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A 62-year-old Taiwanese man presented to our hospital with soft masses over his right shoulder and left elbow that had rapidly developed over the previous three months. Diagnostic biopsy showed abnormal lymphoplasmacytoid cells in the soft tissue and bone marrow. Serial studies including immunohistochemistry and flow cytometry showed that these abnormal cells strongly expressed cell surface markers such as IgM and CD-20, but not CD3, CD5, or CD10, leading to the diagnosis of Waldenstrom macroglobulinemia (WM). These soft tissue lesions and abnormal cells in the bone marrow decreased gradually after multiple rounds of chemotherapy with R-COP. This study presents a case of WM—a rare B-cell lymphoproliferative disorder—with initial extramedullary soft tissue presentation. Thus, physicians should be aware of this rare soft tissue clinical manifestation in patients.

The production of ethanol from the fast-growing perennial C4 grass Miscanthus floridulus by simultaneous saccharification and fermentation (SSF) was investigated. M. floridulus biomass was composed of 36.3% glucan, 22.8% hemicellulose, and 21.3% lignin (based on dried mass). Prior to SSF, harvested stems of M. floridulus were pretreated separately by alkali treatment at room temperature, alkali treatment at 90 °C, steam explosion, and acid-catalyzed steam explosion. The delignification rates were determined to be 73.7%, 61.5%, 42.7%, and 63.5%, respectively, by these four methods, and the hemicellulose removal rates were 51.5%, 85.1%, 70.5%, and 97.3%, respectively. SSF of residual solids after various pretreatments was performed with dried yeast (Saccharomyces cerevisiae) and cellulases (Accellerase 1000) by using 10% water-insoluble solids (WIS) of the pretreated M. floridulus as the substrate. The ethanol yields from 72-h SSF of M. floridulus biomass after these pretreatments were 48.9 ± 3.5, 78.4 ± 1.0, 46.4 ± 0.1, and 69.0 ± 0.1% (w/w), respectively, while the ethanol concentrations after 72-h SSF were determined to be 15.4 ± 1.1, 27.5 ± 0.3, 13.9 ± 0.1, and 30.8 ± 0.1 g/L, respectively. Overall, the highest amount of ethanol (0.124 g/g-dried raw material) was generated from dried raw material of M. floridulus after alkaline pretreatment at 90 °C. The acid-catalyzed steam explosion pretreatment also resulted in a high ethanol yield (0.122 g/g-dried raw material). Pretreatment resulting in high lignin and hemicellulose removal rates could make biomass more accessible to enzyme hydrolysis and lead to higher ethanol production.

BACKGROUND Patients with triple-negative breast cancer (TNBC) are at increased risk of brain metastases (BMs). In this retrospective single-institutional study, we assessed the radiographic features from a cohort of breast cancer (BC) patients with confirmed BM. METHODS Women diagnosed with BC with BM from January 1, 1996 to May 31, 2012 were identified through institutional databases. Relevant medical records were reviewed to assess patterns of recurrence, treatment, magnetic resonance imaging (MRI) features of BM, and survival after BM. The MRI finding of BM was classified as solid, necrotic, leptomeningeal spread, or mixed type. We assigned the patient into three groups according to histologic subtype of primary BC. RESULTS In total, 62 patients, median age 53 years (range 20-78), were identified and specific treatment for BM consisted of radiotherapy, surgical resection, and systemic chemotherapy. The initial stage, post-BM survival and overall survival were not significantly different. However, cystic necrotic BMs appeared on MR images were significantly more associated with the TNBC group. CONCLUSION Patients with BMs from TNBC have distinct MRI features helping the assessment of newly developed BM. A large confirmatory study with correlated histology in this unique patient population will be required.

Infiltrating neutrophils, lymphocytes, macrophages, and cytokines constitute a state of chronic inflammation within the tumor microenvironment. Tartrate-resistant acid phosphatase 5a (TRACP5a) protein, a novel product of activated macrophage, is postulated to be a biomarker for systemic inflammatory burden in states of chronic inflammation. We aimed to investigate the clinical significance of TRACP5a expression in tumor-infiltrating macrophages and serum TRACP5a in patients with metastatic breast cancer (BC). We retrospectively analyzed the clinical data from 34 BC patients with confirmed skeletal/visceral metastasis upon or during first-line palliative treatment. Patients were stratified into 3 groups based on the therapeutic responses and follow-up disease course. The association of TRACP5a protein with other inflammatory and cancer biomarkers was assessed among the clinically distinct group of patients. Higher TRACP5a protein was significantly correlated with earlier disease progression and survival (P = 0.0045) in comparison to other inflammatory markers, CRP or IL-6. Patients with higher serum TRACP5a level and shorter survival and treatment refractoriness also had more TRACP+ tumor-infiltrating macrophages. Our data support a hypothesis that serum TRACP5a protein can potentially be a predictive and prognostic marker to evaluate disease progression and therapeutic response in BC patients with bone/visceral metastasis. The associations between overall survival and TRACP expression by macrophages require further prospective investigation.

Patients with triple-negative breast cancer (TNBC) are at increased risk of brain metastases (BMs). In this retrospective single-institutional study, we assessed the radiographic features from a cohort of breast cancer (BC) patients with confirmed BM.Women diagnosed with BC with BM from January 1, 1996 to May 31, 2012 were identified through institutional databases. Relevant medical records were reviewed to assess patterns of recurrence, treatment, magnetic resonance imaging (MRI) features of BM, and survival after BM. The MRI finding of BM was classified as solid, necrotic, leptomeningeal spread, or mixed type. We assigned the patient into three groups according to histologic subtype of primary BC.In total, 62 patients, median age 53 years (range 20-78), were identified and specific treatment for BM consisted of radiotherapy, surgical resection, and systemic chemotherapy. The initial stage, post-BM survival and overall survival were not significantly different. However, cystic necrotic BMs appeared on MR images were significantly more associated with the TNBC group.Patients with BMs from TNBC have distinct MRI features helping the assessment of newly developed BM. A large confirmatory study with correlated histology in this unique patient population will be required.