Diagnosis, Pathological Findings, and Clinical Management of Gangliocytic Paraganglioma: A Systematic Review

Background: Although gangliocytic paraganglioma (GP) is considered a rare benign neuroendocrine tumor, cases of mortality have been reported. Occasionally, GP is misdiagnosed as neuroendocrine tumor G1, which is associated with a poorer prognosis than GP. To avoid such misdiagnoses, it is important to understand the clinicopathological characteristics of GP. Thus, herein, we discuss the current literature on the clinicopathological characteristics of GP.Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed and Japana Centra Revuo Medicina searches were used to identify papers describing GP. Inclusion criteria included confirmation of epithelioid, spindle-shaped, and ganglion-like cells in the main article and/or figures and whether the paper was cited in other studies of GP. Data were collected on age, sex, site of the primary lesion, tumor size, treatment, prognosis, lymph node metastasis (LNM), depth of tumor invasion, rate of preoperative diagnosis, and clinical symptoms.Results: In total, 162 papers containing 263 cases of GP met the criteria. The mean age at diagnosis was 53.5 years. The male-to-female ratio was 157:104. The mean tumor size was 25.7 mm. The predominant site of the primary tumor was the duodenum (89.7%). The most common clinical sign of GP was gastrointestinal bleeding (47.9%). Other signs and symptoms of GP included abdominal pain (44.7%), anemia (20.3%), incidental findings (12.9%), nausea (6.9%), weight loss (5.5%), general fatigue (5.1%), jaundice (4.6%), and incidental autopsy findings (5.1%). LNM was observed in 11.4% of patients. Liver metastasis was observed in 1.1% of patients. Depth of tumor invasion (penetrating beyond the submucosal layer or sphincter of Oddi) was by far the most significant risk factor for LNM in patients with GP. This suggests, along with histological heterogeneity, that GP may have hamartomatous characteristics. Furthermore, immunohistochemical expression of progesterone receptor and pancreatic polypeptide were useful in distinguishing between GP and neuroendocrine tumor G1, even in small biopsy specimens.Conclusions: We reveal the clinicopathological characteristics of GP, including risk factors for LNM, differential diagnostic approaches, and improvements in the clinical management of this tumor.In addition, GP may have hamartomatous characteristics

女性の年齢と食育の認識が食生活に及ぼす影響

本研究では､成人女性の年齢別に食育の認識が食生活にどのような影響を及ぼしたのかを明らかにすることを目的とし分析を行った｡その結果､年齢の差が食育の認識や多くの食生活に影響していた｡また､年齢別に食育の認識と食生活を比較すると､全年齢において食育の認識が｢食事ﾊﾞﾗﾝｽｶﾞｲﾄﾞ･食生活指針の認識｣に影響していた｡一部の年齢では｢朝食摂取頻度｣｢食前･食後の挨拶｣｢食品表示の確認｣｢よく噛むことへの意識｣に食育の認識の有無が影響していたが､｢家族との共食頻度｣｢夕食開始時刻｣等は全年齢において食育の認識の影響が確認されなかった｡今後の成人女性に対する食育活動では､食育の認識がない者に対してはこれまでと同様に食育の普及に努め､食育を認識できている者に対しては家族との共食頻度の増加や夕食開始時刻の健康への影響等の食育における意味を周知させることが必要と考える｡In this study, in order to clarify how awareness of dietary education had an effect on dietary habit according to adult\u27s female-age, we analyzed the data. As a result, it was found that age-gap had an effect on awareness of dietary education and many dietary habits. When comparing awareness of dietary education with dietary habit according to age, it was revealed that awareness of dietary education had an effect on“guidance of well-balanced meal and awareness of guideline of dietary habit”in all age groups. Although, in some generation, presence or absence of dietary awareness had an effect on“frequency of having breakfast”,“greeting before/after meal”,“confirmation of food-labeling”and“awareness of chewing-well”, but it was not confirmed that awareness of diet had an effect on“frequency of having meals with family”nor on“starting time of dinner”in all generations. The results indicate the positive benefits of popularizing dietary education among adult females who are not knowledgeable about this topic. At the same time, it is important to inform health-conscious people of the health effects of having meals with family and having dinner at a certain time

Low HER2 expression is a predictor of poor prognosis in stage I triple-negative breast cancer

IntroductionTriple-negative breast cancer (TNBC) is negative for hormone receptors and human epidermal growth factor receptor 2 (HER2). In stage I TNBC, adjuvant therapy or follow-up are performed according to risk factors, but clinical trial data is scarce. In recent years, it has been reported that HER2-low cases (1+/2+ and in situ hybridization negative) have different prognoses than HER2-0 cases. However, the risk of recurrence and risk factors in this HER2-low population for stage I TNBC have not yet been investigated.MethodsHerein, out of 174 patients with TNBC who underwent surgery from June 2004 to December 2009 at the National Cancer Center Hospital (Tokyo), we retrospectively examined 42 cases diagnosed as T1N0M0 TNBC after excluding those treated with preoperative chemotherapy.ResultsAll patients were female, the median age was 60.5 years, and 11 cases were HER2-low and 31 cases were HER2-0. The median follow-up period was 121 months. Postoperative adjuvant therapy was administered in 30 patients and recurrence occurred in 8 patients. HER2-low cases showed a significantly shorter disease-free survival (HR: 7.0; 95% CI: 1.2– 40.2; P=0.0016) and a trend towards shorter overall survival (hazard ratio [HR]: 4.2, 95% confidence interval [CI]: 0.58–31.4) compared with that of HER2-0 cases. HER2 was also identified as a factor for poor prognosis from the point- estimated values in univariate and multivariate analyses after confirming that there was no correlation between the other factors.ConclusionFor patients with stage I TNBC, the HER2-low population had a significantly worse prognosis than the HER2-0 population

佐世保市民における食育の認知及び実践

佐世保市では平成18年に｢佐世保市食育推進計画｣を策定し､食育に取り組んできた｡本報告では平成18年からの5か年で佐世保市民の食育に関する知識や食生活がどのように変化したのかを平成22年9月に行った｢食育に関するｱﾝｹｰﾄ調査｣の結果を基に検討し､今後の食育推進における資料を得ることを目的とした｡食育に関する知識は平成18年と比較すると広く普及していたが､食生活の改善に結びついていない項目も多くみられた｡また､食生活の改善には食育の取り組みを行うという意識を持つことが最も重要であることが示されたが､食育に関する知識がない者も正しい知識を得ることで､改善する可能性が示された｡以上のことより､佐世保市においては今後も継続した食育の推進を図ることが必要であり､食生活の改善のためには､食育に取り組むことを目指すだけでなく､食育に関する正しい知識の普及が重要であることが示された｡“Sasebo Food Education Promotion Plan”was designed in 2006 in Sasebo city and then incorporated into food education. Subsequently, after 5 years, a“questionnaire survey related to food education”was conducted in September 2010 in order to examine whether there was a change in the dietary habits and dietary knowledge of the residents of Sasebo city. The objective of the present report was to obtain a future data regarding the promotion of food education on the basis of the results of the questionnaire administered in 2010.The information about food education is spreading widely now, as compared to 2006. However, many instances not related to the improvement of dietary habits were found. Moreover, it was indicated that in order to improve dietary habits, one has to be aware of incorporating the food education plan in his or her life, but the right dietary knowledge should be provided to people who do not have any knowledge regarding this.Therefore, in future, a plan for continuous promotion of food education should be designed in Sasebo city, and it should not only be incorporated in food education, but the right information should be imparted in order to improve the dietary habits

佐世保市の食育に関するｱﾝｹｰﾄ調査報告(学齢期)

近年の子どもたちを取り巻く社会環境においては､朝食欠食や偏食等にみられるような不規則な食生活など､様々な問題が提起されている1-4)｡平成17年に食育基本法が公布され､佐世保市においても､平成18年度に｢佐世保市食育推進計画｣(平成18年度～平成22年度)6) を作成し､食育の推進に努めてきた｡この食育推進計画における目標値の達成状況を把握するために｢食育に関するｱﾝｹｰﾄ調査｣7) を行った｡本報告においては､特に学齢期の子どもを対象とした調査結果および数値目標との比較を行った｡その結果､計画策定時の状態よりも改善されている事項が多く､食育推進の取組の効果があった｡ただし､目標値にまだ達していないことから､今後も継続した食育推進の取組が必要であり､それには､家庭や教育機関､社会など環境が関与する必要があることが示唆された｡Children in recent years are irregular eating habits in breakfast skipping a meal or an unbalanced diet, and have become a social problem. The basic law on nutritional education was proclaimed in 2005, the Sasebo food education promotion plan was drawn up also in Sasebo in 2006, and it has striven for promotion of food education. In this food education promotion plan, the questionnaire about food education was performed to the original investigation, and the progress which is a plan was checked. Especially this report compared results of an investigation and a desired value for the school age child. As a result, there were many improving points as an effect of a food education promotion plan. However, since a desired value has not been reached yet, the continued food education promotion is required. And it was suggested to goal achievement that the influence of a home, educational facilities, and society is a theme

Associations of High-Density Lipoprotein Functionality with Coronary Plaque Characteristics in Diabetic Patients with Coronary Artery Disease: Integrated Backscatter Intravascular Ultrasound Analysis

High-density lipoprotein (HDL) functionality has been reported to be associated with coronary artery disease (CAD). However, little is known about the impact of HDL functionality on coronary atherosclerosis. Thirty-eight type 2 diabetic patients with CAD who underwent percutaneous coronary intervention were examined. Coronary atheroma burden and plaque composition of the culprit lesions were assessed using conventional gray-scale and integrated backscatter intravascular ultrasound. HDL-mediated cholesterol efflux capacity (HDL-CEC) and HDL antioxidant capacity, estimated as HDL inflammatory index (HII), were examined. The associations between HDL functionality and coronary plaques were analyzed using multivariate data analysis, including principal components analysis and orthogonal partial least squares (OPLS) models. Percent atheroma volume was correlated with HDL-CEC (r = 0.34, p = 0.04) but not with HII (p = 0.65). The OPLS model demonstrated that the percentage lipid volume was significantly associated with HDL functionality [coefficient (95% confidence interval); HDL-CEC: −0.26 (−0.49, −0.04); HII: 0.34 (0.08, 2.60), respectively]. HII exhibited the highest variable importance in projection score, indicating the greatest contribution. HDL functionality was associated with coronary plaque composition, a key component of plaque vulnerability. Our findings highlight the potential importance of HDL functionality for coronary plaque stabilization

Duodenal Rare Neuroendocrine Tumor: Clinicopathological Characteristics of Patients with Gangliocytic Paraganglioma

Gangliocytic paraganglioma (GP) has been regarded as a rare benign tumor that commonly arises from the second part of the duodenum. As GP does not exhibit either prominent mitotic activity or Ki-67 immunoreactivity, it is often misdiagnosed as neuroendocrine tumor (NET) G1. However, the prognosis might be better in patients with GP than in those with NET G1. Therefore, it is important to differentiate GP from NET G1. Moreover, our previous study indicated that GP accounts for a substantial, constant percentage of duodenal NETs. In the present article, we describe up-to-date data on the clinicopathological characteristics of GP and on the immunohistochemical findings that can help differentiate GP from NET G1, as largely revealed in our new and larger literature survey and recent multi-institutional retrospective study. Furthermore, we would like to refer to differential diagnosis and clinical management of this tumor and provide intriguing information about the risk factors for lymph node metastasis on GP