Journal of Nippon Medical School最新文献

Metastatic breast tumors are rare and often misdiagnosed as primary breast cancer. Herein, we present a case of breast metastasis from malignant melanoma. A 46-year-old woman presented to our department with a lump in her left breast. Examination revealed a relatively soft mass measuring 4 cm in diameter in the left breast. A needle biopsy was performed, and immunostaining for S-100, human melanoma black-45, CD56/neural cell adhesion molecule, and Melan-A confirmed a diagnosis of malignant melanoma. The metastasis was confined to the breast and was thus treated by surgery to excise the tumor. Malignant melanoma is a rare disease in the Japanese population and is associated with a poor prognosis because of the risk of early metastasis to multiple organs and lymph nodes. However, when complete resection of distant metastases is feasible, curative resection may be indicated. Herein, we report a case of breast metastasis from malignant melanoma and review previously published case reports on this rare condition.

Prosopagnosia is a cognitive disorder in which facial recognition is severely impaired despite normal vision and intelligence. Prosopagnosia was first reported in the 1800s, but its cause remains unclear. Although other neurological symptoms are often present, some patients have pure prosopagnosia. The bilateral occipital lobes are believed to be associated with symptoms. Recent brain imaging techniques have identified the right fusiform gyrus (rFG), located at the junction of the right occipital temporal lobe, as the affected region. In this report, we present a case of associative prosopagnosia with no concomitant symptoms in a 76-year-old man. Brain magnetic resonance imaging detected a subcortical hemorrhage in the right temporal lobe. Using tractography based on diffusion tensor imaging, we visualized atrophy of the right inferior longitudinal fasciculus (ILF). This is the first time tractography has been used to show a clear association between associative prosopagnosia and ILF damage projecting from the rFG.

Simple radiography is the most frequently and widely available technology to examine bone pathologies. Computed tomography (CT) can evaluate pathologies more accurately in multiple planes and three dimensions; however, radiation exposure is much higher than with simple radiography. In addition, diagnostic ability is decreased for both technologies when metal devices are present. Tomosynthesis is a radiographic technology used to evaluate tissues quasi-three-dimensionally with less radiation exposure. Tomosynthesis technology was recently upgraded to reduce the effects of metal artifacts. This case report compares examination time, medical expense, image resolution, and radiation exposure for upgraded tomosynthesis, simple radiography, CT, and standard tomosynthesis in three patients with metal devices in the affected knees. Examination times were similar for the imaging technologies. Diagnostic performance was better for upgraded tomosynthesis than for simple radiography and standard tomosynthesis, and similar to that for CT. Moreover, radiation exposure and expense were higher for tomosynthesis than for simple radiography but lower than for CT. These findings suggest that upgraded tomosynthesis is the best method for evaluating bone pathology when metal devices are present and radiation exposure must be limited.

Sellar reconstruction is important for preventing cerebrospinal fluid (CSF) leakage after transsphenoidal pituitary surgery. This report describes how, despite standard sellar reconstruction, CSF exudation resulted from dural thinning at the anterior skull base, outside the intrasellar area manipulated during pituitary tumor resection. A 76-year-old man underwent endoscopic transsphenoidal surgery for a pituitary tumor extending toward the anterior skull base. After opening the sellar floor, intractable bleeding from the anterior intercavernous sinus occurred during bone removal at the anterior skull base. Pseudocapsule-based extracapsular resection was completed after stopping the bleeding. On the 10th postoperative day, the patient developed CSF rhinorrhea complicated by marked pneumocephalus, and emergency endoscopic repair of the CSF leak was performed. CSF leakage originated from the thinned dura at the anterior skull base located outside the intrasellar area manipulated during tumor resection. The thinned dural area at the anterior skull base coincided with the site of intractable bleeding of the anterior intercavernous sinus during bone removal in tumor resection. The thinned anterior skull base dura was covered with fascia, overlaid with fat, and closed with the nasoseptal flap. Endoscopic CSF leak repair was successful. Severe damage to the anterior intercavernous sinus can cause extensive exposure of the single-layered inner meningeal dura, where thinning might result in CSF exudation. Therefore, use of autologous tissues to cover and reinforce the severely damaged area of the anterior intercavernous sinus might help prevent postoperative CSF exudation.

A 56-year-old right-handed man was referred to our hospital for evaluation of sudden-onset transient quadrantanopia, which was followed by throbbing headache consistent with migraine with aura (MA). Magnetic resonance imaging (MRI) of the right parieto-occipital cortex on admission showed a hyperintense region on diffusion-weighted imaging, which disappeared 7 days later. A small cortical infarct in the parieto-occipital cortex can cause MA-like headache, and the present infarct lesion was only detectable on MRI during the acute phase. Performing MRI for patients with suspected acute MA might help identify the cause of MA-like headache and ensure appropriate management of patients.

Background: In the field of orthopedics, few studies have examined pain associated with soft tissue tumors. To accurately and promptly diagnose soft tissue tumors and provide appropriate treatment, it is necessary to have a comprehensive understanding of the relationship between soft tissue tumors and pain.

Methods: We analyzed data from patients with mass lesions in the extremities or trunk diagnosed by biopsy or surgery in our department and patients with ganglion cysts diagnosed by puncture between October 1, 2005, and September 30, 2011. Using medical records, we retrospectively investigated the clinical data.

Results: Data from 473 patients with 482 lesions were analyzed. Pain was observed in 204 of the 482 lesions (42.3%). So-called painful tumors accounted for approximately half of the painful lesions (45.0%). Logistic regression indicated that pain was significantly associated with so-called painful tumors (odds ratio [OR]: 5.64; P < 0.001), inflammatory nodules (OR: 3.42; P = 0.007), and sites with strong physical stimulation (OR: 2.45; 95% confidence interval [CI]: 1.58-3.81; P < 0.001) but not with long diameter (OR: 0.90; P = 0.001) or malignancy (OR: 1.78; P = 0.144).

Conclusion: Our findings suggest that so-called painful tumors account for approximately half of soft tissue mass lesions requiring surgery, biopsy, or puncture in orthopedics. It is thus important to have a clear understanding of such tumors. Inflammatory nodules are also important in the differential diagnosis of painful soft tissue lesions. Lesions at sites exposed to strong physical stimulation can cause pain.

Background: We retrospectively examined image quality (IQ) of thin-slice virtual monochromatic imaging (VMI) of half-iodine-load, abdominopelvic, contrast-enhanced CT (CECT) by dual-energy CT (DECT) with deep learning image reconstruction (DLIR).

Methods: In 28 oncology patients with moderate-to-severe renal impairment undergoing half-iodine-load (300 mgI/kg) CECT by DECT during the nephrographic phase, we reconstructed VMI at 40-70 keV with a slice thickness of 0.625 mm using filtered back-projection (FBP), hybrid iterative reconstruction (HIR), and DLIR; measured contrast-noise ratio (CNR) of the liver, spleen, aorta, portal vein, and prostate/uterus; and determined the optimal keV to achieve the maximal CNR. At the optimal keV, two independent radiologists compared each organ's CNR and subjective IQ scores among FBP, HIR, and DLIR to subjectively grade image noise, contrast, sharpness, delineation of small structures, and overall IQ.

Results: CNR of each organ increased continuously from 70 to 40 keV using FBP, HIR, and DLIR. At 40 keV, CNR of the prostate/uterus was significantly higher with DLIR than with FBP; however, CNR was similar between FBP and HIR and between HIR and DLIR. The CNR of all other organs increased significantly from FBP to HIR to DLIR (P < 0.05). All IQ scores significantly improved from FBP to HIR to DLIR (P < 0.05) and were acceptable in all patients with DLIR only.

Conclusions: The combination of 40 keV and DLIR offers the maximal CNR and a subjectively acceptable IQ for thin-slice VMI of half-iodine-load CECT.

Background: Psoriasis is accompanied by systemic inflammation that includes the liver. The fibrosis-4 (FIB-4) index was developed to predict significant liver fibrosis. The present study evaluated the effects of biologics, including TNF inhibitors, on the FIB-4 index in psoriasis patients.

Methods: All adult patients with psoriasis who were prescribed biologics (TNF inhibitors, IL-17 inhibitors, or IL-23 inhibitors) at Nippon Medical School from June 2014 to January 2024 for the first time (biologic-naïve patients) were included in this study. The FIB-4 index was calculated before and after 6 months of treatment with biologics.

Results: A total of 105 patients were enrolled. The FIB-4 index was higher after 6 months of treatment with TNF inhibitors (P=0.0018) and IL-17 inhibitors (P=0.045) but did not change with IL-23 inhibitors. Aspartate aminotransferase and alanine aminotransferase levels did not change after treatment with TNF inhibitors, IL-17 inhibitors, or IL-23 inhibitors. Platelet count decreased after treatment with TNF inhibitors (P=0.0011) and IL-23 inhibitors (P=0.039) but did not change with IL-17 inhibitors.

Conclusions: Downregulation of platelets seems to be a major contributing factor for the increase in FIB-4 index in patients treated with TNF inhibitors. Although the FIB-4 index is a simple marker to screen for liver fibrosis, changes in this index should be interpreted with caution, and imaging findings such as transient elastography should also be used to evaluate the status of liver fibrosis.

Tarsal tunnel syndrome (TTS) is elicited by compression of the tibial nerve in the tarsal tunnel. TTS in the absence of a lesion tends to be idiopathic, and most TTS is idiopathic. Patients complain of several plantar symptoms, and TTS affects their quality of life. The symptoms tend to worsen with walking, and ankle joint movement and arterial distortion may also be involved. Because TTS symptoms are similar to those of diabetic neuropathy and lumbar disease, clinical symptoms are diagnostically important. While magnetic resonance imaging reveals nerve compression, it is difficult to identify causative factors, and false-positive results are a concern. Wound-related complications after TTS surgery may be reduced by a zigzag skin incision. Surgery for carpal tunnel syndrome yields better outcomes and greater patient satisfaction than TTS surgery.

Cell adhesion molecule 1 (CADM1) is an immunoglobulin superfamily cell adhesion molecule that was first identified as a tumor suppressor in non-small cell lung cancer because of its role in suppressing tumor formation in nude mice. CADM1 forms a homophilic dimer on the cell membrane and associates with actin-binding proteins (4.1s) and scaffold proteins (MAGuKs), which contain PDZ motifs. It forms a ternary protein complex involved in cell adhesion and the formation of epithelium-like structure. While CADM1 is expressed in epithelium, neuronal tissue, and testes, CADM1 expression is absent in many cancers of epithelial origin, including cancers of the lung, esophagus, stomach, liver, pancreas, breast, and prostate. In addition to its tumor-suppressive activity in epithelial cell adhesion, CADM1 acts as a tumor antigen, recognized by activated NK cells and CD8+ T cells through heterophilic interaction with CRTAM, thereby serving as a tumor suppressor in two ways. In contrast, CADM1 is overexpressed in adult T-cell leukemia/lymphoma (ATL) cells, making it a specific diagnostic marker of ATL on FACS analysis. CADM1 is also highly expressed in small cell lung cancer (SCLC) and other neuroendocrine tumors, and promotes metastasis, suggesting its potential as a target for diagnosis and treatment of SCLC. CADM1 also has a role in synapse formation and spermatogenesis, and deficient or abnormal CADM1 is linked to disorders such as male infertility in mice and autism spectrum disorder. Here, we summarize the multiple functions of CADM1 and its involvement in cancer and other diseases, focusing on disorders of aberrant cell adhesion.