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Dieulafoy’s lesion, also known as a caliber-persistent artery of the stomach, is an uncommon cause of GI bleeding; it accounts for only 2% of episodes of acute and chronic bleeding.1,2 This mucosal lesion, usually occurring along the lesser curvature of the proximal stomach, is small and shallow but can be associated with a massive, life-threatening hemorrhage. Dieulafoy’s lesion may be difficult to diagnose, especially when bleeding is absent. Although initial descriptions were based on surgically resected specimens, endoscopy is a sensitive and accurate means of diagnosis. Dieulafoy’s lesion is now almost always treated endoscopically, with hemostasis achieved in most patients.3,4 A patient is described with gastric cancer who presented with massive upper GI hemorrhage from a Dieulafoy’s lesion in the stomach; hemostasis was established endoscopically. To the investigators’ knowledge, there is only one other report of gastric cancer associated with a histopathologically proven Dieulafoy’s lesion.5 Whenever the slightest suspicion of malignancy is present in cases with atypical endoscopic findings for Dieulafoy’s lesion, follow-up endoscopy with biopsies should be performed for accurate diagnosis.

A case of nasal NK/T cell lymphoma with central nervous system (CNS) involvement is reported. A 56-year-old man presented with eyelid edema and transverse myelopathy. Cerebrospinal fluid examination revealed atypical lymphoid cells with azurophilic granules, which were positive for CD2, CD8, and CD56, and negative for CD3 and CD5 by flow cytometry. Because a tumor mass was found involving the ethmoid and maxillary sinuses, CNS involvement was considered to have resulted from local invasion by the nasal lymphoma. In spite of intensive chemotherapy including intrathecal infusion, the patient died 6 months after the initial diagnosis. Autopsy revealed that lymphoma cells were positive for cytotoxic molecules, granzyme B and TIA-1, and EB virus-encoded RNA-1 (EBER-1), and they showed no rearrangement of TCR-beta, -gamma, or -delta genes, suggesting an NK-cell origin of the lymphoma cells. They showed an angiocentric and angiodestructive pattern in the subarachnoid space, focally extending to the cerebral cortex and cranial and spinal nerve roots. Marked demyelination was found in the lateral and posterior funiculi of the spinal cord. Thus, the pathogenesis of this spinal demyelination might be attributed to ischemia secondary to angiocentric and angiodestructive infiltration by lymphoma cells.

A bamboo joint-like (BJL) appearance is an endoscopic finding characterized by swollen longitudinal folds transversed by erosive fissures or linear furrows, and it seems to be associated with Crohn's disease (CD). We performed gastroduodenoscopy in 1781 patients, and found BJL lesions in 15 (65.2%) of 23 CD patients and 20 (1.1%) of 1758 non-CD patients. Histological examination of the biopsy specimens showed sharp, fissure-like erosion or mucosal cleft in 7 (50%) out of 14 CD patients and one (20%) out of 5 non-CD patients. All cases with fissure-like erosion or, mucosal cleft revealed lymphoid aggregates, eosinophilic infiltration and edema in the superficial portion of the surrounding lamina propria. Epithelioid granuloma was seen at the base of the fissure-like erosion in two cases with CD. Our results indicated that fissure-like erosion or mucosal cleft in gastric biopsy specimens reflects the BJL appearance, and that such findings may provide a diagnostic clue to CD.

Background Solitary fibrous tumor is a rare spindle cell tumor and has been forced at a variety of sites. To the best of our knowledge, only two cases of solitary fibrous tumor arising in the spinal cord have been reported; no cytologic findings were documented. Case A 62-year-old male presented with a spinal cord tumor. A scrape smear of the resected tumor revealed naked, spindle-shaped nuclei. Some nuclei were twisted or had long spindles. In the background, abundant, thin and thick collagen fibers were present. Immunohistochemically, the spindle cells were positive for CD34 and negative for S-100 protein and alpha-smooth muscle actin. Histologic diagnosis of the tumor was benign solitary fibrous tumor. Conclusion Our case indicates that solitary fibrous tumor can occur in the spinal cord and should be differentiated from other benign spindle cell tumors, such as meningioma and schwannoma. The key cytologic features of solitary fibrous tumor may be the presence of abundant thin and thick collagen fibers in scrape specimens.

We report a case of sarcomatoid renal cell carcinoma with chromophobe cell foci. The patient was a 57-year-old Japanese woman with a renal mass measuring 12x8x8 cm in diameter. Histologically, the tumor was composed predominantly of sarcomatoid renal cell carcinoma with foci of chromophobe cell carcinoma. The patient died of multiple metastases 2 months after operation. To the best of our knowledge, there have been only two reports of the coexistence of sarcomatoid renal cell carcinoma and chromophobe renal cell carcinoma in the literature. Our case indicates that chromophobe cell carcinoma may be connected with sarcomatoid renal cell carcinoma. In such a case, the prognosis may be related to the latter component.

A型胃炎に合併した神経内分泌細胞過形成の塗抹細胞像について報告する. 患者はA型胃炎を有する61歳, 女性で, 切除された胃の多発性小隆起性病変から捺印細胞診が行われた. 塗抹標本では異型性に乏しい小型類円形細胞が腺房状もしくは孤立散在性に出現していた. 核クロマチンは穎粒状で, 細胞質内には好酸性の顆粒が観察された. これらの所見はカルチノイドに類似しており, 細胞診所見のみからの鑑別は困難と考えられた.なお, われわれが検索した限り, 神経内分泌細胞過形成の細胞像に関する報告はなかった.

色素嫌性腎細胞癌成分を伴った肉腫型腎細胞癌の1例を報告する. 患者は57歳の女性で, 右腎臓に12×8×8cm大の腫瘤が認められたため, 腎摘除術が行われた. 摘出された腫瘤の捺印細胞診では, 異型性に富む紡錘形細胞と核周囲明量や明瞭な細胞境界を特徴とする多稜形細胞の二種類の腫瘍細胞が観察された. 組織学的には腫瘍のほとんどは肉腫型の腎細胞癌で占められており, 一部に色素嫌性腎細胞癌の成分が存在した. 患者は腎摘除術から2ヵ月後に多発性の転移と癌性腹膜炎のため死亡した. 他の組織型よりも予後良好といわれている色素嫌性腎細胞癌が予後不良の肉腫型腎細胞癌に合併した症例の細胞像に関する報告はわれわれの調べた限りなく, 本例はきわめてまれな症例である.

Thyroid follicles in vivo are embedded in extracellular matrix (ECM). The composing epithelial cells are in close contact with ECM at the basal side. To examine cell-to-ECM interactions, we studied adhesion, proliferation and differentiation of porcine follicle cells monolayer-cultured on type I and IV collagen, fibronectin or laminin. At 3 h in culture, laminin had the lowest rate of cell adhesion. In proliferation, type IV collagen induced the highest level of nuclear bromodeoxyuridine intake. In a functional differentiation, laminin had about 3 times as much triiodothyronine production as the other ECM molecules. In confluent, culture cells, we also examined an expression of c-fos protein, a transcription factor that plays crucial roles in signal transduction. Immunocytochemistry detected the protein mainly in the nuclei. Western blot showed that laminin induced the highest level of its expression. Thyrotropin (TSH, 10 mU/ml) did not affect adhesion of the cells on any of the substrata or proliferation of the cells on fibronectin ; nor did TSH affect c-fos protein expression of the cells on the substrata except for fibronectin. Our results suggest that type IV collagen and laminin, major components of basement membrane, play positive roles in proliferation and differentiation of follicle cells, respectively, while laminin has no positive effect on adhesion of the cells at early culture ; that the cells express c-fos protein even in contact inhibition of growth and its expression is regulated in part by ECM ; and that ECM controls some behaviors of the cells in a TSH-dependent or TSH-independent manner.

A rare case of primary choriocarcinoma of the lung in a male is described with immunohistochemistry for human chorionic gonadotropin (hCG), epidermal growth factor (EGF) and EGF-receptor. The extragonadal trophoblastic origin of this pulmonary carcinoma was definitely confirmed by an autopsy examination, and hCG-production and hCG-positive staining of the tumor cells. Furthermore, the tumor cells clearly expressed EGF and its receptor which play an important role in the proliferation and differentiation of normal and neoplastic trophoblasts of the uterus. Our present case suggests that EGF may act in an autocrine manner in the tumor cells of primary pulmonary choriocarcinoma.

BACKGROUND: Macrofollicular variant of papillary thyroid carcinoma is defined as a combination of numerous macrofollicles occupying 50% of the tumor and foci of the conventional follicular variant of papillary carcinoma. To the best of ou knowledge, there have been no English-language reports on its cytologic findings. CASE: A fine needle aspiration specimen from a mass of the thyroid in a 59-year-old female showed a large collection of dense, inspissated colloid and a few sheets of tumor cells with nuclei characteristic of papillary carcinoma. There were no three-dimensional, branching papillae with fibrovascular cores. CONCLUSION: Although macrofollicular variant of papillary carcinoma is very rare, fine needle aspiration cytology may contribute to its correct diagnosis.

BACKGROUND: Sertoli cell tumor of the test is is a relatively rare neoplasm, and few reports concerning its cytologic findings have been previously documented. CASE: A 41-year-old male had Sertoli cell tumor in the left testis. An imprint smear revealed tumor cells showing a less cohesive or singly dispersed cell pattern. The cytoplasm was faintly stained, and most tumor cells were naked. The nuclei were oval or short and spindle in shape, and some of them showed coffee bean nuclei or nuclear indentation. CONCLUSION: Coffee bean nuclei can be observed in Sertoli cell tumor.

BACKGROUND: Sclerosing lipogranuloma of the scrotum is a rare granulomatous lesion of the subcutis. To the best of our knowledge, there have been no English-language reports dealing with its cytologic findings. CASE: A fine needle aspiration specimen from a mass in the scrotum in a 62-year-old male showed epithelioid cells, multinucleated giant cells and fibroblasts, which were suggestive of sclerosing lipogranuloma. The diagnosis was confirmed by histology of the resected specimen. CONCLUSION: Fine needle aspiration cytology is useful for the diagnosis ofsclerosing lipogranuloma. It is important, however, to interpret the fine needle aspiration cytology specimen in conjunction with the clinical information.

We describe a rare case of papillary carcinoma with extensive proliferation of stromal cells. The stromal cells were immunocytochemically positive for vimentin, alpha-smooth muscle actin and desmin, but negative for cytokeratin, epithelial membrane antigen, S-100, thyroglobulin and CD34. These results and the ultrastructure of the stromal cells, which exhibited the characteristics of both fibroblasts and smooth muscle cells, indicated an origin from myofibroblasts. We conclude that myofibroblastic proliferation may contribute to the stromal response in the slow growth of the papillary carcinoma.

The distribution of lipid peroxidation products in liposomes after γ-irradiation at various doses was studied. Increases in thiobarbituric-acid-reactive substances, in the absorbance at 232 nm and in hydroperoxides were observed mainly in liposomal membranes after relatively low doses of irradiation, while carbonyl compounds were distributed both inside and outside the membranes. After higher doses of irradiation, however, the absorbance at 232 nm and the amount of hydroperoxides reached a maximal level in the membrane portion and then decreased when the decomposition products were released from the membranes. Under this condition, malondialdehyde and other carbonyl compounds were increased mainly in the medium of liposomal suspension. These results are discussed with reference to the lipid peroxidation process which is induced quantitatively by ionizing radiation.