Osteoid osteoma of the rib with strong F-18 fluoro-deoxyglucose uptake mimicking osteoblastoma: a case report with literature review.

Osteoid osteoma is a benign osteoblastic bone lesion, characterized by nocturnal pain alleviated by salicylates or nonsteroidal anti-inflammatory drugs. This tumor distinctly affects the long bones, typically the femur or tibia and is rarely located in the ribs. Usually, this tumor is usually diagnosed by computed tomography or magnetic resonance imaging, but F-18 fluoro-deoxyglucose positron emission tomographic (FDG-PET)/computed tomography is usually negative and is not used for diagnosis. We recently encountered a case of an osteoid osteoma located in the rib of 44-year-old Asian male with strong FDG uptake as high as 12.0 at the maximum standardized uptake value at FDG-PET/computed tomography. His computed tomography and magnetic resonance imaging showed osteosclerosis, bone marrow edema, and edema of surrounding tissues not only in the bone with nidus but also in the adjacent bone, and pathological findings showed strong infiltration munched radiology. Strong FDG uptake mimicking osteoblastoma. Osteoid osteoma with strong FDG uptake suggested a strong inflammatory response.

Skeleton construction upon local regression of the sponge body.

We previously revealed that the mechanism of demosponge skeleton construction is self-organization by multiple rounds of sequential mechanical reactions of player cells. In these reactions, "transport cells" dynamically carry fine skeletal elements (spicules) on epithelia surrounding the inner body space of sponges (basal epithelium (basopinacoderm) and the endodermal epithelium (ENCM)). Once spicules pierce ENCM and apical pinacoderm, subsequently they are cemented to the substratum under the sponge body, or connected to other skeleton-constructing spicules. Thus, the "pierce" step is the key to holding up spicules in the temporary periphery of growing sponges' bodies. Since sponges can regress as well as grow, here we asked how skeleton construction occurs during local regression of the body. We found that prior to local basopinacoderm retraction (and thus body regression), the body became thinner. Some spicules that were originally carried outward stagnated for a while, and were then carried inwards either on ENCM or basopinacoderm. Spicules that were carried inwards on ENCM pierced epithelia after a short transport, and thus became held up at relatively inward positions compared to spicules carried on outwardly extending basopinacoderm. The switch of epithelia on which transport cells migrate efficiently occurred in thinner body spaces where basopinacoderm and ENCM became close to each other. Thus, the mechanisms underlying this phenomenon are rather mechanical: the combination of sequential reactions of skeleton construction and the narrowed body space upon local retraction of basopinacoderm cause spicules to be held up at more-inward positions, which might strengthen the basopinacoderm's attachment to substratum.

Dynamic Transport and Cementation of Skeletal Elements Build Up the Pole-and-Beam Structured Skeleton of Sponges.

Animal bodies are shaped by skeletons, which are built inside the body by biomineralization of condensed mesenchymal cells in vertebrates [1, 2] and echinoderms [3, 4], or outside the body by apical secretion of extracellular matrices by epidermal cell layers in arthropods [5]. In each case, the skeletons' shapes are a direct reflection of the pattern of skeleton-producing cells [6]. Here we report a newly discovered mode of skeleton formation: assembly of sponges' mineralized skeletal elements (spicules) in locations distant from where they were produced. Although it was known that internal skeletons of sponges consist of spicules assembled into large pole-and-beam structures with a variety of morphologies [7-10], the spicule assembly process (i.e., how spicules become held up and connected basically in staggered tandem) and what types of cells act in this process remained unexplored. Here we found that mature spicules are dynamically transported from where they were produced and then pierce through outer epithelia, and their basal ends become fixed to substrate or connected with such fixed spicules. Newly discovered "transport cells" mediate spicule movement and the "pierce" step, and collagen-secreting basal-epithelial cells fix spicules to the substratum, suggesting that the processes of spiculous skeleton construction are mediated separately by specialized cells. Division of labor by manufacturer, transporter, and cementer cells, and iteration of the sequential mechanical reactions of "transport," "pierce," "raise up," and "cementation," allows construction of the spiculous skeleton spicule by spicule as a self-organized biological structure, with the great plasticity in size and shape required for indeterminate growth, and generating the great morphological diversity of individual sponges.

[A phase II study of gemcitabine and carboplatin bi-weekly combination chemotherapy for complete resected non-small-cell lung cancer patients].

Recently, postoperative adjuvant chemotherapy is very popular for completely resected non-small-cell lung cancer patients, but cisplatin-based regimens are not safety and tolerable for outpatients. In this study, gemcitabine plus carboplatin regimen is selected as more safety and feasible for outpatient chemotherapy, and scheduled bi-weekly administration to reduce hematological toxity, especially thrombocytopenia. Twenty patients with completely resected non-small-cell lung cancer (pStage IA - IIIB) administered gemcitabine 1,000 mg/m2 and carboplatin area under the curve (AUC) 3 bi-weekly for 8 times at outpatient chemotherapy center except that 1st treatment was done with short stay in hospital. Of 20 patients, 13 (65%) completed the 8 times bi-weekly treatment and 7 patients incompleted because of neutropenia in 2, anemia in 1, liver dysfunction in 3, interstitial pneumonia suspected in 1. Relative dose intensity was 79%. Seven patients had grade 3/4 neutropenia, 2 had grade 3 thrombocytopenia, 2 had grade 3 anemia, and 2 had grade 3 liver dysfunction. Hematological toxity, especially thorombocytopenia are less than standard administration of gemcitabine and carboplatin regimen, so we conclude that this regimen is feasible in outpatient adjuvant chemotherapy for completely resected non-small-cell lung cancer.

[Ectopic mediastinal parathyroid adenoma].

We experienced 3 surgical cases with ectopic mediastinal parathyroid adenoma. All patients checked elevated serum calcium levels and parathyroid hormone levels above normal range so we diagnosed their illness as primary hyperparathyroidism. Two had treated urinary tract lithiasis for long time, and the other had no symptoms by hypercalcemia. To determine the location of abnormal parathyroid glands, 99mTc-methoxy-isobutyl-isonitrile (MIBI) scintigraphy, chest computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were done, then posterior and anterior mediastinal tumors were revealed. Especially MIBI scintigraphy was very useful as diagnostic procedure for small ectopic parathyroid adenoma. It's considered that large tumor in the posterior mediastinum like case 1 is originated from upper parathyroid gland, and small tumor in the anterior mediastinum like case 2, 3 is originated from lower parathyroid gland. Tumors were resected via small thoracotomy with thoracoscope, cervical incision and partial median sternotomy respectively. Serum calcium and parathyroid hormone levels were normalized immediately. If we can detect the accurate location of small ectopic parathyroid adenoma using some intraoperative method, the tumor is resected by less invasive procedure.

Generalized myositis mimicking polymyositis associated with chronic active Epstein-Barr virus infection.

BACKGROUND: Chronic generalized myositis has not so far been reported as a complication of chronic active Epstein-Barr virus infection (CAEBV). We encountered three patients with chronic generalized myositis mimicking polymyositis associated with CAEBV. METHODS: To clarify the pathological character of this myositis, we investigated the distribution, clonality, and the immunophenotype of EBV-infected cells and lymphocytes infiltrating in muscles. RESULTS: Clinically, two patients showed symmetrical proximal weakness and muscle atrophy as the initial and main symptom. Although the condition resembled polymyositis, they had also lingual and/or orbital myositis. The other patient showed generalized myositis at the late phase of CAEBV. In all of them, immunotherapy was ineffective and prognosis was poor. Intramuscular infiltrating lymphocytes in our patients were mainly CD45RO+, CD3+, CD4-, CD8-, TCR betaF1-, TCR deltaTCS1-, CD56-, CD79a-, CD21-, HLA-DR+, ZEBRA -, LMP1-, and EBER+ T cells. Oligoclonal expansion of EBV-infected T cells was shown in the muscles. However, there were no malignant lymphocytes. CONCLUSIONS: This new form of myositis must be distinguished from polymyositis and the other conventional forms of myositis. Careful investigation of hidden CAEBV is recommended when patients present with steroid non-responsive chronic progressive generalized myositis, in particular, with lingual or orbital involvement.