Ken Kuriki

Predominant expression of fibroblast growth factor (FGF) 8, FGF4, and FGF receptor 1 in nonseminomatous and highly proliferative components of testicular germ cell tumors

Nonseminomatous components within testicular germ cell tumors affect patient prognosis to varying degrees. These components are well known to mimic early embryonic totipotential tissues. Prompted by the recent observation that fibroblast growth factor (FGF) 8, FGF4, and FGF receptor (FGFR) 1 are required for the growth of early postimplantational embryonic tissues, we investigated the expressions of FGF8, FGF4, and FGFR1 in surgically resected specimens of primary testicular germ cell tumors using an immunohistochemical method. All cases of embryonal carcinoma (14 cases), yolk sac tumor (3 cases), and choriocarcinoma (3 cases) showed positive immunostaining for FGF8, FGF4, and FGFR1. In contrast, out of 13 cases of seminoma, immunostaining was negative for FGF8, FGF4, and FGFR1 in 8 cases (61.5%), 6 cases (46.1%), and 7 cases (53.8%), respectively. In 7 cases of mature and immature teratoma, most areas showed negative immunostaining. In addition, the Ki-67 labeling index showed extremely high mitogenic activity in embryonal carcinoma, yolk sac tumor, and choriocarcinoma, which are precisely the carcinomas with the highest expressions of FGF8, FGF4, and FGFR1. It is in keeping with the immunohistochemical result that murine teratocarcinoma P19 cells were shown to express FGF8, FGF4, and FGFR1 only under undifferentiated growth conditions. Taken together, these findings confirm the involvement of FGF8, FGF4, and FGFR1 in highly proliferative conditions of nonseminomatous germ cell tumors.

Marked Atherosclerosis in a Patient with Familiar Lecithin: Cholesterol Acyltransferase Deficiency Associated with End-Stage Renal Disease and Diabetes Mellitus

Familial lecithin:cholesterol acyltransferase (LCAT) deficiency is a rare genetic disorder of the lipid metabolism caused by the absence of LCAT activity in plasma. It is not generally accompanied by atherosclerosis in spite of low high-density lipoprotein cholesterol levels nor by diabetes mellitus. However, reports of long-term follow-up or autopsy findings are rare, and the true incidence of atherosclerosis in LCAT deficiency is not clear. We report on the long-term observation of a patient with familial LCAT deficiency who developed renal failure, diabetes mellitus, and marked atherosclerosis. The patient died of sepsis from foot ulcers 7 years after starting hemodialysis and 13 years after the diagnosis. Marked atherosclerosis characterized by medial calcification in small arteries was observed at autopsy. The genesis of the atherosclerosis seemed to be on the basis of a combination of factors.

An autopsy case of Alzheimer's disease with a progressive supranuclear palsy overlap

A 74‐year‐old man developed abnormal forgetfulness, soon followed by unstable speech content and marked disorientation. At 77 years of age, the patient started to occasionally fall, an aspect of progressive supranuclear palsy. He then became bedridden. The patient eventually died of pneumonia at 79 years of age. Neuropathological examination revealed profiles of both progressive supranuclear palsy and Alzheimers disease. Although the two conditions both belong to tauopathy, their pathologically proven combination was rare. Furthermore, the case had the possibility of being a subgroup of tauopathy.

Therapy-related leukemia with a novel 21q22 rearrangement

We present a case of a 59-year-old Japanese man with therapy-related acute myeloblastic leukemia (AML) after the chemotherapy for non-Hodgkins lymphoma (NHL). Accumulated doses of cyclophosphamide, procarbazine, doxorubicin, mitoxantrone, and etoposide were 18,300 mg, 3000 mg, 580 mg, 100 mg, and 4150 mg, respectively, which had been administered for the treatment of NHL. Myeloblasts in the peripheral blood increased 43 months after the onset of NHL. He was diagnosed as having AML (M2; FAB classification). The karyotype of the bone marrow cells in the present case contained the following abnormalities: t(2;21)(q21;q22), t(8;21)(q22;q22), and add(13)(q34). In the present case, 645 base pairs of chimeric mRNA were detected by reverse transcription-polymerase chain reaction, indicating the presence of AML1/MTG8 rearrangement. Translocation (2;21)(q21;q22) has not been described previously to our knowledge. It is interesting that the breakpoint of 21q22 existed both in t(2;21) and t(8;21). The disrupted AML1 gene resulting from two 21q22 rearrangements may be involved in the pathogenesis of AML in the present case. The clinical importance of therapy-related AML having the 21q22 rearrangement remains to be examined.

Adult T Cell Leukemia Lymphoma (ATL) Localized in the Right Tibial Bone

A 56-year-old man was admitted complaining of pain in the right tibia. He was diagnosed as having adult T-cell leukemia/lymphoma (ATL/L) in the right knee joint by roentgenographic and histological examination. Monoclonal integration of HTLV-I proviral DNA was demonstrated in the bone tumor cells, although polyclonal integration was observed in the peripheral blood. These results led us to make a diagnosis of ATL with localized growth in the right knee joint. The osteolytic bone change was progressive despite radiation therapy. Complete remission was achieved after amputation of his right lower leg and two courses of chemotherapy. Resection of the localized lesion might be useful in cases of ATL, but further studies are necessary to confirm this conclusion.

Subcarinal neurogenic tumor: Report of a case

We present herein the rare case of a 63-year-old man in whom a subcarinal tumor, demonstrated by enhanced chest computed tomograms (CT), was subsequently confirmed to be a neurilemmoma by histological examination following tumor resection through a diagnostic thoracoscopy. Magnetic resonance imaging (MRI) and transesophageal ultrasonogram findings excluded the possibility of malignant lymphoadenopathy. As the patient was also found to have an elevated level of the squamous cell carcinoma (SCC) tumor marker which did not resolve postoperatively, close follow-up will be required.

A Case of Malignant Mesothelioma Similar to Empyema in Clinical Symptoms.

症例は55歳, 男性.咳嗽と発熱を主訴に入院. 胸部X線写真にて左側胸水を認め, 炎症反応高値, 胸水検査では好中球が97%より, 膿胸を考えた. 抗生剤投与, 胸腔ドレナージを開始したが改善がみられず, 外科的に左胸膜剥皮術を施行した.術後病理組織では悪性胸膜中皮腫, 肉腫型と診断された. 悪性胸膜中皮腫では発熱, 炎症反応高値を伴うものもあり, 胸膜の肥厚を伴う膿胸などとの鑑別を慎重に行う必要があるものと考えられた.

Significant factors influencing the accuracy of PTCD bile cytology for pancreatic cancers.

膵癌に対するPTCD胆汁細胞診の陽性率に関与する因子を知ることを目的に, 膵癌163例, 検査回数1010回の検討を行った. 特に手術的切除55例においては, 腫瘍の膵内胆管への浸潤度, 組織型などの諸因子と陽性率との相関の有無を検討した.1. 膵癌に対するPTCD胆汁細胞診の陽性率は52.8%であった.2. 検査回数が多いほど陽性率が高くなる傾向を示した.3. 偽陰性例の検査回数は陽性例に比べ少なかった.4. 担癌患者において1回の検査で陽性となる確率は21.8%であった.5. 膵内胆管に露出しない膵癌の細胞診は陰性で, 膵内胆管への浸潤度が高いほど陽性率が高くなる傾向を示した.6. 血清ビリルビン値も閉塞の強さに相関する傾向を示し, 膵癌が胆管に露出しなくとも黄疸をきたす症例が含まれた.7. 組織型では, 高分化型管状腺癌に比べ中分化型管状腺癌の陽性率が高かった.8. 腫瘍の大きさ, 間質の量と陽性率には相関がみられなかった.