The Histological Detection of Ulcerative Colitis Using a No-Code Artificial Intelligence Model.

Ulcerative colitis (UC) is an intractable disease that affects young adults. Histological findings are essential for its diagnosis; however, the number of diagnostic pathologists is limited. Herein, we used a no-code artificial intelligence (AI) platform "Teachable Machine" to train a model that could distinguish between histological images of UC, non-UC coloproctitis, adenocarcinoma, and control. A total of 5100 histological images for training and 900 histological images for testing were prepared by pathologists. Our model showed accuracies of 0.99, 1.00, 0.99, and 0.99, for UC, non-UC coloproctitis, adenocarcinoma, and control, respectively. This is the first report in which a no-code easy AI platform has been able to comprehensively recognize the distinctive histologic patterns of UC.

High Infiltration of CD163-Positive Macrophages in Intratumor Compartment Predicts Poor Prognosis in Patients With Upper Urinary Tract Urothelial Carcinoma and Radical Nephroureterectomy.

OBJECTIVES: To investigate the prognostic value of CD68- and CD163-positive macrophages in patients with upper urinary tract urothelial carcinoma (UTUC). PATIENTS AND METHODS: This retrospective study enrolled 50 patients (34 men and 16 women) with UTUC who received radical nephroureterectomy (RNU). We evaluated the expression of CD68 and CD163 in the intratumor compartment by immunohistochemistry. The Kaplan-Meier method and Cox proportional hazards regression model were used to evaluate overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and bladder recurrence-free survival (BRFS). RESULTS: High infiltration of CD163-positive macrophages in patients with UTUC was significantly correlated with worse OS, CSS, and RFS (P < .05 for all). Multivariate analysis showed that high infiltration of CD163-positive macrophages was an independent negative prognostic factor of OS and CSS in patients with UTUC who received RNU. Lymphovascular invasion was an independent negative prognostic factor of RFS, and high infiltration of CD68-positive macrophages was an independent positive prognostic factor of BRFS. CONCLUSION: This study indicated that high infiltration of CD163-positive macrophages in the intratumor compartment might be a useful prognostic marker for survival in patients with UTUC who receive RNU. Further, high infiltration of CD68-positive macrophages in the intratumoral compartment might be a useful prognostic marker for bladder recurrence in these patients.

Fat-poor leiomyomatous angiomyolipoma arising from renal parenchyma negative for HMB-45: A case report.

Fat-poor leiomyomatous angiomyolipoma, which is similar to smooth muscle tumors, is positive for smooth muscle markers and melanocytic marker human melanin black 45 (HMB-45). We report a case of fat-poor leiomyomatous angiomyolipoma arising from renal parenchyma negative for HMB-45 diagnosed by combined staining with melanocytic markers HMB-45 and Melan-A.

Intraabdominal actinomycosis resulting in a difficult to diagnose intraperitoneal mass: A case report.

INTRODUCTION: Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces israelii. Preoperative confirmed diagnosis is very difficult, so most cases are diagnosed preoperatively as malignant tumors. We report a case of intraabdominal actinomycosis which was difficult to diagnose preoperatively. PRESENTATION OF THE CASE: A woman, 60 years old, experienced discomfort in her lower right abdomen. She complained of nausea and anorexia and visited our hospital. Laboratory blood tests, abdominal CT, and abdominal MRI led to a diagnosis of a uterine sarcoma or primary intestinal mass, and she underwent surgery. Her histopathological diagnosis was intraabdominal actinomycosis. DISCUSSION: Actinomycosis is a chronic purulent granulomatous inflammation caused by Actinomyces israelii. No clinical symptoms or laboratory findings are characteristic of abdominal actinomycosis, so this disorder is very difficult to diagnose preoperatively. Therefore, many cases are diagnosed as malignant tumors and undergo surgery. After surgery, long-term antibiotic treatment (penicillin) is usually administered. CONCLUSIONS: We reported a case of intraabdominal actinomycosis that resulted in a difficult to diagnose intraperitoneal mass. When a large intraperitoneal mass is found, actinomycosis needs to be included as one of differential diagnoses.

Renal capsule metastasis from renal pelvic cancer: a case report.

BACKGROUND: Metastatic renal cancers are relatively common. Most are metastases to the renal parenchyma via a hematogenous route and are derived from lung, breast, and gastrointestinal cancer, malignant melanoma, and hematologic malignant cancer. However, little is known about renal capsule metastasis from other cancers. CASE PRESENTATION: We report a 71-year-old woman with breast cancer who was treated with endocrine therapy. She presented with gross hematuria and was diagnosed as having right renal pelvic cancer and renal cell cancer. She underwent right laparoscopic radical nephroureterectomy. Pathological findings revealed right pelvic cancer and renal capsule metastasis. CONCLUSION: Renal capsule metastasis derived from renal pelvic cancer is very rare. When diagnosing renal capsule cancer, we believe that renal capsule metastasis should also be taken into consideration. Clinical and radiological differential diagnosis of renal capsule metastasis from renal cell cancer and primary renal capsule cancer is difficult. Assessment of the histopathological findings of the surgical specimens seems to be the only realistic approach to achieving the correct diagnosis.

Primary splenic malignant lymphoma mimicking metastasis of rectosigmoid cancer: A case report.

INTRODUCTION: Primary splenic malignant lymphoma is quite a rare disease, and its preoperative diagnosis is difficult. CASE PRESENTATION: An 80-year-old man was diagnosed with advanced rectosigmoid cancer with liver and splenic metastases, for which he underwent single-incision laparoscopic high anterior resection for the primary rectosigmoid cancer. After chemotherapy, he underwent laparoscopy-assisted splenectomy and open partial hepatectomy of segment 3 and segment 5/6 of the liver. The resected specimen of the spleen showed primary splenic malignant lymphoma. DISCUSSION: A diagnosis of primary splenic malignant lymphoma seems to be made only occasionally at splenectomy. Patients with primary splenic malignant lymphoma treated by curative resection at an early clinical stage have a more favorable prognosis. Laparoscopy-assisted splenectomy is useful for reducing surgical invasiveness. CONCLUSION: Primary splenic malignant lymphoma should be included among the differential diagnoses of splenic tumors in patients with colorectal cancer with multiple metastases. Curative resection might be a therapeutic option for the treatment of primary splenic malignant lymphoma. Laparoscopy-assisted splenectomy is a useful strategy for reducing surgical invasiveness.

[PRIMARY SMALL CELL NEUROENDOCRINE CARCINOMA OF THE URETER].

Primary small cell neuroendocrine carcinoma of the upper urinary tract is a rare disease that is associated with a poor prognosis. An 81-year-old man was diagnosed with carcinoma of the stomach and underwent laparoscopic distal gastrectomy. Computed tomography (CT) revealed carcinoma of the left ureter and left hydronephrosis. The patient was diagnosed with carcinoma of the left ureter (cT2N0M0) and left laparoscopic radical nephroureterectomy was performed via a retroperitoneal approach. The pathological diagnosis was left ureter carcinoma (small cell neuroendocrine carcinoma, pT3). He was treated with four courses of the CE regimen (carboplatin area under the curve: 5, intravenously [IV] on day 1 and etoposide [80 mg/m2], IV on days 1-3). There is no evidence of disease at 21 months after radical nephroureterectomy.

CUBIC pathology: three-dimensional imaging for pathological diagnosis.

The examination of hematoxylin and eosin (H&E)-stained tissues on glass slides by conventional light microscopy is the foundation for histopathological diagnosis. However, this conventional method has some limitations in x-y axes due to its relatively narrow range of observation area and in z-axis due to its two-dimensionality. In this study, we applied a CUBIC pipeline, which is the most powerful tissue-clearing and three-dimensional (3D)-imaging technique, to clinical pathology. CUBIC was applicable to 3D imaging of both normal and abnormal patient-derived, human lung and lymph node tissues. Notably, the combination of deparaffinization and CUBIC enabled 3D imaging of specimens derived from paraffin-embedded tissue blocks, allowing quantitative evaluation of nuclear and structural atypia of an archival malignant lymphoma tissue. Furthermore, to examine whether CUBIC can be applied to practical use in pathological diagnosis, we performed a histopathological screening of a lymph node metastasis based on CUBIC, which successfully improved the sensitivity in detecting minor metastatic carcinoma nodules in lymph nodes. Collectively, our results indicate that CUBIC significantly contributes to retrospective and prospective clinicopathological diagnosis, which might lead to the establishment of a novel field of medical science based on 3D histopathology.

A resected case of medullary carcinoma of the ascending colon followed by infarction of the greater omentum mimicking anastomotic leakage.

INTRODUCTION: Medullary carcinoma is a rare type of colorectal adenocarcinoma, and omental infarction is a rare cause of acute abdomen. PRESENTATION OF CASE: A 72-year-old woman underwent single-incision laparoscopic right hemicolectomy for ascending colon cancer. Pathological examination showed a medullary carcinoma (MC) of T4aN0M0 Stage IIB. Her postoperative course was uneventful, and she was discharged on postoperative day (POD) 6. From POD 7, she suffered from fever, and she returned to the hospital on POD 9. Plain computed tomography showed free air beside the anastomotic site around the elevated density of fat tissue and gallbladder wall thickening with a gallstone. Suspecting anastomotic leakage with acute cholecystitis, probe laparotomy was performed. Intraoperative observation confirmed omental infarction with acute cholecystitis, and no leakage was found at the anastomotic site. Therefore, the necrotic part of the greater omentum was resected, and cholecystectomy was performed. She has remained well, with no evidence of recurrent cancer during the 12 months of follow-up without chemotherapy after the surgery for MC of the ascending colon. DISCUSSION: MC should be distinguished from other more aggressive, non-glandular tumors of the colon because MC appears to have a better survival outcome than undifferentiated colon adenocarcinoma. Omental infarction should be considered in the differential diagnosis of acute abdomen after surgery. CONCLUSION: A rare case of medullary carcinoma of the ascending colon followed by infarction of the greater omentum mimicking anastomotic leakage is presented.

[Intravesical Recurrence of Small Cell Carcinoma of the Ureter: A Case Report].

A 63-year-old man who presented with asymptomatic gross hematuria was referred to our hospital. Left ureteral tumor (cT3N0M0) was diagnosed and left nephroureterectomy was performed. Pathological examination revealed urothelial carcinoma and small cell carcinoma with local invasion (pT3). The patient was treated with three cycles of adjuvant chemotherapy with gemcitabine and cisplatin. Three months after the chemotherapy, cystoscopy showed an intravesical recurrence of the tumor. Transurethral resection was performed and histopathological examination revealed small cell carcinoma (pT1). We recommended a cystectomy and neoadjuvant chemotherapy with etoposide and carboplatin according to the standard care of small cell carcinoma of bladder. However, the patient refused to undergo cystectomy and desired to preserve his bladder. Therefore, after two cycles of chemotherapy with etoposide and carboplatin, transurethral resection was performed to examine the presence of the residual tumor instead of immediate cystectomy. Because of no residual tumor, another two cycles of chemotherapy were added instead of a cystectomy. There is no evidence of recurrence seven months after the chemotherapy.

Late cardiac effect of radiation therapy on a young woman with mediastinal Hodgkin's lymphoma.

We experienced an excision of the mediastinal tumor located in left anterior mediastinum found in a 21-year-old woman. The histologic diagnosis of Hodgkin's lymphoma was obtained. After operation, she was treated with mantle field radiotherapy (total 42 Gy) followed by chemotherapy. At 43-year old, she developed constrictive pericarditis and heart failure resulted in the late cardiac effects of mediastinal irradiation. Despite pericardiectomy followed by medical treatment, her cardiac symptoms gradually worsened and she died at 51-year old. At autopsy, her heart was smaller than normal person. The residual pericardium and the surface of the myocardium had fibrous degeneration with tight adhesion and thickness that were dominant at the right atrium and ventricle. Likewise, we demonstrated that pericardiectomy scarcely led to a favorable outcome in this patient. These facts might be based on the radiation-associated cardiac effects involving any components of the cardiac structure.

[Primary Carcinoid Tumor of the Urinary Bladder: A Case Report and Questionnaire Survey on the Reported Cases in Japan].

An 83-year-old man presented with asymptomatic macroscopic hematuria while being treated for prostate cancer with hormonal therapy in January 2009. Cystoscopy revealed a 5 mm surface-smooth non pedunculated tumor lateral to the left ureteral orifice. Transurethral resection was carried out to examine the histology of the tumor. Histopathologic examination revealed the tumor arranged in a pseudoglandular pattern covered with erosive urothelial cells. The tumor had inconspicuous nucleoli, and abundant eosinophilic cytoplasm. An immunohistochemical study showed the tumor cells were positively stained for chromogranin A, synaptophysin, CD56, and NSE. Ki67 index of the tumor was below 2 %, indicating that the tumor was a carcinoid tumor. He showed no carcinoid syndrome, and neither recurrence nor metastasis has been detected for 66 months.

[A case of gastric cancer with multiple liver metastases that was successfully treated by chemotherapy].

A man in his 60s received SP (S-1+CDDP) therapy for gastric cancer with multiple liver metastases. After completion of 3 courses, liver metastases had reduced significantly, and the paraaortic lymph nodes, which had swelled previously, had reduced in size. Furthermore, the serum carcinoembryonic antigen (CEA) level had also improved to the standard value from 814.3 ng/mL. The patient was able to discontinue the opioid he had needed for pain control. The chemotherapy was continued for 18 courses, with the dose reduced at the time of the adverse events along the way. By completion of the 18 courses, we recognized regrowth of the primary lesion and a rise in the serum CEA over the standard value. There was no sign of the regrowth of liver metastases and distant lymph nodes according to examinations for enhanced computed tomography (CT) and ¹8F-fluorodeoxyglucose positron-emission tomography (FDG-PET) CT.The patient received distal gastrectomy. The CEA level decreased in standard value or less after surgery and we believed the cancer was limited to the primary stomach lesion.

[A case of SPT therapy( S-1+CDDP+trastuzumab) was successful for HER2-positive gastric cancer accompanied by distant lymph node metastasis].

A 63-year-old man visited our clinic with a chief complaint of a left axillary mass, and after a series of examinations, gastric cancer was diagnosed. Histopathological examination revealed a human epidermal growth factor receptor (HER)-2- positive( immunohistochemistry[ IHC], 2+; fluorescence in situ hybridization[ FISH], positive) poorly differentiated adenocarcinoma, and SPT therapy( S-1 at 120 mg/m2/day+cisplatin[ CDDP] at 60 mg/m2+trastuzumab at 8 mg/kg) was initiated. The primary lesion and swollen lymph nodes initially decreased markedly in size; however, the lymph node swelling worsened at 186 days( 6.2 months) after the initiation of treatment. Progressive disease( PD) was diagnosed, and SPT therapy was terminated. One cycle of S-1+docetaxel was administered as second-line therapy, but the regimen was changed to docetaxel monotherapy due to adverse effects. After 5 cycles of this treatment, the primary lesion had decreased in size and the lymphadenopathy disappeared. Positron emission tomography( PET)-computed tomography (CT) revealed fluorodeoxyglucose( F18)( FDG) accumulation only in the primary lesion, and therefore, with the patient's informed consent distal gastrectomy was performed approximately 14 months after the first treatment. The postoperative diagnosis was gastric cancer fStage IA (T1a, N0, and M0). Here, we discuss a case of HER2-positive gastric cancer with references. Among the advanced recurrent gastric cancers tested between April 2011 and February 2013, 16.4% (11/67) were HER2-positive.

[Primary small cell carcinoma of the bladder in which the bladder preservation was achieved by chemotherapy and transurethral resection].

A 78-year-old man was referred to our hospital for asymptomatic gross hematuria on April 16, 2007. Cystoscopy and abdominal computed tomography revealed a nonpapillary tumor at the upper area of the bladder. Abdominal and thoracic computed tomography showed no lymph nodes and no metastasis to other organs. Transurethral resection of bladder tumor (TURBT) was performed, and a pathological diagnosis of small cell carcinoma of the bladder at stage pT2N0M0 was made. Considering the patient's age and the location of the tumor, we administered chemotherapy using carboplatin and etoposide after resection of the tumor. After 2 courses of chemotherapy, a second-look TURBT was performed, and pathological examination showed no viable tumor cells. Cystoscopy performed after 3 months revealed recurrence of a nonpapillary tumor at a different area of the bladder. We performed TURBT and made a pathological diagnosis of small cell carcinoma of the bladder at stage pT1N0M0. The patient was free from disease in January 2011.

Evaluation of matrix metalloproteinase-2 (MMP-2) activity with film in situ zymography for improved cytological diagnosis of breast tumors.

BACKGROUND: Fine-needle aspiration (FNA) biopsy of breast tumors is a reliable diagnostic method for identifying breast carcinoma. However, it is sometimes difficult to definitely distinguish malignant from benign lesions. To improve the cytological diagnosis of breast tumors, we investigated the expression of active matrix metalloproteinase-2 (MMP-2), as detected by film in situ zymography (FIZ). METHODS: We evaluated 34 fresh breast tumors, 25 paraffin-embedded breast tissue specimens, and a human cancer cell line (HT1080). MMP-2 expression was determined by immunocytochemistry or immunohistochemistry. Frozen sections and aspiration cytology samples of breast cancer were incubated on gelatin-coated films for the detection of active MMP-2. RESULTS: Immunohistochemistry showed that MMP-2 was expressed in cancer cells and stromal cells, but not in most benign breast lesions. Active MMP-2, but not pro-MMP-2, in the conditioned medium of HT1080 cells showed gelatinolytic activity on FIZ analysis, while the expression of both forms of MMP-2 was detected by immunocytochemistry. Gelatinolytic activity was also detected by FIZ analysis of aspiration cytology samples and frozen sections from the breast cancers, and there was a significant correlation between this gelatinolytic activity and the detection of MMP-2 expression by immunocytochemistry. CONCLUSIONS: The present study demonstrated that measurement of gelatinolytic activity by FIZ analysis of aspiration cytology samples may be useful for improving the cytological diagnosis of breast tumors.

[A case of extra-adrenal pheochromocytoma presenting with lung metastasis].

A 34-year-old man was referred to our hospital for small lung nodules. An imaging study including a computed tomographic scan and magnetic resonance imaging showed bilateral lung tumors and huge mass arising from the lower pole of the right kidney as well. The patient underwent right radical nephrectomy in May 2002. Pathological examination revealed that the tumor was pheochromocytoma, which developed from extra-adrenal tissue. In 6 cycles of CVD systemic chemotherapy (Cyclophosphamide 750 mg/m2, Vincristine 1.4 mg/m2, Dacarbazine 600 mg/m2), the lung tumors were decreasing in size, and were removed by a surgical procedure in January 2003. Pathological examination revealed that the lung tumors were pheochromocytomas metastasized from the primary tumor. He is alive without evidence of disease 5 months after the lung operation.

[Malignant pheochromocytoma responsive to multimodal therapy: a case report].

A 62-year-old man underwent right adrenalectomy for pheochromocytoma in May 1987. He was referred to our department for a right renal tumor suggested by ultrasound sonography in December 2000. Computated tomography and MRI showed a 10 cm mass arising from the upper pole of the right kidney. 131I-MIBG scintigram showed strong radio isotope accumulation consistent with the tumor. Right nephrectomy and subsegmental hepatectomy were performed. Histological findings led to the diagnosis of malignant pheochromocytoma. In February 2001, he complained of paraplasia due to Th2 bone metastasis. Radiation and CVD (cyclophosphamide, vincristine, dacarbazine) chemotherapy resulted in tumor regression and marked improvement of clinical symptoms.

[A case of inguinal lymph node metastasis and urethral remnant tumor arising eight years after cystourethrectomy for bladder cancer].

A 59-year-old man had undergone total cystourethrectomy for bladder cancer (TCC G2 > G3 pT1) in July, 1991. Eight years later, he visited our department complaining of bleeding from external urethral meatus. Imaging study including computed tomographic (CT) scan and magnetic resonance imaging (MRI) showed a tumor arising from the urethral remnant and left inguinal lymph node involvement. Partial penectomy and left inguinal lymphadenectomy were performed. Histopathological examination revealed that both tumors were transitional cell carcinomas suggesting recurrence of bladder cancer. Two courses of M-VAC chemotherapy were given as adjuvant therapy.

[A case of renal cell carcinoma metastasizing to contralateral perirenal fat].

Extremely rarely renal cell carcinoma metastasizes to the contralateral perirenal fat. A 57-year-old male was admitted with macroscopic hematuria and lower left abdominal pain in December 1994. He was diagnosed with left renal cancer, and underwent left radical nephrectomy (RCC pT2, grade 1) in January 1995. Followup imaging studies showed a tumor arising from the right perirenal fat in 5 years. Tumor excision was performed in May 2000. Pathological findings revealed renal cell carcinoma growing in the fat, which had the same, pathology as the left renal cancer.