bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary lymphoplasmacytoid lymphoma of the trachea with immunoglobulin G paraprotein
Authors: Gómez‐Román Jose Javier , Pérez‐Montes Rocío , Pérez‐Expósito Maria Angeles , Richard Carlos , Baro Julio , Val‐Bernal Jose Fernando
Published: March 2003

A primary tracheal lymphoma with immunoglobulin G (IgG)‐associated monoclonal serum paraprotein treated with surgery and chemotherapy is reported. As far as we know this is the first lymphoplasmacytoid lymphoma reported in the tracheobronchial tree and the first with a serum and tissue IgG monoclonal paraprotein. Differential diagnosis must be made essentially with extramedullary plasmacytoma and mucosa‐associated lymphoid tissue lymphoma. CD‐45RB strong positivity and the absence of lymphoepithelial lesions may help to differentiate lymphoplasmacytoid lymphoma from them. We expand the spectrum of lymphoid lesions with plasmacytoid features that can occur in the tracheobronchial tract.
Malignant phyllodes tumor of the prostate
Authors: Kim Hyung‐Seok , Lee Jae‐Hyuk , Nam Jong‐Hee , Lee Min‐Cheol , Park Chang‐Soo , Juhng Sang‐Woo , Ro Jae Y , Choi Chan
Published: March 2003

Phyllodes tumor of the prostate is rare. We have recently experienced a case of phyllodes tumor of the prostate in a 57‐year‐old man who complained of urinary retention for 1 year. The epithelial components were positive reactivity for prostate specific antigen. The stromal cells showed nuclear atypia with increased mitotic activity. The tumor was diagnosed as a malignant phyllodes tumor as it invaded into the urinary bladder and rectum, and grew rapidly immediately after operation. We describe the morphological features and immunohistochemical findings of malignant phyllodes tumor and review the literature.
Endogenous liver carcinogenesis in the rat *
Authors: Nakae Dai
Published: March 2003

Carcinogenesis may be effected not only through exposure to exogenous stimuli but also by genetic and epigenetic influences derived from endogenous factors. In the latter case, the mechanisms are still largely obscure because of the limited availability of appropriate in vivo experimental models. However, continuous feeding of a diet deficient in choline and methionine is well known to cause hepatocellular carcinomas (HCC) in rats in the absence of any known exogenous carcinogens and can serve as a good research model. A semi‐synthetic, choline‐deficient,
L‐amino acid‐defined (CDAA) diet, containing practically no choline and low methionine, induces HCC with a background of fatty liver and hepatocyte death, subsequent regeneration and fibrosis resulting in cirrhosis. Using the CDAA diet, we have revealed the participation of oxidative injury to DNA and other subcellular components and of alteration in intrahepatic signal transduction pathways in the mechanisms underlying this rat liver carcinogenesis model. In the present paper, the current understanding of endogenous rat liver carcinogenesis, due to dietary choline deficiency, is reviewed.
Foregut duplication cyst of the stomach
Authors: Kim Duck‐Hwan , Kim Joo‐Seop , Nam Eun Sook , Shin Hyung Sik
Published: March 2003

Foregut duplication cyst of the stomach is an extremely rare disease entity. A 35‐year‐old Korean man presented with epigastric pain. An abdominal cystic mass, measuring 7 × 6 × 5 cm, was found in the lesser curvature of the stomach. The cyst was unilocular with a grey‐white, rubbery wall. Microscopically, the cyst wall was lined by pseudostratified ciliated, columnar epithelium and gastric mucosa with a complete lining of smooth muscle bundles. Although the origin of this lesion remains uncertain, this case suggests that the gastric cyst arose from the embryonic foregut and showed differentiation toward respiratory and gastric structures.
New prognostic histological parameter of invasive ductal carcinoma of the breast: Clinicopathological significance of fibrotic focus
Authors: Hasebe Takahiro , Mukai Kiyoshi , Tsuda Hitoshi , Ochiai Atsushi
Published: March 2003

Immunohistochemistry, DNA ploidy analysis and molecular genetics have made it possible to predict the outcome of breast cancer more precisely than routine histological examination alone. However, in routine practice, it is difficult to incorporate these methodologies in all cases. If certain histological parameters can accurately predict the outcome of patients with breast cancer, they would be more practical for routine use. We showed that the presence of fibrotic focus (FF) in invasive ductal carcinoma (IDC) is closely associated with c‐erbB‐2 or p53 protein expression, high proliferative activity, and high angiogenesis of the tumors. Furthermore, multivariate analyses with well‐known prognostic parameters for IDC demonstrated that the presence of FF is the most useful independent parameter to predict IDC patient outcome. In addition, our data suggested that the interaction between tumor cells and stromal fibroblasts may play an important role in the formation of FF in IDC based on growth factor and growth factor receptor protein expression in the tumor cells and fibroblasts forming FF. Based on the results of our clinicopathological studies, we propose a new prognostic classification scheme for the prediction of IDC patient outcome, which consists of FF, nuclear atypia, and fat invasion. This classification has superior predicting power to existing prognostic classifications.
Solitary fibrous tumor of the vagina
Authors: Akiyama Yutaka , Nabeshima Kazuki , Koita Hiroyuki , Yamanaka Masanobu , Koono Masashi
Published: March 2003

The solitary fibrous tumor (SFT) is a rare tumor that most commonly arises in the pleura. Recent evidence has indicated that this tumor originates from mesenchymal, probably fibroblastic, cells and is not restricted to the pleura. However, its occurrence in the female genital tract is extremely rare. We report a case of primary SFT that originated from the vagina in a 34‐year‐old female. It was a pedunculated polypoid tumor and occurred at the site of scar tissue, caused by laceration during her last labor 7 years previously. Histologically, the tumor was predominantly composed of a random proliferation of spindle cells, intimately admixed with collagen. Immunohistochemically, the cells were strongly positive for CD34, vimentin and bcl‐2, but were negative for S‐100 protein, neuron‐specific enolase, smooth muscle actin, desmin, CD68, cytokeratins and epithelial membrane antigen. To the best of our knowledge, this is the first reported case of a primary vaginal SFT in the English literature. Our report suggests to include SFT in the differential diagnosis of a spindle cell neoplasm originating from the vagina.
Lymphoid hyperplasia of the large intestine: A case report with immunohistochemical and gene analysis
Authors: Nagaoka Sakae , Bandoh Takafumi , Takemura Tamiko
Published: March 2003

A case of lymphoid hyperplasia arising in the large intestine of a 54‐year‐old woman is described. Barium enema X‐ray and colonoscopic examination revealed multiple small polyps in the right side of the colon. Pathological findings from forceps biopsy revealed similar features to a mucosa‐associated lymphoid tissue (MALT) lymphoma. A right hemicolectomy with mesenteric lymph node dissection was carried out. Histological sectioning demonstrated hypertrophic lymphoid follicles with well‐formed germinal centers. Occasionally, lymphocytes infiltrated the crypts, in a way similar to that found in lymphoepithelial lesions, which was suggestive of a MALT lymphoma diagnosis. Cryptitis was also observed in the lamina propria. Immunohistochemically, proliferating lymphocytes were positive for CD20 (L26) and negative for CD45RO (UCHL‐1). Analyses of immunoglobulin gene (IgHJH) rearrangement could not detect any monoclonality in these cells. These findings suggested that the present case should be categorized as lymphoid hyperplasia rather than lymphoma.
Expression of cytokeratin 1, 5, 14, 19 and transforming growth factors‐β1, β2, β3 in osteofibrous dysplasia and adamantinoma: A possible association of transforming growth factor‐β with basal cell phenotype promotion
Authors: Maki Masahiko , Saitoh Kiyoshi , Kaneko Yoshiyasu , Fukayama Masashi , Morohoshi Toshio
Published: March 2003

To elucidate the precise origin and characteristics of the epithelial components of osteofibrous dysplasia (OF) and adamantinoma (AD), the expression of transforming growth factor (TGF)‐β1, β2 and β3 and cytokeratin (CK) subtypes were studied in five cases of AD and 18 cases of OF by immunohistochemistry. CK1 was expressed in 10 out of 18 OF cases; CK5 was expressed in one OF case; CK14 was positively stained in 10 cases of OF; CK19 was positively stained in 16 OF cases; CK1 was expressed in three out of five AD cases; CK5 was expressed in one case of AD; CK14 was positively stained in four AD cases; and CK19 was positively stained in five AD cases. In OF, TGF‐β1, β2 and β3 were expressed in both fibroblasts and osteoblasts. In AD, TGF‐β1, β2 and β3 were expressed in both epithelial and fibrous components. These results suggest that epithelial components of AD and OF share epidermal characteristics, CK1, express basal cell phenotype and cytokeratins 5, 14 and 19. In addition to these epithelial characteristics, strong immunoreactivity for TGF‐β poses the possibility of TGF‐β promotion of basal cell phenotype expression for the epithelial components in OF and AD.
The expression of a novel natural killer inhibitory molecule, Cho‐1, on the chorionic cytotrophoblast cells of successful pregnancy, but not of spontaneous abortion
Authors: Nagata Masami , Akazawa Takashi , Tamura Yasuaki , Kamiguchi Kenjiro , Hirai Itaru , Ohtani Seiji , Sagae Satoru , Kudo Ryuichi , Torigoe Toshihiko , Sato Noriyuki
Published: March 2003

The regulatory mechanism of the recognition and cytotoxicity by natural killer (NK) cells in placental tissue remains unclarified. Previous reports indicated that monoclonal antibody Cho‐1‐defined molecule (Cho‐1 molecule) may act as the negative regulator in the cytotoxicity by human NK cells. The Cho‐1 molecule is composed of non‐covalently asssociated cell surface molecules of approximately 200 kDa and 40 kDa. In the present study we analyzed the expression of this novel molecule in extravillous cytotrophoblast cells, which are presumed to be exposed to the cytotoxic action by maternal NK cells, from clinical cases of successful pregnancy and spontaneous abortion. By using monoclonal antibody Cho‐1, our immunohistochemical data indicated that the Cho‐1 molecule is clearly expressed in the cytotrophoblast cells of the early phase of successful pregnancy, but only weakly expressed in those from spontaneous abortion. The cytotrophoblast cells in the late phase (9–10 months) of pregnancy also expressed this molecule. Fluorescence‐activated cell sorter analysis also showed that it is expressed on the cytotrophoblast cell surface of successful pregnancy but not on that of spontaneous abortion, suggesting that Cho‐1 antigen may act as a negative regulator of the cytotoxicity by NK cells in successful pregnancy of the fetus.
Primary primitive neuroectodermal tumor of the kidney
Authors: Kuroda Makoto , Urano Makoto , Abe Masato , Mizoguchi Yoshikazu , Horibe Yoshimune , Murakami Masamoto , Tashiro Kazuhiro , Kasahara Masao
Published: March 2003

Primitive neuroectodermal tumor (PNET) is a small round cell sarcoma that mainly develops in the central nervous system and soft tissues of childhood; however recently, primary occurrence of this tumor in the kidney has been reported. We experienced one case of PNET primarily arose in the kidney without metastasis. The patient was a 28‐year‐old man whose chief complaint was abdominal pain, especially on exercise. On computed tomography scan and magnetic resonance imaging, a solid lesion was found in the left kidney, and a left nephrectomy was performed based on the diagnosis of a tumor in the left kidney. The tumor was within the parenchyma of lower end of left kidney protruding into the abdominal cavity. Histologically, diffuse proliferation of primitive small round cells with rosette formation was found. Immunohistochemically, MIC2 gene product, neuron‐specific enolase and S‐100 protein were positive. No metastasis to the regional lymph nodes was found. From these observations, the tumor was diagnosed as PNET primarily arising in the left kidney. Although chromosome analysis was not performed, EWS‐FLI1 chimera gene was identified by reverse transcriptase–polymerase chain reaction on the freshly frozen specimen and fluorescence in situ hybridization on paraffin sections.
Blastic natural killer cell lymphoma arising from the mediastinum with terminal deoxynucleotidyl transferase expression
Authors: Isobe Kouichi , Tamaru Jun‐ichi , Nakamura Shigeo , Itami Jun , Aruga Takashi , Uno Takashi , Yasuda Shigeo , Mikata Atsuo , Ito Hisao
Published: March 2003

Blastic natural killer (NK) cell lymphoma/leukemia is a relatively rare NK cell malignancy. We report the second case of blastic NK cell lymphoma arising from the mediastinum with an aggressive clinical course. The patient was a 63‐year‐old Japanese man with an anterior mediastinum tumor. The biopsy specimen showed diffuse proliferation of tumor cells with frequent mitotic figures and apoptotic bodies. Both angiocentric features and small foci of coagulative necrosis were found in this section. The tumor cells had medium to large nuclei with a fine chromatin pattern, inconspicuous nucleoli and scanty cytoplasm. The nuclear contour was oval to moderately irregular, showing slight pleomorphism as compared with typical lymphoblastic lymphoma. The tumor cells were positive for CD2, CD56 and terminal deoxynucleotidyl transferase, but negative for other T‐cell antigens, B‐cell antigens and myeloid markers. In situ hybridization for Epstein–Barr virus encoded small ribonucleic acid 1 was negative.
Establishment and characterization of three new rat renal cell carcinoma cell lines from N‐ethyl‐N‐hydroxyethylnitrosamine‐induced basophilic cell tumors
Authors: Tokuzen Reiko , Iwahori Yoshio , Asamoto Makoto , Iigo Masaaki , Hasegawa Fumio , Satoh Takatomo , Ishidate Motoi , Tsuda Hiroyuki
Published: March 2003

Three new rat cell lines (designated as BP13, BP30 and BP36B), derived from rat basophilic‐type renal cell carcinomas induced with N‐ethyl‐N‐hydroxyethylnitrosamine, were established and characterized. Passaged up to 100 times in vitro for 3 years, each cell line forms epithelial monolayers with cell cycles for BP13, BP30 and BP36B of 29, 21 and 17 h, respectively. Positive glucose‐6‐phosphate dehydrogenase (G6PD) and γ‐glutamyltransferase (γ‐GT) activity in their cytoplasm, but negative succinate dehydrogenase (SD) and slightly positive carbonic anhydrase type II (CA) localization indicates an origin from proximal tubules. Ultrastructural examination showed the presence of variable numbers of mitochondria and many microvilli and intracellular junctions on the plasma membrane. BP13 and BP30 were found to be tetraploid and BP36B diploid. BP13 has one marker chromosome 15p+, and BP36B an isochromosome of 1q. Anchorage‐independent growth and tumorigenicity in immunosuppressed nude mice of BP13 and BP36B, but not BP30, proved their neoplastic nature. These three cell lines should provide useful tools for studying the biological characteristics of renal cell tumors.
Distribution of peripheral nerve terminals in the small and large intestine of congenital aganglionosis rats (Hirschsprung's disease rats)
Authors: Nagahama Masato , Semba Reiji , Tsuzuki Masako , Ozaki Tsuyoshi
Published: March 2003

The congenital aganglionosis rat is considered to be an animal model of Hirschsprung's disease. The mutants had a long constricted segment (from distal ileum to rectum) below the dilated distal ileum. In the dilated region, synaptophysin‐immunoreactivity (IR) was almost preserved in all layers of the intestinal wall. In the constricted distal ileum and oral proximal colon, synaptophysin‐IR was scarce in all layers, including the circular and longitudinal muscle layers. In the anal proximal and distal colon, synaptophysin‐IR was almost scarce in the circular muscle layer (CML). An ultrastructural study confirmed that almost no terminals were found in the CML of any regions of constricted intestine. Therefore, the CML in any region of a constricted segment, is presumed to be poor innervation. However, a few synaptophysin‐IR were found in the longitudinal muscle layer (LML) of an anal part of a constricted segment. An ultrastructural study also confirmed that some terminals were observed in the LML of this segment. The present study suggested that denervated CML is related to the production of constricted segment, irrespective of the presence or absence of terminals in the LML.
Discrepancies between Gleason scores of needle biopsy and radical prostatectomy specimens
Authors: Fukagai Takashi , Namiki Thomas , Namiki Hideo , Carlile Robert G. , Shimada Makoto , Yoshida Hideki
Published: March 2003

The purpose of this study was to determine the accuracy of Gleason scores in prostate needle biopsy diagnosis and to investigate factors affecting the accuracy of the tumor grade. A single pathologist reviewed 116 sets of prostate cancer biopsies and radical prostatectomy specimens. The following factors were examined to determine their effect on the accuracy of the biopsy Gleason scores: (i) relative tumor differentiation; (ii) pathological stage; (iii) amount of tissue in the biopsy specimen; (iv) amount of cancer tissue in the biopsy specimen; (v) tumor heterogeneity; (vi) clinical findings (prostate specific antigen value and digital rectal examination); and (vii) interobserver variability. In 53 cases the Gleason score of biopsy specimens was identical to the score of prostatectomy specimens (45.7%). Fifty‐four cases (46.6%) of biopsy specimens were undergraded. The most common discrepancy was diagnosis of well‐differentiated carcinoma in the biopsy but diagnosis of moderately differentiated tumor in the corresponding prostatectomy specimen. This discrepancy occurred when the amount of tumor in the biopsy was 3 mm or less. Biopsy and prostatectomy results showed less agreement when the original biopsy tumor grade rendered by nine different pathologists was used, suggesting that interobserver variability can adversely affect the accuracy of tumor grade. Clarifying the histologic criteria for distinguishing each grade, especially between Gleason grades 2 and 3, is important for accurate grading.
Expression of p53 protein as a prognostic indicator of reduced survival time in diffuse‐type gastric carcinoma
Authors: Liu Xiu ping , Tsushimi Kureo , Tsushimi Mutsuo , Oga Atsunori , Kawauchi Shigeto , Furuya Tomoko , Sasaki Kohsuke
Published: March 2003

To determine whether p53 expression is different in intestinal and diffuse types of gastric carcinoma, we investigated p53 immunohistochemical expression in 178 primary gastric carcinomas. Overexpression of p53 was observed in 50 out of 100 intestinal‐type tumors (50.0%) and in 27 out of 78 diffuse‐type tumors (34.6%). A significant difference was found in the timing of p53 overexpression between the two types of carcinomas. Overexpression of p53 occurred often in the early stage of intestinal‐type tumors, and there was no significant difference in expression between early and advanced cancers. In contrast, p53 overexpression did not occur often in the early stage of diffuse‐type tumors, but it increased progressively as the tumor advanced. Analysis of patient survival revealed that p53 overexpression correlates significantly with a poor prognosis in diffuse‐type gastric carcinoma (P = 0.003) but not in intestinal‐type. Multivariate analysis showed that only pathological stage was an independent prognostic indicator. Our results suggest that p53 overexpression plays a different role in tumor carcinogenesis and progression of these two types of gastric cancers.
Morphological spectrum of cyclin D1‐positive mantle cell lymphoma: Study of 168 cases
Authors: Yatabe Yasushi , Suzuki Ritsuro , Matsuno Yoshihiro , Tobinai Kensei , Ichinohazama Ryo , Tamaru Jun‐ichi , Mizoguchi Yoshikazu , Hashimoto Yuko , Yamaguchi Motoko , Kojima Masaru , Uike Naokuni , Okamoto Masataka , Isoda Kotaro , Ichimura Koichi , Morishima Yasuo , Seto Masao , Suchi Taizan , Nakamura Shigeo
Published: March 2003

Immunostaining for cyclin D1 is essential for reliable diagnosis of mantle cell lymphoma (MCL). However, a small number of cyclin D1‐positive lymphomas other than MCL have been encountered. Our goal was to investigate the morphological spectrum of MCL as a disease entity, based on cyclin D1 overexpression. We reviewed 181 biopsy specimens obtained from 168 cases of cyclin D1‐positive MCL. Typical findings were the presence of nodular (53.9% of cases) or diffuse (46.1%) histological patterns, containing mantle zone patterns (16.8%), naked germinal centers (33.5%) and perivascular hyaline deposition (83.2%). Unusual findings of residual germinal centers with a mantle cuff (four cases) and follicular colonization (two cases) were seen. High magnification showed a monotonous proliferation of tumor cells with cytological diversity including small (3.0%), intermediate (43.1%), medium (34.1%), medium– large (13.2%) and large (6.6%) cells. Pleomorphic and blastic / blastoid variants were encountered in 9.6 and 7.2% of cases, respectively. Three cases had foci of cells of considerable size, with a moderately abundant pale cytoplasm resembling marginal zone B cells. Two cases showed an admixture of cells which appeared transformed and mimicked the histology of chronic lymphocytic leukemia / small lymphocytic leukemia. In one, neoplastic mantle zones were surrounded by sheets of mature plasma cells, resembling the plasma cell type of Castleman’s disease. An admixture of areas characteristic of MCL and of other larger cells, indicating histological progression or a composite lymphoma, were observed in seven cases. In high‐grade lesions of five cases, nuclear staining of cyclin D1 was rarely detected. In our experience, cyclin D1 expression was also found in nine lymphomas other than MCL (five plasma cell myelomas, three Hodgkin’s disease and one anaplastic large cell lymphoma). The application of cyclin D1 staining prompted us to recognize the broad morphological spectrum of MCL. MCL can be diagnosed with the application of cyclin D1 immunostaining, if careful attention is given to architectural and cytological features.
Low‐grade renal cell carcinoma arising from the lower nephron: A case report with immunohistochemical, histochemical and ultrastructural studies
Authors: Otani Masako , Shimizu Tohru , Serizawa Hiromi , Ebihara Yoshiro , Nagashima Yoji
Published: March 2003

Most renal cell carcinomas (RCC) are composed of clear cells with sinusoid‐like vasculatures and originate from the proximal tubule. On the other hand, collecting duct carcinoma (CDC) and chromophobe RCC are thought to originate from the lower nephron. In the present study, we present a case of unusual RCC. The patient was a 68‐year‐old Japanese woman who had developed general fatigue with hematuria. Computed tomography revealed a left renal tumor suggesting sarcoma. The resected tumor was located in the renal parenchyma, measuring 12 × 10 × 8
cm in size. Histologically, the tumor consisted principally of cuboidal cells forming
parallel or radiating arrays, continuous with the spindle‐shaped cells. Most parts
of the tumor showed hemorrhagic necrosis. Immunohistochemically, tumor cells were
positive for high molecular weight cytokeratins, vinculin, vimentin, CD15 and epithelial
membrane antigen, and showed affinities with some kinds of lectins. N‐ and E‐cadherins
and β‐catenin were diffusely positive in tumor cells. Nuclear positivity for Ki‐67 and p53 protein were approximately 2.0 and 1.7%, respectively. Considering its morphological and histochemical natures, this tumor is considered to have originated from the lower nephron, which is unique for a tumor of low‐grade malignancy.
Epithelioid trophoblastic tumor of the uterus: Cytological and immunohistochemical observation of a case
Authors: Kamoi Seiryu , Ohaki Yoshiharu , Mori Osamu , Yokoyama Munehiro , Kawamoto Youko , Kawamura Takashi , Araki Tsutomu
Published: March 2003

Epithelioid trophoblastic tumor (ETT) is a new entity of trophoblastic tumor and 14 such cases were reported by Shih and Kurman in 1998. However, only three subsequent cases supporting ETT have been reported. Recently, we experienced a case of ETT in a 37‐year‐old woman whose preoperative endometrial brushings showed atypical mononucleate giant cells and who underwent hysterectomy with the diagnosis of a uterine fibroid. The specimens revealed a 2.5 × 3.0 cm yellow–tan intramural nodule located in the lower uterine segment, which was composed of a neoplastic proliferation of intermediate trophoblasts in epithelioid arrangements. Immunohistochemically, the tumor cells were diffusely positive for cytokeratin and inhibin‐α, and focally positive for human chorionic gonadotropin and human placental lactogen. She presented an uneventful clinical course as of September 2001.
Cycloheximide induces apoptosis of astrocytes
Authors: Tsuchida Takahiro , Kato Takayuki , Yamada Akifumi , Kawamoto Keiji
Published: March 2003

Cultured rat astrocytes were incubated in the presence of cycloheximide (CHX; 20 µg/mL), a potent neuroprotective agent. Then cells were subjected to DNA gel electrophoresis. Electrophoresis showed DNA ladder formation, which is characteristic of apoptosis. Inhibitors of interleukin‐1β‐converting enzyme (ICE) and caspase 32(CPP32), which play critical roles in certain apoptotic pathways, did not block the cycloheximide‐induced apoptosis of cultured astrocytes. This observation indicates that the role of ICE and CPP32 is not significant in the CHX‐induced astrocyte apoptosis process. When the blood–brain barrier was disrupted in the rat, the number of brain cells undergoing apoptosis was significantly higher after cycloheximide administration, in contrast to controls. Of the cells that produced glial fibrillary acidic protein, some were observed to undergo apoptosis. Although CHX has been shown to be useful as a neuroprotective agent against ischemic neuronal death, astroglial toxicity may be problematic, depending on CHX concentration. Therefore, a prudent use of this compound is recommended.
Localization of antigen‐presenting cells in Helicobacter pylori‐infected gastric mucosa
Authors: Suzuki Tatsuhiko , Kato Katsuaki , Ohara Shuichi , Noguchi Kenji , Sekine Hitoshi , Nagura Hiroshi , Shimosegawa Tooru
Published: March 2003

Helicobacter pylori (HP) infection is known to induce the specific immune response in the gastric mucosa. The immune response is triggered by presentation of antigen peptides on the major histocompatibility assembly of the antigen‐presenting cells (APC) with the assistance of costimulatory molecules such as B7‐1 (CD80) and B7‐2 (CD86). Their counter‐receptors or ligands on T cells are CD28 or cytotoxic lymphocyte‐associated molecule‐4. The aim of the present study was to clarify the localization of APC and their relation with T cells in HP‐infected human gastric mucosa. Our findings suggest that the macrophages in the lamina propria may mainly act as APC in the HP‐infected gastric mucosa, and the triggered immune response might be involved in the mucosal immune response in the inflamed gastric mucosa to invasive antigens related to HP organisms.
Heterogeneity of expression of cytokeratin subtypes in squamous cell carcinoma of the lung: With special reference to CK14 overexpression in cancer of high‐proliferative and lymphogenous metastatic potential
Authors: Tsubokawa Futoshi , Nishisaka Takashi , Takeshima Yukio , Inai Kouki
Published: March 2003

In surgically resected specimens of squamous cell carcinoma (SCC) of the lung from 45 patients, we immunohistochemically examined the expression of 13 subtypes of cytokeratin (CK), the intermediate filament in cytoplasm of epithelial cells. To investigate heterogeneity of CK, its expression was compared among tumor cell nests with or without keratinization and stratification. Furthermore, the relationship between CK expression and Ki‐67 labeling index or p53 expression was investigated.

The tumor cell nests with keratinization showed the expression of CK1 and CK10 as a central pattern and the expression of CK14 as a peripheral pattern. The nests with stratification showed CK14 expression as a peripheral pattern, whereas those without stratification showed the expression as a diffuse pattern. The tumor cell nests showing stromal invasion with fibrosis in the marginal zone were diffusely positive for CK14. Ki‐67 antigen labeling index was significantly higher in the nests where CK14 expression was diffuse or peripheral than in the nests where the expression was focal or negative. In lymph node metastases, the tumor cells often showed CK14 expression, like trabecular nests in the primary carcinoma. These results suggest that CK14 is a parameter of proliferative activity and metastatic potential of SCC of the lung.
Increased expression of integrin β‐4 in papillary thyroid carcinoma with gross lymph node metastasis
Authors: Kitajiri Shin‐ichiro , Hosaka Naoki , Hiraumi Harukazu , Hirose Tomoko , Ikehara Susumu
Published: March 2003

Although the prognosis is generally good for patients with papillary thyroid carcinoma, gross nodal metastasis of carcinoma has a poor prognosis. It is necessary to clarify how carcinoma progresses to gross nodal metastasis in order to establish a cure. The adhesion molecule integrin β‐4 is considered to be related to cell migration and metastasis in many carcinomas. In the present study, we examined integrin β‐4 expression in 65 cases of human papillary thyroid carcinoma using immunohistochemical methods. Expression of integrin β‐4 was found in all papillary carcinomas, but in few normal thyrocytes. Interestingly, integrin β‐4 expression in the carcinomas with gross (˘3 cm) lymph node metastasis was significantly higher than that in carcinomas with small (<3 cm) or no lymph node metastasis. These results suggest that integrin β‐4 expression in thyroid carcinoma may play a role in the development of gross lymph node metastasis of papillary carcinomas.
Subependymoma of the spinal cord and review of the literature
Authors: Shimada Shio , Ishizawa Keisuke , Horiguchi Hidehisa , Shimada Tetsuya , Hirose Takanori
Published: March 2003

Subependymoma is a tumor of the central nervous system, which frequently occurs in the ventricles and rarely in the spinal cord. Most of the intraventricular subependymomas are subclinical and thus incidentally encountered at autopsy, whereas the spinal ones are inevitably accompanied by myelopathy and are often diagnosed clinically as ependymomas or astrocytomas. Two cases of spinal cord subependymomas are reported, one of which recurred 9 years after the initial operation. All specimens of both cases showed similar microscopic features. Within a highly fibrillary background, round to ovoid tumor cells were unevenly distributed and arranged in cell clusters. Mitoses were rarely encountered. No necrosis was demonstrated in any of the specimens. Ultrastructural examination demonstrated many slender processes containing abundant intermediate filaments and occasional small lumen‐like structures with many microvillous projections and cell junctions. Subependymomas arising in the spinal cord should be distinguished from other more aggressive gliomas, such as diffuse astrocytomas and ependymomas. Characteristic microscopic features and the ultrastructural studies support the diagnosis.
Collagenous gastritis in a young Japanese woman
Authors: Kajino Yuri , Kushima Ryoji , Koyama Shigeki , Fujiyama Yoshihide , Okabe Hidetoshi
Published: March 2003

Collagenous gastritis, a counterpart of collagenous colitis, is a rare disorder with less than 20 cases reported in the literature. A case of collagenous gastritis in a Japanese woman in her early 20s who had been receiving treatment for atopic dermatitis and bronchial asthma is reported. The patient complained of repeated epigastric pain, and endoscopy revealed multifocal atrophic areas and scars in the gastric body. Biopsy specimens showed a thickened eosinophilic band‐like structure with entrapped capillaries approximately 30–70 µm thick beneath the surface epithelium. It was regarded as a collagen band because it was positive on Azan staining but negative on amyloid staining. This finding was accompanied by marked infiltration of mononuclear cells and eosinophils in the lamina propria; however, no evidence of lymphocytic gastritis was found. Helicobacter pylori infection was not detected and inflammatory cell infiltration was minimal in the mucosa without the collagen band. Immunohistochemical analysis revealed that the band was positive for type III and type VI collagen. The size of the collagen band did not change for 2 years. These findings suggest that subepithelial collagen deposition was due to an abnormal local immune response based on generalized allergic disorder.
Light and electron microscopic observation of Nautococcus mammilatus, a neustonic coccoid green alga from China
Authors: Zhengyu Hu , Guoxiang Liu , Xiaoming Zhang , Liu Yongding
Published: March 2003

A rare neustonic green coccoid alga, Nautococcus mammilatus Korschikov from Hubei Province in P.R. China was observed in culture using light and electron microscopy. Ultrastructural observations were mainly made on the cap formation and starch accumulation around the pyrenoid matrix. Accommodation of Nautococcus in the Chlorococcales is discussed.
Corticosteroid rescue in late paediatric acute respiratory distress syndrome
Authors: Goh Adrian Yt , Sekaran D , Roziah M
Published: March 2003

Late acute respiratory distress syndrome (ARDS) is associated with a mortality of more than 80%. Recent reports in adults have shown improved survival in late ARDS treated with prolonged course of steroids, however little data are available in children concerning its safety and efficacy. We report the successful treatment of a child dying from refractory late ARDS using a prolonged course of high‐dose methylprednisolone instituted after 12 days of advanced mechanical ventilation. Progressive improvement was seen from days 3, 7, 10 and 14 after treatment with improvement in Pa
O2/fraction of inspired oxygen (FiO2) ratios, lung injury score and chest radiographical score. Treatment was complicated by a fungal urinary tract infection that was easily controlled. There were no major metabolic side effects. Steroid therapy can be considered in the treatment of children with refractory late ARDS but larger prospective studies are needed to define indications, timing, dosing and safety of this mode of treatment in children.
Mechanisms of bronchial hyperresponsiveness: The interaction of endothelin‐1 and other cytokines
Authors: Xu Jun , Zhong Shan
Published: March 2003

Bronchial hyperresponsiveness (BHR) is a fundamental characteristic of asthma and has become part of a more recent definition of asthma. Data show a close link between bronchial hyperresponsiviness (both transient and persistent) and airway inflammation. Airway inflammation is orchestrated by a complex network of cytokines. It has been considered that endothelin‐1 is involved in bronchoconstriction and airway structural remodelling and has several pro‐inflammatory properties of potential relevance to asthma. We focus on endothelin‐1, its activities and interaction with other cytokines in the pathogenesis of asthma.
Impact to lung health of haze from forest fires: The Singapore experience
Authors: Emmanuel Shanta Christina
Published: March 2003

Objective:

From late July to the beginning of October 1997, countries of Southeast Asia experienced severe smoke haze pollution from uncontrolled forest fires mainly in the Indonesian states of Kalimantan and Sumatra. In Singapore, the impact of the 1997 haze was felt in the period from the end of August to the first week of November 1997 as a result of prevailing winds.

Methodology: The Ministry of the Environment monitors ambient air quality by a country‐wide telemetric air quality monitoring and management network, with 15 stations located throughout the island, linked via a public telephone network to a central control station at the Environment Building. The monitoring methods used are the United States Environmental Protection Agency (USEPA) reference methods. The Pollutant Standards Index (PSI) developed by the USEPA is used for the reporting of daily air pollution concentrations. Intervals on the PSI scale are related to the potential health effects of the daily measured concentrations of the five major air pollutants: sulfur dioxide, particulate matter (PM10), nitrogen dioxide, ozone and carbon monoxide. Public sector health facilities which come under the Ministry of Health, have computerized patient care systems which enable the routine ongoing surveillance of disease conditions for the period of the haze. Attention during the period of the haze was focused on conditions related to health effects of the haze. Data sources for the monitoring of the lung health effects of the haze included morbidity from public sector outpatient care facilities, accidents and emergency departments, public sector inpatient care facilities and national mortality data.

Results: Findings from the health impact of the haze showed that there was a 30% increase in outpatient attendance for haze‐related conditions. An increase in PM10 levels from 50 μg/m3 to 150 μg/m3 was significantly associated with increases of 12% of upper respiratory tract illness, 19% asthma and 26% rhinitis. Supplementary findings from scanning the electron microscopic sizing of the haze particles showed that 94% of the particles in the haze were below 2.5 μm in diameter. This was consistent with emissions from combustion sources originating over 500 km from Singapore. This has been of some concern because particles smaller than 2.5 μm in diameter can easily bypass normal body defence metabolism and penetrate deeply into the alveoli of the lungs. During the same period, there was also an increase in accident and emergency attendance for haze‐related conditions. There was no significant increase in hospital admissions or in mortality.

Conclusion: The present study found that the health effects from the 1997 smoke haze in Singapore were generally mild.
Characteristic modifications of the peripheral airways in patients with bronchial asthma in areas with air pollution
Authors: Tanaka Mitsuru
Published: March 2003

Objective:

Changes in the peripheral airways in patients with bronchial asthma who were living in the Kawasaki industrial zone, region with severe air pollution, were morphologically investigated in order to determine the pathological conditions of such bronchial asthma, in particular ascertaining the effect of air pollution.

Methodology: Studies were made of the morphological characteristics of the peripheral airways in patients with bronchial asthma who had resided for long periods in an area near Tokyo affected by air pollution.

Results: The endoscopic findings of the peripheral airways were distinct, consisting of reddening, stenosis, pigmentation, pallor, lustrelessness and hypersecretion. The histological findings also differed from those in usual forms of asthma.

Conclusions: The bronchial asthma in the present patients appeared to be a totally different form from a morphological viewpoint, although it was quite similar to known types in its clinicophysiological features.
Diagnostic yield of bronchoscopic sampling methods in bronchial carcinoma
Authors: Lam Bing , Wong Maria P. , Ooi Clara , Lam Wah K. , Chan Kwok N. , Ho James C. , Tsang Kenneth W.
Published: March 2003

Objectives:

The aim was to study the yield of malignant or suspicious cells from bronchoalveolar lavage (BAL), endobronchial biopsy (BX) and endobronchial brushing (BR) specimens obtained at bronchoscopy.

Methodology:

We prospectively followed up all patients who had undergone bronchoscopy and studied those with subsequent diagnosis of bronchial carcinoma at a tertiary referral centre. Bronchoalveolar lavage, BX and BR were performed, sequentially whenever possible, by one pulmonologist. The parameters assessed were age, gender, macroscopic bronchoscopic findings, TNM staging, radiological findings, histological typing, and diagnostic yield from BAL, BX, and BR.

Results:

One hundred patients (31 females, 69 males; mean age ± SD, 61.8 ± 12.7 years; range 32–81 years) were studied between 1995 and 1997. Of these, BAL, BX and BR were performed on 100, 64 and 37 cases which yielded diagnostic specimens for bronchial carcinoma in 69, 78.1, and 62.2% of cases, respectively (P > 0.05). Diagnostic specimens were therefore obtained in 69, 50, and 23% of the entire patient cohort from BAL, BX, and BR, respectively (P < 0.001). The diagnostic yield of BAL was independent of patient age, gender, site of lesion, TNM staging, histological typing and macroscopic bronchoscopic findings. Addition of BX, BR and postbronchoscopic sputum sampling to BAL only increased the yield of diagnostic specimens for bronchial carcinoma by 7, 0, and 4%, respectively.

Conclusion:

Bronchoalveolar lavage is a highly effective sampling method to obtain cytological evidence for bronchial carcinoma. The diagnostic yield for BAL is independent of tumour or other clinical characteristics. Further studies should be performed to confirm these important and clinically relevant findings.
Subcutaneous emphysema associated with chest tube drainage
Authors: Jones Peter M. , Hewer Robert D. , Wolfenden Hugh D. , Thomas Paul S.
Published: March 2003

Background: Subcutaneous emphysema may complicate a pneumothorax, but may also occur as a consequence of its treatment by chest tube drainage. The aim of this study was to evaluate the factors involved in the association between subcutaneous emphysema and chest tube drainage, and the clinical outcomes in these cases.

Methodology: One hundred and sixty‐seven patients undergoing chest tube drainage within a 12‐month period were evaluated retrospectively. There were 30 reported cases of subcutaneous emphysema (SE). Comparisons were made between those with subcutaneous emphysema and those who did not develop this complication.

Results: A total of 134 patient notes were evaluated (25 SE and 109 non‐SE). Subcutaneous emphysema was more commonly associated with trauma, bronchopleural fistulae, large and bilateral pneumothoraces, and mechanical ventilation. Subcutaneous emphysema was also associated with prolonged drainage, poor tube placement, tube blockage, side‐port migration, and a greater number of chest tubes. Importantly, those with SE had a longer length of stay and increased mortality.

Conclusion:

Subcutaneous emphysema can be spontaneous or traumatic, but is associated with avoidable causes such as inadequate chest tube drainage, particularly due to poor tube placement, anchorage and blockage, and also with side‐port migration into the subcutaneous tissue. It is associated with an increased morbidity and mortality, and may indicate the need for urgent chest tube replacement.
Extrathoracic staging of non‐small cell bronchogenic carcinoma: Relationship of the clinical evaluation to organ scans
Authors: BILGIN SEVINÇ , YILMAZ ADNAN , ÖZDEMIR FILIZ , AKKAYA ESEN , KARAKURT ZUHAL , POLUMAN ARMAN
Published: March 2003

Objective: The aim of this study was to investigate the value of systemic evaluation of extrathoracic extension of non‐small cell lung cancer and to assess the value of the clinical evaluation in detecting extrathoracic metastases.

Methodology: The study included 90 patients [87 men, three women; mean age 57.5 years (range 28–76)] with potentially resectable non‐small cell carcinoma. Fifty‐two were squamous cell carcinomas and 38 were adenocarcinomas. Organ‐specific and non‐organ‐specific clinical findings suggesting metastases were analysed and computed tomographic scans of the brain and abdomen and whole‐body bone scanning were performed in all patients.

Results: Extrathoracic metastases were detected in 23 (25.5%) of 90 patients. The
metastases were located in the following areas: brain (n = 12, 13.3%);
bone (n = 9, 10%); liver (n = 5, 5.6%); and adrenal
gland (n = 5, 5.5%). Histological analysis revealed metastases in
21.1% (11/52) of the squamous cell carcinomas and 31.6% (12/38) of
the adenocarcinomas (P > 0.05). Eleven (47.8%) of the 23 patients with extrathoracic metastases had no organ‐specific clinical findings suggesting metastases. Eight patients with squamous cell carcinomas were intrathoracic T1N0 stage and in two (25%) of these patients extrathoracic metastases were detected. These patients had no organ‐specific or non‐organ‐specific clinical factors suggesting metastases.

Conclusions: Evaluation of extrathoracic extension should be routinely performed in all patients with newly diagnosed lung cancer. This approach will prevent many unnecessary thoracotomies.
Spontaneous bilateral rupture of the Achilles tendon in a patient with chronic obstructive pulmonary disease
Authors: KHURANA ROHIT , TORZILLO PAUL J. , HORSLEY MARK , MAHONEY JOHN
Published: March 2003

A 69‐year‐old man with chronic obstructive pulmonary disease (COPD) presented with an exacerbation of cough and breathlessness, as well as a 5 day history of sudden‐onset bilateral calf tenderness. He had been commenced on inhaled steroids 41/2 years earlier and then received maintenance oral prednisone. Upon examination, there was a haematoma inferior to the medial malleolus with no Achilles tenderness on the left side. On the right side, there was focal tenderness over the mid‐portion of the Achilles tendon with pain accentuated upon dorsi flexion. A venous duplex study confirmed superficial venous thrombosis involving the left gastrocnemius vein extending proximally to the popliteal vein junction. The major axial deep veins of the left lower leg were patent. Findings on the right side were normal. A subsequent diagnostic ultrasound demonstrated unequivocal bilateral Achilles tendon ruptures. The patient subsequently underwent corrective surgery. There have been several reports of bilateral Achilles tendon rupture associated with long‐term corticosteroid use. It is likely that this entity is underdiagnosed because of a lack of awareness of this association by physicians. Recognition and surgical intervention are likely to reduce morbidity and improve outcome.
The relationship between FEV1 and PEF in the assessment of the severity of airways obstruction
Authors: LLEWELLIN PETER , SAWYER GILLIAN , LEWIS SIMON , CHENG SOO , WEATHERALL MARK , FITZHARRIS PENNY , BEASLEY RICHARD
Published: March 2003

Objective: International consensus guidelines suggest that in asthma and chronic obstructive pulmonary disease (COPD), measurements of FEV1 and PEF are equivalent in the assessment of the degree of airflow obstruction when expressed as the per cent of predicted values.

Methodology: In this retrospective study, 2587 paired measurements of PEF and FEV1 performed by 101 adult patients with asthma (n = 56) and COPD (n = 45) attending an outpatient chest clinic were obtained. The mean differences between FEV1 and PEF measurements when expressed as the percentage of predicted values was determined. The level of agreement between the two measurements in the classification of asthma severity (life‐threatening, severe, moderate and mild asthma determined by PEF or FEV1 measurements of <30%, 30–60%, 60–80%, and >80% of the predicted values, respectively) was determined.

Results: There was considerable variability between measurements of FEV1 and PEF when expressed as % predicted values. In both asthma and COPD, the FEV1% predicted was smaller than the PEF % predicted, with the mean difference being –10.9% (95% CI, –12.8% to –8.9%) with limits of agreement of –35.4% to +13.6%. The weighted Kappa statistic for agreement was 0.59 (95% CI, 48–70%) in the classification of the severity of airflow obstruction.

Conclusion: When expressed as percentage of predicted values, PEF and FEV1 values are not equivalent. We recommend that guidelines be modified to state that across the spectrum of the severity of airflow obstruction there is considerable variability between measurements of FEV1 and PEF when expressed as % predicted such that the FEV1 may be as much as 35% lower or up to 15% higher than the PEF for patients with obstructive lung diseases.