[A Case of Intradural Retroclival Chordoma].

A 67-year-old woman was referred to our department with a retroclival lesion including a cyst on MRI. MRI revealed a lesion appearing as an isointense region on a diffusion-weighted image(DWI). Gadolinium(Gd)-DTPA T1-WI showed heterogeneous enhancement of the lesion in the prepontine cistern. Computed tomography(CT)revealed an isodense lesion with no invasion into the clival bone. Based on a preoperative diagnosis of retroclival chordoma, extended trans-sphenoidal surgery(TSS)was performed by a direct endoscopic endonasal approach via the left nostril. We found a round dural defect with a diameter of 5 mm, through which the tumor was incarcerated. However, the tumor had no connection to the clival bone. The lesion was totally removed and histologically diagnosed as a chordoma. Furthermore, the clival bone included no tumor cells. Based on those radiological and histological findings, we diagnosed the lesion as an intradural retroclival chordoma. We should consider intradural retroclival chordoma as a candidate for the differential diagnosis of a retroclival lesion without clival bone invasion.

Utility of cytopathological specimens and an automated image analysis for the evaluation of HER2 status and intratumor heterogeneity in breast carcinoma.

OBJECTIVES: Although updated HER2 testing guidelines have been improved by a collaboration between the American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) in 2013, HER2 evaluation is still problematic because of issues involving CEP17 polysomy, heterogeneity, and HER2 score 2+ cases. The aim of this retrospective study was to evaluate the relationship between HER2 gene heterogeneity, or so called CEP17 polysomy, using breast carcinoma cells sampled by scraping and the IHC score graded by automated image analysis using whole slide image. MATERIAL AND METHODS: We randomly selected 23 breast carcinoma cases with a HER2 score 0, 24 cases with a HER2 score 1+, 24 cases with HER2 score 2+, and 23 cases with HER2 score 3+ from the records of patients with breast cancer at Hiroshima University Hospital. We compared the results of fluorescent in situ hybridization (FISH) using formalin-fixed, paraffin-embedded (FFPE) tissues and cytological samples and compared the HER2 score calculated using an automated image analysis using wholly scanned slide images and visual counting. RESULTS: We successfully performed the FISH assay in 78 of 94 cases (83%) using FFPE tissues and in all 94 (100%) cases using cytological samples. Frequency of both HER2 amplification and CEP17 polysomy was higher when cytological samples were used than when FFPE tissue was used. Frequency of HER2 heterogeneity using cytological samples was higher that than using FFPE tissue, except for the IHC score 3+ cases. CONCLUSIONS: When assessment of HER2 status based on FISH using FFPE tissue cannot be accomplished, FISH using cytological samples should be considered. When intensity of HER2 is heterogeneous in the tumor tissue, particularly in cases regarded as score 2+, they should be evaluated by automated image analysis using the whole slide image.

Slow-wave photic stimulation relieves patient discomfort during esophagogastroduodenoscopy.

BACKGROUND AND AIM: Although pretreatment with a sedative drug is effective in relieving pain during esophagogastroduodenoscopy (EGD), such drugs can cause significant side-effects. The aim of this study was to examine the effect of slow-wave photic stimulation on discomfort and/or pain felt during EGD. METHODS: Forty consecutive patients (25 men and 15 women) who underwent diagnostic EGD in our hospital were included in the study. Twenty patients received photic stimulation for 25 min, and underwent electroencephalographic recording, in addition to the usual premedications. Twenty control patients received the same treatment but without photic stimulation. All patients evaluated the discomfort/pain felt during endoscopy against a five-grade scale in comparison with what they had experienced in their previous examination. RESULTS: Patients with an improved discomfort/pain score were 18/20 and 3/20 in the treated and control groups, respectively. Overall comparison of pain scores between both groups was significant (P<0.0001). The proportion of slow-wave activity recorded in patients' electroencephalograms significantly increased in the treated group compared to control values (36.6+/-6.8% vs 29.1+/-3.4%, P<0.001). There was a close correlation between the degree of discomfort/pain felt during endoscopy and the proportion of slow-wave activity (P<0.001). CONCLUSION: Slow-wave photic stimulation shows promise as a treatment for relieving the discomfort and/or pain felt by patients undergoing EGD.