We report a case of microsecretory adenocarcinoma of the hard palate. The patient is a 37‐year‐old woman with a 15 mm submucosal tumor, which was incidentally found by her primary care dentist, in ...her hard palate. Preoperative magnetic resonance imaging revealed a tumor exhibiting high signal on T2‐weighted image, which was gradually enhanced on dynamic study. Histologically, the tumor border was ill‐defined without fibrous capsule and adjoined minor salivary gland with permeative infiltration at the tumor periphery. The tumor comprised intercalated duct‐like cells with polygonal narrow eosinophilic to clear cytoplasm and small, uniform oval nuclei. These cells formed small infiltrative microcysts, tubules and fascicular cords collecting pale basophilic secretions and small vacuoles setting in an abundant fibromyxoid stroma. The tumor cells were positive for CK AE1+AE3, S‐100 protein, and p63, while are completely negative for p40, alpha‐SMA, and calponin. The MEF2C‐SS18 fusion was identified by reverse transcriptase‐polymerase chain reaction followed by Sanger sequencing. The combination of characteristic histology, immunophenotype, and presence of MEF2C‐SS18 fusion indicated the diagnosis of microsecretory adenocarcinoma of the hard palate, an entity described only recently. Post‐operative course was uneventful and there was no evidence of disease at 4 months after surgery.
Inclusion body myositis (IBM) is a refractory muscle disease characterized by inflammatory and degenerative features in myofibers. Macroglossia is common in systemic amyloid light chain amyloidosis; ...however, no reports have been published on patients with IBM. We encountered a female patient with clinicopathologically defined IBM who exhibited relatively rapid progression of dysphagia, gait disturbance, and macroglossia. Muscle biopsy demonstrated endomysial mononuclear inflammatory infiltrates, fiber necrosis and regeneration with rimmed vacuoles, and sarcoplasmic inclusions of p62. Tongue biopsy demonstrated fiber degeneration with fatty replacement and fibrosis, nonnecrotic fibers surrounded and invaded by mononuclear cells, and sarcoplasmic dotlike inclusions of p62. Based on the parotid gland, lip, and muscle biopsy, she was diagnosed as having IBM with Sjögren's syndrome. She was treated with steroid pulse and intravenous immunoglobulin therapy followed by oral administration of prednisolone, which resulted in temporary clinical improvement. Macroglossia might be an indicator of immunotherapy effectiveness.
Objectives
The 14-item Freiburg Mindfulness Inventory-short form assesses mindfulness, and enhanced mindfulness is beneficial for reducing anxiety and depressive symptoms. This study aims to develop ...a Japanese version of the measure (J-FMI) and examine its reliability and validity in a clinical population.
Methods
Patients (
N
= 340) with mainly depression and/or anxiety completed the J-FMI and a set of questionnaires to measure the five facets of trait mindfulness, anxiety, and depressive symptoms after attending a 2.5-h mindfulness training program.
Results
The exploratory factor analysis revealed that the J-FMI had two factors, with five items in the presence factor and nine in the acceptance factor. Internal consistency and reliability were high for the overall scale (
α
= .90, ω = .92), J-FMI presence (
α
= .80, ω = .80), and acceptance (
α
= .89, ω = .90) factors. In the correlation analyses, each J-FMI factor was significantly correlated with the five facets of trait mindfulness (
r
= .11 to .65) and anxiety and depressive symptoms (
r
= − .22 to − .61). There were no significant correlations between J-FMI presence and anxiety and depressive symptoms after acceptance was controlled (
r
= − .04 to − .05) in the partial correlation analyses. Conversely, significant correlations were noted between J-FMI acceptance and anxiety and depressive symptoms after presence was controlled (
r
= − .27 to − .53).
Conclusions
These findings demonstrate the J-FMI’s high internal consistency, reliability, and factorial validity and support its criterion, convergent, and discriminant validity in a clinical sample, thus confirming its high reliability and validity.
A four-session program of mindfulness and cognitive behavioral therapy (M-CBT) is a low-intensity treatment module for individuals with high cost/probability bias and social anxiety symptoms. We ...tested its effectiveness with 23 patients with social anxiety disorder. The patients completed a set of questionnaires that evaluated social anxiety symptoms, cost/probability bias, fear of negative evaluation from others, self-focused attention, trait mindfulness, depressive symptoms, cognitive reappraisal, and suppression at pretreatment, the time before each session of treatment, post-treatment, and follow-up. Linear mixed-effects models showed that the M-CBT was effective for social anxiety symptoms, cost/probability bias, fear of negative evaluation from others, self-focused attention, trait mindfulness, depressive symptoms, and cognitive reappraisal. The M-CBT also produced significant pre-post-improvements in social anxiety symptoms and cost bias with high effect sizes (social anxiety symptoms:
d
= 1.04–1.06, cost bias:
d
= 0.82–1.02). These results suggest that M-CBT is effective for treating social anxiety symptoms and cost bias. This study demonstrates that M-CBT is feasible and acceptable for social anxiety disorder. It may comprise a treatment module for those who do not respond to traditional cognitive behavioral therapy. Trial registration number: University Hospital Medical Information Network (UMIN CTR) UMIN000043720, Registered 23 Mar 2021.
Benefit of carboplatin and dose-dense weekly paclitaxel (ddCT) in first line treatment of ovarian cancer patients has been different in Western and Asian studies. In the present study we compare ...progression-free survival (PFS) of ddCT to three-weekly carboplatin and paclitaxel (CT) in first-line treatment of ovarian carcinoma in a single institution in a Western population.
We conducted a retrospective review of medical records from patients with ovarian carcinoma treated in a tertiary cancer center from 2007 to 2018. All patients treated with ddCT or CT in the first-line setting were included. Patients who received first-line bevacizumab were not included. PFS and overall survival (OS) were compared in a propensity score-matched cohort to address selection bias. Patients were matched according to age, ECOG performance status, CA 125, FIGO stage, residual disease, and histological subtype, in a 1:2 ratio.
Five hundred eighty-eight patients were eligible for propensity score matching, the final cohort consisted of 69 patients treated with ddCT and 138 CT group. Baseline characteristics were well-balanced. After a median follow-up of 65.1 months, median PFS was 29.3 vs 20.0 months, favouring ddCT treatment (p = 0.035). In the multivariate cox regression ddCT showed a 18% lower risk of progression (HR 0.82, 95% CI 0.68-0.99, p = 0.04). Overall survival data is immature, but suggested better outcomes for ddCT (not reached versus 78.8 months; p = 0.07).
Our retrospective study has shown superior PFS of ddCT over CT regimen in first-line treatment of ovarian carcinoma in a Western population not treated with bevacizumab.
Background
Langerhans cell histiocytosis (LCH) is an abnormal accumulation of Langerhans cells in various organs that sometimes induces organ dysfunction. LCH can affect the liver, resulting in ...sclerosing cholangitis and biliary cirrhosis. However, liver and bile duct involvement is usually observed in the disseminated form of LCH. We herein report a rare case of LCH localized only in the extrahepatic bile duct that resulted in severe liver cirrhosis.
Case presentation
A 3-year-old boy with elevated liver enzymes, obstructive jaundice, and dilation of the common bile duct was referred to our institution. Contrast-enhanced computed tomography showed atrophy of the right hepatic lobe, relative hypertrophy of the left hepatic lobe, choledocholiths, and biliary debris extensively with biliary duct dilation. Magnetic resonance cholangiopancreatography revealed dilation of the intrahepatic and extrahepatic bile ducts and multiple choleliths in the gallbladder and common bile duct. Laparoscopic cholecystectomy, intraoperative cholangiography, liver biopsy, and gastrointestinal fiberscopy were performed. A liver specimen showed severe biliary cirrhosis due to sclerosing cholangitis. The patient then underwent living-donor liver transplantation because of severe liver cirrhosis 3 months after the first surgery. The common bile duct was not suitable for duct-to-duct anastomosis and was resected because of severe inflammation. Histologic sections of the common bile duct showed histiocytic cell proliferation. Immunohistochemistry revealed histiocytoses that were positive for Langerin, S-100 protein, and CD1a. However, no histiocytic cell proliferation was noted in the liver tissue. The definitive diagnosis was LCH localized to the extrahepatic bile duct. LCH in the extrahepatic bile duct seemed to cause sclerosing cholangitis. The patient was discharged uneventfully 2 months after living-donor liver transplantation.
Conclusions
LCH localized to the extrahepatic bile duct is extremely rare; however, LCH can still affect the extrahepatic bile ducts on occasion. LCH should be considered as a differential diagnosis if pediatric patients show the presence of sclerosing cholangitis.
A 96-year-old woman developed hemiparesis 2 weeks after orthopedic surgery. Magnetic resonance imaging revealed multiple cerebral infarctions in the bilateral hemisphere. Transthoracic ...echocardiography revealed a mobile structure attached to the anterior mitral leaflet that protruded toward the left ventricular outflow tract. The structure was identified as an accessory mitral valve. Doppler echocardiography showed that there was no significant left ventricular outflow obstruction. This is a rare case of a silent accessory mitral valve that was detected after multiple cerebral infarctions.
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