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Breast metastases from extra-mammary malignancies, especially those mimicking primary inflammatory breast carcinoma, are extremely rare. We report here two cases of inflammatory breast metastases from gastric or ovarian cancer. Both patients, who had prior advanced malignant disease, presented with unilateral breast redness and swelling with peau d'orange sign, resembling primary inflammatory breast cancer or acute mastitis. Breast biopsy revealed poorly differentiated adenocarcinoma with signet-ring cells or clear cell carcinoma in the lymphatic vessels and the parenchyma without an in situ lesion, similar to primary lesions of the stomach or ovary, respectively. Immunohistochemical staining for estrogen receptor, progesterone receptor, and gross cystic disease fluid protein 15 was of value for correct diagnosis. Since breast metastasis is a sign of poor prognosis of the primary malignant disease, the possibility of breast metastasis should be considered in appropriate patients to preclude unnecessary major surgery.

Solitary/multiple plasmacytoma of bone, a rare disease as compared to multiple myeloma, is characterized by monoclonal proliferation of plasma cells in local legion (s) of bone, with no bone marrow abnormalities. Monoclonal gammagloblinemia is often absent in these conditions, and useful examinations allowing evaluation of responses to treatment are as yet lacking. Recently, 18F-FDG PET/CT (PET/CT) was reported to be useful for detecting bone lesions. PET/CT is also valuable for predicting the outcomes of patients with solitary plasmacytoma, when applied in combination with the serum free light chain (sFLC) κ/λ ratio. We present a 62-year-old male with multiple plasmacytoma of bone (MPB), in whom PET/CT and the sFLC κ/λ ratio were useful for evaluating the response to treatment. The patient was diagnosed with MPB, with PET/CT showing multiple abnormal tracer uptakes in the scapula, spine, and ribs. The sFLC ratio was markedly elevated, with the κ chain level being especially high. We administered bortezomib and dexamethasone, after which the abnormal uptakes on PET/CT disappeared. The sFLC ratio and the FLC value also normalized, and have remained stable for more than one year, to date, since treatment. In our case, PET/CT and the sFLC κ/λ ratio were found to be extremely useful for monitoring treatment responses.

症例は87歳女性。平成12年9月に傍矢状洞部髄膜腫にて手術を施行されている。平成17年5月に右こめかみに紅色丘疹が出現した。急速に拡大し, 潰瘍化し, 7月からは膿汁分泌も伴うようになった。9月上旬に近医皮膚科を受診し, 有棘細胞癌を疑われ, 当科で切除術を施行した。病理組織所見では, HE染色にて核分裂像, 好酸性封入体様構造を示すラブドイド細胞のシート状の増生を認めた。免疫染色ではcytokeratin7, vimentinが陽性で, desmin, S-100蛋白は陰性であり, 悪性ラブドイド腫瘍と診断した。既往症の髄膜腫とは組織像が異なり, 髄膜腫の転移は否定的であった。外来にて経過観察中であるが, 現在のところ転移や再発は認めていない。

A 73-year-old woman was diagnosed as primary hyperparathyroidism. Hypercalcemia recurred after parathyroidectomy, though serum calcium concentration temporarily resumed to normal. Hypercalcemia was eventually shown to be due to multiple myeloma. In spite of the frequent association of hypercalcemia with malignant disease and the relative frequency of primary hyperparathyroidism as a cause of hypercalcemia, primary hyperparathyroidism accompanied by multiple myeloma has been considered in only a limited number of reports. Here, the cases in the literature are reviewed and discussed.

We report a case of a 58-year-old man with adrenal medullary hyperplasia associated with cortisol producing adenoma. Preoperative examination showed both adrenocortical and adrenomedullary hyperfunction. No Cushingoid sign was present and pheochromocytoma-like symptoms were predominant. Abdominal computerized tomography revealed a left adrenal tumor stained by contrast medium. Histologically, the adrenal tumor was found to be a cortical adenoma, and medullary hyperplasia was observed in the remaining parenchyma.

We report here an extremely rare case of breast signet-ring cell carcinoma (SRCC) initially manifesting as duodenal metastasis and acute pancreatitis. A 62-year-old female presented with duodenal obstruction and swollen head of the pancreas, and the diagnosis of acute pancreatitis was initially made. Upper gastrointestinal endoscopy revealed duodenal stenosis with erosive mucosa, with signet-ring cells infiltrating the submucosal layer, suggesting duodenal metastasis of SRCC. Despite absence of a palpable mass in both breasts, computed tomography revealed diffuse enhancement of the left breast in addition to left axillary lymphadenopathy. Histological examination of mammary needle biopsy samples revealed SRCC with a non-invasive lobular carcinoma component. Primary breast SRCC with duodenal metastasis was therefore diagnosed. The patient underwent palliative surgery twice for intestinal obstruction due to peritoneal dissemination. She has remained alive without bowel obstruction for 18 months while being treated with cytotoxic chemotherapies.

We report the case of a 61-year-old woman with cryptogenic liver abscesses who had been profoundly ill with severe upper abdominal pain, impaired consciousness, prostration, continuous high fever secondary to sepsis, and thrombocytopenia (platelets, 1–5 × 104/mm3) since admission. Ultrasonograms and computed tomograms revealed two separate multiloculated lesions in the right lobe of the liver, consistent with the liver abscesses. Immediately after diagnosis, percutaneous abscess drainage was performed under ultrasonographic guidance; however, only a small amount of pus was drained, prompting continuous irrigation of the abscess cavity. Four days later, transcatheter hepatic arterial infusion of antibiotics was attempted. However, the abscesses had enlarged and her general condition had worsened. On hospital day 8, she underwent right hepatectomy because the multiloculated lesions were refractory to drainage. The operation was successful in terms of hepatectomy, although she continued to suffer from sepsis, secondary right subphrenic abscess formation, and prolonged thrombocytopenia with associated coagulation disorders for two months. Examination of multiple cross sections of the resected specimen disclosed that the lesions consisted of aggregations of multiple small locules. There was no communication between the locules and there were true septations, rather than multiloculated lesions with pseudoseptations. The patient has been well for 2 years without recurrent abscess of the liver or any infectious disease.

A 60-year-old Japanese man was hospitalized because of urinary leakage from the anus on October 3, 1994. Retrograde urethrography detected a fistula between the bulbous urethra and the rectum. Urethrocystoscopy revealed a tumor on the urethrorectal fistula. Tumor biopsy showed a well differentiated adenocarcinoma. Cystourethrectomy with fistulectomy, and ileal conduit urinary diversion were performed. Pathological examination revealed primary adenocarcinoma in the fistula with invasion to the prostatic urethra and bladder wall. The patient showed no evidence of a recurrence as of August, 1996.

The interrelation of the aluminum content and aging change of the nerve cells was studied with special reference to the neurofibrillary tangle (NFT) and occurrence of senile plaque (SP), in 15 autopsied brains (cerebrum) of non-demented elderly subjects varying in age from 75 to 101 years old and 10 cases of non-demented non-elderly adult subjects. 1) In the brain of non-demented non-elderly adult subjects, the aluminum content of the hippocampus was 14.4 +/- 1.39 ppb and that of the cortex of the frontal lobe was 20.4 +/- 2.54 ppb. In the brain of the non-demented elderly subjects, the aluminum content of the hippocampus was 401.7 +/- 60.05 ppb and that of the cortex of the frontal lobe was 373.29 +/- 72.35 ppb. Comparison of the two groups showed obviously higher levels in the latter group, being 28 times in the hippocampus and 19 times in the cortex of the frontal lobe. 2) The histochemical demonstration of the aluminum localization by the Morin method disclosed the positive fluorescence reaction along the part of the disintegrating neurofibrillary tangle and amyloid core in the senile plaques of non-demented elderly subjects. In the normal brain tissue, positive fluorescence reaction was observed in the wall of the capillary vessels of the blood brain barrier, perivascular glial supporting tissues, the nuclei of the astrocytes and nuclei, nucleoli of the nerve cells partially. No fluorescence reaction was observed in the non-demented adult subjects. 3) Morphologically, the appearance of the neurofibrillary tangle was noted in some cases of non-demented elderly group with higher aluminum levels. Classical and diffuse type senile plaques were dispersed in the 1st to 4th zone of the cortex of the frontal lobe. However, diffuse type senile plaques in the hippocampus appeared to a lesser extent. Neurofibrillary tangles were slightly noted in the cortex of the frontal lobe, however marked increase was confirmed in the CA1 to CA3 zones of the hippocampus. Ultrastructurally, paired helical filaments (PHF) were noted in the neurofibrillary tangle constituent and the increase of amyloid fibrils in senile plaques was confirmed. In this study, high levels of the aluminum content of the brain were confirmed in the non-demented elderly subjects. Moreover, the histochemical demonstration of aluminum localization by the Morin method disclosed a positive fluorescence reaction along the sites of neurofibrillary tangles and amyloid core in the senile plaques of non-demented elderly subjects.(ABSTRACT TRUNCATED AT 400 WORDS)

A 51-year-old woman with Cushing's disease associated with adrenal myelolipoma is reported. A further characteristic feature was the coexistence of bilateral adrenal calcification and thyroid cancer. Previously several cases of adrenal myelolipoma associated with endocrine dysfunction were reported. The combination of Cushing's disease and adrenal myelolipoma has only been described in two cases of recurrent Cushing's disease but never in an initial occurrence of Cushing's disease. Continued stimulation by excessive adrenocorticotropic hormone (ACTH) not only developed adrenal hyperplasia but also might be involved in the pathogenesis of adrenal myelolipoma.

We report an unusual case of granulomatous hypophysitis in which visual impairment, meningitis and hypopituitarism in a 76-year-old female were associated with radiological evidence of a pituitary mass. The sellar lesion was indistinguishable from pituitary tumor on neuroimaging studies, but the recovery of visual acuity and visual field abnormalities together with the improvement of pituitary function after steroid administration indicated that the mass lesion was due to an inflammatory disease of the pituitary gland. The pituitary tissue obtained by transsphenoidal hypophysectomy revealed granulomatous inflammatory cell infiltration with epithelioid cells and scattered multinucleated giant cells. Although a causal relationship with meningitis was not ascertained, possible exposure of the CSF space to the autoimmune inflammatory process of the pituitary gland was likely in view of the positive pituitary antibody reaction and radiological evidence of suprasellar extension. This entity should be considered when evaluating patients with a pituitary mass, hypopituitarism and meningitis.

Nuclear magnetic resonance spectroscopy (MRS) is a new technique for the evaluation of myocardial metabolism. Recently, localized MRS has been clinically available to measure by a non-invasive method the relative concentrations of the high-energy phosphate metabolites in the myocardium. We performed ECG gated P-31 MRS using ISIS (image-selected in vivo spectroscopy) in 15 normal volunteers, 12 patients with hypertrophic cardiomyopathy, 12 with left ventricular hypertrophy, 6 with dilated cardiomyopathy and 11 with specific heart muscle disease. Myocardial peak height ratios of PCr/gamma-ATP, Pi/gamma-ATP and PCr/Pi were measured. Myocardial P-31 MRS demonstrated a significant decrease in the ratio PCr/ATP in patients with hypertrophic cardiomyopathy and specific heart muscle disease as compared with normal subjects, indicating myocardial metabolic disturbance in these patients. The ratio of PCr/ATP in patients with dilated cardiomyopathy did not differ significantly from that of normal subjects. However, exercise MRS revealed a marked decrease of PCr peak in an asymptomatic patient with dilated cardiomyopathy, which may indicate a latent metabolic disturbance in the myocardium of dilated cardiomyopathy.

On hydrazinolysis in 1:4 acetic acid-pyridine, and in pyridine, partial O -deacylation of fully acylated methyl glycosides and some other glycosyl compounds (23 compounds) was found to be induced, to give, in good yields, products bearing one free hydroxyl group; the results obtained indicated that, among the primary and secondary O -acyl groups, the 2- O -acyl groups were, in general, the most labile toward the nucleophile (hydrazine). Hydrazinolysis of 1,2- O -isopropylidenealdofuranose acylates (3 compounds), on the other hand, gave, in high yield, the corresponding monoacyl derivatives having the protecting group on their primary hydroxyl group. The factors possibly involved in the regioselectivity of the hydrazinolysis were discussed.

反すう動物の第一胃からのカルシウム,リン,マグネシウムの吸収•分泌を検討するために,2頭の去勢メン羊を用い,動静脈血差法による試験を実施した.メン羊は,第一胃フィステル,頸動脈ループおよび第一胃静脈カテーテルが取り付けられ,大麦,大豆粕,乾草が1日2回給与された.朝の給餌前(0時間),給餌終了後(1時間),以下1.5,2.5,4.0,7.0時間目の1日計6回,メン羊1で4日間,メン羊2では2日間にわたり第一胃内容液,動脈血および第一胃静脈血が採取された.その結果,第一胃内容液中の各ミネラル含量が通常の場合でも,カルシウム,リン,マグネシウムの第一胃壁からの吸収•分泌が認められ,第一胃壁はカルシウム,リン,マグネシウムに対して透過性を有することが示きれた.マグネシウムは,第一胃内容液中のマグネシウム含量が100mg/l前後にある時も,常時吸収されているような傾向を示した.飼料摂取後の経時的な変化には,各ミネラルともに一定の傾向はなかった.また,従来,関係があるとされていたマグネシウム吸収量と,第一胃内容液マグネシウム含量,および第一胃内容液pH値の間には,本試験の結果からは有意な相関は認められなかっこ.

乳頭分泌物の直接塗抹法により診断した1例および集細胞法 (蓄乳法) を併用しmicrodochectomyで確認した5例, 計6例のT0・Tis乳癌を用い乳頭分泌細胞診について検討した. 6例中3例は乳頭分泌物が唯一の自・他覚的症状であった.乳頭分泌物内には全例で赤血球がみられ, 4例で壊死物が認められた. 癌細胞の核長径は7～10μ と小型で, その細胞集塊は乳頭状構造を示す症例が多かった. 直接法と蓄乳法を比較すると後者では乾燥がなく良好な状態で観察でき, また得られた細胞集塊数は1～37倍と多く得られた. したがって直接法で判定不能であった3例が蓄乳法で陽性と判定できた. ただし1例は直接法で陽性であったが蓄乳法では疑陽性にとどまった. 組織学的には5例が非浸潤性乳管癌, 1例が浸潤性アポクリン癌であった.乳頭分泌物で陽性を示す症例では早期乳癌の頻度が高いことを考慮すると, 乳頭分泌細胞診, 特に蓄乳法は診断的意義が高く, また疑陽性例の存在などに対してmicrodochectomyの併用により診断率が向上できると考えた.

An autopsy case of a 45 years old Japanese female with malignant masothelioma a showing peculiar stromal change was presented. The tumor had occupied the abdominal cavity around the uterus and both ovaries, and was diagnosed as a malignant peritoneal mesothelioma of epithelial type. The characteristic feature of the tumor was that the foam cells, which contained abundant amount of lipid droplets in the cytoplasm, and were thought to be histiocytes, massively occupied the stroma of the papillary tumor. Macroscopically, the tumor simulated a codfish roe. To our knowledge, no case of this sort of appearance of mesothelioma has ever been reported. ACTA PATHOL. JPN. 34: 687–692, 1984.

An adenocarcinoma of the second portion of the duodenum in a 26-year-old male is presented. The patient was suffering from pain in the epigastrium. Immunofluorescent studies revealed that it consisted almost exclusively of cells with a distincly positive somatostatin-like immunoreactivity. Ultrastructurally, the cytoplasm of the tumor cells had numerous large round granules (about 400 micrometers) with variable electron density. Most of these cells closely resembled the D cells normally seen in the duodenum and the islets of the pancreas, although a few argyrophil cells could be demonstrated by light microscopy. Radioimmunoassay of extracts of the tumor revealed a large amount of somatostatin (2260 pg/mg); substance P and VIP were detected also. Somatostatinoma has been known to occur in the pancreas, but this seems to be the first somatostatinoma found in the intestine.

Fusion of 2-acetamido-1,3,4,6-tetra-O-acetyl-2-deoxy-β- d -glucopyranose, 1,3,4,6-tetra-O-acetyl-2-deoxy-2-phthalimido-β- d -glucopyranose, and 1,3,4,6-tetra-O-acetyl-2-benzamido-2-deoxy-β- d -glucopyranose with 2,6-dichloropurine, theophylline, and 6-benzylaminopurine in activating agents afforded the corresponding aminonucleosides in good yields. The simultaneous formation of a positional isomer was confirmed in three examples in the reactions with 2,6-dichloropurine and 6-benzylaminopurine. On the basis of these results, the potential effect of 2-acylamido functional groups on the reaction is discussed.

A 25-year-old female who suffered from longstanding incurable leg ulcers was found to have prolidase deficiency with iminodipeptiduria. On ultrastructural studies of autopsy specimens, the lamina densa of the epidermal basement membrane was found to show irregular splitting and the basement membranes of the dermal blood vessels were lamellated with interruptions. Lamellar changes and splitting of the basement membranes of the renal tubules, interstitial blood vessels and glomerular capillaries also occurred. These morphological abnormalities seem to be one of causes of the clinical symptomatology.

Reciprocal interaction between the hemopoietic organ stromal cells and the cells of the granulocytic, megakaryocytic and erythrocytic series in the human liver obtained from 109 embryos 28 to 49 days after ovulation and 76 fetuses from 8 to 22 weeks of gestation were investigated by light and electron microscopy. The close association of stromal cells with immature cells of the three series was confirmed under the electron microscope and a presumptive HIM (hemopoietic inductive microenvironment) was visualized. A majority of immature erythroblasts intruded into the cytoplasm of the hepatocytes, so the presumptive hemopoietic stem cell types II and IV are undoubtedly differentiated into cells of the erythroid line by contact with hepatocytes at a certain stage of maturation. Granulopoiesis developed among the reticular cells around the ductus venosus--or large arteries in hepatic parenchyma--and the cells of the granulocytic series were enclosed by thin cytoplasmic projections of mesenchymal cells. Neither erythropoiesis nor megakaryopoiesis was noted here. Therefore the compartments composed of one or more reticular cells around the ductus venosus or large arteries seem to have a capacity to regulate the differentiation of the presumptive hemopoietic stem cells type IV into cells of the granulocytic series. This differentiation of presumptive hemopoietic stem cell types II and IV into the megakaryocytic series is belived to be induced by the presence of the microenvironments that consist of foci of a few reticular cells in the hepatic parenchyma, as immature cells of megakaryocytic lineage were encircled by the cytoplasmic projection of one or more reticular cells among hepatocytes. Erythroblastic islets are concluded to be a kind of HIM, where erythroblasts loosely adhere to the central macrophages and undergo mitoses and maturation.

Forty substituted phenyl glycosides and corresponding thioglycosides were synthesized and tested the tumor growth effect against sarcoma 180 with these compounds. Most of the aromatic thioglycosides markedly increased the tumor growth in weight. It seems that compound XIV or XVII possessed the highest activity among the compounds examined. One of most active substances accelerate a growth of the body weight in young mice and a regeneration of the partial hepatectomy in rats. On the other hand, these compounds have no immunosuppressive or activating effect.

An examination of the site where the acidic catalysts might strongly interact in the fusion reaction of a purine derivative with a fully-acylated sugar led to the conclusion that a purine derivative was activated by the interaction with the catalysts, and, moreover, resulted in the discovery of a new type of activating agent other than the acidic catalysts which had previously been known in the fusion method. In the presence of an excess amount of activating agents, e.g., p-nitrophenol, the condensation reaction of theophylline with 1,2,3,4,6-penta-O-acetyl-β-D-glucopyranose proceeded, even in the absence of p-toluenesulfonic acid, to give the corresponding nucleoside. Some of the activating agents were found to form molecular compounds with theophylline, and a few of the latter to afford the corresponding nucleoside similarly. A possible mechanism for the activation process of theophylline by the above agents was discussed.

Intermolecular interaction between nitrophenols, such as m-, p-nitrophenol, 2,4-dinitrophenol, and picric acid, and adenine derivatives, such as N(6)-benzoyladenine, N(6)-benzoyl-2-methylthioadenine, and N(6)-benzyladenine, was verified by the formation of the corresponding molecular compounds. On the basis of these results, condensation reactions of these adenine derivatives with 1-O-acetyl-2,3,5-tri-O-benzoyl-β-D-ribofuranose were carried out in nitrophenols, which were used as the activating agents. They were proved to afford the corresponding nucleosides in good yields. In addition, a novel glycosyl rearrangement reaction was first observed in the case of the reaction of N(6)-benzyladenine with the ribofuranosyl acylate.

Cells of erythrocytic series in the human liver obtained from 109 embryos 28 to 49 days after ovulation and 76 fetuses between 8 to 22 weeks of gestation were investigated by light and electron microscopy. Antisera against fetal hemoglobin (Hb-F) were used in the immuno-peroxidase method to identify erythroblasts in the embryonic and fetal liver.Immunoperoxidase staining for Hb-F revealed that most of the hemopoietic cells found in fetal hepatic parenchyma were erythrocytic in nature. The cells of the erythrocyte series consisted of large immature cells which were usually invaginating into the cytoplasm of hepatocytes, and small mature erythroblasts which tended to gather in the subendothelial spaces of the sinusoids.The early hepatic erythroid progenitor cells observed in the intercellular spaces of the hepatocytes until 10 weeks of gestation (the early stage of hepatic hemopoiesis) distinctly differed in ultrastructure from the late hepatic erythroid progenitor cells which appeared after 10 weeks of gestation (the late stage of hepatic hemopoiesis).These findings indicate that the progenitor cells of the erythrocytic series and the hemopoietic stem cells in the early stage of hepatic hemopoiesis are morphologically different from those in the late stage, and that the cells of erythrocytic series in the liver in the early stage differ in the course of maturation from those in the late stage.

A case of a thymic carcinoid tumor is presented. The tumor was a mass measuring 7 by 6 by 5 cm in size. Microscopically, the tumor was composed of a mixture of round, cytoplasm-rich cells in addition to the predominantly spindle-shaped cells. The ultrastructural observation showed many secretory granules, about 120 mmu in size, in almost every cell of the tumor. In the cytoplasm many microfilaments were seen, in places forming large nodules and bundles. Centrioles were often observed in the tumor cells. Sometimes three or even more centrioles were seen in a single cell.

Presumptive hemopoietic stem cells in the human liver obtained from 109 embryos 28 to 49 days after ovulation and 76 fetuses between 8 and 22 weeks of ovulation were investigated by light and electron microscopy. Presumptive hemopoietic stem cells in the human embryonic liver are concluded to be a series of cells that show a variegated ultrastructure. They are classified into four subtypes (type I, II, III and IV). Presumptive hemopoietic stem cells of type I are thought to differentiate from the undifferentiated mesenchymal cells that are derived from the septum transversum. Presumptive stem cells of type I, II and III transitorily appear in the liver during the early stage of hepatic hemopoiesis, and cannot be detected in late stages. With the development of the fetus, presumptive stem cells of the type IV, however, gradually increase in number. The cells of megakaryocytic, granulocytic and erythrocytic lineages originate from the presumptive stem cells of type II in the early stage of hepatic hemopoiesis, whereas the cells of the three lineages originate from the presumptive stem cells of type IV in the late stage. The presumptive hemopoietic stem cells of type IV are surmised as corresponding to the pluripotent hemopoietic stem cells (CFU-S) in laboratory animals or pluripotent hemopoietic progenitors in human bone marrow (CFU-mix).

A case of mesodermal mixed tumor arising in the uterus of a 57-year-old woman is presented. The tumor was a mixture of adenocarcinoma with occasional squamous metaplasia, stromal sarcoma, myxosarcoma and chondrosarcoma. Light and electron microscopic examinations of the tumor revealed close transition between stromal sarcomatous component and each of other sarcomatous and carcinomatous component. The histogenesis of mixed mesodermal tumor was discussed and it was concluded that the tumor might be derived from endometrial stromal cell which possessed the pluripotency to differentiate toward various epithelial and mesenchymal tissues including the heterologous mesenchymal tissue.