Kiyosuke Ishiguro

Different immune functions of peripheral blood, regional lymph node, and tumor infiltrating lymphocytes in lung cancer patients

Immune functions of peripheral blood (PBL), regional lymph node (RLNL), and tumor infiltrating lymphocytes (TIL) were evaluated in lung cancer patients. PBL had many natural killer (NK) cells and the highest NK activity, and it showed the highest augmentation of NK activity by interferon‐SgM (IFN‐γ) + recombinant interleukin‐2 (rIL‐2) among the three groups of lymphocytes. PBL had high lymphokine‐activated killer (LAK) activity of against a broad spectrum of cell lines and moderate activity against autologous tumor cells by increased effector to target (ET) ratio but the lowest ability of IL‐2 production of the three groups of lymphocytes. The RLNL not associated with tumor metastasis had a few NK cells and lower NK activity than PBL, but its LAK activity was almost the same but not greater than that of PBL. RLNL had the highest ability of IL‐2 production among the three groups of lymphocytes. All activities of RLNL associated with tumor metastasis were lower than those not associated with tumor metastasis. TIL exclusively consisted of T‐cells, especially cytotoxic/suppressor T‐Iymphocytes. NK activity and lymphocyte blastogenesis of TIL were lower than those of other groups. The LAK activity of TIL differed greatly with the case, and it was the highest against autologous tumor cells among the three groups of lymphocytes in three of eight cases. These findings showed that PBL, RLNL, and TIL had characteristic subpopulations of lymphocytes and different functions of host immune responses in lung cancer. Efficient augmentation of the characteristic immune responses will lead to a more effective total cancer therapy.

Delayed remission after thymectomy for myasthenia gravis of the purely ocular type

Twenty-two cases of purely ocular myasthenia gravis were reviewed to evaluate the long-term effects of thymectomy. Remission rate increased gradually with time (11.8% at 3 years, 23.1% at 5 years, and 33.3% at 10 years). Analysis of factors influencing remission with time showed that patients with short duration of illness attained remission significantly earlier (p = 0.035 at 5-year follow-up). One of 22 patients with purely ocular myasthenia gravis (4.5%) had disease progression. Because ocular myasthenia gravis often progresses to the generalized type and because duration of illness before operation is one of important factors influencing remission, we conclude that thymectomy in the earlier stages of the disease is the preferred treatment for ocular myasthenia gravis, just as for generalized myasthenia gravis.

Needle Track Dissemination of Follicular Thyroid Carcinoma Following Fine-Needle Aspiration Biopsy: Report of a Case

Few reports have been concerned with the risk of needle track dissemination of tumor cells following fine-needle aspiration biopsy, especially for follicular thyroid nodules. A 61-year-old woman who underwent fine-needle aspiration biopsy and surgery 5 years previously for follicular thyroid adenoma presented with nodules that had developed in the sternocleidomastoid and omohyoid muscles of the anterior neck. These nodules were located along a line from the skin to the thyroid that coincided with the needle track of the previous biopsy. Following surgical resection, histological diagnosis determined the nodules to be follicular carcinoma. The clinical course and linear arrangement of the lesions were highly suggestive of needle track dissemination of tumor cells following fine-needle aspiration biopsy. Although fine-needle aspiration biopsy is a useful tool for the diagnosis of thyroid nodules, it is important to consider the risk of tumor cell dissemination.

Pheochromocytoma multisystem crisis successfully treated by emergency surgery: report of a case.

Pheochromocytomas are rare neuroendocrine tumors that produce symptoms through the excess release of catecholamines. The treatment of choice is a complete surgical removal after pretreatment with an α-blocker, to prevent dangerous hemodynamic fluctuations. Newell and colleagues defined the rare, fatal condition of catecholamine crisis, which includes multiple organ failure (MOF), severe blood pressure variability, high fever, and encephalopathy, as pheochromocytoma multisystem crisis (PMC). The indications for emergency surgery in this unstable state still remain controversial. This report presents the case of a 52-year-old female patient with PMC who successfully underwent a surgical resection. This case showed that early tumor removal may be the only means of halting the progression of this disease.

Laparoscopic bilateral partial adrenalectomy for adrenocortical adenomas causing cushing's syndrome : Report of a case

Laparoscopic total adrenalectomy has become a standard technique for small adrenal tumors; however, bilateral adrenalectomy results in postoperative adrenal insufficiency, necessitating lifelong steroid replacement. To preserve adrenocortical function in a 41-year-old woman with bilateral adrenocortical adenoma (BAA) causing Cushings syndrome, we performed laparoscopic bilateral partial adrenalectomy. We based our preoperative diagnosis of bilateral adrenocortical tumors causing Cushings syndrome on the results of endocrinological investigations and imaging findings. Thus, we performed lateral transperitoneal laparoscopic bilateral partial adrenalectomy, preserving the adrenal glands, which were normal. Pathological examination of both tumors confirmed the diagnosis of adrenocortical adenoma. The patient had no postoperative complications, and her adrenocortical function was normal without steroid replacement at her 10-month follow-up. This report shows that Cushings syndrome resulting from bilateral adenomas can be effectively treated by laparoscopic bilateral partial adrenalectomy as a minimally invasive, adrenocortical-preserving operation.

Autoantibody against WD repeat domain 1 is a novel serological biomarker for screening of thyroid neoplasia

Thyroid nodules are common among adults, and accurate diagnosis is critical in for management decisions. Ultrasound and fine needle aspiration cytology are the most common methods to evaluate nodules, but they are not practical for screening large numbers of patients because of cost and time considerations.

Section 1. Parathyroid: Minimally invasive parathyroidectomy under local anesthesia

Abstract Primary hyperparathyroidism is commonly associated with uniglandular swelling, and thus the lesion has been localized before surgical reduction. Since March 1997, we have performed uniglandular parathyroidectomy under local anesthesia with combined scintigram and ultrasound tomography in patients with primary hyperparathyroidism preoperatively identified for uniglandular swelling. We had seen consecutive 18 patients with primary hyperparathyroidism until April 2001; 15 of those underwent surgical reduction. Postoperative intact PTH value was normalized in 14 patients. The remaining patient, diagnosed with thyroid adenoma, required re-surgery due to proved intake on scintigram a year later. Mean follow-up period is 33 months, and the disease does not relapse. In addition, we removed the swollen gland in two patients with renal hyperparathyroidism under local anesthesia; the disease involved two glands in a patient and one gland in another patient. After surgery, their subjective symptoms including itching and arthralgia were eliminated, and did not relapse at 30 and 14 months, respectively. Minimally invasive parathyroidectomy under local anesthesia might be performed as a same-day surgery, and improve QOL of patients.

Implication of intracellular localization of transcriptional repressor PLZF in thyroid neoplasms

BackgroundPromyelocytic leukaemia zinc finger (PLZF) is a transcriptional repressor that was originally isolated from a patient with promyelocytic leukaemia. PLZF also affects key elements for cell cycle progression, such as cyclin A, and can affect the tumourigenicity of various cancers. Thus far, the behaviour of PLZF in thyroid carcinoma remains unclear.MethodsWe analysed the expression profile of PLZF in different types of benign and malignant thyroid lesions as well as in normal thyroid tissue. Specifically, we examined PLZF expression in normal thyroid (N; n = 4), adenomatous lesion (AL; n = 5), follicular adenoma (FA; n = 2), papillary thyroid carcinoma (PTC; n = 20), and anaplastic thyroid carcinoma (ATC; n = 3) samples. PLZF expression was estimated by western blotting and immunohistochemical (IHC) staining.ResultsPLZF was expressed in all samples of thyroid lesions examined. In N, AL, and FA, PLZF was mainly localized in the nucleus. In contrast, in PTC and ATC, PLZF was mainly expressed in the cytosol with high intensity. In more detail, the cytoplasmic IHC scores in PTC with capsular invasion (CI) and lymph node (LN) metastasis were higher than those in PTC without CI and LN metastasis.ConclusionsPLZF shows different subcellular localizations among PTC, ATC, and other thyroid lesions. Furthermore, high cytoplasmic expression of PLZF may be correlated with CI and LN metastasis in thyroid carcinoma. The present report is the first to describe the implications of intracellular PLZF expression in thyroid carcinomas.

Small extra-adrenal pheochromocytoma causing severe hypertension in an elderly patient.

We report the case of a 67-year-old woman withsevere hypertension caused by an extra-adrenal pheochromocytoma.The tumor was detected by 131I metaiodobenzylguanidinescintigraphy and it was found to be small (2 cm ø) by enhanced CT. After the extirpation of the tumor, the blood pressure ofthe patient immediately normalized. It should be taken into accountthat a small extra-adrenal pheochromocytoma can be one of the causesof secondary hypertension in elderly patients. Since small extra-adrenal pheochromocytomasare difficult to detect, it is also important to perform suitableexaminations to establish the diagnosis. Furthermore, we emphasizethe importance of an accurate diagnosis in elderly patients with pheochromocytoma,for they often have less symptomatology and more severe cardiovascularcomplications due to refractory hypertension than younger patients.

Thymic metastasis of breast cancer 22 years after surgery: A case report

We report a rare case of thymic metastasis of breast cancer. A 68‐year‐old woman, who had undergone surgery for cancer in her right breast and had been free of recurrence for 22 years, was noted to have an abnormal shadow on a chest X‐ray at a regular medical checkup. Further workup, including chest CT, revealed a 22 × 18‐mm mass in the anterior mediastinum. Fluorine‐18‐fluorodeoxyglucose‐PET showed increased fluorine‐18‐fluorodeoxyglucose uptake that was highly suggestive of thymoma. Thoracoscopic thymothymectomy was performed. The tumor had invaded the pericardium, which was also resected. A small nodule was found in the right lung, and it was also resected. The intraoperative frozen‐section diagnosis was breast cancer metastasis to the thymus and lung. The pathological diagnosis was luminal A solid tubular carcinoma (strongly estrogen receptor and progesterone receptor positive, HER2 negative) with an MIB‐1 index of less than 5%. After surgery, the patient was treated with an aromatase inhibitor. As of August 2013, she has been free of recurrence for more than 36 months. It is extremely rare for breast cancer to metastasize to the thymus more than 20 years after surgery.