Publications by authors named "Natsuko Suzui"

26 Publications

  • Page 1 of 1

The Utility of Combined Target and Systematic Prostate Biopsies in the Diagnosis of Clinically Significant Prostate Cancer Using Prostate Imaging Reporting and Data System Version 2 Based on Biparametric Magnetic Resonance Imaging.

Curr Oncol 2021 Mar 22;28(2):1294-1301. Epub 2021 Mar 22.

Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan.

This study aimed to determine the predictive value of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) based on biparametric magnetic resonance imaging (bpMRI) with combined target biopsy (TBx) and systematic biopsy (SBx) in patients with suspicion of having clinically significant prostate cancer (csPCa). In this retrospective study, we reviewed the clinical and pathological records of 184 consecutive patients who underwent bpMRI before prostate biopsy. We focused on patients with PI-RADS v2 scores ≥ 3. MRI was performed using a 3-Tesla clinical scanner with a 32-channel phased-array receiver coil. PI-RADS v2 was used to describe bpMRI findings based on T2-weighted imaging and diffusion-weighted imaging scores. The primary endpoint was the diagnostic accuracy rate of PI-RADS v2 based on bpMRI for patients with prostate cancer (PCa) who underwent combined TBx and SBx. A total of 104 patients were enrolled in this study. Combined TBx and SBx was significantly superior to either method alone for PCa detection in patients with suspicious lesions according to PI-RADS v2. TBx and SBx detected concordant csPCa in only 24.1% of the patients. In addition, the rate of increase in the Gleason score was similar between SBx (41.5%) and TBx (34.1%). The diagnostic accuracy of bpMRI is comparable to that of standard multiparametric MRI for the detection of csPCa. Moreover, combined TBx and SBx may be optimal for the accurate determination of csPCa diagnosis, the International Society of Urological Pathology grade, and risk classification.
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http://dx.doi.org/10.3390/curroncol28020123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025823PMC
March 2021

CT and MRI characteristics of ovarian mature teratoma in patients with anti-N-methyl-D-aspartate receptor encephalitis.

Diagn Interv Imaging 2021 Mar 27. Epub 2021 Mar 27.

Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.

Purpose: The purpose of this study was to determine the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of ovarian mature teratoma in patients with anti-N-methyl-d-aspartate receptor encephalitis (NMDAR-E).

Materials And Methods: A total of 125 women (mean age, 40.9±17.8 [SD] years; age range: 12-85 years) with 146 histopathologically or radiologically proven ovarian mature teratomas who underwent preoperative CT and MRI examinations were retrospectively included. Eight patients with 11 teratomas had NMDAR-E, whereas 117 patients with 135 teratomas did not have NMDAR-E. CT and MRI examinations were retrospectively reviewed and teratomas in patients with NMDAR-E were compared to those in patients without NMDAR-E. Comparisons were performed using Mann-Whitney U test or Fisher exact test.

Results: In patients with NMDAR-E, maximum diameter of teratomas (26.1±9.3 [SD] mm), prevalence of teeth/calcification (36%) and rate of occupation by fat components (26%) were lower than those in patients without NMDAR-E (67.0±37.6 [SD] mm [P<0.01]; 75% [P<0.05]; and 65%[P<0.01], respectively). More than 75% of space was occupied by fat components in 76/135 teratomas (56%) in patients without NMDAR-E, whereas this was not observed in any teratoma in patients without NMDAR-E.

Conclusion: By comparison with teratomas in patients without NMDAR-E, teratomas in patients with NMDAR-E are smaller, have few teeth/calcification, and the amount of space occupied by fat components is smaller.
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http://dx.doi.org/10.1016/j.diii.2021.02.010DOI Listing
March 2021

Imaging findings of cutaneous angiosarcoma of the scalp: Comparison with cutaneous squamous cell carcinoma.

Neuroradiol J 2021 Mar 3:1971400921998941. Epub 2021 Mar 3.

Department of Radiology, Gifu University, Japan.

Purpose: This study aimed to evaluate imaging findings of cutaneous angiosarcoma (cAS) of the scalp compared with those of cutaneous squamous cell carcinoma (cSCC).

Methods: This study included 15 patients with primary cAS and 10 with primary cSCC of the scalp. Seven patients with cAS and eight with cSCC underwent magnetic resonance imaging, and 11 patients with cAS and eight with cSCC underwent F-fluorodeoxyglucose-positron emission tomography/computed tomography imaging. Imaging findings for both pathologies were retrospectively reviewed and compared.

Results: All 15 cAS cases were elevated lesions with an obtuse angle, invading the subcutaneous fat tissue. Multiple lesions were observed in only five cAS cases (33%) and no cSCC cases. Maximum diameter-to-height ratio was significantly higher in cAS than in cSCC (3.3 ± 1.0 versus 2.3 ± 0.6;  < 0.01). On T2-weighted images, intratumoral hypointensity (86% versus 13%;  < 0.01) and mixed hyper- and hypointensity (71% versus 0%;  < 0.01) were observed more frequently in cAS than in cSCC. No significant differences were observed between cAS and cSCC regarding flow void (29% versus 25%;  = 0.656). Maximum standardized uptake values were marginally significantly lower in cAS than in cSCC (5.6 ± 3.1 versus 10.5 ± 6.6;  = 0.078).

Conclusions: Cases of cAS of the scalp always exhibited flat elevated lesions with invasion of the subcutaneous fat tissue. Compared with cSCC, intratumoral hypointensity and mixed hyper- and hypointensity on T2-weighted images were more frequent in cAS. These findings will help with the differential diagnosis of cAS.
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http://dx.doi.org/10.1177/1971400921998941DOI Listing
March 2021

A case of multiple metastatic sarcomatoid renal cell carcinoma with complete response to nivolumab.

Cancer Rep (Hoboken) 2021 Mar 3:e1356. Epub 2021 Mar 3.

Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan.

Background: Sarcomatoid renal cell carcinoma (SRCC) is associated with poor prognosis. Although there is no standard treatment for SRCC, recent studies have reported the effectiveness of immune checkpoint inhibitors.

Case: An 82-year-old Japanese man presented to our hospital with an incidental right renal tumor. Abdominal computed tomography (CT) showed an exophytic tumor in the right kidney with suspected right iliopsoas muscle invasion. Laparoscopic right radical nephrectomy was performed. Histopathological diagnosis revealed a clear cell RCC with a spindle cell carcinoma component. CT performed 3 months after surgery revealed multiple bilateral lung metastases and local recurrence. Although the patient received tyrosine-kinase inhibitors for treating multiple metastases, the lung metastases continued to gradually increase, and peritonitis carcinomatosis was observed. Thus, the patient was intravenously administered nivolumab once every 2 weeks. After nivolumab administration, lung metastases, local recurrence, and peritonitis carcinomatosis gradually reduced. After 20 months of nivolumab treatment, the patient achieved a complete response of multiple metastases on CT.

Conclusion: Nivolumab may be used as a treatment option for sarcomatoid renal cell carcinoma with multiple metastases.
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http://dx.doi.org/10.1002/cnr2.1356DOI Listing
March 2021

Inhibition of FGF10-ERK signal activation suppresses intraductal papillary neoplasm of the bile duct and its associated carcinomas.

Cell Rep 2021 Feb;34(8):108772

Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.

Evidence regarding intraductal papillary neoplasm of the bile duct (IPNB) as a type of precancerous lesion of cholangiocarcinoma is limited. Moreover, a reproducible in vivo model is lacking, and IPNB pathogenesis remains unclear. Here, we use a doxycycline-inducible tetracycline (Tet)-on mice model to control fibroblast growth factor 10 (FGF10) expression, which regulates branching and tubule formation. FGF10-induced IPNB mimics the multifocal and divergent human IPNB phenotypes via the FGF10-FGF receptor 2 (FGFR2)-RAS-extracellular-signal-regulated kinase (ERK) signaling pathway. A paracrine/autocrine growth factor is sufficient to initiate and maintain IPNB originating from the peribiliary glands, including biliary stem/progenitor cells. With Kras, p53, or p16 mutations or both, Fgf10-induced IPNB shows stepwise carcinogenesis, causing associated invasive carcinoma. Fgf10-induced papillary changes and progression are suppressed by the inhibition of the FGF10-FGFR2-RAS-ERK signaling pathway, demonstrating that the signal is a therapeutic target for IPNB and associated carcinoma.
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http://dx.doi.org/10.1016/j.celrep.2021.108772DOI Listing
February 2021

Case of Muckle-Wells syndrome with erythema dominantly infiltrated by lymphocytes.

J Dermatol 2021 Feb 8;48(2):e100-e101. Epub 2020 Nov 8.

Department of, Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan.

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http://dx.doi.org/10.1111/1346-8138.15686DOI Listing
February 2021

Comparison of Imaging Findings between Human Papillomavirus-positive and -Negative Squamous Cell Carcinomas of the Maxillary Sinus.

J Clin Imaging Sci 2020 1;10:59. Epub 2020 Oct 1.

Department of Radiology, Gifu University, Gifu, Japan.

Objectives: This study aimed to assess the efficacy of imaging findings when differentiating between human papillomavirus (HPV)-positive and -negative squamous cell carcinomas (SCCs) of the maxillary sinus.

Material And Methods: This study included 37 patients with histopathologically and immunohistochemically confirmed SCCs of the maxillary sinus (three HPV positive and 34 HPV negative). Apparent diffusion coefficients (ADCs), MR signal intensities, CT findings, and maximum standardized uptake (SUVmax) were correlated with the two pathologies.

Results: The minimum ADC (ADCmin) was significantly lower in HPV-positive SCCs than in HPV-negative SCCs (0.50 ± 0.02 vs. 0.70 ± 0.13 × 10 mm/s, < 0.01). The mean ADC (ADCmean) was not significantly different between HPV-positive SCCs and HPV-negative SCCs (0.84 ± 0.07 vs. 0.97 ± 0.18 ×10 mm/s, = 0.18). The areas under the receiver operating characteristic curves for ADCmin and ADCmean were 0.986 ( < 0.01) and 0.754 ( < 0.05), respectively. The sensitivity and specificity, with a threshold of ADCmin (0.516 × 10 mm/s) for a diagnosis of HPV-positive SCCs, were 100% and 96%, respectively. However, no significant differences were observed in MR signal intensities, CT findings, and SUVmax between HPV-positive and HPV-negative SCCs.

Conclusion: ADCmin is a useful parameter for the differentiation of HPV-positive and HPV-negative SCCs of the maxillary sinus.
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http://dx.doi.org/10.25259/JCIS_116_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568092PMC
October 2020

MR imaging findings for differentiating cutaneous malignant melanoma from squamous cell carcinoma.

Eur J Radiol 2020 Nov 16;132:109212. Epub 2020 Sep 16.

Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.

Purpose: This study aimed to assess the efficacy of using MR imaging findings for differentiating cutaneous malignant melanoma (cMM) from cutaneous squamous cell carcinoma (cSCC).

Methods: Preoperative MR images of patients with histopathologically proven primary cMM and primary cSCC were retrospectively reviewed and compared between the two pathologies.

Results: A total of 16 patients with primary cMM (7 men and 9 women; age range, 45-97 years; median age, 75 years) and 49 with primary cSCC (37 men and 12 women; age range, 46-90 years; median age, 76 years) were enrolled in this study. Intratumoral T1 hyperintensity compared to that of the dermis was more frequently observed in cMM than in cSCC (50 % vs. 4 %; p < 0.01). Superficial depression (51 % vs. 19 %; p < 0.05), superficial irregular margins (55 % vs. 25 %; p <  0.05), and reticular or linear T2 hyperintensity (27 % vs. 0 %; p <  0.05) were more frequently observed in cSCC than in cMM, respectively.

Conclusions: cMM predominantly exhibited intratumoral T1 hyperintensity, whereas cSCC predominantly exhibited superficial depression, superficial irregular margins, reticular or linear T2 hyperintensity.
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http://dx.doi.org/10.1016/j.ejrad.2020.109212DOI Listing
November 2020

Serum Exosomal Gamma-Glutamyltransferase Activity Increased in Patients with Renal Cell Carcinoma with Advanced Clinicopathological Features.

Oncology 2020 29;98(10):734-742. Epub 2020 Jul 29.

Biological Process of Aging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan,

Background: There has been no clinically useful diagnostic or prognostic biomarker for renal cell carcinoma (RCC). Serum γ-glutamyltransferase (GGT) activity has been reported to be a prognostic marker for several types of cancer including RCC. Exosomes or small extracellular vesicles present in body fluids have potential as a biomarker. We have recently demonstrated that GGT activity on exosomes isolated from serum is useful for the differential diagnosis of prostate cancer and benign prostate hyperplasia. In this study, we aimed to examine if serum exosomal GGT activity could be a marker for RCC.

Methods: We examined GGT1 expression and GGT activity in cell lysates and exosomes from culture medium of HK-2 proximal tubule epithelial and RCC cell lines. GGT activity was measured using a fluorescent probe for GGT, γ-glutamyl hydroxymethyl rhodamine green. Serum and serum exosomal GGT activities were measured in patients with RCC. GGT1 expression in RCC tissues was evaluated by immunohistochemical staining.

Results: GGT1 levels in exosomes from KMRC-1, OS-RC-2 and 786-O cells were elevated compared with those from HK-2 cells. In exosomes, GGT1 expression correlated with GGT activity determined using a fluorescent probe for GGT. In RCC patients, serum exosomal GGT activity was elevated in those with advanced stages (III/IV vs. I/II, p = 0.037) and those with microvascular invasion (with vs. without, p = 0.034). Immunohistochemical analysis showed that membranous GGT1 expression was increased in RCC with microvascular invasion. Notably, preoperative serum exosomal GGT activity could predict the likelihood of having microvascular invasion diagnosed by pathological examination of surgically resected specimens.

Conclusions: Our results suggest that serum exosomal GGT activity could be a clinically useful marker for advanced clinicopathological features of RCC patients, and its combined use with conventional diagnostic modalities may improve the diagnosis and treatment of patients.
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http://dx.doi.org/10.1159/000508688DOI Listing
October 2020

A somatic activating KRAS variant identified in an affected lesion of a patient with Gorham-Stout disease.

J Hum Genet 2020 Nov 26;65(11):995-1001. Epub 2020 Jun 26.

Department of Medical Genetics, Tohoku University School of Medicine, Sendai, 980-8574, Japan.

Gorham-Stout disease (GSD), a rare disorder of unknown etiology, is characterized by massive osteolysis that is associated with proliferation and dilation of lymphatic vessels. Variants in cancer-associated genes have been described in complex lymphatic anomalies. To explore the pathogenesis of GSD, we performed the amplicon-based deep sequencing on 50 cancer-related genes to assay affected tissues from the six patients with GSD. In one patient, a somatic activating KRAS c.182A > G variant (p.Q61R) was detected in 1% of the tissue sample. Conversely, the mutant allele was not detected in uninvolved normal skin and blood samples. Histopathology of the patient's tissue sample showed proliferation of abnormal lymphatic and blood vascular endothelial cells, osteoclasts, and activated macrophages. The activating KRAS variant is a known 'hotspot' variant, frequently identified in several types of human cancer. This is the first report of identifying a pathogenic variant in a patient with GSD. This finding may set the stage for elucidation of pathophysiology and the development of novel therapies for GSD.
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http://dx.doi.org/10.1038/s10038-020-0794-yDOI Listing
November 2020

MR imaging findings of low-grade serous carcinoma of the ovary: comparison with serous borderline tumor.

Jpn J Radiol 2020 Aug 3;38(8):782-789. Epub 2020 Apr 3.

Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.

Purpose: To assess MR imaging findings of low-grade serous carcinoma (LGSC) of the ovary compared with those of serous borderline tumor (SBT).

Methods: Twenty-four patients with histopathologically proven 7 LGSCs and 25 SBTs who underwent preoperative MR imaging were included. We retrospectively reviewed MR images and compared MR findings between the two pathologies.

Results: The predominantly solid lesions were marginally more frequent in LGSCs than in SBTs (43% vs. 8%, p = 0.057). All predominantly cystic LGSCs were multilocular cystic lesions with mural nodules. Predominantly solid LGSCs exhibited pure solid masses in 2 of 3 and solid masses with intratumoral cysts in 1 of 3. Papillary growth pattern with internal branching was observed only in 18 of 25 SBTs. Signal intensity ratio on T2-weighted images (4.48 ± 1.55 vs. 8.40 ± 3.53, p < 0.01) and apparent diffusion coefficient (ADC) values (1.12 ± 0.21 vs. 1.73 ± 0.27 × 10 mm/s, p < 0.01) of solid components was significantly lower in LGSCs than in SBTs.

Conclusion: Compared with SBTs, lower signal intensity on T2-weighted images and lower ADC values were characteristic features of solid components in LGSCs. Papillary growth pattern with internal branching was not observed in LGSCs.
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http://dx.doi.org/10.1007/s11604-020-00960-2DOI Listing
August 2020

[Retroperitoneal Dedifferentiated Liposarcoma which Could Be Diagnosed Using Dual Color in Situ Hybridization : A Case Report].

Hinyokika Kiyo 2020 Feb;66(2):45-48

The Department of Urology, Gifu University Graduate school of Medicine.

Ten years ago, a seventy-year-old female underwent extirpation of a left retroperitoneal tumor that was 58×36 mm in size. The pathological diagnosis was malignant peripheral nerve sheath tumor (MPNST) at that time. The patients visited our hospital with the chief complaint of back pain at ten years after surgery. Computer tomography (CT) showed recurrent tumors at the pancreas and the left kidney. Fine-needle aspiration biopsy was performed because of the possibility of pancreatic tumor. The pathological diagnosis was the recurrence of MPNST. The patient underwent extirpation of the recurrent tumors along with the pancreatic body and tail, transverse colon, spleen and left kidney. The definitive diagnosis was dedifferentiated liposarcoma with murine double minute 2 (MDM2) gene amplification and positive of p16Ink4 (p16). The previously resected tumor also revealed MDM2 gene amplification and positive of p16. Based on these results, our diagnosis in this case was recurrence of dedifferentiated liposarcoma. At 6 months after surgery, the patient had no local recurrence or distant metastases.
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http://dx.doi.org/10.14989/ActaUrolJap_66_2_45DOI Listing
February 2020

Magnetic Resonance Imaging Findings Differentiating Cutaneous Basal Cell Carcinoma from Squamous Cell Carcinoma in the Head and Neck Region.

Korean J Radiol 2020 03;21(3):325-331

Department of Radiology, Gifu University School of Medicine, Gifu, Japan.

Objective: This study aimed to evaluate the efficacy of magnetic resonance (MR) imaging in differentiating between cutaneous basal cell carcinoma (cBCC) and cutaneous squamous cell carcinoma (cSCC) in the head and neck region.

Materials And Methods: Among patients with cutaneous head and neck cancers, 14 with primary cBCCs and 15 with primary cSCCs with a histologic tumor height of ≥ 4 mm underwent MR examinations; the findings were then examined for correlations.

Results: cBCCs (71%) occurred more frequently on the nose than cSCCs (13%) ( < 0.01). The maximum diameter (23.5 ± 7.2 mm vs. 12.7 ± 4.5 mm; < 0.01) and diameter-to-height ratio (2.8 ± 0.9 vs. 1.7 ± 0.4; < 0.01) were significantly greater in cSCCs than in cBCCs. Superficial ulcer formation (67% vs. 21%; < 0.05), protrusion into the subcutaneous tissue (60% vs. 21%; < 0.05), ill-demarcated deep tumor margins (60% vs. 7%; < 0.01), and peritumoral fat stranding (93% vs. 7%; < 0.01) were more frequently observed in cSCCs than in cBCCs. Intratumoral T2-hyperintense foci (57% vs. 13%; < 0.05) were more frequently observed in cBCCs than in cSCCs.

Conclusion: cBCCs predominantly occurred on the nose with intratumoral T2-hyperintense foci, whereas cSCCs predominantly exhibited a flattened configuration, superficial ulcer formation, protrusion into the subcutaneous tissue, ill-demarcated deep tumor margin, and peritumoral fat stranding.
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http://dx.doi.org/10.3348/kjr.2019.0508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039720PMC
March 2020

Endoscopic and Pathological Characteristics of Helicobacter pylori Infection-Negative Early Gastric Cancer.

Dig Dis 2020 11;38(6):474-483. Epub 2020 Feb 11.

Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.

Background: The characteristics of Helicobacter pylori (HP) infection-negative gastric cancer (HPINGC) have not been well documented because of the rareness. The aim of this study was to classify HPINGC endoscopically and clinicopathologically.

Methods: This retrospective study included 1,741 early gastric cancer lesions and evaluated their HP infection status. Expression levels of MUC5AC, MUC6, MUC2, CD10, p53, MIB-1, pepsinogen-I, H+/K+ ATPase, chromogranin A, E-cadherin, and gastrin were evaluated in tumors by immunohistochemistry (IHC).

Results: Among the analyzed lesions, 19 (1.1%) were diagnosed as HPINGC and classified into 6 types: undifferentiated (5 lesions), fundic gland (2 lesions), cardiac gland (1 lesion), pyloric gland (3 lesions), foveolar (5 lesions), and mixed (3 lesions) types. Undifferentiated lesions were of pale color, with unclear demarcation and decreased E-cadherin expression. Fundic-type lesions were tan to reddish in color, with submucosal tumor-like protrusions, and positive for pepsinogen-I and H+/K+ ATPase. The cardiac gland type was located in the gastroesophageal junction and was positive for MUC6 and pepsinogen-I. Pyloric gland-type lesions were of the same color as normal mucosa, with mild elevation and unclear demarcation, likely positive for CD10 and chromogranin A. Foveolar epithelial-type lesions were white and elevated, with defined demarcation, and contained MUC5AC-positive cells. Mixed-type lesions, showing various staining patterns in IHC, had both elevated and depressed shape and reddish color.

Conclusion: Endoscopic observation and IHC were useful for classifying the characteristics of HPINGC, which may preserve the characteristics of its region of origin.
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http://dx.doi.org/10.1159/000506120DOI Listing
November 2020

A case of lung adenocarcinoma complicated by pulmonary talcosis occurring in a patient employed in the confectionery industry.

Pathol Int 2019 Apr 18;69(4):229-234. Epub 2019 Feb 18.

Department of Pathology, Gifu University Hospital, Gifu-City, Japan.

A 73-year-old Japanese man, who worked at a confectionery company for more than 20 years, was diagnosed with a 28 mm nodular lesion in the superior lobe of the right lung by whole-body computed tomography examination. A biopsy revealed the presence of adenocarcinoma. With a diagnosis of a primary lung cancer, a right upper lobectomy was performed. A nodular lesion, 25 × 23 mm in size, was observed in the upper right lobe lung field, and was diagnosed histopathologically as a papillary adenocarcinoma. In addition, fibrous scars in the central part of the tumor showed numerous Langhans and/or foreign body giant cells, and histiocytic cells that had phagocytized numerous small transparent crystals, together with coal powder deposition. The extracted crystals were observed with a scanning electron microscope, and although plate-like structures were observed, ferruginous bodies suggestive of asbestos were not found. The crystals were demonstrated to be talc by powder X-ray diffraction. Herein, we investigated a case of lung adenocarcinoma in a patient with talcosis, with discussions based on a literature search. This collision of talcosis and lung adenocarcinoma adds to an increasing body of knowledge on an apparent association between talc and cancer cases.
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http://dx.doi.org/10.1111/pin.12772DOI Listing
April 2019

MR imaging findings differentiating uterine submucosal polypoid adenomyomas from endometrial polyps.

Br J Radiol 2019 Mar 10;92(1095):20180430. Epub 2019 Jan 10.

1 Department of Radiology, Gifu University School of Medicine , Gifu , Japan.

Objective:: This study aimed to assess the efficacy of MRI for differentiating between uterine submucosal polypoid adenomyomas (PAs) and endometrial polyps (EPs).

Methods:: MRI was used to examine 40 histopathologically confirmed benign polypoid endometrial tumors (8submucosal PAs and 32 EPs). Atypical PAs were excluded from this study. Quantitative measurements (maximum tumor diameter, maximum cyst diameter, number of cysts, and apparent diffusion coefficient values) and qualitative imaging findings (predominance of cystic or solid components as well as presence of cysts, hemorrhage, myometrial invasion, fluid-fluid level, and fibrous core) were correlated with the two pathologies.

Results:: The predominance of cystic components (37% vs 6%; p < 0.05) was more frequently observed in PAs than in EPs. The frequency of cysts (88% vs 25%; p < 0.01), hemorrhage (50% vs 9%; p < 0.05), and myometrial invasion (25% vs 0%; p < 0.05) were significantly higher in PAs than in EPs. No significant differences were observed in terms of the maximum tumor diameter, maximum cyst diameter, number of cysts, apparent diffusion coefficient values, and presence of fluid-fluid level and fibrous core between PAs and EPs.

Conclusion:: The differences of MR findings with emphasis on cystic components and hemorrhage may be useful for differentiating between PAs and EPs.

Advances In Knowledge:: The predominance of cystic or solid components and the presence of cysts, hemorrhage, and myometrial invasion were useful MR findings for differentiating between PAs and EPs.
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http://dx.doi.org/10.1259/bjr.20180430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541179PMC
March 2019

Local recurrence of T1a rectal cancer following radical endoscopic mucosal resection: A case report.

Mol Clin Oncol 2018 Sep 5;9(3):305-309. Epub 2018 Jul 5.

Department of Surgical Oncology, Gifu University School of Medicine, Gifu, Gifu 501-1194, Japan.

We herein report a case of local recurrence of T1a rectal cancer following radical endoscopic mucosal resection (EMR). A 63-year-old man underwent EMR for a 0-IIa lesion of the Ra portion of the rectum. The findings on pathological examination were tub1, T1a (SM1, 420 µm), ly0 and v0, and the EMR had been considered a transitional procedure. Colonoscopy performed 26 months after EMR revealed a submucosal tumor (SMT) near the EMR scar in the left wall of the Ra portion of the rectum. An abdominal enhanced computed tomography scan revealed infiltration of the thickness of the wall with limited extramural extension, and a lymph node 10 mm in diameter. Endoscopic ultrasound-guided fine-needle aspiration also indicated a SMT on the left side of the Ra portion of the rectum that extended from the submucosal layer to beyond the serosal layer, and a lymph node sized 17×11 mm to the left of the Ra portion near the oral side 2 cm from the SMT. The pathological findings confirmed the SMT to be an adenocarcinoma with a metastatic lymph node. Local and lymph node recurrence of rectal cancer following radical EMR was diagnosed, and laparoscopic ultra-low anterior resection, D3 lymph node dissection and a diverting ileostomy were performed. The pathological findings of the excised specimen were T3 (A/SS), ly0, v3, PN1b, pPM0, pDM0, pRM0 (100 µm) and pN0 (0/15). XELOX therapy was administered for 6 months postoperatively as adjuvant chemotherapy, and there has been no recurrence during the first 12 months of follow-up.
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http://dx.doi.org/10.3892/mco.2018.1667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109672PMC
September 2018

A Review of HPV-Related Head and Neck Cancer.

J Clin Med 2018 Aug 27;7(9). Epub 2018 Aug 27.

Pathology Division, Gifu University Hospital, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.

Head and neck squamous cell carcinomas (HNSCCs) arise in the mucosal lining of the upper aerodigestive tract. Tobacco and alcohol use have been reported to be associated with HNSCC. Infection with high-risk human papillomaviruses (HPVs) has recently been implicated in the pathogenesis of HNSCCs. It is now widely accepted that high-risk HPV is a cause of almost all cervical cancers as well as some forms of HNSCCs. HPV-related HNSCCs are increasing. HPV-related HNSCCs and HPV-unrelated HNSCCs differ with respect to the molecular mechanisms underlying their oncogenic processes. HPV-related HNSCCs are known to have a better prognosis response to treatment as compared with HPV-unrelated HNSCCs. Therefore, in recent years, it has been required to accurately discriminate between HPV-related and HPV-unrelated HNSCCs. To diagnose the HPV-related HNSCCs, various methods including immunohistochemistry, FISH, and genetic analyses of the HPV gene from histopathological and liquid biopsy specimens have been employed. Based on the results of the differential diagnosis, various treatments employing EGFR TKI and low-dose radiation have been employed. Here, we review the involvement of the HPV virus in HNSCCs as well as the molecular mechanism of carcinogenesis, classification, prognosis, diagnostic procedures, and therapy of the disease.
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http://dx.doi.org/10.3390/jcm7090241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162868PMC
August 2018

Frontal Tumefactive Demyelinating Lesion Mimicking Glioblastoma Differentiated by Methionine Positron Emission Tomography.

World Neurosurg 2018 Nov 13;119:244-248. Epub 2018 Aug 13.

Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu City, Japan.

Background: Tumefactive demyelinating lesion (TDL) is often reported as a rare variation of multiple sclerosis (MS). TDL is difficult to diagnose solely by magnetic resonance imaging (MRI) in patients with no history of MS. This is because the lesion often shows ring enhancement with perifocal brain edema on gadolinium MRI, thus mimicking glioblastoma multiforme (GBM).

Case Description: A 54-year-old healthy woman complained of headache 1 month before admission. She developed a decline in cognitive function, decreased attention, and executive function disorder 10 days before admission. Gadolinium magnetic resonance imaging showed a ring-shaped enhancement accompanied by massive brain edema in the left frontal lobe. This suggested GBM, but methionine positron emission tomography (MET PET), surprisingly, showed no uptake with a tumor-to-normal brain ratio of 1.18. Accordingly, we eliminated GBM and suspected brain abscess because diffusion-weighted images showed high signal intensity in the lesion. Although we performed drainage, we could not demonstrate the presence of pus. Pathologic analysis of a specimen obtained by needle biopsy revealed broad necrosis and a small number of inflammatory cells. We therefore prescribed steroid therapy, by which symptoms gradually improved. No relapse occurred for 2 years. We finally diagnosed the patient as having TDL.

Conclusions: MET PET is considered a possible diagnostic modality for demyelinating disease as it can appropriately reflect pathologic findings. MET PET will facilitate decision making regarding surgery in patients with TDL.
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http://dx.doi.org/10.1016/j.wneu.2018.08.027DOI Listing
November 2018

[A case of an elderly patient with inverted Meckel's diverticulum with small intestinal bleeding detected using capsule and double-balloon endoscopies].

Nihon Shokakibyo Gakkai Zasshi 2017;114(11):2005-2011

Department of Pathology, Gifu University Hospital.

An 80-year-old man was examined with esophagogastroduodenoscopy and colonoscopy because of digestive tract hemorrhage;however, no specific cause was found. Small intestinal capsule endoscopy revealed a reddish elevated lesion in the ileum. This lesion was also detected using double-balloon endoscopy as a 5-cm reddish elevated lesion covered with normal villous architecture in the 95-cm part of the Bauhin valve on the oral side. The lesion was laparoscopically resected and diagnosed as inverted Meckel's diverticulum based on pathological examination. This was a rare case where Meckel's diverticulum was inverted, and the lesion was observed using capsule and double-balloon endoscopies before surgery. Although complications of Meckel's diverticulum are rare in the elderly, it is necessary to identify this disease as a cause of small intestinal bleeding, even in elderly patients.
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http://dx.doi.org/10.11405/nisshoshi.114.2005DOI Listing
May 2018

Distinctive crypt shape in a sessile serrated adenoma/polyp: Distribution of Ki67-, p16INK4a-, WNT5A-positive cells and intraepithelial lymphocytes.

Oncol Rep 2017 Aug 15;38(2):775-784. Epub 2017 Jun 15.

Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.

Serrated lesions in the colorectum are currently predominantly classified as hyperplastic polyps (HPs), sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs) according to their morphology. However, the histological morphology and the molecular changes in the serrated lesions are still unclear. We performed immunohistochemistry for Ki67, p16INK4a, and WNT5A in human HPs (n=22), SSA/Ps (n=41), and TSAs (n=19). The distribution of Ki67 and p16INK4a positive cells in TSAs was different from that in HPs and SSA/Ps. Co-expression of Ki67 and P16INK4a was infrequent in HPs and SSA/Ps; p16INK4a-positive cells were found in the crypt cleft and stromal WNT5A-positive stromal cells were localized near the cleft in SSA/Ps, while intraepithelial lymphocytes (IELs) in SSA/Ps were more abundant than HPs. In conclusion, our study provides evidence that HPs branch because of the increase in and patchy distribution of senescent and proliferative cells, with increased and misdistributed stromal and inflammatory cells, which might contribute to creation of L- and/or T-shaped crypts, which are of distinctive shapes in SSA/Ps. Our findings may facilitate better understanding and therapy in the serrated lesions.
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http://dx.doi.org/10.3892/or.2017.5725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561931PMC
August 2017

p53 Expression as a Diagnostic Biomarker in Ulcerative Colitis-Associated Cancer.

Int J Mol Sci 2017 Jun 16;18(6). Epub 2017 Jun 16.

Pathology Division, Gifu University Hospital, Gifu 501-1194, Japan.

Ulcerative colitis (UC) is defined as an idiopathic inflammatory disorder primarily involving the mucosa and submucosa of the colon. UC-associated colon cancers (also known as colitic cancers) develop through the inflammation-dysplasia sequence, which is a major problem affecting the prognosis of patients with UC. It is therefore very important to detect malignancy from UC at an early stage. As precancerous lesions arising in UC, there are pathological adenomatous changes, basal cell changes, in situ anaplasia, clear cell changes, and pan-cellular change. It is considered that the mutation of the p53 gene plays a crucial role, and the protein expression of p53 in dysplastic crypts may serve as a good biomarker in the early stages of UC-associated colon carcinogenesis. Immunohistochemistry for p53 is a very valuable diagnostic tool in UC-associated colon cancers. However, protein expression of p53 is not always universal, and additional methods may be required to assess p53 status in UC-associated colon cancers.
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http://dx.doi.org/10.3390/ijms18061284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486106PMC
June 2017

ALK Gene Translocation in Inflammatory Myofibroblastic Tumor of the Urinary Bladder: A Case Report.

Urol Case Rep 2015 Sep 2;3(5):138-40. Epub 2015 Jul 2.

Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu city, Gifu 501-1194, Japan.

A 26-year-old woman with gross hematuria was seen in a previous hospital. Magnetic resonance imaging (MRI) showed a tumor at the dome of the urinary bladder with invasion outside of the bladder wall. The patient underwent transurethral resection of the bladder tumor (TUR-BT). From the result of the pathological examination, the tumor was suggested to be carcinosarcoma of the bladder. The patient was then referred to our hospital for treatment. We performed radical cystectomy and ileal conduit diversion. Pathological examination of the excised specimen revealed an inflammatory myofibroblastic tumor as the basis for immunostaining of anaplastic lymphoma kinase (ALK).
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http://dx.doi.org/10.1016/j.eucr.2015.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4672650PMC
September 2015

18-F fluorodeoxyglucose uptake in positron emission tomography as a pathological grade predictor for renal clear cell carcinomas.

Eur Radiol 2015 Oct 9;25(10):3009-16. Epub 2015 Apr 9.

Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.

Objectives: To evaluate the usefulness of Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18-F FDG-PET/CT) in the prediction of Fuhrman pathological grades of renal clear cell carcinoma (cRCC).

Methods: This retrospective study was approved by our institutional review board, and written informed consent was waived. Thirty-one patients with pathologically proven cRCC underwent 18-F FDG-PET/CT for tumour staging. Maximum standardized uptake value of cRCC (tumour SUVmax) and mean SUV of the liver and spleen (liver and spleen SUVmean) were measured by two independent observers. Tumour SUVmax, tumour-to-liver SUV ratio, and tumour-to-spleen SUV ratio were correlated with the pathological grades.

Results: Logistic analysis demonstrated that only the tumour-to-liver SUV ratio was a significant parameter for differentiating high-grade (Fuhrman grades 3 and 4) tumours from low-grade (Fuhrman grades 1 and 2) tumours (P = 0.007 and 0.010 for observers 1 and 2, respectively). Sensitivity, specificity, and positive and negative predictive values for detecting tumours of Fuhrman grades 3 and 4 were 64, 100, 100, and 77%, respectively, for observer 1, and 79, 88, 85, and 83%, respectively, for observer 2.

Conclusions: The tumour-to-liver SUV ratio with 18-F FDG-PET/CT appeared to be a valuable imaging biomarker in the prediction of high-grade cRCC.

Key Points: • Tumour SUV max was correlated with the Fuhrman grades. • High-grade tumours have significantly higher SUV max than low-grade tumours. • Tumour-to-liver SUV ratio is useful in the prediction of high-grade cRCC.
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http://dx.doi.org/10.1007/s00330-015-3687-2DOI Listing
October 2015

Phenotype and physiological significance of the endocardial smooth muscle cells in human failing hearts.

Circ Heart Fail 2015 Jan 2;8(1):149-55. Epub 2014 Dec 2.

From the Departments of Emergency and Disaster Medicine (H.O., K.M., H.U., S.O.) and Cardiology (H.K., A.T., K.G., I.K., T.W., N.M., T.T., M.K., K.N., A.M., S.M.), Gifu University Graduate School of Medicine, Gifu, Japan; Department of Internal Medicine, Asahi University, Mizuho, Japan (G.T.); and Division of Pathology, Gifu University Hospital, Gifu, Japan (T.M., N.S.).

Background: Extravascular smooth muscle cells are often observed in the endocardium of human failing hearts. Here, we characterized the phenotype of those cells and investigated their physiological significance.

Methods And Results: We examined left ventricular biopsy specimens obtained from 44 patients with dilated cardiomyopathy and 6 nonfailing hearts. In Masson trichrome-stained histological preparations, bundles of smooth muscle cells were seen localized in the endocardium in 23 of the 44 specimens (none of the 6 controls). These cells were immunopositive for α-smooth muscle actin, type 2 smooth muscle myosin, desmin, and calponin, but were negative for embryonic smooth muscle myosin, vimentin, fibronectin, and periostin. This profile is indicative of a late differentiation (contractile) smooth muscle phenotype. Electron microscopy confirmed that phenotype, revealing the cells to contain abundant myofilaments with dense bodies but little rough endoplasmic reticulum or Golgi apparatus. In the endocardial smooth muscle-positive group, the left ventricular end-systolic volume index (73±34 versus 105±50 mL/m(2); P=0.021), left ventricular peak wall stress (164±47 versus 196±43 dynes 10(3)/cm(2); P=0.023), and left ventricular end-systolic meridional wall stress (97±38 versus 121±37 dynes 10(3)/cm(2); P=0.036) were all significantly smaller, and the ejection fraction was larger (41±8.8 versus 33±9.3%; P=0.005) than in the endocardial smooth muscle-negative group. However, no histological parameters differed between the 2 groups.

Conclusions: Endocardial smooth muscle cell bundles in hearts with dilated cardiomyopathy exhibit a mature contractile phenotype and may play a compensatory role mitigating heart failure by reducing left ventricular wall stress and systolic dysfunction.
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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.114.001746DOI Listing
January 2015

[Small cell carcinoma of the prostate effectively treated for relatively long term: a case report].

Hinyokika Kiyo 2014 Oct;60(10):517-21

The Department of Surgical Pathology, Gifu University Hospital.

A 72-year-old Japanese man was referred to a hospital because of urinary retention. Digital rectal examination revealed a stony, hard nodule in the prostate. A high level of serum PSA was not detected. Prostatic biopsy was performed, and pathological examination indicated adenocarcinoma of the prostate. He was referred to our hospital for treatment. Imaging examinations revealed no metastases (T4N0M0), so we re-evaluated the biopsy specimens. Immunohistochemical examination revealed prostatic small cell carcinoma. His levels of neuron-specific enolase (NSE) and pro-gastrin-releasing peptide (Pro-GRP) were high. We treated him with combination chemotherapy comprising irinotecan and cisplatin, and the treatment was effective. After four courses of the chemotherapy, levels of NSE and Pro-GRP had decreased, and the prostatic mass had decreased in size. Needle rebiopsy of the prostate demonstrated no evidence of malignancy. Adjuvant external beam radiation therapy was also performed. The patient iss till alive at 18 month after diagnosis with no evidence of relapse or metastasis of the disease.
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October 2014