Esophageal carcinosarcoma with granulocyte colony-stimulating factor: a case report

A 62-year-old man was admitted to our hospital for dysphagia, leukocytosis, and pyrexia. The serum level of granulocyte colony-stimulating factor (G-CSF) was high and immunostaining of a biopsy specimen of esophageal tumor using anti-granulocyte-macrophage colony-stimulating factor (anti-GM-CSF) antibody demonstrated GM-CSF expression in the cytoplasm of the tumor cells. After esophagectomy, the leukocyte count and serum G-CSF level normalized. Histologically, this tumor was diagnosed as a carcinosarcoma with two components: squamous cell carcinoma and sarcoma. Tumor cells were also positive for G-CSF receptor, suggesting autocrine growth regulation by G-CSF. Moreover, tumor cells were positive for Ki-67, cyclin D1, p53, and epidermal growth factor receptor (EGFR), which were related to the acquisition of more aggressive tumor behavior. Although G-CSF-producing esophageal carcinosarcoma is very rare, we should consider such disease when a patient has symptoms of leukemia such as leukocytosis and high fever.     

Endocytoscopic observation of various types of esophagitis

Background

Use of an endocytoscopy system (ECS) makes it possible to omit biopsy histology for esophageal squamous cell carcinoma (ESCC). However, for differential diagnosis of ESCC, the endocytoscopic characteristics of esophagitis should be clarified.

Methods

We examined the morphology of surface cells in 20 cases of gastroesophageal reflux disease (GERD) (Grade M: 6 cases, A: 5 cases, B: 1 cases, C: 4 cases, D: 4 cases), five cases of candida esophagitis, and one case of eosinophilic esophagitis. One endoscopist classified the lesions using the modified type classification, and one pathologist judged the endocytoscopy images as “neoplastic”, “borderline”, or “non-neoplastic”.

Results

All cases of Grade M, A, and B GERD were classified as “type 1 or 2” by the endoscopist. However, 3/8 Grade C and D GERD lesions that had been diagnosed as regenerative squamous epithelium from biopsy histology were diagnosed as Type 3. All Grade M, A, and B cases were interpreted by the pathologist as “non-neoplastic”, whereas 4/8 Grade C and D GERD lesions, including three cases of regenerating epithelium, were diagnosed as “borderline” on the basis of ECS images. In 80 % of candida esophagitis cases, hyphae were visualized as white areas. Eosinophilic esophagitis showed a slight increase of cell density with marked infiltration of inflammatory cells.

Conclusion

Some cases of severe GERD cannot be clearly distinguished from esophageal squamous cell carcinoma (ESCC) using ECS, and therefore at present, cases of ESCC coexisting with severe GERD should not be diagnosed by ECS alone and probably require biopsy. (UMIN000007627).

     

G-CSF induces the release of the soluble form of LR11, a regulator of myeloid cell mobilization in bone marrow

Granulocyte colony-stimulating factor (G-CSF) induces the mobilization of leukocytes from the bone marrow (BM) to the circulation by a yet incompletely understood mechanism. Here, we describe that the membrane-bound receptor LR11 is highly expressed in human myeloid cells and that the shed soluble form of LR11 (sLR11) is a modifier of myeloid cell migration. In the process of leukocyte mobilization by G-CSF treatment, circulating sLR11 levels are transiently elevated in humans and mice. Moreover, following G-CSF treatment, the sLR11 levels in patients show significant positive correlation with the numbers of mobilized leukocytes. The changes of LR11 levels in BM cells and of sLR11 released into the BM fluid of mice correlate tightly with the changes in circulating sLR11 levels. G-CSF dose-dependently enhanced sLR11 release from HL-60 cells, which in turn accelerated cell migration. Finally, cooperatively with tumor necrosis factor-α (TNF-α) and G-CSF, sLR11 increased the attachment of floating cells (HL-60 and U937) to endothelial cells. We propose that sLR11 is a novel candidate modifier of G-CSF-mediated mobilization of hematologic cells. Identification of sLR11 as a regulatory component of G-CSF-mediated hematologic cell mobilization may facilitate further improvement of hematologic stem cell collection for clinical applications.     

Early aortic endograft failure in the presence of periaortic lymphadenopathy with neurofibromatosis (von Recklinghausen’s disease)

A 78-year-old man with a history of neurofibromatosis was transferred to our hospital for treatment of an abdominal aortic aneurysm. T The patient was treated by stent graft implantation and was discharged from the hospital without complications. After discharge, the patient reported repeated episodes of abdominal pain. Computed tomography performed 3 months postoperatively showed localized lymphadenopathy along the graft with extravasation of contrast, suggesting the diagnosis of rupture of the aortic aneurysm. Emergent laparotomy was performed, which showed penetration of the graft through the aortic wall due to deformation of the aorta caused by lymphadenopathy. The lymphadenopathy resolved after removal of the graft. This is the first reported case of stent graft failure due to aortic deformation associated with neurofibromatosis.     

Preoperative FDG-PET Predicts Recurrence Patterns in Hepatocellular Carcinoma

Purpose  

We investigated the usefulness of preoperative fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) as a tool for predicting recurrence patterns to select patients for liver resection as an initial surgical strategy for hepatocellular carcinoma.     

Simvastatin improves morphological and functional recovery of sciatic nerve injury in Wistar rats

AimThe purpose of this work is to investigate the effects of simvastatin on sciatic nerve regeneration in male Wistar Rats.Materials and methodsForty animals were allocated into four groups: (1) control (C); (2) control + simvastatin (CS); (3) lesioned animals + sterile PBS (LC) and (4) lesioned animals + simvastatin (LS). Lesioned animals were submitted to crushing lesion of right sciatic nerve. Simvastatin (20 mg/kg/day, i.p.) was administered for five days. Footprints were obtained weekly for evaluation of functional locomotor recovery by means of the Sciatic Function Index (SFI). Blood samples were obtained weekly for quantifying circulating leukocytes. Animals were sacrificed after 21 days for histological analyses of sciatic nerve and spleen.ResultsLS Animals presented increased SFI scores, decreased areas of oedema and mononuclear cell infiltration during Wallerian degeneration and nerve regeneration (7,14 and 21 days; P < 0.05). Spleen weight and white pulp areas was increased in LC animals after 21 days. Increased numbers of circulating neutrophils were observed in simvastatin treated animals (CS e LS) at seven, 14 and 21 days, compared to non-treated groups (C and LC).ConclusionThe study suggests that simvastatin accelerates the morphological and functional recovery process of the peripheral nervous system interfering with innate and acquired immunity.     

Successful endovascular repair with chimney graft technique and carotid artery bypass for ruptured aortic arch aneurysm

An 83-year-old man with a decreasing level of consciousness was carried to the emergency room. Computed tomography (CT) revealed a ruptured aortic arch aneurysm. He was deemed a high risk candidate for conventional surgical repair. The case was treated by a hybrid approach. Endo-exclusion of thoracic aortic aneurysm (TAA) was obtained by implanting stentgrafts from the ascending to descending aorta. The brain circulation was maintained by right to left carotid and to left subcravian artery bypasses combined with" chimney endo-debranching graft" of the innominate artery. This could be a method of choice for the acute patients under similar circumstances.     

Safety and feasibility of combined coiling and neuroendoscopy for better outcomes in the treatment of severe subarachnoid hemorrhage accompanied by massive intraventricular hemorrhage

Subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) is associated with poor outcomes. The aim of this study was to evaluate the safety and feasibility of combined coiling and neuroendoscopy for treating severe SAH with massive IVH. Between April 2008 and June 2011, 49 patients with a severe SAH were treated at the Department of Neurosurgery, Fukuoka University, Japan; 10 of these patients had a massive IVH with a ruptured aneurysm. All 10 patients (three men and seven women; mean age, 63.1 ± 8.5 years) were treated with coiling and neuroendoscopic removal of the IVH within 2 days of onset. Coiling was successfully performed at a mean volume embolization ratio of 21.8 ± 5.5%. Neuroendoscopic removal of the IVH reduced the mean Graeb score from 10.5 ± 2.0 to 4.8 ± 2.5 (p = 0.005). All external drains were removed on day 3. No rebleeding or acute hydrocephalus was noted. The Glasgow Outcome Scale scores at discharge indicated two patients with good recovery, three with moderate disability, four in a vegetative state, and one dead. A good modified Rankin Scale (mRS) score (0–2) at least 6 months later (mean follow-up period, 15.4 ± 9.2 months) was observed for five patients (50%), and a poor mRS score (3–6) was observed for the remaining four patients. Neuroendoscopically removing the IVH from all of the ventricles between the lateral and the fourth ventricle and coiling the ruptured aneurysm is a safe, feasible approach for treating severe SAH with massive IVH.     

Effect of pH on fluoride penetration into natural human plaque

Since recent studies have demonstrated that penetration profiles of fluoride into plaque falls from the saliva plaque interface towards the enamel, it was hypothesized that charged components may restrict the inward diffusion of fluoride i.e., protonated fluoride and may penetrate more effectively than fluoride ion. Therefore, in this study, we investigated the effects of pH on fluoride uptake and distribution in natural undisturbed human plaque formed in vivo by means of the Leeds in situ device. At pH 3 significantly less fluoride was present throughout the plaque layer compared with pH 7. Similar profiles were seen in the plaque produced over 1 week and 3 weeks. These results may be due to binding to components of the plaque matrix via hydrogen bonding. Protonation of bacterial cell surfaces may also lead to binding of the ionized portion of fluoride. In conclusion, low pH affected the short-term fluoride uptake from a 1,000 ppm fluoride solution.