Diagnostic utility of fine-needle aspiration cytology in syphilitic lymphadenitis: A case report

Syphilis is a sexually transmitted infection that causes serious health problems without treatment. Detection of syphilis is necessary to stop the spread of the infection. Cytological screeners and pathologists may experience fine-needle aspiration cytology (FNAC) for syphilitic lymphadenitis; however, its characteristic cytological features are rarely reported. We present FNAC cytological features of syphilitic lymphadenitis in a case of a 21-year-old man. He presented with a sore throat and painful neck lymphadenopathy. His swollen and painful neck persisted even with antibiotic treatment. Necrotizing lymphadenitis and lymphoma were clinically suspected. FNAC was taken from the swollen lymph node. Cytologic findings of the specimen showed various inflammatory cells with small-sized vessels arranged in a branching/arborizing fashion. The vessels were surrounded by inflammatory cells, including plasma cells, neutrophils, and macrophages. Perivascular plasma cell cuffing was focally seen along with inconspicuous granulomas. Neutrophils appeared to involve the vascular wall. The cytological findings suggested syphilitic lymphadenitis, and clinical findings and serological tests confirmed primary syphilis with concomitant human immunodeficiency virus infection. Branching/arborizing vessels associated with many plasma cells, vascular involvement of neutrophils, and granulomas may suggest syphilitic infection if the specimen is obtained via FNAC. (189 words).

Entrapment partly participates in the longitudinal progression of neuropathy with anti-MAG antibodies

Neuropathy with anti-myelin-associated glycoprotein (MAG) antibodies commonly demonstrates distal-dominant prolongation of nerve conduction. However, recent electrophysiological studies have shown that distal motor demyelination is not always a distinct feature. We aimed to elucidate whether the longitudinal progression of nerve impairment occurs in a distal-dominant manner. Seven patients with neuropathy with anti-MAG antibodies were enrolled. Sequential nerve conduction studies revealed nerve conduction reduction only at the wrist segment in the median nerve of the patients, but not in the ulnar nerve. Median nerve entrapment at the wrist may play a role in longitudinal disease progression in neuropathy with anti-MAG antibodies.

P-205 Blastocyst derived from oocytes with smooth endoplasmic reticulum aggregates (SERa) has similar clinical and perinatal outcomes with those of oocytes without SER

Study question

This study was to investigate effect of SERa on the fertilization rate, embryonic development after ICSI, and clinical and perinatal outcomes after single blastocyst transfer.

Summary answer

SERa (+) derived embryo can be selected as embryos for transfer when no available SERa (-) derived embryos.

What is known already

Based on findings that the risk of congenital abnormalities in the newborn is higher in ovum with SERa in the cytoplasm, the Istanbul consensus workshop at the 2011 meeting of the ESHRE recommended against fertilizing ovum with SERa due to these risks. However, there have been several reports of healthy infants born from embryos derived from SERa, suggesting that, while more long-term follow-up is necessary, healthy births are possible from such embryos. In 2017, the 2011 recommendations were reviewed in the Alpha/ESHRE consensus (Vienna), which said the approach should be determined on a case-by-case basis.

Study design, size, duration

We retrospectively investigated 23,007 oocytes which was retrieved between January 2016 and March 2020. Of these, 1,038 oocytes (4.5%) with visible SERa comprised SERa (+), while 21,969 oocytes (95.5%) without SERa comprised SERa (-).

Participants/materials, setting, methods

SERa were observed under the microscopy after denudation. The rate of fertilization, good-quality day-3 embryos, good-quality day-5 blastocysts, and day-5, 6 or 7 blastocysts were evaluated for both groups. We also compared the rate of clinical pregnancy, live birth, miscarriage, and birth defects in single blastocyst transfer between SERa (+) derived 114 blastocysts and SERa (-) derived 6,290 blastocysts from January 2016 and December 2018.

Main results and the role of chance

The results are shown. 2PN fertilization rate outcomes after ICSI (SERa(-) eggs vs. SERa(+)eggs),81.4%(17,873/21,969) vs.79.4% (823/1,038),and good-quality day3 rate was 61.1%(10,927/17,873)vs.60.9% (501/823) which was not significantly different. Good-quality day5 blastocyst rate was 46.5% (7,876/16,955) vs. 39.8%(304/763), and day 5 blastocyst success rate was 60.8% (10,317/16,955) vs.54.3% (414/763), which were both significantly lower with SERa(+). (P < 0.001) The day 6 blastocyst success rate was 69.9% (11,849/16,955) vs. 65.5% (500/763) (P = 0.01), and the day 7 blastocyst success rate was 70.9% (12,024/16,955) vs. 67.5% (515/763) (P = 0.04), which were all significantly lower with SERa(+).The clinical pregnancy rate was 39.4% (2,481/6,290) vs. 35.1% (40/114), the live birth rate was 27.7% (1,745/6,290) vs. 26.3% (30/114), and the miscarriage rate was 27.5% (683/2,481) vs. 20.0% (8/40) and the congenital abnormality rate was 1.6% (29/1,757) vs. 0% (0/30) for SERa(-) embryos and SERa(+) embryos, respectively, which were not significantly different. Blastocyst derived from oocytes with SERa has similar clinical and perinatal outcomes with those of oocytes without SERa. Significant differences were examined using the chi-squared test, with p < 0.05, indicating a significant difference.

Limitations, reasons for caution

Embryos derived SERa (+) were transferred when the patient did not want any more oocytes retrievals, no embryos derived SERa (-) were available, and only if the couple desired embryo transfer after the problems associated with SERa (+) embryos were fully explained.

Wider implications of the findings

To the best of our knowledge, this study is the largest number of live births investigating the outcome of SERa (+) derived embryos. SERa (+) derived embryo can be selected as embryos for transfer when no available SERa (-) derived embryos.

Trial registration number

Not Applicable

AB0228 COMPREHENSIVE RHEUMATOID HAND ASSESSMENT THROUGH PATTERN OF DEFORMITIES USING CLUSTER ANALYSIS

Background:

The treatment of rheumatoid hand, which is characterized by thumb deformity, finger deformities, and ulnar drift (UD), is challenging. Its pathophysiology is complex, and a comprehensive understanding of the optimal intervention for this condition requires high technical skill and extensive clinical experience. Moreover, the natural course of rheumatoid hand itself remains unclear.

Objectives:

This study was performed to comprehensively evaluate rheumatoid hand through the specific parameters of each deformity.

Methods:

A rheumatoid hand cohort was established in 2004. In total, 134 hands of 67 patients were registered and underwent clinical evaluations. All hands surgically treated during follow-up were excluded from the study, but the contralateral hands were assessed. Evaluations were repeated in 2009 (100 hands of 52 patients) and in 2015 (63 hands of 37 patients) among all available patients. Therefore, among the data obtained from the 3 study endpoints, 297 hands were available for the cross-sectional analysis and 43 hands were available for the longitudinal analysis.

Thumb deformities and finger deformities (swan-neck and boutonnière) were semi-quantitated by the Nalebuff classification score, and UD was quantified using a metacarpophalangeal joint condition scoring method1). A two-step cluster analysis was performed with entered parameters, and the distribution of each parameter was considered to clarify the characteristics of each cluster. The hands with different clusters at each endpoint were recruited for the following longitudinal analysis. The natural course of rheumatoid hand was considered based on the cluster change.

Results:

Seven clusters were used in this study to emphasize the impact of thumb deformity on function. The characteristics of each cluster were as follows. Cluster 1: mild finger deformities and various severities of UD; Cluster 2: type 1 thumb deformity and various severities of UD; Cluster 3: type 2 thumb deformity and severe UD; Cluster 4: type 3 or 4 thumb deformity, low or moderate level of swan-neck deformity, and various severities of UD; Cluster 5: various types of thumb deformity, severe boutonnière deformity, and various severities of UD; Cluster 6: type 1 thumb deformity, severe swan-neck deformity, and various severities of UD; and Cluster 7: type 6 thumb deformity.

The longitudinal analysis showed that Cluster 1 mainly changed to Cluster 2 or 4, indicating progression of thumb deformity. Cluster 2 changed to Cluster 3, indicating that thumb type 1 progressed to type 2 (Figure 1). When the affected period was shorter than 10 years, the incidence of severe hand deformity (including two or more affected joint areas and low hand function) was <10%. In contrast, when the affected period was longer than 10 years, the incidence of severe hand deformity was >30% (Figure 2).

Figure 1.Figure 2.

Conclusion:

This study suggests the presence of seven patterns of deformity enabling a comprehensive understanding of rheumatoid hand. Furthermore, the results of the longitudinal analysis suggest a natural course of rheumatoid hand progression. Therefore, from the distribution of parameters of each deformity and its severity, rheumatologists can easily classify rheumatoid hand and determine its pathophysiology to choose the most effective intervention.

References:

[1]Toyama S, Oda R, Tokunaga D et al. A new assessment tool for ulnar drift in patients with rheumatoid arthritis using pathophysiological parameters of the metacarpophalangeal joint. Modern rheumatology 2019, 29: 113-8.

Acknowledgments:

This work was supported by JSPS KAKENHI Grant Numbers JP19K19914.

Disclosure of Interests:

None declared

Impaired residual renal function predicts denosumab-induced serum calcium decrement as well as increment of bone mineral density in non-severe renal insufficiency

Denosumab treatment of osteoporotic patients, except those with severe renal insufficiency, reduced cCa levels. Low baseline cCa, low estimated glomerular filtration rate, and high bone turnover increased the risk of lower cCa, while increasing bone mineral density. Pretreatment with antiresorptive agents was beneficial in reducing the risk of hypocalcemia.

INTRODUCTION

Although denosumab-induced hypocalcemia has been frequently observed in patients with chronic kidney disease (CKD) stages 4-5D being treated with denosumab for osteoporosis, few studies have assessed the risk factors for serum-corrected calcium (cCa) reductions in patients with non-severe renal insufficiency. This study assessed the risk factors for reduced cCa concentration following denosumab administration and analyzed factors predictive of changes in bone mineral density (BMD).

METHODS

Seventy-seven osteoporotic patients, not including those with CKD stages 4-5D, were treated with 60 mg denosumab once every 6 months. Biochemical parameters and BMD were analyzed from prior to the initial dose until 1 month after the second dose.

RESULTS

Following the first administration of denosumab, cCa levels decreased, reaching a minimum on day 7. Multiple linear regression analyses showed that baseline cCa, estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m², tartrate-resistant acid phosphatase-5b (TRACP-5b), and bone alkaline phosphatase (BAP) or pretreatment with antiresorptive agents were significant factors independently associated with the absolute reduction in cCa from baseline to day 7 (ΔcCa_0-7 days). ΔcCa_0-7 days after the second dose of denosumab was significantly lower than that after the first dose. After 6 months of denosumab treatment, both LS-BMD and FN-BMD significantly increased from baseline. LS-BMD and FN-BMD correlated significantly with baseline TRACP-5b or BAP and eGFR, respectively.

CONCLUSIONS

Both low eGFR and high bone turnover were independent risk factors for denosumab-induced cCa decrement, and for increases in BMD. Pretreatment with antiresorptive agents may reduce the risk of hypocalcemia.

Cytological features in eight patients with ALK-rearranged lung cancer

BACKGROUND

ALK-rearranged lung cancer has been recently identified. Although signet-ring cell morphology and mucinous cribriform pattern are considered to be characteristic of ALK-rearranged lung cancer. Some studies have also suggested cytological features.

METHODS

This study investigated cytological features of ALK-rearranged lung cancer in eight patients.

RESULTS

Cytologically, the tumor cell group varied from isolated to large clusters. Small nucleoli, fine granular to vesicular chromatin, and nuclear groove were observed in all patients. Furthermore, extracellular and intracellular mucin and signet-ring cells were identified in five patients.

CONCLUSION

This study demonstrated that the presence of extracellular and intracellular mucin, signet-ring cells, small nucleoli, fine granular to vesicular chromatin, and nuclear groove in cytological samples may be a diagnostic clue for ALK-rearranged lung cancer.

Comparing the risk of hepatitis B virus reactivation between direct-acting antiviral therapies and interferon-based therapies for hepatitis C

Hepatitis B virus (HBV) reactivation has been reported during antihepatitis C treatment in patients with hepatitis C virus (HCV) and HBV co-infection. We aimed to evaluate the frequency and risk factors of HBV reactivation during anti-HCV therapy and compared those between interferon (IFN)-free direct-acting antiviral (DAA) therapies and IFN-based therapies. Three hundred and twenty-two patients with HCV infection receiving anti-HCV therapy were retrospectively screened. The baseline HBV infection statuses of all eligible patients and the HBV-DNA level of all patients with current or previous HBV infection were examined at the end of treatment. In patients with baseline anti-HBs positivity, changes in anti-HBs titre were evaluated. Of 287 patients who met the inclusion criteria, 157 had current (n=4) or previous (n=153) HBV infection; 85 were treated with IFN-free DAA therapies and 72 were treated with IFN-based therapies. Six patients experienced HBV reactivation (n=2) or HBV reappearance (n=4) after IFN-free DAA therapies, while no patient developed HBV reactivation after IFN-based therapies. The risk factors of HBV reactivation or reappearance were DAA therapies and a reduction in anti-HBs titre to <12 mIU mL^-1 by the end of treatment. The decline changes of anti-HBs titre were significantly higher in patients treated with DAA therapies. Although HBV reactivation hepatitis was not observed, three of four patients with HBV reactivation or reappearance after achieving HCV eradication had viremia 8 weeks after completion of therapy. A significant proportion of patients develop HBV reactivation or reappearance without hepatitis after IFN-free DAA therapies. Low levels of anti-HBs and their decrease to <12 mIU mL^-1 after treatment are significant risk factors for HBV reactivation or reappearance.

Cytological findings of ROS1-rearranged lung adenocarcinoma

ROS1-rearranged lung adenocarcinoma has been recently identified. We report a case of ROS1-rearranged lung adenocarcinoma with special emphasis on cytological findings. Here, we report a case of young woman with ROS1-rearranged lung adenocarcinoma diagnosed by cytology and discuss the clinical, cytological, and molecular findings. Cytologically, the tumor consisted of small tight clusters of cells with high nuclear/cytoplasmic ratio. Nuclei were enlarged and small nucleoli were occasionally observed. Signet-ring cells were focally identified. Neoplastic cells were positive for ROS1 immunocytochemistry. Subsequently, the translocation of ROS1 gene was confirmed in a histological specimen. In conclusion, the specific histology of adenocarcinoma on cytological materials should promote testing for ROS1 immunohistochemistry. Immunocytochemical detection of ROS1 protein helps identify patients suitable for molecular targeted therapy.

Imprint cytologic and immunocytochemical findings of sclerosing pneumocytoma

To the best of our knowledge, there is no description on immunocytochemical study of sclerosing pneumocytoma (SP) using a cell transfer method. In this article, we report imprint cytological and immunocytochemical findings of SP. Three cases of SP possessing both imprint cytological and histological materials were examined. All tumors showed well-defined margin grossly. On microscopic examination, the tumor consisted of surface and stromal round cells. Cytologically, surface and stromal round cells showed fragments or clusters of papillary configuration with low N/C ratio and cell clusters of small to medium-sized cells with high N/C ration. Immunocytochemically, surface cells showed the positive reaction for surfactant apoprotein A (SPA), but stromal round cell exhibited the negative reaction for SPA. Cytologists and pathologists should steadily recognize cytological findings of surface and stromal round cells of SP. Immunocytochemistry of SPA may be useful in the discrimination of both cells. Diagn. Cytopathol. 2017;45:274-278. © 2016 Wiley Periodicals, Inc.

Abstract P1-15-03: Prevention of letrozole–induced bone loss using risedronate in postmenopausal women with hormone receptor positive breast cancer: A multicenter randomized clinical trial

Background

Prevention of letrozole–induced bone loss using oral risedronate has not been proved in the Japanese women. The aim of this study was to assess the effect of risedronate 17.5mg/week on bone mineral density (BMD) in postmenopausal, early breast cancer patients scheduled to receive adjuvant letrozole.

Patients and Methods

Postmenopausal women with hormone receptor–positive early breast cancer were assigned to one of two strata according to their baseline BMD T-score as being at low and high risk of osteoporosis. Patients with low risk (-2.5 ≤ T score) were randomly assigned to letrozole and risedronate (L+R) or to letrozole alone (L). Patients with high risk (-2.5 &gt; T score) received letrozole and risedronate (L+R). Letrozole was given at a dosage of 2.5 mg/day while oral risedronate was given at 17.5mg/week. The primary end point was the change in lumbar spine (LS) BMD at 12 months. The secondary end points included change in total hip (HP) BMD and bone turnover markers.

Results

In the low risk group (N=103), treatment with L+R resulted in a significant increase in BMD at LS and at HP compared to treatment with L only at 12 months (1.8% vs -2.2%, P &lt; 0.001, and -0.3% vs -2.9%, P = 0.001, respectively). In the L+R group, significant decreases in bone turnover makers, NTX and PINP, were recognized compared with L only at 12months (-11.1% vs. 27.5%, P&lt;0.001, -42.3% vs. 15.2%, P&lt;0.001, respectively). In the high risk group (N=28), treatment with L+R resulted in a significant increase in BMD at LS and prevention of decrease in BMD at HP (3.6%; 95%CI, 1.8% to 5.3%, p=0.003, 0.3%; 95%CI, -1.3% to 1.8%, p=0.47, respectively).

Estimated Percentage Change From Baseline to 6 and 12 Months in Lumbar Spine and Total Hip BMD   From Baseline to 6 MonthsFrom Baseline to 12 MonthsBMD areaRisk GroupTreatmentChange in BMD (%), 95% CIPChange in BMD (%), 95% CIPLumbar spineLow riskL+R1.7 (-1.3 to 4.7)&lt;0.0011.8 (-2.1 to 5.7)&lt;0.001  L-1.6 (-4.3 to 1.1) -2.2 (-5.7 to 1.3)  High riskL+R1.8 (0.4 to 3.2)0.043.6 (1.8 to 5.3)0.003Total hipLow riskL+R-0.2 (-2.7 to 2.3)0.001-0.3 (-3.2 to 2.6)0.001  L-2.2 (-5.4 to 1.0) -2.9 (-7.2 to 1.4)  High riskL+R0.1 (-1.3 to 1.6)0.610.3 (-1.3 to 1.8)0.47BMD: bone mineral density, L: Letrozole, R: risedronate

Four patients (14.3%) improved from osteoporotic region to the osteopenic region with L+R treatment. Letrozole and risedronate were well tolerable and there was no serious adeverse event including osteonecrosis of jaw.

Conclusions

At 12 months, 17.5mg/week risedronate therapy prevented bone loss in postmenopausal women with breast cancer who were receiving adjuvant letrozole, of which results were compatible with previous findings of western populations.

Citation Format: Kadoya T, Masumoto N, Shigematsu H, Emi A, Kajitani K, Kobayashi Y, Funakoshi M, Kawabuchi Y, Ohara M, Matsuura K, Noma M, Sasada T, Okada M. Prevention of letrozole–induced bone loss using risedronate in postmenopausal women with hormone receptor positive breast cancer: A multicenter randomized clinical trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-15-03.

Abstract P4-01-04: Role of FDG-PET/CT in evaluating surgical outcomes of operable breast cancer: Usefulness for malignant grade of triple-negative breast cancer

Background: The aim of this study was to evaluate the significance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for speculating the malignant level and prognostic value of operable breast cancers.

Methods: Of 578 consecutive patients with primary invasive breast cancer who underwent curative surgery between 2005 and 2010, 311 patients (53.8%) who received FDG PET/CT before initial therapy were examined.

Results: Receiver operating characteristics (ROC) curve analysis showed the cutoff value of the maximum standardized uptake value (SUVmax) to predict cancer recurrence was 3.8 in all patients and 8.6 in patients with the triple-negative subtype, respectively. In all patients, 3-year DFS rates were 98.8% for patients with a tumor of SUVmax ≤ 3.8 and 91.6% for patients with a tumor of SUVmax &gt; 3.8 (p &lt; 0.001). High value of SUVmax was significantly associated with large tumor size (p &lt; 0.001), lymph node metastasis (p = 0.040), high nuclear grade (p &lt; 0.001), lymphovascular invasion (p = 0.032), negative hormone receptor status (p &lt; 0.001), and positive HER2 status (p = 0.014). Based on the results of multivariate Cox analysis in all patients, high SUVmax (p = 0.001) and negative hormone receptor status (p = 0.005) were significantly associated with poor prognosis. In patients with triple-negative subtype, 3-year DFS rates were 90.9% for patients with a tumor of SUVmax ≤ 8.6 and 42.9% for patients with a tumor of SUVmax &gt; 8.6 (p = 0.002), and high SUVmax was the only significant independent prognostic factor (p = 0.047).

Conclusion: FDG-PET/CT is useful for predicting malignant behavior and prognosis in patients with operable breast cancer, especially the triple-negative subtype.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-04.

Effects of sex and age on serum 1,5-anhydroglucitol in nondiabetic subjects

The aim of this study was to demonstrate the effects of sex and age on serum levels of 1,5-AG in nondiabetic subjects.A total of 1 134 nondiabetic subjects aged 16-96 years with HbA1c less than 6.8% were recruited and divided into 4 HbA1c groups (Q1: HbA1c≤5.3; Q2: 5.4-5.8; Q3: 5.9-6.3; and Q4: 6.4-6.8 [%]). 38 elderly subjects (65 years or older) in the Q3 and Q4 groups (13 men and 25 women) underwent a 75-g oral glucose tolerance test (OGTT).The Q4 group had significantly lower 1,5-AG levels than did the Q1 group among nonelderly males, nonelderly females, and elderly men. In elderly women, 1,5-AG levels did not differ among the 4 HbA1c groups. In both nonelderly and elderly subjects, the 1,5-AG level of the Q1 group was significantly higher in males than in females. Stepwise multivariate regression analysis showed that age was significantly associated with 1,5-AG level in both sexes. HbA1c was significantly associated with the 1,5-AG level in males, while there was no significant association between HbA1c and the 1,5-AG level in females. In the elderly OGTT group, although the glucose levels of both sexes during OGTT were identical, the mean urinary glucose levels and the percentages of subjects with glucosuria were significantly higher in elderly men than in elderly women.Serum 1,5-AG levels were significantly associated with age and sex. The sensitivity of the 1,5-AG level for identifying postprandial hyperglycemia in elderly women with near-normoglycemia is less reliable because they have a higher renal threshold for glucose.

Smear cytology findings of large cell neuroendocrine carcinoma of the uterine cervix

Large cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is a rare tumor. Moreover, there are only three reports to date that have focused on the cytologic findings of cervical LCNEC. We report the case of a 59-year-old Japanese woman with cervical LCNEC combined with small cell carcinoma (SmCC). Cytologic specimens from the uterine cervix demonstrated large cells with coarse chromatin and prominent nucleoli. Frequent mitotic figures were also observed. Curettage of the uterine endometrium revealed an endometrioid adenocarcinoma with squamous differentiation; i.e., an adenoacanthoma. Histologic examination of surgically resected uterine cervical tissue revealed LCNEC with minor foci of SmCC. Neuroendocrine differentiation in LCNEC was confirmed by immunohistochemistry for synaptophysin and CD56. Cytotechnologists or pathologists need to consider a differential diagnosis of LCNEC while examining cervical cytologic specimens; therefore, it is important to correctly identify the cytologic characteristics of this tumor.

Topical application of Aggregatibacter actinomycetemcomitans cytolethal distending toxin induces cell cycle arrest in the rat gingival epithelium in vivo

BACKGROUND

Aggregatibacter actinomycetemcomitans is one of the etiological pathogens implicated in the onset of periodontal disease. This pathogen produces cytolethal distending toxin (CDT) that acts as a genotoxin to induce cell cycle arrest and cellular distension in cultured cell lines. Therefore, CDT is a possible virulence factor; however, the in vivo activity of CDT on periodontal tissue has not been explored. Here, CDT was topically applied into the rat molar gingival sulcus; and the periodontal tissue was histologically and immunohistochemically examined.

MATERIALS AND METHODS

Recombinant purified A. actinomycetemcomitans CDT was applied to gingival sulcus of male Wistar rats and tissue samples were immunohistochemmically examined.

RESULTS

One day after application, infiltration of neutrophils and dilation of blood vessels in the gingival connective tissue were found. At day three, desquamation and detachment of cells in the junctional epithelium was observed. This abrasion of junctional epithelium was not observed in rats treated with mutated CDT, in which a His274Ala mutation is present in the CdtB subunit. This indicates the tissue abrasion may be caused by the genotoxicity of CdtB. Expression of the proliferating cell nuclear antigen (PCNA), a marker for proliferating cells, was significantly suppressed using CDT treatment in the junctional epithelium and gingival epithelium.

CONCLUSION

Using the rat model, these data suggest CDT intoxication induces cell cycle arrest and damage in periodontal epithelial cells in vivo.

Hybrid sclerosing adenosis and basal cell hyperplasia of the prostate

Hybrid sclerosing adenosis and basal cell hyperplasia of the prostate is a rare lesion. Here we report the seventh case of such lesions. Histological examination of the transurethral resection of the prostate of a 83-year-old Japanese man showed a small lesion consisted of sclerosing adenosis and basal cell hyperplasia, in addition to the diffuse glandular and fibromuscular hyperplasia. Immunohistochemically, many basal cells in sclerosing adenosis and basal cell hyperplasia areas showed a positive reaction for p63, cytokeratin 5, and D2-40. Additionally, many basal cells in the sclerosing adenosis area and some basal cells in the basal cell hyperplasia area were positive for S-100 protein and alpha-smooth muscle actin, which are myoepithelial cell markers. Finally, we suggest that hybrid sclerosing adenosis and basal cell hyperplasia may be actually a special form of hyperplastic lesion of all components of prostatic tissue, reflecting the unbalanced distribution of glandular, stromal (sclerosing adenosis), and basal cell hyperplasia with the differentiation toward myoepithelial cells predominantly occurring in a sclerosing adenosis area. Additionally, this case showed that D2-40 is a useful marker of basal cells.

Dilemmas in human and rat pregnancy: proposed mechanisms relating to arterial vasodilation

There are several mysteries about the normal physiology of pregnancy (1). Renal sodium and water reabsorption occurs despite an increase in total blood volume. Moreover, the renin-angiotensin-aldosterone system (RAAS) is also stimulated in normal pregnancy, even though an increase in total blood volume normally suppresses the RAAS and increases sodium excretion in the nonpregnant state. Water retention also occurs and leads to hypoosmolality in normal pregnancy, even though total blood volume is expanded. On rare occasions, an extreme polyuria occurs in pregnancy that is unresponsive to arginine vasopressin (AVP). The receptors whereby AVP and oxytocin stimulate the principal cell of the collecting duct, vascular smooth muscle, glomerular mesangial and endometrial cells are in need of clarification. The present study proposes potential mechanisms relating to systemic arterial vasodilation to explain some of the apparent dilemmas of pregnancy.

[Thymoma with long-term survival treated by polysurgery; report of a case]

A 50-year-old man was found to have a chest abnormal shadow during a check-up and visited our hospital in 1991. Tumor shadow was observed in the anterior mediastinum. Resection of the tumor was performed by partial thymectomy. The pathological diagnosis was a thymoma type B1 and stage I based on Masaoka' s classification. In 2004, he underwent radical thymectomy and partial resection of the lung to remove the local recurrent tumor followed by postoperative radiation therapy. In 2006, 3rd operation was performed and the tumor in the superior mediastinum was resected. Since then, the patient is well without signs of recurrence. We experienced a case of thymoma with long-term survival treated by polysurgery.

Sarcomatoid acquired cystic disease-associated renal cell carcinoma

In this article, we report a rare case of hitherto undescribed acquired cystic disease (ACD)-associated renal cell carcinoma (RCC) with sarcomatoid change. A 78-year-old woman had been receiving hemodialysis for fourteen years at the time when a renal tumor was encountered on the follow-up examination of the kidney. Microscopically, oncocytic cuboidal cells proliferated with tubular, cribriform or papillary growth patterns, and atypical columnar cells with abundant cytoplasm proliferated with papillary configuration. Oxalate crystal deposition was observed in the stroma and the tumor focally resembled translocation type (TFE3) RCC. Sarcomatous neoplastic cells were also seen. The cytoplasm of oncocytic and sarcomatous neoplastic cells was diffusely positive for anti-mitochondrial antibody and the ultrastructural examination detected many mitochondria in the cytoplasm of oncocytic carcinoma cells and sarcomatous neoplastic cells. The loss of chromosomes 1p, 2q11-22, 9 and 14 was observed using comparative genomic hybridization analysis. We thus report here a case of hitherto undescribed ACD-associated RCC intermingled with oncocytic cells, translocation type RCC-like area and sarcomatoid change. This is the sixth case of sarcomatoid RCC arising in end-stage kidney disease.

Significance of D2-40 expression in the diagnosis of gastrointestinal stromal tumor

We incidentally found the expression of D2-40 in Cajal interstitial cells for the immunohistochemical valuation of lymphatic invasion by gastric and colonic cancer cells. Therefore, we suggested that D2-40 might become an available marker for gastrointestinal stromal tumors (GISTs). In this study, we performed immunohistochemical study of 21 GISTs, As a result, we confirmed a positive reaction for D2-40 in sixteen GISTs. Among sixteen tumors, thirteen tumors were focally positive and remaining three tumors were diffusely positive. We could find no relationship between positive findings for D2-40 and size or location of the tumor. Three of four tumors with intermediate risk of aggressive behavior and two of four tumors with recurrence showed a negative reaction for D2-40. In conclusion, we suggest that D2-40 may be an available marker of GISTs, but the expression of D2-40 seems to be not associated with the degree of risk of aggressive behavior.

Invasive micropapillary carcinoma of the colon: an immunohistochemical study

Invasive micropapillary carcinoma has recently been reported in various anatomic sites. In this article, we report a case of micropapillary carcinoma of the sigmoid colon. A 70-year-old Japanese woman presented with bloody stool for 2 months. Detailed examination disclosed ulcerative and localized tumor in the sigmoid colon. Histological examination of the colon tumor showed a combination of conventional adenocarcinoma (60%) and micropapillary carcinoma (40%). Immunohistochemically, micropapillary carcinoma cells were positive for cytokeratin (CK) 20, carcinoembryonic antigen, and CA125, but negative for CK7, thyroid transcription factor-1, surfactant apoprotein A, estrogen receptor, and progesterone receptor. Additionally, the immunohistochemistry of epithelial membrane antigen revealed reverse polarity of neoplastic cells. Results of conventional adenocarcinoma were basically identical to those of micropapillary carcinoma. In the stroma of both conventional adenocarcinoma and micropapillary carcinoma, many myofibroblasts were present and CD34-positive stromal cells were absent. Finally, we report the fourth case of micropapillary carcinoma arising in the colon. Immunohistochemical results of CK7(-)/CK20(+) strongly suggest the colon as a primary site of micropapillary carcinoma. Additionally, micropapillary carcinoma of the colon may cause a similar stromal reaction to conventional adenocarcinoma of the colon.

Large cell neuroendocrine carcinoma of the lung with calcification and expression of osteopontin

A large cell neuroendocrine carcinoma (LCNEC) is a rare neoplasm. In this article, we report a case of LCNEC with stromal calcification. A 46-year-old Japanese man was found to have an abnormal shadow in the left upper lobe in a chest X-ray. As the size of the tumor increased during the follow-up, a left upper lobectomy was performed. Histological examination disclosed neuroendocrine morphology consisting of large cells, and subsequent immunohistochemistry confirmed the neuroendocrine differentiation. A diagnosis of LCNEC was established. Additionally, calcification was observed in the stroma within the tumor. Immunohistochemically, parts of neoplastic cells of LCNEC and calcified foci were positive for osteopontin. Finally, we suggest that osteopontin as well as dystrophy within the tumor may be involved in the stromal calcification of LCNEC.

Anaplastic carcinoma of the pancreas with rhabdoid features and hyaline globule-like structures

A 59-year-old Japanese man presented with a giant submucosal tumor with ulceration during follow-up of duodenal ulcer. Pancreaticoduodenectomy was undertaken, and subsequent histological examination of the tumor disclosed anaplastic carcinoma of the pancreas head. The carcinoma components contained adenocarcinoma and squamous cell carcinoma. Additionally, undifferentiated spindle or pleomorphic cells were seen in continuity with the carcinoma component. Undifferentiated neoplastic cells with rhabdoid features and with hyaline globule-like structures positive for PAS stain with diastase pretreatment were also observed. Immunohistochemically, cytoplasmic inclusions corresponding to rhabdoid features showed aggregates of vimentin. Ultrastructurally, hyaline globule-like structures corresponded to lysosomes. Finally, we report here the first case of anaplastic carcinoma of the pancreas with hyaline globule-like structures.

Adenoid basal carcinoma arising in the cervical polyp: an immunohistochemical study of stromal cells

Adenoid basal carcinomas of the uterine cervix are uncommon neoplasms and generally run a favorable clinical course. Although it is well known that these tumors do not evoke the stromal reaction, we immunohistochemically examined a stromal reaction in a case of adenoid basal carcinoma. A 40-year-old woman was found to have a cervical polyp during a medical checkup and underwent polypectomy. Histological examination revealed the finding of adenoid basal carcinoma. Immunohistochemically, a smaller number of CD34-positive and CD31-negative stromal cells, namely fibroblasts, in the stroma of tumor center than in normal cervical stroma were observed. On the other hand, alpha-smooth muscle actin-positive and h-caldesmon-negative stromal cells, namely myofibroblasts, were completely absent in the stroma of tumor center. Finally, our preliminary report suggests that the decrease of CD34-positive fibroblasts in adenoid basal carcinoma may show an early stromal reaction to tumor invasion. Gynecologists and pathologists should bear in mind that adenoid basal carcinoma may arise in a cervical polyp.

An Asian variant of intravascular lymphoma: unique clinical and pathological manifestation in the gallbladder

We here present a rare case of intravascular lymphoma (IVL) in a Japanese man. 4 months after cholecystectomy due to cholecystitis, a diagnosis of intravascular lymphoma (IVL) was strongly suspected. Lymphoma cells were diffusely observed in the bone marrow parenchyma, but were absent in the vascular spaces. The patient died of respiratory failure and at autopsy a small number of lymphoma cells in the extravascular parenchyma of the adrenal gland and bone marrow were seen. Serial sections of the surgically resected gallbladder retrospectively confirmed the diagnosis of IVL. In addition, congestion and edema were observed in the connective tissue layer. It is possible that edema or ischemia in the gallbladder wall or at other anatomic sites due to the circulation disturbance induced by the intravascular obstruction of lymphoma cells may have caused the initial symptoms. In conclusion, clinicians and pathologists should keep in mind that the gallbladder may be initially involved in IVL.

Anal canal adenocarcinoma with MUC5AC expression suggestive of anal gland origin

Anal canal adenocarcinomas arising in the anal ducts or glands are very rare neoplasms, and few useful immunohistochemical markers of these carcinomas are known to date. A 57-year-old man presented with anal bleeding, difficulty of defecation, and anal pain. Macroscopic findings of the surgically resected material showed circular stenosis of the anal canal. The mucosal surface was generally intact, but focal ulceration was seen. Microscopically, the proliferation of adenocarcinoma cells with mucin production was observed in the submucosal and muscular layers. The special stains of periodic acid-Schiff (PAS) and Alcian blue confirmed the presence of neutral and acid mucin. Immunohistochemically, normal rectal-type mucosa and normal anal ducts/glands showed the patterns of cytokeratin 7 (CK7)(-)/CK19(+, focal)/MUC5AC(-) and CK7(+, diffuse)/CK19(+, diffuse)/MUC5AC(+, focal), respectively, and neoplastic cells showed the pattern of CK7(+, diffuse)/CK19(+, diffuse)/MUC5AC(+, focal). Finally, our preliminary report suggests that the immunohistochemical combination of CK7, CK19, and MUC5AC may be an available marker for adenocarcinoma of anal ducts/glands origin.

Hyaline globule-like structures in undifferentiated sarcoma cells of malignant müllerian mixed tumor of the fallopian tube

Malignant müllerian mixed tumors (MMMTs) of the fallopian tube are very rare neoplasms, and we present such a case with unusual findings here. A 57-year-old Japanese woman, after she received a medical checkup, underwent salpingo-oophorectomy on the suspicion of ovarian cancer. At the time of operation, the main tumor was present predominantly in the fallopian tube. Microscopically, the tumor consisted of carcinoma and sarcoma components. The carcinoma showed moderately to poorly differentiated adenocarcinoma. The sarcoma consisted of predominantly undifferentiated sarcoma and focally rhabdomyosarcomatous cells with abundant eosinophilic cytoplasm. Immunohistochemically, the differentiation toward rhabdomyosarcoma was confirmed. Interestingly, the cytoplasm of undifferentiated sarcoma cells contained hyaline globule-like structures. These structures showed a positive reaction for PAS, and these structures were not digested by the diastase pretreatment. Ultrastructurally, hyaline globule-like structures corresponded to lysosomes. Finally, pathologists should keep in mind that undifferentiated sarcoma cells in MMMT of the fallopian tube may contain hyaline globule-like structures in the cytoplasm.

Bridging necrosis and reticulin bridging fibrosis induced by intrahepatic involvement of acute biphenotypic leukemia

A 47-year-old Japanese woman was diagnosed as having acute biphenotypic leukemia with association of t(9;22)(q34;q11). Cholestatic liver dysfunction arose, and she died of cachexia and intracranial hemorrhage. Autopsy showed unusual hepatic fibrosis. In the liver, bridging infiltration, bridging necrosis and bridging fibrosis by leukemic cells were seen. It seemed that the degree of fibrosis was associated with the number of aggregates of infiltrating leukemic cells. The fibrotic foci were predominantly composed of reticulin and collagen fibers, and distortion of the lobules was observed. Immunohistochemically, dense bundles of alpha-smooth muscle actin (ASMA)-positive stromal cells, namely activated hepatic stellate cells (HSCs), were observed in the immature fibrotic foci as well as along the sinusoids densely infiltrated by leukemic cells. No cells positive for TGF-beta1 or PDGF-BB were identified. In conclusion, extensive intrahepatic involvement by neoplastic cells in adult acute biphenotypic leukemia may cause the unusual "disorganized" hepatic fibrosis.

Invasive ductal carcinoma of the breast with signet-ring cell and mucinous carcinoma components: Diagnostic utility of immunocytochemistry of signet-ring cells in aspiration cytology materials

Breast cancer with signet-ring cells is very rare. In this article, we present a case of invasive ductal carcinoma with signet-ring cells and mucinous carcinoma components, which could be diagnosed as a primary cancer by immunocytochemical study of fine-needle aspiration cytology material. A 73-yr-old Japanese woman noticed a palpable mass in the left breast. The aspiration cytology disclosed the monotonous proliferation of signet-ring cell with cytological atypia. The immunocytochemical examination of neoplastic cells showed a positive reaction for estrogen receptor. The extensive examination of body before the operation did not disclose any tumors in other anatomic sites. The histological examination of surgically resected breast tumor showed invasive ductal carcinoma with foci of signet-ring cell and mucinous carcinomas. Finally, our preliminary report suggests that immunocytochemical examination of aspiration cytology materials may provide useful information in searching the primary site of breast carcinoma with signet-ring cells.

Myofibroblasts in the stroma of metastatic pulmonary calcification in a patient with chronic renal failure

We present a case of metastatic pulmonary calcification. Histologically, deposition of hematoxyphilic materials was seen along the alveolar and vessel walls. Fibrous tissues were also seen within the alveolar lumens, resulting in intra-alveolar fibrous pneumonia. Immunohistochemically, CD34-positive perivascular adventitial fibroblasts were seen in normal alveolar septa, whereas no myofibroblasts were observed. In contrast, perivascular adventitial fibroblasts were absent in the alveolar septa of the lesion of metastatic calcification, whereas many myofibroblasts were present in the fibrous tissue within alveolar lumens. No positive cells for TGF-(beta1) were observed in the lesion of metastatic calcification, but positive cells for PDGF-BB were focally seen in adveolar epithelial cells. Finally, many myofibroblasts appear in the alveolar lumens of metastatic pulmonary calcification, and we suggest that these myofibroblasts may be derived from CD34-positive perivascular adventitial fibroblasts and PDGF-BB may be involved in the pathogenesis of surrounding fibrosis.