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Objective: To examine the safety and efficacy of microwave tissue coagulation (MTC) for prostate cancer and assess its use in lesion‐targeted focal therapy in a non‐clinical study and a clinical phase II trial. Methods: In the non‐clinical study using Microtaze®‐AFM‐712 (Alfresa Pharma Corporation, Osaka, Japan) with an MTC needle, MTC was performed using a transperineal approach to targeted canine prostatic tissue under real‐time ultrasonography guidance. Using various MTC output and irradiation time combinations, the targeted and surrounding tissues (rectum, bladder and fat) were examined to confirm the extent of coagulative necrosis or potential cell death, and to compare intra‐operative ultrasonography and pathology findings. The exploratory clinical trial was conducted to examine the safety and efficacy of MTC. Five selected patients underwent transperineal MTC to clinically single lesion magnetic resonance imaging (MRI)‐visible lesions with Gleason score 3 + 4 or 4 + 4. Prostate‐specific antigen (PSA), MRI and Expanded Prostate Cancer Index Composite questionnaire findings were compared before and 6 months after surgery. Results: The region of coagulative necrosis was predictable by monitoring of ultrasonically visible vaporization; thus, by placing the MTC needle at a certain distance, we were able to perform a safe procedure without adverse events affecting the surrounding organs. Based on the non‐clinical study, which used various combinations of output and irradiation time, MTC with 30‐W output for 60‐s irradiation was selected for the prostate. Based on the predictable necrosis, the therapeutic plan (where to place the MTC needle to achieve complete ablation of the target and how many sessions) was strictly determined per patient. There were no serious adverse events in any patient and only temporary urinary symptoms related to MTC therapy were observed. Furthermore, post‐treatment satisfaction was very high. All preoperative MRI‐visible lesions disappeared, and PSA decreased by 55% 6 months after surgery. Conclusion: Microwave tissue coagulation may be an option for lesion‐targeted focal therapy for prostate cancer. [ABSTRACT FROM AUTHOR]

Background and Aim: High‐grade dysplasia (HGD) and T1 lesions are accidentally resected by cold snare polypectomy (CSP) and the characteristics, and follow‐up of them has not been reported. In this study, we analyzed the histopathological findings and recurrence of them. Methods: This was a multicenter retrospective‐cohort study. We collected HGD and T1 lesions of ≤ 10 mm resected by CSP among 15 520 patients receiving CSP from 2014 to 2019 at nine related institutions, and we extracted only cases receiving definite follow‐up colonoscopy after CSP of HGD and T1 lesions. We analyzed these tumor's characteristics and therapeutic results such as R0 resection and local recurrence and risk factors of recurrence. Results: We collected 103 patients (0.63%) and extracted 80 lesions in 74 patients receiving follow‐up colonoscopy for CSP scar. Mean age was 68.4 ± 12.0, and male rate was 68.9% (51/80). The mean tumor size (mm) was 6.6 ± 2.5, and the rate of polypoid morphology and rectum location was 77.5% and 25.0%. The rate of magnified observation was 53.8%. The rates of en bloc resection and R0 resection were 92.5% and 37.5%. The local recurrence rate was 6.3% (5/80, median follow‐up period: 24.0 months). The recurrence developed within 3 months after CSP for four out of five recurrent cases. Comparing five recurrent lesions to 75 non‐recurrent lesions, a positive horizontal margin was a significant risk factor (60.0% vs 10.7%, P < 0.001). Conclusions: High‐grade dysplasia and T1 resected by CSP were analyzed, and the local recurrence rate of them was substantially high. [ABSTRACT FROM AUTHOR]

We elucidated clinicopathological characteristics of giant cell tumor of bone (GCTB) in Japan, and significant clinicopathological factors for predicting local recurrence. Clinicopathological profiles of 213 patients with GCTB (100 male, 113 female) involving extra‐craniofacial bones were retrieved. Pathological slides obtained at the initial surgery were reviewed. Fourteen pathological and five clinical features were statistically analyzed to disclose prognostic significance. Patient age ranged from 12–80 years (Average 38.7). Long bones were most frequently affected (86.4%), especially around the knee (62.9%). Histological features are basically similar to those previously reported. Within a follow‐up period (24–316 months, average 106.1 months), the local recurrence rate is 29.1%. Metastasis has occurred in 9 patients. Cox regression analysis of representative clinicopathological features shows that younger age, higher mitotic count, smaller zones of stromal hemorrhage, considerable vascular invasion and absence of ischemic necrosis are significant predictors for local recurrence. Initial operative method (curettage) is a significant risk factor in univariate analysis but not by multivariate analysis (P = 0.053). Denosumab administration increases risk but not significantly (P = 0.053). Histone 3.3 G34W immunopositivity is not significant for predicting local recurrence. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusion There are no previous studies in which computer‐aided diagnosis (CAD) diagnosed colorectal cancer (CRC) subtypes correctly. In this study, we developed an original CAD for the diagnosis of CRC subtypes.Pretraining for the CAD based on ResNet was performed using ImageNet and five open histopathological pretraining image datasets (HiPreD) containing 3 million images. In addition, sparse attention was introduced to improve the CAD compared to other attention networks. One thousand and seventy‐two histopathological images from 29 early CRC cases at Kyoto Prefectural University of Medicine from 2019 to 2022 were collected (857 images for training and validation, 215 images for test). All images were annotated by a qualified histopathologist for segmentation of normal mucosa, adenoma, pure well‐differentiated adenocarcinoma (PWDA), and moderately/poorly differentiated adenocarcinoma (MPDA). Diagnostic ability including dice sufficient coefficient (DSC) and diagnostic accuracy were evaluated.Our original CAD, named Colon‐seg, with the pretraining of both HiPreD and ImageNET showed a better DSC (88.4%) compared to CAD without both pretraining (76.8%). Regarding the attentional mechanism, Colon‐seg with sparse attention showed a better DSC (88.4%) compared to other attentional mechanisms (dual: 79.7%, ECA: 80.7%, shuffle: 84.7%, SK: 86.9%). In addition, the DSC of Colon‐seg (88.4%) was better than other types of CADs (TransUNet: 84.7%, MultiResUnet: 86.1%, Unet++: 86.7%). The diagnostic accuracy of Colon‐seg for each histopathological type was 94.3% for adenoma, 91.8% for PWDA, and 92.8% for MPDA.A deep learning‐based CAD for CRC subtype differentiation was developed with pretraining and fine‐tuning of abundant histopathological images. [ABSTRACT FROM AUTHOR]

The case of 70‐year‐old man with mantle cell lymphoma (MCL) carrying t(11;14) translocation that relapsed as nodal lymphoma combining MCL and classic Hodgkin lymphoma (cHL) 9 years after autologous peripheral blood stem cell transplant (auto‐PBSCT) is reported. Lymph nodes contained two separate areas of MCL and cHL‐like components. Hodgkin and Reed–Sternberg (HRS)‐like cells were accompanied by a prominent histiocyte background. HRS‐like cells were CD5−, CD15+, CD20−, CD30+, PAX5+, Bob.1−, Oct2− and EBER+. The MCL component expressed cyclin D1 and SOX11, whereas cyclin D1 and SOX11 expressions were reduced and lost, respectively, in HRS‐like cells. Polymerase chain reaction results showed a single clonal rearrangement of the IGH gene in MCL and cHL‐like components. CCND1 break apart fluorescence in situ hybridization showed split signals in both MCL and HRS‐like cells, suggesting that MCL and cHL‐like components were clonally related. Acquisition of p53 expression and Epstein–Barr virus (EBV)‐positivity was seen in HRS‐like cells. The patient died of disease progression with elevated hepatobiliary enzymes. The autopsy showed both MCL and cHL‐like components around the bile ducts, splenic white pulp and bone marrow. The two components were phenotypically distinct, but genetically related, suggesting that transformation of MCL to HRS‐like cells during the course of MCL in association with EBV infection. [ABSTRACT FROM AUTHOR]

A tumor metastasis within another tumor is known as tumor‐to‐tumor metastasis (TTM). We report a 43‐year‐old woman who presented with hypermenorrhea and an abdominal mass. She had history of a soft tissue tumor on her left ankle at 38 years of age. Laboratory data showed slight elevation of CA125 and no other abnormal findings and magnetic resonance imaging revealed a circumscribed margin mass in the uterine fundus. We diagnosed the mass as benign leiomyoma and performed total laparoscopic hysterectomy. Postoperative pathological examination revealed TTM of synovial sarcoma within the uterine leiomyoma. A database search identified 29 cases of TTM within uterine leiomyoma. The donor tumor was mostly breast cancer (in 23 cases). To the best of our knowledge, this is the first report of a sarcoma TTM to a uterine leiomyoma. Despite the difficulty of preoperative diagnosis, TTM should be considered during the treatment approach for a patient with leiomyoma and a history of malignant tumors. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection (ESD) for superficial gastrointestinal neoplasms has become widespread. However, certain aspects of the procedure remain difficult to manage, such as intraoperative bleeding and perforation. There are two kinds of scissor‐type knife: the Clutch Cutter (Fujifilm Co., Tokyo, Japan) and the SB knife (Sumitomo Bakelite Co., Tokyo, Japan). These knives have different features from other types of ESD knives and enable the performance of all ESD procedures, including mucosal incision, submucosal dissection, and hemostasis. The standard approach with scissor‐type knives involves first grabbing the tissue and then incising or dissecting it. Theoretically, perforation as a result of unintentional movement should never happen with scissor‐type knives compared to needle‐ or blade‐type knives, which may induce perforation through unintentional movement. Moreover, the rates of severe bleeding and self‐completion of ESD with scissor‐type knives by non‐experts were reported to be significantly better than for other knives. Thus, scissor‐type knives can resolve these problems and help to further standardize ESD globally. In this review, we summarize reports on the efficacy of such scissor‐type knives for ESD of gastrointestinal tumors. We also present the pocket‐creation method and the application of traction devices, such as dental floss and S‐O clips (Zeon Medical Co., Tokyo, Japan) for improving the performance of ESD with a Clutch Cutter. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to identify the pathological features of high‐grade PanIN that presents with imaging‐detectable abnormalities. Methods and results: Ten cases of isolated, main‐duct, high‐grade PanIN as the primary clinical presentation were identified. All patients presented with stenosis of the main pancreatic duct, with two being associated with extensive upstream duct dilatation (>5 mm in diameter). Pancreatic juice cytology suggested adenocarcinoma in all seven cases examined. In resected specimens, high‐grade PanIN was present chiefly in the main pancreatic duct, with longitudinal extension ranging between 3 and 40 mm in length (median = 18 mm). In four cases, in which hypoechoic or hypovascular masses were observed on imaging, radiopathology correlations suggested that they represented parenchymal atrophy and subsequent fibrosis around affected ducts, but not invasive malignancy. On immunohistochemistry, the loss of p16 expression was found in five (50%), p53 overexpression in two (20%) and loss of SMAD4 expression in none (0%). KRAS mutations were detected in nine cases, with two dominant clones being found in three by ultrasensitive droplet digital polymerase chain reaction, suggesting the genetic heterogeneity of dysplastic cells composing individual lesions. Mutant GNAS was also observed in one case. Conclusions: Isolated high‐grade PanIN may present with pancreatic duct stenosis. Therefore, intensive investigations including pancreatic juice cytology will be required for patients with unexplained pancreatic duct stenosis. The abnormal expression of p53 and SMAD4 is infrequent, while GNAS may be mutated in premalignant lesions mainly affecting the main pancreatic duct, similar to KRAS. [ABSTRACT FROM AUTHOR]

We present three cases of sclerosing mesenteritis and review the literature to learn whether or not sclerosing mesenteritis is an Ig G4-related disease ( Ig G4- RD). Our patients were all adult males. Their mesenteric masses ranged from 6.5 to 14.5 cm in the greatest diameter. Tissue specimens showed moderate to severe lymphoplasmacytic infiltration with occasional eosinophils against a background of irregular fibrosis. Both obliterative phlebitis and storiform fibrosis were noted in all cases. Ig G4+ plasma cells were moderately increased in number (46 to 85 cells/high-power field). However, unlike Ig G4- RD, the Ig G4+/ Ig G+ plasma cell ratio was <40% (28% to 35%). Serum Ig G4 concentrations were also within the normal range (43.2 to 105 mg/dL; normal range <135 mg/dL). Two biopsy cases showed spontaneous regression on imaging approximately 5 months later. No sclerosing conditions were found in other organs. The literature review identified 11 additional cases of sclerosing mesenteritis with Ig G4+ plasma cell infiltration. However, conclusive cases with four characteristic features (high serum Ig G4 levels, tissue Ig G4 elevation, multi-organ involvement, and effective response to glucocorticoid therapy) have never been reported. In conclusion, although sclerosing mesenteritis shares histological features with Ig G4- RD, most cases are less likely to be Ig G4-related. Ig G4- RD seemingly seldom, if ever, affects this anatomical site. [ABSTRACT FROM AUTHOR]