Takashi Utsunomiya

Fibrosarcoma versus cellular fibroma of the ovary : A comparative study of their proliferative activity and chromosome aberrations using MIB-1 immunostaining, DNA flow cytometry, and fluorescence in situ hybridization

We retrospectively analyzed the proliferative activity and the centromeric copy number of chromosomes 8, 12, and 17 in three cases of fibrosarcoma and eight cases of cellular fibroma of the ovary using MIB-1 immunostaining, DNA flow cytometry, and fluorescence in situ hybridization (FISH) on paraffin-embedded tissue specimens. In our study, both the MIB-1 labeling index (LI) and the proliferative index (% of cells in S + G2 + M phase) in fibrosarcomas were higher than those in cellular fibromas. The FISH analysis demonstrated the sole abnormality of a gain of trisomy 12 cells in all eight cases of cellular fibroma. Both a gain of trisomy 12 cells and a gain of tetrasomy 12 cells were observed in one case of fibrosarcoma. A gain of trisomy 8 cells was observed in all two fibrosarcomas in which signals were detected. By contrast, neither a gain of trisomy 8 cells nor a gain of tetrasomy 12 cells was observed in any of the eight cases of cellular fibroma. Chromosome 17 showed disomy in all eleven cases. On the basis of these findings, a gain of trisomy 8 cells is therefore considered to be an adequately effective marker to distinguish between cellular fibroma and fibrosarcoma of the ovary, and it may also be related to the proliferative activity of fibrosarcoma of the ovary.

An intestinal counterpart of pyogenic granuloma of the skin: a newly proposed entity

Pyogenic granuloma is a common disease in the skin, but it is extremely rare in the gastrointestinal tract except for the oral cavity. We have seen three lesions (from three patients) of an intestinal counterpart of pyogenic granuloma and have reviewed their clinicopathologic features. Macroscopically, all three lesions revealed a polypoid growth with either a sessile or pedunculated configuration. All had an ulceration on the top. Microscopically, all these lesions were composed of a lobular proliferation of varying sizes of capillaries with an edematous stroma. Endothelial cells of the capillaries were swollen variously and in one case revealed a few mitotic figures. An inflammatory process was associated with the presence of ulcerations. Immunohistochemically, both Factor VIII-related antigen and QB-end/10(CD34) were positive only for the endothelial cells in all three cases. The characteristic macroscopic and histologic features thus allow for an early diagnosis of pyogenic granuloma in the gastrointestinal tract, which is similar to that observed in the skin.

Risk factors related to liver metastasis in colorectal carcinoma: a multivariate analysis of clinicopathologic and immunohistochemical variables.

Specimens from 48 consecutive patients undergoing surgery for colorectal carcinoma and having synchronous or metachronous liver metastases (Group 1) and those from 52 consecutive patients who had no evidence of hepatic metastases within at least 5 year after colorectal resection (Group 2) were selected and compared using a multiple logistic regression analysis. A multivariate analysis using a stepwise logistic regression revealed six independent risk factors significantly related to hepatic metastases. In addition, the following logistic regression model was obtained from this analysis. P = exp a/(l+exp a): a = 3.524CSM‐V) + 2.731(Ex‐V) + 2.718CE/M) + 2.562(Lo) + 1.858(p53) + 1.941 (HIR)‐4.397, where P is the probability of hepatic metastasis given six independent risk factors (E/M, Ex/M ratio; Lo, location; HIR, host inflammatory cell reaction). When the estimated probability “P” in the above logistic regression model is more than 0.55 after an examination of surgical specimens, we must consider adjuvant chemotherapy and closely monitor the patient to ensure early detection of hepatic metastases.

p53 expression patterns in colorectal adenomas and early carcinomas: A special reference to depressed adenoma and non‐polypoid carcinoma

The purpose of the present study was to investigate the role of p53 in tumor progression of colorectal adenomas and early carcinomas, while especially focusing on flat tumors (depressed adenomas and non‐polypoid carcinomas). Paraffin sections of 61 pure adenomas (33 polypoid, 28 depressed), 26 carcinomas in polypoid adenoma (CIA) and 63 pure carcinomas (36 polypoid, 27 non‐polypoid) were examined for immunostaining using p53 monoclonal antibody (PAb 1801). All of the carcinomas were restricted to the mucosa. The number and distribution of the p53 positive tumor cells was evaluated, and then compared with tumor growth patterns and histologlcal features. The incidence of p53 expression in carcinomas (58% in CIA and 51% in pure carcinomas) was significantly higher than that in polypoid adenoma (27% in CIA and 21% in pure adenomas). However, the same incidence In depressed adenomas (51%) was significantly higher than In polypoid adenomas. No correlation in carcinomas was observed between p53 expression and cllnlco‐pathologic data except for age. The distribution of p53 positive cells was different between adenomas and carcinomas. There tended to be fewer p53 positive cells in adenomas, even in depressed ones, than in carcinomas and they also tended to be confined to the superficial areas in adenomas, while they were diffusely distributed in carcinomas. Interestingly, the p53 positive cells were more frequently present in the deep mucosal areas than in the superficial areas of some non‐polypoid carcinomas. In conclusion, the following hypotheses are suggested: (i) the increase of p53 expression from adenoma to carcinoma supports the hypothesis of an adenoma‐carcinoma sequence in a polypoid tumor; (ii) the unique p53 expression in non‐polypoid carcinoma suggests the existence of another type of carcinogenesis; and (iii) depressed adenomas are thus considered to have a high potential risk of carcinoma.

Natural history of colorectal carcinoma: Can the tumor volume doubling time be predicted by radiologic findings or immunohistochemical variables?

Background and Objectives: The factors influencing the growth rate of colorectal carcinoma have not been determined. The aim of this study was to clarify the relationship between the doubling time (DT), morphology, and proliferating cell nuclear antigen, Ki‐67 and p53 immunohistochemistry in colorectal carcinoma.

Huge uterine leiomyoma with adenomyotic cysts mimicking uterine sarcoma on MR imaging

Magnetic resonance imaging of a 39-year-old woman who presented with an abdominal mass revealed a tumor with hemorrhagic lesions extending from the intrauterine space to the subserosa. Hysterectomy was performed for probable uterine sarcoma. The histological examination diagnosed uterine leiomyoma with severe myxoid degeneration and without malignant components. Hemorrhagic lesions were diagnosed as adenomyotic cysts, resulting in findings similar to those of a uterine sarcoma.

Intracellular distribution of intermediate filaments in vimentin-positive gastric carcinomas: confocal laser scanning microscopy using formalin-fixed paraffin-embedded specimens.

Intermediate filaments are known as cytoskeletal elements. Recently, additional vimentin expression has been reported in some carcinomas; however, the function of such expression remains unclear. We studied the intracellular distribution of low-molecular weight cytokeratin and vimentin by immunohistochemistry in 17 vimentin-positive gastric carcinomas using confocal laser scanning microscopy. All materials were formalin-fixed and paraffin-embedded. Low-molecular weight cytokeratin expression showed a membranous pattern with a prominent deposition just below the cytoplasmic membrane in both tubular and solid components of the carcinomas. This unique membranous deposition was frequently absent in diffuse components. On the other hand, vimentin expression showed a fibrillary pattern in all components and also showed a unique basal distribution in the tubular components. We also recognized an aggregate pattern of the intermediate filament expression in diffuse components. We conclude that the significance of vimentin expression in carcinoma cells cannot be explained as a simple substitution for low-molecular weight cytokeratin because the distribution of vimentin and low-molecular weight cytokeratin is different.

Gastric Mucosal Changes Caused by Lugol's Iodine Solution Spray: Endoscopic Features of 64 Cases on Screening Esophagogastroduodenoscopy

Aim. To clarify the endoscopic mucosal change of the stomach caused by Lugols iodine solution spray on screening esophagogastroduodenoscopy (EGD). Methods. Sixty-four consecutive patients who underwent EGD for esophageal squamous cell carcinoma screening were included in this study. The records for these patients included gastric mucosa findings before and after Lugols iodine solution was sprayed. The endoscopic findings of the greater curvature of the gastric body were retrospectively analyzed based on the following findings: fold thickening, exudates, ulcers, and hemorrhage. Results. Mucosal changes occurred after Lugols solution spray totally in 51 patients (80%). Fold thickening was observed in all 51 patients (80%), and a reticular pattern of white lines was found on the surface of the thickened gastric folds found in 28 of the patients (44%). Exudates were observed in 6 patients (9%). Conclusion. The gastric mucosa could be affected by Lugols iodine; the most frequent endoscopic finding of this effect is gastric fold thickening, which should not be misdiagnosed as a severe gastric disease.