Young J. Choi

Diagnostic value of C-reactive protein in acute appendicitis

Serum C-reactive protein was measured in 56 patients hospitalized with a suspected diagnosis of acute appendicitis. Based on these determinations, four groups of patients were defined: Group A=26 patients with acute appendicitis who had a C-reactive protein level higher than 2.5 mg/dl. Group B=4 patients with a C-reactive protein level lower than 2.5 mg/dl who, after surgery based on a presumed diagnosis of acute appendicitis, were found to have a normal appendix. Group C=22 patients with nonspecific abdominal pain, 18 (72 percent) of whom had an elevated C-reactive protein level, although in only 4 (7.1 percent) were these levels higher than 2.5 percent mg/dl. Group D=4 patients who had diseases other than acute appendicitis. It is concluded that an increase in C-reactive protein levels to more than 2.5 mg/dl is not a definite indicator of acute appendicitis. However, if the C-reactive protein level in blood drawn 12 hours after the onset of symptoms is less than 2.5 mg/ dl, acute appendicitis can be excluded.

Kimura's disease : A case report and literature review

Kimuras disease, which occurs endemically in the Far East and sporadically in the West, has so far eluded efforts to determine its exact pathogenesis. It presents as solitary or multiple benign swellings of the skin, has a predilection for the periauricular and scalp regions, and often is associated with regional lymphadenopathy. Morphologically, the lesions are characterized by proliferating blood vessels with rich eosinophilic infiltrate. Peripheral blood eosinophilia and raised serum IgE levels are signature features of the condition. The overall prognosis is good. When surgery is not possible, conservative treatment with either corticosteroids or radiation often can produce a favorable response. Complete surgical excision whenever feasible is the preferred treatment despite a high recurrence rate. Based on a recent case of Kimuras disease in a 55‐year‐old black woman, we discuss the pitfalls in the diagnosis of this chronic inflammatory disorder. J. Surg. Oncol. 1999;70:190–193.

Interobserver variability and aberrant E-cadherin immunostaining of lobular neoplasia and infiltrating lobular carcinoma.

The distinction between lobular neoplasia and infiltrating lobular carcinoma from ductal neoplasia and infiltrating duct carcinoma with equivocal histologic features may present a challenge as this distinction has important therapeutic implications. Although E-cadherin staining has been of value in helping to make this determination, the variability of the E-cadherin staining pattern and the immunohistochemistry techniques can be problematic in clinical practice. A total of 161 cases of breast lesions previously diagnosed as lobular neoplasia and infiltrating lobular carcinoma were selected from the departmental files. Three surgical pathologists interpreted them in a blinded manner for the histology diagnoses and E-cadherin staining. E-cadherin staining was conducted on the paraffin-embedded sections of the breast lesions using two different source antibodies. Our results using morphology and E-cadherin stain agreed with the previous diagnoses of lobular neoplasia and infiltrating lobular carcinoma in 140 of 161 cases (86.9%). Among the 140 cases, three pathologists agreed with the morphologic diagnoses of lobular neoplasia and infiltrating lobular carcinoma in 100 (71.4%), two pathologists in 26 (18.6%) and one pathologist in 14 (10%). All three pathologists disagreed with the previous diagnoses of lobular neoplasia and infiltrating lobular carcinoma but reevaluated as ductal lesions in 21 cases (13.0%). E-cadherin staining was confirmatory in 136 of total 161 cases (84.5%) of both lobular and duct lesions by showing the loss of staining in lobular lesions and the presence of complete membrane staining in duct lesions. Aberrant E-cadherin reactions were retained weak or partial incomplete thin membrane reaction in lobular-type lesions and reduced membrane reaction in ductal-type lesions were seen in 25 of the total 161 cases (15.5%). E-cadherin immunoreaction with two different antibodies showed discrepant results in 5 of 78 cases tested (6.4%). This study illustrates (1) interobserver variability of the morphologic diagnoses of lobular neoplasia/infiltrating lobular carcinoma and duct neoplasia/infiltrating duct carcinoma, (2) the occasional presence of aberrant E-cadherin stain pattern in these breast lesions and (3) variability of E-cadherin immunostaining results by two different antibodies.

Estrogen receptor beta in breast cancer: associations between ERbeta, hormonal receptors, and other prognostic biomarkers.

The estrogen receptor (ER)-beta isoform has been recently identified to be distinct from ERalpha isoform and regulates separate sets of genes, and can exert opposite signaling functions depending on the ligand and response elements. Previous studies of ERbeta have been at the mRNA level and few by immunohistochemistry, and the results are inconsistent. In this study the authors compared expression of ERbeta with those of other prognostic biomarkers by immunohistochemistry on tissue microarray slides, and with morphologic parameters on 147 cases of primary breast cancer. Immunoreactivity of more than 10% of cancer cells was considered to be positive. Associations between categoric variables were analyzed using the chi test, and a P value less than 0.05 was considered to be significant. ERbeta was expressed in benign epithelium and stromal cells, and breast cancer cells in 59% of different histologic types of breast cancer. ERbeta was coexpressed with ERalpha in 45% of cases. There was a statistically significant association between expression of ERbeta and Her-2/neu (P<0.000), cathepsin D (P<0.02), p53 (P<0.03), and PS2 (P<0.002). Ki-67 was almost exclusively expressed in ERbeta-positive cells. No statistically significant association was seen between ERbeta expression and histologic grade, DNA ploidy, or S-phase.

Direct application of Etest to Gram-positive cocci from blood cultures: Quick and reliable minimum inhibitory concentration data

The Etest was applied directly to 100 Gram-positive bacterial strains from blood cultures to measure their minimum inhibitory concentration (MIC). Results showed 100% concordance of MIC data between a direct Etest method and the standard Etest method for Streptococcus pneumoniae, beta-hemolytic streptococci, and viridans group streptococci. In addition, direct Etest for Staphylococcus aureus, coagulase negative staphylococci, Enterococcus faecium, and Enterococcus faecalis showed 83 to 100% correlation with standard Etests. These data indicate that the Etest is useful to obtain MIC data on Gram-positive cocci (especially streptococci) directly from positive blood cultures. The advantages of a direct Etest are two fold: MIC results can be obtained 24 hours earlier than standard methods and a more representative population of the bacterial isolate is tested.

Ultrastructural "fingerprint" in cryoprecipitate and glomerular deposits: a case report of systemic lupus erythematosus.

A 20 year old woman had lupus nephritis and cryoglobulinemia. The cryoglobulins isolated from the serum and a renal biopsy specimen were studied by means of immunofluorescence, immunochemistry, and electron microscopy. Ultrastructural fingerprint structures were observed both in the cryoprecipitate and in the glomerular deposits, as were IgG, IgM, and IgA. These observations furnish morphologic evidence for the glomerular deposition of cryoglobulins in lupus nephritis.

Correlation of viral RNA, alanine aminotransferase, and histopathology in hepatitis C virus-associated hepatitis.

BACKGROUNDnHepatitis C virus (HCV) infection is usually monitored by the level of alanine aminotransferase (ALT) and histopathological changes in liver biopsy specimens. However, accumulating data indicate these parameters are not always correlated with disease progression or the response of HCV infection to therapy.nnnMATERIALS AND METHODSnUsing the Amplicor PCR Monitor Test Kit (Roche Diagnostic Systems, Branchburg, NJ), HCV RNA level was measured in 38 patients with positive anti-HCV antibodies and in 21 of those patients after interferon treatment. The grade and stage of histological changes on hematoxylin and eosin-stained sections of liver biopsy specimens were evaluated on a scale of 1 to 4. In each case, the HCV RNA level was compared with the histological grade or stage and level of ALT and statistically analyzed by Students t-test.nnnRESULTSnALT level did not correlate with pretreatment and posttreatment levels of HCV RNA or histopathological changes. However, there was a statistically significant correlation between HCV RNA and histological grade (P,.05).nnnCONCLUSIONnHCV RNA measurement is a better means of determining and monitoring HCV infection than either ALT level or histopathological characteristics and may provide insight into hepatic injury caused by HCV infection even without an invasive liver biopsy.

Syphilitic lymphadenitis Immunofluorescent identification of spirochetes from imprints

We are reporting two cases of early syphilis with inguinal buboes which were surgically excised. Th clinical impression was lymphoma in one case and inguinal hernia in the other. The correct and specific diagnosis was quickly established by the application of fluorescent antibody technique to imprints of the enlarged lymph node.

Abstract 4548: The anti-proliferative activity of TAS-108 (a steroid anti-estrogen) is augmented by high ERβ levels in breast cancer cells

Proceedings: AACR Annual Meeting 2014; April 5-9, 2014; San Diego, CAnnBackground: TAS-108 is an anti-estrogen that binds to both ERα and ERβ and has potent anti-proliferative activity in vitro and in vivo assay. Recently, the phase II clinical study of TAS-108 demonstrated competitive clinical benefits with decreased adverse effects. However, the molecular mechanism TAS-108 remains uncharacterized.nnMethods: Plasmids containing ERα or ERβ fused with N- and C-terminal fragments of firefly luciferase were constructed for split luciferase complementation assays. The resulting plasmids were transfected in HEK293 cells for 24 hr and TAS-108 was added to the media for 6 hr. For RT-qPCR of AREG and TFF1 and proliferation assay, ERβ was transfected in MCF7 cells for 24hr. The proliferation level was determined by measuring the fluorescent level induced by Prestoblue® reagent.nnResults: The split luciferase complementation assay demonstrates that TAS-108 increases ERα/β heterodimerization by ≈100-fold than ERα/α homodimerization. The potency of TAS-108 in MCF7 cells was increased significantly by the enforced expression of ERβ via transfection (MCF7-ERβ); 30nM TAS-108 was suitable to block the E2 mediated increases of AREG and TFF1 expression and significantly decreased proliferation of MCF7-ERβ.nnConclusions: TAS-108 has a higher affinity for ERα/β heterodimerization than ERα/α homodimerization, and TAS-108 anti-proliferative activity is augmented by blocking the expression of E2-induced proliferative genes when coupled with increased levels of ERβ. Our findings underscore the molecular role of ERβ in the biology and suggest that promoting ERα/β heterodimerization may be an effective strategy to increase anti-tumor activity in breast cancer.nnNote: This abstract was not presented at the meeting.nnCitation Format: Ye-Hwang Cheong, Young J. Choi. The anti-proliferative activity of TAS-108 (a steroid anti-estrogen) is augmented by high ERβ levels in breast cancer cells. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4548. doi:10.1158/1538-7445.AM2014-4548

Abstract 2146: The chemo-preventive effect of ER-β agonist on DMBA induced breast cancers

Introduction: ER-beta (ER-β) regulates genes involved in cellular proliferation and apoptosis, and is considered to be anti-proliferative and tumor suppressive. ER-β is frequently reduced or lost in breast cancers (BrC). ER-β can also transdominantly inhibit ER-α transcription at some genes, even in the absence of ligand. Thus, ER-β selective agonists such as diarylpropionitrile (DPN) may inhibit breast cancer cells, and may also prevent tumor initiation or tumor growth of BrC through lowering proliferation and higher apoptosis. Methods: A total of 49 Sprague-Dawley rats (19 ovariectomized (OVX) and 30 non-OVX) were treated with DMBA breast cancer carcinogen. Then the rats were separated into two groups. In the first group, the rats received daily DPN injections (1000ug/kg BW) starting immediately after DMBA administration, to observe tumor prevention or initiation. In the second, only the rats developed tumor(s) ≥ 1cm received daily DPN, to observe reduction or increase of tumor sizes. The rats were sacrificed to collect tumors and normal breast tissues, which were tested for HE 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2146. doi:10.1158/1538-7445.AM2014-2146