Clinicopathological study on pIgR expression and tumor progression in advanced colorectal cancer

This study is aimed at investigating the relationship between the polymeric immunoglobulin receptor （pIgR） expression and clinicopathological factors in advanced colorectal cancer （CRC） patients. The study involved 47 advanced CRC patients who were surgically resected and underwent KRAS gene test. The pIgR expression was analyzed by immunohistochemistry, and the patients were classified into high and low （pIgR-H and pIgR-L, respectively） groups based on the staining intensity and range. A total of 13 cases was classified under the pIgR-H group, and the remaining 34 were classified under the pIgR-L group. Results suggest no significant differences in most clinicopathological factors between the pIgR-H and pIgR-L groups, although the pIgR-L group had a significantly higher frequency of venous invasion than the pIgR-H group, whereas the frequency of KRAS gene mutation was significantly higher in the pIgR-H group than that in the pIgR-L group. The findings in this study showed little significant correlation between the pIgR expression and clinicopathological factors in advanced CRC patients. Further research on the biological behavior of pIgR as a drug treatment option for KRAS-mutated advanced CRCs is also warranted

Acute Fulminant Necrotizing Amebic Colitis and Enterocolitis Associated with Perforation in a Male Breast Cancer Patient

In Japan, amebiasis is typically found in men who have sex with men and in individuals with recent travel to endemic areas. We experienced a patient with fulminant necrotizing amebic colitis and enterocolitis who presented with a severe disorder of the liver and renal function. The patient was a 71-year-old man who had lived in Yokohama City, Japan for 30 years. His stool sample showed no amebic dysentery protozoa and cultured negatively for human immunodeficiency virus. Despite being treated with meropenem, pyrexia of 39-40°C continued for 4 days. On hospital day 8, a colonic abscess and perforation of the transverse colon were detected by computed tomography（CT）. His fever did not improve, suggesting progression of infectious disease. Subsequent emergency laparotomy revealed a perforation in the middle of the transverse colon. Peritoneal lavage and right hemicolectomy were performed; however, a CT scan on hospital day 16 （postoperative day 8） showed re-perforation of the colon and an abscess around the site of anastomosis, prompting emergency intestinal and left hemicolectomy resection. Amebae observed pathologically during the second emergency operation led to a diagnosis of amebic colitis. Endotoxin adsorption therapy was performed, and metronidazole was administered. Despite prompt diagnosis and treatments, the patient’s general conditions became fulminant, and multiple organ failure developed. On hospital day 18 （postoperative day 10）, his C-reactive protein level was 20mg/dl. He was clinically diagnosed as having sepsis and multiple organ failure. The patient died on hospital day 23. Acute colitis is commonly encountered in daily practice, but it is difficult to differentiate between amebic and non-amebic colitis preoperatively and thus, the possibility of amebic colitis should be considered in such clinical presentations

C-arm Cone-beam CT-guided Needle Biopsies through the Erector Spinal Muscle for Posterior Thoracic Pulmonary Lesions

This study investigated retrospectively the diagnostic yield and complication rate of transthoracic needle biopsies for posterior thoracic pulmonary lesions using C-arm cone-beam computed tomography （CBCT）. The risk factors for pulmonary hemorrhage were evaluated. Our study included 113 patients with 113 posterior pulmonary lesions （mean longest diameter: 30.6mm, and mean depth: 4.7mm） through the erector spinal muscles using a 19/20-gauge coaxial system. The diagnostic performances of procedures for malignant lesions and the incidence of complications after biopsies were also assessed. The patient-related and procedure-related variables were investigated. Risk factors for pulmonary hemorrhage were analyzed with a multivariate logistic regression analysis. Findings revealed 99 malignant, 13 benign, and one intermediate lesion. Sensitivity, specificity, and diagnostic accuracy rates were 100％ （99/99）, 92.3％ （12/13）, and 99.1％ （111/112）, respectively. Air embolization, hemothorax, hemoptysis, pneumothorax, and pulmonary hemorrhage, occurred in 0, 2, 12, 48, and 70 procedures. The averaged spinous process-pleura depth and the traversed lung parenchyma depth achieved by the introducer needles were 54.2mm and 27.4mm, respectively. The needle position at the pleural puncture site within the intercostal space was in middle （31％） and inferior （69％） areas. The incidence of pulmonary hemorrhage was significantly higher in smaller lesions （p＝0.001）. Manual evacuation was performed in five procedures for patients with pneumothorax. The chest tube placement （trocar＞8 Fr） was performed in two procedures in patients with hemothorax and pneumothorax. In conclusion, the biopsy method with a posterior intercostal approach for posterior thoracic pulmonary lesions yielded high diagnostic accuracy and few major complications

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

A Case of Giant Mesenteric Cyst Originating from the Small Intestine

A 62-year-old man was admitted to Showa University Fujigaoka Hospital because of a giant mass that was discovered approximately 8 weeks after the development of obvious symptoms, namely upper abdominal pain, vomiting, and progressive distension. Ultrasonography revealed a giant cystic mass that was occupying the right upper abdomen, and contrast-enhanced computed tomography revealed a huge, relatively well-defined, and low-density cystic mass that measured 10cm in diameter. Radical resection of the tumor was performed via open laparotomy, along with segmental small intestine resection to address potential invasion into adjacent tissues. Histological findings of the resected specimen indicated mesenteric cyst. The patient\u27s postoperative recovery was uneventful and he was discharged after 11 days. At the 12-month follow-up, the patient was in good health with no signs of recurrence

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

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

Significance of Ki-67 Expression and Risk Category (St. Gallen 2007) in Elderly Breast Cancer Patients, with Emphasis on the Need for Postoperative Adjuvant Therapy

Breast cancer is increasing in the elderly. Although elderly breast cancer patients frequently receive less invasive therapy, its appropriateness is debatable. Ki-67 expression is a controversial prognostic factor and predictor of the efficacy of postoperative adjuvant therapy. This study investigated the value of the Ki-67 labeling index (LI) in elderly breast cancer patients, especially with respect to adjuvant therapy. This retrospective study investigated 82 primary breast cancer patients aged 70 years who underwent surgery between 1995 and 2005. Their clinicopathological findings were reviewed and their Ki-67 LIs were determined. The patients\u27 mean age was 78 years, the mean observation period was 53.8 months, and 60 patients (73.2%) underwent adjuvant therapy. The St. Gallen (2007) risk category and the Ki-67 LI (mean, 15.3%) were both significantly correlated with relapse and prognosis. In the 31 cases with a low Ki-67 LI (< 10%), 1 patient who underwent adjuvant treatment relapsed, but there were no deaths. Among the intermediate- and high-risk patients, Ki-67 was low in 15; 1 patient who underwent adjuvant treatment relapsed, but there were no deaths. For elderly breast cancer patients aged 70 years categorized low risk by St. Gallen (2007) or with a low Ki-67 LI, the risk of relapse and death appears to be low regardless of adjuvant therapy. Though further investigation is needed to determine a method of measuring the Ki-67 LI and determining a cut-off value, our findings suggest that the Ki-67 LI helps with the selection of adjuvant therapy in elderly patients

Involvement of Adrenomedullin Expression in Tumor Cells and Stroma in the Development of Diabetes in Pancreatic Cancer Patients

Some studies have reported that adrenomedullin （AM） is involved in diabetes mellitus （DM） associated with pancreatic cancer. Therefore, in this study we investigated the relationship between diabetes and AM expression in patients with pancreatic cancer. We examined 48 biopsies and 26 surgical resections from 74 patients with histologically diagnosed pancreatic cancer. Patients were classified into either DM or non-DM groups. The immunohistochemical expression of AM and various clinicopathological factors were compared between the two groups. Among the biopsy cases, 21 were classified as DM and 27 as non-DM. AM expression in pancreatic cancer cells was significantly lower in the DM group （p＝0.03）. No significant differences were noted in age, body mass index, tumor diameter or location, serum CA19-9, amylase, or C-reactive protein levels, pancreatic ductal dilatation, portal vein invasion, clinical stage, or histological differentiation between the DM and non-DM groups. The proportion of men was significantly lower in the DM group （p＝0.04）, as was the frequency of liver metastasis at diagnosis （p＝0.03）. Among the resection cases, 13 were classified as DM and 13 as non-DM. There were no significant differences in AM expression in pancreatic cancer cells between the two groups. However, marked AM expression was observed in the inflammatory cells and fibroblasts of the tumor stroma in all cases. In addition, the inflammatory response in the tumor stroma tended to be stronger in the DM group. Although the present study failed to find a positive correlation between diabetes and AM expression in pancreatic cancer cells, the results indicate that AM expression in stromal cells may be more closely related to the development of DM in pancreatic cancer patients

A Clinicopathological Study of Primary Small Intestinal Cancer with Emphasis on Cellular Characteristics

We examined the clinicopathological profiles and cellular characteristics of 10 cases of surgically resected primary small intestinal cancers (excluding duodenal cancers). Histological examination revealed nine adenocarcinomas and one sarcomatoid carcinoma. Invasion depth was subserosal in five cases, serosal in four cases and to the adjacent transverse colon in the remaining case. Metastasis was present in lymph node in seven cases, in distant organs in six, and in the peritoneum in seven cases. Of the 10 cases, 7 underwent postoperative chemotherapy, and 6 of the eight traceable patients died from the disease (mean period of survival: 386 days). Histomorphologically, eight of nine adenocarcinomas showed an intestinal phenotype (unclassifiable in the other) in the upper layer, while in the lower layer, there showed an intestinal phenotype and five a non-intestinal phenotyp. Immunohistochemistry revealed a mean positive rate in the upper/lower layers as follows: 93%/86% and 38%/29% by intestinal markers CDX2 and MUC2; 19%/28% and 13%/32% by pancreatobiliary markers CK7 and MUC1; and 4%/19% and 2%/9% by gastric markers MUC5AC and MUC6, respectively. Thus, the intestinal phenotype predominated in almost all small intestinal cancer in this study, although some showed a transformation to non-intestinal or hybrid phenotypes with tumor progression. Flexible management for the diversity and transformation of cellular characteristics is therefore recommended treating and diagnosing small intestinal cancers