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Thursday, May 31, 2007
Lancet & Science & amj pathol 2004articles
Lancet
１）May 25, 2007
A mimic of sarcoidosis
from The Lancet by Larisa Dzirlo
In June, 1998, a 48-year-old man presented to the University Hospital of Vienna with large, red, partly ulcerated cutaneous plaques on the anterior surfaces of his lower legs. He also described shortness of breath on exertion. He had no other medical history of note. Whipple disease による皮膚病変、縦隔リンパ節腫大。ステロイドで軽快せず、後にタンパク漏出胃腸症で診断された。PAS陽性。Tropheryma whipplei が原因。
9 years of recurrent dysphagia
from The Lancet by Krishna P Basavaraju
A 46-year-old man was referred with a 9-year history of recurrent, intermittent, painful dysphagia, mainly for solids. His appetite was good and his weight remained steady. The results of his barium swallow, gastroscopy, oesophageal manometry, and 24-hour oesophageal pH study were unremarkable. In view of the patient's continued dysphagia, gastroscopy was repeated 4 months later, when it revealed multiple concentric rings in the upper and middle oesophagus (); the gastroscope could not be advanced beyond 28 cm. A biopsy of the oesophagus showed dense eosinophilic infiltration, consistent with eosinophilic oesophagitis. The patient's symptoms settled with a 3-month course of steroids. 5 months after the end of the course, his symptoms recurred, but responded equally well to 10 mg of montelukast daily, on which he has remained symptom-free for a year. 好酸球性食道炎で膜状構造
２）May 28, 2007.
Book: Too busy to have cancer?
from The Lancet by Priya Shetty
“What happens when a shoe-crazy, lipstick-obsessed, wine-swilling, pasta-slurping, fashion-fanatic, madly-in-love, single-forever, about-to-get-married big city girl cartoonist with a fabulous life finds…A LUMP IN HER BREAST!?” She writes a darkly funny graphic memoir of her fight with breast cancer through an alter ego “Cancer Vixen”—replete with 5-inch gold heels and sassy slogan: “cancer, I'm gonna kick your butt!” In Marisa Acocella Marchetto's New York life “B.C.” (Before Cancer), her biggest problems were which fashionable party to go to next, a rivalry with another female cartoonist, and the models vying for her rakish Italian restaurateur fiancé's attention. Finally, aged 43, having found the man she wants to marry, and with her cartoons in demand by the likes of The New Yorker, she is diagnosed with breast cancer. In her words, “now is not a good time!” What happens next is the story she relates in Cancer Vixen.
Radiotherapy and the heart
from The Lancet by Matthias Bramkamp
In June, 2006, a 47-year-old man was admitted to our emergency department with chest pain. There was ST segment elevation on his ECG, and his troponin T concentration was raised at 0·24 μg/L (normal <0·10 μg/L). His LDL cholesterol concentration was marginally raised at 3·1 mmol/L, but his total cholesterol concentration was within the normal range, as was his blood pressure. He was a non-smoker, and had been working as an instructor in a gymnasium. His medical history had only one notable feature: in his teens, he had been diagnosed with Hodgkin's lymphoma, for which he had undergone mediastinal radiotherapy at a total dose of 40 Gy ().冠動脈疾患
リスクファクターが僅かな47歳男性。心筋虚血で来院。10代の頃HDで胸部照射の既往あり。
それによる冠動脈疾患が疑われた。
２）Science May 11, 2007.
A Common Variant in the FTO Gene Is Associated with Body Mass Index and Predisposes to Childhood and Adult Obesity
Timothy M. Frayling, Nicholas J. Timpson, Michael N. Weedon, Eleftheria Zeggini, Rachel M. Freathy, Cecilia M. Lindgren, John R. B. Perry, Katherine S. Elliott, Hana Lango, Nigel W. Rayner, Beverley Shields, Lorna W. Harries, Jeffrey C. Barrett, Sian Ellard, Christopher J. Groves, Bridget Knight, Ann-Marie Patch, Andrew R. Ness, Shah Ebrahim, Debbie A. Lawlor, Susan M. Ring, Yoav Ben-Shlomo, Marjo-Riitta Jarvelin, Ulla Sovio, Amanda J. Bennett, David Melzer, Luigi Ferrucci, Ruth J. F. Loos, Inês Barroso, Nicholas J. Wareham, Fredrik Karpe, Katharine R. Owen, Lon R. Cardon, Mark Walker, Graham A. Hitman, Colin N. A. Palmer, Alex S. F. Doney, Andrew D. Morris, George Davey Smith, The Wellcome Trust Case Control Consortium, Andrew T. Hattersley, and Mark I. McCarthy
Science 11 May 2007: 889-894.
Bat Flight Generates Complex Aerodynamic Tracks
A. Hedenström, L. C. Johansson, M. Wolf, R. von Busse, Y. Winter, and G. R. Spedding
Science 11 May 2007: 894-897.
The wake of small flying bats shows multiple vortices when traced, suggesting that their flight is based on somewhat different principles than that of birds.
３）Other
Most Osteomalacia-associated Mesenchymal Tumors Are a Single Histopathologic Entity: An Analysis of 32 Cases and a Comprehensive Review of the Literature.
Original Article
American Journal of Surgical Pathology. 28(1):1-30, January 2004.
Abstract:
colon; Oncogenic osteomalacia (OO) is a rare paraneoplastic syndrome of osteomalacia due to phosphate wasting. The phosphaturic mesenchymal tumor (mixed connective tissue variant) (PMTMCT) is an extremely rare, distinctive tumor that is frequently associated with OO. Despite its association with OO, many PMTMCTs go unrecognized because they are erroneously diagnosed as other mesenchymal tumors. Expression of fibroblast growth factor-23 (FGF-23), a recently described protein putatively implicated in renal tubular phosphate loss, has been shown in a small number of mesenchymal tumors with known OO. The clinicopathological features of 32 mesenchymal tumors either with known OO (29) or with features suggestive of PMTMCT (3) were studied. Immunohistochemistry for cytokeratin, S-100, actin, desmin, CD34, and FGF-23 was performed. The patients (13 male, 19 female) ranged from 9 to 80 years in age (median 53 years). A long history of OO was common. The cases had been originally diagnosed as PMTMCT (15), hemangiopericytoma (HPC) (3), osteosarcoma (3), giant cell tumor (2), and other (9). The tumors occurred in a variety of soft tissue (21) and bone sites (11) and ranged from 1.7 to 14 cm. Twenty-four cases were classic PMTMCT with low cellularity, myxoid change, bland spindled cells, distinctive "grungy" calcified matrix, fat, HPC-like vessels, microcysts, hemorrhage, osteoclasts, and an incomplete rim of membranous ossification. Four of these benign-appearing PMTMCTs contained osteoid-like matrix. Three other PMTMCTs were hypercellular and cytologically atypical and were considered malignant. The 3 cases without known OO were histologically identical to the typical PMTMCT. Four cases did not resemble PMTMCT: 2 sinonasal HPC, 1 conventional HPC, and 1 sclerosing osteosarcoma. Three cases expressed actin; all other markers were negative. Expression of FGF-23 was seen in 17 of 21 cases by immunohistochemistry and in 2 of 2 cases by RT-PCR. Follow-up (25 cases, 6-348 months) indicated the following: 21 alive with no evidence of disease and with normal serum chemistry, 4 alive with disease (1 malignant PMTMCT with lung metastases). We conclude that most cases of mesenchymal tumor-associated OO, both in the present series and in the reported literature, are due to PMTMCT. Improved recognition of their histologic spectrum, including the presence of bone or osteoid-like matrix in otherwise typical cases and the existence of malignant forms, should allow distinction from other mesenchymal tumors. Recognition of PMTMCT is critical, as complete resection cures intractable OO. Immunohistochemistry and RT-PCR for FGF-23 confirm the role of this protein in PMTMCT-associated OO.
１）May 25, 2007
A mimic of sarcoidosis
from The Lancet by Larisa Dzirlo
In June, 1998, a 48-year-old man presented to the University Hospital of Vienna with large, red, partly ulcerated cutaneous plaques on the anterior surfaces of his lower legs. He also described shortness of breath on exertion. He had no other medical history of note. Whipple disease による皮膚病変、縦隔リンパ節腫大。ステロイドで軽快せず、後にタンパク漏出胃腸症で診断された。PAS陽性。Tropheryma whipplei が原因。
9 years of recurrent dysphagia
from The Lancet by Krishna P Basavaraju
A 46-year-old man was referred with a 9-year history of recurrent, intermittent, painful dysphagia, mainly for solids. His appetite was good and his weight remained steady. The results of his barium swallow, gastroscopy, oesophageal manometry, and 24-hour oesophageal pH study were unremarkable. In view of the patient's continued dysphagia, gastroscopy was repeated 4 months later, when it revealed multiple concentric rings in the upper and middle oesophagus (); the gastroscope could not be advanced beyond 28 cm. A biopsy of the oesophagus showed dense eosinophilic infiltration, consistent with eosinophilic oesophagitis. The patient's symptoms settled with a 3-month course of steroids. 5 months after the end of the course, his symptoms recurred, but responded equally well to 10 mg of montelukast daily, on which he has remained symptom-free for a year. 好酸球性食道炎で膜状構造
２）May 28, 2007.
Book: Too busy to have cancer?
from The Lancet by Priya Shetty
“What happens when a shoe-crazy, lipstick-obsessed, wine-swilling, pasta-slurping, fashion-fanatic, madly-in-love, single-forever, about-to-get-married big city girl cartoonist with a fabulous life finds…A LUMP IN HER BREAST!?” She writes a darkly funny graphic memoir of her fight with breast cancer through an alter ego “Cancer Vixen”—replete with 5-inch gold heels and sassy slogan: “cancer, I'm gonna kick your butt!” In Marisa Acocella Marchetto's New York life “B.C.” (Before Cancer), her biggest problems were which fashionable party to go to next, a rivalry with another female cartoonist, and the models vying for her rakish Italian restaurateur fiancé's attention. Finally, aged 43, having found the man she wants to marry, and with her cartoons in demand by the likes of The New Yorker, she is diagnosed with breast cancer. In her words, “now is not a good time!” What happens next is the story she relates in Cancer Vixen.
Radiotherapy and the heart
from The Lancet by Matthias Bramkamp
In June, 2006, a 47-year-old man was admitted to our emergency department with chest pain. There was ST segment elevation on his ECG, and his troponin T concentration was raised at 0·24 μg/L (normal <0·10 μg/L). His LDL cholesterol concentration was marginally raised at 3·1 mmol/L, but his total cholesterol concentration was within the normal range, as was his blood pressure. He was a non-smoker, and had been working as an instructor in a gymnasium. His medical history had only one notable feature: in his teens, he had been diagnosed with Hodgkin's lymphoma, for which he had undergone mediastinal radiotherapy at a total dose of 40 Gy ().冠動脈疾患
リスクファクターが僅かな47歳男性。心筋虚血で来院。10代の頃HDで胸部照射の既往あり。
それによる冠動脈疾患が疑われた。
２）Science May 11, 2007.
A Common Variant in the FTO Gene Is Associated with Body Mass Index and Predisposes to Childhood and Adult Obesity
Timothy M. Frayling, Nicholas J. Timpson, Michael N. Weedon, Eleftheria Zeggini, Rachel M. Freathy, Cecilia M. Lindgren, John R. B. Perry, Katherine S. Elliott, Hana Lango, Nigel W. Rayner, Beverley Shields, Lorna W. Harries, Jeffrey C. Barrett, Sian Ellard, Christopher J. Groves, Bridget Knight, Ann-Marie Patch, Andrew R. Ness, Shah Ebrahim, Debbie A. Lawlor, Susan M. Ring, Yoav Ben-Shlomo, Marjo-Riitta Jarvelin, Ulla Sovio, Amanda J. Bennett, David Melzer, Luigi Ferrucci, Ruth J. F. Loos, Inês Barroso, Nicholas J. Wareham, Fredrik Karpe, Katharine R. Owen, Lon R. Cardon, Mark Walker, Graham A. Hitman, Colin N. A. Palmer, Alex S. F. Doney, Andrew D. Morris, George Davey Smith, The Wellcome Trust Case Control Consortium, Andrew T. Hattersley, and Mark I. McCarthy
Science 11 May 2007: 889-894.
Bat Flight Generates Complex Aerodynamic Tracks
A. Hedenström, L. C. Johansson, M. Wolf, R. von Busse, Y. Winter, and G. R. Spedding
Science 11 May 2007: 894-897.
The wake of small flying bats shows multiple vortices when traced, suggesting that their flight is based on somewhat different principles than that of birds.
３）Other
Most Osteomalacia-associated Mesenchymal Tumors Are a Single Histopathologic Entity: An Analysis of 32 Cases and a Comprehensive Review of the Literature.
Original Article
American Journal of Surgical Pathology. 28(1):1-30, January 2004.
Abstract:
colon; Oncogenic osteomalacia (OO) is a rare paraneoplastic syndrome of osteomalacia due to phosphate wasting. The phosphaturic mesenchymal tumor (mixed connective tissue variant) (PMTMCT) is an extremely rare, distinctive tumor that is frequently associated with OO. Despite its association with OO, many PMTMCTs go unrecognized because they are erroneously diagnosed as other mesenchymal tumors. Expression of fibroblast growth factor-23 (FGF-23), a recently described protein putatively implicated in renal tubular phosphate loss, has been shown in a small number of mesenchymal tumors with known OO. The clinicopathological features of 32 mesenchymal tumors either with known OO (29) or with features suggestive of PMTMCT (3) were studied. Immunohistochemistry for cytokeratin, S-100, actin, desmin, CD34, and FGF-23 was performed. The patients (13 male, 19 female) ranged from 9 to 80 years in age (median 53 years). A long history of OO was common. The cases had been originally diagnosed as PMTMCT (15), hemangiopericytoma (HPC) (3), osteosarcoma (3), giant cell tumor (2), and other (9). The tumors occurred in a variety of soft tissue (21) and bone sites (11) and ranged from 1.7 to 14 cm. Twenty-four cases were classic PMTMCT with low cellularity, myxoid change, bland spindled cells, distinctive "grungy" calcified matrix, fat, HPC-like vessels, microcysts, hemorrhage, osteoclasts, and an incomplete rim of membranous ossification. Four of these benign-appearing PMTMCTs contained osteoid-like matrix. Three other PMTMCTs were hypercellular and cytologically atypical and were considered malignant. The 3 cases without known OO were histologically identical to the typical PMTMCT. Four cases did not resemble PMTMCT: 2 sinonasal HPC, 1 conventional HPC, and 1 sclerosing osteosarcoma. Three cases expressed actin; all other markers were negative. Expression of FGF-23 was seen in 17 of 21 cases by immunohistochemistry and in 2 of 2 cases by RT-PCR. Follow-up (25 cases, 6-348 months) indicated the following: 21 alive with no evidence of disease and with normal serum chemistry, 4 alive with disease (1 malignant PMTMCT with lung metastases). We conclude that most cases of mesenchymal tumor-associated OO, both in the present series and in the reported literature, are due to PMTMCT. Improved recognition of their histologic spectrum, including the presence of bone or osteoid-like matrix in otherwise typical cases and the existence of malignant forms, should allow distinction from other mesenchymal tumors. Recognition of PMTMCT is critical, as complete resection cures intractable OO. Immunohistochemistry and RT-PCR for FGF-23 confirm the role of this protein in PMTMCT-associated OO.
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