Daiki Taniyama

Whole-slide imaging at primary pathological diagnosis: Validation of whole-slide imaging-based primary pathological diagnosis at twelve Japanese academic institutes: Validating whole-slide imaging in Japan

Several reports have demonstrated the use of whole‐slide imaging (WSI) for primary pathological diagnosis, but no such studies have been published from Asia. We retrospectively collected 1070 WSI specimens from 900 biopsies and small surgeries conducted in nine hospitals. Nine pathologists, who participated in this study, trained for the College of American Pathologists guidelines, reviewed the specimens and made diagnoses based on digitized, 20× or 40× optically magnified images with a WSI scanner. After a washout interval of over 2 weeks, the same observers reviewed conventional glass slides and diagnosed them by light microscopy. Discrepancies between microscopy‐ and WSI‐based diagnoses were evaluated at the individual institutes, and discrepant cases were further reviewed by all pathologists. Nine diagnoses (0.9%) showed major discrepancies with significant clinical differences between the WSI‐ and microscopy‐based diagnoses, and 37 (3.5%) minor discrepancies occurred without a clinical difference. Eight out of nine diagnoses with a major discrepancy were considered concordant with the microscopy‐based diagnoses. No association was observed between the level of discrepancy and the organ type, collection method, or digitized optical magnification. Our results indicate the availability of WSI‐based primary diagnosis of biopsies and small surgeries in routine daily practice.

Overexpression of topoisomerase II alpha protein is a factor for poor prognosis in patients with luminal B breast cancer

Background The prognostic value and the best method of testing of topoisomerase II alpha (TOP2A) status have not been established in modern tailored therapy based on breast cancer subtype. Results The frequencies of TOP2A overexpression and TOP2A amplified were 55.8% and 9.5%, respectively. TOP2A overexpression correlated strongly with non-luminal A subtype (χ2-test, p < 0.001). TOP2A overexpression was significantly associated with relapse-free survival in luminal B breast cancer (n = 316; log rank test, p < 0.001) but not in other breast cancer subtypes. Cox regression analysis showed that TOP2A overexpression is a significant prognostic factor in luminal B breast cancer (hazard ratio (HR) 4.00, 95% confidence interval (CI) 1.65–9.54, p = 0.002). TOP2A amplified was recognized in HER2 positive breast cancer (p < 0.001). In HER2 positive breast cancer, TOP2A amplified (HR 0.30, 95% CI 0.085–1.07, p = 0.063) appeared to be a better prognostic factor. Conclusion In modern tailored therapy, TOP2A overexpression can be a poor prognostic factor in luminal B breast cancer. In contrast, TOP2A amplified could be a better prognostic factor in HER2 positive breast cancer. Materials and methods Between May 2005 and April 2015, a total of 643 consecutive non-metastatic invasive breast cancers were evaluated for TOP2A amplified using fluorescence in situ hybridization analysis (FISH) and for TOP2A overexpression using the immunohistochemistry assay. FISH ratios of 2 or higher were designated as TOP2A amplified, and TOP2A staining >10% was defined as TOP2A overexpression. The prognostic values of TOP2A amplified and TOP2A overexpression were retrospectively evaluated.

Primary cardiac rhabdomyosarcoma developed after receiving radiotherapy for left breast cancer 18 years prior

The heart is an organ where primary malignant tumors rarely develop. In particular, the incidence of cardiac rhabdomyosarcoma (RMS) is extremely low. It has been reported that the risk of second malignant tumors in mediastinum is increased by radiotherapy in women with breast cancer. However, little is known about the association between irradiation to heart and cardiac RMS. Here, we report a case of a 68-year-old woman with primary cardiac RMS. She suddenly presented syncope at a workplace, and was taken to the emergency room at our hospital. Several imaging tests, including echocardiogram and cine magnetic resonance imaging, detected two tumors in the right ventricle (RV) and its outflow tract, which had almost obstructed the main trunk of the pulmonary artery (PA). To avoid sudden PA occlusion by the tumor, we emergently performed surgical excision of the tumors from the RV. Pathological analysis revealed that these tumors were embryonal type RMS. She had received radiotherapy after mastectomy for left breast cancer 18 years previously, and no recurrence of breast cancer had been detected. This cardiac RMS is considered as a second malignant tumor related to radiotherapy for breast cancer. <Learning objective: We experienced a 68-year-old woman having two tumors of the RMS in RV, who had received radiotherapy for left breast cancer 18 years previously and had previously presented no recurrence. There is literature suggesting that radiotherapy may increase the risk of soft-tissue sarcoma in women with breast cancer. We should be aware of cardiac RMS as a second malignant tumor related to radiotherapy for breast cancer, although its incidence is extremely low.>.

Epithelioid sarcoma-like hemangioendothelioma on the chest wall

Epithelioid sarcoma-like hemangioendothelioma is a rare vascular neoplasm that usually occurs in the distal extremities of young adults. Although the overall behavior of this neoplasm is usually indolent with a low risk of distant metastasis, the risk of local recurrence is significant. Therefore, initial surgical treatment with an adequate margin is important to improve the prognosis. However, epithelioid sarcoma-like hemangioendothelioma is frequently misdiagnosed. A preoperative misdiagnosis could result in resection without a sufficient margin. Herein, we describe a 68-year-old man with epithelioid sarcoma-like hemangioendothelioma on the chest wall, which was treated by wide resection despite difficulties with the preoperative diagnosis.

A Case Report of Visual Disturbance Caused by Thrombosis of the Superior Sagittal Sinus

Superior sagittal sinus thrombosis is a rare condition caused by several diseases including malignancy. Major symptoms include headache, seizure, and motor weakness. Ocular sign is a minor symptom. The present case had visual disturbance caused by thrombosis of the superior sagittal sinus, which is an extremely rare case that was treated successfully by our team

Pathological Diagnosis with a Whole Slide Imaging System

Diagnosis. A VS800 (OLYMPUS, Tokyo, Japan) in a WSI system and an AS-400 (KURABO, Tokyo, Japan) for the ASP systemwere used. Up to 100 slides consisting of biopsy, endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD) specimenswere scanned and stored digitally in one set and the digital images were viewed on a monitor in a separate room using a VS800 viewer. Ocular observation using a conventional microscope was used when necessary to look at the specimens directly. One hundred sixty-six biopsy specimens were analyzed to evaluate the basic ability of the current WSI system in making a pathological diagnosis.