Prevalence of possible idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia: a replication study.

BACKGROUND: We recently reported that older patients with schizophrenia (SZ) show possible idiopathic normal pressure hydrocephalus (iNPH) more frequently than the general population. In this study, we estimated the prevalence of iNPH in a larger number of older SZ patients and explored useful examination values for diagnosis in the SZ population. METHODS: We enrolled older inpatients with SZ (n = 39, mean age = 68.6 ± 7.7 years) from several psychiatric hospitals in Ehime, Japan and acquired brain imaging data using computed tomography. We evaluated three iNPH symptoms (dementia, gait disturbance, and urinary incontinence). In addition, we combined these data with our previous data to elucidate the relationship between iNPH and characteristics of SZ symptoms. RESULTS: In total, five (12.8%) patients were diagnosed with possible iNPH. Evans' index for patients with iNPH was significantly higher than for those without iNPH (p = 0.002). The number of disproportionately enlarged subarachnoid space hydrocephalus (DESH) findings was significantly higher in patients with iNPH than in those without iNPH (p <  0.001). Using combined data, Drug-Induced Extra-pyramidal Symptoms Scale (DIEPSS) subscales of gait and bradykinesia showed an increasing trend in the SZ with iNPH group. CONCLUSIONS: We reconfirmed that older inpatients with SZ experienced possible iNPH more frequently than the general population. We should pay attention to the DIEPSS subscales of gait and bradykinesia and DESH findings in addition to the three main symptoms of iNPH and Evans' index so as to not miss SZ patients with iNPH.

MRI and CT findings of the giant cell tumors of the skull; five cases and a review of the literature.

PURPOSE: To investigate CT and MR findings of giant cell tumors (GCTs) of the skull, an unusual site for such tumors. MATERIALS AND METHODS: CT and MR features of five histologically proven giant cell tumors of the skull were retrospectively reviewed. We also reviewed 22 cases in the literature that included MR or CT findings. RESULTS: Three of the tumors originated from the temporal bone with predominantly medial extension, and the other two were centered in the body of the sphenoid bone and featured symmetrical soft tissue extension. CT images with bone window settings showed reactive bone changes for all three tumors of the temporal bone, suggesting slow growth for example, an expanded intradiploic space, expansive remodelling and development of foci of pressure erosion. GCTs of the sphenoid bone showed purely osteolytic changes without remodelling. Although the MR signals and enhancement patterns varied, all the tumors of the temporal bone had a markedly low intensity area on T2-weighted images, which was not seen in the tumors of the sphenoid bone. The findings for our cases generally corresponded to those reported in the literature. CONCLUSION: Giant cell tumors of the skull have two preferential sites and may have characteristic tendencies as to their extent. Bone changes and MR signals appear to show differences between the two sites.

Expression of Fas ligand and bcl-2 in cervical carcinoma and their prognostic significance.

Apoptosis-related factors are known to influence survival with many malignant tumors. We performed immunohistochemical analysis of Fas ligand (FasL) and bcl-2 in invasive cervical cancer to determine the association with prognosis. In 125 patients with cervical cancer, 93 cases (74.4%) were positive for FasL, and 94 cases (75.2%) were positive for bcl-2. When 101 cases, clinical stages I through IV, were analyzed by univariate analysis, negative bcl-2 (P = .035) and combined positive FasL and negative bcl-2 (PFNB; P = .0025) were associated with significantly decreased disease-free survival. Positive FasL (P = .042), negative bcl-2 (P = .0004), and PFNB (P < .0001) were associated with a significantly worse prognosis in overall survival. In clinical stages II through IV, positive FasL (P = .04), negative bcl-2 (P = .002), and PFNB (P < .0001) had significant associations with shorter disease-free survival and positive FasL (P = .049), negative bcl-2 (P < .0001), and PFNB (P < .0001) with worse overall survival.

Application of immunofluorescence for intraoperative evaluation of sentinel lymph nodes in patients with breast carcinoma.

BACKGROUND: Sentinel lymph node (SLN) sampling is used to predict axillary lymph node (AxLN) metastasis in patients with breast carcinoma; AxLN sampling can be avoided in SLN-negative patients. Multistep sectioning and immunohistochemistry are reported to increase the sensitivity of micrometastasis detection. The authors used immunofluorescence (IF) staining with cytokeratin (CK) antibodies for intraoperative evaluation of touch imprints from multistep sections of SLNs. METHODS: A combined total of 150 SLNs from 69 patients who had breast carcinoma and underwent surgery were analyzed. SLNs were sectioned at 2 mm intervals, and touch imprints subsequently were prepared. After ethanol fixation, slides were incubated with fluorescein isothiocyanate-conjugated CK and propidium iodide and then subjected to microwave irradiation for 3 minutes. Finally, fluorescence microscopy was used to evaluate slides for the presence or absence of metastatic disease. RESULTS: Metastatic disease was identified in 36 (24.0%), 26 (17.3%), 32 (21.3%), and 31 (20.7%) of 150 lymph nodes using IF staining, Papanicolaou (Pap) staining, immunocytochemical (ICC) staining, and hematoxylin and eosin (H and E) staining, respectively. The sensitivities of IF, Pap, ICC, and H and E staining were 94.6%, 70.3%, 86.5%, and 83.8%, respectively. Except for IF staining (specificity, 99.1%), each method had a specificity of 100%. The accuracy rates for IF, Pap, ICC, and H and E staining were 98.0%, 92.7%, 96.7%, and 96.0%, respectively. CONCLUSIONS: IF is a rapid, highly sensitive, and highly specific staining technique by which touch imprints can be used to intraoperatively evaluate SLNs in patients with breast carcinoma.

Comparison of frozen section and touch imprint cytology for evaluation of sentinel lymph node metastasis in breast cancer.

BACKGROUND: Sentinel lymph node metastasis of breast cancer is evaluated by frozen section (FS) or touch imprint cytology (TIC). However, which of the two methods is superior remains controversial. Here we directly compared the sensitivity of these methods prospectively. METHODS: The study included 208 SNs harvested from 107 consecutive patients with breast cancer who underwent sentinel lymph node biopsy. SNs were serially sectioned at 2-mm intervals, and two sections were subjected to intraoperative evaluation of FS with hematoxylin and eosin staining. TIC specimens were prepared from all cut surfaces and analyzed by Papanicolaou (TIC) and cytokeratin (TIC with immunohistochemistry; TIHC) immunohistochemistry. RESULTS: Thirty-five SNs from 27 patients were positive by final histopathology. The sensitivity per sentinel lymph node of FS was 89%; it was 86% for TIC and 89% for TIHC. Among 173 negative SNs, the results of FS were concordant with final histopathology, but TIC and TIHC were positive in 1 and 5 histopathology-negative SNs, respectively. The sensitivity per patient of FS was 85%; it was 85% for TIC and 89% for TIHC. Among 80 patients with node-negative disease, the results of FS and TIC were concordant with final histopathology, whereas TIHC was positive in 3 patients (3.8% were upstaged). A slight improvement of sensitivity per patient was achieved by the combination of FS and TIC (to 89%) or FS and TIHC (to 93%). CONCLUSIONS: The sensitivity of FS was almost equivalent to that of TIC. TIHC had a better sensitivity than FS and TIC, but it upstaged a few node-negative patients.

Feasibility of sentinel node biopsy for breast cancer after neoadjuvant endocrine therapy: a pilot study.

BACKGROUND AND OBJECTIVES: Sentinel node biopsy (SNB) is used for evaluation of axillary lymph node status of patients with breast cancer. The usefulness of SNB after neoadjuvant chemotherapy is not established. In addition, SNB after endocrine therapy has rarely been evaluated. We assessed the feasibility of dye guided SNB after neoadjuvant endocrine therapy in comparison with those of SNB after chemotherapy. METHODS: A total of 36 patients subjected to SNB after endocrine therapy alone (n = 16) (tamoxifen, anastrozole or combination of goserelin and tamoxifen) or after chemotherapy (n = 20) (anthracycline and/or taxane) were included. SNB was performed with indigocarmine dye prior to the wide resection of the tumor or mastectomy. RESULTS: Sentinel nodes were successfully identified in 100% (16/16) of patients after endocrine therapy and in 85% (17/20) of patients after chemotherapy. The mean number of harvested sentinel nodes was 2.2 after endocrine therapy and 1.8 after chemotherapy. There was no false negative case after endocrine therapy and there was one false negative case after chemotherapy (8% of overall false negative rate). CONCLUSIONS: SNB seemed feasible and accurate after neoadjuvant endocrine therapy in patients with breast cancer.

Primary solitary intracranial melanoma in the sylvian fissure: MR demonstration.

We present a rare case of a primary intracranial melanoma originating from leptomeningeal melanoblasts in the sylvian fissure. The mass appeared hyperintense on T1-weighted MR images and hypointense on T2-weighted MR images, reflecting the presence of abundant melanin granules in the tumor. Associated leptomeningeal enhancement suggested a dire prognosis.