Distinct morphologic, phenotypic, and clinical-course characteristics of indolent peripheral T-cell lymphoma

Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) consists of a heterogeneous group of lymphomas. Patients. generally show an aggressive clinical course and very poor outcome. Although the 2008 World Health Organization classification of PTCL-NOS includes 3 variants, low-grade lymphoma is not Included. Of 277 PTCL-NOS cases recorded in our consultation files, we examined the clinicopathologic characteristics of 10 patients with T-cell lymphomas composed of small-sized cells with slight nuclear atypia. Eight patients showed extranodal involvement (5 patients, spleen; 3 patients, thyroid), and 5 patients were at clinical stage I or II. Histologically, all samples presented diffuse infiltrate of small lymphoid cells, with few mitotic figures. Immunohistologically, all samples were positive for CD3, and CD:20 Was detected in 5 samples. All samples showed a low Ki-67 labeling index (mean, 1.05%), and 7 samples were positive for central memory T-cell markers. Clonal T-cell receptor gamma chain and/or alpha-beta chain gene rearrangements were detected in all 10 patients. Five patients received chemotherapy, whereas for 3 patients, treatment consisted only of observation following surgical resection of the spleen or thyroid. Nine patients were alive at a median follow-up time of 19.5 months, whereas 1 patient died of an unrelated disease. The present study strongly indicates that T-cell lymphoma with small-sized lymphoma cells and a low Ki-67 labeling index is a distinct variant. Recognition of this novel lymphoma subtype, which should not be defined merely as PTCL-NOS, should be seriously considered

臨床的絨毛癌として治療された侵入奇胎のMRI所見

絨毛性疾患は世界的に減少しており,特に侵入奇胎と絨毛癌は今日の日本において稀である.今回我々は,臨床的絨毛癌と診断され,子宮全摘術が施行されたが,組織学的に侵入奇胎と診断された症例を経験したので,そのMRI所見を中心に報告する.症例は49歳女性.妊娠3回,分娩2回.最終妊娠は人工妊娠中絶が施行された.不正性器出血を主訴に近医受診し,子宮内膜掻爬が施行されたが,組織学的に変性脱落膜のみであった.経腔超音波検査にて子宮頚部に嚢胞性病変を認め,子宮外妊娠が疑われ,当院産婦人科に紹介受診となり,血清β-hCGが1,000ng/mL,尿中hCGも230,083IU/Lと高値であった.FIGOスコアでhigh risk GTD(9点),絨毛癌診断スコアで臨床的絨毛癌(11点)と診断され,子宮全摘術が施行されたが,組織学的に侵入奇胎と確定された.術前MRIでは腫大した子宮体部筋層内に不整形腫瘤を認めた.腫瘤はT2強調像で不均一な高信号を示し,内部にT1強調像で出血を示唆する高信号域を有し,造影早期相で濃染され,腫瘤周囲にはflow voidが目立ち,富血管性腫瘍の特徴を示した.子宮傍組織への浸潤所見と腫瘤内には多数の嚢胞性病変を認め,組織学的には水腫様に腫大した絨毛組織に相当し,通常絨毛癌では認められない.また,遠隔転移も認めず,以上のMRI所見は侵入奇胎に合致していた.MRIは組織コントラストが高く,病変の組織学的特徴の評価に有用である.侵入奇胎や絨毛癌はFIGOスコアや日本独自の絨毛癌診断スコアをもとに臨床的に診断され,主に化学療法で治療されるが,両者の治療方針は異なり,その鑑別は非常に重要である.MRIを併用することにより,両者を鑑別でき,適切な治療に導くことが可能になると考えられた.Recently, the incidence of gestational trophoblastic disease, which comprises a spectrum of trophoblastic tumors that includes hydatidiform mole (partial and complete), invasive mole, and choriocarcinoma, has been decreasing worldwide; in particular, invasive mole and choriocarcinoma are now rare in Japan. We describe the case of a 49-year-old Japanese woman with a histologically confirmed invasive mole who was clinically treated for choriocarcinoma and underwent total hysterectomy. Preoperative magnetic resonance imaging revealed an intramyometrial hypervascular tumor in the enlarged uterine body that included multiple cystic lesions that represented hydropic villi and that invaded into the parametrium. These features were consistent with invasive mole. Although patients with gestational trophoblastic disease are primarily treated by chemotherapy following a clinical diagnosis based on clinical scoring systems, magnetic resonance imaging, which often reflects histological characteristics of the disease, can be feasible for correct diagnosis and appropriate treatment

臨床的絨毛癌として治療された侵入奇胎のMRI所見

絨毛性疾患は世界的に減少しており,特に侵入奇胎と絨毛癌は今日の日本において稀である.今回我々は,臨床的絨毛癌と診断され,子宮全摘術が施行されたが,組織学的に侵入奇胎と診断された症例を経験したので,そのMRI所見を中心に報告する.症例は49歳女性.妊娠3回,分娩2回.最終妊娠は人工妊娠中絶が施行された.不正性器出血を主訴に近医受診し,子宮内膜掻爬が施行されたが,組織学的に変性脱落膜のみであった.経腔超音波検査にて子宮頚部に嚢胞性病変を認め,子宮外妊娠が疑われ,当院産婦人科に紹介受診となり,血清β-hCGが1,000ng/mL,尿中hCGも230,083IU/Lと高値であった.FIGOスコアでhigh risk GTD(9点),絨毛癌診断スコアで臨床的絨毛癌(11点)と診断され,子宮全摘術が施行されたが,組織学的に侵入奇胎と確定された.術前MRIでは腫大した子宮体部筋層内に不整形腫瘤を認めた.腫瘤はT2強調像で不均一な高信号を示し,内部にT1強調像で出血を示唆する高信号域を有し,造影早期相で濃染され,腫瘤周囲にはflow voidが目立ち,富血管性腫瘍の特徴を示した.子宮傍組織への浸潤所見と腫瘤内には多数の嚢胞性病変を認め,組織学的には水腫様に腫大した絨毛組織に相当し,通常絨毛癌では認められない.また,遠隔転移も認めず,以上のMRI所見は侵入奇胎に合致していた.MRIは組織コントラストが高く,病変の組織学的特徴の評価に有用である.侵入奇胎や絨毛癌はFIGOスコアや日本独自の絨毛癌診断スコアをもとに臨床的に診断され,主に化学療法で治療されるが,両者の治療方針は異なり,その鑑別は非常に重要である.MRIを併用することにより,両者を鑑別でき,適切な治療に導くことが可能になると考えられた.Recently, the incidence of gestational trophoblastic disease, which comprises a spectrum of trophoblastic tumors that includes hydatidiform mole (partial and complete), invasive mole, and choriocarcinoma, has been decreasing worldwide; in particular, invasive mole and choriocarcinoma are now rare in Japan. We describe the case of a 49-year-old Japanese woman with a histologically confirmed invasive mole who was clinically treated for choriocarcinoma and underwent total hysterectomy. Preoperative magnetic resonance imaging revealed an intramyometrial hypervascular tumor in the enlarged uterine body that included multiple cystic lesions that represented hydropic villi and that invaded into the parametrium. These features were consistent with invasive mole. Although patients with gestational trophoblastic disease are primarily treated by chemotherapy following a clinical diagnosis based on clinical scoring systems, magnetic resonance imaging, which often reflects histological characteristics of the disease, can be feasible for correct diagnosis and appropriate treatment

Coffee Consumption and Lung Cancer Risk: The Japan Public Health Center-Based Prospective Study

Background: Many epidemiological studies have indicated a positive association between coffee intake and lung cancer risk, but such findings were suggested to be confounded by smoking. Furthermore, only a few of these studies have been conducted in Asia. Here, we investigated the association between coffee intake and lung cancer risk in one of the largest prospective cohort studies in Japan. Methods: We investigated the association of coffee drinking and subsequent incidence of lung cancer among 41,727 men and 45,352 women in the Japan Public Health Center-based Prospective Study using Cox proportional hazards regression, with adjustment for potential confounders and by strata of smoking status. Coffee and other dietary intakes were assessed once at baseline with a food frequency questionnaire (FFQ). Results: During 1,481,887 person-years of follow-up between 1990 and 2011, a total of 1,668 lung cancer cases were identified. In a multivariate regression model, coffee consumption was not associated with risk of lung cancer (HR 1.16; 95% CI, 0.82–1.63; Ptrend = 0.285 for men and HR 1.49; 95% CI, 0.79–2.83; Ptrend = 0.942 for women). However, there was a significant increase in the risk for small cell carcinoma (HR 3.52; 95% CI, 1.49–8.28; Ptrend < 0.001). Conclusion: Our prospective study suggests that habitual consumption of coffee is not associated with an increased risk of lung cancer incidence, despite observing a significant increase in the risk for small cell carcinoma