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To determine the role of MRI in the early diagnosis of tubal ectopic pregnancy (EP). Clinical and MRI features of 27 cases of tubal pregnancy were reviewed. A thick-walled gestational sac (GS)-like structure was demonstrated lateral to the uterus in all cases. On T2-weighted images, the thick wall typically exhibited 3 discrete rings in 22 cases (81 %), among which 17 cases (63 %) displayed small vessels and 6 cases (33 %) exhibited small areas of fresh haemorrhage inside the thick wall. The contents demonstrated non-specific liquid in 26 %, papillary solid components in 56 %, and fresh blood or fluid-fluid level in 19 % of the cases. Dilatation of the affected fallopian tube associated with hematosalpinx was demonstrated in 18 cases (67 %) and marked enhancement of the tubal wall was observed in 22 cases (81 %). No correlation was found between the size of the GS and the estimated gestational age (r = 0.056). MRI plays an important role in the early diagnosis and management of tubal pregnancy. The characteristic MRI features include a GS-like structure with a “three rings” appearance on T2-weighted images, presence of solid components in the sac, dilatation of the affected fallopian tube with hematosalpinx, and tubal wall enhancement. • MR imaging has served as a problem-solving procedure in ectopic pregnancy. • MR imaging features can be criteria for early diagnosis of tubal pregnancy. • Detailed assessment of ectopic implantation is necessary for management decision-making.

Reports describing a rapid increase in the cystic volume of anaplastic astrocytoma (AA) in a short time frame are rare. The present study reports the case of a 68-year-old male who was admitted to the No. 9 People's Hospital, Shanghai Jiaotong University School of Medicine (Shanghai, China), with a small cystic brain lesion and positive immunological testing for cysticercosis. Head magnetic resonance imaging (MRI) showed a cystic lesion, 6 mm in diameter, in the left frontal lobe. Neurocysticercosis was suspected and the patient was treated with a clinical trial of albendazole and steroids. A period of 25 days later, the patient's condition had deteriorated, and MRI revealed a cystic lesion in the left frontal lobe; thereafter, the cystic lesion was removed and a diagnosis of AA was established. The tumor was soft, ivory white and gelatinous due to myxoid degeneration. In this case, tumor-related angiogenesis and microvascular extravasation (blood-brain barrier disruption) may have been the main cause of the rapid increase in the cystic volume in such a short time frame. The similarity of the glioma and cysticercus antigens may have been the cause of the positive reactions in the cystic fluid. The present study reports the rare occurrence of a rapid increase of cystic volume and potential diagnostic difficulties.

Background and aim: Cyclooxygenase-2 (COX-2) plays an important role in colorectal cancer development and is frequently up-regulated in colorectal cancer. The purpose of this study was to investigate COX-2 overexpression in colorectal adenocarcinoma and to evaluate the correlation with the clinicopathological parameters and p53 expression, as well as its effect on patient survival. Methods: We evaluated the expression of COX-2 and p53 on the tissue microarray of 414 colorectal adenocarcinomas by immunohistochemistry. Data was analyzed by Fisher's exact test, χ2-test, one-way ANOVA, Cox regression hazards model and log-rank test with Kaplan–Meier curves. Results: The cytoplasmic COX-2 overexpression was detected in 56.3% of colorectal adenocarcinoma samples. COX-2 overexpression was correlated with favorable clinicopathologic factors in lymph node metastasis (P= 0.002), American Joint Committee on Cancer and Dukes’ stage (P= 0.008 and P= 0.017, respectively), and lymphatic invasion (P= 0.001). Other characteristics associated with COX-2 overexpression were colonic site of tumor (P= 0.008) and poor differentiation (P= 0.017). There was no correlation between COX-2 overexpression and p53 expression (P= 0.485). In univariate survival analysis, patients with COX-2 overexpression revealed better overall survival and disease-free survival (P= 0.021 and P= 0.017, respectively, log-rank test). In multivariate survival analysis with the Cox proportional hazards model, COX-2 overexpression was an independent prognostic factor of overall survival and disease-free survival (P= 0.029 and P= 0.039, respectively). Conclusions: COX-2 overexpression was significantly associated with favorable clinicopathologic phenotype and an indicator of better survival in our cohort of colorectal cancer patients.

Background and aim: Survivin, an antiapoptotic protein, is involved in both the control of the cell division and the inhibition of apoptosis. The regulation of apoptotic cell death may have a profound effect on the carcinogenesis and progression of colorectal cancer. This study was designed to evaluate the survivin expression in colorectal tissues and to investigate whether the survivin expression is associated with the clinicopathologic characteristics and the patient survival. Methods: Immunohistochemical analysis of survivin was performed using the tissue microarrays of 622 colorectal tissue samples from 529 colorectal adenocarcinomas, 40 normal mucosa, 34 adenomatous polyps, and 59 metastatic lymph nodes. Results: Normal colorectal mucosa were completely negative for survivin (0/40, 0%), but survivin was expressed in adenomatous polyps (8/34, 23.5%), adenocarcinomas (327/529, 61.8%), and metastatic lymph nodes (27/59, 45.8%). In the analyses between the survivin expression and clinicopathologic parameters, the survivin expression was correlated with tumor location in colon (P= 0.026), lymph node metastasis (P= 0.003) and American Joint Committee on Cancer (AJCC) stage (P= 0.040). The patient survival was significantly associated with age, histologic grade, AJCC stage, and lymphovascular invasion. On stage wise analyses of patient survival, the survivin expression was significantly correlated with overall survival (P < 0.001) and disease free survival (P < 0.001), especially in stage II colorectal adenocarcinomas. Conclusions: The results suggest that the survivin expression is a relatively frequent early event of colorectal carcinogenesis and may play an important role in the adenoma-carcinoma transition sequence. Survivin expression provides important prognostic information and an apoptosis-based therapeutic target in colorectal adenocarcinomas.

Apoptotic protease activating factor-1 (Apaf-1) is one of the key regulators in the mitochondrial apoptotic pathway, and the loss of Apaf-1 leads to cellular resistance against the apoptotic signals. We investigated the expression of Apaf-1 in colorectal tissues corresponding to the multistep carcinogenesis model to determine correlations between the clinicopathologic characteristics and the expression of this molecule and to evaluate the role of Apaf-1 in the development and progression of colorectal adenocarcinoma. Immunohistochemistry for Apaf-1 was performed on the tissue microarray of 38 normal mucosal tissues, 46 adenomatous polyps, 529 colorectal adenocarcinomas, and 76 metastatic tumors. Normal colonic mucosa tissues and adenomas were positive for Apaf-1 with no exceptions (100%). However, in colorectal adenocarcinomas, 119 of 529 cases (22.5%) were positive and 410 cases (77.5%) were negative. Moreover, 67 of 76 metastatic cases (88.2 %) were negative and only nine cases (11.8%) were positive for Apaf-1 expression. In the analyses between Apaf-1 expression and clinicopathologic parameters, reduced expression of Apaf-1 correlated with left colon location (p < 0.001), deeper tumor invasion (p < 0.001), frequent lymph node metastasis ( p= 0.021), higher American Joint Committee on Cancer (AJCC) and Dukes’ stage (p = 0.02 and p = 0.001, respectively) and poorer differentiation (p < 0.001). The patient survival was significantly associated with age, histological grade, AJCC stage, and lymphovascular invasion, but not Apaf-1 expression (p = 0.478). The results suggest that the loss of Apaf-1 expression is a relatively frequent late event and the loss of Apaf-1 expression may play an important role in tumorigenesis and tumor progression in colorectal adenocarcinoma.

OBJECTIVE: To evaluate the findings of computed tomography (CT) and histopathology of the bulla ethmoidalis as objective markers of bone remodeling in chronic rhinosinusitis (CRS). METHODS: Preoperative ostiomeatal unit (OMU) scans and histopathologic findings of the bulla ethmoidalis were performed on 23 patients (39 sides) undergoing endoscopic sinus surgery for CRS. Lund-Mackay scores and Hounsfield units (HU) of the bulla were checked in coronal CT scans. The pathologist graded the severities of the mucosal and bony changes in histopathology. Statistical analysis was performed using Mann-Whitney U test and Spearman correlation coefficient (r). RESULTS: The HU values of the bulla were significantly increased with higher Lund-Mackay scores in OMU CT (r = 0.405, P = 0.01). The bony grades in histopathology were significantly increased with higher mucosal grades (r = 0.821, P = 0.0001). These findings in CT scans and histopathology were well correlated with each other (r > 0.3, P < 0.05). CONCLUSION: HU may be a useful objective marker of bone remodeling in chronic rhinosinusitis.

The signal transducer and activator of the transcription (Stat)-family of proteins are latent cytoplasmic transcription factors that transmit signals from cytokines and growth-factor receptors to the nucleus. Stat proteins, especially Stat3 and Stat5, are constitutively activated in various solid tumors and hematological malignancies. However, the role of Stat3 signaling in gastric carcinoma has not yet been fully determined. This study was conducted to investigate the clinical value of phospho-Stat3 expression in gastric carcinoma. Expression of phospho-Stat3 (Tyr705), vascular endothelial growth factor (VEGF), p53, and Bcl-2 was determined by immunohistochemical staining of tissue microarrays from 137 cases of resected gastric cancer specimens. We evaluated the relationships among phospho-Stat3, VEGF, p53, and Bcl-2 expression and the correlation between expression of these proteins and various clinicopathological factors, including overall survival. Phospho-Stat3 nuclear expression was observed in 18.2% of the cases. Of the total number of cases, 68.6% were positive for VEGF, 40.1% for p53, and 11.7% for Bcl-2. Phospho-Stat3 expression correlated with VEGF (p=0.021) and Bcl-2 (p=0.005) expression. Positive phospho-Stat3 staining was significantly associated with poor pathological grade. However, there was no significant difference in other clinicopathological parameters, such as tumor stage (T, N, M), pathological type, relapse-free survival, and overall survival between the phospho-Stat3-positive and -negative groups. Co-expression of phospho-Stat3 and VEGF was found in many patients with N3 and Stage IV disease. These results suggest that phospho-Stat3 expression might be associated with angiogenesis, anti-apoptosis, and tumor progression. Further studies are needed to determine the role of phospho-Stat3 in gastric cancer.

Tailgut cyst is a rare congenital cystic lesion arising from the remnants of the embryonic postanal gut. It occurs exclusively within the retrorectal space and rarely in the perirenal area or in the subcutaneous tissue. A prerectal and retrovesical location of tailgut cyst is extremely rare. To the best of our knowledge, only three cases have been reported in the English literature. We experienced an unusual case of tailgut cyst developed in the prerectal and retrovesical space in a 14-year-old boy. Abdominal computed tomography demonstrated a prerectal cyst which was located at the anterolateral portion to the rectum. The cyst contained yellowish inspissated mucoid material. Microscopically, the cyst was lined by squamous, columnar, cuboidal and transitional epithelia and the wall was fibrotic with dispersed smooth muscle cells. Although tailgut cyst arising in prerectal area is extremely rare, its possibility should be considered in differential diagnosis of a prerectal and retrovesical cystic mass.

The aim of this study is to investigate the possible role of inhibitor of DNA binding (Id-1) overexpression in human breast cancer. We examined Id-1 expression by immunohistochemistry in 263 human breast cancers, 15 in situ lesions and 248 invasive cancers to investigate the relationship between its expression and various clinicopathological factors. Id-1 expression was significantly higher in invasive ductal carcinoma than in in situ ductal carcinoma or other invasive cancer subtypes (P=0.029 and 0.006, respectively). We also examined the association between Id-1 expression and tumor angiogenesis by measuring microvessel densities (MVD). Regarding the endothelial cells of microvessels showed negative or very weak Id-1 expression, Id-1 overexpression was found to be significantly related to MVD (P=0.014). Furthermore, Id-1 overexpression was found to be significantly associated with higher MVD in the ER-negative and node-involved subgroups of breast cancer (P=0.040 and 0.046, respectively). These data indicate that Id-1 overexpression is significantly associated with tumor angiogenesis, especially in the ER-negative and node-positive subtypes of invasive breast cancer. Thus, Id-1 presents a possible therapeutic antitumor target molecule in ER-negative and node-positive breast cancer.

Calcifying fibrous pseudotumor is an uncommon benign lesion that has unique histologic features. We report a case of calcifying fibrous pseudotumor of the pleura occurring in a 31-year-old woman. A computed tomographic scan revealed a pleural mass in the right anterior costophrenic angle. The excised mass was well circumscribed, nonencapsulated, solid, and firm. The tumor showed dense hyalinized collagenous tissue interspersed with spindle cells, psammomatous calcifications, and a predominantly lymphoplasmocytic infiltrate. Most spindle cells were diffusely positive for vimentin, focally positive for CD34, and negative for desmins, smooth muscle actin, S-100 protein, and anaplastic lymphoma kinase-1.

Purpose: Some gastric cancer patients in whom the cancer has infiltrated up to the muscularis propria (mp) have a good postoperative course similar to that of early gastric cancer (EGC) patients (this does not match the general classification of gastric cancer). Therefore, we performed a retrospective analysis of 125 patients with mp gastric cancer based on the degree of mp invasion. Materials and Methods: The clinicopathologic features of 125 cases of mp gastric cancer were subdivided according to depth of invasion, and were retrospectively reviewed and compared with the surgical features of 222 patients with gastric cancer invading the submucosa (sm). For each tumor, using the section that showed the greatest extent of invasion, we evaluated the degree of tumor invasion into the mp layer at a magnification of 100. The patients were classified into 2 groups: mp1, the tumor was limited to the first of the 3 mp layers, and mp2, the tumor had expanded beyond the first layer. Results: Patients with mp1 (n=50) had a significantly lower incidence of lymph node metastasis, and a smaller tumor size than patients with mp2 (n=75) (P=0.01 and P=0.029, respectively). The 5-year survival rate of mp1 patients was significantly better than that of mp2 patients (, P=0.0282), but was similar to that () of the 222 sm patients. The 5-year survival rate of mp patients without lymph node metastasis (n=55) was significantly better than that of those with lymph node metastasis (n=70)(, P=0.0192). Patients with mp1 had a significantly higher incidence of lymph node metastasis (, P=0.006) than patients with sm. Conclusion: There were clear differences in clinical features between the mp1 and the mp2 patients. Subdivision of mp gastric cancer according to the depth of invasion may enable a more precise prognosis and a more pertinent treatment plan for mp patients. In particular, as the clinicopathological findings and surgical outcomes for mp1 patients were akin to those of the sm patients, mp1 patients may require treatment analogous to that administered to patients with sm gastric cancer.