Yasuhiro Ishido

Gadd45β expression in chondrosarcoma: A pilot study for diagnostic and biological implications in histological grading

BackgroundAlthough the diagnosis of chondrosarcoma, especially the distinction between enchondroma and low-grade chondrosarcoma or low-grade chondrosarcoma and high-grade chondrosarcoma, is pathologically difficult, differential diagnosis is very important because the treatment strategies for these diseases are completely different. The grading system is crucial in predicting biologic behavior and prognosis, however, exact pathological grading is difficult using only routine examinations because the criteria of the grading system are not necessarily definitive. Growth arrest and DNA damage-inducible protein 45β (GADD45β) is an essential molecule for chondrocytes during terminal differentiation. In the present study, we investigated the immunohistochemical expression of GADD45β in enchondroma, and chondrosarcoma of histological grades I, II, and III, to clarify the diagnostic significance of GADD45β in pathological grading of chondrosarcoma.MethodsTwenty samples (enchondroma = 6, chondrosarcoma grade I = 7, grade II = 6, grade III = 1) were used for immunohistochemical analysis to investigate the expression of GADD45β. Quantitative analysis was performed to compare the number of GADD45β positive cells and pathological grading.ResultsOver 70% of the cells in enchondromas expressed GADD45β. On the other hand, the expression of GADD45β decreased significantly according to the histological grade of chondrosarcoma (grade I: 45%; grade II: 13.8%; and grade III: 3.8%).ConclusionsThe association of GADD45β expression and pathological grading of chondrosarcoma in the present study suggests that the immunohistochemical study of GADD45β may be a specific diagnostic parameter for chondrosarcoma cell differentiation.

Intramedullary subependymoma of the cervical spinal cord: a case report with immunohistochemical study.

ABSTRACT Spinal subependymomas, which have a relatively benign nature, are very rare tumors. It is difficult to distinguish spinal subependymomas from other intramedullary spinal tumors based on neuroradiological findings. A case of cervical intramedullary subependymoma in a 63-year-old female is reported. The diffused enlargement of the spinal cord at C2 level involved the lesion with isointensity on a T1-weighted MRI and relatively high intensity on a T2-weighted MRI. Enhancement in the small part of the tumor was observed on a T1-weighted MRI with gadolinium administration. The tumor occupied the left side of the spinal cord, and was totally removed through a laminoplasty of C2. Immunohistochemistry was useful for pathological diagnosis. The clinical feature of this patient is described with the review of literatures.

Intradural Neurenteric Cyst—Two Case Reports of Surgical Treatment

ABSTRACT Intradural neurenteric cysts are rare congenital lesions and arise from incomplete separation of the developing notochord and foregut in the embryo. Neurenteric cysts are often seen in conjunction with other forms of occult spinal dysraphism. The cases of a 48-year-old male with pain in the right shoulder and numbness in both hands and a 7-year-old girl with subacute muscle weakness of the lower extremities are presented. Both patients underwent surgery. One lesion was completely excised, while the other could be only partially removed because of negative monitoring potential during the operation. Histological examination, showing pseudostratified ciliated columnar epithelium, confirmed the diagnosis of neurenteric cyst. The symptoms in both patients nearly disappeared after surgery. Recurrence of cyst was observed in the girl, though without neurological symptoms. In conclusion, two cases of intradural extramedullary cysts are reported. Clinical presentations, intraoperative findings, and histological features are discussed with a review of the literature.

Pedicle Subtraction Osteotomy for Adult Tethered Cord Syndrome With Lumbar Canal Stenosis: Report of Two Cases

ABSTRACT Tethered cord syndrome with spinal lipoma is the most common form of occult spinal dysraphism. For the symptomatic patients, surgical treatment is recommended; however, there are many patients who have not been encouraged to seek medical attention until adulthood, since their symptoms are not severe enough to interfere with their daily activities. We performed pedicle subtraction osteotomy (PSO) to achieve indirect untethering and neural decompression in two senior patients with tethered cord syndrome, who showed deteriorating neurological condition due to coexisting lumbar canal stenosis. Here we report two patients (aged 56 and 60 years) who underwent PSO of L3 or L4. The pain disappeared and the bladder dysfunction recovered significantly after surgery. Complete bone union and untethering were achieved in both patients. PSO is an alternative surgical technique for senior patients with tethered cord syndrome caused by lumbosacral spinal lipoma, when the syndrome occurs along with lumbar canal stenosis.

Classification of Odontoid Destruction in Patients with Rheumatoid Arthritis Using Reconstructed Computed Tomography: Reference to Vertical Migration

Objective. To reveal the factors that determine the natural course of subluxation of occipital-cervical lesions in rheumatoid arthritis (RA). The atlanto-axial region is one of the most common locations for lesions in RA. Some cases progress from reducible atlanto-axial subluxation (AAS) to irreducible vertical migration, while others continue to exhibit reducible AAS. No study has revealed the factors that determine the natural course of subluxation. We focus on the odontoid as a key structure of the progression of occipito-cervical lesions and investigated this region in patients with RA using reconstructive computed tomography (CT) images, and analyzed factors in association with CT findings. Methods. Fifty-eight patients with RA and 40 age-matched controls, all women, were studied. Associated factors, including C-reactive protein, erythrocyte sedimentation rate, steroid usage, and the severity of local osteoporosis, were analyzed as measurements in association with odontoid destruction. Results. The destruction of odontoid and atlanto-odontoid joint were common in patients with RA. The more destruction observed in the odontoid process, the greater is the degree of progression of vertical migration. Local osteoporosis is a significant factor in odontoid destruction, based on a cortico-cancellous index of 42% in cases of grade III odontoid destruction. Conclusion. The odontoid process is a key structure in the progression of occipito-cervical lesions in patients with RA.

Suppurative Arithritis of Facet Joint of Rheumatoid Arthritis Patient Using Human Monoclonal Antibody Rheumatoid Arthritis

腰痛を主訴として発症したまれなL2/3化膿性椎間関節炎に対し，外科的治療により良好な成績を得たので報告する．（症例）51歳女性．RA罹患歴5年．RA治療として生物学的製剤使用中．平成20年12月4日より左腰殿部痛出現．高熱出現し近医受診．炎症所見認めた為，抗菌薬投与開始．翌1月3日当科紹介入院．左優位の大腿部以下の筋力低下，左大腿内側より足先まで知覚鈍麻認めた．MRIで左L2/3椎間関節付近に造影効果を有するT1低信号，T2高信号の膿腫を認めた．診断確定の為，L2/3椎間関節より穿刺，培養結果でMSSA検出．抗菌薬投与としたが，症状改善認められず．そのため内視鏡下膿腫摘出術実施．術後症状消失，MRIで膿腫の消失が確認．外科的治療により症状改善を得た．

Clinical Outcome of Arthroscopic Partial Resection of Hip Acetabular Labrum Tear: A Case Report

51歳男性．1年程前より，誘因なく右股関節痛が出現し，平成18年10月当科紹介受診．股関節内外旋での疼痛認めるも，単純レントゲンにて明らかな異常を認めなかった．腰椎を含め，他部位に異常を認めず，臨床所見より股関節唇損傷を疑い，MRI，CT arthrographyを行った．その結果，いずれにおいても関節唇の一部に関節唇損傷を疑う所見を認めた．また，関節内局麻注入にて一時的な症状改善を認め，症状，画像を総合的に判断し，最終的に関節唇損傷と診断し，関節鏡を行った．鏡視にて前外側の関節唇損傷を認め，鏡視下関節唇切除術を行った．術後早期より，歩行時の疼痛などの症状の改善を認め，経過良好である．股関節唇損傷は症状やCT arthrography，MRI，関節内局麻注入などで診断されることが多いが，画像上明らかな異常所見がない例も少なくない．原因が明らかでない股関節痛が持続する症例では，関節唇損傷も考慮に入れて，関節鏡を用いた．診断治療を行うことは有効な方法であると考える．

Clinical Findings of Chiari Pelvic Osteotomy with Arthroscopic Debridement for Osteoarthritis of Hip

（目的）キアリ骨盤骨切り術施行時と内固定材料抜釘時に股関節鏡を行い，鏡視所見と治療成績について検討した．（対象と方法）2001年以降のキアリ症例44例47股中，鏡視を行い得た10例10股（全例女性）を対象とした．手術時平均年齢は43歳で，抜釘術までの期間：平均1年1ケ月，病期分類は進行期3例，末期7例であった．評価はJOAスコアと種田分類を用いた．（結果と考察）JOAスコアは48点から74点に改善していた．種田分類では多くの症例で変化なかった．疼痛などの臨床所見はよく改善されていたが，関節鏡所見の変化は乏しく，臨床成績との関連性は明らかではなかった．またキアリ変法に関節内処置を併用することが，どれほど臨床成績の向上に貢献しているかも不明であるため，今後長期にわたる経過観察が必要であると思われる．

Evaluation of Perfusion of the Femoral Head after Femoral Neck Fracture using Bone Scintigraphy.

We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation.