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Background Intramedullary hyperintense lesions associated with spinal cord edema on T2-weighted MR images (T2WI) are rare findings in patients with cervical spondylosis and are poorly characterized. We investigated the clinical characteristics of spinal cord edema due to cervical spondylosis (SCECS). Methods In total, 214 patients with cervical spondylotic myelopathy who underwent surgery between April 2007 and March 2017 were divided into SCECS and non-SCECS groups with SCECS defined as follows: (1) intramedullary signal intensity (ISI) of the cervical spinal cord in sagittal T2WI extending to more than one vertebral body height; (2) “fuzzy” ISI, recognized as a faint intramedullary change with a largely indistinct and hazy border; and (3) a larger sagittal diameter of the spinal cord segment with ISI just above or below the cord compression area compared with areas of the cervical spine without ISI. Radiographic parameters, demographic characteristics, and the Japanese Orthopedic Association (JOA) surgical outcomes score were compared between the groups. Results Seventeen patients (7.9%) were diagnosed with SCECS. These patients were younger than those in the non-SCECS group [median (interquartile range), 64 (20) vs. 69 (15) years, respectively, p = 0.016], and the disease duration from onset to surgery was significantly shorter in the SCECS group than in the non-SCECS group [6 (7) vs. 20 (48) months, respectively]. No significant difference was observed between groups with respect to sex, radiologic findings, or surgical outcomes. Conclusion The disease showed an earlier onset and more rapid progression in the patients with SCECS than in those without SCECS.

症例は85歳，女性．平成20年6月に肛門部痛，下腹部痛を主訴に当科を紹介受診された．受診時には明らかなイレウス症状は認められなかったが，下部消化管内視鏡検査で肛門縁より5cmの位置に腸管内腔に突出するI型の隆起性病変を認め，一部表面不整を認めた．また骨盤部CT検査にて直腸内腔に重積腸管を示すmultiple concentric ring signを認めた．以上の所見より腸重積を合併した早期直腸癌の診断のもと手術を施行した．開腹後重積腸管のen-block切除を試みたが困難であり，用手的解除を施行した．解除時に一部直腸壁の損傷を認めたためHartmann手術を施行した．早期直腸癌に起因する腸重積症は稀であり，若干の文献的考察を加え報告する．

症例は18歳の男性, 下腹部腫瘤と頻尿を主訴に来院. 下腹部正中に小児頭大の無痛性で可動性不良の硬い腫瘤を触知した. エコー, CT, MRI, 注腸造影にて左尿管の途絶, 左水腎症, 直腸狭窄像を呈し, 骨盤腔内に最大径18cmの充実性腫瘍を認めた. 血管造影では血管に富む腫瘍を認め, 左閉鎖動脈と上直腸動脈に栄養されていた. 術前腫瘍塞栓術を施行し, 腫瘍とともに左尿管, 膀胱, 左精嚢, 直腸を合併切除した. 再建は, 左尿管と膀胱との間にS状結腸を間置し, 直腸は低位前方切除とした. 摘出標本では大小さまざまな不規則な血管腔の周囲に紡錘形の細胞の増生を認め, 分裂像や核異型性に乏しく低悪性度のhemangiopericytomaであった. 術後6年, 再発転移を認めていない. 本疾患は病理組織像のみからでは良悪性の鑑別が困難であり, 今後とも長期にわたる経過観察が必要と思われる.

A 41-year-old woman had felt a pain and noticed a mass in the right breast since March, 1993, but she did not consult any hospital and had been treated by some folk medicien. Five months later the mass started to enlarge rapidly, and eventually it penetrated the skin to be exposed on the surface during a further 5-month period. The patient was admitted to the hospital for operation. On admission the tumor presented a cauliflower like proliferation occupying the entire right breast. It was 23×19.4cm in size, easily hemorrhagic, and discharged a large quantity of exudate. Pathological diagnosis on biopsy at another hospital indicated that the tumor was benign phyllode tumor. But we were not able to rule out a possibility of malignancy, because the tumor rapidly enlarged in one year and was huge in size. Modified radical mastectomy (Patrey method) and full-thickness graft were performed. Histopathological examination confirmed malignancy. There has been no sign of recurrence, as of about 2 years after the operation. She is doing well.

It is not always easy to make a differential diagnosis of cystic lesion of the pancreas whether it is a cyst, cystadenoma, or cystadenocarcinoma. Particularly cystic lesions with the size of less than several centimeter which can be detected by ERP, ultrasonography, and CT scan often have atypical papillary hyperplasia, which poses a problem whether it is reactive or tumorous. This paper describes our experience with a case of ductectatic type cystadenoma of the pancreas which was difficult to differentiate from mucous-producing cancer of the pancreas preoperatively. A 53-year-old was admitted to the hospital because of right hypochondraligia. Computed tomographic examination showed a low density area in the head of the pancreas. Pancreaticoduodenectomy was performed when endoscopic retrograde pancreaticography (ERP) showed dilatation of the main pancreatic duct and cystic dilatation of the lesser ducts with a filling defect. Pathological findings revealed atypical papillary hyperplasia with staining by anti-CEA monoclonal antibody and goblet cell metaplasia. Further investigations to diagnose the pancreatic cystic lesions whether cancerous or not are necessary measuring oncogene expression such as K-ras point mutation.