Akira Okimura

Undifferentiated carcinoma with osteoclast-like giant cells arising in a mucinous cystic neoplasm of the pancreas.

A 26‐year‐old woman presented with pain in the left hypochondrium, for which pancreatectomy and splenectomy was performed, with total gross excision of a mass. A tumor measuring 11 × 9 cm was found in the pancreas. On cut surface there were two cysts filled with a necrotic substance and hemorrhagic content. Spindle or ovoid‐shaped cells, in the sarcomatous component, had diffusely infiltrated along the inner side of the walls of one cyst. Osteoclast‐like giant cells (OGC) were also contained in the sarcomatous component. Adenoma components of mucinous epithelium with foci of borderline and adenocarcinomatous components were seen on the inner side of the other cyst. An ovarian‐type stroma beneath the epithelial component was seen in the cyst wall. A diagnosis of undifferentiated carcinoma with OGC arising in a mucinous cystic neoplasm (MCN) of the pancreas, was made. Seven months after the initial operation the patient had a local recurrence, and the tumor was removed. One month after the second operation, the patient was free of symptoms. Only four cases of undifferentiated carcinoma with OGC arising in MCN, involving an ovarian‐type stroma of the pancreas, have been reported.

Autopsy case of congenital pulmonary lymphangiectasis

Congenital pulmonary lymphangiectasis (CPL) is a rare anomaly. We report a female infant born at 39 weeks of gestation who was found to have CPL. Cyanosis and tachypnea were noted immediately after birth, and, at room air, PaO2 was 30.7 mmHg, PaCO2 was 82.5 mmHg and pH was 7.12. The infants symptoms did not improve even with the initiation of artificial ventilation. Chest X‐ray film showed cotton‐like infiltrates in both lungs and an air‐leak surrounding the cardiac shadow. Echocardiography study showed no abnormality. The neonate died 3 days after birth due to hypoxemic cardiac failure. At autopsy, the pleural surface contained numerous dilated vessels that had the appearance of lymphatics. Microscopic features of the lungs were marked lymphatic dilatation of the perivascular, subpleural and interlobular areas. Lymphangiectasis was found in the liver, kidney, pancreas, thyroid and alimentary canals, such as the esophagus, stomach and rectum. Patients with lymphatic dilatations in extrapulmonary organs have mild pulmonary involvement and symptoms and a better prognosis. However, a few cases of CPL with lymphatic dilatations in extrapulmonary organs and an aggressive course, such as the present case, have been reported. The clinical behavior and prognosis of CPL depend on the extent of pulmonary involvement of the lymphatic dilatations regardless of systemic lymphatic dilations.

Immunohistochemical analyses of E-cadherin, β-catenin, CD44s, and CD44v6 expressions, and Ki-67 labeling index in intraductal papillary mucinous neoplasms of the pancreas and associated invasive carcinomas

We examined the expressions of adhesion molecules (E-cadherin, β-catenin, CD44s, and CD44v6) and Ki-67 labeling index (Ki-67 LI) in low- and moderate-grade dysplasia and invasive carcinoma components in ten noninvasive intraductal papillary mucinous neoplasms (IPMNs) of the pancreas and eight invasive carcinomas associated with IPMNs of the pancreas using immunohistochemical methods. There was no significant difference in regard to the proportion of components expressing either E-cadherin or β-catenin in more than 70% of the tumor cells between the low- and moderate-grade dysplasia components. In contrast, the proportion of those in invasive carcinoma components was significantly lower than in low- or moderate-grade dysplasia components. Also, there was no significant difference in the proportion of components expressing CD44s or CD44v6 in more than 5% of tumor cells among low-grade dysplasia, moderate-grade dysplasia, and invasive carcinoma components. In contrast, the Ki-67 LI values increased in the order of low-grade dysplasia, moderate-grade dysplasia, and invasive carcinoma components, with significant differences among them. The present results indicate that carcinoma components are associated with a decrease in tumor cells expressing E-cadherin and β-catenin and have the highest proliferative activity.

Usefulness of High Suction Pressure for Sufficient Tissue Collection During Endobronchial Ultrasound Guided Transbronchial Needle Aspiration

Introduction The optimal suction pressure during endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) remains to be determined. The aim of this study was to compare suction pressures for performance in collecting sufficient tissue specimens from mediastinal and hilar lymph nodes during EBUS-TBNA. Methods Retrospective analysis of consecutive patients with mediastinal and hilar lymphadenopathy who underwent EBUS-TBNA over a 3-year period. Results from patients who underwent EBUS-TBNA using a dedicated 20-mL VacLoc (Merit Medical Systems, Inc, South Jordan, UT) syringe (conventional method, group C) were compared with results from patients in whom a disposable 30-mL syringe (high pressure group, group H) was used. The yield for sufficient histologic specimen retrieval and amount of tissue obtained were compared between the 2 groups. Results Of 178 patients who underwent EBUS-TBNA, 131 had lung cancer confirmed by EBUS-TBNA: 35 in group C and 96 in group H. There were 7 patients in group C and 6 in group H who received final diagnoses by cytology alone. There were 28 in group C and 90 in group H who were diagnosed by both cytology and histology. There was a statistically significant difference between the groups in terms of the rate of sufficient sampling for histological specimens (p = 0.04). The H group revealed a tissue area approximately twice that of the C group (p = 0.003). There were no major procedure-related complications in either group. Conclusion Higher suction pressures with larger syringe volumes during EBUS-TBNA may be useful for safely collecting sufficient tissue specimens.

Malignant mesothelioma of the peritoneum: case reports and immunohistochemical findings including Ki-67 expression

A malignant mesothelioma (MM) is an aggressive neoplasm, although some patients have shown long-term survival, and factors related to survival remain uncertain. We present three cases of MM of the peritoneum including autopsy results, in which factors related to long-term survival were investigated. Case 1 was a 69-year-old man who died 6 years after the initial diagnosis. In case 2, a 67-year-old woman came to us with abdominal distention and, despite chemotherapy, died 9 months after the initial diagnosis. The patient in case 3 was a 68-year-old man who also had abdominal distention and died 9 months after the initial diagnosis. We studied the clinicopathological appearance and performed immunohistochemical staining including Ki-67 labeling index (Ki-67 LI) in primary and metastatic sites of these cases. The histological findings of case 1 indicated epithelioid type; case 2 and 3 were of biphasic type. Immunohistochemical results were consistent with MM. The Ki-67 LI value for both primary and metastatic sites of case 1 was significantly lower than those in cases 2 and 3. We consider Ki-67 LI to be a useful prognostic indicator for MM of the peritoneum.

Surgical results and staging of non-small cell lung cancer with interlobar pleural invasion

The aim of this study was to compare the survival rates of non-small cell lung cancer (NSCLC) with interlobar pleural invasion (IPI) with that of patients with other T2 and T3 diseases according to the seventh TNM staging system. One thousand and one patients with pathologic T2 and T3 NSCLC (according to the seventh staging criteria) treated between 1980 and 2004 were retrospectively evaluated. Among these, 682 patients were pathologically staged as T2 without IPI (T2 group), 25 as T2 with IPI (IPI group) and 294 as T3 (T3 group). The 5-year survival rate for the T2, IPI and T3 groups were 52.0, 31.1 and 36.3%, respectively. In patients without nodal involvement, the 5-year survival rates of the T2N0, IPIN0 and T3N0 groups were 60.9, 40.0 and 45.9%, respectively. The survival rate was significantly different between the T3N0 and T2N0 groups (P < 0.001) and between the IPIN0 and T2N0 (P = 0.020) groups. There was no significant difference in the survival rate between the IPIN0 and T3N0 groups (P = 0.644). In patients without nodal involvement, the survival of NSCLC with IPI is similar to that of the T3 disease.

Pulmonary carcinosarcoma with an osteosarcomatous component

Pulmonary carcinosarcoma is a rare disease entity defined as a neoplasm, which has biphasic features consisting of both epithelial and sarcomatous components. It has been reported that the most frequent epithelial component is squamous cell carcinoma, while the most frequent sarcomatous component is rhabdomyosarcoma. Pulmonary carcinosarcomas with osteosarcoma components are even rarer. We report a case of a potentially curative resection for carcinosarcoma with an osteosarcoma component. Thoracic surgeons should be aware of this rare tumor when lung tumors with ossification are encountered.

Intrapulmonary neurofibroma independent of neurofibromatosis type 1

Intrapulmonary neurofibromas without neurofibromatosis type 1 are rare—so rare that only 11 cases have been reported previously. This case report describes a 37-year-old woman who was otherwise healthy. Chest radiography and computed tomography showed a solitary nodule, 20 mm diameter, in the left lung. The tumor was removed and examined. It was not encapsulated but was covered with an intact bronchial mucosa and lacked a clear partition into two areas of Antoni A (a palisading cellular component) and Antoni B (a loose myxoid component). Tumor cells were strongly positive for neuron-specific enolase and S-100 protein. These data characterized the tumor as a rare benign neurofibroma. The patient shows no sign of recurrence after 12 months of follow-up. We reviewed and characterized surgically resected cases of intrapulmonary neurofibroma without neurofibromatosis type 1 especially in comparison with cases of endotracheobronchial neurofibroma.

Carcinoma In Situ of the Esophagus: Case Report

Because the prognosis of esophageal cancer is generally poor, it is important to detect the disease at an early stage. Although iodine staining is an excellent method for finding early esophageal cancer by endoscopy, it is almost impossible to spray iodine in all patients. We fortunately have detected a tumor without iodine staining because of its white color. We report here a fiat-type esophageal tumor with controversial histopathology.