Search

Summary Background In a recent study, it was reported that transcatheter arterial embolization with spherical embolic material for life-threatening hemorrhages in various cancer patients was safe and effective. Calibrated microspheres are able to access distal regions of the target arteries, which results in the disappearance of tumor staining. However, there are few reports on the pathological behavior of EmboSpheres in gastric cancer specimens. In this case, we succeeded in salvage embolization for advanced gastric cancer with hemorrhagic shock using spherical embolic material. To our knowledge, this is the first report of a pathological evaluation of spherical embolic microspheres in a gastric cancer specimen. Case Report A 70-year-old man with scirrhous gastric cancer was admitted to our hospital for staging laparoscopy. Unfortunately, he had a sudden onset of hematemesis and melena leading to hemorrhagic shock due to bleeding from the gastric cancer. While undergoing a rapid blood transfusion, he underwent emergent embolization to achieve hemostasis. The left gastric and right gastroepiploic arteries were embolized with spherical embolic material, and the patient survived. Two days later, the patient was able to undergo gastrectomy. A large number of microspheres were observed in areas of hemorrhage. The range and median diameter of the minor axis were 177–1048 μm and 281 μm, respectively. Conclusions Transcatheter arterial embolization using spherical embolic material could become one of safe and effective options, especially when there is no extravasation or pseudoaneurysm but only tumor staining from the clinical and pathological point of view.

Very few studies have been published on the long-term histopathologic follow-up of spherical embolic agents after their injection. To our knowledge, there are no reports in the literature regarding pathological analysis of the transvascular migration of HepaSphere particles. We here report a case of a patient with hepatocellular carcinoma (HCC) who underwent liver transplantation 12 months after drug eluting microsphere transcatheter arterial chemoembolization (DEM-TACE), and long-term histopathologic follow-up of the microspheres was performed. Furthermore, to our knowledge, this is the first report in which transvascular migration of a HepaSphere particle was confirmed histologically. A 60-year-old male with chronic hepatitis B was treated with entecavir and seroconversion was obtained. The patient had decompensated cirrhosis, and desired to undergo living donor liver transplantation (LDLT). However, 2 HCC tumors of 3 cm or less were detected in his liver. The transplantation surgeon proposed DEM-TACE as a bridge therapy. The HCCs were located in the right lobe and lateral segment of the liver. A 1.9 F preshaped microcatheter (ProgreatΣ, Terumo, Japan) was selectively inserted into the A3 and anterior segmental branch, 10 mg of epirubicin was injected into each artery, and the arteries were embolized with 7 mg and 13 mg of HepaSphere loaded with epirubicin, respectively. Two months later, contrast-enhanced CT displayed a complete response. At that time, lung metastasis was suspected, but after partial lung resection, the patient was diagnosed as having inflammatory granuloma. One year after DEM-TACE treatment, LDLT was performed. No cancerous cells were detected in the area where the tumor was present, but 22 HepaSphere particles were detected. All particles were present in the interstitium. Furthermore, the transvascular migration of a HepaSphere particle was histologically confirmed. The largest and smallest HepaSphere diameters were 241.6 ± 52.5 µm and 186.5 ± 41.4 µm, respectively, and deformity was 22.6% ± 13.0 %. All the HepaSpheres detected in the examined pathological specimen were noted to be extravascular.

The patient was a 45-year-old man with underlying alcoholic liver cirrhosis. Two years prior, he was repeatedly hospitalized for liver failure symptoms and requested a living-donor liver transplantation (LDLT) because of end-stage cirrhosis. A pretransplantation blood test revealed a high 1,3-beta-d-glucan (BDG) value of 102.0 pg/mL (reference value

Background. Thyroid carcinoma complicated by hemiagenesis is very rare, and previous reports have not described this cancer on the side of the absent lobe. Methods and Results. We report the case of a 64-year-old woman in whom left thyroid hemiagenesis was discovered incidentally during investigations of abnormal sensation during swallowing. A tumorous 1.4 cm lesion was also found on the side of the absent lobe, left of the isthmus. Fine-needle aspiration biopsy revealed class V papillary carcinoma, but no lymph node metastases. Total thyroidectomy was performed for stage cT1bN0M0 carcinoma. Histopathology revealed normal thyroid tissues in the right lobe and isthmus, while the left lobe was absent. The mostly papillary carcinoma was adjacent to the truncated thyroid tissue, with a portion histologically consistent with poorly differentiated carcinoma. Conclusions. All previously reported cases of thyroid cancer complicated by hemiagenesis have represented carcinoma occurring within the present lobe. This case is extremely rare.

We report a very unusual cytologic feature, intranuclear inclusion bodies, in mesothelioma of a predominantly adenomatoid type. The patient, a 57-year-old woman, was presented with dyspnea and right pleural effusion. Pleural aspiration cytology revealed many cohesive ball-like clusters, with a tubular pattern, composed of small atypical cells displaying a high-nuclear-cytoplasmic ratio. They had a nuclear groove and irregular intranuclear inclusion bodies. Right lung partial resection with thoracoscopy revealed that a white tumor had proliferated along the pleural surface at S(8) . Histology revealed nodular tumor cells forming dilated structures mixed with small tubular or glandular structures similar to those seen in benign adenomatoid tumors. These tumor cells had invaded peripheral lung tissues. Such inclusion bodies have not been reported earlier in mesothelioma. On the basis of this observation, we propose that the adenomatoid type of malignant mesothelioma be added to the differential diagnosis of malignant effusions when tumor cells with nuclear grooves and intranuclear inclusions are found in pleural aspiration cytology.

Bloody nipple discharge is a clue in the detection of ductal carcinoma of the breast that do not display a mass. Since sensitivity of discharge cytology is not sufficiently high and mammary ductendoscopy (MS) contributes to the diagnosis of intraductal lesions. We set out to determine whether the intraductal approach is effective for detection of ductal carcinoma. We performed 445 MS procedure in 323 patients who had nipple discharge but no overt mass. The diagnostic accuracy rates of discharge cytology and intraductal breast biopsy (IDBB) were studied in detecting malignancy. The therapeutic value of IDBB for intraductal papillomas was studied in 73 patients. Out of 323 patients, 80 had breast cancer and 155 had intraductal papilloma. MS detected intraductal tumors in 47 cases (58.8%). IDBB was performed in 35 of these 47 cases. The sensitivity was 37.1% by touch cytology, 68.6% by IDBB, and 82.8% by directed ductal lavage cytology. Of the 73 intraductal papilloma patients who were followed for more than 3 years, the therapeutic effectiveness of IDBB was recognized in 57 (78.1%). Directed ductal lavage cytology was the most sensitive method in detecting malignancy. MS and IDBB were benefit in the treatment of intraductal papilloma.

61歳, 女性. 1993年に左乳癌にて胸筋温存乳房切除術, 腋窩リンパ節郭清施行. 病理組織学的診断は浸潤性小葉癌n=8/12, Estrogen receptor (ER) (+), Progesterone receptor (PR) (+). 術後放射線療法 (左鎖骨上, 左腋窩, 傍胸骨) 50Gy施行. 術後薬物療法はクエン酸タモキシフェン (20mg/day) とフルオロウラシル (200mg/day) を3年間投薬. 術後10年無再発にて経過. 2003年8月より下腹部痛出現. 経過観察していたが症状増強するため, 2004年7月に下部消化管内視鏡検査を施行. 直腸に全周性の発赤と狭窄を認め, 同部位の生検結果は低分化腺癌であった. 腫瘤を形成しないびまん性病変で, 直腸癌としては非典型的のため乳癌転移も疑い免疫染色を施行した所, 乳腺原発巣と同様にER (+), PR (+) であった. 以上より乳癌直腸転移と診断し, エキセメスタン (25mg/day) の内服を開始した. 内服2カ月後より腹部症状は軽快し, 22カ月経過し現在も外来通院している.

Summary Background Levels of pepsinogen have been reported to correlate with the degree of gastric atrophy in Helicobacter pylori-infected gastric mucosa. Aim To investigate the relationship between PG levels and histological atrophy before and after H. pylori eradication. Methods Eradication therapy was conducted on 180 H. pylori-positive patients with upper gastrointestinal conditions. Endoscopy was performed prior to and at 2, 12 and 24 months after successful eradication therapy. Histological findings were scored using the updated Sydney System in the antrum and the corpus of the stomach. Pepsinogen was measured. Results Pepsinogen I levels dropped significantly at 2 months after the eradication. By 12 months and 24 months post-eradication they had risen again. Histological improvement was seen in atrophy at all sites at 24 months after the eradication. A significant correlation between atrophy and pepsinogen I was seen from prior to eradication. The correlation coefficient was greater at 2 months post-eradication, decreased again at 12 months and was no longer significant at 24 months. Conclusions Our results suggest that pepsinogen levels correlate with the degree of gastric mucosal atrophy prior to and soon after successful eradication therapy, but that the degree of correlation subsequently declines over time.

Purpose: Highly invasive and metastatic cancer cells, such as adenocarcinoma of the lung cells, form irregular protrusions by assembling a branched network of actin filaments. In mammalian cells, the actin-related protein 2 and 3 (Arp2/3) complex initiates actin assembly to form lamellipodial protrusions by binding to Wiskott-Aldrich syndrome (WASP)/WASP family verproline-homologous protein 2 (WAVE2). In this study, colocalization of Arp2 and WAVE2 in adenocarcinoma of the lung was investigated to elucidate its prognostic value. Experimental Design: Immunohistochemical staining of Arp2 and WAVE2 was done on mirror sections of 115 adenocarcinomas of the lung from pathologic stage IA to IIIA classes. Kaplan-Meier disease-free survival and overall survival curves were analyzed to determine the prognostic significance of the coexpression of Arp2 and WAVE2. Results: Immunoreactivity for both Arp2 and WAVE2 was detected in the same cancer cells in 78 (67.8%) of the 115 lung cancer specimens. The proportion of cancer cells expressing both Arp2 and WAVE2 was significantly higher in cases with lymph-node metastasis (P = 0.0046), and significantly lower in bronchioloalveolar carcinomas (P < 0.0001). The patients whose cancer cells coexpressed them had a shorter disease-free survival time (P < 0.0001) and overall survival time (P < 0.0001). Multivariate Cox regression analysis revealed that coexpression of Arp2 and WAVE2 is an independent risk factor for tumor recurrence. Conclusions: Coexpression of Arp2 and WAVE2 is correlated with poorer patient outcome, and may be involved in the mechanism of cancer metastasis.

The combination of white light and autofluorescence bronchoscopy has been reported to show better sensitivity in detecting dysplasia and cancer of the bronchus than white light alone. However, fiberoptic bronchoscopy has been replaced by videoendoscopy at most leading facilities for over a decade. To avoid interruption of the videoendoscopy examination to perform fiberscopy-based autofluorescence examination as well as enhancing the sensitivity of intraepithelial lesions, autofluorescence diagnosis system integrated into a videoendoscope (SAFE 3000, Pentax, Tokyo) was created. A total of 154 consecutive patients were studied using this system, containing 83 known or suspected lung cancer cases, 46 of the cases with abnormal sputum cytology findings, 10 follow up cases following lung cancer operations, and 15 heavy smokers with respiratory symptoms. Abnormal findings were recognized by white light and/or SAFE 3000 at 166 sites and biopsies were taken to evaluate the relationship between endoscopic findings and pathology results. The sensitivity of the system for CIS+dysplasia was 65% in white light and 90% in SAFE. This videoendoscopy-based autofluorescence system had significantly higher sensitivity for intraepithelial lesions than white light videoendoscopy alone.

Primary Sjögren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of the salivary glands and lacrimal glands. The histological features of chronic inflammation in primary Sjögren's syndrome may be associated with B cell hyper-reactivity. This syndrome also has various manifestations associated with other exocrine glands and nonglandular tissues. The hematological abnormalities usually seen in Sjögren's syndrome are lymphopenia, leucopenia, and thrombocytopenia. Although the direct Coomb's test is often positive, the occurrence of autoimmune hemolytic anemia (AIHA) is rare. Here, we report an elderly patient with primary Sjögren's syndrome who developed AIHA during the clinical course.

Salivary duct carcinoma (SDC) is an uncommon, high-grade tumor. We present 8 cases of sarcomatoid SDC, which has been defined recently as a rare variant of SDC. The 8 patients (5 men, 3 women) had a mean age of 63.6 years. Histologically, all tumors were characterized by a biphasic neoplasm composed of both SDC and sarcomatoid elements. In 3 cases, sarcomatoid components showed osteosarcomatous heterologous differentiation. A residual pleomorphic adenoma was detected in 5 tumors. The sarcomatoid component showed focal immunoreactivity for cytokeratin in 4 cases and epithelial membrane antigen in all 8 cases. Diffuse p53 immunostaining was detected in 3 cases, and it was coexpressed in both components. Our observations support the histogenetic theory of a common origin of the carcinomatous and sarcomatoid populations. Of the 13 patients, including our 8, reported to have sarcomatoid SDC arising in a major salivary gland and for whom long-term follow-up data were available, 7 have died of disease (mean survival, 15.6 months). These results indicate that sarcomatoid SDC is a highly aggressive tumor, similar to conventional SDC.

We report a case of persistent local recurrence of rhabdoid meningioma in the cervical spinal cord. Recently, the meningioma has been reported to be undergoing rhabdoid transformation, but the clinical course is still unclear. Histopathological examination of the tumor showed that it was composed of both meningothelial cells and rhabdoid cells. At each recurrence of the tumor, the population of the rhabdoid cells had increased and the ability to grow had also increased, confirmed by the MIB-1 labeling index. This case showed that phenotypic change of the cells with "rhabdoid" morphology may affect meningiomas and that such changes are associated with aggressive biological and clinical behavior. This newly classified tumor should be recognized in the differential diagnosis of meningioma.

Background: Helicobacter pylori causes chronic gastritis and is also associated with many other gastrointestinal diseases. The incidence of gastric cancer is thought to vary according to the degree and topography of chronic gastritis. Histological findings of specimens obtained at endoscopy are therefore important. In the present study, we investigated the correlation between these histological findings and serum pepsinogen (PG) levels. Methods: Helicobacter pylori eradication therapy was conducted in 100 H. pylori-positive patients. Endoscopies were performed prior to, and 2 months after, eradication therapy; gastric mucosal biopsies were taken from the antrum and corpus. Helicobacter pylori infection was diagnosed using the rapid urease test, culture and histology. Using the Updated Sydney System, histological findings of inflammation, activity, atrophy and intestinal metaplasia were each graded. Blood was taken on the same two occasions for determination of serum levels of PG I and II. Results: Levels of PG I were highest in association with antrum-predominant gastritis (APG), followed in order by pangastritis (PAN) and corpus-predominant gastritis (CPG), with a significant difference between APG and CPG. No correlations were seen between PG II levels and gastritis topography. Examination of the relationship between PG levels and histological findings revealed significant correlations between PG I levels after eradication atrophy and intestinal metaplasia in the gastric corpus. No significant correlations were seen between PG II levels and before or after eradication histological findings. Conclusion: Our results indicate that serum PG levels may be a useful indicator of before-eradication gastritis topography and after-eradication gastric atrophy in the gastric corpus.

An invasive micropapillary component has been described in tumors of several organs and is nearly always associated with aggressive biologic behavior. We present 14 cases of salivary duct carcinoma (SDC) with an invasive micropapillary component (invasive micropapillary SDC) and compare the clinicopathologic findings of these cases with those of cases of conventional SDC. The mean age of the 14 patients (10 men, 4 women) was 65.8 years (range, 26-80 years). The mean size of the tumors was 2.4 cm (range, 1.3-5 cm). The parotid gland was involved in 12 patients and the submandibular gland in 2. Histologically, all tumors had an invasive micropapillary architecture admixed with features typical for SDC. Invasive micropapillary carcinoma was characterized by morula-like small cell clusters without fibrovascular cores, surrounded by a clear space. Tumor cells exhibited moderate- to high-grade nuclear features, conspicuous nucleoli, and eosinophilic cytoplasm. This component was distributed diffusely in 9 tumors and focally in 5. Angiolymphatic and perineural invasion was seen in all tumors. A residual pleomorphic adenoma was detected in four tumors. Of the 12 tumors examined, all were diffusely positive for cytokeratin 7 and epithelial membrane antigen (with a distinctive "inside-out" pattern) but negative for cytokeratin 20. Tumors were frequently immunoreactive for BRST-2 (gross cystic disease fluid protein-15) and androgen receptor protein. Aberrant expression of HER-2/neu or p53 was detected in seven tumors each. The mean Ki-67 labeling index was 33.1% (range, 6.3%-61.6%). All 14 patients with invasive micropapillary SDC had cervical or periglandular lymph node metastasis, and this value was significantly higher than for conventional SDCs. Local recurrence developed in 4 patients and distant metastatic disease in 9. Clinical follow-up (mean, 25.5 months) was available for 13 patients: 9 died of disease within 24 months after the diagnosis (mean, 17.6 months), 1 was alive with metastatic disease at 19 months, and 3 were free of disease. Overall survival of these patients with invasive micropapillary SDC was significantly shorter than that of patients with conventional SDC (n = 49) in our series (P = 0.031). Our results suggest that invasive micropapillary SDC is a distinct, aggressive variant of SDC, with a propensity for extensive lymph node metastasis and rapid disease progression.

Dedifferentiated adenoid cystic carcinomas are a recently defined, rare variant of adenoid cystic carcinomas characterized histologically by two components: conventional low-grade adenoid cystic carcinoma and high-grade "dedifferentiated" carcinoma. We examined six cases and analyzed their clinicopathologic profiles, including immunohistochemical features and p53 gene alterations. The 6 patients (3 men and 3 women) had a mean age of 46.8 years (range, 34-70 y). The mean size of the tumors was 3.5 cm (range, 1.7-6 cm). The submandibular gland, maxillary sinus, and nasal cavity were involved in 2 cases each. Postoperatively, 5 patients had local recurrence and 5 developed metastatic disease. Five patients died of disease at a mean of 33.7 months after diagnosis (range, 6-69 mo), and one other was alive with disease at 60 months. Histologically, the conventional low-grade adenoid cystic carcinoma component of the tumors consisted of a mixture of cribriform and tubular patterns with scant solid areas. The high-grade dedifferentiated carcinoma component was either a poorly differentiated adenocarcinoma (4 cases) or undifferentiated carcinoma (2 cases). Three tumors were studied immunohistochemically. Myoepithelial markers were expressed in low-grade adenoid cystic carcinoma but not in the dedifferentiated component. In 2 cases, diffusely positive p53 immunoreactivity together with HER-2/neu overexpression was restricted to the dedifferentiated component. Loss of pRb expression was demonstrated only in the dedifferentiated component of the 1 other case. The Ki-67-labeling index was higher in the dedifferentiated component than in the low-grade adenoid cystic carcinoma component. Furthermore, molecular analysis of 2 cases demonstrated the loss of heterozygosity at p53 microsatellite loci, accompanied by p53 gene point mutation, only in the dedifferentiated carcinoma component of 1 case, which was positive for p53 immunostaining. These results indicate that dedifferentiated adenoid cystic carcinoma is a highly aggressive tumor. Because of frequent recurrence and metastasis, the clinical course is short, similar to that of adenoid cystic carcinomas with a predominant solid growth pattern. Limited evidence suggests that p53 abnormalities in combination with HER-2/neu overexpression or loss of pRb expression may have a role in dedifferentiation of adenoid cystic carcinoma.

Mucoepidermoid carcinoma (MEC), a common malignant salivary gland neoplasm, is generally divided into low-, intermediate-, and high-grade types according to the histologic features. To our knowledge, the present report describes the first case of dedifferentiation occurring in a low-grade MEC. A 55-year-old man presented with a biphasic neoplasm of the right parotid gland composed of low-grade MEC and dedifferentiated high-grade anaplastic undifferentiated carcinoma. Immunohistochemically, carcinoembryonic antigen expression was restricted to the low-grade MEC portion. The Ki-67-labeling index was higher in the dedifferentiated component than in the low-grade component. On image cytometric analysis, the low-grade MEC was diploid, whereas the dedifferentiated carcinoma was aneuploid. Although the patient was alive 10 years after the initial diagnosis, the tumor has recurred twice, at 3 months and 7 months after the initial resection. It is important to recognize that dedifferentiation can occur in a low-grade MEC, similar to other low-grade salivary gland carcinomas.

We report a dumbbell-type solitary fibrous tumor in the cervical spine. Eight spinal solitary fibrous tumors have been reported previously, but the cervical location is rare and this may be the first report of a dumbbell-type tumor. Histopathological examination showed that the tumor was composed of spindle cells in a collagen-rich matrix, although regional variability was noted. Diffuse immunostaining for CD34 and vimentin was noted in the cytoplasm of the tumor cells. This rare tumor should be recognized in the differential diagnosis of cervical spinal tumors.

We present a new cell line, EN, established from an invasive endometrioid adenocarcinoma of the uterine corpus in 50-year-old patient. The cells show rapid growth in culture with a doubling time of 24.4 hours and high migration activity. Monolayer-cultured cells were polygonal in shape and showed a tendency to pile up without contact inhibition. Subcutaneous transplantation of the EN cells into nude mice formed solid tumors that were histologically diagnosed as adenocarcinoma, whereas no metastasis was observed. Cultured EN cells produced tissue polypeptide antigen. Genetic and molecular analyses revealed high telomerase activity and estrogen receptor beta but not alpha expression. Using the polymerase chain reaction-single strand conformation polymorphism technique, we have screened EN cells for TP53 mutation in exons 5-8. A mobility shift was observed in this cell line in exon 8. A nucleotide insertion (CGT-->CAGT) was detected at codon 273, which resulted in a creation of a stop codon at codon 308. This cell line thus appears to represent the development of a more malignant clone with divergent receptor function and growth behavior, and provides us with an interesting new tool for the study of tumorigenesis in the human endometrium.

ejd.2012.1748 Auteur(s) : Yuta Kurashige1 kurasige@tokyo-med.ac.jp, Takayuki Kariya1, Hirofumi Hirano1, Hiroshi Kawakami1, Tokuya Minemura1, Tetsuo Nagatani1, Hiromi Serizawa2 1 Department of Dermatology, 2 Department of Pathology, Hachioji Medical Center, 1163 Tatemachi Hachioji-shi, Tokyo 193-0998, Japan Primary mucinous carcinoma of the skin (PMCS) is a rare form of malignant neoplasm with characteristic histopathological findings, such as an abundance of mucin pooled on the stroma. However, [...]

CD10 is a cell surface metalloprotease expressed by a variety of normal cell types, including lymphoid precursor cells, germinal center B lymphocytes, and some epithelial cells. We noticed that stromal cells of some cancers are positive for CD10. In this study, we investigated the role of CD10 produced by the stromal cells of colorectal neoplasms in the progression of colorectal neoplasms. Immunohistochemical examination of CD10 and p53 was performed in 169 colorectal epithelial neoplasms representing various stages of carcinogenesis. The results were correlated with the morphologic characteristics of the neoplasms. There was no expression of CD10 in the stromal cells of normal colorectal tissue. CD10-positive stromal cells were present adjacent to the tumor cells in 16 of 73 adenomas with mild or moderate dysplasia. More frequent expression of CD10 by the stromal cells was detected in adenomas with severe dysplasia (12 of 17), intramucosal carcinomas (10 of 16), and invasive carcinomas (50 of 63) than in adenomas with mild or moderate dysplasia (P0.0001). Expression of CD10 by10% of the stromal cells was detected only within the area of the invasive growth front of invasive carcinomas, not in adenomas and in only 1 of the intramucosal carcinomas. The difference between invasive and non invasive tumors was significant (P0.0001). The stromal expression of CD10 was significantly associated with the accumulation of p53 and a larger tumor size. These results indicate that CD10 expression is an integral part of colorectal carcinogenesis. CD10 expression seems to contribute to the invasion and thus probably facilitates metastasis.

A 49-year-old Japanese female was initially diagnosed as having monoclonal gammopathy of undetermined significance in June 1993 (IgG lambda: 3,120 mg/dl). Four years later, she developed AL amyloidosis complicated by nephrotic syndrome and renal failure. Before receiving 5 courses of MP therapy (melphalan plus prednisolone), her serum IgG level had decreased in accordance with the appearance of nephrotic syndrome, which led to the leakage of serum immunoglobulin into the urine. After the discontinuation of the MP therapy, hypogammaglobulinemia has been kept over 24 months, though she still shows a leakage of 4-5 g/day of serum protein, including IgG into the urine. There were no signs of the progression of amyloidosis or renal failure, resulting in a good clinical performance status. Hypogammaglobulinemia due to nephrotic syndrome may have prevented the progression of AL amyloidosis in this case.

背景:皮膚原発のアポクリン癌はまれで, さまざまな抗体を用いることにより組織学的診断が可能であるが, 細胞所見の報告は少ない.われわれは腋窩部原発アポクリン癌の2例を経験し, その細胞学的特徴を検討した.症例:症例1は49歳男性で5年前に左腋窩部腫瘍摘出術を受けたが, 局所再発をきたした.吸引細胞診ではほとんどが孤立散在性で, 一部に上皮性細胞集塊が含まれていた.腫瘍細胞は細胞質が厚くて広く, 断頭分泌を認めた.組織学的には充実性, 索状および腺管状構造を示し, 腫瘍細胞の細胞質は広く好酸性で, 断頭分泌, ジアスターゼ抵抗性PAS陽性顆粒が認められた.GCDFP-15が陽性であった.症例2は53歳の男性で, 15年前に左腋窩部腫瘤の診断を受け, 摘出術が施行された.リンパ節の擦過細胞診では比較的重積性の少ない上皮性細胞集塊が主体で, 腫瘍細胞は大型で広い細胞質, 円形から卵円形の偏在核と明瞭な核小体を持ち, 断頭分泌が認められた.組織学的には潰瘍を形成し, 腺管形成を伴い皮下脂肪織まで浸潤していた.細胞質は広く好酸性で断頭分泌が認められ, ジアスターゼ抵抗性PAS陽性顆粒を含んでいた.GCDFP-15が陽性であった.結論:腋窩部に発生するアポクリン癌は汗腺あるいは副乳由来のアポクリン癌や転移性腺癌が鑑別となる.皮膚原発アポクリン癌は細胞診でも特徴的な像を保持しており, 詳細な検討によって推定診断が可能であると考えられた.

背景:乳腺の紡錘細胞癌はWorld Health Organization (WHO) の分類ではcarcinoma with metaplasiaの一型と考えられている。われわれは経時的に2回の穿刺吸引細胞診を行い, 細胞所見に大きな相違の認められた症例を経験した.症例:患者は33歳女性で, 右乳頭より血性分泌物が認められ, 腫瘤を触知するようになった. 第1回目の穿刺吸引細胞診で浸潤性乳管癌と診断されたが放置していた. 2ヵ月後に行われた第2回目の穿刺吸引細胞診では, 肉腫様細胞集塊が主体で, 破骨細胞様の多核巨細胞が含まれていた. 手術標本による病理組織学的検索では, 辺縁部に充実腺管癌を認めたが, 大部分が肉腫様であった. 両者には移行が認められた.結論:紡錘細胞癌は予後不良と考えられており, その診断は重要である. しかし, 細胞診では必ずしも, その特徴を反映しているとは限らず, 確定診断は困難であることが多い. さらに同一症例でも採取時の条件により細胞所見に大きな相違が認められる可能性が示唆された.

We report 2 patients with follicular lymphoma (FL) which was accompanied by Waldenström's macroglobulinemia (WM). One patient was a 65-year-old woman and the other a 60-year-old man. Both patients showed a high level of circulating macroglobulin (4.6 g/dL and 3.6 g/dL, respectively) and bone marrow involvement of small lymphoid cells. Moreover, in each case, the macroglobulin-producing component and the follicular component were determined to be of the same clone based on their identical light-chain restriction pattern and other factors. However, there was a difference in the histopathological characteristics of the macroglobulin-producing components of the 2 patients, especially the cytoplasmic immunoglobulin (Ig)M+ cell distribution in the biopsied lymph nodes. Test results for the female patient showed intrafollicular proliferation of those cells. The male patient's test results showed that IgM+ cells were located in the narrow extrafollicular areas of the lymph nodes. Our observations suggest that at least 2 different subtypes of FL may also be causative of a WM presentation.

Background Intracytoplasmic lumina have been recently recognized as a characteristic histologic feature of ependymoma. However, the cytologic diagnostic usefulness has not been discussed. We encountered two imprint cytology cases of spinal cord ependymomas in which there were intracytoplasmic lumina in the tumor cells. Cases Two women had spinal cord tumors on magnetic resonance imaging. Imprint cytology study was carried out on the resected tumors. The cytologic specimen of the first case, aged 52, showed tumor clusters consisting of elongated epithelioid cells, a few of which also had intracytoplasmic lumina. Histologically, tumor cells formed ependymal rosettes and pseudoperivascular rosettes. There were a few tumor cells with intracytoplasmic lumina. The cytologic specimen of the second patient, aged 37, had scattered and isolated tumor cells with intracytoplasmic lumina resembling signet-ring cells and paired tumor cells forming small, glandlike structures. Histologically, the tumor was composed mainly of signet-ring-like cells containing intracytoplasmic lumina. Conclusion Intracytoplasmic lumina were observed in the imprint cytologic specimens of spinal cord ependymoma. The diagnosis of ependymomas can be made cytologically when intracytoplasmic lumina are found since no other primary neuroepithelial tumors of the central nervous system possess such a characteristic feature.

症例は70歳女性.平成8年8月,右C領域の腫瘤を主訴として来院.同年12月にT2a, N0, M0, Stage II乳癌の診断で当科にて乳房円状部分切除術およびLevel II郭清を施行した.切除断端は陰性で,組織型は充実腺管癌, n0, f (+), ly (-), v (-)であった.放射線療法は本人の希望にて施行せず,遠方のため近医での外来通院となった.その間補助療法は施行されず,平成10年10月創部の硬結を主訴に再来した.マンモグラフィにて,同部位に一致した集簇型微細石灰化像と,超音波上の腫瘤像を認めたため,残存乳房内の局所再発と診断し,外来にて局麻下に乳腺部分切除術を施行した.術後の病理組織検索においては約1.5cmの腫瘤を認めるも,癌細胞は認められず,間質組織に瀰漫性に広がる微細石灰沈着が著明な巨細胞肉芽腫であり,ヘモジデリン貪食細胞の集団も認められた.現在再発の徴候は認められていない.

We report a case of malignant phyllodes tumor of the prostate which is the eleventh reported case in the world. Phyllodes tumor of the prostate is extremely rare and histologically resembles mammary phyllodes tumor. Phyllodes tumor of the prostate is classified into benign, borderline and malignant, but health professionals should carefully follow up the borderline cases in case they take a malignant clinical course. This case was the first to be treated by pre- and postoperative radiation therapy. Although the patient had a slight response to radiation therapy, he eventually developed metastasis. Because malignant phyllodes tumor of the prostate is a very aggressive tumor, people with the condition should undergo systemic chemotherapy as adjuvant therapy.

In a woman with chronic lymphocytic leukemia (CLL), a plasmacytoma developed on the back region after four years. CLL cases complicated with plasmacytoma are rare. In the present case, the plasmacytoma showed kappa cytoplasmic immunoglobulin (Ig), and the CLL showed gamma lambda surface Ig. To reveal the clonal origin of CLL and plasmacytoma, we analyzed Ig gene rearrangements in the patient's peripheral blood and plasmacytoma. Ig gene DNA analysis confirmed the presence of different rearrangements in the heavy and light chain genes of CLL and plasmacytoma. These findings suggest that in this patient, the two B cell malignancies arose from expansion of two phenotypically and genotypically distinct clones.

We searched for the Chlamydia psittaci DNA the touchdown enzyme time release PCR (TETR-PCR) in 23 specimens from 21 patients with ocular adnexal lymphoproliferative disorders, including 12 patients with MALT lymphoma to identify C. psittaci infection. Southern hybridization of the PCR product using the C. psittaci-specific probe failed to detect C. psittaci, although three samples appeared to be positive by ethidium bromide staining. This indicates that technical approach for detecting C. psittaci infection in ocular adnexal lymphoma might be an essential in disclosing this association.

BACKGROUND Mucinous tubular and spindle cell carcinoma of the kidney is a newly established subtype in the World Health Organization classification. The tumor has a good prognosis, and its diagnosis is clinically important. However, there are no reports of its cytologic features. Here we report the cytologic findings of this rare tumor. CASE A 68-year-old female had left-sided abdominal pain, fatigue and hematuria. A large mass in the left kidney was removed. Histologically, the tumor was compatible with mucinous tubular and spindle cell carcinoma. Imprint cytologic examination revealed a large amount of tumor cells arranged in tubular, sheetlike and spindle structures. Some tumor cells showed clear cytoplasm. Nuclear atypia was mild, with occasional distinctive nucleoli. CONCLUSION The cytologic features of mucinous tubular and spindle cell carcinoma have a varied appearance. It should be included in the differential diagnosis to avoid overtreatment.

A case of simultaneous double cancer of the breast and malignant melanoma is reported. A 33-year-old single woman with a lentigo on left sole was admitted to the department of dermatology for further examination. In the same time, she moticed her left mastalgia and bloody nipple discharge. But no lump was palpated in the breast. She was performed a wide tumor excision of the left sole, and histological diagnosis was malignant melanoma. Initially, it was diagnosed that the complaints night depend on mastopathy, but cytological findings of the specimen indicated an existance of breast cancer. Mammography showed scattered malignant calcification and ultrasonography showed intraductal spreading. From these findings, a non-invasive ductal carcinoma on the left breast was suspected. Wide exsicion with out axillary dissection and radiation therapy were performed by histological findings. The postoperative course was uneventful and no tumor has recurred for about one year after the operation. There are a few reports of double cancer of the breast and malignant melanoma. The cancer patients must be followed up with attention to probable second malignancy.

Smooth muscle cells are extremely rare stromal components of fibroadenoma. Eighty-five cases of fibroadenoma were reviewed in order to investigate the frequency of smooth muscle cells and to discuss its origin. Of the 85 cases, four (4.7%) cases showed smooth muscle cells in the stroma. Distribution in terms of age and tumor size did not show any difference from other cases. Three cases were classified as an intracanalicular subtype, and one was a mastopathic subtype. The cells possessed most of the ultrastructural characteristics of smooth muscle cells, but poor indentation of nuclear contours suggested the last remnant of fibroblasts. It was therefore easy to recognize the cells derived from fibroblasts. In two of four cases, smooth muscle cells were observed in the stroma, which had marked hyalinization and calcification. Therefore, it was supposed that smooth muscle cells could appear in the stroma of long-standing tumors.

40歳の男性。平成元年1月に梅毒感染の機会があった。同年8月頃に左前腕に紅色の皮疹が出現し, その後両上肢, 躯幹に拡大した。皮疹出現時より全身倦怠感あり。放置していたが症状が軽快しないため10月31日当科初診。両上肢, 躯幹に紅色で小豆大∼示指頭大の扁平隆起性丘疹が多発していた。血液生化学検査で肝機能障害を認めた。血沈の亢進も認めた。病理組織学的には弾性線維の変性とそれを多核巨細胞が貪食する像(elastophagocytosis)を認めた。臨床症状より梅毒が疑われたため梅毒抗体価を測定したところTPHA法10240倍, ガラス板法512倍であった。梅毒抗体価の上昇, 臨床症状より第2期梅毒と診断した。サワシリン®(amoxicillin)1500mg/day投与により皮疹, 肝障害は改善し, その後症状の再燃はない。梅毒の際には多彩な組織所見を呈することが知られているが自験例のようにelastophagocytosisを認めたとの報告は調べ得た限りなくきわめて稀と思われた。

本研究の目的は, 子宮内膜の細胞集塊を立体構築的にみて増殖症にはどのような特徴が有り, それがどの程度診断に役立つかを検討することである. 対象はエンドサイト法, 直接塗抹にて得られた, 正常内膜40例 (24～76歳, 平均48歳) と腺腫性および異型増殖症28例 (40～58歳, 平均48歳) である. 判定は, 裂隙形成集塊あるいは乳頭状集塊の出現の有無, それら集塊における問質成分の有無と最外層核の位置について検索を行った. 正常内膜の集塊には3層以上の重積のある乳頭状集塊で複雑な乳頭状分岐が作り出す “すきま” を持つ集塊あるいは分岐のない単純な乳頭状集塊は認めず, 間質成分, 内膜上皮, 内膜腺が種々の程度に混在する集塊として認めるか, おのおの単独に認められた. 増殖症では10例 (36%) に裂隙形成集塊あるいは乳頭状集塊を認めた. そのうちの9例は集塊周囲に少量の間質成分を伴い, 最外層の核が間質側に偏在している集塊 (以下, 集塊の外側), つまり粘膜固有層内にとどまる増殖を示唆する集塊が認められた. また集塊周囲に問質成分を欠き, 最外層の核は内側に位置している集塊 (以下, 集塊の内側), つまり子宮内腔および腺腔内へ突出する増殖を示す集塊は3例に認められた.われわれは以前に, 高分化内膜腺癌では子宮内腔へ乳頭状突出を示唆する集塊が得られやすいという報告をしたが, 本検索において増殖症では粘膜固有層内にとどまる増殖を示唆する集塊の出現する割合が高いという特徴が得られたと考える.

The cytomorphological aspects of a mammary angiosarcoma in a 44 year-old woman are presented. The imprint cytology of the resected mastectomy specimen revealed a small number of scattered isolated cells and variously sized cellular clusters. The clusters were characterized by a mixture of centrally oriented spindle shaped cells and peripherally located epitheloid-like oval-to-polygonal cells forming papillary projections. These features correlated well with the intraluminal papillary patterns in the histological sections and also agreed with many of the cytological features of angiosarcoma which previously described in the literature. The characteristic cellular pattern with mixed spindle cells and epitheloid-like cells in clusters as seen in this case, although not reported previously, may be of diagnostic value.