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A 60-year-old woman with an 8-year history of Cushing’s syndrome was evaluated. Biochemical data were consistent with those of Cushing’s disease. Plasma ACTH levels responded paradoxically to GnRH. MRI demonstrated a large tumor occupying the sphenoid sinus, which was enhanced by gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA). The pituitary gland was normal in shape and was located in the sella turcica without dislocation. The pituitary gland and the sphenoid tumor could be distinguished by the obvious difference in their MRI intensities. Three consecutive partial resections of the sphenoid tumor were performed, but plasma ACTH and cortisol levels remained high just after the third operation. Histological studies revealed a chromophobe adenoma immunohistochemically positive for ACTH. However, adrenal crisis occurred 3 months after the third operation during reserpine administration ( 1.5 mg/day for approximately 2 mo) for the treatment of Cushing’s syndrome due to the residual tumor in the sphenoid sinus. Subsequent MRI showed no change in the tumor shadow, and the paradoxical response of plasma ACTH levels to GnRH remained unchanged. The fourth operation reconfirmed the existence of the ACTH-producing adenoma in the sphenoid sinus. There was no anatomical interaction between the sphenoid tumor and the pituitary gland, and, histologically, no tumor cells were present in the pituitary gland. These findings suggest that the tumor is an ACTH-producing ectopic pituitary adenoma arising from the sphenoid sinus. The patient has been in remission for 4 years on glucocorticoid replacement therapy. The factors responsible for the adrenal crisis were not well understood, although reserpine administration might have had some role.

Hassall's corpuscles are regular structures in the medulla of the normal thymus and in non-neoplastic thymic conditions, e.g. in multilocular thymic cysts. In thymomas, however, they are inconsistently found, and are believed to indicate medullary differentiation of WHO type B1-3 thymomas. We present five organotypical thymomas resembling WHO type B2 and B3 thymomas, but with an abundance of Hassall's corpuscles. We wonder whether this exceedingly rare observation might herald a distinct entity. Four tumors were asymptomatic, incidental findings and of low Masaoka stage (I or II) [20] . One patient suffered from myasthenia gravis which disappeared upon surgical removal of the thymus, while all other patients had no concomitant autoimmune disease. Two patients had a relapse-free follow-up of 12 and 2 years, respectively, upon curative surgery, and another tumor was an autopsy finding; follow-up data of two more recent cases was not yet available. The neoplastic epithelium other than Hassall's corpuscles was arranged either in a cortical type B2 pattern or in type B3 solid cords. In all examples, there was cyst formation, inflammatory reaction and repair, indicative of a long-standing condition. Immature T cells were present in all instances. “Corpuscular thymomas” morphologically resemble WHO type B2 and B3 thymomas, but appear biologically indolent and are rarely associated with myasthenia gravis. Whether they qualify for a separate entity has to be proven by larger series, including genetic studies.

We report an unusual case of a large solitary fibrous tumor (SFT) in the retroperitoneum. A 53-year-old man was referred to our hospital for surgical treatment of a swelling in the right flank with dull pain. Abdominal computed tomography (CT) and echograms showed a large encapsulated tumor compressing the right kidney and liver. At laparotomy, the tumor was found to be encapsulated but fixed to the capsule of the right kidney within a small area. Therefore, complete removal was achieved. The resected specimen was an encapsulated elastic hard tumor, 14 x 13 x 10 cm in size. Immunohistochemical studies revealed reactivity for CD34 and vimentin, but no staining for keratin, S-100, or alpha-smooth muscle actin, confirming a diagnosis of SFT. Although SFT is usually associated with a favorable prognosis, close follow-up is recommended because of the limited information on its long-term behavior.

目的. 印環細胞型腺癌成分を含む原発性肺腺癌について臨床病理学的な検討を行った. 対象・方法. 最近12年間で生検にて印環細胞型腺癌成分を確認した4例を対象とした. 臨床事項として, 年齢, 性別, 喫煙歴, 臨床もしくは病理病期, 手術適応, 予後, および画像病理学的事項として, サイズ, 局在, 病変の内部および辺縁性状, 血管集束の有無, 分化度, 隣接臓器への進展および遠隔転移の有無を検討した. 結果. 同時期の肺腺癌に占める頻度は, 0.82%(4/488) で, 性別は男性3例, 女性1例. うち1例は39歳の若年者であった. 2例は中枢発生, 2例が末梢発生であった. 画像上は, 充実性で境界は明瞭, 辺縁はnotchもしくはspiculaを呈し, 周囲にすりガラス状の領域はみられなかった. 4例中3例は検診指摘例であったにもかかわらず, いずれも隣接臓器への浸潤もしくは遠隔転移を伴い, 手術施行例は1例のみであった. 手術不適応例は数ヶ月以内に癌死し, 手術施行例も術後11ヶ月で癌死した. 考察. 今回の検討では, 症例数が限られているが, 画像上, 充実性, 境界明瞭, 辺縁不整な性状を呈し, 周囲にすりガラス領域はみられなかった. 所属リンパ節転移もしくは局所浸潤/遠隔転移を伴い, 悪性度の高い性格が示唆された. また生検組織診断の結果, 転移性肺腫瘍疑いとされ, 肺以外の全身検索を施行した. 印環細胞型腺癌は最近改訂されたWHO分類の肺腺癌Variantsの中にも記載されており, 正しい認識が必要であり, 今後の症例の蓄積と更なる臨床病理学的検討が望まれる.

Stereotactic radiosurgery is an encouraging approach to deliver higher doses of radiation boost for malignant gliomas safely and precisely. The purpose of this study was to investigate the radiation response and histological changes of malignant astrocytic tumors after stereotactic linac radiosurgery (SLRS). We studied an autopsy case of recurrent glioblastoma multiforme (GBM) and two surgical cases with gross total removal of recurrent GBM and anaplastic astrocytoma transformed from fibrillary astrocytoma treated with SLRS. Destructive changes, such as the disappearance of viable cells, coagulation necrosis, and fibrinoid degeneration of vascular walls, were observed in the center of the target of SLRS, which showed histologically similar radiobiological reactions to well-known delayed central nervous system radiation necrosis caused by conventional radiotherapy. The region showing such radiation necrosis was within the area irradiated with approximately 15–20Gy or more by SLRS; however, dense viable tumor cells remained in the periphery that was irradiated with less than 15 Gy. In a comparative immunohistochemical study of the tumors before and after SLRS, neither MIB-1 and p53 labeling indices nor immunoreactivity for GFAP represented any persistent tendencies. There were very few TUNEL-positive cells in either tumor before and after SLRS. These results showed that radiosurgery for malignant gliomas leads to earlier radiation necrosis than conventional radiation and that it is useful in eradicating tumor cells in the center of the target. However, some viable tumor cells may remain in the periphery irradiated with an insufficient dose for cell death and may be partly transformed in character by DNA damage due to radiation. Proton magnetic resonance spectroscopy (MRS) was suggested to characterize the radiation response in radiosurgery tumor targets for correlation with histological findings.

A nondissecting aneurysm of the distal descending thoracic aorta, 55 mm in diameter, in a 35-year-old woman who was undergoing 24-year steroid therapy of systemic lupus erythematosus was successfully resected and replaced with a tube graft. The suture line of the aortic wall was reinforced with a polytetrafluoroethylene felt strip. Histologically, the media and adventitia contained numerous lymphoplasmacytic infiltrates that consisted of b and activated t cells mixed with plasmacytes. These findings would have been in accordance with active aortitis. Systemic lupus erythematosus was suggested as possibly associated with nondissecting thoracic aortic aneurysm, especially in patients undergoing chronic steroid therapy in which inflammation continued. (J Vasc Surg 2002;35:801-4.)

Angiogenesis is considered to play an important role in the development of malignant brain tumors, especially glioblastoma multiforme (GBM). Abnormal vascular construction with a glomeruloid appearance is characteristic of GBM. beta-catenin is known as one of the adhesive molecules associated not only with cell adhesion and cell polarity, but also with carcinogenesis. We postulated the relevance of beta-catenin to vigorous endothelial proliferation in human GBM because the vascular cells (VCs) are apt to lose their cell polarity. The object of this study is to compare the immunohistochemical localization of beta-catenin in VCs between GBMs and normal brain tissues. Immunohistochemical analysis of beta-catenin for VCs in 32 GBMs and 10 normal brain tissues was performed. beta-catenin was found concentrated in the areas of vascular cell-cell junction and internal surface of the vascular lumen in all normal brains. In contrast, beta-catenin, in proliferating VCs in GBMs, was stained homogeneously and intensely in the cytoplasms of 26 cases (81.3%), in which nuclear staining of beta-catenin was also recognized in four cases (12.5%). In conclusion, the intracellular localization of beta-catenin in VCs of GBMs was found to be different from that of normal brain tissues. The changes of expression of beta-catenin may be associated with the angiogenesis or transformation of the VCs in human GBM.

症例は74歳の女性. 右卵巣嚢腫, 胆嚢ポリープの診断で経過観察中. 平成6年8月28日, 腹部超音波検査で脾に径20×20mmの低エコー病変を認めた. 症状はとくに無く病変も小さいことから経過観察とした. 10月9日再検で脾病変は38×45mmと増大していたため, 精査を勧めたが本人の希望で経過観察とした. 左側腹部痛が出現したため12月12日当院受診, 再検で腫瘍は68×67mmと更に増大していた. 腹部CT, 腹部血管造影, 67Gaシンチグラフィーなどの画像診断から脾原発悪性リンパ腫を疑い, リンパ節郭清を伴う脾摘出術を施行した. 病理組織学的所見はmalignant lymphoma, diffuse lymphomalarge cell typeと診断された.術後化学療法は行っていないが, 3年を経過した現在, 再発の兆候なく経過観察中である.

BACKGROUND Multiple chondromatous hamartomas of the lung, which are very rare, are a feature of Carney syndrome. The relation between the two entities is not clear. METHODS A patient with multiple chondromatous hamartomas of the lung is described in this article. The literature was reviewed with special reference to the relation between multiple chondromatous hamartomas of the lung and Carney syndrome as well as the triad of gastric epithelioid leiomyosarcoma, functioning extra-adrenal paraganglioma, and pulmonary chondroma. RESULTS A total of 15 cases of multiple chondromatous hamartomas of the lung have been published worldwide. Two cases exhibited two other features of Carney syndrome, namely, gastric leiomyogenic neoplasms and extra-adrenal paragangliomas, and three other cases demonstrated only gastric leiomyomatous neoplasms. These five patients were all young females. CONCLUSIONS Some patients with multiple chondromatous hamartomas of the lung have a history of Carney syndrome. Patients with multiple chondromatous hamartomas require further examination of other sites, particularly the stomach and nervous system. Cancer 1999;85:2557–61. © 1999 American Cancer Society.

Background and Objectives: Lymph node metastasis is known as a significant predictor of prognosis in colorectal cancer patients. Recently, reverse transcriptase polymerase chain reaction (RT-PCR) has been applied to detecting micrometastasis. To assess the risk of recurrence and accurately determine the spread of tumor cells, we examined lymph node micrometastases in a series of colorectal cancer patients. Methods We examined 202 lymph nodes obtained from 13 colorectal cancer patients who underwent curative operation and were histologically diagnosed to be node-negative, using RT-PCR to amplify mRNAs for two epithelial markers, carcinoembryonic antigen (CEA) and cytokeratin 20 (CK-20). Results All the cases, including early stage patients, had micrometastases. A total of 102 among 202 lymph nodes (50.5%) were positive for either CEA or CK-20, or both (47.0, 40.1, and 36.6% respectively). Positive lymph nodes were spread along the courses of vascular trunks as well as being located in more distant regions. Conclusions Even in histologically negative lymph nodes, there is a considerable possibility that micrometastases may exist. Their detection by RT-PCR may improve clinical staging and indications for cancer therapy. We should also take care in the choice of surgical approach. J. Surg. Oncol. 1998;68:34–40. © 1998 Wiley-Liss, Inc.

A 52-year-old man with a past history of a pituitary adenoma and hyperparathyroidism due to a parathyroid adenoma was admitted because of a solitary tumour of the pancreas revealed by ultrasonography. His family history was unremarkable. Plasma glucagon levels were slightly elevated (280 ng/l, normal range, 40-180 ng/l) with decreased plasma amino acid levels. Plasma glucagon levels disclosed an exaggerated response during an arginine infusion test and paradoxical elevation during a 75 g oral glucose tolerance test. Endoscopic ultrasonography revealed a monolocular cystic mass of about 3 cm in diameter in the body of the pancreas. A pancreatic tumour was diagnosed before surgery as a cystic glucagonoma. Intra-operative ultrasonography showed one cystic mass in the body of pancreas and two other solid tumours, about 1 cm and 0.5 cm in diameter, in the tail of the pancreas. Histologically, all three tumours showed neoplastic epithelial cells with round nuclei forming cords and/or a ribbon-like arrangement. They showed positive staining for Grimelius' silver stain and immunopositive cells for glucagon. Genetic analysis of the main cystic tumour revealed loss of heterozygosity (LOH) on chromosome 11. After the operation, the responses of plasma glucagon to arginine infusion and oral glucose became normal. Here we describe the usefulness of these provocation tests for early diagnosis and post-operative follow-up in a rare cystic glucagonoma associated with multiple endocrine neoplasia type 1 (MEN 1) which had LOH on chromosome 11.

Thirty-five patients with prostate cancer were examined for micrometastases to the bone marrow using reverse transcription-polymerase chain reaction (RT-PCR) with primers specific for the prostate-specific antigen (PSA) gene. Of nine patients with bone metastases detectable by bone scan imaging, five patients had PSA mRNA expression in the bone marrow detectable by RT-PCR. Of 26 patients with negative bone scan findings, seven patients had PSA mRNA expression detectable in the bone marrow. RT-PCR could detect micrometastatic prostate cancer cells in the bone marrow that were not detectable by bone scan imaging. Of 16 patients with a serum PSA concentration of 25 ng ml(-1) or greater, only nine (56.3%) had bone metastases detected by bone scans. Of the remaining seven patients, five had micrometastases to the bone marrow detected by RT-PCR. Overall, 14 of 16 patients (87.5%) with a serum PSA concentration of 25 ng ml(-1) or greater had metastatic bone diseases including bone marrow micrometastases. Of 19 patients with a serum PSA concentration of less than 25 ng ml(-1), two (10.5%) had only micrometastatic disease detected by RT-PCR. A significant correlation was observed between the incidence of bone involvement and the serum PSA concentration. This study suggests that RT-PCR will potentially develop into a relevant tool to assess bone involvement including bone marrow micrometastases and establish a precise correlation between serum PSA concentration and metastatic bone disease in patients with prostate cancer. Images Figure 1

An increase in the number of Ag-NORs has been described as a possible marker for histopathological cancer diagnosis. The ultrastructural correlation of the reaction, however, has never been elucidated. In tissue samples of the endocervix of the uterus, we compared the ultrastructural configuration of Ag-NORs with the number of Ag-NORs dots. Light microscopic studies showed that the number of Ag-NORs in adenocarcinoma cells significantly increased, but the relation to the bromodeoxyuridine labeling index was not determined. By electron microscopy, Ag-NORs were only observed in the nucleoli and the nuclear bodies of nuclei. Ag-NORs were localized on all components of the nucleolar structure, but the dense fibrillar component was the predominant site in several cases. The nuclear bodies were exclusively found in adenocarcinoma cells and were argyrophilic. A spotted distribution of Ag-NORs was often found in the nucleoli of adenocarcinoma cells that showed an increased Ag-NOR count. The number of Ag-NORs was attributed not only to the number of nucleoli and nuclear bodies in a nucleus but also to the speckled distribution of silver deposits in a nucleolus. These results imply that the Ag-NOR count is a more definitive indicator of a hyperactive state of the cells than the combined number of nucleoli and nuclear bodies in adenocarcinoma of the uterine cervix.

症例は47歳男性.1976年多発性肺軟骨性過誤腫のため腫瘍摘出及び中葉部分切除術を施行された.その後無症状で経過していたが, 1994年7月上気道炎のため近医を受診した際, 胸部異常影を指摘され当院放射線科紹介となった.画像上右胸壁を基底として胸腔内に大小結節状に進展する腫瘤影及び中葉に結節影がみられた.エコー下針生検にて軟骨の増生像が認められ, 軟骨性過誤腫の再発と診断し, 同年12月13日手術を施行した.多発性肺軟骨性過誤腫は稀な疾患で, 内外で15例が報告されているにすぎない.本疾患の特徴として,(1) 若年発生であること (平均発症年齢34.3歳) (2) 再発が高率 (6/1540.0%) で, 再発までの期間が長いこと (平均期間12.7年) (3) 若年女性で胃平滑筋腫瘍, 副腎外傍神経節腫を合併することがあること (肺軟骨性過誤腫を含めたこれら3疾患は“Carneysyndrome”として報告されている) を挙げることができる.

胃癌組織CEA局在様式と術前血清CEA値の予後規定因子としての有用性を検討した. 過去8年間の胃癌切除例450例を対象に, 血清CEA陽性78例と陰性372例の生存率を比較した. また1982年から1984年に経験した胃癌切除150例についてCEA免疫組織染色を行い, CEA局在様式を陰性 (G0), apical (GI), cytoplasmic (GII)), stromal (GIII) typeに分類し, GEA局在様式と予後との関係を検討した. その結果, 血清CEA陽性群は陰性群に比べ, 有意に予後不良であったが, 陽性群に肝転移例などの進行例が多かった. 組織CEA陽性群の生存率は, 陰性群に比べ明らかに不良で, 局在様式別ではGI, G0, G (II+III) の順で有意に不良であった. 組織CEA局在様式別生存率は血清CEA陰性群においても, GI, G0, G (II+III) の順で有意に不良であった.組織CEA染色, とくに局在様式と術前血清CEA測定は胃癌患者の予後を推定する上で有用であることが示唆された.

Nonseminomatous germ cell tumor (NSGCT) has been treated with cisplatin-based chemotherapeutic regimens. In cases of good response of tumor to chemotherapy, elevated tumor markers such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) return to normal with tumor shrinkage. However, a small proportion of cases demonstrate tumor growth during or after the treatment. This distinctive situation was first described for testicular NSGCT by Logothetis and colleagues 1 and was designated the growing teratoma syndrome (GTS). In this report we describe GTS of the mediastinum after cisplatin-based chemotherapy and radiotherapy for intracranial germ cell tumor. Clinical Summary A 20-year-old man with a rapidly growing mediastinal tumor was referred to our department. One month before, tumors in the pineal and the suprasellar regions had been found, with bitemporal hemianopia. Results of routine blood chemistry and coagulation studies were normal; however, serum AFP and hCG were increased to 447 ng/mL and 240 ng/ml, respectively. Serum carcinoembryonic antigen level was normal. The patient underwent partial resection of the suprasellar lesion for pathologic diagnosis. The pathologic diagnosis in the lesion was germinoma. Thereafter, the patient underwent chemotherapy consisting of ifosfamide, cisplatin, and etoposide followed by 20 Gy local irradiation. The intracranial lesions completely disappeared. Serum AFP and hCG were decreased to within normal limits. After these therapies, a chest roentgenogram accidentally disclosed a mass located in the mediastinum. Chest computed tomography showed a round and lobulated mass in the anterosuperior mediastinum. The size of the mass rapidly increased (Figure 1). Tumor doubling time was calculated at 34.3 days. The tumor showed no response to 20 Gy irradiation. Gallium scintigraphy showed a slightly intense mediastinal enhancement region and no other lesion outside the chest. Histologic examination of a percutaneous needle biopsy specimen showed necrotic and fibrous connective tissue. A median sternotomy was performed. The tumor was encapsulated in the thymic tissue. A complete resection was performed with negative margins. On pathologic examination, the specimen of the mediastinal tumor was characteristic of mature teratoma. The tumor consisted of mature squamous epithelium with immature glandular structures. Immature structure tested immunohistochemically positive for carcinoembryonic antigen and keratin but negative for AFP and hCG (Figure 2, A). However, the immature component was less than 10% of the tumor. Retrospective pathologic examination in the intracranial lesion resected before chemoradiotherapy revealed pure germinoma with negative results of immunohistochemical testing for AFP and hCG (Figure 2, B). The postoperative course was uneventful. At 8-month followup, the patient is doing well with no evidence of disease.

Histochemical staining using lectins from Ricinus communis (RCA-1), Arachis hypogaea, and Canavalia ensiformis was investigated in 40 human gliomas, three central neurocytomas, one human neuroblastoma cell line (IMR-32), and two normal brain tissues. Staining was uniform in low-grade gliomas, but heterogeneous in high-grade gliomas, particularly with RCA-1. The correlation between RCA-1 reactivity and cellular proliferative potential was investigated in 10 high-grade gliomas using a combined staining technique: the silver colloid method for nucleolar organizer regions (Ag-NORs) and histochemistry with RCA-l. The mean number of Ag-NORs counted on a simple preparation was significantly greater in the nuclei of RCA-1-negative cells than in those of RCA-1-positive cells (p < 0.001). The staining intensity of inflammatory cells was obviously higher than that of neoplastic cells, and therefore inflammatory cells were easily discriminated from neoplastic cells. Combined RCA-1 histochemical and Ag-NOR silver colloid staining revealed heterogeneous expression of RCA-1 receptor in high-grade gliomas with changes in Ag-NOR number. This result seems to show that high-grade gliomas express heterogeneous cellular carbohydrate structure and proliferative potential even within the same tumor.

A case of gastric cancer with multiple myeloma is reported. A 72-year-old woman was admitted to the hospital because of epigastralgia. An upper gastrointestinal series revealed an elevated type tumor on the greater curvature of the corpus, and it was diagnosed as adenocartinoma by histological examination. On admission, RBC count was 306×104/mm3. Serum electrophoresis showed a presence of M component. Bence-Jones protein in urine was negative. The bone marrow smear showed 30% of atypical plasma cells. Immunoelectrophoresis showed IgG (λ type. From these findings this case was diagnosed as synchronous double cancer, multiple myeloma and gastric cancer. As multiple myeloma lacked in symptoms, operation for the gastric cancer was preceded. Laparotomy was performed and no peritoneal dissemination was found. Subtotal gastrectomy with R2 lymph node dissection was performed. The resected spesimen revealed an elevated cancer lesion of the stomach mesuring 3×2.8cm. Histological examination revealed moderately differentiated adenocartinoma invaded the serosa of the stomach. Post-operative course was uneventful. The patient was discharged from the hospital on the 30th day after surgery, and is followed on an ambulant basis.

21歳女性の肺硬化性血管腫の1例を経験した.本症例は肺硬化性血管腫としては若年である.術前胸部X線写真, 胸部CTでは縦隔腫瘍様の像を呈していた.肺硬化性血管腫の鑑別診断の一つに縦隔腫瘍をあげる必要がある.

The histologic distinction between craniopharyngioma and epidermoid is equivocal. Eight craniopharyngiomas and ten epidermoids (including three dermoids) as well as nine rat (Wistar) abdominal skins that acted as control were investigated by a silver colloid method for nucleolar organizer regions (Ag-NORs). The mean number of Ag-NORs in at least 200 cells of both basal (columnar) epithelial cells and suprabasal (prickle) cells was evaluated. It was found that the mean number of Ag-NORs in basal cells of epidermoid and rat skin was significantly greater than that in suprabasal cells (P

Investigation of lectin cytochemical staining of inflammatory cells in human gliomas showed that Allomyrina dichotoma (Allo-A) cytochemistry can reliably distinguish inflammatory from neoplastic cells. Allo-A cytochemistry combined with silver colloid staining of argyrophilic nucleolar organizer regions (Ag-NORs) was performed in human gliomas. Inflammatory cells possessed usually one but sometimes two Ag-NORs and macrophages often possessed several Ag-NORs. The mean Ag-NOR number per nucleus of inflammatory cells ranged from 1.81 to 2.34, and that of neoplastic cells ranged from 2.57 to 3.53 and from 2.84 to 4.46 in low- and high-grade gliomas, respectively. The mean Ag-NOR number per nucleus of inflammatory cells was significantly smaller than that of neoplastic cells (p less than 0.001). Combined Allo-A cytochemical and silver colloid Ag-NOR staining can provide a reliable Ag-NOR number in human gliomas by distinguishing inflammatory cells.

Dolichos biflorus agglutinin (DBA) binding was examined in 32 cases of intracranial human germ-cell tumors. In embryonal carcinomas, intense DBA binding sites were found on the free surface and cytoplasm of embryonal cells. In teratomas, glandular structures often had positive DBA binding sites. Yolk sac carcinomas and choriocarcinomas showed negative DBA affinity. Of 19 cases of germinomas, 10 showed no DBA-positive cells, while sporadically and/or collectively distributed-DBA positive cells were found in the other 9 cases. Common brain tumors such as gliomas, neurinomas and meningiomas were negative for DBA staining. Considering the cellular carbohydrate structure, these findings suggest that DBA-positive cells in germinoma might be evidence of differentiation into embryonal or some somatic components. In addition, because of the absence of DBA binding sites in the common brain tumors, the identification of such binding sites in brain tumors might act as a marker for embryonal or somatic components, especially among germ-cell tumors.

A 59-year-old male complained of a palpable abdominal mass which was revealed to be a primary omental tumor by means of abdominal ultrasonography, computed tomography, angiography and laparoscopy. Histological examinations of the surgically resected tumor further disclosed leiomyoblastoma with positive stainings of both vimentin and desmin, markers for mesenchymal cells and for muscle cells, respectively. He has been well for 2 years since resection, without any relapse or distant metastasis of the tumor. Leiomyoblastoma of the greater omentum is very rare, and is important to distinguish from extraluminal tumor of the abdomen.

The development of hepatic metastases in 344 patients with colorectal carcinoma was examined for correlation with the presence of both venous invasion by the primary tumor and basement membranes in the tumor tissue. The former was detected by Victoria blue and hematoxylin-eosin staining and the latter by antilaminin antibody. A significant difference in the incidence of venous invasion was noted between patients with and those without liver metastasis at surgery. Basement membrane deposition was found in half of all cases of well differentiated adenocarcinoma, which was significantly high compared with other tumor types. This was more distinct in metastatic foci in the liver and lymph nodes than in the primary lesion, but less marked in intravascular tumor tissue. Basement membrane deposition was seen more frequently in Dukes' A tumors than in B tumors, although this was not statistically significant. No relationship was found between basement membrane laminin positivity and five-year survival, nor was there any correlation between the incidence of liver metastasis and tumor histologic type. Venous invasion was considered to be intimately related to the development of liver metastasis. Deposition of laminin-positive basement membrane was dependent on the grade of tumor differentiation, whereas it had no direct relation to the development of liver metastasis.

A 34-year-old female visited our hospital because of epigastralgia. We performed an upper gastrointestinal x-ray examination, and both conventional endoscopy and dye-spraying endoscopy (indigo-carmine contrast method). We diagnosed early gastric lymphoma which simulated Borrmann 3 type gastric cancer with IIb type early gastric cancer on the middle body and reactive lymphoreticular hyperplasia (RLH) of cobble stone-like granular pattern by endoscopic appearance on the lower body. Although dye-spraying endoscopy showed the details of the mucosa, it was very difficult to diagnose the lesions correctly by gross appearance alone. Because gastric lymphoma arises from the mucosal or submucosal layer and spreads in the mucosa diffusely, ultrasonic visualization by echo-endoscopy might be useful in the diagnostic procedure. We report a case of early gastric lymphoma coexisting with RLH; both lesions showed uncommon endoscopic features.

We report a 69-year-old female patient with mucinous cystadenocarcinoma of the appendix and elevated serum carcinoembryonic antigen (CEA). Serum CEA levels were 27.6-37.8 ng/ml. An oval shaped cystic mass at the ileocecal region was consistently seen by several radiologic procedures such as, barium enema, ultrasonography, computed tomography, and magnetic resonance imaging. The tumor was resected, and the histopathologic findings indicated mucinous cystadenocarcinoma of the appendix. CEA was demonstrated in the neoplastic columnar cells in immunohistochemical studies. The literature on the determination of serum CEA level in adenocarcinoma of the appendix is reviewed.

臨床病理学的に種々の点で近似した2群の胃癌, A群235例, B群115例の切除胃について静脈侵襲を検索した. 病理組織学的検査は, A群で平均1.7枚, B群で3.8枚の組織片について, ビクトリアブルー-ヘマトキシリン・エオジン染色, 第VIII因子関連抗原およびラミニン染色を行い検索した. 癌が粘膜層のみに限局している症例を除くと, 静脈侵襲はA群48.3%, B群56.0%に認められ, 癌の深達度, リンパ管侵襲およびリンパ節転移の程度に平行して増加し, これらとの間に正の相関が認められたが, 組織型ではとくに有意差は認められなかった. ビクトリアブルー-ヘマトキシリン・エオジン染色は静脈の識別に, 基底膜染色は小静脈の判別に有用であるが, 細静脈とリンパ管の鑑別には内皮細胞染色が必要であった. また, 検索は腫瘍中心部および末梢部より採取した組織片, 少なくとも4個について行うのが適切と思われた.

We report a case of prostate cancer that presented initially as an intracranial tumor. Biopsy specimens of the prostate before endocrine treatment were nearly negative immunohistochemically for prostate-specific antigen and the androgen receptors. All metastases including those in the brain expressed neither androgen receptor nor prostate-specific antigen at the protein and mRNA levels. The tumor, which did not respond to the anti-androgen therapy, had an aggressive course. In this case, the androgen-independent growth and rapid progression might be associated with the initial loss of the antigen and androgen characteristics of the prostate.

Background Metastasis to the urinary bladder from gastric cancer is rare. Metastasis to a diverticulum of the bladder from gastric cancer is extremely rare. We report a case of isolated bladder metastasis from gastric cancer and invasion localized to the muscularis propria of the primary site (stomach). Case presentation A 90-year-old female presented with nausea and vomiting that was diagnosed as gastric cancer, the patient also had intermittent hematuria. Pelvic computed tomography identified an abnormally thickened area in the bladder wall that was diagnosed as a diverticulum of the bladder. A biopsy of the bladder wall revealed well differentiated tubular adenocarcinoma metastatic from gastric carcinoma. Conclusion Almost all cases of bladder metastasis from gastric cancer had peritoneal dissemination. This particular presentation of bladder metastasis from gastric cancer, to the best of our knowledge, has not been previously reported.

We describe a very rare non-infantile case of desmoplastic infantile astrocytoma (DIA). A 9-year-old boy presented with motor weakness and sensory disturbance in his right upper and lower limbs. CT and MRI showed a contrast-enhanced large cystic tumor in the left sensorimotor area. We successfully resected the entire tumor. Its histopathological features were typical of DIA.The patient's neurological symptoms improved postoperatively. Neither radiotherapy nor chemotherapy was used postoperatively. The patient developed normally and had been doing well for 12 months after surgery without tumor recurrence.

We present a retrospective study of 82 patients with intraoral minor salivary gland tumors which were diagnosed from 1979 to 2003 in Gifu University Hospital. The histological diagnoses were reevaluated according to the 1991 WHO classification. A total of 82 tumors, consisting of 55 benign and 27 malignant tumors, were found in 28 male and 54 female Japanese patients; the male-to-female ratio was 1:1.9. The mean age of the patients was 51.4 ± 18.1 years. The tumors affected the palate (n = 64), the buccal region (n = 10), the upper lip (n = 6), the floor of the mouth (n = 1), and the retromolar region (n = 1). Histologically, the tumors were classified as pleomorphic adenoma (n = 54), papillary cystadenoma (n = 1), adenoid cystic carcinoma (n = 10), mucoepidermoid carcinoma (n = 8), acinic cell carcinoma (n = 3), adenocarcinoma (n = 2), basal cell adenocarcinoma (n = 1), papillary cystadenocarcinoma (n = 1), and carcinoma in pleomorphic adenoma (n = 2). From the results of the present study and review of the literature, it is suggested that the minor salivary gland tumors in Japan may be characterized by a higher incidence of benign tumors, especially of pleomorphic adenoma; a more marked tendency for female predominance; a higher incidence of palatal involvement; and a rarer occurrence of polymorphous low grade adenocarcinoma, in comparison with those reported in the literature from outside of Japan.

Hepatocyte growth factor (HGF) has a stimulatory effect on the synthesis of matrix metalloproteinase-2 (MMP-2), which is involved in glioma invasion. In this study, to clarify the correlation between the expression of HGF and MMP-2 in glioma tissues, immunohistochemical analysis of HGF and MMP-2 was performed in 11 cases of astrocytoma, 10 cases of anaplastic astrocytoma, and 9 cases of glioblastoma. As a result, expression of HGF and MMP-2 was correlated with the grade of malignancy (P = 0.0181 and 0.0001, respectively), and a significant correlation between the immunoreactivity of HGF and that of MMP-2 was observed (P0.05). Immunofluorescence study revealed the concomitant expression of HGF and MMP-2 in glioma tissue. In cultured glioma cell lines (SNB-19, U87MG, and U373MG), exogenous recombinant HGF effectively acted on the production of the active and latent forms of MMP-2 protein in a dose-dependent manner. Active MMP-2 increased more effectively than the latent form. Taken together, these results suggest that HGF may promote glioma invasion in vivo by production of MMP-2.

Chordoid meningioma is a relatively rare variant that is often associated with peritumoral lymphoplasmacellular infiltration causing Castleman syndrome (CS). We present a 44-year-old woman with chordoid meningioma not associated with CS. The patient presented with epilepsy and right hemiparesis (Todd's palsy) on admission. The radiological findings revealed an extraaxial mass lesion in the premotor cortex. They were compatible with a preoperative diagnosis of meningioma. No physical abnormalities related to CS were detected. A left frontal craniotomy was performed. The tumor surface was gelatinous, and it was totally resected with the attached dura mater (Simpson grade I). The patient had an uneventful recovery, and her seizures subsided. The pathological findings of the specimens revealed nests and cords of spindle and epithelioid cells with abundant myxoid matrix, mimicking the features of chordoma. On the basis of radiological, immunohistochemical, and electron microscopic findings, chordoid meningioma was verified, and a review of the literature was performed.

We performed this study to analyze the endoscopic findings, dissecting microscopic features, and p53 immunostaining in superficial depressed-type (depressed) colorectal neoplastic lesions.Dissecting stereomicroscopy was used to ascertain the size and pit pattern of lesions removed by endoscopic snare polypectomy. Immunohistochemical staining of p53 was performed with an antigen retrieval system using a monoclonal antibody to p53.All depressed neoplastic lesions (submucosal carcinoma, n = 6; high-grade dysplasia, n = 14; and adenoma, n = 30) were small (1 cm in diameter) and were detected as a depression with or without a marginal elevation on colonoscopic examination. In the dissecting microscopic study, submucosal carcinomas and lesions of high-grade dysplasia almost exclusively showed irregular small pits, with the exception of four malignant lesions with moderate submucosal invasion in which the pit structure was absent. In contrast, adenomas had either regular small (29/30 lesions) or oval pits (1/30 lesions). Rates of p53 positivity were 100%, 64%, and 7% in depressed submucosal carcinomas, lesions of high-grade dysplasia, and adenomas, respectively, thus the prevalence of p53 positivity was significantly higher in the former two groups than in the adenoma group.The high frequency of invasive carcinoma and high-grade dysplasia found in depressed colorectal neoplastic tumors, despite their small size, indicates that these lesions may be a subtype of colorectal tumor with more aggressive malignant potential at an earlier stage.

Fifty samples from inflamed tissues were examined by immunohistochemical techniques, using antibodies against apo(a), apo B, plasminogen, fibrinogen, proliferating cell nuclear antigen (PCNA), and various components of extracellular matrix. The immuno-histochemical features of granulation tissues were characterized by different stages of wound healing. In the first stage, immunoreactivities for anti-apo(a) and anti-apo B were weak and focal, whereas those for anti-plasminogen and anti-fibrinogen were strong and were widespread on the tissue surface. In the second stage, granulation tissues were covered with loose fibrous connective tissue, designated as a “fibrous cap.” In this stage, markedly positive staining for lipoprotein(a) [Lp(a)] was observed closer to the surface of the fibrous cap than plasminogen, suggesting that Lp(a) may prevent external fibrinolysis. Lp(a) was also found in endothelial cells and the extracellular space of small vessels underlying the fibrous cap. In the last stage of healing, apo(a) and apo B were not detectable in completely organized tissues. These findings suggest that Lp(a) plays a role in the wound healing.

Binding sites of Helix pomatia agglutinin (HPA) were examined in 32 patients with intracranial human germ cell tumors. HPA reactivity was found in vascular endothelial cells and erythrocytes of patients with blood type A or AB. HPA-positive neoplastic cells were seen in one yolk sac carcinoma in a patient with blood group. A, and in embryonal carcinomas and teratomas irrespective of blood group type. Although in 10 out of 18 germinomas neoplastic cells were totally negative for HPA, another 8 germinomas showed HPA-positive neoplastic cells which were distributed sporadically or in an area and independent of blood group types. HPA-negative germinoma patients showed a very good response to radiotherapy, whereas 4 out of 8 HPA-positive tumors showed poor radiosensitivity, with a residual lesion seen on computed tomography even after the total radiation dose of 40–50 Gy. These findings suggest that HPA-positive neoplastic cells in germinomas indicate components of differentiation of non-germinomatous germ cells. HPA-positive germinomas might be less radiosensitive than HPA-negative germinomas.

Endodermal sinus tumor is a rare and highly malignant lesion. This report documents the clinical findings and magnetic resonance imaging (MRI) of an uncommon case of the endodermal sinus tumor arising in the vagina of a 6-month-old infant. MRI was extremely accurate in delineating the possible extent and location of the vaginal lesion. This is the first report to demonstrate MRI of vaginal endodermal sinus tumor.

Specimens from 235 surgically treated cases of gastric cancer were examined for venous invasion in order to investigate its clinical significance. A total of 87 (37.0 per cent) cases showed histologic evidence of venous invasion, with the incidence being 48.3 per cent of 180 cases, after the exclusion of 55 cases where cancerous invasion was limited to the mucosa. The frequency of venous invasion varied with the gross type of tumor, the depth of penetration and the degree of differentiation, being highest in tumors of type 2 and moderately differentiated adenocarcinoma. It increased proportionately dependeing upon the depth of penetration and the incidence increased in cases where there was evident lymphatic invasion or lymph node metastasis. The long term survival rate significantly decreased in patients with venous invasion when compared to those without it. In this report, we also discuss the marked difference in the incidence of liver metastasis between gastric and colorectal carcinomas in relation to venous invasion of the primary tumor. Double staining with Victoria blue and hematoxylin-eosin for elastic fibers proved useful for detecting venous invasion in the carcinomatous tissue, though endothelial markers have great specificity for differentiating small veins from lymphatics.

TO date only 3 cases of malignant melanoma presenting as a renal pelvic mass have been reported in adulthood.1.2 To our knowledge we report the first primary malignant melanoma composed of clear cells in the renal pelvis of a child. CASE REPORT A 3-year-old girl was found to have microscopic hematuria during a routine medical examination. Excretory urography revealed a filling defect in the left renal pelvis. Abdominal sonography showed a 2 cm. isoechoic tumor with normal renal parenchyma within the lesion. Abdominal computerized tomography confirmed the lesion in the renal pelvis and demonstrated no evidence of visceral metastasis (fig. 1). Left radical nephrectomy was performed for the presumed diagnosis of Wilms tumor. Histological evaluation of the surgical specimen revealed a solid tumor composed of clear cells with focal pigmentation in the renal pelvis. The transitional cell epithelium was intact (fig. 2). Fontana-Masson staining was positive for melanin and tumor cells were immunoreactive for HMB-45. The patient had no history of malignant melanoma and postoperative clinical and radiological evaluation failed to reveal any other focus of melanoma. Microscopic hematuria resolved postoperatively. The patient remained asymptomatic and without evidence of residual disease 13 months after surgery. DISCUSSION

A male case of Alagille's syndrome associated with a hamartomatous nodule of the liver is described. The patient developed jaundice soon after birth, and was diagnosed as the syndrome with signs such as paucity of the intrahepatic bile ducts, pulmonary stenosis and embryotoxon in the cornea at 15 years of age. The liver was examined in recurrent biopsies and other tests. However, no evidence of liver cirrhosis was confirmed until his 15th year. The patient died of hepatic dysfunction when he was 17 years old. At autopsy, a large hamartomatous nodule was found in the liver showing biliary cirrhosis. Morphology of the nodule resembled that of focal nodular hyperplasia. Abnormalities of the large vessels were noted around the liver. Vascular abnormalities were also seen in the mass. The relation of these vascular abnormalities to etiological background of the syndrome and occurrence of the nodular lesion is discussed.