The midgut, which plays a major role in the feeding behavior of insects, is believed to be controlled by various factors including neuropeptides. In the present study, we identified a neuropeptide crustacean cardioactive peptide (CCAP) as a novel gut factor in insects. CCAP was isolated from the midgut of the cockroach, Periplaneta americana. RT-PCR analysis detected the expression of the cockroach CCAP mRNA in the ventral nerve cord and the midgut, revealing the production of CCAP in the midgut as well as the central nervous system. Moreover, we observed expression of the CCAP gene in the endocrine cells of the midgut by in situ hybridization, and immunohistochemical analysis showed that CCAP was distributed around the lateral surfaces of the endocrine cells. Elevation of alpha-amylase activity was observed upon addition of CCAP to the midgut. These results suggest that CCAP is involved in digestion of carbohydrate in a paracrine manner. In situ hybridization and immunohistochemistry also revealed CCAP expression in the cell bodies of the ingluvial ganglion, which innervates the midgut muscle layer but not the epithelium, indicating that CCAP is produced in the ingluvial ganglion and then transported to the muscle layer through nerve fibers. Furthermore, CCAP was found to stimulate the contraction of the foregut, midgut, and hindgut in a dose-dependent manner. Taken together, our data indicate the multifunctionality of CCAP in the regulation of gut tissues as both a neuropeptide and a novel midgut factor.

Aims : Although histological features of hepatic angiomyolipoma (AML) are highly variable, true malignant change is extremely rare. The aim was to review the histological features of invasive growth and clinical outcomes in 39 cases of hepatic AML. Methods and results : An invasive growth pattern into surrounding hepatic parenchyma, portal triads and/or around hepatic veins was found in 24 of 39 tumours (62%). One variant showed tumour cells replacing hepatocytes within the liver cell cords. The other consisted of portal or perivascular invasive growth along blood vessels. In the former pattern, small isolated tumour cell clusters were occasionally found in the vicinity of the main mass, showing a sprouting pattern. Although these histological features suggest malignancy, distant metastases were not found in any of the cases within a mean follow‐up period of 6.8 years. Conclusions : A previously unrecognized histological feature of an invasive growth pattern, which suggests malignancy and might promote an erroneous diagnosis, was frequently found in hepatic AMLs. However, among about 180 reported hepatic AMLs, including the present cases, only one hepatic AML with distant metastasis has been reported to date and nearly all hepatic AMLs behave in a benign fashion. Therefore, pathologists should not overdiagnose malignancy based solely on the histological invasive growth patterns described in this paper.

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Carbon ion therapy is a type of radiotherapy that can deliver high-dose radiation to a tumor while minimizing the dose delivered to organs at risk. Moreover, carbon ions are classified as high linear energy transfer radiation and are expected to be effective for even photon-resistant tumors. A 73-year-old man with glottic squamous cell carcinoma, T3N0M0, refused laryngectomy and received carbon ion therapy of 70 Gy (relative biological effectiveness) in 35 fractions. Three months after the therapy, the patient had an upper airway inflammation, and then laryngeal edema and pain occurred. Five months after the therapy, the airway stenosis was severe and computed tomography showed lack of the left arytenoid cartilage and exacerbation of laryngeal necrosis. Despite the treatment, 5 and a half months after the therapy, the laryngeal edema and necrosis had become even worse and the surrounding mucosa was edematous and pale. Six months after the therapy, pharyngolaryngoesophagectomy and reconstruction with free jejunal autograft were performed. The surgical specimen pathologically showed massive necrosis and no residual tumor. Three years after the carbon ion therapy, he is alive without recurrence. The first reported laryngeal squamous cell carcinoma case treated with carbon ion therapy resulted in an unexpected radiation laryngeal necrosis. Tissue damage caused by carbon ion therapy may be difficult to repair even for radioresistant cartilage; therefore, hollow organs reinforced by cartilage, such as the larynx, may be vulnerable to carbon ion therapy. Caution should be exercised when treating tumors in or adjacent to such organs with carbon ion therapy.