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In Japan, 2 comprehensive genome profiling(CGP)tests for cancer was covered by national health insurance in June 2019, and cancer genome medicine was introduced at a total of 225 hospitals designated by the Ministry of Health, Labor and Welfare as"core center hospitals for cancer genome medicine(12 hospitals)"," core hospitals for cancer genome medicine (33 hospitals)", and"collaborative hospitals for cancer genome medicine(180 hospitals)". On the other hand, the interpretation of the results of the cancer CGP test must be discussed by an expert panel conducted at the core center hospitals for cancer genome medicine or the core hospitals for cancer genome medicine, and the results must be explained to patients in order to be covered by insurance. In other words, these hospitals are required to review not only their own cases but also those of collaborating hospitals. In addition, core center hospitals for cancer genome medicine are required to share information and develop human resources with core hospitals and collaborative hospitals for cancer genome medicine. We herein describes the system for providing cancer genome medicine in our hospital as a core center hospital for cancer genome medicine.

From June 2019, 2 different comprehensive genomic profiling(CGP)test panels were covered by National Health Insurance System in Japan. However, the indication of CGP was solid cancer patients refractory to standard chemotherapy or those without standard of care, while other countries indicate CGP to chemotherapy naIve advanced cancer patients. To be covered by National Health Insurance System, certified core hospital for genomic medicine should hold expert panel with affiliated hospitals. We develop a unique system for expert panel collaborated with SYSMEX Corporation to streamline medical staffs' effort. To provide precision medicine to cancer patients, we have to maximize the merit of CGP and solve several issues.

We developed a simple rapid analysis of multi-pesticide residues in agricultural products. In this study, we attempted to simplify the purification process, and reduce the amount and type of solvent used. The test solution was prepared by clean-up, a 0.5 mL aliquot of QuEChERS extract solution of agricultural products using a 3-layer solid-phase (C18/SAX/PSA) extraction mini-column, and the test solution was subjected to GC-MS/MS analysis, modified with a large volume injection and a stomach-type glass-lined injector. This method met the acceptability criteria of recovery (70-120%) and standard deviation of repeatability (RSD<25%) in 241-331 pesticides in 8 types of agricultural products.

Renal cell carcinoma (RCC), the most common solid lesion of the kidney, accounts for approximately 2%-3% of all malignancies among adults. Clear cell carcinoma and papillary cell carcinoma are the most common types of renal tumors. Some case reports have described synchronous benign and malignant tumors in the same kidney. In particular, angiomyolipoma and RCC in patients with tuberous sclerosis (TSC) and non-TSC have been reported many times in the literature. However, unilateral concordance of malignant renal tumors is very rare; thus, only few cases have been reported in the literature.Here we report the case of a 58-year-old male who had ipsilateral synchronous mucinous tubular and spindle cell carcinoma (MTSCC) and clear cell papillary renal cell carcinoma (CCPRCC). Both cancers are rare and relatively recently defined subtypes of RCC. Additionally, both were successfully treated using partial nephrectomy. MTSCC has been a distinct entity in the World Health Organization classification of kidney tumors since 2004. The classic type of MTSCC is characterized by small elongated tubules lined with clear cuboidal or spindle cells with mucinous stroma. Neoplastic cells always exhibit low-grade histological features. However, unclassified variants of MTSCC, such as mucin-poor, papillary, high-grade, and sarcomatoid variants, have also been reported. MTSCC is considered to have a relatively good prognosis, but some patients with poor prognoses have recently been reported. CCPRCC is a recently recognized entity and represents the fourth most common variant of RCC. It has unique morphological and immunohistochemical features and shows indolent clinical behavior. Microscopically, CCPRCC may mimic other RCCs with clear cell features, such as clear cell RCC, translocation RCC, and papillary RCC, with clear cell changes. In 2006, CCPRCC was described as a subtype of renal tumors in patients with end-stage renal disease. However, currently, CCPRCC has also been shown to occur in kidneys with normal function.To the best of our knowledge, this is the first report of ipsilateral synchronous MTSCC and CCPRCC, which we present with a review of the pertinent literature.

A 75-year-old woman with epigastric pain was admitted to our emergency department. She was diagnosed with an acute exacerbation of chronic pancreatitis based on the results of blood tests and abdominal computed tomography (CT). The abdominal CT and magnetic resonance cholangiopancreatography revealed pancreas divisum. Abdominal CT also showed a stone in the minor papilla, with impaction of the stone being the most likely cause of the acute episode. Therefore, endoscopic sphincterotomy of the minor papilla and endoscopic naso-pancreatic duct drainage were performed to remove the stone and decrease the internal pressure of the pancreatic duct. These procedures improved the patient's clinical status. The naso-pancreatic drainage tube was removed, and her pancreatitis has not recurred. Herein, we report a rare case of an impacted minor papilla stone in a patient with pancreas divisum that caused an acute exacerbation of chronic pancreatitis.

A 54-year-old male patient underwent upper gastrointestinal endoscopy, which revealed a 25-mm brown region in the angular section of the greater curvature of the stomach. The region was histologically determined to be gastric mucosa with an accumulation of histiocytes containing eosinophilic substances in the cytoplasm and chronic inflammatory cell infiltration. Histiocytes were immunohistologically positive for CD68, IgG, and κ. Based on these findings, the patient was diagnosed with gastric crystal-storing histiocytosis comprised of histiocytes phagocytosing IgG-κ-type immunoglobulin. This is a rare disease of which there have been no previous reports that included long-term follow-up. Here, we report the case with a literature review.

A 67-year-old male was diagnosed with advanced esophageal cancer. A computed tomography scan showed multiple intra-abdominal lymphadenopathies. Because the tumor was thought to be unresectable, we initiated chemotherapy. Twelve months later, the patient was admitted to our hospital because of hematemesis. Gastroduodenoscopy revealed oozing bleeding from the esophageal tumor. Hemostasis was not achieved with conservative treatment, and frequent blood transfusions were required. Endoscopic hemostasis was difficult to achieve because of the malignant esophageal stenosis. To treat the malignant esophageal stricture and esophageal tumor bleeding, we attempted to insert an esophageal covered self-expandable metallic stent. After the procedure, hemostasis was achieved by mechanical tamponade. Here we report a rare case of esophageal tumor bleeding that was managed with mechanical tamponade using an esophageal covered self-expandable metallic stent.

An 85-year-old woman with jaundice was referred to our hospital where she was diagnosed with obstructive jaundice due to carcinoma of the pancreatic head based on blood tests and abdominal computed tomography (CT). We performed endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage, but 5 days after the procedure, she complained of epigastric pain. Laboratory data revealed an elevated white blood cell count and a high serum amylase concentration. Follow-up CT 6 days after the ERCP revealed that the main pancreatic duct diameter had increased since the time of admission. Therefore, ERCP was performed for pancreatic ductal drainage. Purulent pancreatic juice was drained by endoscopic placement of a nasopancreatic drainage tube in the main pancreatic duct, resulting in marked alleviation of clinical symptoms;however, after removal of the tube, the abdominal pain recurred. Subsequent endoscopic placement of a pancreatic stent improved her clinical status once again. Herein, we report this rare case of acute obstructive suppurative pancreatic ductitis in a patient with carcinoma of the pancreatic head.

A 73-year-old man with a history of tarry stools was admitted to our hospital. Gastroduodenoscopy on admission revealed an ulcer with an exposed vessel at the duodenal bulb. During endoscopic clipping for prevention of re-bleeding, a large amount of bleeding from the vessel was observed. Hemostasis was achieved after the procedure. However, 7 days later, the patient passed a large amount of tarry stools and experienced hypovolemic shock. Endoscopic re-examination revealed a pulsatile aneurysmal vessel at the base of the duodenal ulcer. Abdominal contrast-enhanced computed tomography and abdominal angiography demonstrated an aneurysm of the gastroduodenal artery, which was successfully treated with transcatheter arterial embolization. Thus, here we report a rare case of an aneurysm of the gastroduodenal artery caused by a duodenal ulcer.

A 70-year-old woman with jaundice was referred to our hospital. Obstructive jaundice caused by common bile duct (CBD) stones was diagnosed based on the results of blood tests, abdominal computed tomography, and endoscopic retrograde cholangiopancreatography. We attempted to remove the CBD stones endoscopically. After endoscopic sphincterotomy, a polypoid lesion was exposed at the ampulla of Vater. Histological examination of a biopsy specimen from the ampullary lesion revealed a tubular adenoma, and the patient underwent pylorus-preserving pancreatoduodenectomy. Pathological examination of the resected specimen revealed a polyp-type ampullary carcinoma-in-adenoma arising from the ampullary channel. Herein, we report a rare case of polyp-type ampullary carcinoma-in-adenoma displaying an intraductal growth pattern.

A 73-year-old man was referred to our hospital for further examination of an intra-abdominal mass. An upper gastrointestinal endoscopy revealed a 0-IIa+IIc lesion on the lesser curvature of the middle body. The lesion was diagnosed as early gastric cancer (tub1, SM), and a partial gastrectomy was performed. Pathological evaluation revealed a well-differentiated intramucosal adenocarcinoma that had partially spread to the submucosa. On immunohistochemical examination, the lesion displayed an intestinal phenotype. The submucosal lesion had poor stromal reaction, and there was smooth muscle tissue surrounding the lesion. As mentioned earlier, we diagnosed the lesion as a gastric intramucosal cancer spreading to the submucosal heterotopic gastric glands.

Invasive micropapillary carcinoma (IMPC), a rare subtype of adenocarcinoma, has a high incidence of lymph node metastasis and is associated with a poor prognosis. A 77-year-old woman was admitted to our hospital for the assessment of intraductal papillary mucinous neoplasm (IPMN). We diagnosed her with pancreatic cancer concomitant with IPMN and performed pancreaticoduodenectomy. The lesion was predominantly composed of ductal adenocarcinoma with a micropapillary component. On immunohistochemical analysis, a characteristic " inside-out pattern" was observed in the micropapillary component. This confirmed the diagnosis of pancreatic cancer with a micropapillary component. In the present report, we describe a very rare case of IMPC of the pancreas.

A 45-year-old woman with persistent abdominal pain was admitted to our hospital. Detailed examination revealed a type 4 lesion with circumferential narrowing, which was diagnosed as a poorly differentiated carcinoma following forceps biopsy and ascitic fluid cytology. Although the lesion was surgically resected, the ascites increased rapidly, and her general condition deteriorated in the postoperative period. She died 6 weeks after the appearance of her symptoms. Autopsy and histological examination confirmed a very rare undifferentiated colon carcinoma with rhabdoid features, which is a high-grade malignant lesion associated with a poor prognosis.

A 62-year-old man was admitted for the evaluation of epigastric pain. Upper gastrointestinal endoscopy revealed a type 3 circumferential carcinoma in the gastric antrum. Distal gastrectomy was performed, and the lesion was histopathologically diagnosed as gastric cancer with an invasive micropapillary carcinoma component. Chemotherapy was administered after surgery; however, he died with multiple liver metastases after 39 months. Micropapillary carcinoma is a rare, high-grade, malignant histological subtype of gastric cancer that has not been described in detail till date. Here we describe this rare lesion and present a review of the relevant literature.

We report an extremely rare case of a calcifying fibrous tumor (CFT) occurring in the abdominal wall. A 43-year-old woman was referred to our hospital because of a gastric submucosal tumor. Imaging findings revealed a gastric submucosal tumor with calcification. Endoscopic ultrasound-guided fine-needle aspiration was attempted to obtain a tissue specimen; however, the tumor was not adequately visualized because of calcification. Local excision was performed because of the tumor growth and the risk of progression to gastrointestinal stromal tumor. The tumor was histologically diagnosed as a CFT. We describe the imaging and pathological findings, and discuss the differential diagnosis and histogenesis of CFT.

A 77-year-old man who complained of melena was admitted to our department. Colonoscopy revealed a type 2 tumor in the hepatic flexure of the ascending colon. Biopsy examination revealed a poorly differentiated adenocarcinoma. Abdominal computed tomography(CT)revealed 3 tumors within the posterior segment of the right hepatic lobe. Initially, a right hemicolectomy was performed. Immunohistochemically, the tumor was diagnosed as an endocrine cell carcinoma. After surgery, a capecitabine, oxaliplatin, and bevacizumab(CapeOX/BEV)regimen was administered. However, after 5 chemotherapy courses, abdominal CT revealed enlargement of the 3 tumors in the posterior segment of the right hepatic lobe. There was no metastasis besides the liver metastasis. The patient underwent a radical hepatectomy of the posterior segment. At 8 months post-surgery, the patient remains alive and well. Endocrine cell carcinoma of the colon and rectum is usually malignant and is associated with a very poor prognosis because of rapid hematogenous or lymphogenous metastasis. Effective multimodal treatment regimens, including surgery and new chemotherapies such as molecular targeted therapies, should be established to improve the prognosis of patients with endocrine cell carcinomas of the colon and rectum.

A 53-year-old woman was referred to our hospital with a round, discolored lesion measuring 4mm in diameter that was identified as a minute gastric signet ring cell carcinoma. According to the Japanese classification of gastric carcinoma, it was graded as type 0-IIb. Seven years back, the woman had undergone pylorus-side gastrectomy for a small signet ring cell carcinoma, and the present lesion was assumed to result from heterochrony and ectopic recurrence. Endoscopic submucosal dissection was performed for the minute lesion. Clinicopathological findings revealed gastric mucosal cancer without invading lymph vessels or veins, similar to the previous lesion. We therefore report two very rare lesions in the same case. This case report demonstrates the importance of performing regular follow-up gastroduodenoscopy to detect recurrence in patients with these lesions.

We report a case of a 60-year-old woman with poor performance status (PS). She suffered from advanced right breast cancer with multiple lung metastases, which was controlled by chemotherapy with trastuzumab as the key drug. The patient presented with a 4 cm-sized large right breast mass. Her PS was poor due to progressive spinocerebellar degeneration. The biopsy specimen of the breast mass showed scirrhous type of the invasive ductal carcinoma (ER+, HER2 2+). Multiple lung metastases were also detected by computed tomography. Considering her poor PS, the patient was treated with mild systemic therapy using trastuzumab as the key drug. A different drug response was achieved between the breast mass and lung metastatic lesions, and the tumors were maintained as stable disease (SD) during first 18 months. However, she finally passed away due to respiratory failure resulting from lung metastasis, 33 months after starting treatment. The autopsy findings showed a difference of HER2 expression between the breast tumor and lung metastatic lesions. It must be recognized that differences of HER2 expression between the primary tumor and metastatic lesions are sometimes demonstrated in patients with breast cancer, and that trastuzumab can be used as a key drug in some patients as in the current case.

Objective: To investigate of the effectiveness of biological adhesives in corneal perforation treatment., Method: Three types of surgical treatment of corneal perforation were performed on albino rabbits. Procedure 1 involved perforation closure using cyanoacrylate adhesive (DERMABOND), Procedure 2 involved a gelatinous glue adhesive, gelatin resorcin and formaldehyde (GRF), and Procedure 3 involved routine perforation repair using 10-0 nylon sutures. The healing status of the wounds was examined by comparing anterior eye photos taken before and after perforation. Pathological changes were also observed., Results: 1) The closure using DERMABOND showed less inflammation in pathological findings, resulting in the best corneal clarity. 2) Pathological findings from the wounds closed using GRF showed early cell necrosis (possibly due to the formaldehyde), resulting in corneal vascularization and minor corneal opacity. 3) The outcome of the suturing procedure depended highly on the surgeon's skills; chronic physical stimulation from the sutures caused corneal vascularization and corneal opacity., Conclusions: The application of biological adhesives is effective in treating corneal perforations, with minimal effect on wound healing, and is recommended as a treatment option for these injuries.

A 41-year-old man was admitted to our hospital with gastrointestinal bleeding. Esophagogastroduodenoscopy revealed a submucosal protrusion with erosion in the duodenal bulb which was thought to be the bleeding source. Dynamic CT scan, ultrasonography and angiography of the abdomen revealed a hepatic artery aneurysm and a dilated celiac artery that dissected from its origin. Although we considered percutaneous transcatheter arterial embolization with metallic coils, we chose surgical resection and vascular reconstruction to prevent hepatic ischemia resulting from interruption of collateral circulation. On the 8(th) day, hepatic artery aneurysmectomy and revascularization with a great saphenous vein was carried out without any severe complication. The pathological specimen demonstrated segmental arterial mediolysis.

A 57-year-old man with advanced gallbladder cancer and accompanying hepatic, colonic and duodenal invasion and para-aortic lymph node metastasis was referred to our hospital. Gemcitabine plus S-1 administration was chosen. Gemcitabine was administered intravenously at a dose of 1000 mg/m(2) on days 1 and 15, and repeated every 4 weeks. S-1 was administered orally at a dose of 40 mg/m(2) b.i.d. on days 1-14. Chemotherapy was effective for the primary gallbladder tumor and lymph node metastasis. The primary tumor and metastatic lymph nodes were shown to have disappeared by a FDG-PET CT study after 10 courses of chemotherapy. Informed consent was obtained prior to performing surgery of the primary lesion. Pathological examination showed fibrosis and a small focus of residual cancer in the resected gallbladder. Complete resection was achieved as all the margins were negative. The findings suggest that gemcitabine plus S-1 treatment may be effective against advanced gallbladder cancer.

A59 -year-old woman was referred to our hospital for a close examination and treatment of an advanced gastric carcinoma. A physical examination and CT scan showed that the right cervical and axillar lymph nodes were swelling, and a histopathological examination of the axillar lymph node revealed metastatic growth of the gastric carcinoma (Stage IV). Then, we started S-1/CDDP combination chemotherapy. S-1 (80 mg/m2/day)was orally administered for 3 weeks followed by 2 weeks of rest, and CDDP (60 mg/m2) was administered by drip on day 8. Since the distant metastases were greatly reduced after 6 courses of combination therapy, a distal gastrectomy with lymph nodes dissection (D2) was performed. Histopathological examination of the resected tissues revealed no residual cancer cells, suggesting a pathologically complete response. The clinical course after the operation went well without any complications, and the patient is alive with no evidence of recurrence 1 year after surgery. S-1/CDDP combination chemotherapy appears to be one of the effective treatments for advanced gastric carcinoma.

A 72-year-old man was admitted to our hospital for further investigation of pancreatic mass. Ultrasonography revealed hypoechoic mass with hyperechoic and aechoic area. Contrast enhanced ultrasonography (CE-US) revealed a vascular image in the lesion. CT showed some enhanced parts of low density mass in the pancreatic body, which was recognized as low-, high- and relatively high-intensity mass on T1-, T2-WI MRI and MRCP, respectively. The final pathological diagnosis showed mucinous carcinoma. CE-US may be useful for diagnosis of mucinous carcinoma.

A 42-year-old Japanese woman, who resided in Indonesia suffered from watery diarrhea. As soon as she returned to Japan, she had a medical examination at our hospital. Oocysts of Cyclospora cayetanensis were isolated from her stool on the 14th day. Treatment with 1.6g/day sulfamethoxazole/trimethoprim combination for 1 week was effective. Cyclosporiasis is a of newly-emerging infection and causes group infection or traveler's diarrhea. Cyclosporiasis should be suspected in patients with diarrhea who have returned from the endemic areas to Japan.

Basophils are the least common granulocytes, and account for less than 1% of peripheral blood leukocytes. Because of this minority status and their phenotypic similarity to mast cells, basophils have often been neglected in immunological studies or considered to have minor, redundant roles in immune responses in vivo. We have recently demonstrated that basophils play critical roles in IgG-mediated systemic anaphylaxis and IgE-mediated chronic allergic inflammation. Basophils also promote the Th2 differentiation and enhance the humoral memory response. Thus, basophils are a key player in both immune regulation and allergic responses. Basophils and their products seem to be promising therapeutic targets for allergic disorders.

A 35-year-old man was admitted with continuous general fatigue and low grade fever. He was HIV-positive, and had gastric diffuse large B-cell lymphoma and renal T-cell anaplastic large cell lymphoma (T-ALCL). We diagnosed double lymphomas related to AIDS. The patient received anti-retroviral therapy, and started the CHOP regimen for the double lymphomas, resulting in transient improvement. However, fever again appeared during HAART and CHOP treatment, and a right inguinal subcutaneous lesion appeared. Biopsy specimen demonstrated null cell ALCL, and this patient demonstrated multiple lymphomas. This case suggested that cancer generation was promoted by low immunity, although it is known that ambivalent tumors such as non-Hodgkin lymphomas can occur frequently.

A 24-year-old woman was referred to our hospital with fever and cervical lymphadenopathy. On admission, her serum concentration of soluble IL-2 receptor had increased to 1,740 IU/ml, LDH was 2,889 IU/l, and ferritin was 2,389 ng/ml. Dyspnea became evident (PaO2 60 Torr) with a further increase of serum ferritin to 96,552 mg/ml on day 11. Chest CT findings showed the thickening of the interlobular septa, bilateral pleural effusion, and swelling of mediastinal lymph nodes, symptoms which were very similar to those associated with lymphangitis carcinomatosis. She received steroid pulse therapy (methylprednisolone, 1,000 mg/day for three days). This resulted in a rapid improvement of her dyspnea and disappearance of the lymphatic blockade-mediated pulmonary findings in two days. A cervical lymph node biopsy was performed on day 12, and revealed that she had subacute lymphadenitis (Kikuchi disease). This case suggests that acute respiratory failure should be considered in cases of Kikuchi disease when associated with a lymphatic blockade.

Purpose: The action of lens epithelial cells (LECs) is important for cataract and posterior subcapsular cataract after cataract surgery. In this study, we analyzed the effects of calcium on the characteristics of LECs., Methods: The LECs were collected using albino rabbits and incubated in minimum essential medium [MEM, Introgen Corp. (12% fetal bovine serum: FBS)] (37 degrees C, 5 % CO2) for a week to induce their proliferation. Cell culture dishes (35 mm) were prepared and 7 mm cylindrical pipes were placed in them. After that, around 10,000 cultured LECs were placed in the pipes and incubated. After 2 hours incubation, the pipes were removed and various doses of MEM (0, 2, 10 and 20 mM) replaced the calcium. Proliferation and shapes of LECs were observed using a confocal microscope and immunohistological analysis [alpha-smooth muscle actin (alpha-SMA) and bromodeoxyuridine (BrdU)]. The LECs were incubated with collagen gel and different calcium doses (0, 2, 10 and 20 mM) of MEM to calculate the contraction rate., Results: It was observed that the LECs changed to fibroblast-like cells at high doses of calcium using a confocal microscope. Histological studies showed that the BrdU positive cells were increased by using 10 and 20 mM calcium MEM, but the positive cells were decreased by using 0 and 2 mM calcium MEM. Increase of alpha-SMA stained cells was recognized when using 0, 10 and 20 mM calcium MEM. The contraction rate of collagen gel was increased by using the 10 and 20 mM calcium MEM., Conclusion: The changes of calcium concentration might be an important factor for the development of cataract, posterior subcapsular opacification, and contraction of the lens capsule after cataract surgery.

Purpose: The present study was performed to evaluate the corneal endothelium protection and anterior chamber stagnation abilities of three different types of viscoelastic substances (Healon, Viscoat, HealonV)., Methods: Viscoelastic substances were selected at random for 120 eyes with cataracts, and the postoperative reduction rates of the corneal endothelium cells were compared. The residual viscoelastic substances after filling of the anterior chamber of pig eyes and aspiration with a handpiece were measured by an anterior eye segment image analysis system. The same procedures were performed in rabbit eyes and the residual levels of viscoelastic substances on the corneal endothelium were photographed histologically., Results: The reduction rate of endothelium corneal cells tended to decrease with Viscoat three months after surgery. The results obtained with the anterior eye segment image analysis system showed that the residual level in the anterior chamber was higher with Healon. Histological analyses demonstrated residual Viscoat at the center of the corneal endothelium after perfusion., Conclusion: HealonV was superior in terms of spatial retention and Viscoat had corneal endothelium protection potential.

Ductal adenocarcinoma is the most common tumor type of cancer of the pancreas. It is generally a poorly demarcated, white to grey-solid tumor located in the pancreatic head. Histologically, it is often well-to moderately-differentiated tubular adenocarcinoma along with marked desmoplastic change. There are three well-defined precursors to invasive cancer; mucinous cystic neoplasms (MCNs), intraductal papillary mucinous neoplasms (IPMNs), and pancreatic intraepithelial neoplasia PanINs. PanIN is now considered to be a precursor of pancreatic ductal adenocarcinoma based on molecular studies. However, it is difficult to distinguish between small IPMNs and PanINs pathologically because both of them often show similar epithelium with cytoplasmic mucin. IPMNs and MCNs can form similar invasive carcinomas such as tubular adenocarcinoma and/or mucinous carcinoma. Another focus of this review is the issue of pathologic evaluation of the surgically resected specimens. Histologic grading and pathologic staging of each case are important especially in terms of the clinical aspects. Careful attention should be paid to the processes and/or criteria of pathologic diagnosis.

We report a case of pulmonary intravascular lymphoma of large B cell type in a 72-year-old woman. She had a one-month history of fever and dry cough before admission. Chest X-ray revealed ground glass shadow in both lung fields, and the high-resolution CT disclosed centrilobular distribution of ground glass opacities. Transbronchial lung biopsy demonstrated large lymphoid cells in the capillaries of alveolar septa. The tumor cells showed strong immunohistochemical reactivity to CD 20. After combined treatment with CHOP and rituximab, clinical symptoms, laboratory and radiological findings were improved. As with diffuse large B cell lymphoma, CHOP chemotherapy plus rituximab may prove useful as a standard regimen for pulmonary intravascular lymphoma.

A 60-year-old man, who had been diagnosed as having paroxysmal nocturnal hemoglobinuria(PNH) in 1994, was admitted to our hospital with general fatigue, and dark urine after a common-cold in January 2001. In the peripheral blood, the red blood cell count was 136 x 10(4)/microl, hemoglobin 4.0 g/dl and hematocrit 12.4%. The serum creatinine level was 9.9 mg/dl. Kidney biopsy revealed focal and segmental proliferation of mesangial cells, mesangial matrix expansion, acute tubular necrosis, interstitial fibrosis and hemosiderine deposits in the tubular epithelial cells confirmed by Berlin-blue staining. Immunofluorescence microscopy showed IgA and C3 deposition in the mesangium. Electron microscopy revealed electron dense deposits in the mesangial area and heavy electron-dense hemosiderin pigments in proximal tubular epithelial cells. After the transfusion of six units of washed red blood cells and two sessions of hemodialysis, the renal function returned to the levels before admission.

A 60-year-old male was referred to our hospital because of cervical lymphadenopathy and a left hilar abnormal shadow seen on chest X-ray in May 1999. The pathological findings of the cervical lymph nodes revealed that the patient had a malignant lymphoma, of the diffuse large B cell type, at clinical stage IIIB. Immunohistochemistry demonstrated that the lymphoma cells were positive for CD11a, CD19, CD20, CD23, CD25, CD45, IgM, IgD and lambda, but negative for CD5. Although a complete remission was obtained after 8 courses of CHOP therapy, the patient relapsed 32 months later. Two courses of a half dose of CHASE therapy consisting of CPM, ara-C, VP-16 and dexamethasone, followed by rituximab (600 mg/week x4) resulted in a transient re-induction of complete remission. However, multiple cutaneous tumors became apparent just 10 days after the last rituximab therapy. Immunohistochemistry of the cutaneous tumors revealed infiltration of CD20-negative lymphoma cells. A series of chemotherapy including high-dose MTX was ineffective, and the patient died in August 2003. Autopsy findings revealed the systemic intra-capillary infiltration of CD20 negative-lymphoma cells into multiple organs, including the lungs, liver, and kidneys. A CD20 negative-clone selected by rituximab therapy appeared to have expanded in this case.

A 64-year-old man with primary esophageal lymphoma suffered from dysphagia. An upper gastrointestinal examination revealed a partly ulcerated submucosal tumor in the upper portion of the esophagus. Histopathological and immunohistological examination of endoscopic biopsy specimens showed diffuse large B-cell lymphoma of the immunoblastic type. Improvement of the dysphagia and esophageal findings were noted after chemotherapy and radiotherapy. A review of the literature indicated that primary esophageal lymphomas account for less than 1% of all gastrointestinal lymphomas, and less than 0.1% of all malignant lymphomas. Because of the rarity of primary esophageal lymphoma, its clinical and biological characteristics are not currently well known. It is important to accumulate information on, and to further investigate patients with, primary esophageal lymphoma.

A 46-year-old woman visited our hospital in January 1998 because of a painful palate mass. In the ten years previous to presenting, she noticed dryness of the mouth and occasionally had conjunctivitis. The pathological findings of the biopsy from the hard palate revealed that she had an extranodal marginal zone B cell type lymphoma (MALT type). Results of the Schirmer test, rose-bengal test and a gum test all supported the diagnosis that she had also Sjögren syndrome. However, complete self-remission of the hard palate lymphoma was observed 4 months after the diagnosis, and no relapse has been seen in a follow-up of over 2.5 years. Watch and wait should be emphasized for a patient having a palate MALToma at an early stage accompanied by Sjögren syndrome.

Successful simultaneous operation for cardiac and lung disease was performed in a 71-year-old man with lung carcinoma and ischemic heart disease. Chest CT scan revealed a mass in the right lower lobe and absence of mediastinal lymphadenopathy. Coronary angiography revealed significant stenosis of the left anterior descending artery, circumflex artery and right coronary artery. We performed concomitant video-assisted right lower lobectomy with mediastinal lymph node dissection as a form of less invasive surgery and triple coronary artery bypass grafting under cardiopulmonary bypass. Curative surgery for lung carcinoma and complete revascularization for ischemic heart disease were completed. The postoperative course was uneventful.

This is a rare case of thoracic duct cyst in 34-year-old woman. She complained of a left supraclavicular mass and admitted our hospital. A clinical examinations were all within normal limit. The chest X-ray and the magnetic resonance imaging examinations revealed a round tumor 65 x 40 mm in diameter with clear margin located at the left upper mediastinum. The slightly dilated thoracic duct was connected to the tumor. The left supraclavicular vein was compressed by the tumor. The cystectomy was performed under diagnosis of thoracic duct cyst by Trap door method on September, 17, 1999. Macroscopically, thin-capsulated elastic soft tumor contained chyle, and it was connected to the thoracic duct and the left jugular vein. The histological diagnosis was thoracic duct cyst. The postoperative course was uneventful, and the patient was discharged 9 days after operation. The patient remains disease-free at 8 months after the operation.

A 65-year-old man was admitted with swelling of the right neck and bilateral inguinal lymph nodes. Endoscopic examination revealed no nasal infiltration. Pathological examination of a neck lymph node biopsy specimen revealed peripheral T-cell lymphoma according to the Revised European-American Classification of Lymphoid Neoplasms (REAL). The phenotype of the lymphoma cells was CD56+, CD16-, CD2+, surface CD3-, cytoplasmic CD3+, CD4+, CD8-, CD5+, CD7- and CD45RO+. May-Giemsa staining demonstrated no azurophilic granules in the lymphoma cells. Immunohistopathologic examination showed negativity for TIA-1 and granzyme B, and rearrangement of the TCR C beta 1 gene was also noted. These findings strongly suggested that this was a T-cell lymphoma. The patient received 8 courses of CHOP chemotherapy plus sobuzoxane. This led to a marked decrease of lymph node swelling, and currently the patient is still in remission. According to the REAL classification, T/NK-cell lymphomas are included among the peripheral T cell tumours, and seem to constitute a heterogeneous group of neoplasms. Although some cases of CD4+ CD56+ lymphoma have been reported, the present case appears to be the first example to show TCR gene rearrangement and negativity for TIA-1 and granzyme B. Since the classification of T/NK-cell lymphoma is still controversial, accumulation of such cases may help to better define T/NK-cell neoplasms.

A 67-year-old woman experienced a sudden severe pain in the area of her left shoulder and back. Three days later the pain recurred, after which she fell into shock and was taken to another hospital by ambulance. A plain chest CT scan showed a cardiac tamponade, while an enhanced chest CT scan demonstrated a coronary aneurysm in the left anterior descending branch draining to the pulmonary artery. Coronary arteriography revealed a saccular type aneurysm, 5 cm in diameter, with a coronary artery-pulmonary artery fistula. After pericardiocentesis, she recovered from her state of shock. The patient was then transferred to our hospital, where she underwent emergency surgery. Under a cardiopulmonary bypass, the stem of the aneurysm and the fistula were ligated and resected. She recovered smoothly and was discharged on the 24th postoperative day.

Background and Purpose: The cataract in Sprague-Dawley rats injected with selenite is a dense nuclear opacity that appears by 4 or 5 days after selenite injection and becomes irreversible by 7 days. Injection of Wistar rats with selenite resulted in a similar nuclear opacity by 4 or 5 days that began to recover transparency by 7 days. In this report, the cytoplasmic proteins were analyzed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) in lenses from Sprague-Dawley and Wistar rats at 4 and 7 days after injection., Results: In the opaque lens cells, degradation of the 31 kDa protein and cytoskeletal proteins (vimentin, spectrin, and actin) was observed during cataract development using SDS-PAGE and western blot analysis. During recovery from opacity, the decreased 31 kDa protein and the vimentin increased., Conclusion: The results suggest that the 31 kDa protein and the vimentin may be important for recovery of transparency in a reversible model of cataract formation.

Background and Purpose: Previous studies used sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) to characterize the modifications to lens proteins during opacification in the selenite model for cataract. To analyze the protein modifications in more detail, two dimensional electrophoresis (2 DE), which is more sensitive than 1 D electrophoresis, was used., Results: The results of 2 DE demonstrated rapid changes in cytoskeletal proteins including spectrin and vimentin at the earliest stages of opacification., Conclusion: The results suggested that the mechanism of opacification might involve changes in cytoskeletal proteins during the earliest stages of cataract formation.

Purpose: Approximately 50% of congenital and childhood cataract seen in the clinic is of undetermined origin. Biochemical analysis of the cataracts is rare. This study analyzes lens proteins to determine the mechanism of congenital and childhood cataracts., Method: We analyzed the lens proteins from 10 young patients after cataract operations, using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), densitometry analysis, and western immunoblotting., Results: Densitometry of separated proteins showed a decrease in the high molecular protein bands of posterior subcapsular cataract (PSC). Specifically, spectrin (235 kDa), filensin (100 kDa), and vimentin (57 kDa) were absent from the SDS-PAGE of PSC. Increases in filensin and vimentin were observed in a Christmas tree cataract and lamellar cataracts. Western immunoblots confirmed the densitometry of SDS-PAGE., Conclusion: These results suggest that changes in cytoskeletal proteins may contribute to congenital and childhood cataract.

We describe a 36-year-old man with pneumococcal meningitis who suddenly showed a left central type facial palsy and left hemiparesis. Magnetic resonance imaging (MRI) revealed a low intensity area in the posterior limb and genu of the right internal capsule to caudate nucleus in T1-weighted images and a high intensity area in T2-weighted images. We surmised vasculitis as the cause of cerebral infarction, because steroid treatment was effective.

We report a case of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) associated with prosopagnosia, topographical disorientation, and periodic lateralized epileptiform discharge (PLED) on electroencephalography (EEG) in a 23-year-old right-handed man. The first MELAS attack occurred on March 1, 1991, while the patient was drinking. Magnetic resonance imaging (MRI) revealed a lesion of abnormal intensity in the left occipital lobe. The second attack occurred on October 1, 1991. This time, the major symptoms were visual loss of acute onset, nausea, and vomiting. EEG examination showed transient PLED. MRI revealed a new area of abnormal intensity in the right occipital lobe, lingual gyrus, fusiform gyrus and the posterior part of the parahippocampal gyrus. During the clinical course of the patient, prosopagnosia and topographical disorientation appeared. There have been few reports of MELAS associated with prosopagnosia, topographical disorientation, and PLED. However, MELAS attacks tend to occur in the cortex of the occipital lobe. We therefore believe that these neuropsychological symptoms and PLED are likely to be associated with MELAS.

We report a case of 73-year-old male HTLV-I carrier with cryptococcal meningitis. The patient, who was born in Taiwan, has raised golden pheasants for ten years and bantams for five years. Antibody to HIV was negative. Flow cytometric study of the peripheral lymphocytes showed reduced CD4+CD45RA+ (naive cells) and increased CD4+CD45RO+ (memory cells), CD3+CD25+ and CD3+ HLA-DR(DR)+ cells. Lymphocyte responses to phytohemagglutinin and concanavalin A were depressed. Cerebrospinal fluid (CSF) cells and serum and CSF antigen to cryptococcal neoformans were decreased by therapy with fluconazole and flucytosine. Although the naive, memory and CD3+DR+ cell abnormalities showed no change, the CD45RA/CD45RO ratio and CD3+CD25+ level tended to improve. Opportunistic infections such as cryptococcal meningitis may be induced by severe decreases in naive cells and increases in memory cells in HTLV-I carriers.

A female patient, 73 years of age, who underwent CABG for the RCA and First Diagonal Branch by SVG 39 months ago was readmitted to our clinic after an onset of acute angina pain, whereupon successful PTCA was performed to Cx segment 13. However, with the angina pain continuing unabated, and with the recognition through emergent CAG that the graft to the RCA was occluded. PTCA was performed again to the RCA segment 1. The segment was closed off by dissection. The emergent CABG was carried out via femoro-femoral extracorporeal circulation and intra aortic balloon pumping. This CABG was of a RCA to RCA bypass nature, with SVG performed with the heart "beating" and without cooling. The patient was thus relieved of her angina pain and her cardiac function has since been in good order.

We experienced a very rare case of hyalinizing trabecular adenoma of the thyroid. The histopathological features of this case included the following. 1) In puncture-aspiration cytodiagnosis, tumor cells aggregated around pink-stained hyaline acellular areas in an ellipsoidal or spindly configuration, with a part of the cytoplasm appearing as filamentous with unclear borders. In addition, a large number of intranuclear "holes" and nuclear grooves were evident. 2) In biopsy, tumor cells appeared in ellipsoidal or spindly configuration, with cytoplasm that easily stained with thyroglobulin but did not stain with calcitonin. The nuclei were irregular in size and some of the nuclei appeared strongly atypical, occasionally seen with cytoplastic inclusion body in the nucleus. These cells showed funicular structures in a radical arrangement with a hyaline material at the center. The hyaline material was stained positively with PAS or Laminin, but not with Cong red.