Timing of chronic subdural hematoma treatment affects middle meningeal artery embolization outcome.

Background: Chronic subdural hematoma (CSDH) is a condition that tends to recur frequently. Although middle meningeal artery embolization (MMAE) is an effective CSDH treatment, there is currently no consensus regarding the optimal timing for embolization. Methods: In this single-center and retrospective study, we reviewed 72 cases with 1st-time recurrent CSDH from January 2018 to July 2023 and identified those treated with MMAE to examine its effect and the impact of differences in the timing of treatment. Results: Of the 72 cases with CSDH recurrence for the 1st time (mean age: 80.4 ± 9.7 years; men: 62 [86.1%]; mean first recurrence interval: 33 ± 24 days), 27 (37.5%) experienced a second recurrence. The mean first recurrence interval was shorter in cases with a second recurrence compared to cured cases: 24.3 ± 18.6 versus 38.3 ± 25.6 days, respectively (P = 0.005). MMAE was performed in 17 (23.6%) cases (mean age: 82 ± 6.2 years; men: 14 [82.4%]). The mean time from initial surgical treatment to embolization was 52.4 ± 35.4 days, and the mean recurrence interval before MMAE was 24.9 ± 19.6 days. Six cases (35.3%) experienced post-embolization recurrence and required surgical treatment. The mean recurrence interval before MMAE was shorter in cases with recurrence after MMAE (15 ± 6.4 vs. 30 ± 22.1 days, P = 0.023). The time from initial surgical treatment to embolization was significantly shorter: 31.3 ± 12.8 versus 63.9 ± 38.9 days (P = 0.039). Conclusion: Cases with a short first recurrence interval were more likely to experience a second recurrence. Repeated recurrences within a short time increased the likelihood of post-embolization recurrence. MMAE performed early following the initial surgical treatment increased the recurrence risk.

The contribution of carbon budget to masting intervals in Veratrum album populations inhabiting different elevations.

PREMISE: Mast flowering/seeding is often more extreme in lower-resource environments, such as alpine compared to lowland habitats. We studied a masting herb that had less extreme masting at higher elevations, and tested if this difference could be explained by higher photosynthetic productivity and/or lower reproductive investment at the higher-elevation sites. METHODS: We examined the relationship between flowering intervals and carbon budget (i.e., the balance between reproductive investment and annual carbon fixation) in a masting herb, Veratrum album subsp. oxysepalum, across five lowland and six alpine populations in northern Japan. We evaluated the previous flowering histories of individual plants based on rhizome morphology and analyzed the masting patterns of individual populations. Total mass of the reproductive organs, as a proxy of reproductive investment, was compared between the lowland and alpine populations. Annual carbon fixation was estimated on the basis of photosynthetic capacity, total leaf area per plant, and seasonal transition of light availability. RESULTS: Interval between high-flowering years was shorter and total reproductive investment was smaller in the alpine than in the lowland populations. Owing to its high photosynthetic capacity and continuous bright conditions, annual carbon fixation per plant was 1.5 times greater in alpine habitat than in lowland habitat. These results suggest that V. album alpine populations have shorter flowering intervals than lowland populations due to faster recovery from energy loss after reproduction. CONCLUSIONS: Our study demonstrated that masting intervals in V. album populations can be explained by habitat-specific carbon budget balances.

Comparison of cold snare polypectomy for sessile serrated lesions ≥10 mm between experienced and trainee endoscopists: A propensity score matching cohort study.

Objectives: Previous studies of cold snare polypectomy (CSP) for sessile serrated lesions (SSLs) ≥10 mm were performed by experienced endoscopists, and therefore their skills might have significantly influenced results. In this study, we compared the efficacy and safety of CSP for SSLs ≥10 mm between experienced and trainee endoscopists. Methods: In a 1:1 propensity score matched retrospective cohort study, we compared the complete resection rate, en-bloc resection rate, adverse event rate, and procedure time between experienced and trainee groups. Thirteen endoscopists performed CSP, and we defined the experienced group as endoscopists with board certification from the Japan Gastroenterological Endoscopy Society. Results: We examined 616 lesions with SSLs ≥10 mm resected by CSP between February 2018 and May 2022. We excluded 61 lesions from the analysis because they had simultaneously undergone hot snare polypectomy (n = 57) or had been taken over by experienced endoscopists from trainees in the CSP procedure (n = 4). Finally, we identified 217 propensity score-matched pairs (n = 434). Between experienced and trainee groups, the results were complete resection rate (100 vs. 100%; p = 1.00), en-bloc resection rate (73.2 vs. 75.6%; p = 0.24), adverse event rate (3.2 vs. 2.8%; p = 0.77), or procedure time (6.2 vs. 5.9 min; p = 0.64). Conclusions: We have demonstrated the safety and efficacy of CSP for SSLs ≥10 mm performed by experienced and trainee endoscopists.

Endoscopic management of gastric ectopic pancreas with repeated ulcerations and bleeding: A case report.

A 25-year-old man was referred to our center for investigation of a gastric submucosal tumor and an ulcer that had developed on its oral side. Endoscopic ultrasonography findings suggested the presence of an ectopic pancreas, and treatment with an oral proton pump inhibitor was planned for the ulcer. Over the subsequent 3 years, the patient endured recurring epigastric pain and episodes of passing black stools. Emergency endoscopy revealed that the morphology of the gastric submucosal tumor had transformed into a pedunculated polyp-like morphology with a bleeding ulcer at the apex of the lesion. Endoscopic hemostasis using hemostatic forceps was performed. However, the patient continued to pass black stools. In light of the persistent symptoms and unique morphology of the lesion, endoscopic resection was attempted as a curative approach. The lesion was excised by hot snare polypectomy. Post-treatment, the patient exhibited no signs of recurrence, marking a successful resolution. Three months later, a gastroduodenal endoscopy showed that the excised site had undergone scar formation without recurrence of the lesion. This case holds significant clinical value as it demonstrates the efficacy of a minimally invasive treatment strategy in managing repeated bleeding ulcerations of an ectopic pancreas, ultimately achieving a complete cure.

Efficacy and safety of cap-assisted endoscopic mucosal resection for superficial duodenal epithelial neoplasia ≤ 10 mm.

Background and study aims Endoscopic treatment strategies for small superficial duodenal epithelial neoplasia (SDET) have not been established, and the R0 resection rates of all previously reported endoscopic techniques are somewhat low. Furthermore, no reports of cap-assisted endoscopic mucosal resection (EMRC), which is reportedly associated with a relatively high R0 resection rate, have been evaluated in sufficient numbers of patients. Therefore, we assessed the efficacy and safety of EMRC for SDETs ≤ 10 mm in a retrospective cohort study. Patients and methods We examined a prospectively maintained database and identified 248 consecutive patients (248 lesions) who had undergone endoscopic resection for SDETs ≤ 10 mm between January 2017 and June 2022. Our treatment strategy was consistent, with EMRC indicated for all SDETs ≤ 10 mm without non-lifting signs. The primary endpoint was the R0 resection rate. Results Overall, 20 lesions had non-lifting signs and were selected for endoscopic submucosal dissection, while the remaining 228 lesions were treated with EMRC. As a result of EMRC, the median tumor size was 5 mm, and the mean procedure time was 5 minutes. Most of the lesions (89.2%) were located in the descending part. The R0 resection rate was 97.4% (222/228 cases), and the en bloc resection rate was 99.6%. Only seven patients(3.1%) experienced adverse events (6 patients, delayed bleeding; 1 patient, acute pancreatitis), which were successfully managed without surgical intervention. Furthermore, no recurrences were observed. Conclusions We have demonstrated that EMRC is an effective and safe treatment for SDETs ≤ 10 mm that do not have non-lifting signs.

Perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection: successful conservative treatment without perforation closure: a case report.

BACKGROUND: Perigastric abscess caused by delayed perforation after endoscopic submucosal dissection is a very rare complication. In principle, delayed perforation after endoscopic submucosal dissection is treated surgically. Herein, we report a case of perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection that was treated conservatively, without perforation closure, and in which the patient was discharged from hospital in a short period. CASE PRESENTATION: A-74-year-old Asian man was diagnosed with having early gastric cancer on follow-up endoscopy and was admitted to our hospital for endoscopic resection. Endoscopic submucosal dissection was performed without intraoperative complications. On postoperative day 2, the patient complained of a slight abdominal pain localized to the epigastric region and a small amount of melena. A computed tomography scan revealed the presence of free air in the peritoneal cavity, and a little fluid collection abutting the dorsal area of the stomach. An endoscopy examination showed a deep ulcer with the accumulation of pus, suggesting a perforation in the post-endoscopic submucosal dissection ulcer. We diagnosed a perigastric abscess, caused by delayed perforation after endoscopic submucosal dissection, and opted for conservative treatment, leaving the perforation site open to allow spontaneous drainage from the abscess into the stomach. A follow-up computed tomography scan revealed an encapsuled and localized perigastric abscess on postoperative day 5, and the disappearance of the free air and the regression of the perigastric abscess on postoperative day 7. A follow-up endoscopy examination on postoperative day 7 showed the closure of the perforation. Finally, surgery was avoided, and the patient was discharged on postoperative day 14, after a relatively short hospital stay. CONCLUSION: Regarding the treatment of perigastric abscess, caused by delayed perforation after endoscopic submucosal dissection, leaving the perforation site open to allow spontaneous drainage may shorten the conservative treatment period.

Gastric-type duodenal neoplasms with rapid growth: A report of two cases.

While duodenal neoplasms of the gastric phenotype are uncommon and their natural history is unknown, gastric neoplasms of gastric phenotype reportedly grow rapidly and can invade the submucosa. Several studies suggest that duodenal neoplasms of gastric phenotype might have a high risk of deep invasion and lymph node metastasis. Duodenal neoplasms of gastric phenotype might also have a high biological malignancy and likely require early treatment if detected. Here, we report two cases of intramucosal duodenal carcinoma with a gastric phenotype that grew rapidly but was successfully resected endoscopically.

Early gastric mixed neuroendocrine-non-neuroendocrine neoplasms with endoscopic findings of neuroendocrine cell carcinoma components exposed on the mucosal surface: a case report.

BACKGROUND: Gastric mixed neuroendocrine-non-neuroendocrine neoplasms are rare malignant tumors. The lack of specific findings makes it difficult to diagnose endoscopically. We report the case of early gastric mixed neuroendocrine-non-neuroendocrine neoplasms treated by endoscopic submucosal dissection. CASE PRESENTATION: An 81-year-old Japanese female underwent esophagogastroduodenoscopy for screening and was treated with endoscopic submucosal dissection for the diagnosis of early gastric cancer. Histopathologically, the lesion was diagnosed as mixed neuroendocrine-non-neuroendocrine neoplasms (tubular adenocarcinoma 2 60%, endocrine cell carcinoma 40%), pT1b(submucosa (SM) 900 µm), pUL(-), Ly(+), v(-), pHM0, pVM0. After additional surgical resection without adjuvant chemotherapy, she has had no recurrences or metastases for 3 years. CONCLUSIONS: Comparing narrow-band imaging magnified endoscopic findings with pathological findings, the depressed area with a lack of surface structure was consistent with the neuroendocrine cell carcinoma component, while narrow-band imaging magnification findings showed non-network vessels. In this case, we examined endoscopic findings of early stage mixed neuroendocrine-non-neuroendocrine neoplasms in detail and compared it with the pathological findings. We believe that these endoscopic findings contribute to the diagnosis of mixed neuroendocrine-non-neuroendocrine neoplasms and can lead to its early detection.

The selective advantage of mast flowering in Veratrum album subsp. oxysepalum: Implications of the predator satiation hypothesis.

PREMISE: Synchronous, highly variable flower or seed production among years within a population (i.e., masting) has been reported in numerous perennial plants. Although masting provides ecological advantages such as enhancing pollination efficiency and/or escape from predator attack, little is known about the degree of these advantages and variations in masting behavior among populations of conspecific plants. METHODS: We determined flowering ramet density and reproductive success (fruit-set success and herbivorous damage) of a perennial herb, Veratrum album subsp. oxysepalum, across six lowland and six alpine populations in northern Japan during 2-3 years. We then analyzed the relationship between floral density and reproductive success to assess the ecological significance of mast flowering. Flowering intervals of individual plants were estimated by counting annual scars on rhizomes. RESULTS: Most populations had mast flowering, but the intervals between flowering for individual plants were shorter in the alpine populations than in the lowland populations. Floral damage by stem borers (dipteran larvae) and seed predation by lepidopteran larvae were intense in the lowland populations. Seed production of individual ramets increased with higher floral density owing to the effective avoidance of floral-stem damage and seed predation. Although stem borers were absent in the alpine habitat, seed predation decreased with higher floral density also in the alpine populations. Pollination success was independent of floral density in both of the alpine and lowland populations. CONCLUSIONS: These results strongly support the predator satiation hypothesis for mast flowering by this species.

Detection of mecA and 16S rRNA Genes Using Real-Time PCR Can Be Useful in Diagnosing Iliopsoas Abscess, Especially in Culture-Negative Cases: RT-PCR for Iliopsoas Abscess.

The rapid detection of etiological agents is important for the successful treatment of iliopsoas abscess (IPA). The purpose of this study was to investigate the clinical utility of a real-time polymerase chain reaction (PCR) that targets the mecA gene for methicillin-resistant staphylococci (MRS) and the 16S rRNA gene for pan-bacteria. Our retrospective diagnostic study included 22 patients exhibiting IPAs and four patients with noninfectious iliopsoas mass regions who underwent computerized tomography or ultrasonography-guided biopsy and/or surgical treatment. Clinical symptoms, serum data, imaging analysis, and tissue microbiological culture were utilized for the diagnosis of IPA. The diagnostic accuracy of real-time PCR was determined based on the diagnosis of IPA and microbiological culture results. The microbiological culture was positive for 12 IPA cases that included 2 MRSA infections. Among 12 culture-positive IPA cases, 16S rRNA-PCR was positive in 12 and MRS-PCR in two. Among 10 culture-negative IPA cases, including 3 TB cases, 16S rRNA-PCR was positive in 8 and MRS-PCR in 2. In noninfectious iliopsoas mass patients, neither 16S rRNA nor MRS-PCR detected bacterial DNA. The sensitivity, specificity, positive predictive, and negative predictive values of 16S rRNA-PCR for diagnosing IPA were 0.91, 1.00, 1.00, and 0.67, respectively, while those for the diagnosis of MRS infection with MRS-PCR were 1.00, 0.92, 1.00, and 0.50, respectively. Real-time PCR targeting bacterial DNA can detect bacterial DNA in culture-negative cases and offer improved detectability of MRS infection in IPA patients.

Postural Sway in Older Patients with Sagittal Imbalance and Young Adults during Local Vibratory Proprioceptive Stimulation.

This study aimed to assess differences in somatosensory control strategies between older patients with sagittal imbalance and young adults during postural tasks. The center of pressure displacement in 27 older patients with sagittal imbalance and 27 young adults was determined upon standing blindfolded on a balance board. Vibratory stimulation at 56 to 100 Hz was applied bilaterally to the gastrocnemius and soleus muscles (GS) and lumbar multifidus to evaluate the contributions of proprioceptive signals to postural control. Data of older patients and young adults were compared using the Mann-Whitney U-test or independent sample t-tests. Compared with the young adults, the older patients were significantly more reliant on the GS (p < 0.005) for their postural control and showed a higher relative proprioceptive weighting ratio (RPW) (p = 0.038). The postural strategy adopted by the older patients depended on the level of proprioceptive stimulation applied to the GS, and the postural control strategy of the ankle correlated with RPW. Overall, this study identifies RPW as a novel measure of postural strategy in older patients with sagittal imbalance and provides an understanding of strategies used to maintain balance, which may assist in developing preventative measures to reduce the risk of falls.

Relationship between postural stability and fall risk in elderly people with lumbar spondylosis during local vibratory stimulation for proprioception: a retrospective study.

Purpose: Reduced proprioception affects fall risks in elderly people with lumbar spondylosis. The decrease in proprioception in the trunk or lower legs may contribute to a decline in postural stability. We aimed to investigate the association between proprioceptive postural stability and fall risks in elderly individuals with lumbar spondylosis.Materials and Methods: In this retrospective study, the centre-of-pressure displacement was determined in elderly individuals with lumbar spondylosis during upright stance while standing on a Wii Balance Board with their eyes closed (fall-risk group, n = 55; non-fall-risk group, n = 60). Vibratory stimulations at 30 Hz were applied to the lumbar multifidus and gastrocnemius to evaluate the relative contributions of proprioceptive signals used in postural control (relative proprioceptive weighting ratio).Results: Compared with the non-fall-risk group, the fall-risk group displayed a high relative proprioceptive weighting ratio (p = 0.024). Relative proprioceptive weighting ratio (odds ratio, 1.1; 95% confidence interval: 1.004-1.109) was independently associated with fall risks after adjusting for confounding factors. Among variables related to fall risk, the relative proprioceptive weighting ratio was a significant factor (p < 0.035).Conclusion: The fall-risk group of elderly individuals with lumbar spondylosis was dependent on the ankle strategy. The fall risk in elderly people with lumbar spondylosis could be due to over-dependence on the input from muscle spindles in the gastrocnemius.

Association Between Back Muscle Strength and Proprioception or Mechanoreceptor Control Strategy in Postural Balance in Elderly Adults with Lumbar Spondylosis.

This study aimed to investigate the relationship between back muscle strength and proprioception or mechanoreceptor control strategies used for postural balance in elderly adults with lumbar spondylosis. The displacement of the center of pressure (COP) excursion was determined in 24 elderly adults with lumbar spondylosis and 24 healthy young adults while the participants were standing upright on a balance board with their eyes closed. Vibratory stimulations of 30, 60, and 240 Hz were applied to the gastrocnemius (GS) and lumbar multifidus (LM) muscles to evaluate the effect of different proprioceptive signals on postural control. Back muscle strength was evaluated. Spearman's rank correlation analysis was performed to determine the relationship between back muscle strength and significant COP excursion. Compared with young adults, elderly adults with lumbar spondylosis showed an increase in COP excursion displacement when a vibratory stimulation of 240 Hz was applied to the GS (P = 0.002) and LM muscles (P < 0.001). LM stimulation at 240 Hz was significantly associated with back muscle strength (P = 0.038). Postural control assessment with 240-Hz mechanoreceptor stimulation of the trunk could be a good indicator of postural instability due to over-dependence on mechanoreceptors and back muscle weakness in elderly adults with lumbar spondylosis.

Postural Sway during Local Vibratory Stimulation for Proprioception in Elderly Individuals with Pre-Sarcopenia.

OBJECTIVE: Many studies have demonstrated that the loss of muscle mass (LMM) poses a risk of postural instability in the elderly; however, few studies have shown how LMM decreases proprioception. In this study, we investigated the changes in postural sway among older individuals with LMM induced by application of a local vibratory stimulus. METHOD: We enrolled 64 older adults (mean age). Postural sway was measured while applying vibration stimuli of 30, 60, and 240 Hz to both the gastrocnemius and lumbar multifidus muscles. We also measured the relative proprioceptive weighting ratio (RPW) of postural sway. The patients were divided into LMM and non-LMM (NLMM) groups. The study subjects were compared in terms of their age, height, weight, body mass index (BMI), lower leg skeletal muscle mass index (LSMI), L4/5 lumbar multifidus cross-sectional area ratio, and RPW at 30, 60, and 240 Hz. RESULTS: Subjects in the LMM group showed a significantly lower RPW at 60 Hz, LSMI, and BMI than did those in the NLMM group. CONCLUSIONS: Decrease in RPW with 60-Hz stimulation concerning the lower leg proprioception is a risk factor for LMM-associated postural instability in the elderly. Consequently, with respect to the gastrocnemius muscles proprioception in LMM, it is necessary to perform assessments using muscle spindle stimuli.

Postural Strategy in Elderly, Middle-Aged, and Young People during Local Vibratory Stimulation for Proprioceptive Inputs.

Proprioceptive input may greatly affect postural stability. However, the proprioceptive postural strategy in elderly, middle-aged, and young people has not been investigated sufficiently. Hence, in this study, we aimed to investigate differences in proprioceptive postural strategies of elderly, middle-aged, and young people. The center of pressure displacement was determined in 23 elderly, 23 middle-aged, and 23 young people during upright stance on a balance board with their eyes closed. Vibratory stimulations at 30, 60, and 240 Hz were applied to the lumbar multifidus (LM) and gastrocnemius (GS) muscles to evaluate the contributions of different proprioceptive signals used in balance control. Compared with middle-aged and young people, elderly people showed a high dependence on postural control of the GS at 30 Hz (p-values: Young and elderly: 0.033; middle-aged and elderly: 0.001). Moreover, compared with young people, elderly people were more dependent on postural control of the LM at 240 Hz (p = 0.016). There were no significant differences with respect to the GS at 60 and 240 Hz, and with respect to the LM at 30 and 60 Hz between the elderly, young, and middle-aged people. Thus, the postural control strategy of elderly people depends on the GS at 30 Hz.

Striated duct adenoma presenting with intra-tumoral hematoma and papillary thyroid carcinoma-like histology.

Striated duct adenoma of the salivary gland is a rare benign tumor characterized by unilayered duct epithelium and striations of the tumor cell membranes. To the best of our knowledge, only six cases have been reported in the literature. Here we report an additional case, which was complicated by an intra-tumoral hematoma on clinical presentation and by papillary thyroid carcinoma-like histology on intra-operative frozen section diagnosis. An asymptomatic 78-year-old male presented with a two-year-history of a painless tumor of the left parotid. An intra-tumoral hematoma, which is unusual for a salivary gland tumor, was suspected from results of pre-operative radiology. The patient then underwent a left parotidectomy. The intra-operative frozen section diagnosis indicated a benign tumor, although ectopic papillary thyroid carcinoma was raised as a differential diagnosis since the eosinophilic tumor cells occasionally possessed nuclear grooves and nuclear pseudo-inclusions. By precise histopathological examination using paraffin sections, the tumor was finally diagnosed as striated duct adenoma. This type of tumor has unique features of hypervascular stroma and papillary thyroid carcinoma-like nuclei. In our case, the former feature was associated with the intra-tumoral hematoma and the latter feature, with difficulty in frozen section tumor diagnosis.

Expression of cancer/testis antigens in salivary gland carcinomas with reference to MAGE-A and NY-ESO-1 expression in adenoid cystic carcinoma.

AIMS: Cancer/testis antigens (CTAs) are detected in cancer cells but not in healthy normal tissues, with the exception of gametogenic tissues. CTAs are highly immunogenic proteins, and thus represent ideal targets for cytotoxic T-lymphocyte-mediated specific immune therapy. The aim of this study was to screen CTA expression in various types of salivary gland carcinoma and to clarify clinicopathological significance of MAGE-A and NY-ESO-1 expression in adenoid cystic carcinomas (AdCCs) of the salivary gland, which is one of the most common salivary gland carcinomas, and usually has a fatal outcome. METHODS AND RESULTS: We used immunohistochemistry to examine the expression of four CTAs (MAGE-A, NY-ESO-1, CT7, and GAGE7) in various types of salivary gland carcinoma (n = 95). When carcinoma cases were divided into low-grade and intermediate/high-grade types, NY-ESO-1 and CT7 were expressed more frequently in intermediate/high-grade carcinomas. We then focused on MAGE-A and NY-ESO-1 expression in a large cohort of adenoid cystic carcinomas (AdCCs) (n = 46). MAGE-A and NY-ESO-1 were frequently expressed in AdCC; specifically, MAGE-A was expressed in >60% of the AdCC cases. MAGE-A expression and tumour site (minor salivary gland) were identified as independent risk factors for locoregional tumour recurrence. CONCLUSIONS: These findings suggest that CTAs may be expressed in a variety of salivary gland carcinomas, especially in those with higher histological grades. In addition, MAGE-A, which is frequently expressed in AdCC cases, may be a useful prognostic factor for poorer locoregional recurrence-free survival.

Salivary duct carcinoma with rhabdoid features: a salivary counterpart of pleomorphic lobular carcinoma of the breast.

AIM: To analyse the clinicopathological features and immunohistochemical characteristics of nine cases of salivary duct carcinoma (SDC) with rhabdoid features (SDCRF), representing a new, extremely rare type of salivary gland malignancy. METHODS AND RESULTS: We analysed 2511 cases of salivary gland tumour, clinicopathologically and immunohistochemically. The incidence of SDCRF was 0.4%. Eight patients were male. The age of patients ranged from 36 years to 85 years (mean, 61 years). SDC arose from the parotid glands and submandibular gland in six and three cases, respectively. Seven cases appeared as a carcinoma component of carcinoma ex pleomorphic adenoma cases. Six patients died of disease. Histologically, diffuse proliferations of non-coherent large ovoid or polygonal carcinoma cells with eosinophilic cytoplasm and eccentric nuclei were observed in all cases; such cytological characteristics were defined as 'rhabdoid features'. Immunohistochemically, all cases were positive for cytokeratin, gross cystic disease fluid protein-15, androgen receptor, and SMARCB1, seven cases were positive for HER2, and two cases were positive for epidermal growth factor receptor. However, all cases were negative for vimentin and myoepithelial markers. Eight cases showed no or aberrant expression of E-cadherin and ß-catenin. The results suggest that SDCRF is an extremely rare subtype of SDC, and not a sarcomatoid variant of SDC. SDCRF is histologically unique, and is positive for SDC markers but negative for vimentin, unlike rhabdoid-type carcinomas arising from other organs. CONCLUSIONS: The morphogenesis of SDCRF is related to no or aberrant expression of cell-cell adhesion molecules. Therefore, SDCRF could be a salivary counterpart to pleomorphic lobular breast carcinoma.

Cellular-level characterization of B cells infiltrating pulmonary MALT lymphoma tissues.

Mucosa-associated lymphoid tissue (MALT) lymphoma mainly consists of three types of tumor B cells, small (centrocyte-like), scattered large transformed, and intraepithelial. However, it is difficult to differentiate tumor B cells from reactive B cells at the cellular level. We examined five cases of API2-MALT1 fusion-positive MALT lymphoma of the lung. A single paraffin section for each case was subjected to sequential retrieval of whole-slide imaging (WSI) data of hematoxylin and eosin (HE) staining, immunofluorescence staining for CD79a, and fluorescence in situ hybridization (FISH) for the MALT1 split. We counted the number of MALT1 split-positive or MALT1 split-negative cells among CD79a-positive cells. The MALT1 split was detected in 59, 46, and 76 % of small, large, and intraepithelial B cells, respectively. A review of the HE-WSI data showed that cytomorphological distinction between the MALT1 split-positive and MALT1 split-negative B cells was virtually impossible. None of CD79a-negative lymphoid cells, epithelial cells, and microvascular endothelial cells was positive for MALT1 splits. As API2-MALT1 fusion is an early and critical event in the lymphomatogenesis, our findings are best interpreted as that a considerable number of B cells, either small, large, or intraepithelial, are reactive cells and that it is difficult to distinguish cytomorphologically between tumor B cells and reactive B cells. These findings suggest that the tumor architecture may be the central factor for making a correct histopathological diagnosis of MALT lymphoma. The sequential WSI of HE staining, immunofluorescence staining, and FISH as described here is a useful tool for pathological analysis at the cellular level.

Expression of amphiregulin in mucoepidermoid carcinoma of the major salivary glands: a molecular and clinicopathological study.

In mucoepidermoid carcinoma (MEC), CRTC1-MAML2 fusion indicates a favorable prognosis. Amphiregulin (AREG), an epidermal growth factor receptor (EGFR) ligand, has been shown to be a downstream target of CRTC1-MAML2 fusion, and to play a role in tumor growth and survival in CRTC1-MAML2-positive MEC cell lines. The aim of this study was to characterize the AREG and EGFR expression in the fusion-positive and fusion-negative MEC of the major salivary gland. The AREG and EGFR expression were studied by immunochemistry in 33 MEC cases of the major salivary glands. CRTC1-MAML2 fusion was tested by reverse-transcription polymerase chain reaction (23 CRTC1-MAML2 fusion-positive, 10 fusion-negative). Of 23 fusion-positive cases, AREG and EGFR overexpression were detected in 17 (73.9%) and 14 (60.9%) cases, respectively. Of 10 fusion-negative cases, AREG and EGFR overexpression were detected in 1 (10%) and 3 (30.0%) cases, respectively. There was a positive correlation between CRTC1-MAML2 fusion and AREG overexpression (P < .01), but not between CRTC1-MAML2 fusion and EGFR overexpression. The AREG overexpression was associated with a longer disease-free survival of the MEC patients (P = .042), but EGFR overexpression was not. In this study, we showed that AREG overexpression was detected more frequently in the CRTC1-MAML2 fusion-positive tumors than in fusion-negative tumors. Detection of AREG expression may be useful for identifying CRTC1-MAML2-positive MECs and as a marker for favorable prognosis.