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Other iatrogenic immunosuppressive‐associated lymphoproliferative disorders (OIIA‐LPDs) rarely occur in the central nervous system (CNS). Additionally, they almost always present as lymphoma and withdrawal by cessation of immunosuppressive treatment. We report a case of primary CNS OIIA‐LPD that presented as extraosseous plasmacytoma (EP) with a progressive clinical course in spite of immunosuppressive treatment cessation. A 78‐year‐old man with a history of rheumatoid arthritis (RA) presented with a month‐long headache. Magnetic resonance imaging showed mass lesions in the left temporal lobe, left middle fossa, and intradural cervical spine. The left temporal lesion was resected and diagnosed as EP histologically, and OIIA‐LPD presented as plasmacytoma integrally due to his history of immunosuppressive treatment using tacrolimus for RA. Despite immunosuppressive treatment cessation, OIIA‐LPD lesions did not regress but, on the contrary, showed a progressive clinical course. Considering his advanced age and renal dysfunction, postoperative treatment with radiation and moderate chemotherapy using prednisolone were administrated. Subsequently, the disease state stabilized, and the patient had a Karnofsky performance status score of 90 for 6 months; however, the tumor recurred with meningeal dissemination, and he died 8 months after treatment. Types of OIIA‐LPD onset as EP and its progressive clinical course resistant to cessation of immunosuppressive treatment are rare. Moreover, this OIIA‐LPD disease state worsened despite its radiosensitivity. We believe the progressive clinical course of this OIIA‐LPD case with its high cell proliferation is similar to Epstein–Barr virus negative plasmablastic lymphoma, which could lead to a poor outcome. [ABSTRACT FROM AUTHOR]

Objectives: To identify prostatic quadrants that could be preserved without intervention, using diffusion-weighted magnetic resonance imaging (DWI) and extended core biopsy, as a step toward implementation of quadrant-based focal ablation with potential preservation of erectile and ejaculatory functions, based on comparisons with unilateral hemi-gland ablation. Patients and Methods: We conducted a prebiopsy DWI study including 648 quadrants in 162 men who underwent 14-core biopsy including anterior sampling and radical prostatectomy (RP) for localised cancer. Imaging and pathology were analysed on a quadrant basis. Each quadrant was assessed through four-core sampling. Predictive performance of DWI and biopsy for quadrant status was analysed. Results: On RP specimens, 170 anterior (52.5%) and 172 posterior quadrants (53.1%) harboured significant cancer. Negative predictive values of DWI, biopsy, and their combination for significant cancer were 79.7%, 70.6%, and 91.1%, respectively, in anterior quadrants, and 78.5%, 81.3%, and 91.7%, respectively, in posterior quadrants. DWI incrementally improved the negative predictive values of biopsy in anterior (P < 0.001) and posterior quadrants (P = 0.025), without untoward impacts on positive predictive values. Negative findings on both DWI and biopsy were identified in posterior quadrants of 109 sides (33.6%), but in entire hemi-glands of 54 sides (16.7%). Conclusions: The combination of DWI and 14-core biopsy including anterior sampling efficiently identifies quadrants without significant cancer in men with localised prostate cancer; the remaining quadrants, therefore, could be potential candidate areas for focal ablation. Focal therapy designed based on quadrant-based assessment could be superior to unilateral hemi-gland ablation for preservation of posterior quadrants and retaining of sexual function in more sides. [ABSTRACT FROM AUTHOR]

Study Type - Prognosis (inception cohort) Level of Evidence 2 What's known on the subject? and What does the study add? The criteria used for selecting patients with prostate cancer for active surveillance (AS) are still not satisfactory due to the difficulty in predicting the significance of the prostate cancer. Urologists could predict insignificant prostate cancer by incorporating cumulative cancer length and biopsy Gleason score, derived from extended biopsy. The present study has added new criteria for predicting insignificant prostate cancer, which would lead to a better selection of candidates for AS. OBJECTIVE To develop extended biopsy based criteria for predicting insignificant cancer (IC) using extended biopsy findings., PATIENTS AND METHODS From 2000 to 2009, 1575 patients with prostate cancer were primarily treated by radical prostatectomy in two referral hospitals., Of these, the study cohort comprised 499 patients with extended biopsy confirmed, clinically organ-confined (cT1-2N0M0) prostate cancer with PSA levels of <20 ng/mL., Cancer information obtained through extended biopsy included cumulative cancer length (CCL) divided by the number of biopsy cores (CCL/core)., RESULTS Pathological examination revealed 39 ICs (7.8%). All these ICs fell in a category of prostate cancer with clinical stage ≤T2a and 2005 International Society of Urological Pathology Consensus Conference (ISUP) modified biopsy Gleason score ≤7., Accordingly, we analysed predictors of IC in a subset cohort of 370 patients in this category. A multivariate logistic regression analysis revealed that 2005 ISUP modified biopsy Gleason score and CCL/core were independently significant predictors of IC., We determined a threshold value of CCL/core of 0.20 mm for predicting IC using receiver operating characteristic analysis., Based on these findings, we developed simple extended biopsy based criteria for predicting IC as follows: (i) PSA level of <20 ng/mL; (ii) Clinical stage ≤T2a; (iii) 2005 ISUP modified biopsy Gleason score ≤6; (iv) CCL/core of <0.20 mm., The specificity of the criteria was 91%, which was significantly higher than the value from a subset of criteria without item iv ( P < 0.001)., CONCLUSION We have developed extended biopsy based criteria for predicting IC incorporating the 2005 ISUP modified biopsy Gleason score and CCL/core. [ABSTRACT FROM AUTHOR]

The article presents a case a study of a male infant with congenital hydrocephalus and severe thinning of the cerebral cortex. A systematic examination found increased muscular tonus and the patellar tendon reflex was active. Gastrostomy was conducted to control nutrition as well as tracheostomy to separate the trachea from the larynx.

The aim of this study is to compare the expression pattern of matrix metalloproteinases (MMP) in primary CNS lymphoma (PCNSL) with that of nodal lymphoma (NL). PCNSL possesses a characteristic pattern of brain infiltration, specifically, perivascular aggregation and destruction of the surrounding connective tissue. Hypotheses have been proposed that this infiltration pattern indicates the infiltration of lympoma cells from outside the CNS. However, the mechanism of this infiltration pattern has not been clearly explained. Here we performed quantitative analysis of mRNA expression of MMP1, 2, 3, 7 and 9 in lymphoma cells from 10 cases of PCNSL, all of which were diagnosed as diffuse large B-cell lymphoma (DLBCL), and 14 cases of nodal DLBCL. Immunohistochemistry was also performed for phenotyping of lymphoma cells and for examining the localization of MMPs. The expression level of MMP7 in PCNSL (median ratio to normal lymophocytes, 45.6) was significantly higher than the level in NL (median, 7.55). By contrast, the expression levels of MMP2 (median, 31.7) and MMP9 (median, 1.30) in PCNSL were significantly lower than those in NL (median, 120 and 16.5, respectively). The expression levels of MMP1 and MMP3 were very low and not different between PCNSL and NL (almost comparable to those in normal lymphocytes). Immunohistochemical phenotyping revealed that the frequency of non-germinal center type DLBCL was significantly higher in PCNSL than in NL. These results, notably the significantly increased expression of MMP7 in PCNSL, suggest the involvement of this MMP in the characteristic infiltration pattern of PCNSL. They also support the existing hypothesis that PCNSL and NL are of different origins. [ABSTRACT FROM AUTHOR]

OBJECTIVE To assess the impact of preoperative C-reactive protein (CRP) levels on the prognosis in patients with upper urinary tract (UUT) urothelial carcinoma (UC) primarily treated surgically, as it is increasingly recognized that a systemic inflammatory response is associated with the prognosis for patients with various malignancies. PATIENTS AND METHODS The clinical records of 130 patients treated surgically for UUT-UC were reviewed retrospectively. An elevated CRP was defined as >0.5 mg/dL. Actuarial survival curves were calculated by Kaplan–Meier method, with the difference between curves evaluated using the log-rank test. A multivariate analysis was used to identify prognostic factors, with Cox’s proportional hazard model. RESULTS The median (range) follow-up was 47 (3–190) months. The preoperative serum CRP level was elevated in 24 patients (23%). There were significant associations between CRP level and haemoglobin concentrations, pathological T stage, tumour grade, lymph node involvement and lymphovascular invasion. The 5-year disease-specific and recurrence-free survival rates of 24 patients with elevated CRP were significantly worse than those of the 106 with no CRP elevation (both P < 0.001). On multivariate analysis, preoperative CRP level, pathological T stage and lymph node involvement were significant prognostic factors for disease-specific and recurrence-free survival. CONCLUSION This study indicated that an elevated preoperative CRP level predicts a poor survival in patients with UUT-UC. [ABSTRACT FROM AUTHOR]

Purpose To determine the usefulness of high-resolution three-dimensional (3D) constructive interference in steady state (CISS) MRI for evaluating mural invasion and morphologic features in esophageal carcinomas. Materials and Methods Twenty-four esophageal specimens with carcinomas were studied with a 1.5-T system using a 4-cm-diameter loop coil. High-resolution 3D-CISS MR images were obtained with a field of view (FOV) of 80 mm, matrix of 256 × 256, and section thickness of 0.5 mm (voxel size of 0.05 mm3). 3D-CISS MR images were compared with histopathologic findings, and virtual MR endoscopic images were compared with macroscopic findings at surgery. Results 3D-CISS MR images clearly depicted the normal esophageal wall as consisting of eight layers, which correlated well with the histologic layers. In 22 of 24 esophageal carcinomas (92%), the depth of mural invasion visualized with 3D-CISS MRI correlated well with the histopathologic staging. In all 24 carcinomas (100%), virtual MR endoscopic images clearly depicted the macroscopic types of the carcinomas, including adjacent lymph node swelling. Conclusion High-resolution 3D-CISS MRI has a high diagnostic accuracy for evaluating mural invasion and macroscopic findings in esophageal carcinomas, and may be applicable to preoperative histopathologic staging and morphologic evaluation. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Intrabiliary growth of liver metastases from colorectal cancer has rarely been studied. A surgically resected case of a metastatic liver tumor with prominent intrabiliary growth derived from rectal cancer is reported. The patient was a 62-year-old man who had received a low anterior resection for rectal cancer in March 2000. He was re-admitted due to obstructive jaundice in January 2003, and was diagnosed with hepatic malignancy in segment II of the liver with an intrabiliary tumor extending from the intrahepatic bile duct of segment II to the common hepatic duct. He underwent a left hepatectomy, a partial resection of segment VI, and an extrahepatic bile duct resection with reconstruction of the biliary tract. In the resected specimen, there were whitish tumors of 3 cm and 1.5 cm in diameter in segments II and VI, respectively, and an intrabiliary tumor originating from the main tumor in segment II extended to the common hepatic duct. Both the liver tumors and the intrabiliary tumor consisted of a well- to moderately differentiated adenocarcinoma, which showed the same histological features as the rectal cancer. The immunohistochemical findings strongly supported that these tumors, including the intrabiliary growth, were liver metastasis from the rectal cancer. The intrabiliary invasion and growth of metastatic liver tumors has generally been overlooked, notwithstanding their frequently observed biological behavior. The present case is informative, and further investigation into this type of metastatic liver tumor may be warranted. [ABSTRACT FROM AUTHOR]

The macroscopic and microscopic redox potentials of the four hemes of the small tetraheme cytochrome c from Shewanella oneidensis were determined. The microscopic redox potentials show that the order of reduction is from hemes in the C-terminal domain (hemes 3 and 4) to the N-terminal domain (heme 1), demonstrating the polarization of the tetraheme chain during reduction. This makes heme 4 the most efficient electron delivery site. Furthermore, multi-step reduction of other redox centers through either heme 4 or heme 3 is shown to be possible. This has provided new insights into the two-electron reduction of the flavin in the homologous flavocytochrome c–fumarate reductase. [Copyright &y& Elsevier]