Kyorin University (杏林大学, Kyōrin daigaku) is a private university in the western part of Tokyo, Japan. Its three campuses are in Mitaka and Hachiōji, Tokyo. It was established in 1970. The predecessor of the school, Mitaka Shinkawa Hospital, was founded in 1953 by Shinyu Matsuda.
We report a case with pilocytic astrocytoma (PA) morphology carrying a histone H3 K27M mutation (H3-K27M) that progressed to PA with anaplasia. A 34-year-old woman presented with headache due to obstructive hydrocephalus from a tectal lesion. She underwent subtotal tumor resection. Histology showed a biphasic architecture with piloid cells, consistent with PA. Five months later, she developed recurrence. A second, partial resection was performed, with pathology again indicating PA. Despite subsequent radiation and chemotherapy, the tumor progressed. A third resection was done 15 months after the second. This time, histology revealed PA with anaplasia. The patient died of progressive disease 25 months after initial treatment. KIAA1549::BRAF fusion, H3-K27M, and loss of p16 expression due to promoter methylation were detected in all specimens. In all specimens, the presence of NF1 Y2285fs*1 was confirmed by Sanger sequencing, with an increasing proportion of the aberrant sequence at the third resection. DNA methylation profiling revealed that the second and third specimens were classified as diffuse midline glioma, H3 K27-altered. This case suggests that the H3-K27M mutation, MAPK pathway activation, and loss of p16 expression contribute to tumorigenesis, while clonal proliferation of the tumor harboring the NF1 mutation may play a role in malignant progression.
Background: The ONCO DVT study demonstrated potential benefits of extended edoxaban treatment in patients with isolated distal deep vein thrombosis in terms of thrombotic risk. However, the risk-benefit balance in patients with anemia remains unclear. Methods and Results: This prespecified subgroup analysis included 601 patients, divided into anemia (n=402) and no-anemia (n=199) groups. The primary endpoint was symptomatic recurrent venous thromboembolism (VTE) or VTE-related death. Anemia was defined as hemoglobin <12g/dL for women and <13g/dL for men. In the anemia subgroup, the primary endpoint occurred in 3 (1.5%) and 17 (8.4%) patients in the 12-and 3-month edoxaban treatment groups, respectively (odds ratio [OR] 0.17; 95% confidence interval [CI] 0.05-0.58), compared with 0 and 5 (4.9%) patients, respectively, in the no-anemia subgroup (P interaction=0.997). Major bleeding occurred in 26 (13.1%) and 17 (8.4%) patients with anemia in the 12-and 3-month edoxaban treatment groups, respectively (OR 1.64; 95% CI 0.86-3.14), compared with 2 (2.1%) and 5 (4.9%) patients without anemia (OR 0.67; 95% CI 0.26-1.73; P interaction=0.13). Conclusions: Regardless of the presence of anemia, edoxaban treatment for 12 months was superior to treatment for 3 months in reducing thrombotic events, whereas the risk of major bleeding did not differ significantly between the 2 treatment groups.
A 67-year-old man presented with bilateral diplopia and gait instability. Brain magnetic resonance imaging revealed two adjacent lesions in the right middle cerebellar peduncle: a 2.7-cm cystic lesion with an enhancing mural nodule and a 1.7-cm ring-enhancing nodule with surrounding edema and associated brainstem compression. Biopsy followed by surgical resection demonstrated a biphasic tumor composed of glioma-like and epithelial-like components. Immunohistochemically, the glioma-like component expressed GFAP and OLIG2, whereas the epithelial-like component lacked glial and epithelial lineage markers and exhibited a high proliferative index (Ki-67 labeling index, 50%). Aberrant calponin-1 expression was observed in both components but was not associated with definitive smooth muscle or myoepithelial differentiation. DNA methylation profiling did not yield a definitive classification and demonstrated borderline similarity to established high-grade glioma classes, clustering near the glioblastoma, IDH-wild-type, midline subtype. Molecular analysis of the epithelial-like component was not feasible due to limited tissue availability, preventing assessment of clonal relatedness between components. This case illustrates the diagnostic challenges posed by intratumoral heterogeneity and sampling limitations in adult cerebellar high-grade gliomas. This report highlights the interpretive constraints of current histopathological and molecular classification frameworks when confronted with spatially heterogeneous tumors and incomplete sampling, rather than defining a novel tumor entity.
Nivolumab plus chemotherapy has shown efficacy in clinical trials for advanced or recurrent gastric cancer (GC). However, real-world utilization data are limited. In this study, we aimed to assess the effectiveness, safety, and treatment status of first line nivolumab plus chemotherapy in Japanese patients with treatment-naïve advanced or recurrent GC. Untreated patients with advanced or recurrent GC who initiated nivolumab plus chemotherapy as first line treatment from November 2021 to June 2023 across 23 Japanese sites were enrolled in this observational study (G-KNIGHT). This report focused on the objective response rate (ORR), real-world progression-free survival (rwPFS), and the treatment-related adverse event (TRAE) incidence. Furthermore, subgroup analyses for ORR and rwPFS were conducted for patients stratified by various factors including age and the programmed cell death ligand 1 (PD-L1) combined positive score (CPS). Among 527 patients (median age, 70.3 years; 25.2
