Fujio Kishida

Hyaluronan synthesis by anaplastic large cell lymphoma with massive lymphomatous effusion. A case report.

BACKGROUND Hyaluronan (HA) synthesis is frequently observed in malignant mesothelioma cells, whereas it is rarely found in lymphoma cells. Previous studies have reported that a high HA concentration in the serum was related to poor prognosis in lymphomas, although the mechanism was not elucidated. We recently encountered a case of anaplastic large cell lymphoma with an HA-rich, massive, lymphomatous effusion. Several studies were performed to clarify the character of this unusual lymphoma and to observe whether the lymphoma cells synthesized HA. CASE A 59-year-old female was admitted with abdominal pain. Radiologic studies revealed a pleural effusion and paraaortic lymph node swelling. A biopsied specimen was compatible with anaplastic large cell lymphoma. Detailed cytologic observations revealed that the lymphoma cells in the pleural effusion had alcian blue-positive, productive material in the prominent Golgi area and microvillous structures on the surface. Further studies found that most of the lymphoma cells had HA-binding protein and expressed CD44 antigen, a receptor for HA. In addition, the HA concentration in the supernatant of the primary culture cells was extremely high and increased time dependently. CONCLUSION These observations suggest that the lymphoma cells synthesized and released HA. Interactions of the released HA and CD44 on the surface might play an important role in the peculiar serosal growth of lymphoma cells.

Cytologic studies of cerebrospinal fluid in invasive lobular carcinoma of the bilateral breasts accompanied with carcinomatous meningitis.

浸潤性小葉癌の髄膜転移例を経験したので, その髄液細胞所見を中心に報告した. 患者は32歳の女性で29歳時, 右側乳房腫瘤を指摘されたが放置していた. 1991年2月腹部膨満感を自覚し, 当院を受診する. 両側乳房に不整形の硬い腫瘤を認め, 右側では大胸筋と固定しており皮膚への浸潤を認めた. また, 著明な腹水とともに両側卵巣の腫大がみられ, 4月両側卵巣摘出術を行い, 同時に両側乳房の生検を行った. 両側乳房は浸潤性小葉癌で, 両側卵巣および大綱に転移を認めた. 1991年11月頃より, 頭痛, 嘔吐などの髄膜刺激症状を認めたため, 髄液細胞診を行った. シート状にならぶ小型の腫瘍細胞および対細胞を呈する腫瘍細胞を認めた. またマクロファージ, 悪性細胞ともに風船状, 樹枝状の突起を有していた. 剖検では腫瘍細胞は脊髄くも膜下腔血管周囲に認められた. 下垂体には腫瘍細胞の浸潤を認めたが, 脳実質にはみられなかった.

A case of intracranial chondroid chordoma diagnosed intraoperatively by squash method cytology.

本症例は20歳, 女性で斜台に発生した脊索腫である. 手術時の圧挫細胞診で, 背景は粘液様物質にとみ, 腫瘍細胞は担空胞細胞 (physaliphorous cells) と空胞を有しない上皮性細胞を認め, 一部でlacuna内に存在する核を認め, 軟骨様脊索腫と診断した. ホルマリン固定ヘマトキシリンエオジン標本ではalcian blueに濃染する軟骨様基質を背景に, 脊索腫に特有なphysaliphorous cellsを認め, 明らかなlacunaをもつ軟骨へ分化したものを認めた. 腫瘍細胞は免疫染色法で, NSE, S-100, Keratin, EMA, Vimentinに陽性を示した. 脊索腫は細胞診診断上, 臨床像, 部位, 肉眼所見から困難ではないが, 予後を知るうえで脊索腫を軟骨様, 非軟骨様の2型に分けることは重要である. 本症例では手術時圧挫細胞診がその鑑別に有効であった.