DNA mismatch repair-related protein loss as a prognostic factor in endometrial cancers / 부인종양

OBJECTIVE: Recent investigations have revealed DNA mismatch repair (MMR) gene mutations are closely related with carcinogenesis of endometrial cancer; however the impact of MMR protein expression on prognosis is not determined. Correlations between MMR-related protein expression and clinicopathological factors of endometrial cancers are analyzed in the present study. METHODS: A total of 191 endometrial cancer tissues treated between 1990 and 2007 in our hospital were enrolled. Immunoreactions for MSH2, MLH1, MSH6, and PMS2 on tissue microarray specimens and clinicopathological features were analyzed retrospectively. RESULTS: Seventy-six cases (40%) had at least one immunohistochemical alteration in MMR proteins (MMR-deficient group). There were statistically significant differences of histology, International Federation of Gynecology and Obstetrics (FIGO) stage, and histological grade between MMR-deficient group and the other cases (MMR-retained group). Response rate of first-line chemotherapy in evaluable cases was slightly higher in MMR-deficient cases (67% vs. 44%, p=0.34). MMR-deficient cases had significantly better progression-free and overall survival (OS) compared with MMR-retained cases. Multivariate analysis revealed MMR status was an independent prognostic factor for OS in endometrial cancers. CONCLUSION: MMR-related proteins expression was identified as an independent prognostic factor for OS, suggesting that MMR was a key biomarker for further investigations of endometrial cancers.

Clear cell histology as a poor prognostic factor for advanced epithelial ovarian cancer: a single institutional case series through central pathologic review / 부인종양

OBJECTIVE: Compared with serous adenocarcinoma (SAC), clear cell carcinoma (CCC) often shows chemo-resistance, which would potentially lead to a poor prognosis. On the other hand, there have been arguments over prognoses of CCC and SAC disease. In the present study, multivariate analysis to compare prognosis of CCC patients with that of SAC was aimed for the patients selected from central pathologic review. METHODS: Between 1984 and 2009, a total of 500 ovarian cancer patients were treated at our university hospital. Among them, 111 patients with CCC and 199 patients with SAC were identified through central pathological review. Overall survival and progression-free survival were compared using Kaplan-Meier method, and prognostic factors were investigated by multiple regression analyses. RESULTS: Median age was 52 years for CCC and 55 years for SAC (p=0.03). The ratio of stage I patients were significantly higher in CCC compared with SAC (55% vs. 13%, p<0.01). Among evaluable cases, response rate was significantly lower in CCC than that in SAC (32% vs. 78%, p<0.01). No significant differences of progression-free survival and overall survival were observed in stage I patients; however, prognoses of CCC were significantly poorer than those of SAC in advanced-stage disease. In stage II-IV patients, not only residual tumors and clinical stages, but also clear cell histology were identified as predictors for poor prognosis. CONCLUSION: Clear cell histology was identified as a prognostic factor for advanced-stage ovarian cancers. Histologic subtypes should be considered in further clinical studies, especially for advanced epithelial ovarian cancers.

Sudden Death as Viewed From Autopsy Findings. A Study of 86 Cases / 日本農村医学会雑誌

We examined the rates of sudden death to ordinary deaths of the patients in two hospitals in Obihiro. A total of 130 sudden death cases (89 men and 41 women) out of 1, 088 ordinary deaths were listed (11.9%) during the period of two years from 1992 through 1993.<BR>We also looked into the cause of sudden death in 86 autopsied cases over a 15-year period from 1985 through 1999 from a pathological stand point. Cardiac diseases underlay 49 cases of sudden death. Myocardial infarction (42 cases), cardiomyopathy (2), sarcoidosis (1), amyloidosis (2) and valvular disease (2) were regarded as the causes of death in the 49 cases. Myocardial infarction occurred more frequently in men than in women (27: 15). Next to cardiac diseases came aortic diseases such as ruptured aortic aneurysm (7 cases) and dissecting aneurysm (6). Cardiac diseases (49 cases) and aortic diseases (13) combined to account for 62 of 86 (72.1%) autopsied cases. Among noncardiovascular diseases, respiratory diseases (18 cases) topped the list, followed by alimentary diseases (3) and cerebral bleeding (2). The major cause of respiratory diseases was pulmonary embolism (16). Pulmonary embolism more often occurred in women than in men (14: 2). There was one case of unidentifiable sudden death, namely Pokkuri disease. A decreased incidence of sudden death on Sunday should be noted. A circadian rhythm was evident. The incidence of sudden death started rising from 6: 00 and peaked at 15: 00. Sudden death occurred during rest (42 cases), during routine daily activity (14), during sleep (11), during bathing (1), during defecation (8), during surgery (2), during physical exercise (6) and during agricultural work (2).