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

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

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 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

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

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

Positive Relationship between L-type Amino Acid Transporter 1 Expression and Liver Metastasis in T3 Colorectal Cancer

The aim of this retrospective study was to evaluate L-type amino acid transporter 1 (LAT1) expression in colorectal cancer with invasion to the subserosal layer (T3), its relationship with clinicopathological characteristics, and its potential metastatic significance. LAT1 expression was measured by immunohistochemistry in tumors from 65 patients with primary colorectal carcinomas. LAT1 expression was deemed positive when more than 10% of the tumor cells showed distinct membranous immunoreactivity. Positive LAT1 expression was demonstrated in 29.2% (19 of 65) of primary tumors. LAT1 expression showed no significant relationship with clinicopathological characteristics, such as age, gender, tumor location, tumor size, macroscopic/microscopic classification, or lymph node metastasis. However, LAT1 expression showed a positive relationship with liver metastasis (P < 0.05). LAT1 expression in cancer cells may be a good marker for predicting potential metastasis to the liver in colorectal cancer

Solitary Peutz-Jeghers Type Colorectal Polyp with Hamartonia-adenoma-carcinoma Sequence in a Non-Peutz-Jeghers Syndrome Patient

Peutz-Jeghers (P-J) syndrome is an inherited disorder characterized by multiple hamartomatous gastrointestinal polyps, mucocutaneous pigmentation, and an increased risk of both digestive tract and non-digestive tract cancers. P-J type polyps are characteristic of P-J syndrome but rarely present as solitary polyps. Though cancerous lesions frequently develop from polyposis in P-J syndrome, reports of malignancy in solitary colorectal P-J type polyps are rare; our literature search identified only two examples. This report describes a non-Peutz-Jeghers syndrome patient with a solitary P-J type polyp showing the hamartoma-adenoma-carcinoma sequence

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