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We experineced a case of liver cell adenoma which was resected after having been observed for about 6 years, in a 75-year-old man. In 1990 the patient had had a malignant lymphoma and a remission had been attained by 5 courses of CHOP, when a low-density tumor shadow 2cm in diameter was noted in the S6 of the liver on abdominal CT. Needle aspiration biopsy cytology was conducted with a suspicion of HCC, but no definitive diagnosis was made. Then, the patient was periodically followed up by abdominal CT, ultrasonography, magnetic resonance imaging (MRI). In 1996, the tumor had enlarged to 5cm in diameter on imagings and a possible malignancy was unable to be ruled out with a needle biopsy. A segmentectomy (S6) including the tumor was carried out. The resected tumor was capsulated, and the section was segmented and yellowish brown with a part of green in color, without central cicatrix. Histological findings included proliferation of tumor cells with trabecular arrangement like hepatic cell which was light in color and poor in atypia, and normal liver except the tumor. So the definite diagnosis of liver cell adenoma was made. Liver cell adenoma presents a problem of differentiation from FNH and highly differentiated HCC. The disease is a relatively rare benign tumor of the liver in this country, and so the case of the disease is reported, together with a review of the literature.

We experienced a case of thyroid oxyphilic cell follicular carcinoma causing tracheal stenosis. A 62-year-old man was seen at the hospital because of wheezing expirations. A chest X-ray film revealed a tumorous shadow in the left upper mediastinum and displacement and stenosis of the trachea. After admission thyroglobulin (Tg) level in blood increased to 88.9ng/ml. CT and magnetic resonance imaging visualized a tumor shadow extending from the neck to anterior upper mediastinum, displacement to the right of the tracha and esophagus, and a nodular shadow in the lung field. Angiography showed extrinsic pressure, distenstion, and displacement of the brachiocephalic and common carotid arteries; and displacement and narrowing of the internal carotid artery. From needle biopsy findings the patient was diagnosed as the disease and was operated on. At surgery, the tumor extended from the left lobe of the thyroid into the mediastinum, oppressing the vascular vein, and there was infiltration into the trachea and esophagus. Extiraption of the tumor with lymph node dissection in the mediastinum was carried out. The extirpated tumor was 11×8×4cm in size. The section was bright yellowish brown. Histopathologically trabeculer and solid proliferation of large tumor cells with oxyphilic plasma was seen. Postoperative Tg level was normalized. There have been only 37 cases of the disease in Japan so far. This rare case is described here.

Lipomas are the most common benign tumors, and in addition mature adipose tissue rarely shows cartilaginous or osseous metaplasia. This paper presents a rare case of lipoma showing areas of both cartilage and bone formation.A 17-year-old student presented to our hospital complaining of painless swelling over a large portion of the antero-lateral aspect of the right thigh, initially noted two years previously as a small swelling. It gradually increased to its present size. The tumor spontaneously appeared without any association with injury or symptoms of infection. The tumor was movable, but tenderness or local heat were not noted. Plain X-P disclosed a large radiolucent mass, with calcification or ossification at the center of the mass. The results of CT and MR imaging indicated the mass to posssibly be a large adiposelike tumor with calcification and ossification. The tumor, situated inter-muscularly among the rectus femoris muscle, vastus intermedius muscle, tensor fasciae latae muscle and vastus lateralis muscle, was surgically extirpated en bloc. Gross examination indicated a large mass, 15×7×5cm, soft, well circumscribed, and thinly encapsulated. A cut section was pale yellow, and bony masses were seen. Pathological examination data warranted a diagnosis of lipoma with cartilaginous and osseous metaplasia.

In May 2006, a 72-year-old man with acute myelogenous leukemia (M4Eo) was admitted to our hospital. He had been receiving antiandrogen treatment for prostate cancer (after an operation in 1998) and treatment for diabetes mellitus. He received chemotherapy according to the JALSG GML200 protocol, which led to complete remission; however, in January 2007, his leukemia recurred. CAG combination chemotherapy also resulted in complete remission by May 2007. In August 2007, he developed multiple liver tumors, abdominal pain, and fever. Contrast-enhanced computed tomography revealed hypovascular tumors in both early and delayed phases. Angiography showed ring-like tumor staining and a massive tumor, similar to those seen in metastatic hepatocellular carcinomas (HCCs). He eventually died because of aggressive enlargement of liver tumors during the following month accompanied by the simultaneous recurrence of leukemia and unsuccessful embolization of the hepatic artery. Autopsy specimens showed fibrosis and considerable iron deposition in the liver, suggested secondary hemochromatosis due to transfusion. We also detected multiple moderately differentiated primary HCCs. Secondary hemochromatosis, androgen imbalance, and humoral factors from leukemic cells were believed to be the causes of the rapid onset and development of HCCs.

Goblet cell carcinoid of the appendix is a rare neoplasm and clinically tends to take a malignant course. Most cases are young and early stage, and the surgical strategy is available. But appropriate chemotherapy for inoperable cases with peritoneal dissemination is not established. A 77-year-old woman with a past history of appendectomy was admitted to our hospital complaining of abdominal fullness. Abdominal computed tomography showed massive ascites and slight contrast enhancement of appendix. A tumor was found by colonoscopic examination at the orifice of vermiform and was diagnosed pathologically as goblet cell carcinoid of the appendix. Laparoscopy showed multiple peritoneal dissemination. We performed intraperitoneal paclitaxel(PTX)administration at 70 mg/m(2) week without any resection of the tumor. Ascites were reduced immediately, but drug-induced interstitial pneumonia occurred due to PTX. After steroid therapy, we switched to systemic S-1 therapy. For about one year, her tumor was controlled but became worse thirteen months after diagnosis and died. It is thought that intraabdominal paclitaxel administration and systemic S-1 therapy can be one of appropriate forms of chemotherapy for inoperable peritoneal carcinomatosis from goblet cell carcinoid of appendix.

We presented the case of a 46-year-old man with no medical or family history but with a history of smoking 3 packs of cigarettes per day for the past 25 years. He was admitted to our hospital due to hemoptysis. Chest computed tomography revealed a tumor of right upper lung and interstitial pneumonia in the surrounding lung parenchyma. He was operated upon and diagnosed with stage IIB pleomorphic carcinoma of the lung with invasion of the chest wall. He underwent three courses of postoperative carboplatin (CBDCA) (area under the curve 5 on day 1, every 3 weeks and paclitaxel(PTX) (200 mg/m(2); day 1, every 3 weeks) combination chemotherapy. No recurrence was observed for a period of 760 days after the operation. According to previous reports, lung pleomorphic carcinoma is aggressive and has a poor prognosis. Further, the significance of chemotherapy in the management of this disease has not been established. Postoperative combination chemotherapy of CBDCA and PTX may result in a good prognosis for this disease.

The authors encountered a rare case of necrotizing myositis in the upper extremity due to invasive Group A Streptococcal infection. This is the first such case reported in Tokushima.The patient was forty-three year old male who came to our hospital for pain of the right upper extremity and fever.His general condition suddenly worsened, followed by septic shock (Toxic shock-Like Syn-drome). Internal medication was administered and surgical treatment conducted for six months with good results.The present case demonstrates the importance of early diagnosis and the need for internal medication and surgery.

39歳男性.腹痛と右側胸部腫瘤のため入院.右側胸部の皮下と右肺尖部に腫瘍がみられたほか,右腎周囲後腹膜の腫脹と腹腔内リンパ節の腫大を認めた.入院後,血性の胸腹水が急速に増加し,化学療法の効果なく,入院24日目に出血性ショックのため死亡した.剖検後の組織学的検討により,後腹膜原発の脱分化型脂肪肉腫と診断した.脱分化型脂肪肉腫は稀な疾患で,後腹膜に好発するが,本例のような体腔内出血による急激な転帰の報告はない.

Distribution of intracytoplasmic lysozyme in proliferative and neoplastic fibrohistiocytic lesions and non fibrohistiocytic tumors was studied by immunoperoxidase technique on formalin fixed, paraffin-embedded sections. The cases examined were 161 fibrohistiocytic lesions and 86 non-fibrohistiocytic tumors. Contrary to our expectation, the lysozyme positive cells were found only in the minority of cases with fibrohistiocytic lesions. Cells positive for lysozyme were found only in 13 out of 100 cases of dermatofibroma, one out of 4 cases of xanthogranuloma and 8 out of 33 cases of malignant fibrous histiocytoma. Dermatofibrosarcoma protuberans and non-fibrohistiocytic tumors were negative for lysozyme. It is suggested that in proliferative fibrohistiocytic lesions, induction of lysozyme synthesis is weak or absent. Some malignant fibrous histiocytomas showed scattered lysozyme positive neoplastic cells, indicating their probable histiocytic origin or differentiation. On the other hand, evidence of histiocytic differentiation of dermatofibrosarcoma protuberans was not obtained using lysozyme immunohistiochemistry.

A case of recurrent periosteal epithelioid hemangioendothelioma of the right femur in a 66-year-old woman is reported. Microscopic examination showed epithelioid tumor cells with frequent intracytoplasmic vacuoles arranged in small nests or cords in hyalinized stroma. Immuno- and lectin-histochemical studies for factor VIII-related antigen and ulex europaeus I lectin indicated the endothelial nature of the tumor cells. Ultrastructurally, a few tumor cells contained leptomeric fibrils and crystalline filamentous aggregates in addition to showing certain features of endothelial cells. There seems to be no previous report of a vascular tumor containing leptomeric fibrils, which are often noted in normal striated muscle cells and their tumors. The bland appearance of the epithelioid tumor cells, poor vasoformative nature and prolonged clinical course differentiated this tumor from conventional angiosarcoma and so-called hemangioendothelioma of bone.

The epithelial properties of the cells in six cases of synovial sarcoma, five biphasic and one monophasic, were examined. Epithelial cells formed well demarcated glandular nests with a multi- or single-layered lining, poorly defined nest-like clusters, or appeared as scattered single plump cells in a spindle-cell stroma. Keratinization was seen in multi-layered epithelia, and was suggested in single-layered epithelia from the presence of some enlarged eosinophilic cells. Immunohistochemically, epithelia lining glands showed reactivity for both low- and high-molecular-weight (MW) cytokeratins, and the reactions for both were strongest in keratinized cells. Clustered or single plump cells showed low-MW cytokeratin reactivity. All epithelial cells were negative for the largest cytokeratin (no. 1), and occasionally stained positively for vimentin. Spindle-shaped stromal cells usually stained positively for vimentin only. Type IV collagen was distributed linearly around well circumscribed epithelia, but not around poorly defined epithelia or plump cells. Epithelial membrane antigen was distributed linearly along glandular spaces and irregularly or granularly in clustered plump cells. The immunophenotypic epithelialization in synovial sarcoma was restricted, but showed considerable correlation with the histological grade of differentiation.