Search

The initial technetium-99m pertechnetate abdominal scintigraphy revealed equivocal or normal results. However, a second scintigraphy without pentagastrin demonstrated a focal area of persistently increasing radioactivity in the right lower quadrant of the abdomen. At surgery, Meckel's diverticulum was confirmed, and histological examination of the excised specimen revealed that it was lined with ectopic gastric mucosa. It has not been satisfactorily explained why the initial imaging failed to demonstrate the ectopic gastric mucosa. The necessity to perform repeated scintigraphy must be emphasized because 50 to 91 percent of bleeding Meckel's diverticula in the pediatric age group are said to contain gastric mucosa.

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.

A case of lipoma which recurred repeatedly in the left breast in a 68-year-old woman is reported. In 1969, the patient underwent extirpation of a fist-size tumor in the left breast at ahospital, and it was diagnosed lipoma. In 1970, she noticed regrowth of the tumor at the same site, and it was removed in 1974 at our place. In 1982, there was another recurrence of the tumor, and two tumors 16×11×4cm and 11×6×2cm in size were extirpated. In 1985, the third recurrent tumor infiltrating into the pectral muscle was revealed, and was suspected of malignant change. In 1988, radical operation with axillary lymphadencetomy was performed. The tumor was 23×11×6.5cm in size, 760g in weight, and looked like a bengin lipoma. A small solid tumor of the size of a thumb was found beside the main tumor. The histological diagnosis of them were intramuscular lipoma and spindle cell lipoma, respectively. Her postoperative course was uneventful, and was discharged soon after the operation.

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 report here a 65-year-old man with ptosis, diplopia, and progressive lower limb muscle weakness without nasal symptoms. CA19-9 and CEA were elevated in the serum and cerebrospinal fluid (CSF), but Squamous Cell Carcinoma Antigen (SCC) was not. CA19-9-positive atypical cells were found in the CSF. A right ethmoidal tumor was discovered by paranasal CT and 18F-Deoxyglucose Positron Emission Tomography (FDG-PET) studies. The ethmoidal tumor invaded to the orbits and disseminated into the CSF space through the cribriform plate. Biopsy demonstrated that the paranasal tumor consisted of mucoepidermoid carcinoma. We report here the first case of meningeal carcinomatosis due to mucoepidermoid carcinoma in the ethmoid sinus.

Dissection limited to the abdominal aorta contributes 4% of all aortic dissections, and inflammatory injury of the aortic media is one of factors associated with dissection. In multiple myeloma, leukocytoclastic vasculitis of the skin has been known. We describe limited dissection of an abdominal aortic aneurysm with dense lymphocyte infiltration in a 62-year-old man with multiple myeloma. Although it is unclear whether the lymphocyte infiltration in the aortic wall, which was denser than that of atherosclerotic aneurysm, was associated with multiple myeloma, the excessive aortic wall inflammation may have somewhat influenced aneurysm formation or aortic dissection.

Study design Case report of a solitary fibrous tumor in the occipitocervical region. Objective To describe a rare clinical entity and successful management in a patient with solitary fibrous tumor in the occipitocervical region. Summary of background data Solitary fibrous tumor is a rare spindle cell neoplasm of adults that arises most commonly in the pleura. Recently, this tumor has been reported in a number of other sites. However, its occurrence in the occipitocervical region is rare. Methods The patient presented with a painless mass in the left posterior neck. Resection of the tumor was performed. Results Histopathological study revealed features of a solitary fibrous tumor. Clinical follow-up review for 2.5 years shows no evidence of recurrence or metastasis. Conclusion A case of extrapleural solitary fibrous tumor in the occipitocervical region was reported. Solitary fibrous tumor should be considered in the differential diagnosis in a tumoral mass of this region.

Summary Cervical vertebral involvement of clear cell meningioma is very rare. We report a case of clear cell meningioma in the cervical vertebral body in a 72-year old male. Seven years prior to this presentation, the patient underwent palliative surgery and posterior instrumentation for a cervical vertebral tumor at C5, which had been diagnosed as a metastatic renal cell carcinoma. On this admission, the patient presented with severe neck pain. Examination revealed hypesthesia on the left in a C6 nerve root distribution. Plain X-rays and MRI revealed an enlarging tumor in the C5 and C6 vertebral bodies. The tumor was resected via an anterior approach followed by fusion using a strut bone graft. Histological examination of the surgical specimen diagnosed a clear cell meningioma. Postoperatively, the patient achieved pain relief and resolution of the neurological deficit. At follow-up two years postoperatively, he remains asymptomatic. We emphasize that cervical clear cell meningioma with involvement of the vertebral bodies may mimic metastatic renal cell carcinoma.

We report a 77-year-old Japanese man with superficial ureteral carcinoma with elevation of serum CA19-9 and carcinoembryogenic antigen (CEA) at recurrence. We performed radical nephroureterectomy and partial bladder resection for the right ureteral carcinoma. Pathological diagnosis was UC, G2G1, pTa, NO, MO (according to UICC classification). Eighteen months later, local recurrence and multiple metastases were observed, accompanied by the elevation of serum CA19-9 and CEA. His autopsy specimens showed positive immunostaining for serum CA19-9 and CEA. In Ki-67 labeling index, the autopsy specimens showed higher scores than the surgical specimen.

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.

A 24-year-old Japanese woman clinically showing pseudomyxoma peritonei arising from ovarian mucinous cystadenocarcinoma FIGO stage Ic is reported. She received intra-abdominal administrations of cisplatin five times following left oophorectomy. After being free of disease for 6 months, she conceived and carried two pregnancies to successful deliveries at 34 and 37 weeks, respectively. At the Cesarean sections, there were no abnormal findings except for right ovarian mucinous cystadenoma. She has had no evidence of recurrence by the time of the 60-month postoperative examination.

Isolated true aneurysm of the subclavian artery is rare and can rupture, thrombose, embolize, or cause symptoms by local compression. We describe a case of a 67-year-old man with proximal left subclavian artery aneurysm presenting with hemoptysis, hoarseness, and diplopia. These symptoms suggested that the aneurysm ruptured, that the left recurrent laryngeal nerve was compressed by it, and that its mural thrombus caused cerebral embolism. It was incidentally confirmed that the aneurysm grew at the rate of 1.31 cm/year, from 3.0 to 4.2 cm in diameter for 11 months, preciously measured in a computed tomography scan. The aneurysm was successfully repaired via partial cardiopulmonary bypass and separate perfusion of the left common carotid artery through cross-clamping the descending thoracic aorta and the aortic arch between the origins of the brachiocephalic artery and the left common carotid artery. Neither partial clamping of the aortic arch at the portion branching the left subclavian artery nor taping the aortic arch between the origins of the left common carotid artery and the left subclavian artery could be achieved.

Abdominal aortic aneurysm with arteritis in ankylosing spondylitis is described. An abdominal aortic aneurysm, 48-mm in diameter, in a 68-year-old woman with HLA-B27–associated ankylosing spondylitis was successfully replaced with a tube graft. The suture lines of the aortic wall were reinforced with Teflon felt strips. Pathologic examination of the aneurysmal wall revealed hyalinization of the connective tissue, with numerous lymphocytic infiltrates, remarkable calcification, and no elastic fibers. The original structure of the arterial wall was not recognized. These findings are compatible with aortitis reported in ankylosing spondylitis.

Clinical and histopathological features were investigated in 43 cases of oral lobular capillary hemangiomas (LCH) with a special reference to characteristics of the vascular elements. The lesions affected females more than males by a ratio of 1:1.5. Average age of the patients was 52.7 years. The lesions involved the gingiva (n = 15), the tongue (n = 13), the labial mucosa (n = 10) and other sites. The lesions appeared usually as a pedunculated mass with ulceration; size of the lesions was up to 15 mm. Histologically, a lobular area and an ulcerative area were distinguished. The density of vessels was about 1045/mm2 and 160/mm2 in the lobular and ulcerative areas, respectively. The average diameter of the vascular lumen was 9.1 5.6 mm (range: 2.8-42.0 mm) and 18.8 20.9 mm (range: 5.6-139.7 mm) in the lobular and ulcerative areas, respectively. In the lobular area, most of the vessels had an inner layer of endothelial cells showing positive reaction for von Willebrand factor (vWF) and CD34, as well as an outer layer of mesenchymal cells showing positive reaction for alpha-smooth muscle actin (ASMA). However, in the ulcerative area, there was a variety of types of vessels consisting of various proportions of both endothelial and ASMA-positive perivascular mesenchymal cells. These results indicate that most of the vascular elements in the lobular area resemble more pericapillary microvascular segments than they do capillaries. Thus, the authors propose the term 'lobular pericapillary hemangioma' to represent this type of lesion.

We encountered a case of left hepatic duct cancer that developed 7 years after surgical resection of early-stage adenocarcinoma of the gallbladder. A 65-year-old woman was hospitalized with high fever and general fatigue. She also had elevated serum levels of alkaline phosphatase, gamma-glutamyltranspeptidase, and carbohydrate antigen 19-9. Seven years earlier, she had undergone extended cholecystectomy and resection of the extrahepatic bile duct for early-stage mucinous adenocarcinoma of the gallbladder. Conventional examinations did not reveal any responsible lesions. Magnetic resonance (MR) cholangiography, however, showed a tumor obstructing the left hepatic duct, and dynamic MR images revealed multiple foci of bacterial abscess in the liver. Surgically resected tissue again revealed mucinous adenocarcinoma. The present case is rare in that metachronous mucinous adenocarcinoma of the biliary system occurred after a long interval. This case suggests the usefulness of MR imaging in the postsurgical monitoring of patients with gallbladder carcinoma.

We performed successful simultaneous operations for an abdominal aortic aneurysm (AAA) and liver cancer in a patient complicated by severe ischemic heart disease. A 59-year-old man with a history of liver dysfunction presented with acute epigastric pain. Abdominal computed tomography findings of ascites and a liver tumor indicated a diagnosis of ruptured hepatocellular carcinoma. He had a concomitant 65-mm AAA and a 48-mm right common iliac aneurysm. Elective surgery was scheduled because of his good general condition. Although triple-vessel disease was detected preoperatively, there were no graftable coronary arteries. The aneurysms were repaired first to utilize intra-aortic balloon pumping (IABP) during resection of the liver cancer, followed by left lateral segmentectomy. Perioperative hemodynamics were maintained by administering catecholamines and vasodilators, without the need for IABP. The patient was discharged on the 21st postoperative day without any complications, and no recurrence of liver cancer has been found in the 5 months since his operation.

Objective. The dual function of β-catenin (e.g., as an intermediate protein between adherence junctions and the microfilaments, and as a mediator of the Wnt signaling pathway) is currently known. Stabilization of β-catenin and subsequent activation of the Wnt signaling pathway are involved in the development of some malignancies. We analyzed the immunohistochemical localization of β-catenin and the somatic mutation of exon 3 of the β-catenin gene in the malignant phenotype of the uterine cervix. Methods. Immunohistochemical localization of β-catenin and mutation of exon 3 of the β-catenin gene were analyzed in 38 precancerous lesions and 43 cancerous lesions. Results. In normal cervix, β-catenin was observed around the plasma membrane of the cells in the basal and parabasal layers of the epithelium. The frequency of cytoplasmic/nuclear β-catenin expression correlated with a high histological grade of cervical intraepithelial neoplasia. Among invasive carcinomas, 11 (73%) of 15 samples showed cytoplasmic/nuclear localization to variable extents. A mutational analysis showed that mutation occurred in 7 of 68 specimens. Six cases with mutations revealed cytoplasmic/nuclear β-catenin expression, though 32 (84%) of the 38 samples showing cytoplasmic/nuclear β-catenin expression were not associated with the mutation. Conclusion. These results indicate that cytoplasmic/nuclear expression of β-catenin is associated with the malignant phenotype of the cervix, but the contribution of mutation of the β-catenin gene is limited.

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.

Leiomyomas of the fallopian tube are rare. They are typically incidental findings seen at autopsy or unrelated surgical procedures. A 32-year-old woman presented with lower abdominal pain and mass. Transvaginal sonogram and magnetic resonance imaging showed the solid mass at the outside of the uterus. At surgery, the left fallopian tube contained a firm mass with torsion in the area of the ampullary-isthmic junction. The left tube and the infundibulopelvic ligament were rolled in torsion and showed edematous change. We report a rare case in whom torsion of a pedunculated tubal leiomyoma caused abdominal pain.

We report herein the case of a 27-year-old woman found to have an abdominal desmoid tumor involving the xyphoid and costal chondrium associated with pregnancy. The patient was referred to our department on the third day after delivery for investigation of a fist-sized, firm tumor in the infrasternal angle, first noticed during the eighth month of gestation. Computed tomography and magnetic resonance imaging revealed a well-defined mass, 9 x 7.5 cm in size, invading the xyphoid. The tumor could be radically excised with the xyphoid, a lower part of sternum, and the chondrium of the bilateral sixth and seventh ribs, including 1.5 cm of free margin. The resected specimen measured 10 x 11.5 x 11.5 cm and weighed 395 g. Histological examination revealed the lesion to be a desmoid tumor consisting of spindle cells with small, elongated nuclei infiltrating dense collagenous fibers. The patient had an uneventful postoperative course and was discharged on the 11th postoperative day. There has been no evidence of recurrence in the 6 months since her operation. This case is of interest with regard to the possible contribution of sex hormones, especially estrogen, to desmoid tumor development.

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.

OBJECTIVE The purpose was to examine whether MR and CT imaging can detect extracapsular invasion of hepatocellular carcinoma (HCC) and, if this is possible, to determine its characteristic signs on MR and CT images. MATERIALS AND METHODS Thirty-eight patients with small HCC (< or = 3.0 cm in diameter) were studied to correlate the findings in surgically resected specimens with the findings on MR and CT images. RESULTS Ten of 38 patients had histologically proven extracapsular invasion of HCC. Of these 10 patients with extracapsular invasion, partial projections of the tumor into the surrounding area or satellite nodules in the immediate vicinity of the tumor were observed in 9 patients on T1-weighted images and in 5 patients on postcontrast CT images. Partial tumor projection or satellite nodules were not observed in patients without extracapsular invasion of HCC. The detection rate for these characteristic signs was 90% on MR and 50% on CT. CONCLUSION Magnetic resonance and CT imaging were useful for detection of extracapsular invasion of HCC. The characteristic signs for extracapsular invasion of HCC were partial tumor projection into the surrounding area and satellite nodules in the immediate vicinity of the tumor.

The present study was designed to confirm the transient increases of plasma Lp(a) levels as an acute-phase reactant and to clarify the significance of these increases with the use of patients with acute myocardial infarction and patients subjected to surgical operations. Although interleukin 6, C-reactive protein and alpha 1 antitrypsin reached the maximal levels 1-2 days, 3 days and 4-5 days, respectively, after the episodes, the peak time of Lp(a) levels was delayed some extent in both patient groups. Studying the transient increases of Lp(a) levels as a function of apo(a) isoforms analyzed by density-gradient ultracentrifugation and SDS-PAGE, the higher-density Lp(a) particles preferentially containing high-molecular-weight apo(a) isoforms increased more than the lower-density Lp(a) particles containing low-molecular-weight apo(a) after the episodes. The immunohistochemical findings suggest that Lp(a) may play an important role as an acute-phase reactant in the repair of tissue injury, especially in the process of angiogenesis.

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.

We report the effectiveness of bromocriptine therapy in resolving the abnormal responses of plasma FSH and LH to TRH in a 70-year-old male with FSH-secreting pituitary macroadenoma who had unsuccessful transsphenoidal pituitary surgery. In the pre-treatment and post-operative periods, respectively, basal plasma levels of FSH were increased to 88.7 and 65.6 mIU/ml (normal range; 8.5-32.4) but those of plasma LH were normal being 7.0 and 4.1 mIU/ml; (normal range; 4.1 to 14.0). The responses of plasma FSH and LH to LHRH were exaggerated and their paradoxical responses to TRH were highly suggested. During the bromocriptine therapy, the basal level of plasma FSH was normalized and that of plasma LH remained normal. The magnitude of FSH and LH responses to LHRH decreased and their paradoxical responses to TRH were completely resolved.

No effective chemotherapy for advanced extramammary Paget's disease has yet been established. A case of vulvar Paget's disease with systemic metastases was treated with a mitomycin C, vincristine and cisplatin combination chemotherapy, by which the vulvar lesion and serum CEA were clearly decreased. After surgery and 5-fluorouracil treatment, a similar combination chemotherapeutic regimen was administered to treat a recurrence, however, the lesions became resistant.

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.

Tumors at the trigone of the lateral ventricles are relatively rare. The authors have operated on eight cases with trigonal tumors during a 10-year period. Four cases were true intraventricular tumors arising from the ventricular walls, consisting of two meningiomas, one cavernous angioma, and one choroid plexus papilloma. On the other hand, the remaining four cases were paraventricular tumors originating in the adjacent brain and consisted of three astrocytomas and one glioblastoma multiforme. Although these trigonal tumors were readily detected with computed tomographic (CT) scanning, differential diagnosis was difficult because of their similar appearances on CT scans. The initial symptoms were headache in seven, and the neurological examination revealed personality changes, choked disc, visual field defects, hemiparesis, etc., in four, and no deficits in the remaining four cases. All cases were operated on via superior or middle temporal gyrus incision, and the surgical results were good except for one case who died of postoperative brain edema. In the four cases with tumors located in the dominant hemisphere, two were left with sensory aphasia, dyslexia, dyscalculia, and hemianopsia which improved within 6 months. In these two cases, postoperative CT scans revealed cerebrospinal fluid retention with severe edema along the surgical route which disappeared spontaneously within 3 months. We consider that the temporal gyrus incision was the safest approach, even though the tumor was located in the dominant side.

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.