[An 81-year-old man with a hilar mass demonstrated by computed tomography].
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Aged↗
Biomedical subjects
N Tsuda
Publications and source records attributed to N Tsuda.
Intrahepatic cholangiocarcinoma with extensive sarcomatous change: report of a case.
A 77-year-old woman was admitted to our hospital with severe upper abdominal pain. Ultrasonography showed a well-defined hypoechoic mass with heterogeneity in the left lobe of the liver, and computed tomography demonstrated a low-density mass with enhanced peripheral areas. Magnetic resonance imaging revealed a mass with iso- to low signal intensity on T1-weighted images (WI) and heterogeneous high and low signal intensity on T2 WI. The tumor was found to be hypovascular by angiography. During 5 months of observation, the tumor increased in size, which strongly suggested malignancy. A laparotomy was performed under the provisional diagnosis of a neoplasm other than hepatocellular carcinoma, revealing that the hepatic mass had invaded the gastric wall. Therefore, a left hepatic lobectomy with dissection of the lymph nodes and hemigastrectomy was carried out. Histologically, the tumor was found to be composed of a large amount of sarcomatous elements and a small amount of adenocarcinomatous elements, both of which were partly intermingled. Immunohistochemically, the sarcomatous element demonstrated the features of malignant fibrous histiocytoma (MFH). Thus, a diagnosis of intrahepatic cholangiocarcinoma with MFH-like sarcomatous change was confirmed.
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Apoptosis-induced and -suppressed cells in salivary gland adenoid cystic carcinoma: correlation with histological growth patterns.
OBJECTIVE: It is well known that adenoid cystic carcinoma (ACC) arising from salivary glands shows a correlation between prognosis and histological growth patterns. The aim of the study was to evaluate whether three growth patterns of ACC are related to the distributions of apoptosis-induced and -suppressed tumor cells. MATERIALS AND METHODS: We examined 77 cases of ACC including tubular (18 cases), glandular (50) and solid (9) patterns. In order to visualize the apoptotic cells, terminal deoxynucleotidyl transferase (TdT)- mediated dUTP-biotin nick end labeling (TUNEL) and avidin-biotin complex staining using Lewis Y (LeY) antibody were applied to paraffin sections. For detection of the apoptosis-suppressed cells, immunohistochemistry employing bcl-2 antibody was utilized. RESULTS: Apoptosis index (AI) based on the TUNEL-stained specimens were tubular, 7.0; glandular 2.4; solid, 5.1. In tubular type, apoptotic cells were frequently located in the inner tubular layer rather than the outer layer. Solid type had scattered apoptotic cells in the nests. Bcl-2 expression was found in 61% of tubular, 20% of glandular and 22% of solid cases. The localization of bcl-2 protein was noticed in outer tubular cells, and peripheral cells or undifferentiated cells in solid pattern. CONCLUSIONS: The peculiar distribution of apoptotic cells may result from the various proportions and distinctive arrangement of neoplastic ductal cells and neoplastic myoepithelial cells in ACC. Apoptotic cells and bcl-2 positive apoptosis-suppressed cells may participate in the construction of characteristic histological appearances of ACC.
Apoptosis↗
Chronic Chagas' heart disease in a Japanese-Brazilian traveler. A case report.
A 57-year-old Japanese-Brazilian man, visiting Japan for only 9 days, was admitted to our hospital due to syncope and frequent ventricular premature beats. He grew up in a rural area of Brazil and moved to Sao Paulo in 1959 when he was 20 years old. We suspected chronic Chagas' heart disease, i.e., dilated cardiomyopathy with apical ventricular aneurysm, right bundle branch block with left anterior fascicular block, and various arrhythmias including supraventricular premature beats, ventricular premature beats and non-sustained ventricular tachycardia because he showed typical echo- and electrocardiographic features of the disease. Coronary arteriograms were normal, and left ventriculogram confirmed the existence of apical ventricular aneurysm. A left ventricle biopsy specimen showed hypertrophic cardiac muscle with mild fibrosis. The diagnosis of chronic Chagas' disease was finally confirmed by the demonstration of Trypanosoma cruzi itself in the blood as well as Trypanosoma cruzi antibodies.
Animals↗
[Intracranial and orbital extension of a nasal cavity adult T-cell leukemia: a case report].
Adult T-cell leukemia (ATL) is one kind of leukemia induced by human T lymphotropic virus type I (HTLV-I) infection. An unusual case of ATL is presented. A fifty-one-year-old male patient was admitted to our hospital because of nasal obstruction and blindness in the left eye. Imaging study revealed a mass lesion in the nasal cavity, the left paranasal sinus extending to the left orbit and intracranial frontal base. Biopsy of the mass from the paranasal sinus was carried out and the histological diagnosis was a granulomatous lesion with non-specific inflammation. The clinical impression of the lesion was lethal midline granuloma. After steroid therapy and 50 Gy of local radiotherapy, the patient's symptoms disappeared except for his blindness in the left eye. Imaging study revealed that the mass lesion had become smaller. In spite of local improvement, new lesions such as cervical lymph node swelling and multiple nodular shadows in the lung fields appeared on CT scan. Histological diagnosis of the biopsied cervical lymph node was T-cell dominant non-Hodgkin's lymphoma of the diffuse type. Serologically, anti-HTLV-I antibody was positive. Southern blot analysis of lymph node biopsy showed monoclonal proliferation of ATL cells. We made the diagnosis of our case as ATL. The patient died 16 months later despite repeated systemic chemotherapy with cyclophosphamide, vincristine, adriamycin, and prednisolone. ATL can involve the central nervous system (CNS) and manifest CNS symptoms. The neurosurgeon also should consider the CNS involvement of ATL especially in Japan.
Brain Neoplasms↗
[A case of pyonephrosis caused by ureteral stones with elevated serum levels of CA19-9].
A case of pyonephrosis with high levels of serum CA19-9 antigen is reported. A 71-year-old woman was admitted with right flank pain. Computed tomography and ultrasonography showed severe hydronephrosis and hydroureter due to a right ureter stone. Laboratory data revealed a high level of serum CA19-9. However, no tumor was found in the pancreas, gallbladder, liver, gastrointenstinal tract or genitourinary tract. Drip infusion pyelography showed a non-functioning pattern of right kidney. Therefore, right nephroureterectomy was performed for right pyonephrosis. Histological examination revealed chronic inflammation. Malignant cells were not seen in the resected specimen. The serum CA19-9 levels before and after operation were 102.9 U/ml and 24 U/ml, respectively, being normal after the operation. Immunohistochemical examination revealed the presence of CA19-9 antigen in the urethelium, indicating its expression in the specimen. To our knowledge this might be the first case of pyonephrosis associated with high levels of serum CA19-9 antigen.
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Detection of the apoptosis-suppressing oncoprotein bcl-2 in salivary gland lymphoma.
The bcl-2 proto-oncogene encodes an inner mitochondrial membrane protein that blocks apoptosis and programmed cell death in human lymphoid tissue. In this study a monospecific anti-human bcl-2 antibody that is reactive in formalin-fixed tissues was used with an avidin-biotin complex immunoperoxidase method to evaluate 41 cases of lymphoproliferative disorders of the salivary gland. The study cases were 26 primary salivary gland lymphomas (including 21 B-cell lymphomas four T-cell lymphomas and one true histiocytic lymphoma) and 15 cases of myoepithelial sialadenitis. Bcl-2 expression is restricted to the mantle zone and interfollicular lymphocytes around reactive germinal centers of myoepithelial sialadenitis. Seventeen of the 21 B-cell lymphomas were positive for bcl-2, and were composed of mucosa-associated lymphoid tissue (MALT), centrocytic, centroblastic-centrocytic and centroblastic lymphomas. Noticeably, all 11 cases of MALT lymphoma were bcl-2 positive. In contrast, staining for bcl-2 was present in only one of four cases of T-cell lymphomas and was negative in one true histiocytic lymphoma. The expression of bcl-2 protein was also investigated in the ductal systems and epimyoepithelial islands of salivary glands from patients with malignant lymphoma and myoepithelial sialadenitis. While salivary ducts in eight of 15 cases of myoepithelial sialadenitis immunostained for bcl-2, epimyoepithelial islands showed bcl-2 expression in only five cases of myoepithelial sialadenitis. We found that ductal cells in the salivary gland from patients with primary non-Hodgkin's lymphomas expressed bcl-2 protein. It was of interest that epimyoepithelial islands in all cases of MALT lymphoma displayed bcl-2 expression whereas other subtypes of B-cell lymphoma, T-cell lymphoma and true histiocytic lymphoma were invariably negative. These results indicate that bcl-2 is expressed in a wide variety of non-Hodgkin's lymphomas, especially when all 11 cases of MALT lymphoma are bcl-2 positive. Epimyoepithelial islands in MALT lymphoma express this oncoprotein, and their ability to induce bcl-2 synthesis resulted in the prevention of apoptosis and prolonged cell survival. Furthermore, the expression of bcl-2 protein in the lymphoma cells may be responsible for the induction of bcl-2 expression in the adjacent epimyoepithelial islands through a lymphocyte chemical mediator.
Apoptosis↗
Treatment of infantile primary pulmonary hypertension by intravenous infusion of lipo-prostaglandin I2 analog.
We used a new vasodilator, TTC-909 (a prostaglandin I2 analog incorporated in lipid microspheres), which produced marked reduction in the pulmonary arterial pressure and resistance in an infant with primary pulmonary hypertension.
Epoprostenol↗
Clinical significance of cytokine measurement for detection of meningitis.
Levels of interleukin-6 and tumor necrosis factor alpha were measured in cerebrospinal fluids from patients with meningitis. Interleukin-6 was increased in aseptic and bacterial meningitis, whereas tumor necrosis factor alpha was increased only in bacterial meningitis. We concluded that measurement of cytokines in cerebrospinal fluid may be useful for the rapid diagnosis of meningitis.
Case-Control Studies↗
Primary renal angiosarcoma: a case report and review of the literature.
Primary renal angiosarcoma is very rare. To our knowledge, only 15 cases have been reported to date. A 77-year-old Japanese man with a unilateral kidney presented with massive hematuria followed by renal failure. A renal tumor was suspected and a left nephrectomy was performed. The histopathological diagnosis was angiosarcoma of the kidney. A hemorrhagic tumor measuring 10 x 5 cm and clotted blood was found in the medullary area. The atypical tumor cells had a sinusoidal and solid appearance, and showed immunohistochemically positive reactions for some of the endothelial markers. The patient died about 21 months after the nephrectomy and the autopsy revealed massive metastases to the liver and retroperitoneum. One of the differential diagnoses of the case was angiomyolipoma, because the tumor cells were relatively bland in their histological appearance with entrapped fat cells in the pelvic area. Fifteen case reports with titles that included the term 'hemangiosarcoma/angiosarcoma', 'hemangioendothelioma/endothelioma' or 'vascular sarcoma' of the kidney were reviewed and compared to the present case.
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Latent infection with Epstein-Barr virus in odontogenic disorders: comparison among ameloblastoma, dentigerous cyst and odontogenic keratocyst.
In order to investigate the relationship between Epstein-Barr virus (EBV) latent infection and histogenesis of odontogenic disorders, in situ hybridization for EBV-encoded small RNA (EBER) was applied to the paraffin sections of ameloblastoma, dentigerous cyst, and odontogenic keratocyst. Eight cases (15%) of 53 ameloblastomas showed scattered signals for EBER in the parenchymal cells, whereas no reaction of EBER transcript was observed in the non-neoplastic cystic lesions. In the ameloblastoma, the follicular and plexiform types revealed the signals in the nuclei, but cystic, acanthomatous, granular, and basal cell types exhibited no reaction with EBER. The distribution of the signals without monoclonarity indicated that ameloblastoma cells may exclude EBV genomes or inactivate EBER-encoded genes. The results suggested that EBV participates as one of the transforming factors in the occurrence of ameloblastoma.
Adolescent↗
Metastasis of breast carcinoma to eyelid and orbit of a postmenopausal woman: good response to tamoxifen therapy.
We report a case of metastatic eyelid and orbital carcinoma in a postmenopausal woman 8 years after mastectomy for cancer. MRI scan T1-weighted images with fat suppression revealed an intraconal lesion surrounding the left optic nerve in addition to the left lid tumor. Excision biopsy demonstrated tumor cells in an Indian file pattern. We diagnosed metastasis of breast carcinoma to the eyelid and orbit. Therapy with tamoxifen reduced eyelid and orbital metastases of carcinoma of the breast. Metastatic breast carcinoma should be listed as one of the causes of lesions of the eyelids.
Adenocarcinoma↗
Expression of bcl-2 oncogene product in primary non-Hodgkin's malignant lymphoma of the oral cavity.
The B-cell leukemia/lymphoma-2 (bcl-2) proto-oncogene is peculiar, as its product appears to provide survival advantage to B cells by blocking apoptosis. Expression of bcl-2 protein was analyzed in 54 cases of primary non-Hodgkin's malignant lymphomas of the oral cavity by immunohistologic staining of paraffin-embedded tissue. The immunophenotype of each tumor was established with the use of a panel of monoclonal and polyclonal antibodies to lymphoid cell differentiation antigens. The cases in the present study were 42 B-cell lymphomas, 7 T-cell lymphomas and 5-lymphomas revealing histiocytic markers. Sixteen of the 42 B-cell lymphomas were positive for bcl-2 protein, and were composed of 7 low-grade B-cell lymphomas and 9 high-grade B-cell lymphomas. Seven low-grade B-cell lymphomas were composed of one mucosa-associated lymphoid tissue type, three centrocytic types and three centroblastic-centrocytic types. Nine high-grade B-cell lymphomas comprised four centroblastic types, one immunoblastic type and four lymphoblastic types. Enhanced expression of the bcl-2 oncogenic protein was detectable in lymphoma cells in 2 cases for the T-cell lymphoma, and one case for the true histiocytic lymphoma. In contrast to the previous reports of American node-based lymphomas, Japanese primary oral lymphomas in our series expressed a lower frequency of bcl-2 protein. Furthermore, the present study indicated that bcl-2 protein was expressed on a wide variety of B-cell lymphomas, T-cell lymphomas and true histiocytic lymphoma, and that differences in bcl-2 protein expression may be useful in the diagnostic separation of lymphoblastic lymphoma with B-cell marker from Burkitt's lymphoma.
Adult↗
An inverse method to optimize heating conditions in RF-capacitive hyperthermia.
An inverse method to directly optimize the electrode configuration (positions, sizes, and driving voltages) for radio frequency (RF) capacitive hyperthermia was proposed. The main algorithm, based on the two-dimensional finite element method (2-D-FEM) solution of Laplace and bio-heat transfer equations, iteratively modified the individual boundary potentials around an object thereby making a calculated temperature distribution approach a target temperature distribution. A penalty function governed continuity and smoothness among the boundary potentials so that the optimized boundary potentials became attainable for two plate electrodes. Case simulations demonstrated the viability of the algorithm. For instance, in a computed tomography (CT)-based human abdomen model which had deep-and shallow-seated tumors, the optimized electrodes produced a temperature distribution suitable for heating the tumors; the average temperature differences between the tumors and normal tissues were 3.5 degree C for the deep-seated and 7.6 degree C for the shallow-seated tumors within 600 s of heating. A drawback with the present algorithm is that the choice of penalty coefficient and modification of the boundary potentials to coincide with the use of two plate electrodes are carried out manually. These procedures would be automated.
Algorithms↗
A histopathologic and immunohistochemical study of small nodules of renal angiomyolipoma: a comparison of small nodules with angiomyolipoma.
Small mesenchymal nodules (SNs) are observed in some cases of renal angiomyolipoma (AML), with or without tuberous sclerosis. They are composed of blood vessels and/or nonvascular smooth muscle cells (SMCs) and/or fat cells. We examined 20 cases of AML, performed detailed histopathologic and immunohistochemical studies of SNs, verified the histologic relationship between SNs and AMLs, and compared the SNs of the tuberous/nontuberous sclerosis groups. Seventy-seven SNs were observed in five cases of AML. The SNs were 0.11 mm to 20.0 mm in diameter. The location of small-sized SNs in the kidney was variable; almost all of the SNs larger than 3.25 mm were in the renal capsule. The small-sized SNs contained mainly epithelioid-type nonvascular SMCs. Blood vessels and fat cells were not observed in the small-sized SNs but appeared gradually in the large-sized SNs. Almost all of the SNs were rounded lesions, and no fusion was observed between the SNs. Nonvascular SMCs of all of the SNs and AMLs were positive for vimentin, alpha-SM actin, and S-100 protein. The SNs less than 1.13 mm in diameter were negative for HMB-45; the nonvascular SMCs of AMLs and of SNs greater than 1.13 mm in diameter were positive for HMB-45. Nonvascular SMCs of SNs and AMLs showed a neurogenic phenotype. The SNs of the nontuberous sclerosis group contained only SMC components, whereas the same-size SNs of the tuberous sclerosis group contained SMCs, fat cells, and blood vessels. The SNs of the nontuberous sclerosis group may not increase in size or may grow slowly. Some of the SNs of patients with tuberous sclerosis grow to become AML. Although the SNs in patients with nontuberous sclerosis do not contain any blood vessels or fat cells, their SMCs show the histologic and immunohistochemical characteristics of AMLs; this indicates that SNs are the "buds" of AML.
Actins↗
[Progressive ataxic hemiparesis with asymmetric cortical and cerebral peduncular atrophy--report of two cases].
We report two patients, 73- and 70-year-old men, characterized by progressive hemiparesis and homolateral limb ataxia as the main clinical symptoms; magnetic resonance (MR) imaging of the brain revealed asymmetric cerebral cortical and peduncular atrophy; 99mTc-ECD single photon emission computed tomography (SPECT) of brain showed decreased RI uptake in the cerebral hemisphere correlated with clinical deficits. Brain SPECT of case 1 showed decreased RI uptake in the cortex of the right hemisphere and the left cerebellar hemisphere ("crossed cerebellar diaschisis; CCD"). These findings indicate that ataxia of our patients may depend on the lesions of the corticopontocerebellar tracts, although it is possible that ataxia may be related to lack of spatial orientation associated with parietal lobe lesion. The mechanism of the occurrence of asymmetric cerebral peduncular atrophy would be explained by wallerian degeneration of the pyramidal tract and other cortically originated fibers associated with the cortical degeneration. From these clinical and radiologic features, it seems likely that our two patients are categorized in the "asymmetric cortical degeneration syndromes", and we propose the term "progressive ataxic hemiparesis" for our patients.
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Expression of heat shock protein 70 (HSP70) and EBV latent membrane protein 1 (LMP1) in Reed-Sternberg cells of Hodgkin's disease.
Tissue sections embedded in paraffin and fixed in formalin from 65 patients with Hodgkin's disease (HD) were examined for the presence of heat shock protein 70 (HSP70) and Epstein-Barr virus (EBV)-encoded latent membrane protein 1 (LMP1) using avidin-biotin immunoperoxidase complex technique. The staining results in Reed-Sternberg (R-S) cells and their variants were evaluated independently. HSP70 expression was found in R-S cells in 55 cases (85%) of HD examined and the frequency of HSP70 positive cases was significantly higher than that of HSP70 negative cases (P < 0.01). This protein was present in pathogenic cells in 9/12 cases (75%) of lymphocyte predominant Hodgkin's disease (LPHD), 21/27 cases (78%) of mixed cellularity Hodgkin's disease (MCHD), 10/10 cases (100%) of lymphocyte depleted Hodgkin's disease (LDHD) and 15/16 cases (94%) of nodular sclerosing Hodgkin's disease (NSHD). The association between HSP70 expression and HD thus appeared to be more frequent in patients wish LDHD and NSHD subtypes, although examples of HSP70-positive tumors were found in all histological subtypes. Studies of non-neoplastic lymphoid tissues demonstrated that centroblasts (large lymphocytes in germinal centers) were constantly positive; occasional histiocytes revealed variable reactivity for.
HSP70 Heat-Shock Proteins↗
Phonon structure in the tunneling conductance of Bi2Sr2CaCu2O8.
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Journal Article↗