Haruaki Izumi

Congenital Absence of Lacrimal Puncta and of All Major Salivary Glands: Case Report and Literature Review

A 7-year-old girl had dry mouth and recurrent infections of the lacrimal fistulae with decreased lacrimal secretion. All four puncta were absent, and a Schirmer test showed decreased lacrimal secretion. Salivary gland imaging with sodium pertechnetate 99mTcO4 showed absence of all major salivary glands. Lower lip biopsy disclosed normal structure of the salivary gland. No evidence of abnormal inheritance patterns could be demonstrated.

AN AUTOPSY CASE OF HEPATOID CARCINOMA OF THE OVARY WITH PIVKA-II PRODUCTION : IMMUNOHISTOCHEMICAL STUDY AND LITERATURE REVIEW

A case of hepatoid carcinoma of the ovary in a 61‐year‐old Japanese woman, who showed high serum levels of α‐fetoprotein and CA125, is reported. Grossly, the left ovarian tumor, which measured 12 × 9 cm, was solid and multinodular. Histologically, the tumor resembled hepatocellular carcinoma by its architectural and cytological features. Liver cell differentiation was indicated functionally by the immunohistochemical detection of α‐fetoprotein and protein induced by vitamin K absence or antagonist II (PIVKA‐II) and by positive bile production, and the hepatocellular differentiation was structurally in accord with keratin 7, 8 and 18 expression. CA125 expression, commonly present in ovarian surface epithelial carcinomas, suggested that this neoplasm originated from ovarian common epithelial cells. There are only nine such cases in the literature. A review of these cases reveals that hepatoid carcinoma of the ovary occurs exclusively in postmenopausal women (mean age, 62.7 years) and that the prognosis is poor.

Right intraventricular metastasis of squamous cell carcinoma of the uterine cervix: an autopsy case and literature review.

An autopsy case of squamous cell carcinoma of the uterine cervix, which developed cardiac intracavitary metastasis in a 28‐year‐old Filipina, is reported. At autopsy, the right ventricle contained a soft, red–purple, cauliflower‐like mass. Histologically, this mass was made up of sheets of malignant squamous cells similar to the primary uterine foci. The metastases were extensive and associated with multiple organ involvement. Although this case was stage Ib at operation, vascular invasion at the primary site was characteristic, and the intracavitary tumor of the right ventricle developed without myocardial involvement. The carcinoma of the primary site extended along the inferior vena cava and settled as an intracardiac obstructive mass. A literature review (including the present case) disclosed only 14 uterine cervical carcinomas with right intracavitary metastasis. The mean age of these patients was 46 years of age (range, 28–77 years). The clinical stage was Ib in two cases, IIa in one case, IIb in six cases, and IIIb in two cases. The prognosis of these cases was poor; 13 of the patients died at an average of 19.1 months after diagnosis.

IMMUNOHISTOCHEMICAL STUDIES ON CARCINOEMBRYONIC ANTIGEN IN ADENOCARCINOMAS OF THE UTERUS

In order to distinguish endocervical adenocarcinoma from endometrial adenocarcinoma, an immunoperoxidase stain for carcinoembryonic antigen (CEA) was tried. All of 10 endocervical adenocarcinomas revealed CEA and an adenosquamous carcinoma in the uterine cervix also showed it, while a mesonephroid adenocarcinoma in the uterine cervix did not. The immunohistochemical reaction products for the antigen were not observed in the glandular structures of 20 endometrial adenocarcinomas, although CEA was detected in all foci of squamous epithelial metaplasia occurred within 7 endometrial adenocarcinomas. CEA was detected in the endocervical type of glandular epithelium within a special endometrial adenocarcinoma containing predominantly endocervical type glandular epithelium. The immunoperoxidase staining pattern for CEA in the endocervical adenocarcinoma was related to the degree of histological differentiation of tumors, as follows; in the well differentiated glandular structure CEA was located on the luminal surface, while it was detected in the whole cytoplasm of tumor cells within the moderately and poorly differentiated areas. In conclusion, the immunoperoxidase stain for CEA would be useful for estimating malignancy of glandular structures within the uterus, distinguishing endocervical adenocarcinoma from endometrial adenocarcinoma, and grading of histological differentiation of endocervical adenocarcinoma.