太田 昌幸

Abstract Large uterine fibroids that grow rapidly over a short period should be differentiated from uterine leiomyosarcoma, and their treatment remains controversial in women seeking to conceive. Here, we report two cases of uterine fibroids treated with short‐term relugolix administration followed by myomectomy. Needle biopsy specimens obtained before relugolix administration showed no malignancy, and significant tumor shrinkage was observed following treatment. Both patients subsequently underwent myomectomy. One patient achieved a live birth 14 months after myomectomy, whereas the other experienced improvement in severe anemia, allowing her to prepare for pregnancy. Histological examination after relugolix administration revealed atrophic changes in spindle cells within the fibroids, characterized by nuclear crowding and decreased immunoreactivity for desmin and α‐smooth muscle actin. The significant fibroid shrinkage observed after the short‐term administration of relugolix provided a rationale for myomectomy, improved anemia, and facilitated appropriate uterine reconstruction, ensuring structural integrity for future pregnancies in women of reproductive age.

The relationship between cancer prognosis and intratumoral microbiome has recently gained attention. Regarding lung cancer, most studies have focused on bacteria outside tumors, such as sputum or lavage fluid, with few examining intratumoral bacteria and their impact on prognosis. In this study, we extracted DNA from lung tumor samples of 507 patients undergoing surgery at Chiba University Hospital and quantified intratumoral bacterial abundance using bacteria-specific PCR primers. Bacteria were detected in 77.1% of cases, and bacterial abundance was significantly higher in lung adenocarcinoma than in squamous cell carcinoma. Patients were categorized into three groups (High, Low, and Very-Low) based on bacterial abundance, and associations with clinicopathological factors were analyzed. In lung squamous cell carcinoma, higher bacterial abundance was significantly associated with worse recurrent-free survival and overall survival and was found to be a poor prognostic factor independent of pathological tumor stage. In conclusion, intratumoral bacterial abundance was found in the majority of lung cancer tissues, with variations based on pathology. This abundance may serve as a useful marker for stratifying lung squamous cell carcinoma with distinct prognoses.

類上皮血管肉腫(EA)は血管肉腫の亜型である。今回,低分化な癌との鑑別が困難であった小腸原発のEAを報告する。44歳の男性が腹部CTと内視鏡検査で低分化腺癌を疑われ,小腸部分切除術を受けた。手術検体での詳細な組織形態の観察と免疫染色により,EAと診断した。消化管発生の血管肉腫は類上皮形態を伴う頻度が高く,診断には複数の血管内皮マーカーの確認が有用である。消化管の生検で低分化な上皮様パターンを示す場合は,EAも考慮すべきである。(著者抄録)

Mycobacterium goodii, a rapidly growing non-tuberculous mycobacterium, rarely causes pulmonary diseases. A patient was admitted to our hospital with a fever and cough. Chest radiography revealed consolidation in the right middle lung. As he had previously been treated for organizing pneumonia (OP), he was diagnosed with OP recurrence and administered systemic corticosteroids. Although initial improvement was observed, the pulmonary consolidations worsened. Transbronchial lung cryobiopsy revealed an OP pattern. M. goodii was identified in sputum acid-fast bacilli cultures. The patient was diagnosed with M. goodii pulmonary disease and secondary OP. Although intravenous imipenem-cilastatin, amikacin, and ciprofloxacin led to initial improvement in pulmonary consolidations, the consolidations re-worsened. Systemic corticosteroids were initiated, resulting in improvement in the consolidations. The dose of systemic corticosteroids was tapered; oral antimycobacterial therapy was continued. M. goodii can cause pulmonary disease and induce OP; antimycobacterial therapy and systemic corticosteroids can be effective.

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been used to diagnose and stage lung cancer. Acquire™ Pulmonary and Expect™ Pulmonary dedicated EBUS-TBNA needles were introduced as the Franseen and Lancet needles, respectively. It is still unclear whether the Franseen or Lancet needles yield a higher quality specimen especially focusing on next-generation sequencing-based molecular testing. METHODS: A single-center, prospective study performed at the Chiba University Hospital randomly assigned patients to two groups: Group A, wherein the first and second EBUS-TBNA were performed using Lancet and Franseen needles, respectively, and Group B, wherein the first and second EBUS-TBNA were performed using Franseen and Lancet needles, respectively. Each specimen was compared and analyzed pathologically. The primary outcome was the histological tissue area except blood clot and the cellularity of each sample. We also examined the success rate of molecular testing. RESULTS: Twelve patients who underwent EBUS-TBNA between November 2022 and February 2023 were enrolled in this study. The tissue area of the specimens obtained by the Franseen and Lancet needles was 13.3 ± 6.4 mm2 and 10.6 ± 6.3 mm2, respectively (P = .355). The tumor cellularity in the specimens obtained using the Franseen and Lancet needles was 54.0 ± 30.3 and 46.2 ± 36.3%, respectively (P = .608). The success rate of molecular testing using the single-pass sample by Franseen needle was 85.7 and 57.1% by Lancet needle. No serious complications were reported. CONCLUSIONS: The Franseen needle tended to show a greater amount of specimen with higher tumor cellularity than the Lancet needle which may contribute higher success rate of molecular testing. Further studies must be conducted to validate the results of this study. KEY FINDINGS: What is known and what is new?  What is the implication, and what should change now?