The diagnostic utility of PAX8 immunostaining of malignant peritoneal mesothelioma presenting as serous ovarian carcinoma: A single-center report of two cases.

Malignant peritoneal mesotheliomas (MPMs) are rare and progressive tumors, which may present similarly to primary peritoneal carcinoma or ovarian carcinoma (OC). The current study reports two cases of MPM that initially presented with the features of OC, for which paired box 8 (PAX8) immunostaining was found to be useful for diagnosis. The two patients were women, aged 58 and 56 years, respectively. The primary presenting symptoms and clinical findings included prolonged abdominal pain, abdominal swelling and cough. The two cases were initially diagnosed as OC and were treated with primary debulking surgery. The patient in case 1 had no history of asbestos exposure, while the patient in case 2 did. Final diagnoses were determined based on histological and immunohistochemical results, which included negative PAX8 immunostaining, and which were consistent with MPM. The present cases demonstrated that PAX8 negativity may be a useful diagnostic biomarker for differentiating MPM from OC.

Vitamin D-mediated hypercalcemia in multicentric Castleman's disease.

Multicentric Castleman's disease (MCD) is a rare lymphoproliferative disorder, which represents various symptoms caused by the hyperproduction of interleukin-6 (IL-6). However, case studies of MCD accompanied by hypercalcemia have rarely been reported thus far. A 78-year-old male had generalized fatigue, and his laboratory data revealed elevated serum calcium (Ca) and 1,25-dihydroxyvitamin D [1,25(OH)2D] levels (11.5 mg/dl and 80 pg/ml, respectively), while the serum intact parathyroid hormone level was low (4 pg/ml). Computed tomography showed multicentric lymphadenopathy. The serum IL-6 level was elevated (20.7 pg/ml), and pathological examination of a supraclavicular lymph node specimen led us to diagnose MCD. Moreover, immunostaining analysis showed that vitamin D-activating enzyme 25-hydroxyvitamin D 1-alpha-hydroxylase was expressed in lymph node macrophages. Prednisolone treatment improved the hypercalcemia and decreased the levels of 1,25(OH)2D and IL-6. We first reported a case of vitamin D-mediated hypercalcemia in MCD.

Interpretation of postmortem head computed tomography for non-traumatic in-hospital deaths by non-radiologists: a preliminary study.

PURPOSE: Postmortem computed tomography (PMCT) has recently become important to clarify the cause of death in forensic medicine. It has also been proven to be useful for in-hospital deaths to a certain extent when interpreted by radiologists. However, accuracy of the interpretations of PMCT by non-radiologists remains to be elucidated. Nevertheless, they are often required to write death certificates based on the findings of PMCT in the absence of radiologists in Japan. We compared the interpretations of postmortem head CT (PMCT-H) by non-radiologists with the autopsy findings. METHODS: This study included 13 patients who underwent both brain dissection at autopsy and PMCT between June 2011 and December 2014. All cases were non-traumatic in-hospital deaths. Interpretation of PMCT was performed by the clinicians in charge of the patients, not by radiology experts. RESULTS: The patients were first examined with PMCT and then autopsies were performed. Ten out of 13 cases were confirmed to have no lesions in the cranial cavity by both PMCT-H and autopsy. Two cases were diagnosed with intracranial hemorrhage (intracerebral and/or subarachnoid hemorrhage) and one with recurrent malignant lymphoma by both the clinicians and the pathologists. Intracranial hemorrhages were thought to be the direct causes of mortality of the two patients, and recurrent malignant lymphoma was considered to be one of the cardinal findings of the cancer death. There were no discrepancies between PMCT-H and autopsy findings. CONCLUSIONS: The interpretations of PMCT-H by non-radiologists were completely the same as the autopsy findings regarding the non-traumatic in-hospital deaths in this study. It is premature to draw a definitive conclusion at present, but PMCT-H might be as effective as autopsy not only for those lesions described above but also for no remarkable changes in the brain. There has been no report on such a comparison. We believe further verification of the validity of interpretation of PMCT by non-radiologists is worthwhile in terms of death certificates made out in the absence of radiology experts and pathologists.

Efficacy of microwave ablation for the treatment of endometrial carcinoma: A report of 3 cases.

Microwave endometrial ablation (MEA) is effective for the emergency control of uterine hemorrhage. However, to the best of our knowledge, there has been only a single report of life-threatening hemorrhage induced by endometrial carcinoma that was treated with MEA. The present report evaluates the efficacy of MEA as an emergency therapeutic option for the control of bleeding due to advanced endometrial carcinoma and minimally-invasive, early-stage endometrial carcinoma in 3 patients. MEA was able to effectively control massive uterine bleeding due to endometrial carcinoma in 2 patients with advanced disease and was curative in a patient with minimally-invasive endometrial carcinoma. Given its safety, simplicity and effectiveness, MEA may be utilized for the emergency treatment of uterine bleeding in advanced endometrial carcinoma, and may be used as a curative treatment in early-stage endometrial carcinoma.

Diffuse and multifocal nephrogenic adenoma with Familial Mediterranean Fever: a case report with molecular study.

Nephrogenic adenoma, also referred to nephrogenic metaplasia, is a benign proliferative lesion of urothelium, usually associated with chronic physical stimuli or inflammation. Familial Mediterranean fever is an inherited autosomal recessive disease characterized by recurrent short episodes of fever. The site of mutation is found in MEFV gene which controls inflammatory responses. We have experienced a case of nephrogenic adenoma in a 16-year-old girl with Familial Mediterranean Fever, showing proliferative lesions diffusely in the urinary bladder and multifocally in the other parts of urinary tract. These lesions disappeared after colchicine treatment. We searched for MEFV gene mutation using the specimen from the resected urinary bladder and detected heterozygous mutation of E148Q. There is a possibility that control of inflammation caused by the surgery for vesicoureteral reflux in the local site didn't work well on the background of heterozygous mutation of MEFV gene, and as a result, nephrogenic adenoma appeared. This is the first report of a combination of two rare diseases. We have to be aware that nephrogenic adenoma can occur in association with Familial Mediterranean Fever, and the former condition should be taken into consideration when rendering a correct pathological diagnosis.

Solitary fibrous tumor with rapid progression after 16 years' follow up.

A 79-year-old woman was admitted to our hospital for an investigation of a large 13-cm tumor in the chest and treatment for dyspnea in January 2010. The tumor had been observed on chest X-rays since 1992. It had measured 7 cm in 2008, then started to grow rapidly. Further investigations revealed that it was a malignant solitary fibrous tumor that was strongly suspected to have transformed from a benign to malignant state. Resection was not possible, and the patient died one month later. Benign solitary fibrous tumors of the pleura may become malignant during long-term follow-up. All suspected or proven solitary fibrous tumors of the pleura should be resected.