Understanding the genomic landscape of malignant tumors has revealed novel diagnostic, prognostic, and predictive molecular biomarkers to refine their pathological classifications. However, it remains a major challenge to incorporate molecular genetic information into the routine diagnostics of cancer to achieve "Precision Medicine." Significant progress towards this goal has been achieved owing to the new World Health Organization (WHO) 2016 Classification of Tumors of the Central Nervous System which has enabled traditional histology-based diagnostics to be replaced with a multi-layered approach that combines histologic features and molecular information in an "integrated diagnosis." Described here are state-of-the-art pathological diagnostic approaches using molecular markers for malignant tumors, focusing particularly on brain tumors, which are likely to help ensure more precise diagnostics for personalized medicine.

Background: Non-specific complaints are common in women, and tend to be diagnosed as menopausal disorders or autonomic imbalance without adequate examination. In Women Specific Clinic (WSC), we carry out a careful differential diagnosis on the basis of patients' complaints, taking account of women's mental and physical characteristics. One point that warrants particular attention is that many non-specific complaints resemble the symptoms of thyroid dysfunction and malignant tumor (MT). Thyroid cancer (TC), 90 % of which is papillary thyroid carcinoma (PTC), is also about three times more common in women than in men. TC is commonly diagnosed at a younger age than other adult-onset cancers, and the risk of TC peaks earlier in women than it does in men, being highest in the 40s and 50s, around the age of menopause.

We therefore focused on MT and PTC as a common female cancer that often coincides with menopause, and investigated the prevalence and attributes of patients diagnosed with PTC in our clinic as well as the diagnostic process.

Materials and Methods: We investigated the prevalence and type of malignancy and the diagnostic process for those patients diagnosed with PTC out of 668 patients who were first examined in WSC between June 2011 and June 2012.

Results: MT was identified in 6 of 668 patients (0.9 %) and PTC was identified in 4 of 668 patients (0.6 %) examined during this 1-year period. The attributes and complaints of these patients varied; the common factor was the fact that the physician listened carefully to symptoms peripheral to the principal complaint and carried out the appropriate investigation (ultrasonography) required for a differential diagnosis.

Conclusions: Women tend to experience a variety of menstruation-related and menopausal symptoms that present as non-specific complaints. These may easily mask the symptoms of underlying disease such as PTC in menopausal or premenopausal woman. At women's medicine, health providers should be aware of this point and conduct a careful differential diagnosis.

We present a case of sporadic hemiplegic migraine in a 10-year-old girl, in which the clinical course and findings on electroencephalography (EEG) showed a relatively good correlation. She presented with chief complaints of right-sided hemiplegia and mild disturbance of consciousness after developing right unilateral pulsatile headache. No particular abnormalities were found from blood tests, cerebral spinal fluid analysis, plain computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the head, or plain MRI of the cervical vertebrae performed on hospital day 1. EEG showed high-amplitude slow waves and disappearance of basic waves in the left hemisphere. Cerebrovascular disorder was suspected, and treatment with large-volume fluid replacement and continuous administration of heparin was initiated. Right-sided hemiplegia improved on hospital day 2, and she became alert and conscious. No abnormalities were seen on plain CT of the head performed the same day, and large-volume fluid replacement and continuous administration of heparin were discontinued. She progressed without relapse of any symptoms, and EEG performed on hospital day 5 indicated normal background activity and disappearance of high-amplitude slow waves. She was therefore diagnosed with a first attack of sporadic hemiplegic migraine. Hemiplegic migraine can be relatively easily diagnosed when a patient experiences recurring attacks, but can be more challenging when the first attack is accompanied by hemiplegia and disturbance of consciousness as in our patient, given that other conditions such as cerebrovascular disorder, epileptic seizure, and acute encephalopathy/encephalitis show similar presentations. Since treatment strategies for these disorders differ substantially, our findings suggest the importance of considering the possibility of sporadic hemiplegic migraine when a patient with headache presents with atypical symptoms. According to the International Classification of Headache Disorders, 3rd edition (beta version), EEG is not essential for the diagnosis of migraine, including hemiplegic migraine. However, many reports since early times have suggested an association between migraine and EEG findings. Our findings were also characteristic in that clinical symptoms of the patient and EEG findings were correlated. Given that EEG is non-invasive and technically easy to perform, EEG should be considered as a significant diagnostic tool when a patient with headache presents with atypical symptoms such as disturbance of consciousness and motor paralysis.

A 50-year-old woman underwent distal gastrectomy for gastric cancer 9 years ago. On histopathology, a primary poorly-differentiated adenocarcinoma (T4, N0, CY1, P0, Stage IV) was diagnosed. The patient received 4 courses of S-1 combined with cisplatin for adjuvant chemotherapy. She noticed a tumor on the upper abdominal wall 9 years after the initial surgery. Computed tomography showed a thickened area in the right rectus abdominis muscle and fluorodeoxyglucose positron emission tomography showed uptake in the same area. Adenocarcinoma was diagnosed with biopsy. Further examination did not reveal any other metastasis. Staging laparoscopy revealed no peritoneal metastasis and abdominal cytology result was negative. We therefore diagnosed recurrent gastric cancer with metastasis to the abdominal wall. The patient received 4 courses of S-1 combined with oxaliplatin. Tumor size was reduced, and surgery was then performed. The tumor and gastric cancer specimen showed similar patterns on pathological examination. Postoperatively, chemoradiotherapy was performed because of positive margins. After 7 months of follow-up, the patient has no signs of recurrence.