Magnetic resonance imaging-based radiomics analysis of the differential diagnosis of ovarian clear cell carcinoma and endometrioid carcinoma: a retrospective study.

PURPOSE: To retrospectively evaluate the diagnostic potential of magnetic resonance imaging (MRI)-based features and radiomics analysis (RA)-based features for discriminating ovarian clear cell carcinoma (CCC) from endometrioid carcinoma (EC). MATERIALS AND METHODS: Thirty-five patients with 40 ECs and 42 patients with 43 CCCs who underwent pretherapeutic MRI examinations between 2011 and 2022 were enrolled. MRI-based features of the two groups were compared. RA-based features were extracted from the whole tumor volume on T2-weighted images (T2WI), contrast-enhanced T1-weighted images (cT1WI), and apparent diffusion coefficient (ADC) maps. The least absolute shrinkage and selection operator (LASSO) regression with tenfold cross-validation method was performed to select features. Logistic regression analysis was conducted to construct the discriminating models. Receiver operating characteristic curve (ROC) analyses were performed to predict CCC. RESULTS: Four features with the highest absolute value of the LASSO algorithm were selected for the MRI-based, RA-based, and combined models: the ADC value, absence of thickening of the uterine endometrium, absence of peritoneal dissemination, and growth pattern of the solid component for the MRI-based model; Gray-Level Run Length Matrix (GLRLM) Long Run Low Gray-Level Emphasis (LRLGLE) on T2WI, spherical disproportion and Gray-Level Size Zone Matrix (GLSZM), Large Zone High Gray-Level Emphasis (LZHGE) on cT1WI, and GLSZM Normalized Gray-Level Nonuniformity (NGLN) on ADC map for the RA-based model; and the ADC value, spherical disproportion and GLSZM_LZHGE on cT1WI, and GLSZM_NGLN on ADC map for the combined model. Area under the ROC curves of those models were 0.895, 0.910, and 0.956. The diagnostic performance of the combined model was significantly superior (p = 0.02) to that of the MRI-based model. No significant differences were observed between the combined and RA-based models. CONCLUSION: Conventional MRI-based analysis can effectively distinguish CCC from EC. The combination of RA-based features with MRI-based features may assist in differentiating between the two diseases.

Identification of calmodulin-like protein 5 as tumor-suppressor gene silenced during early stage of carcinogenesis in squamous cell carcinoma of uterine cervix.

In the course of identifying the molecular mechanism that is related to strong cell-cell adhesion in stratified structures of the squamous epithelium, calmodulin-like protein 5 (CALML5) was identified as a spinous structure-associated protein by producing monoclonal antibodies with the use of the crude intercellular portion of squamous tissue as an immunogen and by subsequent morphologic screening. By electrophoretic mobility shift assay (EMSA) and a series of mutagenesis studies, two transcription factors, ZNF750 and KLF4, by binding in line to the CALML5 gene promoter, were found to play a central role in CALML5 transcription. Knockdown of CALML5 by siRNA in the A431 cell line that expresses high levels of CALML5 resulted in the acceleration of wound confluence in a scratch assay, indicating that CALML5 functions as a tumor-suppressor in uterine cervical cancer. Immunohistochemical evaluation of squamous intraepithelial lesions, carcinoma in situ (CIS) and invasive uterine cancer, revealed a reduction in CALML5 expression during the stages of CIS through various molecular pathways including the blockage of the nuclear translocation of KLF4. Conversely, restoration of the nuclear translocation of KLF4 by inhibiting ERK-signaling reactivated CALML5 expression in ME180 cells expressing low levels of CALML5. Thus, alteration of the p63-ZNF750-KLF4 axis may result in critical functional loss of CALM-related genes during cancer progression. Although the morphological association of CALML5 with the spiny-structure in relation to cell motility is not clear, evaluation of CALML5 expression provides a useful diagnostic indicator of differentiating dysplasia, preinvasive and invasive cervical cancers.

Comparison of single- and multiple-dose cefazolin as prophylaxis for transurethral enucleation of prostate: A multicenter, prospective, randomized controlled trial by the Japanese Research Group for Urinary Tract Infection.

OBJECTIVES: To compare the optimal administration period of antimicrobial prophylaxis in patients undergoing transurethral enucleation of the prostate for benign prostatic hyperplasia. METHODS: We carried out a randomized controlled trial to compare the differences in incidence of perioperative genitourinary tract infection between single and multiple (3 days) administrations of cefazolin for transurethral enucleation of the prostate in benign prostatic hyperplasia patients without pyuria or bacteriuria between January 2015 and December 2018. RESULTS: This multicenter randomized controlled trial included 203 patients who underwent a transurethral enucleation of the prostate procedure. All received antimicrobial prophylaxis, and were randomized into those who received single-dose (n = 101) or multiple-dose (n = 102) therapy. The rate of genitourinary tract infection after transurethral enucleation of the prostate for all patients was 1.5%, whereas that in the single-dose group was 1.0% and in the multiple-dose group was 2.0%, which were not significantly different (P = 1.00). CONCLUSIONS: A single dose of antimicrobial prophylaxis as a prophylactic antibacterial drug is sufficient for patients undergoing transurethral enucleation of the prostate who do not have presurgical pyuria or bacteriuria.

[PRIMARY SQUAMOUS CELL CARCINOMA OF THE PROSTATE: A CASE REPORT].

SQUAMOUS CELL CARCINOMA, prostate carcinoma, The patient was a 67-year-old man who visited our hospital with urge incontinence. His serum prostatic specific antigen level was normal (1.191 ng/mL). Digital rectal examination and magnetic resonance imaging suggested common prostatic carcinoma. A transperineal needle biopsy was performed, and the histological diagnosis was squamous cell carcinoma (SCC). The serum SCC-antigen level was normal, and the patient underwent a radical prostatectomy. Computed tomography 15 months later revealed multiple metastases in the lymph nodes. The patient underwent systemic chemotherapy using fluorouracil (5-FU) and cisplatin (CDDP). After 3 courses of chemotherapy, the multiple lymph node metastases could not be detected.

Usefulness of neuroimaging and immunohistochemical study for accurate diagnosis of chordoid glioma of the third ventricle: A case report and review of the literature.

BACKGROUND: Chordoid glioma of the third ventricle is a rare neuroepithelial tumor characterized by a unique histomorphology within the third ventricular region, but with radiological and histopathological features mimicking benign lesions such as meningioma. We report a case of chordoid glioma of the third ventricle and suggest a useful indicator for accurate diagnosis. CASE DESCRIPTION: A previously healthy 46-year-old woman was admitted to our hospital with mild headache. Neuroimaging revealed a large tumor measuring approximately 18 mm in the suprasellar region, and perifocal edema in the optic tract and internal capsule on magnetic resonance imaging. Laboratory findings revealed no pituitary dysfunction including diabetes insipidus. Gross total resection of the tumor was performed by the interhemispheric translamina terminalis approach. Histological findings revealed nests of regular epithelioid cells with large nuclei and abundant eosinophilic cytoplasm within myxoid stroma. Immunohistochemical studies demonstrated diffuse cytoplasmic expression of glial fibrillary acidic protein (GFAP) and CD34, and strong nuclear staining for thyroid transcription factor 1 (TTF-1). We, therefore, histologically classified the tumor as chordoid glioma of the third ventricle. Headache improved immediately postoperatively, and follow-up neuroimaging after 12 months showed no signs of recurrence. CONCLUSIONS: Chordoid glioma of the third ventricle is a very rare tumor that is difficult to diagnose on routine neuroimaging. Accurate diagnosis requires detailed analysis of neuroimaging and immunohistochemical studies using CD34 and TTF-1 staining.

Novel GLI3 variant causing overlapped Greig cephalopolysyndactyly syndrome (GCPS) and Pallister-Hall syndrome (PHS) phenotype with agenesis of gallbladder and pancreas.

BACKGROUND: A proper balance between the activator and the repressor form of GLI3, a zinc-finger transcription factor downstream of hedgehog signaling, is essential for proper development of various organs during development. Mutations in different domains of the GLI3 gene underlie several congenital diseases including Greig cephalopolysyndactyly syndrome (GCPS) and Pallister-Hall syndrome (PHS). CASE PRESENTATION: Here, we describe the case of an overlapped phenotype of these syndromes with agenesis of the gallbladder and the pancreas, bearing a c.2155 C > T novel likely pathogenic variant of GLI3 gene by missense point mutation causing p.P719S at the proteolytic cleavage site. CONCLUSIONS: Although agenesis of the gallbladder and the pancreas is uncommon in GLI3 morphopathy, a slight difference in the gradient or the balance between activator and repressor in this case may hinder sophisticated spatial and sequential hedgehog signaling that is essential for proper development of gallbladder and pancreas from endodermal buds.

Primary Type3 (Non-ABC, Non-GCB) Subtype of Extranodal Diffuse Large B-Cell Lymphoma of the Thyroid Bearing No MYD88 Mutation by Padlock Probe Hybridization.

Primary extranodal malignant lymphoma of the thyroid is a rare entity composed of mostly neoplastic transformation of germinal center-like B cells (GCB) or memory B cells. Other B-cell-type malignancies arising primarily in the thyroid have rarely been described. Immunohistochemical examination of autopsied primary malignant lymphoma of the thyroid in an 83-year-old Japanese female revealed the presence of a non-GCB subtype of diffuse large B-cell lymphoma (DLBCL) without the typical codon 206 or 265 missense mutation of MYD88. The lack of the highly oncogenic MYD88 gene mutation, frequently observed in DLBCL of the activated B-cell (ABC) subtype, and the detection of an extremely aggressive yet local clinical phenotype demonstrated that the present case was an exceptional entity of the type3 (non-GCB and non-ABC) subtype.

Changes in Gestational Weight Gain and Birth Weight in Women who Delivered at Hyogo Prefectural Kaibara Hospital in Tamba, Japan during 27 Years.

Two independent guidelines on appropriate weight gain for Japanese pregnant women have been established in 1997 and 2006. This study aimed to evaluate changes in the amount of gestational weight gain in pregnant women, the birth weight of their neonates, and the incidence of complications of pregnancy and neonatal outcome in women who delivered at Hyogo Prefectural Kaibara Hospital. Between 1988 and 2014, 6367 women delivered live singleton neonates at full term. The study period was divided into period I (1988-1996), period II (1997-2005), and period III (2006-2014). Changes in weight gain and birth weight were assessed. Complications of pregnancy and neonatal outcome were compared among the periods. Weight gain had been decreased in periods I and II, and weight gain was increased in period III. There was no difference in birth weights between the periods. The incidences of pregnancy-induced hypertension in periods II and III were higher than that in period I (p<0.01). The incidences of vacuum extraction in periods II and III were less than that in period I (p<0.01). The incidence of macrosomia in periods II was less than that in period I (p<0.01). There were no significant differences in the incidence of cesarean section, light-for-date, heavy-for-date, or low birth weight among the three periods. The establishment of guidelines for weight gain and maternity education based on the two guidelines significantly affected complications of pregnancy and neonatal outcome. Prevention of pregnancy-induced hypertension might be difficult when only reducing weight gain in pregnant women.

[Renal metastasis originating from colon cancer : a case report].

In 2008, a 65-year-old woman was referred to our department because of a right renal tumor detected by computed tomography (CT) that was associated with macroscopic hematuria. She underwent right hemicolectomy for ascending colon cancer in 2003, and right lower lobectomy for lung metastasis of colon cancer in 2004. CT, magnetic resonance imaging, fluorodeoxyglucose positron emission tomography computed tomography and bone scintigraphy did not indicate any other metastatic lesion except the right renal mass ; therefore, open right nephrectomy was performed. Results of the histopathologic examination demonstrated renal metastasis of colon cancer. Although administration of chemotherapy was continued, the patient died of multiple metastases 8 months after the right nephrectomy.

[Unclassified renal cell carcinoma accompanying pyonephrosis: a case report].

A 73-year-old male, admitted to a local hospital because of fever and consciousness disturbance, was referred to our institute. He had a history of long-term steroid administration and diabetes mellitus. Under diagnosis of severe right pyonephrosis associated with severe inflammatory response syndrome as well as disseminated intravascular coagulopathy, he was transferred to our hospital. Computed tomography and magnetic resonance imaging showed a mass 5 cm in diameter at the right ureteropelvic junction and lymph node swelling at the renal hilum, suggesting obstructive pyonephrosis by a malignant tumor such as renal pelvic cancer. Since the patient failed to respond to conservative medical treatment including polymyxin B hemoperfusion, hemodialysis, and antimicrobials, we performed right nephrectomy. Histopathological examination demonstrated that the tumor obstructing the pelvis arose from the parenchyme under the muscle layer, and was diagnosed as unclassified renal cell carcinoma while the renal pelvic epithelium was normal. Although his general condition and laboratory data transiently improved after nephrectomy, he died of carcinomatous peritonitis 30 days postoperatively. We advocate that, in the case of pyonephrosis with a lesion highly suspected to be an infiltrating neoplasm, nephrectomy is justified as first choice to control the septic condition.

Anterior cervical reconstruction with pedicle screws after a 4-level corpectomy.

STUDY DESIGN: Case report. OBJECTIVE: To describe a new method of anterior cervical reconstruction with pedicle screws. SUMMARY OF BACKGROUND DATA: Anterior reconstruction after multilevel corpectomy is a challenging technique, and there are many reports on its complications. Graft dislodgement is one of the major complications after long cervical fusion. The main cause of failure seems to be a lack of stability in the conventional reconstruction technique. However, pedicle screws for posterior cervical reconstruction show remarkable stability. We describe a new technique of anterior cervical reconstruction with pedicle screws and fibular strut grafting. METHODS: Seven patients with multilevel cervical myelopathy were treated with this new reconstruction technique after a 4-level corpectomy. We describe this new technique and review the patients' clinical history, results of radiographical imaging, and outcomes. Clinical outcomes were assessed preoperatively and at 3 months postoperatively. Postoperative radiographs were assessed 3 months and 6 months postoperatively. RESULTS: The mean operative time was 182 minutes and the mean blood loss was 271 mL. The average Japanese Orthopaedic Association score for cervical myelopathy improved from 11.5 points preoperatively to 14.5 points 3 months postoperatively. No patients experienced major complications, such as neurological deterioration, infection, or massive blood loss. There was no case of reconstruction failure, graft dislodgement, migration, or screw displacement. CONCLUSION: To our knowledge, this is the first description of an anterior cervical reconstruction approach, using pedicle screws and fibular strut grafting after a 4-level corpectomy. It is likely that this technique will result in better clinical outcomes with fewer complications in the treatment of patients with multilevel cervical myelopathy.

Primary carcinoid tumor of the urinary bladder with prominent subnuclear eosinophilic granules.

Primary carcinoid tumor of the urinary bladder is a very rare neoplasm. We report here a case of primary carcinoid tumor of the urinary bladder with an unusual cytological feature in a 72-year-old Japanese man. A bladder polypoid mass was incidentally found by ultrasonography during the follow-up of a benign prostate hyperplasia. Histological examination of the transurethrally resected tissue revealed that the upper part of the mass was a tumor showing tubuloglandular anastomosing structures. Most of the tumor cells had peculiar subnuclear eosinophilic granules. The features of the granules were reminiscent of those observed in neuroendocrine cells of the intestine. The tumor cells were immunohistochemically positive for chromogranin A and synaptophysin. The tumor was diagnosed as carcinoid tumor of pure form of the urinary bladder. The lower part of the mass showed the findings of glandular cystitis, as its coexistence with carcinoid tumors of the bladder has often been described in previous reports.

Apoptosis of bladder cancer by sodium butyrate and cisplatin.

The effects of sodium butyrate (SB), a histone deacetylase inhibitor, in combination with cisplatin (CDDP), for inhibition of cell growth and induction of apoptosis were investigated in bladder cancer cell lines in vitro. Bladder cancer cell lines T24, 253J, and UMUC3 were treated with different concentrations of CDDP or SB. Cell proliferation was studied by XTT assay. Cell-cycle analysis and induction of apoptosis were analyzed by laser scanning cytometry (LSC). Western blot analysis was used to determine expression of p21, p27, TRADD, FADD, caspase-2, and caspase-7. We observed that SB in combination with CDDP induced significant inhibition of cell growth in a dose-dependent manner through G1 arrest and apoptosis, as determined by LSC. When bladder cancer cell lines were treated with SB plus CDDP, Western blotting showed increased expression of p21 but not p27 in T24 cells, whereas both p21 and p27 increased in 253J and UMUC3 cells. All cell lines exhibited a moderate increase in TRADD and decrease in procaspase-2 but no significant change in FADD and procaspase-7. The results showed the synergistic anticancer effect of SB in combination with CDDP, their potential for treatment of bladder cancer, and their mechanism of action in terms of cell signal transduction and induction of apoptosis.

[Metachronous urothelial cancer in bilateral upper urinary tracts and bladder associated with hereditary nonpolyposis colorectal cancer].

A 40-year-old man had undergone right hemicolectomy and sigmoidectomy under the diagnosis of ascending and sigmoid colon cancer and right nephroureterectomy under the diagnosis of right ureteral cancer, in 1997 and in 2002, respectively. In 2007, He visited our hospital with a complaint of bloody stool and hematuria. Colon fiberscopy, ureteropelvicscopy and cystoscopy demonstrated colon cancer, left renal pelvis cancer and bladder cancer, respectively, as diagnosed by biopsies, followed by restative colectomy, left nephroureterectomy and cystectomy. The final histopathological examination showed well differentiated adenocarcinoma (pSM) in the colon, and urothelial carcinoma in the left renal pelvis (pT2) and the bladder (pT1). Since his uncle and elder brother had suffered from stomach cancer and colon cancer, respectively, he was diagnosed with hereditary nonpolyposis colorectal cancer (HNPCC : Lynch syndrome). He has been well doing without recurrence for 3 years after the surgery.

[A case of primary urothelial carcinoma of the prostate responsive to MVAC intra-arterial chemotherapy: a case report].

A 70-year-old man visited a urological clinic on May 2008 complaining of dysuria and nocturia since 2 years prior. He was diagnosed as having gross benign prostatic hypertrophy, and was referred to a nearby hospital for transurethral resection of prostate (TURP). During TURP, a papillary tumor was found in the prostatic urethra on the left side and a biopsy was performed. A pathological examination revealed urothelial carcinoma G3. Cystoprostatectomy was planned, but the patient refused the procedure. Therefore, he underwent three courses of MVAC intra-arterial chemotherapy (methotrexate, vinblastin, doxorubicin, cisplatinum) at our hospital. After chemotherapy, no tumor was found in the prostatic urethra and a pathological report of repeat TUR showed no tumor. Currently, the patient is alive and there has been no evidence of recurrence for 1 year and 10 month.

A single-dose regimen for antimicrobial prophylaxis to prevent perioperative infection in urological clean and clean-contaminated surgery.

A single dose of antimicrobial prophylaxis (AMP) was administered parenterally for the prevention of perioperative infection in a total of 788 patients undergoing urological surgery, including 380 endoscopic-instrumental, 328 clean, and 80 clean-contaminated operations performed at our institute between January 2007 and December 2009. Surgical site infections (SSIs), urinary tract infections (UTIs), and remote infections (RIs) were prospectively surveyed. The definition for a single dose of AMP allowed for the administration of an additional dose of an antimicrobial during surgery if the procedure was longer than 3 h, but not for the parenteral or oral administration at the end of the procedure in the recovery room, or at a later time over a period of more than 24 h. UTI was observed in 12 (3.2%) patients after endoscopic-instrumental operation, 1 (0.3%) after clean operation, and 1 (0.9%) after clean-contaminated operation. SSI was observed in 2 (0.6%) patients after clean operation but in none after clean-contaminated operations. RI was observed in 1 (0.3%) patient after endoscopic-instrumental operation, 3 (0.9%) after clean operation, and none after clean-contaminated operations. A single-dose regimen of AMP was effective and feasible for the prevention of perioperative infections, including SSIs, UTIs, and RIs, in endoscopic-instrumental, clean, and clean-contaminated urological surgical procedures.

The nationwide study of bacterial pathogens associated with urinary tract infections conducted by the Japanese Society of Chemotherapy.

This study was conducted by the Japanese Society of Chemotherapy and is the first nationwide study on bacterial pathogens isolated from patients with urinary tract infections at 28 hospitals throughout Japan between January 2008 and June 2008. A total of 688 bacterial strains were isolated from adult patients with urinary tract infections. The strains investigated in this study are as follows: Enterococcus faecalis (n = 140), Escherichia coli (n = 255), Klebsiella pneumoniae (n = 93), Proteus mirabilis (n = 42), Serratia marcescens (n = 44), and Pseudomonas aeruginosa (n = 114). The minimum inhibitory concentrations of 39 antibacterial agents used for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. All Enterococcus faecalis strains were susceptible to ampicillin and vancomycin. Although a majority of the E. faecalis strains were susceptible to linezolid, 11 strains (7.8%) were found to be intermediately resistant. The proportions of fluoroquinolone-resistant Enterococcus faecalis, Escherichia coli, Proteus mirabilis, and S. marcescens strains were 35.7%, 29.3%, 18.3%, and 15.2%, respectively. The proportions of E. coli, P. mirabilis, K. pneumoniae, and S. marcescens strains producing extended-spectrum ß-lactamase were 5.1%, 11.9%, 0%, and 0%, respectively. The proportions of Pseudomonas aeruginosa strains resistant to carbapenems, aminoglycosides, and fluoroquinolones were 9.2%, 4.4%, and 34.8%, respectively, and among them, 2 strains (1.8%) were found to be multidrug resistant. These data present important information for the proper treatment of urinary tract infections and will serve as a useful reference for periodic surveillance studies in the future.

[A case of lymphangioma of the intrascrotum in an adult].

We reported a rare case of intrascrotal lymphangioma in an adult. A 31-year-old man visited a urological clinic with a chief complaint of left scrotal swelling since a few days ago, and was pointed out to have a left intrascrotal cystic mass. The patient was sent to our hospital for further examination in 23 April 2008. The left scrotal mass was palpated elastic hard below the left testis and its surface was irregular. Light transillumination test showed positive. Ultrasonography revealed a cystic mass 7.0 x 4.4 x 4.5 cm with multiseptate accumulation at the lower pole of the left testis. Magnetic resonance imaging showed low intensity by T1WI and high intensity by T2WI, suggesting a protein-rich component. We suspected left intrascrotal lymphangioma and extirpated the scrotal mass under lumbar anesthesia. Pathological examination demonstrated lymphangioma. The patient had no evidence of recurrence after 1 year.

[A case of primary testicular malignant lymphoma associated with contralateral testicular recurrence after a nine-year interval: a case report].

A 69-year-old man visited our hospital in February 1996 with a chief complain of left scrotal swelling. The left scrotal content was hard by palpation and ultrasonography showed a hypo-echoic lesion. Left high orchiectomy was performed with suspicion of a testicular tumor. Pathological examination demonstrated a diffuse large B-cell lymphoma (DLBCL) originating from the left testis, and then he underwent 5 courses of chemotherapy consisting of THP-COP (THP-adriamycin, cyclophosphamide, vincristin, predonisone). Following the treatment for five years, he had no evidence of recurrence. Nine years later, in October 2005, he noticed right scrotal swelling. He underwent right high orchiectmy with suspicion of a contralateral testicular malignant lymphoma. Pathological examination revealed DLBCL. He underwent chemotherapy (rituximab-THP-COP) and achieved complete remission again. He is doing well without recurrence of disease for three years after the last treatment.