Duodenal Carcinoma from a Duodenal Diverticulum Mimicking Pancreatic Carcinoma

An 81-year-old man was found to have a pancreatic head tumor on abdominal computed tomography (CT) performed during a follow-up visit for sigmoid colon cancer. The tumor had a diameter of 35mm on the CT scan and was diagnosed as pancreatic head carcinoma T3N0M0. The patient was treated with pylorus-preserving pancreaticoduodenectomy. Histopathological examination showed that the tumor had grown within a hollow structure, was contiguous with a duodenal diverticulum, and had partially invaded the pancreas. Immunohistochemistry results were as follows:CK7 negative, CK20 positive, CD10 negative, CDX2 positive, MUC1 negative, MUC2 positive, MUC5AC negative, and MUC6 negative. The tumor was diagnosed as duodenal carcinoma from the duodenal diverticulum. Preoperative imaging showed that the tumor was located in the head of the pancreas and was compressing the common bile duct, thus making it appear like pancreatic cancer. To the best of our knowledge, this is the second report of a case of duodenal carcinoma from a duodenal diverticulum mimicking pancreatic carcinoma

非小細胞肺癌におけるEGFR遺伝子変異と臨床病理学的因子の関係

PURPOSE: Recent studies reported that clinical responsiveness to gefitinib was associated with somatic mutation of epidermal growth factor receptor (EGFR) gene in non-small cell lung cancers (NSCLC). Here, we investigated the relationship between EGFR mutation and clinicopathologic features. EXPERIMENTAL DESIGN: EGFR mutational status of 120 NSCLCs was determined mainly in EGFR exons 18 to 21 by direct sequence and correlated with clinicopathologic parameters. RESULTS: EGFR mutations were present in 38 cases (32%) and the majority of mutations were in-frame deletions of exon 19 (19 cases) and a missense mutation in exon 21 (18 cases). EGFR mutations were frequently associated with adenocarcinoma (P < 0.0001), never smoker (P < 0.0001), and female gender (P = 0.0001). Of interest, increasing smoke exposure was inversely related to the rate of EGFR mutation (P < 0.0001). Multivariate analysis showed that smoking and histology were independent variables. Furthermore, gender difference was observed for the mutational location (P = 0.01) dominance of exon 19 for males and exon 21 for females. Twenty-one cases were treated with gefitinib and found that EGFR mutation was significantly related to gefitinib responsiveness (P = 0.002). In addition, median survival times of patients with and without EGFR mutations treated with gefitinib were 25.1 and 14.0 months, respectively. Patients with EGFR mutations had approximately 2-fold survival advantage; however, the difference was not significant. CONCLUSIONS: We show that EGFR mutations were significantly related to histology and smoke exposure and were a strong predictive factor for gefitinib responsiveness in NSCLC

Impact of GLUT1 and Ki-67 expression on early-stage lung adenocarcinoma diagnosed according to a new international multidisciplinary classification

High expression levels of glucose transporter isoform 1 (GLUT1) and Ki-67 are reportedly associated with malignancy-related clinicopathological factors in malignant tumors. Recently, a new histological IASLC/ATS/ERS classification for lung adenocarcinoma was proposed. In this study, we investigated the clinicopathological impact of GLUT1 and Ki-67 expression on early-stage lung adenocarcinoma classified according to the IASLC/ATS/ERS classification. One hundred and five patients with completely resected stage IA lung adenocarcinoma were retrospectively classified into two groups, a 'non-invasive type' (n=31) or an 'invasive type' (n=74), based on the IASLC/ATS/ERS classification. GLUT1 and Ki-67 expression status was evaluated using immunohistochemistry. The epidermal growth factor receptor (EGFR) and KRAS mutation status was determined using PCR-based assays. Positive GLUT1 and Ki-67 expression and EGFR and KRAS mutations were detected in 28 (27%), 33 (31%), 51 (49%) and 5 (8%) cases, respectively. Positive GLUT1 expression was significantly associated with a wild-type EGFR and mutant KRAS status. A multivariate analysis revealed that positive GLUT1 expression was independently associated with the 'invasive type'. In multivariate analyses for overall survival (OS) and disease-free survival (DFS), positive Ki-67 and GLUT1 expression was the only independent factor for a poor OS (P=0.012) and DFS (P=0.040), respectively. In addition, when stratified according to the GLUT1 and Ki-67 status, double-positive cases had the poorest DFS and OS times, compared with the other categories. Positive GLUT1 expression is associated with the invasive character of early-stage lung adenocarcinoma and with early disease relapse. Our results strongly suggest that GLUT1 and Ki-67 play important roles in acquiring biological malignant potential in early-stage lung adenocarcinoma

Mesenteric Bleeding due to a Ruptured Aneurysm of the Middle Colic Artery

An outpatient with repeated colic attacks of unknown cause was hospitalized and was subjected to CT scan, ultrasound inspection, cytodiagnosis via abdominocentesis, resulting in the diagnosis of epigastrial hematoma. Further angiographical investigation evidenced the presence of middle colic artery. Aneurysm was also detected in the right colic artery. Other celiac arteries, however, were normal. The aneurysms detected were surgically removed with a portion of the intestinal tract. The pathological investigation of the resected aneurysm in the present cast could not prove the association with several other diseases which have been mentioned as possible causes for aneurysm. While only 10 cases of aneurysm at the superior mesenteric arterial branch have been reported, the authors believe that angiographical inspection should indispensably be attempted for diagnosis in cases of abdominal pain or abdominal tumors of unknown causes

Embryoid and Callus Formation from Eggplant Microspores by Cultrre of Anthers Treated with High and Low Temperatures

Anthers containing uninucleate microspores of eggplant cv.'Wase-Shinkuro' were cultured on MS supplemented with 0.02mg/1 2,4-D and kinetin,3% sucrose and 0.2% Gelrite with high and low temprerature treatments to increase number of haploids,in early August and September and on November 4,1992.Anthers plated were kept heated at 35℃ for 48h in early November,and callus and embryoid were formed from microspores.The frequency of anthers foming callus was as high as 28% in treated anthers,but 14% in non-treated ones.Embryoids were obtained only in treated anthers,and the frequency of anthers forming embryoid was 5.1%.On the other hand,low temprerature pretreatments at 4℃ for 0,5 or 10days to flower buds in summer season were ineffective for embryoid formation and inhibitory for callus formation with treatement for langer periods.ナス（品種’早生真黒’）を供試し、葯培養におけるカルス及び杯様体形成を高めるために高温処理を試みた。培地はMS培地に2,4-Dとkinetinをそれぞれ0.02mg/ℓ、ショ糖を3％、Gelriteを0.2％添加したものとした。葯は11月上旬に採取したものを用いた。カルス形成率は対照では14％であったのに対し、葯置床後35℃で48時間の高温処理を行った場合は28％と約2倍まで向上した。また胚様体は高温処理区のみで得られた。また、夏期に同様の品種、培地を用いて花蕾に対する低温処理（4℃-0,5,10日）の効果について検討した。低温処理の効果は認められず、カルス形成葯率は処理日数が長くなるにつれて低下した。また胚様体はいずれの区でも形成されなかった

The Prognostic Effect of VEGF Expression in Squamous Cell Carcinoma of the Cervix Treated with Radiation Therapy Alone

We investigated the relationship between vascular endothelial growth factor (VEGF) expression and clinical outcome in squamous cell carcinoma of the cervix treated with radiotherapy alone. The immunohistochemical study was performed for forty-two paraffin embedded specimens with anti-VEGF mouse monoclonal antibody. Staining was defined as positive for VEGF when more than 10% of the tumor cells were stained from 500 cells counted. Positive VEGF expression was observed in twenty-one among forty-two patients. VEGF expression according to stage (p=0.101), lymph node status (p=0.621), parametrial invasion (p=0.268), and age (p=0.5) revealed no significant difference. But the VEGF expression was significantly higher in tumors larger than 4 cm (p=0.031). Five year survival rates according to VEGF expression status were 89% for VEGF negative group and 47% for VEGF positive group (p=0.02). FIGO stage (p=0.007), tumor size (p=0.025) and the duration of external beam radiation therapy (p=0.006) were also significant prognostic factors for overall survival. We suggest that VEGF expression may be a prognotic factor of the cervix cancer patients treated with radiation therapy alone

The gonio scratch study: methodology of a multicenter clinical trial establishing a new minimally invasive glaucoma surgery

There are numerous surgical procedures for glaucoma. Minimally invasive glaucoma surgery is becoming popular; however, the disadvantage is the high incidence of anterior chamber hemorrhage. Heavy bleeding can also lead to increased intraocular pressure (IOP) postoperatively. Gonio scratch is a surgical procedure that improves aqueous humor outflow by rubbing off deposits on the trabecular meshwork with a Diamond Dusted Sweeper. As the conjunctiva and trabecular meshwork are not incised, no postoperative bleeding is expected, and the IOP spike will be minimal. We designed this study to determine the efficacy and safety of gonio scratch. This is an on-going multicenter, prospective, clinical trial. Patients who are scheduled for glaucoma surgery with or without cataract surgery are being enrolled. A total of 80 eyes will be recruited in the Hiroshima University Hospital, Miyoshi Eye Clinic, Yokoyama Retina Clinic, and Kusatsu Eye Clinic. All patients will undergo gonio scratch. When combined with cataract surgery, gonio scratch is performed after the intraocular lens is inserted. The primary study endpoint is the change in IOP from baseline to 1 year after surgery. The secondary endpoints are complications, number of glaucoma medications, surgical time, and changes in visual acuity and the visual field. This study protocol was approved by the institutional review board of Hiroshima University. The trial results will be shared with the scientific community at international conferences and by publication in a peer-reviewed journal. Trial registration number is jRCTs062200003.departmental bulletin pape

Antral Somatostatin Contents and Acidity of Gastric Juice in Normal Subjects and Patients with Duodenal Ulcer

The antral somatostatin contents were investigated in biopsy specimens of the antrum from normal subjects and patients with duodenal ulcer. There was good correlation (r=0.77044) between antral somatostatin contents and maximal acidity in normal subjects, but the correlation between antral somatostatin contents and maximal acid output was not significant (r=0.254367). This result may indicate that antral somatostatin content is regulated by intragastric pH in normal subjects. On the other hands, no correlation was observed between antral somatostatin contents and acidity or acid output in patients with duodenal ulcer. Therefore the impaired regulation of acid on antral somatostatin contents could be one of the important factors in the pathogenesis of duodenal ulcer disease