AID is a poor prognostic marker of high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements

Diffuse large B-cell lymphoma with MYC rearrangement is defined as double/triple-hit lymphoma (DHL/THL) or single-hit lymphoma (SHL) by the inclusion of the BCL2 and BCL6 rearrangements status. DHL/THL is called as "high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements" in the World Health Organization 2017 Classification of Tumors of Hematopoietic and Lymphoid Tissues. To find a prognostic biomarker of DHL/THL, we firstly examined 19 cases (molecular analysis series;10 cases of DHL/THL and 9 cases of SHL) with gene expression profile analysis. The gene expression profile analysis showed that the high expression of AICDA was associated with an adverse prognosis in DHL/THL, but not in SHL. Then, we evaluated immunohistochemical expression of AID, the protein product of AICDA, in 50 cases (molecular analysis series of 19 cases and additional immunohistochemistry series of 31 cases; 12 cases of DHL/THL and 19 cases of SHL) and confirmed that its expression was also associated with an adverse prognosis in DHL/THL. Therefore, AICDA and AID can be a predictor of an adverse clinical outcome in DHL/THL and immunohistochemistry of AID is useful to find DHL/THL-adverse prognosis group.

[National survey of radiation protection for workers in positron emission tomography facilities in Japan-1st report: occupational role assignment, radiation exposure to medical workers]

We have investigated the role assignment and radiation exposure of medical workers (including receptionists) in PET (positron emission tomography) facilities in Japan using a questionnaire. The survey period was from October 1st to November 15th 2006. The response rate for the questionnaire was 60.0% (72/120 facilities). Nurses were engaged in the intravenous administration of radioactive FDG in 66.9% of PET facilities. In 89.5% of PET facilities, radiological technologists mainly performed the PET examination. The average radiation exposure to medical workers was 0.13 mSv/month (n: 709, S.D.: 0.16) as the effective dose. It was shown that radiation exposure was significantly different depending on the occupation and content of work (p<0.01). The radiation exposure of cyclotron operators and radiological technologists was higher than that of the other occupations (p<0.01). The highest radiation dose to one worker per a PET facility was 0.60 [mSv month(-1)], which was 4.6 times higher than the average dose of 0.13 [mSv month(-1)]. We have clarified the actual conditions of radiation protection in PET facilities in Japan for the first time.

[Lateral tunnel versus extracardiac cavopulmonary connections]

To examine the mid term outcome of the lateral tunnel Fontan and the result is to be compared to extracardiac Fontan operation. Between March 1991 and May 2002, 72 lateral tunnel (LT) and 28 extracardiac conduit (EC) total cavopulmonary connection (TCPC) were performed. Right atrium was incised parallel to the sulcus terminalis and LT was created by using autologous right atrial wall. Lateral tunnel size was determined 1-2 mm larger than normal half pulmonary artery (PA) size according to the body weight. There were 1 early and 1 late death, both initial LT group. Supraventricular tachycardia was found in 1 patient with EC group and 4 in LT group (all heterotaxy syndrome). There were no differences in mortality and mobidity between LT and EC TCPC. Lateral tunnel TCPC is useful especially to small infants and children.

[Comparison of measuring an area with a planimeter and by rectangular dimensional methods]

We have developed a system that measures the volume of air cells in the temporal bone through computerized digital processing of high-resolution CT images. By using this method, the volume of pneumatization was measured, and the results were compared with the measured area of pneumatization obtained from two conventionally used simple ear X-ray methods (the planimeter and rectangular dimensional methods). A total of 57 ears, from 34 subjects, confirmed as normal by CT were examined. The average volume of pneumatization measured on CT images was 5.97 +/- 4.15ml, and the average areas of pneumatization measured by the planimeter and rectangular methods were 9.08 +/- 5.64 and 17.39 +/- 9.77 cm2, respectively. Graphically, when the volume of pneumatization was plotted on the Y axis and the planimeter-measured area of pneumatization on the X axis, a regression formula of Y = 0.651X + 0.054 was obtained, with a correlation coefficient of 0.89. With the volume of pneumatization plotted on the Y axis and the rectangular-dimensional-measured area of pneumatization on the X axis, the regression formula was Y = 0.375X - 0.559, with a correlation coefficient of 0.88. Both these correlation coefficients were considered high. Furthermore, 3D models of the air cells in the temporal bone were created and compared for patients with high and low correlations. In order to capture the morphological characteristics of these 3D models, they were examined from four different angles (lateral, upper lateral, anterior lateral and upper medial). The results showed that regardless of whether air-cell growth was present in the direction of the apex partise petrosae in patients with a low correlation coefficient, such growth played a major role in the degree of the correlatiton. Future studies will be required to clarify this point, though it can already be said that 3D models are indispensable for studying the air cells in the temporal bone. When we compared the volume and area of pneumatization in the temporal bone at different CT cross-sections, we found correlation coefficients in the vicinity of the canalis semicircularis lateralis of about 0.9 or higher. A statistical comparison of correlation coefficients for the CT, planimeter, and rectangular dimensional methods, made by using the CT cross-section with the highest coefficient, found a significant difference between the CT method and the other two methods (p < 0.05). In other words, the volume of pneumatization can be estimated more accurately with CT images than with simple ear X-rays.

[Tissue UFT distribution and histological changes following UFT administration in metastatic liver cancer cases]

For the purpose of assessing the anti-tumor effect of UFT in metastatic liver cancer, blood futraful (FT), 5-fluorouracil (5-FU) and uracil levels and their distribution in tissue (cancer lesion, etc.) following oral UFT administration were examined in 10 surgically treated cases of metastatic liver cancer secondary to cancer of the large intestine and 4 cases of metastatic liver cancer secondary to stomach cancer. Liver tissue 5-FU distribution following UFT treatment was excellent. 5-FU concentration in liver cancer lesion was 0.164 +/- 0.128 micrograms/g, which was markedly higher than the minimal effective tissue concentration for 5-FU (0.050 micrograms/g). 5-FU level in normal tissue of the organ with primary cancer was significantly lower than that in the tumor-affected tissue of the same organ, while no difference in 5-FU level was noted between cancer-affected and normal tissues of the liver. Tissue 5-FU level in both primary and metastatic cancer lesions was significantly higher than the simultaneously determined blood 5-FU level. Histological findings of cancer-affected liver did not differ between different UFT dose levels, but degeneration of cancer cells was severe in some cases given high doses of UFT.

[Hepatocellular carcinoma with extrahepatic malignancies]

A clinical investigation of 16 hepatocellular carcinoma (HCC) patients with extrahepatic malignancies (13 male, 3 female) has been conducted. The age of these patients ranged from 55 to 76 years. Three of these double cancer cases were hemocronous, and 13 were heterochronous. The duration between the occurrence of the cancers ranged from 2 years and 4 months to 22 years. As for the site of the other cancer, the stomach was the most common organ (12 cases). In nine cases out of 16, the HCC was resected, whereas the other cases were treated with a TAE and hepatic artery ligation because the cancer were far advanced stages. Early detection of an HCC by AFP or an ultrasonographic examination, and a subsequent surgical resection in cases of a postoperative cancer patient with a liver dysfunction may lead to a more favorable prognosis.