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Sachiko Kitamura,Kaoru Abiko,Noriomi Matsumura,Hidekatsu Nakai,Yumiko Akimoto,Hirotoshi Tanimoto,Ikuo Konishi 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.4
Objective: Some, but not all, granulosa cell tumors are characterized by estrogen production. This study was designed to determine whether there are clinical or pathological variations ingranulosa cell tumors in relation to the expression of sex steroid synthesis enzymes. Methods: Clinical symptoms, serum hormonal values, and histology of 30 granulosacell tumor patients who underwent surgery between 2002 and 2014 were retrospectivelyreviewed. Results: Most patients presented with abnormal genital bleeding including abnormalmenstrual cycles. Eight of 16 patients older than 50 years had endometrial hyperplasia andone had endometrial cancer. Serum 17β-estradiol (E2) levels tended to be higher in patientsover 50 years of age (p=0.081). Serum follicle-stimulating hormone (FSH) levels were low inall patients irrespective of serum E2 levels. Magnetic resonance imaging revealed a thickerendometrium in older as compared to younger patients (p<0.05). Tumor cells in the majorityof cases were positive for inhibin α and P450 aromatase, irrespective of age and serum E2levels. P450 17α-hydroxylase (P450c17) expression varied among cases. P450c17 was stronglypositive in luteinized tumor cells and weakly positive in theca cells and fibroblasts. High E2levels were associated with P450c17-positive cells in the tumor (p<0.05). Conclusion: The expression of hormone-synthesizing enzymes divides granulosa celltumors into 2 distinct types; tumors with P450c17-positive cells show elevated serum E2 andrelated clinical symptoms, while tumors without these cells show symptoms related to FSHsuppression by inhibin.
Naoyuki Takashima,Hisatomi Arima,Yoshikuni Kita,Takako Fujii,Sachiko Tanaka-Mizuno,Satoshi Shitara,Akihiro Kitamura,Yoshihisa Sugimoto,Makoto Urushitani,Katsuyuki Miura,Kazuhiko Nozaki 대한뇌졸중학회 2020 Journal of stroke Vol.22 No.3
Background and Purpose Although numerous measures for stroke exist, stroke remains one of the leading causes of death in Japan. In this study, we aimed to determine the long-term survival rate after first-ever stroke using data from a large-scale population-based stroke registry study in Japan. Methods Part of the Shiga Stroke and Heart Attack Registry, the Shiga Stroke Registry is an ongoing population-based registry study of stroke, which covers approximately 1.4 million residents of Shiga Prefecture in Japan. A total 1,880 patients with non-fatal first-ever stroke (among 29-day survivors after stroke onset) registered in 2011 were followed up until December 2016. Five-year cumulative survival rates were estimated using the Kaplan-Meier method, according to subtype of the index stroke. Cox proportional hazards models were used to assess predictors of subsequent allcause death. Results During an average 4.3-year follow-up period, 677 patients died. The 5-year cumulative survival rate after non-fatal first-ever stroke was 65.9%. Heterogeneity was present in 5-year cumulative survival according to stroke subtype: lacunar infarction, 75.1%; large-artery infarction, 61.5%; cardioembolic infarction, 44.9%; intracerebral hemorrhage, 69.1%; and subarachnoid hemorrhage, 77.9%. Age, male sex, Japan Coma Scale score on admission, and modified Rankin Scale score before stroke onset were associated with increased mortality during the chronic phase of ischemic and hemorrhagic stroke. Conclusions In this study conducted in a real-world setting of Japan, the 5-year survival rate after non-fatal first-ever stroke remained low, particularly among patients with cardioembolic infarction and large-artery infarction in the present population-based stroke registry.