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Background: A special type of meningioma is known to have infiltrated inflammatory cells within the tumor, associated with peritumoral inflammation. However, there have been no reports of meningioma with inflammatory response only around the tumor, without inflammatory cells within the tumor itself. Case Description: A 70-year-old woman presented with transient right hemiparesis due to an extra-axial tumor on the left frontal convexity. The tumor appeared hypointense on T1-weighted magnetic resonance images and hyperintense on T2-weighted images without peritumoral edema, and was homogenously enhanced associated with the peritumoral leptomeningeal enhancement. Cerebrospinal fluid examination showed an increase in the number of inflammatory cells with a predominance of mononuclear cells. During the following 1 month, the tumor size was unchanged, but the peritumoral leptomeningeal enhancement was remarkably enlarged with uncontrolled focal seizures. The tumor was subtotally removed and semisolid substances in the subarachnoid space were biopsied. Pathological examination with immunostaining revealed angiomatous meningioma: the tumor had no inflammatory cell infiltration within it, but was associated with the infiltration of immunoglobulin G4-negative lymphocytes into the border zone between the tumor and the dura mater, as well as numerous neutrophils and fibrinous exudates in the peritumoral subarachnoid space. The tumor removal rapidly improved the leptomeningeal enhancement and inflammatory reactions. Conclusion: The authors reported the first case of angiomatous meningioma associated with massive peritumoral inflammation without inflammatory infiltrates within the tumor itself.

Dyspnea is a high priority symptom in the emergency department, with heart failure (HF) as one of its leading causes. Recently, the "comet tail sign (CTS)," a pulmonary ultrasonographic sign, has been proposed as an efficacious tool for detecting pulmonary edema. However, to the best of our knowledge, there have been no published data regarding its utility when performed by non-experts, including junior residents.Between September 2017 and December 2018, patients with dyspnea, who were admitted to the ER, were enrolled. CTS was evaluated by junior residents at the ER. All patients were evaluated by cardiologists independently, and clinical HF was defined as requiring pharmacological intervention by a cardiologist. At the end of this study, we investigated the results of CTS, laboratory data, and available radiological images.A total of 95 patients were enrolled in the current study, wherein 42 patients were treated by cardiologists as those with clinical HF. Our results showed that CTS could identify clinical HF with a sensitivity of 71.4% and a specificity of 81.1%. The sensitivity of CTS against brain natriuretic peptide (BNP) (cut-off value, 100 pg/ml) was calculated at 92.5%. Furthermore, when evaluated together with peripheral edema, CTS identified clinical HF with a sensitivity of 96%. False positives for CTS included bilateral pneumonia, hypoalbuminemia, and interstitial pneumonitis.Our results indicate that CTS is a simple and effective tool for the use of non-experts, including junior residents.

The beneficial effect of magnesium oxide upon the performance of crack-resistant oxide glasses has been explored in a series of aluminoborosilicate glasses with the compositions 60SiO2–(20 – x)Al2O3–xB2O3–20Na2O and 60SiO2–(20 – x)Al2O3–xB2O3–10Na2O–10MgO. The simultaneous presence of both boron and aluminum oxides in these glasses produces a synergetic effect upon crack resistance (CR), whose structural origins are being explored by detailed 11B, 23Na, 27Al, and 29Si single and double resonance solid-state NMR studies. Aluminum is exclusively four-coordinated, whereas boron is found in both three- and four-coordination. Substitution of B2O3 with Al2O3 and Na2O with MgO leads to a dramatic reduction of N4, the fraction of four-coordinate boron, accompanied by an increase in CR. 11B/27Al double resonance NMR studies show only weak interactions between the boron oxide and aluminum oxide components, giving no evidence of the formation of new structural units not already realized in the ternary aluminosilicat...

A 74-year-old man developed hepatic injury after intravesical Bacillus Calmette-Guérin (BCG) therapy for bladder carcinoma. Although hepatitis-associated disseminated BCG was suspected, granulomatous formations were undetectable. The hepatic injury was considered to have resulted from an allergic reaction to BCG therapy because a histopathological assessment revealed enlarged portal areas with eosinophils and neutrophils. The hepatic injury was resolved by prednisolone. This case suggested that hepatic injury associated with BCG therapy might be due to an allergic mechanism unrelated to disseminated BCG disease. A liver biopsy is needed to confirm the histopathological findings of hepatic injury after BCG therapy in order to differentiate allergic hepatic injury from infectious hepatic injury.

Benzpyrimoxan (5-(1,3-dioxan-2-yl)-4-{[4-(trifluoromethyl)phenyl]methoxy}pyrimidine, NNI-1501) was discovered as a novel insecticide structurally characterized by a pyrimidine derivative substituted with 1,3-dioxanyl and 4-trifluoromethylbenzyloxy groups. The compound showed remarkable activity against nymphs of rice planthoppers, including strains resistant to existing insecticides. Furthermore, benzpyrimoxan had low adverse effects on pollinators and beneficial arthropods. Because of these features, benzpyrimoxan is expected to be a suitable part of an integrated pest management strategy. In this report, the history of the discovery to reach benzpyrimoxan and details of the structure-activity relationships are described.

Benzpyrimoxan, (5-(1,3-dioxan-2-yl)-4-[4-(trifluoromethyl)benzyloxy]pyrimidine), is a novel insecticide with a unique chemical structure that contains benzyloxy and cyclic acetal groups on the pyrimidine moiety. The compound showed molting inhibition and provided excellent residual efficacy against nymphs of rice plant hoppers, including populations that had developed resistance to the existing chemical groups of insecticides. In addition, benzpyrimoxan had low impacts on the natural enemies and honey bees, suitable for integrated pest management strategy. In this review the history of discovery to reach benzpyrimoxan, the discovery of insecticidal pyridine or pyrimidine derivatives as lead compounds, and the details of substituent optimizations are discussed.

Background/aims It is sometimes difficult to distinguish between malignant and benign biliary strictures using imaging studies alone, and pathological diagnosis is necessary. The aim of this study was to determine the usefulness of endoscopic transpapillary tissue sampling and factors predictive of diagnostic accuracy. Methods From April 2008 to December 2014, 136 patients underwent endoscopic transpapillary tissue sampling for malignant biliary strictures. The cytological and histological findings were reported as negative, suspicious, or positive. Suspicious and positive findings were defined as pathologically positive. Results The sensitivity was 65.0% for forceps biopsy, 49.5% for brush cytology, 46.2% for bile aspiration cytology, and 21.9% for endoscopic nasobiliary drainage cytology. The combination of these procedures improved the sensitivity (72.8%). Endoscopic transpapillary tissue sampling was more sensitive for lesions of biliary origin (91.4%) than for extrabiliary lesions (66.3%). In surgical cases, the sensitivity for tumors with an infiltrative growth pattern (53.3%) was significantly lower than for a tumor with an expanding or intermediate growth pattern (87.5%). Conclusions Combining procedures can improve diagnostic accuracy. It may be possible to predict the sensitivity of endoscopic transpapillary tissue sampling by evaluating the etiology and tumor growth pattern using preoperative imaging studies.

In this report, we reviewed the results of RCPC held at the 63rd national congress of the Japanese Society of Laboratory Medicine. The case was a 9th decade female with dementia, who had anemia pointed out on a routine laboratory check. The type of anemia was macrocytic(MCV130 fL). The serum Vit.B12 and folate levels were markedly decreased. However, her anemia was not improved despite supplementation with Vit.B12 and folate (data on MCV were improved). The WBC increased gradually, but she subsequently died. Laboratory data were assessed by three doctors (DN, NM, and TT: blood cell counts, smear morpholo- gy of peripheral blood cells, and clinical chemistry, respectively). They diagnosed the patient with a hema- tological disorder, probably neoplastic hematological diseases; however, it was very difficult to make a further clinical diagnosis because of the necessary data not presented at this meeting. The final diagnosis was acute myeloid leukemia (AML-M4). The direct cause of death was rupture of her spleen due to the massive infil- tration of neonlastic cells. rReviewl.

Ciliated muconodular papillary tumor (CMPT) of the lung is a newly defined and extremely rare tumor characterized by a papillary growth pattern, consisting of ciliated columnar cells, mucous cells, and basal cells with abundant mucin production. Tumor definitions and clinicopathological features continue to be debated. Herein, we report five surgical cases of CMPT to characterize its radiographic, gross, and microscopic features. The five cases involved three male patients aged 80, 67, and 66 years, and two female patients aged 73 and 70 years. Three cases were discovered during health care screenings, and two cases were found during follow-up for another synchronous cancer. Histopathological examination revealed that the tumor tissue was composed of ciliated columnar cells, mucous cells, and basal cells with abundant mucin production. Neither nuclear atypia nor mitotic figures were observed. All patients had good prognoses. The benign histological features and clinical courses in these five cases suggest that CMPT is an independent and benign tumor of the lung.

A district heating system for household heating and road snow melting utilizing waste heat from Gas Turbine High-Temperature Reactors of 300 MW (GTHTR300s), a high-temperature gas-cooled reactor design, was analyzed. The application area was set in Sapporo and Ishikari, cities with heavy snowfall in northern Japan. The heat transport analyses were performed by modeling heat-transfer components in the system to estimate the system's overall heat supply profile. These components included the pipelines of the secondary water loops between the GTHTR300s and the heat-application area; heat exchangers to transfer the heat from the secondary loops to the tertiary water loops of the district-heating pipes; and the district-heating pipes of the tertiary loops between the heat exchangers and houses and roads. Single- and double-pipes for the secondary loops were compared. Although the double-pipes were advantageous for having less heat loss and a smaller excavation area, these advantages did not compensate for the higher construction cost of the pipes. To satisfy the heat demand of the application area in the month of maximum requirement, 520-529 MW of heat were supplied by 3 GTHTR300s and delivered by 6 secondary loops, 3,450 heat exchangers about 90 m long, and 3,450 tertiary loops. More efficient designs for the heat exchangers and improvements to the tertiary loops applying branched flow networks are desired to reduce the number of heat exchangers and tertiary loops and to make the heat exchangers smaller. Heat lost to the ground from the tertiary loops comprised 80%-90% of the heat loss. Applications of the larger pipe or loops using the branched flow network or double-pipe are required for more efficient heat utilization. More than 90% of the construction cost went into thermal insulators. The thickness and properties of the insulator must be reevaluated for economical heat delivery.

A 47-year-old woman with a single-nodule hepatic tumor was referred to our hospital. She had no symptoms. The tumor was located at the surface of the right lobe of the liver; it showed peripheral low signal intensity on a magnetic resonance imaging apparent diffusion coefficient (ADC) map, and an influx of blood flow into the peripheral area of the tumor at the early vascular phase on perflubutane microbubble (Sonazoid(®)) contrast-enhanced (CE) ultrasonography. Since we suspected a malignant tumor, the patient underwent surgical resection. The hepatic tumor was resected curatively. Pathological examination revealed that the tumor was composed of epithelioid cells with an epithelioid structure and/or cord-like structure. Immunohistochemical staining was positive for cluster of differentiation 34 and factor VIII-related antigen. Based on the above, a final diagnosis of hepatic epithelioid hemangioendothelioma (EHE) was made. Hepatic EHE is a rare hepatic tumor: only a few cases of hepatic EHE with curative resection have been reported. We were unable to reach a diagnosis of hepatic EHE by imaging studies; however, an ADC map was useful in showing the malignant potential of the tumor, and CE ultrasonography was useful in revealing the peripheral blood flow of the tumor. When an unusual hepatic mass is encountered, hepatic EHE should be kept in mind, and the mass should be inspected with more than one imaging modality, including an ADC map, in the process of differential diagnosis.

A 70-year-old woman was referred to our hospital because of early gastric cancer (lesser curvature of the antrum, 0-IIc, tub1, 15 mm) and underwent endoscopic submucosal dissection. Microscopically, the lesion was found to be confined to the mucosa, and predominantly composed of well-differentiated tubular adenocarcinoma with a micropapillary component. On immunohistochemical examination, the characteristic "inside-out pattern" of the micropapillary component was observed; thus, we diagnosed the lesion as gastric cancer with a micropapillary component. Invasive micropapillary carcinoma is a rare subtype of gastric carcinoma, and, to our knowledge, this is the first case of invasive micropapillary carcinoma of the stomach confined to the mucosa.

Tumor lysis syndrome (TLS) is an oncological emergency caused by massive cytolysis of malignant cells. This syndrome eventually induces metabolic abnormalities. TLS is observed mainly among tumors with rapid cell proliferation or high sensitivity to antineoplastic treatment. In rare cases, TLS occurs without any cytotoxic treatment. Previous reports have shown that alternative stress including proceeding infection or an operation might play a role in TLS. However, exact mechanism of spontaneous TLS remains unknown. Here, we describe a case of a 59-year-old woman who presented with dedifferentiated endometrial adenocarcinoma and developed TLS without any cytotoxic chemotherapy. Although spontaneous TLS in solid malignancies are extremely rare, clinicians should consider the possibilities of TLS especially in aggressive solid tumors.

Here, a case of Ewing’s sarcoma family of tumors (ESFT) of the femur with an unusual clinical course is reported. At 20 years of age, the patient had undergone curettage of a bone tumor of the right femur which was diagnosed as ESFT. One cycle of chemotherapy with vincristine and cyclophosphamide and radiotherapy for a total dose of 40 Gy was administered. The patient did not develop any recurrence or metastases for the following 18 years, in spite of the inadequacy of the initial treatment. At 38 years of age, he was referred to our institution with right thigh pain that had persisted for several months. Radiographs and magnetic resonance imaging findings showed a mass lesion in his proximal femur extending to the soft tissue. An open biopsy was performed and the lesion was diagnosed as recurrence of ESFT, although a molecular biological investigation did not reveal any expression of the characteristic fusion genes that have previously been reported. The patient received standard multimodal therapy employing standard combination chemo-therapy for ESFT and wide surgical excision. The patient has been disease-free for 9 years since the treatment. This patient may have a rare subtype of ESFT with an unknown chromosomal translocation and relatively non-aggressive biological behavior.

Carcinoma with a large central acellular zone (central acellular carcinoma, CAC) and matrix-producing carcinoma (MPC) have been recently noted as basal-like-type breast cancers, but the two entities are often confused. To clarify their histological differences, the histopathological sections of 15 CAC and seven MPC were examined and the following features were compared by reviewing slides: (i) mode of invasion; (ii) alteration of cancer cell adhesion in the transitional area between cellular and acellular zones; (iii) staining of the stromal matrix; (iv) lymphocyte infiltration; and (v) tumor grade. Complete agreement was required between two observers for the assessments of these features. All CAC had relatively sharp margins but showed infiltrative growth accompanied by eosinophilic intercellular matrix. In CAC there was abrupt transition between peripheral cellular and central acellular zones without alteration of cancer cell adhesion. In contrast, all MPC showed expansive growth with a well circumscribed margin, accompanied by basophilic and myxoid intercellular matrix. In MPC there was gradual transition from cellular to acellular areas with gradual loss of cancer cell adhesion. Histological grade 3 and peripheral lymphocyte infiltration were common features. It is suggested that CAC and MPC are histologically distinct entities, and that the aforementioned features are helpful for differential diagnosis.

A rare case of post-radiation epithelioid hemangioendothelioma arising in a congenital hemangioma of the lower leg 18 years after radiotherapy is reported. At 7 years of age, the patient underwent partial resection of a subcutaneous congenital hemangioma with intramuscular extension of the left lower leg, and at 10 years of age, the patient was given radiotherapy with a total dose of 30 Gy for recurrence. At 28 years of age, the patient noticed a large tumor mass with intractable pain at the antero-lateral aspect of the proximal lower leg, and she presented to our hospital. Since microscopic examination of a biopsy specimen showed epithelioid hemangioendothelioma, disarticulation at the knee joint was performed. Although malignant change in a benign vascular tumor is extremely rare, irradiation can induce malignant transformation of a hemangioma.

Post-transplant lymphoproliferative disorders (PTLD) represent a heterogenous group of lymphoid proliferations that develop as a consequence of immunosuppressive therapy in recipients of solid organ or bone marrow (BM) transplantation (BMT). PTLD range from benign hyperplastic lesions to lymphoid neoplasm including plasma cell tumors, and they are mostly Epstein–Barr virus-related [1, 2]. In contrast to the high incidence of post-transplant lymphomas, PTLD manifesting as plasma cell tumors such as multiple myeloma and extranodal plasmacytoma are extremely rare [3]. We report a case of plasmacytoma without evidence of Epstein–Barr virus (EBV) infection which developed rapidly after bone marrow transplantation. A 45-year-old Japanese male with myelodysplastic syndrome (MDS, RAEB-1) received myeloablative allogeneic bone marrow transplantation due to progressive pancytopenia and episodes of recurrent infection. Pretransplant evaluation did not detect plasma cell proliferation in bone marrow aspirate and clot sections, monoclonal gammopathy on serum protein electrophoresis, or splenomegaly on the computed tomography (CT) scan (Fig. 1a). The serum IgG, IgA and IgM values were 1,160, 188, and 123 mg/dl, respectively. These were within the normal range. The conditioning regimen comprised conventional TBI and CY. He had no available HLA-identical family donors. He received an infusion of unmanipulated bone marrow containing 3.6 9 10/kg nucleated cells from a minor ABO-incompatible, one allele-mismatched (HLA DRB1) (disparities in the rejection direction), unrelated male donor. Tacrolimus and short-term MTX were administered for GVHD prophylaxis. Treatment with G-CSF was initiated on day ?5. On day ?7, severe stomatitis and febrile neutropenia (FN) developed. Immediate treatment was started with broad-spectrum antibiotics and an anti-fungal agent. The patient engrafted (ANC[500/mm) on day ?18 after the transplant. However, a platelet count above 5 9 10/mm was not observed. Along with recovery of the neutrophil count, stomatitis and FN improved. Cytomegalovirus (CMV) antigenemia developed on day ?28. Treatment with ganciclovir was started and CMV antigenemia disappeared. The patient did not develop acute graft-versus-host disease (GVHD). On day ?36, a fever of unknown origin and bilateral lower limb pain developed. Radiograph of bilateral lower limb did not show any abnormality including osteolytic lesion. These symptoms did not resolve despite the administration of broad-spectrum antibiotics and an anti-fungal agent. The neutrophil count began to decrease on day ?42. On day ?49, the serum IgG was 1,028 mg/dl, which was within the normal range. K. Kawakami (&) H. Mitani M. Nakao Division of Hematology, Suzuka General Hospital, Yasuzuka-cho, Suzuka, Mie 1275-53, Japan e-mail: Kawakei@cocoa.ocn.ne.jp

目的 : 子宮内膜細胞診における標本作製の諸問題を把握し, それらの解決方法を検討する. また, 臨床運用に即した報告形式を考察し, 細胞採取より報告までの診断システムを作成する.方法 : 1. 子宮内膜細胞診における標本の適正を定義し, その定義に基づいて過去に診断された標本を再評価する. 2. 適正標本を作製するための手技的問題を検討する.成績 : 1. 標本が不適性である原因として, 臨床情報不足が最も高頻度に認められ, 9.0%であった. 次いで細胞採取量の不足が多く, 5.7%に認められた. 2. 細胞診標本においては, 内膜から採取された検体の圧挫を行わず, 直接塗抹する方法が観察性に優れている. また, 観察性を低下させる因子としての出血性背景や標本の乾燥は, 標本を作製する際の工夫や注意によって改善される必要がある.結論 : 子宮内膜細胞診において, 婦人科医による正しい臨床情報提供の再認識が求められる. また, 細胞検体の採取・塗抹においては観察性を保ち十分な細胞量を得る工夫が必要である. 今後, 子宮内膜診断システムにより, 精度の高い細胞採取および標本作製が実現され, より高い精度の診断が実現されることが期待される.

We encountered a case of acute myeloblastic leukemia (AML), with extramedullary leukemia (EML) and a masked type of the variant translocation t(8;21)(q22;q22). Morphologically, the AML M2 subtype according to the French-American-British (FAB) classification was present. Phenotypically, leukemic cells were negative for CD19 and positive for CD56. Clinically, the case showed chemo-refractoriness and a poor outcome. The initial karyotypic interpretation was t(8;9)(q22;q34) on G-banding. Multiplex-fluorescence in situ hybridization (multiplex-FISH) analysis revealed a three-way translocation involving chromosomes 8, 9, and 21, and identified a masked type of variant t(8;21)q22;q22) translocation. The karyotype was finally determined as 45,X,-Y,der(8)t(8;21)(q22;q22), der(9)(8;9)(q22;q34), and der(21)t(9;21)(q34;q22). Results of FISH using the AML1/ETO probe and detection of the AML1/ETO fusion transcripts by reverse transcriptase-polymerase chain reaction (RT-PCR) support the karyotype as well as the sequence of the PCR product. Additionally, C-KIT mutation was detected.

The resonant and non-resonant X-ray scattering technique have been applied to the observation of a valence fluctuated (VF) state in R 4 As 3 ( R = Yb and Eu). In Yb 4 As 3 , the resonant signal reflecting a short range order of the charge ordering of Yb ions was clearly found at Yb L 3 -edge in the VF state above the charge ordering temperature. This is the first observation of the spatial correlation of the valences in the VF state. The valence state in Eu 4 As 3 was also investigated near Eu L 3 -edge for comparison.

A 79-year-old male was referred to the hospital with a history of abdominal discomfort. Abdominal computed tomography revealed a cystic tumor with irregular wall thickness, approximately 50 mm in diameter, along the lesser curvature of the gastric body. Magnetic resonance imaging visualized the mass as signal-hyperintense on T2-weighted imaging. Esophagogastroduodenoscopy showed a submucosal tumor with normal mucosa. Surgery was performed and the 60 × 50 × 50 mm mass was resected. The resected tumor comprised cystic and solid regions; the cystic region was filled by light bloody serous fluid. On histological examination, a solid region of the resected tumor showed a spindle-cell appearance. The diagnosis was gastric gastrointestinal stromal tumor (GIST) with predominant cystic formation. GISTs are usually solitary tumors, but in this case the tumor demonstrated extremely predominant cystic formation. Lesions with a hemorrhage or necrosis may form large cystic spaces. GISTs may show extensive cystic changes in response to tyrosine kinase inhibitor treatment; however, this patient had not undergone any such treatment before diagnosis. This represents an interesting case of a gastric GIST with predominant cystic formation occupying most of the tumor volume. Care should be taken to differentiate between GISTs and actual intra-abdominal cystic lesions.

Multipath fading is one of the most serious problems in mobile communications. Various methods to solve or mitigate it have been proposed in time or frequency domain. Previously we proposed a channel prediction method that combines complex-valued neural networks and chirp z-transform that utilizes both the time- and frequency-domain representation, resulting in much higher performance. In this paper, we propose to deal with polarization additionally in its adaptive channel prediction to improve the performance further. A preliminary experiment demonstrates improvement larger than what is expected by a simple diversity gain.

It was hypothesized that four histopathological types or subtypes of breast carcinoma were undifferentiated types characterized by bidirectional differentiation toward both luminal epithelial and myoepithelial cells and had characteristic molecular changes: invasive ductal carcinoma (IDC) with a large central acellular zone, atypical medullary carcinoma (a subgroup in Grade 3 solid-tubular carcinoma), matrix-producing carcinoma, and spindle-cell carcinoma (or carcinoma with spindle-cell metaplasia). In 32 cases of the undifferentiated type and 37 cases of the relatively differentiated types, we immunohistochemically examined the expressions of myoepithelial markers and KIT, epidermal growth factor receptor (EGFR), and c-erbB-2 oncoproteins. Vimentin, S-100, and alpha-smooth muscle actin were positive in 28 (88%), 22 (69%), and 15 (47%) of the undifferentiated types, but were positive in seven (19%), one (3%), and one (3%) of relatively differentiated types (P < 0.0001). KIT and EGFR overexpressions were detected more frequently in the undifferentiated types (34 and 88%, respectively) than in relatively differentiated types (3 and 3%, respectively) (P < 0.0001, for both). In 11 (85%) of 13 cases with KIT overexpression, EGFR overexpression concurred. c-erbB-2 overexpression was almost equally detected in both the undifferentiated and relatively differentiated types, and did not correlate with KIT or EGFR overexpression. Phosphotyrosine was detected in 16 (67%) of 24 cases with KIT, EGFR, and/or c-erbB-2 overexpression but only in six (18%) of 34 cases without KIT, EGFR, or c-erbB-2 overexpression (P = 0.0002). The undifferentiated-type breast carcinomas appeared to show mammary epithelial stem cell-like features, and they could be identified by KIT and/or EGFR overexpressions.

Kuttner tumor (known as chronic sclerosing sialadenitis) is a totally benign inflammatory lesion and to date there has been no report of malignancy. However, because of its clinical features, the clinical diagnosis is often that of a salivary gland neoplasm. We report a case of Kuttner tumor and discuss its differential diagnosis, especially the pathological diagnosis. Kuttner tumor may be mainly due to T lymphocyte immune reaction and of itself is a benign lesion, but it may provide a state in which a malignant lesion arises.

Primary carcinoid tumor of the testis only accounts for 0.2% of all carcinoid tumors in Japan. The clinicopathological features, including differences between Japanese and Europe/United States (Eur/US) series', which are known in ovarian carcinoids, have not yet been sufficiently recognized. In the present study, five testicular carcinoids from various clinicopathological viewpoints were analyzed, with a review of the literature. All 15 cases in Japan, including 10 previously reported, were insular carcinoids. Three of the 15 cases (20%) were associated with a teratoma. Serotonin production was confirmed in at least 10 cases (five cases in the present study and five cases in previous studies), but carcinoid syndrome was present in only two cases. Three of the 15 cases (20%) showed distant metastases, and the tumors that metastasized were larger than those that did not. These features were almost similar to those observed in the Eur/US series. Three pure carcinoids were also studied for the number of sex chromosomes by fluorescence in situ hybridization (FISH). They did not show a significant numerical abnormality of the X chromosome, which is common in testicular germ cell tumors. Therefore, the genetic background of pure carcinoids might be different from that of common germ cell tumors.

The chromosome aberration t(7;11)(p15;p15) is uncommon but recurrent in leukemia. We experienced a case of acute leukemia with t(7;11)(p15;p15), the hematological appearance of which mimicked myeloid crisis in chronic myeloid leukemia (CML). This case showed splenomegaly, a decreased neutrophil alkaline phosphatase (NAP) score, increased vitamin B12 value, and cells at all stages of neutrophilic maturation in both bone marrow and peripheral blood. We initially had difficulty differentiating acute myeloid leukemia (AML) M2 with marked myeloid differentiation from myeloid crisis of Philadelphia chromosome (Ph)-negative CML. Immature myeloid cells in the peripheral blood disappeared and cytogenetic analysis indicated that marrow cells changed to the normal karyotype after remission induction therapy. Therefore, this case was thought not to be myeloid crisis but AML M2 subtype. The NUP98/HOXA9 fusion transcript was detected by reverse transcription-polymerase chain reaction (RT-PCR) at exon A but not exon B of NUP98.

We report an extremely rare case of a calcifying fibrous tumor (CFT) occurring in the abdominal wall. A 43-year-old woman was referred to our hospital because of a gastric submucosal tumor. Imaging findings revealed a gastric submucosal tumor with calcification. Endoscopic ultrasound-guided fine-needle aspiration was attempted to obtain a tissue specimen; however, the tumor was not adequately visualized because of calcification. Local excision was performed because of the tumor growth and the risk of progression to gastrointestinal stromal tumor. The tumor was histologically diagnosed as a CFT. We describe the imaging and pathological findings, and discuss the differential diagnosis and histogenesis of CFT.