Objective: The purpose of this study was to establish a new formula predicting liver metastasis in patients with colorectal cancer (CRC). Methods: Nine previously reported predictive markers for liver metastasis and/or prognosis (COX-2, dysadherin, E-cadherin, β-catenin, Ki-67, p53, laminin5γ2, matrilysin and MUC-1) were immunohistochemically investigated in 439 consecutive patients with CRC. We tried to determine the combination of molecules which best predicted liver metastasis. A formula for predicting liver metastasis was constructed using a training cohort comprising 150 cases, and applied to a validation cohort comprising 190 cases and another comprising 99 cases from an outside hospital. Results: A combination of dysadherin, E-cadherin and matrilysin was identified to be best for predicting liver metastasis (area under the curve value, 0.807). The predictive formula: 3× dysadherin score [0 for low expression (≤50% of tumor cells positive) or 1 for high expression (>50%)] + 4× E-cadherin score [0 for preserved (>80% of tumor cells positive) or 1 for reduced (≤80%)] + 2× matrilysin score [0 for low expression (≤30% of tumor cells positive) or 1 for high expression (>30%)] was able to discriminate patients with liver metastasis in the training cohort with a sensitivity of 85.7% and a specificity of 58.9%. The discriminative capacity of the formula was validated in the first cohort with a sensitivity of 87.0% and a specificity of 66.5%, and in the second cohort with a sensitivity of 80% and a specificity of 60.0%. Conclusions: We have established a formula for predicting liver metastasis in patients with CRC, and confirmed that it has a high sensitivity potentially useful for clinical application.

A 75-year-old man was admitted to our hospital complaining of a 4-year history of persistent dry cough and progressive dyspnea on exertion. Chest computed tomography images revealed diffuse reticular opacities and traction bronchiectasis in the bilateral lower lobes and emphysema predominantly in the upper lobes. He was treated with inhaled N-acetylcystein therapy, oral corticosteroids, and pirfenidone in addition to oxygen administration. However, his symptoms and oxygenation gradually deteriorated. In addition, echocardiography showed that estimated pulmonary arterial pressure was 109 mm Hg, sildenafil was started. Twenty months later, he suddenly died of decompensated right heart failure. The autopsied lungs demonstrated a diffuse fibrotic nonspecific interstitial pneumonia (NSIP) pattern with emphysema (combined pulmonary fibrosis and emphysema) and widespread severe intimal and medial thickening ranging from proximal elastic to distal muscular pulmonary arteries. To our knowledge, little has been reported on clinicopathological characteristics of idiopathic NSIP associated with emphysema and severe pulmonary hypertension.

Abstract.A 37-year-old female smoker without a history of exposure to asbestos was referred to our hospital with persistent pericardial effusion. Chest computed tomography imaging examination revealed an irregular thickened pericardium with large amounts of pericardial effusion and a small pleural effusion. Fluorodeoxyglucose (FDG) positron emission tomography imaging demonstrated intrapericardial FDG accumulation. Blood tests revealed an increase in serum mesothelin levels. Examination of a surgically resected specimen revealed a grayish-white thickening of the pericardium, with a straw-colored mucinous pericardial effusion. Histopathological examination confirmed the diagnosis of epithelioid malignant mesothelioma. Although the patient's condition temporarily improved, with decreased levels of serum mesothelin during chemotherapy with carboplatin and pemetrexed, she succumbed to cardiac tamponade 18 months after the initial onset of the symptoms. Primary malignant pericardial mesothelioma (PMPM) is an extremely rare and refractory disorder. Thus, an early definitive diagnosis and timely treatment are crucial for the management of PMPM.

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