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A 40-year-old woman was seen at the hospital because of a tumor of the right breast in the middle of July, 1992. Physical examination revealed that she had a tumor of small bean sized, hard (solid), and well-movable, at the lateral side of the right breast. On mammography any sharp tumor shadow was not found and echomammographyshowed an 6×4mm sized, relatively smoothly outlined hypoechoic mass, which was considered as fibroadenoma. Simultaneously ultrasound-guided aspiration biopsy cytology was performed and it was confirmed that the tumor was ductal carcinoma. On August 11th, a partial mastectomy (less than 1/4) with axillary lymph node dissection was done under the consideration of T1aN0M0, stage I of UICC criteria, on the lateral side of CD boundary in the right breast. Postoperative radiotherapy (contact irradiation, 2 Gy×25, total dose 50 Gy) was performed against the residual breast.

A 42-year-old female visited the hospital because of a right breast tumor. On the first visit she had already massive local lymph nodes involvements and multiple bone metastases (T3N2M1, stage IV). Irradiation and chemoendocrine therapy were repeatedly performed after standard radical mastectomy, but the patient died of far advanced distant metastases at 19th month after the onset. Histological examination of the resected tumor revealed a variety of features, i.e., papillo-tubular growth, sarcomatous growth mainly composed of spindle cells, and the transition between the two. Thus, the tumor was diagnosed as papillo-tubular carcinoma with spindle cell metaplasia. Immunohistochemical stainings of the tumor showed that vimentin existed only in the sarcomatous region, and keratin was not detected in the tumor. The prognosis of patients with spindle cell carcinoma (so-called carcinosarcoma) is thought to be similar with that of common type of breast carcinoma, but it is still in controversy. Therefore, we investigated the relation between the prognosis and the existence of vimentin as a marker of sarcomatous change of the tumor in 65 patients with breast carcinoma. Vimentin was immunohistochemically detected in 7 carcinomas, in which a decrease in keratin was observed. Such findings indicated a decrease of feature of epitherial cell in the vimentin-positive carcinomas. Four out of the 7 patients with vimentin-positive tumor had metastatic lesions, and showed a poor prognosis compared to that of vimentin-negative patients.

A 70-year-old woman underwent emergency operation 7 hours after the onset of spontaneous rupture of the esophagus which was diagnosed by esophagofluoroscopy. The ruptured site was found in the left anterior wall of the esophagus which was located right above the diaphragm. The site was bistratally sutured by one-step method and two intrathoracic drainages were made. After surgery insufficiency of the suture and empyema developed, in which sustained washing and sustained hypotonic aspiration leaded to a fistulization of the empyema with a slight decrease in size. However, the patient also had a syringeal bronchial fistula, and the contamination with saliva as well as digestive liquid made the therapy difficult. After careful observation of this refractory fistula by endoscopy, it was filled with a fibrin-paste preparation while the contamination was prevented by two balloons. In a relatively short period, the fistula could be successfully closed.