This multicenter prospective study (Japanese Radiation Oncology Study Group: JROSG 05-5) aimed to evaluate the effectiveness of postoperative radiotherapy (PORT) in patients with ductal carcinoma in situ (DCIS) with an involved surgical margin or close margin widths of <= 1 mm or less. PORT consisted of whole-breast irradiation (50 Gy in 25 fractions) followed by boost irradiation (10 Gy in 5 fractions). Eligibility criteria were as follows: (i) DCIS without an invasive carcinoma component, (ii) age between 20 and 80 years old, (iii) involved margin or close margin widths of <= 1 mm, (iv) refusal of re-resection, (v) performance status of 0-2, and (vi) written informed consent. The primary endpoint was ipsilateral breast tumor recurrence (IBTR), and secondary endpoints were overall survival (OS), relapse-free survival (RFS), recurrence patterns, and adverse events. A total of 37 patients from 12 institutions were enrolled from January 2007 to May 2009. The median follow-up time was 62 months (range, 28-85 months). The median pathological tumor size was 2.5 cm (range, 0.3-8.5 cm). Of the 37 patients, 21 had involved margins, and 16 had close margins. The 5-year IBTR, OS and RFS rates were 6% (95% confidence interval [CI]: 2-21), 97% (95% CI: 83-99) and 91% (95% CI: 77-97), respectively. Two patients developed local recurrence at the original site after 39 and 58 months. No severe adverse events were found. Our study suggests that this PORT regimen could be a treatment option for patients with DCIS with involved margin or close margin who don't desire re-resection.

In a study of patients with high-risk DCIS for whom margin widths were less than 1 mm after breast conservation surgery followed by postoperative radiation therapy (RT), Silverstein et al. reported an 8-year ipsilateral breast recurrence probability of 30%, with approximately 80% of recurrence developing within 3 years. This retrospective study included the various RT schedules. Only a few prospective studies have evaluated the role of postoperative RT for only high-risk DCIS. The present prospective study aimed to evaluate the effectiveness of postoperative RT which included whole breast irradiation followed by boost irradiation in patients with high-risk DCIS. We conducted a multi-center phase II study (Japanese Radiation Oncology Study Group: JROSG 05-5) to evaluate the effectiveness of postoperative RT including tangential whole breast irradiation (50 Gy/25 fractions) followed by boost irradiation (10 Gy/5 fractions) using electron beams for patients with high-risk DCIS. A patient was eligible if they (1) had DCIS without an invasive carcinoma component, (2) were between 20 and 80 years of age, (3) were diagnosed as having involved margins or margin widths not more than 1 mm after pathological evaluation using 5 mm thickness specimens, (4) refused re-resection, (5) had a performance status 0−2, and (6) provided written informed consent. The primary endpoint was the ipsilateral breast recurrence rate (IBR), and secondary endpoints were overall survival (OS), relapse-free survival (RFS), recurrence patterns, and adverse events. Thirty-seven patients from 12 institutions were enrolled from January 2007 through May 2009. Median follow-up time was 45 months (range, 27-64 months), median age was 52 years (range, 33-78 years), and median pathological tumor size was 2.5 cm (range, 0.3-8.5 cm). Twenty-one patients had close margins, and sixteen patients had involved margins. Fourteen patients received adjuvant hormonal therapy. Four-year IBR, OS and RFS rates were 3% (95% CI, 0-20), 97% (95% CI, 82-100), and 94% (95% CI, 77-99), respectively. One patient with close margins developed local recurrence after 39 months. She was subjected to a salvage mastectomy, and the pathological diagnosis was DCIS without an invasive component. One patient died due to colon cancer after 28 months, without breast cancer recurrence. No recurrence was identified in regional lymph nodes or distant sites, and no severe adverse events were found. These preliminary results suggest that this RT schedule could be promising for patients with high-risk DCIS. A longer follow-up time is required, however, to make any definitive conclusions.

One of the unusual patterns of local recurrence in breast cancer patient is an inflammatory skin recurrence (ISR) sharply demarcating the area of previous radiation fields. To clarify the characteristics of this recurrence, we conducted a nationwide survey. We sent a survey to radiation oncologists at 200 institutions in Japan and received answers from 92. Of these, 24 institutions had some experience with patients who developed ISR affecting the previously irradiated area. The case details of 16 patients from 11 institutions were available and analyzed in this study. Eight patients experienced ISR after breast conservative therapy (groupA) and 8 patients experienced ISR after post-mastectomy radiotherapy (groupB). The postoperative pathological examination of groups A and B showed positive axillary lymph-nodes in 7/8 and 8/8 patients, positive lymphatic invasion in 4/7 and 7/8 patients, and ER status negative in 7/8 and 6/7 patients respectively. Median survival period was 266 days in groupA and 1105 days in groupB (p = 0.0001). Patients who developed the ISR tended to have several characteristics, including positive lymph-node metastases, intensive lymphatic invasion, and ER status negative. Physicians should contemplate the diagnosis of ISR next to radiation recall or radiation dermatitis, especially when the aforementioned risk factors are present.

OBJECT:To validate the cross-sectional and longitudinal use of the Medical Outcome Study Short Form 36 (SF-36) for measuring health-related quality of life (HRQL) in patients with idiopathic pulmonary fibrosis (IPF).METHODS:Patients were administered the SF-36 and concomitantly underwent laboratory and physiologic tests and high-resolution computed tomography (HRCT). Forty-six patients participated in the initial cross-sectional study, and 32 patients who were available more than one year later again underwent these studies under the same conditions.RESULTS:Patients with IPF had significantly lower scores across all 8 domains of the SF-36 when compared with the general population. Significant decline of HRQL was observed in 2 physical domains. There were significant differences in within-subject changes in a few domains according to worsening of the physiologic parameters. Vital capacity as percent of predicted was significantly correlated with the results of 6 subscales and its changes were significantly correlated with those of 4 subscales. The 6-min-walk distance was correlated significantly with 3 subscales and its changes were significantly correlated with those of 4 subscales. Changes in the HRCT ground-glass score were significantly correlated with those of 3 subscales. No significant correlations between changes in 3 domains and those of any clinical parameters were observed.CONCLUSION:Patients with IPF had significantly impaired HRQL in both physical and psychological functions. This disease clearly decreased the physical aspects of HRQL over time. HRQL instruments should be incorporated into routine evaluations of IPF patients, since they measure dimensions not fully estimated by clinical assessment.

Purpose We assessed magnetic resonance imaging (MRI) features and clinical characteristics of ovarian endometrioid adenocarcinoma. Materials and methods A total of 31 patients with 39 surgically proven ovarian endometrioid adenocarcinomas were analyzed retrospectively. Histologically, 13 lesions in 12 patients arose from proven endometriomas (group A), and 26 lesions in 19 patients did not coexist with endometrioma (group B). The morphological pattern of the lesion on MRI was classified as a solid or a cystic type: A solid type was defined as a solid component occupying more than half of the lesion; and a cystic type was a cystic lesion with one or more mural nodules. Results Altogether, 11 lesions in group A were the cystic type on MRI, whereas 24 lesions in group B were the solid type ( P < 0.0001). Among the 11 cystic-type lesions in group A, the cysts of 5 lesions were hypointense on T1-weighted images, and the cysts of 6 lesions were hyperintense on T1- and T2-weighted images without “shading.” The nuclear grade was higher ( P = 0.0028) and the clinical stage more advanced ( P = 0.0018) in group B compared to group A. Conclusion MRI of ovarian endometrioid adenocarcinomas revealed two types: a solid type and a cystic type. The lesions arising from endometriomas tended to be the cystic type on MRI and have a good prognosis. Preexisting endometrioma in this entity rarely showed “shading” on T2-weighted images.

This report concerns a 40-year-old woman case of ovarian dysgerminoma presenting the MRI findings of predominantly hemorrhagic multilocules with papillary projections and irregular septa.

OBJECTIVE. Our objective was to describe the MRI findings of uterine lipoleiomyoma and to correlate them with histopathologic findings.CONCLUSION. Uterine lipoleiomyoma typically presents as a well-demarcated mass showing hyperintensity with hypointense amorphous bundles on T1- and T2-weighted images with chemical shift artifacts. The hyperintense region suppressed on chemical shift fat-suppressed sequences and the hypointense bundles enhanced by contrast material pathologically correspond to mature fat tissue and smooth muscle tissue, respectively. Even in an atypical case with a small volume of fat tissue in the mass, a fat-suppression MRI sequence is especially useful for the diagnosis.

OBJECTIVE:To study the magnetic resonance imaging findings of typical polypoid adenomyoma and correlate radiological findings with histopathologic findings.METHODS:Magnetic resonance imaging and histopathologic findings were retrospectively reviewed in 8 patients. The size, location, polyp's shape, and signal intensity of magnetic resonance imaging findings were evaluated.RESULTS:The polyp's shape of 8 cases is pedunculated in 7 and sessile in 1, and all 8 cases are well circumscribed. Four cases (50%) show an isointense mass relative to the myometrium with small or large hyperintense foci on T1-weighted imaging (T1WI) or T2-weighted imaging (T2WI), reflecting the fascicle of smooth muscle with islands of hemorrhagic endometrial tissue. One case forms a large hemorrhagic cavity, being hyperintense on T1WI and hypointense on T2WI. Three cases (37%) show almost homogeneous isointense or hyperintense mass on T2WI.CONCLUSIONS:When there is a well-defined polypoid mass protrusion into the uterine endometrial cavity that is isointense relative to the myometrium with small or large foci of high signal on T1WI or T2WI in a premenopausal woman, typical polypoid adenomyoma can be considered in the differential diagnosis.

The magnetic resonance imaging findings in 2 patients pathologically proven to have pure leiomyoma of the prostate are reported.

We report the magnetic resonance (MR) imaging findings of ovarian transitional cell carcinoma (TCC), a rare subtype of ovarian surface epithelial-stromal cancer. MR imaging showed large solid mass including various amounts of cystic components and necrosis, vividly describing this entity's pathological structures.

Objective: Idiopathic pulmonary fibrosis poses a significant therapeutic challenge because of its progressive course. Since oxidative stress plays an important role in the pathogenesis of idiopathic pulmonary fibrosis, an open, randomized trial of long‐term inhalation therapy with the antioxidant, N‐acetylcysteine was conducted.Methodology: A total of 30 patients with idiopathic pulmonary fibrosis were randomly assigned to one of the following inhalation therapies: N‐acetylcysteine (352 mg per day) or bromhexine hydrochloride (4 mg per day) as the control. Efficacy was assessed by analysing changes occurring from baseline to 12 months in pulmonary function, the 6‐min walking test, high‐resolution CT, health‐related quality of life, and serum KL‐6‐values.Results: Four patients (n = 2 in each group) died within 12 months due to progression of idiopathic pulmonary fibrosis. A total of 22 patients (control, n = 12; N‐acetylcysteine, n = 10) completed the study. At 12 months there were significant differences between the N‐acetylcysteine and control groups in terms of mean changes in lowest SaO2 during the 6‐min walking test (−0.3 ± 2.1% vs −6.8 ± 1.8%, P < 0.05), serum KL‐6 (−482 ± 220 U/mL vs 176 ± 204 U/mL, P < 0.05), and the ground‐glass score on high‐resolution CT (−1.3 ± 1.6 vs 6.7 ± 1.5, P < 0.01). No significant differences were observed in pulmonary function, 6‐min walking distance or quality of life.Conclusions: These data suggest that although long‐term aerosolized N‐acetylcysteine administration did not influence pulmonary function or quality of life, it may delay disease progression as evidenced by exercise desaturation, high‐resolution CT, and serum KL‐6.

Malignant transformation is a rare but well-documented complication of endometriosis, occurring in 0.7% to 1% of cases. The ovary is involved in 76% of such cases, and extragonadal sites constitute the remaining 24%: the colon and rectum are involved in only 5%. Several previous papers have discussed risk factors for and immunohistochemical studies of malignant transformation of intestinal endometriosis, but few include imaging features. In this report, we demonstrate and discuss the imaging features of a case of malignant transformation of intestinal endometriosis.

Hepatic metastases are generally known to be composed of three structures (central necrosis, viable tumor cells, and peritumoral changes such as edema or congestion). We experienced a case of hepatic metastasis that was examined with ferucarbotran-enhanced magnetic resonance (MR) imaging, dynamic MR imaging using Gd-DTPA, and CT during arterial portography (CTAP), and was confirmed pathologically. MR imaging of this case vividly described the three pathological structures of the hepatic metastasis.

We report the magnetic resonance (MR) imaging findings of proliferative trichilemmal tumor (PTT), a rare benign tumor of the scalp. MR imaging showed a well-margined mass with isointense signal on T(1)-weighted images and heterogeneous mixed intensity signal on T(2)-weighted images After i.v. administration of contrast material, the mass showed significant enhancement, with small portions remaining unenhanced. It was considered that these findings reflected the pathological characteristics of PTT, which consists of solid lobules and cystic cavities.

The magnetic resonance imaging findings in 2 patients pathologically proven to have endometrial tuberculosis are reported.

We report a rare case of large cell neuroendocrine carcinoma of the uterine cervix as revealed by MR imaging and histologic findings.

Our objective was to identify the factors adversely affecting long-term patency after percutaneous transluminal angioplasty (PTA) for hemodialysis Brescia-Cimino arteriovenous fistulas. Between November 1995 and March 2000, 91 PTA procedures were performed on 50 patients with 57 Brescia-Cimino fistulas. A retrospective study based on the chart review was performed. The initial technical success rate for all procedures and the primary and secondary patency rates for all fistulas were calculated. Regarding fistulas successfully maintained by the primary PTA, the primary and secondary patency rates were compared using the Kaplan-Meier method between two patient groups. They were classified on the basis of several factors, including age (older, over 70 years, and younger group), age of the fistulas (older, over 6 months, and younger group), with or without diabetes mellitus (DM), solitary or multiple lesions, long or short segment lesion, stenosis or occlusion, and with or without arterial and/or anastomotic lesions. Initial technical success rates for all procedures and fistulas were 91.2 and 89.5%, respectively. Cumulative primary and secondary patency rates at 1 year were 47.3 and 67.3%, respectively. In the comparative study, the secondary patency rate for the older group was lower than that of the younger group with statistical significance ( p=0.029). The higher age is the only factor that reduces the long-term patency rate after PTA.

A 55-year-old woman was admitted with a cough and fever in August. A diagnosis of Japanese summer-type hypersensitivity pneumonitis was made on the basis of radiological, serological and pathological findings, in addition to positive returning home provocation. Serum KL-6 was monitored during the clinical course. Although KL-6 fluctuated slowly in comparison with the clinical symptoms and HRCT findings, it was considered useful for confirming the effects of treatment. Serum anti-Trichosporon antibody and the phenotype of HLA were studied in both the patient and her asymptomatic roommate, with whom she had no blood relationship. Though both were sensitized immunologically, HLA-DQ 3, which was reported to be associated with Japanese summer-type hypersensitivity pneumonitis, was detected in the patient but not in her roommate. It was suggested that HLA plays a role in the development of this disease.