Oestrogen receptor‐β1 but not oestrogen receptor‐βcx is of prognostic value in apocrine carcinoma of the breast

Apocrine carcinoma of the breast, which frequently expresses oestrogen receptor‐β (ER‐β) in the absence of ER‐α and only infrequently is treated endocrinologically, gives an opportunity to investigate the clinicopathological role of ER‐β in breast cancer independent of ER‐α expression or tamoxifen treatment. Several isotypes of ER‐β, ER‐β1–5 etc., have been identified thus far; however, the clinicopathological importance of each ER‐β isotype in breast cancer is still uncertain. Here we aimed to clarify the clinicopathological importance of ER‐β1 and ER‐βcx (ER‐β2) in apocrine carcinomas, immunohistochemically examining expressions of ER‐β1 and ER‐βcx in 47 apocrine carcinomas. Positivity for ER‐β1 and ER‐βcx was observed in 41 (87%) and 18 (38%) of 47 cases, respectively. ER‐β1 positivity was related to smaller tumor size (P=0.0359), lower histological grade (P=0.0322), and higher disease‐free survival (P<0.0001), whereas ER‐βcx status was related to none of these parameters. ER‐β1 positivity was also associated with favorable clinical outcome in 24 so‐called triple‐negative (ER‐α‐negative/PR‐negative/HER2‐negative) apocrine carcinomas. ER‐β1 itself, independent of ER‐α expression and tamoxifen treatment, seems to have a tumor‐suppressive effect, at least in apocrine carcinomas. Further study of ER‐β1 is desired to optimize breast cancer treatment.     

Intussusception of the bladder neck does not promote early restoration to urinary continence after non-nerve-sparing radical retropubic prostatectomy

BACKGROUND: The objectives of the present study were to investigate whether buttressing sutures, which prevent the bladder neck from pulling open as the bladder fills, can promote earlier recovery from urinary incontinence after radical retropubic prostatectomy (RRP) and to identify possible risk factors associated with urinary incontinence after RRP. METHODS: The present study included 72 patients who underwent non-nerve-sparing RRP without neoadjuvant therapy between January and December 2003. Among these 72 patients, intussusception of the bladder neck was performed in 24 who consented to this procedure. In the present series, continence was defined as the absence of any need to use sanitary pads or diapers. Continence was evaluated by a patient interview 1, 3 and 6 months after RRP. RESULTS: There were no significant differences in clinicopathological characteristics between patients with and without intussusception of the bladder neck. The percentage of continent patients 1, 3 and 6 months after RRP was 34.7%, 63.9% and 95.8%, respectively, and there were no significant differences in continence between the two groups at any time point. Among several factors examined, only bladder neck preservation was an independent predictor of recovery from urinary incontinence 1 and 3 months after RRP. CONCLUSIONS: These findings suggest that it would be important to preserve the bladder neck for early return to continence after non-nerve-sparing RRP; however, intussusception of the bladder neck may not offer significant improvement in earlier return of urinary control.     

Alteration of T-Lymphocyte Subpopulations in Patients with Primary Renal Diseases and Systemic Lupus Erythematosus

Forty-eight patients with a variety of primary renal diseases and systemic lupus erythematosus (SLE) were examined for the proportion of circulating T lymphocytes bearing receptors for IgM Tμ cells) or IgG (Tγ cells). Although the control group showed strikingly similar mean values for both Tμ and Tγ cells, the whole group of patients with primary renal diseases and SLE showed a wide scatter of values. Sixteen patients with primary renal diseases and SLE had higher proportions of Tγ cells than the control group, whereas seven patients with chronic glomerulonephritis (CGN), membranoproliferative glomerulonephritis (MPGN), lipoid nephrosis (LN), and SLE showed very marked decrease in the proportions of Tγ cells in the peripheral blood. On the other hand, six out of the total group of patients had low proportions of Tμ cells in the peripheral blood. However, no consistent relationship between the proportion of Tμ and Tγ cells was found in our study. These findings indicate that there exists a heterogeneity of T-lymphocyte subpopulation distribution in some patients with primary renal diseases and SLE. The possible significance of these phenomena in the pathophysiology of renal diseases is discussed.     

ENDOSCOPIC AND CLINICAL STUDY ON HEMORRHAGIC GASTRITIS IN PATIENTS WITH LIVER CIRRHOSIS

Abstract: During a 5-year period from 1984 through 1988, an emergency endoscopy was performed for an upper digestive tract hemorrhage in 283 consecutive patients with 290 lesions. Of these, 54 patients were diagnosed as having hemorrhagic gastritis on the basis of the endoscopic findings and were employed as the subjects of the present study. They were classified on the basis of the presence/absence of liver cirrhosis into two groups, i. e. the cirrhosis group (C-group) and non-cirrhosis group (NC-group), and the two groups were comparatively studied. The incidence of hemorrhagic gastritis in hemorrhagic sources of the upper digestive tract was higher in the C-group than in the NC-group, and it was seen in the gastric body most frequently. In addition, no clear causes for hemorrhagic gastritis could be identified in many of the cases in the C-group. These clinical findings were thought to indicate that, in patients with liver cirrhosis, the gastric mucosa itself, especially of the gastric body, is in an impending state of mucosal hemorrhage. A hemorrhage was the major cause of death in the C-group. In patients with liver cirrhosis, the incidence of hemorrhagic gastritis had no correlation with the grade of esophageal varices, but was high in patients with severe liver cirrhosis. Thus, patients with severe liver cirrhosis were considered to be a high risk group of hemorrhagic gastritis.     

Trichogenic trichoblastoma arising on the supraclavicular fossa with an immunohistochemical study of cytokeratin expression

We report a 52-year-old female with trichogenic trichoblastoma arising on the supraclavicular fossa. Clinical and histological examinations revealed a thumbnail sized, elastic, hard, subcutaneous nodule which consisted of keratinous cysts and epithelial cords of basaloid cells with locally follicular differentiation. Based on histological observations, a diagnosis of trichogenic trichoblastoma was made. An immunohistochemical study using a panel of monoclonal antibodies against cytokeratins was performed to investigate the nature and differentiation of this tumour. The most characteristic findings of the immunohistochemistry were CK 8 and 19 expression in the epithelial cords and the outer cells of the cystic structures. These immunoreactivities were similar to those of the outermost layer of the outer root sheath between the lower permanent portion and the upper transient portion, and immunostaining with the other antibodies confirmed this similarity. We can speculate that trichogenic trichoblastoma differentiates mainly toward the outermost layer of the outer root sheath between the lower permanent portion and the upper transient portion, and then into follicular structures.