Publications by authors named "Kanako Ogura"

56 Publications

Dysgerminoma with Estrogen-Producing Functioning Stroma Presenting Precocious Puberty.

Case Rep Pathol 2021 22;2021:5545645. Epub 2021 Apr 22.

Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Tokyo, Japan.

Dysgerminoma is a malignant ovarian germ cell tumor, and unlike sex-cord stromal tumors, endocrine manifestation is considered rare. Here, we report the first case of dysgerminoma presenting precocious puberty. The patient is a 7-year-old girl who presented with a breast development in Tanner stage 3. Serum estradiol (E) was markedly elevated while luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were suppressed below the detection limit. Microscopically, the right ovarian mass displayed nests of large polygonal cells and fibrous septa which were focally concentrated by theca-like plump spindle cells. Immunohistochemistry revealed that the spindle cells expressed various steroidogenic enzymes involved in estrogen biosynthesis including P450 aromatase. The tumor was diagnosed with pure dysgerminoma with estrogen-producing functioning stroma. After the operation, serum E declined below the detection limit; LH and FSH returned within the normal range. This case demonstrates that even a conventional dysgerminoma can present endocrine manifestation through functioning stroma.
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http://dx.doi.org/10.1155/2021/5545645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112997PMC
April 2021

Plasmablastic Lymphoma of the Small Intestine in an HIV- and EBV-negative Patient.

Intern Med 2021 Mar 29. Epub 2021 Mar 29.

Department of Gastroenterology, Juntendo University, Japan.

Plasmablastic lymphoma (PBL) is a rare aggressive B-cell lymphoproliferative disorder that is strongly associated with immunodeficiency, most often with human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) infection, and that mainly occurs in the oral cavity. Although some clinical features can lead to a diagnosis, PBL in an extraoral site is difficult to suspect clinically in a patient who is HIV negative. The small intestine as a site of PBL has also been described very rarely. We herein present a rare case of PBL of the small intestine in an 85-year-old HIV- and EBV-negative male.
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http://dx.doi.org/10.2169/internalmedicine.6837-20DOI Listing
March 2021

Oncocytic intraductal carcinoma of salivary glands: a distinct variant with TRIM33-RET fusions and BRAF V600E mutations.

Histopathology 2020 Nov 1. Epub 2020 Nov 1.

Department of Anatomical Pathology, Tokyo Medical University, Tokyo, Japan.

Aims: Salivary gland intraductal carcinoma (IDC) is a complex ductal neoplasm surrounded by a layer of myoepithelial cells. Recent insights have shown that there are three different types: intercalated duct-like, with frequent NCOA4-RET fusions; apocrine, with salivary duct carcinoma-like mutations; and mixed intercalated duct-like/apocrine, with RET fusions, including TRIM27-RET. In addition, an oncocytic IDC has been described, but it remains unclear whether it represents a fourth variant or simply oncocytic metaplasia of another IDC type. Our aim was to more completely characterize oncocytic IDC.

Methods And Results: Six IDCs with oncocytic changes were retrieved from the authors' archives, from three men and three women ranging in age from 45 to 75 years (mean, 63 years). Five arose in the parotid gland, with one in an accessory parotid gland. Four patients with follow-up were free of disease after 1-23 months. Several immunostains (S100, mammaglobin, androgen receptor, and p63/p40) and molecular tools (RNA sequencing, RET fluorescence in-situ hybridisation, BRAF V600E VE1 immunohistochemistry, and Sanger sequencing) were applied. Histologically, the tumours were variably cystic with solid intracystic nodules often difficult to recognise as intraductal. In all, tumour ducts were positive for S100 and mammaglobin, negative for androgen receptor, and completely surrounded by myoepithelial cells positive for p63/p40. Molecular analysis revealed TRIM33-RET in two of six cases, NCOA4-RET in one of six cases, and BRAF V600E in two of six cases. One case had no identifiable alterations.

Conclusions: Oncocytic IDC shares similarities with intercalated duct-like IDC. Although additional verification is needed, the oncocytic variant appears to be sufficiently unique to be now regarded as the fourth distinct subtype of IDC. Because of its indolent nature, oncocytic IDC should be distinguished from histological mimics.
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http://dx.doi.org/10.1111/his.14296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315294PMC
November 2020

Improved FcεRI-Mediated CD203c Basophil Responsiveness Reflects Rapid Responses to Omalizumab in Chronic Spontaneous Urticaria.

J Allergy Clin Immunol Pract 2021 03 6;9(3):1166-1176.e8. Epub 2020 Sep 6.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.

Background: Omalizumab is effective in patients with chronic spontaneous urticaria (CSU) although its mechanism of action is poorly understood. Several studies reported that decreased high-affinity IgE receptor (FcεRI)-mediated histamine release and/or responsiveness was characteristic of basophils in patients with CSU. However, few studies have focused on the relationship between changes in basophil responsiveness via FcεRI after omalizumab treatment and the therapeutic effect in patients with CSU.

Objective: To assess basophil responsiveness via FcεRI stimulation, as well as FcεRI expression and IgE binding on blood basophils from patients with CSU before and after omalizumab treatment and its possible association with the clinical response.

Methods: We analyzed 34 patients with CSU treated with omalizumab who were categorized as fast responders (FRs) (n = 20) and non or slow responders (N/SRs) (n = 14). CD203c expression induced by FcεRI stimulation, and IgE and FcεRI expressions on blood basophils from patients with CSU before and after omalizumab treatment were analyzed. Basophil responsiveness via FcεRI stimulation was observed in vitro using basophils pretreated with omalizumab.

Results: FRs had increased CD203c responsiveness after treatment with omalizumab compared with N/SRs. This improvement of basophil responsiveness via FcεRI stimulation in FRs was not observed in peripheral blood basophils preincubated with omalizumab in vitro, suggesting that omalizumab does not directly affect circulating pre-existing abnormal basophils.

Conclusion: Increased basophil responsiveness via FcεRI after omalizumab treatment is associated with the therapeutic effect and mechanism of action of omalizumab.
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http://dx.doi.org/10.1016/j.jaip.2020.08.048DOI Listing
March 2021

Molecular and clinicopathological features of appendiceal mucinous neoplasms.

Virchows Arch 2021 Mar 21;478(3):413-426. Epub 2020 Aug 21.

Department of Human Pathology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.

Appendiceal mucinous tumors (AMTs) include low-grade mucinous appendiceal neoplasms (LAMNs), high-grade mucinous appendiceal neoplasms (HAMNs), and mucinous adenocarcinomas (MACs). We collected 51 AMT samples (LAMN: 34, HAMN: 8, MAC: 9). Three of the eight HAMN cases contained LAMN components, and four out of nine MAC cases contained LAMN and/or HAMN components within the tumor. A next-generation sequencing (NGS) cancer hotspot panel was used to analyze 11 pure LAMN, 4 HAMN, and 3 MAC cases. The results revealed KRAS and GNAS as the most frequently mutated genes. Sanger sequencing was then performed to detect KRAS, GNAS, and TP53 mutations in the remaining 31 cases and RNF43 mutations in all cases. KRAS/GNAS and TP53 mutations occurred exclusively in pure LAMNs; however, five LAMN cases had mutations in both KRAS and GNAS. RNF43 mutations almost exclusively occurred with KRAS/GNAS mutations in pure LAMNs. In MAC and HAMN, KRAS/GNAS mutation status was nearly preserved between lower-grade areas. Most of the detected RNF43 mutations was missense type. RNF43 mutations were detected in both components of MAC with lower-grade area; however, RNF43 mutations detected in these two lesions were entirely different. RNF43 mutations were detected in only one of the eight HAMN patients, which was the sole case without pseudomyxoma peritonei (PMP). None of the four MAC patients with RNF43 mutation showed PMP. These findings suggest that RNF43 mutations occur at a later stage of MAC development and do not associate with PMP. Furthermore, a gradual transition from LAMN to MAC via HAMN could be considered.
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http://dx.doi.org/10.1007/s00428-020-02906-5DOI Listing
March 2021

Hydrocele of the Canal of Nuck with Endometriosis: Right-Side Dominance Confirmed by Literature Review and Statistical Analysis.

Case Rep Pathol 2020 4;2020:2567267. Epub 2020 May 4.

Department of Diagnostic Pathology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, Japan.

. The canal of Nuck is an embryological remnant of the peritoneal pouch that extends into the labium majus of women. Hydrocele is the most common presentation, but only a small number of cases are reported in association with endometriosis. . The patient is a 45-year-old woman who presented with left inguinal mass with persistent pain. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 30 mm cystic mass, and a hydrocele of the canal of Nuck (HCN) was suspected. The excised mass was a cyst containing yellow-tan serous fluid, and the cyst wall was lined by mesothelium. The morphology was consistent with conventional HCN. However, since several foci of endometrial-like epithelium and stroma were identified beneath the mesothelium, the mass was diagnosed with HCN with endometriosis (EM-HCN). . Right-side dominance of EM-HCN is suggested by several authors, but a thorough review has never been performed. For the first time, we reviewed the literature and statistically confirmed that EM-HCNs dominantly occur on the right side compared to those without endometriosis. We consider that this supports the theory that endometriosis derives from retrograde menstruation of endometrial tissue through fallopian tubes. When endometriosis is discovered in HCN, the clinician should be aware of the possibility of pelvic endometriosis.
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http://dx.doi.org/10.1155/2020/2567267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368960PMC
May 2020

Development of MRI Projection Mapping System for Breast-Conserving Surgery in the Operating Room: Preliminary Clinical Results in Invasive Breast Cancer.

Biomed Res Int 2020 29;2020:5314120. Epub 2020 Jun 29.

Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.

Aim: To evaluate the feasibility of a newly developed prototype MRI projection mapping (PM) system for localization of invasive breast cancer before breast-conserving surgery.

Methods: This prospective study enrolled 10 women with invasive breast cancer. MRI was performed in both prone and supine positions. The tumor location was drawn on the breast skin using palpation and sonography while referring to the prone MRI (i.e., a conventional method). A maximum intensity projection image generated from the supine MRI was projected using our PM system, and the tumor location was drawn. The PM system consisted of a projector and a camera and was used to measure the shape of the breast surface using the structured light method. Breast-conserving surgery was performed based on the conventional method. We compared the tumor size and location between the PM and conventional methods or pathology.

Results: There were no significant differences in the maximum diameters of invasive cancers between the PM system and the conventional method or pathology. The maximum discrepancy in tumor location between the PM and conventional method was 3-8 mm.

Conclusions: This PM system may support breast-conserving surgery by showing the tumor size and location on the breast surface.
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http://dx.doi.org/10.1155/2020/5314120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341375PMC
April 2021

Pazopanib as a potential chemotherapy for cutaneous angiosarcoma: A case series of 10 patients from a single institution.

J Dermatol 2020 Jul 12;47(7):e273-e274. Epub 2020 May 12.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.

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http://dx.doi.org/10.1111/1346-8138.15381DOI Listing
July 2020

[Spindle cell type anaplastic carcinoma of the pancreas: review of 27 Japanese case reports].

Nihon Shokakibyo Gakkai Zasshi 2020 ;117(5):430-436

Department of Diagnostic Pathology, Juntendo University Nerima Hospital.

Spindle cell type anaplastic carcinoma of the pancreas is extremely rare and has a very poor prognosis. A previously healthy 68-year-old woman was referred to our hospital due to a large tumor in the body of the pancreas. Abdominal computed tomography revealed an irregular, well-enhanced 140-mm tumor containing a cystic component. The patient underwent distal pancreatectomy for a possible malignant tumor (e.g., mucinous cystic neoplasms). Histological examination showed that the tumor contained spindle-shaped cells and adenocarcinoma with nuclear atypia, and a definitive diagnosis of anaplastic carcinoma spindle cell type was made. A review of 27 cases reported in Japan revealed 43% of these lesions invaded other organs, and 26% were classified in Stage IV at the time of diagnosis. Postoperative recurrence rate was 78.2%, and mortality rate was 59.3%. Early diagnosis and sequential radial surgery would improve the poor prognosis.
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http://dx.doi.org/10.11405/nisshoshi.117.430DOI Listing
July 2020

Establishment of the basophil activation test to detect photoallergens in solar urticaria.

J Allergy Clin Immunol Pract 2020 09 26;8(8):2817-2819.e1. Epub 2020 Apr 26.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan.

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http://dx.doi.org/10.1016/j.jaip.2020.04.042DOI Listing
September 2020

Clinical utility of the basophil activation test in the diagnosis of sweat allergy.

Allergol Int 2020 Apr 12;69(2):261-267. Epub 2019 Oct 12.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.

Background: Many patients with atopic dermatitis and cholinergic urticaria display an immediate-type allergy to autologous sweat. Although the histamine release test (HRT) using semi-purified sweat antigen (QR) was available for the detection of immediate sweat allergy, the existence of HRT low responders could not be disregarded. Furthermore, it has not been established whether the results of the HRT are consistent with the autologous sweat skin test (ASwST). We aimed to compare the HRT and basophil activation test (BAT) for the diagnosis of immediate sweat allergy.

Methods: The HRT and BAT were performed on 47 subjects (35 ASwST positive, 12 negative) whose symptoms had worsened on sweating. For the BAT, blood was incubated with QR or crude sweat and CD203c upregulation was assessed. A commercial HRT was performed and histamine release induced by QR was quantified.

Results: When excluding non-responders for anti-IgE antibody, the BAT using QR and the HRT had a sensitivity of 100% and 44% and specificity of 75% and 100%, respectively. The BAT and HRT had a positive predictive value of 91.3% and 100% and negative predictive value of 100% and 30%, respectively. The BAT detected 0% non-responders, whereas the HRT identified 22.5%. When using crude sweat for the BAT, the false-positives observed when using QR were not detected.

Conclusions: The BAT using QR displayed a higher sensitivity and negative predictive value and a lower number of non-responders compared with the HRT. Furthermore, the BAT using crude sweat can also be an alternative tool for the ASwST.
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http://dx.doi.org/10.1016/j.alit.2019.09.003DOI Listing
April 2020

Low Responsiveness of Basophils via FcεRI Reflects Disease Activity in Chronic Spontaneous Urticaria.

J Allergy Clin Immunol Pract 2019 Nov - Dec;7(8):2835-2844.e7. Epub 2019 May 25.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.

Background: The insufficient effect of H1-antihistamine in some patients with chronic spontaneous urticaria (CSU) suggests that factors other than histamine are involved in the pathophysiology of CSU. Moreover, a central role for basophils in the pathophysiology of CSU has been hypothesized. However, few studies have focused on the relationship between basophil reactivity via FcεRI and clinical features in patients with CSU.

Objective: To assess basophil reactivity via FcεRI against anti-IgE and FcεRI stimulation in patients with CSU, and its association with disease activity in CSU. FcεRI expression and IgE binding on basophils from patients with CSU were also investigated.

Methods: We analyzed 38 patients with CSU, 8 patients with atopic dermatitis (AD), and 11 healthy controls (HCs). The surface CD203c expression with or without anti-IgE or FcεRI stimulation, and IgE and FcεRI (CRA1, CRA2) expression on blood basophils were evaluated. Patients with CSU were also evaluated and classified by disease activity and the above parameters were compared.

Results: The proportion of CD203c basophils after anti-IgE or anti-FcεRI stimulation was lower in patients with CSU compared with HCs and patients with AD. It was lowest in the CSU group with severe disease. Basophils from patients with CSU had higher FcεRI (CRA1) expression, although it was not closely related to the severity of CSU. Subgroup analysis revealed that patients with CSU showing low responsiveness of basophils via FcεRI exhibited a short duration of disease but severe disease activity.

Conclusions: Low reactivity of basophils via FcεRI is characteristic of patients with CSU. This attenuated reactivity is associated with severe clinical activity in patients with CSU (250 of 250).
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http://dx.doi.org/10.1016/j.jaip.2019.05.020DOI Listing
October 2020

Hepatic Sclerosing Hemangioma with Predominance of the Sclerosed Area Mimicking a Biliary Cystadenocarcinoma.

Case Reports Hepatol 2018 4;2018:7353170. Epub 2018 Oct 4.

Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Japan.

We report here an extremely rare case of hepatic sclerosing hemangioma mimicking a biliary cystadenocarcinoma. A previously healthy 39-year-old woman was referred to our hospital because of a large tumor in the liver. Abdominal computed tomography revealed early peripheral ring enhancement in the arterial phase and slight internal heterogeneous enhancement in the delayed phase. Magnetic resonance imaging revealed a tumor with low intensity in the T1-weighted image and very high intensity in the fat-saturated T2-weighted image. The patient underwent hepatectomy for a possible malignant liver tumor. Grossly, the tumor appeared as a white, solid, and cystic mass (weighted 1.1 kg and measured 170×100×80 mm) that was elastic, soft, and homogeneous with a yellowish area. Histological examination showed that the tumor mostly consisted of fibrotic areas with hyalinization. The typical histology of cavernous hemangioma was confirmed in part, and the tumor was diagnosed as a sclerosing hemangioma with predominancy of the sclerosed area. A review of 20 cases reported previously revealed that only 2 (10%) patients were diagnosed as having sclerosing hemangioma preoperatively.
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http://dx.doi.org/10.1155/2018/7353170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193354PMC
October 2018

Pyloric Gland Adenoma (PGA) of the Gallbladder: A Unique and Distinct Tumor from PGAs of the Stomach, Duodenum, and Pancreas.

Am J Surg Pathol 2018 09;42(9):1237-1245

Department of Human Pathology, School of Medicine, Juntendo University.

Twenty-four surgically resected, gallbladder pyloric gland adenomas (GB-PGAs) were examined and their features were compared with the reported features of stomach, duodenum, and pancreatic PGAs to better understand GB-PGAs. Clinical information on background gallbladder lesions and histologic data, including tumor grade, existence of squamoid morules, intratumoral cholesterosis, and intracytoplasmic mucins were collected. Immunohistochemical staining for MUC2, MUC5AC, MUC6, CDX2, pepsinogen I, p53, and MIB-1/nuclear β-catenin were evaluated. Targeted mutational analyses of KRAS exon2, GNAS exon 7, and CTNNB1 exon 3 were conducted. We found that 29.2% of the GB-PGAs were histologically high-grade dysplasias/carcinomas; 70.8% were low grade; and 20.8% and 33.3% contained squamoid morules and intratumoral cholesterosis, respectively. In addition, 45.8% and 54.2% of GB-PGAs were mucin-rich and mucin-poor types, respectively. Immunohistochemically, MUC6 was diffusely positive in all GB-PGAs; MUC2, MUC5AC, and CDX2 were only focally positive, and no pepsinogen-I positive cells were observed. Nuclear β-catenin accumulation was observed in all cases; however, the ratio varied among cases. Mucin-poor types were significantly associated with high histologic grade dysplasias/carcinomas and high nuclear β-catenin labeling indices. Mutational analyses identified CTNNB1 mutations in 100% of GB-PGAs (21/21), KRAS in 4.2% (1/23), and GNAS in 0% (0/22). The present study clarified the unique histologic features, phenotypic differentiation, and molecular statuses frequently associated with GB-PGAs. Altogether, our data suggest that tumorigenesis of GB-PGA is distinct from that of stomach, duodenum, and pancreatic PGAs.
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http://dx.doi.org/10.1097/PAS.0000000000001117DOI Listing
September 2018

Coexistence of Cervical Leiomyosarcoma and Gastric-Type Adenocarcinoma In Situ with Extensive Extension to the Endometrium and Fallopian Tube.

Case Rep Pathol 2018 18;2018:5848629. Epub 2018 Feb 18.

Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Tokyo, Japan.

Cervical leiomyosarcoma is known to be rare from the previous reviews of a large number of malignant cervical tumors. The patient was a 66-year-old woman with irregular vaginal bleeding. She underwent modified radical hysterectomy and bilateral salpingooophorectomy. Histopathologically, we diagnosed the coexistence of uterine cervical leiomyosarcoma and cervical gastric-type adenocarcinoma in situ with endometrial lesions that had continuous and skip patterns and fallopian tubal lesions with a partial lesion. To the best of our knowledge, cases of synchronous leiomyosarcoma and cancers have not often been reported; only two cases of synchronous cervical leiomyosarcoma and cervical squamous cell carcinoma have been published. This case is the first presentation of coincidental primary cervical leiomyosarcoma and cervical gastric-type adenocarcinoma in situ. Additionally, we considered cervical gastric-type adenocarcinoma in situ with continuous lesions on the endometrium and skip lesions on the left fallopian tube.
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http://dx.doi.org/10.1155/2018/5848629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835282PMC
February 2018

Low-grade intraductal carcinoma of the salivary gland with prominent oncocytic change: a newly described variant.

Histopathology 2018 Aug 21;73(2):314-320. Epub 2018 May 21.

Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan.

Aims: Low-grade intraductal carcinoma (LG-IDC) is a clinically indolent malignant tumour of the salivary glands. Because of its rarity, the histological variants of LG-IDC have not been well characterised. Herein, we describe five LG-IDC cases with prominent oncocytic change in the major salivary glands.

Methods And Results: We examined five cases, three males and two females (mean age = 63 years), of LG-IDC with oncocytic change. The sites affected by LG-IDC were the parotid and submandibular glands. The lesions were macroscopically unilocular or multilocular cysts with a solid tumour arising from the cyst wall. Smaller tumour cell nests were also observed. As with classic LG-IDC, the cyst wall was surrounded by myoepithelial cells with no invasive component. The tumour cells had abundant oncocytic cytoplasm and proliferated in a low-papillary, tubular or cribriform pattern. Immunohistochemically, the tumour cells were diffusely positive for pan-cytokeratin, S100, mammaglobin and antimitochondria antibody, and were negative for androgen receptor and gross cystic disease fluid protein-15. Unlike classic LG-IDC, some of these cases demonstrated focal invagination of myoepithelial cells in the intraductal tumour.

Conclusion: Oncocytic LG-IDC should be recognised as a histologically unique variant of LG-IDC. Awareness of this entity is important to avoid erroneous diagnosis and inappropriate treatment for histological mimics.
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http://dx.doi.org/10.1111/his.13517DOI Listing
August 2018

Aquagenic urticaria: Severe extra-cutaneous symptoms following cold water exposure.

Allergol Int 2018 Apr 9;67(2):295-297. Epub 2018 Jan 9.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.

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http://dx.doi.org/10.1016/j.alit.2017.10.007DOI Listing
April 2018

Bipolar Cutting Method: Another Technique for Harvesting Donor Artery With Histological Investigation.

Oper Neurosurg (Hagerstown) 2018 01;14(1):16-19

Department of Neurosurgery, Teishinkai Hospital, Sapporo, Hokkaido, Japan.

Background: Safe and appropriate harvesting of the donor scalp vessel is the first key procedure in any type of bypass surgery.

Objective: To use the so-called bipolar cutting method to harvest donor arteries, in which the donor arteries are skeletonized with bipolar cautery. The surgical procedure and the preparation of the equipment of the bipolar cutting method are described. The surgical results and histological assessment are presented.

Methods: The bipolar generator was set at 50 Malis units in the coagulation mode. Under the surgical microscope, the surrounding tissue of the donor artery was divided and coagulated with the bipolar forceps. The donor artery was completely skeletonized to provide adequate length. After the recipient artery was chosen and the anastomosis site was decided, the distal end of the donor artery was cut to the appropriate length. The remnant fragment of the donor artery was histologically investigated for any damage to the arterial wall. The specimen was cut longitudinally to observe the entire length of the arterial wall and stained with hematoxylin and eosin and elastica van Gieson.

Results: A total of 30 bypass surgeries were performed and 38 histological specimens were obtained between February 2015 and June 2016. The success rate of the bypass was 96%. No arterial wall damage such as thermal injury or dissection of the wall was recognized in any of the specimens.

Conclusion: The bipolar cutting method is a useful and safe method for harvesting donor scalp artery.
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http://dx.doi.org/10.1093/ons/opx086DOI Listing
January 2018

Useful aspects of diagnosis of imprint cytology in intraoperative consultation of ovarian tumors: comparison between imprint cytology and frozen sections.

Diagn Cytopathol 2018 Jan 16;46(1):28-34. Epub 2017 Oct 16.

Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Tokyo, Japan.

Background: In the intraoperative consultation of ovarian tumors, the histological diagnosis of frozen sections (FS) of large tumors is frequently difficult because of the limited number of tumor samples. The application of imprint cytology (IC), in which samples are obtained from wide areas of the tumors, is useful for intraoperative consultation. However, the useful aspects of IC have not been clearly defined. The present study is a detailed comparison of IC and FS that clearly defines the useful aspects of IC.

Methods: Fifty-five cases of ovarian tumors that were examined using both IC and FS were evaluated. The histological diagnoses consisted of benign (16), borderline (6), and malignancy (33). All of the malignant tumors consisted of various types of carcinoma.

Results: Benignity and malignancy were accurately diagnosed by both IC and FS. In the borderline group, the diagnostic accuracy of IC was very low (1/6: 16.6%) compared with FS (4/6: 66.6%). The diagnostic accuracy including benign, borderline, and malignant groups was 90.9% (50/55) for IC and 96.3% (53/55) for FS. Concerning the diagnosis of the types of carcinoma, the overall diagnostic accuracy of IC (25/31: 80.6%) was greater than that of FS (21/31: 67.7%), especially for the diagnosis of clear cell carcinoma (IC, 100%; FS, 80%) and mixed carcinoma (IC, 66.6%; FS, 16.6%).

Conclusion: The useful aspects of IC in the intraoperative consultation are the diagnosis of benignity or malignancy and the accuracy of diagnosing clear cell carcinoma and mixed carcinoma.
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http://dx.doi.org/10.1002/dc.23844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765498PMC
January 2018

Anti-Inflammatory Role of Langerhans Cells and Apoptotic Keratinocytes in Ultraviolet-B-Induced Cutaneous Inflammation.

J Immunol 2017 10 11;199(8):2937-2947. Epub 2017 Sep 11.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan.

UV radiation, particularly UVB, is the major risk factor for the induction of skin cancer, and it induces skin inflammation and immunosuppression. Although reports documented that Langerhans cells (LCs) play various roles in photobiology, little is known about whether they contribute to UVB-induced cutaneous inflammation. Recently, the anti-inflammatory effect of apoptotic cells was noted. This study focuses on the roles of LCs and apoptotic cells in UVB-induced cutaneous inflammation. We show that LCs are essential for resolution of UVB-induced cutaneous inflammation. Administration of quinolyl-valyl--methylaspartyl-[2,6-difluophenoxy]-methyl ketone, a broad-spectrum caspase inhibitor with potent antiapoptotic properties, inhibited the formation of UVB-induced apoptotic cells and aggravated UVB-induced cutaneous inflammation in wild-type mice. In contrast, exacerbation of UVB-induced cutaneous inflammation following quinolyl-valyl--methylaspartyl-[2,6-difluophenoxy]-methyl ketone administration was not observed in LC-depleted mice. These results suggest that the interaction between LCs and apoptotic cells is critical for resolution of UVB-induced cutaneous inflammation. Interestingly, UVB-induced apoptotic keratinocytes were increased in LC-depleted mice. In addition, we revealed that UVB-induced apoptotic keratinocytes were phagocytosed by LCs ex vivo and that prolongation of UVB-induced cutaneous inflammation following treatment with Cytochalasin D, an inhibitor of phagocytosis, was partially attenuated in LC-depleted mice. Collectively, our findings demonstrate that the interaction between LCs and apoptotic cells, possibly via LC-mediated phagocytosis of apoptotic keratinocytes, has an essential anti-inflammatory role in the resolution of UVB-induced cutaneous inflammation.
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http://dx.doi.org/10.4049/jimmunol.1601681DOI Listing
October 2017

Designing behavioral self-regulation application for preventive personal mental healthcare.

Health Psychol Open 2017 Jan 16;4(1):2055102917707185. Epub 2017 May 16.

The University of Tokyo, Japan.

Most of computerized cognitive behavioral therapy targeted restoration and few have targeted primary prevention. The purpose of this study is to obtain the knowledge for further development on preventive mental healthcare application. We developed a personal mental healthcare application which aimed to give users the chance to manage their mental health by self-monitoring and regulating their behavior. Through the 30-day field trial, the results showed improvement of mood score through conducting of suggested action, and the depressive mood of the participants was significantly decreased after the trial. The possibility of application and further problem was confirmed.
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http://dx.doi.org/10.1177/2055102917707185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5438042PMC
January 2017

Cholinergic urticaria: epidemiology, physiopathology, new categorization, and management.

Clin Auton Res 2018 02 5;28(1):103-113. Epub 2017 Apr 5.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.

Purpose: The aim of this study was to review the evidence on the epidemiology, physiopathology, categorization, and management of cholinergic urticaria. We specifically focused on several subtypes of cholinergic urticaria and investigated the relationship between cholinergic urticaria and idiopathic anhidrosis.

Methods: Using an integrative approach, we reviewed publications addressing the epidemiology, clinical features, diagnostic approach, physiopathology, subtype classification, and therapeutic approach to cholinergic urticaria.

Results: Multiple mechanisms were found to contribute to the development of cholinergic urticaria. This disorder should be classified based on the pathogenesis and clinical characteristics of each subtype. Such a classification system would lead to better management of this resistant condition. In particular, sweating function should be given more attention when examining patients with cholinergic urticaria.

Conclusions: Because cholinergic urticaria is not a homogeneous disease, its subtype classification is essential for selection of the most suitable therapeutic method.
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http://dx.doi.org/10.1007/s10286-017-0418-6DOI Listing
February 2018

Cystic Endometrioma with Coexisting Fibroma Originating in a Supernumerary Ovary in the Rectovaginal Pouch.

Case Rep Obstet Gynecol 2017 22;2017:7239018. Epub 2017 Jan 22.

Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Tokyo, Japan.

A supernumerary ovary is an exceedingly rare disorder, in which the structure containing ovarian tissue is located at some distance from the normally placed ovary. 16 cases of endometriosis or tumors originating in a supernumerary ovary have been published in the English literature, but no case of coexisting endometriosis and a tumor has been published. We present the case of a 40-year-old female with cystic endometrioma with coexisting fibroma originating in a supernumerary ovary in the rectovaginal pouch. The present case is the first to be reported with coexisting endometriosis and a tumor originating in a supernumerary ovary. Our experience with this case and the results of our previous studies of rectovaginal endometriosis indicated that the possibility of originating in a supernumerary ovary shall be examined in cases of cystic endometrioma in the rectovaginal pouch.
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http://dx.doi.org/10.1155/2017/7239018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292170PMC
January 2017

Interstitial pregnancy after ipsilateral salpingectomy: Report of a case and discussion of the possible migration route.

Gynecol Minim Invasive Ther 2017 Jan-Mar;6(1):40-41. Epub 2016 May 7.

Department of Obstetrics and Gynecology, Juntendo Nerima Hospital, Nerima-ku, Japan.

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http://dx.doi.org/10.1016/j.gmit.2016.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113952PMC
May 2016

Clinical characteristics in cholinergic urticaria with palpebral angioedema: Report of 15 cases.

J Dermatol Sci 2017 Feb 11;85(2):135-137. Epub 2016 Nov 11.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.

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http://dx.doi.org/10.1016/j.jdermsci.2016.11.001DOI Listing
February 2017

Complete Atrioventricular Block Complicating Mitral Infective Endocarditis Caused by Streptococcus Agalactiae.

Am J Case Rep 2016 Sep 8;17:650-4. Epub 2016 Sep 8.

Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.

BACKGROUND Infective endocarditis (IE) involving the mitral valve can but rarely lead to complete atrioventricular block (CAVB). CASE REPORT A 74-year-old man with a history of infective endocarditis caused by Streptococcus gordonii (S. gordonii) presented to our emergency room with fever and loss of appetite, which had lasted for 5 days. On admission, results of serologic tests pointed to severe infection. Electrocardiography showed normal sinus rhythm with first-degree atrioventricular block and incomplete right bundle branch block, and transthoracic echocardiography and transesophageal echocardiography revealed severe mitral regurgitation caused by posterior leaflet perforation and 2 vegetations (5 mm and 6 mm) on the tricuspid valve. The patient was initially treated with ceftriaxone and gentamycin because blood and cutaneous ulcer cultures yielded S. agalactiae. On hospital day 2, however, sudden CAVB requiring transvenous pacing occurred, and the patient's heart failure and infection worsened. Although an emergent surgery is strongly recommended, even in patients with uncontrolled heart failure or infection, surgery was not performed because of the Child-Pugh class B liver cirrhosis. Despite intensive therapy, the patient's condition further deteriorated, and he died on hospital day 16. On postmortem examination, a 2×1-cm vegetation was seen on the perforated posterior mitral leaflet, and the infection had extended to the interventricular septum. Histologic examination revealed extensive necrosis of the AV node. CONCLUSIONS This rare case of CAVB resulting from S. agalactiae IE points to the fact that in monitoring patients with IE involving the mitral valve, clinicians should be aware of the potential for perivalvular extension of the infection, which can lead to fatal heart block.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017695PMC
http://dx.doi.org/10.12659/ajcr.898142DOI Listing
September 2016

Application of Returned Cell Block Method (Cell Block from a Papanicolaou Staining Smear on a Glass Slide) for the Evaluation of Fine Needle Aspiration Cytology of Tumors of the Breast.

Diagn Cytopathol 2016 Jun 8;44(6):505-11. Epub 2016 Apr 8.

Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Tokyo, Japan.

Background: In the fine needle aspiration cytology (FNAC) for tumors of the breast, evaluation is frequently difficult because of the thick-layered cell clusters and blood inclusion. Such problems may be resolved by the returned cell block method, but its use has not spread worldwide. Here, we examined the application of the returned cell block method to cases involving difficulty in the evaluation of FNAC to diagnose tumors of the breast.

Methods: In Juntendo University Nerima Hospital, there were 22 cases which were difficult to diagnose by Papanicolaou stain only, and they underwent additional examination using the returned cell block method (cell block from a Papanicolaou staining smear on a glass slide). The usefulness of the returned cell block method in these cases was examined.

Results: Among the 22 cases, a correct diagnosis was facilitated in 20 cases using the returned cell block method. In 16 of the 20 cases, the difficulty in FNAC was because of thick-layered cell clusters (12 cases) and blood inclusion (four cases). Among the 12 cases with difficulty because of the thick-layered cell clusters, 10 cases (83%) comprised intraductal papilloma (six cases) and intraductal papillary carcinoma (four cases). Papilloma and papillary carcinoma were correctly diagnosed by the addition of histological images and immunostaining of myoepithelial cells using the returned cell block method.

Conclusion: The application of the returned cell block method is useful for precise evaluation of the cytological diagnosis of tumors of the breast, especially papillary lesions. Diagn. Cytopathol. 2016;44:505-511. © 2016 The Authors Diagnostic Cytopathology Published by Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/dc.23480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074305PMC
June 2016

Telangiectatic lichen sclerosus on the cheek successfully treated with topical tacrolimus.

Eur J Dermatol 2016 Jun;26(3):321-2

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.

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http://dx.doi.org/10.1684/ejd.2016.2769DOI Listing
June 2016

Addition of lafutidine can improve disease activity and lead to better quality of life in refractory cholinergic urticaria unresponsive to histamine H1 antagonists.

J Dermatol Sci 2016 May 8;82(2):137-9. Epub 2016 Feb 8.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; Department of Dermatology, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe 651-2273, Japan; Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.

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http://dx.doi.org/10.1016/j.jdermsci.2016.02.001DOI Listing
May 2016

Utility of immunohistochemistry with an antibody against MYC at the initial diagnosis of follicular lymphoma, grade 3A, for predicting a more aggressive clinical course: a case report and review of the literature.

Int J Clin Exp Pathol 2015 1;8(6):7559-64. Epub 2015 Jun 1.

Department of Hematology, Juntendo University Nerima Hospital Tokyo, Japan.

Follicular lymphoma (FL) is the most common indolent lymphoma, and associated with the chromosomal translocation t(14;18)(q32;q21). While, FL harboring both BCL2 and MYC translocation at diagnosis is very rare. The evaluation of MYC expression in typical FL at presentation using southern blot, G-banded karyotyping or fluorescence in situ hybridization (FISH) analyses has been described so far. However, there are no reports about the use of immunohistochemistry (IHC) to evaluate MYC protein expression in FL at presentation. Here, we present a FL patient who transformed to a B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt's lymphoma, accompanied by concurrent BCL2, BCL6, and MYC translocations; i.e., triple-hit lymphoma. Paraffin-embedded tissue section-FISH analysis demonstrated that the FL was negative for MYC, but MYC protein expression was subsequently detected in the lymph node specimen obtained at the initial diagnosis using IHC. This case revealed aggressive clinical course and central nervous system involvement. In the literature concerning MYC positive FL five out of 8 patients were dead within 24 months. The detection of MYC protein expression in FL using IHC might be useful to predict more aggressive clinical course.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526003PMC
May 2016
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