Hirohiko Tanaka

Aspiration of Giant Hepatic Cyst in the Fetus in utero

A large hepatic cyst was diagnosed in a fetus at 29 weeks of gestation by puncture and aspiration performed under ultrasonographic guidance. This procedure was repeated five times at about 2-week intervals, with a total of 1,446 ml of cystic fluid aspirated. A healthy female infant was delivered vaginally at 40 weeks of gestation. Her Apgar score was 9 at 1 min, and she weighed 2,790 g. On the 14th postnatal day, the hepatic cyst was punctured percutaneously under ultrasonographic guidance, and 119 ml of yellow fluid was aspirated. The cyst was subsequently not visible on computed tomography at 9 months. Surgery was not indicated in this infant, and the cyst was also not detected at the age of 21 month. Thus, treatment in utero appeared to have obviated the need for surgery.

Venous thromboembolic diseases associated with uterine myomas diagnosed before hysterectomy: a report of two cases.

Large uterine myomas (compressed veins in the pelvis), and the resulting impaired blood flow have been associated with deep vein thrombosis and pulmonary embolism. Careful detection of the preoperatively formed thrombi and strict perioperative management, such as in the following cases we report, may reduce lethal pulmonary embolism and may positively affect patient prognosis.

Autoimmune Hepatitis Complicated with Antiphospholipid Syndrome in Pregnancy

PROBLEM: There are few reports on the association between autoimmune hepatitis (AIH) and antiphospholipid syndrome; only five reports were found on a MEDLINE search between 1966 and 2001. Therefore, the etiology and the optimal treatment of them are not clear.

Nonbacterial thrombotic endocarditis complicated with stage Ia ovarian cancer

Nonbacterial thrombotic endocarditis (NBTE) commonly occurs in advanced malignancies associated with a cancer-related hypercoagulable state, but the prevalence of NBTE in patients with less advanced malignancies is unknown. A 46-year-old woman had multiple thromboembolic events and disseminated intravascular coagulation on admission. Transthoracic echocardiography showed several growths on the mitral valve. Pelvic magnetic resonance imaging revealed a rapidly enlarging large tumor. In spite of anticoagulation therapy, she died 1.5 months after admission. At autopsy, NBTE with stage Ia ovarian cancer was diagnosed. In cases of higher-growth rate tumors with abundant necrosis, NBTE may occur in early-stage (even in stage Ia) ovarian cancer. In the majority of stage Ia ovarian cancers, curative surgical resection can be done. Prognostic improvement may be gained by such positive intervention, although this depends on the patient’s general condition when NBTE occurs. With tumor resection, there is a possibility that the patient will recover from the hypercoagulable state and a poor outcome will be avoided.

Spinal intradural hemorrhage due to a neurinoma in an early puerperal woman

A spinal intradural hemorrhage due to a neurinoma is very rare and requires emergency surgery. We report the first case of a spinal intradural hemorrhage due to a neurinoma in an early puerperal woman. The patient had a history of intermittent episodes of lower back pain for 3 years. The antenatal course to that time had been uneventful. Two days after a normal vaginal delivery, she presented with sudden onset of spinal lesion with severe symptoms and an emergency laminectomy was performed to remove an intradural hemorrhagic lesion due to a neurinoma. In this case, we speculate that clots in the intratumoral vessels spontaneously occurred during pregnancy and obstructions of these vessels followed by necrosis and hemorrhage of distal tissues occurred in the early postpartum stage. Moreover, the change in posture caused by the change in the maternal center of gravity following delivery, as well as the frequent bending required for the care of the newborn, may have been contributing factors. Mild but repetitive traction force caused by the change in posture and frequent bending may have created exertion on the vascular attachment to the nerve roots, causing the intradural hemorrhage.

Low-grade appendiceal mucinous neoplasm with disseminated peritoneal adenomucinosis involving the uterus, mimicking primary mucinous endometrial adenocarcinoma: A case report

We present a patient with a low‐grade appendiceal mucinous neoplasm, resulting in disseminated peritoneal adenomucinosis (pseudomyxoma peritonei) with uterine involvement, and mimicking primary mucinous endometrial adenocarcinoma. On immunohistochemistry, neoplastic glands were cytokeratin 7‐negative and cytokeratin 20‐positive, indicating a gastrointestinal origin rather than a primary ovarian mucinous neoplasm. A diagnosis of uterine metastasis of appendiceal origin was made, based on the constellation of clinicopathological findings, that is, preceding appendiceal neoplasm, peritoneal involvement, absence of coexisting prototypical endometrioid adenocarcinoma or endometrial hyperplasia. The patient underwent hysterectomy and there was no evidence of disease progression at the 12‐month follow up. This suggested the indolent nature of this particular neoplasm, despite its advanced stage.

A case of thyroid-type papillary carcinoma derived from ovarian mature cystic teratoma, resected by laparoscopic surgery.

Follicular variant thyroid‐type papillary carcinoma (FVTPC) arising from thyroid tissue in mature cystic teratoma of the left ovary is extremely rare, and it is not easy to diagnose preoperatively. However, with reports of an early postoperative death, we must prudently select the strategy for this lesion.

Cotyledonoid dissecting leiomyoma treated by laparoscopic surgery: a case report.

A cotyledonoid dissecting leiomyoma is categorized as a leiomyoma with an unusual growth pattern, which is characterized by remarkable extrauterine bulbous growth in continuity with a dissecting myometrial component. A 36‐year‐old patient was preoperatively diagnosed with a mature cystic teratoma of the left ovary, and according to MRI, the tumor protruded from the uterus into the right broad ligament and was 10 cm in diameter. She underwent laparoscopic surgery to resect ovarian teratoma and the tumor under the right broad ligament. The tumor was almost completely resected and diagnosed as a cotyledonoid dissecting leiomyoma based on intraoperative and pathological findings. Recurrence was not seen for 26 months postoperatively in our case. Gross specimens are often mistaken for malignant lesions, but this was a benign disease. Even if some remnants of the leiomyoma remained postoperatively, recurrence has never been reported. When a cotyledonoid dissecting leiomyoma is resected laparoscopically, intrapelvic structures around it, such as the ureter, uterine artery, bladder, rectum and external iliac vessels, must be given careful attention.

Aortitis during intraarterial chemotherapy for cervical cancer.

Abstract A 76-year-old woman with stage IIb cervical cancer with a bulky tumor experienced aortitis during continuous intraarterial cisplatin-based chemotherapy. The chemotherapy was administered through a catheter tip placed in the aorta abdominalis, utilizing an external infusion pump. During the third course of chemotherapy, she complained of left-sided lower back pain and moderate fever was observed. Elevated white blood cell count (WBC) and C-reactive protein (CRP) level were noted, and an abdominal X-ray and urgent computed tomography (CT) were performed. The catheter tip was displaced against the arterial blood flow. At this level of the aortic wall, soft tissue density surrounded the aorta completely. Aortitis caused by the intraarterial chemotherapy, was strongly suspected. It was thought that the maldistribution of drugs and changes in the drug flow occurrred due to the vertebral height movement of the catheter tip against the aortic blood flow, and there, flow to the vasa vasorum may have occurred. Chemical vasculitis of the vasa vasorum due to the anticancer drugs was strongly suspected as a contributing factor of the aortitis. Because of the long-term use of an intraarterial catheter, the maldistribution of drugs and changes in the drug flow occurred physically and biologically during the course of the chemotherapy. We recommend occasional monitoring of the location of the catheter tip and a repeat evaluation with contrast medium in regard to flow to the vasa vasorum.

Diagnostic evaluation of necrotic debris in breast aspiration cytology-A diagnostic flow-chart by the new reporting form of breast cytology-

目的:乳腺穿刺吸引細胞診で観察される壊死物質について診断上の評価と問題点について検討した.方法:組織学的に診断が確定した乳腺細胞診症例906件 (悪性524件, 良性382件) を対象とした.成績:壊死物質が観察された標本の873%は悪性病変であり, 非浸潤性乳管癌と乳頭腺管癌 (ともに面庖癌) が多かった. 壊死物質とともに石灰化小体がみられた例はすべて悪性病変であり, 多数の石灰化小体を伴う例の95%は面庖癌であった. 良・悪性を問わず梗塞性病変では, 壊死物質とともに立方状, 多角形, 紡錘形など多様な形態を示す変性細胞や核濃縮細胞, ghost細胞が観察された. また壊死物質と鑑別の紛らわしい壊死様物質について述べた.結論:変性細胞や壊死物質を認める標本ではviableな細胞で診断する. 壊死物質および壊死様物質が観察される標本の判定と取り扱いについて乳腺細胞診新報告様式に基づく診断フローチャートを提案し, その評価法について述べた.