Magnetic resonance imaging detection of aortic and pulmonary artery wall thickening in the acute stage of takayasu arteritis. Improvement of clinical and radiologic findings after steroid therapy

Objective. Early diagnosis of Takayasu arteritis in the acute stage (prepulseless stage) is extremely difficult. Identification of a useful approach to detecting the initial changes of arteritis is therefore desirable. Methods. Careful clinical examination of a young woman with persistent fever and dry cough revealed faintly audible bruits at the cervical, supraclavicular, and abdominal regions. Aortographic features suggested thickening of the wall of the descending thoracic aorta. Magnetic resonance imaging (MRI) of this area was diagnostic. Results. MRI demonstrated involvement of the ascending aorta and right main pulmonary artery. Steroid therapy (prednisolone 60 mg/day) induced dramatic clinical and radiologic improvement in 2 months. Conclusion. This is the first report of MRI-documented reduction in the thickness of the walls of both the aorta and the pulmonary artery following steroid therapy.     

Cytopathological and immunocytochemical findings of pancreatic anaplastic carcinoma with ZEB1 expression by means of touch imprint cytology

Pancreatic anaplastic carcinoma (PAC) is rare and has an aggressive clinical course. We report an autopsy case of PAC focusing on the cytopathological characteristics of the tumor and immunocytochemical staining for vimentin, E‐cadherin, and zinc finger E‐box binding homeobox 1 (ZEB1), which markers are associated with epithelial markers of epithelial‐mesenchymal transition (EMT). A 50‐year‐old woman presented to our hospital with a chief complaint of jaundice. A pancreatic head tumor and multiple liver nodules were detected on abdominal computed tomography. Biliary cytology under endoscopic retrograde cholangiopancreatography suggested ductal adenocarcinoma. Three months after admission, she died of multiorgan failure. At autopsy, touch imprint cytology using squash preparation of the pancreatic tumor identified two different cell types; numerous isolated malignant cells with large and pleomorphic nuclei and a few clusters showing irregularly overlapped nuclei and irregular contours within the necrotic background. Immunocytochemically, isolated cells were positive for vimentin and ZEB1, and negative for E‐cadherin. Conversely, clusters were negative for vimentin and ZEB1, and positive for E‐cadherin. Histologically, the tumor was composed of sarcomatous cells with small foci of adenocarcinoma, which were consistent with a diagnosis of PAC. Immunohistochemical staining of the adenocarcinoma and sarcomatous cells corresponded to those of the clusters and isolated malignant cells, respectively. Immunostaining of these EMT markers is useful to distinguish sarcomatous cells from adenocarcinoma and can contribute to the accurate diagnosis of pancreatic tumors with EMT.     

Accurate diagnosis and treatment of Vibrio vulnificus infection: a retrospective study of 12 cases

Background and aimsVibrio vulnificus causes an infectious disease that has extremely poor convalescence and leads to necrotic fasciitis. In this study, we sought to define the characteristic epidemiology of V. vulnificus infection and clarify its diagnosis at the global level.MethodsOver a period of 10 years, we investigated the appearance of symptoms, underlying conditions, treatment, and mortality in 12 patients (eight men, four women; >50 years old; average age, 66 years,) infected with V. vulnificus.ResultsThe development of symptoms occurred primarily between June and September, a period during which seawater temperature rises and the prevalence of V. vulnificus increases. All patients had underlying diseases, and seven patients reported a history of consuming fresh fish and uncooked shellfish. The patients developed sepsis and fever with sharp pain in the limbs. Limb abnormalities were observed on visual examination. All patients underwent debridement; however, in the survival group, the involved limb was amputated early in 80% patients. The mortality rate was 58.3%.ConclusionRecognition of the characteristic epidemiology and clinical features of this disease is important, and positive debridement should be performed on suspicion. When the illness reaches an advanced stage, however, amputation should be the immediate treatment of choice.     

Establishment of an ovarian metastasis model and possible involvement of E‐cadherin down‐regulation in the metastasis

Clinical observations of cases of ovarian metastasis suggest that there may be a unique mechanism underlying ovarian‐specific metastasis. This study was undertaken to establish an in vivo model of metastasis to the ovary, and to investigate the mechanism of ovarian‐specific metastasis. We examined the capacity for ovarian metastasis in eight different human carcinoma cell lines by implantation in female NOD/SCID mice transvenously and intraperitoneally. By transvenous inoculation, only RERF‐LC‐AI, a poorly differentiated carcinoma cell line, frequently demonstrated ovarian metastasis. By intraperitoneal inoculation, four of the eight cell lines (HGC27, MKN‐45, KATO‐III, and RERF‐LC‐AI) metastasized to the ovary. We compared E‐cadherin expression among ovarian metastatic cell lines and others. All of these four ovarian metastatic cell lines and HSKTC, a Krukenberg tumor cell line, showed E‐cadherin down‐regulation and others did not. E‐cadherin was then forcibly expressed in RERF‐LC‐AI, and inhibited ovarian metastasis completely. The capacity for metastasizing to the other organs was not affected by E‐cadherin expression. We also performed histological investigation of clinical ovarian‐metastatic tumor cases. About half of all ovarian‐metastatic tumor cases showed loss or reduction of E‐cadherin expression. These data suggest that E‐cadherin down‐regulation may be involved in ovarian‐specific metastasis. (Cancer Sci 2008; 99: 1933–1939)     

Lymphangioma of the colon: a case report and review of the Japanese literature

Intraabdominal lymphangiomas are rare, although these lesions can occur in the mesentery, omentum, retroperitoneum, or gastrointestinal tract wall. Here we report a case of lymphangioma of the transverse colon and review the other cases reported in the Japanese literature. Our patient presented with lower abdominal pain and barium enema revealed a filling defect in the transverse colon. Colonoscopy disclosed a submucosal tumor, which changed shape with alteration the patient's position and showed the cushion sign. This lesion was covered with normal-looking mucosa. A correct diagnosis was made from these findings. Knowledge of these endoscopic features may help physicians to provide appropriate diagnosis and treatment of colonic lymphangioma.     

Decrease of suppressor-inducer (CD4+ CD45RA) T lymphocytes and increase of serum immunoglobulin G due to perceived job stress in Japanese nuclear electric power plant workers

To clarify the effects of perceived job stress on the immune system, a cross-sectional study was conducted in 116 male Japanese workers of a nuclear electric power plant (age, 20 to 39; mean, 31 years). Perceived job stress, i.e., psychological job demand, job control, worksite social support, and job strain, was assessed by means of the Japanese version of the Job Content Questionnaire. The job strain score was calculated as the ratio of the job demand score to the job control score. Blood samples were taken from all workers, and numbers of T and natural killer cell subpopulations, B lymphocytes, total lymphocytes and white blood cells, and serum concentrations of immunoglobulins (IgG, IgM, IgA, IgE and IgD) in their blood were measured. The workers were divided into higher and lower strain groups according to their job strain scores. The number of CD4+ CD45RA+ T lymphocytes in the higher strain group having the job strain score of 0.5 or more (41 workers) was significantly smaller than that in the lower strain group having the score of less than 0.5 (75 workers). In contrast, the serum IgG concentration in the former group was significantly higher than that in the latter group (analysis of covariance with age and smoking as covariates). Also, the numbers of total CD4+ T and total T (CD3+) lymphocytes and of white blood cells in the former group were significantly smaller than those in the latter group. After controlling for age and smoking by the partial correlation coefficient in all 116 workers, the number of CD57+ CD16+ natural killer cells was inversely correlated with job demand and with job strain; the number of CD8+ T lymphocytes was positively correlated with worksite social support; and serum IgG and IgM concentrations were positively correlated with job strain. It is suggested that higher job strain decreases the number of CD4+ CD45RA+ T lymphocytes in male Japanese workers but increases serum IgG concentrations.     

Prognostic significance of in vitro thymidine uptake in patients with colorectal carcinoma

In 127 patients with colorectal carcinoma, we measured thymidine uptake by tumor cells cultured in a semisolid medium and compared the influence of various parameters on survival by univariate and multivariate analysis. Fifty-four of the 127 carcinomas (42.5%) incorporated >1,000 cpm of tritiated thymidine per culture dish and were designated as the high-uptake group, while the other tumors (57.5%, 73/127) were designated as the low-uptake group. There was no significant correlation between high or low thymidine uptake and most of the clinicopathological characteristics of the patients. Patients in the high-uptake had a poor prognosis and a 7-year survival rate of 32.6%, which was significantly different from the rate of 69.3% in the low-uptake group (P < 0.0005). Multivariate analysis showed that thymidine uptake was one of the variables strongly associated with survival in our study population. Thus, it is concluded that thymidine uptake by tumor cells has a high capacity of predicting prognosis, independent of its relationship to other variables. Furthermore, it seems to us that thymidine uptake can help in selecting those patients with colorectal carcinoma who are most likely to benefit from perioperative adjuvant therapy. © Wiley-Liss, Inc.