Cytologic morphometric approach for the prediction of lymph node involvement in papillary thyroid cancer

OBJECTIVE

Papillary thyroid cancer frequently metastasizes to lymph nodes; however, it is generally difficult to make a precise diagnosis preoperatively. The present study was carried out to evaluate lymph node status preoperatively by using quantitative estimations of various cytologic features obtained by fine needle aspiration biopsy from 110 patients with papillary thyroid cancer.

STUDY DESIGN

Using a microscope connected to a computerized video system, mean nuclear area (NA) mean circumferential length of nuclei (CL), circular rate (CR), largest to smallest diameter ratio of nuclei (LS), coefficient of variation of NA (NACV), and rates of intranuclear cytoplasmic inclusions (CIs) and nuclear grooves (NG) were calculated and analyzed.

RESULTS

LS, NACV and NG were significantly higher in cases with metastasized lymph nodes than node-negative cases (P < .05, P < .0001, P < .05, respectively). Furthermore, all parameters except CR and LS correlated exactly with the histopathologic features (P < .0001). The number of positive lymph nodes correlated well with the value of NACV, and all cases with recurrences proved to have NACV > 22%.

CONCLUSION

Preoperative quantitative estimations of cytologic features are useful parameters for the prediction of lymph node metastases in papillary thyroid cancers.

A case of bilateral reversible thalamic lesions

We describe a case of bilateral reversible thalamic lesions with no neurological deficits and a good prognosis. The lesions appeared as low-density areas on CT and high-intensity areas on T2-weighted MR imaging, and resolved within 1 month, suggesting that the cause was edema.

Significance of tubal resection in surgical treatment of middle ear carcinoma

We successfully carried out total en bloc resection of squamous cell carcinoma of the middle ear in two patients. Both patients have been free of the disease for 32-39 months. In one of the cases, the eustachian tube was resected totally with the temporal bone. Postoperative histopathological examination proved tumor invasion into the cartilaginous part of the tube. We would like to emphasize the significance of total resection of the eustachian tube when neoplastic invasion into the tube is highly suspected. Axial computed tomography is of great value for preoperative evaluation of such invasion. Anterior mobilization of the carotid artery from the carotid canal facilitates resection of the petrous apex and should be done after management of the eustachian tube. The carotid canal is best exposed ventrally, since lateral exposure is at high risk for injuring the bony part of the eustachian tube and may possibly disseminate tumor cells.

Correlation between MIB-1 staining index and the immunoreactivity of p53 protein in recurrent and non-recurrent meningiomas

Wild type p53 protein has been shown by recent investigations to be involved in the negative regulation of cell proliferation, whereas aberrant p53 protein has lost this negative regulation of cell growth. Wild type p53 protein, which has a very short half-life, has generally been considered to be undetectable using immunohistochemical methods; however, according to a recent report, wild type p53 protein may accumulate in the nuclei because of a defective ubiquitin pathway. Aberrant p53 protein has a longer half-life, and thus is visible using immunohistochemical methods. In this study, both the proliferative potential represented by the MIB-1 staining index (SI) and the immunoreactivity of p53 protein in 51 intracranial meningiomas were studied applying immunohistochemical staining methods to archival paraffin sections. The correlation among MIB-1 SI, p53 immunoreactivity, histopathologic findings and the clinical course of the meningiomas was also analyzed retrospectively. Although it is not possible with available reagents to distinguish between aberrant p53 protein and wild type p53 protein, statistical analyses show that p53 protein was immunostained both in meningiomas with high MIB-1 SI and in recurrent meningiomas. This demonstrates the close relationship among p53 immunoreactivity, MIB-1 SI, and recurrence; therefore, the presence of p53 protein by immunohistochemical examination may suggest the proliferative activity of meningioma and is capable of serving as a predictor of future recurrence.

Simultaneous ultrastructural identification of growth hormone and its messenger ribonucleic acid using combined immunohistochemistry and non-radioisotopic in situ hybridization: a technical note

The present electron microscopical study is concerned with the simultaneous visualization of messenger ribonucleic acid (mRNA) and its encoded protein in the same specimen. Pre-embedding electron microscopical in situ hybridization (EM-ISH) on rat pituitary gland tissue localized growth hormone mRNA in the polysomes of the rough endoplasmic reticulum, and subsequent postembedding immunolabelling using protein A-colloidal gold particles identified growth hormone mainly in the secretory granules. We believe that our report provides the first simultaneous ultrastructural identification of mRNA and its encoded protein using combined pre-embedding EM-ISH and immunohistochemistry. In this method, the signals for mRNA were localized specifically as highly electron dense products on the polysomes of the endoplasmic reticulum, and those for its encoded protein were recognized as gold particles both in the cisternae of the reticulum and in the secretory granules. Our ultrastructural double labelling method for mRNA and protein may provide a tool to find important clues for elucidating the intracellular correlation of mRNA translation and secretion of translated protein, because of its high resolution, good morphological preservation, and the specific localization of the reaction products.

Gradenigo's syndrome: CT and MRI findings

We report the case of an 8-year-old girl with Gradenigo's syndrome. Involvement of the petrous portion of the left temporal bone was demonstrated by CT and an inflammatory lesion of the left petrous apex was clearly shown by MRI, which is useful in diagnosis and management of apical petrositis.

Syringomyelia associated with Hajdu-Cheney syndrome: case report

OBJECTIVE AND IMPORTANCE

Hajdu-Cheney syndrome is a rare idiopathic bone disease based on a generalized bone dysplasia accompanied by acro-osteolysis. We describe a surgical case of this syndrome that was accompanied by neurological signs associated with cervical syringomyelia.

CLINICAL PRESENTATION

A 41-year-old woman was referred to our hospital with mild quadriparesis and sensory disturbance resulting from a car accident. There was a neck injury. She showed almost all of the major characteristic clinical features and roentgenographic findings of Hajdu-Cheney syndrome with syringomyelia.

INTERVENTION

Surgical treatment was indicated because of the progressive neurological deficits. Foramen magnum decompression and C1 laminectomy were performed, and the dura was exposed. The dura was opened at the area of the foramen magnum and C1. The occipitocervical posterior fusion was carried out with an iliac bone graft and titanium wires.

CONCLUSION

Postoperatively, quadriparesis and sensory disturbance improved and the patient showed improved ambulation. Magnetic resonance imaging disclosed the well-decompressed foramen magnum. The syringomyelia disappeared in the segmental area of C2 and was decreased in the segmental areas of C5-T6. The treatment of this syndrome is symptomatic. In this patient, magnetic resonance imaging disclosed compression of the brain stem by basilar invagination and platybasia, disturbance of cerebrospinal fluid flow at the level of the foramen magnum, and syringomyelia. It was suspected that the obstruction of cerebrospinal fluid flow at the level of foramen magnum caused the cervical syringomyelia. However, the long-term prognosis remains uncertain. Follow-up is necessary to assess the final result of the treatment.

Clinical and histopathological analysis of proliferative potentials of recurrent and non-recurrent meningiomas

Proliferative potentials of meningiomas from 127 patients were examined immunohistochemically using the anti-Ki-67 monoclonal antibody, MIB-1, on paraffin sections, and the correlation among MIB-1 staining index (SI), histopathological finding, and clinical course of the disease was analyzed retrospectively. The mean MIB-1 SI of 50 male patients with meningioma was 5.5%, whereas that of 77 female patients was 2.7%. Higher MIB-1 SI were observed for younger patients. These age- and sex-related differences in MIB-1 SI were statistically significant. The patients were assigned to one of three groups: those with non-recurrent meningioma (n = 73); those with recurrent meningioma in whom the specimens obtained during the initial surgery were used to calculate the MIB-1 SI (n = 21); and those with recurrent meningioma for whom the specimens obtained during the surgery for recurrent tumors were used to calculate the MIB-1 SI (n = 33). The mean MIB-1 SI in these patients were 1.6%, 3.6%, and 8.8%, respectively, and there were statistically significant differences among these three groups. Statistical analyses reveal that meningiomas with a MIB-1 SI of 3% or more have a significantly high tendency for recurrence during the clinical courses, especially within the first 10-year follow-up periods. Moreover, there is statistically significant correlation between MIB-1 SI and recurrence in each Simpson's grade. The time interval to the next recurrence for recurrent meningiomas is associated with the proliferative potential represented by the MIB-1 SI, and a correlation equation has been proposed to predict the date of the next recurrence. Analyses on cellularity of meningiomas revealed no statistically significant difference in cellularity between non-recurrent and recurrent meningiomas. There was no statistically significant relationship between cellularity and MIB-1 SI of meningiomas. In conclusion, examination on proliferative potentials of meningiomas using MIB-1 SI is very important for biological and histopathological analyses and the prediction of future recurrence.

Insulin-like growth factors (IGFs) and IGF-binding proteins (IGFBP-1, -2 and -3) in diabetic pregnancy: relationship to macrosomia

To evaluate the role of insulin-like growth factors (IGFs) and IGF-binding proteins (IGFBPs) in excessive fetal growth (macrosomia) in diabetic pregnancy, 84 insulin-treated diabetic mothers and their infants were tested for serum concentrations of IGF-I, IFG-II, and IGFBP-1, -2 and -3. These parameters were correlated with the birth weight of neonates and placental weight. IGF-I and II levels were determined by specific radioimmunoassays (RIAs) after serum samples were extracted with aid-ethanol. IGFBPs were measured by Western immunoblot with specific antibodies to the respective IGFBP species. Serum concentrations of both IGF-I and IGF-II in mothers with either IDDM or NIDDM increased with the gestational period, reached a plateau at the third trimester, and returned to non-pregnant levels within 7 days after delivery. These values were not different from those in normal mothers before and throughout pregnancy. As previously reported, IGF-I concentrations in cord serum of neonates born to diabetic mothers were (P < 0.01) higher than those of newborns of normal mothers. Likewise, cord blood IGF-II levels were 2-fold higher in babies of diabetic mothers (P <0.001). Fetal IGF-I and IGF-II correlated with each other and with maternal HbA1C, and they positively correlated with either birth weight or placental weight. Cord IGFBP-3 concentrations were significantly higher in diabetic pregnancy, but IGFBP-2 concentrations were not different from those in normal pregnancy. Cord IGFBP-1 concentrations were significantly higher only in babies of mothers with IDDM. None of these cord IGFBP concentrations correlated with birth weight or placental weight. The data suggest that fetal IGF-II, like IGF-I, is involved in fetal and placental growth in diabetic pregnancy. The role of IGFBPs remained to be determined.

[Expiratory ventilation and carbon dioxide production measured with a thermistor flow-through system]

A thermistor flow-through system for measuring expiratory volume without a mouthpiece and a nose clip was developed. First, a thermostat and a large syringe were connected to a box used to stimulate a subject's head. A carbon dioxide (CO2) gas mixture was driven through the box, while the output of a thermistor sensor of the thermistor flow-through system was recorded. The correlation between the area under the temperature-time curve and the actual volume of gas driven through the box was computed. Second, the effects of driving time, gas temperature, and room temperature on the area under the temperature-time curve were measured. Third, corrections for expiratory time and for the temperature of exhaled gas were derived from regression analysis of the relation between the time taken to drive the CO2 gas mixture and the area under the temperature-time curve, and between the temperature of the CO2 gas mixture and the area under the temperature-time curve, respectively. Fourth, CO2 production was computed from the area under the CO2 concentration-time curve (obtained at the same time as the temperature-time curve). To measure the temperature-time curve and the CO2-time curve for the simulator, the box was placed under the transparent hood of the thermistor flow-through system. To measure the temperature-time and CO2-time curves for a subject, the head was placed in the hood while the subject was supine. The subject breathed with the mouth held slightly open, and the mixture of room air and expired gas was continuously drawn at a constant flow through an outlet at the top of the hood. The outlet was connected to a flow meter and to a constant-speed blower. The CO2 concentration and the temperature in the hood exhaust were measured at the outlet, and were continuously recorded with a chart recorder. To measure the actual volume of CO2, a Douglas bag was also used, and was connected to the blower. Increases in the driving time and in gas temperature caused increases in the area under the temperature-time curve of 9%/sec and 6%/degrees C, respectively; increases in room temperature caused it to decrease at 7%/degrees C. After the thermistor-derived expiratory volume was corrected for expiratory time and temperature, it correlated significantly with expiratory volume as measured with a respiratory inductance plethysmograph. The correlation coefficients were +0.904 for expiratory volume and +0.881 for tidal volume. A significant correlation (r = +0.992) was also found between the volume of CO2 computed from the area under the CO2-time curve and the actual volume of CO2 delivered by the simulator. A similar correlation was found between CO2 production computed from the area under the CO2-time curve and the volume of CO2 collected in the Douglas bag during breathing. With corrections for expiratory time and temperature, and with the development of more advanced thermistor sensors, a thermistor flow-through method such as the one described here may be used to measure expired volume. Such a system may also be used to measure CO2 production in the clinical pulmonary function laboratory.

Three novel AVPR2 mutations in three Japanese families with X-linked nephrogenic diabetes insipidus

We identified three novel mutations of the arginine vasopressin (AVP) V2 receptor (AVPR2) gene in Japanese families with X-linked congenital nephrogenic diabetes insipidus (NDI). In kindred #1 of siblings, a single base deletion of one out of three guanosines (nucleotides 786-788, 786delG) was detected. This deletion shifts the reading frame with an altered amino acid sequence and introduces a premature stop codon (TGA) at position 270. In kindred #2 of siblings and one unrelated additional patient (patient #3), point mutations that change the same Pro residue at codon 322 in the seventh transmembrane domain to either a Ser or His (P322S or P322H) were detected. This P322 residue is well conserved among rat V1 and V2 receptors, the human oxytocin receptor, and other G protein-coupled receptors, and is thought to be important for proper insertion of the receptor into the membrane. The AVPR2 mutations are heterogeneous both in Japanese and Caucasians populations.

Intradural spinal lipomas not associated with spinal dysraphism: a report of four cases

Intradural spinal lipomas that are not associated with spinal dysraphism are rare. We report four cases of adult patients with intradural spinal lipomas. All of the patients were young adults, three women and one man, who ranged in age from 22 to 37 years (mean, 30.3 yr). The clinical presentation of these lesions varied, depending upon the size and location of each lipoma. It is interesting that the symptoms in the women gradually deteriorated during pregnancy or after delivery. Magnetic resonance imaging was very useful in determining the exact location of lipoma. In three of four patients, neurological improvement was obtained after decompressive laminectomy and partial removal of the lipoma.

[Hydrodynamics of syringomyelia]

Abnormality of CSF hydrodynamics is an important factor of the pathogenesis of syringomyelia. Recent development of cine-MRI visualized real time CSF movement in the syrinx or subarachnoid space. In the present study, twenty cases of syringomyelia associated with Chiari I malformation, 10 cases of syringomyelia associated with spina bifida aperta, and 10 cases of syringomyelia associated with spina bifida occulta were studied with MRI and cine-MRI. The result demonstrated that hydrodynamics of these three groups were different to each other. Chiari I malformation showed CSF hydrodynamic abnormality at the foramen magnum and marked flow void in the syrinx. On the other hand, myelomeningocele showed hydrocephalus and less prominent flow void in the syrinx. Spinal lipoma which is the majority of spina bifida occulta showed no abnormality of CSF hydrodynamics. In conclusion, the selection of treatments should be individualized depending on the hydrodynamical abnormality of each patient.

A sex reversal infant with XX karyotype and complete male external genitalia

The unusual case of a Japanese newborn XX male is presented. Examination of chromosomes in amniotic fluid cells had shown a normal female karyotype (46,XX), but ultrasonography revealed a penis and a scrotum. The neonate had normal male external genitalia, and serum levels of luteinizing hormone, follicle stimulating hormone, and testosterone were all within the normal range. High resonance chromosome analysis revealed an excess portion on the short arm of one of the X chromosomes. We examined his genomic DNA by polymerase chain reaction (PCR) and detected two Y specific regions in his genomic DNA, the sex-determining region Y (SRY) and pseudoautosomal boundary Y. Nucleotide sequencing of the PCR products of SRY indicated no mutation. These findings suggested that the translocation or insertion of an SRY region on the X chromosome led to the development of testicles and a male phenotype.

[The relationship between infiltrating grade and prognosis by the preoperative diagnosis in ultrasonogram in breast carcinoma]

To evaluate peripheral infiltrative growth (inf) of breast catrcinomas as a prognostic factor, overall survival probabilities in 169 patients with tumor less than 5 cm in diameter were analysed in relation to the degree of inf (alpha, beta, gamma) using Kaplan-Meier method. There were statistically significant correlations between inf alpha and beta, inf alpha and gamma. On the other hand, the boundary echo (BE) observed at the peripheral margin of tumor in ultrasonogram is considered to reflect inf patterns of breast carcinomas. Therefore, BE was classified into three types as follows. Type I; negligible or regular thin marginal hyperecho. Type II; irregular thick marginal hyperecho. Type III; radiating boundary echo. These three types were matched to the patterns of infiltration so as to find any correlation between ultrasonogram and a corresponding histrogical specimen. Three types of ultrasonographic infiltrative grades (U-INF alpha, beta, gamma) were defined as follows. U-INF alpha; Type I BE is observed almost all surface of tumor. U-INF beta; Type II or III BE is observed in less than 50% of tumor surface. U-INF gamma; Type II or III BE is observed in over 50% of tumor surface. Total of 108 cases with tumor less than 3cm in diameter were received preoperative ultrasonographic studies. U-INF had highly significant correlation with inf and the occurrence of lymph node metastasis.

A novel point mutation (R243Q) in exon 7 of the c-erbA beta thyroid hormone receptor gene in a family with resistance to thyroid hormone

Resistance to thyroid hormone (RTH) is characterized by variable tissue hyporesponsiveness to thyroid hormones. Recently, a large number of different point mutations have been identified in the c-erbA beta thyroid hormone receptor (TR beta) in subjects with RTH. We describe a Japanese family with RTH with a novel point mutation in exon 7 of the TR beta gene. A single nucleotide substitution, guanine for adenine, was identified at the second position of codon 243 located in the hinge domain between the ligand binding and DNA binding domains in one of the two alleles of the proband and his mother, resulting in the substitution of the normal arginine (CGG) with a glutamine (CAG). Except for one family, point mutations so far described in RTH are clustered at exons 8-10 of the TR beta gene. This report presents a novel mutation in the characteristic portion in exon 7 of the TR beta.

Effects of wortmannin on glucose uptake and protein kinase C activity in rat adipocytes

Wortmannin is known to be an inhibitor of myosin light chain kinase and phosphatidylinositol 3-kinase (PI 3-kinase) (J. Biol. Chem. 268, 25846, 1993). We studied the effects of wortmannin on insulin- and 12-O-tetradecanoylphorbol 13-acetate (TPA)-induced glucose uptake, purified PKC activity and in vitro 80 kDa protein phosphorylation to elucidate the relationship between insulin-induced PI 3-kinase and PKC activations. Pretreatment with 10(-12)-10(-6) M wortmannin for 60 min resulted in a dose-responsive reduction of 10 nM insulin-stimulated glucose uptake in rat adipocytes. Pretreatment with 10(-6) M wortmannin resulted in 80% and 20% decreases of glucose uptake stimulated by insulin and TPA, respectively. Partially purified rat brain PKC activity and 80 kDa protein in vitro phosphorylation of rat adipocyte cytosol by addition of Ca2+ and phospholipid were dose-dependently decreased by 10(-8)-10(-6) M wortmannin; 20% decrease of PKC activity and 50% decrease of 80 kDa protein phosphorylation by 10(-6) M wortmannin were observed. These results suggest that wortmannin has a potent inhibitory effect on PI 3-kinase and a weak inhibitory effect on PKC activity, and both effects cause a significant inhibition of insulin-stimulated glucose uptake in rat adipocytes.

A new algorithm for predicting splice site sequence based on an improvement of categorical discriminant analysis

The splicing signals which govern the excision of introns are not yet well explained, since actual splice site sequences are to some extent different from the generally accepted consensus sequences. While a quantification method (categorical discriminant analysis: CDA) has been proposed to analyze splice site signals, sample sequences lying in the overlapping region of sample scores are not discriminated well by CDA, thus limiting the predictive ability of this analytical technique. In this paper, we propose a method to improve the performance of CDA, which is applicable to the analysis of 5'-splice site signals in various mammalian genes. The proposed algorithm has revealed a distinct enhancement in the predicting ability compared to that of traditional CDA and could explain point mutations in the 5'-splice site region of rabbit beta-globin gene fairly well.

[Effects of separate administration of low-dose CDDP on antitumor immune reactivity for treatment of malignant glioma]

Recently, it has been reported that CDDP modifies the immune responses of tumor bearing hosts, but problem of the most appropriate treatment with CDDP to augment the host immunity remains unresolved. The purpose of this study was to determine the most advantageous administration of CDDP to increase both its cytotoxic effect and antitumor immune reactivity. Cell growth inhibition in vitro was assessed by MTT assay after treatment of U-251MG cells with various concentrations of CDDP for 24 or 120 hours. The results of this experiment showed that the growth of U-251MG cells in vitro was suppressed by CDDP in a dose-dependent as well as a time-dependent manner. Ten days after subcutaneous inoculation of human glioma cells, GL-9, in the rear flank of nude mice, they were assessed for growth suppression by CDDP. Totally, 20 ml/kg of CDDP was administered to each mouse; in one group (high-dose CDDP group), 5 ml/kg of CDDP on every fifth day, and in the other group (low-dose CDDP group), 2 ml/kg on every day. Measurement of the tumor volume in each group revealed no significant difference between the two groups in terms of the efficacy of tumor growth suppression. Twenty-one days after inoculation, we measured the splenic natural killer(NK) cell activity in each mouse. The results showed that NK cell activity was significantly increased in the low-dose cisplatin (2 ml/kg) group, and significantly decreased in the high-dose cisplatin (10 mg/ml) group, as compared to the control group. The results of our study suggest that the separate administration of low-dose CDDP is a useful treatment strategy for malignant glioma, because it increases the antitumor immune reactivity of hosts without decreasing the direct tumor cytotoxicity of CDDP.

[Effect of 5'-deoxy-5-fluorouridine (5'-DFUR) on the activity of pyrimidine nucleoside phosphorylase (pyNPase) in normal and tumor tissues of human stomach]

PyNPase (pyrimidine nucleoside phosphorylase) activity and IL-1 alpha were measured in normal and tumor tissues of the specimens resected from gastric cancer patients who had been divided into two groups; one given preoperative 5'-DFUR (oral administration at a mean dose of 10.0 g) and one not given 5'-DFUR (control). PyNPase activities in both groups were higher in tumor than in normal tissues (p = 0.0001), but, less in tumor tissue of the preoperative administration group than the controls (p = 0.0376). IL-1 alpha levels in both groups were higher in tumor than in normal tissues (p < 0.01). Multiple regression analysis of the results showed that IL-1 alpha strongly influenced on PyNPase activity in tumor tissues (higher IL-1 alpha levels resulted in higher PyNPase activities in tumor tissues) (p = 0.0334).

Intracerebral ring-enhancing lesions in a patient with multiple sclerosis: a case report

BACKGROUND Intracerebral cystic lesions can easily be identified by computed tomography (CT) and magnetic resonance imaging (MRI). Cystic gliomas, brain abscesses, or metastatic carcinoma are the usual underlying causes for this neuroradiologic finding. CASE PRESENTATION We report here the case of a patient with multiple sclerosis who has two intracerebral cystic lesions. CONCLUSIONS Central nervous system (CNS) tissue destruction, necrosis, and cyst formation are very unusual in multiple sclerosis. Diagnostic difficulty therefore arises when patients suspected of having multiple sclerosis have radiologic evidence of cystic CNS lesions.

[A case of tongue cancer effectively treated with tegafur]

We administered a slow-release formulation of tegafur (SF-SP) to a patient with cancer of the tongue. We would like to report the findings of this case which showed clear improvement. SF-SP was administered at 800 mg/day to a 58 year-old male for cancer of the tongue (T4N1). By the 17th day after the start of SF-SP administration, the tumor had shrunk, and by the 37th day the submandibular lymph nodes could not be located by touch. At the completion of the test on the 60th day, no cancer cells were detected. Following the completion of the test, there have been no symptoms of recurrence and a complete response was observed. At present, we are continuing administration of SF-SP and making observations.