"Double eyes" sign of congenital bilateral dacryocystoceles.

Dacryocystocele is caused by nasolacrimal duct obstruction and results in cystic dilatation of the proximal part of the nasolacrimal duct, which is located inferomedial to the orbit, leading to fluid accumulation. It is important to consider that persistent congenital bilateral dacryocystoceles may cause neonatal nasal obstruction resulting in respiratory difficulty, and large dacryocystoceles may require surgical drainage. Ultrasonography demonstrates that congenital bilateral dacryocystoceles and normal eyeballs prenatally resemble two pairs of cystic "lesions" of different sizes. We herein present a case of prenatally diagnosed isolated congenital bilateral dacryocystoceles and propose the new name of "double eyes" sign for this rare condition to create an impact on medical students and residents.

Pre-treatment mitotic index versus computer-quantitated Ki-67 nuclear antigen labeling index as predictors of response to neoadjuvant chemotherapy in uterine cervical carcinoma.

In order to evaluate the usefulness of the mitotic index (MI) and the Ki-67 nuclear antigen labeling index (Ki67LI) in pre-treatment biopsy specimens as predictors of response to chemotherapy for uterine cervical carcinomas, twelve patients with squamous cell carcinoma who received neoadjuvant chemotherapy before radical surgery were investigated. The MI and computer-quantitated Ki67LI were determined using H&E and immunostained slides of biopsy specimens collected before chemotherapy. Tumor size was measured three-dimensionally by MR imaging, and assessed before and after chemotherapy. We compared the values of MI and Ki67LI with changes in tumor size and the following results were obtained. 1) The percentage reduction in tumor size ranged from 0 to 98%. The MI ranged from 0.5 to 15, and Ki67LI ranged from 0.01 to 50.1%. 2) A significant positive correlation was observed between response to chemotherapy assessed on MR image and MI [Spearman's correlation coefficient (r) =0.66, n=12, p=0.027], and between response to chemotherapy and Ki67LI (r=0.72, n=12, p=0.017). 3) A significant correlation was observed between MI and computer-assessed Ki67 LI [Pearson's correlation coefficient (r) =0.80, n=12, p=0.002]. Therefore, pre-chemotherapy MI and Ki67LI were both good predictors of response to platinum-based chemotherapy. Because MI is technically more convenient and economically less expensive than computer-quantitated Ki67LI, MI remains a simple and reliable predictor from the clinical point of view.

Association of ovarian tumor epithelium coexpressing HLA-DR and CA-125 antigens with tumor infiltrating cytotoxic T lymphocytes.

Understanding of the relationship between tumor infiltrating cytotoxic T lymphocytes (CD 8(+)TILs) and tumor cells as well as tumor-associated antigens is important and may reflect the extent of immune response of the patient to the tumor, thus providing a useful clue relevant to the prognosis. The purpose of this study was to determine the relationship between the expression of HLA-DR and CA-125 antigens and the presence of CD 8(+)TILs with regard to the established clinicopathological factors of ovarian carcinomas using immunohistochemical methods. Thirty-one ovarian carcinomas consisting of 20 serous, 7 mucinous, and 4 clear cell types were examined. Of these, 18 (58%) and 22 (71%) were positive for HLA-DR and CA-125 antigens respectively, and the overall mean number of the CD 8(+)TILs was 7.2+/-2.9. A significant association was observed between the mean number of CD8(+)TILs and tumor grade (P=0.01), disease stage (P=0.003), and patient outcome (P=0.01). The mean number of CD 8(+)TILs in HLA-DR positive (8.6+/-2.2) or CA-125 positive (8.4+/-2.1) tumors was significantly higher than that in HLA-DR negative (5.2+/-2.5; P=0.0003) or CA-125 negative (4.2+/-2.2; P=0.00002) tumors. These significant levels were further enhanced by one order of magnitude when the mean number of CD 8(+)TILs in tumors positive for both HLA-DR and CA-125 antigens (9.1+/-1.7) was compared to that in HLA-DR negative or CA-125 negative tumors. The frequency of cancer-related deaths in HLA-DR and CA-125 positive tumors was significantly lower than in the negative tumors (P=0.01). These data suggest that concurrent expression of HLA-DR and CA-125 antigens may augment the immune response of the patient to the tumor, thus providing a potential clue relevant to the prognosis.

A case of ovarian endometrioid adenocarcinoma with yolk sac tumor component in a postmenopausal woman.

The co-existence of an endometrioid adenocarcinoma with an ovarian yolk sac tumor is very rare. Only eight cases have been reported in the English language literature. A 54-year-old postmenopausal woman with a 6-month history of progressive abdominal distension was seen at our hospital. MR imaging revealed a large cyst with a solid intramural node. Serum alpha-fetoprotein and CA125 levels were 13143 ng/ml and 170 U/ml, respectively. At laparotomy, a large tumor approximately 20 cm in diameter was found to occupy the abdominal cavity, adhering to the swollen appendix and part of the omentum. Microscopically, foci of endometrioid adenocarcinoma together with a yolk sac tumor component were observed within a large endometriotic cyst. Since the tumor was clinically staged 1c, the patient was given 500 mg of intraperitoneal carboplatin postoperatively, followed by five courses of combination chemotherapy consisting of cisplatin, etoposide and peplomycin at 4-week intervals. The levels of both serum alpha-fetoprotein and CA 125 decreased gradually to normal ranges and remained normal at the most recent follow-up on 29 December, 2001. In contrast to a very poor prognosis of this tumor in previously reported cases, our patient showed no sign of recurrence during a 21-month follow-up period.