Anal canal adenocarcinoma with neuroendocrine features accompanying secondary extramammary Paget disease, successfully treated with modified FOLFOX6: a case report

Background:Anal canal cancer occasionally accompanies extramammary Paget disease. Although most of themare squamous cell carcinoma, anal canal adenocarcinoma with neuroendocrine features accompanying secondaryextramammary Paget disease has never been reported.Case presentation:Here, we report a 76-year-old man presented with pruritus in the perianal area. Investigationrevealed a fist-sized perianal erythema, diffuse liver tumors, and right inguinal lymph node swelling. Pathologicalexamination of biopsies from the erythema suggested secondary extramammary Paget diseasewith positive cytokeratin-7 and -20 expressions and negative GCDFP-15 expression. The anal canal tumor was confirmed by digital examinationand endoscopy. Biopsies from the anal canal tumor, swollen lymph node, and Paget lesion all showed poorlydifferentiated adenocarcinoma with neuroendocrine features expressing synaptophysin and chromogranin A.Serum CEA and NSE levels were high, 809.4 ng/ml and 85.8 ng/ml, respectively. After chemotherapy with modifiedFOLFOX6 for 2 months, the Paget lesion disappeared, and the primary anal canal tumor and liver metastases shrunkremarkably. Serum CEA and NSE levels decreased promptly to within normal ranges.Conclusions:This is a clinically significant case, as it reveals novel pathological features about anal canal cancer withsecondary Paget disease and successfully treated with modified FOLFOX6. Careful pathological investigation andappropriate treatment choice are needed for this rare cancer

研修生参画型院内教育において教育委員に求める能力の検討

研修生参画型院内教育を企画・支援した教育委員の学び・感想より、そのプロセスを明らかにし、教育委員に求める能力を明らかにすることを目的とした。具体的には、本教育方法を担当した教育委員7名に、学び・感想を人10～ 15枚のカードに記入してもらい、K」法により図解化した。その結果、本教育方法のプロセスは、［参画支援要素］と［相互成長促進要素］が循環する「研修生－教育委員の相互成長循環モデル」として表すことができた。教育委員に求める能力として、〈研修生の力を信じる力〉が必要であり、研修生の成長や満足感を知って喜ぶことができ、〈こだわりと決断を使い分けられる力〉〈連携・調整する力〉〈やる気を引き出す力〉が抽出できた

Molecular mechanisms of cell death: recommendations of the Nomenclature Committee on Cell Death 2018.

Over the past decade, the Nomenclature Committee on Cell Death (NCCD) has formulated guidelines for the definition and interpretation of cell death from morphological, biochemical, and functional perspectives. Since the field continues to expand and novel mechanisms that orchestrate multiple cell death pathways are unveiled, we propose an updated classification of cell death subroutines focusing on mechanistic and essential (as opposed to correlative and dispensable) aspects of the process. As we provide molecularly oriented definitions of terms including intrinsic apoptosis, extrinsic apoptosis, mitochondrial permeability transition (MPT)-driven necrosis, necroptosis, ferroptosis, pyroptosis, parthanatos, entotic cell death, NETotic cell death, lysosome-dependent cell death, autophagy-dependent cell death, immunogenic cell death, cellular senescence, and mitotic catastrophe, we discuss the utility of neologisms that refer to highly specialized instances of these processes. The mission of the NCCD is to provide a widely accepted nomenclature on cell death in support of the continued development of the field

Structure, function, and evolution of mouse TL genes, nonclassical class I genes of the major histocompatibility complex

In contrast to well-studied "classical" class I genes of the major histocompatibility complex (MHC), the biology of nonclassical class I genes remains largely unexamined. The mouse TL genes constitute one of the best defined systems among nonclassical class I genes in the T region of the MHC. To elucidate the function and the evolution of TL genes and their relationship to classical class I genes, seven TL DNA sequences, including one from a Japanese wild mouse, were examined and compared with those of several mouse and human classical class I genes. The TL genes differ from either classical class I genes or pseudogenes in the extent and pattern of nucleotide substitutions. Natural selection appears to have operated so as to preserve the function of TL, which might have been acquired in an early stage of its evolution. In a putative peptide-binding region encoded by TL genes, the rate of nonsynonymous (amino acid replacing) substitution is considerably lower than that of synonymous substitution. This conservation is completely opposite that in classical class I genes, in which the peptide-binding region has evolved to diversify amino acid sequences so as to recognize a variety of antigens. Thus, it is suggested that the function of TL antigens is distinct from that of classical class I antigens and is related to the recognition of a relatively restricted repertoire of antigens and their presentation to T-cell receptors