Right Pleural Effusion in Fitz-Hugh-Curtis Syndrome

Right pleural effusion was diagnosed in a 36-year-old woman with right upper quadrant pain and fever. Enhanced pelvic computed tomography performed because of irregular genital bleeding revealed the pelvic inflammatory disease. Upon further questioning, the patient confirmed that she had recently undergone therapy for Chlamydia trachomatis infection. Therefore she was given an injection of tetracycline because we suspected Fitz-Hugh-Curtis syndrome (FHCS), a pelvic inflammatory disease characterized by perihepatitis associated with chlamydial infection. A remarkable clinical response to antibiotics was noted. The right upper quadrant pain was due to perihepatitis, and the final diagnosis was FHCS. Right pleural effusion may be caused by inflammation of the diaphragm associated with perihepatitis. Once chlamydial infection reaches the subphrenic liver, conditions in the closed space between the liver and diaphragm due to inflammatory adhesion may be conductive to chlamydial proliferation. The possibility of FHCS should be considered in patients and carefully distinguished from other abdominal diseases

Periductal Induction of High Endothelial Venule-Like Vessels in Type 1 Autoimmune Pancreatitis

信州大学博士（医学）・学位論文・平成24年3月31日授与（甲第946号）・丸山 雅史This is a non-final version of an article published in final form in PANCREAS. 42(1):53-59 (2013).Objectives: Type 1 autoimmune pancreatitis (AIP) is histologically characterized by dense lymphoplasmacytic infiltration and marked storiform fibrosis, manifestations associated with pancreatic ducts. Such periductal lymphocyte recruitment is thought to be elicited by dysregulation of mechanisms governing physiological lymphocyte homing. The present study was undertaken to determine whether vascular addressins including peripheral lymph node addressin and mucosal addressin cell adhesion molecule 1 (MAdCAM-1) play a role in type 1 AIP histogenesis. Methods: Tissue sections of type 1 AIP and tumor-associated non-AIP chronic pancreatitis, as well as normal pancreas, were subjected to immunohistochemical analysis using vascular addressin-related antibodies. Results: The number of periductal mouse endothelial cell antigen 79-positive high endothelial venule (HEV)-like vessels was increased in type 1 AIP relative to that seen in non-AIP chronic pancreatitis, whereas the number of MAdCAM-1-positive HEV-like vessels did not differ between the 2 conditions. Mouse endothelial cell antigen 79 antigens are expressed on duct-forming epithelial cells not only in pancreas but also in salivary glands, which often harbor extrapancreatic lesions in type 1 AIP. Conclusions: Type 1 AIP can be characterized by periductal induction of MECA-79-positive HEV-like vessels. MECA-79-positive 6-sulfo sialyl Lewis X-related carbohydrate antigens expressed on duct-forming epithelial cells could be associated with type 1 AIP pathogenesis.ArticlePANCREAS. 42(1):53-59 (2013)journal articl

MUC1 Expression in Colorectal Cancer is Associated with Malignant Clinicopathological Factors

This study aimed to evaluate the frequency, distribution, and corresponding histology of MUC1 expression in colorectal cancer and examine its association with clinicopathological factors. MUC1 expression was confirmed in 86 of 169 surgically resected colorectal cancers (51%), although the ratio of MUC1-positive cells was less than 5% in 33 cases (20%), 5-50% in 46 cases (27%), and greater than 50% in only 7 cases (4%). None or less than 5% of MUC1 expression cases were classified as L-group cancers (116 cases, 69%), while cancers showing higher than 5% expression were classified into the H-group (53 cases, 31%). Analysis of the intratumoral distribution of positive cells in the H-group cases showed MUC1 expression distributed predominantly in the upper layers in 3 cases (6%), in the lower layers in 18 cases (34%), and in all layers in 32 cases (60%). MUC1 expression was observed in various histomorphological cancer forms, but the most frequent expression was noted in the monolayer cuboidal (pancreatobiliary-type) neoplastic glands. Considering the relationship between MUC1 expression and clinicopathological factors, H-group cases demonstrated significantly larger lesions showing a greater number of ulcerated-type cancers, deeper invasion, poorer differentiation, higher frequency of budding, and higher rate of lymph node metastasis than L-group cancers. Furthermore, there was a difference of 10% between the H-group and L-group with regard to the frequency of relapse/tumor mortality three years after surgery. In colorectal cancer, MUC1 expression increases with progression of the tumor indicating that it is one of the useful indicators of malignancy and may facilitate appropriate treatment regimens; however, as its expression is heterogeneous and localized, it will be necessary to confirm the state of MUC1 expression by case

Expression of Standard CD44 in Advanced Gastric Cancer: Relationship with Metastasis to Lymph Nodes

Standard CD44 (CD44s) is reported to play an important role in determining the malignant potential of various carcinomas. The aim of the present study was to evaluate CD44s expression in T2-T3 gastric cancer (Japanese Classification of Gastric Cancer stages MP, SS, SE) and the relationship between CD44s expression and clinicopathological parameters. CD44s expression was measured using immunohistochemistry in tumors from 98 patients with primary gastric cancer. Cases were categorized into two groups based on CD44s staining; the CD44s positive group had > 10% positively stained tumor cells and the CD44s negative group had < 10%. CD44s positivity was demonstrated in 59.1% (58/98) of tumors. CD44s expression showed no significant relationship with patient age or gender, or tumor location, size or macroscopic/microscopic classification. However, CD44s expression showed a significantly negative relationship with metastasis to lymph nodes (p < 0.0001). Thus, in T2-T3 gastric cancer, loss of CD44s expression suggests that metastasis of the tumor to lymph nodes is likely

Three Cases of Noninvasive Carcinoma ex Pleomorphic Adenoma of the Parotid Gland and a Literature Survey Focusing on their Clinicopathologic Features

Only 30 cases of non-invasive carcinoma ex pleomorphic adenoma have been reported in the English language literature. Here, we report on three cases of non-invasive carcinoma ex pleomorphic adenoma. Only one of the 33 patients showed recurrence or metastasis after surgery most likely as a result of benign pleomorphic adenoma. Pleomorphic adenoma with focal areas showing malignant changes should be carefully assessed by serial sectioning. The prognosis and therapeutic appoach will depend on evidence of capsular invasion. HER-2/neu is a useful marker in the differential diagnosis of pleomorphic adenoma versus noninvasive carcinoma ex pleomorphic adenoma

Expression of HER2 and MUC1 in Advanced Colorectal Cancer: Frequency and Clinicopathological Characteristics

There have been many reports on the overexpression of human epidermal growth factor receptor 2 (HER2) in patients with colon cancer. However, the role and frequency of HER2 overexpression have not been clearly defined. Anti-HER2 therapy has been shown to improve the prognosis of HER2-positive patients with breast and stomach cancers. In this study, we explored HER2 expression in patients with colon cancer at stages II and III by immunohistochemistry (IHC) and dual-color in situ hybridization (DISH), and examined the correlation between HER2 expression and clinicopathological factors. Moreover, we examined the correlation between HER2 expression and mucin 1 (MUC1) expression. The subjects were 121 patients with colon cancer at stages II and III who underwent surgery in our hospital during the period from 2007 to 2009. Sections containing the deepest part of a lesion were subjected to immunostaining for HER2 and MUC1. HER2 expression was assessed in accordance with Ventana\u27s Guidelines for HER2 Testing in Stomach Cancer, with sections comprising less than 10% of weakly to moderately stained tumor cells scored as 1 > 2. HER2 expression scored as 2 was defined with sections comprising more than 10% of the weakly to moderately stained tumor cells. Patients with a score of 1 > 2 and 2 were also subjected to DISH using a Dual ISH HER2 kit. MUC1 expression was scored according to the percentage of stained area as follows: 0, 0 to 5%; 1, 5 to 50%; and 2, 50% and higher. Patients with a score of 1 and 2 were defined as MUC1-positive. The analysis of HER2 by IHC yielded the following scores: 45 patients (37.2%), 0; 38 patients (31.4%), 1; 14 patients (11.6%); 1 > 2; 24 patients (19.8%), 2; and 0 patients (0%), 3. For the 38 patients with a score of 1 > 2 and 2, DISH returned ratios of HER2 to Chr17 expression (HER2: Chr17 ratio) from 1.13 to 1.93 (mean = 1.46). There was no significant correlation between HER2 expression and clinicopathological factors. The numbers of MUC1-positive patients according to HER2 score were as follows: 22 patients (48.9%) in the score 0 group (45 patients); 25 patients (65.8%) in the score 1 group (38 patients); 10 patients (71.4%) in the score 1 > 2 group (14 patients), and 22 patients (91.7%) in the score 2 group (24 patients). There was a positive correlation between HER2 expression and MUC1 expression. Specifically, MUC1 expression levels increased with HER2 expression level, and the percentage of MUC1-positive patients was significantly higher in the HER2 score 2 group than in the HER2 score 0 group (P < 0.01). Rates of HER2 positivity by DISH or fluorescence in situ hybridization (FISH) in patients who had an HER2 score of 2+ by IHC were 45% and 24% in the patients with stomach and breast cancers, respectively. However, the positivity rate was 0% in the patients with colon cancer in this study. This result indicates that patients with colon cancer who have an IHC HER2 score of 2+ are more likely to be HER2 negative by DISH than patients with breast and stomach cancers, although larger cohort studies are required before a definitive conclusion can be made. There was a positive correlation between HER2 expression and MUC1 expression in this study, although further examination is required because there were no patients who had an HER2 score of 3+ or 2+ by IHC and were HER2 positive by DISH in this study. HER2 expression in colon cancer should be cautiously assessed by both IHC and DISH

Clinicopathologtcal Study of Serrated Polyps of the Colorectum, with Special Reference to Maspin Expression

Aims: We compared the clinicopathologic features of three types of colorectal serrated polyps, namely, hyperplastic polyps (HPs), sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs), and analyzed the expression pattern of maspin in these serrated lesions. We retrospectively examined 173 polypoid lesions that were endoscopically excised from 136 patients and diagnosed as hyperplastic or adenomatous serrated lesions, and histologically classified as HPs, SSA/Ps, or TSAs. Maspin expression was immunohistochemically examined in all lesions. Overall, 59 lesions (34%) were classified as HPs, 70 (40%) as SSA/Ps and 44 (25%) as TSAs. There were no significant differences in mean age or gender of patients between types, but SSA/Ps frequently developed on the right colon and showed a superficial/flat elevation, whereas HPs and TSAs frequently developed on the left colon and showed protruded lesions. The average diameters of HPs, SSA/Ps, and TSAs were 7.2, 9.9, and 12.9mm, respectively, showing significant differences. Diffuse cytoplasmic expression of maspin was observed in the serrated glands of all three types. In addition, focal or diffuse intranuclear localization of maspin was observed in 15% of HPs, 13% of SSA/Ps, and 84% of TSAs, showing significant differences between TSAs and the other two types. The three types of serrated polyp examined in this study showed distinct clinicopathological features. The presence of maspin expression in these polyps, regardless of whether they were hyperplastic or neoplastic, indicates that maspin might be commonly associated with cell proliferation, although the underlying mechanism might be different between types

Expression of HER2, EGFR, CD44, PPARγ and AR in Salivary Cancer-immunohistochemical Analysis Focusing on the Possibility of Specialized Molecular-targeted and Hormonal Therapy for Different Histological Subtypes

The aim of this study was to determine the expression of human epidermal growth factor receptor type 2 (HER2), epidermal growth factor receptor (EGFR), peroxisome proliferator-activated receptor γ (PPARγ), CD44 and androgen receptor (AR) in adenoid cystic carcinomas (ACC), carcinoma ex pleomorphic adenomas (CXPA) and mucoepidermoid carcinomas (MEC) of the salivary glands, to investigate their molecular difference and to estimate the availability of molecular-targeted and hormonal therapy in salivary-gland tumors. Forthy patients with a salivary gland tumor, diagnosed and treated at our hospital, were studied. On the basis of histopathology, 10, 19 and 11 patients were identified with ACC, CXPA and MEC, respectively. The associations between histological types were evaluated by the chi-square test. Differences were considered statistically significant at P < 0.05. HER2-positive expression was observed in 10% of ACC, 84% of CXPA and 18% of MEC. EGFR-positive expression was observed in 40% of ACC, 68% of CXPA and 91% of MEC. CD44-positive expression was observed in 40% of ACC, 47% of CXPA and 91% of MEC. PPARγ-positive expression was observed in 10% of ACC, 53% of CXPA and 18% of MEC. AR-positive expression was observed in 20% of ACC, 32% of CXPA and 9% of MEC. Compared with other histological types, CXPA demonstrated significant HER2 and PPARγ staining and MEC demonstrated significant EGFR and CD44 staining. The differences in expression of markers between histological types in our study suggests the possibility that HER2- and PPARγ-targeted therapy may be effective in CXPA, and that EGFR-target therapy may be effective in MEC of the salivary glands

An Autopsy Case of Multiple Jejunal Diverticula Showing Severe Malabsorption

A rare autopsy case of multiple jejunal diverticula showing severe malabsorption is reported. A 56-year-old man was admitted due to vomiting and leg edema. On admission, his height was 160cm, his body weight was 39kg, and laboratory data revealed severe hypoproteinemia (TP: 4.0g/dl, ALB: 2.1g/dl). On the 14th day of admission, agonal breathing and disturbance of consciousness occurred after massive vomiting of gastric juice, and the patient died of respiratory failure. At autopsy, on abdominal sectioning, multiple diverticula situated on the mesenterium side of the enteron extending 70cm in length from the proximal jejunum were identified. However there were no findings suggesting perforation or diverticulitis. Histologically, the diverticula were lined by ordinal jejunum mucosa associated with muscularis mucosa, but the muscularis propria was not involved in the diverticular walls. The diverticula were identified as false diverticula. In both lower lungs, aspiration pneumonia was widely seen. The cause of death was considered to be aspiration pneumonia due to the vomiting caused by multiple jejunal diverticula.Only 16 case reports of multiple jejunal diverticulosis in Japan could be found in the literature however most of the reported complications were perforation and diverticulitis, and there were no reports of malabsorption. Therefore, the present case is significant concerning the cause of malabsorption in routine explorations