bluuebunny/crossref_metadata_2025 huggingface dataset:
Small cell undifferentiated carcinoma of the submandibular gland: Immunohistochemical evidence of myoepithelial, basal and luminal cell features
Authors: Toyosawa Satoru , Ohnishi Akio , Ito Reiko , Ogawa Yuzo , Kishino Mitsunobu , Yasui Yasunobu , Kitamura Ryuji , Matsuya Tokuzo , Ishida Takeshi , Ijuhin Naokuni
Published: March 2003

A primary small cell undifferentiated carcinoma of the submandibular gland is reported. Histological studies revealed that the major part of this tumor was composed of cells slightly larger (10–14 μm) than lymphocytes. These tumor cells showed myoepithelial‐cell differentiation, which was confirmed by the immunohistochemical and ultrastructural findings. Furthermore, some of them showed luminal‐cell and basal‐cell differentiation immunohistochemically. However, there was no evidence of neuroendocrine differentiation. These findings demonstrated that the tumor had the features of all the salivary ductal components (myoepithelial , basal, and luminal cells) and supported that the tumor might arise from the salivary duct. Furthermore, it supports the hypothesis of multipotential stem cells as the origin for small cell undifferentiated carcinomas in salivary glands.
Role of the macrophage in erythropoiesis
Authors: Sadahira Yoshito , Mori Masaharu
Published: March 2003

Macrophages, which are derived from precursor cells in the bone marrow, differentiate specifically under the influence of the local microenvironment. Resident macrophages in hematopoietic tissues can be distinguished from other stromal cells and monocytes by immunostaining with monoclonal antibody F4/80 and anti‐Forssman glycosphingolipid antibody, respectively. Erythroid colony‐forming units adhere to a resident macrophage and differentiate to erythroblasts in the presence of erythropoietin (EPO), resulting in the formation of an erythroblastic island. Resident macrophages play a supportive role in erythropoiesis, probably by preventing apoptosis of the erythroid precursors via adhesive interaction between very late activation antigen 4 and vascular cell adhesion molecule 1. Herein is proposed a model of erythropoiesis based on cooperative interaction between EPO and resident macrophages.
Existence and distribution of melanocytes and HMB‐45‐positive cells in the human minor salivary glands
Authors: Takeda Yasunori
Published: March 2003

The existence and distribution of melanocytes in the human minor salivary glands were investigated in a series of autopsy and biopsy materials. The cells with the following characteristics were regarded as melanocytes; spindle‐shaped or dendritic cells with fine granular pigments: (i) stained brownish‐black by hematoxylin‐eosin stain, and black by Masson–Fontana’s silver impregnation method; and (ii) disappeared after treatment with peroxide and potassium permanganate solution. In addition, the expression of antigen identified by anti‐HMB‐45 antibody in serial sections with melanocytes was examined. Melanocytes were found in eight (1.8%) of 445 cases, and there was no relationship between the existence of melanocytes and significant diseases of the subjects. Various numbers of melanocytes were distributed in fibrous tissue around the interlobular ducts, intralobular ducts and acini, but were not in direct contact with the epithelia. Neither melanocytes nor melanin granules were found in the salivary gland epithelia. HMB‐45‐positive cells without intracytoplasmic fine granules were found solitarily or in small groups in periductal and periacinar fibrous tissues with or without slight infiltration of small mononuclear cells.
Primary hepatic leiomyosarcoma in a patient with hepatitis C virus‐related liver cirrhosis
Authors: Tsuji Motomu , Takenaka Rika , Kashihara Takeshi , Hadama Tohru , Terada Nobuyuki , Mori Hiroshi
Published: March 2003

We describe an autopsy case of primary hepatic leiomyosarcoma in a 68‐year‐old man with hepatitis C virus‐related liver cirrhosis. The patient, who had a history of acute hepatitis 20 years previously, died of a ruptured hepatic tumor. At autopsy, a well‐circumscribed 14 × 16 × 15 cm tumor replaced the medial site of the right hepatic lobe with multiple intrahepatic and distant metastases. Histologically the tumor, which had extensive central necrosis, consisted predominantly of well or moderately differentiated spindle‐shaped cells, which were positive for smooth muscle actin and vimentin on immunohistochemical staining. In addition, clusters of markedly atypical cells and myxoid change of the matrix were discretely found in the focal and small areas of the tumor. These findings indicated that many sections were necessary for the histologically accurate estimation of primary hepatic smooth muscle tumor. The histological examination of a non‐tumorous lesion showed liver cirrhosis. Hepatitis C virus was detected in the cytoplasm of cirrhotic hepatocytes by immunohistochemistry and reverse transcriptase–polymerase chain reaction, but not in the tumor cells. This suggested that the virus was not directly involved in the development of primary hepatic leiomyosarcoma.
Signet‐ring cell carcinoma of the breast
Authors: Liu Shian‐Min , Chen Dar‐Ren
Published: March 2003

Primary signet‐ring cell carcinoma of the breast is a very rare tumor and is not recognized as an independent entity of the World Health Organization classification of breast tumor. Primary signet‐ring cell carcinoma of the breast is usually considered as a variant of mucinous carcinoma or lobular carcinoma and usually originates from the lobular epithelium. A case of primary signet‐ring cell carcinoma of the breast in a 68‐year‐old woman is presented. Histologically, the majority of neoplastic cells had an intracytoplasmic mucin collection. The histological presence of ductal carcinoma in situ, absence of lobular lesion and immunoreactivity for estrogen and progesterone receptors implicated the tumor cells arising from ductal epithelium. The papillary or organoid growth pattern is characteristic in this case. The patient underwent a modified radical mastectomy and was subsequently followed up for 6 months.
Quantitative analysis of apoptotic cell death in granulomatous inflammation induced by intravenous challenge with Cryptococcus neoformans and bacillus Calmette‐Guérin vaccine
Authors: Matsunaga Kotaro , Ito Makoto
Published: March 2003

Apoptotic cell death of macrophage has become recognized as a significant mechanism responsible for the resolution of inflammation. The purpose of this study was to examine how the apoptotic cell death involves the formation and resolution of granulomas in rats intravenously inoculated with Cryptococcus neoformans (Cr. neoformans) and Mycobacterium bovis‐derived bacillus Calmette‐Guérin (BCG) vaccine. The number and size of granulomas in the livers obtained on days 5, 10, 15, 20 and 25 after inoculation were examined by morphometric image analysis, as well as the occurrence of apoptotic cell death quantitatively analyzed by terminal deoxynucleotidyl transferase (TdT)‐mediated dUTP‐biotin nick end‐labeling (TUNEL) procedure on tissue sections. In both groups the number and size of granulomas were maximized on day 10, then the granulomas were almost resolved until day 25 when the inoculated Cr. neoformans and BCG almost disappeared. From the induction to the resolving stages of granulomatous inflammation, TUNEL‐positive cells constantly appeared in granulomas, and the highest frequency of apoptotic cells in granulomas was observed in the earlier stage of granuloma formation. These results indicate that the maintenance and resolution of infectious granulomas are regulated by the balance between the influx of newly recruited macrophages and the apoptotic elimination of granuloma macrophages. The apoptosis of granuloma macrophages actively involves the cellular turnover in both granuloma formation and resolution.
Fibromatosis of the mesoappendix
Authors: Pilichowska Monika , Kimura Noriko , Yamazaki Hideo , Ohuchi Akio , Yamamoto Kyoji
Published: March 2003

Mesenchymal tumors of the appendix are very rare. Mesenteric fibromatosis is the most common diagnosis in the case of isolated proliferative fibroblastic lesion found in this region. However, the differential diagnosis between fibromatosis and well‐differentiated fibrosarcoma (Grade I) can be difficult in some borderline cases. A rare case of proliferative fibroblastic lesion involving the appendix and mesoappendix is presented, and its origin, diagnosis and differential diagnosis are discussed.
Esophageal squamous cell carcinoma characterized by extensive chondroid differentiation
Authors: Sugai Tamotsu , Oikawa Moriyasu , Uesugi Noriyuki , Habano Wataru , Jiao Yu‐Fei , Nakamura Shin‐ichi , Hatakeyama Setsuko , Suhara Makoto , Hatafuku Kouei
Published: March 2003

A rare case of carcinoma characterized by extensive chondroid elements at a site of primary esophageal and metastatic lesion is reported. The patient was a 67‐year‐old man complaining of dysphagia due to an ulcerative lesion at the lower middle esophagus. He underwent irradiation treatment prior to surgery. Histologically, the tumor consisted of both carcinomatous and chondroid elements and had invaded deeply into the esophageal wall. The carcinomatous cells had gradually become chondroid cells embedded within an extensive extracellular matrix. In addition, the metastatic lesion showed findings similar to those of the primary lesion. Immunohistochemistry revealed that both carcinomatous and chondroid elements were immunostained with cytokeratin and epithelial membrane antigen, suggesting an epithelial nature to the chondroid cells. Conversely, only chondroid cells were positively stained for S‐100 protein. Furthermore, bone morphogenetic proteins (BMP) were positive for chondroid cells and their surrounding carcinomatous cells. Given the apparent transition between carcinomatous and chondroid cells based on microscopy and immunohistochemical findings in the present case, we concluded that the chondroid cells were derived from carcinomatous cells. In addition, our findings suggest that BMP produced by carcinomatous cells lead to chondroid differentiation of the carcinoma cells.
Mucinous endometrial adenocarcinoma simulating microglandular hyperplasia of the cervix
Authors: Fukunaga Masaharu
Published: March 2003

A case of endometrial adenocarcinoma simulating microglandular hyperplasia (MGH) of the cervix is presented. A postmenopausal 53‐year‐old woman, with no previous history of taking exogenous hormones, presented with vaginal bleeding. An endometrial biospy exhibited a tumor composed predominantly of a microglandular proliferation of tightly packed glands with mild to moderate atypia and mitotic figures. The majority of the tumor cells contained intracytoplasmic mucin. There were numerous neutrophils within the microglandular lumens and in the stroma. The tumor was focally positive for carcinoembryonic antigen and vimentin. The MGH‐like proliferation, focally, had a transition to a conventional mucinous adenocarcinoma. Hysterectomy specimens showed a residual mucinous endometrial adenocarcinoma with no myometrial invasion, the uterine cervix was unremarkable. Four years following her hysterectomy the patient was well, with no evidence of disease. Pathologists need to be cautious about MGH‐like changes in the endometrial biopsy of postmenopausal women and be aware of this type of endometrial cancer as it may be misdiagnosed.
Expression of osteopontin messenger RNA by macrophages in ovarian serous papillary cystadenocarcinoma: A possible association with calcification of psammoma bodies
Authors: Maki Masahiko , Hirota Seiichi , Kaneko Yoshiyasu , Morohoshi Toshio
Published: March 2003

Calcified psammoma bodies often appear in human ovarian serous papillary cystadenocarcinoma. Osteocalcin (OC), osteonectin (ON) and osteopontin (OPN) are three members of non‐collagenous bone‐related proteins known to be related with mineralization of bone. To clarify possible involvement of these bone matrix proteins in the calcification of the psammoma bodies, the expression of OC, ON and OPN was analyzed by immunohistochemical and in situ hybridization studies using 15 surgical specimens. OPN protein was detected in the calcified area of the psammoma bodies which was positively stained by von Kóssa’s staining, while OC and ON proteins were not. OPN protein was not detected in any cells in tissues, but OPN messenger ribonucleic acid (mRNA) was detected in CD68‐positive macrophages, indicating that OPN was produced and promptly secreted by macrophages. These results suggest that OPN produced and promptly secreted by macrophages and subsequently translocated to psammoma bodies may be causally related with the calcium phosphate deposition in the psammoma bodies of the ovarian serous papillary cystadenocarcinomas.
Immunohistochemical adrenomedullin expression is decreased in the placenta from pregnancies with pre‐eclampsia
Authors: Kanenishi Kenji , Kuwabara Hiroko , Ueno Masaki , Sakamoto Haruhiko , Hata Toshiyuki
Published: March 2003

The purpose of the present study was to investigate whether placental immunohistochemical adrenomedullin expression in normal normotensive pregnancies is different from that in pregnancies with pre‐eclampsia. Placental tissues were obtained from seven normal normotensive pregnancies and 12 pregnancies with pre‐eclampsia. The intensity of adrenomedullin staining in syncytiotrophoblasts was evaluated by means of immunohistochemistry and the ratio of the number of intact tertiary villi to that of total tertiary villi (intact/total villi ratio) was determined. The intensity of adrenomedullin expression in the placenta obtained from pregnancies with pre‐eclampsia was significantly decreased compared with expression in placentas from uncomplicated normotensive pregnancies (P< 0.005). The intact/total villi ratio in placentas obtained from pregnancies with pre‐eclampsia was significantly lower than that in placentas from normal normotensive pregnancies (P< 0.0001). In the amnion and extravillous trophoblast cells in both groups, no difference for the intensity of adrenomedullin expression was noted. These results suggest that adrenomedullin synthesis in the villous syncytiotrophoblasts is decreased in pregnancies with pre‐eclampsia.
Primary cutaneous B‐cell lymphoma in Japanese patients
Authors: Liu Qiang , Ohshima Koichi , Kikuchi Masahiro
Published: March 2003

Primary cutaneous B‐cell lymphoma (PCBCL) is a rare group of lymphoproliferative disorders. There have been few reports of Japanese patients with PCBCL, so the present study investigated the clinicopathological and immunological features and Bcl‐2 gene rearrangement and protein expression in 28 Japanese patients with PCBCL. According to the Revised European–American Lymphoma (REAL) classification, there were 25 diffuse large B‐cell lymphomas (DLBCL), one Burkitt type lymphoma, one lymphoblastic lymphoma and one marginal zone cell lymphoma. Of the 25 DLBCL, 17 were in males and eight in females, with an average age of 69.4 years. Follow‐up data were available in 19 cases of DLBCL of which seven died and 12 were alive. The overall 5‐year survival rate was 61%. Cases of DLBCL involving the legs were found to have poorer clinical outcomes; two of four cases with leg lesions died, with a mean survival of 13 months. Of 14 cases with non‐leg lesions, four died, and the mean survival was 38.9 months. Only one case of Burkitt type lymphoma was CD10 positive. Bcl‐2 rearrangement was not observed in 13 cases studied by polymerase chain reaction. Bcl‐2 expression was observed in nine of 13 cases studied. All five cases with leg lesions exhibited Bcl‐2 expression, but four of six cases with non‐leg lesions also expressed the protein. These results show that DLBCL is the most frequent subtype of PCBCL in Japanese patients and that the prognosis of Japanese patients with DLBCL is worse than that of reported European cases. The study also found that PCBCL was frequently associated with Bcl‐2 expression, which was not site‐confined, and that there was no evidence for a follicular center origin of PCBCL.
Epithelial inclusion cyst (epidermoid cyst) formation with epithelioid cell granuloma in an intrapancreatic accessory spleen
Authors: Horibe Yoshimune , Murakami Masamoto , Yamao Kenji , Imaeda Yoshihiro , Tashiro Kazuhiro , Kasahara Masao
Published: March 2003

The histologic characteristics of a case of epidermoid cyst formation with an epithelioid cell granuloma that developed in intrapancreatic accessory spleen were investigated, with the aim of clarifying its origin as well as etiologic factors. The patient, a 48‐year‐old male, was found to have a cystic lesion in the tail of the pancreas and renal cell carcinoma (clear cell carcinoma) during a medical check up. The pancreatic mass appeared to be a so‐called ‘mucinous tumor’ on imaging, and combined resection of the body and tail of the pancreas and the spleen was performed together with a left nephrectomy. The lesion in the tail of the pancreas was then demonstrated to have accessory splenic tissue with cyst formation in its central region. The cystic wall was covered with stratified squamous epithelium and ductal epithelium with squamous metaplasia, and pancreatic islet cells were evident at various sites within the accessory spleen. Formation of epithelioid cell granuloma tissue was observed around the cysts. The epithelium of the cyst was positive for CA19‐9 and negative for antibodies against mesothelial cells, whereas the pancreatic island cells were positive for insulin. These results suggested that cystic epithelium in the accessory spleen could be derived from pancreatic duct epithelium. Frequent recurrence of chronic inflammation and epitheloid cell granuloma formation may have resulted from an aberration of the ectopic remaining pancreatic tissue in the spleen.
Inflammatory myofibroblastic tumor of small bowel wall in childhood: Report of a case and a review of the literature
Authors: Demirkan Nese Calli , Akalin Taner , Yilmaz Funda , Ozgenc Funda , Ozcan Coskun , Alkanat Murat Bülent , Aydogdu Sema
Published: March 2003

Benign intestinal tumors are rare in children, however we describe an inflammatory myofibroblastic tumor (IMT) of the jejunum in a 2‐year‐old girl who presented with an intestinal obstruction. During laparotomy, an annular mass around the jejunum was resected, from which a histological diagnosis of IMT was made. A review of the literature for this rare entity emphasizes the importance of histological confirmation of its benign nature. Because of the risk of local recurrence, IMT cases should have a long‐term follow up.
Tetrasomy 12 in ovarian tumors of thecoma‐fibroma group: A fluorescence in situ hybridization analysis using paraffin sections
Authors: Liang Sheng‐Ben , Sonobe Hiroshi , Taguchi Takahiro , Takeuchi Tamotsu , Furihata Mutsuo , Yuri Kazunari , Ohtsuki Yuji
Published: March 2003

Recent cytogenetical studies have indicated that trisomy 12 is a feature of ovarian tumors in the thecoma‐fibroma group. Ten cases of these ovarian tumors were studied in total, including two thecomas, two fibrothecomas, four fibromas, one cellular fibroma and one fibrosarcoma, to clarify the relationship between polysomy 12 and proliferative activity in these tumors. Each formalin‐fixed, paraffin‐embedded tumor tissue was examined by fluorescence in situ hybridization to determine copy numbers of chromosome 12 and by immunohistochemical staining of Ki‐67 for evaluation of tumor cell proliferation. Gains of trisomy 12 were found in seven of the 10 cases, and the percentage of cells with tetrasomy 12, but not that of cells with trisomy 12, was significantly and positively correlated with percentage of Ki‐67‐positive cells, but significantly and inversely correlated with patient age. These findings suggest that tetrasomy 12 is an age‐related aberration of chromosome 12 in ovarian tumors of the thecoma‐fibroma group, and that such tumors exhibit more active proliferation in younger patients.
A rat model of hypereosinophilic syndrome
Authors: Sano Kenji , Kobayashi Motohiro , Sakaguchi Nobuki , Ito Makoto , Hotchi Masao , Matsumoto Kiyoshi
Published: March 2003

Hypereosinophilia‐occurring rats without chemical and antigen treatment have been maintained in our laboratory. The rat, Matsumoto Eosinophilia Shinshu (mes), showed hypereosinophilia at the age of 9 weeks or older and developed eosinophil‐related inflammatory lesions in many organs. These lesions included: aortitis, granulomatous lesion in the mesenteric lymph node, inflammatory fibroid polyp of the stomach and pulmonary vasculitis with septal infiltration. These lesions were involved with cellular infiltration of eosinophils and macrophages, and deposition of eosinophilic crystals which immunohistologically showed major basic protein and eosinophilic peroxidase derived from eosinophilic lysosomal constituents. Although the distribution of lesions in mes is a little different from that of hypereosinophilic syndrome (HES) in humans, in that endomyocardial fibrosis appears in HES while aortitis appears in mes, mes is probably comparable with HES. The present paper describes the pathological aspects of the lesions in mes and discusses the pathogenesis of tissue injury related to eosinophilic infiltration.
Immunohistochemical expression of gonadotropin releasing hormone receptor in human breast carcinoma
Authors: Moriya Takuya , Suzuki Takashi , Pilichowska Monika , Ariga Naohiro , Kimura Noriko , Ouchi Noriaki , Nagura Hiroshi , Sasano Hironobu
Published: March 2003

Gonadotropin releasing hormone (GnRH) analogs can cause regression of hormone‐dependent breast carcinomas via the specific GnRH receptor (GnRH‐R). In an attempt to obtain a better understanding of GnRH actions in human breast carcinoma, the expression of GnRH‐R was examined immunohistochemically in 58 invasive ductal carcinomas and correlated with various clinicopathological parameters. GnRH‐R was immunolocalized in the cytoplasm of carcinoma cells in 37 of 58 invasive ductal carcinoma cases (64%). Immunoreactivity for GnRH‐R was also detected focally in the cytoplasm of morphologically normal glandular epithelia adjacent to the carcinoma. A significant correlation was observed between the immunohistochemical expression of GnRH‐R and estrogen receptor labeling index (LI; P= 0.030) or progesterone receptor LI (P= 0.0074). There was a significant inverse correlation between GnRH‐R immunoreactivity and Ki‐67 LI (P= 0.012). No significant correlations were detected between GnRH‐R and other clinicopathological parameters, including patient age, menopausal status, stage, tumor size, lymph node status, histological grade and prognosis. This study indicates that GnRH‐R is widely distributed in human breast carcinoma cells and regulates GnRH actions locally. Breast carcinomas positive for GnRH‐R maintain some hormonal regulatory mechanisms, and GnRH actions may lead to a low proliferative rate in human breast carcinoma.
Familial amyloidotic polyneuropathy (ATTR Val30Met) with widespread cerebral amyloid angiopathy and lethal cerebral hemorrhage
Authors: Sakashita Naomi , Ando Yukio , Jinnouchi Katsunori , Yoshimatsu Mika , Terazaki Hisayasu , Obayashi Konen , Takeya Motohiro
Published: March 2003

We report an autopsy case of familial amyloidotic polyneuropathy (FAP) with cerebral hemorrhage. A 38‐year‐old woman with a typical FAP pedigree started developing severe diarrhea and sensori‐motor polyneuropathy at the age of 28 years; autonomic nervous system, heart and renal dysfunction manifested themselves in the following years. Genetic analysis revealed a single amino acid substitution at codon 30 of transthyretin (ATTR Val30Met). Ten years after her initial symptoms, the patient died of a sudden convulsive attack and respiratory failure. Autopsy revealed lethal cerebral hemorrhages and uremic lungs. Histochemical and immunohistochemical analyses revealed TTR‐derived amyloid protein in every tissue examined, particularly in glomeruli and peripheral vessels. Severe meningo‐cerebrovascular amyloidosis was also detected. Because uremia causes oxidative damage to the vascular system and amyloid formation is closely associated with oxidative stress, it is possible that uremic endothelial damage facilitated an unusual cerebral amyloid deposition. In typical FAP (ATTR Val30Met), cerebral amyloid angiopathy does not usually have clinical manifestations. However, cerebral amyloid angiopathy should be considered to explain FAP symptoms when some risk factors such as uremic vascular damage are accompanying features.
Warthin‐like tumor variant of papillary thyroid carcinoma: Case report and literature review
Authors: Urano Makoto , Abe Masato , Kuroda Makoto , Mizoguchi Yoshikazu , Horibe Yoshimune , Kasahara Masao , Tanaka Koichi , Sudo Kensuke , Hirasawa Yutaka
Published: March 2003

A tumor approximately 4.0 × 3.0 cm in size with a cystic change was observed in the left lobe of the thyroid gland of a 52‐year‐old woman. The removed tumor had lymph follicle formation with a germinal center. This lymphatic tissue showed papillary and island‐like growth; the growths were surrounded by atypical epithelium showing nuclear features of papillary carcinoma. The atypical epithelium had ground‐glass nuclei with nuclear grooves, clearly indicating intranuclear cytoplasmic inclusion bodies. No chronic thyroiditis was observed in the background of the patient. Parts of the metastatic lymph nodes had cells with an eosinophilic cytoplasm, clearly showing an intratumor lymph follicle formation, as in the primary lesion. This is a rare case of thyroid papillary carcinoma similar to Warthin's tumor of the salivary gland. Here we present this case, with a review of previously published reports.
Rare case of biphasic tumor of the breast with prominent CD34‐positive spindle cells
Authors: Hayashi Masahiro , Tamura Gen , Matsumoto Osamu , Motoyama Teiichi
Published: March 2003

We report an unusual case of biphasic tumor of the breast with prominent CD34‐positive spindle cells. A 53‐year‐old woman presented with a mass in her right breast. Following an incisional biopsy, a partial mastectomy was done. Histologically, the tumor was a biphasic variant of a malignant spindle cell tumor of the breast. The lack of a leaf‐like structure, together with the apparent myoid features of the spindle‐shaped tumor cells, made it difficult to distinguish from malignant phyllodes tumor and from myoepithelial carcinoma. Immunohistochemistry revealed the spindle‐shaped tumor cells to be myofibroblastic, but not myoepithelial in nature, ultimately categorizing this tumor as a malignant phyllodes tumor with prominent myofibroblastic differentiation.
Overexpression of MDM2 in a sclerosing epithelioid fibrosarcoma: Genetic, immunohistochemical and ultrastructural study of a case
Authors: Jiao Yu‐Fei , Nakamura Shin‐ichi , Sugai Tamotsu , Uesugi Noriyuki , Habano Wataru , Ogata Masaya , Fujioka Tomoaki
Published: March 2003

Sclerosing epithelioid fibrosarcoma (SEF) is an extremely rare soft‐tissue neoplasm. Here, we describe the molecular genetic alterations and histological, immunohistochemical and ultrastructural features of a primary SEF arising in the retroperitoneum. The tumor consisted of uniform small round to ovoid epithelioid cells, arranged in nests and cords and surrounded by a prominent hyalinized collagenous matrix. The tumor cells expressed only vimentin. Ultrastructurally, the tumor cells showed features of fibroblasts, with an abundant rough endoplasmic reticulum in the cytoplasm. Neither p53 gene mutations nor p53 protein overexpression were detected, but more than 70% of all tumor cells showed strong immunoreactivity with murine double minute 2 (MDM2). Our results suggest that MDM2 overexpression is likely to play a role in tumorigenesis in this lesion in p53‐dependent or p53‐independent pathways. To our knowledge, the present study is the first molecular genetic study of this rare lesion. Further studies will be necessary to clarify the molecular basis of tumorigenesis of this rare lesion.
Giant inflammatory polyposis of the descending colon associated with a Crohn’s disease‐like colitis
Authors: Kosugi Isao , Tada Toyohiro , Tsutsui Yoshihiro , Sato Yoko , Mitsui Takamori , Itazu Ippei
Published: March 2003

A case of giant inflammatory polyposis associated with a localized inflammatory bowel disease of the descending colon in a 49‐year‐old man is presented. Lower abdominal distension rapidly appeared without any previous history of gastrointestinal disease. Two months later, he underwent a left hemicolectomy. Postoperative recovery was complete and he remains in good health more than 2 years later. The resected colon showed a giant and bizarre polyposis measuring up to 12 cm in length and 2 cm in height and covering the entire circumference of the colon. The polyposis consisted of narrow worm‐ or noodle‐like polyps that bridged over the irregularly shaped ulcers, which sometimes extended into muscularis propria. Although longitudinal ulcers or scars, stricture, and a cobble‐stone appearance were not observed, transmural inflammation and deep fissures were found in the interpolypoid area. From these findings, this case seems to be more similar to Crohn’s disease than other inflammatory bowel diseases.
Relationship between histological findings and clinical findings in rheumatoid arthritis
Authors: Matsuno Hiroaki , Yudoh Kazuo , Nakazawa Fujio , Koizumi Fumitomo
Published: March 2003

The aim of the present study was to compare histological findings and clinical symptoms of patients with advanced stages of rheumatoid arthritis (RA). Synovial tissue specimens were obtained during reconstructive knee surgery from 93 RA patients (18 men; 75 women). The histological assessments of specimens were evaluated using two histological scoring systems reported by Rooney and Koizumi. Clinical symptoms (duration of morning stiffness, joint score, grip strength), laboratory data (erythrocyte sedimentation ratio, C‐reactive protein (CRP), rheumatoid factor), X‐ray findings (Larsen score) and drug usage were assessed before surgery. Significant statistical correlations between both histological scoring systems were observed; however, there was no significant correlation between the clinical findings and the histological scoring systems. A statistically significant correlation was found between the levels of CRP and Koizumi's scoring system. In addition, Koizumi score correlated significantly to X‐ray findings. Rooney's scoring system had an inverse correlation to methotrexate history. Histological findings do not correlate to simultaneous clinical symptoms in advanced RA patients. However, our data indicate that observed histological changes reflect X‐ray damage.
Minute mixed ductal‐endocrine carcinoma of the pancreas with predominant intraductal growth
Authors: Terada Tadashi , Kawaguchi Masaharu , Furukawa Kazuo , Sekido Yasutomo , Osamura Yoshiyuki
Published: March 2003

We report a rare case of minute (5 mm × 4 mm) mixed ductal‐endocrine carcinoma of the pancreas with predominant intraductal growth. A 34‐year‐old Japanese man was admitted because of elevated serum pancreatic enzymes. Endoscopic retrograde pancreatography revealed an unidentified material of 18 mm within the main pancreatic duct. Stone or parasite with acute pancreatitis was suspected clinically, and the biopsy revealed malignant cells positive for CA19‐9, carcinoembryonic antigen (CEA) and synaptophysin. No apparent tumor was identified in the pancreas by various imaging techniques. Resection of pancreatic body and tail was performed. Grossly, the main pancreatic duct in the pancreatic body was occluded by as much as 20 mm. The pancreas had minute carcinoma of 5 mm × 4 mm just around the occluded main pancreatic duct. The tumor cells invaded the main pancreatic duct and spread within it as long as 20  mm. Histologically, the carcinoma had biphasic pattern; one was ductal carcinoma with tubular formations and another was carcinoma with neuroendocrine features. These two elements were admixed, and the ductal element comprised 30% while the endocrine element comprised 70%. The ductal element was immunoreactive for cytokeratins, CEA and CA19‐9, while the endocrine element was immunoreactive for chromogranin A and synaptophysin. No immunoreactivity for pancreatic enzymes was noted. Ultrastructural observations showed dense core granules and no zymogen granules. Our case is unique clinically in that the tumor manifested as an intraductal material and no apparent tumor was found by imaging modalities, and pathologically in that the tumor was rare mixed ductal‐endocrine carcinoma and the tumor was very small and mainly grew within the main pancreatic duct.
Effects of salinity on growth and content of intracellular solutes in Heterococcus sp. (Tribonennatales, Xanthophyceae) from Antarctica
Authors: Fujii Shuhei , Yamamoto Ryoichi , Nakayama Shin , Yasui Shinro , Broady Paul A.
Published: March 2003

The growth and osmoregulation of Heterococcus sp. isolated from dry soil collected in Antarctica were investigated in relation to salinity. This alga was able to grow over a wide range of saline conditions from 0 to 0.8 mol L‐1 NaCI, although growth was suppressed in proportion to the increase in extracellular concentration of NaCI. This indicates that the alga is halotolerant. Using gas‐liquid chromatography‐mass spectroscopy, it was found to contain mannitol as an osmoticum. The intracellular content of mannitol increased with increase in concentration of extracellular NaCI, suggesting that mannitol acts as an osmoregulatory substance.
Addition of inhaled salmeterol to inhaled corticosteroids in patients with poorly controlled nocturnal asthma
Authors: Norhaya MR , Yap TM , Zainudin BMZ
Published: March 2003

The effect of adding inhaled salmeterol to inhaled corticosteroids was studied in patients with poorly controlled nocturnal asthma. In a double‐blind, cross‐over study, 20 patients were randomized to receive either salmeterol 50 μg twice daily or placebo via a Diskhaler® after a 1‐week run‐in period. After 4 weeks of treatment, patients were subsequently crossed over to receive the other treatment for a further 4 weeks with a 2‐week wash‐out period in between. The response to treatment was assessed by peak expiratory flow rates (PEF) measured in the morning and evening, symptom scores of asthma, number of bronchodilators used, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) at regular intervals. Patients’ preference for the Diskhaler® or metered‐dose inhaler was assessed at the last visit. The results showed that morning PEF was significantly higher while on salmeterol than on placebo (296.9 ± 70.2 vs 274.6 ± 77.4 L/min). Evening PEF showed a trend towards a higher value while on salmeterol than on placebo (321.1 ± 73.4 vs 288.7 ± 79.4 L/min), but the difference was not significant. There was no statistically significant improvement in symptom scores, number of rescue bronchodilators used and FEV1 or FVC between the two treatment groups. The occurrence of side effects in terms of tremors and palpitations between treatment and placebo were similar. There were more patients who preferred Diskhaler® to metered‐dose inhaler (70% vs 30%). We conclude that salmeterol 50 μg twice daily produces significant improvement in morning PEF and is well tolerated in patients with nocturnal asthma. Diskhaler® is a device which is easy to use and preferred to a metered‐dose inhaler.
Syndrome of inappropriate secretion of antidiuretic hormone associated with amyotrophic lateral sclerosis in respiratory failure
Authors: Yoshida Yoshimasa , Kato Bunichi , Mizushima Yutaka , Arai Nobuki , Matsui Shoko , Maruyama Muneharu , Kobayashi Masashi
Published: March 2003

A 65‐year‐old man who had muscle weakness and dysarthria was admitted for investigation of motor neuron disease. He had lost 12 kg of weight in 6 months. Neurological findings disclosed upper and lower motor neuron disturbances with normal sensory nerve function, and needle electromyography showed a neurogenic pattern. Laboratory findings on admission demonstrated dilutional hyponatraemia due to an excessive secretion of antidiuretic hormone (ADH). Based on these findings, the patient was diagnosed as having the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with amyotrophic lateral sclerosis (ALS). During the night of first hospital day, the patient complained of severe dyspnoea, and mechanical ventilation was commenced. Following the mechanical ventilation, plasma ADH levels and serum sodium concentration were normalized. We propose that respiratory failure secondary to the atrophy of respiratory muscle might be responsible for the development of SIADH.
The role of cysteinyl leukotrienes in the pathogenesis of asthma: Clinical study of leukotriene antagonist pranlukast for 1 year in moderate and severe asthma
Authors: Kohrogi Hirotsugu , Iwagoe Hajime , Fujii Kazuhiko , Hamamoto Junji , Fukuda Koichiro , Hirata Naomi , Kawano Osamu , Matsumoto Mitsuhiro , Suga Moritaka , Ando Masayuki
Published: March 2003

Clinical studies have shown that pranlukast (Ono Pharmaceutical Co., Osaka, Japan) is effective for mild and moderate asthma. However, it is not well known that pranlukast is also effective on moderate and severe persistent asthma in the long term. We studied the effect of pranlukast on moderate and severe asthmatics by evaluating the change of peak expiratory flow (PEF) and therapeutic scores for 1 year before and during pranlukast therapy. We gave pranlukast 225 mg twice daily orally to 25 patients who were receiving more than 400 μg/day beclomethasone inhalation and β2 stimulant inhalation with or without oral corticosteroid. Pranlukast increased PEF more than 10 L/min in 14 patients in the first 4 weeks. In these 14 patients, 10 patients continued to monitor PEF and kept asthma diaries for 1 year. We compared the data for 1 year before and during the pranlukast therapy. During the pranlukast therapy, PEF significantly increased, puffs of β2 stimulant inhalation significantly decreased. The incidence of oral corticosteroid rescue therapy reduced, and the mean daily dose of oral corticosteroid decreased; however, they were not statistically significant. During treatment with pranlukast, no side effect was observed. From these results, we suggest that pranlukast is effective for more than half of the moderate and severe persistent asthmatics, and that the effectiveness continues for more than 1 year.
Utility of near patient testing and home care analysis using a portable critical care analyser
Authors: Hosokawa Yoshifumi , Yoshizawa Akitaka , Yoshizawa Takayuki , Sawada Sigemasa , Horie Takashi
Published: March 2003

Objective:

This study was conducted in order to determine the usefulness of the application of home patient care using a portable critical care analyser (OPTI‐C) after the precision of the OPTI‐C was examined.

Methodology: The OPTI‐C, which measures sodium (Na+) and potassium (K+) as well as pH, PCO2 and PO2 in whole blood, was used. In order to confirm the linearity of the OPTI‐C, analysis using reference materials was performed (n = 81). Correlation testing with whole blood samples from patients was also performed using other analysers in the laboratory (n = 108). Home patient testing was performed with 15 patients.

Results: The slope linearity and correlation coefficients were as follows: pH, 1.0174 ± 0.0091, 0.99972; PCO2, 0.9681 ± 0.0094, 0.99967; PO2, 0.9844 ± 0.0085, 0.99974; NaST, 0.9788 ± 0.0115, 0.99911 and KST 0.9964 ± 0.0128, 0.99893.

The equivalent results from other analysers showed pH, 1.071 ± 0.009, 0.9963; PCO2 0.985 ± 0.016, 0.9870; PO2 0.989 ± 0.007, 0.9976; Na+, 1.075 ± 0.278, 0.9662 and K+ 1.120 ± 0.020, 0.9842. The correlation coefficients and P values were as follows: pH, 0.9790, P > 0.1; PCO2, 0.9990, P > 0.1; PO2, 0.9980, P > 0.1; Na+, 0.9438, P > 0.05, and K+, 0.9174, P > 0.1.

Conclusion: The use of portable critical care analysers for near patient testing for home‐care patients is recommended in order to increase the efficiency of visits as well as to improve the quality of patient care.
Diesel exhaust particles activate human bronchial epithelial cells to express inflammatory mediators in the airways: A review
Authors: Takizawa Hajime , Ohtoshi Takayuki , Kawasaki Shin , Abe Shinji , Sugawara Isamu , Nakahara Kazuhiko , Matsushima Kouji , Kudoh Shoji
Published: March 2003

Objective:

Epidemiological as well as experimental studies suggest that particulate air pollutants, including diesel exhaust particles (DEP), may play a role in the recent increase of respiratory morbidity and mortality. We studied the effect of DEP on the production of inflammatory cytokines and mediators including IL‐8 and granulocyte macrophage colony stimulating factor (GM‐CSF) by human airway epithelial cells in vitro.

Methodology:

Suspended DEP were added to cultured normal human bronchial epithelial cells or transformed BEAS‐2B cells. The release of cytokines and mediators was evaluated by enzyme‐linked immunosorbent assay. The transcriptional levels of IL‐8 mRNA was studied by northern blot analysis and run‐on transcription assay. Activation of transcription factors was assessed by electrophoretic mobility shift assay.

Results: Non‐toxic doses of suspended DEP showed a significant stimulatory effect on IL‐8 and GM‐CSF production by airway epithelial cells. Diesel exhaust particles increased the steady‐state levels of IL‐8 mRNA, which was suggested to be largely due to increased transcriptional rates. Electrophoretic mobility shift assay demonstrated that DEP induced increased binding to the specific motif of nuclear factor (NF)‐κB, but not of transcription factor AP‐1. Both N‐acetylcysteine and pyrrolidine dithiocarbamate attenuated the action of DEP on IL‐8 mRNA expression, suggesting that oxidant‐mediated pathway might be involved in its processes. Transient transfection of airway epithelial cells with wild and NF‐κB binding motifs indicated that the activation of NF‐κB was essential for IL‐8 gene upregulation by reporter gene assay.

Conclusions: These results suggested that DEP activate NF‐κB, which might be an important pathway for the expression of inflammatory cytokines in vitro.
Endobronchial actinomycosis associated with a foreign body
Authors: Ho James C. M. , Ooi Gaik C. , Lam Wah‐Kit , Lam Bing , Cheung Tung‐Fai
Published: March 2003

Primary endobronchial actinomycosis is an exceedingly rare condition which closely mimics bronchial carcinoma both clinically and radiologically. We report the case of a middle‐aged Chinese man who had right lower lobe endobronchial actinomycosis associated with inhalation of a presumed chicken bone. The patient made a complete clinical and radiological recovery after a 2 month combined course of amoxycillin and clavulanate, after removal of the foreign body, which was only detected after using contiguous computed tomography. Our experience in the management of this patient should help clinicians in the investigation and management of this rare but treatable condition.
Use of star volume to measure the size of the alveolar space in the asthmatic guinea‐pig lung
Authors: YANG ZHENG‐WEI , QIN YAN‐HONG , SU SHU‐RONG
Published: March 2003

Background:

The ovalbumin‐sensitized guinea‐pig is a useful small‐animal model of allergic asthma; however, it is unclear whether considerable morphological changes occur in the lung.

Methodology:

Guinea‐pigs were initially given ovalbumin (i.p. injection) for 14 days and asthma was then induced by daily challenges with aerosolized ovalbumin for 10 days. During this time, animals were treated with either saline (positive control) or dexamethasone. Pulmonary sections were prepared to estimate the volume and surface area of the alveolar space, mean thickness of the alveolar septum and star volume of the alveolar space using stereological methods.

Results:

The primary change in the lung in the positive control group was a significantly increased star volume, which was approximately threefold that of animals not treated with ovalbumin and the dexamethasone‐treated group. There were no significant differences in other morphometric parameters between the groups.

Conclusion:

Star volume of the alveolar space appears to be a good and useful parameter to detect morphological changes of the asthmatic lung.
Adherence to asthma self‐management plans with inhaled corticosteroid and oral prednisone: A descriptive analysis
Authors: WRAIGHT JONATHAN M. , COWAN JAN O. , FLANNERY ERIN M. , TOWN G. IAN , TAYLOR D. ROBIN
Published: March 2003

Background: Asthma self‐management plans (SMP) are widely recommended for use, but there is little information regarding the degree of patient adherence to their instructions. The aim of the present study was to perform a descriptive analysis of patient responses to worsening asthma with regard to using individualized SMP.

Methods: Diary data were obtained from an earlier 2 year study in which patients used regularly revised SMP in combination with daily recordings of peak expiratory flow (PEF) and symptoms to manage intercurrent asthma episodes. Based on PEF and symptom changes, the SMP contained instructions about increasing the dose of inhaled corticosteroid (ICS) or commencing oral prednisone during worsening asthma, depending on severity. Data from 165 patient diaries were analysed. First, documented responses to episodes of worsening asthma were matched against SMP instructions and adherence was determined using a priori criteria. Second, each occasion when the ICS dose was increased or prednisone was commenced was identified and changes in PEF and/or symptoms that may have led to these actions were sought.

Results: Adherence for increasing the ICS dose was dependent on asthma severity, ranging from 78% during severe episodes to 31% during mild short‐lived events. When oral prednisone was indicated, patients were adherent on 56% of occasions. Symptoms prompted intervention more frequently than changes in PEF. Significant changes in PEF were absent on 41 and 48% of occasions for ICS dose increase and oral prednisone use, respectively.

Conclusions: Adherence to asthma SMP is variable and often poor. It tends to increase in proportion to the severity and duration of an asthma episode. This underscores the importance of SMP in more severe asthma. Symptoms are more important then PEF in prompting patients to alter treatment. This ought to modify our approach in constructing individual asthma SMP.
Prevalence of self‐reported respiratory symptoms in rural areas of Iran in 2000
Authors: GOLSHAN MOHAMMAD , ESTEKI BEHNOOSH , DADVAND PAYAM
Published: March 2003

Objectives: The aims of the present study were to measure the population prevalence of symptoms of asthma, chronic bronchitis, obstructive lung disease and non‐specific respiratory symptoms in randomly selected rural communities in south‐west Isfahan, Iran.

Methodology: Nine hundred and ninety‐four subjects from a total of 1127 villagers (88.2% response rate) took part in a medical interview conducted by interns from the Isfahan Medical School.

Results: The mean (±SD) age of the population surveyed was 25.21 ± 17.55 years and the smoking rate was 7.2%. The self‐reported prevalence rates for current asthma, chronic bronchitis, non‐specific exercise‐induced cough and night cough were 6.1, 4.4, 13.3 and 11.3%, respectively.

Conclusion: Asthma, chronic bronchitis and other respiratory disorders in rural Isfahan are more prevalent than expected for a young rural population with low smoking rates. The cause of this should be investigated.