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Gastrointestinal stromal tumors are common mesenchymal tumors of the gastrointestinal tract. The major site of metastasis for gastrointestinal stromal tumors is the liver or peritoneum, while metastasis to the ovary is exceptionally rare. A 53-year-old woman visited the hospital for bloating and anorexia and was diagnosed with a huge gastric gastrointestinal stromal tumor and peritoneal metastasis in the pelvis on upper gastrointestinal endoscopy and abdominal enhanced computed tomography. After administration of imatinib, the tumor was significantly reduced, and we performed laparoscopic pelvic tumor resection and open proximal gastrectomy with transverse colectomy. Intraoperatively, the pelvic tumor was found to be an ovarian tumor. Microscopic examination confirmed a gastric gastrointestinal stromal tumor with ovarian metastasis. In conclusion, we experienced a rare case of gastric gastrointestinal stromal tumor with ovarian metastasis. Preoperative administration of imatinib was successful and radical resection was achieved. Although pelvic tumors are difficult to differentiate preoperatively, the possibility of ovarian metastasis from gastrointestinal stromal tumor should be considered.

The association of primary biliary cirrhosis (PBC) and bronchial asthma was observed in three patients. All of these patients were female (53, 54, and 41 years old, respectively), and were positive for antimitochondrial antibodies. The patients fulfilled the diagnostic criteria of both PBC and bronchial asthma. Bronchial asthma preceded PBC in two patients, and the reverse order was seen in the other. Patient the clinical symptoms were mainly due to the bronchial asthma. Two patients had asymptomatic PBC and the third patient complained of pruritus. The liver histology showed mild to moderate eosinophilic infiltration in addition to the ductal and hepatic parenchymal changes characteristic of PBC. A survey of 266 cases of PBC referred to us disclosed that, in 6 of these, the PBC was associated with bronchial asthma, while no association with bronchial asthma was the material of found in 166 patients with viral hepatitis in our liver biopsy files. The 3 present cases we experienced suggest that bronchial asthma may be included in the list of extrahepatic diseases associated with PBC. The significance of this association is unclear and may merit further study. Steroid therapy, which is known to cause adverse effects in PBC, was employed for bronchial asthma in these 3 patients. Another therapeutic approach will have to be considered in patients with bronchial asthma associated with PBC.

無症候性原発性胆汁性肝硬変(a-PBC) 31例を対象として,その自然経過とursodeoxy-cholic acid (UDCA)投与後の経過について,項目別にスコア化した組織変化を含め臨床病理学的に検討した.3～94ヵ月(平均32ヵ月)の自然経過では血液生化学的に有意な変動はみられず,症候性への移行を31例中4例(12.9%)に認め,うち1例では診断後94ヵ月後に肝不全にて死亡した.一方,UDCA (600mg/日)を投与した16例では,3ヵ月後よう肝胆道系酵素,IgM値の有意な減少が認められた.組織所見については,UDCA非投与期では胆管炎のスコアのみが低下したが,UDCA投与期では胆汁うっ滞,胆管炎,線維化,グ鞘炎の各スコアにいずれも有意の改善が認められた.以上より,一部のa-PBCは緩徐ながら進行性で,s-PBCへの移行が認められた.一方,UDCA療法は血液生化学的,組織学的に有意の改善をもたらしたことから,a-PBCに対する有効な治療法である可能性が示唆された.

A male patient with syphilitic lesions in the tonsil and stomach is presented. The patient was infected while practising oral sex with heterosexual friends. He complained of nausea and snoring; his left tonsil was enlarged. Spirochetes were detected in a smear preparation from the left tonsil. As a gastric lesion, initially believed to be cancer, appeared to result from spirochete ingestion, the case is considered to represent primary syphilis. After antibiotic therapy with ampicillin, the left tonsil returned to normal size and gastric changes were no longer evident endoscopically. Gastroscopy should be considered if syphilis of the tonsil is observed, particularly when gastrointestinal symptoms are present. Both the oral and the gastric lesion can be mistaken for malignant neoplasm.

画像診断にて嚢胞性肝腫瘍が疑われ,開腹生検にて確診し,肝動脈塞栓療法(TAE)および化学療法が奏効した多発性嚢胞性病変を呈した肝硬変非合併肝細胞癌の1例を経験したので報告する.症例は52歳の女性.主訴は腹部膨満感.身体所見では著明な肝腫大を認め,各種画像診断から多発性嚢胞性病変を伴う肝細胞癌が疑われ,開腹生検を施行.肝右葉全体を占める巨大な塊状型の腫瘍で一部に嚢胞性病変が認められ,肝左葉に数個の娘結節を認めた.肝生検組織所見から非硬変肝に合併した肝細胞癌と診断した.TAE, 5-FU持続動注,CDDP動注の併用による治療を行ったところ,肝腫の縮小率は63.8%で奏効度PRを呈した.また,画像診断上も腫瘍および嚢胞性病変の明らかな縮小を認めた.本例は多発性嚢胞性病変を伴う肝細胞癌で,肝硬変を合併していない点で特徴的であり,嚢胞性病変の発生機序および治療効果を検討する上で,興味深い症例と考えられた.

症候性原発性胆汁性肝硬変症(s-PBC) 15例を対象として,その予後,治療法に関する臨床病理学的検討を行った.血清総ビリルビン値が初めて3mg/dlを越えてからの生存期間と各種病理学的因子の間に明らかな関連は示されなかったが,死亡例11例中9例に上部消化管出血を認め,全例出血後短期間で死亡したことから,上部消化管出血の予防及び治療はs-PBCの予後を決定する因子として重要と思われた.また,血漿交換療法(PE),食道離断,食道静脈瘤硬化療法などの積極的治療を試みた群の平均生存期間は47.8±9.0ヵ月であり,非施行群の17.4±5.0ヵ月に比し延長しており,その差は有意であった.なお積極的治療中の生存例4例の生存期間は現在23～60ヵ月である.一方,PEの方法について,二重濾過法及び単一濾過法の比較を行い,両者間で血液生化学的変化に明らかな差を認めなかったことから,副作用の予防を考え,可能な限り二重濾過法が望ましいと思われた.