Haruki Fukuda

Prognostic significance of Ki67 (MIB1) proliferation index and p53 over‐expression in chondrosarcomas

To investigate the prognostic significance of the Ki67 (MIB1)‐proliferation index and p53 over‐expression in chondrosarcomas, we retrospectively analyzed a cohort of 29 patients with chondrosarcomas using immunohistochemical assays with MIB1 and p53 monoclonal antibodies on formalin‐fixed, paraffin‐embedded tissue samples with microwave preparation. We also assessed 19 patients with benign cartilaginous tumors as a control group. There was a significant positive correlation between MIB1 index and tumor grade in chondrosarcomas, while there was no significant difference in the MIB1 index between the grade‐I chondrosarcomas and the benign cartilaginous tumors. Patients categorized in the high‐MIB1‐index group had a significantly lower survival rate than those in the low‐index group. Moreover, in analyzing the sub‐set of the patients with grade‐II chondrosarcomas, it was found that they could be prognostically sub‐divided according to MIB1 index. The p53 index also significantly correlated with patient survival, and there was significant correlation between the MIB1 index and the p53 index. However, in multivariate analysis, only the MIB1 index and tumor grade proved to be independent prognostic indicators of chondrosarcomas. These results demonstrate that the MIB1 index can be a useful procedure for assessing tumor grade in chondrosarcomas, especially for determining the prognosis of patients with grade‐II chondrosarcoma.

Dedifferentiated liposarcoma of the subcutis

This report describes an 82-year-old woman with dedifferentiated liposarcoma, an extremely rare neoplasm of the subcutis. The patient had first recognized a very soft mass in the anterolateral part of the right thigh more than 20 years earlier, but because the tumor showed little change over this period, she did not seek treatment. She recently noticed a hard, rapidly growing mass within the former tumor. Both magnetic resonance imaging and axial computed tomography revealed a subcutaneous fatty lesion measuring 12 x 7 x 4 cm and a well-delineated mass-like area (4 x 3 x 3 cm) of nonfatty tissue within the lesion. Histologically, the former was a mature lipomatous tumor with broad fibrous septa containing some atypical stromal cells, and the latter was a much more cellular, spindle cell tumor with a malignant fibrous histiocytoma-like pattern. The authors propose that dedifferentiated liposarcoma is not restricted to the deep soft tissues and may develop in the subcutis and further suggest appropriate surgical management for well-differentiated fatty tumors of subcutaneous origin.

Hyperfunctioning intrathyroid parathyroid adenoma: Report of two cases

We report herein two cases of intrathyroid parathyroid adenoma, which is a rare condition in patients with hyperparathyroidism. In the first patient, an excised intrathyroid nodule was diagnosed to be parathyroid adenoma postoperatively. In the second patient, preoperative localization studies suggested the possibility of an intrathyroid adenoma. When a pathological gland is not found during surgery for primary hyperparathyroidism, an ectopic parathyroid gland including an intrathyroid adenoma should thus be considered.

Synovial sarcoma after chemotherapy for osteosarcoma : A case report

A 23-year-old man had eight cycles of adjuvant chemotherapy including doxorubicin, cisplatin, methotrexate, and ifosfamide and radical surgery for biopsy-proved osteosarcoma of the right fibular shaft. Two years after the initial diagnosis, he noticed a mass in the medial aspect of his right knee. Magnetic resonance imaging scans revealed a soft tissue tumor measuring 2 × 2 cm in the pericapsular region of the right knee. Histologically, this soft tissue tumor was composed of spindle cells with occasional atypical mitoses and without matrix formation. Immunohistochemically, the tumor cells were positive for vimentin, cytokeratin, and epithelial membrane antigen, and negative for alpha smooth muscle actin. A fusion gene, SYT-SSX was detected with reverse transcription-polymerase chain reaction. From the results, the secondary tumor was diagnosed as a synovial sarcoma. The current case of double sarcomas is rare. Both sarcomas were diagnosed accurately using immunohistochemical and molecular procedures. This case suggests a positive association between a second tumor and chemotherapy including intraarterial perfusion of doxorubicin.

Histologic examination of two cases of cystosarcoma phylloaes with pulmonary metastases

BackgroundCystosarcoma phyllodes (CP) is a rare neoplasm of the breast. Many studies of the histology of CP have been reported. However, few reports have included an evaluation of the histologic appearance of pulmonary metastases, or the change in histologic grade as a function of time in patients with recurrent tumors.MethodsWe treated two patients with pulmonary metastases, CP from 1973 to 1995. One patient died of respiratory failure. The other underwent six operations for CP. We evaluated the histologic characteristics of these metastases and changes in the histologic grade of recurrent tumors.ResultsThe primary lesions in these two cases were typical high-grade malignant tumors. Case 1 had multiple pulmonary metastases and histologic findings indicated typical malignant CP. Case 2 had a solitary pulmonary metastasis and histologic findings showed low-grade malignant CP, which could be resected. The first patient died of respiratory failure ten months after surgery. The second had no further pulmonary metastases although she had frequent local recurrences, and the histologic features of these tumors became progressively worse.ConclusionWe suggest that patients with malignant CP be followed closely and that when pulmonary metastases are detected, they should be resected if possible, because pulmonary metastatic tumors may represent lower-grade malignant CP.