A Case of Uterine Cervical Adenocarcinoma in Which Initial Total Laparoscopic Hysterectomy Was Performed for Suspected Atypical Endometrial Hyperplasia.

The patient was a 69-year-old multiparous female (gravida/para, 3/3) who had hypertension and arrhythmia. Her history included cerebral infarction treated with conservative therapy. She visited our hospital for atypical genital bleeding. She was diagnosed with atypical glandular cells (AGC) based on cervical cytology, atypical cells in endometrial cytology, and atypical endometrial hyperplasia on preoperative endometrial biopsy, and underwent total laparoscopic hysterectomy. However, in a postoperative pathologic examination, she was diagnosed with stage IB1 cervical adenocarcinoma without endometrial abnormality. AGC appeared in cervical cytology before surgery, but a surgical plan was not made with consideration of cervical adenocarcinoma.

A Case of Recurrent Peritoneal Cancer in Which an Antitumor Effect Was Obtained Using a Combination of Etoposide and a Chinese Herbal Medicine with Maintenance of Daily Life.

The patient was a 50-year-old multiparous female (gravida/para 4/2) who had divorced. She was followed up for 1 year and 5 months after completion of initial treatment for peritoneal cancer (preoperative chemotherapy + optimal surgery + chemotherapy). A gradual increase in the tumor marker CA125 occurred, and computed tomography and ultrasonography showed bilateral neck, left supraclavicular and right axillary lymphadenopathy. The patient wanted to continue her job. Therefore, she was treated with etoposide (25 mg) daily for 3 weeks and TJ-48 (juzen-taihoto, 7.5 g) daily for 4 weeks, and then followed up. After two weeks, swelling of lymph nodes had been reduced or eliminated and tumor marker CA125 was negative. The only adverse reaction was slight numbness and the patient continued to work while receiving the same drugs orally for 2 years and 8 months without any symptoms or recurrence. This case shows that a combination of etoposide and TJ-48 has an antitumor effect on recurrent progressive peritoneal cancer while allowing a patient to work and have a normal daily life.

Recurrent Cervical Cancer with Intestinal Perforation That Was Related to Bevacizumab after Long-term NSAIDs Administration and Was Treated with Laparoscopy-assisted Anastomosis.

Bevacizumab is an effective drug for recurrent/advanced cervical cancer. A 59-year-old patient diagnosed with FIGO stage I B2 squamous cell carcinoma of the cervix at our hospital was treated with concurrent chemoradiotherapy as initial treatment. The outcome was judged as close to CR. Local recurrence in the irradiation field and paraaortic lymph node metastasis were noted 2 months after completion of this treatment. Chemotherapy of bevacizumab combined with paclitaxel plus carboplatin (TC) was initiated for recurrent cervical cancer. At 17 days after the 4th cycle, abdominal pain suddenly developed, and a close examination detected free air on abdominal CT, based on which intestinal perforation was diagnosed. Laparoscopic surgery performed to investigate the intraabdominal cavity showed that the small intestine was perforated at 2 sites. These were treated with laparoscopy-assisted partial resection of the small intestine and functional end-to-end anastomosis. Drug therapy for the recurrent cervical cancer was considered, but the primary disease rapidly aggravated and the patient died of the primary disease 11 months after completion of the initial treatment.

Microrobotic Platform for Single Motile Microorganism Investigation.

We propose a microrobotic platform for single motile microorganism observation and investigation. The platform utilizes a high-speed online vision sensor to realize real-time observation of a microorganism under a microscopic environment with a relatively high magnification ratio. A microfluidic chip was used to limit the vertical movement of the microorganism and reduce the tracking system complexity. We introduce a simple image processing method, which utilizes high-speed online vision characteristics and shows robustness against image noise to increase the overall tracking performance with low computational time consumption. The design also considers the future integration of a stimulation system using microtools. Successful long-time tracking of a freely swimming microorganism inside of a microfluidic chip for more than 30 min was achieved notwithstanding the presence of noises in the environment of the cell. The specific design of the platform, particularly the tracking system, is described, and the performance is evaluated and confirmed through basic experiments. The potential of the platform to apply mechanical stimulation to a freely swimming microorganism is demonstrated by using a 50-µm-thick microtool. The proposed platform can be used for long-term observation and to achieve different kinds of stimulations, which can induce new behavior of the cells and lead to unprecedented discoveries in biological fields.

Case of metastatic uterine cervical squamous cell carcinoma in the right atrium.

INTRODUCTION: Metastasis of uterine cervical carcinoma to the heart is uncommon and cases with metastasis to the right atrium are especially rare. This type of metastasis occurs in the epicardium and the myocardium in over 90% of cases with a heart metastatic tumor. Most cases of a metastatic tumor in the heart are found by chance during autopsy. CASE REPORT: We present the case of a patient with stage IIa uterine cervical carcinoma who visited our hospital with a chief complaint of arrhythmia 1.9 years after surgical treatment of carcinoma. CT and MRI showed that recurrent metastatic uterine cervical carcinoma had grown from the inferior vena cava upward into the right atrium. CONCLUSION: Although gynecological malignant tumors rarely metastasize to the heart, it is important to consider this possibility in patients with chest symptoms, and to make an early definite diagnosis and give appropriate treatment.

Gene expression of lymphocyte prolactin receptor was suppressed in lactating mothers.

Prolactin (PRL) receptor (PRL-R) was proven to be ubiquitously expressed by cells in the immune system, while the physiological role of PRL was established in milk production in mammary glands. We analyzed the mRNA content of PRL-R in human lymphocytes in normo- and hyperprolactinemic conditions to document the presence of functioning PRL-R of human lymphocytes. Blood samples were obtained prior to treatment, and with written informed consent, from outpatients with ovarian dysfunction and hyperprolactinemia (n = 8; 19 ~ 41 y/o), from breast-feeding mothers after normal delivery (n = 12; 27 ~ 36 y/o), and from healthy volunteers: men (n = 9; 33 ~ 40 y/o) and women (n = 9; 26 ~ 36 y/o). Subsequently, total RNA was prepared from the lymphocytes separated. The quantity of PRL-R mRNA was examined by reverse transcription and polymerase chain reaction and normalized with a simultaneously measured amount of b actin. The resultant mRNA level of PRL-R was analyzed for its correlation with serum concentration of PRL measured by immunoassay. PRL-R mRNA levels of lymphocytes were significantly suppressed in lactating mothers, while there was a statistically significant negative correlation between PRL-R mRNA and serum PRL levels. However, there was no significant difference of PRL-R mRNA in the pathological condition of outpatients with ovarian dysfunction and/or hyperprolactinemia. While a few investigators reported the extra-mammary regulation on PRL-R by PRL, our data suggest that the PRL-R levels of circulating lymphocytes could be down-regulated by the elevated serum levels of PRL and that pituitary PRL may participate in regulating the expression of PRL-R genes on cells of the human immune system, especially in physiological circumstances such as in the postpartum period.

Cerebral hyperperfusion syndrome associated with non-convulsive status epilepticus following superficial temporal artery-middle cerebral artery anastomosis. Case report.

A 77-year-old man developed cerebral hyperperfusion syndrome with temporal deterioration of consciousness and worsening of left hemiparesis on the 6(th) postoperative day following superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for right M(1) occlusion. Electroencephalography (EEG) revealed frequent ictal discharges in the right hemisphere, although convulsive seizures were not apparent. Administration of anticonvulsants was performed based on the diagnosis of non-convulsive status epilepticus (NCSE). Complete recovery from hyperperfusion syndrome was achieved with rapid improvement of EEG findings. The present case demonstrates the pathophysiological mechanism of hyperperfusion syndrome associated with NCSE after STA-MCA anastomosis.

Diffusion-weighted magnetic resonance imaging for assessment after neoadjuvant chemotherapy in breast cancer, based on morphological concepts.

The study aimed to evaluate the utility of diffusion-weighted imaging (DWI) and to assess the response of breast cancer patients to neoadjuvant chemotherapy (NAC), based on morphological concepts. This retrospective study included 35 breast cancer patients (36 lesions) who had conventional magnetic resonance imaging (MRI), with DWI acquired before and after NAC. The morphological pattern of delayed enhancement on MRI before NAC was classified into two types: focal mass (FM), and multiple masses and/or non-mass like (MM/NM), based on Breast Imaging Reporting and Data System (BI-RADS). Of the 36 tumors, 26 were classified as FM and 10 as MM/NM. Tumors were clearly visualized on the initial DWI although one case of suspected MM/NM was not observed on DWI following NAC. A correlation was found between changes in the apparent diffusion coefficient and response rates to NAC in FM tumors (r=0.608, p<0.001), but not in MM/NM tumors (r=0.141, p=0.717). There was agreement between MRI findings after NAC and pathological findings in 30 of the 36 tumors (83.3%). Thus, we concluded that DWI is potentially useful in assessing the response to NAC for breast cancer for tumors diagnosed as FM on the initial conventional MRI.

Targeted drug delivery system for oral cancer therapy using sonoporation.

Ultrasound-mediated destruction of microbubbles has been proposed as an innovative non-invasive drug delivery system for cancer therapy. We developed a specific drug delivery system for squamous cell carcinoma that uses sonoporation with the anti-epidermal growth factor receptor (EGFR) antibody. Administration of a low dose of bleomycin (BLM) by sonoporation with the anti-EGFR antibody produced a marked growth inhibition of Ca9-22 cells in vitro. In addition, scanning electron microscopic analysis revealed apparent surface deformation of Ca9-22 cells treated with sonoporation in the presence of the antibody. Interestingly, the population of apoptotic cells was remarkably increased when a low dose of BLM was delivered using sonoporation with the Fab fragment of the anti-EGFR antibody. These findings indicate that sonoporation with the Fab fragment makes it possible to administer drugs into cells more efficiently and specifically, suggesting a novel application for chemotherapy and gene therapy treatments for oral squamous cell carcinoma.

Beneficial aspect of oral estriol as hormone replacement therapy: consideration on bone and lipid metabolism.

To improve the quality of life of elderly people in Japanese society where women have the longest life expectancy in the world, osteoporosis, and hyperlipidemia are among the major targets of medical treatment. To differentiate two types of regimens for hormone replacement therapy (HRT), we tried to evaluate the efficacy on lipid and bone metabolism. With informed consent, 34 postmenopausal women of more than 2 years were assigned to receive 1 of 2 types of HRT (the HRT group) for 12 months observation: one with a combination of conjugated equine estrogen (CEE) 0.625 mg/day and medroxyprogesterone acetate (MPA) 2.5 mg/day (the CEE group), and the other with oral estriol (E3) 2 mg/day (the E3 group). Parameters of serum lipid were measured, as well as those of bone metabolism with bone mineral density (BMD) by dual-energy X-ray absorptiometry (DEXA) using QDR-2000. In HRT groups, lipid and bone metabolism were confirmed to be improved. Whereas, an increase of triglycerides (TG) observed in the CEE group was not observed in the E3 group. Thus, in the clinical management of postmenopausal women, oral E3 preparation as an alternative regimen for HRT for CEE might be efficacious.

[Autopsy of a suspected venous circulatory disturbance localized in the medulla oblongata and upper cervical cord accompanied by an aneurysm].

We describe an autopsied case of an 86-year-old woman who presented with acute tetraparesis, bulbar palsy, and respiratory insufficiency. MRI showed a T2 hyperintensity lesion in the medulla oblongata and C1 and C2 level cervical cord, and an unruptured aneurysm in the left posterior inferior cerebellar artery. With an initial diagnosis of Bickerstaffs brainstem encephalitis, we started corticosteroid therapy. Initially, the corticosteroid treatment gradually improved her general condition; however, about two weeks later she died of an acute respiratory insufficiency. From the postmortem pathological examination, we considered a venous circulatory disturbance of the medulla oblongata and upper cervical cord. No arteriovenous shunt was found in the intramedulla and the medulla oblongata was partially compressed on the left side by an unruptured aneurysm. However, neither inflammatory nor malignant cells were found in the lesion. What caused the venous circulatory disturbance was unclear, but the dural arteriovenous fistula could have been responsible. Our case suggested that venous circulatory disturbances accompanied with an aneurysm need rapid consideration by angiography followed by intervention.

A subchondral fracture in transient osteoporosis of the hip.

Although subchondral changes are reported to be associated with transient osteoporosis of the hip (TOH), the etiology of this disorder is unknown.In this paper, we describe a 45-year-old man with TOH who underwent both MRI and CT examinations. Plain radiographs obtained 2 months after the onset of hip pain showed a focal loss of radiodensity in the left femoral head. MRI revealed a bone marrow edema pattern in the left femoral head and neck with an associated subchondral serpiginous low signal intensity line on the T1-weighted images. A CT scan showed a subchondral fracture in the corresponding area. The hip pain and imaging abnormalities resolved spontaneously following conservative treatment. This case study demonstrated that a subchondral fracture of the femoral head was associated with TOH using MRI and CT examinations, and suggests that the presence of a subchondral fracture may be important for the pathophysiology of TOH.

Sebaceous carcinoma of the breast: case report and review of the literature.

Sebaceous differentiation has been described in only limited examples of benign and malignant epithelial lesions of the breast. We report a rare case of mammary sebaceous carcinoma to further delineate its morphologic features. Microscopically, the tumor, arising in the right mammary gland of a 63-year-old woman, was composed of well-defined solid sheets or lobules of atypical epithelial cells including many large pale or clear cells with often scalloped nuclei and coarsely vacuolated cytoplasm, in which abundant lipid droplets were identified with oil-red-O staining. Immunohistochemical expressions of cytokeratin, epithelial membrane antigen, and receptors of estrogen and progesterone were detected, whereas GCDFP-15, S-100 protein, vimentin, alpha-smooth muscle actin, p63, androgen receptor, and the HER2/neu protein were not expressed. Besides, a subset of the tumor cells co-expressed synaptophysin, neurofilament, and PGP9.5, suggesting neuroendocrine differentiation that is a hitherto undescribed phenomenon in the mammary tumors with sebaceous features. This case would expand the morphologic diversity of carcinoma of the breast.

Absence of pretreatment markers that predict the emergence of YMDD mutants during lamivudine treatment--the results of a prospective multi-center study.

BACKGROUND/AIMS: The emergence of YMDD mutants in patients who are treated with lamivudine may determine the clinical prognosis. However, currently there are no clinical or virological factors that predict specifically the emergence of the mutants. METHODOLOGY: To define these factors, we analyzed 69 patients with chronic hepatitis B infection who were treated with lamivudine (LAM) and followed prospectively for at least 12 months. RESULTS: Of the 69 patients, 12 (17.4%) developed YMDD mutants up to 12 months after the start of LAM. The incidence of YMDD mutants was slightly higher in those who were younger, had higher HBV DNA titers, lower ALT levels, genotype C, and mutations in the core promoter before treatment. However, we could not find any significant factors that correlated with the appearance of the mutants. CONCLUSIONS: Currently, using conventional virological assays, it is difficult to predict the development of mutants before LAM treatment. Management of flare-ups of hepatitis, due to the appearance of mutants, should always be envisaged when LAM treatment is started.

Treatment strategy for recurrent and refractory epithelial ovarian cancer: efficacy of high-dose chemotherapy with hematopoietic stem cell transplantation.

According to population statistics in Japan, approximately 3,800 women die of ovarian -cancer annually, and approximately 6,000 are affected by this disease. Ovarian cancer is -referred to as a "silent tumor", since patients have few subjective symptoms and by the time symptoms are observed, the cancer has progressed to Stage III or IV in about half of the patients. The basic treatment for advanced epithelial ovarian cancer is to remove as much of the tumor as possible, and subsequently to perform anticancer therapy using drugs such as cisplatin, carboplatin and paclitaxel, all of which have been shown to be effective for epithelial ovarian cancer. However, the 5-year survival rate in advanced ovarian cancer patients is still only about 20%, and a treatment that leads to long-term survival has yet to be developed. Here, we review the available treatments for ovarian cancer, and present the results of high-dose chemotherapy (HDC) performed in our hospital for recurrent and refractory -ovarian cancer.