A Case Report of Lipid-Rich Carcinoma of the Breast Including Histological Characteristics and Intrinsic Subtype Profile

A 57-year-old Japanese woman with schizophrenia, who had received long-term treatment with neuroleptics, noticed a painless, pea-sized lump in her right breast. She was admitted to our hospital and a malignant tumor was diagnosed. The patient underwent a conservative radical mastectomy (Patey's operation). The excised tumor measured 2.0 × 1.2 × 1.1 cm in diameter, and its cut surface was grayish-white. Histologically, tumor cells with clear to foamy cytoplasm were invariably Oil Red O-positive and periodic acid Schiff-negative with or without diastase digestion. The tumor was diagnosed as a lipid-rich carcinoma accompanied by an in situ component. Neuroleptics increase serum prolactin levels by interfering with dopaminergic inhibition of prolactin secretion. Immunohistochemical analysis revealed that, although prolactin was not detected, the tumor cells expressed prolactin receptor, indicating prolactin as the genesis of this neoplasm. In immunohistochemical intrinsic subtype analysis, the tumor was negative for estrogen receptor, progesterone receptor, human epidermal growth factor receptor 1 and 2, and basal cytokeratins (CK5, CK6, and CK14), indicating an unclassified (all-marker negative) subtype. Axillary lymph nodes were free of metastasis (stage I), and the patient has been well for 20 years without any evidence of recurrence

N -Ethyl- N -Nitrosourea Induces Retinal Photoreceptor Damage in Adult Rats

Seven-week-old male Lewis rats received a single intraperitoneal injection of N-ethyl-N-nitrosourea (ENU) (100, 200, 400 or 600 mg/kg), and retinal damage was evaluated 7 days after the treatment. Sequential morphological features of the retina and retinal DNA damage, as determined by a TUNEL assay and phospho-histone H2A.X (γ-H2AX), were analyzed 3, 6, 12, 24 and 72 hr, 7 days, and/or 30 days after 400 mg/kg ENU treatment. Activation of the nuclear enzyme poly (ADP-ribose) polymerase (PARP) was analyzed immunohistochemically by poly (ADP-ribose) (PAR) expression in response to DNA damage of the retina. All rats that received ≥ 400 mg/kg of ENU developed retinal degeneration characterized by the loss of photoreceptor cells in both the central and peripheral retina within 7 days. In the 400 mg/kg ENU-treated rats, TUNEL-positive signals were only located in the photoreceptor cells and peaked 24 hr after ENU treatment. The γ-H2AX signals in inner retinal cells appeared at 24 hr and peaked at 72 hr after ENU treatment, and the PAR signals selectively located in the photoreceptor cell nuclei appeared at 12 hr and peaked at 24 hr after ENU treatment. However, degeneration was restricted to photoreceptor cells, and no degenerative changes in inner retinal cells were seen at any time points. Retinal thickness and the photoreceptor cell ratio in the central and peripheral retina were significantly decreased, and the retinal damage ratio was significantly increased 7 days after ENU treatment. In conclusion, ENU induced retinal degeneration in adult rats that was characterized by photoreceptor cell apoptosis through PARP activity

Late recurrence of acinic cell carcinoma of the parotid gland

Acinic cell carcinoma of the salivary glands is a rare cancer representing a low grade malignancy. The recurrence of a tumor is sometimes encountered, usually within 5years of initial operation. We describe an unusual recurrence after a long interval following primary surgery. In1987, a 60-year-old woman underwent excision of a mass in the superficial lobe of the right parotid gland under the preoperative diagnosis of a benign tumor. A histologic diagnosis of acinic cell carcinoma was made by examining sections from the resected mass. The patient noted several small nodules in the right parotid region in 1995, but she did not visit our clinic until 1998 when tenderness developed. A locally recurrent tumor and cervical lymph nodes containing metastases were resected and postoperative radiotherapy was given11years after the first operation. At least 10years of follow-up may be necessary for patients with acinic cell carcinoma because of slow-tumor growth

CD20陰性DLBCL

A ６８-year-old woman presented with sustained fever for more than １ month and admitted due to hematemesis and systemic edema. Computed tomography scan revealed swelling of the cervical, paraaortic lymph nodes. Blood test results showed severe anemia, elevation of white blood cell count, elevation of liver enzyme and coagulopathy with high C-reactive protein. Biopsy of the right cervical lymph node showed proliferation of abnormal lymphoid cells with necrosis and hemorrhage, which are positive for CD７９α, CD３０, MUM‐１, and bcl‐６ and negative for CD２０, CD５, CD１０, ALK, CD３８, CD１３８, and EBER. Gene rearrangement of immunoglobulin heavy chain was detected in tumor cells. Bone marrow aspiration showed tumor involvement. The patient was diagnosed with de novo CD２０‐negative diffuse large B-cell lymphoma（DLBCL）stage IV B. Reduced CHOP therapy was performed under artificial respiration due to pulmonary edema and takotsubo cardiomyopathy. Although her general condition and high CRP levels temporarily improved, she died ４７ days after admission due to rapid relapse. De novo CD２０‐negative DLBCL was rare and presented with high CRP levels and rapid progression, and was thought to be clinically different from the existing DLBCL. It is imperative to elucidate molecular pathophysiology and establish new treatment strategy for de novo CD２０‐negative DLBCL

Inflammatory bowel disease in Tokushima prefecture : A report of questionnaire investigation

To investigate the number of cases and clinical features of inflammatory bowel disease, a questionnaire was sent to 1,271 hospitals or clinics in Tokushima prefecture. A total of 320 cases were collected from 60 institutes for the period from January to December 1997. Eight cases were excluded from this study because of duplicated report (6 cases) and inadequate diagnosis (2 cases). Finally, 312 cases were investigated on their clinical features, treatments, complications, and prognosis. The cases included 195 ulcerative colitis (male 106, female 83, gender unknown 6 cases, age ranged 9-81, mean 39.5± 14.3 (standard deviation (SD) years old), 69 Crohn's disease (male 39, female 24, gender unknown 6 cases, age ranged 17-87, mean 35.1±10.5 (SD) years old), 28 ischemic colitis (male 11, female 17, mean age 65.9±12.6 (SD) years old), 9 intestinal tuberculosis (male 1, female 6, gender unknown 2, age 66.9±6.1 (SD) years old), 4 intestinal Behcet (male 3, female 1, age 39.0±14.2 (SD) years old), 6 simple ulcers (male 3, female 3, age 67.7±11.8 (SD) years old), and a case of aphtous enteritis. Two toxic megacolon cases and 5 colorectal cancer cases were reported among the 195 ulcerative colitis patients. 44 cases out of 69 Crohn's disease patients were received surgical treatment because of severe complications including perforation (12 cases), stenosis (10 cases), internal fistula formation (8 cases) and so on. However, no case died because of the diseases except 3 untraceable patients

Improving Students’ Communicative Competence in “Speaking (Presentation)” in Primary School Foreign Language Activities and Foreign Language Studies-Based on Explicit and Implicit Teaching of Communicative Competence, Peer Assessment by Pairs and Groups, and Cooperative Learning-

departmental bulletin pape

Cutoff Values of Serum IgG4 and Histopathological IgG4+ Plasma Cells for Diagnosis of Patients with IgG4-Related Disease

IgG4-related disease is a new disease classification established in Japan in the 21st century. Patients with IgG4-related disease display hyper-IgG4-gammaglobulinemia, massive infiltration of IgG4+ plasma cells into tissue, and good response to glucocorticoids. Since IgG4 overexpression is also observed in other disorders, it is necessary to diagnose IgG4-related disease carefully and correctly. We therefore sought to determine cutoff values for serum IgG4 and IgG4/IgG and for IgG4+/IgG+ plasma cells in tissue diagnostic of IgG4-related disease. Patients and Methods. We retrospectively analyzed serum IgG4 concentrations and IgG4/IgG ratio and IgG4+/IgG+ plasma cell ratio in tissues of 132 patients with IgG4-related disease and 48 patients with other disorders. Result. Serum IgG4 >135  mg/dl demonstrated a sensitivity of 97.0% and a specificity of 79.6% in diagnosing IgG4-related disease, and serum IgG4/IgG ratios >8% had a sensitivity and specificity of 95.5% and 87.5%, respectively. IgG4+cell/IgG+ cell ratio in tissues >40% had a sensitivity and specificity of 94.4% and 85.7%, respectively. However, the number of IgG4+ cells was reduced in severely fibrotic parts of tissues. Conclusion. Although a recent unanimous consensus of all relevant researchers in Japan recently established the diagnostic criteria for IgG4-related disease, findings such as ours indicate that further discussion is needed

Bilateral corneal denting after surgery under general anesthesia: A case report

Purpose: To report a case of temporary bilateral corneal denting in a patient who underwent cardiovascular surgery under general anesthesia. Observations: A 71-year-old male with no history of ophthalmological disease experienced bilateral corneal denting immediately after undergoing surgery for aneurysm of the thoracic aorta under general anesthesia. Anesthesia was induced with propofol and maintained with rocuronium bromide and remifentanil hydrochloride. The initial examination revealed significant denting on the surface of both the corneas and ocular hypotension. Visual evaluation could not be performed due to the patient's low level of consciousness resulting from delayed emergence from anesthesia. After applying tropicamide and phenylephrine ophthalmic solution for fundus examination, the ocular morphology improved. Ocular pressure was normal on the day after surgery, and creasing on the surface of the corneas had disappeared. Conclusions: and Importance: We experienced a patient with bilateral corneal denting following a cardiovascular surgery under general anesthesia. The dents could be attributed to augmentation of ocular hypotension using several types of anesthesia at relatively high doses. Keywords: General anesthesia, Cornea denting, Complication, Cardiovascular surger

Photodynamic therapy combined with anti-vascular endothelial growth factor therapy for pachychoroid neovasculopathy.

This multicenter retrospective study was conducted to evaluate the 1-year treatment outcome of photodynamic therapy (PDT) combined with anti-vascular endothelial growth factor (VEGF) therapy for pachychoroid neovasculopathy (PNV). A total of 42 eyes of 42 patients with treatment-naïve PNV who were treated with PDT combined with intravitreal injections of an anti-VEGF agent (ranibizumab or aflibercept) for 1 year. All eyes showed exudative and/or hemorrhagic changes that affected the fovea at baseline. After the initial combination therapy, subfoveal choroidal thickness (SCT) and central retinal thickness (CRT) were significantly reduced and were maintained as such for 12 months (P < 0.01 in SCT and CRT). The best-corrected visual acuity (BCVA) (0.19 ± 0.30 at baseline) significantly improved at 3 months (0.15 ± 0.29, P < 0.05) and further improved at 12 months (0.10 ± 0.30, P < 0.01) when compared to that at baseline. After the initial combination therapy, 32 eyes (76.2%) required no additional treatments for 12 months. The mean number of additional PDT and intravitreal injections of anti-VEGF agents was 0.1 ± 0.3 and 0.9 ± 1.9, respectively. Of the 42 eyes included in this study, 22 eyes (52.4%) had polypoidal lesions at baseline. No significant differences in SCT, CRT, or BCVA were observed at any time points between eyes with and without polypoidal lesions. Of 20 eyes without polypoidal lesions, only 1 eye (5.0%) needed additional treatments. PNV, especially without polypoidal lesions, can be treated effectively with PDT combined with anti-VEGF therapy with few sessions