Akitsugu Hino

Malignant schwannoma of the esophagus with lymph node metastasis: literature review of schwannoma of the esophagus

An extremely rare case of malignant schwannoma of the esophagus with lymph node metastasis is reported. A 49-year-old woman was found to have an abnormal shadow on a chest X-ray film taken during an annual checkup. Upper gastrointestinal series showed extrinsic pressure on the middle thoracic esophagus, without a mucosal lesion. An exploratory operation was performed, with a tentative diagnosis of esophageal leiomyoma. The tumor was enucleated with part of the esophageal mucosa, and a few enlarged lymph nodes around the tumor were dissected. The resected tumor was an elastic firm mass, measuring 8.2 x 5.8 x 3.7 cm, and had a smooth surface. Histological examination of the tumor revealed the proliferation of spindle-shaped cells with chromatin-rich nuclei. The nuclei were variable in size and showed remarkable atypia. A paraesophageal lymph node had same findings as the main tumor. Immunohistochemically, the tumor cells were diffusely positive for S-100 protein and neuron-specific enolase. The pathological diagnosis of this tumor was malignant esophageal schwannoma with lymph node metastasis. Esophageal schwannoma is extremely rare. We reviewed the literature on 19 cases of esophageal schwannoma, including that in our patient. The majority of the tumors were benign. Only three cases of schwannoma were malignant, and this is the first reported case of malignant schwannoma with lymph node metastasis.

Primary peritonitis associated with streptococcal toxic shock-like syndrome: report of a case.

Several reports over the past 15 years describe severe group A streptococcal infections causing septic shock, soft-tissue necrosis, and multiple organ failure; a phenomenon known as streptococcal toxic shock-like syndrome (TSLS). However, primary peritonitis associated with TSLS is rare. We report the case of a 40-year-old man admitted with pain in both thighs, hypotension, and severe abdominal pain. His daughter had been diagnosed with streptococcal pharyngitis 3 days earlier. We performed an emergency laparotomy for peritonitis, and culture of the ascites was positive for group A β-hemolytic streptococcus (GAS). Further serotyping of the isolated GAS strain revealed the T-type 22 and the pyrogenic exotoxin gene, spe-C. The criteria for TSLS were clearly met, including the isolation of GAS from ascites, hypotension, liver failure, renal failure, coagulopathy, myositis, and a generalized erythematous macular rash with desquamation.

Clinical evaluation of branched chain aminoacid infusion in patients with liver cirrhosis following direct operation for esophageal varices with special reference to changes in serum neutral aminoacid concentration.

食道静脈瘤を有する肝硬変症の血漿遊離アミノ酸を測定した結果, 芳香族アミノ酸 (AAA) の上昇と, 分枝鎖アミノ酸 (BCAA) の低下を認めた. これらの症例に食道静脈瘤直達手術を施行し術後の血漿遊離アミノ酸の変動を検討したところ, 術前値よりさらにBCAA/AAA (モル比) は低下し, 手術後2例に羽ばたき振顫が認められた. 20例において術後に特殊組成アミノ酸製剤を輸液したところ, 血漿遊離アミノ酸のインバランスは改善された. その際短時間に点滴輸液するよりはIVHにて24時間かけて輸液する方が効果的であった. また20例中術後肝性脳症を来した症例は1例も認められなかった.