Microsatellite instability in poorly differentiated colorectal adenocarcinoma, particularly in relation to two subtypes

BACKGROUND/AIMS: There have been a few reports indicating the characteristics of poorly differentiated colorectal adenocarcinoma by dividing it into subtypes. However, we have not found any reports describing microsatellite instability (MSI) of each subtype. In this study, we elucidated the clinicopathological features of subtypes in the poorly differentiated adenocarcinoma, especially the relationship between MSI and each subtype. METHODOLOGY: The present study included 28 cases with poorly differentiated adenocarcinoma. The 28 cases were classified into two groups; the solid group and the non-solid group. For each group, the clinicopathological aspects and MSI were examined. RESULTS: No significant differences were noted between the solid group and the non-solid group in terms of clinicopathological findings excluding male/female ratio. The 5-year survival rate of the solid group (38.5%) was significantly higher than that of the non-solid group (0.00%) (p=0.0013). The ratio of cases with MSI-H in the solid group (80.0%=12/15) was significantly higher than that of the non-solid group (30.8%=4/13) (p=0.0087). CONCLUSIONS: The incidence of MSI as well as the prognosis was different between solid and non-solid type with poorly differentiated colorectal adenocarcinoma. Therefore, we think that poorly differentiated colorectal adenocarcinoma should be classified into two subtypes: solid type and non-solid type when analysis for poorly differentiated adenocarcinoma is performed.     

A case of bird fanciers' lung with endobronchial polyps]

A 34-year-old woman who had been keeping five budgerigars in her home was admitted with cough and progressive exertional dyspnea that had continued for three months. Chest CT scan demonstrated diffuse centrilobular nodular opacities throughout both lung fields. Flexible bronchoscopy revealed polypoid lesions with diameters of 2-3 mm located at the right B1/B2 spur. B3a/B3b spur and middle/lower bronchus spur. Their surfaces were glossy and smooth but slightly lobulated. The histological findings were consistent with inflammatory polyps containing lymphoid follicles in a dense infiltrate of lymphocytes. A positive environmental provocation test and precipitating antibodies confirmed the diagnosis of hypersensitivity pneumonitis (HP) caused by budgerigars (bird fanciers' lung). To our knowledge, there is no previous report of HP accompanied with endobronchial polyps, but this rare case shows the involvement of large airways in HP.     

Molecular cloning of the breakpoint of t(11;22)(q23;q11) chromosome translocation in an adult acute myelomonocytic leukaemia

Southern blot analysis with a cDNA probe of MLL indicated that the breakpoint is in a Bam HI 8.3 kb fragment which carries the exon 5–11 of MLL gene in DNA from an adult acute myelomonocytic leukaemia with a t(11;22)(q23;q11) translocation. The structural analysis of the rearranged MLL locus demonstrated that the breakpoint is localized between exon 8 and 9 of MLL locus. The normal counterpart fused to the MLL locus was proved to be derived from chromosome 22q11( AF-22 ) by somatic cell hybrids analysis and FISH. By FISH, AF-22 locus was localized to the region more centromeric to the BCR gene.     

Reevaluation of Prognostic Factors in Gastric Leiomyosarcoma

Objectives : The aim of our study was to reevaluate the prognostic factors in gastric leiomyosarcomas, particularly those under 6 cm, which, because or improved diagnostic techniques, make up a large proportion of this series, in contrast to previously puhlislied works. Methods : The clinicopathological features in 83 patients with gastric leiomyosarcoma were reviewed. Cox's proportional hazards regression analysis was used to determine the prognostic factors. Results : Sixty of 84 leiomyosar-comas (71.4%) were less than 6 cm in diameter. In university analysis, the following factors were considered to he unfavorable, with statistical significances: 1) presence of distant metastasis and/or direct invasion of adjacent structures at diagnosis (hazard ratio 36.60), 2 ) ≥4 mitoses per 20 high-power fields (25.39), 3 ) severe nuclear atypia (16.74), 4 ) presence of ulceration of overlying gastric mucosa (12.57), and 5 ) diameter ≥6 cm (5.57). Among these factors, mucosal ulceration has been identified as a new factor associated with poor prognosis. Histological. the tumors with ulceration showed more severe nuclear atypical ( p < 0.05), necrosis ( p < 0.01), and a higher incidence of mitosis ( p < 0,01), compared with tumors without ulceration. In multivariate analysis, factors 1, 2, and 3 were statistically significant, although neither size nor ulceration was significant. Conclusions : The presence of distant metastasis and/or direct invasion, high mitotic rate, and severe nuclear atypia were confirmed to he unfavorable prognostic indicators. Mucosal ulceration, indicating high proliferative activity of the tumor, even if small, suggests a poor prognosis, although it was not significant in multivariate analysis.     

Primary sclerosing cholangitis in which differential diagnosis from gallbladder carcinoma was difficult

We report a case of localized primary sclerosing cholangitis (PSC) which was difficult to distinguish from gallbladder carcinoma. A 75-year-old woman with elevated serum bilirubin was hospitalized and underwent endoscopic nasobiliary drainage (ENBD). There was no history of diseases such as gallbladder stone, pancreatitis, or ulcerative colitis. Cholangiography through the ENBD tube showed localized stenosis of the common bile duct; the gallbladder could not be seen. Angiography showed no encasement of the hepatic artery. Ultrasonography showed a tumor in the cystic duct, and the tumor had invaded the gallbladder and common bile duct. We diagnosed gallbladder carcinoma on radioimaging, and performed an S4aS5 subsegmentectomy of the liver and resection of the extrahepatic biliary tree. Pathologically, no malignant cells were detected, and fibrosis around bile ducts and infiltration of inflammatory cells into hepatic tissue were found. It is well known that PSC is sometimes difficult to differentially diagnose from cholangiocarcinoma. Our case is of high interest because ultrasonography showed findings suggestive of gallbladder carcinoma. It is therefore necessary to keep the possibility of PSC in mind for the diagnosis and treatment of such localized biliary stenosis.     

Evaluation of FDG-PET imaging for the detection of gastrointestinal tract cancer in patients with suspected lung cancer]

This study evaluated 18F-FDG-PET imaging for the detection of gastrointestinal tract cancer in patients with suspected lung cancer. A total of 351 patients who had abnormal lung shadows and who underwent whole-body FDG-PET between June 1998 and January 2006 were retrospectively entered for analysis. Gastrointestinal tract cancers were subsequently found in 15 patients (4.3%) who had been found to have lung diseases consisting of 7 inflammatory changes, 6 lung cancers, and 2 metastatic lung carcinomas, 9 colon cancers, 4 gastric cancers, and 2 esophageal cancers. Five patients (2 colon cancers, 2 gastric cancers, and 1 esophageal cancer) had early stage carcinoma. In this study, FDG-PET was useful not only for the diagnosis and staging of lung cancer, but also for the detection of unexpected gastrointestinal tract cancers. FDG-PET may be most suitable for cancer screening.     

Waiting list mortality of patients with primary biliary cirrhosis in the Japanese transplant allocation system

Background

The present study aimed to evaluate etiology-based differences in the risk of waiting list mortality, and to compare the current Japanese transplant allocation system with the Child–Turcotte–Pugh (CTP) and the Model for End-Stage Liver Disease (MELD) scoring systems with regard to the risk of waiting list mortality in patients with primary biliary cirrhosis (PBC).

Methods

Using data derived from all adult candidates for deceased donor liver transplantation in Japan from 1997 to 2011, we assessed factors associated with waiting list mortality by the Cox proportional hazards model. The waiting list mortality risk of PBC patients was further estimated with adjustment for each scoring system.

Results

Of the 1056 patients meeting the inclusion criteria, 743 were not on the list at the end of study period; waiting list mortality was 58.1 % in this group. In multivariate analysis, increasing age and PBC were significantly associated with an increased risk of waiting list mortality. In comparison with patients with hepatitis C virus (HCV) infection, PBC patients were at 79 % increased risk and had a shorter median survival time by approximately 8 months. The relative hazard of PBC patients was statistically significant with adjustment for CTP score and medical point score, which was the priority for ranking candidates in the Japanese allocation system. However, it lost significance with adjustment for MELD score. Stratification by MELD score indicated a comparable waiting list survival time between patients with PBC and HCV.

Conclusions

PBC patients are at high risk of waiting list mortality in the current allocation system. MELD-based allocation could reduce this risk.