Enucleation assisted with filler for open-globe injury

In cases of severe open-globe injury, it is often difficult to reconstruct the globe and maintain visual acuity. Ocular globe enucleation may decrease the risk of sympathetic ophthalmia in the fellow eye. However, the surgical procedure is difficult to perform with an open globe, because the injured globe is inclined to collapse. We report the case of an enucleation for an open-globe injury in which we used alginate, which is often used for dental impressions, as filler for the collapsed globe. We were able to maintain the resistance of the globe sufficiently well enough to perform the procedure easily and without complication. Thus, alginate may be a novel aid to assist in enucleation by preserving globe resistance

Low atrial septal pacing with dual-chamber pacemakers reduces atrial fibrillation in sick sinus syndrome

SummaryBackgroundSick sinus syndrome (SSS) is often complicated with the additional presence of atrial fibrillation (AF). Atrial septal pacing, compared with right atrial appendage (RAA) pacing, shortens the atrial conduction time and reduces the dispersion of the refractoriness. However, low atrial septal (LAS) pacing's efficacy for preventing AF in SSS remains controversial in Japan.Methods and resultsWe analyzed 95 consecutive patients with SSS who underwent dual-chamber pacemaker implantations. Forty-two patients (44%) had a history of AF at the time of the pacemaker implantation. In the group without a history of AF, LAS pacing was performed in 17 patients, and RAA pacing in 36 patients. In the group with a history of AF, LAS pacing was performed in 15 patients, and RAA pacing in 27 patients. We evaluated whether LAS pacing prevented the development of de novo AF and the persistence of AF after pacemaker implantations. No significant differences were found in the baseline characteristics between the RAA and LAS groups regardless of an AF history. During a 1-year follow-up period, in the SSS patients without a history of AF, 19.0% (7/36) of the RAA group developed de novo AF, however, 5.9% (1/17) of the LAS group developed de novo AF (p=0.20). On the other hand, in the SSS patients with a history of AF, 22.0% (6/27) of the RAA group developed persistent AF, but none of the LAS group developed any persistent AF (p=0.049). There were no post-operative complications related to the LAS pacing.ConclusionsLAS pacing is safe and feasible. LAS pacing may prevent the progression to persistent AF in SSS patients with dual-chamber pacemakers

Thyroid metastasis of pulmonary adenocarcinoma with EGFR G719A mutation: Genetic confirmation with liquid-based cytology specimens

Presented is a case of advanced pulmonary adenocarcinoma and a thyroid tumour with calcification. EGFR gene mutation testing of the thyroid aspirate specimen revealed a G719A point mutation in exon 18 that was identical to that in the patient's known lung cancer. This case demonstrates the usefulness of liquid-based cytology samples, which enable genetic testing leading to a conclusive diagnosis while preserving the cytological specimens

A multilocular thymic cyst associated with mediastinal seminoma: evidence for its medullary epithelial origin highlighted by POU2F3-positive thymic tuft cells and concomitant myoid cell proliferation

Multilocular thymic cyst (MTC) and germ cell tumors are common diseases that impact the mediastinum. Correctly diagnosing these diseases can be difficult because several other conditions can mimic them. We report a male patient with MTC associated with mediastinal seminoma. A needle biopsy of the mediastinal tumor revealed numerous epithelioid cell granulomas that mimicked sarcoidosis or mycobacterial infection. However, large atypical cells positive for Oct3/4 and KIT were noted between the granulomas; thus, we diagnosed the patient with mediastinal seminoma. The resected tumor, after chemotherapy, consisted of multiple cystic lesions, and a residual germ cell tumor was first considered. However, thymic medulla-specific elements, namely, POU2F3-positive thymic tuft cells and rhabdomyomatous myoid cells accompanying the epithelium, led to the correct diagnosis of MTC. Our case underscores the importance of recognizing the histological features associated with mediastinal seminoma and provides novel findings for MTC pathogenesis, namely, the presence of thymic tuft cells

Central nervous system mature teratoma producing carbohydrate antigen 19-9: illustrative case

BACKGROUND: Central nervous system (CNS) mature teratoma is a rare disease with symptoms that can vary according to tumor location. Most lesions are benign; rarely, malignancy can develop in any of the somatic components. Elevated levels of tumor markers such as α-fetoprotein and β-human chorionic gonadotropin are not usually found in patients with CNS mature teratoma, and no reports have described an association with carbohydrate antigen 19-9 (CA19-9). OBSERVATIONS: A 64-year-old woman with headache was found to have a mass lesion in the anterior cranial fossa. Magnetic resonance imaging of the brain suggested a mature teratoma. Serum and cerebrospinal fluid (CSF) tests showed significant CA19-9 elevations (2, 770 U/mL and 4, 387 U/mL, respectively). Other examinations, including whole-body 18F-fluorodeoxyglucose positron emission tomography, did not detect the origin of elevated CA19-9, suggesting that the high CA19-9 levels were caused by intracranial tumor. The patient underwent tumor removal. The histopathological diagnosis was mature teratoma with positive CA19-9 staining. CA19-9 levels in serum and CSF decreased significantly after tumor removal. LESSONS: The histopathological findings and postoperative decreased CA19-9 levels established the diagnosis of CA19-9-producing CNS mature teratoma. CNS mature teratoma can cause elevations in CA19-9 in cases with absence of neoplasms in the trunk

EMBRIOGÊNESE SOMÁTICA DIRETA EM FOLHAS DE PHALAENOPSIS: ORCHIDACEASE

Phalaenopsis é um gênero de orquídeas largamente produzido para floricultura por apresentarem flores grandes e planas em hastes longas e de durabilidade elevada, além de serem de cultivo rápido e de alto valor comercial. Uma das vias de se propagar estas plantas por meio de cultura de tecidos. Porém, mesmo com as mais refinadas técnicas de propagação clonal têm-se o aparecimento de calos, que podem, conseqüentemente, levar ao aparecimento de variantes somaclonais que muitas vezes não são interessantes. Visando minimizar a formação de calos foi testado o protocolo de embriogênese somática, em folhas de materiais comerciais, para a produção de embriões sem necessariamente passar pela fase de calo. Uma série de combinações entre NAA (ácido naftaleno acético; zero, 0,1 e 0,2mg L-1) e BAP (benzilaminopurina; zero, 1 e 2mg L-1 ) foi testada. O número de explantes mortos, fenolizados, sobreviventes e o número de embriões por explante foram analisados. As combinações de 0,1mg L-1 ou 0,2mg L-1 de NAA e 1mg L-1 BAP foram os mais eficientes para a formação de embriões somático

下部直腸癌におけるMRIを用いた歯状線浸潤の診断精度

Purpose: To retrospectively assess the accuracy of magnetic resonance imaging (MRI) in predicting dentate line invasion in low rectal cancer. Materials and methods: Eighty-one patients with primary rectal cancer were assessed by dynamic contrast-enhanced MRI. The location of the dentate line was assessed on MRI in 27 patients with upper-mid rectal cancer. Two observers independently evaluated the distance between the distal tumor edge and the MRI-defined dentate line in 54 patients with low rectal cancer, and the imaging and histological findings were compared. Results: The MRI-defined dentate line was 24.0 ± 3.8 mm above the anal verge in patients with upper-mid rectal cancer. The dentate line invasion status agreed with the histological findings in 49/54 (91%) patients (κ = 0.72 [95% CI 0.50-0.95]) for observer 1, and in 51/54 (94%) patients (κ = 0.83 [0.65-1.00]) for observer 2 in patients with low rectal cancer. Interobserver agreement was good (κ = 0.83 [0.65-1.00]). The MRI-derived distance between the distal tumor edge and the dentate line had significant correlation with the histological distance (r = 0.86 for reader 1 and 0.75 for observer 2). Conclusion: MRI demonstrates high accuracy in predicting dentate line invasion in low rectal cancer.博士（医学）・甲第748号・令和2年6月30日© Japan Radiological Society 2020© 2020 Springer Nature Switzerland AG. Part of Springer Nature.This is a post-peer-review, pre-copyedit version of an article published in Japanese journal of radiology. The final authenticated version is available online at: http://dx.doi.org/10.1007/s11604-020-00933-5

Papillary glioneuronal tumor growing slowly for 26 years: illustrative case

BACKGROUND: Papillary glioneuronal tumors (PGNTs) are classified as a type of World Health Organization grade I mixed neuronal-glial tumor. Most PGNTs involve cystic formations with mural nodules and solid components in the cerebral hemispheres, and PGNTs occur mainly in young adults. The long-term prognosis of PGNTs remains unclear. OBSERVATIONS: A 38-year-old male had been diagnosed with an arachnoid cyst associated with epilepsy in a local hospital. The initial magnetic resonance imaging (MRI) study showed the tumor as a heterogeneously enhanced nodule in the left postcentral gyrus. Subsequent MRI studies showed slow growth of the tumor for 26 years. He underwent gross total resection to control his epilepsy. The histopathological findings revealed pseudopapillary structures involving hyalinized blood vessels with a single or pseudostratified layer of cuboidal glial cells with round nuclei and scant cytoplasm. At the periphery of the lesion, Rosenthal fibers and acidophilic granule bodies were observed in the gliotic brain tissue. Immunohistochemically, some interpapillary cells were positive for NeuN. On the basis of these findings, the tumor was diagnosed as a PGNT. LESSONS: This PGNT showed slow growth for 26 years. When recognizing a slowly growing tumor in the cerebral hemispheres of relatively young people that is associated with epileptic seizures, PGNT should be considered as a differential diagnosis

Tumor Stiffness is Associated with Reduced CD45+ Immune Cell Penetration of Tumors in a Rat Hepatocellular Carcinoma Model

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