A Case of Super-giant Basal Cell Carcinoma Initially Diagnosed as Multiple Traumas

Basal cell carcinoma (BCC), which is relatively easy to diagnose in a clinical setting, is the most common malignant tumor in the skin. Conversely, a giant BCC, a tumor beyond 5 cm in diameter, is a rare disease. In particular, a giant BCC beyond 20 cm in diameter is called a super-giant BCC, which frequently invades into deeper tissues, including the dermis, bones, or muscles. Here, we present a case of a 71-year-old patient who was initially diagnosed with multiple traumas with a large periosteal defect of the head. The ulcer was surrounded by malodorous necrotic tissue and slough, and several bacteria that caused necrotizing fasciitis were detected. Mapping biopsies after extensive debridement yielded BCC, and therefore, he was finally diagnosed with a super-giant BCC. A careful consultation revealed a history of ulcer on the head after a head injury approximately 10 years ago. He underwent radical dissection including the external table of the skull, followed by a free latissimus dorsi muscle flap with a meshed split-thickness skin graft. Because of the slow and chronic development of a super-giant BCC, accurate diagnosis is often difficult. Careful attention should be paid in patients with long-sustained ulcers

Superchargeを付加した腹直筋皮弁を用いた乳房再建

2013年以降、乳がん全摘後に保険適応となった人工ゲル充填乳房を用いた乳房再建術のまれな合併症として、T細胞型非ホジキンリンパ腫が報告され、同タイプの人工ゲル充填乳房は使用できなくなった。これを受けて、当院では自家組織を用いた乳房再建の症例が増加している。ボリュームのある乳房の場合、腹部を用いた有茎腹直筋皮弁、遊離皮弁が選択されることが多い。有茎皮弁では上腹壁動静脈を血管茎とするが、腹直筋の血行は深下腹壁動静脈優位のため血行が不十分と考えられる硬結が術後に生じることがある。これを改善するため、当科では可能な限り深下腹壁動静脈を胸部のレシピエント血管に吻合してsuperchargeを行い、血行の増強に努めている。遊離皮弁と異なり、皮弁の自由度が制限されるため血管吻合がやや困難であるが、術後は柔らかい乳房が再現されることが期待できる。With the onset of insurance coverage in 2013, implant-based techniques had been popular for breast reconstruction in Japan until fairly recently. However, possible complications of non-Hodgkin’s lymphoma caused by implant materials led a recall of textured-typed implants for breast reconstruction. Such situation led patients head for breast reconstruction using autologous tissue. In case of well-developed breasts, either rectus abdominal musculocutaneous flap or deep inferior epigastric perforator flap is frequently selected for breast reconstruction. The former flap is well-vascularized but rectus abdominal muscle is used to transpose the flap, which could cause the herniation of the abdominal wall as a complication at late-stage. In the latter flap, since abdominal fat tissue is used, reconstructed breasts are similar to original breasts, while operation periods are relatively long in order to anastomose vessels under microscopy. Besides, thrombosis in anastomosed vessels could cause the total necrosis of reconstructed breasts.To overcome the disadvantages of the both methods, rectus abdominal musculocutaneous flaps anastomosed with vessels in the recipient region (i.e., Supercharged flap) have been developed. Here, we will describe seven cases with supercharged flaps to reconstruct breasts performed in our hospital

A Case of Super-giant Basal Cell Carcinoma Initially Diagnosed as Multiple Traumas

Summary:. Basal cell carcinoma (BCC), which is relatively easy to diagnose in a clinical setting, is the most common malignant tumor in the skin. Conversely, a giant BCC, a tumor beyond 5 cm in diameter, is a rare disease. In particular, a giant BCC beyond 20 cm in diameter is called a super-giant BCC, which frequently invades into deeper tissues, including the dermis, bones, or muscles. Here, we present a case of a 71-year-old patient who was initially diagnosed with multiple traumas with a large periosteal defect of the head. The ulcer was surrounded by malodorous necrotic tissue and slough, and several bacteria that caused necrotizing fasciitis were detected. Mapping biopsies after extensive debridement yielded BCC, and therefore, he was finally diagnosed with a super-giant BCC. A careful consultation revealed a history of ulcer on the head after a head injury approximately 10 years ago. He underwent radical dissection including the external table of the skull, followed by a free latissimus dorsi muscle flap with a meshed split-thickness skin graft. Because of the slow and chronic development of a super-giant BCC, accurate diagnosis is often difficult. Careful attention should be paid in patients with long-sustained ulcers

Gold–Titanium(IV) Oxide Plasmonic Photocatalysts Prepared by a Colloid-Photodeposition Method: Correlation Between Physical Properties and Photocatalytic Activities

Colloidal gold (Au) nanoparticles were prepared and successfully loaded on titanium­(IV) oxide (TiO₂) without change in the original particle size using a method of colloid photodeposition operated in the presence of a hole scavenger (CPH). The prepared Au nanoparticles supported on TiO₂ showed strong photoabsorption at around 550 nm due to surface plasmon resonance (SPR) of Au and exhibited a photocatalytic activity in mineralization of formic acid in aqueous suspensions under irradiation of visible light (>ca. 520 nm). A linear correlation between photocatalytic activity and the amount of Au loaded, that is, the number of Au nanoparticles, was observed, indicating that the activity of Au/TiO₂ plasmonic photocatalysts can be controlled simply by the amount of Au loading using the CPH method and that the external surface area of Au nanoparticles is a decisive factor in mineralization of formic acid under visible light irradiation. Very high reaction rates were obtained in samples with 5 wt % Au or more, although the rate tended to be saturated. The CPH method can be widely applied for loading of Au nanoparticles on various TiO₂ supports without change in the original size independent of the TiO₂ phase. The rate of CO₂ formation also increased linearly with increase in the external surface area of Au. Interestingly, the TiO₂ supports showed different slopes of the plots. The slope is important for selection of TiO₂ as a material supporting colloidal Au nanoparticles

A Case of Super-giant Basal Cell Carcinoma Initially Diagnosed as Multiple Traumas

Basal cell carcinoma (BCC), which is relatively easy to diagnose in a clinical setting, is the most common malignant tumor in the skin. Conversely, a giant BCC, a tumor beyond 5 cm in diameter, is a rare disease. In particular, a giant BCC beyond 20 cm in diameter is called a super-giant BCC, which frequently invades into deeper tissues, including the dermis, bones, or muscles. Here, we present a case of a 71-year-old patient who was initially diagnosed with multiple traumas with a large periosteal defect of the head. The ulcer was surrounded by malodorous necrotic tissue and slough, and several bacteria that caused necrotizing fasciitis were detected. Mapping biopsies after extensive debridement yielded BCC, and therefore, he was finally diagnosed with a super-giant BCC. A careful consultation revealed a history of ulcer on the head after a head injury approximately 10 years ago. He underwent radical dissection including the external table of the skull, followed by a free latissimus dorsi muscle flap with a meshed split-thickness skin graft. Because of the slow and chronic development of a super-giant BCC, accurate diagnosis is often difficult. Careful attention should be paid in patients with long-sustained ulcers

Marine ω-3 polyunsaturated fatty acids and risk for colorectal cancer according to microsatellite instability

© 2015 The Author. Published by Oxford University Press. All rights reserved. Background: Chronic inflammation is involved in the development of colorectal cancer (CRC) and microsatellite instability (MSI), a distinct phenotype of CRC. Experimental evidence indicates an anti-inflammatory and antineoplastic effect of marine ω-3 polyunsaturated fatty acids (PUFAs). However, epidemiologic data remain inconclusive. Methods: We investigated whether the association between marine ω-3 PUFAs and CRC varies by MSI-defined subtypes of tumors in the Nurses\u27 Health Study and Health Professionals Follow-up Study. We documented and classified 1125 CRC cases into either MSI-high tumors, in which 30% or more of the 10 microsatellite markers demonstrated instability, or microsatellite-stable (MSS) tumors. Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of MSS tumors and MSI-high tumors in relation to marine ω-3 PUFA intake. All statistical tests were two-sided. Results: Marine ω-3 PUFA intake was not associated with overall incidence of CRC. However, a statistically significant difference was detected by MSI status (P heterogeneity =. 02): High marine ω-3 PUFA intake was associated with a lower risk for MSI-high tumors (comparing 0.30g/d with \u3c0.10g/d: multivariable HR = 0.54, 95% CI = 0.35 to 0.83, P linearity =. 03) but not MSS tumors (HR = 0.97, 95% CI = 0.78 to 1.20, P linearity =. 28). This differential association appeared to be independent of CpG island methylator phenotype and BRAF mutation status. Conclusions: High marine ω-3 PUFA intake is associated with lower risk for MSI-high CRC but not MSS tumors, suggesting a potential role of ω-3 PUFAs in protection against CRC through DNA mismatch repair. Further research is needed to confirm our findings and elucidate potential underlying mechanisms

Prediagnosis plasma adiponectin in relation to colorectal cancer risk according to KRAS mutation status

© The Author 2015. Background: Low levels of adiponectin (ADIPOQ; HGNC ID; HGNC:13633), an adipokine, are associated with obesity, adiposity, excess energy balance, and increased risk of colorectal neoplasia. Given the reported association of increased body mass index (BMI) and low-level physical activity with KRAS-mutated colorectal tumor, we hypothesized that low-level plasma adiponectin might be associated with increased risk of KRAS-mutant colorectal carcinoma but not with risk of KRAS wild-type carcinoma. Methods: We conducted molecular pathological epidemiology research using a nested case-control study design (307 incident rectal and colon cancer case patients and 593 matched control individuals) within prospective cohort studies, the Nurses\u27 Health Study (152 case patients and 297 control individuals, with blood collection in 1989-1990) and the Health Professionals Follow-up Study (155 case patients and 296 control individuals, with blood collection in 1993-1995). Multivariable conditional logistic regression models and two-sided likelihood ratio tests were used to assess etiologic heterogeneity of the associations. Results: The association of low-level plasma adiponectin with colorectal cancer risk statistically significantly differed by KRAS mutation status (Pheterogeneity= .004). Low levels of plasma adiponectin were associated with KRAS-mutant colorectal cancer (for the lowest vs highest tertile: multivariable odds ratio [OR] = 2.83, 95% confidence interval [CI] = 1.50 to 5.34, Ptrend = .002) but not with KRAS wild-type cancer (for the lowest vs highest tertile: multivariable OR = 0.83, 95% CI = 0.4

MicroRNA MIR21 and T cells in colorectal cancer

© 2015 American Association for Cancer Research. The complex interactions between colorectal neoplasia and immune cells in the tumor microenvironment remain to be elucidated. Experimental evidence suggests that microRNA MIR21 (miR-21) suppresses antitumor T-cell-mediated immunity. Thus, we hypothesized that tumor MIR21 expression might be inversely associated with T-cell density in colorectal carcinoma tissue. Using 538 rectal and colon cancer cases from the Nurses\u27 Health Study and the Health Professionals Follow-up Study, we measured tumor MIR21 expression by a quantitative reverse-transcription PCR assay. Densities of CD3+, CD8+, CD45RO (PTPRC)+, and FOXP3+ cells in tumor tissue were determined by tissue microarray immunohistochemistry and computer-assisted image analysis. Ordinal logistic regression analysis was conducted to assess the association of MIR21 expression (ordinal quartiles as a predictor variable) with T-cell density (ordinal quartiles as an outcome variable), adjusting for tumor molecular features, including microsatellite instability; CpG island methylator phenotype; KRAS, BRAF, and PIK3CA mutations; and LINE-1 methylation. We adjusted the two-sided a level to 0.012 for multiple hypothesis testing. Tumor MIR21 expression was inversely associated with densities of CD3+ and CD45RO+ cells (Ptrend \u3c 0.0005). Themultivariateodds ratio of the highest versus lowest quartile of MIR21 for a unit increase in quartile categories of CD3+ or CD45RO+ cells was 0.44 [95% confidence interval (CI), 0.28 to 0.68] or 0.41 (95% CI, 0.26-0.64), respectively. Our data support a possible role of tumor epigenetic deregulation by noncoding RNA in suppressing the antitumor T-cell-mediated adaptive immune response and suggest MIR21 as a potential target for immunotherapy and prevention in colorectal cancer

MicroRNA MIR21

The complex interactions between colorectal neoplasia and immune cells in the tumor microenvironment remain to be elucidated. Experimental evidence suggests that microRNA MIR21 (miR-21) suppresses antitumor T-cell–mediated immunity. Thus, we hypothesized that tumor MIR21 expression might be inversely associated with T-cell density in colorectal carcinoma tissue. Utilizing 538 rectal and colon cancer cases in the Nurses’ Health Study and the Health Professionals Follow-up Study, we measured tumor MIR21 expression by quantitative reverse-transcription polymerase chain reaction assay. Densities of CD3(+), CD8(+), CD45RO (PTPRC)(+) and FOXP3(+) cells in tumor tissue were determined by tissue microarray immunohistochemistry and computer-assisted image analysis. Ordinal logistic regression analysis was conducted to assess the association of MIR21 expression (ordinal quartiles as a predictor variable) with T-cell density (ordinal quartiles as an outcome variable), adjusting for tumor molecular features including microsatellite instability; CpG island methylator phenotype; KRAS, BRAF, and PIK3CA mutations; and LINE-1 methylation. We adjusted two-sided α level to 0.012 for multiple hypothesis testing. Tumor MIR21 expression was inversely associated with densities of CD3(+) and CD45RO(+) cells (P(trend) < 0.0005). Multivariate odds ratio of the highest vs. lowest quartile of MIR21 for a unit increase in quartile categories of CD3(+) or CD45RO(+) cells was 0.44 (95% confidence interval [CI], 0.28 to 0.68) or 0.41 (95% CI, 0.26 to 0.64), respectively. Our data support a possible role of tumor epigenetic deregulation by non-coding RNA in suppressing antitumor T-cell–mediated adaptive immune response, and suggest MIR21 as a potential target for immunotherapy and prevention in colorectal cancer