metastasized to the maxillary sinus via the plexus venous vertebralis and/or the azygos vein, or lymph duct. In our reviewed 29 cases of metastatic HCC in the oro-maxillofacial region, most patients were men in the 50- to 70-year age range. At least 11 cases did not have lung metastasis, and in 18, metastasis to the oro-maxillofacial region was the first sign of HCC. One should be aware of the possibility to encounter the oral lesion as first sign of metastatic HCC.

The transport mechanisms of 222Rn in soil at Tateishi as an anomaly spot in Japan

The (222)Rn concentration profiles in soil have been measured at an anomaly spot in Tateishi, Japan. In winter, the concentrations were low and showed a negative gradient with depth, but in other seasons, the concentration had both positive and negative gradients with depth, and dramatically changed by time. On the assumption that there was ventilation in deep layers and with driving forces of wind and temperatures, these phenomena were successfully explained. This finding would contribute to a numerical model for (222)Rn transport in soil.

Neurological Disorders Identified during Treatment of a SARS-CoV-2 Infection

A 69-year-old man was admitted to our hospital under diagnosis of pneumonia due to severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) (Day 0). He underwent endotracheal intubation from Day 3. Although his respiratory condition improved and anesthetic drugs were discontinued, no cough reflex was observed despite intubation having been performed until Day 17. His tendon reflexes were also diminished. We suspected that he had developed Guillain-Barré syndrome (GBS), and administered intravenous immunoglobulin from Day 18. The absence of cough reflex improved and extubation was successfully performed on Day 23. Neurological disorders including GBS should be considered when intubated SARS-CoV-2 patients present with a loss of cough reflex during the treatment period.

Instrument performance of a radon measuring system with the alpha-track detection technique

An instrument performance test has been carried out for a radon measuring system made in Hungary. The system measures radon using the alpha-track detection technique. It consists of three parts: the passive detector, the etching unit and the evaluation unit. A CR-39 detector is used as the radiation detector. Alpha-track reading and data analysis are carried out after chemical etching. The following subjects were examined in the present study: (1) radon sensitivity, (2) performance of etching and evaluation processes and (3) thoron sensitivity. The radon sensitivity of 6.9 x 10(-4) mm(-2) (Bq m(-3) d)(-1) was acceptable for practical application. The thoron sensitivity was estimated to be as low as 3.3 x 10(-5) mm(-2) (Bq m(-3) d)(-1) from the experimental study.

Influence of soil environmental parameters on thoron exhalation rate

Field measurements of thoron exhalation rates have been carried out using a ZnS(Ag) scintillation detector with an accumulation chamber. The influence of soil surface temperature and moisture saturation on the thoron exhalation rate was observed. When the variation of moisture saturation was small, the soil surface temperature appeared to induce a strong effect on the thoron exhalation rate. On the other hand, when the variation of moisture saturation was large, the influence of moisture saturation appeared to be larger than the soil surface temperature. The number of data ranged over 405, and the median was estimated to be 0.79 Bq m(-2) s(-1). Dependence of geology on the thoron exhalation rate from the soil surface was obviously found, and a nationwide distribution map of the thoron exhalation rate from the soil surface was drawn by using these data. It was generally high in the southwest region than in the northeast region.

Infrared thermography of bullfrog skeletal muscle at rest and during an isometric tetanus

Heat production in skeletal muscle has been studied with a thermopile consisting of several thermocouples in contact with muscle surface, and the experimental results have been interpreted on the assumption that heat is produced in a uniform manner. In the present study we have examined the temperature distribution of bullfrog sartorius muscle by the technique of infrared thermography, in which muscle temperatures at various regions can be measured and displayed as a thermogram on the monitor screen without thermal contact. It was found that in the muscle at rest and during an isometric tetanus, the temperature was not uniform, but differed from region to region. The amount of heat production during an isometric tetanus also differed from region to region, but the time course of heat production was nearly uniform in every region. By putting position markers on the muscle surface, it was possible to record muscle segment length changes together with temperature changes. It was found that during an isometric tetanus, the tibial region was stretched by the other regions, and the amount of heat produced was significantly greater in the other regions than in the tibial region. The application of infrared thermography in muscle energetics studies seems promising if the sensitivity of infrared detectors is improved.

Marked elevation of carcinoembryonic antigen and carbohydrate antigen 19-9 in the peripheral blood as an initial manifestation of meningeal carcinomatosis

Marked elevation of tumor markers in the peripheral blood was initially a sole manifestation of meningeal carcinomatosis in a man with gastric carcinoma. In addition to extensive meningeal carcinomatosis, no metastatic lesions were found at autopsy other than microscopic infiltration into a tiny paraaortic lymph node. Elevation of these markers in the peripheral blood is best explained by meningeal carcinomatosis. When elevation of these markers is otherwise unexplainable, meningeal carcinomatosis should be considered as a diagnostic possibility even in the absence of neurological symptoms.

Safety and efficacy of tisagenlecleucel in patients with relapsed or refractory B-cell lymphoma: the first real-world evidence in Japan

BACKGROUND

Tisagenlecleucel, an autologous CD19-directed T-cell immunotherapy, can induce a durable response in adult patients with relapsed/refractory (r/r) B-cell lymphoma.

METHODS

To elucidate the outcome of chimeric antigen receptor (CAR) T-cell therapy in Japanese, we retrospectively analyzed the outcomes of 89 patients who received tisagenlecleucel for r/r diffuse large B-cell lymphoma (n = 71) or transformed follicular lymphoma (n = 18).

RESULTS

With a median follow-up of 6.6-months, 65 (73.0%) patients achieved a clinical response. The overall survival (OS) and event-free survival (EFS) rates at 12 months were 67.0% and 46.3%, respectively. Overall, 80 patients (89.9%) had cytokine release syndrome (CRS), and 6 patients (6.7%) had a grade ≥ 3 event. ICANS occurred in 5 patients (5.6%); only 1 patient had grade 4 ICANS. Representative infectious events of any grade were cytomegalovirus viremia, bacteremia and sepsis. The most common other adverse events were ALT elevation, AST elevation, diarrhea, edema, and creatinine elevation. No treatment-related mortality was observed. A Sub-analysis showed that a high metabolic tumor volume (MTV; ≥ 80 ml) and stable disease /progressive disease before tisagenlecleucel infusion were both significantly associated with a poor EFS and OS in a multivariate analysis (P < 0.05). Notably, the combination of these 2 factors efficiently stratified the prognosis of these patients (HR 6.87 [95% CI 2.4-19.65; P < 0.05] into a high-risk group).

CONCLUSION

We report the first real-world data on tisagenlecleucel for r/r B-cell lymphoma in Japan. Tisagenlecleucel is feasible and effective, even in late line treatment. In addition, our results support a new algorithm for predicting the outcomes of tisagenlecleucel.

Transitional cell papilloma in the fossa navicularis is positive for human papillomavirus

Transitional cell papillomas rarely develop in the fossa navicularis of the anterior urethra. We observed such a case of transitional cell papilloma and detected human papillomavirus type 6 (HPV-6) DNA in this papilloma by polymerase chain reaction. To our knowledge this report is the first of HPV-infected transitional papilloma in the anterior urethra.

Thoron exhalation rates in areas of Japan

Thoron exhalation rates were measured with a newly made portable instrument at 33 areas in 7 prefectures of Japan. Thoron exhalation rates ranged from 49 to 4890 mBq m(-2) s(-1). Radon exhalation rates were also measured in many of the areas at the same time and ranged from 2.1 to 11 mBq m(-2) s(-1). Thoron exhalation rates showed a rough correlation with radon exhalation rates. Both exhalation rates also showed a rough correlation with geological features.

The whole blood transcriptional regulation landscape in 465 COVID-19 infected samples from Japan COVID-19 Task Force

Coronavirus disease 2019 (COVID-19) is a recently-emerged infectious disease that has caused millions of deaths, where comprehensive understanding of disease mechanisms is still unestablished. In particular, studies of gene expression dynamics and regulation landscape in COVID-19 infected individuals are limited. Here, we report on a thorough analysis of whole blood RNA-seq data from 465 genotyped samples from the Japan COVID-19 Task Force, including 359 severe and 106 non-severe COVID-19 cases. We discover 1169 putative causal expression quantitative trait loci (eQTLs) including 34 possible colocalizations with biobank fine-mapping results of hematopoietic traits in a Japanese population, 1549 putative causal splice QTLs (sQTLs; e.g. two independent sQTLs at TOR1AIP1), as well as biologically interpretable trans-eQTL examples (e.g., REST and STING1), all fine-mapped at single variant resolution. We perform differential gene expression analysis to elucidate 198 genes with increased expression in severe COVID-19 cases and enriched for innate immune-related functions. Finally, we evaluate the limited but non-zero effect of COVID-19 phenotype on eQTL discovery, and highlight the presence of COVID-19 severity-interaction eQTLs (ieQTLs; e.g., CLEC4C and MYBL2). Our study provides a comprehensive catalog of whole blood regulatory variants in Japanese, as well as a reference for transcriptional landscapes in response to COVID-19 infection.

Measurement of radon concentration in water using the portable radon survey meter

A measurement method for measuring radon in water using the portable radon survey meter (RnSM) was developed. The container with propeller was used to stir the water samples and release radon from the water into the air in a sample box of the RnSM. In this method, the measurement of error would be <20 %, when the radon concentration in the mineral water was >20 Bq l(-1).

A case of successful CAR-T cell therapy for early isolated CNS recurrence of DLBCL with persistent CAR-T cells

Secondary central nervous system (CNS) lymphomas typically require CNS-penetrating drugs; however, the available agents are limited with temporary effects and poor outcomes. Chimeric antigen receptor T (CAR-T) cell therapy (lisocabtagene maraleucel; liso-cel) has been used to treat a few cases of isolated secondary CNS lymphoma. Herein, we report the case of a 66-year-old male diagnosed with diffuse large B-cell lymphoma (Ann Arbor grade IV; R-IPI, good risk; CNS IPI: Intermediate risk) who achieved complete remission (CR) after six courses of R-CHOP therapy. Three months later, he presented with ptosis and eye movement disorder. Systemic CT and bone marrow examination revealed no lymphoma. Although cranial-enhanced MRI showed normal findings, an increased number of B-cells (51/μL) with the original lymphoma phenotype (CD19+CD79a+CD5-CD10-CD20-Igλ+) was detected in cerebrospinal fluid (CSF), indicating an isolated CNS relapse. Seven high-dose methotrexate courses led to partial response. Subsequently, the patient received CAR-T cell therapy with tolerable adverse events - cytokine release syndrome treated with tocilizumab, no immune effector cell-associated neurotoxicity syndrome, and bone marrow failure treated with granulocyte-colony stimulating factor and eltrombopag. Sequential flow cytometry revealed a high peak of CAR-T cells and the presence of residual CAR-T cells in the peripheral blood, indicating immune surveillance of CNS lymphoma by CAR-T cells. This treatment led to a second CR. This case is the first to validate the efficacy and safety of CAR-T cell therapy for isolated secondary CNS lymphoma in clinical practice. Future accumulation of evidence on the efficacy and safety of CAR-T cell therapy is essential.