Melanotic oncocytic metaplasia of the nasopharynx: A case report discussing the pathogenesis of a lesion

Background: Melanotic oncocytic metaplasia is a rare non-neoplastic lesion. It has been described as a phenomenon in which cells change their morphology to adapt to various stimuli. The incidence of melanotic oncocytic metaplasia is higher in middle-aged Asian males and smokers. The nasopharynx is the most common site of occurrence. Clinically, it is necessary to distinguish this lesion from malignant melanoma. Case: The patient was a man in his sixties and a heavy smoker. Brownish lesions were observed at bilateral pharyngeal openings of the eustachian tube through nasopharyngoscopy. Histopathologically, oncocytic cells without atypia having abundant granular cytoplasm and brownish pigmented granules were observed in the biopsy specimen obtained from the lesion. Immunohistochemically, most of these cells showed positive reaction for anti-mitochondria, S100, and Melan A, but not for HMB45. Discussion: The characteristic histological finding of this lesion was the presence of abundant mitochondria and melanin pigments in the cytoplasm. The former may be the result of a mitochondrial response to various stimuli, while the latter may be transported from dendritic cells mixed in the surrounding mucosal epithelium. Conclusion: It is important that otolaryngologists understand the features of this lesion, perform thorough observations, and reach a diagnosis through biopsy

がん患者のアドバンス・ケア・プランニングがもたらす効果に関する研究

application/pdfアドバンス・ケア・プランニング（ACP）とは、将来の意思決定能力の低下に備えて、今後の治療･療養について患者・家族と医療者とがあらかじめ話し合うプロセスである。本研究では国内外で行われたACP研究について文献レビューを行い、ACPの方法や時期について検討した。そしてACPを行うことが、患者・家族と医療者にもたらす効果を検討するために、進行婦人科がん患者を対象に、がん看護専門看護師による定期的なACPを実践し、その効果を質的・量的側面から検討を行った。Advance Care Planning (ACP) is a process of communication between individuals and their healthcare agents to understand, reflect on, discuss and plan for future healthcare decisions for a time when individuals are not able to make their own healthcare decisions. In this study, we researched ACP for cancer patients on the methods and the timings through literature reviews. An interventional study on ACP was performed using a mixed method design.　The purpose of this study was to clarify the effects of ACP on patients, their families, and their healthcare agents. 　The participants were advanced gynecological cancer patients, and each of them discussed their anxieties with a CNS (Certified nurse specialist in oncology) in ACP, when they had tri-weekly chemotherapy. Participants’QOL (FACIT-Sp) and Self-Efficacy for Advanced Cancer patients (SEAC) were observed, and participants and their healthcare agents were interviewed about their feelings about the ACP process by researchers.2013年度～2015年度科学研究費補助金(基盤研究(C))研究成果報告書2546340