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ABSTRACT: High-intensity focused ultrasound (HIFU) has excellent potential as a non-invasive therapeutic tool in various fields of medicine. We present a case of twin reversed arterial perfusion (TRAP) sequence, in which non-invasive blood flow occlusion in the acardiac fetus was successfully achieved by means of HIFU exposure from outside the maternal abdomen. HIFU was applied to the umbilical cord entered into the body of the acardiac fetus at 13 and 17 gestational weeks. The HIFU intensity was set at approximately 2,300 W/cm2 and 4,600 W/cm2 respectively, with exposure periods of 10 s. As color Doppler did not show the blood supply to the acardiac fetus after the latter HIFU exposure, we thought complete occlusion of target vessels was achieved. Delivery was by Cesarean section at 37 weeks' gestation. A male neonate (the pump fetus) was born weighing 1903g with Apgar score of 8 and 9 at 1 and 5 minutes. The baby is healthy and growing normally expect congenital pseudoarthrosis.
Ultrasound in Obstetrics and Gynecology 03/2013; · 3.01 Impact Factor
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ABSTRACT: We report a non-invasive mixed mucin-producing and squamous differentiated tumor of the uterine cervix. This tumor was composed of two cell types: mucin-producing cells and non-mucin-producing cells. These cells were intimately mixed with each other, and showed intraepithelial spreading. The mucin-producing cells showed signet-ring or columnar shapes, and were localized to the lower-to-upper epithelial layer. The non-mucin-producing cells had eosinophilic cytoplasms with a monotonous appearance through the epithelium. Mitosis was sometimes observed in both cell types. Immunohistochemically, both cell types were positive for p16(INK4A) . The non-mucin-producing cells were positive for p63 and 34βE12, suggesting squamous differentiation. Although most mucin-producing cells were p63(-) , a few of them were p63(+) and many 34βE12 immunoreactive cells were found in the mucin-producing cells. This tumor was adenosquamous carcinoma in situ.
Journal of Obstetrics and Gynaecology Research 01/2013; 39(1):420-3. · 0.94 Impact Factor
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ABSTRACT: We report a case of high-grade endometrial stromal sarcoma with cytological and immunocytochemical findings. Cytologically, major tumor cells showed round-to-short spindle shapes with round- to oval-shaped nuclei and moderately abundant delicate cytoplasm. Tumor cells with tapered shapes and eccentric nuclei were also observed. A few spindle cells having enlarged cigar-shaped nuclei with conspicuous nucleoli and delicate wispy cytoplasm, which resembled leiomyosarcoma, were intermingled. One rhabdomyoblast cell with both α-sarcomeric muscle actin and myoglobin was also observed. Most of the tumor cells, including the leiomyosarcomatous spindle cells, were positive for CD10, and negative for desmin and h-caldesmon. Accordingly, when relatively monotonous round-to-short spindle tumor cells and taper-shaped tumor cells are observed in the female genital tract, high-grade endometrial stromal sarcoma should be considered in the differential diagnosis. Immunocytochemistry contributed to the correct diagnosis. This case was high-grade endometrial stromal sarcoma with smooth muscle and skeletal muscle differentiation.
Diagnostic Cytopathology 04/2011; 39(4):301-5. · 1.16 Impact Factor
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ABSTRACT: We report on a case of a primary low-grade endometrial stromal sarcoma (ESS) that progressed to a secondary high-grade ESS. In the secondary tumor, the immunohistochemical profile and focal tumor cell proliferation pattern suggested that this tumor was not truly undifferentiated, but possessed features of endometrial stroma. Low-grade ESS of our patient's primary tumor showed p53 protein overexpression, which is unusual in low-grade ESS, and her secondary high-grade ESS showed more prominent p53 immunoreactivity. This indicates that low-grade ESS that shows p53 immunoreactivity might progress to high-grade ESS, and it is considered that such cases of low-grade ESS should pay attention to the prognosis. Immunoreactivity for epidermal growth factor receptor was observed in both tumors, suggesting a relationship between the primary and secondary tumors in our case. Further study requires more immunohistochemical data for cases in which low-grade ESS transitions to high-grade ESS; in particular, data on epidermal growth factor receptor expression are necessary to define new therapeutic strategies for ESS.
International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists 07/2010; 29(4):374-7. · 2.07 Impact Factor
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ABSTRACT: Tumors of germ cell origin uncommonly arise in extragonadal sites. We report two cases of intracranial germinoma, in which it was necessary to distinguish between intracranial germinoma and metastatic carcinoma in cytological specimens. Cytologically, not only single tumor cells or loosely connective tumor cells but also closely packed clusters of cells and pair cells were recognized. Immunocytochemically, almost all tumor cells were immunoreactive for M2A, placental alkaline phosphatase, and c-kit. Closely packed clusters were also immunoreactive for pan-cytokeratin. Therefore, Cytopathologists should be aware that tumor cell clusters, mimicking carcinoma might appear in cytological specimens of intracranial germinomas. Although immunocytochemical analysis assists in correct diagnosis, some cell clusters showing cytokeratin immunoreactivity does not become the basis for the diagnosis of metastatic carcinoma. A panel of antibodies including D2-40, PLAP, and c-kit should be used.
Diagnostic Cytopathology 02/2010; 38(2):132-6. · 1.16 Impact Factor
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Pediatrics International 02/2010; 52(1):149-53. · 0.63 Impact Factor
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Kazuhiro Kaneko,
Yosuke Kumekawa,
Reiko Makino,
Hisako Nozawa,
Yuichi Hirayama,
Mari Kogo,
Kazuo Konishi,
Atsushi Katagiri,
Yutaro Kubota,
Takashi Muramoto, Miki Kushima,
Tohru Ohmori,
Tsunehiro Oyama,
Norio Kagawa,
Atsushi Ohtsu,
Michio Imawari
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ABSTRACT: Esophageal squamous cell carcinoma (ESCC) exhibits abnormalities in epidermal growth factor receptor (EGFR) gene. To identify a prognostic marker, the overexpression of EGFR protein, mutations in EGFR and p53 mutations were analyzed in pretreatment biopsy specimens removed from T3-4 and/or M1 LYM ESCC patients who received chemoradiotherapy. A silent mutation comprised of a single nucleotide polymorphism (SNP) at codon 787 of exon 20 of the EGFR gene was found in 19 patients (33%). In multivariate analysis, a significant difference was seen in the overall survival (odds ratio; 2.347, 95% confidence interval; 1.183-4.656, p = 0.015) between patients with and without the EGFR heterozygous genotype. Among the 57 eligible patients, 3-year survival rates was 21%, while in patients with EGFR heterozygous genotype the rate were 0%. However, neither overexpression of EGFR nor p53 mutations was associated with the overall survival. These results suggest that the EGFR SNP at codon 787 of exon 20 determined in pretreatment biopsy specimens may be a clinically useful biomarker for predicting the prognosis of ESCC patients.
Frontiers in Bioscience 01/2010; 15:65-72. · 3.52 Impact Factor
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Mayumi Homma,
Toshiko Yamochi-Onizuka,
Eisuke Shiozawa,
Masafumi Takimoto,
Hirotsugu Ariizumi,
Hidetoshi Nakashima,
Isao Matsuda,
Tsuyoshi Nakamaki,
Toshiaki Kunimura, Miki Kushima,
Shigeru Tomoyasu,
Hidekazu Ota
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ABSTRACT: We report a case of primary pulmonary classical Hodgkin lymphoma (CHL) in a 58-year-old woman. Twelve years ago, the patient complained of slight fever and weight loss. A mass of about 5 cm in diameter was seen in the right lung on radiography and computed tomography (CT). Right total pneumonectomy and resection of mediastinal lymph nodes were performed. A pathological examination led to a strong suspicion of Hodgkin disease (HD) (now referred to as CHL), but a definite diagnosis could not be made at the time. Six years later, a chest CT showed a tumor around the ascending aorta, which was treated successfully by radiation therapy. Six years later, the chest CT revealed a tumor in the anterior mediastinum. CHL was diagnosed based on an immunohistochemical re-examination of lung specimens resected 12 years earlier and CT-guided fine needle tumor biopsy specimens of the second recurrent tumor in the anterior mediastinum were compatible with the recurrence of CHL. Therefore, we diagnosed this case as primary pulmonary CHL that later relapsed in the mediastinum. The tumor size was reduced by radiation therapy and the patient is currently under observation as an outpatient.
Journal of Clinical and Experimental Hematopathology 01/2010; 50(2):151-7.
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ABSTRACT: Cigarette smoking and alcohol consumption are well-known risk factors for esophageal squamous cell carcinoma (ESCC), which has a very poor prognosis. Successful screening strategies for precursor lesions that can be targets for early detection and treatment are required to prevent ESCC.
This is a prospectively cross-sectional study. To clarify whether daily smoking and/or alcohol consumption are risk factors for dysplasia, which is the initial lesion leading to ESCC. Lugol chromoendoscopy was performed in 1,345 eligible individuals. Six hundred ninety individuals had daily smoking and/or alcohol consumption; 655 individuals did not smoke and drink alcohol. The effects of smoking and alcohol consumption among high-grade dysplasia (HGD), low-grade dysplasia (LGD), and controls without dysplasia were evaluated using multiple logistic regression analysis.
Among 1,345 individuals, 17 HGD and 23 LGD lesions were confirmed histologically. The prevalence of both smoking and drinking consumption was significantly higher in HGD than in LGD individuals (age and sex adjusted odds ratio; 113.0, 95% confidence interval; 6.26), whereas no significant difference was seen in both consumption between LGD individuals and controls (odds ratio; 1.29, 95% confidence interval; 0.33-6.37). Approximately 70% of HGD individuals, but only 13% of LGD individuals, both smoked and consumed alcohol.
Daily cigarette and alcohol consumption were not the risk factors for LGD, however, consumption of both were high-risk factors for HGD. We suggest that documenting the difference of risk factors for LGD and HGD can assist in the development of effective screening, early detection, and prevention strategies for ESCC.
Journal of clinical gastroenterology 10/2009; 44(3):173-9. · 2.21 Impact Factor
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Yutaro Kubota,
Kazuhiro Kaneko,
Kazuo Konishi,
Hiroaki Ito,
Taikan Yamamoto,
Atsushi Katagiri,
Takashi Muramoto,
Yuichiro Yano,
Yoshiya Kobayashi,
Tsunehiro Oyama, Miki Kushima,
Michio Imawari
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ABSTRACT: Microvessel density (MVD) is an excellent predictive biomarker regarding tumor stage and survival in esophageal squamous cell carcinomas (ESCCs). However, it is obscure when tissues initiate angiogenesis in the malignant transformation of human esophageal squamous epithelium. To investigate the onset of angiogenesis in the multistep progressive process of ESCCs, immunohistochemical staining for CD31, CD105, and vascular endothelial growth factor receptor 2 (VEGFR-2) was performed in normal epithelium, Lugol-unstained lesions with non-dysplastic epithelium (LULs-NDE), low-grade dysplasia (LGD), and high-grade dysplasia (HGD) samples. There were significant differences in the mean MVD for CD31 and CD105 between LULs-NDE and LGD (p less than 0.001, p less than 0.001), and between LGD and HGD (p less than 0.001, p=0.006), respectively. Furthermore, a significant difference in MVD for CD105 was seen in normal controls and LULs-NDE (p=0.002), while thick vessels (less than 10m m) stained with anti-CD105 were not present in normal controls and LULs-NDE despite the presence of these thickened vessels in dysplasia. Our results suggest that CD105 is an efficient marker protein to determine MVD, suggesting that the angiogenic switch occurs at the earliest stage of dysplastic transformation in ESCC.
Frontiers in Bioscience 02/2009; 14:3872-8. · 3.52 Impact Factor
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ABSTRACT: 5-Fluorouracil (5-FU) and its prodrugs are used to treat various cancers. Response to 5-FU-based chemotherapy and expression of 5-FU-related enzymes differ among cancers. The objective of the present study was to investigate the relationship between the expression of 5-FU-related enzymes and clinicopathologic factors in bladder cancer. Formalin-fixed, paraffin-embedded sections of 44 bladder cancers and 27 normal bladders were included in this study. After laser capture microdissection, "Danenberg tumor profile," was performed for the measurement of 5-FU-related enzymes. There was no significant difference between dihydropyrimidine hydrogenase (DPD) mRNA expression in bladder cancer and in normal bladder. On the contrary, mRNA expressions of orotate phosphoribosyltransferase (OPRT), thymidylate synthase (TS), and thymidine phosphorylase (TP) in bladder cancer were higher than those in normal bladder. Compared with previously reported DPD mRNA expressions in other types of cancer, DPD mRNA expression in bladder cancer was relatively low. The 5-FU-related enzymatic condition of bladder cancer is favorable for 5-FU.
Oncology Research Featuring Preclinical and Clinical Cancer Therapeutics 01/2009; 18(4):153-62. · 1.30 Impact Factor
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ABSTRACT: PurposeThe purpose of this study was to investigate the sequential changes in rat artery blood flow and tissue degeneration after
exposure to high-intensity focused ultrasound (HIFU) in vivo.
MethodsHIFU was applied through the skin to the femoral artery of Sprague-Dawley rats. The peak intensities used were 530, 1080,
2750, and 4300 W/cm2. After exposure, we measured the peak systolic velocity (PSV) in the artery every 1 min until the velocity stabilized. The
vessel was resected and examined histologically 7 days after exposure.
ResultsPSV was not significantly affected by HIFU exposure at 530 W/cm2. PSV increased immediately after HIFU exposure at intensities of 1080 and 2750 W/cm2. PSV after HIFU exposure at 1080 W/cm2 fell to the control level within minutes; however, PSV increased immediately after HIFU exposure at 2750 W/cm2 and then decreased slowly but remained at a higher level than the control for 15 min. On HIFU exposure at 4300 W/cm2, the target artery was completely occluded. Histological studies 7 days after HIFU exposure demonstrated that exposure at
530 and 1080 W/cm2 induced vacuolar degeneration in the tunica media of the femoral artery in rats; exposure to HIFU at 2750 and 4300 W/cm2 resulted in strong necrotic degeneration in the tunica media. These histological changes were more marked than those found
immediately after HIFU exposure. Organized thrombus formation was observed only for HIFU exposure at 4300 W/cm2.
ConclusionSequential changes in arterial blood flow after HIFU exposure vary with the intensity, and the histological changes in arterial
tissue progress over time. These phenomena should be considered when HIFU is clinically applied to achieve arterial occlusion.
Journal of Medical Ultrasonics 11/2008; 35(4):177-182. · 0.33 Impact Factor
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ABSTRACT: To report a patient with azoospermia who achieved an induction of spermatogenesis after undergoing orchiopexy of long-standing bilateral traumatic dislocated testes.
Case report.
Clinical.
A 33-year-old man.
Imaging studies, orchiopexy, testicular biopsy, and a review of similar cases.
Recovery of spermatogenesis after orchiopexy.
A patient with azoospermia with bilateral traumatic dislocated testes due to a motorcycle accident 15 years previously. A bilateral testicular dislocation in the superficial inguinal pouch was diagnosed by palpation, imaging studies, and exploration. A recovery of spermatogenesis was obtained after performing orchiopexy of bilateral dislocated testes.
The recovery of spermatogenesis in patients with azoospermia with a bilateral testicular dislocation therefore may be successfully obtained after appropriately performing orchiopexy.
Fertility and sterility 07/2008; 90(5):2009.e9-11. · 3.97 Impact Factor
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ABSTRACT: We report a case of adenocarcinoma with pyloric gland features, which appears to have originated from lobular endocervical glandular hyperplasia (LEGH). Hematoxylin and eosin staining, as well as histochemical and immunohistochemical stainings were performed on formalin-fixed and paraffin-embedded specimens. LEGH was observed in the conization specimens. In the hysterectomy specimens, LEGH, atypical LEGH, and mucinous adenocarcinoma coexisted. The adenocarcinoma was located at a site distant from the transition zone. p16(INK4a) immunopositivity was extremely rare. Front formation was observed, and a transition from benign-looking columnar cells of LEGH to adenocarcinoma was recognized. These findings suggested that the adenocarcinoma with pyloric gland features arose from LEGH. LEGH is no longer regarded as a pseudoneoplastic lesion, and it is necessary to consider that LEGH is able to transform into a precursor lesion and to develop into an adenocarcinoma with pyloric gland features.
Pathology - Research and Practice 06/2008; 204(9):683-7. · 1.21 Impact Factor
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ABSTRACT: We report a case of a clear cell adenocarcinoma arising from a giant cystic adenomyosis, with immunohistochemical analysis of p53 and laminin-5 gamma2 chain overexpression. Microscopically, not only clear cell adenocarcinoma showing myometrial invasion but also single-layered clear cell adenocarcinoma cells lining the cyst wall were observed. Transition from these single-layered tumor cells to papillary proliferative lesions of various degrees was recognized. Moreover, these tumor cells were continuous with minimal atypical cells. Although the tumor cells within the uterus showed a low positive cell ratio for p53, the metastatic foci showed a remarkable p53 overexpression. Laminin-5 gamma2 chain expression was low in papillary proliferation and high in myometrial invasion and metastatic foci. The single-layered tumor cells showing non-invasive proliferation also contained laminin-5 gamma2 chain-positive cells. When non-invasive tumor cells were considered to be at an early stage in tumor progression, some tumor cells had already acquired an invasive feature. p53 overexpression was not related to expression of the laminin-5 gamma2 chain.
Pathology - Research and Practice 06/2008; 204(9):677-82. · 1.21 Impact Factor
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ABSTRACT: Aim: Regulatory T cells (Tregs) maintain immunological tolerance and suppress autoreactive immune responses. We evaluated the intrahepatic status of Tregs in patients with autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), chronic hepatitis C (CH-C), or chronic hepatitis B (CH-B).Methods: We analyzed 85 patients (20 AIH, 22 PBC, 27 CH-C, and 16 CH-B) and 14 controls. Using liver tissue samples obtained by needle biopsy or from marginal parts of resected metastatic liver tumors in the controls, immunohistochemical analyses of forkhead box P3+, which is a specific marker for Tregs, CD4+, and CD8+ cells were performed.Results: Intrahepatic Tregs were significantly more infiltrated in patients with liver diseases than in the controls. There were significantly fewer intrahepatic Tregs in the AIH patients than in the PBC patients (P = 0.037). Patients with alow frequency of intrahepatic Tregs were detected significantly more in the AIH and CH-B groups than in the PBC and CH-C groups (P < 0.05). In addition, the frequency of Tregs decreased in the liver of PBC patients as the pathological stage of the disease advanced. We found significantly less infiltration of CD4+ T cells in AIH than in other diseases (P < 0.05). Liver-infiltrating CD8+ T cells were detected more frequently in the CH-B group than in other groups (P < 0.003).Conclusion: Intrahepatic Tregs were increased in both patients with autoimmune liver diseases and those with viral hepatitis. In autoimmune liver diseases, intrahepatic Tregs were fewer in the AIH patients than in the PBC patients.
Hepatology Research 11/2007; 38(4):354 - 361. · 2.20 Impact Factor
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ABSTRACT: This study investigated the induction of tissue necrosis by arterial blood flow occlusion using ultrasound image-guided high-intensity focused ultrasound (HIFU). We constructed a prototype HIFU transducer in combination with an imaging probe that provided color Doppler imaging and ultrasound contrast imaging. The HIFU beam was aimed into a branch of the renal artery in vivo. The renal artery branches of eight rabbits were occluded by HIFU at an intensity of 4 kW/cm(2) (from 2 to 10 times of each sonication for 5 s). When the HIFU exposure was successful, complete cessation of blood flow was observed by color Doppler imaging with success rate of 100% (8/8). Furthermore, lack of perfusion was observed in the renal cortex with a contrast-enhanced image. Postmortem histologic evaluation showed a wedge-shaped area of infarction in six of seven cases, corresponding to the lack of the contrast medium in the ultrasound image. These results demonstrated that ultrasound image-guided HIFU can be used to induce arterial occlusion, thus producing infarction and necrosis of the perfused tissue.
Ultrasound in Medicine & Biology 04/2007; 33(3):452-9. · 2.29 Impact Factor
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ABSTRACT: To determine the prevalence of testicular microlithiasis (TM) in the contralateral testis of patients with unilateral testicular tumor, and evaluate the association of TM with carcinoma in situ (CIS) MATERIALS AND METHODS: In a period of 12 years, ultrasonography was performed in 41 patients with unilateral testicular tumor. TM was defined as multiple small hyperechogenic foci. Only images of the tumor-free testis were reviewed. In addition, archived biopsy specimens of the contralateral testicle were reviewed after immunostaining for placental alkaline phosphatase (PLAP) as a marker for CIS.
TM was diagnosed in 11 (26.8%) patients. Of them, microliths were pathologically confirmed in only 2. Prevalence of CIS was higher in patients with TM (2 of 11 patients) than in those without TM (0 of 30 patients, p = 0.017)
TM was associated with testicular tumor. TM in the contralateral testis of patients with unilateral testicular tumor may increase the risk of CIS.
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 03/2007; 98(3):541-6.
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ABSTRACT: To determine the prevalence of testicular microlithiasis (TM) seen by testicular ultrasonography (US) in Japanese adult men referred for andrologic symptoms and evaluate associations of TM with pathologic conditions.
For 7 years, US was performed in 969 patients (mean age 40.9 years) at one institution. The patients were divided into groups with infertility (n = 550), unilateral testicular tumor (n = 46), or other andrologic conditions (n = 373). TM was identified as multiple small hyperechogenic foci. In the tumor group, only images of the tumor-free testis were reviewed. Patients with TM accompanying tumor or infertility completed follow-up questionnaires and US examinations.
TM was diagnosed in 46 patients (mean age 38.5 years, range 23 to 75). The prevalence of TM was 17.4% in the tumor group, 5.6% in the infertility group, and 1.9% in the other-conditions group. TM was associated with testicular tumor and infertility, but not with other conditions. In patients with unilateral testicular germ cell tumor, the prevalence of carcinoma in situ in the contralateral testis was greater when TM was present in that testis (2 of 8 patients) than when TM was absent (0 of 32, P = 0.0037). No new testicular tumor developed subsequently. In the infertility group, the 31 patients with TM showed no subsequent testicular tumor development, and neither patient undergoing testicular biopsy had carcinoma in situ.
TM, as demonstrated by US, was associated with infertility, as well as testicular tumor. TM in a testis contralateral to a unilateral testicular germ cell tumor may increase the risk of carcinoma in situ.
Urology 10/2006; 68(3):636-41. · 2.43 Impact Factor
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ABSTRACT: Ovarian clear-cell carcinoma (OCCA) and ovarian endometrioid carcinoma (OEMC) are often associated with endometriosis. This study determined the immunohistochemical expression of steroid hormone receptors and cancer-related genes in OCCA and OEMC specimens containing endometriosis and atypical endometriosis. Pathological progression from endometriosis to atypical endometriosis to carcinoma was identified in 4 of 22 OCCAs and 4 of 16 OEMCs. Using paraffin-embedded tissue samples, expression and changes in expression for estrogen receptors (ERs) and progesterone receptors (PRs) were examined in relation to the observed pathological changes. A gradual reduction in ERalpha and PRA expression was observed with malignant transformation from endometriosis to atypical endometriosis to OCCA. In OEMC, ERalpha expression increased with malignant transformation. In conclusion, reductions in ERalpha and PRA expression were observed with progression from endometriosis to atypical endometriosis in OCCA specimens. Disappearance of hormone dependency might therefore be associated with malignant transformation to OCCA.
International Journal of Gynecological Pathology 11/2005; 24(4):369-76. · 1.45 Impact Factor
