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In this report, we reviewed the results of RCPC held at the 63rd national congress of the Japanese Society of Laboratory Medicine. The case was a 9th decade female with dementia, who had anemia pointed out on a routine laboratory check. The type of anemia was macrocytic(MCV>130 fL). The serum Vit.B12 and folate levels were markedly decreased. However, her anemia was not improved despite supplementation with Vit.B12 and folate (data on MCV were improved). The WBC increased gradually, but she subsequently died. Laboratory data were assessed by three doctors (DN, NM, and TT: blood cell counts, smear morpholo- gy of peripheral blood cells, and clinical chemistry, respectively). They diagnosed the patient with a hema- tological disorder, probably neoplastic hematological diseases; however, it was very difficult to make a further clinical diagnosis because of the necessary data not presented at this meeting. The final diagnosis was acute myeloid leukemia (AML-M4). The direct cause of death was rupture of her spleen due to the massive infil- tration of neonlastic cells. rReviewl.

A 45-year-old woman with persistent abdominal pain was admitted to our hospital. Detailed examination revealed a type 4 lesion with circumferential narrowing, which was diagnosed as a poorly differentiated carcinoma following forceps biopsy and ascitic fluid cytology. Although the lesion was surgically resected, the ascites increased rapidly, and her general condition deteriorated in the postoperative period. She died 6 weeks after the appearance of her symptoms. Autopsy and histological examination confirmed a very rare undifferentiated colon carcinoma with rhabdoid features, which is a high-grade malignant lesion associated with a poor prognosis.

A 62-year-old man was admitted for the evaluation of epigastric pain. Upper gastrointestinal endoscopy revealed a type 3 circumferential carcinoma in the gastric antrum. Distal gastrectomy was performed, and the lesion was histopathologically diagnosed as gastric cancer with an invasive micropapillary carcinoma component. Chemotherapy was administered after surgery; however, he died with multiple liver metastases after 39 months. Micropapillary carcinoma is a rare, high-grade, malignant histological subtype of gastric cancer that has not been described in detail till date. Here we describe this rare lesion and present a review of the relevant literature.

We report an extremely rare case of a calcifying fibrous tumor (CFT) occurring in the abdominal wall. A 43-year-old woman was referred to our hospital because of a gastric submucosal tumor. Imaging findings revealed a gastric submucosal tumor with calcification. Endoscopic ultrasound-guided fine-needle aspiration was attempted to obtain a tissue specimen; however, the tumor was not adequately visualized because of calcification. Local excision was performed because of the tumor growth and the risk of progression to gastrointestinal stromal tumor. The tumor was histologically diagnosed as a CFT. We describe the imaging and pathological findings, and discuss the differential diagnosis and histogenesis of CFT.

A 53-year-old woman was referred to our hospital with a round, discolored lesion measuring 4mm in diameter that was identified as a minute gastric signet ring cell carcinoma. According to the Japanese classification of gastric carcinoma, it was graded as type 0-IIb. Seven years back, the woman had undergone pylorus-side gastrectomy for a small signet ring cell carcinoma, and the present lesion was assumed to result from heterochrony and ectopic recurrence. Endoscopic submucosal dissection was performed for the minute lesion. Clinicopathological findings revealed gastric mucosal cancer without invading lymph vessels or veins, similar to the previous lesion. We therefore report two very rare lesions in the same case. This case report demonstrates the importance of performing regular follow-up gastroduodenoscopy to detect recurrence in patients with these lesions.

We experienced a pulmonary artery injury which might have been caused by a pulmonary artery catheter (PAC). A 66-year-old woman after mitral valve replacement, developped massive tracheal bleeding during weaning from the cardiopulmonary bypass. Transesophageal echocardiography revealed the air bell in the right pulmonary artery synchronized with ventilation. We speculated pulmonary artery injury and performed pulmonary artery angiography; however, it could not clarify the bleeding point. Surgical approach found the air leak from the erasure of the bronchus intermedius and the lobectomy led to lifesaving. A pulmonary artery injury caused by PAC is very rare, but life-threatening. In this case, she had some risk factors (i. e. 60 years or older, female, short statue, and mitral valve disease); however, it was hard to predict the pulmonary injury from these factors.

It is not rare that string-like adhesion between lung apex and chest wall is observed during videoassisted thoracic surgery (VATS) for spontaneous pneumothorax. This adhesion may cause hemothorax which requires emergency operation, although the precise incidence of such cases is uncertain. We analyzed consecutive 120 spontaneous pneumothorax cases underwent VATS at Suzuka General Hospital from January 2005 to September 2008. Twenty-one out of 120 (17.5%) were such cases receiving partial resection of the lung including the adhesion after dividing it. Pathological study revealed the bullae close to the adhesion in all cases, suggesting that these adhesion caused after possible former pneumothorax. Thus, 21 cases might be recurrent pneumothorax. Even in clinically 1st onset pneumothorax, those cases may be good indication for VATS.

Extraskeletal osteosarcoma (ESOS) occurs in approximately 1% of soft tissue sarcomas and 2-4% of all osteosarcomas. In particular, subcutaneous osteosarcoma is extremely rare, occurring in less than 10% of ESOS cases. This report presents a case of a subcutaneous tumor in the upper arm of a 79-year-old male. Imaging and pathological findings led to the conclusion that the soft tissue tumor should be diagnosed as subcutaneous osteosarcoma. Additionally, this case report documented the clinicopathological findings of the extraskeletal subcutaneous osteosarcoma in this case and discussed its clinical features by reviewing cases previously described in the literature.

A 64-year-old man receiving hemodialysis underwent a tricuspid valve replacement. We used an arterial pressure-based cardiac output (APCO) monitor and a central venous oximetry catheter instead of pulmonary artery catheter because the enlargement of the right ventricle caused by tricuspid valve regurgitation might make it difficult to insert the pulmonary artery catheter. Aortic calcification was so severe that an arterial cannula was sewn into the right subclavian artery. Therefore, we had to insert an arterial catheter into the shunt placed on his left upper limb, and connected it to the APCO monitor FloTrac (Edwards Life-sciences, U.S.A.). Anesthesia was induced with intravenous fentanyl, midazolam and rocuronium, and maintained with fentanyl and propofol. A triple lumen PreSep central venous oximetry catheter (Edwards Lifesciences, USA) was inserted via his right internal jugular vein. Under cardiopulmonary bypass beating tricuspid valve replacement was performed. Although a large amount of catecholamine was needed for weaning from cardiopulmonary bypass, it was performed referring to the cardiac index of APCO monitor. The operation was finished successfully. We concluded that cardiac function should be evaluated with the relative change of cardiac index from APCO monitor when the absolute value was uncertain from patient's pathology (e.g., valvular disease).

The human homologue of Drosophila disc large tumor suppressor protein (hDlg) is one of the proteins known to act cooperatively in regulating cell polarity and proliferation, suggesting an important connection between epithelial organization and cellular growth control. An abnormal expression of hDlg has been reported in several cancer types. However, the expression of hDlg in soft-tissue sarcomas has not yet been reported. We examined the expression of hDlg immunohistochemically in 46 specimens of malignant fibrous histiocytoma (MFH). The expression of hDlg was negative in 19 specimens, weak in 4, moderate in 16, and strong in 7. The patients with a weak or negative expression of hDlg had a significantly shorter metastasis-free survival rate and disease-free survival rate in comparison with those with a strong or moderate expression in both univariate analysis (p=0.0287 and 0.0237, respectively; log-rank test) and multivariate analysis (p=0.0087 and 0.0126, respectively; Cox proportional hazards regression model). Moreover, the patients with a weak or negative expression of hDlg had a significantly shorter overall survival rate in comparison with those with a strong or moderate expression in a univariate analysis (p=0.0214; log-rank test). This is the first report to demonstrate that a reduced expression of hDlg protein is an independent negative prognostic factor for MFH.

We present a case of malignant melanoma with a rhabdoid phenotype in a 44-year-old female with a quite unique and aggressive clinical course. Rhabdoid features are defined by characteristics such as sheets or solid trabeculae of neoplastic cells with large, vesicular, round to bean-shaped nuclei, prominent centrally located nucleoli, and abundant eccentric cytoplasm. Although various histological differential diagnoses were cited for the present case that showed 'rhabdoid features', most of them were excluded on the basis of the clinical history, tumor location, clinical behavior, and a broad panel of immunohistochemical stains. In the present case, the immunohistochemical findings were positive for vimentin, S-100 protein, melan-A, and EMA, but negative for HMB45, cytokeratin, CD34 and desmin. In addition, the positive expression of BAF47 was also recognized. These findings lead to the conclusion that this quite unique aggressive soft tissue tumor should therefore be diagnosed as malignant melanoma with a rhabdoid phenotype.

Background: GNAS1 encodes the a-subunit of the Gs protein (Gsa), which binds GTP and stimulates adenylyl cyclase. Activating mutations lead to somatotroph, thyroid, adrenal and gonadal adenomas or the McCune-Albright syndrome and recently the T399C polymorphism in GNAS1 has been reported to be associated with malignancies. The purpose of the present case-control study with 349 Japanese prostate cancer patients and 203 urological controls was to determine whether the GNAS1 T393C polymorphism is associated with prostate cancer risk., Materials and Methods: The GNAS1 T393C polymorphism was examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Odds ratios (OR) were adjusted for age using multiple logistic regression analysis with SPSS Medical Pack., Results: The allele frequencies were compatible with the control population in Hardy-Weinberg equilibrium with 80, 169 and 100 for GNAS1 C/C, C/T and T/T, respectively in the patients with prostate cancer, compared with 42, 94 and 67 in the controls. No association between the GNAS1 polymorphism and prostate cancer risk was apparent. The C/C genotype was more frequent among the prostate cancer patients (22.9%) than the controls (20.7%), although without significance (OR, 1.30; 95% CI, 0.80-2.12; p=0.29)., Conclusion: This pilot study does not support involvement of the GNAS1 polymorphism in prostate cancer risk.

Actual activities of Infection Control Team (ICT) in Suzuka General Hospital is reported. Surveillance of hospital infection, feedback of actual information of infection to each fields and ward round by ICT with certified Infection Control Nurse (ICN) can lead good confidence between ICT and other departments. Participation of ICN for ICT is important due to its trans-department activities.

A pathologists' assistant (PA) is recognized as a well-trained clinical technologist in pathologic examinations. Some nations including the United States and United Kingdom have developed such roles with good results. In Japan, there are some serious problems with the PA system. The most important problem is the limitation of activity, such as cutting specimens and screening biopsy samples. The latter probably conflicts with Japanese medical law. Although a PA system would relieve the burden on pathologists it should be careful to introduce of a PA system in Japan.

The use of neoadjuvant chemotherapy for pancreatic cancer has been advocated for its potential ability to optimize patient selection for surgical resection and to downstage locally advanced tumors, especially for patients with Stage IV b (Japan criteria). We report our experience with a six-drug chemotherapeutic regimen that resulted in sufficient downstaging of the tumor in some patients to justify surgical resection. From Jan. 2001 through December 2003, 6 patients received 5-FU as a continuous infusion (200 mg/m2/day), calcium leucovorin weekly by intravenous bolus injection (30 mg/m2), mitomycin-C every 6 weeks (10 mg/m2 intravenously), and dipyridamole daily orally (75 mg), according to the UCLA regimen and gemcitabine weekly (600 mg/m2) and heparin as a continuous infusion (0-3,000 U/day) for locally advanced unresected pancreatic cancer. All of these patients were evaluable for response and survival. There were 5 partial responses (83% response rate) and 1 no response. Four of 5 responding patients had sufficient tumor regression to meet clinical criteria for resectability, three of whom underwent a curative resection. All patients who underwent downstage operation were still alive for the follow-up period (4-23 months).

Carcinogenesis of the prostate involves androgen influences, and associations between genetic polymorphisms of androgen receptor and metabolizing enzymes and prostate cancer risk have been reported. Roles for non-androgenic hormones are not well defined, but they also may have an impact judging from epidemiological and animal experimental alphalambda zeta of data. The purpose of the study was to determine whether hormone-related polymorphisms are associated with prostate cancer risk. A case-control study was performed with 147 Japanese prostate cancer patients and 266 urological controls. Polymorphisms of target genes [cytochrome P450 (CYP) 1B1, Leu432Val; debrisoquine hydroxylase, (CYP2D6)*4; aromatase (CYP19), Arg264Cys; estrogen receptor (ER)alpha-Xx (Xba I) and Pp (Pvu II); ERbeta-Rr (Rsa I); progesterone receptor (PR) Alu in intron 7] were examined by PCR-based methods. The capital and small letters signify the absence and presence of restriction sites, respectively. Odds ratios (OR) were adjusted for age using multiple logistic regression analysis with SPSS Medical Pack. Among the seven examined genetic polymorphisms, significant associations between CYP1B1 Leu432Val (OR 4.80; 95% confidence interval (CI), 1.21-19.05) and Alu in intron 7 of PR (OR 4.17; 95%CI, 1.26-13.85) were found. As for combined effects, the CYP1B1 polymorphisms (Leu/Val+Val/Val) together with heterozygosity for Alu in the PR were more frequent among prostate cancer patients (1.45%) than controls (0.41%), although without significance (OR, 3.99; 95%CI, 0.36-44.8). The combination of ERalpha (P/p+p/p) polymorphisms with heterozygosity for Alu in the PR demonstrated an OR of 4.56 (95%CI, 1.01-20.6). This pilot study showed that CYP1B1 and PR polymorphisms, alone or in combination, might be associated with prostate cancer risk. They might, therefore, have potential as a tool for identifying high-risk individuals.

It is generally agreed that the autogenous bone flap which has been removed at the time of external decompression would be superior to any artificial material if it can be used in cranioplasty. Cranioplasty using autogenous frozen bone graft has been reported and showed good results except for infection and severe bone absorption. We conducted 39 cases of cranioplasty with cryopreserved autogenous bone in the presence of 10% of Dimethylsulfoxide (DMSO), which has been reported as a cryoprotective agent. Although no remarkable histological effects have been recognized in frozen bone with or without DMSO, we have obtained excellent clinical results without bone absorption in 24 of the cases. These results suggest that DMSO is helpful for frozen bone preservation.