Kun-Bow Tsai

Immunohistochemical Study of DPC4 and p53 Proteins in Gallbladder and Bile Duct Cancers

Gallbladder and bile duct carcinomas belong to the family of biliary tract tumors, but they demonstrate different clinical behavior. We evaluated a series of biliary tract carcinomas to determine whether they also had genotypic differences by analysis of the tumor suppressor genes DPC4 and p53. Twenty-one gallbladder cancers, 20 intrahepatic bile duct carcinomas, and 10 extrahepatic bile duct carcinomas were retrieved from the surgical pathology files of Kaohsiung Medical University Hospital. Sections were immunostained with monoclonal antibodies to the DPC4 and P53 proteins. Statistical differences between gallbladder cancer and bile duct carcinomas were determined using ?2 analysis or the Fisher’s exact test, when appropriate. Two of the 21 gallbladder cancers (9.5%), 7 of the 20 intrahepatic bile duct carcinomas (35%), and five of the 10 extrahepatic bile duct carcinomas (50%) were negatively labeled for DPC4. The differences were significant between gallbladder carcinoma and both intrahepatic bile duct carcinomas (p = 0.023) and extrahepatic bile duct carcinomas (p = 0.012). A higher frequency of P53 overexpression was found in gallbladder cancers (61.9%) than in intrahepatic bile duct carcinomas (26.3%) (p = 0.024). This study suggests that the DPC4 gene may play a limited role in gallbladder carcinoma; however, p53 gene mutation is more frequently found in gallbladder cancers. In contrast, DPC4 deletion may be more common in bile duct carcinomas, especially in those arising from the extrahepatic bile duct. These findings support the concept that gallbladder and bile duct carcinomas are different tumors with differing etiologies and tumorigenesis.

The clinical significance between activation of nuclear factor kappa B transcription factor and overexpression of HER-2/neu oncoprotein in Taiwanese patients with breast cancer.

BACKGROUND This study investigated the role of nuclear factor-kappa B (NF-kappaB) activity in human breast cancer with overexpression of HER-2/neu oncoprotein, as well as its role on expression of different histological grades of cancer cells taken from Taiwanese breast cancer patients. MATERIALS AND METHODS Specimens were collected from 82 female breast cancer patients. The HER-2/neu oncoprotein was measured by immunohistochemistry. NF-kappaB activity expression was assessed by the electrophoretic mobility shift assay, and confirmed by the supershift technique using anti-P65 antibody in both breast cancer tissue and the adjacent normal tissue. The histological grades were measured by Modified Bloom-Richardson Grading Scheme. RESULTS Of the 82 cancer specimens, 81 (98.7%) showed higher or equal expressions of NF-kappaB activity when compared to the adjacent normal tissue. Fifty-five cases (67.1%) had higher levels of NF-kappaB activity in the cancerous tissue than in the adjacent normal tissue (p<0.005). With regard to tumor size, steroid receptors, stages, histological types, and node status, there were no statistically significant differences in NF-kappaB activity between cancerous tissues and adjacent normal tissues. However, significantly higher expressions of NF-kappaB activity were seen in those cases with positive HER2/neu oncoprotein, poorly differentiated histological grades, high nuclear pleomorphisms, and high mitotic counts (p<0.05). Positive HER-2/neu overexpression of oncoprotein had higher NF-kappaB activity (86%) than negative overexpression (60%) (p<0.05). It has been shown that the NF-kappaB activity increases in the HER-2/neu oncoprotein overexpression in human breast cancer. CONCLUSION Overexpression of HER-2/neu gene could induce NF-kappaB activity in human breast cancer cells, as has been confirmed in other research on cell lines.

Acute Hemorrhagic Rectal Ulcer Syndrome: A New Clinical Entity? Report of 19 Cases and Review of the Literature

PURPOSE:Acute hemorrhagic rectal ulcer syndrome is characterized by sudden onset, painless, and massive hemorrhage from rectal ulcer(s) in patients with serious underlying illnesses. It is a matter of controversy whether acute hemorrhagic rectal ulcer syndrome is a distinct clinical entity. This is the first Asian report on acute hemorrhagic rectal ulcer syndrome to be made outside Japan.METHODS:From January 1989 to December 1999, 8,085 patients underwent total colonoscopy at our institution. We retrospectively analyzed the medical records and colonoscopic files. The diagnosis of acute hemorrhagic rectal ulcer syndrome was made by means of the clinical, histologic, and colonoscopic findings.RESULTS:Among the 8,085 patients, 19 patients (11 males; mean age, 71.2 ± 10.1 years) were diagnosed with acute hemorrhagic rectal ulcer syndrome, which accounted for 2.8 percent of the patients with massive lower gastrointestinal bleeding. The duration from hospitalization to the onset of massive bleeding ranged from 3 to 14 (mean, 9 ± 3.3) days. Characteristics of colonoscopic appearance were solitary or multiple rectal ulcer(s), with round, circumferential, geographical, or Dieulafoy-like lesions located within a mean of 4.7 cm ± 1.5 cm from the dentate line. Histopathologically, the lesions appeared as necrosis with denudation of covering epithelium, hemorrhage, and multiple thrombi in the vessels of the mucosa and underlying stroma, which is considered to be similar to stress-related mucosa injury. Successful hemostasis was obtained in 74 percent (14/19) of patients with direct therapeutic maneuvers. Prognosis was largely dependent on accurate diagnosis and management of the underlying disorders.CONCLUSIONS:We assert that acute hemorrhagic rectal ulcer syndrome is a rare but important entity and stress that awareness of this clinical entity should lead to a high index of suspicion resulting in early detection, diagnosis, and appropriate therapy.

Hepatic angiomyolipoma with trace amounts of fat: a case report and literature review

Hepatic angiomyolipoma (AML), a rare benign mesenchymal tumour, is characterised by the presence of mature adipose tissue, smooth-muscle cells and thick-walled blood vessels. Increasing attention to hepatic AMLs has led to the discovery that sufficient proportions of fat often allow for definite diagnoses preoperatively. However, the proportion of fatty tissue in these tumours is highly variable. One case of hepatic AML is reported, where the amount of fat was <1%. In this case, the viral hepatitis markers, including hepatitis B antigen and anti-hepatitis C virus antibody, were negative. The serum α-fetoprotein level was 3.4 ng/ml and in the normal range. Abdominal ultrasonography showed a hypoechoic mass measuring 5 cm in diameter and without an obvious capsule in the left lobe of the liver. A dynamic computed tomography scan showed a well-defined and slightly enhanced mass in the medial segment of the left lobe of the liver. Angiography showed that the mass was hypervascular in character. As hepatocellular carcinoma was highly suspected from these preoperative image studies, a left lobectomy was carried out. Microscopically, the amount of fat was too low to establish a diagnosis of hepatic AML. However, positive homatropine methylbromide 45 immunoreactivity of the smooth-muscle cells seemed to assist in arriving at the diagnosis.

Pigmented eccrine poroma with enhanced endothelin-1 expression: implications for mechanism of hyperpigmentation

which excluded systemic disease. As there were no remnants of lesion, radiotherapy was not performed. Mycophenolate mofetil and tacrolimus ANH were reduced to half the previous dosage. There was no recurrence at 12-month follow-up. Cutaneous CD30+ ALTCL is characterized by the expression of CD30 (an activation marker for B or T cells) in more than 75% of cells, and can be subdivided mainly into a primary cutaneous form, defined by skin-only involvement at presentation, or a systemic form, with secondary skin involvement from a node-based lymphoma, or following transformation of mycosis fungoides. The localization of PTLs in the skin, as well as the CD30+ ALTCL type, are very uncommon. To our knowledge, only five cases of CD30+ PT ALTCL have been reported to date: three in kidney recipients, one in a heart transplant and the other in a combined liver and heart transplantation recipient. Whereas classical primary cutaneous CD30+ ALTCL usually carries a good prognosis, CD30+ PT ALTCLs seem to pursue an aggressive course: the previously reported cases were characterized by multiple lesions at presentation and ⁄or a rapid appearance of new nodules within a few months. In our patient, there was a unique tumour at presentation, and no further lesions appeared within 12 months, although we think that a longer follow-up is necessary to evaluate the clinical behaviour more thoroughly. We think that the small size of the lesion was the most favourable prognostic factor in our case, as it allowed for a complete excision of tumour. We also found strong positivity for MUM1 ⁄ IRF4, which is thought to be crucial for lymphoid development and has been found to be strongly expressed in various types of leukaemia, Band T-cell lymphomas, including ALTCL. MUM1 ⁄ IRF4 expression is thought to be helpful for diagnostic purposes, whereas its prognostic role is controversial, probably depending on the type of leukaemia ⁄ lymphoma considered. MUM1 ⁄ IRF4 was not investigated in the previously reported cases of CD30+ PT ALTCLs; it could be worthwhile to study its expression on a larger series of PTLs. The unusual clinical behaviour and histotype and the immunophenotype of our case may add knowledge to the spectrum of PTLs.

Cocaine-Related Vasculitis Causing Scrotal Gangrene

Objective: To describe a case of possible cocaine-related vasculitis resulting in gangrene of the scrotum and review the literature on cocaine-related vascular complications. Case Summary: A 22-year-old male presented with fever, painful swelling of the right scrotum, and a blackened ulcerated lesion on the right scrotum 3 hours after smoking crack cocaine. Blood and urine cultures and serologic tests were negative, and the D-dimer level was normal. Echocardiogram showed no evidence of vegetation and results of a chest X-ray were normal. Despite treatment for presumptive orchitis with intravenous levofloxacin 750 mg/day, the ulcerated lesion of the right scrotum progressed the next day. The patient received debridement of the necrotic tissue and pathology revealed some degenerated vessels with fibrinoid deposits and inflammatory infiltrates, suggestive of vasculitis. No further tenderness and swelling of the scrotum occurred and the patient was discharged after 10 days. When he returned for follow-up, the wound had healed completely. Discussions: Cocaine-related vascular complications, including ischemic stroke, myocardial infarction, and peripheral occlusive disease, all of which have various possible mechanisms, are of clinical importance. Vasculitis is one of the mechanisms of vascular complications associated with cocaine use. According to the Naranjo probability scale, cocaine was the possible causative agent of the patients vasculitis, which led to scrotum gangrene. To our knowledge, this is the first report in the literature of scrotum gangrene developing after crack cocaine was smoked. Conclusions: This case report describes a rare occurrence of gangrene of the scrotum associated with cocaine smoking, which is consistent with cocaines potent vasoconstrictive activity. Cocaine abuse has the potential to cause clinically significant ischemic events anywhere in the body, independent of the method of administration.

Expression of HER-2/NEU oncoprotein in familial and non-familial breast cancer.

The HER-2/neu proto-oncogene amplification or oncoprotein overexpression is an important prognostic factor and a predictive factor for resistance to endocrine therapy and adjuvant chemotherapy in breast cancers. Moreover, it is an entry criterion in the assessment of patients for whom Herceptin (Trastuzumab) treatment is considered. The overexpression rate of HER-2/neu oncoprotein has been identified in 10% to 40% of human breast cancers. In Taiwan, a higher grade of pathobiologic characteristics of familial breast cancer was also noted than that found in the non-familial group. It is worthwhile to evaluate whether the overexpression is more frequent in familial breast cancers. Fifty-six familial and 111 non-familial breast cancers were studied between 1990 and 1999 to assess both the overexpression of HER-2/neu oncoprotein immunohistochemically and the correlation with the histological type, grade and stage of breast carcinoma. The overexpression rate is higher in the familial breast cancer group (50.0%) when compared with non-familial breast cancer group (36.9%), which did not prove to be statistically significant (P = 0.1068). However, when the infiltrating ductal carcinomas of both groups are compared, it is statistically significant (52.3% vs. 33.7%, P = 0.0429). Overexpression correlated with node status and histological grade of infiltrating ductal carcinomas in non-familial and overall breast cancers. It also correlated with nuclear pleomorphism and mitotic counts, but not tubule formation or tumor size. All 3 cases of Pagets disease revealed overexpression, whereas all 12 cases of mucinous and one case of metaplastic carcinoma and one case of medullary carcinoma were negative. The overexpression rate was higher both in familial and non-familial intraductal carcinomas (57.1% vs. 73.3%, P = 0.4716). No statistical difference was identified between the 2 subsets. A case of infiltrating ductal carcinoma combined with intraductal carcinoma revealed heterogeneous staining in the component of ductal carcinoma in situ, while the invasive component did not. This suggests that overexpression decreases within individual tumors as they evolve from in situ to invasive lesioins. The HER-2/neu may imply a different role in intraductal carcinoma, Pagets disease and invasive duct carcinoma. Although the overexpression rate of HER-2/neu oncoprotein of familial breast cancer was not significantly higher than that of the non-familial group, it is appropriate to evaluate the rate of HER-2/neu overexpression according to the histological type of breast cancers from familial breast cancer and non-familial breast cancer. The prognoses will be needed for future evaluation.

A Simple Intraductal Aspiration Method for Cytodiagnosis in Nipple Discharge

OBJECTIVE To increase cytodiagnostic accuracy for women with spontaneous nipple discharge using a simple intraductal aspiration method. STUDY DESIGN We compared the cytodiagnostic accuracy of the conventional squeezing collection method and intraductal aspiration by intravenous catheter in a total of 146 women with spontaneous nipple discharge in a single duct without a mass; they had been pathologically identified at Kaohsiung Medical University Hospital. RESULTS Adequate specimens were collected in 96.6% (141/146 cases) of the sample by the intraductal aspiration method as compared to 76.0% collected by the conventional squeezing method (P < .05). An adequate specimen should consist, at a minimum, of six cohesive clusters of well-preserved epithelial cells, with each cluster composed of at least five cells other than foam cells. The cytologic diagnosis was divided into five categories: positive in 9 cases, suspicious in 10, negative with atypical findings in 59, negative in 33 and inadequate specimens in 35 cases that employed the squeezing method. These results were less satisfactory than with the intraductal aspiration method: the smears were positive in 17 cases, suspicious in 14, negative with atypical findings in 78, negative in 32 and inadequate specimens in 5. Our results showed a sensitivity of 92.3% and specificity of 93.9% for the intraductal aspiration method as compared to a sensitivity of 52.9% and specificity of 89.3% for the squeezing method. Among the 27 cancers in this series, correct cytodiagnosis, including suspicious cases, was made in 24 cases by intraductal aspiration, with an accuracy of 88.9%, as compared to the 33.3% (9/27) accuracy of the squeezing method (P < 0.5). CONCLUSION For patients with spontaneous nipple discharge, the intraductal aspiration method provides much more accurate cytodiagnosis than does the conventional squeezing method.

Infantile CD4+/CD56+ hematodermic neoplasm.

CD4+/CD56+ hematodermic neoplasm (formerly known as blastic natural killer (NK) cell lymphoma) is a rare and aggressive neoplasm with a poor prognosis. It is a recently described entity with a predilection for skin involvement.[1][1] Previously, the disease was thought to originate from NK cells

Eccrine Porocarcinoma of the Auricle: A Case Report

Eccrine porocarcinoma (EP) is a rare skin malignant lesion representing 0.005–0.01% of all cutaneous tumors. It is a tumor that most commonly present in elderly people aged over 60 years. Approximately 250 cases of EP have been reported since this disease was first described in 1963. However, only three cases occurring specifically on the ear (including the current case) have been documented in the literature to date. Based on the rarity of EP of the ear, we present this 78‐year‐old man with EP on the right ear lobule, which was diagnosed accidentally during the management of other unrelated problems. The etiology, diagnosis, treatment and prognosis of this disease are discussed, with a brief review of the literature in this report.