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Pleural metastasis in rectal cancer is often due to secondary invasion or dissemination from intrapulmonary metastases. To date, there are no reports on solitary pleural metastasis. Here, we report a rare case of lower rectal cancer that recurred as pleural metastasis 4 years after surgical resection of the primary tumor. He was a 65-year-old man who visited our department with an abnormal shadow on his chest X-ray. He had a history of lower rectal cancer and had undergone laparoscopic low anterior resection of the rectum and bilateral lymph node dissection after neoadjuvant chemotherapy. Pathological ypT3N1M0 stage IIIA tumor was diagnosed, and adjuvant chemotherapy was administered. According to the computed tomography scan, a pleural tumor or pulmonary metastasis was suspected. Thoracoscopic partial resection of the lung and a partial pleurectomy were performed for diagnostic and therapeutic purposes. Histopathological examination revealed a highly differentiated tubular adenocarcinoma, consistent with metastatic rectal cancer. The nodule arose from the visceral pleura and invaded the parietal pleura with few malignant cells in the lung parenchyma. The lesion was surgically resected. However, 3 months after the second surgery, tumor recurrence with pleural dissemination was observed, and chemotherapy was initiated.

Background The UICC 8th TNM classification of lung cancer has been changed dramatically, especially in measuring methods of T‐desriptors. Different from squamous‐ or small‐cell carcinomas, in which the solid‐ and the invasive‐diameter mostly agree with each other, the diameter of the radiological solid part and that of pathological invasive part in adenocarcinomas often does not match. Aim We aimed to determine radiological and pathological tumor diameters of pulmonary adenocarcinomas with clinicopathological factors and evaluate the validity of the 8th edition in comparison with the 7th edition. Methods and Results We retrospectively analyzed clinicopathological factors of 429 patients with surgically resected pulmonary adenocarcinomas. The maximum tumor and their solid‐part diameters were measured using thin‐sectioned computed tomography and compared with pathological tumor and invasive diameters. Overall survival (OS) rate was determined using the Kaplan–Meier method for different subgroups of clinicopathological factors. Akaike's information criteria (AIC) was used as a discriminative measure for the univariate Cox model for the 7th and 8th editions. Multivariate Cox regression analysis was performed to explore independent prognostic factors. Correlation coefficients between radiological and pathological diameters in the 7th and 8th editions were 0.911 and 0.888, respectively, without a significant difference. The major reasons for the difference in the 8th edition were the presence of intratumoral fibrosis and papillary growth pattern. The weighted kappa coefficients in the 8th edition were superior those in the 7th edition for both the T and Stage classifications. In the univariate Cox model, AIC levels were the lowest in the 8th edition. Multivariate analysis revealed that age, lymphovascular invasion, pT(8th), and stage were the most important determinants for OS. Conclusion The UICC 8th edition is a more discriminative classification than the 7th edition. For subsolid nodules, continuous efforts are necessary to increase the universality of the measurement of solid and invasive diameters.

Intrahepatic cholangiocarcinoma with rhabdoid morphology is rare, and only three case reports have been published to date, none of which discuss the genetic changes in the rhabdoid component. We present a case of intrahepatic cholangiocarcinoma with focal rhabdoid features and SMARCA4-deficiency detected using immunohistochemistry. A Japanese man in his 60s without viral hepatitis was diagnosed with an avascular tumor in the liver, measuring 4.4 cm in the greatest dimension. The tumor was mostly composed of moderately differentiated adenocarcinoma, focal poorly differentiated adenocarcinoma, and an undifferentiated rhabdoid component. Immunohistochemical analysis showed an inclusion-like staining pattern for keratin AE1/AE3 and vimentin in the rhabdoid component. BRG1/SMARCA4 was detected in the differentiated component but not in the poorly- and undifferentiated components. Our novel findings reflecting the morphological and genetic heterogeneity of intrahepatic cholangiocarcinoma and will aid the research on drugs targeting the aberrant SWItch/Sucrose NonFermentable complex.

Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a generally slow-progressing rare disorder of unknown etiology. The direct cause of death in cases of IPPFE is rarely investigated. We experienced an autopsy case of a Japanese man with IPPFE and found aspiration pneumonia to be the major trigger of death. The individual had left vocal cord paralysis at admission, which may have contributed to aspiration pneumonia, and which probably was affected by the fibrous adhesion of the left apex of the chest wall resulting from IPPFE. The prevention of aspiration pneumonia is important for maintaining the respiratory function, especially in IPPFE patients with repeated pneumothorax.

Background The aim of the study was to clarify the frequency of colorectal neoplasm (CRN) complicating superficial esophageal squamous cell carcinoma (ESCC) and the need for colonoscopy. Methods We retrospectively reviewed 101 patients who had undergone initial endoscopic resection (ER) for superficial ESCC. Control group participants were age- and sex-matched asymptomatic subjects screened at our hospital over the same period of time. Advanced adenoma was defined as an adenoma ≥10 mm, with villous features, or high-grade dysplasia. Advanced CRN referred to advanced adenoma or cancer. We measured the incidence of advanced CRN in superficial ESCC and controls, and we compared the characteristics of superficial ESCC patients with and without advanced CRN. Results In the superficial ESCC group, advanced CRNs were found in 17 patients (16.8%). A history of smoking alone was found to be a significant risk factor of advanced CRN [odds ratio 6.02 (95% CI 1.30-27.8), P=0.005]. Conclusion The frequency of synchronous advanced CRN is high in superficial ESCC patients subjected to ER. Colonoscopy should be highly considered for most patients who undergo ER for superficial ESCC with a history of smoking, and is recommended even in superfi cial ESCC patients. Keywords Advanced adenoma, colonoscopy, colorectal neoplasm, esophageal squamous cell carcinoma Ann Gastroenterol 2016; 29 (3): 318-324

Background and Aim White globe appearance (WGA) is a small white lesion with a globular shape that can be identified by magnifying endoscopy with narrow-band imaging (M-NBI). WGA was recently reported as a novel endoscopic marker that can differentiate between gastric cancer (GC) and low-grade adenoma. However, the usefulness of WGA for differentiating GC from non-cancerous lesions (NC), including those of gastritis, is unknown. Methods To compare the prevalence of WGA in GC and NC, we carried out a prospective study of 994 patients undergoing gastroscopy. All patients were examined for target lesions that were suspected to be GC. When a target lesion was detected, the presence or absence of WGA in the lesion was evaluated using M-NBI, and all target lesions were biopsied or resected for histopathological diagnosis. Primary endpoint was a comparison of WGA prevalence in GC and NC. Secondary endpoints included WGA diagnostic performance for diagnosing GC. Results A total of 188 target lesions from 156 patients were analyzed for WGA, and histopathological diagnoses included 70 cases of GC and 118 cases of NC. WGA prevalence in GC and NC was 21.4% (15/70) and 2.5% (3/118), respectively (P < 0.001). WGA diagnostic accuracy, sensitivity, and specificity for detecting GC were 69.1%, 21.4%, and 97.5%, respectively. Conclusions WGA prevalence in GC is significantly higher than that in NC. Because WGA is highly specific for GC, the presence of WGA is useful to diagnose GC.

A 36-year-old male was found two nodules in the right lower lobe of the lung. After the surgical resection, both lesions were diagnosed as invasive adenocarcinomas. One lesion was primarily lepidic growth component with EGFR-L858R mutation, and the other was micropapillary component with ALK translocation accompanying mediastinal lymphnode metastases. While he experienced disease recurrence, the disease was controlled by an ALK inhibitor, given based on the findings of surgical specimens. This is the first case who had two simultaneous lung cancers with EGFR mutation and ALK translocation in each respective lesion, and was successfully treated with ALK inhibitor at the post-surgical recurrence. J. Med. Invest. 64: 305-307, August, 2017.

A 36-year-old male was found two nodules in the right lower lobe of the lung. After the surgical resection, both lesions were diagnosed as invasive adenocarcinomas. One lesion was primarily lepidic growth component with EGFR-L858R mutation, and the other was micropapillary component with ALK translocation accompanying mediastinal lymphnode metastases. While he experienced disease recurrence, the disease was controlled by an ALK inhibitor, given based on the findings of surgical specimens. This is the first case who had two simultaneous lung cancers with EGFR mutation and ALK translocation in each respective lesion, and was successfully treated with ALK inhibitor at the post-surgical recurrence. J. Med. Invest. 64: 305-307, August, 2017.

Background Nonmagnifying observation by using narrow-band imaging (NBI) is useful for detecting pharyngeal lesions. Magnifying observation by using NBI can distinguish between cancerous and noncancerous lesions and is therefore useful for the early detection of pharyngeal cancer. Objective To evaluate the usefulness of observation of the pharynx by using NBI in the overall population undergoing upper GI endoscopy. Design Retrospective study. Setting Single tertiary referral center. Patients A total of 11,050 upper GI endoscopies between January 2009 and December 2012. Interventions Observation of the pharynx by using NBI. Main Outcome Measures The rate of detection of pharyngeal cancer, the rates of detection according to the reason for endoscopy, and the types of cancers detected. Results Thirty-eight cancerous lesions were detected in 29 patients (0.26%, 29/11,050). The rate of detection of pharyngeal cancer was significantly higher in patients with a history of head and neck cancer (9.7%, 3/31) or a history of esophageal cancer (3.5%, 10/282). In patients undergoing endoscopy for screening, pharyngeal discomfort, and a history of gastric cancer, the rates of detection of pharyngeal cancer were 0.11% (10/8872), 1.1% (3/265), and 0.19% (3/1600), respectively. Two patients (6.9%) were female. One had a history of esophageal cancer, and the other had pharyngeal discomfort. Limitations Single-center, retrospective study. Conclusions Observation of the pharynx by using NBI in patients with previous head and neck cancer or esophageal cancer or who have pharyngeal discomfort is very important. Moreover, pharyngeal cancer was certainly found in the male patients undergoing screening endoscopy, although the rate was lower.

Background Narrow-band imaging (NBI) is useful for detecting superficial oropharyngeal lesions. However, the diagnostic and treatment guidelines for NBI are not established. The aim of the present study was to evaluate the treatment strategy for these microlesions. Methods From October 2008 to September 2009, 68 flat-type brownish microlesions were observed in the orohypopharynx using NBI. Lesions were examined via magnifying NBI (M-NBI) and followed up without biopsy or endoscopic resection for >12 months. To clarify the characteristics, lesions were compared with the endoscopic characteristics of flat-type lesions diagnosed by biopsy and endoscopic resection as squamous cell carcinoma and high-grade intraepithelial neoplasia. Results The average diameter of the 68 lesions was 1.6 mm (range, 0.5–5 mm). At the 1-year follow up, 19 lesions had disappeared. No size increases or morphological changes wereobserved among 49 lesions followed for >1 year. At 2 years, 10 patients had dropped out and 11 lesions had disappeared. No changes were observed among 28 lesions followed for >2 years. Of the flat-type lesions as squamous cell carcinoma and high-grade intraepithelial neoplasia, a distinct border and irregular distribution of atypical vessels were observed in all cases using M-NBI. These findings were observed in two of 68 flat-type brownish microlesions during follow up. Conclusion Although there is some possibility of squamous cell carcinoma or high-grade intraepithelial neoplasia, flat-type microlesions of ≤5 mm diameter in the orohypopharynx may be followed for up to 2 years without biopsy or endoscopic resection.

White globe appearance (WGA) refers to a small white lesion of globular shape underneath cancerous gastric epithelium that can be clearly visualized by magnifying endoscopy with narrowband imaging (M-NBI). WGA has been reported to be a novel endoscopic marker that is highly specific in differentiating early gastric cancer (GC) from low-grade adenoma, and has a significantly higher prevalence in early GCs than in noncancerous lesions. However, interobserver agreement in detecting WGA and whether training intervention can improve diagnostic accuracy are unknown. Twenty sets of M-NBI images were examined by 16 endoscopists. The endoscopists attended a lecture about WGA, and examined the images again after the lecture. Interobserver agreement in detecting WGA in the second examination and increases in the proportion of correct diagnoses and the degree of confidence of diagnoses of cancerous lesions were evaluated. The kappa value for interobserver agreement in detecting WGA in the second examination was 0.735. The proportion of correct diagnoses was significantly higher in the second examination compared with the first examination when WGA was present (95.5% vs 55.4%; P

Hypereosinophilic syndrome (HES) is defi ned by elevation more than 1.5×109/L of presence of a peripheral blood count, evidence of organ involvement, and exclusion of secondary eosinophilia such as allergic, vasculitis, drugs, or parasite infection and also clonal eosinophilia. We present the HES case with hepatic involvement. The patient is 70-year-old male. He complained fever and back pain. Blood examination showed marked peripheral eosinophilia, elevation of transaminase and biliary enzymes. Multiple irregular mass lesions of the liver were pointed out by CT and MRI. The liver biopsy was done for differentiation from malignancy. In parenchyma, hepatic necrotic lesion was observed accompanying severe eosinophilic infi ltration with Charcot-Leyden’s crystals. There was granulomatous reaction. He was diagnosed as HES and got recovery due to steroid therapy. From the review of HES article, the hepatic histology is categorized into four types as below: 1) cholangitis type; 2) chronic active hepatitis type; 3) vasculopathic type, 4) hepatic necrosis type. Our case is classifi ed in hepatic necrosis type. This type seems to be important to distinguish malignant tumor and also visceral larva migrans by liver biopsy.

金沢大学医薬保健研究域医学系, We report the case of an 80-year-old female suffering from pancreatic cancer who developed severe non-alcoholic steatohepatitis (NASH) resulting in fatal hepatic failure after anti-cancer chemotherapy with gemcitabine. Hepatic encephalopathy appeared 1 year after the chemotherapy, and the patient developed progressive liver failure and eventually died. Radiological examination showed severe fatty liver. Histopathological examination of a liver needle necropsy showed almost panlobular macrovesicular fatty change. Ballooning degeneration and necrosis of hepatocytes accompanying neutrophil infiltration, Mallory bodies, and a few bile plugs were found in zone 3. Marked perivenular and pericellular/perisinusoidal fibrosis and extensive bridging fibrosis were also found. Together, these findings indicated steatohepatitis at a precirrhotic stage. Because the patient had no history of drinking in excess, we made a diagnosis of NASH, in particular, chemotherapy-associated steatohepatitis (CASH). Gemcitabine is a pyrimidine nucleoside antimetabolite with anti-cancer activity. A few reports have mentioned fatal hepatotoxicity caused by gemcitabine, but, to our knowledge, this is the first report of steatohepatitis, possibly associated with gemcitabine. Physicians treating patients with this drug should be aware of the possibility of steatohepatitis. © Springer 2010.

金沢大学大学院医学系研究科がん細胞学, Aim: Serum antinuclear antibodies (ANA) are occasionally noted in patients with non-alcoholic steatohepatitis (NASH). We examined the significance of ANA in NASH. Methods: We compared clinicopathological features in patients with ANA-positive NASH (n = 35) and ANA-negative NASH (n = 36). Inflammatory cell profiles and the distribution of oxidative stress markers were also examined immunohistochemically. Results: ANA-positive NASH was significantly associated with female gender (P = 0.005), high degree of portal inflammation (P = 0.039), interface activity (P = 0.036) and hepatocellular ballooning (P = 0.0008). In addition, ANA of high titer (320-fold or more) was significantly associated with the histological grade and stage of NASH (P = 0.02). The degree of steatosis wais rather mild in the high-titer ANA group(P = 0.01). The analysis of inflammatory cell profiles revealed that CD3-positive T cells were predominant and plasma cells were rather few in the portal area and hepatic lobules in both ANA-positive and ANA-negative groups. There was no difference in the distribution of oxidative stress markers between ANA-positive and ANA-negative groups. Conclusion: These findings suggest that the presence of ANA may be related to the progression of NASH and that a different type of autoimmune mechanism may be involved in the pathogenesis of NASH with ANA, compared to the pathogenesis of autoimmune hepatitis. © 2007 The Japan Society of Hepatology.

Recently, attention has been drawn to papillary neoplasm of the pancreatobiliary systems. In the pancreas, the disease entity of intraductal papillary mucinous neoplasm (IPMN-P) is widely recognized. In contrast, the pathological characteristics of biliary papillary tumors, such as biliary papilloma(tosis) and papillary cholangiocarcinoma, have not yet been well documented. In this study, we compared the pathological features and post-operative prognosis among biliary papillary tumors (10 cases of biliary papilloma(tosis) and 22 cases of papillary cholangiocarcinoma), conventional non-papillary cholangiocarcinoma (15 cases), and IPMN-P (31 cases). Macroscopically, all biliary papillary tumors were characterized by the prominent intraductal papillary proliferation, and macroscopic mucin-hypersecretion was seen in 9 of 32 cases (28%). Histologically, biliary papillary tumors consisted of three types of tumor cells (pancreaticobiliary, intestinal and gastric types), whereas only the pancreaticobiliary type was observed in non-papillary cholangiocarcinoma. Immunohistochemically, biliary papillary tumors were characterized by the common expression of MUC2, CDX2 and cytokeratin 20. In addition, biliary papillary tumors could be associated with two types of invasive lesions: tubular adenocarcinoma (9 cases) and mucinous carcinoma (5 cases). Patients with tubular adenocarcinoma had a poor prognosis compared to non-invasive papillary tumor or papillary tumor with mucinous carcinoma. These pathological characteristics and the survival status of biliary papillary tumors were different from those of non-papillary cholangiocarcinoma, and rather closely resembled those of IPMN-P. In conclusion, biliary papillary tumors may be the biliary counterpart (intraductal papillary neoplasm of the bile duct) of IPMN-P.

The association between IgG4 dysregulation and inflammatory pseudotumor (IPT) was first reported in sclerosing pancreatitis. Recently, we described IPTs of the liver and breast, into both of which many IgG4-positive plasma cells had infiltrated. In this study, we examined the clinical and histological features of 9 cases of IPT (histologically corresponding to plasma cell granuloma) of the lung with an emphasis on IgG4-positive plasma cell infiltration. The lesions were characterized histologically by dense lymphoplasmacytic infiltrates intermixed with fibrosis and, in some cases, prominent eosinophilic infiltration, irregular narrowing of bronchioles entrapped in nodules, and an interstitial pneumonia pattern at the boundaries of nodules. Obliterative phlebitis was easily found in all cases, and 5 lesions also had obliterative arteritis. Immunostaining revealed many IgG4-positive plasma cells diffusely distributed within nodules, and the ratios of IgG4-positive to other plasma cells were extraordinarily high. Of the 9 patients, 8 underwent surgical treatment and in 1 patient, lesion was diagnosed on transbronchial biopsy and effectively treated with corticosteroid. Two cases were associated with chronic sclerosing sialadenitis or lymphadenopathy, in which many IgG4-positive plasma cells were also identified by immunostaining. The clinicopathologic similarities between IPT of the lung and sclerosing pancreatitis suggest that IgG4-related immunopathologic processes might be involved in the pathogenesis of the pulmonary lesions.

Sclerosing cholangitis (SC) is a heterogeneous disease entity. Different etiologies such as choledocholithiasis, biliary tumor, or pericholangitis can manifest as SC. Hepatic inflammatory pseudotumor (IP) is rarely associated with SC (sclerosing cholangitis associated with hepatic inflammatory pseudotumor; SC-hepatic IP), but sclerosing pancreatitis (SP) is not infrequently associated with bile duct lesions (sclerosing pancreatitis-associated sclerosing cholangitis; SP-SC). In this study, we compared the histologic changes of hepatic hilar and extrahepatic bile duct lesions of SC (7 cases), SC-hepatic IP (5 cases), SP-SC (5 cases), and typical primary sclerosing cholangitis (PSC) (5 cases). Histologically, all SP-SC cases showed extensive and dense fibrosis with marked lymphoplasmacytic infiltration, many eosinophils, and obliterative phlebitis. Four cases of SC showed bile duct lesions similar to those of SP-SC, whereas other three cases of SC showed milder lymphoplasmacytic infiltration, scant eosinophilic cell infiltration, and no obliterative phlebitis. All SC-hepatic IP cases showed bile duct lesions identical to those of SP-SC. Immunohistochemically, many IgG4-positive plasma cells were found in the bile duct lesions of all SP-SC cases, 4 SC cases with marked lymphoplasmacytic infiltration, and all SC-hepatic IP cases. By contrast, IgG4-positive plasma cells were scarce or hardly found in the remaining 3 SC cases and all PSC cases. In conclusion, 4 SC cases and all SC-hepatic IP cases showed bile duct lesions identical to those of SP-SC, suggesting that these three conditions may be a single disease entity. Their pathogenesis may be similar or closely related to that of SP, and in that respect they may represent an IgG4-related biliary disease. They may respond to steroid therapy as SP does.

Basal cell adenoma is a rare disease that was introduced as an entity by the World Health Organization in 1991. Histologically, this tumour can be easily confused with basal cell adenocarcinoma and the solid basaloid subtype of adenoid cystic carcinoma. In this report, immunohistochemical methods were used for accurate diagnosis. No reaction for cytokeratin 10/13 was observed. The distribution of cytokeratin 14 was localised in the outer layer of the tubular patterns and the duct-like structures of the adenoid cystic carcinomalike nest. The reactions for cytokeratin 18 and cytokeratin 19 were positive in the inner layer of tubular patterns. The immunoreactivity for S-100 protein closely corresponded with that for cytokeratin 18. The reaction for Ki67 was slight positive. These findings indicate that histopathological and immunohistochemical analysis might be useful discrimination techniques for the diagnosis, treatment, and prognosis of parotid gland tumours.

A 51-year-old housewife with hypersensitivity pneumonitis caused by Humicola fuscoatra is reported. The diagnosis was made by an inhalation challenge with H. fuscoatra antigen. She was admitted for diagnosis and treatment of a fever and productive cough. Auscultation of her lungs revealed inspiratory fine crackles. Her chest CT showed diffuse miliary nodules in a centri-lobular distribution with patchy ground glass opacities. Findings of transbronchial lung biopsy and BAL fluid were compatible with a hypersensitivity pneumonitis. Her symptoms worsened on returning home, which suggested the existence of some aetiological agent in the subject's house. H. fuscoatra, Penicillium decumbens and Aspergillus versicolor were isolated from a number of rooms. High titres of serum anti H. fuscoatra, P. decumbens and A. versicolor were detected. Inhalation challenge tests with both P. decumbens and A. versicolor antigen were negative, in contrast to that with H. fuscoatra which was positive. Based on these results, we advised the patient to cleanse her entire house. Since cleaning, her symptoms have not worsened upon returning home. This is the first report of hypersensitivity pneumonitis caused by H. fuscoatra antigen.

背景. 肺癌の遠隔転移の中でも子宮および子宮付属器への転移は稀とされている. 症例. 67歳女性. 52歳時に右中葉原発性肺腺癌のため右中葉切除術を受けた. 1995年に同側胸膜に肺癌の再発を認め, 抗癌剤の胸腔内投与を受けた. その後画像上大きな変化を認めなかったが, 1999年2月頃より右腋窩リンパ節腫脹を認め, リンパ節生検を施行した. H. E. 染色およびsurfactant apoprotein-Aの免疫染色にて肺腺癌のリンパ節転移と診断された. さらに両側卵巣および子宮漿膜への遠隔転移も明らかとなり, surfactant apoprotein-Aの免疫染色も陽性であった. 15年前の原発巣は中分化型乳頭状腺癌であり,II型肺胞上皮細胞とクララ細胞が主体である混合型であった. surfactant apoprotein-Aの免疫染色も陽性であった. 結論. 肺癌の術後15年の経過の後, 子宮および子宮付属器への転移を認めたことは臨床的に興味深く報告する.

症例は黄疸が主訴の36歳の女性で,以前から肝機能障害を時々指摘されていた. 1999年2月に主訴にて近医を受診, ERCP検査はされなかった. 10月には主訴が増悪し, 12月22日に当院紹介入院となった.腹部超音波, CT, MRI検査にて三管合流部に嚢胞性病変が認められた. ERCPは拒否され, PTCDを行い総肝管での狭窄が判明した.血管造影検査では著変はなかった. 2000年1月18日に手術が行われた.嚢胞は三管合流部にあり,総胆管からは剥離可能であったが,胆嚢とは不能であった.嚢胞を含めて胆嚢摘出術を行った.温存総胆管を術中胆道造影で評価したところ狭窄は不変で,総肝管を切除,胆道再建術を施行した.切除標本では胆嚢管自体が嚢胞状に変化し,内部に透明のゼリー状の粘液を有していた.病理組織学的検査では,卵巣様間質を有する多胞性の嚢胞で,胆嚢管の粘液嚢胞腺腫との診断を得た.極めて稀な症例と考えられた.

We herein report a case of pharyngeal cancer that was not detected during preoperative transoral endoscopy with narrow band imaging (NBI). A 61-year-old female was referred to our hospital for further evaluation of a pharyngeal lesion. Endoscopy revealed a small, elevated lesion, approximately 7 mm in size, at the right pyriform sinus. We performed endoscopic resection to remove this lesion under general anesthesia based on the biopsy results. Intraoperatively, we detected another tumor in the left oropharyngeal wall with Lugol staining after insertion of a curved laryngoscope. Although this lesion was ≥20 mm in diameter, we were unable to detect it during preoperative transoral endoscopy with NBI and white light imaging. We performed endoscopic treatment for this lesion 2 months later. The pathological diagnosis was pharyngeal cancer; the lesion had low vascularity. This case report provides an example of false-negative endoscopy with NBI. Although transoral endoscopy with NBI has improved the early diagnosis of superficial squamous cell carcinomas of the head and neck, pharyngeal cancers that are less vascular may be missed with NBI.

A man in 60s underwent total gastrectomy for advanced gastric cancer with para-aortic lymph node metastases. Although postoperative chemotherapy decreased the metastases, he was subsequently admitted with progressive respiratory distress. Pulmonary hypertension and right-sided heart failure developed, and he died of sudden cardiopulmonary arrest 30 hours after admission. Autopsy revealed widespread tumor embolism, fibrocellular intimal proliferation, and thrombus formation in the small arteries, consistent with a diagnosis of pulmonary tumor thrombotic microangiopathy (PTTM) associated with gastric cancer. Although PTTM a rare clinicopathological entity that causes severe pulmonary hypertension, it should be considered as a differential diagnosis for acute dyspnea or pulmonary hypertension in patients with carcinoma, regardless of clinical improvement.

A 74-year-old female underwent hysterectomy and bilateral ovariectomy for uterine endometrial stromal sarcoma( ESS), low grade, at another hospital 31 years previously. When the patient was admitted for pneumonia, a lung tumor was pointed out on her chest X-ray and computed tomography( CT) scan. Chest X-ray showed an oval figure shadow of about 3.5 cm in diameter in the right lower lung field.Chest CT scan revealed an irregular form tumor of 3.5 cm in diameter in the right S8 of the lung. Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan identified an abnormal accumulation of FDG at the tumor site. A pulmonary metastasis of the ESS was suspected by transbronchial lung biopsy, and the patient underwent the thoracoscopic partial resection of the right lower lobe of the lung.Histologically, the tumor was diagnosed as metastasis of the ESS, low grade.

Papillary cystadenoma (PC) is an uncommon benign tumor of the salivary glands, sometimes involving the minor salivary glands. We report a case of PC of minor salivary gland origin located in the hard palate of an 82-year-old woman. The patient complained of swelling of the hard palate, and medical examination of the left side revealed an elastic, hard, painless mass, which was normal in color and measured 8 mm in diameter. After establishing a clinical diagnosis of benign tumor of the hard palate, the lesion was excised under local anesthesia. Histopathologically, the tumor showed papillary proliferations of the lining epithelium, composed of one or two layers of cuboidal or columnar epithelial cells, in multiple cystic spaces. Histogenesis of the tumor was confirmed immunohistochemically, and the lesion was diagnosed as PC.

Vascular leiomyoma is a benign tumor of the smooth muscle that originates in the blood vessels and mainly occurs on the limbs in middle-aged to elderly women. It rarely occurs in the oral cavity. We report a case of vascular leiomyoma arising in the palate. A 36-year-old man visited our department because of a hemispherical tumor in the palate. The clinical diagnosis was a salivary gland tumor, and excision of the tumor was performed. Histopathologically, the tumor was diagnosed as vascular leiomyoma. The patient's postoperative course has been good, with no evidence of recurrence as of 1 year after the operation.

目的:乾燥迅速Papanicolaou染色 (乾燥Pap.) を試み, 術中迅速診断における有用性について検討した.方法:術中迅速診断例482検体と術中腹腔洗浄液51検体を対象とした. 全身32臓器の組織1が含まれ, 良性311例, 悪性171例であった. 検体到着後, 乾燥Pap. と凍結切片を作成し, それぞれに診断を行った. Papanicolaou染色 (Pap.) とギムザ染色用の標本も作製し, 洗浄液では粘液染色用の標本も作製した.成績:乾燥Pap. の手技は迅速かつ簡便であり, 塗抹後2分以内で鏡検できた. 細胞像はPap. とやや色調が異なったが, 基本的には類似していた. 透明感と色調のバラエティある細胞像が観察され, 核クロマチンや核小体も明瞭であった. また, 背景の赤血球は溶解し, 細胞観察が容易であった. 乾燥Pap. の正診率は97.3%であり, 通常のPap. は96.1%で, 凍結切片は98.2%であった. 乾燥Pap. と凍結切片をあわせた診断では正診率は99%に上昇した.結論:乾燥Pap. は種々の利点を有し, Pap. に勝るとも劣らない染色法と考えられた. 細胞採取や塗抹方法に注意すれば, 術中迅速診断に十分応用でき, 利用価値の高い染色法と考えた.

症例は41歳,女性.右乳房腫瘤を主訴に来院した.右乳腺AC領域に1.5cmの腫瘤を触知した.腫瘍摘出術を施行し,高分化型乳腺血管肉腫の病理診断を得た.乳房扇状部分切除術,および腋窩リンパ節郭清を施行し,術後から5年経過した現在,無再発で生存中である. 乳腺血管肉腫は稀な疾患であり,その予後は極めて不良である.そのため,病初期に診断し,切除することが本症の治療においては極めて重要となる.

A 66-year-old woman was admitted to the hospital because of abdominal distention. Abdominal CT scan revealed a giant tumor extending from the left hypochondrium to lower abdomen. We suspected a leiomyosarcoma and performed an operation. The resected specimen was 30×2×17cm in size and 3274g in weight. The tumor existed in the submucosal layer to the subserosa of the upper body of the stomach with hematoma and necrosis in it. Histopathologically, atypical spindle cells proliferated and the cellularity was high. Approximately one mitosis was observed with each high-power field. Immunohistochemical study showed that the tumor was positive for vimentin, CD34 and c-kit but was negative for muscle or neural markers. Therefore, we diagnosed the tumor as a malignant uncommitted type gastrointestinal stromal tumor (GIST) of the stomach. Hepatic and splenic metastases and peritoneal dissemination occurred seven months after the operation. The biological mechanisms of uncommitted type GISTs have not been elucidated as yet. Further accumulation of cases of uncommitted type GIST is expected to clarify the malignant potential or the mechanism of metastasis of uncommitted type GISTs. We report a case of giant uncommitted type GIST of the stomach supposed having high grade of malignancy which relapsed in a short time after the operation.

Background: Gallbladder carcinoma is known to develop frequently in patients with pancreaticobiliary maljunction, though the causal relationship remains speculative. Methods: Histopathologic changes, expression of mucin core protein MUC1 and MUC2, and cell proliferative activities in the gallbladder mucosa from 27 patients with panceaticobiliary maljunction and 21 control gallbladders were examined. Three cases of pancreaticobiliary maljunction were associated with gallbladder carcinoma. Results: The lining epithelia of the non-neoplastic gallbladder mucosa of pancreaticobiliary maljunction showed frequently papillary hyperplasia and higher proliferative activities, when compared to the control. In 3 cases with carcinoma, MUC1 was expressed on the luminal border and in the cytoplasm of carcinoma cells, particularly in de-differentiated and invasive areas. MUC1 was variably expressed on the luminal surface of the lining epithelia of non-neoplastic gallbladder mucosa in babies, children, youths and adults with pancreaticobiliary maljunction. However, such expression was focally seen in 2 of the 21 control cases (p

今回われわれは, 舌扁平上皮癌患者の放射線治療後の経過観察中に発見された甲状腺癌の1例を経験したので, その概要を報告する。患者は40歳の女性で, 1997年7月初旬頃より, 左舌側縁部疼痛を自覚するようになり, 1998年7月9日当科を受診した。顔貌の変形なく, 頸部リンパ節に有意なリンパ節は触知しなかった。左側舌下面に, 大きさ10×12mm, 境界不明瞭, 有痛性, 硬結を伴う, 潰瘍を認めた。舌生検を施行し, 舌扁平上皮癌 (T1N0M0) の病理診断を得た。放射線科にて電子線腔内照射12Gy×3回 (計36Gy) をおこない, 病変は完全に消失した。以後, 経過観察していたが, 頸部リンパ節触診時に, 約1センチ程度の腫瘤を左甲状腺部に認めた。当院一般消化器外科にて甲状腺細胞診を行い, 乳頭癌の診断を得た。CTでは, 甲状腺左葉に直径1cm程度の腫瘍を認めたが, 周囲への浸潤は認められなかった。一般消化器外科にて, 10月13日, 全身麻酔下にて, 甲状腺左葉切除術および保存的頸部郭清術を施行した。病理診断は乳頭癌であった。口腔内および頸部ともに再発傾向は認めず, 経過は良好である。

Aims Five cases of angiomyolipoma (AML) composed exclusively or predominantly of smooth muscle cells (SMC) are presented to emphasize the histological diversity and to caution against errors in histological diagnosis. Methods and results Four tumours were located in the liver and one in the renal capsule. Three patients were female and two were male, ranging from 36 to 76 years of age with a mean age of 50 years. One patient with a renal capsular tumour was associated with tuberous sclerosis. Two tumours were composed predominantly of a spindle-shaped SMC component, whereas three others were composed predominantly of epithelioid SMC elements. AMLs composed exclusively or predominantly of spindle-shaped smooth muscle cells (SMCs) simulated leiomyoma, whereas AMLs composed exclusively or predominantly of epithelioid SMCs resembled epithelioid leiomyoma or leiomyosarcoma or other sarcoma when cellular atypia was present. However, both spindle and epithelioid SMCs were characteristically positive for HMB-45 melanoma-specific antibody; no other tissue components in either the liver or kidney were reactive to HMB-45. Conclusions AML is often composed predominantly of SMC elements, and morphological features of the SMC elements are quite variable. Therefore, careful attention must be given to histological assessment of AML. Whenever a pathologist encounters an unfamiliar hepatic or renal tumour, the possibility of AML should be considered. Reactivity for HMB-45, however, confirmed the diagnosis of AML.

A 60-year-old female underwent screening colonoscopy. Narrow-band imaging (NBI) without magnification showed a 20-mm, well-demarcated brownish area located close to the dentate line of the anal canal. Conventional white-light imaging revealed an ill-defined, flat lesion with scattered reddish spots at the same site. Magnifying endoscopy with NBI (M-NBI) revealed abnormal microvessels with dilatation, tortuosity, caliber change and various shapes that were similar to the intrapapillary capillary loop patterns seen in esophageal squamous cell carcinoma in situ. Endoscopic submucosal dissection (ESD) was performed, and on histological examination, the resected specimen showed squamous cell carcinoma (SCC) in situ and clear surgical margins. Thus, NBI is an efficient method for detecting superficial SCC in the anal canal and M-NBI may be useful for determining the extent of the lesion. During screening colonoscopy, the anal region should be carefully observed using NBI, as early detection offers a greater opportunity for ESD which is a less invasive procedure.