bluuebunny/crossref_metadata_2025 huggingface dataset:
Are radiologists meeting the needs of Australian medical oncologists? Results of a national survey
Authors: Koczwara B , Tie M , Esterman A
Published: August 2003

Although radiological evaluation plays an integral role in the management of oncology patients, little is known about which elements of such evaluation are most important or about how satisfied clinicians are with the quality of radiology services in cancer patients. We have developed a 36‐item anonymous survey evaluating availability of and satisfaction with radiology services to medical oncologists. The survey was distributed to members of the Medical Oncology Group of Australia resident in Australia. We received 124 responses (51%). Most respondents (76.9%) were satisfied with their radiology services. Satisfaction correlated closely with the availability of standardized reporting and promptness of reporting (P < 0.001). Oncologists in private practise were more likely to receive prompt reports (P < 0.0001). Oncologists in public practice were more concerned about availability of CT scanning (P = 0.02). Services that were reported as less frequently available, despite being ranked as very important, included measurements of key lesions and comparison to previous studies. Standardized reporting was considered helpful by 91% of respondents. Only 32.5% of respondents reported receiving such a summary in more than 50% of cases and 21% never received such a summary. Our findings highlight the need for closer collaboration between oncologists and radiologists in order to address specific needs and develop optimal patterns of practise. Consideration should be given to standardization of reporting of radiology studies in oncology.
Neurosarcoidosis of the conus medullaris and cauda equina
Authors: Prelog Kristina , Blome Steven , Dennis Christopher
Published: August 2003

An uncommon case of neurosarcoidosis of the conus medullaris and cauda equina is described in a 24‐year‐old man with a 4‐year history of urological symptoms and rash. Chest X‐ray and biopsy confirmed sarcoidosis and MRI diagnosed conus medullaris involvement.
Uterine arteriovenous malformation: A rare cause of uterine bleeding. Diagnosis and treatment
Authors: Clarke Michael J , Mitchell Peter J
Published: August 2003

A case of uterine arteriovenous malformation following a dilatation and curettage is presented. Initial diagnosis with colour and pulsed Doppler ultrasound and treatment with transcatheter arterial embolization are described.
Pelvic chondrosarcoma in an 18‐year‐old man masquerading as tuberculous ilipsoas abscess
Authors: Zacharia Titty Thomas , Lakhar Bhushan , Perumpallichira James Joseph , Chavhan Govind
Published: August 2003

Chondrosarcoma is distinctly uncommon in the younger age group. We report an unusual presentation of pelvic bone chondrosarcoma in an 18‐year‐old man clinically creating an impression of tuberculous abscess, and we discuss the CT and MRI appearances.
Chondrosarcoma of bone complicating Ollier's disease: Report of a favourable response to radiotherapy
Authors: Le Anhchuong , Ball David , Pitman Alex , Fox Richard , King Kevin
Published: August 2003

Because chondrosarcoma of bone is traditionally thought to be a radioresistant malignancy, it is usually managed surgically. We report a case of multifocal chondrosarcoma arising in Ollier's disease for which the patient declined surgery. He was given a course of radical radiotherapy that resulted in symptom palliation and a radiologically confirmed response before he died of disseminated disease. In patients with inoperable chondrosarcoma, radiotherapy can provide palliative benefit.
Leptomeningeal carcinomatosis from squamous cell carcinoma of the supraglottic larynx
Authors: Thompson Stephen R , Veness Michael J , Morgan Gary J , Shannon Jeniffer , Kench James G
Published: August 2003

Leptomeningeal carcinomatosis is an uncommon but devastating form of metastatic spread. To our knowledge, only 16 cases originating from a head and neck cancer have been reported. We describe the first case of a patient with leptomeningeal carcinomatosis arising from a laryngeal squamous cell carcinoma. Shortly after completing treatment for an advanced supraglottic laryngeal cancer, this 63‐year‐old man presented with lower limb neurological symptoms and signs. Radiological and cytological evidence of leptomeningeal carcinomatosis of the distal spinal canal was identified. He was treated with intrathecal methotrexate and palliative radiotherapy. Although his pain improved, his lower limb weakness worsened. He died 3 weeks after completing radiotherapy. Presumed mode of spread was via the haematogenous route. The natural history and management of leptomeningeal carcinomatosis are discussed. Clinicians should be aware of the uncommon possibility of leptomeningeal carcinomatosis in a patient presenting with an appropriate constellation of symptoms and signs, and a past history of cancer.
Stereotactic breast biopsy: An audit of 18 months at BreastScreen Auckland
Authors: Greenberg Darrilyn , Johnston Jane , Hart Rosemary , Weston Margaret , Benson‐Cooper David
Published: August 2003

Stereotactic biopsy has become a widely used technique for marnmographically detected lesions that are clinically and sonographically occult. Vacuum‐assisted (mammotome) biopsy on a dedicated prone stereotactic unit has further increased ease of biopsy and utility of the technique. Results of an 18‐month audit in the national breast screening programme (BreastScreen Auckland and North) in the Auckland region demonstrates results comparable with those achieved elsewhere. Of a total of 399 stereotactic biopsies, 23 were excluded as they were 14‐G core biopsies rather than 11‐G mammotome biopsies. Of 376 mammotome biopsies, 10 (2%) failed, 266 (70.7%) were benign, 39 (10.3%) were atypical ductal hyperplasia (ADH) and 70 (18.6%) were malignant. Of these, 14.6% were ductal carcinoma in situ (DCIS) and 4% were invasive carcinomas. All cases diagnosed as ADH underwent formal excision biopsy. Of the 39 cases, 33 demonstrated benign disease or residual ADH only on excision (84.6%) and six (15.4%) patients were upgraded: five to DCIS and one to invasive carcinoma. The significant complication rate was 0.5%. Indications for biopsy were calcification in 89% of cases, mass lesions in 10.6% of cases and architectural distortion in 0.2% of cases. The failure rate of 2% compares with hookwire biopsy series. Practical issues and protocols have been presented.
Imaging features of primary pulmonary liposarcoma
Authors: Said Mourad , Migaw Hayet , Hafsa Chiraz , Braham Radhia , Golli Mondher , Moussa Adnene , Zakhama Abdelfateh , Elkamel Ali , Gannouni Amor
Published: August 2003

Primary liposarcoma of the lung is extremely rare. We report a 28‐year‐old pregnant woman who complained of dyspnoea during the third trimester. Chest radiography, thoracic ultrasound, CT and MRI showed a huge heterogeneous tumour involving all the left lung and the mediastinum. The tumour was composed of soft tissue, and fatty and cystic components with calcifications. Diagnosis was made on core biopsy under CT guidance. Surgical excision was performed but unfortunately the patient died during the operation.
Esophageal xanthoma: Report of two cases and a review of the literature
Authors: HIROKAWA MITSUYOSHI , TAKENAKA RYUTA , TAKAHASHI AKIRA , SUGIHARA KEIKO , WADA HISANORI , TASHIRO TAKASHI , HORIGUCHI HIDEHISA , WAKATSUKI SHINGO , SANO TOSHIAKI
Published: August 2003

Abstract  So far, three cases of esophageal xanthoma have been reported. We describe here endoscopic, microscopic and immunohistochemical findings of two new cases of this rare condition, and a review of five cases of esophageal xanthoma, including our cases. Esophageal xanthomas endoscopically show yellow granular spots or a slightly elevated lesion, and are similar to an ectopic sebaceous gland. Microscopically, an aggregate of foamy histiocytes (lipid islands) is seen immediately beneath the squamous epithelium, particularly between the rete ridges. Immunohistochemically, xanthoma cells are positive for CD68, which indicate a histiocytic origin. The etiology of esophageal xanthoma remains unclear. We emphasize that esophageal xanthomas may have been erroneously diagnosed as an ectopic sebaceous gland on endoscopic examination.
Of blood and guts: Association between Helicobacter pylori and the gastric microcirculation
Authors: KALIA NEENA , BARDHAN KARNA DEV
Published: August 2003

Abstract  The relative importance of acid in Helicobacter pylori (H. pylori) ulcer pathogenesis is in doubt, with possibilities existing that other contributing factors may be involved. Vascular insufficiency may lead to the development of ischemic lesions or ulcers within the gastric mucosa. H. pylori produces a striking inflammatory response following infection and one of the major components of gastrointestinal inflammation is alterations in the vascular structure and function. This suggests that the microcirculation may be a key target of H. pylori‐released factors. Recent evidence has accumulated to suggest that H. pylori can affect a number of microcirculatory variables including blood flow, leukocyte activity and also induce changes in the endothelial lining of the vessels themselves. The majority of these findings have been described by employing the technique of fluorescent in vivo microscopy, which allows direct, dynamic and real time observations of the microcirculation to be made. A universal feature of these experimental studies has been the formation of circulating or adherent platelet aggregates. It is now recognized that platelets participate in the inflammatory response by acting as a potent source of inflammatory mediators and modulating the activity of other inflammatory cells. Circulation of platelet emboli may be of cause for concern, especially as a number of studies have demonstrated an association between H. pylori infection and coronary heart disease. The present review highlights the major findings from these studies and proposes an important role for the gastric microcirculation in the pathophysiology of H. pylori‐induced injury.
Differential expression of CCR5 and CRTH2 on infiltrated cells in colonic mucosa of patients with ulcerative colitis
Authors: MATSUZAKI KOJI , HOKARI RYOTA , KATO SHINGO , TSUZUKI YOSHIKAZU , TANAKA HIROFUMI , KURIHARA CHIE , IWAI ATSUHIRO , KAWAGUCHI ATSUSHI , NAGAO SHIGEAKI , ITOH KAZURO , NAGATA KINYA , MIURA SOICHIRO
Published: August 2003

Background and Aim:  The pathogenesis of ulcerative colitis (UC) is unclear, but abnormal infiltration of T lymphocytes in the colonic mucosa has been implicated in the mucosal tissue damage. The abnormal cytokine production because of a T helper (h)1/Th2 imbalance may play an important role in continuing inflammation in the colonic mucosa. In the present study, the expression of chemokine receptor 5 (CCR5) as a Th1 marker and a chemoattractant receptor‐homologs molecule expressed on Th2 cells (CRTH2) were investigated in order to analyze impaired Th1/Th2 responses in the colonic mucosa of UC patients.

Methods:  Tissue samples were obtained by colonic biopsies from patients with UC or colonic polyps, with informed consent. Immunohistochemical analysis was performed on periodate, lysine‐paraformaldehyde‐fixed serial cryostat sections using the labeled streptavidin biotin method. Monoclonal antibodies against CD4, CCR5 or CRTH2 were used as primary antibodies. The number of cells expressing CD4, CCR5 or CRTH2 per unit area was calculated by using an image analyzer.

Results:  In the patients with UC, the numbers of CD4‐ and CCR5‐positive cells were significantly increased in inflamed mucosa, and appeared to be correlated with the disease activity. The infiltration of CRTH2‐positive cells was predominantly observed in the mildly inflamed or the margin of inflamed mucosa of UC patients.

Conclusion:  There is a possibility that Th1 responses significantly occur in colonic mucosa with severe inflammation, while Th2 responses mainly occur with mild inflammation in UC patients. The Th1/Th2 imbalance in colonic mucosa may be related to the disease progression of UC.
Effect of Helicobacter pylori infection and low‐dose aspirin use on iron stores in the elderly
Authors: KAFFES ARTHUR , CULLEN JOHN , MITCHELL HAZEL , KATELARIS PETER H
Published: August 2003

Background and Aims:  Helicobacter pylori infection has been associated with lower ferritin levels in some adult populations, but subsets of potentially higher risk subjects, such as the elderly have not been examined. The aim of the present study was to determine the impact of H. pylori infection and low‐dose aspirin use on iron stores in a well elderly population.

Methods:  Consecutive subjects aged 65 years or older attending day care facilities were studied. Each subject was assisted in completing a medical questionnaire. Serum ferritin, hemoglobin, mean corpuscular volumes (MCV) and IgG antibodies (ELISA) against H. pylori were measured.

Results:  In 220 subjects (age 75 ± 8 years), 42% were H. pylori seropositive (male 41%, female 44%). The median (IQR) ferritin level (ug/L) was higher in men 149 (89–280) than women 94 (54–161), p < 0.002. The ferritin levels were not different in H. pylori positive males 151 (105–283) compared with H. pylori negative males 145 (72–249), or H. pylori positive females 93 (60–142) compared with H. pylori negative females 97 (45–149). This relationship was not altered when controlled for non‐steroidal anti‐inflammatory agents (NSAID) use (9% of subjects), alcohol or dietary iron intake. Low‐dose aspirin use was common (28%), but did not have an independent impact on iron stores: male users 181 (95–248), non‐users 145 (86–284); female users 92 (43–162), non‐users 95 (62–163). However, in female aspirin users, H. pylori infection was associated with significantly lower ferritin levels: 65 (43–112) compared with uninfected subjects 103 (41–180), p < 0.04.

Conclusions:  In this well elderly population, the combination of H. pylori infection and low‐dose aspirin use was associated with significantly lower serum ferritin concentrations in females. This difference supports the observation that H. pylori, even in asymptomatic subjects, may be a stressor of iron stores.
p53 expression, K‐ras gene mutation and microsatellite instability in gastric B‐cell lymphomas
Authors: HIYAMA TORU , TANAKA SHINJI , MASUDA HIROSHI , SHIMA HIDEYUKI , KOSE KAZUHIRO , TUNCEL HANDAN , ITO MASANORI , KITADAI YASUHIKO , SUMII MASAHARU , UEMURA NAOMI , YOSHIHARA MASAHARU , SHIMAMOTO FUMIO , HARUMA KEN , CHAYAMA KAZUAKI
Published: August 2003

Background and Aims:  Genetic mechanisms involved in the development of gastric B‐cell lymphomas remain unclear. The aim of the present study was to clarify the roles of mutations of the p53 and K‐ras genes, and microsatellite instability (MSI) in the development of gastric B‐cell lymphomas.

Methods:  We investigated p53 immunoreactivity, mutations of the K‐ras gene, and MSI in 27 gastric marginal zone B‐cell lymphomas of mucosa‐associated lymphoid tissue type (MZBCL) and 24 diffuse large B‐cell lymphomas (DLBCL). p53 immunoreactivity was examined using a monoclonal antibody, DO‐7. Mutation of the K‐ras gene was detected by polymerase chain reaction‐single strand conformation polymorphism (PCR‐SSCP) analysis. MSI was examined at five microsatellite loci with a microsatellite assay. Cases were classified as having high‐frequency MSI (MSI‐H) (≥ 2 loci showing instability), low‐frequency MSI (MSI‐L) (only one locus showing instability), or as microsatellite stable.

Results:  p53 immunoreactivity was detected in 1 of 16 (6%) MZBCL and 8 of 19 (42%) DLBCL. Frequency of p53 immunoreactivity in DLBCL was significantly higher than that in MZBCL (P = 0.018). MSI‐H was detected only in 1 of 20 (5%) DLBCL. None of the cases examined showed mutation of the K‐ras gene.

Conclusions:  These data suggest that mutations of the p53 gene may play an important role in the development of gastric DLBCL, and that mutations of the K‐ras gene and MSI may be involved in little part of the development of gastric B‐cell lymphomas.
Experimental studies on morphological changes of microcirculation of DMN‐induced liver cirrhosis after normothermic ischemia with charge‐coupled device microscope
Authors: SHIMAMOTO TSUYOSHI , MORI YOSHIO , TAKAGI HISATO , YAMADA TAKUYA , SAKAMOTO KENICHI , MATSUO HIROSHI , NITTA TOYOO , MIZUTANI TOMOHIRO , IWATA HISASHI , HIROSE HAJIME
Published: August 2003

Aim:  The purpose of the present experiment was to find indices for intraoperative ischemic‐reperfusion injury in the cirrhotic liver.

Methods:  One percent dimethylnitrosamine (DMN) was administered intraperitoneally to liver cirrhosis (LC) groups of Wister rats on three consecutive days of each week for a period of four weeks. The rats were divided into a N60 group with 60 minute ischemia in normal livers, a LC60 group with 60 minute ischemia in cirrhotic livers, and a LC30 group with 30 minute ischemia in cirrhotic livers. Digital videotapes recorded with a pencil lens‐probe charge‐coupled device (CCD) microscope were analyzed with NIH Image software. In zone 3, the sinusoid diameter (SD) was measured and the volume fraction (Vv) of zone 3 was calculated in preischemia and after 10, 20, 30, and 60 min of reperfusion. At the same time, bile flow was measured.

Results:  The SD was significantly shorter in the cirrhotic liver groups than in the normal liver group at each point. The Vv after 60 min of reperfusion was significantly smaller in the LC60 group, with a survival rate of 0%, than in the LC30 group which had a survival rate of 67%. However, there was no significant difference in bile flow after 60 min of reperfusion in the LC30 and LC60 groups. Therefore, the Vv is suggested to be the better index for viability after ischemic‐reperfusion.

Conclusion:  SD and Vv indicate microcirculatory differences and indices in the normal and cirrhotic livers in preischemia during reperfusion.
Concurrent pancreatic ductal changes in alcoholic liver disease
Authors: KOCHHAR RAKESH , KUMAR SETHY PRADEEPTA , SOOD AJIT , NAGI BIRINDER , SINGH KARTAR
Published: August 2003

Background:  Alcohol is a common etiological factor in both liver disease and chronic pancreatitis, but in a single individual it does not usually produce clinically significant disease in both organs. We assessed the prevalence of pancreatic ductal changes in patients presenting with alcoholic liver disease of different stages.

Methods:  Forty‐six patients with alcoholic liver disease were included in the present study. Liver biopsy was performed in patients with normal coagulogram. Endoscopic retrograde pancreatogram was performed in all patients and changes in chronic pancreatitis were noted.

Results:  Of the 46 patients with alcoholic liver disease, 31 had cirrhosis of the liver, nine had fatty liver and two patients had alcoholic hepatitis. Twenty (43.47%) patients had features of chronic pancreatitis on endoscopic retrograde pancreatogram and these consisted of minimal pancreatitis changes in 10 patients, moderate changes in nine patients and advanced changes in one patient. There was no difference in the prevalence of pancreatitis changes in cirrhotics in comparison to non‐cirrhotics. There was no correlation between the amount and length of alcohol intake and changes in pancreatitis.

Conclusion:  Pancreatic ductal changes on endoscopic retrograde pancreatogram are common in patients with alcoholic liver disease.
Comparison of the effect on intragastric pH of a single dose of omeprazole or rabeprazole: Which is suitable for on‐demand therapy?
Authors: INAMORI MASAHIKO , TOGAWA JUN‐ICHI , TAKAHASHI HIROKAZU , YONEDA MASATO , FUJISAWA NOBUTAKA , IWASAKI TOMOYUKI , OZAWA YUTAKA , KIKUCHI TAISUKE , MURAMATSU KENICHI , CHIGUCHI GAKU , MATSUMOTO SHUHEI , KAWAMURA HARUNOBU , ABE YASUNOBU , KIRIKOSHI HIROYUKI , KOBAYASHI NORITOSHI , SAKAGUCHI TAKASHI , TAKAMURA TOMOO , NAKAJIMA ATSUSHI , UENO NORIO , SEKIHARA HISAHIKO
Published: August 2003

Background and Aims:  An ideal medication for heartburn should have the rapid onset of action needed for on‐demand treatment. However, assessment of the onset of action of proton pump inhibitors has been largely subjective. We compared the inhibitory effect on gastric acid secretion of a single oral dose of omeprazole with that of rabeprazole.

Methods:  Fourteen Helicobacter pylori‐negative men participated in this randomized, double‐masked, two‐way cross‐over study. Intragastric pH was monitored continuously for 6 h after a single, randomly assigned 20 mg oral dose of either omeprazole or rabeprazole. After a 7‐day washout period, the other drug was administered. Each patient's S‐mephenytoin 4′‐hydroxylase (CYP2C19) genotype was determined by polymerase chain reaction‐restriction fragment length polymorphism.

Results:  Intragastric pH and pH holding time did not differ between treatments when the data were analyzed for the whole group without stratifying for CYP2C19 status. In CYP2C19 homozygous and heterozygous extensive metabolizers (10 subjects), rabeprazole maintained the intragastric at pH > 3 and> 4 for longer than omeprazole during both the 5 and 6 h study periods, and the average pH during the 6 h study period was higher with rabeprazole than with omeprazole. In these extensive metabolizers, rabeprazole maintained the pH > 2,> 3,> 3.5 and> 4 for longer during the 6 h study period than did omeprazole.

Conclusions:  In H. pylori‐negative men who are CYP2C19 homozygous or heterozygous extensive metabolizers, the intragastric pH after a single dose of 20 mg rabeprazole is higher during first 5–6 h than that after a single dose of 20 mg omeprazole.
Inducible nitric oxide synthase activity induced by sodium chloride solution prolongs luminal pH elevation in rat and mouse stomachs
Authors: TATEMICHI MASAYUKI , OGURA TSUTOMU , SAKURAZAWA NOBUYUKI , NAGATA HIROSHI , SUGITA MINORU , ESUMI HIROYASU
Published: August 2003

Background:  Sodium chloride (NaCl) is a strong promoter of gastric cancer. We hypothesized that inducible nitric oxide synthase (iNOS) induced by NaCl may be involved in its promoting effects. We investigated iNOS expression by hypertonic NaCl solutions and its pathophysiological roles in the gastric mucosa of rats and mice.

Methods:  iNOS mRNA and protein expressions were examined in the rat and mouse gastric mucosa after intragastric administration of NaCl solution by northern blot, reverse transcription‐polymerase chain reaction (RT‐PCR) and immunohistochemistry. The effect on luminal pH by iNOS activity was assessed using aminoguanidine, a potent iNOS inhibitor, and iNOS gene deficient (iNOS–/–) mice.

Results:  iNOS expression was detected at concentrations higher than 1.7 M, mainly in the cells infiltrating the damaged mucosa of rats. Administration of a higher than 3.4 M NaCl solution elevated luminal pH of the rat stomach remarkably, enabling bacterial overgrowth and dramatically increasing iNOS expression (n = 5 per concentration). Pretreatment with ampicillin (p.o), an antibiotic, attenuated the iNOS expression in duplicate experiments. Co‐treatment with aminoguanidine (s.q) accelerated recovery of elevated luminal pH at 8 h and 16 h or 24 h after administration of 3.4 M (n = 8) and 5.2 M NaCl solution (n = 5), respectively. iNOS expression and luminal pH elevation were also observed in mice stomachs after administration of 3.4 M NaCl solution. The elevated luminal pH of iNOS–/– mice stomachs after the administration of NaCl solution was significantly lower at 6 h (n = 7) and at 9 h (n = 11), compared to that of wild type mice (n = 9 and 10, respectively).

Conclusions:  Hypertonic NaCl solutions induced iNOS expression in the gastric mucosa. iNOS activity prolonged the elevation of the luminal pH, potentially leading to bacterial overgrowth, which in turn enhanced iNOS expression. This vicious cycle might be related to the promoting effect of NaCl.
Irinotecan causes severe small intestinal damage, as well as colonic damage, in the rat with implanted breast cancer
Authors: GIBSON RACHEL J , BOWEN JOANNE M , INGLIS MARK RB , CUMMINS ADRIAN G , KEEFE DOROTHY MK
Published: August 2003

Background and Aims:  Irinotecan (CPT‐11) is a chemotherapeutic drug for cancer that causes severe diarrhea by an uncertain mechanism. The aim of the present study was to investigate the time‐course of apoptosis and whole intestinal damage after irinotecan to further elucidate the mechanism behind the diarrhea.

Methods:  Groups of breast cancer‐bearing dark agouti (DA) rats were treated with 100, 150 or 200 mg/kg doses of irinotecan or vehicle control daily for two days, and killed at 6, 24, 72 or 96 h after treatment. Apoptosis and morphometry were examined in both the small and large intestines. Histopathology and goblet cell numbers were recorded. Data were analyzed using the Peritz′F‐test.

Results:  Irinotecan increased apoptosis and caused villous atrophy and crypt hypoplasia in the small intestine, and increased apoptosis, crypt hypoplasia, crypt dilation and mucus secretion in the large intestine. Irinotecan at 100 and 150 mg/kg caused crypt hypoplasia at 6 and 24 h, with rebound hyperplasia at 72 and 96 h. At 200 mg/kg, irinotecan caused a more pronounced crypt hypoplasia earlier and all animals died by 96 h. Apoptosis peaked at 6 h and remained elevated over the remainder of the time‐points. This was not dose‐dependent. Irinotecan at all doses altered colonic, but not jejunal, goblet cells. Irinotecan increased colonic mucus secretion.

Conclusions:  We conclude that irinotecan causes diarrhea by inducing apoptosis and hypoproliferation in both the small and large intestines, and causes colonic damage with changes in goblet cells and mucin secretion.
Discordant lymphoma: MALT lymphoma of the stomach and follicular lymphoma of the parotid gland
Authors: Yamamoto Yutsuki , Yamochi‐Onizuka Toshiko , Shiozawa Eisuke , Kushima Miki , Nakamaki Tsuyoshi , Tomoyasu Shigeru , Kaneko Kazuhiro , Mitamura Keiji , Hoshino Mitsunori , Ishii Hiroshi , Kusano Mitsuo , Ota Hidekazu
Published: August 2003

More than one histological type of malignant lymphoma can occur simultaneously in an individual. The entity is classified as either composite or discordant lymphoma. Both types of lymphoma, particularly discordant lymphoma comprised of extranodal marginal zone B‐cell lymphoma of mucosa‐associated lymphoid tissue lymphoma (MALT‐L) and follicular lymphoma (FL), are rare. We report a case of discordant lymphoma comprising MALT‐L in the stomach and FL in the parotid gland. The patient was a 50‐year‐old Japanese woman who visited the University Hospital of Showa (Tokyo, Japan) because a barium study showed erosive gastric lesions. A gastro‐intestinal endoscopy was performed 2 months after the barium study, which showed irregular erosions throughout the stomach body. A gastric biopsy showed MALT‐L, and Helicobacter pylori (H. pylori) infection was confirmed. The patient had noticed a painless and elastic hard tumor mass of about 2 cm in diameter in the area of the left parotid gland 6 months before the barium study. We removed the parotid gland tumor and diagnosed it as FL 6 months after the barium study. We were able to diagnose the MALT‐L and FL by morphological, immunohistochemical and molecular analyses of paraffin‐embedded sections. This appears to be the first reported case of MALT‐L and FL occurring together as a discordant lymphoma.
Glomerulosclerosis develops in Thy‐1 nephritis under persistent accumulation of macrophages
Authors: Kaneko Yoko , Shiozawa Satoshi , Hora Kazuhiko , Nakazawa Koh
Published: August 2003

To clarify the relationship between macrophages and development of glomerulosclerosis, the authors developed a new experimental nephritis model with macrophages persisting in Thy‐1 nephritis. Methyl‐cellulose was administered intraperitoneally in addition to the intravenous injection of the anti‐Thy‐1 antibody to Wistar rats. Foamy macrophages influxed into the lytic mesangium and stayed to form nodular aggregates. Mesangial cells proliferated with the formation of extracellular matrices around these nodular aggregates of macrophages. Immunohistochemical analyses revealed that α‐smooth muscle actin (α‐SMA) was expressed in the proliferative area around these nodules of foamy macrophages from day 7. Type I collagen and type IV collagen were also expressed around the foamy macrophages in correspondence with α‐SMA expression from day 7. The electron microscopic study revealed that collagen fibrils were formed around the transformed mesangial cells. The expression of platelet endothelial cell adhesion molecule‐1 (PECAM‐1, CD31), a marker of glomerular vasculature endothelial cells, was not found in the area occupied by the foamy macrophages, suggesting the impairment of glomerular reconstruction. Macrophages may participate in the progression of glomerulosclerosis in Thy‐1 nephritis by enhancing the production of the extracellular matrix through transformed mesangial cells and preventing reconstruction of the capillary network.
Prognostic significance of the infiltrative pattern invasion in endometrioid adenocarcinoma of the endometrium
Authors: Suzuki Chikako , Matsumoto Toshiharu , Sonoue Hiroshi , Arakawa Atsushi , Furugen Yoshiaki , Kinoshita Katsuyuki
Published: August 2003

The prognostic significance of the invasive type of carcinoma cells in endometrial carcinoma is not defined. We evaluated the prognostic significance of the invasive type, as well as the immunostains of p53, c‐erbB‐2, Ki‐67 antigen and MDM2 in endometrial endometrioid adenocarcinoma. This prospective analysis comprised 112 patients with endometrioid adenocarcinoma of the uterine corpus who had undergone surgery and were traced for more than 5 years after the operation. They were divided into re‐currence (16 patients) and non‐recurrence (96 patients) groups. The invasive type of carcinoma cells was divided into expansile, mixed (expansile and infiltrative) and infiltrative pattern. The difference in the invasive type (P < 0.001) and p53 expression (P = 0.004) between the recurrence and non‐recurrence groups was significant in the univariate analysis. Moreover, the invasive type was significant in the multivariate analysis (P = 0.004). In contrast, the difference in MDM2 expression, c‐erbB‐2 expression and the Ki‐67 labeling index in both groups was not significant in the univariate analysis. The infiltrative pattern of the invasive type (P < 0.001) and p53 expression (P = 0.043) were significantly related to a poor prognosis in the Kaplan–Meier method using the log–rank test. In conclusion, the current study indicated that the infiltrative pattern of the carcinoma cells is a predictor for poor prognosis in endometrioid adenocarcinoma in the uterine corpus. It was also indicated that p53 immunostains are useful as a predictor, but Ki‐67 antigen, c‐erbB‐2 and MDM2 stains are not.
Pyothorax‐associated angiosarcoma of the pleura with metastasis to the brain
Authors: Kimura Masatomo , Ito Hiroyuki , Furuta Tomoko , Tsumoto Tomoyuki , Hayashi Seiji
Published: August 2003

Pleural angiosarcoma is an extremely rare, highly malignant neoplasm. Chronic tuberculous pyothorax is one of the etiological factors associated with the development of pleural angiosarcoma. This report details a case of pleural angiosarcoma in a 70‐year‐old woman with a history of tubercul‐ous pyothorax. Coagulated blood surrounded by thickened pleura in the right thorax and hematoma‐like multiple metastases in the brain were noted on autopsy. The pleural lesion was presumed to be the primary site. Microscopic examination revealed rudimentary channels lined by plump neoplastic cells in the coagulated blood of the pleura and the brain. These neoplastic cells stained positive for endothelial markers. A literature review of English language journals revealed this to be the first patient described in detail who developed cerebral metastasis secondary to pleural angiosarcoma.
Intrarenal epidermal cyst
Authors: Lim Sung Chul , Kim Chul Sung
Published: August 2003

An epidermal cyst is a very unusual cause of a renal mass, with only three cases reported in English literature. The authors report a case of this in a 51‐year‐old man with left flank pain and hematuria. A 5 × 4 cm‐sized cystic mass, having an irregular margin with stippled calcification, was identified in the lower pole of the left kidney. A retroperitoneal laparoscopic simple nephrectomy was performed under the assumption that it was a renal tumor. Histologically, the tumor was identical in appearance to an epidermal cyst within the skin. Aberrant ectodermal implantation during embryogenesis has been postulated as a histogenesis of intrarenal epidermal cyst. However, the present case had a history of renal stone, which was treated with extracorporeal shock wave lithotripsy. Therefore, the authors suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin. The diagnosis of an epidermal cyst was not made preoperatively in the present case, or in the cases described in the literature. This diagnosis should be included in the differentiation of calcified intrarenal masses.
Diagnosis of renal amyloidosis using Congo red fluorescence
Authors: Şen Sait , Başdemir Gülçin
Published: August 2003

Early diagnosis and classification of amyloid deposition and differentiation from other glomerular fibrillar deposits relies on routine Congo red (CR) histochemistry. Congo red fluorescence (CRF) is an alternative method based on examination of the CR‐stained section by ultraviolet (UV) light. The aim of this study is to investigate the usefulness of CRF, especially when applied to frozen kidney sections. Congo red fluorescence was applied to sections of frozen kid‐ney biopsies prospectively and to paraffin sections retrospectively. The findings of CRF were compared to CR staining in bright light. Prospectively, 15 cases of amyloidosis were diagnosed on frozen sections and identical CR staining was found in all of the paraffin‐stained sections. There were no false positives or negatives. Retrospectively, 146 renal biopsies previously stained with CR were re‐evaluated with CRF. Eighty‐seven CR positive cases were confirmed by CRF, and one new case was identified. Congo red fluorescence is simple to perform and more pronounced, therefore easier to evaluate than CR in bright light. Congo red, when combined with immunohistochemistry, is still visible under UV whereas CR is masked in bright light. Although not widely used, the CRF method for detecting amyloid is simple to use with a high specificity and sensitivity, and may be applied successfully to frozen sections.
Comedonecrosis is an unfavorable marker in node‐negative invasive breast carcinoma
Authors: Yagata Hiroshi , Harigaya Kenichi , Suzuki Masato , Nagashima Takeshi , Hashimoto Hideyuki , Ishii Genichiro , Miyazaki Masaru , Nakajima Nobuyuki , Mikata Atsuo
Published: August 2003

Breast carcinoma is usually accompanied by an invasive component with an intraductal component, and each component shows different morphological features. We evaluated whether the presence or absence of comedonecrosis is correlated with prognosis and biological features in node‐negative invasive breast carcinoma. Ninety‐four node‐negative breast carcinomas with an intraductal component were classified into two types: comedo type (n = 36) showing comedonecrosis partly or extensively in the intraductal component, and non‐comedo type (n = 58) showing either an absence or small foci of necrosis. The Kaplan–Meier method was used to calculate disease‐free survival. Immunohistochemical examination for p53 and HER‐2 was conducted on the comedo (n = 35) and non‐comedo (n = 47) type tumor specimens. Disease‐free survival was significantly shorter in the comedo type than in the non‐comedo type (P = 0.019). The expression of p53 was observed in 16 (45.7%) of the 35 comedo type cases, but only in two (4.3%) of the 47 non‐comedo type cases (P < 0.0001). HER‐2 overexpression was observed in seven (20.0%) of the 35 comedo type cases, while none of the 47 non‐comedo type cases overexpressed HER‐2 (P < 0.0001). These results suggest that the presence of comedonecrosis may be predictive of an unfavorable prognosis with aggressive biological behavior in node‐negative invasive breast carcinoma.
Polyangitis overlap syndrome: A fatal case combined with adult Henoch‐Schönlein purpura and polyarteritis nodosa
Authors: Watanabe Kazuo , Abe Hiroyuki , Mishima Tomoko , Ogura Go , Suzuki Toshimitsu
Published: August 2003

Henoch‐Schönlein purpura (HSP) is a rather common disease characterized by systemic hypersensitivity vasculitis in the skin and other visceral organs. It has a favorable prognosis unless it is complicated by severe glomerular disease. We report a distinctive fatal case of systemic vasculitis combined with HSP and polyarteritis nodosa (PN) in a 56‐year‐old man who died of progressive renal failure one month after the onset of the disease. He complained of arthralgia, purpura of both lower extremities, nasal bleeding and tarry stool, and acute renal failure was noted at the time of admission to hospital. A skin biopsy from the purpura lesion exhibited leucocytoclastic vasculitis with IgA deposition, and HSP was considered. However, renal failure progressed rapidly and subsequently was complicated by acute myocardial infarction. Postmortem examination revealed PN type necrotizing vasculitis in the kidneys, heart and mesentery resulting in acute multiple infarctions of these organs. We think the current case was a polyangitis overlap syndrome. It is important to suspect the polyangitis overlap syndrome positively when progressive acute renal failure is seen in a patient with HSP and to begin appropriate therapy immediately.
Bone marrow cell transfer of autoimmune diseases in a MRL strain of mice with a deficit in functional Fas ligand: Dissociation of arteritis from glomerulonephritis
Authors: Ito Mitsuko R. , Ono Masao , Itoh Junpei , Nose Masato
Published: August 2003

MRL/MpTn‐gld/gld (MRL/gld) mice, which are deficient in a functional Fas ligand (FasL), spontaneously develop autoimmune diseases involving both lethal glomerulonephritis and systemic arteritis, while MRL/Mp‐+/+ (MRL/+) and C3H/HeJ‐gld/gld (C3H/gld) do not. To determine the cells responsible for the development of glomerulonephritis and arteritis, we transferred bone marrow cells from MRL/gld mice to undiseased MHC‐compatible gld/gld or +/+ mice. In bone marrow irradiation chimeras, MRL/gld bone marrow cells were transferred to lethally irradiated MRL/+ or C3H/HeJ‐+/+ (C3H/+) mice, and both recipients developed glomerulonephritis associated with hypergammaglobulinemia without causing graft‐versus‐host (GVH)‐like diseases. However, a striking difference between them was that MRL/+ recipients developed arteritis, but C3H/+ recipients did not. In bone marrow mixed chimeras formed by transferring MRL/gld bone marrow cells to unirradiated mice, the MRL/gld bone marrow cells induced glomerulonephritis in C3H/gld mice, but not in C3H/+ and MRL/+ mice. These results indicate that bone marrow cells from MRL/gld mice can cause glomerulonephritis in mice, even in those with a C3H background, possibly if they survive longer by escaping from Fas‐mediated apoptosis, while the development of arteritis requires the MRL genetic background in the re‐cipients. This is the first report of the transfer of arteritis in lupus mice to undiseased recipients.
Highly anaplastic extraventricular ependymoma arising in an adult, mimicking metastatic adenocarcinoma with heavy stromal inflammation and emperiporesis
Authors: Moritani Suzuko , Kushima Ryoji , Bamba Masamichi , Kobayashi Tadao K. , Oka Hideki , Fujimoto Masato , Hattori Takanori , Okabe Hidetoshi
Published: August 2003

We report a case of extraventricular ependymoma arising in a 50‐year‐old woman that took an aggressive clinical course with recurrence three times. The initial tumor was a well‐circumscribed nodule in the right temporal white matter measuring 2 cm in diameter. It showed variegated histological findings mimicking metastatic adenocarcinoma: an epithelioid arrangement of highly pleomorphic cells with pseudopapillary structures and perivascular pseudorosettes, and bizarre multinucleated giant cells with occasional emperiporesis surrounded by abundant mononuclear inflammatory cells, as well as a focal small area of conventional ependymoma. Emperiporesis and abundant mononuclear cell infiltration were not previously described in an ependymoma. The recurrent tumors predominantly showed an epithelioid pattern with frequent formation of astroblastoma‐like pseudopapillary structures. Neoplastic cells were markedly atypical and had characteristic intracytoplasmic eosinophilic inclusion bodies. Much of the cells in both the initial and recurrent tumors showed a positive immunostaining for glial fibrillary acidic protein (GFAP) with accentuation to the cytoplasmic processes of the pseudorosettes and pseudopapillary structures. Epithelial membrane antigen (EMA) highlighted the epithelial differentiation of the tumor cells, while cytokeratin was completely negative. Although this tumor might be classified to at least WHO grade III from the histology and aggressive behavior, the exact grading is still controversial because of the rarity of such cases.
Hyperexcitability of intact neurons underlies acute development of trauma‐related electrographic seizures in cats in vivo
Authors: Topolnik Lisa , Steriade Mircea , Timofeev Igor
Published: August 2003

Cortical trauma can lead to development of electrographic paroxysmal activities. Current views of trauma‐induced epileptogenesis suggest that chronic neuronal hyperexcitability and extensive morphological reorganization of the traumatized cortex are required for the generation of electrographic seizures. However, the mechanisms responsible for the initiation of electrographic seizures shortly after cortical injury are poorly understood. Here we show that, in the experimental model of partially deafferented (undercut) cortex, an increase in intrinsic and synaptic excitability of neurons in areas adjacent to the undercut cortex is sufficient for the generation of electrographic paroxysmal activity within few hours after partial cortical deafferentation. Locally increased and spatially restricted neuronal excitability arose from the increased incidence of intrinsically bursting neurons, enhanced intrinsic and synaptic neuronal responsiveness, and slight disinhibition. These mechanisms only operate in neurons located in the vicinity of partially deafferented sites because, after the cortical injury, partially deafferented neurons are mostly silent and hypoexcitable. Our results suggest that trauma‐induced electrographic seizures first arise in cortical fields that are closest to the site of injury and such seizures do not require long‐term neuronal reorganization.
A double dissociation between serial reaction time and radial maze performance in rats subjected to 192 IgG‐saporin lesions of the nucleus basalis and/or the septal region
Authors: Lehmann O. , Grottick A. J. , Cassel J. ‐C. , Higgins G. A.
Published: August 2003

The cholinergic basal forebrain has been implicated in aspects of cognitive function including memory and attention, but the precise contribution of its major components, the basalocortical and the septohippocampal systems, remains unclear. Rats were subjected to lesions of either the nucleus basalis magnocellularis (Basalis), the medial septum/vertical limb of the diagonal band of Broca (Septum), or both nuclei (Basalis + Septum), using the selective cholinotoxin 192 IgG‐saporin. Cognitive performance was evaluated in tasks taxing attention (the five‐choice serial reaction time task, 5‐CSRTT) and spatial working memory (radial arm maze, RAM). Nucleus basalis lesions disrupted performance of the 5‐CSRTT, as demonstrated by decreased choice accuracy, increased incidence of missed trials, increased latencies to respond correctly, and a disrupted pattern of response control. Combined lesions of the Basalis and Septum resulted in qualitatively similar deficits to Basalis lesions alone, although interestingly, these rats were unimpaired on measures of response speed, and showed weaker deficits on accuracy and omissions. Decreasing the attentional load by lengthening stimulus duration reversed some of the deficits in Basalis and Basalis + Septum rats, suggesting an attentional deficit rather than motivation or motor perturbations. Performance in rats with septal lesions was only affected when task difficulty was increased. In the RAM an opposing pattern of effects was observed, with Septum and Basalis + Septum rats showing dramatic impairments, and Basalis rats performing normally. Taken together, these data provide clear evidence for a functional dissociation between septohippocampal and basalocortical cholinergic systems in aspects of cognitive function.
Multipleacegenes encoding acetylcholinesterases ofCaenorhabditis eleganshave distinct tissue expression
Authors: Combes Didier , Fedon Yann , Toutant Jean‐Pierre , Arpagaus Martine
Published: August 2003

ace‐1andace‐2genes encoding acetylcholinesterase in the nematodeCaenorhabditis eleganspresent 35% identity in coding sequences but no homology in noncoding regions (introns, 5′‐ and 3′‐untranslated regions). A 5′‐region oface‐2was defined by rescueof ace‐1;ace‐2mutants. When green fluorescent protein (GFP) expression was driven by this regulatory region, the resulting pattern was distinct from that oface‐1. This latter gene is expressed in all body‐wall and vulval muscle cells (Culettoet al., 1999), whereasace‐2is expressed almost exclusively in neurons.ace‐3andace‐4genes are located in close proximity on chromosome II (Combeset al., 2000). These two genes were first transcribedin vivoas a bicistronic messenger and thus constitute anace‐3;ace‐4operon. However, there was a very low level of monocistronic mRNA oface‐4(the upstream gene)in vivo, and no ACE‐4 enzymatic activity was ever detected. GFP expression driven by a 5′ upstream region of theace‐3;ace‐4operon was detected in several muscle cells of the pharynx (pm3, pm4, pm5 and pm7) and in the two canal associated neurons (CAN cells). A dorsal row of body‐wall muscle cells was intensively labelled in larval stages but no longer detected in adults. The distinct tissue‐specific expression oface‐1,ace‐2andace‐3(coexpressed only in pm5 cells) indicates thatacegenes are not redundant.
N‐methyl‐d‐aspartate‐triggered neuronal death in organotypic hippocampal cultures is endocytic, autophagic and mediated by the c‐Jun N‐terminal kinase pathway
Authors: Borsello Tiziana , Croquelois Karine , Hornung Jean‐Pierre , Clarke Peter G. H.
Published: August 2003

Acute excitotoxic neuronal death was studied in rat organotypic hippocampal slices exposed to 100 µmN‐methyl‐d‐aspartate. Fulgurant death of pyramidal neurons occurred in the CA1 and CA3 regions and was already detectable within 2 h of the N‐methyl‐d‐aspartate administration. Morphologically, the neuronal death was neither apoptotic nor necrotic but had the hallmarks of autophagic neuronal death, as shown by acid phosphatase histochemistry in both CA1 and CA3 and by electron microscopy in CA1. The dying neurons also manifested strong endocytosis of horseradish peroxidase or microperoxidase, occurring probably by a fluid phase mechanism, and followed, surprisingly, by nuclear entry. In addition to these autophagic and endocytic characteristics, there were indications that the c‐Jun N‐terminal kinase pathway was activated. Its target c‐Jun was selectively phosphorylated in CA1, CA3 and the dentate gyrus and c‐Fos, the transcription of which is under the positive control of c‐Jun N‐terminal kinase target Elk1, was selectively up‐regulated in CA1 and CA3. All these effects, the neuronal death itself and the associated autophagy and endocytosis, were totally prevented by a cell‐permeable inhibitor of the interaction between c‐Jun N‐terminal kinase and certain of its targets. These results show that pyramidal neurons undergoing excitotoxic death in this situation are autophagic and endocytic and that both the cell death and the associated autophagy and endocytosis are under the control of the c‐Jun N‐terminal kinase pathway.