Schizophrenic outpatient perceptions of psychiatric treatment and psychotic symptomatology: An investigation using structural equation modeling

Schizophrenic patient perceptions of treatment have clinical value and deserve detailed psychiatric investigation. The present study sought a model indicating statistically estimated cause-effect relationships of perceptions and psychotic symptomatology of outpatients with schizophrenia by applying a method of structural equation modeling. The perceptions included in this model were patient satisfaction with treatment, perceptions of their treating psychiatrists, and patient-role perception. Scores of Positive and Negative Syndrome Scale and poor insight measures were added to the model as possible influential factors. The constructed model revealed that the poor insight exerted a major influence on the patient-role perception that had small effects on the reliable therapist perception and the satisfaction. It was also shown that satisfaction was chiefly determined by the reliable therapist perception that was formed in the treatment relationship, rather independently of the other construct. These findings were valuable in terms of their implications for understanding the makeup of the perceptions and the strategy for interventions to improve them.     

Prognostic significance of programmed cell death‐1‐positive cells in follicular lymphoma patients may alter in the rituximab era

Programmed cell death‐1 (PD‐1) is involved in one of the inhibitory pathways of the B7‐cluster of differentiation (CD) 28 family; this pathway is known to be involved in the attenuation of T‐cell responses and promotion of T‐cell tolerance. PD‐1 is known to negatively regulate T‐cell receptor‐mediated proliferation and cytokine production, lead to alternation in the tumor microenvironment. Although several studies have shown that high levels of PD‐1‐positive cells in follicular lymphoma (FL) patients influence their prognosis, those studies included patients treated without rituximab, and the prognostic impact of PD‐1 positivity in the rituximab era (R‐era) has not yet been elucidated. We retrospectively studied 82 patients with FL uniformly treated with standard R‐CHOP therapy at six institutions between 2001 and 2009 (median follow‐up for survivors: 55 months). We also collected and examined biopsy specimens for diagnosis with respect to PD‐1 positivity. The PD‐1 positivity was significantly higher in male patients and patients with high beta‐2 microglobulin (B2M ≥ 3.0) (P = 0.03 and 0.003, respectively). Three‐year progression free survival (PFS) and overall survival (OS) were 60% and 86%, respectively. By univariate analysis, elevated LDH (P = 0.07) worsened PFS. Male gender (P = 0.03), high FLIPI score (P = 0.05), and high B2M levels (P = 0.08) worsened OS. Multivariate analysis detected no significant prognostic factors, including PD‐1 positivity. However, in male subgroup, high levels of PD‐1‐positive cells were found to be a prognostic factor for PFS. Addition of rituximab might have altered the prognostic impact of PD‐1‐positive cells.     

Anaplastic variant of diffuse large B‐cell lymphoma: Reappraisal as a nodal disease with sinusoidal involvement

Anaplastic variant (av) of diffuse large B‐cell lymphoma (DLBCL) is morphologically defined in the 2017 World Health Organization classification, but still an enigmatic disease in its clinicopathologic distinctiveness, posing the differential diagnostic problem from gray zone lymphoma (GZL) and classic Hodgkin lymphoma (cHL). Thirty‐one cases previously diagnosed as avDLBCL were reassessed. Of these, 27 (87%) and 4 (13%) were node‐based and extranodal diseases, respectively. They were further reclassified into nodal avDLBCL (n = 18), nodal CD30+ DLBCL with T‐cell/histiocyte‐rich large B‐cell lymphoma‐like features (CD30+ DLBCL‐THRLBCL) (n = 6), GZL with features intermediate between DLBCL and cHL (n = 3) and CD30+ extranodal DLBCL, NOS (n = 4). The nodal avDLBCL cases had a sheet‐like proliferation of large cells and/or Hodgkin/Reed‐Sternberg (HRS)‐like cells in 12 (67%) notably with a sinusoidal pattern in 16 (89%). They showed an expression of CD20 and/or CD79a in all and CD30 in 15 of 18. All of them were negative for PD‐L1 on tumor cells, although HRS‐like cells showed negativity or partial loss of other B‐cell markers to varying degrees. The present study highlighted the distinctiveness of the nodal avDLBCL with sinusoidal pattern, but without neoplastic PD‐L1 expression, which provide refined diagnostic criteria for a more precise pathologic and clinical characterization of this disease.     

IgG4‐related disease of the paratestis with the scrotal fluid: A case report

IgG4‐related disease (IgG4‐RD) can affect various organs, and the pancreas and salivary gland are representative examples. We report a rare case of IgG4‐RD of the paratestis. A 74‐year‐old man presented with left scrotal swelling. Scrotopuncture drainage and cytology confirmed a clear, yellow retention liquid (130 mL) with many small, similar lymphocytes and a few plasmacytes. Many lymphoid cells were immunopositive for CD3 on a cell block section, indicating that a predominant type of lymphoid cells was T cell. There were also some CD20 immunopositive cells and a few IgG4 immunopositive cells. Two months later the left scrotal swelling had returned, and he underwent radical inguinal orchiectomy. Microscopically, there was considerable lymphoplasmacytic inflammatory infiltration, fibrosis and abundant IgG4 immunopositive cells in the paratesticular region. The histopathologic and immunohistochemistry findings were consistent with IgG4‐RD. However, the abundant T cells in the scrotal fluid complicated the cytological diagnosis in our case.     

Lymphoepithelioma-like carcinoma of the uterine cervix

A 36-year-old woman presented unwell, with abdominal pain. A pelvic mass was found and being investigated but when she deteriorated and became peritonitic. An emergency laparotomy was performed and she required a pelvic clearance for a Stage IIB ovarian tumour, later confirmed as a yolk sac tumour. Accurate staging and tumour-reductive surgery strongly affects the prognosis of yolk sac tumours. Thus ability to perform a meticulous surgical clearance may well positively impact on the outcome for these young patients. This case describes the challenges that generalists will be faced with when highly suspicious cancer patients present as an emergency.     

Influenza A H1N1 pdm09‐associated myocarditis during zanamivir therapy

A 9‐year‐old girl developed influenza A H1N1 pdm09‐associated myocarditis and pericarditis 2 days after starting zanamivir therapy. The virus was detected in the respiratory tract but not in the serum or pericardial effusion. The virus sampled from the respiratory tract had normal susceptibility to neuraminidase inhibitors. Although no differences in interferon‐γ, interleukin (IL)‐1β, and tumor necrosis factor‐α were observed between the plasma and pericardial effusion, some inflammatory cytokines or chemokines (IL‐6 and IL‐8) and vascular endothelial growth factor were remarkably elevated in the pericardial effusion compared with the plasma. This suggested that the influenza virus, after infecting the respiratory tract, affected the myocardium, causing myocarditis to gradually develop, which might have been followed by an autoreactive pericarditis causing increased pericardial effusion. Therefore, influenza‐associated myocarditis should be considered when influenza patients have respiratory and cardiac involvement, even during treatment with a neuraminidase inhibitor.