A 24-year-old woman, under the treatment for atypical depression, visited our emergency room on foot with a chief complaint that she stabbed herself in the chest with a sewing needle. Chest X-ray and plain CT showed the needle penetrating the chest into the heart. There was no sign of pneumothorax or cardiac tamponade. She was hemodynamically stable. Echocardiography revealed atrial septal defect (ASD) by chance. We performed urgent surgery for needle removal and ASD closure through median sternotomy. The needle was easily recognized near the right ventricle apex. The right atrium was opened, but the needle was not seen through the tricuspid valve because of trabecular formation. After the needle was removed, ASD was closed using the direct suture method. The needle was 35 mm long. She was transferred to the psychiatry department on postoperative day 4 and had a good postoperative course.

Peripheral neuroblastic tumors (pNTs including Neuroblastoma, Ganglioneuroblastoma and Ganglioneuroma) are biologically and clinically heterogeneous. In order to develop efficient clinical treatment protocols of this disease, patients are stratified into different risk groups based on the combination of so-called prognostic factors. In this review, the prognostic factors are classified as clinically defined (Clinical staging and Age at diagnosis), histopathologically defined [International Neuroblastoma Pathology Classification (INPC) distinguishing Favorable Histology (FH) Group and Unfavorable Histology (UH) Group] and genetically/molecularly defined [MYCN oncogene amplification, DNA index, Segmental chromosomal aberrations, ALK (Anaplastic Lymphoma Kinase) mutation/amplification and Abnormal maintenance/elongation of telomeres], are outlined. According to the Children’s Oncology Group (COG) Neuroblastoma studies, the survival rate of patients in low- or intermediate-risk group is more than 90%. In contrast, the survival rate of patients in the high-risk group remains less than 50% despite currently available high-intensity and multimodal therapy. As described in the genetically/molecularly defined prognostic factors, tumors in the high-risk group, majority of which are classified into the UH group according to the INPC, are molecularly heterogeneous. Based on the recent progress of precision medicine along with our correlative analyses between molecular alterations and their morphological manifestations, four subgroups; i.e., MYC subgroup, TERT subgroup, ALT subgroup and Null subgroup, are identified immunohistochemically in the UH group for future management of the patients with this unique d isease.

We had previously reported a close association between pathological response and the maximum tumor standardized uptake value (SUVmax) measured by 18F-fluorodeoxyglucose positron emission tomography prior to chemotherapy in estrogen receptor (ER)-positive breast cancer. We hypothesized that glucose hypermetabolism by luminal B tumors may result in chemotherapy responsiveness. Using a single-gene expression assay, TargetPrint(R) (Agendia) and a 70-gene expression classifier, MammaPrint(R) (Agendia), we divided 20 patients with ER-positive primary breast cancer into luminal A and luminal B subtypes and compared the tumor SUVmax value between the two groups. A significantly higher SUVmax was measured for luminal B tumors (n=10; mean+/-SD, 7.6+/-5.6) than for luminal A tumors (n=10; mean+/-SD, 2.6+/-1.2; p=0.01). Glucose hypermetabolism could help predict intrinsic subtyping and chemotherapy responsiveness as a supplement to ER, progesterone receptor, HER2, and Ki-67 histochemical scores.
Breast ; Breast Neoplasms ; Estrogens ; Glucose ; Humans ; Phenobarbital ; Positron-Emission Tomography ; Receptors, Progesterone