Reasons for the delays in the definitive diagnosis of lung cancer for more than one year from the recognition of abnormal chest shadows

金沢大学医薬保健研究域医学系Objective. Primary lung cancer generally has a poor prognosis if not diagnosed at an early stage. But some lung cancers grow very slowly. In particular, adenocarcinoma is sometimes observed for years with no change of tumor size. In this study, we examined the reasons for the delays in reaching a definitive diagnosis of lung cancer. Methods. We retrospectively reviewed primary lung cancer cases between January 1995 and December 1999 and examined those whose definitive diagnoses were delayed for more than a year. Results. A total of 222 primary lung cancers were diagnosed. Of those, 19 patients (group A, 8.6%) were diagnosed after more than a year, and the other 203 (group B, 91.4%) were diagnosed within one year. The proportion of women in group A was significantly higher than that in group B (p<0.05). The mean age of group A was significantly younger than that of group B (p<0.05). The Brinkman Index of group A was significantly lower than that of group B (p<0.05). The histologic types were significantly different between the two groups (p<0.05). In group A, 18 patients (94.7%) had adenocarcinomas. Five primary reasons for the delays in group A were identified: 1) Four patients were tentatively diagnosed as inflammation or benign tumor on CT and were consequently not followed-up. 2) The chest CT shadows in 6 patients were suspected lung cancers but transbronchial lung biopsy findings did not show malignancy. 3) Four patients were tentatively diagnosed as inflammation or benign tumor on CT, but the tumors showed only very slow growth or no change at all. 4) The chest CT shadows of 2 patients were suspected lung cancer, but the patients refused to undergo video-assisted thoracic surgery (VATS) or closer examination. 5) Three patients did not consult medical facilities for a second examination. Conclusions. Many of the adenocarcinomas reviewed in our study grew slowly or remained unchanged for years. Doctors are mainly responsible for the delays in the definitive diagnosis and should aggressively perform VATS or closer examinations without hesitation

腹膜および胸膜悪性中皮腫におけるEGFR発現の比較

An evaluation of epidermal growth factor receptor (EGFR) phenotypic expression in malignant pleural and peritoneal mesothelioma was undertaken, using immunohistochemical (IHC) and fluorescence in situ hybridization (FISH) analysis. Thirty-eight malignant mesothelioma (MM) specimens were subjected to IHC staining and FISH to evaluate the expression of EGFR protein and gene status. Overall positive IHC reaction was detected in 20/38 (53%) cases, in 11/22 (50%) pleural MM, and in 9/16 (56%) peritoneal MM. Our study confirmed that EGFR membranous expression is a common feature in MM, but not in benign mesothelial lesion. Thirty-seven cases did not show a gene copy number gain. Only one case showed a copy number gain. The protein overexpression of EGFR was not related to a gene copy number gain.博士（医学）・乙第1299号・平成24年5月28日© 2012 The Authors. Pathology International© 2012 Japanese Society of Pathology and Blackwell Publishing Asia Pty Ltd

Clinicopathological significance of antinuclear antibodies in non-alcoholic steatohepatitis

金沢大学大学院医学系研究科がん細胞学Aim: Serum antinuclear antibodies (ANA) are occasionally noted in patients with non-alcoholic steatohepatitis (NASH). We examined the significance of ANA in NASH. Methods: We compared clinicopathological features in patients with ANA-positive NASH (n = 35) and ANA-negative NASH (n = 36). Inflammatory cell profiles and the distribution of oxidative stress markers were also examined immunohistochemically. Results: ANA-positive NASH was significantly associated with female gender (P = 0.005), high degree of portal inflammation (P = 0.039), interface activity (P = 0.036) and hepatocellular ballooning (P = 0.0008). In addition, ANA of high titer (320-fold or more) was significantly associated with the histological grade and stage of NASH (P = 0.02). The degree of steatosis wais rather mild in the high-titer ANA group(P = 0.01). The analysis of inflammatory cell profiles revealed that CD3-positive T cells were predominant and plasma cells were rather few in the portal area and hepatic lobules in both ANA-positive and ANA-negative groups. There was no difference in the distribution of oxidative stress markers between ANA-positive and ANA-negative groups. Conclusion: These findings suggest that the presence of ANA may be related to the progression of NASH and that a different type of autoimmune mechanism may be involved in the pathogenesis of NASH with ANA, compared to the pathogenesis of autoimmune hepatitis. © 2007 The Japan Society of Hepatology

Casce of Pancreatic Cancer with Invasion to the Wall of the Intrahepatic Bile Duct

69才の女性で癌性腹膜炎, 胆管拡張およぴ胆嚢腫大などが認められ, 剖検時まで確定診断の困難であった膵摘の1例を報告した. 腹水の細胞診ではclass V(adenocardnoma)であったが, 画像診断では原発巣を特走し得なかった. 剖検時の肉眼的所見でも膵臓に腫瘍塊を認めなかったが, 組織学的検索により膵体部より高分化型腺癌(duct cell carcinoma)がみられ, これが肝内胆管を這うような形で肝内に転移していた.(1987年2月10日 受付)Presented here is the case of a 69-year-old woman with pancreatic cancer, Efforts were made to discover the origin of the cancer but without success. Tumor nodules were scarcely observed in the pancreas macroscopically at autopsy, while histological examination of the pancreas revealed the presence of a well-differentiated adenocarcinoma (duct cell carcioma). The invasion to the wall of the intrahepatic bile duct was also observed microscopically