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Hodgkin lymphoma (HL) is a hematologic malignancy that typically presents with lymphadenopathy. We herein report a patient with HL who presented with an intramuscular mass that required differentiation from an inflammatory lesion. A 65-year-old Japanese woman was referred to our hospital with a chief complaint of chronic and expanding tumor in her left thigh. By surgical resection, she was diagnosed with primary intramuscular, Epstein-Barr virus-positive, mixed-cellularity classic HL. She received combined modality therapy, resulting in a complete response. Primary intramuscular classic HL is extremely rare. It should be listed as a differential diagnosis of intramuscular tumors.

Introduction Skeletal muscle depletion, referred to as sarcopenia, has recently been identified as a risk factor for poor outcomes in various malignancies. However, the prognostic significance of sarcopenia in patients with NSCLC after surgery has not been adequately determined. This study investigated the impact of sarcopenia in patients undergoing pulmonary resection for lung cancer. Methods This retrospective study consisted of 328 patients with pathologically confirmed NSCLC who underwent curative resection between January 2005 and April 2017. Preoperative computed tomography imaging at the third lumbar vertebrae level was assessed to measure the psoas muscle mass index (PMI, cm2/m2). Sarcopenia was defined as a cutoff value of PMI less than 6.36 cm2/m2 for males and 3.92 cm2/m2 for females, based on PMI values from “healthy” subjects. Results The median patient age was 71 years and 59% were male. Sarcopenia was present in 183 (55.8%) and was significantly related with increasing age (p Conclusions Sarcopenia as determined using preoperative computed tomography could be used to predict postoperative major complication and prognosis in patients with resected NSCLC. Our results may provide some important information for preoperative management.

(Case 1) A 63-year-old man was diagnosed as retroperitoneal fibrosis by the exploratory laparotomy for the pelvic mass with high IgG4 levels. (Case 2) A 64-year-old man had past medical history of autoimmune pancreatitis which was treated by steroid use. Three years later, he was diagnosed as IgG4-related gallbladder tumor by the cholecystectomy. And, then he was diagnosed as right hydronephrosis with high IgG4 levels. (Case 3) A 71-year-old man was diagnosed as left hydronephrosis and pelvic mass by computerized tomography with high IgG4 levels. We reported three cases of IgG4-related focal retroperitoneal fibrosis. All cases had pelvic mass with high IgG4 levels and were also treated effectively with steroid use. Those symptoms of the patients occurred in close association with IgG4 levels. It is necessary to acknowledge that retroperitoneal fibrosis may have aspects of IgG4-related systemic disease and that the measurement of serum IgG4 should be considered for diagnosing and treating the conditions.

Apoptotic protease activating factor-1 (APAF-1) is a key regulator gene of apoptosis, located downstream from p53. Loss of APAF-1 expression is associated with chemorefractory malignant melanoma and neuronal cell differentiation. In order to make clear the function of APAF-1 in the carcinogenesis of germ cell tumors, we evaluated the expression levels of APAF-1 and several apoptosis and differentiation markers by immunohistochemistry in formalin-fixed paraffin-embedded samples from 43 cases of testicular germ cell tumor (TGCT) and six specimens of normal testis tissue. Expression of cleaved caspase-3, Oct-3/4, and Ki-67 were also examined by immunohistochemistry to evaluate apoptotic reactivity, tumor differentiation, and proliferation activity, respectively. APAF-1 was downregulated in two TGCT cell lines by siRNA transfection, and subsequent expression of the Ki-67 and Oct-3/4 genes and differentiation markers of three embryonic germ layers including keratin16 (KRT16) for ectoderm, vimentin (VIM) for mesoderm and GATA4 for endoderm were then tested. No significant relationship was found between APAF-1 expression and apoptotic activity in TGCTs. Expression of APAF-1, Oct-3/4, and Ki-67 was significantly higher in seminomas than in non-seminomas. In TGCTs, higher APAF-1 expression was correlated with higher proliferation (high Ki-67) and a lower degree of differentiation (high Oct-3/4). Interestingly, the expression of APAF-1 gradually decreased in accordance with tumor differentiation (seminoma and embryonal carcinoma > teratoma). Downregulation of APAF-1 in TGCT cell lines resulted in a decrease of Ki-67 and Oct-3/4 and an increase of VIM and KRT16 gene expression. These data show that higher expression of APAF-1 is related to an undifferentiated state in the TGCT pathway.

症例は40歳の女性で，腹痛，下血の精査治療目的で本院入院となった．精査にて骨盤腔に約10 cm大の腫瘍を認め，回腸gastrointestinal stromal tumor（以下，GIST）の術前診断で回盲部切除術を施行した．術中所見では約7 cm大の粘膜下腫瘍を終末回腸に認め回腸GISTが強く疑われたが，病理組織学的診断では重複腸管に発生した腺癌であった．嚢胞状の腫瘍内腔には古い血液が充満しており，内腔面に裏打ちするように菲薄化した粘膜が散在し腺癌が認められた．嚢胞を構成する壁は厚く腸管壁の構造が保たれており癌は筋層内および漿膜下層にまで浸潤していた．Type5型，6.0×6.0×4.0 cm，tub2，pSS，ly0，v0，pN1（2/13），fStage IIIaであった．術後問題なく第11病日に退院した．補助化学療法は大腸癌に準じUFT/LV（経口）併用療法を7コース施行し再発転移はない．腸管重複症に発生した腺癌の症例はまれであるため治療法は確立されていない．終末回腸に発生した重複腸管の癌化の文献報告例は本邦第1例目であった．

Introduction Neuronatin is a protein that is specifically expressed in the nervous system in the course of embryonal brain development, and its expression is limited to the pituitary gland in normal human adults. Neuronatin expression has been reported in some types of tumor. The purpose of this study was to clarify the significance of neuronatin expression in pulmonary non-small cell carcinoma. Methods We determined the frequency of neuronatin expression in surgically resected samples from non-small cell lung carcinoma (51 adenocarcinoma and 41 squamous cell carcinoma) by immunohistochemical staining, and investigated the correlations between expression level and various clinicopathological features. Results Expression of neuronatin was observed more frequently in squamous cell carcinoma (63%) than in adenocarcinoma (25%). In most cases, nontumorous lung tissue did not react with the antibody against neuronatin. In both adenocarcinoma and squamous cell carcinoma, less differentiated tumors expressed neuronatin more frequently than did differentiated tumors. In adenocarcinoma, but not squamous cell carcinoma, the prognosis of neuronatin-positive cases was significantly worse than that of neuronatin-negative cases. Conclusion Neuronatin expression is specific for tumor tissue and was detected in both pulmonary adenocarcinoma and squamous cell carcinoma at high frequency, particularly in less differentiated tumors. Neuronatin expression is associated with poor prognosis in patients with adenocarcinoma, and may be useful as a prognostic marker for lung adenocarcinoma.

Atypical adenomatous hyperplasia (AAH) is classified as a precancerous lesion of lung adenocarcinoma. We established an immortalized AAH cell line (PL16T) and a human non-neoplastic bronchial epithelial cell line (PL16B) from the same patient by transfection with the gene for SV40 large T antigen. The expression profile of PL16T was compared with that of PL16B by the suppression subtractive hybridization method. From 704 selectively hybridized clones, we finally selected 25 fragments of mRNA that showed transcription levels more than three times higher in PL16T than in PL16B. Thirteen (52%) and eight (32%) of them encoded tumor-associated calcium signal transducer 2 (TACSTD2) and S100 calcium binding protein A2 (S100A2), respectively. The high transcription of TACSTD2 and S100A2 in PL16T was confirmed by in situ hybridization. In normal lung tissue, both TACSTD2 and S100A2 were expressed at very low levels, but seven and five of 14 AAH were positive for TACSTD2 and S100A2, respectively. The frequency of TACSTD2 positivity was increased in 16 of 22 bronchioloalveolar carcinomas (BAC) and adenocarcinoma with mixed subtype with BAC component (mixed BAC). Positivity for S100A2 occurred in four of 22 BAC and mixed BAC. The abnormal transcription of TACSTD2 and S100A2 are thought to be unique molecular markers of the preinvasive stage of lung adenocarcinoma.

AIDSが誘因となった播種性非定型感染症にて腸閉塞をきたした1例を経験した. 症例は48歳の男性. 主訴は腹痛と嘔吐であった. 開腹既往歴なし. 1996年カリニ肺炎にてAIDS発症, その後サイトメガロ網膜炎, 陰部ヘルペス, 頸部リンパ節腫脹を伴う播種性非定型抗酸菌感染症を発症し当院外来にて加療中であった. 2000年に左下腹部痛を主訴に当院を受診した. 身体所見上左下腹部圧痛を認め, 諸検査にて腸閉塞と診断され, 入院した. 入院3日後症状増悪し緊急開腹手術を施行した. 開腹所見にて, 横行結腸と癒着しarch を形成する上部空腸腸間膜リンパ節の著明な腫大を認め, 空腸が陥入し腸閉塞となっていた. Archを解除し陥入する小腸を引き出したところ, 腸管の色調は著明に改善を認めたために腸切除を行うことなく手術を終了した. 術後25日目に退院したが, 術後123日目にAIDSの増悪にて死亡した. AIDSが誘因となった腸閉塞は本邦でも今後増加する可能性があり, 文献的考察を加え報告する.

背景:組織学的に肺異型腺腫様過形成atypical adenomatous hyperplasia (AAH) と診断された症例の擦過細胞診標本を作製したので, その細胞所見の特徴を挙げる.また, 核面積に関しての検討を行ったので, 合わせて報告する.症例:48歳, 女性.気管支拡張症で加療中, 血疾が出現したため胸部CT検査を施行したところ, 左肺下葉に最大径10mmまでのlocalized-ground glass opacity (l-GGO) を呈する病変が計3つ認められた.AAHないし高分化型腺癌疑いのもと, 1つの病変に対して術中迅速検査が施行され, high-grade AAHと診断された.この際同時に作製した擦過細胞診標本では, 出現細胞は平面的配列を示し, 異型は弱いものの軽度の核腫大と核内封入体の出現を認めた.また, 核面積を測定し正常細胞と比較したところ, 腫瘍細胞の方がやや大きく, 大小不同がみられることがわかった結論:今後l-GGO病変に遭遇した場合, 腺癌の可能性について考慮するのみならず, 細胞異型が弱い場合でもAAHの細胞学的特徴を捉え, その可能性を積極的に指摘することが重要であると考えられた.

The p16 (CDKN2/MTS-1/INK4A) tumor-suppressor gene is frequently inactivated by DNA methylation in lung carcinomas. To clarify whether background anthracosis may play a role in DNA methylation and inactivation of the p16 gene, we examined DNA methylation of the p16-promoter region by methylation-specific polymerase chain reaction, and p16 expression immunohistochemically, and compared the results with the level of background anthracosis which was measured by an original quantitative method. At autopsy, DNA methylation of the p16 gene was observed in 6/19 tumors (32%) from patients who had died of pulmonary adenocarcinoma. The degree of background anthracosis (the effect of extrinsic carcinogenic factors) (mean absorbance value, A = 0.715) of the cases with p16-gene methylation was significantly higher than that without methylation (mean A value = 0.298). p16 expression was inactivated in all tumors with p16-gene methylation. The mean A value of black dust matter deposition in cases with normal expression of p16 (A = 0.151) was significantly lower than cases with abnormal expression of p16 (A = 0.531). These results indicate that the level of background anthracosis is closely associated with inactivation of p16 expression and also DNA methylation of the p16-gene promoter region in pulmonary adenocarcinogenesis. Int. J. Cancer (Pred. Oncol.) 84:609–613, 1999. © 1999 Wiley-Liss, Inc.

application/pdf, A 71-year-old male was treated for suspected bronchial asthma because of dyspnea and stridor for 3 months before presenting at our hospital. Chest computed tomogram and a laryngotracheoscopy revealed a mass occupying the subglottic cavity. Instead of a laryngotracheal resection, the tumor was extirpated from the posterior wall of the subglottis and the first two tracheal rings successfully through a vertical tracheotomy just above the life-saving trachestomy tube, and was diagnosed as pleomorphic adenoma. The patient is alive and well with no recurrent tumor 12 years after surgery, without any effect on the function of the voice or swallowing., Case report

Malignant myoepithelioma of the head and neck usually arises in the salivary glands. We experienced a rare case with malignant myoepithelioma in the maxillary sinus. A 47-year-old woman with malignant myoepithelioma in the maxillary sinus underwent partial maxillectomy. However, local recurrence occurred 28 months after surgery and she was subsequently treated with radiation therapy with proton beams. The recurrent tumor showed complete response and the patient was alive with no evidence of disease 30 months after irradiation. No therapy-related severe toxicities were observed. A rare case with malignant myoepithelioma in the maxillary sinus was successfully treated with radiation therapy.

BACKGROUND Although the cytologic characteristics of advanced adenocarcinomas of the lung have been described, the unique cytologic features of early adenocarcinomas have not been established. METHODS Cytologic specimens from 193 patients with small-sized lung adenocarcinoma, up to 2 cm in dimension, were reviewed. Cytologic investigations were performed on sputum, bronchial brushings or washings, or fine-needle aspirates obtained from the patients preoperatively. The cytologic characteristics of early adenocarcinoma were confirmed with Image Processor for Analytical Pathology from Sumitomo Chemical Co., Ltd. RESULTS Nuclear size, variations in nuclear size, appearance of nucleolus, and nuclear atypia of the adenocarcinoma cells were found to differ between the various histologic subtypes of adenocarcinoma. The nuclei in small but advanced adenocarcinoma were generally larger and showed more variation in size than those in early adenocarcinoma (localized bronchioloalveolar carcinoma). CONCLUSIONS Surgically curable, early adenocarcinomas of the lung were found to have a unique cytologic appearance, including small nuclear size and slight variation in nuclear size. Using these unique characteristics, they can be distinguished easily from advanced adenocarcinomas. Cancer (Cancer Cytopathol) 2001;93:124–131. © 2001 American Cancer Society.