ICG-FI is a useful method and is especially recommended in cases where no radiotracers are available.

The purpose of this clinical note is to describe the feasibility of using diffusion‐weighted imaging for diagnosing placental invasion with a case of placenta increta and six cases without it. Diffusion‐weighted imaging (DWI) at a b‐value of 1000 sec/mm2 can clearly define the border between the placenta and myometrium because only the placenta shows very high signal intensity. The corresponding image at a b‐value of 0 sec/mm2 shows the myometrium with high signal intensity compared with the surrounding fat. Therefore, fusion of the two images can be used additionally to visualize thickness of the myometrium. As a result, DWI can be used to visualize the focal thinning of the myometrium caused by placenta increta, which has been difficult to diagnose on conventional magnetic resonance imaging sequences without contrast enhancement. However, the use of DWI for placental invasion should be determined following careful consideration of its risks and benefits, as fetus safety has not been established. J. Magn. Reson. Imaging 2009;30:666–671. © 2009 Wiley‐Liss, Inc.

Dermoscopic findings for 17 cases of lichen planus-like keratosis (LPLK) were chronologically evaluated. Three males and 14 females were included in the study and the ages ranged from 43 to 85 years (median 65 years). Three cases were diagnosed based on stereotypical dermoscopic findings, while the other 14 cases were histopathologically diagnosed as LPLK. Dermoscopy photographs were divided into four groups depending on the number of days (D) from the initial visit: 1) D = 0 (initial visit or biopsy day); 2) D = 61 to 180; 3) D = 181 to 270; 4) D = 271 to 360. Dermoscopic findings, described as light brown pseudonetwork, pinkish area, gray pseudonetwork, annular granular structures, and blue-gray fine dots, were evaluated at every visit to the hospital.Initial dermoscopy features included light brown pseudonetworks due to residual solar lentigo and overlapping pinkish areas attributed to lichenoid inflammation. Annular granular structures and gray pseudonetwork appeared to be the main features of the regressing stage; these features seemed to progress to “blue-gray fine dots” in the late regressing stage. Blue-gray dots or globules reflecting melanophages, the hallmark dermoscopic features of LPLK, were believed to resolve in approximately one to two years. Based on the clinical and dermoscopic observations, we have specified five stages of evolution of LPLK, namely 1) pre-existing solar lentigo, 2) early inflammatory stage, 3) early regressing stage, 4) regressing stage, and 5) late regressing stage.The limitations of the study are that this is a small-sized, retrospective, observational study and that ethnicity of participants is limited to Japanese patients with skin phototype III.

A great majority of adrenocortical tumors are benign, and many adrenocortical carcinomas (ACC) are obviously malignant at presentation. The histopathological diagnosis of ACC is occasionally difficult, particularly with stage I and stage II disease. The prognosis of ACC is generally poor. Surgery is the major treatment, with chemotherapy and radiotherapy being applicable to only restricted patients. The Weiss criteria are useful in diagnosing the common adult type of ACC. Histopathological prognostic factors of ACC have not been fully established because of the rarity of the disease. In this article, we first describe the current histopathological diagnostic and prognostic factors of ACC, highlighting the special types of ACC to which Weiss's criteria are not fully applicable. These special type tumors include pediatric adrenocortical tumors, oncocytomas, and aldosterone-producing tumors of pure zona glomerulosa type. Then we present three cases with unusual small adrenocortical tumors. One patient had an unequivocal ACC showing metastatic disease. One had a histologically defined ACC with no metastasis or macroscopic invasion. The third was a pediatric patient with a tumor showing a nodule-in-nodule pattern with insulin-like growth factor II expression.

The human zona glomerulosa (zG) is morphologically atrophic in the "endocrinologically normal" adrenal cortex, in contrast to that of other mammals on the land such as oxen and pigs, as well as rats and mice (Symington 1969;Carney and Lloyd 2007). Studies of the morphology on hematoxylin and eosin (HE)-stained sections have revealed clusters of zG-like small cells discontinuously arranged just under the capsule, with zona fasciculata (zF)-like cells on the top of cords reaching the capsule, suggesting atrophy of the zG in the adrenals of human adults. However, few studies have been performed to examine the changes in the zG of the human adrenals with age using functional immunohistochemistry because of relative unavailability of suitable zG markers and "normal" human adrenal tissues.We investigated the immunohistochemically defined zG, zF, and zona reticularis (zR) of 61 adrenal glands derived from humans ranging in age from newborn to the 90s ( Fig. 1; Aiba and Fujibayashi 2005). We found a well-developed zG in earlier life but a marked decrease of the zG population and replacement by the progenitor zone (zP) after 40 years of age. The results were discussed from the viewpoint of a SummaryFew studies have examined functional adrenal zonation throughout human life. Adrenals from 61 surgical/autopsy patients from 1 day old to 92 years old who had no clinical endocrinological/mineralocorticoid abnormalities were assessed for immunohistochemically defined adrenal zonation. The zona glomerulosa (zG) was well developed in all 11 patients ranging in age from newborn to the 30s. After 40 years of age, however, the zG occupied less than one-quarter of the adrenal circumference, suggestive of zG involution. The other subcapsular areas were occupied by the progenitor zone (zP), which expressed neither cytochrome P450aldo nor P45011β but 3β-hydroxysteroid dehydrogenase and P450scc, although some autopsy cases had adrenals with zG zonation because of secondary aldosteronism, and others who had experienced severe stresses showed subcapsular zona fasciculata (zF). In conclusion, the adrenal cortex consists of homogeneous zG-topped columns from birth to adolescence. Subsequently, in the fifth decade of life, the cortex is reconstituted by integration of three types of cortical columns: scattered zG-topped columns and zonal zP-topped columns, the latter having the ability for bidirectional differentiation into either zG-topped columns or zF-topped columns, according to secondary aldosteronism or the presence of severe stresses. Such adrenocortical remodeling is ascribed to high-sodium/low-potassium diets. (J Histochem Cytochem 59:557-564, 2011) Keywords human, immunohistochemistry, adrenal zonation, involution of the zona glomerulosa, progenitor zone, zona fasciculata, aging, adrenocortical remodeling, high sodium/low potassium diet