Abstract. there is strong evidence that the angiopoietin family is involved in the regulation of tumour progression. recently, it has been reported that angiopoietin-like 4 (Angptl4) expression in cancer cells promotes the metastatic process by increasing vascular permeability. the present study was conducted to examine Angptl4 expression and its association with clinicopathological factors and prognosis in human colorectal cancers. We examined 144 cases of surgically-resected human colorectal adenocarcinomas by immunohistochemistry, rt-pcr and Western blot analysis. Also, overall survival was investigated. Among 144 cases of adenocarcinoma, 95 cases (66.0%) showed positive staining in the cytoplasm of the carcinoma cells for Angptl4. Histologically, well, moderately, poorly differentiated adenocarcinoma or mucinous carcinoma showed 55.2, 79.3, 61.5 or 44.4% expression of Angptl4, respectively. the expression of Angptl4 was correlated with the depth of tumour invasion (p<0.0005), Vienna classification (category 3-5) (p<0.00005), venous invasion (p<0.0005) and Duke's classification (p<0.005). However, Angptl4 expression was not correlated with overall survival. However, all patients (100%) with distant metastasis showed immunopositivity for Angptl4. the mrnA and the protein expression of Angptl4 were shown in four resected samples and cultured cell lines by rt-pcr or Western blot analysis. These findings suggest that Angptl4 is one of the factors involved in the progression of human colorectal cancer, especially venous invasion and distant metastasis. Introductioncolorectal cancer is one of the most common cancer types in the world today (1). the occurrence and progression of cancer are considered to be a series of genetic events affecting the structure and/or expression of a number of oncogenes, tumour suppressors, and growth factors (2,3). the deep invasive carcinomas, such as colorectal cancer, have higher rates of lymph duct and venous invasions, and lymph node metastasis (3). However, the mechanisms of invasion and metastasis of colorectal cancer are not fully understood.there is strong evidence that the angiopoietin family is involved in the regulation of tumour progression, cellular growth, and differentiation (4-6). Angiopoietin-like 4 (Angptl4) is a member of the family of angiopoietins and is also known as hepatic fibrinogen/angiopoietin-related protein (HeArp) (7), peroxisome proliferator-activated receptor-γ (ppArγ) angiopoietin-related gene (pgAr) (8), or fasting-induced adipose factor (FIAF) (9). Angptl4 is a circulating plasma protein and is expressed in the liver, adipose tissue, placenta, as well as in ischemic tissue (8,9). similar to angiopoietins and other angiopoietin-like proteins, Angptl4 contains an amino-terminal coiled-coil domain and a carboxyl-terminal fibrinogen-like domain (10). Angptl4 induces a strong proangiogenic response, independently of vascular endothelial growth factor (11), and is known to undergo hypoxia-induced gene expression in endothelial cells. this protein is up-regu...

We assessed the usefulness and limitations of utilizing apparent diŠusion coe‹cient (ADC) values on diŠusion-weighted imaging (DWI) for the diŠerential diagnosis of benign and malignant non-mass-like breast lesions. We retrospectively reviewed 27 such lesions (16 malignant, 11 benign) detected on magnetic resonance (MR) imaging and analyzed the enhancing patterns of dynamic contrast-enhanced DCE-MRI (distribution and internal enhancement), kinetic curve patterns, and ADC values. All images were obtained with a 1.5-tesla MR unit, with patients supine. On DCE-MRI, malignant lesions tended to show either segmental or branching-ductal distribution, and when lesions with these patterns were considered malignant, sensitivity was 68.8z; speciˆcity, 63.6z; positive predictive value (PPV), 73.3z; negative predictive value (NPV), 58.3z; and accuracy, 66.7z. Kinetic curve analysis did not reliably diŠerentiate benign and malignant non-mass-like lesions. There was no signiˆcant diŠerence between the mean ADC value of the malignant lesions, 0.968×10 -3 mm 2 /s at b＝1000 s/mm 2 , and that of benign lesions, 1.207×10 -3 mm 2 /s (P ＝0.109). Receiver operating characteristic (ROC) analysis revealed the most eŠective threshold of ADC value for diŠerentiating tumors as 1.1×10 -3 mm 2 /s; values lower than this were observed more often in malignant than benign lesions (P＝0.054). Us of this threshold yielded sensitivity of 68.8z; speciˆcity, 72.7z; PPV, 78.6z; NPV, 61.5z; and accuracy, 70.4z. Combining the ADC value criteria with the analysis of DCE-MRI pattern increased sensitivity to 93.8z, negative predictive value (NPV) to 85.7z, and accuracy to 77.8z but decreased speciˆcity to 54.5z. Use of ADC values does not adequately improve DCE-MRI performance for diŠerential diagnosis of non-mass-like breast lesions, but adding the ADC value criteria to the DCE-MRI pattern analysis improves sensitivity, NPV, and accuracy.

Identifying plaque components such as intraplaque hemorrhage, lipid rich necrosis, and calcification is important to evaluate vulnerability of carotid atherosclerotic plaque; however, conventional vessel wall MR imaging may fail to discriminate plaque components. We aimed to evaluate the components of plaques using quantitative susceptibility mapping (QSM), a newly developed post-processing technique to provide voxel-based quantitative susceptibilities. Methods: Seven patients scheduled for carotid endarterectomy were enrolled. Magnitude and phase images of five-echo 3D fast low angle shot (FLASH) were obtained using a 3T MRI, and QSM was calculated from the phase images. Conventional carotid vessel wall images (black-blood T 1-weighted images [T 1 WI], T 2-weighted images [T 2 WI], proton-density weighted images [PDWI], and time-of-flight images [TOF]) were also obtained. Pathological findings including intraplaque hemorrhage, calcification, and lipid rich necrosis at the thickest plaque section were correlated with relative susceptibility values with respect to the sternocleidomastoid muscle on QSM. On conventional vessel wall images, the contrast-noise ratio (CNR) between the three components and sternocleidomastoid muscle was measured respectively. Wilcoxon signed-rank test analyses were performed to assess the relative susceptibility values and CNR. Results: Pathologically, lipid rich necrosis was proved in all of seven cases, and intraplaque hemorrhage in five of seven cases. Mean relative susceptibility value of hemorrhage was higher than lipid rich necrosis unexceptionally (P = 0.0313). There were no significant differences between CNR of hemorrhage and lipid rich necrosis on all sequences. In all six cases with plaque calcification, susceptibility value of calcification was significantly lower than lipid rich necrosis unexceptionally (P = 0.0156). There were significant differences between CNRs of lipid rich necrosis and calcification on T 1 WI, PDWI, TOF (P < 0.05). Conclusion: QSM of carotid plaque would provide a novel quantitative MRI contrast that enables reliable differentiation among intraplaque hemorrhage, lipid rich necrosis, and calcification, and be useful to identify vulnerable plaques.

No abstract

A 48-year-old female presented with an extremely rare primary tumor of the pineal region with papillary features manifesting as morning headaches persisting for 1 month. Magnetic resonance imaging showed a well-defined mass, with some cystic components, in the region of the pineal gland. The tumor was completely removed through an occipital transtentorial approach in the prone position. Histological examination found a distinctive papillary growth pattern in which the vessels were covered by multiple layers of tumor cells. The histological diagnosis was papillary tumor of the pineal region (PTPR), which has recently been described as a distinct clinicopathological entity requiring careful follow up because the prognosis is not well understood. Postoperatively, the patient has continued to do well, with no recurrence at the 8-month follow-up examination. PTPR should be considered in the differential diagnosis of pineal tumors. PTPR may have been frequently misinterpreted in the past as either ependymoma or choroid plexus papilloma due to the similar morphology.

A 56-year-old Japanese woman with muscle weakness, increased creatine kinase and aldolase levels, and characteristic cutaneous lesions was diagnosed with anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 antibody)-positive dermatomyositis. She also had interstitial lung disease (ILD). After corticosteroid and tacrolimus combination therapy was started, bicytopenia and elevated serum ferritin and transaminase emerged. Because the bone marrow tissues were hypoplastic with hemophagocytes, she was diagnosed with concomitant autoimmune-associated hemophagocytic syndrome (HPS). Intravenous cyclophosphamide pulse therapy and plasmapheresis were performed. The laboratory findings indicated improved abnormalities, and the ILD did not progress. Anti-MDA5 antibody-positive dermatomyositis can be complicated by HPS.

BackgroundComposite pheochromocytoma is a rare pathological condition characterized by elements of both pheochromocytoma and neurogenic tumors. However, detailed clinical outcomes of this tumor have not been fully shown. From 2007 to 2013, we experienced three cases of adrenal composite pheochromocytoma. In this report, we investigate the clinicopathological features of these three cases of composite pheochromocytoma and compare them with previously reported cases.Case presentationsCases 1 and 2 were a 29-year-old Japanese woman and a 59-year-old Japanese man, respectively. They underwent laparoscopic left adrenalectomy, and pathological examination revealed composite pheochromocytoma–ganglioneuroma. Case 3 was a 53-year-old Japanese man who had been receiving hemodialysis for 17 years. He underwent laparoscopic right adrenalectomy, and pathological examination revealed composite pheochromocytoma–ganglioneuroblastoma. Although the Ki67-positive rates varied from 1.0 to 6.2% among the three cases, no clinical recurrences occurred. Despite the relatively high rate of Ki67 positivity, complete tumor resection resulted in favorable clinical outcomes.ConclusionWe experienced three cases of adrenal composite pheochromocytoma. Although the clinical findings and treatment outcomes of composite pheochromocytoma were similar to those of ordinary pheochromocytoma, further studies of the biological behavior and genetic profiles of composite pheochromocytoma are necessary to achieve a better understanding of this tumor.

No abstract