Keiichi Iwabuchi

Diffusion-weighted imaging of malignant breast tumors: the usefulness of apparent diffusion coefficient (ADC) value and ADC map for the detection of malignant breast tumors and evaluation of cancer extension.

The authors used breast diffusion-weighted imaging (DWI) to diagnose breast cancer and identify cancer extension. Isotropic DWI was performed with EPI. The apparent diffusion coefficient (ADC) value was calculated and displayed on an ADC map. The authors compared between the distribution of low ADC values and pathologic cancer extension. The mean ADC value of breast cancer was 1.12 ± 0.24 × 10−3 mm2/s, which was lower than that of normal breast tissue. The ADC value for invasive ductal carcinoma was lower than that of noninvasive ductal carcinoma. The sensitivity of the ADC value for breast cancer using a threshold of less than 1.6 × 10−3 mm2/s was 95%. Seventy-five percent of all cases showed precise distribution of low ADC value as cancer extension. The causes of underestimation were susceptibility artifact from bleeding and the limit of spatial resolution. Benign proliferative change showed a low ADC value. The authors conclude that DWI has a potential for clinical appreciation in detecting breast cancer.

Intraoperative radiotherapy for advanced carcinoma of the pancreas.

A detailed retrospective analysis of the efficacy of intraoperative radiotherapy (IOR) in advanced carcinoma of the pancreas is presented. During a 10‐year period from 1973 through 1982, 70 patients with advanced carcinoma of the pancreas were treated by multimodal methods, separate or combined therapy of surgery, IOR, and chemotherapy in two different institutions. Among these, 33 patients underwent IOR, mostly combined with additive surgery. A single dose of 20.1 to 40.0 Gy with 8 to 25 meV electrons was delivered through radiation cones ranging from 6 to 10 cm in diameter. Excellent relief was noticed in 50% of the patients who had complained of pain. Among Stage IV patients, a significant difference of survival rate was observed between IOR and control groups (P < 0.05); the mean survival time of the IOR group was 4.6 ± 2.6 (SD) and that of the control group 2.5 ± 1.4 (SD) months. Intraoperative radiotherapy proved to be effective in prolonging the survival of patients with advanced stage of the lesion.

Malignant Fibrous Histiocytoma of the Bladder with Focal Rhabdoid Tumor Differentiation

A case of primary malignant fibrous histiocytoma of the bladder is presented. This tumor involving the bladder is rare and the unusual histological features in the present case caused significant delay in accurate diagnosis. Since early diagnosis and aggressive surgical resection are essential to the effective treatment of this neoplasm, physicians should continually bear in mind the possibility of this malignant tumor whenever the pathological diagnosis is inconclusive.

Diagnostic findings of bronchial brush cytology for pulmonary large cell neuroendocrine carcinomas: comparison with poorly differentiated adenocarcinomas, squamous cell carcinomas, and small cell carcinomas.

Large cell neuroendocrine carcinoma (LCNEC) of the lung has been proposed as a new disease entity. To establish diagnostic features, bronchial brush cytologic findings were evaluated.

Pulmonary adenocarcinoma with heterotopic bone formation

Adenocarcinoma of the lung is a common malignancy. Frequently, this tumor can cause calcification within a primary tumor. However, an extremely rare occurrence in lung carcinomas is ossification within a primary tumor, and to our knowledge only three cases have been reported. We report a case of pulmonary adenocarcinoma with ossification, and discuss the pathogenesis of intratumoral ossification with a review of the literature.

Splenic infarction after Epstein-Barr virus infection in a patient with hereditary spherocytosis.

We describe the first patient with hereditary spherocytosis (HS) known to have developed splenic infarction following infectious mononucleosis (IM). An 18-year-old Japanese man was referred to our hospital in November 2004 because of continuous fever and icterus. He had undergone cholecystectomy at the age of 14 years. On patient admission in November 2004, a physical examination showed marked hepatosplenomegaly, icterus, and jaundice. He had a white blood cell count of 14.9 x 109/L with 9.5% atypical lymphocytes, a red blood cell count of 2.93 x 1012/L, and a hemoglobin concentration of 7.8 g/dL. Microspherocytes were observed in the patient’s peripheral blood smear, and immunoglobulin M antibody to Epstein-Barr virus (EBV) viral capsid antigen was detected. The patient’s diagnosis was HS with IM. On day 4 of admission, the patient complained of severe abdominal pain. Abdominal computed tomography scanning revealed findings of splenic infarction.Two months after the occurrence of splenic infarction, a splenectomy was performed. A pathohistologic examination of the resected spleen revealed no evidence of thrombosis or arterial occlusion. We assume that the cause of splenic infarction was insufficient blood flow to oxygenate the entire spleen during the acute enlargement of the spleen.

Association of CD20 levels with clinicopathological parameters and its prognostic significance for patients with DLBCL

Diffuse large B-cell lymphomas (DLBCL) express CD20. CD20 expression is described as negative, weak, or normal as determined by flow cytometry (FCM) and is an important target for the treatment of DLBCL. However, the impact of CD20 levels at onset of the disease on patient prognosis has not been fully elucidated. We analyzed 174 DLBCL cases newly diagnosed between January 1998 and April 2010. The relationship of the association between CD20 levels and patients’ backgrounds and prognoses was analyzed using the Kaplan–Meier method and Cox proportional hazard regression. Of the 174 patients, three cases (1.7%) were defined as CD20 negative based on immunohistochemistry (IHC). Although the other 171 cases were positive by IHC, eight cases (4.7%) were defined as negative and 33 cases (19.3%) were defined as weak when analyzed by FCM. Of the 105 patients who received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy, those who were CD20 negative (FCM) showed significantly inferior overall (hazard ratios (HR): 6.79, 95% CI: 1.32–34.96, p = 0.04) and progression-free survival (HR: 7.3, 95% CI: 1.49–35.8, p = 0.04) compared to patients who were CD20 normal. Our findings indicate that the CD20 level (FCM) at onset is an independent predictor of the prognosis of patients with DLBCL.

Combined clear and granular cell leiomyoma of soft tissue: evidence of transformation to a histiocytic phenotype

We present an unusual case of leiomyoma with a clear and granular cell pattern in which there was immunohistochemical evidence of transformation to a histiocytic phenotype.

Development of hepatosplenic γδ T-cell lymphoma with pancytopenia during early pregnancy: a case report and review of the literature

Abstract:  Lymphomas rarely develop during pregnancy, but hepatosplenic γδ T‐cell lymphoma (HSγδTCL) is extremely rare. We encountered a case of T‐cell intracellular antigen‐1 (TIA‐1) positive and granzyme B‐positive HSγδTCL that developed early during the course of pregnancy. The patient was a 31‐yr‐old female who was referred to our hospital because of pancytopenia and splenomegaly at the time of the14th week of her gestation. Her pancytopenia and hepatosplenomegaly worsened and she became fibril at the 27th week of gestation and Cesarean section was performed at the 29th week. Histopathological examination of the spleen, which was resected 28 d after delivery for a diagnostic purpose, revealed medium to large‐sized nodules composed of dense proliferation of lymphoid cells having round to oval‐shaped nuclei and abundant weakly eosinophilic cytoplasm. They were CD3ɛ+, mCD3+, CD4−, CD8−, CD56+, CD79a−, T‐cell receptor (TCR)‐γδ protein+, TIA‐1+, and granzyme B+ by either immunohistochemistry or flow cytometry. Clonal rearrangement of TCR‐γ genes without such rearrangement of TCR‐δ and TCR‐β genes was confirmed by Southern blot hybridization. Thus, the patient was diagnosed as having HSγδTCL, and combination chemotherapy was initiated. She is currently in partial remission. To our knowledge, this is the first case report of HSγδTCL that developed during pregnancy. Pathogenesis of pregnancy‐associated lymphoma is not known, but it is possible that maternal immunity during pregnancy or a hormonal imbalance, such as a change in the progesterone level, induces the development of lymphoma. Pregnancy‐associated lymphoma is resistant to standard chemotherapy and is associated with poor prognosis. Therefore, it is important to accumulate clinicopathologic data of such cases for the development of a treatment modality.

Advanced clear-cell adenocarcinoma of the bladder successfully treated by radical surgery with adjuvant chemoradiotherapy

A 52-year-old woman was referred to our institute for the evaluation of a tumor in her pelvic cavity. The tumor seemed to have arisen from the bladder or urethra, and bilateral iliac lymphadenopathy was seen. Her urethral mucosa looked intact according to the results of cystourethroscopy. Histopathological examination of the biopsy specimens showed clear-cell adenocarcinoma. She underwent radical cystourethrectomy with complete pelvic lymph node dissection and the construction of a bilateral ureterocutaneostomy. Macroscopically, the tumor had arisen from the trigone of the bladder, and histopathological examination of the tumor revealed adenocarcinoma exhibiting solid clear cells with glandular and papillary patterns. The tumor had infiltrated perivesical structure (pT3a), and metastases in multiple pelvic lymph nodes were recognized (pN3). Postoperatively, three courses of systemic combination chemotherapy with 5-fluouracil (FU) and cisplatin, along with a total of 45 Gy of irradiation during the second course of chemotherapy, were conducted. No evidence of the disease has been seen 28 months after the surgery.