Toshikatsu Shibata

RADIATION ENCEPHALOPATHY:—AN AUTOPSY CASE and SOME COMMENTS ON THE PATHOGENESIS OF DELAYED RADIONECROSIS OF CENTRAL NERVOUS SYSTEM

An autopsy case of radiation encephalopathy is reported. This case was bilaterally irradiated for epipharyngeal carcinoma with ,60Go (Total dosis of each side: 6020 r/20 fractions /23 days) and taken ill with the latent period of 2 years after the termination of the irradiation and had a clinical course of 3 years.

Correlation between the expression of telomerase reverse transcriptase and proliferative activity in breast cancer cells using an immunocytochemical restaining method

Telomerase activity is thought to contribute to the immortality of cancers. Recently, some investigators described a correlation between the activity of telomerase and the proliferative activity of cancer cells. The aim of this study was to evaluate the correlation between the expression of telomerase‐associated protein and proliferative activity. Telomerase reverse transcriptase (TERT) is one of the proteins that correlates with telomerase activity. We investigated TERT protein and its mRNA, and examined the correlation between the TERT protein and Ki‐67, which reflects proliferative activity with immunostaining, and its mRNA, which correlates with telomerase activity, using in situ hybridization. Imprint smears from 17 invasive ductal adenocarcinomas were investigated. In most cases positive for TERT mRNA, the percentage of TERT protein‐positive cells was also high and was closely related to mRNA (P = 0.024). The positive rates of TERT for the cases with lymph node metastasis were significantly higher than those for the cases without metastasis (P = 0.046). The positivity of TERT protein also correlated significantly with the Ki‐67‐positive rate (r = 0.82). As the proliferation activity increased, the number of cells positive for both proteins also increased (r = 0.89). In conclusion, it was suggested that the expression of TERT  protein is associated with the expression of Ki‐67, and is concerned with maintenance of the high proliferative activity in cancer cells with aggressive proliferation.

TWO AUTOPSY CASES OF ATYPICAL MYELOPROLIFERATIVE DISORDER WITH GROUP C MONOSOMY OCCURRING IN SIBLINGS

Two cases of atypical myeloproliferative disorder with monosomy of of a group C chromosome are described, which, to our best knowledge, are the first report of autopsied cases occurring in siblings.

Clinicopathologic roles of tumor-infiltrating lymphocytes and CD8-positive lymphocytes in lung cancer imprint smears in squamous cell carcinoma and adenocarcinoma.

OBJECTIVE To investigate the presence of tumor-infiltrating lymphocytes (TILs) and CD8-positive lymphocytes (CD8s) in lung cancers and to examine the prognostic significance of their relationship with clinicopathologic parameters. STUDY DESIGN Primary tumor imprint smears from 83 lung cancers were consecutively obtained at surgery at Tsuchiura Kyodo General Hospital between 1996 and 1998. TILs were observed in Papanicolaou-stained smears, and CD8s were immunocytochemically visualized. RESULTS TILs were judged positive in 42 cases (51%), and 34 of 83 cases (41%) were positive for CD8s. There was no correlation between the frequency of TILs and CD8s. TILs assessed by Papanicolaou staining in 83 cases showed no correlation with any clinicopathologic factors. CD8s were observed more frequently in squamous cell carcinomas (SCCs) than other adenocarcinomas. A high frequency of CD8s was associated with lymph node metastasis (p = 0.043), stage (p = 0.025) and tumor differentiation (p = 0.03). TILs and CD8s made no significant difference in survival. However, in SCC the patients positive for TILs but negative for CD8s survived and had a significantly better prognosis than did the others (p = 0.037). CONCLUSION CD8s were associated with tumor progression and development of malignancy in lung cancers. Especially in SCC, the cases had a high frequency of TILs. A low number of CD8s may correlate with a favorable prognosis.

A case of malignant eccrine spiradenoma metastatic to intramammary lymph node

Eccrine spiradenoma (ES) is a fairly common, benign, cutaneous tumor originating from the sweat glands. In contrast, the malignant counterpart of ES, malignant eccrine spiradenoma (MES), is extremely rare. A long-standing lesion rarely begins to enlarge rapidly. A growth that results in ulceration or discoloration may be associated with malignant transformation. We present the first reported case of this tumor metastasizing to an intramammary lymph node (IMLN). The uncommon metastasizing focus of the periumbilical MES and its histopathological similarity with a primary breast carcinoma made the diagnosis difficult.

Proposal for two strategies to prevent remnants of gastric cancers after endoscopic mucosal resections: fluorescein electronic endoscopy and rapid stump diagnosis based on pit patterns

BackgroundThe aim of the present study was to establish strategies to prevent cancer remnants after gastric endoscopic mucosal resection (EMR).MethodsWhether surgical stumps could be diagnosed by pit patterns was examined on 38 well-fixed EMR materials. Furthermore, a rapid stump diagnostic method, which enables pit patterns of EMR material to be observed within 10 min, was developed. This rapid stump diagnosis was tested in 6 EMR cases of early gastric cancers, one of which was absolutely obscure to routine endoscopy. Fluorescein electronic endoscopy had been performed to reveal the extent of this cancer before EMR.ResultsAdenocarcinomas showed irregular pit patterns that were significantly different from those of normal gastric mucosae. Among the 38 cases, all 20 EMR materials that were diagnosed as stump (−) and 5 that were diagnosed as stump (+), based on pit patterns, were confirmed by tissue sections to be stump (−) and stump (+), respectively. Six of the 13 EMR materials diagnosed as stump (±) by pit patterns were finally diagnosed as stump (+) by tissue sections. These data indicate that cancer remnants could be avoided if the stumps were judged positive or suspiciously positive just after EMR, and additional resections were continuously done until the stumps became negative. Rapid stump diagnosis based on pit patterns was successful in all 6 tested cases. The extent of the early gastric cancer that was absolutely obscure to routine endocscopy was clearly and exactly revealed by fluorescein electronic endoscopies done before EMR and subsequent rapid stump diagnosis.ConclusionIt is probable that fluorescein electronic endoscopy, as a precise preoperative examination, and rapid stump diagnosis, based on pit patterns, will become effective strategies to prevent cancer remnants after EMR.

Usefulness of broncoalveolar lavage samples for detection of Pneumocystis carinii using PCR method

We use PCR to diagnose Pneumocystis carinii (PC) pneumonia together with cytology. In this report, we studied the difference in detection of PC between PCR and cytology, sputum, and broncoalveolar lavage samples suspicious for PC pneumonia. First, we made cytology smears from samples and treated them with Papanicolaou and Grocott stainng. DNA extractation from remnant samples and amplification of DNA specific for PC were also done. Using PCR, we detected PC in 12 of 22 (55%) samples of broncoalveolar lavage, but only 4 of 33 (12%) sputum samples (p=0.0018). In cytology, we similarly detected 6 cases (27%), but only 1 case (3%)(p=0.013). Broncoalveolar lavage samples were thus more suitable than sputum in detecting PC. PCR was significantly more sensitive than cytology (p=0.039). Grocott staining is generally used and is important for detecting PC. However, it could not confirm positive in case of insufficiency of PC on the smears. We concluded that detection using broncoalveolar lavage samples using PCR were suitable for detecting PC.

The expression of MMP-7 in colon cancer and its clinical application.

To study the clinical significance of MMP-7 in colorectal cancers, we investigated 69 cases of imprint smear using immunocytochemistry and in situ hybridization. A total of 39 of 69 cases were positive for MMP-7 expression by immunocytochemistry. The expression of MMP-7 protein and mRNA were correlated. Positive cases of MMP-7 proteintented to be moderately differentiated tumors of the sigmoid colon or rectum, and invasive cases. The expression of MMP-7 and metastases to lymph nodes and liver were strongly correlated. In conclusion, MMP-7 may be a useful marker for invasion and metastasis in colorectal cancer.