Primary syphilis with a tongue ulcer mimicking tongue cancer: a case report

The main symptom in primary syphilis is a small, painless, sore or ulcer called a chancre on the penis, vagina, or around the anus, although chancres can sometimes appear in the mouth or on the lips, fingers, or buttocks. We present the case of a man in his early 60 s with a chief complaint of a painful tongue ulcer. An ulcerated, indurated, and hemorrhagic lesion (23 × 14 mm) was found on the ventral tongue surface, near the oral floor. Palpation identified several swollen, mobile, elastic cervical lymph nodes, with no tenderness. We initially diagnosed tongue cancer; however, during a subsequent detailed examination for a malignant tumor, including biopsy and obtaining additional history, his disease was finally identified as primary syphilis with multiple swollen cervical lymph nodes. Oral amoxicillin and probenecid were started, and after 14 days, there was partial reduction in the size of the submandibular lymph nodes and the ulcer on the left tongue margin. The number of patients with syphilis in Japan increased by eight times from 2012 to 2018. We suggest that dentists consider primary syphilis as a differential diagnosis for oral refractory ulcer with induration and obtain a detailed patient history.

Surveillance for Patients with Oral Squamous Cell Carcinoma after Complete Surgical Resection as Primary Treatment: A Single-Center Retrospective Cohort Study

BACKGROUND

The surveillance methods oral squamous cell carcinoma (OSCC) patients may be chosen by considering the risk for recurrence, and it is important to establish appropriate methods during the period in which latent/dormant cancer cells become more apparent. To investigate the appropriate surveillance of patients with OSCC based on the individual risk for recurrence and/or metastasis, we performed a retrospective cohort study after the complete surgical resection of OSCC as the primary treatment.

METHODS

The study was performed in 324 patients with OSCC who had been primarily treated with surgery from 2007 to 2020 at our hospital. We investigated the period, timing, and methods (visual examination, palpation and imaging using FDG-PET/CT or CECT) for surveillance in each case that comprised postsurgical treatment.

RESULTS

Regarding the time to occurrence of postsurgical events, we found that half of cases of local recurrence, cervical lymph node metastasis, and distant metastasis occurred within 200 days, and 75% of all of these events occurred within 400 days. However, the mean time for second primary cancer was 1589 days. The postsurgical events were detected earlier by imaging examinations than they were by visual examination and palpation.

CONCLUSIONS

For the surveillance of patients with OSCC after primary surgery, it is desirable to perform FDG-PET/CT within 3-6 months and at 1 year after surgery and to consider CECT as an option in between FDG-PET/CT, while continuing history and physical examinations for about 5 years based on individual risk assessment.

Identification of Binding Proteins for TSC22D1 Family Proteins Using Mass Spectrometry

TSC-22 (TGF-β stimulated clone-22) has been reported to induce differentiation, growth inhibition, and apoptosis in various cells. TSC-22 is a member of a family in which many proteins are produced from four different family genes. TSC-22 (corresponding to TSC22D1-2) is composed of 144 amino acids translated from a short variant mRNA of the TSC22D1 gene. In this study, we attempted to determine the intracellular localizations of the TSC22D1 family proteins (TSC22D1-1, TSC-22 (TSC22D1-2), and TSC22(86) (TSC22D1-3)) and identify the binding proteins for TSC22D1 family proteins by mass spectrometry. We determined that TSC22D1-1 was mostly localized in the nucleus, TSC-22 (TSC22D1-2) was localized in the cytoplasm, mainly in the mitochondria and translocated from the cytoplasm to the nucleus after DNA damage, and TSC22(86) (TSC22D1-3) was localized in both the cytoplasm and nucleus. We identified multiple candidates of binding proteins for TSC22D1 family proteins in in vitro pull-down assays and in vivo binding assays. Histone H1 bound to TSC-22 (TSC22D1-2) or TSC22(86) (TSC22D1-3) in the nucleus. Guanine nucleotide-binding protein-like 3 (GNL3), which is also known as nucleostemin, bound to TSC-22 (TSC22D1-2) in the nucleus. Further investigation of the interaction of the candidate binding proteins with TSC22D1 family proteins would clarify the biological roles of TSC22D1 family proteins in several cell systems.

Oral squamous cell carcinoma may originate from bone marrow-derived stem cells

Molecules that demonstrate a clear association with the aggressiveness of oral squamous cell carcinoma (OSCC) have not yet been identified. The current study hypothesized that tumor cells in OSCC have three different origins: Epithelial stem cells, oral tissue stem cells from the salivary gland and bone marrow (BM) stem cells. It was also hypothesized that carcinomas derived from less-differentiated stem cells have a greater malignancy. In the present study, sex chromosome analysis by fluorescence in situ hybridization and/or microdissection PCR was performed in patients with OSCC that developed after hematopoietic stem cell transplantation (HSCT) from the opposite sex. OSCC from 3 male patients among the 6 total transplanted patients were considered to originate from donor-derived BM cells. A total of 2/3 patients had distant metastasis, resulting in a poor prognosis. In a female patient with oral potentially malignant disorder who underwent HSCT, there were 10.7% Y-containing cells in epithelial cells, suggesting that some epithelial cells were from the donor. Subsequently, gene expression patterns in patients with possible BM stem cell-derived OSCC were compared with those in patients with normally developed OSCC by microarray analysis. A total of 3 patients with BM stem cell-derived OSCC exhibited a specific pattern of gene expression. Following cluster analysis by the probes identified on BM stem cell-derived OSCC, 2 patients with normally developed OSCC were included in the cluster of BM stem cell-derived OSCC. If the genes that could discriminate the origin of OSCC were identified, OSCCs were classified into the three aforementioned categories. If diagnosis can be performed based on the origin of the cancer cells, a more specific therapeutic strategy may be implemented to improve prognosis. This would be a paradigm shift in diagnostic and therapeutic strategies for OSCC.

Clinical characteristics, treatment methods and prognoses of patients with oral squamous cell carcinoma in Japanese population: a single institution retrospective cohort study

BACKGROUND

The status of oral cancer therapy in elderly patients in Japan, where ageing is rapidly progressing, may serve as a model for other countries with similar demographics. There is controversy over what kind of treatment should be applied and how aggressively it should be applied to very elderly patients who have exceeded the average life expectancy. Given that 85 years is approximately the overall Japanese life expectancy at birth, we considered a threshold of 85 years and hypothesized that the prognosis of oral squamous cell carcinoma (SCC) patients aged ≥85 years was not inferior to that of those < 85 years. The aim of the present study was to investigate the clinical characteristics, treatment methods, and prognoses of Japanese oral SCC patients aged ≥85 years.

METHODS

A retrospective cohort study was performed. The data of patients with primary oral SCC (n = 358) from 2005 to 2018 in our institute were extracted from electronic medical records. A total of 358 patients with oral SCC were divided into two groups (≥85 years group [n = 26] and < 85 years group [n = 332]) based on the age threshold of 85 years at the first visit. Kaplan-Meier survival analyses and Cox proportional hazard models were used to analyse overall survival (OS) and hazard ratios (HRs) according to age group, treatment, and TNM classification.

RESULTS

There was no difference in the 5-year OS rate between the ≥85 years and < 85 years groups (80.8% vs. 82.2%, P = 0.359). This finding was the same in the operative (94.7% vs. 85.8%, P = 0.556) and non-operative (42.9% vs. 33.2%, P = 0.762) groups, indicating that age did not affect prognosis. Mortality was lower in the operative group than in the non-operative group (adjusted HR: 0.276, 95% CI: 0.156-0.489, P < 0.001), suggesting that surgery is a superior method. However, non-surgical treatment was selected at a higher rate in the ≥85 years group (26.9% vs. 11.1%, P = 0.028).

CONCLUSIONS

This study suggests the prognosis of ≥85-year-old patients was not inferior to that of < 85-year-old patients. We recommend that surgery as the first choice treatment for ≥85-year-old patients with oral SCC who can tolerate surgery should be performed.

Paclitaxel Potentiates the Anticancer Effect of Cetuximab by Enhancing Antibody-Dependent Cellular Cytotoxicity on Oral Squamous Cell Carcinoma Cells In Vitro

Administration of cetuximab (C-mab) in combination with paclitaxel (PTX) has been used for patients with head and neck squamous cell carcinoma (SCC) clinically. In this study, we attempted to clarify the molecular mechanisms of the enhancing anticancer effect of C-mab combined with PTX on oral SCC cells in vitro. We used two oral SCC cells (HSC4, OSC19) and A431 cells. PTX alone inhibited cell growth in all cells in a concentration-dependent manner. C-mab alone inhibited the growth of A431 and OSC19 cells at low concentrations, but inhibited the growth of HSC4 cells very weakly, even at high concentrations. A combined effect of the two drugs was moderate on A431 cells, but slight on HSC4 and OSC19 cells. A low concentration of PTX enhanced the antibody-dependent cellular cytotoxicity (ADCC) induced by C-mab in all of the cells tested. PTX slightly enhanced the anticancer effect of C-mab in this ADCC model on A431 and HSC4 cells, and markedly enhanced the anticancer effect of C-mab on OSC19 cells. These results indicated that PTX potentiated the anticancer effect of C-mab through enhancing the ADCC in oral SCC cells.

Desempenho e características bioquímicas de leitões submetidos a dietas com aditivos probióticos, prebióticos, simbióticos e antibióticos

Avaliaram-se o desempenho e as características bioquímicas de leitões desmamados, utilizando-se aditivos alternativos em substituição aos antibióticos. Foram utilizados 480 leitões machos, distribuídos em delineamento inteiramente ao acaso, composto por cinco tratamentos. A ração foi à base de milho, farelo de soja e um núcleo comercial para leitões. Os tratamentos consistiram em T1: ração sem aditivos, T2: dieta basal com antibiótico, T3: dieta basal com adição de prebiótico, T4: dieta basal com adição de probiótico e T5: dieta basal com adição de simbiótico. Foram avaliados peso corporal, ganho de peso, consumo de ração e conversão alimentar. Em 50 amostras de sangue de leitões, sendo 10 amostras de cada tratamento, avaliaram-se as concentrações séricas de proteínas totais, de albumina e globulina, a relação albumina:globulina e a fosfatase alcalina, creatinina, alanina aminotransferase, aspartato aminotransferase, gama- glutamiltransferase, colesterol, ureia, cálcio e fósforo e a relação cálcio:fósforo. A substituição de antibióticos por aditivos alternativos não influenciou o desempenho nem as características bioquímicas dos leitões.

Crossflow filtration of yeast broth cultivated in molasses

A broth of yeast cells cultivated in molasses was crossfiltered with a thin-channel module. The permeation flux gradually decreased at a constant cell concentration. The flux was much lower than that obtained for yeast broth cultivated in yeast extract, polypeptone, and dextrose (YPD) medium during the filtration. The flux did not depend on the membrane pore size (0.45 to 5 mum). The steady-state flux was one-twentieth that calculated for a cake filtration mode from the amount of cake per unit filtration area and the specific resistance of the cake measured in a dead-end filtration apparatus. The lower flux was due to small particles (most of which were less than 1 mum in diameter) in the molasses. The mehanism of crossflow filtration of broths of yeast cells cultivated in molasses was clarified by analysis of the change in flux with time and observations with scanning electron microscopy. At the initial stage of crossflow filtration the yeast cells and particles from the molasses were deposited on the membrane to form the molasses were deposited on the membrane to form a cake in a similar way to dead-end filtration. After the deposition of cells onto the membrane ceased, the fine particles from molasses formed a thin layer, which had higher resistance than the cake formed next to the membrane. The backwashing method was effective to increase the flux. The flux increased low when the pore size was 0.45 to 0.08 mum, but using larger pores of 3 to 5 mum it returned almost to the bases line. (c) 1994 John Wiley & Sons, Inc.

Growth induction of rat primary hepatocytes using antisense oligonucleotides

We examined growth control of adult and fetal hepatocytes by regulating the expression of cell-cycle-related proteins using antisense S-oligonucleotides to tumor suppressors retinoblastoma (RB) protein and p53, and cyclin-dependent kinase (CDK) inhibitors p21 and p27. The protein expression in both adult and fetal hepatocytes was significantly suppressed with the addition of corresponding antisense oligonucleotides at a concentration of 2.5 microM. For the evaluation of growth, 3H-thymidine incorporation and DNA content were measured and the results demonstrated that all the antisense oligonucleotides had growth-promoting effects and the promoting potential was equivalent or slightly greater than that with the addition of hepatocyte growth factor (HGF) (10 ng/ml). The growth-promoting effect of the antisense oligonucleotides was enhanced by HGF in both adult and fetal hepatocyte cultures, and the effects on hepatocyte growth were also observed in a suspension culture.

Arteriosclerosis in the influx and intravisceral arteries of the liver, kidney and lung of WHHL rabbits

We performed a histopathological investigation on arteriosclerotic development in the influx and intravisceral arteries of the liver, kidney and lung of male WHHL rabbits. In the influx arteries of these organs, we observed severe atherosclerotic vascular lesions with high-grade luminal stenosis. In the intravisceral arteries of the liver and kidney, no arteriosclerotic lesions were observed. However, in the intrapulmonary arteries, we recognized severe atherosclerotic vascular changes with high-grade stenosis or total obstruction of the lumen in some middle to large sized pulmonary arteries. These observations indicate that the development of arteriosclerosis in parenchymatous organs differs, and that some organs are predisposed to arteriosclerosis formation.

Pulmonary atherosclerosis and pulmonary arterial pressure in cholesterol-fed New Zealand white rabbits

The lung produces many vasoactive substances originating from its vascular endothelium and plays an important part in various pathose. The present study was carried out to clarify pulmonary atherosclerosis and pulmonary arterial pressure, and to elucidate a part of the pulmonary pathosis in cholesterol-fed rabbits. Atherosclerosis was induced by feeding the animals a cholesterol-rich diet. When the rabbits were fed the cholesterol-enriched diets for 15 weeks, the grade of the atherosclerosis was severer than in 8W-feeding rabbits. The lesions of 8W-feeding rabbits were mainly composed of foam cells and fibrous components, whereas in 15W-feeding rabbits, the aggregation of foam cells beneath the endothelium of the vessel was infiltrating the media and severe stenose of the lumen was observed. In the entire pulmonary arterial system, the severe obstructive vascular lesions were localized and not diffused. The pulmonary arterial pressures of the rabbits increased slightly with time and the mean pressures were 11.3+/-0.9 (control group), 11.8+/-1.0 (8W group) and 13.7+/-1.5 mmHg (15W group) respectively. A significant difference existed in the mean pressure between the control group and 15W-feeding group, but there were no significant differences in the systolic and diastolic pressures among the three groups. In conclusion, we could induce pulmonary atherosclerosis in rabbits by feeding them a hyper-cholesterol diet but not overt pulmonary hypertension.

Surgical management of early stage central (hilar) and peripheral nonsmall cell lung carcinoma

BACKGROUND

To the authors' knowledge, the definitions of early lung carcinoma used in Japan are not yet approved internationally. In the current study the diagnostic methods, pathology, and results of the surgical treatment of early hilar and peripheral nonsmall cell lung carcinoma cases defined by Japanese criteria are presented.

METHODS

Between 1977 and 1998, 43 patients with early hilar lung carcinoma were encountered. These patients constituted 14.5% of 200 hilar lung carcinoma patients who underwent resection during the same period. Between 1973 and 1998, there were 174 early peripheral lung carcinomas, which comprised 14.8% of 1173 peripheral lung carcinoma patients who underwent resection during the same period.

RESULTS

The 5-year and 10-year survival rates of the early hilar lung carcinoma were 100% and 96.9%, respectively. The majority of the patients underwent bronchoplastic surgery, such as sleeve lobectomy and parenchymal-sparing surgery including seven sleeve segmentectomies and two second carinal resections. The effectiveness of the parenchymal-sparing resections was assessed by the conventional pulmonary function test as well as perfusion and ventilation scanning. There were 174 cases of peripheral early lung carcinoma among the 218 cases of peripheral lung carcinoma with tumor dimensions of < or = 2 cm. The cell types were 142 (81.6%) cases of adenocarcinoma, 18 (10.3%) cases of squamous cell carcinoma, and 14 (8%) cases of other cell types. These 174 patients comprised 14.8% of 1173 patients with peripheral nonsmall cell lung carcinoma who underwent surgery during the same period. The 5-year and 10-year survival rates for adenocarcinoma were 89.6% and 86.8%, respectively. The 5-year and 10-year survival rates for other cell types were both 71.8%. The overall 5-year and 10-year survival rates were 86.8% and 84.6%, respectively.

CONCLUSIONS

Early lung carcinoma in both the hilar and peripheral regions, is curable if it is properly diagnosed and treated.

Salt water promotes hypertension in Dahl-S rats

Hypertension was induced in Dahl-salt-sensitive (Dahl-S) rats by administering salt in drinking water. Control rats receiving tap water did not show a significant change in blood pressure or abnormalities in the kidney. Rats receiving 0.5% NaCl solution developed moderate hypertension and renal lesions. Rats receiving 1.0% NaCl solution showed prominent and increasing hypertension and severe renal damage. This method of salt administration should be simpler than administration in the diet as a means of promoting renal hypertension. The lower concentration salt water caused chronic mild hypertension in Dahl-S rats, and may serve as a useful model for progressive hypertension.

Expression of cholesterol 7alpha-hydroxylase and delta(4)-3-ketosteroid 5beta-reductase genes in rat pancreatic hepatocyte-like cells

Hepatocyte-like cells have been observed in the pancreas of the rat. We examined the bile acid biosynthetic function of these cells to determine whether they were real hepatocytes. This study investigated the existence of two liver-specific enzymes involved in bile acid biosynthesis (cholesterol 7alpha-hydroxylase and delta(4)-3-ketosteroid 5beta-reductase) in the hepatocyte-like cells. We could demonstrate cholesterol 7alpha-hydroxylase activity and its circadian rhythm in the hepatocyte-like cells. Northern blot analysis demonstrated the expression of messenger RNA for the 7alpha-hydroxylase and delta(4)-3-ketosteroid 5beta-reductase in the pancreatic hepatocyte-like cells. To measure the amount of the messenger RNA, we used the competitive polymerase chain reaction method for the 7alpha-hydroxylase. This quantitation revealed the existence of a circadian rhythm of cholesterol 7alpha-hydroxylase messenger RNA in the hepatocyte-like cells. These results indicated that bile acid biosynthesis was performed in the pancreatic hepatocyte-like cells as noted as in the liver parenchymal cells.

Development of atherosclerotic lesions in cholesterol-loaded rabbits

To examine both of the target vessels and the optimal time of their endothelial denudation to study vascular restenosis after balloon injury in cholesterol-loaded rabbits, we made 36 atherosclerotic rabbits by feeding a hypercholesterol diet, and histologically examined the onset time and the development of atherosclerosis. Atheromatous changes were observed first after the 5th week in the thoracic aorta from the start of the diet, and then extended to the abdominal aorta, coronary artery with time. The atherosclerotic lesions in the thoracic aorta and the proximal portion of the coronary artery showed high-grade concentric intimal thickening with luminal stenosis. The abdominal aortic lesion mildly progressed. In the renal, carotid and femoral arteries, in contrast, slight atheroscleromatous changes developed during the diet period. These results suggest that the thoracic and abdominal aortas and the coronary artery would be suitable as target vessels to study vascular restenosis after balloon injury, and the endothelial denudation of these vessels should be performed between the 8th and 15th week in this diet protocol for an accurate analysis.

Division of donor liver for successful split-liver transplantation in pigs

Split Liver Transplantation (SLT) is an attractive method to solve the problem of a shortage of liver grafts. A through knowledge of the anatomy of the porcine liver vessels and bile duct is essential in performing the experimental SLT. This study was undertaken to decide the split line for successful SLT in pigs by examining the main branching patterns both vessels and bile duct in 30 porcine livers macroscopically and angiographically. The hepatic arterial branching patterns were divided into three types and bile duct patterns into two types. There was no exception in branching patterns of the portal vein and the hepatic vein. We conclude it is desirable that the donor liver should be divided into two grafts between the left medial lobe and quadrate lobe.

Partially covered Gianturco stent for tracheobronchial stricture caused by intraluminal tumor

Partially covered Gianturco stents were used successfully in two patients to treat tracheobronchial strictures caused by intraluminal tumor growth. The stents were accurately placed without complications. The covered portion of the stent compressed the tumor, and prevented tumor ingrowth until the patients' deaths. This stent seems to act as effective palliation for tracheobronchial stricture caused by intraluminal tumor.

Knowledge-based systems, artificial neural networks and pattern recognition: applications to biotechnological processes

Recent years have witnessed the increasing application of artificial intelligence techniques, specifically, knowledge-based systems, artificial neural networks, and pattern recognition, to biotechnological processes. Although progress has been made in simple control applications, more work is needed to establish the advantages of these techniques for industrial process control, for diagnosis/monitoring, and to upgrade the information content of historical data.

Branching patterns in coronary artery and ischemic areas induced by coronary arterial occlusion in the CLAWN miniature pig

This study of 28 CLAWN miniature pigs (male 17, female 11, mean weight 29 kg) was undertaken to investigate the coronary arterial branching patterns and the ischemic area induced by surgical occlusion of the left anterior descending artery (LAD) and change in the ischemic area over time. These results were compared with those in dogs, which have frequently been used in myocardial ischemic research. Regarding the coronary arterial branching pattern, there were fewer ventricular branches from the right and left coronary arteries than in dogs. The septal branches arose from only the LAD and the posterior descending artery (PD). The largest septal artery branched from the LAD. There were two types of septal artery branching patterns. In approximately 80% of the CLAWN miniature pigs, the PD arose from the right coronary artery (Right dominance). The peculiarity of the coronary arterial branching pattern in the CLAWN miniature pigs was more similar to human beings than to dogs. The ischemic area induced by occlusion at three-fifths distal section of the LAD was 12.1% to 22.6% (mean 17.1%) of the left ventricle. The ischemic area in all animals that died of global left ventricular malfunction and hemodynamic instability after LAD occlusion was more than 25% of the left ventricle.

[Screening CT of the lungs: image quality compared with conventional CT]

More sensitive imaging methods may be required in the screening of early peripheral lung cancer. Among new radiologic techniques, helical volumetric computed tomography (CT) seems to be attractive. The image quality of helical CT with single breath-hold and low-dose technique (screening CT) was compared with conventional sequential CT in 12 patients to detect the pulmonary metastases. The screening CT protocol consisted of a 20 mm/sec table feed during a 20-second breath-hold at 40 mA, with reconstruction of images at 10 mm intervals. Conventional CT was performed with a 1-second scan time, 200 mA, and contiguous 10 mm-thick sections. In the evaluation of mediastinal vessels, bronchi and pulmonary nodules, screening CT showed high detectability images comparable to conventional CT. But subsegmental bronchi or small nodules overlapping pulmonary vessels were more difficult to visualize by screening CT because of image noise. The authors conclude that although further improvement is necessary, screening CT of the lung is an attractive new application of CT.

Fine structure of the parotid gland in tree shrew (Tupaia glis)

The parotid glands of Tupaia glis were examined by light and transmission electron microscopy. The acinar cells were seromucous in nature, and contained many acidophilic granules with strong affinity for periodic acid-Schiff (PAS) and weak affinity for alcian blue (AB). These granules consisted of a fine granular matrix of moderate density in which a denser corpuscles or semilunar materials were present. Intercalated duct cells had a few fine vesicles, vacuoles and very few dense granules in the apical region. In occasional epithelial cells, acidophilic, PAS-positive and AB-negative bodies with moderate density were observed in the supranuclear region. The striated ducts consisted of columnar light and dark cells containing round or small ovoid granules of moderate density and did not show the granular duct as seen in the parotid glands of kobe mole and tenrec which are placed in the order insectivora.

Clinical application of single dual-energy subtraction technique with digital storage-phosphor radiography

We used a single-exposure dual-energy subtraction technique with a storage-phosphor computed radiography (CR) system to evaluate various pulmonary diseases. Clinical applications of this method have been studies at our institution. In our experience, the dual-energy subtraction technique provided better visualization of pulmonary nodules, tracheobronchial abnormalities, pulmonary vascular diseases, calcification in a nodule, and rib lesions than conventional CR images did. Single-exposure dual-energy subtraction images were obtained with a sandwich technique using two storage-phosphor imaging plates with a 1-mm-thick copper filter interleaved between the two. The front plate obtains a lower kilovoltage image, whereas the back plate obtains a higher kilovoltage image. We can visualize soft tissue and bone images as well as unsubtracted digital images by the subtraction process.

Small giant cell carcinoma of the lung diagnosed preoperatively by transthoracic aspiration cytology. A case report

Giant cell carcinoma (GCC) of the lung is considered an aggressive form of lung cancer. Most patients with GCC have large tumors with widespread metastases on hospital admission. We describe a small GCC in the lower lobe of the right lung. Preoperative aspiration cytology showed numerous bizarre, giant epithelial cells, highly suggestive of GCC. The resected tumor measured 1.2 x 1.0 x 0.7 cm in diameter, with an ill-defined margin. Histologically the tumor was composed of pleomorphic mononucleate or multinucleate giant cells without adenocarcinoma or squamous cell differentiation. The tumor cells were loosely organized and noncohesive or free in the alveolar space. The histology was interpreted as GCC of the lung. The clinicopathologic features of giant cell carcinoma are discussed.

Clinicopathological study of primary malignant tumors of the lung: an analysis of 993 tumors resected at the Kanazawa University Hospital between 1979-1993

A retrospective study was conducted of 993 malignant tumors of the lung in 977 patients. The male-female sex ratio was 2.6:1. The age distribution of the males did not differ from that of the females and the overall mean age was 64.3 +/- 9.5 years (range, 13-85 years). Forty-three percent of the patients were in their seventh decade. The location was peripheral in 81% of the tumors and central in 19%. Of the central tumors, 85% were squamous cell (epidermoid) carcinoma (SCC), while 58% of the peripheral tumors were adenocarcinoma (ADENO). In males, 49% of all tumors were SCC and 36% ADENO, while in females 76% were ADENO. The incidence of positive lymph node metastasis increased in parallel with the pT status in both central and peripheral carcinomas. However, it was noted that, of peripheral lung carcinomas, no SCC with a diameter of 15 mm or less had lymph node metastasis, whereas 18.9% of the ADENO of this size were positive for lymph node metastasis. These results indicate that lymph node metastasis can occur even in small-sized peripheral ADENO less than 15 mm. Thus, early detection and surgery together with mediastinal lymph node dissection are necessary even for small-sized tumors to improve the prognosis in patients with peripheral ADENO of the lung.

Effects of invert soap with 0.05% sodium hydroxide on infectious bursal disease virus

The effects of invert soaps with sodium hydroxide on infectious bursal disease virus (IBDV) were studied. Didecyldimethylammonium chloride was most effective, followed by alkylbenzyldimethylammonium chloride and [mono-bis(tri-methylammonium-methylene chloride)]-alkyl (C9-15) toluene. Dilutions without NaOH had little effect on virus titer. Didecyldimethylammonium chloride was further tested for its effects on IBDV by varying temperature, concentration of invert soap, and pH of the dilution. The effect of the invert soap was strong at 40 C, moderate at room temperature, and weak at 4 C. The concentration of invert soap influenced its efficacy at room temperature but not at 4 C. At pH values below 12.9, the invert soap showed decreased efficacy.

[Dual-energy subtraction technique with FCR: clinical application for diagnosis of pulmonary vascular diseases]

The use of dual-energy techniques has already proved to be beneficial in nodule detection and characterization of the calcification in nodules. Other clinical applications, in which simplification of the background might lead to improved results, should be investigated. We evaluated the image quality of pulmonary vessels in the dual-energy techniques with FCR. In visualization of the pulmonary vessels of normal patients, dual-energy soft tissue images were equal or inferior to the original unsubtracted digital images because of increased noise. In the diagnosis of some pulmonary vascular diseases (e.g., Takayasu's arteritis), however, soft tissue images resulted in improved conspicuity of involved sites compared with the unsubtracted images.

Simultaneous occurrence of lung adenocarcinoma and fibular osteosarcoma in a 13-year-old girl

Bronchogenic cancer in the pediatric age group is extremely rare and less than 100 cases have been reported in the world literature. We report a 13-year-old girl with simultaneous occurrence of lung adenocarcinoma and osteosarcoma. The patient was admitted with lower leg pain, and an abnormal shadow in the right fibula was noted on X-ray examination. Further examination of the fibular lesion including tumor biopsy revealed an osteosarcoma. Following completion of the first course of preoperative chemotherapy, multiple lung shadows were found on chest X-ray films. After five courses of preoperative chemotherapy, however, all lung shadows except one in the right lower lobe disappeared. The fibular tumor was then resected. Postoperatively, an additional six courses of chemotherapy was given. However, the lung shadow in the right lower lobe was still present. Exploratory thoracotomy was performed. Pathologically, the lung tumor measured 0.8 cm in diameter with an ill-defined border, and histological examination revealed a well differentiated papillary adenocarcinoma. To our knowledge, only a few cases of pediatric lung cancers have been reported to be associated with congenital cystic malformation of the lung. However, this combination of pediatric lung adenocarcinoma and osteosarcoma has not been previously reported.

Simultaneous detection of intercellular adhesion molecule-1 (CD54) and carcinoembryonic antigen in lung adenocarcinoma

Simultaneous detection of intercellular adhesion molecules-1 (ICAM-1) and carcinoembryonic antigen (CEA) was investigated in AMeX (Acetone, Methyl benzoate and Xylene)-fixed, paraffin-embedded tumor sections of 24 adenocarcinomas of the lung, using the avidin-biotin-peroxidase complex (ABC) method. Distinct expression of both ICAM-1 and CEA was found in tumor cells in all cases. The staining pattern of these two antigens was quite similar and was mainly affected by the tumor grade. In well-differentiated adenocarcinoma, uniformly positive staining was demonstrated predominantly along the apical surfaces of the tumor cell nests, and to a lesser degree on the lateral cell surface and in the cytoplasm with apical concentration, but no positive staining was found on the basal cell surfaces. In poorly differentiated adenocarcinoma, positive staining was found along the entire cell surface and in the cell cytoplasm without any apical concentration, and the staining intensity varied from region to region in the same tumor cell and from cell to cell within the same tumor cell nest. In moderately differentiated adenocarcinoma, the staining pattern was intermediate between those of well and poorly differentiated adenocarcinoma with some degree of apical concentration. The expression pattern of ICAM-1 or CEA on tumor cells did not correlate well with stromal inflammatory cell infiltration. These results indicate that the expression pattern of CEA and ICAM-1 is an inherent characteristic of tumor cells, and that their abnormal expression may play an important role in the physiological behavior of tumor cells because the polarity of their expression is lost in parallel with histological tumor grades.

Abscessing bronchioloectasia with elements of plasma cell granuloma

A 79-year-old male was admitted to the hospital with the complaint of bloody sputum. Chest X-ray revealed an abnormal shadow in the right upper lobe. Macroscopically, the lesion measured about 3.5 x 2.5 x 2.0 cm with a central cavity containing pus. Histologically, the lesion was composed of interlacing fibroblastic proliferation with abundant plasma cell infiltration and central cavitation. The inner surface of the cavity wall was partially covered by bronchial epithelial cells; there was no cartilage found, suggesting that the lesion had developed from chronic inflammatory processes in relation to ectatic bronchioles. Since the pathogenesis of plasma cell granuloma (PCG) has not been well established, it is probable that this case represents one stage in the development of classic PCG.

A new animal model for split liver transplantation using an infrahepatic IVC graft

An animal model of split liver transplantation using pigs is described herein. The donor liver was divided into two grafts, the right graft consisting of the right medial and lateral segments with the caudate lobe, and the left graft consisting of the left lateral and medial segments. To make implantation easier, a distal part of the donor's inferior vena cava (IVC) was isolated and attached to the left graft with an anastomosis between the orifice of the renal vein and the graft's hepatic vein. The left graft thereby contained a newly constructed retrohepatic IVC for anastomosis to the recipient. During the anhepatic phase, no conventional bypass procedure was used, but an abdominal aortic clamp in combination with general hypothermia was employed. Ten pigs were used as donors and a total 20 liver transplantations performed. No immunosuppressive drugs were given in this series. Ten of the 20 recipients survived for more than 2 days, the mean survival time being 4.7 days, with a range of 2-14 days. The mean survival time of the left grafts was much longer than that of the right grafts, although no technical problems such as kinking of the graft or occlusion of the hepatic vein were encountered in either. This model is the first report of split liver transplantation in animals. The advantages of using the infrahepatic IVC graft include stability of the graft and safe hepatectomy. This model will therefore be useful for the experimental study of split liver transplantation and may also be employed for clinical use in the future.

Demonstration of nucleolar organizer regions in lung carcinoma by silver staining

Nucleolar organizer regions (NORs) were investigated in lung carcinomas by silver staining. This method was applied to 111 lung carcinoma specimens, including 40 with squamous cell carcinoma (SCC), 42 with adenocarcinoma (ADENO), 8 with adenosquamous carcinoma (ADESQ), 8 with small cell carcinoma (SMCC), 6 with large cell carcinoma (LGCC), and 7 with typical carcinoid tumors (CAOID). The mean AgNOR counts of ADENO, SCC, ADESQ, SMCC, and LGCC were significantly higher than those of the normal bronchial surface and those of the glandular or alveolar epithelium. The mean AgNOR count of CAOID was significantly higher than those of the normal glandular and alveolar epithelium but not that of the surface epithelium. The mean AgNOR count of SCC was significantly higher than that of bronchial squamous metaplasia, and the count of SMCC was significantly higher than that of CAOID. Within the same cancer category, the mean number of AgNORs increased in parallel with the histological tumor grades. These results indicate that the AgNOR method is useful for differentiating lung carcinoma from its normal counterparts and for evaluating histological tumor grades in the same lineage of lung carcinoma.

Primary extramedullary plasmacytoma of the lung

A case with primary plasmacytoma of the lung is described. The patient, a 55-year-old Japanese female, who simultaneously had a pulmonary plasmacytoma and bladder carcinoma. The bladder tumor was treated with transurethral resection. Pathologically, the bladder tumor was a non-invasive, papillary transitional cell carcinoma, grade II. The lung tumor was located in the right upper lobe and upper lobectomy was performed. The tumor measured 2.8 x 2.7 x 2.0 cm and had a white-yellowish cut surface. Histologic, electron microscopic and immunohistochemical examinations of the lung tumor revealed monoclonal proliferation of plasma cells (IgA, lambda light chain). There was no evidence of multiple myeloma.

Seven patients with plasma cell granuloma (inflammatory pseudotumor) of the lung, including two with intrabronchial growth: an immunohistochemical and electron microscopic study

Seven patients (mean age, 50.7 +/- 20.4 years; range 21-77) with plasma cell granuloma (PCG) of the lung are reported. Cough and sputum were the most common presenting symptoms, followed by fever. Elevated erythrocyte sedimentation rate and serum C-reactive protein levels were found in all patients tested. Radiologically, five cases presented as solitary, well-circumscribed masses and two as ill-defined, pneumonia-like densities. One showed focal calcification. No predilection of occurrence was observed in either lobe of the lung. Histologically, the lesions consisted of a proliferation of mature plasma cells and reticulo-endothelial cells supported by a stroma of granulation tissue, with varying degrees of myxoid change or collagenization. Angioinvasion within the lesion was observed in 4 of the 7 cases. Immunohistochemical staining revealed the IgG-predominant polyclonal nature of the plasma cells, indicating a reactive inflammatory process rather than a neoplastic one. Electron microscopy confirmed the benign nature of the plasma cells with fibroblast and myofibroblast proliferation admixed with that of other inflammatory cells.

[Screening for tracheobronchial diseases with digital storage phosphor radiography]

Digital storage phosphor radiography (FCR: Fuji computed radiography) has a wide dynamic range and unique postprocessing capabilities. This study was designed to test whether chest imaging with FCR and its image processing would increase the accuracy of and confidence in the diagnosis of tracheobronchial abnormalities. In a phantom study, the performance of digital images having the appearance of a conventional chest radiograph was compared with that of a conventional system in detecting simulated tracheobronchial nodules. The digital images of lower kilovoltage (ROC area = 0.647 +/- 0.035) were equivalent to the conventional radiographs (ROC area = 0.620 +/- 0.028). On the other hand, nodule detectability was significantly improved in the digital images of higher kilovoltage (ROC area = 0.826 +/- 0.020). The author also compared the impact of five postprocessing algorithms (standard image, wide latitude image, enhanced image, reversed image, and subtraction image). ROC analysis indicated that the default standard image (ROC area = 0.826 +/- 0.020) was as good as an image with a linear rather than a sigmoid gradation curve (ROC area = 0.843 +/- 0.020), an image with strong enhancement of high frequencies (ROC area = 0.804 +/- 0.020), and an image with reversed gray scale polarity (ROC area = 0.775 +/- 0.015). Therefore these specific algorithms had no effect on the detection of tracheobronchial nodules. However, digital subtraction soft tissue images (ROC area = 0.961 +/- 0.030) were significantly better than the control images. Clinical study also indicated that subtraction images improve diagnostic accuracy in tracheobronchial diseases.

[Normal bronchi on high resolution CT]

The delineation of normal bronchi was evaluated by high resolution CT. Under the usual conditions for lung survey, with window width of 1500, window level -650, and slice thickness 10 mm, using high spatial frequency algorithm, the subsegmental bronchi were delineated in 77% of total branches. Sub-subsegmental bronchi were delineated in 8% of branches. Under thin slice high resolution CT, with slice thickness of 1.5 mm and slice interval 10 mm, subsegmental bronchi were delineated in 89% of branches, and sub-subsegmental bronchi were delineated in 35% of branches. In two of the cases in which almost the whole lungs were studied on continuous slice images with thin slice high resolution CT, sub-sub-subsegmental bronchi could be easily delineated, except in for the lingular segment. High resolution CT is very useful for the interpretation of normal pulmonary structures and for diagnosis of bronchial lesions.

Early hilar lung cancer: its clinical aspect

Early hilar lung cancers are rare, but are curable if they are properly diagnosed and treated. In the past 14 years, we have treated 27 patients with early hilar cancers that fulfilled the criteria proposed by the Japanese Lung Cancer Society (JLCS). Eighteen patients presented with symptoms and 9 were detected by the mass screening examination of sputum cytology. All lesions in both groups were finally diagnosed by bronchoscopy. Twenty patients (74%) had positive sputum cytology, whereas only 7 (26%) had positive chest X-ray findings. All the patients underwent surgery, and bronchoplasty was the most frequent operative procedure. The 5-year survival rate was 100%, and the 10-year survival rate was 91.7%, as one patient died of a second primary lung cancer in the 6th postoperative year. In conclusion, the definition of early hilar lung cancer proposed by the JLCS is thought to be reasonable, and early hilar lung cancer is a curable disease, if it is properly diagnosed and treated.

Proposals regarding some deficiencies in the new international staging system for non-small cell lung cancer

The new international staging system remains a source of some controversial issues as the survival of 716 non-small cell lung cancer patients in our series (286 in stage I, 63 in stage II, 225 in stage IIIA, 81 in stage IIIB and 61 in stage IV) is analyzed with regard to the T, N and M categories. The problems are aired and some proposals made for revising the staging system. Multivariate analysis of significant factors contributing to the prognoses of stage I patients made it clear that the most important factor was the size of the primary tumor. A significant difference in survival was found between T1N0M0 and T2N0M0 disease. Furthermore, patients having tumors larger than 5 cm in diameter showed a significantly worse prognosis than those having tumors less than 5 cm. Accordingly, stage I should be divided into stage IA (T1N0M0, tumors less than 3 cm) and stage IB (T2aN0M0, tumors less than 5 cm). Tumors greater than 5 cm should be categorized as T2b, and T2bN0M0 disease should be classified as stage II. Patients having N2 disease involving the pretracheal (#3) node had a significantly worse survival rate than those with other ipsilateral nodal involvement, so #3 nodal involvement should be categorized as N3 disease. Patients having ipsilateral intrapulmonary satellite nodules, most of which were verified by microscopic examination of the resected specimens, had a significantly better survival rate than stage IIIB patients and showed no significant difference from stage IIIA disease. Accordingly, ipsilateral intrapulmonary satellite lesions should be categorized as T3 disease.

Technique for procurement of heart, liver and kidneys from a single donor for transplantation

The purpose of this report is to present a safe, simple technique for procurement of the heart, liver, and kidneys from a single donor with no warm ischemic time. Twenty mongrel dogs were divided into 5 groups of 3 recipients and 1 donor each. Liver and kidney mobilization was performed when the core temperature of the liver reached 27 degrees C, a result of ice slush in the abdominal cavity. As the core temperature of the liver reached 20-22 degrees C, the aorta and inferior vena cava were clamped just above the diaphragm. After excision of the liver and kidneys, another team harvested the heart as it continued to beat. The heart and liver were transplanted orthotopically after simple preservation for 12 and 6 hours, respectively. The kidney was transplanted heterotopically after simple 12-hour preservation. The maximum survival time was 7 hours for heart transplantation and 16 days for liver transplantation. Kidney homogenate ATP levels decreased to 19% of baseline after preservation and were restored to 68% one hour after reperfusion. Our method is simple and safe for harvesting the heart, liver, an kidneys for transplantation and may offer a definite possibility for clinical application.

[A case of lung cancer suspected to be pulmonary mycosis of the fungus ball type]

This paper reports a 73-year-old male case of lung cancer presenting as thin-walled cavity which was suspected to be pulmonary mycosis of the fungus ball type. Routine chest X-ray film showed a thin-walled cavity without a round shadow inside it. CR tomogram taken 2 months after the previous plain chest X-ray film showed an irregular thickening of the cavity wall and a round shadow inside it. Pulmonary mycosis of the fungus ball type was suspected based on the CR tomogram. But chest X-ray CT film taken 1 month after the previous CR tomogram revealed that the entire cavity wall was thickened with irregular convexity and no round shadow was seen in the cavity. Cavitary lung cancer was also suspected based on the findings of X-ray CT film. The surgical specimen, obtained by right upper lobectomy, revealed a moderately differentiated squamous cell carcinoma unaccompanied by pulmonary mycosis in the cavity space. Even in cases suggestive of mycosis, aggressive surgical intervention is recommended in those suspected of malignancy.

Transient subpleural curvilinear shadow caused by pulmonary congestion

We present two cases of transient subpleural curvilinear shadows (SCSs) on CT caused by pulmonary congestion. Subpleural curvilinear shadows, which are usually visible in the middle or lower dorsal lung field on CT, have been reported as the initial finding of pulmonary fibrosis. But SCS is not a specific finding since pulmonary congestion may be one cause of it.

[Single exposure energy subtraction chest radiography--clinical survey on utility of bone image]

The authors undertook a clinical study to determine the values and limitations of soft tissue subtracted image by dual-energy digital radiography. 573 patients were examined by dual-energy subtraction with a single exposure using computed radiography. Soft tissue subtracted image were found informative in 37 patients (6.5%) compared with non-subtraction image. It provided useful information about demonstrating calcification in pulmonary nodules, assessing the presence or absence of rib lesions, and excluding the possibility of pulmonary nodules.