Abstract Background Ossified cartilage is much more susceptible to cancer infiltration, but the reason remains unknown, and the relationship between the ossification pattern and cancer infiltration has not been studied. Methods The presence of thyroid cartilage ossification, cancer infiltration, ossification pattern (usual: direction from inferior to superior; unusual: other than the usual pattern), and distance between cancer and ossified cartilage were evaluated in laryngectomy specimens. Results There were 28 and 27 cases of usual and unusual patterns, respectively. There was no association between ossification pattern and cancer infiltration. However, the distance between the ossified area and cancer cells was greater in the usual pattern than in the unusual pattern ( p = 0.006). And the usual pattern was more frequently observed in cases with a distance >1 mm than in cases with cancer infiltration or a distance ≤1 mm ( p = 0.004). Conclusion These results suggest the possibility of an active ossification due to tumor progression.
Although strengthened concrete members with Fiber Reinforced Polymer Plastic (FRP) are well-known to improve both strength and stiffness of constructions, relatively little is known about their premature failure, and specially, the development of interface debonding when flexural macro cracks at the mid-point of a strengthened beam reach a critical state and an interface crack propagates to the end-block. Herein, an experimental study using GFRP-strengthened beams is performed, in which the effects of length, thickness, and plate width on interface debonding failure were examined. According as strengthening length is increased, failure pattern changed from ripoff to interface debonding, and there was comparatively smaller effect in which failure pattern by the strengthening amount changes. From the comparison of anchoring schemes in end-block of FRP, U-wrap anchoring is more effectively resistant to shear stress than fiber anchor. As flexural cracks developed near the mid-point of the beams, horizontal interface debonding cracks between the concrete and GFRP propagated to the end-blocks of the plates after the tensile rebars yielded. In this study, a semi-empirical equation is developed to predict debonding loads, based on the test results. The proposed theory, which is based on nonlinear analysis and the critical flexural crack width, predicted the debonding failure loads of the specimens relatively well, and can be used for the analysis and design of GFRP-strengthened RC beams.
Anaplastic lymphoma kinase tyrosine kinase inhibitors (ALK-TKIs) are usually effective in lung adenocarcinoma patients with anaplastic lymphoma kinase (ALK) rearrangement. However, even after a good response to ALK-TKI therapy, most patients acquire resistance to these agents. Histological transformation is one of several suggested mechanisms of acquired resistance to ALK-TKIs. The clinicopathologic features of four patients with ALK-expressing adenocarcinoma and neuroendocrine features were analyzed.We selected combined neuroendocrine differentiation in pulmonary adenocarcinoma cases with positive ALK immunostaining. Neuroendocrine differentiation was confirmed by CD56 immunohistochemical stain. Additional ALK fluorescence in situ hybridization (FISH) study and epidermal growth factor receptor (EGFR) mutation tests were also performed.All four cases were positive for ALK immunohistochemistry and no EGFR mutations were detected. Interestingly, the results of ALK FISH assays showed rearrangement in only two cases. Three cases showed combined adenocarcinoma and neuroendocrine component without history of ALK-TKI administration; one of them was treated with crizotinib and experienced partial tumor regression. The remaining case had an adenocarcinoma at initial biopsy and she showed a partial response to crizotinib, and neuroendocrine changes were visible on second biopsy. Then she was treated with ceritinib and achieved a partial response.We suggest that ALK-rearranged adenocarcinoma with combined neuroendocrine component is responsive to ALK-TKIs. Moreover, even after neuroendocrine transformation as a result of resistance to ALK-TKIs, the tumor may have partial response to second generation ALK-TKIs.
Wnt7a is a known tumor suppressor gene in non-small cell lung cancer that regulates normal cellular proliferation and differentiation. The purpose of this study was to investigate the clinicopathologic significance of Wnt7a expression in colorectal adenocarcinoma. Wnt7a expression was immunohistochemically examined in 46 normal colorectal tissues, 47 tubular adenomas, 393 adenocarcinomas, and 93 lymph node metastases. Wnt7a was expressed in the cytoplasm. Loss of Wnt7a expression was more frequent in adenocarcinoma and lymph node metastasis compared to that in normal and tubular adenoma (P < 0.001). Wnt7a expression was inversely correlated with tumor size (P = 0.026), gross type (P = 0.008), differentiation (P = 0.009), vascular invasion (P = 0.038), tumor deposit (P = 0.007), tumor invasion (T category) (P = 0.003), lymph node metastasis (N category) (P < 0.001), and AJCC stage (P < 0.001). There was a significant correlation between loss of Wnt7a expression and overall survival and disease-free survival (P < 0.001 and P = 0.001, respectively) on univariable analysis. On multivariable analysis, loss of Wnt7a expression was an independent prognostic factor for both overall and disease-free survival (P = 0.002 and P = 0.047, respectively). Loss of Wnt7a expression may contribute to the carcinogenesis and tumor progression of colorectal adenocarcinoma and may be a new prognostic marker of colorectal adenocarcinoma.
Cytomegalovirus (CMV) infection of the gastrointestinal tract has been reported most frequently in the setting of immunodeficiency.The whole gastrointestinal tract can be affected; however, the small bowel is rarely affected.We report a case of CMV enteritis with jejunal perforation in a 53-year-old woman with a history of chemoradiation therapy for endometrial cancer 8 years previously.At follow-up evaluation, lower abdominal pain, diarrhea and vomiting appeared.Abdominal computed tomography showed intra-abdominal free air in the subphrenic space and porta hepatis.The jejunal segment revealed serosal purulent exudates with a perforation.The resected jejunal segment showed a large geographic ulcerative mucosal lesion.The microscopic findings revealed a diffuse ulcerative mucosal change with a prominent granulation tissue formation and many large atypical vascular endothelial cells and stromal fibroblasts with intranuclear or intracytoplasmic inclusion bodies.These cells were positive for CMV antibody.The final diagnosis was CMV-associated jejunitis with a jejunal perforation.
A 61-year-old female patient with chronic kidney disease due to diabetes mellitus and hypertension-induced nephropathy received a deceased donor kidney transplant in March 2020. In July 2020, she was transferred from a local hospital due to the exacerbation of general weakness and diarrhea. Upon her arrival, we noticed a high level of serum creatinine (sCr) of 1.5 mg/dL and a decrease in urine output. Her laboratory results indicated significant hemolysis, with a hemoglobin level of 7.0 g/dL, platelet count of 20 ×103/μL, and a lactate dehydrogenase level of 3,207 IU/L. Kidney biopsy showed severe thrombotic microangiopathy without any evidence of acute rejection. Under the impression of atypical hemolytic uremic syndrome (aHUS), we immediately started plasmapheresis and hemodialysis for anuria. Eculizumab was considered as a kidney graft rescue therapy since her sCr level was not effectively decreased, and her anuria continued despite hemodialysis and plasmapheresis. Eculizumab (900 mg) was administered weekly for 4 weeks. An additional 600 mg of eculizumab was administered on the day of plasmapheresis. Since the patient's laboratory data gradually improved, hemodialysis and plasmapheresis were ceased on admission day 37. After that, eculizumab was administered biweekly (1,200 mg) two more times. The patient's sCr and platelet count normalized after 2 months of eculizumab treatment. Based on our experience, a shorter interval between the clinical diagnosis of aHUS and administration of eculizumab increases the likelihood of rescuing the kidney.
CD47, a transmembrane protein, is widely overexpressed on the tumor cell surface. However, the prognostic significance of CD47 expression in colorectal adenocarcinoma (CRA) has not yet been clarified. Here, we investigated the clinicopathologic significance of CD47 expression in CRA. CD47 expression was evaluated via immunohistochemical analysis of microarray sections of 328 CRA tissues. CD47 expression was observed in 53 (16.2%) of the 328 CRA tissues, and positive expression was associated with lymphatic invasion (p = 0.018), perineural invasion (p = 0.024), tumor budding (p = 0.009), the pathologic N stage (p = 0.022), and the American Joint Committee on Cancer (AJCC) stage (p = 0.027). In survival analyses of 329 patients, a positive CD47 expression was associated with a poor recurrence-free survival (RFS) (p = 0.032). In multivariate analysis, however, it was not an independent prognostic factor. In patients who underwent surgical resection without adjuvant treatment, a positive CD47 expression was associated with a shorter RFS (p = 0.001) but not with cancer-specific survival (CSS). In patients who received postoperative adjuvant treatment, no significant differences were found in both RFS and CSS. In conclusion, we investigated CD47 expression in 328 CRA tissues. A positive CD47 expression was observed in a minority (16.2%) of the tissues and was significantly associated with adverse clinicopathologic features and a poor patient outcome.
Sarcomatoid carcinoma is a rare malignant tumor that has both malignant epithelial and mesenchymal components. We describe a sarcomatoid carcinoma arising in the right renal pelvis of a 68-year-old man. The dominant component of the tumor was osteosarcomatous, but there were also focal carcinomatous areas. The sarcomatous tumor cells produced abundant osteoid matrix surrounded by osteoblastic cells. The carcinomatous tumor cells consisted of papillary urothelial carcinoma. Immunohistochemical assay showed that the sarcomatous tumor cells were positive for vimentin and negative for cytokeratin. The papillary urothelial carcinoma was positive for cytokeratin and negative for vimentin. After surgery, the patient underwent adjuvant chemotherapy. Four months later, he presented with recurrence in the right subphrenic area and metastasis in the right middle lobe of the lung.
Background/Aim: Microtubule-associated tumor suppressor 1 (MTUS1) is a novel tumor suppressor involved in proliferation and migration, and down-regulation of MTUS1 is associated with the poor prognosis of several cancers. We evaluated the clinicopathological significance of MTUS1 expression in renal cell carcinoma (RCC). Patients and Methods: We assessed MTUS1 expression by immunohistochemical staining of tissue microarrays from 249 cases of RCC. We analyzed the correlation of MTUS1 expression and clinicopathological characteristics. Additionally, we used public databases and performed bioinformatics analysis. Results: We investigated The Cancer Genome Atlas databases and identified that MTUS1 mRNA expression was significantly lower in RCC tissues than in normal tissues. Loss of MTUS1 expression was correlated with high WHO/ISUP nuclear grade, lymphovascular invasion, renal vein thrombus, and high pT stage in patients with RCC. Although there was no statistically significant correlation between MTUS1 expression and patients9 prognosis in our cohort, MTUS1 overexpression was significantly correlated with a favorable prognosis in public data. Conclusion: Loss of MTUS1 expression in RCC might be a potential biomarker for predicting clinical outcome.
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