Shunta Inai

Expression of caspase-activated deoxyribonuclease (CAD) and caspase 3 (CPP32) in the cochlea of cisplatin (CDDP)-treated guinea pigs

Cisplatin, an anti-cancer drug, is known to induce apoptosis. During apoptosis, double-stranded DNA is broken into single-stranded DNA by the action of caspases and caspase activated deoxyribonuclease (CAD). We immunohistochemically examined the cochlea of guinea pigs for signs of the apoptosis after the administration of cisplatin. Cisplatin (10 mg/kg b.w.) was intraperitoneally injected to guinea pigs and 3 days later, the animals were sacrificed by intracardiac perfusion of 4% paraformaldehyde. The temporal bones were then removed and immunohistochemically stained for CAD and caspase 3, using the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labelling method. CAD was observed in the stria vascularis and the spiral ligament. Caspase 3 was also detected in the stria vascularis, the spiral ligament and the supporting cells of the organ of Corti. These findings suggest that apoptosis is involved in the cochlear damage observed in cancer patients treated with cisplatin.

Acoustic stimulation promotes the expression of inducible nitric oxide synthase in the vestibule of guinea pigs.

Loud acoustic stimulation is known to cause inner ear disturbance. We examined immunohistochemically the vestibule of 12 guinea pigs after acoustic stimulation. The animals were divided into two equal groups: a control group and an acoustic stimulation group. The temporal bones were fixed by means of a cardiac infusion of fixative and immunohistochemically stained for inducible nitric oxide synthase (iNOS). The temporal bones in the control group did not show any iNOS. In the acoustic stimulation group, immunoreactivity for iNOS was detected in the supporting cells and sensory cells of the sensory epithelium, in the dark cell areas and in the vestibular ganglion cells. These findings suggest that free radicals are involved in the pathogenesis of noise-induced inner ear damage. Furthermore, free radicals may cause vestibular damage, as is seen in noise-induced inner ear damage.

Surgical management of tongue cancer during pregnancy

There are ethical dilemmas in managing head and neck cancers during pregnancy. Diagnostic and treatment modalities need to be carefully determined. We herein describe 3 cases of tongue cancer during pregnancy. The details of the management would contribute to the daily practices for head and neck cancers. All three patients were Japanese female patients, two of them were 29 years old and one was 26 years old. All patients were admitted to the Nippon Medical School Hospital during pregnancy, complaining of oral pain and/or discomfort. Case 1 was diagnosed as tongue cancer stage T3N0M0, however, the tumor was superficial and controllable by partial glossectomy. Case 2 was stage T2N0M0 with deep invasion with ulcer, and the hemi-glossectomy with neck dissection and the reconstruction was thought to be the standard modality. However, she underwent partial glossectomy in order to reduce the stress of the fetus. Case 3 could not be diagnosed on admission by biopsy and she underwent partial glossectomy after delivery. In case 3, the pathological diagnosis was pT1 tongue cancer. In case 1 and case 3, the patient and baby were healthy. In case 2, however, the patient died of recurrence at the primary site. In decision making of the strategy, the most important factors are not only oncological evaluation but also ethical and emotional factors.

Sebaceous Carcinoma of the Nose with a Regional Metastasis Following False-negative Sentinel Lymph Node Biopsy

A recent large-scale retrospective study has revealed that the frequency and aggressiveness of extraocular sebaceous carcinoma is comparable with that of the periocular counterpart (1) and a signiflcant number of extraocular sebaceous carcinomas show regional and widespread métastases (2). However, sentinel lymph node (SLN) biopsy has seldom been used for identifying regional nodal metastasis in extraocular sebaceous carcinoma. We report here the case of a nasal sebaceous carcinoma which was excised in combination with SLN biopsies showing no tumour cells. However, 6 months after surgery, a metastasis to the submental lymph node was detected. The efticacy of SLN biopsy in extraocular sebaceous carcinoma is discussed.

Nodular fasciitis in the parotid gland: A case report and review of the literature

Nodular fasciitis (NF) is a benign, reactive lesion with a self‐limiting process. Because NF is rare in the parotid gland and has many cytological similarities to other benign or malignant tumors, cytological misinterpretation is common. The patient, a 30‐year‐old woman, had a painless mass in her right parotid gland. Fine needle aspiration cytology (FNAC) was performed. Spindle cells with basophilic and well‐demarcated cytoplasm were observed in a mucoid‐like background. The mucoid‐like substance was metachromatic and appeared to be the matrix of PA. Histopathologically, spindle‐shaped cells with intervening birefringent mature collagen were arranged in short irregular bundles. Prominent mucoid‐like matrixes as well as few infiltrating neutrophils and lymphocytes were found in the background. Lesional cells were positive for CD10 and β‐catenin in the cytoplasm, but negative for cytokeratin, the S‐100 protein, CD34, and neurofilament. Ultimately, this patient was diagnosed with NF. In FNAC of the parotid gland region, distinguishing NF from other real tumors is important for deciding treatment strategies. Diagn. Cytopathol. 2013;41:829–833.

Descending necrotizing mediastinitis associated with Lactobacillus plantarum

BackgroundDescending necrotizing mediastinitis (DNM), a severe infection with a high fatality rate, develops in mediastinal spaces due mainly to deep cervical abscesses. The majority of causative microbes of DNM are Streptococci and oral anaerobes. DNM associated with Lactobacillus-infection is rather rare.Case presentationA 69-year-old male with an unremarkable past medical history was referred to our hospital for surgical resection of advanced laryngeal cancer. Full examination revealed a neck abscess and DNM with a background of untreated diabetes mellitus. Initially, he was treated with meropenem. However, Lactobacillus plantarum was isolated from surgical drainage of a mediastinal abscess. Despite using antibiotics capable of eradicating all isolates with susceptibilities not differing significantly from those of the neck and mediastinal abscesses, we attributed DNM to the L. plantarum detected only in the mediastinal abscess. After DNM treatment, he underwent total pharyngolaryngectomy with bilateral neck dissection followed by reconstruction using free jejunum. He was discharged fully recovered.ConclusionWe concluded that L. plantarum as the sole cause of the mediastinal abscess in the present case cannot be ruled out. As the number of immunocompromised patients increases, we should be cautious regarding this “familiar” microbe.

Induction of apoptosis in the vestibule of guinea pigs after middle ear inoculation with lipopolysaccharide (LPS)

OBJECTIVE During the process of apoptosis, double-stranded DNA is broken into single-stranded DNA (ssDNA) by the action of caspases and caspase activated deoxyribonuclease (CAD). We immunohistochemically examined the apoptotic changes induced by endotoxin in the vestibule of guinea pigs. METHODS Lipopolysaccharide (LPS) (5 mg/ml, 0.2 ml), a bacterial endotoxin, was transtympanically injected into the middle ear. 48 h after injection of LPS, animals were sacrificed by intracardiac perfusion of fixative. The temporal bones were then removed and immunohistochemically stained for ssDNA, CAD and caspase 3. RESULTS ssDNA was detected after 48 h in the dark cell area of the LPS group, not in the sensory epithelium. CAD was observed both in the dark cell area and the sensory epithelium. Caspase 3 was also detected both in the dark cell area and the sensory epithelium. CONCLUSION Our findings suggest that apoptosis is involved in the dysfunction of the vestibule under inflammatory conditions.

Carcinosarcoma ex Pleomorphic Adenoma of the Submandibular Gland in a 64-Year-Old Man: A Case Report

Carcinosarcoma (CS) is a rare tumor, consisting of both carcinomatous and sarcomatous components. In this paper, we present a case of CS arising from a pleomorphic adenoma (PA) of the submandibular gland. A 64-year-old Japanese man presented with a left submandibular mass that had developed for 20 years with complaints of pain for the last 3 months. Magnetic resonance imaging showed a lesion involving the left submandibular gland. The patient underwent total dissection of the left submandibular gland and left cervical lymph nodes. Upon gross examination, the mass appeared completely covered by fibroadipose tissue measuring 46×42×45 mm; sectioning revealed a solid-white nodule with central bleeding and necrosis, invading into the surrounding adipose tissue. Microscopically, the presence of carcinomatous and sarcomatous components in the fibro-myxomatous stroma was detected, suggestive of pre-existing PA. The carcinoma component was diagnostic of salivary adenocarcinoma, not otherwise specified, whereas the sarcomatous component exhibited features of osteosarcoma characterized by formation of osteoid. As the border between the carcinomatous and sarcomatous components was not evident, CS may have occurred via transformation of the carcinoma into sarcoma. Tumor metastasis was detected in the cervical lymph nodes. Immunohistochemically, AE1/AE3 expression was noted in the carcinomatous component, but not in the osteosarcoma component. Both components were diffusely positive for vimentin. Four months after the operation, the patient developed a metastatic CS lesion in the lung, suggesting tumor aggression.

Diagnostic procedure and prediction of prognosis of the asymmetry of the lip after parotidectomy

Functional preservation of the marginal mandibular branch of the facial nerve is crucial in head and neck surgeries. It is important not only for the postoperative QOL of the operated patients, but also for improving the surgical skills of the surgeons. Appropriate evaluation of postoperative facial paralysis is necessary for utilizing feedback information. In this study, we retrospectively analyzed the postoperative status of marginal mandibular branch function. Patients with non-malignant disease who underwent parotidectomy were selected. One hundred consecutive patients who were operated from 2013 were included. None had preoperative facial paralysis. Mean and standard deviation of age were 54.8 and 16.4. Fifty males and 50 females were included. Postoperative mobility of the lip was evaluated in depressing and everting the lip. In addition, the function of the mentalis muscle was scored by inspection and palpation ; no paralysis as score 0, complete paralysis as score 2, and incomplete paralysis as score 1. This was assessed at day 2, 1 month, 2 months and 3 months after surgery. Asymmetric depressing of the lip occurred in 36 of the 100 patients. In these, the number of patients with each score (0 to 2) of the mentalis muscle paralysis was 22, 9, and 5, respectively. Residual rates of asymmetric depressing in patients with score 0 were 31.8% in 1 month, 22.7% in 2 months, 4.5% in 3 months after surgery. Those incidences were 77.7%, 55.5%, 55.5% in patients with score 1. There were no patients with score 2 whose asymmetric depressing of the lip was cured within 3 months after surgery. Prognosis of asymmetrical depressing of the lip could be predicted by assessing contraction of the mentalis muscle in protrusion of the lip after surgery, which might indicate the postoperative condition of the marginal mandibular branch of the facial nerve.

Neck abscess due to Salmonella Choleraesuis: case study and literature review

Introduction. We herein describe a case with a neck abscess due to non-typhoidal Salmonella (NTS). NTS habitually reside in our environment and colonize all animals including mammals. Colonizations of pigs, chickens, cows and sheep are important because food poisoning episodes in human are often associated with meat. Extra-intestinal infection due to NTS has numerous presentations and complications, with aortic aneurysms being common. Case presentation. A 26-year-old Japanese male complaining of left-sided neck swelling was referred to our hospital for a suspected deep neck abscess. An enhanced computed tomography scan of the neck revealed a low density lesion in the left-sided deep neck area, and consequently the patient underwent urgent incision and drainage. After this urgent operation, Salmonella Choleraesuis was isolated from a greyish-white abscess. The patient ultimately recovered with antimicrobial administration, though re-incision for lymphadenectomy was necessary. The neck abscess may have developed because he had eaten raw meat. Furthermore, untreated diabetes mellitus was diagnosed at presentation. Conclusion. Salmonella enterica serovar Choleraesuis infections are rare in Japan. NTS are generally recognized as important pathogens in food poisoning globally, and attention is required to avoid the development of extra-intestinal infections. In Japan, the increasing lifestyle diversity in recent years highlights the importance of recognizing rare infections.