Acta Medica Nagasakiensia Vol. 59(2014) No. 2
ACTA MEDICA NAGASAKIENSIA

Background; Core needle biopsy (CNB) specimens have been widely used not only for the diagnosis of breast cancer, but also for assessing biomarkers, including lymphovascular invasion (ly and v), nuclear grading, the estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2) and Ki-67. We herein compared the pathological biomarkers of ER+/HER2- invasive breast cancers in CNB with those in the subsequent surgical specimens. 　Methods; Patients with ER+/HER2- invasive breast cancer who presented to our department from August 2011 to July 2013 who had CNB and subsequent surgery were included. Lymphovascular invasion (ly, v) and nuclear grading were determined by hematoxylin and eosin staining, and the ER, PgR, HER-2, and Ki-67 status were evaluated by immunohistochemistry. 　Results; The concordance rates between CNB and surgical specimens for the ly, v, nuclear grading, ER and PgR were 2.4%, 2.9%, 63.0%, 96.4% and 82.1%, respectively. Lymphovascular invasion and nuclear grading tended to be underestimated with CNB in discordant cases. The Ki-67 labeling index in CNB specimens was strongly correlated with that in surgical specimens (correlation coefficient 0.75, p<0.0001). Consequently, there was a reasonable level of agreement between CNB and surgical specimens for surrogate subtyping (82.1%). 　Conclusions; CNB provided reliable information on the expression of hormone receptors, Ki-67 in ER+/HER2- invasive breast cancers. However, because of the substantial discordance between CNB and surgical specimens, the status of lymphovascular invasion and nuclear grading should not be concluded based on CNB specimens.

The precise roles of visceral (VAT) or subcutaneous adipose tissue (SAT) on hepatic fat accumulation have not been fully elucidated. In this report, we examined the correlation between VAT or SAT volume and severity of hepatic fat accumulation. In the present study, Sprague-Dawley (SD) rats were fed a standard diet containing 10% fat or a high-fat diet containing 45% or 60% fat for 16 weeks. Abdominal VAT and SAT volume, as well as fat percentage of the liver were measured by computed tomography (CT). Hepatic triglyceride (TG) content and histopathological findings of hepatic steatosis were also examined. Abdominal SAT weight/body weight ratio was positively and strongly correlated with abdominal VAT weight/body weight ratio. Fat percentage of the liver by CT evaluation, hepatic TG content, and hepatic steatosis score by histopathological evaluation showed positive correlations with one another. Fat percentage of the liver by CT evaluation and hepatic TG content was positively correlated with both the abdominal VAT weight/body weight ratio and SAT weight/body weight ratio, respectively. Furthermore, hepatic TG content was negatively correlated with the abdominal VAT weight/SAT weight ratio. Our data suggest that abdominal SAT accumulation is positively correlated with hepatic steatosis in SD rats, rather than abdominal VAT accumulation. Further investigations are needed in order to clarify the precise mechanisms of SAT and VAT effects on the development of hepatic fat accumulation.

Activated lymphocytes morphologically change into large aberrant cells known as atypical lymphocytes (atyLy). AtyLy are seen in various non-neoplastic conditions such as viral infection of Epstein-Barr virus, cytomegalovirus and hepatitis viruses. These activated cells release various cytokines or soluble receptors such as soluble interleukin-2 receptor (sIL-2R) and Fas-receptor (Fas-R). Accordingly, we measured serum sIL-2R in 25 pediatric patients. The data and other hematological/biochemical parameters were analyzed by the statistical processing method of Principle Component Analysis (PCA). 23 out of 25 patients with atypical lymphocytosis-related conditions (atyLy/lymphocyte ratio > 5%) were found to have higher serum sIL-2R levels than the cut-off-value of 400 U/mL. The correlation between sIL-2R and the atyLy/lymphocyte ratio was the best indicator for discriminating the severity of disease. The first component (contribution ratio: 0.384) of PCA showed that lymphocyte activity was mostly represented by sIL-2R, lactate dehydrogenase, white blood cell count, lymphocyte count, lymphocyte percentile and atyLy/lymphocyte ratio. 　Conclusively, these findings suggest a strong correlation between serum sIL-2R level and atypical lymphocytosis.

Polymorphism of the UGT1A1 gene is known to play an important role in irinotecan pharmacokinetics and severe toxicity. A 71-year-old man with lung cancer (squamous cell carcinoma cT2aN3M0 stage IIIB) received irinotecan and cisplatin with concurrent thoracic radiotherapy. Although all treatments were discontinued after day 7, severe leukopenia, neutropenia, febrile neutropenia, thrombocytopenia, and diarrhea developed. His life was at risk, and his ECOG performance status (PS) fell to 4. He had UGT1A1*6 heterozygous and UGT1A1*28 wild-type gene polymorphisms. Considering its frequency in Asians, we should take care when using irinotecan to treat patients with UGT1A1*6 heterozygous polymorphism.

Introduction 　Gefitinib is a molecularly targeted drug for oral administration, a selective epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). It is effective for patients with lung cancer who have EGFR mutation and enables long-term survival of patients with advanced disease. Case presentation 　An 84-year-old Asian female with lung cancer (adenocarcinoma, cT4N3M1b stage IV PUL BRA OSS ADR) was treated by gefitinib for two years. The primary tumor was markedly reduced, and bone metastasis had almost disappeared. However, the patient became unconsciousness with general edema and died two days after falling unconsciousness. In the autopsy, it was diagnosed as infectious cerebral thromboembolism due to infectious endocarditis. The cause of death was cardiac tamponade. Conclusions 　While long-term survival can be expected in patients with advanced lung cancer by molecular-targeted agents, cautious management is warranted for complications, the same as for the primary disease.

A 70-year-old woman undergoing chronic maintenance hemodialysis had felt a mass in her left hip 4 years prior. As the mass gradually expanded, magnetic resonance imaging (MRI) was performed. The MRI findings showed mosaic patterns with various signal intensities inside the mass and a low-signal band at its periphery. Because of the slow expansion of the mass over a course of at least 4 years and its characteristic MRI findings, the patient was diagnosed with a chronic expanding hematoma (CEH), a comparatively rare type of hematoma. To our knowledge, this is the first report of a CEH occurring in a hemodialysis patient in the English literature.