Development of a classifier for gambling disorder based on functional connections between brain regions

AIM

Recently, a machine-learning (ML) technique has been used to create generalizable classifiers for psychiatric disorders based on information of functional connections (FCs) between brain regions at resting state. These classifiers predict diagnostic labels by a weighted linear sum (WLS) of the correlation values of a small number of selected FCs. We aimed to develop a generalizable classifier for gambling disorder (GD) from the information of FCs using the ML technique and examine relationships between WLS and clinical data.

METHODS

As a training dataset for ML, data from 71 GD patients and 90 healthy controls (HCs) were obtained from two magnetic resonance imaging sites. We used an ML algorithm consisting of a cascade of an L1-regularized sparse canonical correlation analysis and a sparse logistic regression to create the classifier. The generalizability of the classifier was verified using an external dataset. This external dataset consisted of six GD patients and 14 HCs, and was collected at a different site from the sites of the training dataset. Correlations between WLS and South Oaks Gambling Screen (SOGS) and duration of illness were examined.

RESULTS

The classifier distinguished between the GD patients and HCs with high accuracy in leave-one-out cross-validation (area under curve (AUC = 0.89)). This performance was confirmed in the external dataset (AUC = 0.81). There was no correlation between WLS, and SOGS and duration of illness in the GD patients.

CONCLUSION

We developed a generalizable classifier for GD based on information of functional connections between brain regions at resting state.

Framing effects on financial and health problems in gambling disorder

Gambling disorder (GD) patients show excessively risky decision-making in the financial domain. We aimed to clarify whether GD patients show risky decision-making in domain-general or in domain-specific. Furthermore, we also investigated the effect of the well-known cognitive bias, the framing effect on GD's decision-making under risk. Sixty-two male GD patients and 74 age-matched healthy male controls (HC) conducted a risky choice task in which they should choose solutions for difficult situations between a sure and a risky option that had the same expectations. Six situations were prepared for each financial and health domain. For each domain, three situations were presented with options using positive frames, and the other three situations were presented with options using negative frames. The results showed that GD chose more risky options in the financial domain with positive frames than HC, but chose comparably in the financial domain with negative frames, whereas GD and HC chose comparably in the health domain regardless of the frames. Thus, GD showed risky decision-making in domain-specific. In addition, the results indicate the importance of considering the influence of the framing effect for assessment of risky decision-making by GD. Domains and the influence of the framing effect should be considered when decision-making patterns of neuropsychiatric disorders are studied.

Amygdala volume is associated with risky probability cognition in gambling disorder

Gambling disorder (GD) is characterized by continual gambling despite negative consequences. Risky decision-making is a hallmark of the disorder. We applied a tool from behavioral economics for assessing probability cognition in both gain and loss domains to GD. We aimed to examine the alteration of probability cognition and its relationship with brain structure in GD. Forty-six GD patients and 52 age-matched healthy controls (HCs) conducted a risky choice task in which subjects should choose between a sure and a risky option in both loss and gain domains. The distortion and elevation parameters of the probability weighting function were estimated. We compared the parameters between GD and HC and examined their relationships with the striatum and amygdala volumes in GD. GD showed greater elevation parameter in the gain domain and smaller regional gray matter volume in the left amygdala than HC. The elevation parameter in the gain domain showed a negative correlation with the left amygdala volume in GD. Altered probability cognition in the gain domain but not in the loss domain might be more relevant to risky decision-making in GD. Our findings indicate that alteration in the amygdala might play a significant role in risky decision-making of GD. Longitudinal studies are recommended to examine the causal relationship between brain abnormalities and risky decision-making in GD.

An fMRI study of decision-making under sunk costs in gambling disorder

The sunk cost effect is the tendency to continue an investment, or take an action, even though it has higher future costs than benefits, if costs of time, money, or effort were previously incurred. This type of decision bias is pervasive in real life and has been studied in various disciplines. Previous studies and clinical observations suggest that decision-making under sunk costs is altered in gambling disorder (GD). However, the neural mechanisms of decision-making under sunk costs in GD remain largely unknown, and so is their association with the clinical characteristics of this patient group. Here, by combining functional magnetic resonance imaging and the task that demonstrated a clear example of the sunk cost effect, we investigated the neural correlates during decision-making under sunk costs in GD. We found no significant differences in the strength of the sunk cost effect between the GD and healthy control (HC) groups. However, the strength of the sunk cost effect in patients with GD showed a significant negative correlation with abstinence period and a marginally significant positive correlation with the duration of illness. We also found a reduction in the neural activation in the dorsal medial prefrontal cortex during decision-making under sunk costs for the GD group compared with the HC group. Furthermore, in patients with GD, the levels of activation in this area negatively correlated with the duration of illness. These findings have important clinical implications. This study will contribute to a better understanding of the mechanisms underlying altered decision-making abilities in GD.

Common and differential brain abnormalities in gambling disorder subtypes based on risk attitude

Studying brain abnormalities in behavioral addiction including GD enables us to exclude possible confounding effects of exposure to neurotoxic substances, which should provide important insight that can lead to a better understanding of addiction per se. There have been a few brain structural magnetic resonance imaging studies for GD, although the results have been inconsistent. On the other hand, GD was suggested to be a heterogeneous disorder in terms of risk attitude. We aimed to examine the heterogeneity of GD by combining a behavioral economics task and voxel-based morphometry. Thirty-six male GD patients and 36 healthy male control subjects underwent a task for estimation of loss aversion, which can assess risk attitude in real-life decision-making. The GD patients were divided into two groups based on their level of loss aversion, low and high. While both groups showed common gray matter volume reduction in the left supramarginal gyrus and bilateral posterior cerebellum, high loss-aversion GD showed pronounced reduction in the left posterior cerebellum and additional reduction in the bilateral medial orbitofrontal cortex. Our study suggests that the heterogeneity of GD is underpinned at the brain structural level. This result might be useful for understanding neurobiological mechanisms and for the establishment of precise treatment strategies for GD.

Heterogeneity of Loss Aversion in Pathological Gambling

Pathological gambling (PG) is characterized by continual repeated gambling behavior despite negative consequences. PG is considered to be a disorder of altered decision-making under risk, and behavioral economics tools were utilized by studies on decision-making under risk. At the same time, PG was suggested to be a heterogeneous disorder in terms of personality traits as well as risk attitude. We aimed to examine the heterogeneity of PG in terms of loss aversion, which means that a loss is subjectively felt to be larger than the same amount of gain. Thirty-one male PG subjects and 26 male healthy control (HC) subjects underwent a behavioral economics task for estimation of loss aversion and personality traits assessment. Although loss aversion in PG subjects was not significantly different from that in HC subjects, distributions of loss aversion differed between PG and HC subjects. HC subjects were uniformly classified into three levels (low, middle, high) of loss aversion, whereas PG subjects were mostly classified into the two extremes, and few PG subjects were classified into the middle range. PG subjects with low and high loss aversion showed a significant difference in anxiety, excitement-seeking and craving intensity. Our study suggested that PG was a heterogeneous disorder in terms of loss aversion. This result might be useful for understanding cognitive and neurobiological mechanisms and the establishment of treatment strategies for PG.

The validity of the classification for lateral hinge fractures in open wedge high tibial osteotomy

The objective of this study was to validate the efficacy of Takeuchi classification for lateral hinge fractures (LHFs) in open wedge high tibial osteotomy (OWHTO). In all 74 osteoarthritic knees (58 females, 16 males; mean age 62.9 years, standard deviation 7.5, 42 to 77) were treated with OWHTO using a TomoFix plate. The knees were divided into non-fracture (59 knees) and LHF (15 knees) groups, and the LHF group was further divided into Takeuchi types I, II, and III (seven, two, and six knees, respectively). The outcomes were assessed pre-operatively and one year after OWHTO. Pre-operative characteristics (age, gender and body mass index) showed no significant difference between the two groups. The mean Japanese Orthopaedic Association score was significantly improved one year after operation regardless of the presence or absence of LHF (p = 0.0015, p < 0.001, respectively). However, six of seven type I cases had no LHF-related complications; both type II cases had delayed union; and of six type III cases, two had delayed union with correction loss and one had overcorrection. These results suggest that Takeuchi type II and III LHFs are structurally unstable compared with type I. Cite this article: Bone Joint J 2015;97-B:1226-31.

Identification of serum miRNAs as novel non-invasive biomarkers for detection of high risk for early gastric cancer

BACKGROUND

Many micro-RNAs (miRNAs) are differentially expressed in Helicobacter pylori-infected gastric mucosa and in gastric cancer tissue and previous reports have suggested the possibility of serum miRNAs as complementary tumour markers. The aim of the study was to investigate serum miRNAs and pepsinogen levels in individuals at high risk for gastric cancer both before and after H. pylori eradication.

METHODS

Patients with recent history of endoscopic resection for early gastric cancer and the sex- and age-matched controls were enrolled. Serum was collected from subjects before or after eradication and total RNA was extracted to analyse serum levels of 24 miRNAs. Serum pepsinogen (PG) I and II levels were measured using enzyme-linked immunosorbent assay kits.

RESULTS

Using miR-16 as an endogenous control, the relative levels of miR-106 and let-7d before and after H. pylori eradication and miR-21 after eradication were significantly higher in the high-risk group than in the controls. H. pylori eradication significantly decreased miR-106b levels and increased let-7d only in the control group. After eradication, the combination MiR-106b with miR-21 was superior to serum pepsinogen and the most valuable biomarker for the differentiating high-risk group from controls.

CONCLUSION

Serum miR-106b and miR-21 may provide a novel and stable marker of increased risk for early gastric cancer after H. pylori eradication.

Toxoplasma gondii Does Not Persist In Goldfish (Carassius auratus)

Recent reports of toxoplasmosis in marine mammals raise concern that cold-blooded marine animals are a potential source of Toxoplasma gondii infection. To examine the transmissibility of T. gondii to fish, we observed the development of T. gondii tachyzoites inoculated into oviduct epithelial cells of goldfish (Carassius auratus) microscopically in vitro. Further, the survival period of tachyzoites inoculated into goldfish muscle was bioassayed in mice and through PCR analysis. In cell cultures at 37 C, both RH and Beverley strains of T. gondii tachyzoites had penetrated into cells at 6 hr post inoculation, and were multiplying. In cell cultures at 33 C, many tachyzoites of both strains attached to the host cells, but no intracellular tachyzoites were observed at 24 hr post inoculation. In the T. gondii inoculated goldfish kept at 33 C, tachyzoite DNA was detected in the inoculated region on day 3, but not on day 7. When inoculated goldfish were kept at 37 C, live tachyzoites were seen at the inoculation site on day 3, but not on day 7. These results suggest that T. gondii does not persist in fish.

Isolated posterior cruciate ligament insufficiency induces morphological changes of anterior cruciate ligament collagen fibrils

We studied the ultrastructural changes of the human anterior cruciate ligament (ACL) with transmission electron micrograph cross-sections following isolated posterior cruciate ligament (PCL) injury. Biopsy specimens were obtained from the proximal third and anteromedial aspect of the ACL. Fourteen patients with PCL-deficient knees at a mean of 22.1 months from injury to surgery and 5 normal knees amputated secondary to malignant tumors or traumatic injuries were used as controls. A significant difference was found in the number of collagen fibrils per 1 microm2 between the PCL-deficient knee group and the control group. There was a significant difference found in the collagen fibril diameter between the PCL-deficient knee group and the control group. The collagen packing density (the percentage of sampled area occupied by collagen fibrils) was also significantly different between the PCL-deficient knee and the control group. The current study shows that an isolated PCL insufficiency can induce morphological changes in ACL collagen fibrils, suggesting that a PCL insufficiency can have adverse effects on other ligamentous structures in the knee joint.

Image storing system for radiation therapy (radiation oncology information system: ROIS) as a branch of diagnostic PACS; implementation and evaluation

We have implemented the new system that is called as ROIS for storing medical images of the patients underwent radiotherapy as a branch of medium-scale diagnostic PACS. It was estimated that, for about nine years, we can store all medical images of the patients who received radiation therapy under the on-line storage condition. Further, we can retrieve all medical images of the radiotherapy patients on ROIS faster than conventional film library or on the diagnostic PACS, even if the patient had been treated many years ago. Implementation of ROIS provided us a great help in our clinical work.

Peripheral primitive neuroectodermal tumour with ganglioneuroma-like areas arising in the cauda equina

Peripheral primitive neuroectodermal tumour (pPNET or peripheral neuroepithelioma) is one of the malignant small round cell tumours of peripheral nerves, soft tissues and bones, but rarely originates in the spinal canal. We report an example of pPNET arising in the cauda equina of a 14-year-old Japanese boy. At surgery, a well-demarcated tumour measuring 2 x 4 cm in diameter and involving one of the nerve roots of the cauda equina was located within the intradural space with no evidence of extradural extension. Microscopically the tumour was made up of sheets of closely packed small round cells, associated with ganglioneuroma-like islands. Immunohistochemically, the small round tumour cells were intensely positive for neuron-specific enolase (NSE), an MIC2 gene product (O13) and beta 2-microglobulin, whereas the foci with ganglion cell-like cells reacted positively to NSE, synaptophysin and beta 2-microglobulin but were negative for O13. A chimeric transcript of the EWS/FLI-1 fusion gene detected by a nested reverse transcriptase-polymerase chain reaction using formalin-fixed paraffin-embedded tissue justified the diagnosis of pPNET. Only 6 cases of PNET in the cauda equina have been described in the literature, and this is the first case of a pPNET with ganglio-neuroma-like areas. This finding suggests that the primitive tumour cells of pPNET may respond to unknown inductive effects and express a ganglion cell-like morphology.

The adverse effects of sectioning the posterior cruciate ligament in rabbits. Changes in the structural and morphological properties of the femur-anterior cruciate ligament-tibia complex

This study examined the changes in the structural properties of the femur-anterior cruciate ligament-tibia complex (FATC) and the histologic changes of the anterior cruciate ligament (ACL) following sectioning of the posterior cruciate ligament (PCL) of 20 rabbits. The PCL in the right knee was sectioned through an arthrotomy. The left knee underwent arthrotomy only and was used as a control. The animals were killed 3 and 6 months postoperatively. The tensile properties of the FATCs were tested, and the ACLs were histologically examined using polarized light microscopy and transmission electron microscopy. There were significant decreases in the ultimate load following sectioning of the PCL, although there were no significant changes in the stiffness. There were no significant differences in either the crimp period or the crimp amplitude of the ACL following sectioning of the PCL. There were significant increases in the number of collagen fibrils per square micrometer, and significant decreases in the collagen fibril diameter and proportion of total collagen fibril area per square micrometer following sectioning of the PCL. These findings suggest that isolated PCL injury may cause pathological changes in the ACL and its insertion sites.

18 years of conformation radiotherapy at Nagoya University Hospital

Conformation radiotherapy is one of the best techniques for minimizing the radiation dose absorbed by the surrounding normal tissue while delivering a high dose to a cancerous target area. The cases of all patients who underwent external irradiation at Nagoya University Hospital from 1975 to 1992 were reviewed. A total of 5740 patients with 6179 lesions were irradiated during this time, and 3795 treatment plans involved radical intended irradiation. Of the 5740 patients, 1017 had head and neck cancer, 982 had cervical cancer, 506 had lung cancer, 439 had primary brain tumors, 308 had esophageal cancer, 1213 had metastatic tumors, and 1275 had other types of tumors. The total number of treatment plans per year decreased from 442 in 1975 to 292 in 1992. Likewise, the percentage of conformation radiotherapy performed in all patients decreased from 29.4% (130/442) in 1975 to 8.6% (25/292) in 1992. It occupied 14.5% (982/6179) of all intended plans, and 20% (775/3795) of radical treatment plans. The conformation technique was used in cases of cervical cancer (72%), esophageal cancer (65%) and primary brain tumors (25%). Boost Conformation radiotherapy represented 2% of all treatment planning and 29% of the conformation radiotherapy. Boost Conformation radiotherapy has recently become more popular and now represents more than 50% of conformation radiotherapy. With respect to cases of cervical cancer, the rates of local recurrence and late complications in cases treated by conformation radiotherapy were lower than in cases treated by two parallel opposed radiotherapy.

[Analysis of verotoxin-producing Escherichia coli (O157:H7) strains isolated in the Fukuoka area in 1994 by pulsed-field gel electrophoresis]

Nine verotoxin-producing Escherichia coli O157:H7 strains were isolated from 9 pediatric patients with sporadic enteritis between July and September 1994 at four clinics in the Fukuoka area. The patients included two families with two cases each. These strains were analyzed by pulsed-field gel electrophoresis for Xba I-digested DNA fragments. The restriction patterns were identical between each two strains within the two family outbreaks, but different among the seven strains of the distinct seven sporadic cases. It is strongly suggested that the seven sporadic cases were infected through distinct sources, and that the two family cases were due to a common source of infection or person to person infection.

[Influence of the overall time of radiotherapy on local control for T2 cancer of the tongue]

Forty patients with T2 cancer of the tongue treated with external irradiation plus radium implants at Aichi Cancer Center were reviewed retrospectively to analyze the influence of overall treatment time on local control. One hundred percent (11/11) local control was achieved in patients irradiated within 35 days, in contrast to only 52% (13/25) local control in those irradiated over 35 days. This result indicates that prolonged overall time is associated with loss of local control. This prolongation is mainly due to the prolonged interval between external and interstitial irradiation. The interval was likely to be longer because of enhanced acute radiation mucositis, especially in patients administrated bleomycin during external irradiation. External irradiation should be followed by interstitial irradiation as soon as possible to keep overall time shorter.

[A retroperitoneal embryonal carcinoma with a high HCG level]

A case of an embryonal carcinoma of the retroperitoneum in a 23-year-old male is reported. His serum, urinary HCG, serum alpha-fetoprotein, and LDH values were high. After combination chemotherapy, when the tumor markers decreased to within normal values, the retroperitoneal tumor was extirpated. Histologically, a small focus in the embryonal carcinoma and cartilage was seen in the fibrous scar tissue. Immunohistochemically, the cancer cells revealed negativity for HCG, alpha-fetoprotein, and the epithelial membrane antigen. However, with the recurrence of the tumor, his HCG and LDH values elevated. The patient died 8 months after the surgical extirpation of his retroperitoneal tumor.

[Studies on relationship between histology, tumor markers (prostatic acid phosphatase.prostate specific antigen.gamma-seminoprotein.leu-7) and clinical course in prostate cancer]

We are interested in the therapeutic response to chemotherapy and radiotherapy of relapsed prostate cancer. In 9 cases of prostate cancer treated by endocrine therapy, tumor markers (PAP.PA.gamma-Sm.Leu-7) and cell types at the start of endocrine therapy and that taken at a hormone independent point were compared between prostatic tissue obtained. All cases had a period of response to endocrine therapy, but subsequently relapsed. The results were divided into the following 3 groups: Group I (changed cell type.decreased positive rate of markers) had the shortest response duration to endocrine therapy and there was no response to chemotherapy; Group II (unchanged cell type.decreased positive rate of markers) had a long response duration and slow progression under endocrine therapy; Group III (unchanged cell type.unchanged positive rate of markers) was chemo- or radiotherapy sensitive during post-endocrine therapy relapse. These results suggest that this is an effective method which dictated the choice of treatment method and allowed an approximate prognosis for relapsed prostate cancer previously treated by endocrine therapy.

[A case of adenoid cystic carcinoma of the esophagus]

A surgical case of an adenoid cystic carcinoma (ACC) of the esophagus in a 75-year-old man is reported. Histologically, the tumor consisted of an ACC, a squamous cell carcinoma and a small tubular adenocarcinoma. The ACC and the tubular adenocarcinomatous regions in the submucosa and the lamina propria were continuous with the overlying squamous cell carcinoma and atypical squamous epithelium. Immunohistochemically, two types of tumor cells were detected in the ACC. One was found to have EMA-positive epithelial cells whereas the other had actin-positive myoepithelial cells. In the normal esophageal gland, actin-positive cells are found at the periphery of acini and around the layer of epithelial cells in the small duct but they have not been detected in the main duct. These findings suggest that the tumor developed from the small duct and differentiated into two directions: an ACC and a squamous cell carcinoma.

[A case of small cell carcinoma of the urinary bladder]

A case of small cell carcinoma with a high serum alpha-fetoprotein level of the urinary bladder is reported. Histologically, in addition to the small cell carcinoma, there were small areas of atypical carcinoids and larger epithelial cells. Immunohistochemically, the small cell carcinoma and the atypical carcinoids showed positivity for neuron-specific enolase, chromogranin, and vimentin. On the other hand, the larger epithelial cells showed positivity for alpha-fetoprotein, keratin, and carcinoembryonic antigen. Electron microscopically, a few neurosecretory granules were noted in the cytoplasm of the small cell carcinoma. After a total cystectomy, the serum alpha-fetoprotein level decreased to within a normal range. Postmortem examination of recurrent tumorous masses revealed only features of the small cell carcinoma. This case supports a theory that a small cell carcinoma of the urinary bladder develops from multipotential epithelial cells.

[A case of vesical carcinoma with sarcomatous changes--immunohistochemical and electron microscopic observations]

The immunohistochemical and electron microscopic characteristics of a vesical carcinoma with a sarcomatous change in a 90-year-old man are described. Keratin was strongly positive in the carcinomatous region and was also identified in the sarcomatous region. CEA was present only in the carcinomatous region. Both the carcinomatous and sarcomatous regions were negative for S 100 protein, myoglobin, lysozyme, and desmin. Electron microscopically, a few tumor cells with tonofilaments were observed in the sarcomatous region. Many tumor cells in the sarcomatous region had no characteristic structures suggestive of epithelial or mesenchymal origin. However, transitional types of tumor cells, between the epithelial cells and the cells with neither epithelial nor mesenchymal differentiation, were noticed. Therefore, this suggested that the sarcomatous region was a site of immature epithelial cell proliferation.

[A case of small cell carcinoma of the prostate]

A case of a small cell carcinoma of the prostate that occurred in a 68-year-old man is reported. Needle biopsy of the prostate showed an adenocarcinoma. A second biopsy revealed both an adenocarcinoma and a small cell carcinoma. A subsequent third biopsy revealed only a small cell carcinoma, and the patient died of respiratory failure 26 months after the initial presentation. An autopsy revealed the tumor that had replaced the prostate extended into the bladder and rectum. Widespread metastatic foci, showing a histologic pattern of solely a small cell carcinoma, were present in various organs. The adenocarcinoma component was seen restricted to the prostatic region. Immunoperoxidase staining for prostate-specific antigen, prostate-specific acid phosphatase, gamma-seminoprotein, and leu-7 showed positivity only in the adenocarcinoma, whereas neuron-specific enolase was positive only in the small cell carcinoma.

[An autopsy case of malignant retroperitoneal paraganglioma]

A case of an extra-adrenal malignant paraganglioma of the retroperitoneum is reported. A 33-year-old woman with a complaint of a dull pain in the right thigh was admitted. A CT scan revealed a large retroperitoneal mass situated between the right kidney and the aorta. A biopsied specimen of the right femur uncovered a metastatic focus of a paraganglioma. Subsequent chemotherapy and irradiation ultimately proved ineffective, and the patient died at the age of 37. Autopsy revealed a retroperitoneal mass 11 X 9 X 4 cm, and its metastatic foci in the vertebrae, ribs, sternum, and liver. Six cases of extra-adrenal malignant paragangliomas of the retroperitoneum that have been reported in Japan also are briefly reviewed.

[Multilocular epidermoid cyst of the spleen--report of a case observed with an electron microscope]

A 27-year-old female, complaining of left hypochondralgia, underwent a splenectomy and a partial pancreatectomy. The spleen, 18.5 x 14 x 6 cm in size and weighing 1060 g., was occupied by a large multicystic mass. The cystic cavities contained turbid chocolate-colored fluid or a yellowish creamy substance. The cysts varied in size and were lined by stratified squamous epithelium. By means of an electron microscope, a few Langer hans cells were seen in the stratified squamous epithelium, but melanocytes and Merkel cells were not noticed. Twenty-eight cases of splenic epidermoid cysts reported in Japan are briefly reviewed.

Adenofibroma of the rete testis. A case report with electron microscopy findings

The light and electron microscopic characteristics of an adenofibroma of the rete testis in a 51-year-old man are described. The tumor was 5.5 cm in greatest diameter and situated in the anterior superior portion of the right testis. It was composed mainly of mesenchymal and secondary epithelial proliferation. Long slit-like spaces and short tubules lined by a layer of epithelial cells were seen in the mesenchymal tissue. The epithelium was histochemically and ultrastructurally similar to that of the rete testis, and the tumor was considered to be of rete testis origin.

[A bronchogenic cyst of the esophageal wall--a case report and differential diagnosis from an esophageal cyst]

A 25-year-old man underwent extirpation of a cystic mass of the esophageal wall. It proved to be an unilocular cyst surrounded by a pseudo-stratified, ciliated columnar epithelium with occasional goblet cells. Outside of the epithelium, a smooth muscle layer was seen and a small foci of seromucous glands were scattered in the wall. Electron microscopic observations of the epithelial layer revealed 5 types of the cells: ciliated columnar cells, mucous cells, brush cells, intermediate cells, and basal cells. Our results suggest that electron microscopic observations are useful for distinguishing the bronchogenic cyst from the esophageal cyst. Nine cases of para-esophageal bronchogenic cysts that have been reported in Japan also are briefly reviewed.

Lymphangioma of the pancreas. A case report with electron microscopic observations

A case of lymphangioma of the pancreas in a 49-year-old woman is presented. The patient noticed a left hypochondral mass, which was clinically diagnosed as a multicystic tumor of the pancreas. A partial pancreatectomy and splenectomy were performed. The surgical specimen showed a multicystic mass measuring 13 X 9 X 5 cm which occupied the anterior region of the body and tail of the pancreas. From the light and electron microscopic findings, the multicystic mass was diagnosed as a lymphangioma with cystic and cavernous features. A small glucagonoma was incidentally found in the tail of the resected pancreas. The previous literature of pancreatic lymphangiomas is reviewed and the clinico-pathologic characteristics of this tumor are discussed.

Ultrahigh accuracy 3-D profilometer

An ultrahigh accuracy 3-D profilometer using a laser heterodyne interferometer has been developed. The profiles of aspheric lenses and their molds have been measured. It can measure not only the rectangular coordinates but also the polar coordinates of the surface profile. The measuring accuracy of each of the three axes is 0.01-0.05 microm if the inclination of the investigated surface is less than +/-25 degrees . The accuracy of the polar coordinate measurement is also better than 0.05 microm when the inclination of the aspheric surface is less than +/-55 degrees . The dynamic range of the X-Y-Z measurement is 40 x 40 x 20 (mm).

[Intravascular papillary endothelial hyperplasia of the breast--report of a case with scanning electron microscopic observations]

A 65-year-old woman noticed a left breast mass and underwent excisional biopsy. The excised mass measured 1.7 cm in diameter. Histologically, the tumor-like mass revealed irregular vascular channels with occasional thrombi and many papillary projections of fibrous stalks lined with a layer of flat endothelial cells. A small cavernous hemangioma was present adjacent to the lesion. Scanning electron microscopic observation revealed disorderly oriented thin and thick cords forming branches and meshworks in the lumina. The luminal wall and cords were covered with flat endothelial cells. Light and scanning electron microscopic differences between intravascular papillary endothelial hyperplasia and angiosarcoma are discussed.

Carcinosarcoma of the urinary bladder. Report of a case with electron microscopy and review of the literature

A case of carcinosarcoma of the urinary bladder in a 33-year-old man is presented. The tumor developed from the left anterolateral wall and protruded into the vesical lumen. The excised tumor revealed that more than 99% was sarcomatous component with the appearance of an osteochondrosarcoma. Small foci of papillo-tubular carcinoma were scattered in the sarcomatous area. The histological features, histogenesis and treatment of carcinosarcoma of the bladder are discussed in relation to the literature.

[So-called "carcinoid tumor of the breast"--a case report]

A 70-year-old woman underwent modified radical mastectomy following excisional biopsy of a right breast mass. The excised tumor was 1.4 cm in diameter. The mastectomy specimen and lymph nodes were negative for malignancy. Histologically, the tumor cells were mainly oval and had formed solid nests in the thick fibrous stroma. The cytoplasm was fine granular and contained many argyrophilic granules. The argentaffin reaction was negative. Electron microscopy revealed oval-shaped light cells and stellate-shaped dark cells. Both types of tumor cells contained abundant filaments, well-developed rough surfaced endoplasmic reticulum and many neurosecretory-type granules measuring 190 approximately 360 nm in diameter. Intracytoplasmic lumina were not discerned. The relationship between carcinoid and conventional breast carcinoma was discussed.

Papillary and solid neoplasm of pancreas in a child. Report of a case in which acinar differentiation was demonstrated by immunohistochemistry and electron microscopy

A case of exocrine carcinoma of the pancreas in a 13-year-old girl is presented. A small tissue biopsy obtained from the duodenal lesion through a duodenofiberscope confirmed a carcinoma of the head of the pancreas, for which pancreaticoduodenectomy was successfully performed. The tumor showed histological features of a papillary and solid neoplasm, but amylase and alpha 1-antitrypsin were detected in the tumor cells by a modified PAP method. Electron microscopic examination of the tumor cells disclosed both acinar and ductal differentiation. Polygonal cells showing acinar differentiation contained zymogen granules, while columnar cells arranged in a papillary pattern contained abundant intracytoplasmic filaments and lacked zymogen granules. Stacks of annulate lamellae were frequently noticed in both types of the tumor cells. This case indicates the importance of immunohistochemistry and electron microscopy for the detection of acinar and ductal differentiation of carcinoma of the pancreas in childhood.

A comparative electron microscopic study of leiomyosarcoma and leiomyoma of the duodenum

Comparison of ultrastructural features between leiomyosarcoma and leiomyoma of the duodenum was made. There was no absolute difference between the two, but the following ultrastructural features of leiomyosarcoma were different from leiomyoma: (1) occasional conglomerations of mitochondria surrounded by granular endoplasmic reticulum; (2) quite rare presence of single cilia; (3) frequent occurrence of intranuclear inclusion bodies; (4) variability in nuclear size and shape; and (5) wide interstitial space with scanty collagen fibrils. Although both tumors were considered to be of smooth muscle origin, their ultrastructural features were distinctively different from the normal smooth muscle in some points. In addition to the light microscopic findings, ultrastructural features were considered to be valuable for distinguishing the malignant from the benign smooth muscle tumors in the gastrointestinal tract.

Screening for multiple myeloma using routine laboratory test results

Characteristics of myeloma protein can be best detected through serum electrophoresis, and are also detected as abnormal results of flocculation tests or hyperglobulinemia by routine laboratory work. The authors identified 38 cases of multiple myeloma in 5 years, actively making use of the available informations in the laboratory. The number screened was 7 times as many as the incidence previously observed, and most of them were screened in subclinical conditions. A formula to discriminate multiple myeloma from other diseases was obtained referring to the thymol turbidity test (TTT) and zinc sulfate turbidity test (ZTT) results through analytical processing the data from the first examination of the 38 patients. The most efficient and practical screening method for multiple myeloma was then developed by combining the formula by which suspicious serum specimens in routine tests are screened, with electrophoresis which confirms the disease.

Ultrastructure of adenoid cystic carcinoma arising in the salivary gland of a child

A case of adenoid cystic carcinoma which developed in the left parotid gland of an 11-year-old girl was studied by electron microscopy. Islands of tumor cells, showing glandular and cribriform appearances, infiltrated the surrounding tissue and nerves. True lumina and pseudocysts were present in the islands of tumor cells. Electron microscopic examination revealed two types of tumor cells; clear cells (secretory epithelial cells) and dark cells myoepitheium-like cells). Some of the tumor cells, showing a transitional form between the two types, formed a part of the luminal wall. There were many crystalline spicules, cellular debris, and fine stellate granules in the lumina. Pseudocysts were composed of replicated basal laminae, fine stellate granules, and a central core of microfilaments. Rarely, a capillary was noted in the center of the pseudocysts. It is speculated that ultrastrutural features of adenoid cystic carcinoma in chidren may differ from the adult cases in the following ways; they contain numerous crystalline spicules in the lumina, dark cells with microvilli forming the luminal wall, and fine capillaries in the pseudocysts.

Papillary adenoma of the duodenum; report of a case and review of the literature in Japan

A papillary (villous) adenoma of the duodenum was found in a 67-year-old male. Radiographic barium studies of the upper gastrointestinal tract revealed a tumor in the second portion of the duodenum. Biopsied specimens taken through a duodenofiberscope showed papillary adenoma. A partial duodenectomy with duodenojejunostomy was performed. The specimen was a pedunculated tumor measuring 3 X 2 X 1.5 cm. Histologically, the tumor was composed of villous and tubular arrangements of mucus-secreting columnar epithelial cells. A moderate number of entero-endocrine cells and a few Paneth cells were also noted. Forty-two other cases reported in Japan are briefly reviewed.

Tumor induction in Swiss mice by filtrable agent and Salmonella typhimurium

Combined inoculation of a cell-free extract of leukotic tissue of D103 mice and Salmonella typhimurium into adult Swiss mice induced leukosis and solid tumors. The induced solid tumors were histologically multifarious, and were transplantable in Swiss mice, but not in other strains of mice.

Fibroma of the urinary bladder: a light and ultrastructural study of a case with review of the literature in Japan

A hard fibroma of the urinary bladder was found in an autopsy case of a 69 year-old female. The tumor, 10x9x6 cm, occurred in the superior wall of the bladder. Ultrastructurally, the principal cells of the tumor were myofibroblasts. Fibroblasts and fibrocytes were also present. Including our case, the number of reported cases of pure fibroma of the urinary bladder in Japan is 12. These are reviewed briefly.

Malignant teratoma of the thyroid gland in an adolescent female

Malignant teratoma of the thyroid gland was found in a 19-year-old female. She was given a combined surgical and irradiation treatment. The tumor was 5.0X4.0X3.6 cm and located in the lower right lobe of the thyroid gland. Light and electron microscopical examination revealed mature or immature derivatives of the three primordial germ layers. The dominant portion of the tumor was composed of numerous masses of cancerous epithelial cells, which were distributed randomly in the mesenchymal tissue. Tumor cells invaded and replaced the surrounding thyroid tissue with occasional tumor thrombi in the lumens of blood vessels. No metastatic tumor was found in the lymph nodes. The patient was given a course of external irradiation, a total dose of 4000 rads, to the right thyroid area. Eight months after surgery, she is well and without any evidence of recurrence or metastasis.

Adenomatoid tumor of the uterus: report of a case and review of the literature

A case of uterine adenomatoid tumor in a 47-year-old female was studied with both light and electron microscopes. The tumor was circumscribed, 2.5 cm in diameter, and located in the posterior wall of the uterus. In light microscopy, tumor cells showing "signet-ring" appearance arranged in cords or tubules. Hyaluronidase-sensitive acid mucopolysaccharide was present in the cells and luminal surfaces. Mucicarmine stain was negative and periodic acid-Schiff reaction was faintly positive. In electron microscopy, the tumor showed basal laminae, well-developed desmosomes and numerous microvilli. Intercellular spaces were present between adjacent cells. Small intercellular spaces were separated from the large lumens by desmosomes and tight junctions, while large spaces communicated with the tubular lumens. Forty-four reported cases of adenomatoid tumor in females were briefly reviewed.