Search

A case of cystitis occurring after administration of nivolumab, an anti-programmed death-1 antibody, which was considered to be an immune-related adverse event, is reported. A 62-year-old man with pulmonary squamous cell carcinoma (T4N0M1a Stage IV) was being treated with nivolumab as fourth-line chemotherapy. He was hospitalized for a fever and diarrhea after 3 courses. Fasting and antibiotic medication reduced the fever and alleviated the diarrhea. He then developed cystitis with no evidence of infection. Cystoscopy showed diffused redness and erosion of the bladder mucosa; urine cytology was negative. Imaging examinations showed no abnormalities. Urinary tract pain and hematuria due to nivolumab were diagnosed by exclusion following a bladder biopsy. Since symptomatic treatment was unsuccessful, steroid pulse therapy was given, which resolved the patient’s signs and symptoms. The patient was then switched to maintenance prednisolone and tapered gradually. The 4th course of nivolumab was then resumed with concomitant administration of steroid, and it was possible to continue administration of nivolumab without progression of cystitis.

We report a case of a 17-year-old man with a spindle cell tumor in the occipital subcutaneous tissue. The enucleated tumor, measuring 2.5 x 2.0 x 1.0 cm, had a broad-bean shape and well circumscribed border and was localized to the subcutis without dermal involvement. Microscopically, the tumor was composed of uniform spindle cells showing interlacing bundle formation and a herringbone pattern. The neoplastic cells were separated by collagen fibers in parallel fashion, the amount of which varied with different areas in the tumor. Mitotic figures were eight mitoses per 50 high-power fields in number. The neoplastic cells were positive for vimentin, Factor-XIIIa, alpha-smooth muscle actin and CD34, but negative for desmin, calponin, high molecular weight caldesmon, smooth muscle myosin heavy chain, collagen type IV, laminin and S-100 protein. These immunohistochemical results indicated that the neoplastic cells showed differentiation toward fibroblasts/myofibroblasts/dendritic interstitial cells. Although more than 50% of the neoplastic cells were positive for CD34, the present tumor should be diagnosed as well differentiated fibrosarcoma, adult type, rather than extrapleural solitary fibrous tumor and fibrosarcomatous areas of dermatofibrosarcoma protuberans, on the basis of routine microscopic findings mentioned above.

肺の大細胞神経内分泌癌の1剖検例を経験したので報告する. 症例は62歳, 男性. 労作時呼吸困難, 胸部痛を主訴に近医受診. 右上肺野に異常陰影を指摘され, 当院紹介となり, 気管支鏡下擦過細胞診が施行された. 壊死を背景に多数の腫瘍細胞が認められ, 孤立散在性のものが多いが, 胞巣状, ロゼット状, インディアンファイル状に配列する像もみられた. 核は卵円形で, 中等大～大型であった. クロマチンは繊細あるいは粗顆粒状で増加しており, 核小体の目立つ細胞も認められた. 大型の腫瘍細胞が混在しているものの小細胞癌 (中間細胞型) が疑われた. 以後, 化学療法を受けたが, 肺炎を合併し, 亡くなり, 病理解剖が施行された. 組織学的に腫瘍はTravisらの提唱する肺の大細胞神経内分泌癌の典型像を呈していた. 本疾患の鑑別診断には小細胞癌や低分化扁平上皮癌, 腺癌, 大細胞癌などが考えられるが, 細胞の詳細な観察に加え, 積極的に特殊染色や免疫組織染色を行い, 総合的に判定することが重要と考えられる.

We report one rare case of superficial angiomyxoma of the right inguinal region, in a 67-year-old man. The tumor, measuring 4.5 x 4.0 x 3.0 cm, had a finger-like shape, was composed of a well circumscribed conglomerate of multiple myxomatous nodules and was located partially in the dermis and partially in the subcutaneous tissue. Microscopically, in contrast to previously reported cases, the tumor was composed mainly of oval plump stromal cells with an amphophilic cytoplasm. Spindle-shaped stromal cells were scattered throughout the tumor. The tumor border was not infiltrative and was well defined by thick hyalized collagen bundles. Neither hyperchromasia nor pleomorphism was apparent. No mitotic figures were detected in the specimens prepared. Small to medium-sized blood vessels showed a scattered distribution, but large vessels, seen frequently in aggressive angiomyxoma, were absent. Moreover, no plexiform capillary pattern was evident. These findings were diagnostic of superficial angiomyxoma. Although this disease entity is considered as including cutaneous focal mucinosis, follicular fibroma, trichofolliculoma and trichogenic adnexal tumor, we propose that these tumors should be excluded.

腎臓の複雑な器官形成機序の解明に，従来の形態学的観察に加え，免疫組織化学的観察法や分子生物学的技法が導入され，機能蛋白や産生細胞の同定や局在，およびその蛋白やmRNAの発現の調節機序など新しい知見が数多く得られてい る。本稿では腎臓の発生・分化に関する最近の免疫組織学的および分子生物学的研究のうち，特に細胞内骨格，細胞外マトリックス，接着分子，サイトカインに関するものを自験例を含め，文献的に整理した。その結果，腎臓の正常発生における細胞内骨格，細胞外マトリックス，接着分子とそれぞれの調節にあずかるサイトカインの役割，機能的意義や相互関係の重要性があきらかになり，さらに各種腎疾患の病態の解明にも，腎臓の発生のメカニズムが重要な手がかりとなることが期待される。

松果体細胞腫は非常にまれな腫瘍である.われわれは最近その1例を経験し, 細胞・病理組織所見に加え細胞増殖能についても検討したので報告する.症例は40歳, 男性.平成4年9月頃より閉塞性水頭症出現.CT, MRIでは松果体部に径2.5cm大の腫瘍を認め, 12月腫瘍摘出術施行.捺印細胞診では多数の腫瘍細胞がシート状, 集籏性に認められた.細胞は小型で均一, 胞体はやや乏しく薄く細胞境界は比較的明瞭.核は類円形～ 卵円形でクロマチンは微細顆粒状.小型の核小体を認めるものもある.細胞集塊の中にロゼット様構造もみられた.組織学的には類円形核と弱好酸性胞体をもつ腫瘍細胞が充実性胞巣状に増殖しており, 一部ではpineocytomatous rosetteが認められた.免疫組織学的にはSynaptophysinが細胞質に顆粒状に陽性.一部の細胞質や細胞突起内でNeurofilament, GFAP, S-100蛋白が陽性.電顕的には細胞内小器官の乏しい未熟な細胞から小器官が比較的よく発達しannulate lamellaeの目立つ細胞もみられた.一部ではシナプス様構造も認められた.BrdU標識率は約3%, PCNA陽性細胞は約5%であり, 本例では細胞増殖能は通常の低悪性脳腫瘍ほど低くはないものと考えられた.

BACKGROUND In order to elucidate the significance of myofibroblasts in invasive growth of colorectal adenocarcinomas, we examined the number of myofibroblasts at the tumor border of colorectal adenocarcinomas. METHOD A total of 91 invasive colorectal adenocarcinomas were examined immunohistochemically using anti-alpha-smooth muscle actin (ASMA) and high-molecular-weight caldesmon (h-CD) antibodies; 25 carcinomas confined to the submucosa (sm carcinomas), 40 carcinomas confined to the muscularis propria (mp carcinomas) and 26 carcinomas invading the subserosa or adventitia (ss carcinomas). We considered ASMA-positive and h-CD-negative stromal cells as myofibroblasts. RESULTS Twenty-seven (67%) of the 40 mp carcinomas and 25 (96%) of the 26 ss carcinomas had a small number of myofibroblasts at the tumor border facing the muscularis propria. CONCLUSIONS Although direct evidence is lacking, there is a possibility that the further immediately vertical and radial invasion of carcinoma cells into the subserosa or adventitia is associated with a smaller number of myofibroblasts at the tumor border facing the muscularis propria in mp carcinomas, resulting in a low incidence of mp and a high incidence of ss carcinomas in the colorectum.