Acquired cystic disease-associated renal cell carcinoma with a focal sarcomatoid component: Report of a case showing more pronounced polysomy of chromosomes 3 and 16 in the sarcomatoid component.

Acquired cystic disease (ACD)-associated renal cell carcinoma (RCC) has recently been established. Herein we report the sixth case of ACD-associated RCC with a sarcomatoid change. The patient was a 77-year-old man who regularly underwent hemodialysis for 14 years due to chronic renal failure resulting from IgA nephropathy. On computed tomography, a large right RCC was observed with contrast enhancement in the arterial phase. A nodular protrusion into the perirenal fat was detected. Right nephrectomy was performed under laparoscopy. Surgically resected specimens revealed a tan-to-yellow tumor (95 × 75 × 55 mm) with a whitish nodule (20 × 15 × 15 mm) invading into the perirenal fat. Histopathologically, the large carcinoma component of the tumor displayed a cribriform or microcystic growth pattern with deposition of oxalate crystals. The whitish nodule corresponded to the sarcomatoid component, and the spindled and pleomorphic tumor cells showed diffuse positivity of p53 on immunohistochemistry. Fluorescence in situ hybridization revealed trisomy of chromosomes 3 and 16 in the carcinoma component, as was expected from the literature. In addition, increased polysomy of these chromosomes was also observed in the sarcomatoid component. This finding may be related to the development of the sarcomatoid component along with the TP53 mutation.

Aggressive Angiomyxoma of the Pelvis with a Cellular Nodule Composed of Tumor Cells showing Epithelioid Features.

A 49-year-old female presented with an aggressive pelvic angiomyxoma (AAM). The completely resected specimen revealed the usual myxedematous tumor with a nodule inside it. Histopathologically, the myxedematous area consisted of bland spindle-shaped cells in the background of blood vessels of varying calibers, and the nodule was composed of tumor cells with epithelioid features. In the nodule, cellularity was increased and nuclear enlargement was observed, but nuclear atypia was not significant and mitotic figures were scarce. Immunohistochemically, both components were positive for desim, αSMA, estrogen receptors, and progesterone receptors. However, they were negative for AE1/3, EMA, S100, CD34, HMB45, and Melan A. The MIB-1 labeling index was 5.8% in the nodule and 1ess than 1% outside it. The nodule was therefore considered a benign component of AAM. To the best of our knowledge, the presence of such a nodule in AAM has not been reported previously.

[A case of topiramate-induced angle closure glaucoma].

A 38-year-old woman with a 10-year history of migraine without aura was treated with topiramate (TPM) for increasing frequency of headache. Initially, TPM was prescribed at a dose of 25 mg per day for 7 days, and then the dose was increased to 50 mg per day. Three days later, the patient complained of blurry vision, redness, and pain in both eyes. On ophthalmological examination, the pupils were found to be mid-dilated, and her visual acuity with correction was 1.2 in both eyes. Slitlamp examination revealed conjunctival hyperemia, chemosis, and shallow anterior chambers. Intraocular pressure in the right eye was 35 mmHg, while that in the left eye was 36 mmHg. Gonioscopy showed angle closure in both eyes, and therefore, a diagnosis of bilateral angle-closure glaucoma was made. TPM was discontinued immediately, and antiglaucoma medications were started. Four days after the initiation of antiglaucoma treatment, conjunctival hyperemia and chemosis disappeared and intraocular pressure in the right and left eyes decreased to 8 mmHg and 7 mmHg, respectively. The treatment was discontinued on the 11th day. To the best of our knowledge, this is the first case of TPM-induced angle-closure glaucoma in Japan.

[Survey of patients with intractable diseases in Kyoto city].

OBJECTIVE: This study was performed to assess changes over a 5-year period in the number of patients with intractable diseases living in Kyoto city who received public financial aid for treatment. Variation in the quality of their lives was also investigated. METHODS: Questionnaires were mailed to all patients with intractable diseases who lived in Kyoto city and who applied for financial aid for treatment in 1996 and in 2001. RESULTS: 1. The total number of patients increased 1.4-fold over the 5 years (from 4,097 to 5,891). 2. The number of patients who required medical treatments increased. Especially a considerable number of patients required treatments for secondary conditions ascribable to a long-term bed-confined state or prolonged treatment for primary diseases. 3. The number of patients who required care to support daily life or hospital visits increased 2-fold. 4. It was demonstrated that 52.8% of patients felt their lives had improved after the introduction of long-term care insurance system. CONCLUSIONS: The number of patients with intractable diseases appears to be increasing and their clinical courses are becoming chronic and more severe. This situation can be expected to persist in the near future, so that further consideration of measures to provide medical care and welfare is necessary.

Evaluation of a sentinel surveillance system for influenza, 1995-2000, Kyoto City, Japan.

We compared a municipal sentinel surveillance system for influenza with the Microbial Isolation Surveillance System (MISS) in Kyoto City, Japan. Sensitivity, specificity, and predictive value positive (PVP) of the Influenza Sentinel Surveillance System (ISSS) compared to the MISS were calculated by influenza season and by month. Sensitivity ranged from 80 to 97%, specificity ranged from 55 to 77%, and PVP ranged from 29 to 52% by season (P < 0.001). On the other hand, sensitivity ranged from 86 to 100%, specificity ranged from 38 to 66%, and PVP ranged from 31 to 50% by month (P < 0.001). Specificity was calculated as 93% in November. The sensitivity of ISSS was found to be sufficient regardless of the magnitude of influenza activity. Specificity varied by season, indicating the difficulty of clinically diagnosing other respiratory illnesses. The PVP remained at less than 50% before and after the influenza seasons and it varied year by year. In general, the ISSS is a good surveillance system for monitoring influenza activity.