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A 42-year-old woman who had a history of Sjögren's syndrome was admitted to our hospital because of a mass lesion in the left cervical region. A hard tumor in the left lobe and a smaller mass in the central area was detected by ultrasonography and computed tomography. Subtotal thyroidectomy with lymph node dissection was performed. The central mass was minimal thyroid carcinoma. The minimal thyroid carcinoma was discovered accidentally during therapy for Sjögren's syndrome. Because the symptoms decreased, surgery of the thyroid carcinoma could be performed. When it was aggravated, it was thought to be diagnosed carefully.

A 47-year-old woman was admitted to our institution with the chief complaint of a right cervical mass. Imaging examination findings showed a cystic mass of 25mm with a nodular lesion in the right cervical region. Therefore, we performed extirpation of the right cervical cystic mass to allow diagnosis of the lesion. The histopathological findings showed a partial thyroid tissue on the cyst wall covered with glandular epithelium or metaplastic squamous epithelium, and tumor cells proliferating in the papillary form. Considering the histopathological evidence of the characteristic epithelium of the thyroglossal duct cyst, the potential carcinogenesis from the remnant thyroid tissues, and the absence of primary tumor in the thyroid gland, the patient was diagnosed with thyroid papillary carcinoma arising from the thyroglossal duct cyst in the right lateral cervical region. We found recurrence of the right cervical lymph node at 1 year and 5 months after the initial operation. Thus, we performed dissection of the right cervical lymph nodes. Two years and 10 months after the operation, neither recurrence nor metastasis have been observed. It was suggested that, thyroid papillary carcinoma arising from the thyroglossal duct cyst should be taken into consideration when a lateral cervical mass lesion is found.

When patients are on long-term dialysis, various kinds of medication are given. We report our experience with a 75-yearold woman with thyroid carcinoma incidentally discovered during dialysis. Ultrasonography of the thyroid showed a tumor of about 3 cm in the right lobe center. The dialysis performed surgery on the day when we were not dialyzed. Heparinization for anticoagulation was not administered. Adhesion with the circumferential organ was strong, and in the perioperative findings, the thyroid gland showed difficulty in sublation. Because there was a lot of bleeding, we were not able to perform a complete resection. During the postoperative period, the recurrent laryngeal nerve was kept, but laryngeal edema developed, and extubation was performed using steroids in the future. Because various complications were caused by performing the surgery during dialysis, hemorrhaging occurred and the surgery time increased. We cared enough for the perioperative period was realized again.

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas often contains multifocal lesions, and total pancreatectomy is sometimes needed for curative resection. We report here our experience with a case of IPMN with multiple invasive carcinoma foci that was successfully treated with total pancreatectomy. A 66-year-old man had jaundice, and a computed tomography (CT) scan revealed a hypovascular mass in the pancreas head in conjunction with calcification and dilation of the entire main pancreatic duct. He was diagnosed with pancreas head cancer and chronic pancreatitis, and a pancreaticoduodenectomy was planned. Intraoperative pathological examination revealed papillary growth of high grade dysplasia in the main and branch duct epithelium and perineural invasion of the atypical glands. After 2 additional resections, we performed a total pancreatectomy. Pathological findings showed that the pancreas head tumor was an invasive carcinoma derived from main-duct IPMN of the pancreas. It was a mucinous carcinoma with calcification. Moreover, we found other multiple, discontinuous invasive foci in the body and tail of the pancreas which were undetectable by preoperative imaging. This case was highly suggestive for preoperative diagnosis for pancreas tumor and developmental pattern of main-duct IPMN.

We report a case of papillary carcinoma of the thyroid gland and cervical lymph node metastases with concurrent tuberculous lymphadenitis that was diagnosed preoperatively. A 35-year-old woman presented with multiple lymph node swellings and an anterior neck mass. No findings suggesting the coexistence of pulmonary tuberculosis were present. The patient underwent a total thyroidectomy with bilateral neck dissection together with medication. Measures to prevent tuberculosis were undertaken during the perioperative period. The histopathological diagnosis was papillary carcinoma with both metastatic and tuberculous lymphadenitis of the lymph nodes in the neck. The possible coexistence of tuberculous lymphadenitis must be ruled out when lymph node swellings are observed in patients with head and neck cancer, including thyroid carcinoma.

We report a rare case of intraductal papillary mucinous carcinoma (IPMC) with acute obstructive suppurative pancreatic ductitis (AOSPD), liver abscess, and pancreatobiliary fistula formation. A man in his sixties was admitted to our hospital with a chief complain of high grade fever and anorexia. CT and MRI revealed a multilocular cystic lesion in the pancreatic head, fistula formation between the common bile duct and this cystic lesion, and multiple liver abscess. We performed endoscopic nasopancreatic drainage for the AOSPD, endoscopic biliary drainage for the biliary flow obstruction, and percutaneous transhepatic drainage for the liver abscess. Klebsiella pneumoniae was detected in the culture of pancreatic juice and liver abscess, but not in the bile and blood culture. These culture studies revealed that the liver abscess was caused by AOSPD. The patient underwent pancreaticoduodenectomy for the IPMC. The pathological diagnosis was IPMC.

Distant metastasis from differentiated thyroid carcinoma is rare and metastasis to the paranasal sinus is extremely rare. We report a case of differentiated papillary thyroid carcinoma (PTC) with metastases to the sphenoid sinus presenting with epistaxis. An 81-year-old undergoing partial lobectomy for differentiated PTC 9 years earlier presented with intermittent epistaxis. Imaging showed a mass filling the sphenoid sinus and extending to the intracranial cavity. Histopathological diagnosis using endoscopic biopsy indicated a metastatic PTC tumor. Compared to the primary site, the metastatic tumor was poorly differentiated thyroid carcinoma. Despite external beam radiation therapy, her general condition worsened and she was moved to a hospice.

A CASE: A 55-year-old woman. Around the year 2006, the right breast lump was found by palpating. The pain also appeared in 2008, too, and confirmed that it appeared to have a tendency to increase. A medical check-up was done and diagnosed as T4b, N0, M0, stage IIIB of the breast cancer by a close inspection. We noted hyperthyroidism in March 2008. We treated it with internal medicine, but we could not control it. We waited for a thyroid function to be normalized. Then we were to perform a surgery. In January 2009, we observed a bleeding from the part of the breast cancer. We controlled the thyroid function by internal medicine. Then we performed a pectoralis muscle preservation breast surgery and dermanaplasty with a shortest anesthesia time in order to control the infestation to be minimal. It was very likely that we caused a heart failure when a major infestation such as general anesthesia in the case of a patient with hyperthyroidism. Because we were able to control the hyperthyroidism this time and a thyroid function to be stabilized for a local advanced breast carcinoma with the hemorrhage temporarily, and were able to operate for the breast cancer, as we reported it in this study.

We report the case of an 80-year-old man given a diagnosis of pancreatic intraductal papillary-mucinous carcinoma (IPMC) and early gastric cancer. He refused surgery, therefore endoscopic mucosal resection (EMR) for gastric cancer and careful observation were performed. Penetration of the IPMC to the stomach was observed 3 months later. Ten months after the initial diagnosis, he was found to have a splenic abscess and was subsequently treated by antibiotics and percutaneous drainage, and a fistula between the IPMC and the splenic abscess was observed. We suppose IPMC penetration to the spleen and bacterial transmission from the stomach through the fistula caused the splenic abscess. While IPMC is recognized as a low-grade malignancy, some cases of invasive carcinoma with fistulation to adjacent organs have been reported. To the best of our knowledge, this is the first case of IPMC associated with splenic abscess due to pancreatosplenic fistula.

A 14-year-old girl was admitted because of general fatigue and cervical lymphadenopathy. She showed bilateral struma (IInd degree) and enlargement of her left cervical lymph nodes. Laboratory data revealed neutropenia (219/microliter) and thrombocytopenia (Plt 5.1 x 10(4)/microliter) with mild anemia (Hb 11.1 g/dl), and the bone marrow aspirate and biopsy specimens showed hypocellularity. In addition, auto-antibodies against thyroid peroxidase (TPO) and thyroglobulin (TG) were highly elevated. Computed tomography of the neck showed a nodule in the left thyroid lobe with marked lymphadenopathy, and fine needle aspiration biopsy demonstrated papillary thyroid carcinoma with Hashimoto's thyroiditis and metastasis to the lymph nodes. One month after left thyroid lobectomy and cervical lymphadenectomy, the patient's condition progressed to very severe aplastic anemia, and she received immunosuppressive therapy consisting of cyclosporin A and anti-thymocyte globulin. Hematologically, partial and complete responses were obtained three and six months later, respectively. Of interest, anti-TPO and TG antibody titers remarkably decreased after immunosuppressive therapy. The patient had HLA-DR 2(DRB 1*1501) and DR 8(DRB 1*0802). The former is frequently found in patients with cyclosporin A-dependent aplastic anemia, and the latter is frequently found in Asian patients with Hashimoto's thyroiditis, suggesting an underlying autoimmune background for the simultaneous outbreak of aplastic anemia and Hashimoto's thyroiditis complicated by thyroid carcinoma.

We reported 2 relatively rare cases of multiple primary cancer including lung cancer accompanied by old pulmonary tuberculosis. Patient 1 was a 62-year-old man admitted to our hospital for further evaluation of an infiltrative shadow on chest X-ray films, and a cervical tumor noted 10 years earlier and thought to be thyroid cancer. A Transbronchial lung biopsy (TBLB) specimen disclosed poorly differentiated squamous cell carcinoma. A right upper lobectomy and thyroidectomy were performed. Histopathologic findings showed a neoplastic lesion adjacent to caseous necrosis with formation of granuloma consistent with tuberculosis. Also, the cervical tumor was considered to be a metastatic lymph node from thyroid papillary carcinoma. Patient 2 was a 73-year-old man with a 14-year history of treatment for transitional cell carcinoma of urinary bladder, who had been admitted to our hospital for further evaluation because of a nodular shadow observed on chest X-ray films. TBLB specimens disclosed adenocarcinoma. A right upper lobectomy was performed. Histopathologic findings revealed a neoplastic tumorlet in the same lobe. No detectable increases in serum TNF-alpha, IL-1 beta or IFN-gamma were observed in either patient. Phytohemagglutinin- and concanavalin-A-stimulated lymphocyte proliferation decreased in Patient 1. These findings suggested that the immunocompromised status of patients with cancer in addition to old pulmonary tuberculosis may contribute to the development of lung cancer.

This case report describes a 59-year-old female patient with superior vena cava syndrome due to large thyroid cancer involving both innominate veins and left common carotid artery. The tumor was resected together with the both innominate veins and left common carotid artery. Right innominate veins and left common carotid artery were reconstructed with FEP-Ringed grafts. Microscopical finding was papillary carcinoma and its lymph node metastasis. Postoperative course was uneventful relatively. Three years after operation the patient is good health without any sign of recurrence.

A sixty-one-year-old female was admitted to our hospital in October 1988 because of fever and a right neck mass associated with redness and tenderness. The size of the thyroid mass had gradually increased over 3 months. Two masses were detected in the thyroid by ultrasonography and MRI. She has positive thyroid autoantibodies, high CRP levels and high erythrocyte sedimentation rates. While she had normal white blood cell counts, massive neutrophils were obtained from her thyroid mass by aspiration biopsy, indicating acute suppurative thyroiditis. However, we could not find any bacteria to cause suppurative thyroiditis either in the blood or in thyroid aspirates. Serum levels of thyroid hormone were slightly elevated but she did not complain of any thyrotoxic symptoms. Radioactive iodine uptake (RAIU) of the thyroid gland was markedly decreased (2%/24h). Following treatment with antibiotics, her inflammation and symptoms immediately improved, and pus spontaneously ran from the collapsed thyroid mass. Then serum thyroid hormone levels and RAIU were normalized and the right thyroid mass disappeared. She was discharged in December 1988. There were no signs of recurrence of suppurative thyroiditis until now. She received a pharyngo-esophageal barium examination in search of the route of infection 4 times, but no fistula was revealed. However, as her left thyroid mass consistently remained thereafter, an operation of the left thyroid mass was performed in December 1989. The histologic examination of the resected thyroid revealed the coexistence of encapsulated follicular adenoma, minute papillary carcinoma and chronic thyroiditis. There are few reports of such a case having a combination of suppurative thyroiditis, thyroid cancer and chronic thyroiditis observed in an elderly female.

Among 18 surgical patients with primary hyperparathyroidism at this institution, 3 patients (16.7%) were found to have associated nonmedullary thyroid neoplasms. Histological examination of the parathyroid tumors revealed two to be parathyroid adenomas and the other to be parathyroid carcinoma. Histology of the thyroid neoplasms were papillary carcinoma, follicular carcinoma and follicular adenoma, respectively. Therefore, in the diagnosis of primary hyperparathyroidism, it is necessary to take into consideration association with not only medullary thyroid carcinoma, but nonmedullary thyroid neoplasms as well.

A 73-year-old woman was admitted with coexistence of multiple metastatic brain tumor and cerebral aneurysm. She has been operated on for a tumor of the thyroid gland 3 years before. Computed tomography (CT) scan revealed well-defined, homogeneously enhanced masses in the left frontal and right posterior temporal region. Right carotid angiography showed a tumor stain supplied by the branch of the fronto-polar artery. Left carotid angiography showed an aneurysm at the anterior communicating artery and a tumor stain supplied by the posterior temporal artery. Total removal of the bilateral tumor and aneurysmal neck clipping were performed simultaneously with bi-frontal craniotomy and right temporal craniotomy in April of 1988. Histology of tumor was papillary carcinoma. The surgical indication and treatment for patients with coexistence of multiple brain tumor and cerebral aneurysm were discussed.

The clinical course of sigmoidovesical and ileovesical fistula due to rupture of colonic diverticulitis is reported. The patient, a 41-year-old male, who had been suffering from intestinocutaneous fistula for 16 months since drainage of abdominal abscess had chief complaints of cloudy urine and fecaluria. Cystoscopic examination revealed bladder papilloma land edema at the apex area of the bladder. Abscess and fistula were identified with transurethral ultrasonotomography and fistulography, respectively. Primary resection was performed after intravesical instillation of mitomycin-C and postoperative course was uneventful. Histological findings of the specimen revealed disappearance of bladder papilloma for the instillation therapy. Statistical analysis was made on 73 cases of sigmoidovesical fistula due to colonic diverticulitis reported in Japan including my own case.