bluuebunny/crossref_metadata_2025 huggingface dataset:
An autopsy case of primary nodal plasmacytoma associated with Sjögren’s syndrome
Authors: Watanabe Kazuko , Yatabe Yasushi , Narita Michihiko , Ogawa Tomoko , Mori Naoyoshi
Published: March 2003

An 81‐year‐old man with a 1 year history of Sjögren’s syndrome and hypergammaglobulinemic purpura was admitted because of high fever and lymphadenopathy. Primary nodal plasmacytoma was suggested from the microscopic and immunohistochemical findings of an inguinal lymph node biopsy specimen. Although chemotherapy achieved a moderate response, the patient died 2 months later from respiratory and cardiac failure. We herein, is described a rare autopsy case of primary nodal plasmacytoma associated with Sjögren’s syndrome, in which the clinical course was progressive and Epstein‐Barr virus‐encoded RNA 1 was positive in a small number of neoplastic plasma cells, showing some difference from previously reported cases.
Histologic and immunohistochemical analysis of early submucosal invasive carcinoma of the colon and rectum
Authors: Kurisu Yoshitaka , Shimoda Tadakazu , Ochiai Atsushi , Nakanishi Yukihiro , Hirata Ichirou , Katsu Ken‐ichi
Published: March 2003

To investigate the development and progression of colorectal carcinoma, submucosal invasive carcinoma (SMC) with residual intramucosal neoplasm was studied histopathologically. Intramucosal neoplasm was confirmed by immunohistochemical staining against anti‐α‐smooth muscle actin antibody. Submucosal invasive carcinoma was classified into polypoid growth‐type carcinoma (PGC) and non‐polypoid growth‐type carcinoma (NPGC), depending on the presence of intramucosal tumor proliferation. Tumors were > 15 mm in size in 78.2% of the PGC lesions studied, but the degree of submucosal invasion was minimal (invasion of the upper 500 μm of the submucosal layer) in 52.9% of the PGC lesions. Conversely, 64.4% of NPGC lesions were
15 mm in size and the degree of submucosal invasion was moderate or severe (involving the middle and deeper layer of the submucosa) for 72.9% of NPGC. In other words, lesions of NPGC were significantly smaller in size but showed deeper infiltration than PGC lesions. Furthermore, PGC was derived from intramucosal polypoid carcinoma (including carcinoma with adenoma) and was morphologically identical to polyp cancer as reported previously. However, NPGC was derived from the flat and/or depressed type of intramucosal carcinoma classified not as polyp type, but as the superficial type. Typical NPGC was, therefore, also of the superficial type. In addition, approximately 25% of PGC lesions were identified as having an adenoma–carcinoma sequence. There was no coexistence with adenoma in the NPGC lesions, suggesting de novo development. When the degree of histologic atypia in the two types of intramucosal carcinoma was compared, 74.7% of PGC lesions showed low‐grade carcinoma, regardless of tumor size, while 62.7% of NPGC lesions showed high‐grade carcinoma in the intramucosal lesion. Approximately 25% of carcinomas with low‐grade atypia were positive for p53 (as were the high‐grade lesions), but it was not expressed in the adenoma. Therefore, tumor development and the degree of invasion differed significantly between the two types of carcinoma.
Cerebellar pleomorphic xanthoastrocytoma in an infant
Authors: Lim Sung‐Chul , Jang Seok‐Jeong , Kim Young‐Sook
Published: March 2003

Pleomorphic xanthoastrocytoma (PXA) is a rare brain tumor and typically occurs in the superficial cerebral hemispheres of young subjects. We report a case of PXA in the cerebellum of a 3‐month‐old infant in view of its unusual location and age. The patient presented with a 1‐month history of upward eyeball gazing difficulty. To the authors’ knowledge, this is the first report of occurrence of this neoplasm in the cerebellum of an infant. We report the morphologic and immunophenotypical features, and literature review with regard to the clinicopathologic aspects of a case of unusual PXA.
Peribiliary capillary plexus around interlobular bile ducts in various chronic liver diseases: An immunohistochemical and morphometric study
Authors: Matsunaga Yoshiko , Terada Tadashi
Published: March 2003

Peribiliary capillary plexus (PCP) is a network of capillaries which arise from the hepatic artery surrounding the intrahepatic bile ducts. We immunohistochemically investigated the density of PCP around interlobular bile ducts in various chronic liver diseases including primary biliary cirrhosis (PBC) (n = 47), autoimmune hepatitis (AIH) (n = 12), chronic hepatitis B (n = 16), chronic hepatitis C (n = 19), liver cirrhosis due to hepatitis B virus (n = 13), liver cirrhosis due to hepatitis C virus (n = 20), alcoholic hepatitis (n = 20), alcoholic liver cirrhosis (n = 17), using human liver biopsies fixed in formalin and embedded in paraffin wax. PCP was immunohistochemically detected by an endothelial marker, the CD34 antigen. The number of PCP per duct was 1.21 ± 0.18 in normal livers. Compared with normal liver, vasopenia was observed in PBC and AIH, the number in which was 0.93 ± 0.34 (P< 0.0001) and 0.82 ± 0.38 (P< 0.005) per duct, respectively. In contrast, increased number of PCP was observed in liver cirrhosis due to hepatitis B or C virus, alcoholic hepatitis, and alcoholic liver cirrhosis, the number in which were 1.59 ± 0.37 (P< 0.005), 1.55 ± 0.52 (P< 0.02), 1.38 ± 0.23 (P< 0.02) and 1.61 ± 0.33 (P< 0.002) per duct, respectively. These data suggest that PCP may be destroyed in autoimmune liver diseases, including PBC and AIH, but PCP may proliferate in other inflammatory and alcoholic liver diseases.
Myoepithelioma of the lacrimal gland: Report of a case with potentially malignant transformation
Authors: Okudela Koji , Ito Takaaki , Iida Man‐ichi , Kameda Yoichi , Furuno Kumiko , Kitamura Hitoshi
Published: March 2003

Myoepithelioma of the lacrimal gland is extremely rare and only four cases, one of which was malignant, have been reported in detail. The present report describes a case of lacrimal gland myoepithelioma in a Japanese male with histological features suggestive of potentially malignant transformation. The excised tumor consisted of two components, a central nodular component and a peripheral component surrounding the former. These components were separated by a fibrous tissue. Microscopically, both components were comprised almost entirely of spindle‐shaped cells, but with some epithelioid cells containing glycogen granules. Extracellular spaces in the peripheral component were filled with eosinophilic materials with the occasional crystalloid structures, which were immunoreactive for collagen type I. Neoplastic cells were immunoreactive focally for vimentin and S‐100, but negative for cytokeratins, epithelial membrane antigen, muscle actin, smooth muscle actin, desmin, myosin, and glial fibrillary acidic protein. The neoplastic cells in the central component showed nuclear pleomorphism and atypia with a higher frequency of mitotic figures, and higher labelings of proliferation markers than those in the peripheral component. Neither invasion, necrosis, nor hemorrhage was observed in the tumor. From these findings we proposed a diagnosis of potentially malignant myoepithelioma.
Quantitative estimation of renin‐containing cells in the juxtaglomerular apparatus in Bartter’s and pseudo‐Bartter’s syndromes
Authors: Okada Mayumi , Lertprasertsuke Nirush , Tsutsumi Yutaka
Published: March 2003

Our colleagues have previously observed the number of renin‐immunoreactive juxtaglomerular apparatus (JGA) in renal specimens from patients with Bartter’s and pseudo‐Bartter’s syndromes and from the normal individual. The question we have is to what extent the renin‐containing cells actually increased their cell number. It is easy to count the number of renin‐positive JGA in the specimens. The data showed that the number of renin‐positive glomeruli was 10–17 times more frequent in both syndromes than in the normal control. A geometrical calculation simply indicated that the probability of detection of a cell mass in a thin cross‐section is proportional to the length of the target structure. The number of renin‐containing cells per JGA is proportional to the increased rate of detection of renin‐immunoreactive JGA per unit area, namely 10–17 times. This is true when we assume that renin‐containing cells are solely located along the afferent arteriole, where differentiation toward renin‐secreting cell occurs in a few layers just outside the arteriole in a longitudinal direction.
Cerebellar basket cells of Creutzfeldt–Jakob disease: Immunohistochemical and ultrastructural study
Authors: Yokoo Hideaki , Isoda Koji , Yamanouchi Hideo , Sasaki Atsushi , Hirato Junko , Nakazato Yoichi , Miwa Yoshihiro
Published: March 2003

To elucidate possible abnormalities of cerebellar basket cells of Creutzfeldt–Jakob disease (CJD), seven sporadic cases were examined neuropathologically. Recently, parvalbumin‐positive, GABAergic cerebral interneurons have been demonstrated to show early, selective loss in CJD, and the phenomenon is postulated as a cause of characteristic neurological symptoms of CJD. In this study, however, we demonstrated that the basket cells, cerebellar counterparts, were resistant even in patients with severe brain atrophy, and their processes showed intense argyrophilia and immunopositivity to phosphorylated neurofilament. They can newly be listed as CJD‐resistant neurons similar to those of the hippocampus and brainstem nuclei. The mechanism to escape cell loss is of great interest, and there might be unknown factors modulating susceptibility within parvalbumin‐positive neuronal subgroups. Furthermore, one case showed abnormal positivity with hematoxylin, crystal violet and pyronin in the basket cells. The pyronin positivity was reduced after ribonuclease digestion, suggesting that the causative substance was composed of RNA. Ultrastructurally, the fibers contained free ribosomes and amorphous electron‐dense deposits. To our knowledge, such a finding has also not been previously reported.
Microsatellite instability and Epstein–Barr virus infection in gastric remnant cancers
Authors: Chang Mee Soo , Lee Joo Ho , Kim Jin Pok , Kim Hee Sung , Lee Hye Seung , Kim Chul Woo , Kim Yong Il , Kim Woo Ho
Published: March 2003

Clinicopathological analysis, microsatellite analysis, detection of Epstein–Barr virus (EBV), and immunohistochemistry on p53 protein were performed in 26 cases of gastric remnant cancer (GRC). They were divided into two groups; Group A (n= 14) who had undergone a primary gastrectomy for benign gastric disease, and Group B (n= 12) who had undergone the same operation for gastric cancer. EBV infection was present in 29% of Group A, 8% of Group B and 6% of the conventional gastric carcinoma (CGC) (Group A vs CGC, P= 0.01). Microsatellite instability (MSI) was found in 7% of Group A, 25% of Group B, and 9% of the CGC (Group B vs CGC; P= 0.08). p53 Overexpression was observed in 46% of the GRC and 33% of the CGC. p53 Overexpression was observed in 90% of the intestinal type of GRC, but in only 20% of the diffuse type of GRC (P= 0.002). The cancer stage was a significant factor in the univariate analysis of survival (P= 0.04). In conclusion, GRC is different from CGC in terms of MSI or EBV association. The pathogenetic differences between the two groups require further investigation. EBV infection may have been involved in the carcinogenesis of Group A. MSI may be an important factor in the carcinogenesis of metachronous multiple gastric cancer (Group B).
Cyclin D1 expression in ductal carcinoma in situ, atypical ductal hyperplasia and usual ductal hyperplasia: An immunohistochemical study
Authors: Umekita Yoshihisa , Yoshida Hiroki
Published: March 2003

The cell cycle regulatory gene, Cyclin D1, plays a critical role in the growth and progression of several types of human cancer, including breast cancer. Immunohistochemical study of Cyclin D1 expression has been extensively reported in invasive ductal carcinoma (IDC). In contrast, there have been few reports concerning Cyclin D1 expression in ductal carcinoma in situ (DCIS) and their positive rates are variable. The differences in the reported frequency may be largely due to the differences in antibodies used, immunohistochemical methods and the positive cut‐off point. However, we speculated that the strictness of diagnosis of DCIS might be somewhat responsible for these differences in frequency. Therefore, we selected cases of DCIS by carefully eliminating cases of predominantly intraductal carcinoma (PIC). Moreover, to clarify whether Cyclin D1 expression is involved in multistep carcinogenesis or the progression of human breast cancer, we immunohistochemically investigated Cyclin D1 expression in 57 DCIS, 10 atypical ductal hyperplasia (ADH), 70 usual ductal hyperplasia (UDH), 44 PIC and 92 IDC. Cyclin D1 expression was detected in 41 DCIS cases (72%), 22 PIC cases (50%) and 40 IDC cases (43%). No expression of Cyclin D1 was observed in either ADH or UDH. There were no significant correlations between Cyclin D1 expression and histological grade or estrogen receptor expression in DCIS. These results suggest that Cyclin D1 expression may play an important role in the early stages of carcinogenesis, and that immunohistochemical detection of Cyclin D1 expression may be helpful in differentiating low‐grade DCIS from ADH.
Pulmonary tuberculosis with unusual cystic change in an immunocompromised host
Authors: Takemura Tamiko , Akiyama Osamu , Yanagawa Takashi , Ikushima Souichiro , Ando Tsunehiro , Oritsu Masaru
Published: March 2003

We present a rare case of upper zone cystic change of the lung with disseminated tuberculosis of a non‐smoking 30‐year‐old immunocompromised male. He suffered from repeated pneumothorax. The basic pathological feature of video‐assisted thoracoscopic lung biopsy revealed granulomatous involvement in the respiratory bronchioles with poorly developed epithelioid cells and disruption of elastic fibers. Electron microscopy demonstrated a decrease in elastic fibers and disruption of the epithelial basement membrane of the respiratory bronchiole and no Langerhans cells in the lesion. Autopsy of the lung revealed centroacinar distribution of multiple cystic lesions in the bilateral upper lobe. Almost all cystic walls showed loss of elastic fibers and cysts frequently involved the respiratory and terminal bronchioles, alveolar ducts and, occasionally, alveoli. Some larger cystic lesions revealed communication to the bronchi. The cystic changes in this case of pulmonary tuberculosis may be caused by a check‐valve mechanism due to granulomatous involvement of the bronchioles and also by excavation of caseous necrotic material by draining bronchi.
Relationship between FIGO grade and AgNOR, S100‐positive Langerhans cells in endometrial adenocarcinoma
Authors: Elagöz Şahande , Aricí Dilek Sema , Aker Handan
Published: March 2003

Cell kinetic information is an important adjuvant to histological grading in some malignant tumors. In the current study, 20 endometrial adenocarcinomas were graded according to the 1988 International Federation of Gynecology and Obstetrics (FIGO) and nuclear grading system and the expression of silver‐stained nucleolar organizer regions (AgNOR) and S100‐positive Langerhans cells were determined. According to the FIGO grade, eight patients were in grade 1, seven were in grade 2 and five were in grade 3. Nuclear grade 1, 2 and 3 was determined in six, eight and six cases, respectively. Although an overlap was seen in some grade 2 and 3 cases, AgNOR counts were the highest in grade 3. S100‐positive Langerhans cells were depleted when the grades elevated. It is concluded that AgNOR and Langerhans cells can be correlated with grades. Further studies, including survival data of the patients, could be performed and AgNOR and Langerhans cells can be correlated with prognosis.
Clear cell adenocarcinoma with endobronchial polypoid growth
Authors: Iyoda Akira , Hiroshima Kenzo , Toyozaki Tetsuya , Tsukamoto Yoshiaki , Haga Yukiko , Fujisawa Takehiko , Ohwada Hidemi
Published: March 2003

Clear cell adenocarcinoma of the lung is extremely rare. On radiography, a 45‐year‐old female with fever was found to have an abnormal shadow in the left lower lung field. Bronchoscopy revealed a polypoid tumor in the left bronchus. On biopsy, the tumor was determined to be adenocarcinoma. Preoperative examination found no tumors outside of the lung. The patient underwent left lower lobectomy with bronchial wedge resection. The tumor had completely obstructed and dilated the left lower bronchus, but had not invaded the tissue outside the bronchial wall. Microscopically, the cytoplasm of the tumor cells contained abundant glycogen, and the tumor had solid and glandular structures. The tumor was diagnosed as clear cell adenocarcinoma of the lung.
Colonic intra‐epithelial carcinoma occurring in a hyperplastic polyp via a serrated adenoma
Authors: Tanaka Masanori , Kusumi Tomomi , Sasaki Yoshio , Yamagata Kazufumi , Ichinohe Hisato , Nishida Jun , Kudo Hajime
Published: March 2003

We present a case of intra‐epithelial carcinoma occurring in a serrated adenoma of the colon. The pedunculated polyp, which measured 12 × 10 × 6 mm, was endoscopically removed from the ascending colon of a 78‐year‐old woman. Histologically, the polyp mainly consisted of serrated adenomatous glands, and had foci of intra‐epithelial carcinoma at the top. Hyperplastic (metaplastic) areas were also present in both borders between the serrated adenomatous area and the surrounding normal mucosa. A sequential increase in the degree of dysplasia, and in the number of nuclei positively reactive for Ki‐67 and p53 was evident from the hyperplastic areas toward the foci of carcinoma. The polyp described here may represent a carcinogenic potential of hyperplastic polyp via serrated adenoma.
Localized malignant mesothelioma of the pleura
Authors: Okamura Hiroshi , Kamei Toshiaki , Mitsuno Ayako , Hongo Hiroshi , Sakuma Nobuo , Ishihara Tokuhiro
Published: March 2003

We describe a case of malignant pleural mesothelioma appearing as a solitary pleural tumor in a 56‐year‐old Japanese man with no history of exposure to asbestos. A chest radiograph revealed an isolated extrapulmonary mass in the left hemithorax. The patient underwent tumor resection, but the tumor later recurred on the contralateral pleura. The patient developed cerebral metastases and died 16 months after the initial surgery. The resected tumor was sessile with broad‐based pleural attachment. Microscopically, the tumor was composed of interlacing fascicles of plump spindle cells intermixed with few polygonal cells. Most of the tumor cells showed positive immunoreactivity for cytokeratins (AE1 and AE3) and vimentin. Many of the tumor cells were positive for epithelial membrane antigen, and a few were positive for desmin. In contrast, the tumor cells were consistently negative for carcinoembryonic antigen, epithelial antigen BerEP4, calretinin, S‐100 protein, neuron‐specific enolase, muscle actin antigen HHF35, α‐smooth muscle actin antigen and CD34. Ultrastructurally, the tumor cells had diffusely distributed cytoplasmic intermediate filaments, desmosome‐like junctions, and a few microvilli. Some tumor cells contained cytoplasmic tonofilaments. Immunohistochemical and ultrastructural findings supported the mesothelial nature of the tumor, and led us to diagnose this tumor as a sarcomatoid localized malignant mesothelioma.
Isolated unilateral absence of a pulmonary artery: Influence of systemic circulation on alveolar capillary vessels
Authors: Maeda Sumiko , Suzuki Satoshi , Moriya Takuya , Suzuki Takashi , Chida Masayuki , Suda Hideichi , Sakuma Hideo , Kondo Takashi , Sasano Hironobu
Published: March 2003

We report a case of isolated unilateral absence of a pulmonary artery. The first clinical symptom that was manifested in the patient was recurrent hemoptysis, and subsequent angiography revealed that the main pulmonary artery was absent in the right lung, which was being fed only from the systemic circulation. Right pneumonectomy was performed, and neither the main pulmonary artery nor its remnant was detected in the resected right lung. Histologically, there were many muscular vessels in the resected lung, with intimal proliferation, or with plexiform‐like lesions. The alveolar septum was moderately thickened and alveolar capillary vessels were dilated. We examined the alveolar capillary endothelial cells of the resected lung for immunoreactivity to thrombomodulin (TM) and von Willebrand factor (vWF) . The endothelial cells were negative for TM and positive for vWF, while in the normal lung control group, these cells were positive for TM and negative for vWF. We considered that the hemodynamics of the systemic circulation in the resected lung caused the alteration of immunohistochemical characteristics in alveolar capillary endothelial cells.
Immunohistochemical analysis of cyclooxygenase (COX)‐2 expression in pancreatic endocrine tumors: Association with tumor progression and proliferation
Authors: Ohike Nobuyuki , Morohoshi Toshio
Published: March 2003

An immunohistochemical study of cyclooxygenase (COX)‐2 expression in pancreatic endocrine tumors (PET) was carried out, and the expression of COX‐2 was compared with pathological features, the expression of several markers (hormones, vascular endothelial growth factor, single‐stranded DNA, and the Ki‐67 labeling index [LI]). Twenty PET, including 10 metastasizing cases (tumor size: 3–8 cm) and 10 non‐metastasizing cases (tumor size: 0.3– 8 cm) were studied. Tumors with a high level of COX‐2 expression were placed in the H group, and the remaining tumors were placed in the L group. The H group was comprised of 13 tumors: all 10 of the metastasizing cases and three of the non‐metastasizing cases. There were significant differences in tumor size between the two groups (H group 46.5 mm; L group 0.9 mm). There were significant differences in the presence of the following histological criteria for malignancy: pleomorphism (H group 13/13; L group 1/7), mitotic activity (H group 2.9; L group 0) and/or angioinvasion (H group 13/13; L group 1/7); and there were also significant differences in the number of cases that expressed ectopic hormones (gastrin, vasoactive intestinal peptide, serotonin and calcitonin; H group 12/13; L group 2/7) and in the Ki‐67 LI (H group 8.3%; L group 0.4%). The distribution of COX‐2‐positive cells tended to be similar to the distribution of Ki‐67‐positive cells. Our data show that COX‐2 is frequently upregulated in malignant PET and that there is a close relationship between COX‐2 expression and tumor progression / proliferative activity.
Alpha‐fetoprotein‐producing lung carcinoma: Report of three cases
Authors: Hiroshima Kenzo , Iyoda Akira , Toyozaki Tetsuya , Haga Yukiko , Baba Masayuki , Fujisawa Takehiko , Ishikura Hiroshi , Ohwada Hidemi
Published: March 2003

Three cases of alpha‐fetoprotein (AFP)‐producing lung carcinoma were studied histologically and immunohistochemically. Samples were obtained from two men and one woman who ranged in age from 64 to 71 years. Serum AFP levels for the three samples were 9826, 74.4 and 24.3 ng/mL. One case was classified as stage IIIA and two as stage IIIB. Two cases were diagnosed as large cell neuroendocrine carcinoma, and AFP expression was detected immunohistochemically. One of these samples showed differentiation to a hepatoid carcinoma, while the other was combined with a squamous cell carcinoma. The remaining case was a squamous cell carcinoma, and AFP was detected in only some of the tumor cells. All patients died within 2 years. The Ki‐67 labeling indices of the AFP‐producing pulmonary carcinomas (30.2 ± 4.6%) were significantly higher than those of AFP‐negative pulmonary carcinomas (P < 0.05). The high proliferative activity, advanced stage at presentation, vascular endothelial growth factor expression and vascular invasion observed in these tumors may explain the poor prognosis of AFP‐producing lung carcinomas.
Squamous cell carcinoma arising from a seminal vesicular cyst: Possible relationship between chronic inflammation and tumor development
Authors: Yanagisawa Nobuyuki , Saegusa Makoto , Yoshida Tsutomu , Okayasu Isao
Published: March 2003

A case of squamous cell carcinoma arising within an acquired seminal vesicular cyst is described. A 61‐year‐old man was hospitalized because of hemospermia and dysuria. Under the diagnosis of a left seminal vesicular cyst, surgical resection was performed. Pathological examination revealed squamous cell carcinoma within a seminal vesicular cyst, along with squamous metaplastic foci and severe chronic inflammation. Cell proliferation, determined with reference to MIB‐1 labeling indices, showed a stepwise increase from normal columnar epithelium, through squamous metaplasia, to squamous cell carcinoma. Sporadic p53 protein accumulation without evident gene mutations was also apparent in both the carcinoma and squamous metaplastic lesions. We therefore concluded that the squamous cell carcinoma might have developed from squamous metaplastic foci associated with chronic inflammatory stimulation, within a seminal vesicular cyst.
Peripheral T‐cell lymphoma with a nodular growth pattern
Authors: Hatano Ben , Fukushima Takuya , Honda Miyuki , Hayashi Tomayoshi , Tsuda Nobuo , Ohshima Koichi , Tsuchiya Takeshi , Kikuchi Masahiro
Published: March 2003

Peripheral T‐cell lymphomas (PTCL) with nodular growth patterns are very rare, with only 17 cases reported previously. Here, we report a case of PTCL with a nodular growth pattern. The patient was an 81‐year‐old Japanese woman who complained of malaise, fever and generalized lymph node swelling. Cervical lymph node biopsy was performed, and histological examination revealed proliferation of medium‐ to large‐sized atypical lymphoid cells with indented to irregular nuclei, distinct nucleoli and clear cytoplasm. The nodular growth pattern of the lymphoma cells was obvious. On immunohistochemistry, the atypical lymphoid cells proved to be of T‐helper cell origin (CD2+CD3CD4+CD5+CD7+ CD8–CD10–CD25–CD30–CD57–). Polymerase chain reaction analysis of the T‐cell receptor γ‐chain revealed a monoclonal rearrangement band. This unusual growth pattern should be distinguished among PTCL, as such cases could be confused with reactive nodular hyperplasia, nodular lymphoma, mantle cell lymphoma and marginal zone lymphoma with nodular colonization.
Maspin expression in human gastric adenocarcinoma
Authors: Son Hee Jung , Sohn Tae‐Sung , Song Sang Yong , Lee Jun Haeng , Rhee Jong Chul
Published: March 2003

Maspin, a member of the serpin family of protease inhibitors, is known to be a tumor suppressor. The relationship between its expression and biological significance in various human cancers has not been elucidated. We studied maspin expression in 30 cases of human gastric adenocarcinoma using immunohistochemistry and reverse transcription–polymerase chain reaction. Twenty‐seven cases (90%) of gastric adenocarcinoma, regardless of histological type, and all the cases of gastric epithelial cells with intestinal metaplasia (GECIM) showed diffuse and strong immunoreactivity for maspin. Eighteen of 26 cases (69.2%) of non‐metaplastic, non‐carcinoma gastric epithelia (NMNCE) showed weak and focal immunoreactivity. The level of maspin expression was higher in the GECIM and lower in the NMNCE than in the adenocarcinoma cases. Maspin mRNA expression was detected in all the samples from non‐carcinoma mucosa and gastric adenocarcinoma, and was higher in the gastric adenocarcinoma than in the non‐carcinoma mucosa (P < 0.001). The lower carcinoma/non‐carcinoma mRNA expression rate correlated to the underexpression of maspin immunohistochemistry (P < 0.001). These data suggest that maspin may contribute to gastric carcinogenesis. In addition, immunohistochemical expression of maspin seems to reflect mRNA expression.
Regression of congenital fibrosarcoma to hemangiomatous remnant with histological and genetic findings
Authors: Miura Katsutoshi , Han Guiping , Sano Michio , Tsutsui Yoshihiro
Published: March 2003

We report a rare case of congenital fibrosarcoma (CFS) showing regression during the course of disease, in which the histological and genetic alterations were investigated. This CFS, located on the patient's right hand, was a hemangiopericytomatous hypervascular tumor showing frequent mitosis and necrosis. Small lymphocytes, predominantly cytotoxic T cells and natural killer cells, infiltrated the tumor. At the age of 3 months, the patient received a partial resection of the tumor. At the age of 1 year, the hemangiopericytomatous tumor with a dilated vascular lumen remained, although most of the tumor cells exhibited focal necrosis with calcification and no mitotic activity. Lymphocytes increased in number and intermingled with the tumor cells. At the age of 4 years, vascular tissue consisting of inner endothelial cells and surrounding pericytomatous actin‐positive cells remained at the previous tumor locus. With reverse transcription–polymerase chain reaction analysis, ETV6–NTRK3 fusion transcripts were detected in tumor samples at 3 months and at 1 year, but not from those at 4 years of age. These genetic and histological changes suggest that the CFS either completely disappeared by apoptosis or showed mature transformation to hemangiomatous tissue with aging.
Mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland
Authors: Yamada Shin‐ichi , Matsuo Takemitsu , Fujita Shuichi , Suyama Kazutaka , Yamaguchi Akira , Mizuno Akio
Published: March 2003

Malignant transformation of Warthin's tumor is extremely rare, although it is the second most common benign tumor of the parotid gland. We describe our experience of mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland in a 64‐year‐old man. He had a swelling in the left parotid‐masseteric region. The removed tumor was well encapsulated and histopathologically comprised Warthin's tumor and low‐grade mucoepidermoid carcinoma. The mucoepidermoid carcinoma infiltrated lymphoid stroma of the Warthin's tumor, but capsular invasion is not found. Considering the clinical course and physical examination, the lesion was diagnosed as mucoepidermoid carcinoma arising in Warthin's tumor because its features filled the criteria of malignant transformation of Warthin's tumor. There has been no recurrence or distant metastasis for 19 months. Histological change from Warthin's tumor to mucoepidermoid carcinoma may be implicated in squamous or goblet cell metaplasia of epithelial cells. It is considered that the neoplastic cells of Warthin's tumor acquire malignant genotypes simultaneously with this dual differentiation.
Application of the AMeX method to the evaluation of HER‐2 status in breast carcinomas: Comparison with the results of HercepTest
Authors: Mizogami Masayo , Sakurai Shinji , Kikuchi Midori , Ohta Kenichi , Sakurai Tatsuo , Tanaka Akira , Saito Ken
Published: March 2003

The recent development of the recombinant humanized monoclonal antibody against HER‐2 oncoprotein requires a simple and accurate method for the evaluation of HER‐2 status in patients with breast cancers. We here report that the evaluation of the HER‐2 status is improved by the use of the acetone‐methanol‐xylene (AMeX) method. Compared with an ordinary test of HercepTest, 25 out of 63 cases (39.7%) were scored upwards by the AMeX method. In addition, the HER‐2 gene amplification was easily estimated by fluorescence in situ hybridization (FISH) using the AMeX method. Thus, the AMeX method is likely to provide more improved data about the HER‐2 status in breast carcinoma specimens.
Localized necrotizing angiitis of the ileum
Authors: Kubosawa Hitoshi , Akikusa Bunshiro , Furukawa Kiyoshi , Ando Katsuhiko , Suzuki Hiroshi , Iura Hiroshi , Shiobara Masayuki , Nunomura Masao , Terano Takashi , Sarashina Hiromi
Published: March 2003

A 20‐year‐old woman was hospitalized repeatedly because of intermittent bouts of intestinal obstruction and the symptoms usually improved with conservative treatments. One year after the first admission the patient was hospitalized in emergency and a laparotomy revealed a circular stricture with a pinhole perforation in the ileum. Histological sections of the stricture showed the characteristic features of microscopic polyangiitis varying from active to resolving stages, which were localized in the ileum. Fibrinoid necrosis, fibroblastic and fibrous proliferation of the intima and fibrous replacement of the media with a variable pan‐ and perivascular inflammatory cell infiltrate were characteristic in the muscular arteries and arterioles. Vascular occlusion by pale eosinophilic, fibrillar‐like materials resembling livedo racemosa of the skin, was noticed in the small arterioles and capillaries. Under no prophylaxis, the postoperative course was uneventful with no recurrence of the illness at an 18‐month follow up. The pathological alterations were distributed focally, occasionally segmentally, and haphazardly, and required detailed examination by stepwise sections for the histological diagnosis.
A survey of the distribution of UV‐absorbing substances in tropical macroalgae
Authors: Karsten Ulf , Sawall Thomas , Wiencke Christian
Published: March 2003

UV‐absorbing mycosporine‐like amino acid compounds (MAA) were identified and quantified in 13 macroalgal Chlorophyceae, six Phaeophyceae and 28 Rhodophy‐ceae collected in the intertidal zone from the tropical island Hainan, People's Republic of China, as well as from tropical mangrove locations in America, Africa, Australia and Japan. All of these habitats receive naturally high solar ultraviolet (UV) irradiances. The study revealed that all Rhodophyceae contained several MAA, which are assumed to function as natural UV sunscreens. Within all species investigated eight distinct compounds were found, seven of which were identified as mycosporine‐glycine, shinorine, porphyra‐334, pal‐ythine, asterina‐330, palythinol and palythene. The unknown substance had an absorption spectrum with a maximum at 357 nm. This compound was restricted to two red algal species from Hainan. In contrast, the Chlorophyceae and Phaeophyceae did not contain MAA or exhibited only trace concentrations. Compared with data from the literature, the amount of all MAA in the tropical Rhodophyceae seemed to be higher than in temperate organisms, probably reflecting acclimation to the stronger solar radiation which is typical for lower latitudes. The data suggest that accumulation of MAA may represent a natural defence system against exposure to biologically harmful UV radiation.
Allergic bronchopulmonary aspergillosis: A rare cause of pleural effusion
Authors: O’CONNOR TERENCE M. , O’DONNELL AONGHUS , HURLEY MICHAEL , BREDIN CHARLES P.
Published: March 2003

Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic
fungi. Allergic bronchopulmonary aspergillosis (ABPA) is a syndrome seen in patients
with asthma and cystic fibrosis, and is characterized by hypersensitivity to chronic
colonization of the airways with A. fumigatus. We report the case of a patient
with ABPA presenting with pleural effusion. A 27‐year‐old male was referred with
recurrent right pleural effusion. Past medical history was remarkable for asthma,
allergic sinusitis, and recurrent pleurisy. Investigations revealed peripheral eosinophilia
with elevated serum immunoglobulin E and bilateral pleural effusions with bilateral
upper lobe proximal bronchiectasis. Precipitating serum antibodies to A. fumigatus
were positive and the A. fumigatus immediate skin test yielded a positive reaction. A diagnosis of ABPA associated with bilateral pleural effusions was made and the patient was commenced on prednisolone. At review, the patient’s symptoms had considerably improved and his pleural effusions had resolved. ABPA may present with diverse atypical syndromes, including paratracheal and hilar adenopathy, obstructive lung collapse, pneumothorax and bronchopleural fistula, and allergic sinusitis. Allergic bronchopulmonary aspergillosis is a rare cause of pleural effusion and must be considered in the differential diagnosis of patients presenting with a pleural effusion, in particular those with a history of asthma.
Using baseline respiratory function data to optimize cycle exercise test duration
Authors: PRETTO JEFFREY J. , BRAUN GARY W. , GUY PAUL A.
Published: March 2003

Background: It is often difficult to select an appropriate workload increment for progressive cycle exercise tests in order to achieve optimal test duration (8–12 min). We hypothesize that baseline respiratory function can be systematically used to select appropriate workload increment to optimize test duration in patients referred to the clinical laboratory.

Methodology: One hundred and eighty consecutive exercise tests (with increments of 15 W/min) were retrospectively assessed. Using regression analysis, an equation was generated that predicts the work rate increment that would provide exercise duration of 8–12 min. The validity of this equation was tested prospectively in 231 consecutive tests performed with the calculated workload increment rounded to the nearest 5 watts (W).

Results: The best regression equation was: workload increment (W/min) = 1.94 × FEV1 (L) + 0.63 × TLCO (mmol/min per kPa) – 0.07 × age + 1.94 × gender (male = 1, female = 0) + 4.12 (r = 0.85, P < 0.0001). Using this equation allowed selection of the most appropriate workload increment in 79% of tests and reduced the number of tests of non‐optimal duration from 72% (for a fixed increment of 15 W/min) to 38%.

Conclusions: Utilization of this regression equation allows standardization in the selection of workload increment, and reduces the number of cycle exercise tests of inadequate duration.
Regression of bilateral bronchiectasis with inhaled steroid therapy
Authors: TSANG KENNETH W. , LAM WAH K. , SUN JUNE , OOI GAIK C.
Published: March 2003

Abstract: Bronchiectasis is defined as pathological and permanent dilatation of the bronchial tree. Affected patients suffer from chronic sputum production and usually slowly progressive airway destruction as a result of continued airway infection and inflammation. Regression of bilateral bronchiectasis has never been reported in the English literature. We report the case of a 60‐year‐old woman with longstanding progressive idiopathic bilateral bronchiectasis whose respiratory symptoms, including sputum, rapidly disappeared after commencement of inhaled budesonide. Repeat computed tomography assessment 40 months after commencement of inhaled steroid therapy, showed partial regression of bronchial dilation and resolution of small airways sepsis. In the absence of other possible explanations for the partial resolution of the bronchiectasis, the present case suggests a possible benefit of inhaled steroid therapy in bronchiectasis.
Comparing transforming growth factor‐β2, talc and bleomycin as pleurodesing agents in sheep
Authors: LEE Y. C. Gary , YASAY Justin R. , JOHNSON Joyce E. , PARKER Richard E. , THOMPSON Philip J. , LANE Kirk B. , LIGHT Richard W.
Published: March 2003

Background: Transforming growth factor (TGF)‐β2 can produce effective pleurodesis in animals, but its efficacy has not been compared with commonly used pleurodesing agents in sheep, which have a thick pleura resembling that of humans. The acute physiological effects and the level of systemic TGF‐β absorption after its intrapleural administration have not been studied. The aims of the present study were to compare: (i) the effectiveness of TGF‐β2, talc and bleomycin in producing pleurodesis in sheep; (ii) the acute side‐effects and systemic TGF‐β levels following the intrapleural administration of these agents; and (iii) histological changes after intrapleural injections of these agents.

Methodology: Twelve sheep were divided into three groups and were given a single intrapleural dose of TGF‐β2 (0.25 μg/kg), talc slurry (5 g) or bleomycin (60 IU) via a chest tube. Saline or buffer was injected into the contralateral side, which served as the control. Arterial blood gases and respiratory and heart rates were monitored for the first 24 h. Plasma levels of TGF‐β1 and TGF‐β2 were measured. Pleurodesis was graded macroscopically from 1 (none) to 8 (symphysis > 50% of hemithorax) at day 14.

Results: At day 14, the pleurodesis score of the TGF‐β2 group (7.7 ± 0.6) was similar to that of the talc (7.0 ± 1.7) group and significantly higher than that of the bleomycin group (3.3 ± 2.3; P < 0.05). No significant differences were seen in arterial blood gas analysis, vital signs and plasma TGF‐β1 and TGF‐β2 concentrations among the three groups.

Conclusions: Transforming growth factor‐β2 was as effective as talc and more so than bleomycin in inducing pleurodesis in sheep. Intrapleural administration of TGF‐β2 appeared safe. No acute changes in gaseous exchange or macroscopic abnormalities were seen following intrapleural TGF‐β2. Importantly, there was no evidence of an increase in systemic TGF‐β levels following its intrapleural administration.
Prevalence of respiratory symptoms related to chronic obstructive pulmonary disease and asthma among middle aged and older adults
Authors: ABRAMSON MICHAEL , MATHESON MELANIE , WHARTON CATHRYN , SIM MALCOLM
Published: March 2003

Objective: The aim of this study was to assess the prevalence of chronic obstructive pulmonary disease in middle aged and older adults.

Methodology: A random sample of 7005 adults aged between 45 and 69 years was drawn from electoral rolls for Melbourne, Victoria, Australia. A postal survey was conducted using the European Community Respiratory Health Survey respiratory screening questionnaire with additional questions on chronic bronchitis and emphysema. Participants were asked to return the survey by reply mail. Non‐responders were sent a reminder postcard after 2 weeks, a replacement questionnaire after 4 weeks and then contacted by telephone.

Results: Completed questionnaires were returned by 4906 (70.0%) participants. The commonest symptoms were exertional dyspnoea (27.2%) and wheezing (20.5%). Chronic bronchitis was reported by 12.0% and emphysema by 1.2%. Males were significantly more likely to report cough and sputum, while females were more likely to report asthma. The prevalence of exertional dyspnoea, cough and sputum, emphysema and heart disease increased with age. Chronic bronchitis, emphysema and most respiratory symptoms were associated with smoking.

Conclusions: Self‐reported chronic bronchitis or emphysema affect one in eight middle aged and older adults. Differences between men and women are partly explained by differences in smoking. These findings require confirmation with lung function tests.
Government action to reduce smoking
Authors: SANDFORD Amanda
Published: March 2003

Abstract:  The major health impacts of smoking were established more than 40 years ago but Governments were slow to respond to the growing health epidemic. Despite laudable tobacco control strategies in many countries, globally deaths from smoking continue to rise and are forecast to reach 10 million a year by the 2030’s. There is now general agreement that in order to substantially reduce smoking rates, governments need to adopt a comprehensive approach to tobacco control. This should include a range of measures, notably: a total ban on tobacco advertising and promotion; restrictions on smoking in public places and in the workplace; sustained increases in tobacco taxation combined with measures to curb smuggling; large, bold health warnings on tobacco products; smoking cessation and health education campaigns; and the regulation of tobacco to standards agreed by the health community rather than those set by the tobacco industry. While legislation is to be favoured over voluntary controls, the key to the successful implementation of these measures is winning public support and ensuring proper enforcement. Given the enormous burden that smoking places on health services, governments in developed nations have generally responded by introducing a range of tobacco control measures. However, the picture is far from uniform and some of the best examples of strong, government‐led action have occurred in less developed nations. Governments can learn much from these countries and, by supporting the impending global treaty on tobacco control, can help to reduce the smoking‐related diseases and deaths of the future.
Floral scents, leaf volatiles and thermogenic flowers in Magnoliaceae
Authors: Azuma Hiroshi , Thien Leonard B. , Kawano Shoichi
Published: March 2003

The role and chemical composition of floral scent in pollination systems of angiosperms has been largely ignored because of the difficulty in characterizing scent components. Magnoliaceae is one of the few plant families in which the floral scents of a large number of species have been analyzed. Within the family, floral scents of taxa are dominated by one chemical class of compounds (e.g. benzenoids or terpenoids etc.). Artificially damaged leaves emit a variety of chemicals, some of which also occur in the floral scents (e.g. 4,8‐dimethyl‐1,3(E),7‐nonatriene, linalool etc.). Floral thermogenesis occurs in Magnoliaceae and enhances evaporation of floral scent (in Magnolia tamaulipana A. Vázquez, sp. nov.) and may serve as a direct energy reward to visiting insects. It is hypothesized that floral heat and scent may have been key components in the breeding systems of early angiosperms. Floral heat may have been a major resource for insects and one that could be provided by plants without evolution of elaborate morphological features. In this regard, fragrance signals not only food and mating sites, but also heat.
Spectrum of renal osteodystrophy in children on continuous ambulatory peritoneal dialysis
Authors: Yalçinkaya Fatoş , Ince Erdal , Tümer Necmiye , Ensari Arzu , Özkaya Nuray
Published: March 2003

Abstract Background: The prevalence of different types of bone disease in chronic renal failure (CRF) has changed significantly during the last decade. The aim of the present study is to evaluate the spectrum of bone disease in children with CRF undergoing continuous ambulatory peritoneal dialysis (CAPD).

Methods
: Seventeen children with CRF on CAPD aged 7–20 years were evaluated. All patients had received regular vitamin D and calcium carbonate therapy during the 6 months preceding the bone biopsy. Serum calcium, phosphate, alkaline phosphatase and immunoreactive parathyroid hormone (iPTH) levels were measured and hand X‐rays were performed. Transiliac bone biopsies were analyzed for histologic diagnosis.

Results
: High turnover renal osteodystrophy (ROD) was the most common bone disease, present in eight patients (47%). Five patients (29%) had low turnover bone disease, and four (24%) had mixed ROD. The mean age of the high turnover ROD group was higher than that of the low turnover group (14~3 vs. 11~3 years, P<0.05). Seven of the nine patients who had tubulo‐interstitial nephritis were found to have high turnover bone disease. In contrast, none of the patients with glomerulonephritis exhibited high turnover bone lesions. Mean serum calcium levels were found to be significantly higher in the low turnover group compared with the patients with high turnover bone disease (P<0.001). A serum iPTH level >200 pg/mL was 100% sensitive and 66% specific in identifying patients with high turnover ROD.

Conclusion
: The spectrum of bone disease of the children with CRF undergoing CAPD seems to depend on the rate of CRF and primary disease. The risk of developing overt hyperparathyroid bone disease is high in children with slowly progressing forms of renal pathology and especially in those with tubulo‐interstitial disease. In contrast, children with glomerular diseases who had a more rapidly progressive course may have a lesser risk of developing high turnover bone disease. The results of the present study indicate that even routinely prescribed regular vitamin D therapy early in the course of disease may lead to low turnover bone lesion in small children who have CRF due to rapidly progressive forms of renal pathology.