岩手医科大学

Improving cognitively healthy survival is important for achieving healthy aging. Therefore, it would be valuable to estimate the future risk of either incident dementia or death in community-dwelling older adults. This study aimed to develop a set of risk prediction models for either incident dementia or death that can be applied according to data availability across diverse clinical settings, using longitudinal data from community-dwelling older Japanese adults. A total of 8,334 participants aged ≥65 years were prospectively followed up from 2016 to 2023. Logistic regression was used to develop multivariable prediction models. The developed models were translated into simplified scoring systems based on the β coefficients. The discrimination abilities of the models were assessed by C-statistics, and the calibration was assessed by calibration plots. During the follow-up period, 1,151 participants developed either dementia or death. In the multivariable model using potential predictors commonly available in the primary care setting, age, male sex, formal education ≤9 years, diabetes mellitus, use of lipid-lowering agents, leanness, history of stroke, history of heart disease, history of respiratory disease, history of cancer, current smoking, no regular exercise habit, and low frequency of social interactions were selected as predictors. Adding cognitive status, depressive symptoms, apolipoprotein E-ε4 carrier status, and brain MRI markers to the model further enhanced its predictive performance. The developed models and simplified scores showed good discrimination and calibration. Risk stratification with our models may be useful for assessing the risks of incident dementia and death and, consequently, for prolonging cognitively healthy survival.

The increasing use of cross-sectional imaging has led to more frequent incidental detection of pancreatic cystic lesions, presenting diagnostic challenges for radiologists. These lesions encompass a heterogeneous spectrum ranging from benign cysts to premalignant and malignant neoplasms, often with overlapping imaging features. Accurate imaging-based characterization is therefore essential for risk assessment and clinical management. This review presents a morphology-based approach to pancreatic cystic lesions, emphasizing morphologic imaging patterns as a practical framework for structured interpretation. Key features—including ductal communication, internal architecture, and the presence of mural nodules or solid components—are discussed in relation to their pathologic basis and clinical implications. Representative examples illustrate the characteristic appearances of common cystic neoplasms, including serous cystic neoplasm, mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm, along with their variants. Particular attention is given to diagnostic pitfalls and mimickers, such as cystic degeneration of solid tumors including neuroendocrine tumors, solid pseudopapillary neoplasms, and pancreatic ductal adenocarcinoma, which may closely resemble true cystic lesions but require fundamentally different management. Through illustrative cases, this review highlights the importance of integrating morphologic pattern analysis with enhancement characteristics, ductal anatomy, and ancillary imaging findings. Recognition of these patterns and potential pitfalls is essential for accurate interpretation and clinically meaningful guidance.

Background Reliable biomarkers for prognostication and recurrence surveillance in esophageal squamous cell carcinoma (ESCC) remain limited. The authors therefore investigated the potential clinical utility of exosomal DNA, which has emerged as a promising component of liquid biopsy. Methods This study screened 54 patients with ESCC. After exclusions, 210 blood samples from 21 patients underwent mutation-specific droplet digital polymerase chain reaction assays of plasma exosomal DNA (exoDNA) and circulating tumor DNA (ctDNA) before and after treatment. Kaplan-Meier and receiver operating characteristic analyses were performed to examine associations with overall survival (OS), disease-specific survival (DSS), relapse-free survival (RFS), and recurrence. Results Pretreatment exoDNA positivity was significantly associated with shorter DSS (p = 0.035) and shorter RFS (p = 0.048). Post-treatment exoDNA positivity was significantly associated with shorter OS (p = 0.0008), DSS (p = 0.0001), and RFS (p = 0.0001). Post-treatment ctDNA positivity was associated with shorter DSS (p = 0.038). Conclusions In ESCC, exoDNA demonstrated prognostic and predictive value, supporting its potential role as a complementary biomarker for postoperative surveillance.

Ovarian metastasis from breast cancer has been reported in a substantial number of cases; however, reports that specifically document ovarian metastasis in the setting of hereditary breast and ovarian cancer syndrome remain limited. We describe a woman in her forties with hereditary breast and ovarian cancer syndrome caused by a germline BRCA1 mutation (c.117_118del) and a history of left-sided triple-negative breast cancer, invasive ductal carcinoma, clinical stage T1cN1M0, treated with mastectomy, adjuvant dose-dense epirubicin/cyclophosphamide and paclitaxel, followed by one year of maintenance therapy with olaparib. Two months after completion of olaparib, surveillance imaging identified bilateral ovarian masses with marked fluorodeoxyglucose uptake, peritoneal dissemination, and para-aortic lymph node enlargement, with elevated cancer antigen-125. Diagnostic laparoscopy with bilateral salpingo-oophorectomy revealed yellow serous ascites and multiple peritoneal nodules. Both ovarian tumors showed adenocarcinoma composed of small nests and cords. Sections prepared using the Sectioning and Extensively Examining the Fimbrial End protocol showed no serous tubal intraepithelial carcinoma. Immunohistochemical staining revealed CK7 and GATA3 expression, but no CK20, PAX8, WT-1, AR, ER, PgR, or HER2 expression. These results support a diagnosis of ovarian metastasis from the patient’s prior triple-negative breast cancer. Cytologic examination of ascitic fluid was negative for malignant cells. This case highlights that, in patients with hereditary breast and ovarian cancer syndrome and a history of breast cancer who present with ovarian tumors, both primary ovarian cancer and metastatic breast cancer should be considered. Diagnostic laparoscopy with pathologic and immunohistochemical evaluation provides a definitive diagnosis, helps avoid unnecessary cytoreductive ovarian cancer surgery, and supports timely initiation of breast cancer-directed systemic therapy.