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A 74-year-old man developed hepatic injury after intravesical Bacillus Calmette-Guérin (BCG) therapy for bladder carcinoma. Although hepatitis-associated disseminated BCG was suspected, granulomatous formations were undetectable. The hepatic injury was considered to have resulted from an allergic reaction to BCG therapy because a histopathological assessment revealed enlarged portal areas with eosinophils and neutrophils. The hepatic injury was resolved by prednisolone. This case suggested that hepatic injury associated with BCG therapy might be due to an allergic mechanism unrelated to disseminated BCG disease. A liver biopsy is needed to confirm the histopathological findings of hepatic injury after BCG therapy in order to differentiate allergic hepatic injury from infectious hepatic injury.

Background/aims It is sometimes difficult to distinguish between malignant and benign biliary strictures using imaging studies alone, and pathological diagnosis is necessary. The aim of this study was to determine the usefulness of endoscopic transpapillary tissue sampling and factors predictive of diagnostic accuracy. Methods From April 2008 to December 2014, 136 patients underwent endoscopic transpapillary tissue sampling for malignant biliary strictures. The cytological and histological findings were reported as negative, suspicious, or positive. Suspicious and positive findings were defined as pathologically positive. Results The sensitivity was 65.0% for forceps biopsy, 49.5% for brush cytology, 46.2% for bile aspiration cytology, and 21.9% for endoscopic nasobiliary drainage cytology. The combination of these procedures improved the sensitivity (72.8%). Endoscopic transpapillary tissue sampling was more sensitive for lesions of biliary origin (91.4%) than for extrabiliary lesions (66.3%). In surgical cases, the sensitivity for tumors with an infiltrative growth pattern (53.3%) was significantly lower than for a tumor with an expanding or intermediate growth pattern (87.5%). Conclusions Combining procedures can improve diagnostic accuracy. It may be possible to predict the sensitivity of endoscopic transpapillary tissue sampling by evaluating the etiology and tumor growth pattern using preoperative imaging studies.

A 47-year-old woman with a single-nodule hepatic tumor was referred to our hospital. She had no symptoms. The tumor was located at the surface of the right lobe of the liver; it showed peripheral low signal intensity on a magnetic resonance imaging apparent diffusion coefficient (ADC) map, and an influx of blood flow into the peripheral area of the tumor at the early vascular phase on perflubutane microbubble (Sonazoid(®)) contrast-enhanced (CE) ultrasonography. Since we suspected a malignant tumor, the patient underwent surgical resection. The hepatic tumor was resected curatively. Pathological examination revealed that the tumor was composed of epithelioid cells with an epithelioid structure and/or cord-like structure. Immunohistochemical staining was positive for cluster of differentiation 34 and factor VIII-related antigen. Based on the above, a final diagnosis of hepatic epithelioid hemangioendothelioma (EHE) was made. Hepatic EHE is a rare hepatic tumor: only a few cases of hepatic EHE with curative resection have been reported. We were unable to reach a diagnosis of hepatic EHE by imaging studies; however, an ADC map was useful in showing the malignant potential of the tumor, and CE ultrasonography was useful in revealing the peripheral blood flow of the tumor. When an unusual hepatic mass is encountered, hepatic EHE should be kept in mind, and the mass should be inspected with more than one imaging modality, including an ADC map, in the process of differential diagnosis.

A 70-year-old woman was referred to our hospital because of early gastric cancer (lesser curvature of the antrum, 0-IIc, tub1, 15 mm) and underwent endoscopic submucosal dissection. Microscopically, the lesion was found to be confined to the mucosa, and predominantly composed of well-differentiated tubular adenocarcinoma with a micropapillary component. On immunohistochemical examination, the characteristic "inside-out pattern" of the micropapillary component was observed; thus, we diagnosed the lesion as gastric cancer with a micropapillary component. Invasive micropapillary carcinoma is a rare subtype of gastric carcinoma, and, to our knowledge, this is the first case of invasive micropapillary carcinoma of the stomach confined to the mucosa.

Tumor lysis syndrome (TLS) is an oncological emergency caused by massive cytolysis of malignant cells. This syndrome eventually induces metabolic abnormalities. TLS is observed mainly among tumors with rapid cell proliferation or high sensitivity to antineoplastic treatment. In rare cases, TLS occurs without any cytotoxic treatment. Previous reports have shown that alternative stress including proceeding infection or an operation might play a role in TLS. However, exact mechanism of spontaneous TLS remains unknown. Here, we describe a case of a 59-year-old woman who presented with dedifferentiated endometrial adenocarcinoma and developed TLS without any cytotoxic chemotherapy. Although spontaneous TLS in solid malignancies are extremely rare, clinicians should consider the possibilities of TLS especially in aggressive solid tumors.

Here, a case of Ewing’s sarcoma family of tumors (ESFT) of the femur with an unusual clinical course is reported. At 20 years of age, the patient had undergone curettage of a bone tumor of the right femur which was diagnosed as ESFT. One cycle of chemotherapy with vincristine and cyclophosphamide and radiotherapy for a total dose of 40 Gy was administered. The patient did not develop any recurrence or metastases for the following 18 years, in spite of the inadequacy of the initial treatment. At 38 years of age, he was referred to our institution with right thigh pain that had persisted for several months. Radiographs and magnetic resonance imaging findings showed a mass lesion in his proximal femur extending to the soft tissue. An open biopsy was performed and the lesion was diagnosed as recurrence of ESFT, although a molecular biological investigation did not reveal any expression of the characteristic fusion genes that have previously been reported. The patient received standard multimodal therapy employing standard combination chemo-therapy for ESFT and wide surgical excision. The patient has been disease-free for 9 years since the treatment. This patient may have a rare subtype of ESFT with an unknown chromosomal translocation and relatively non-aggressive biological behavior.

A rare case of post-radiation epithelioid hemangioendothelioma arising in a congenital hemangioma of the lower leg 18 years after radiotherapy is reported. At 7 years of age, the patient underwent partial resection of a subcutaneous congenital hemangioma with intramuscular extension of the left lower leg, and at 10 years of age, the patient was given radiotherapy with a total dose of 30 Gy for recurrence. At 28 years of age, the patient noticed a large tumor mass with intractable pain at the antero-lateral aspect of the proximal lower leg, and she presented to our hospital. Since microscopic examination of a biopsy specimen showed epithelioid hemangioendothelioma, disarticulation at the knee joint was performed. Although malignant change in a benign vascular tumor is extremely rare, irradiation can induce malignant transformation of a hemangioma.

目的 : 子宮内膜細胞診における標本作製の諸問題を把握し, それらの解決方法を検討する. また, 臨床運用に即した報告形式を考察し, 細胞採取より報告までの診断システムを作成する.方法 : 1. 子宮内膜細胞診における標本の適正を定義し, その定義に基づいて過去に診断された標本を再評価する. 2. 適正標本を作製するための手技的問題を検討する.成績 : 1. 標本が不適性である原因として, 臨床情報不足が最も高頻度に認められ, 9.0%であった. 次いで細胞採取量の不足が多く, 5.7%に認められた. 2. 細胞診標本においては, 内膜から採取された検体の圧挫を行わず, 直接塗抹する方法が観察性に優れている. また, 観察性を低下させる因子としての出血性背景や標本の乾燥は, 標本を作製する際の工夫や注意によって改善される必要がある.結論 : 子宮内膜細胞診において, 婦人科医による正しい臨床情報提供の再認識が求められる. また, 細胞検体の採取・塗抹においては観察性を保ち十分な細胞量を得る工夫が必要である. 今後, 子宮内膜診断システムにより, 精度の高い細胞採取および標本作製が実現され, より高い精度の診断が実現されることが期待される.

A 79-year-old male was referred to the hospital with a history of abdominal discomfort. Abdominal computed tomography revealed a cystic tumor with irregular wall thickness, approximately 50 mm in diameter, along the lesser curvature of the gastric body. Magnetic resonance imaging visualized the mass as signal-hyperintense on T2-weighted imaging. Esophagogastroduodenoscopy showed a submucosal tumor with normal mucosa. Surgery was performed and the 60 × 50 × 50 mm mass was resected. The resected tumor comprised cystic and solid regions; the cystic region was filled by light bloody serous fluid. On histological examination, a solid region of the resected tumor showed a spindle-cell appearance. The diagnosis was gastric gastrointestinal stromal tumor (GIST) with predominant cystic formation. GISTs are usually solitary tumors, but in this case the tumor demonstrated extremely predominant cystic formation. Lesions with a hemorrhage or necrosis may form large cystic spaces. GISTs may show extensive cystic changes in response to tyrosine kinase inhibitor treatment; however, this patient had not undergone any such treatment before diagnosis. This represents an interesting case of a gastric GIST with predominant cystic formation occupying most of the tumor volume. Care should be taken to differentiate between GISTs and actual intra-abdominal cystic lesions.

Kuttner tumor (known as chronic sclerosing sialadenitis) is a totally benign inflammatory lesion and to date there has been no report of malignancy. However, because of its clinical features, the clinical diagnosis is often that of a salivary gland neoplasm. We report a case of Kuttner tumor and discuss its differential diagnosis, especially the pathological diagnosis. Kuttner tumor may be mainly due to T lymphocyte immune reaction and of itself is a benign lesion, but it may provide a state in which a malignant lesion arises.

73歳,男性. 1996年4月より右季肋部痛が出現し,体重減少と発熱,疼痛を繰り返すため近医受診. USにて胆嚢腫瘤を指摘され同年11月19日当科紹介. WBC 18200/mm3, alkaline phosphatase 960IU/l, r-GTP 103IU/lと異常を認め,画像上,胆嚢は8×7cm大で中心壊死を伴う比較的境界明瞭な充実性腫瘤を呈し,肝S 4b, 6, 8にそれぞれ径3cmまでの腫瘤と,傍大動脈リンパ節の腫大を認めた.血管造影では腫瘤はhypovascularで胆嚢動脈にencasementが認められた.胆嚢癌の診断にて同年12月2日800mlの自己血輸血を用いた肝S 4a+5+6切除を施行した.組織学的に腫瘤の大半は肉腫様で強い腫瘍壊死を伴い,一部に腺癌成分が認められる胆嚢未分化癌(紡錘細胞型)であった.術後24日目退院し,術後肝転移巣に対してPEITを施行するも,術後8カ月肝不全にて死亡した.

We report two patients with gastrointestinal stromal tumors (GISTs) of the small intestine that expressed c-kit protein (CD117). One was a 68-year-old woman with epigastralgia and vomiting. A submucosal tumor of the upper jejunum was detected, and partial resection was carried out. The histology revealed a GIST negative for CD34 but positive for CD117. The other was a 42-year-old woman with progressive anemia, melena and lower abdominal pain. Intussusception was detected, and a partial resection was carried out. A submucosal tumor of the lower jejunum was noted. The histology revealed a GIST positive for both CD34 and CD117.

Seventeen cases of primary duodenal adenocarcinoma occurring in the elderly (older than 65 years) were examined to clarify their clinicopathological features and biological behavior. The mean age was 77.4 years (range, 66-104), and there was no appreciable difference in the incidence between the sexes (female: male ratio, 8: 9). Thirteen patients had tumors located in the first portion of the duodenum, three in the second portion and one in the third portion. Grossly, there were three varieties of lesions: six polypoid, four flat-elevated and seven ulcerative-invasive. Sixteen cases showed well-differentiated adenocarcinoma, three of which were difficult to distinguish from adenoma, and one was poorly differentiated adenocarcinoma. Three of 16 tumors had poor differentiation in the invasive area, whereas mucosal lesions were well differentiated. Eight tumors had invaded the duodenal wall with occasional involvement of the pancreas. Immunohistochemistry demonstrated p53 protein overexpression in two intramucosal (22.2%) and five invasive (62.5%) cancers. In the intramucosal area the mean Ki-67-positive rate (PR) of the tumors with distant metastasis was significantly higher than that of the tumors without metastasis (46.0 vs 31.6%; P < 0.05), while there was no significant difference in the association between PR and gross feature or depth of the tumors. Clinical follow-up showed three of the five patients with invasive cancer died of carcinoma within 28 months. Compared with published data from other investigators, the results of the present study indicate a proximal shift of duodenal carcinoma in the elderly. Furthermore, it is concluded that invasive duodenal adenocarcinomas with high PR should be considered as potentially aggressive tumors, although their histology may indicate a high degree of differentiation.

Objective: To evaluate the sensitivity and specificity of the BD SurePath™ liquid-based Papanicolaou test for assessing the cytology of intrauterine endometrial samples according to newly devised cytological diagnostic criteria and a novel descriptive reporting format. Materials and Methods: One hundred and twenty-two endometrial samples were analyzed. All samples were obtained directly from the intrauterine cavity using the Uterobrush or Honest Super Brush. The samples used for the histological examination and cytological tests were collected simultaneously. Our study group devised new cytological diagnostic criteria for examining endometrial samples: the Osaki Study Group method. In this study, histological diagnosis was considered to be the gold standard for cytological diagnosis. A novel descriptive reporting format was also used. Results: Satisfactory cytological specimens were obtained in all cases. The sensitivity and specificity of the SurePath endometrial cytological examination method were 96.4 and 100%, respectively. Conclusion: These results indicate that the SurePath method is acceptable for clinical use. Since the SurePath method seems to be easier and allows greater preparation standardization than the conventional method, coupling it with our newly devised cytological diagnostic criteria and descriptive reporting format might represent a reliable diagnostic method for assessing endometrial specimens.

A case of primary non-Hodgkin lymphoma of the male breast is reported. The patient was a 76-year-old Japanese with a history of bilateral gynecomastia. After the patient had received sex hormone treatment for the gynecomastia, rapid growth of a tumor in the right breast was noted, with regression of a contralateral breast lesion. Clinically, inflammatory breast cancer was suspected, and right mastectomy with ipsilateral axillary lymph node dissection was performed after intraarterial infusion chemotherapy using a cis-platinum derivative. The histology of the surgical specimen was non-Hodgkin malignant lymphoma of the diffuse large cell type, with focal tumor necrosis. Immunohistochemically, the tumor cells showed a B-cell nature. The patient is currently well without disease 39 months after surgery.

Inverted papilloma of the nose and paranasal sinuses is an uncommon lesion recognized as a neoplastic growth of the epithelium which inverts into the underlying stroma rather than proliferating outwardly from the surface. This neoplasm is uniquely characterized by its capacity to destroy bone, tendency to recur after incomplete removal, and association with malignancy. Most authors recommend lateral rhinotomy as the initial surgical approach. In 1992 and 1993, we treated 5 patients with inverted papilloma, one of which presented with bilateral disease. On computed tomography, 3 patients demonstrated opacification of the maxillary sinus, 2 showed localized mass. None of the patients showed bone destruction. Antrostomy and ethmoidectomy were performed in 5 of these cases. Lateral rhinotomy was added in one patient. Intranasal ethmoidectomy was performed in one case. Complete resection and lifelong follow-up are recommended to prevent recurrence and association with malignancy.

Sarcomatoid carcinoma is a rare variant of malignant tumor arising from the urinary tract. This tumor had been termed carcinosarcoma because of its carcinomatous and sarcomatous components. There is still some confusion in the terminology between true carcinosarcoma and sarcomatoid carcinoma; however, the latter is now regarded as primarily a malignant epithelial tumor with pseudosarcomatous transformation. Four cases of sarcomatoid carcinoma arising from the urinary tract are reported. The patients were a 77 year old female, and three males aged 62, 69 and 80 years. All but the eldest patient complained of gross hematuria. Surgical removal was performed in the younger three cases, and an autopsy was done in the remaining case. All the tumors were macroscopically polypoid. Histopathologic examination revealed fasciculated spindle-cell tumors with myxoid stroma or malignant fibrous histiocytoma-like spindle cell tumors. The epithelial nature was proven in these sarcomatous cells by immunohistochemical and/or electron-microscopic examinations. Only a small amount of squamous cell carcinoma components was also evident in the latter three cases. Although the younger three patients were alive at 44, 23 and 39 months' follow-up, respectively, constant careful monitoring is recommended.

Patients with Wiskott-Aldrich syndrome (WAS), a congenital immunodeficiency, show a markedly increased risk of developing non-Hodgkin’s lymphoma compared with the general population [1]. Malignant lymphoma in WAS commonly presents as extranodal disease, and its histology almost always shows diffuse lymphoma, especially of large cell or immunoblastic cell type, as in other congenital or acquired immunodeficiencies [2]. We report a case of B-cell lymphoma occurring in a patient with WAS. At presentation the disease was follicular lymphoma with different histological, immunohistochemical, and molecular biological findings node by node, suggesting the presence of more than a single neoplastic clone. Eventually, the patient was killed by the systemic invasion of monoclonal diffuse large cell lymphoma, which appeared to have existed since the onset of the disease. A 21-year-old Japanese man was admitted because of general lymphadenopathy. Because the patient had been suffering since early infancy from recurrent respiratory infections, atopic eczema, and a tendency to bleed due to thrombocytopenia, his condition was diagnosed as WAS. Physical examination and computed tomographic scans revealed generalized lymphadenopathy. The patient showed a marked Development of Diffuse Large Cell Lymphoma from Follicular Lymphoma with Multiple Immunoglobulin Heavy Chain Gene Rearrangement Occurring in a Patient with Wiskott-Aldrich Syndrome Keiki Kawakami,a Motoko Yamaguchi,b Yasuyuki Watanabe,a Tetsuya Muratac

Extraskeletal osteosarcoma (ESOS) occurs in approximately 1% of soft tissue sarcomas and 2-4% of all osteosarcomas. In particular, subcutaneous osteosarcoma is extremely rare, occurring in less than 10% of ESOS cases. This report presents a case of a subcutaneous tumor in the upper arm of a 79-year-old male. Imaging and pathological findings led to the conclusion that the soft tissue tumor should be diagnosed as subcutaneous osteosarcoma. Additionally, this case report documented the clinicopathological findings of the extraskeletal subcutaneous osteosarcoma in this case and discussed its clinical features by reviewing cases previously described in the literature.

Adult rat ventricular myocytes were used as a model system for investigating the direct effects of nicardipine, a potent calcium-channel blocker, on preservation of the heart during periods of simple cold storage. Cells were stored at 4 degrees C for 24 hr with an acalcemic storage solution. The superfusate then was exchanged with hypoxic Tyrode solution (1.8 mmol/L CaCl2). After 2 hr of hypoxia at 20 degrees C, cells were reoxygenated and simultaneously warmed to 37 degrees C. The addition of nicardipine to both the storage solution and Tyrode solution resulted in the highest percentage of viable cells (70.5%). Using either the storage solution or Tyrode solution containing the compound, the percentages of viable myocytes were 51.9% and 52.2%, respectively. In the absence of the drug in either solution, the percentage was 38.0%. The effect of diltiazem, another potent calcium-channel blocker, was examined using the same experimental procedure. The addition of diltiazem to Tyrode solution elevated the viability of ventricular myocytes, but addition to the storage solution showed no cardioprotective effect. Moreover, the addition of 8-bromo cyclic GMP to the storage solution resulted in a cardioprotective effect. These results suggested that nicardipine exerts a direct effect on myocardial protection in hypothermic and acalcemic storage solution and that the pharmacological effect of nicardipine depends on a mechanism other than its calcium-channel blocking action.

The imaging discrimination between neurofibroma (NF) and malignant peripheral nerve sheath tumor (MPNST) is clinically very important. The purpose of this study is to define the criteria for the differential diagnosis between NF and MPNST on MRI in neurofibromatosis 1 (NF1). A total of 37 patients with NF1, 18 NFs and 19 MPNSTs were evaluated by MRI at 1.5 T. Magnetic resonance imaging (MRI) findings were compared using univariate and multivariate analyses. The MRI findings characteristic of MPNST (p

A case of thoracic myelopathy with alkaptonuria (ochronotic spondyloarthropathy) is presented.To present and review the first reported case of an alkaptonuric patient with concomitant thoracic myelopathy.Alkaptonuria, a rare hereditary metabolic disease, is characterized by accumulation of homogentistic acid, ochronosis, and destruction of connective tissue resulting in degenerative spondylosis and arthritis. Despite the high incidence of intervertebral disc diseases among patients with alkaptonuria, neurologic symptoms caused by spinal disease are rare. Thoracic myelopathy in a patient with alkaptonuria has not been previously reported.The clinical course, radiologic features, pathology, and treatment outcome of an alkaptonuria patient with thoracic myelopathy was documented.Myelopathy of the patient was caused by rupture of a thoracic intervertebral disc. The neurologic symptoms of the patient were markedly improved after surgery.We have reported for the first time, that an alkaptonuria patient showed thoracic myelopathy caused by rupture of a thoracic intervertebral disc. Decompression followed by the instrumented fusion of the thoracic spine was effective for improving the neurologic symptoms.

The clinical and histologic changes in 116 Japanese patients with persistent HBs-antigenemia and chronic liver diseases were analyzed after the patients were divided into three groups depending on the history of alcohol consumption. Group 1 consisted of 45 nondrinkers, Group 2 of 51 social drinkers, and Group 3 of 20 habitual drinkers with a daily intake of more than 60 g of ethanol for at least ten years. The frequency of chronic active hepatitis (CAH) in Group 3 was higher than in Groups 1 and 2 (P less than 0.05). The histologic comparison of patients with CAH between the three groups revealed that only the inflammatory changes at/near portal tracts, such as piecemeal necrosis and inflammatory cell infiltration in Group 3, were more prominent than those in Groups 1 and 2. The alcohol-related changes except for fatty change were not found in any specimens. These findings suggest that alcohol intake, particularly of more than 60 g of ethanol a day, may enhance the viral inflammatory changes of the liver in patients with persistent HBs-antigenemia.

Primary cardiac lymphomas diagnosed antemortem are extremely rare. We present a case of primary cardiac lymphoma initially diagnosed antemortem by cytologic examination of pericardial effusion fluid. Echocardiography suggested the presence of a tumor localized at the right ventricular free wall. The cytologic examination of pericardial effusion was effective in establishing the correct antemortem diagnosis.

We report a case of malignant melanoma of the kidney presenting as a primary tumor. This tumor was found incidentally in a 74-year-old woman. The patient underwent a right radical nephrectomy, and has been living tumor free for 2 years and 3 months. This is the first reported case of primary renal malignant melanoma. We discuss the probability that this tumor is renal in origin and directly linked to the origin of malignant melanoma.

A case of anthracosis of the esophagus is reported. The patient was a previously healthy 69-year-old Japanese woman. A black and slightly elevated lesion was detected in her esophagus by upper gastroesophageal fiberoscopic examination. Endoscopically, the lesion looked like malignant melanoma. Thoracic esophagotomy was then performed. Histological examination revealed a pigmented lesion beneath the mucosal epithelial layer. The lesion consisted of an aggregation of histiocytes containing an abundance of tiny black pigments. A few mature lymphocytes and plasma cells were also evident in the periphery of the lesion. Histologically, these findings looked like lymph nodes in the pulmonary hilus; however, no lymph nodal structure was evident in the esophageal wall. Traction diverticula were also noted in the pigmented lesion. The patient has remained well without disease for 9 months since the surgery. Although anthracosis is a rare condition in the esophagus, the present case gave warning to pathologists and clinicians that it does indeed occur. Endoscopists and pathologists should differentiate anthracosis from malignant melanoma because the treatment and outcome are quite different for each.

✓ The authors describe the case of a 57-year-old woman who had a right-sided hearing disturbance that had remained untreated for 1 year. The diagnosis was of a right cerebellopontine angle tumor, and the patient underwent its removal via retrosigmoid approach. Pathologically, the tumor was a typical benign neuroma. Growth of residual tumor was detected 4 years after the initial operation, and it was treated with gamma knife surgery (GKS). Six months later, the tumor had grown, and the patient underwent surgery via a combined retrosigmoid—translabyrinthine approach. Abnormal mitotic figures were observed on histological studies, indicating that the tumor had become malignant. Thereafter, the tumor grew rapidly, and the patient died 6.5 years after the initial treatment. It cannot be ruled out that GKS affected the outcome, but the causal sequence was unclear. Because such a patient is rare, documentation of the case was considered clinically important.

A case of primary gastric T-cell lymphoma, which was positive for granzyme B, is reported. The patient was a 47-year-old Japanese female who complained of a dull upper abdominal pain. Radiographic and endoscopic examinations revealed an ulcerative infiltrative lesion in her stomach. Following the confirmation of a high-grade malignant lymphoma, a distal gastrectomy with regional lymph nodal dissection was performed. The histology of the gastric lesion revealed a malignant lymphoma of the diffuse pleomorphic type without lymph nodal involvement. Immunohistochemistry revealed that the tumor cells were positive for LCA, CD3, TIA-1 and granzyme B, but were negative for CD4, CD8, CD56, CD30, L-26, EMA, TCR alpha/beta and TCR gamma/delta. Because the tumor cells showed T cell nature with cytotoxic activity proved by TIA-1 and granzyme B, and without evidence of further maturation of T cell, a malignant lymphoma originating from extrathymic-derived T cells was suggested.

A case of breast cancer with choriocarcinomatous features (BCCF) is reported. The patient was a 38-year-old Japanese female with a long history of schizophrenia. Her nursing staff noticed a palpable mass in her right breast, which showed rapid growth. Following cytopathologic confirmation of a malignant breast tumor, she underwent mastectomy with ipsilateral axillary lymph node dissection. Histologic examination revealed BCCF, which was positive for placental alkaline phosphatase and human chorionic gonadotropin (HCG) by immunohistochemistry. The serum HCG level was high. She died 7 months postoperatively, with multiple metastases of BCCF to the chest wall, lung and liver.

A case of matrix-producing carcinoma (MPC), which is a unique variant of breast cancer, is described with cytopathological and radiographical findings. A 75-year-old female presented with a palpable mass in her right breast. After confirmation of the cytopathological diagnosis, the patient received a right mastectomy with ipsilateral axillary lymph node dissection. The histopathological examination revealed MPC. The Union Internationalis Contra Cancrum postoperative clinical stage was IIB. The patient is well and without disease 18 months after the surgery.

A 29-year-old woman with muscle phosphofructokinase (PFK) deficiency had exercise intolerance, painful cramps, elevation of muscle enzyme levels in the serum and compensated hemolysis. After the restriction of exercise, the creatine kinase level and indirect bilirubin level decreased, and the reticulocyte count and haptoglobin level were normalized. It is suggested that the hemolysis which was accelerated by exercise was improved by restriction of exercise.

Anaplastic lymphoma kinase (ALK)-positive lung cancers are generally diagnosed at an advanced clinical stage. Herein, we report a case of an ALK-positive lung cancer patient who had a microlesion of this tumor type. The patient was a 51-year-old woman without a smoking history. Computed tomography performed during a lung cancer screening program showed a 7 × 5-mm subpleural nodule with an irregular border in the right lower lobe. The background lung parenchyma was almost normal. Serum tumor marker levels were not elevated. Histological assessment showed destructive growth in the center of the lesion, as confirmed using Victoria blue-hematoxylin and eosin staining and immunostaining for CD34 and D2-40; however, at the other site, the tumor mainly showed intra-alveolar growth with minor lepidic growth. The tumor cells were positive for thyroid transcription factor-1 and ALK. Fluorescent in situ hybridization of the tumor revealed an ALK gene spilt. Accordingly, the tumor was diagnosed as ALK-positive lung cancer. ALK-positive lung cancer presents diverse histological architectures in the early phase. Keywords: ALK-positive lung cancer, Anaplastic lymphoma kinase, Lung cancer, Adenocarcinoma