Primary squamous cell carcinoma of the breast after cured Hodgkin's disease

An unusual case of primary squamous cell carcinoma of the breast occurring after cured Hodgkin's disease is reported herein. A 27-year-old woman developed a left breast mass 2 years after chemotherapy and radiation for nodular sclerosing stage IIB Hodgkin's disease. Excisional biopsy revealed squamous cell carcinoma of the breast and a modified radical mastectomy was performed, however, no metastasis was found in the axillary nodes. She received etoposide, mitomycin-C, and doxifluoridine as adjuvant chemotherapy, and remains well without any evidence of recurrent Hodgkin's disease or breast cancer. To our knowledge, this is the first reported case of primary squamous cell carcinoma of the breast associated with Hodgkin's disease. The risk of patients treated for Hodgkin's disease developing breast cancer as a second malignant neoplasm is discussed following the report of this case.     

Successful Pregnancy in a Patient with Pseudomyxoma Peritonei Arising from Ovarian Mucinous Cystadenocarcinoma Treated with Cisplatin

A 24-year-old Japanese woman clinically showing pseudomyxoma peritonei arising from ovarian mucinous cystadenocarcinoma FIGO stage Ic is reported. She received intra-abdominal administrations of cisplatin five times following left oophorectomy. After being free of disease for 6 months, she conceived and carried two pregnancies to successful deliveries at 34 and 37 weeks, respectively. At the Cesarean sections, there were no abnormal findings except for right ovarian mucinous cystadenoma. She has had no evidence of recurrence by the time of the 60-month postoperative examination.     

Blackcurrant (Ribes nigrum L.) Extract Exerts Potential Vasculoprotective Effects in Ovariectomized Rats,Including Prevention of Elastin Degradation and Pathological Vascular Remodeling

Estrogen exerts cardioprotective effects in menopausal women. Phytoestrogens are plant-derived substances exhibiting estrogenic activity that could beneficially affect vascular health. We previously demonstrated that blackcurrant (Ribes nigrum L.) extract (BCE) treatment exerted beneficial effects on vascular health via phytoestrogenic activity in ovariectomized (OVX) rats, which are widely used as menopausal animal models. Here, we examined whether BCE treatment reduced elastin degradation and prevented pathological vascular remodeling in OVX rats fed a regular diet (OVX Control) or a 3% BCE-supplemented diet (OVX BCE), compared with sham surgery rats fed a regular diet (Sham) for 3 months. The results indicated a lower staining intensity of elastic fibers, greater elastin fragmentation, and higher α-smooth muscle actin protein expression in OVX Control rats than in OVX BCE and Sham rats. Pathological vascular remodeling was only observed in OVX Control rats. Additionally, we investigated matrix metalloproteinase (MMP)-12 mRNA expression levels to elucidate the mechanism underlying elastin degradation, revealing significantly upregulated MMP-12 mRNA expression in OVX Control rats compared with that in Sham and OVX BCE rats. Together, we identify BCE as exerting a vascular protective effect through reduced MMP-12 expression and vascular smooth muscle cell proliferation. To our knowledge, this is the first report indicating that BCE might protect against elastin degradation and pathological vascular remodeling during menopause.     

Changing behavioral patterns to promote physical activity with motivational signs

Objectives  We have evaluated the effectiveness of motivational signs in promoting stair use instead of escalators, in terms of gender and age, at a train station with a 37-step staircase. We also examined whether a newspaper article, or booster, had any effect on augmenting the impact of the signs. Methods  In a serial cross-sectional survey with prompted signs, the subjects were coded by gender and age (over 65 years, under 65 years), and students (13–18 years old and school uniforms). We used a 2-week baseline period, followed by a 4-week intervention in which a total of 45 posters and banners with motivational messages were used to encourage stair use. As a booster, we published a news release of this study on a web site and in a local newspaper during the intervention period. Results  A total of 43,241 escalator/stair-choice observations were made. Stair use increased significantly from 3.58 to 4.93% during the intervention period of 1–2 weeks for all subjects. In addition, stair use had a significantly high value of 5.80% during the intervention period of 3–4 weeks. Stair use also increased in subgroups during the intervention periods with the exception of women 65 and older. Attempts to publicize the study had no effect on the increase in stair use. Conclusions  The use of signs was effective in changing behavior during the period of sign use, but this effectiveness was limited by gender, age, and the physical ability (e.g., muscle strength) and energy required to climb the stairs. The possible synergistic effects of publicity were inconclusive but are worthy of further investigation.     

Video-assisted thoracoscopic lobectomy with the patient in the semi-prone position: initial experience and benefits of lymph node dissection

Objectives

Recently, the prone position has been used for thoracoscopic oesophagectomy for oesophageal cancer because it is known to facilitate mediastinal dissection. We hypothesized that this advantage of the prone position could apply to video-assisted thoracoscopic surgery, which has been commonly performed with the patient in the lateral position.

Methods

Forty-six patients with clinical stage I, right-sided, non-small cell lung cancer were enrolled in this study. They were classified into three groups: conventional thoracotomy using rib retractors (n = 17), and the lateral (n = 15) and semi-prone (n = 14) positions in video-assisted thoracoscopic surgery. Surgical parameters, such as operation time, the amount of blood loss, and the number of dissected lymph nodes, of each group of patients were compared.

Results

There were three (6.5 %) minor complications in this study, chylothorax and heart failure in the thoracotomy group and atelectasis with the video-assisted thoracoscopic surgery in the lateral position group. No complications were seen in the semi-prone group. The number of dissected lymph nodes was significantly higher in the video-assisted thoracoscopic surgery in the semi-prone position group than in the conventional thoracotomy group for inferior mediastinal nodes (subcarinal, paraeosophageal, and pulmonary ligament, average 8.9 and 5.9 lymph nodes, p = 0.04).

Conclusions

To the best of our knowledge, this is the first report that has described video-assisted thoracoscopic lobectomy with the patient in the semi-prone position. Although the number of cases was limited, the results of this study show that the semi-prone position could be attempted especially for right lower lobe lung cancer.     

Intraductal papillary neoplasm of the bile duct extending superficially from the intrahepatic to extrahepatic bile duct

Intraductal papillary neoplasm of the bile duct (IPNB) or liver is a recently noted rare disease, and its pathogenesis remains unclear. Here we present a case of IPNB with an interesting morphology, which was treated by resection of the right hemiliver and extrahepatic bile duct. A 79-year-old woman was found to have a high alkaline phosphatase level and slight dilatation of the right intrahepatic bile duct on imaging studies. The right intrahepatic bile duct became dilated over a 2-year period; however, no solid mass could be detected, and tumor markers were not elevated. Hepatic resection was scheduled because a mucin-producing bile duct carcinoma of the liver was suspected. A right hemihepatectomy was conducted, and the extrahepatic bile duct was also resected after malignant cells were found in the surgical stump of the right bile duct and in the bile itself. Macroscopically, diffuse dilatation of the intrahepatic bile duct was noted, but no solid component or mucin within the duct was found. Histopathological findings revealed carcinoma in situ, IPNB, in the majority of intrahepatic bile ducts, with no lymph node metastasis, and it extended continuously to the epithelium of the common bile duct. No tumor recurrence or biliary dilatation was observed at follow-up 2 years after surgery. It is important to consider malignancy in the presence of a dilated bile duct and in the absence of any cause of occlusion. Complete resection of IPNB results in a good prognosis and no recurrence.     

Selection of treatment modality for hepatocellular carcinoma according to the modified Japan Integrated Staging score

AIM： To compare the prognosis of patients who underwent hepatectomy and ablation using the modified Japan Integrated Staging score （mJIS）. METHODS： We examined the clinicopathologic records and patient outcomes in 278 HCC patients including 226 undergoing hepatectomy and 52 undergoing ablation therapy. RESULTS： Cirrhosis was more frequent in the ablation group. Tumor size, number and presence of vascular invasion were significantly higher in the operation group compared to the ablation group. The local recurrence rate adjacent to treated lesions was significantly higher in the ablation group compared to the operation group （P 〈 0.05）. The 3- and 5-year survival rates in the ablation and the operation group were 66% and 78%, and 50% and 63%, respectively, but not significantly different. Over 50% survival rates were observed in patients with a m.lIS score of 0-2 in both groups. However, survival rates with a score of 3-5 in both groups were significantly lower. CONCLUSION： According to the mJIS system, both local treatments could be selected for patients with a score of 0-2. However, for patients with a score more than 3, liver transplantation might be a better option in patients with HCC.     

Engraftment and dissemination of T lymphocytes from primary haemophagocytic lymphohistiocytosis in scid mice

Although primary haemophagocytic lymphohistiocytosis (HLH) is a genetic disorder of T lymphocytes, it remains unclear why T lymphocytes of primary HLH patients preferentially infiltrate the central nervous system and peripheral blood, in addition to the reticuloendothelial systems. We engrafted Herpesvirus saimiri (HVS)-immortalized T-lymphocyte lines established from primary HLH patients into severe combined immunodeficient (scid) mice and examined their capacity to infiltrate mouse organs. A diffuse infiltration of human T lymphocytes was detected in each organ of scid mice treated with 1 x 10(6) T lymphocytes from all four primary HLH patients assessed, whereas no infiltration of T lymphocytes from healthy individuals was observed in any organ. The infiltration of T lymphocytes was mainly observed in the lung, brain and peripheral blood, in association with haemophagocytosis. These cells were positive for HLA-DR, CD3 and either CD8 or CD4, but negative for CD68. Certain markers of proliferation and apoptotic activities were highly positive in these cells. There was no difference between the infiltration pattern of T lymphocytes of primary HLH patients with a perforin deficiency and those without. By Southern blot analysis, T lymphocytes infiltrating mouse organs were observed to be polyclonal. These findings suggest that our murine model implementing HVS-immortalized human T lymphocytes is suitable to clarify the pathogenesis of primary HLH.