Energy-Reduced Fabrication of Light-Frame Ceramic Honeycombs by Replication of Additive Manufactured Templates.

Ceramic components require very high energy consumption due to synthesis, shaping, and thermal treatment. However, this study suggests that combining the sol-gel process, replica technology, and stereolithography has the potential to produce highly complex geometries with energy savings in each process step. We fabricated light-frame honeycombs of Al2O3, Ba0.85Ca0.15Zr0.1Ti0.9O3 (BCZT), and BaTiO3 (BT) using 3D-printed templates with varying structural angles between -30° and 30° and investigated their mechanical and piezoelectric properties. The Al2O3 honeycombs showed a maximum strength of approximately 6 MPa, while the BCZT and BaTiO3 honeycombs achieved a d33 above 180 pC/N. Additionally, the BCZT powder was prepared via a sol-gel process, and the impact of the calcination temperature on phase purity was analyzed. The results suggest that there is a large energy-saving potential for the synthesis of BCZT powder. Overall, this study provides valuable insights into the fabrication of complex ceramic structures with improved energy efficiency and enhancement of performance.

Efficacy of cabazitaxel in patients with metastatic castration-resistant prostate cancer: A single-center study in Japan.

OBJECTIVES: Cabazitaxel is a next-generation taxane that can prolong overall survival after docetaxel treatment in patients with metastatic castration-resistant prostate cancer. However, the efficacy of cabazitaxel varies among these patients. The clinical indicators of the prognosis after cabazitaxel treatment were analyzed. METHODS: A retrospective review of patients who received cabazitaxel between February 2015 and June 2021 was performed. All patients had metastatic castration-resistant prostate cancer. Prognostic factors for prostate-specific antigen progression-free and overall survival were analyzed by Cox proportional-hazards analysis and the log-rank test. RESULTS: The study comprised 57 patients who received cabazitaxel (median 4 cycles, range 1-27) at a starting dose of 15-25 mg/m2 . The median age and follow-up duration were 70 years and 9.2 months. The median prostate-specific antigen progression-free survival and overall survival were 2.6 and 10.5 months, respectively. Univariate analysis showed that previous androgen receptor-axis-targeted therapy before cabazitaxel treatment was the only significant risk factor (hazard ratio 2.784, p = 0.022) for prostate-specific antigen progression-free survival. Multivariate analysis for overall survival revealed that poor performance status (≥1) (hazard ratio 2.107, p = 0.039), low hemoglobin (hazard ratio 0.142, p = 0.010), and high neutrophil-lymphocyte ratio (hazard ratio 9.150, p = 0.032) at baseline were significantly associated with a poor prognosis. CONCLUSIONS: Previous androgen receptor-axis-targeted therapy was the only risk factor for biochemical progression. Poor performance status, anemia, and high neutrophil-lymphocyte ratio were risk factors for poor prognosis in patients with metastatic castration-resistant prostate cancer treated with cabazitaxel. These risk factors seem useful for identifying patients with survival benefit from cabazitaxel treatment.

Improved Mechanical Amplification of Monolithic PZT and PZT Composite via Optimized Honeycomb Macrostructures.

Honeycomb-based, modular composites with a relative density of 0.3948 and a slenderness ratio Lges/t of 6.48 were fabricated on PZT building blocks connected with a PZT-filled phenyl silicone resin. The macro- and micro-structure, phase composition, and the interface between the two materials were analyzed by SEM and image analysis techniques. The mechanical in-plane strain response was determined with uniaxial compression tests and the transversal piezoelectric strain response was determined by applying an electric field. These deformations were analyzed by a 2D digital image correlation analysis to calculate the mechanical strain amplification of monolithic and composite PZT lattice structures. Compared to bulk PZT, the piezoelectric strain amplification in the Y-direction |aypiezo| was higher by a factor of 69 for the composite and by a factor of 12 for the monolithic cellular PZT lattice, when it was assumed that the ratio of the deformation of the bulk material to bulk material was 1. The mechanical amplification of the composite lattices increased up to 73 and that of the cellular PZT lattices decreased to 12. Special focus was given to the fracture behavior and the interface of the PZT/PZT-filled phenyl silicone resin interface.

Surface Exchange Reaction of Mixed Conductive La0.65Ca0.35FeO3-δ during Oxygen Evolution and Incorporation as Traced by Operando X-ray Photoelectron Spectroscopy.

High oxygen permeability of mixed conductive La0.65Ca0.35FeO3-δ (LCF) is applicable to pure oxygen gas generators and cathodes for solid oxide fuel cells, etc.; however, lower surface exchange reactions at temperatures below 800 °C reduce permeability. To understand the microscopic surface reaction mechanism, operando soft X-ray photoelectron spectroscopy of an LCF film surface was conducted during the evolution and incorporation of oxygen. LCF film was prepared on yttria-stabilized zirconia and a current was applied throughout the film at ∼600 °C. From operando X-ray photoelectron spectra, surface oxide species involved in the surface exchange reaction obviously appeared on the film during the evolution of oxygen from the surface. The number of surface oxide species abruptly decreased during incorporation of oxygen. By applying the current from a negative to positive value, the numbers of surface oxide species and ligand holes near Fe3+ ions on the surface both significantly increased. The results infer that ligand holes in the Fe 3d-O 2p hybrid orbitals correspond to active reaction sites at which surface oxide species change to oxygen molecules. Increasing the number of active reaction sites is key to improving oxygen evolution of mixed conductive oxides.

Advanced Estimation of Compressive Strength and Fracture Behavior in Ceramic Honeycombs by Polarimetry Measurements of Similar Epoxy Resin Honeycombs.

Finding a non-destructive characterization method for cellular ceramics' compressive strength and fracture behavior has been a challenge for material scientists for years. However, for transparent materials, internal stresses can be determined by the non-destructive photoelastic measurements. We propose a novel approach to correlate the photoelastic stresses of polymer (epoxy resin) prototypes with the mechanical properties of ceramics (alumina). Regular and inverse epoxy honeycombs were 3D-printed via stereolithography with varying structure angles from -35° to 35°, with negative angles forming an auxetic and positive hexagonal lattice. Photoelastic measurements under mechanical loading revealed regions of excess stress, which directly corresponded to the initial fracture points of the ceramic honeycombs. These honeycombs were made by a combination of 3D printing and transfer molding from alumina. The photoelastic stress distribution was much more homogeneous for angles of a smaller magnitude, which led to highly increased compressive strengths of up to 446 ± 156 MPa at 0°. By adapting the geometric structural model from Gibson and Ashby, we showed that we could use a non-destructive technique to determine the compressive strength of alumina honeycombs from the median photoelastic stress measured on similar epoxy honeycomb structures.

Involvement of AAA ATPase AipA in endocytosis of the arginine permease AoCan1 depending on AoAbp1 in Aspergillus oryzae.

AAA ATPases widely exist in many organisms and function in various organelles. However, there is little information about AAA ATPase functioning in endocytosis. In Aspergillus oryzae, we previously discovered a putative AAA ATPase AipA that would be involved in endocytosis. Here, we further examined the function of AipA and AoAbp1 in endocytosis using enhanced green fluorescent protein (EGFP)-tagged arginine permease AoCan1 as an endocytic marker. In the ΔaipA strain, endocytosis of AoCan1-EGFP was more facilitated than the control strain, suggesting that AipA negatively regulates endocytosis. In contrast, in the ΔAoabp1 strain, endocytosis of AoCan1-EGFP was delayed compared with the control strain, suggesting that AoAbp1 positively functions in endocytosis. In addition, in the ΔaipAΔAoabp1 strain, endocytosis of AoCan1-EGFP was delayed. AipA localized at the endocytic collar of the hyphal tip, only in the presence of AoAbp1, suggesting AipA functions downstream of AoAbp1 in endocytosis. Moreover, we investigated the aipA-overexpressing strain, and found that endocytosis of AoCan1-EGFP was inhibited. Furthermore, we examined strains expressing aipAK542A or aipAE596Q, which decreased ATPase activity, in the backgrounds of complementation or overexpression, respectively, and found that AoCan1-EGFP endocytosis was promoted. These results suggested that AAA ATPase activity of AipA is important for its function in endocytosis.

Two cases of delayed onset of immune-related adverse events after discontinuation of nivolumab in patients with metastatic renal cell cancer.

INTRODUCTION: Delayed onset of immune-related adverse events following immune-checkpoint inhibitor discontinuation is underrecognized because of little available evidence. CASE PRESENTATION: A 50-year-old man with metastatic renal cell carcinoma (Case 1) and 58-year-old woman with renal cell carcinoma and retroperitoneal lymph node metastasis (Case 2) underwent nivolumab therapy. Case 1: Progressive disease forced nivolumab discontinuance after 18 months, and he underwent two courses of tyrosine kinase inhibitor therapy. immune-related adverse events of pneumonitis, hepatitis, and renal dysfunction were diagnosed 142 days after nivolumab discontinuation, and he recovered with immunosuppressive treatment. Case 2: The immune-related adverse event of pneumonitis forced nivolumab discontinuance after 14 months, and two courses of tyrosine kinase inhibitor therapy were administered. The immune-related adverse event of hepatitis was diagnosed 436 days after nivolumab discontinuation, and she recovered with immunosuppressive treatment. CONCLUSION: Two patients with delayed onset of immune-related adverse events after nivolumab discontinuation were recovered with immunosuppressive treatment.

Patient-reported outcomes following neoadjuvant endocrine therapy, external beam radiation, and adjuvant continuous/intermittent endocrine therapy for locally advanced prostate cancer: A randomized phase III trial.

BACKGROUND: We evaluated patient-reported outcomes (PRO) during neoadjuvant androgen deprivation therapy (ADT) plus external beam radiation therapy (EBRT) followed by either adjuvant continuous ADT (CADT) or intermittent ADT (IADT) for patients with locally advanced prostate cancer (Pca). METHODS: A multicenter, randomized phase III trial enrolled 303 patients with locally advanced Pca. The patients were treated with 6 months (M) of ADT followed by 72 Gy of EBRT, and were randomly assigned to CADT or IADT after 14 M. The PROs were evaluated at sic points: baseline, 6 M, 8 M, 14 M, 20 M, and 38 M using FACT-P questionnaires and EPIC urinary, bowel, and sexual bother subscales. RESULTS: The FACT-P total scores were significantly better (p < 0.05) in IADT versus CADT at 20 M (121.6 vs.115.4) and at 38 M (119.9 vs. 115.2). The physical well-being scores (PWB) were significantly better (p < 0.05) in IADT versus CADT at 38 M (25.4 vs. 24.0). The functional scores were significantly better in IADT than those in CADT at 14 M (20.2 vs18.7, p < 0.05) and at 20 M (21.0 vs.18.9, p < 0.05). CONCLUSION: The PRO was significantly favorable in IADT on FACT-P total score at 20 M and 38 M, PWB and functional scores at 38 M.

Partial nephrectomy for a Bosniak IV cystic renal mass mimicking a simple renal cyst adjacent to a solid renal tumor.

INTRODUCTION: Renal tumors are often associated with renal cysts. Meanwhile, in some cases there are challenging issues of how to diagnose renal cystic tumors and to decide surgical procedures. CASE PRESENTATION: A 75-year-old man was referred to our department for a 21-mm tumor by his left kidney. Contrast-enhanced computed tomography showed an intense contrast uptake the tumor, which was adjacent to a 64-mm unilocular renal cyst with no contrasting effects. It was clinically diagnosed as renal cell carcinoma, stage T1aN0M0, and treated with robot-assisted partial nephrectomy, for both the solid tumor and the adjacent cyst. Pathological findings revealed a tumor cell clump within the cyst wall, concurrent with the renal cell carcinoma. The patient has remained free of disease at 1 year after surgery. CONCLUSION: A partial nephrectomy that includes the entire cyst wall should be considered for renal tumor associated with unilocular renal cyst.

Renal cell carcinoma with central nervous system demyelination caused by nivolumab.

INTRODUCTION: Central nervous system demyelination caused by immune checkpoint inhibitors is a very rare condition. CASE PRESENTATION: A 65-year-old man who received nivolumab for renal cell carcinoma developed abnormal behavior, such as disagreeable speech and sudden anger. Brain-enhanced magnetic resonance imaging revealed multiple lesions with partial contrast effects in the cerebral white matter. We tentatively diagnosed demyelination caused by nivolumab, and performed steroid pulse therapy twice. After that, his symptoms improved. For the next 2 years, his symptoms did not recur, nor did his cancer progress. CONCLUSION: Demyelination caused by immune checkpoint inhibitors can be fatal and requires early diagnosis and treatment.

Clinical indicators for predicting prognosis after radium-223 administration in castration-resistant prostate cancer with bone metastases.

BACKGROUND: Radium-223 (Ra-223) is a targeted alpha therapy that has been shown to prolong overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) with bone metastases. However, prognosis after Ra-223 administration varies among patients. The aim of the present study was to assess risk factors associated with the poor prognosis of patients treated with Ra-223. METHODS: We retrospectively reviewed patients' records of treatment with Ra-223 between October 2016 and December 2019. All patients had mCRPC, bone metastasis, and no known visceral metastases, and received up to six cycles of Ra-223 (55 kBq/kg). Prognostic factors for OS were analyzed by Cox proportional hazards model and log-rank test. RESULTS: We identified 42 patients who received at least one cycle of Ra-223 (median six cycles, range 1-6). Approximately two-thirds of patients had received at least two lines of therapy for mCRPC. The median age was 74 years, and the median follow-up duration was 13.6 months. The median OS time was 16.6 months. On multivariate analysis, PSA doubling time (PSADT) (0-3 months) at baseline, number of bone metastases (≥ 20), and treatment line of Ra-223 (4th-5th line) remained significantly correlated with the poor OS (HR 4.354, P = 0.003; HR 2.855, P = 0.020; and HR 4.871, P = 0.001, respectively). CONCLUSIONS: Our study demonstrated that a shorter PSADT, a heavier volume of bone metastases, and a later treatment line before Ra-223 are poor prognostic factors for mCRPC patients. These newly discovered risk factors may help select patients who potentially have long-term OS after Ra-223 treatment.

Antiresorptive agent-related osteonecrosis of the jaw in prostate cancer patients with bone metastasis treated with bone-modifying agents.

INTRODUCTION: The incidence rate and risk factors of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) in prostate cancer patients with bone metastasis are not clear. MATERIALS AND METHODS: We retrospectively reviewed patients' records of prostate cancer patients with bone metastasis who were treated with zoledronic acid or denosumab between 1/Dec/2008 and 31/Mar/2019. ARONJ-free survival rate was analyzed with Kaplan-Meier analysis, and risk factors for ARONJ were analyzed with Cox proportional hazard model. RESULTS: We identified 124 and 67 patients treated with zoledronic acid and denosumab, respectively. Seventy-six patients were hormone sensitive, and 115 patients were castration resistant when they started bone-modifying agents (BMA). Twenty-eight patients developed ARONJ during the observation period (median: 23 months, range 1-130 months). Their number of doses of BMA ranged 3-69 (median: 21.5). The 2-year ARONJ-free survival rate was 91.1%, and the 5-year ARONJ-free survival rate was 72.5%. There was no significant difference in the incidence rate of ARONJ between zoledronic acid and denosumab. However, multivariate analysis revealed that use of denosumab (hazard ratio [HR] 3.67, 95% confidence interval [CI] 1.01-13.31; p = 0.0484), serum calcium < 9.2 mg/dL (HR 3.16, 95% CI 1.10-9.13; p = 0.033)), and concomitant or prior use of chemotherapeutic agents (HR 4.71, 95% CI 1.51-14.71; p = 0.0076) were independent risk factors for the development of ARONJ. CONCLUSION: Almost one-quarter of patients had a risk of developing ARONJ within 5 years after starting BMA. Low serum calcium, use of chemotherapeutic agents, and use of denosumab might contribute to the development of ARONJ.

Advanced adrenocortical carcinoma successfully treated with gemcitabine plus capecitabine as second-line chemotherapy.

INTRODUCTION: Adrenocortical carcinoma is a rare malignant tumor with an unfavorable prognosis in the advanced stage for which second-/third-line chemotherapy is not well established. CASE PRESENTATION: A 34-year-old woman was referred to our institution for left adrenal tumor with multiple liver metastases and tumor thrombus extending to the inferior vena cava. According to her clinical diagnosis of adrenocortical carcinoma (T4N0M1, European Network for the Study of Adrenal Tumors stage IV), we resected the left adrenal tumor and tumor thrombus. Pathological examination confirmed the adrenocortical carcinoma diagnosis. After four courses of etoposide, doxorubicin, cisplatin, and mitotane therapy, the liver metastases progressed, and we started gemcitabine, capecitabine, and mitotane therapy as second-line chemotherapy. After 7 months, significant shrinkage of the liver metastases was observed, and they remained stable over 16 months. CONCLUSION: We reported a case of advanced adrenocortical carcinoma with significant shrinkage of liver metastases following gemcitabine, capecitabine, and mitotane therapy, with the effect maintained over 16 months.

Oncological outcomes for patients with locally advanced prostate cancer treated with neoadjuvant endocrine and external-beam radiation therapy followed by adjuvant continuous/intermittent endocrine therapy in an open-label, randomized, phase 3 trial.

BACKGROUND: To date, research has not determined the optimal procedure for adjuvant androgen deprivation therapy (ADT) in patients with locally advanced prostate cancer (PCa) treated for 6 months with neoadjuvant ADT and external-beam radiation therapy (EBRT). METHODS: A multicenter, randomized, phase 3 trial enrolled 303 patients with locally advanced PCa between 2001 and 2006. Participants were treated with neoadjuvant ADT for 6 months. Then, 280 patients whose prostate-specific antigen levels were less than pretreatment levels and less than 10 ng/mL were randomized. All 280 participants were treated with 72 Gy of EBRT in combination with adjuvant ADT for 8 months. Thereafter, participants were assigned to long-term ADT (5 years in all; arm 1) or intermittent ADT (arm 2). The primary endpoint was modified biochemical relapse-free survival (bRFS) with respect to nonmetastatic castration-resistant prostate cancer (nmCRPC) progression, clinical relapse, or any cause of death. RESULTS: The median follow-up time after randomization was 8.2 years. Among the 136 and 144 men assigned to trial arms 1 and 2, respectively, 24 and 30 progressed to nmCRPC or clinical relapse, and 5 and 6 died of PCa. The 5-year modified bRFS rates were 84.8% and 82.8% in trial arms 1 and 2, respectively (hazard ratio, 1.132; 95% confidence interval, 0.744-1.722). CONCLUSIONS: Although modified bRFS data did not demonstrate noninferiority for arm 2, intermittent adjuvant ADT after EBRT with 14 months of neoadjuvant and short-term adjuvant ADT is a promising treatment strategy, especially in a population of responders after 6 months of ADT for locally advanced PCa.

Effect of Crystal Defect on Gas Sensing Properties of Co3O4 Nanoparticles.

Crystal growth-controlled Co3O4 nanoparticles were prepared to examine gas sensing properties. A cube-like, an irregular shaped, and three kinds of raspberry-type structures were observed by morphology analysis. The raspberry-type structures have an expanded lattice volume with a large oxygen deficiency area, and the cube-like structure has a contracted lattice volume as compared to the irregular shaped structure. The raspberry-type structures exhibited a higher sensor signal response than the others. A relationship between sensor properties and crystal defect was investigated, and it was revealed that the gas selectivity to a high dipole moment value of a reducing gas molecule increased with increasing oxygen deficiency area of the Co3O4 nanoparticle. It was considered that the oxygen deficiency area acted as an important reaction site, which can be attributed to the selective reaction of the Co3O4 nanoparticle with gas molecules.

Spiky-shaped niobium pentoxide nano-architecture: highly stable and recoverable Lewis acid catalyst.

Niobium pentoxide particles with a complex three-dimensional (3D) nanostructure consisting of a spiky structure have been developed as recyclable and recoverable Lewis acid catalysts. The morphology of the niobium pentoxide was successfully controlled from 1D to 3D via a bridging-ligand-assisted hydrothermal treatment, without changing the crystal structure. Compared with dispersed one-dimensional (1D) niobium pentoxide nanorods with a major-axis length and minor-axis length of 20 nm and 5-8 nm, respectively, the spiky-shaped niobium pentoxide composed of 300 nm spherical cores and nanorods with a minor-axis length of 5 nm maintained its surface nanostructure even after calcination at 400 °C in air. The 400 °C-calcined spiky particles exhibited the highest production rate of 2-((4-methoxyphenyl)amino)-2-phenylacetonitrile (0.115 mmol m-2) in a Strecker reaction, resulting in a nanoscale and ordered surface structure of spiky particles that simultaneously exhibit high specific reactivity and high structural stability. Acid site analysis and Raman spectroscopy revealed that stable nanorods that grew in the (001) orientation functioned as Lewis acid catalysts and that the origin of the acidity was a flexible Nb-O polyhedral structure in the single-nanoscale (<10 nm) niobium oxide rods. This study proposes that the spiky-shaped niobium pentoxide exhibits sintering resistivity and high activity and has potential applications as a recoverable and recyclable solid acid catalyst.

[A Case of Primary Central Nervous System Lymphoma that Developed during the Treatment of Castration-Resistant Prostate Cancer].

A 64-year-old man was diagnosed with metastatic prostate cancer (cT3bN0M1b) and treated with combined androgen blockade. After two years and three months, he developed castration-resistant prostate cancer. Multiple lung metastases appeared after the administration of five courses of docetaxel and four courses of cabazitaxel therapy. Pulmonary metastases disappeared following rechallenge with docetaxel. Enzalutamide administration was initiated because docetaxel had to be discontinued due to adverse events. Although enzalutamide lowered the prostate specific antigen value, the patient staggered while walking and developed homonymous hemianopsia. Magnetic resonance imaging revealed a brain tumor. Although the brain tumor was considered to have metastasized from the prostate cancer, it was diagnosed as a primary central nervous system lymphoma using open-ended tumor biopsy. The brain tumor was eliminated with whole-brain irradiation. Thereafter, he has been treated with enzalutamide for 3 years without clinical progression of either disease.

The outcomes of adrenalectomy for solitary adrenal metastasis: A 17-year single-center experience.

AIM: We aimed to analyze surgical outcomes of open or laparoscopic adrenalectomy for solitary adrenal metastasis and assess the factors influencing survival. METHODS: We retrospectively reviewed our institutional clinicopathological database for cases of adrenalectomy for solitary adrenal metastasis from solid tumors between 2000 and 2017. RESULTS: Twenty-five patients underwent open adrenalectomy (n = 11) or laparoscopic adrenalectomy (n = 14). The most common primary site was the lung (n = 7), followed by the kidney (n = 5), liver (n = 3), ovary (n = 2), soft tissue (n = 2), and six other sites. The majority of the patients (n = 19) had metachronous metastasis. The median tumor size was 3.1 cm (1-9 cm). With the median follow-up of 32 months (2-144 months), the median progression-free and overall survivals were 14 and 63 months, respectively. Multivariate analysis revealed that synchronous metastasis (hazard ratio [HR] = 7.5) and tumor size ≥ 4 cm (HR = 17.7) were significant prognostic factors for shorter overall survival. There was no significant difference for survival between the laparoscopic and open groups. CONCLUSIONS: Adrenalectomy for solitary adrenal metastasis can be applied for selected patients with various types of malignancy. However, synchronous metastasis and tumor size ≥ 4 cm were prognostic factors for shorter overall survival.

Utility of index lesion volume assessed by multiparametric MRI combined with Gleason grade for assessment of lymph node involvement in patients with high-risk prostate cancer.

PURPOSE: We examined the potential predictors of lymph node involvement and evaluated whether index lesion volume assessed using multiparametric magnetic resonance imaging is associated with lymph node involvement among patients with high-risk prostate cancer. METHODS: Extended pelvic lymph node dissection was used to evaluate patients with lymph node involvement. We retrospectively analyzed consecutive 102 patients with high-risk prostate cancer who underwent extended pelvic lymph node dissection at our institution between 2011 and 2017. To evaluate the index lesion volume at multiparametric magnetic resonance imaging (mrV), lesions were manually contoured on each T2-weighted axial slice in combination with diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging and integrated using image analysis software. Logistic regression analysis was performed to identify predictors of lymph node involvement. RESULTS: The median mrV was 1.4 ml (range 0-30.1 ml), and the median number of resected lymph nodes was 14 (range 7-38). Among 102 patients, 28 (28%) had lymph node involvement. Multivariate analysis identified significant predictors of lymph node involvement as follows: biopsy Gleason-grade group 5 (odds ratio = 17.2; 95% confidence interval, 2.1-299.0; P = 0.005), preoperative mrV (odds ratio = 1.14; 95% confidence interval, 1.02-1.30; P = 0.025) and percentage of positive cores with highest Gleason-grade group (odds ratio = 1.05; 95% confidence interval, 1.01-1.10; P = 0.005). Lymph node involvement was prevalent (69%) among tumors with Gleason-grade group 5 and mrV ≥3.4 ml, but was infrequently (10%) present among tumors with Gleason-grade group ≤4 and mrV <3.4 ml. CONCLUSIONS: The combination of biopsy Gleason-grade and mrV may serve as a useful tool to stratify patients according to their risk of nodal metastases.

Solitary fibrous tumor mimicking adrenal tumor concomitant with contralateral adrenal pheochromocytoma: A case report of surgical resection after long-term observation.

INTRODUCTION: Solitary fibrous tumors (SFT) usually originate from the pleura and rarely occur in the retroperitoneum. There were few reports of SFT around the adrenal gland and its long-term clinical behavior remains unknown. PRESENTATION OF CASE: A 62-year-old woman with bilateral adrenal tumors was referred to our department in 2008. She had elevated urinary normetanephrine. Metaiodobenzylguanidine scintigraphy showed uptake in the right adrenal gland. The tumor in the right adrenal gland was 5 cm in diameter. The patient underwent right adrenalectomy and was diagnosed with pheochromocytoma. The left tumor was 3 cm in diameter and diagnosed as benign using imaging. However, its size gradually increased to 10 cm over 7 years after surgery. The catecholamine hormones were within normal range. The patient underwent the tumor resection and left partial adrenalectomy. A steroid cover was given temporarily after surgery for prophylactic purposes. The histological diagnosis was solitary fibrous tumor. There was no recurrence 2 years after surgery. DISCUSSION: There have been only nine case reports of SFTs that were diagnosed as adrenal tumor by clinical imaging in the English literature. Total adrenalectomy was performed in all patients with a unilateral tumor. One patient with bilateral tumors underwent partial adrenalectomy. CONCLUSION: SFT in the periadrenal region is difficult to differentiate from adrenal tumor. However, tumor resection with partial adrenalectomy should be considered for enlarged tumor with less aggressive behavior in patients with a history of contralateral adrenalectomy.