ATB(0,+) (SLC6A14) is a Na(+)/Cl(-)-coupled arginine transporter expressed at low levels in normal colon. Arginine is an essential amino acid for tumor cells. Arginine is also the substrate for nitric oxide synthases (NOSs). Since arginine and arginine-derived nitric oxide (NO) play a critical role in cancer, we examined the expression of ATB(0,+) in colorectal cancer. Paired normal and cancer tissues from colectomy specimens of 10 patients with colorectal cancer and from the liver tissue of one patient with hepatic metastasis from a colonic primary were used for the analysis of the levels of ATB(0,+) mRNA, inducible NOS (iNOS) mRNA and the corresponding proteins. Tissues samples from the colon, liver, and lymph nodes of an additional patient with metastatic colon cancer were analyzed for ATB(0,+) protein alone. We also examined the levels of nitrotyrosylated proteins. The ATB(0,+) mRNA increased 22.9+/-3.0-fold in colorectal cancer compared to normal tissue and the increase was evident in each of the 10 cases examined. iNOS mRNA increased 5.2+/-1.1-fold in cancer specimens. The changes in mRNA levels were associated with an increase in ATB(0,+), iNOS, and nitrotyrosylated proteins. The increased expression of ATB(0,+) and iNOS was also demonstrated in liver and lymph node specimens with metastases from colonic primaries. This study strongly suggests that the upregulation of ATB(0,+) may have a pathogenic role in colorectal cancer. Since ATB(0,+) is a versatile transporter not only for arginine but also for several drugs including NOS inhibitors, these findings have significant clinical and therapeutic relevance.

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Total laparoscopic hysterectomy has been shown to be an equally effective and safe technique when compared with conventional abdominal surgery for endometrial carcinoma. The procedure, as performed at our institution, involves the use of a uterine balloon manipulator (RUMI manipulator and Koh Colpotomizer system) for optimal surgical control. The fallopian tubes are cauterized to prevent transtubal spread of the tumor. The balloon manipulator thus creates a positive closed pressure system within the uterine cavity. After observing extensive displacement of tumor into small and large blood vessels in 1 case of grade 1, stage 1b endometrial carcinoma, we reviewed slides from 37 hysterectomy specimens (7 for endometrial carcinoma or atypical hyperplasia and 30 for benign conditions) performed laparoscopically between August 2004 and March 2006 at Emory University and Crawford Long Hospitals. We reviewed all slides for the presence or absence of endometrial tumor/tissue in vascular spaces. Patients with endometrial carcinoma/atypical complex hyperplasia included 6 FIGO grade I endometrioid carcinomas (3 stages 1A; 3 stages 1B) and 1 patient with atypical complex hyperplasia. Tumor within blood vessels was noted in 5 of 7 (71%) cases. In 3 cases, including the case of atypical complex hyperplasia, the number of vessels containing tumor were too numerous to count small and large caliber blood vessels. In the remainder, 1 case had 2 small vessels involved and in the other 7 small vessels showed tumor within vascular lumina. Benign endometrial glands and stromal tissue were noted within vascular spaces in 4 of 30 (13%) hysterectomy specimens removed for benign conditions. We describe a hitherto unreported artifact of vascular pseudo invasion in hysterectomy specimens obtained using the technique of total laparoscopic abdominal hysterectomy. We postulate that the creation of a closed pressure system generated as part of the operative technique is likely responsible for this phenomenon. Pathologists need to be aware of this artifact to avoid misinterpretation of vascular invasion in these cases with its associated therapeutic and prognostic implications.

A significant proportion of HNSCC patients with advanced neck disease harbor residual occult metastases after CR. PET-CT is not sufficiently specific or sensitive to reliably predict the need for posttreatment neck dissection.