BACKGROUND: The clinical significance of circumferential resection margin (CRM) in esophageal squamous cell carcinoma (ESCC) remains unclear. Optimal CRM for predicting the recurrence of pathological T3 ESCC was investigated. METHODS: Seventy-three patients were retrospectively investigated in the development cohort. Patients were divided into CRM-negative and CRM-positive groups, and clinicopathological factors and survival outcomes were compared between the groups. The cutoff value was validated in another validation cohort (n = 99). RESULTS: Receiver operating characteristic analysis in the development cohort showed the cutoff value of CRM was 600 µm. In the validation cohort, patients in the CRM-positive group showed a significantly higher rate of locoregional recurrence (p = 0.006) and worse recurrence-free survival (RFS) (p < 0.001) than those in the CRM-negative group. Multivariate analysis identified positive CRM as an independent predictive factor for poor RFS (hazard ratio, 2.695; 95% confidence interval, 1.492-4.867; p = 0.001). The predictive value of our criteria of positive CRM for RFS was higher than that of the Royal College of Pathologists (RCP) and the College of American Pathologists (CAP) criteria. Stratified analysis in the neoadjuvant chemotherapy groups also revealed that the rate of locoregional recurrence was higher in the CRM-positive group than in the CRM-negative group both in the pathological N0 and N1-3 subgroups. CONCLUSIONS: CRM of 600 µm can be the optimal cutoff value rather than the RCP and CAP criteria for predicting locoregional recurrence after esophagectomy. These results may support the impact of perioperative locoregional control of locally advanced ESCC.
We herein report a case of Behçet's disease with renal infarction due to mucormycosis. A 76-year-old man with entero-Behçet's disease had been treated with glucocorticoid and tumor necrosis factor (TNF) inhibitors. His entero-Behçet's disease was refractory to these treatments, and ileocecal resection was performed. After the operation, renal infarction that was unresponsive to anticoagulation therapy developed. He ultimately died of renal failure due to renal infarction. At the autopsy, histopathology of abundant hyphae in the renal vessel wall revealed mucormycosis. Renal mucormycosis is an important cause of renal failure with renal infarction in immunocompromised patients.
Behcet Syndrome , Mucormycosis , Aged , Behcet Syndrome/complications , Behcet Syndrome/diagnosis , Glucocorticoids , Humans , Infarction/etiology , Male , Mucormycosis/complications , Mucormycosis/diagnosis , Tumor Necrosis Factor Inhibitors
The relationship between anti-neutrophil cytoplasmic antibody (ANCA) titer levels and relapse risk in patients with ANCA-associated vasculitis (AAV) following clinical remission remains controversial. We herein report a case showing ectopic relapse of AAV in the pituitary with no ANCA elevation after renal remission. Magnetic resonance imaging revealed an enlarged pituitary gland. A pituitary biopsy showed geographic necrosis with multinucleated giant cells. We diagnosed this case as relapse of AAV in the pituitary. One month after rituximab therapy, the pituitary gland volume had decreased. The intensification of therapy due to the possibility of vasculitis relapse may facilitate better control of AAV.
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis , Antibodies, Antineutrophil Cytoplasmic , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy , Humans , Kidney , Pituitary Gland , Recurrence , Remission Induction , Rituximab/therapeutic use
Although aortic sarcomas are extremely rare, they may arise in association with a Dacron graft. Here, we report a case of an intimal sarcoma in an ascending aortic Dacron graft implanted 17 years earlier. The patient presented with multiple cerebral infarctions; clinically, a thrombus was found to cause the embolic stroke. He successfully underwent re-replacement of the ascending aorta. Although the initial postoperative histopathological diagnosis was a thrombus, he died of multiple metastases of the malignant tumour after 5 months of the surgery. A histopathological re-evaluation of the explant using immunohistochemistry revealed that the mass was an intimal sarcoma.
Aorta/diagnostic imaging , Blood Vessel Prosthesis Implantation/methods , Polyethylene Terephthalates , Sarcoma/diagnosis , Thrombosis/diagnosis , Tunica Intima/pathology , Vascular Neoplasms/diagnosis , Aorta/surgery , Biopsy , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Prosthesis Design , Sarcoma/surgery , Tomography, X-Ray Computed , Vascular Neoplasms/surgery
