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.     

Fibrinolytic Enzyme in Tracheobronchial Secretion of Rats: Existence of Plasminogen Activator

It is known that a plasminogen activator exists in the secretion of various organs, i.e., the existence of plasminogen activator in milk, tears, saliva, seminal fluids, urine and bile has been already demonstrated. However, the existence of the fibrinolytic enzyme in tracheobronchial secretions has not been known until this time. We found a new method to collect the tracheobronchial secretion of rats, and succeeded in detecting the fibrinolytic activity in the tracheobronchial secretions. Furthermore, it was found that the substance exhibiting the fibrinolytic activity in this secretion was not protease but plasminogen activator. In addition, some chemical properties of this plasminogen activator are presented, and the physiological and pathophysiological significances of it are discussed in this paper.     

Suppression of experimental autoimmune uveoretinitis by anti-alphabeta TCR monoclonal antibody

PURPOSE: To evaluate the effects of anti-alphabeta T cell receptor monoclonal antibody (R73) on the induction of experimental autoimmune uveoretinitis (EAU) in rats. METHODS: Lewis rats in which EAU was induced were treated with R73. All rats were examined for the clinical course of EAU, pathological findings of the globe, delayed-type hypersensitivity, and the interleukin-2 (IL-2) gene and protein expression in the eye. RESULTS: The R73 treatment was effective for delaying EAU onset, decreasing the severity of EAU, and suppressing delayed-type hypersensitivity to the antigen. IL-2 gene and protein expression was reduced by R73 treatment in the anterior and posterior segments of the eye. CONCLUSION: R73 treatment is effective for suppression of the development of EAU, inhibiting IL-2 expression in the eye.     

Pregnancy After Undergoing the Fontan Procedure for a Double Outlet Right Ventricle: Report of a Case

We describe a 25-year-old woman who had a successful pregnancy after the repair of a double outlet right ventricle using the Fontan procedure. Although the number of reported patients is small, women who have good hemodynamic results after the operation can apparently tolerate both pregnancy and delivery. Received: November 6, 2000 / Accepted: May 15, 2001     

Multiple Ileal Diverticula Causing an Ileovesical Fistula: Report of a Case

We report a case of multiple ileal diverticula causing an ileovesical fistula in an 85-year-old man. The patient was admitted for investigation and treatment of intractable urethrocystitis, which he had suffered for 5 years. Cystography showed an ileovesical fistula, and contrast study of the small bowel revealed about 80 diverticula in the ileum. The segment involved by diverticula was resected and a pathological diagnosis of diverticulitis leading to ileovesical fistula was confirmed. His postoperative clinical course was uneventful. Received: September 13, 2001 / Accepted: March 5, 2002     

Involvement of 90K/Mac-2 binding protein in cancer metastases by increased cellular adhesiveness in lung cancer

90K/Mac-2 Binding Protein (M2BP) plays a role in regulation of immune responses and cell adhesive ability in patients with cancer and infectious diseases. We previously reported that M2BP was highly expressed in lung cancer and that immune responses to M2BP were increased in many patients with lung cancer. To determine the involvement of M2BP in metastatic processes of cancer progression, we examined the ability of M2BP DNA-transduced lung carcinoma cell lines to adhere to extracellular matrices. Although expressions of cell-surface integrins were not modulated in the M2BP transfectants, they showed increased adhesiveness to fibronectin and collagen IV. We next analyzed the serum levels of M2BP in patients with lung cancer and normal donors and the relationships between M2BP expression and clinicopathological factors in the patients. The M2BP level was markedly elevated in the patients and was strongly correlated with nodal involvement and clinical staging. To determine whether expression of M2BP by cancer cells is modulated in the environment of tumor-bearing hosts, M2BP expression in M2BP-positive QG56 cells following exposure of the cells to pro-inflammatory cytokines was examined. The M2BP expression in QG56 cells was up-regulated by many of the cytokines that activate host protective immunity. The findings in this study suggest that M2BP plays a role in cancer metastasis by increased adhesiveness of cancer cells and that M2BP is increasingly produced even in a state of exposure to the host immune system. This molecule may be useful as a predictive factor of disease progression in lung cancer.     

Novel models for human scirrhous gastric carcinoma in vivo

Human scirrhous gastric carcinoma, a diffusely infiltrating type of poorly differentiated gastric carcinoma also known as linitis plastica type carcinoma, is characterized by cancer cell infiltration and proliferation accompanied with extensive stromal fibrosis. We established two new gastric cancer cell lines, designated OUCM-8 and OCUM-11, which developed the characteristic biology of scirrhous gastric carcinoma upon orthotopic implantation in mice. Involvement of lymph nodes and liver metastasis was also found in both orthotopic models. Histologically, these orthotopic models showed proliferation with extensive fibrosis, resembling human scirrhous gastric cancer. Both cell lines were derived from ascites of patients with scirrhous gastric cancer. The growth of OCUM-8 and OCUM-11 cells following the addition of KGF, FGF, and EGF was increased significantly relative to untreated cells. An increase in the number of attached and spreading cells occurred following the addition of TGF-beta 1 in both cell lines. OCUM-11 cells showed microsatellite instability. Although subcutaneous scirrhous gastric cancer cells show medullary growth, most in vivo studies of scirrhous gastric cancer have used xenografted tumors implanted subcutaneously. Only in a few cases was it confirmed that these scirrhous gastric cancer cell lines retained the original histologic characteristics. Our orthotopic models should contribute to the elucidation of disease progression in situ and to the development of therapy for scirrhous gastric cancer.     

A case of pseudoaldosteronism, accompanied with hypocalcemia and exaggerated ACTH response

Glycyrrhizic acid (GA) inhibits the activity of 11beta-hydroxysteroid dehydrogenase type 2 in the kidney, with the resulting increase in intrarenal cortisol concentration leading to hypertension and suppression of the renin-aldosterone system. In this paper we describe an interesting case of pseudoaldosteronism, associated with hypocalcemia and an exaggerated ACTH response. A 72-year-old woman was referred to our department for further evaluation of hypokalemia and hypocalcemia. The patient had been taking GA (150 mg/day) for the previous year for treatment of liver damage. Plasma renin activity and aldosterone concentration were both within lower normal limits. Urinary excretion of potassium and calcium was within the upper limit of the normal range and increased with administration of supplements. Plasma ACTH levels increased markedly in response to an intravenous injection of CRH. Cessation of GA and the potassium and calcium supplements on admission, led to a gradual normalization of serum potassium and calcium levels and blood pressure. The hypocalcaemia in our patient was related to decreased tubular reabsorption of calcium as a consequence of renal corticoid excess. It is possible that an increase in the number of CRH receptors in the pituitary following GA treatment caused the exaggerated ACTH response in association with pseudoaldosteronism. The existence of hypocalcemia and an exaggerated ACTH response should be observed carefully when managing pseudoaldosteronism.     

Differential detection of PAS-positive inclusions formed by the Z, Siiyama, and Mmalton variants of alpha1-antitrypsin

Several point mutations of alpha(1)-antitrypsin cause a perturbation in protein structure with consequent polymerization and intracellular accumulation. The retention of polymers of alpha(1)-antitrypsin within hepatocytes results in protein overload that in turn is associated with juvenile hepatitis, cirrhosis, and hepatocellular carcinoma. The detection of alpha(1)-antitrypsin polymers and understanding the molecular basis of polymer formation is of considerable clinical importance. We have used a monoclonal antibody (ATZ11) that specifically recognizes a conformation-dependent neoepitope on polymerized alpha(1)-antitrypsin to detect polymers within hepatocytes of individuals with alpha(1)-antitrypsin deficiency. Paraffin-embedded liver tissue specimens were obtained from individuals who were homozygous for the Z (Glu342Lys), Mmalton (52Phe del), and Siiyama (Ser53Phe) alleles of alpha(1)-antitrypsin that result in hepatic inclusions and profound plasma deficiency. Immunohistological staining with a polyclonal anti-human alpha(1)-antitrypsin antibody showed hepatic inclusions in all 3 cases, while ATZ11 reacted with hepatic inclusions formed by only Z alpha(1)-antitrypsin. Polymers of plasma M and Z alpha(1)-antitrypsin prepared under different conditions in vitro and polymers of recombinant mutants of alpha(1)-antitrypsin demonstrated that the monoclonal antibody detected a neoepitope on the polymerized protein. It did not detect polymers formed by a recombinant shutter domain mutant (that mirrors the effects of the Siiyama and Mmalton variants), polymers formed by cleaving alpha(1)-antitrypsin at the reactive loop, or C-sheet polymers formed by heating alpha(1)-antitrypsin in citrate. In conclusion, the ATZ11 monoclonal antibody detects Z alpha(1)-antitrypsin in hepatic inclusions by detecting a neoepitope that is specific to the polymeric conformer and that is localized close to residue 342.