A long-term survival case of histiocytic sarcoma by surgery alone in a Japanese elderly breast tumor patient.

INTRODUCTION: Histiocytic sarcoma (HS) is a rare hematologic malignancy. HS of the breast is extremely rare, and we present a case of an elderly patient with breast HS. CASE PRESENTATION: An 81-year-old woman with unremarkable past medical and family histories presented to our hospital with a palpable mass in her right upper breast. She had noticed a mass in her right breast 3 months before her first visit. Physical examination revealed a mass measuring approximately 30 mm in the right upper quadrant of the breast; there were no cervical or axillary lymphadenopathies. Mammography revealed a high-concentration mass with unclear margins in the upper and outer breast. Ultrasound and magnetic resonance imaging (MRI) revealed a 31 × 23-mm nodule with a relatively clear margin and necrotic sign on the T2-intensified image. A mastectomy was performed upon the patient's request, and the surgical specimen revealed a 35-mm hemorrhagic mass. The lesion was estrogen receptor-, progesterone receptor-, and HER2/neu-negative. The Ki-67 labeling index was approximately 30%. The immunohistochemical panel showed immune reactivity for the histiocytic markers CD68, CD163, and CD206 and was immune-negative for B lineage, T lineage, Langerhans cells, and keratins. The diagnosis of HS was based on the morphological and immunophenotypic characteristics of the mass. The patient received no systemic therapy and survived for 50 months without recurrence. CONCLUSIONS: Here, we report the case of an elderly patient with rare breast HS. Although the prognosis of HS seems poor, the breast HS was not as poor as expected, since it might have been discovered in the local region before it metastasized.

Predictors associated with prefrailty in older Taiwanese individuals with type 2 diabetes.

Type 2 diabetes (T2DM) is one of the most well-studied and important factors that increase the risk of prefrailty in older people in Taiwan. This study was conducted to examine whether metabolic biomarkers, lifestyle behaviors, body composition, and chronic diseases are associated with frailty in older people with T2DM. We also observed how people manage their T2DM related to prefrailty. This study investigated a total of 201 participants diagnosed with T2DM who received care in our hospital from September 2018 to February 2019. Patients were divided into 3 groups (not frail, prefrail, and frail), and frailty was measured with the 5-item FRAIL scale. Socioeconomic characteristics, metabolic biomarkers, lifestyle behaviors, body composition, and chronic diseases were assessed at enrollment. No participants who we tested met the criteria for frailty. Based on the results of chi-square tests, prefrailty was associated with female sex, middle school education, unemployment, alcohol use, high body fat percentage, above-normal waist circumference, obesity, cardiovascular disease, and hypertension. Logistic regression analyses identified a significant correlation of prefrailty with the type of job from which they retired, cardiovascular disease, and hypertension. An important and surprising finding of this study was that the unemployed group was at high risk for prefrailty, which was not observed in previous research. The groups engaged in manual and professional jobs had better hand grip strength, a slower walking speed, and less risk of prefrailty than the unemployed group.

Personality as a predictor of HbA1c level in patients with type 2 diabetes mellitus.

ABSTRACT: Type 2 diabetes mellitus (T2DM) is the most common type of diabetes, accounting for around 90% of all cases worldwide. One means to strengthen the prevention and treatment of diabetes is via changes in self-management and lifestyle behaviors. However, lifestyle and personal health behaviors are strongly influenced by personality traits, and thus personality may play a significant role in such aspects as medication compliance, exercise habits, blood glucose monitoring, diet control, and maintenance of an ideal body weight.In this study, we examined whether certain personality traits of patients with T2DM are correlated with higher glycohemoglobin (HbA1c) levels.A total of 214 participants with T2DM were recruited from an outpatient setting. χ2 test and logistic regression analyses with 5 models were employed.The OR for the "neuroticism" trait was 3.199 (95% CI = 1.228-8.331, P = .017), and those with this trait were 3.199 times more likely to have higher HbA1c levels than those with the "openness-extraversion" personality trait. This strong relationship between neuroticism and a higher HbA1c level was also evident in models 2, 3, 4, and 5. One-way ANOVA also indicated that the group with the neuroticism personality trait had significantly different mean fasting glucose, HbA1c, triglyceride, and high-density lipoprotein cholesterol levels.We found that a personality characterized by neuroticism is an independent predictor of higher HbA1c level in this study. We also found that people in the pre-contemplation and contemplation stages of exercise have higher HbA1c levels.

Ecological, convergent, and discriminative validities of the cognitive abilities screening instrument in people with dementia.

BACKGROUND: The Cognitive Abilities Screening Instrument (CASI) assesses global cognitive function in people with dementia with 9 domains (i.e., long-term memory, short-term memory, concentration, orientation, attention, abstraction and judgment, language abilities, visual construction, and category fluency). However, the ecological, convergent, and discriminant validities of the CASI have not yet been examined. PURPOSE: This study designed to investigate these 3 validities of the CASI in people with dementia. METHODS: Fifty-eight participants underwent assessments with the CASI, 3 functional measures, and 3 cognitive measures. Pearson's r was used to estimate correlations among the CASI and 3 functional measures for examining ecological validity. We computed correlations (r) among the CASI and 3 functional measures for examining convergent validity. An independent t-test was applied to compare the levels of disability, and ceiling/floor effects were analyzed for examining discriminative validity. RESULTS: The CASI total score and domains had moderate to high correlations with 3 functional measures (r = 0.42-0.80), except in 2 CASI domains (i.e., attention and language). The CASI total score and domains showed moderate to high correlations with 3 cognitive measures (r = 0.45-0.93). The t-test results revealed significant differences (P < .05) in the CASI total score and other domains except for the short-term memory domains. Four domains of the CASI showed noticeable ceiling effects (22.4-39.7%). CONCLUSIONS: The CASI has adequate ecological validity, good convergent validity, and acceptable discriminative validity in people with dementia. The 5 domains with nonsignificant differences or ceiling effects should only be used with caution to distinguish people with dementia.

Psychometric properties of the Chinese version thriving of older people assessment scale.

BACKGROUND: The Thriving of Older People Assessment Scale has Scandinavian, Norwegian and English versions but does not yet have a Chinese version that can be used in Chinese populations and compared to global data. OBJECTIVES: To evaluate the psychometric properties of the translated Chinese version of the Thriving of Older People Assessment Scale. METHODS: The English version of the Thriving of Older People Assessment Scale was translated into Chinese using a forward and backward translation method. A convenience sampling strategy was used to recruit participants from five long-term care facilities in northern Taiwan (N = 285). Confirmatory factor analysis was then performed to confirm the theory of the Thriving of Older People Assessment Scale Chinese version. RESULTS: The Thriving of Older People Assessment Scale Chinese version consists of 32 items loading across five domains, namely, 'resident attitudes towards being in long-term care', 'quality of care and caregivers', 'resident engagement and peer relationships', 'keeping in touch with people and places' and 'quality of the physical environment', with good internal consistency (0.971). Confirmatory factor analysis results showed that χ2 = 2255.58 (df = 459, p < .00), χ2 /df = 4.91, CFI = 0.96, IFI = 0.96, NNFI = 0.96 and SRMR = 0.074, indicating a good model fit to previous factor structures. CONCLUSIONS: The Thriving of Older People Assessment Scale Chinese version is a tentatively reliable and valid tool for measuring the experience of thriving in Chinese language older people in long-term care facilities. IMPLICATIONS FOR PRACTICE: The Chinese version of Thriving of Older people Assessment scale can be used to describe the levels of place-related well-being among older Chinese people living in long-term care. Further research and improvements of the Thriving of Older People Assessment Scale Chinese version in diversified Chinese contexts will enable a more comprehensive understanding of older Chinese people's experiences of thriving in long-term care.

A case of secretory breast cancer in a 6 year-old girl: is it possible to make a correct preoperative diagnosis?

Secretory breast carcinoma constitutes the majority of breast cancers in children and young people less than 20 years of age. Noninvasive examination is particularly necessary for the diagnosis of breast carcinoma in children. Herein, we report a case of secretory breast carcinoma in a 6-year-old girl with psychomotor retardation. She was referred to our outpatient clinic for evaluation of a palpable mass in her left breast. A hard mass, rather than the increase in size typical of premature thelarche, was palpated. An excision biopsy was performed. Pathological findings revealed an invasive secretory breast carcinoma. We performed a retrospective review of the preoperative findings of this case, and compared it to the pathological diagnosis. Elastography, which can be performed without deep sedation or general anesthesia and without causing pain, resulted in a stiffness score of 4; however, the distinction between benign and malignant tumors on elastography, which is important to decide the intra-operative procedures, was not sufficient according to the Japanese breast cancer society clinical guidelines. This is the first report of secretory breast carcinoma in a child with a stiffness score determined by tissue elasticity imaging. A breast mass in a child with a high stiffness score of more than 4 on elastography should be referred for invasive diagnostic procedures, such as fine needle aspiration or excisional biopsy. According to our experience, an accurate preoperative diagnosis could be possible for malignant breast tumors in children. Such parameters as stiffness score on elastography are practical, noninvasive, and objective diagnostic tools for the accurate preoperative diagnosis of breast tumors in children.

Necrosis of the small intestine leading to a diagnosis of polyarteritis nodosa: a case report.

BACKGROUND: Polyarteritis nodosa is a disease that presents with necrotizing vasculitis in small and medium-sized arteries. It may occur in various organs, but approximately half of cases have gastrointestinal involvement. Prognosis is not favorable once organ dysfunction begins as evidenced by gastrointestinal symptoms; thus, treatment with steroids should be promptly initiated. We report the case of a patient who presented with necrosis of the small intestine, which was pathologically diagnosed as polyarteritis nodosa and treated successfully with steroids. CASE PRESENTATION: An 18-year-old Japanese woman reported a sudden onset of abdominal pain and vomiting that led her to visit our emergency department, where she was evaluated by a physician. On physical examination, tenderness to palpation in the upper umbilical region was noted, and diagnostic imaging with computed tomography showed emphysema of the wall of her small intestine. She was diagnosed as having necrosis of the small intestine requiring urgent surgery. No strangulations were noted intraoperatively but approximately 20 cm of her small intestine was necrotized. The surrounding arteries were examined and no palpable pulse was observed; therefore, segmentectomy of the necrotized regions was performed. Pathological findings revealed active vasculitis with fibrinoid necrosis, as well as destruction, fibrogenesis, and luminal stenosis of the elastic lamina found in the muscular arteries. A diagnosis of polyarteritis nodosa was confirmed as the cause of the necrosis of her small intestine. No recurrence of polyarteritis nodosa symptoms was observed when she was administered 40 mg of prednisolone daily. CONCLUSION: In cases of idiopathic intestinal necrosis or perforation, systemic diseases such as polyarteritis nodosa should be considered in the differential diagnosis.

Mucin-poor and aggressive mucinous tubular and spindle cell carcinoma of the kidney: Two case reports.

Mucinous tubular and spindle cell carcinoma (MTSCC) is a relatively rare renal epithelial neoplasm. Although MTSCC is considered to be a low-grade and indolent neoplasm, aggressive cases have been recently reported. The present study discussed two additional cases of high-grade MTSCC causing multiple distant metastases with a fatal course. In case 1, a 71-year-old patient presented with hematuria and pyuria. Computed tomography (CT) scan of the right kidney revealed a mass lesion, for which partial nephrectomy was performed. However, a follow-up CT imaging revealed distant metastases in the liver, the paraaortic lymph nodes and the bone. Despite molecular targeted therapy and irradiation, the patient succumbed due to tumor progression. In case 2, a 64-year-old patient presented with an incidentally identified mass lesion in the right kidney. A laparoscopic nephrectomy was performed, and a follow-up CT imaging revealed metastases in the skin and lungs. The cytology of pleural effusion revealed pleuritis carcinomatosa. Histologically, both cases were diagnosed as mucin-poor MTSCC with high-grade transformation, which comprised uniform tumor cells primarily forming slender tubules. The tumors contained low- and high-grade regions. In addition, venous invasion and necrosis were observed. The tumor cells also demonstrated increased Ki-67 labeling indices and cellular tumor antigen p53 (p53) nuclear accumulation. High-grade transformation, large tumor size, necrosis, venous invasion, high Ki-67 labeling index and p53 nuclear accumulation are generally predictive findings for aggressive behavior of malignant tumors. In the current report, it was emphasized that MTSCC possesses a wide spectrum of clinicopathological features. Thus, careful postoperative investigation is required for MTSCC with high-grade elements due to its aggressive nature.

The construction of the indicators of professional competence for exercise instructors of the elderly.

The purpose of this study was to construct the quality indicators of professional competence for exercise instructors of the elderly, and then to rank the importance among those indicators. This study used the Delphi technique to integrate the opinions of 11 experts to construct the indicators, and then adopts the analytic hierarchy process (AHP) to calculate the relative rank among each individual indicator. Results revealed that the experts identified 3 first-degree indicators (professional attitude, professional skills, and professional knowledge), 10 second-degree indicators (teaching attitude, exercise knowledge, professional growth, exercise safety, personal characteristics, exercise instructor, gerontology knowledge, communicative competence, curriculum design, and motor skill), and 72 third-degree indicators. In the indicator weighting system, professional attitude was the most important among all other first-degree indicators, and the teaching attitude was the most important among all other second-degree indicators. The results provided will help in planning the curriculums of training, professional growth and evaluation. The results also provide a reference for future research.

Care pathway networks as a guideline for people with Dementia in Taiwan.

Dementia is a syndrome characterized by the progressive decline in cognitive function and memory that impairs a person's ability to function normally. Although dementia mainly affects older people, it is not a normal part of aging. The population of Taiwan is experiencing a multi-decade ageing trend and regrettably the absolute numbers of people with dementia is also rapidly rising. In 2008, the Taiwan Government initiated a ``Ten-Year Long-term Care Plan'' to categorize dementia's disability and severity, and it evaluates access to home care, respite care services, daycare or home nursing care. This review figure out the features of the features of ``Taiwan Dementia Policy: A Framework for Prevention and Care'' and discuss care pathway network as a guideline for people with dementia in Taiwan. The expectation is for many Taiwanese providers and patients in need simply don't know what services are available or how to access them. A properly designed dementia website could be one such effective tool to meet this need. There is an ongoing risk that future resources allocated will not reach the intended individuals unless this implementation problem is addressed urgently.

The development and evaluation of a nursing information system for caring clinical in-patient.

The research aimed to develop a nursing information system in order to simplify the admission procedure for caring clinical in-patient, enhance the efficiency of medical information documentation. Therefore, by correctly delivering patients' health records, and providing continues care, patient safety and care quality would be effectively improved. The study method was to apply Spiral Model development system to compose a nursing information team. By using strategies of data collection, working environment observation, applying use-case modeling, and conferences of Joint Application Design (JAD) to complete the system requirement analysis and design. The Admission Care Management Information System (ACMIS) mainly included: (1) Admission nursing management information system. (2) Inter-shift meeting information management system. (3) The linkage of drug management system and physical examination record system. The framework contained qualitative and quantitative components that provided both formative and summative elements of the evaluation. System evaluation was to apply information success model, and developed questionnaire of consisting nurses' acceptance and satisfaction. The results of questionnaires were users' satisfaction, the perceived self-involvement, age and information quality were positively to personal and organizational effectiveness. According to the results of this study, the Admission Care Management Information System was practical to simplifying clinic working procedure and effective in communicating and documenting admission medical information.

Care pathway networks as a guideline for people with Dementia in Taiwan.

Dementia is a syndrome characterized by the progressive decline in cognitive function and memory that impairs a person's ability to function normally. Although dementia mainly affects older people, it is not a normal part of aging. The population of Taiwan is experiencing a multi-decade ageing trend and regrettably the absolute numbers of people with dementia is also rapidly rising. In 2008, the Taiwan Government initiated a ``Ten-Year Long-term Care Plan'' to categorize dementia's disability and severity, and it evaluates access to home care, respite care services, daycare or home nursing care. This review figure out the features of the features of ``Taiwan Dementia Policy: A Framework for Prevention and Care'' and discuss care pathway network as a guideline for people with dementia in Taiwan. The expectation is for many Taiwanese providers and patients in need simply don't know what services are available or how to access them. A properly designed dementia website could be one such effective tool to meet this need. There is an ongoing risk that future resources allocated will not reach the intended individuals unless this implementation problem is addressed urgently.

The construction of the indicators of professional competence for exercise instructors of the elderly.

The purpose of this study was to construct the quality indicators of professional competence for exercise instructors of the elderly, and then to rank the importance among those indicators. This study used the Delphi technique to integrate the opinions of 11 experts to construct the indicators, and then adopts the analytic hierarchy process (AHP) to calculate the relative rank among each individual indicator. Results revealed that the experts identified 3 first-degree indicators (professional attitude, professional skills, and professional knowledge), 10 second-degree indicators (teaching attitude, exercise knowledge, professional growth, exercise safety, personal characteristics, exercise instructor, gerontology knowledge, communicative competence, curriculum design, and motor skill), and 72 third-degree indicators. In the indicator weighting system, professional attitude was the most important among all other first-degree indicators, and the teaching attitude was the most important among all other second-degree indicators. The results provided will help in planning the curriculums of training, professional growth and evaluation. The results also provide a reference for future research.

Orbital IgG4-Related Disease Detected by 11C-Methionine PET/CT.

A 64-year-old man presented with a complaint of left exophthalmos. Whole-body F-FDG PET/CT showed increased uptake in the soft tissue masses in the orbits, peripancreas, and left renal hilum. C-methionine (MET) PET/CT of the head and neck showed increased uptake in the orbits, and the SUVmax of the left orbital lesion was 7.0. The patient was finally diagnosed as IgG4-related disease by the results of increased serum IgG4 and the biopsy of the orbital lesion. Although C-MET is generally considered as a tumor-specific tracer, fibrous tissues of IgG4-related disease may be visualized by C-MET PET/CT.

The significance of combined CK5/6 and p63 immunohistochemistry in predicting the risks of subsequent carcinoma development in intraductal papilloma of the breast.

Prediction of subsequent risks of breast carcinoma (BC) development in intraductal papilloma (IDP) has remained controversial with the exception of atypical papilloma (AP). The potential value of immunohistochemistry (IHC) of cytokeratin 5/6 [CK5/6] and p63 have been proposed but its standardization has also remained controversial. We studied 17 patients initially diagnosed as IDP or AP who subsequently developed BC with 34 age-matched controls. We compared histological features, results of IHC (estrogen receptor [ER], progesterone receptor [PR], human epidermal growth factor receptor 2 [HER2], p63, CK5/6, Ki67), and ultrasound findings. Univariate conditional logistic regression analysis revealed that the status of both CK5/6 and p63/CK5/6 were significantly associated with subsequent BC development (P < 0.05). BC development in CK5/6 positive patients was 17.9% and p63/CK5/6 double positive patients 8.6%, respectively. Ultrasound evaluation was not significantly associated with any of the parameters examined and subsequent carcinoma development. Despite CK5/6 positivity, the subsequent incidence of BC development was nearly 20%. However p63/CK5/6 double positive status could predict a significantly lower subsequent carcinoma incidence, indicating a more accurate prognostic utility. Combining p63/CK5/6 with histological findings could be easily applied and could predict the subsequent BC development of the patients diagnosed as IDP at biopsy.

Clinicopathological significance of 'atypical ductal proliferation' in core needle biopsy of the breast.

Atypical ductal proliferation or ADP has been used in histopathological diagnosis of core needle biopsy (CNB) but its details have not been well studied. Therefore, we examined the clinicopathological characteristics of the initial CNB cases diagnosed as 'ADP ' who subsequently turned out to be malignant, and compared the findings to those that did not. Among 101 cases initially diagnosed as ADP in CNB, the second biopsy revealed no carcinoma (38), ductal carcinoma in situ (DCIS) (45) and invasive carcinoma (18). Significant differences were detected between those which turned out to be carcinoma and those that did not, in the status of myoepithelial cells identified by p63 immunohistochemistry (P = 0.026) and ultrasound (US) categories (P < 0.001). We further compared the histopathological characteristics of those initially diagnosed as ADP and subsequently as DCIS or invasive ductal carcinoma (IDC) with those initially diagnosed as such. DCIS or IDC cases initially diagnosed as ADP had significantly lower Ki67 labeling index (P < 0.01, P < 0.01) and histological grade using Van nuys prognostic index (P < 0.01) or Nottingham histological grades (P < 0.01) respectively than those initially as DCIS or IDC. An assessment of myoepithelial components with US findings might contribute to determine the subsequent clinical algorithm of the patients diagnosed as ADP at initial CNB.

Quality of life patterns and survival among older people.

BACKGROUND: As the numbers and proportions of elderly people in the global population increase, quality of life (QOL) within this group becomes an important research issue. Undertaking cross-national comparisons of elderly people can provide a better understanding of QOL patterns. PURPOSE: This study examines QOL patterns using a harmonization data set from two longitudinal studies of the older people in the United Kingdom (UK) and Taiwan and explores the relationship between clusters of older people and mortality hazards in these countries. METHODS: Data were derived from the 1989 wave of the Nottingham Longitudinal Study of Activity and Ageing and the Survey of Health and Living Status of the Elderly in Taiwan. Cluster analysis was used to observe QOL patterns in the older people and their profiles. Cox regression analysis was used to test for the presence of clusters associated with mortality hazards. RESULT: Fifteen subgroups were extracted from cluster analysis of the Nottingham Longitudinal Study of Activity and Ageing sample (n = 690), and 20 groups were generated from cluster analysis of the Survey of Health and Living Status of the Elderly in Taiwan data set (n = 1,438). Cox regression analyses revealed a relationship between mortality risk and certain clusters over a 14-year period in the U.K. and Taiwan. CONCLUSIONS: Using cluster analyses to group the older people according to shared characteristics identified different QOL levels across these profiles both in the UK and Taiwan. The author also identified differences in the same profile levels between the two countries. It is important to explore the relationship between clusters and mortality hazards because clusters reflect important QOL factors affecting mortality risk.

Life satisfaction as a predictor of mortality hazard among elderly people in the United Kingdom and Taiwan.

BACKGROUND: Although numerous predictors of mortality hazard in later life have been identified, the precise relationship between life satisfaction and mortality hazards among elderly people remains unclear. PURPOSE: The purpose of this study was to examine and compare the relationship between life satisfaction and mortality hazards among elderly people in the United Kingdom and Taiwan. METHODS: Data were derived from the 1989 surveys of the Nottingham Longitudinal Study of Activity and Ageing (NLSAA) and the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET). Following data harmonization, the samples included 690 individuals from the NLSAA and 1,438 individuals from SHLSET. Cox proportional hazards regression was used to determine the relationship between life satisfaction in 1989 and 14-year mortality hazard among elderly people in the two samples, first, in unadjusted models and then adjusting covariates for demographic, physical health, psychological health, and social engagement. RESULTS: Higher life satisfaction was significantly associated with a reduced 14-year mortality hazard in unadjusted models in both the United Kingdom (hazard ratio = 0.990; 95% confidence interval [0.986, 0.995], p < .001) and Taiwan (hazard ratio = 0.994, 95% confidence interval [0.990, 0.997], p < .001). After adjusting for demographic, physical health, psychological health, and social engagement variables, life satisfaction remained significantly associated with mortality hazard in the United Kingdom, but not in Taiwan. CONCLUSIONS: This research confirms previous research showing higher life satisfaction as associated with improved survival among elderly people in the United Kingdom. Contrary to expectation, life satisfaction was not a predictor for mortality outcomes in the Taiwan sample when physical, psychological, and social predictors were included, although a baseline assessment showed that life satisfaction is important to predicting long-term survival among community-dwelling elderly people in both countries. The observed association between life satisfaction and mortality hazards may be attributed to common underlying causes such as self-rated health integration and/or health problems. Improving life satisfaction by promoting agents of health or other aspects of well-being and quality of life could have important long-term benefits for elderly people.

Human papillomavirus infection in lung and esophageal cancers: analysis of 485 Asian cases.

The role of human papillomavirus (HPV) in the development of lung and esophageal cancer remains inconclusive, which is in contrast to the established role HPV plays in the development of uterine cervical cancer. One of the reasons for this is the difference among reported HPV infection rates in these cancers. An analysis of 485 lung and esophageal cancers (176 lung squamous cell carcinoma, 128 lung adenocarcinoma, 181 esophageal carcinoma) in eight institutions in Asia (Tokyo, Kochi, Kagoshima, and Okinawa, Japan; Seoul and Daegu, Korea; Changhua, Republic of China (Taiwan); Singapore, Singapore) was carried out in order to clarify infection rates with HPV. Samples were examined in one laboratory of the Department of Pathology, the University of Tokyo, Japan in order to avoid inter-laboratory variation using a combination of polymerase chain reaction and in situ hybridization (ISH). HPV was found in 6.3%, 7%, and 9.4% of patients with lung squamous cell carcinoma, lung adenocarcinoma, and esophageal cancer, respectively. Among the geographic areas surveyed, Kagoshima exhibited a significantly higher prevalence of HPV infection in cases of esophageal carcinoma (24.1%). There was no geographical difference in the infection rates of HPV in lung carcinomas. Subtype-specific ISH was also performed, which identified the high-risk HPV types 16/18 in the majority (75.7%) of the patients with lung and esophageal cancer positive for HPV.

AKR1B10 in usual interstitial pneumonia: expression in squamous metaplasia in association with smoking and lung cancer.

The incidence of lung cancer (LC) is markedly increased among patients with usual interstitial pneumonia (UIP), and tobacco smoking is its superimposed risk factor. AKR1B10 (aldo-keto reductase 1B10) is frequently overexpressed in pulmonary squamous cell carcinoma and adenocarcinoma in smokers. To investigate the role of AKR1B10 in the pulmonary carcinogenesis in UIP with correlation to tobacco smoking, we examined 13 UIP cases with LC, 13 UIP cases without LC, and 30 cases of non-UIP LC using AKR1B10 immunohistochemistry. AKR1B10 immunoreactivity was confined to squamous metaplasia in honeycomb lesions of UIP and neoplastic cells of LC. Squamous metaplastic foci showed AKR1B10 immunoreactivity more frequently in UIP with LC (24/36 foci, 67%) than in UIP without LC (16/44 foci, 37%) (P<0.01). AKR1B10 expression in UIP was also more frequent in squamous metaplastic foci in smokers (38/67 foci, 57%) than in non-smokers (2/13 foci, 15%) (P<0.01). AKR1B10 expression was frequently observed in both UIP-associated LC (10/13 foci, 77%) and non-UIP LC (18/30 foci, 60%). Ki-67 labeling index was significantly higher in AKR1B10-positive squamous metaplasia of UIP than in AKR1B10-negative squamous metaplasia of UIP. Our results demonstrate that AKR1B10 is involved in the development of LC in UIP in association with smoking. AKR1B10 might be useful as a new marker for identification of high LC risk patients in UIP.