Kazuo Fukutome

Ectopic thyroid in the adrenal gland

We report two cases of intraadrenal thyroid gland tissue, both found by abdominal computed tomography (CT) scan and ultrasound echography. Histologically, the lesions were composed of mature thyroid follicles, varying in size, and some with cystic dilatation. Immunohistochemical staining for thyroglobulin confirmed their thyroid follicular nature. In neither case was there any evidence of thyroid gland cancer or teratomatous elements. Clinical examinations, including CT, ultrasound echography, and scintscanning did not show any tumorous lesions in the thyroid gland or elsewhere. The cause of ectopic thyroid in the adrenal gland is not known. It seems difficult to explain these ectopic lesions on the basis of developmental error because their location is distant from the path of embryological descent of the thyroid. The most important practical consideration is that they must be distinguished from metastatic deposits from a clinical point of view.

Progression-linked overexpression of c-Met in prostatic intraepithelial neoplasia and latent as well as clinical prostate cancers

The c-met proto-oncogene encoding the receptor for the hepatocyte growth factor is expressed in several cancers. In the present study, c-met protein (c-Met) was detected in eight of 22 (36%) cases of prostatic intraepithelial neoplasia (PIN), five of 15 (33%) latent and 17 of 21 (81%) clinical prostate cancers, including seven metastatic lesions, using an immunohistochemical method. All seven (100%) metastatic lesions investigated demonstrated strong staining, and a correlation between c-Met expression and histology was observed. These results suggest a significant relationship between c-Met expression and progression of prostate neoplasms, including latent cancers.

Detection of guanine-C8-2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine adduct as a single spot on thin-layer chromatography by modification of the 32P-postlabeling method.

N‐(Deoxyguanosin‐8‐yl)‐2‐amino‐1‐methyl‐6‐phenylimidazo[4,5‐b]pyridine (dG‐C8‐PhIP) has been shown to be a major adduct in DNA of rats given [3H]PhIP. However, when DNA from organs of rats fed PhIP was analyzed by the 32P‐postlabeling method under standard and adduct‐intensification conditions, four adduct spots were observed, and 3′,5′‐pdGp‐C8‐PhIP was detected as a minor, not a major, adduct spot. Since the three other major adduct spots were suspected to be those of adducted di‐ or oligo‐nucleotides, the 32P‐labeled samples were further treated with nuclease PI and phosphodiesterase I and found to yield only a single adduct spot. The material in this adduct spot was confirmed to be 5′‐pdG‐C8‐PhIP, Thus, using this newly modified 32P‐postlabeling method, dG‐C8‐PhIP was detected as a major adduct in DNA of rats given PhIP.

N-Acetyltransferase 1 genetic polymorphism influences the risk of prostate cancer development

The potential involvement of N-acetyltransferase 1 (NAT1) genetic polymorphisms in prostate cancer (PCa) patients was analyzed in 101 patients with PCa and 97 controls with no incidental malignancy. Identification of NAT1*10, the variant allele associated with the rapid acetylator phenotype was by allele-specific polymerase chain reaction (PCR). When the NAT1*10 heterozygote and other genotypes without NAT1*10 allele were considered as low risk genotypes, NAT1*10/NAT1*10 had a significantly higher risk of PCa (OR = 2.4, 95% CI; 1.0-5.6). If our preliminary results can be confirmed in a larger population, it may be a useful marker for PCa risk.

Allelic Loss and Microsatellite Instability in Prostate Cancers in Japan

A series of 25 primary prostate cancers in Japanese were screened for loss of heterozygosity and microsatellite instability using twelve microsatellite markers containing APC, DCC, TP53, BRCA1, and BRCA2. Frequent loss of heterozygosity was observed for D8S201 (48%), LPL (48%), and DCC (26%). In contrast, the incidence did not exceed 15% at BRCA1 and BRCA2 loci. Microsatellite instability was observed in 28% of stage B, C, and D cancers. These data suggest that microsatellite instability and loss of unidentified genes on chromosome 8p may be involved in carcinogenesis of the prostate; however, BRCA1 and BRCA2 may not be largely involved in the development of prostate cancer in the Japanese population.

Malignant myoepithelioma of the breast metastasizing to the jaw

A breast tumor in a 52-year-old female was interpreted as a malignant myoepithelioma based on morphological and immunohistochemical studies. The tumor consisted of elongated cells with clear cytoplasm and lacked glandular components. The tumor cells were stained positively for keratin, S-100 protein, glial fibrillary acidic protein (GFAP) and muscle-specific actin. Distant metastasis in the right jaw developed 8 years after the initial surgery and the metastatic deposit showed a similar morphology and immunoreactivity. Myoepithelial tumors are generally considered as benign or low-grade lesions and distant metastasis has been rarely documented. The present case presents the possibility of delayed occurrence of distant metastasis in myoepithelial tumor of the breast.

Soft-tissue sarcoma mimicking large haematoma: a report of two cases and review of the literature

We report on 2 patients with soft-tissue sarcomas mimicking large haematomas. Neither patient had a medical history of trauma or bleeding tendency. In a patient with a large leiomyosarcoma in the buttock, insufficient biopsy material from initial surgeries precluded a correct diagnosis. In the second patient with epithelioid sarcoma of the forearm, fasciotomy was repeatedly performed for compartment syndrome arising from the tumour. It is important to reconfirm prior trauma and investigate the clinical course and images of patients with an unusual history of haematoma in the extremities. The possibility of a malignant tumour should be suspected, and repeated biopsies should be performed if necessary.

Intraneural metastasis of a synovial sarcoma to a peripheral nerve

We describe a case of intraneural metastasis of a synovial sarcoma, the first published case of a metastasis of a soft-tissue sarcoma to a peripheral nerve.

An autopsy case of a malignant pericardial mesothelioma in a Japanese young man.

An autopsy case of a malignant pericardial mesothelioma in a 27‐year‐old man with no history of exposure to asbestos is reported. He was admitted for heart failure due to pericardial effusion of unknown origin and surgically drained, but later died. The diagnosis of a malignant pericardial mesothelioma was made on the basis of histologic, immunohistochemical and ultrastructural findings. The tumor was located on the pericardium, but autopsy revealed that it had spread extensively in the mediastinum and the lungs. Microscopically, the tumor cells were epithelial like and contained histochemically demonstrable glycogen and hyaluronic acid. Immunohistochemical studies of the tumor demonstrated positive immunoreactivity for cytokeratin 19, muscle actin HHF35, epithelial membrane antigen, CA125, p53 and p21WAF1/CIP1 whereas the tumor was negative for cytokeratins 10 and 17, carcinoembryonic antigen, vimentin, epithelial antigen BerEP4, S‐100, c‐erbB2 and bcl‐2. A high MIB‐1 labeling index was noted. Under the electron microscope the tumor cells exhibited long, thin villi. The operation and autopsy findings thus revealed this to be a very rare case of malignant pericardial mesothelioma in a young man.

Pharyngolaryngeal ulcers associated with the improper use of alendronate

Bisphosphonates can cause mucosal irritation. Although esophageal ulceration is a well-recognized adverse effect of bisphosphonates, pharyngolaryngeal ulcers associated with the improper use of oral bisphosphonates have rarely been described. A previously healthy 78-year-old woman presented with refractory pharyngolaryngeal ulcers. Extensive evaluation, including biopsy, bacterial culture, and blood tests did not identify any findings that indicated a specific disease diagnosis. Antibiotics and oral prednisolone were ineffective. Ultimately, it was found that the patient regularly took a tablet of alendronate, a type of bisphosphonate, by dissolving it in the oral cavity. Within 2 weeks after withdrawal of the use of the medication, her symptoms were eliminated, and the lesions were completely healed. This case illustrates the importance of correct administration of bisphosphonates. Given the widespread use of bisphosphonates, physicians need to be aware that their improper use can cause pharyngolaryngeal ulcers.