Chihiro Tanaka

Mixed medullary-papillary carcinoma of the thyroid with lymph node metastases: report of a case.

Abstract We report herein the case of a 77-year-old woman found to have mixed medullary-papillary carcinoma in the right thyroid with lymph node metastases 30 years after a left thyroidectomy. The preoperative values of serum calcitonin and carcinoembryonic antigen (CEA) were high, and fine-needle aspiration biopsy revealed class V, which led us to suspect papillary carcinoma. A right thyroidectomy with dissection of the right neck lymph nodes was performed. Histopathological examination of the tumor specimens revealed gradual borders between medullary carcinoma and papillary carcinoma with positive immunohistochemical staining to calcitonin, chromogranin A, CEA, and thyroglobulin. The serum levels of calcitonin and CEA decreased to normal after the operation. The point mutation of the RET proto-oncogene was found to be negative by a DNA analysis of the peripheral leukocytes. This cancer seemed not to be associated with multiple endocrine neoplasia type 2 syndrome. The presence of both medullary and papillary components in the thyroid with lymph node metastases is rare and may suggest that the tumor had arisen from a common stem cell.

A Study on Four Cases of Simple Ulcer in the Small Intestine Causing Massive Bloody Stool.

下血にて発症する小腸潰瘍はまれな疾患である. 筆者らは, 緊急開腹術にて単純性小腸潰瘍からの出血であることを究明しえた4例を経験したので報告する. 症例は44歳の女性, 65歳の男性, 54歳の男性, 67歳の女性. いずれも主訴は下血. 術前検索で, 胃・十二指腸・結腸・直腸よりの出血は否定. 全例緊急開腹術施行下, 術中内視鏡にて小腸潰瘍よりの出血を確認後, 病巣を含めて腸切除術を施行. 組織学的には, いずれもU1-II～IIIの良性潰瘍で, 単純性小腸潰瘍と診断された. 小腸潰瘍の術前確定診断を得ることは非常に困難である. したがって, 高度な貧血をきたす下血を認めながら, 消化管検査にて原因を究明しえない症例においては, 小腸潰瘍からの出血の可能性も念頭におき, 診断と治療を兼ねた開腹術下小腸内視鏡の施行を考慮すべきであると考えられる.