Hiroshi Hongo

Localized malignant mesothelioma of the pleura.

We describe a case of malignant pleural mesothelioma appearing as a solitary pleural tumor in a 56‐year‐old Japanese man with no history of exposure to asbestos. A chest radiograph revealed an isolated extrapulmonary mass in the left hemithorax. The patient underwent tumor resection, but the tumor later recurred on the contralateral pleura. The patient developed cerebral metastases and died 16 months after the initial surgery. The resected tumor was sessile with broad‐based pleural attachment. Microscopically, the tumor was composed of interlacing fascicles of plump spindle cells intermixed with few polygonal cells. Most of the tumor cells showed positive immunoreactivity for cytokeratins (AE1 and AE3) and vimentin. Many of the tumor cells were positive for epithelial membrane antigen, and a few were positive for desmin. In contrast, the tumor cells were consistently negative for carcinoembryonic antigen, epithelial antigen BerEP4, calretinin, S‐100 protein, neuron‐specific enolase, muscle actin antigen HHF35, α‐smooth muscle actin antigen and CD34. Ultrastructurally, the tumor cells had diffusely distributed cytoplasmic intermediate filaments, desmosome‐like junctions, and a few microvilli. Some tumor cells contained cytoplasmic tonofilaments. Immunohistochemical and ultrastructural findings supported the mesothelial nature of the tumor, and led us to diagnose this tumor as a sarcomatoid localized malignant mesothelioma.

Surgery for abdominal aortic aneurysms associated with malignancy

Of 148 patients treated for abdominal aortic aneurysms (AAA), 33 (22%) also had cancer. According to the classification of Szilagyi, there were 13 patients in group I, 19 in group II, and 1 in group IV. In group I, the mean interval between the cancer and AAA operations was 7 years (range 1–14 years). Aneurysmectomy was performed in 9 patients, wrapping in 2, and no operation in 2. In group II, a two-stage operation was performed in 8 patients, a single-stage operation in 4, only surgery for cancer in 4, and no operation in 3. Of 4 patients undergoing single-stage operations, 3 had colorectal cancer, and there were no postoperative complications such as graft infection or anastomotic breakdown. In group I, 6 of 13 patients died, but there were no cancer deaths. In group II, 9 of 19 patients died, 6 from progressive cancer. The group IV patient also died of cancer. These results suggest that if a patient can tolerate surgery for both diseases, a single-stage operation is preferable.

Internal echo histogram examination has a role in distinguishing malignant tumors from benign masses in the breast

We analyzed the histograms of reflecting ultrasound (US) from the internal areas of the masses of 50 lesions in the breast. The central average of gravity and the ratio between lower and higher width in the histograms were compared as the parameters. Statistical significance were found in both parameters between malignant tumors and benign masses (P<.001, P<.01). Therefore, analysis of histograms based on reflecting US was useful in making differential diagnoses of malignant tumors and benign masses in the breast.

A New Approach for Abdominal Aortic Aneurysm by a Ringed Y Graft

Nonsuture technique with ringed Y graft (RYG) was applied to 5 high-risk patients with abdominal aortic aneurysm (AAA). All showed marked arterio sclerotic changes. In 3 cases, the AAA was located 1 cm below the renal artery branching. Concomitant diseases were: gastric ulcer in 3 cases, chronic bron chitis in 3, moderate renal failure in 2, thoracic aortic aneurysm in 1, and aortic valvular insufficiency in 1. The RYG method was evaluated by comparing age, size of aneurysm, operating time, blood loss, and aorta clamping time with the conventional Y graft (CYG) method (10 cases). Ages and sizes in the RYG group were nearly identical with those in the CYG group. The mean blood loss was 797 ± 86 ml in the RYG group and 1631 ± 754 ml in the CYG group (p < 0.05). Aorta clamping time was 34 ± 2.4 min in the RYG group and 62 ± 4.9 min in the CYG group (p < 0.01). Although the suprarenal aorta was clamped in 3 of 5 cases in the RYG group, proximal anastomosis took only a few minutes, and none of them required protection to the kidney. The authors conclude that RYG can be reliably applied to high-risk patients with AAA.

Immunohistochemical and Ultrastructural Examination of Histiocytosis X Cells in Pulmonary Eosinophilic Granuloma

We describe histological, immunohistochemical, and ultra‐structural findings in pulmonary eosinophilic granuloma (PEG) from three patients. The specimens were taken by open‐lung biopsy. The lesions of the lung were composed of histiocytic cells, macrophages and eosinophils. The histiocytic cells reacted positively with anti‐S‐100 protein antibody. The histiocytic cells had various types of Birbeck granules in the cytoplasm. The histiocytic cells were histiocytosis X (HX) cells considered to be derived from Langerhans cells. Sporadic mitosis of HX cells was observed. Some HX cells had migrated from the lesions into the alveolar spaces through the alveolar cell layers. In the lesions of PEG, HX cells have self‐reproduction and migration capability. Acta Pathol Jpn 42: 719–726, 1992.

Abdominal Aortic Aneurysm Surgery in Patients with Cardiac and Renal Complications: Retrograde Anastomosis Using a Ringed Y-graft.

When performing high-risk abdominal aortic aneurysm (AAA), aortic cross-clamp time was reduced to a mean of 9 minutes by performing retrograde anastomosis using a ringed Y-graft (RYG). Retrograde anastomosis with RYG was performed in nine patients, (eight men and one woman) with a mean age of 74 years (range: 65–82 years). Three patients had angina pectoris and chronic renal failure, two had angina pectoris, one had thoracoabdominal aortic aneurysm and chronic renal failure, one had renal failure, one had aortic regurgitation, and one had aortic stenosis. First, the right common, external, and internal iliac arteries were clamped, then, the right limb of the graft was anastomosed to the common iliac artery or external iliac artery. Next, the aorta and left common iliac artery were clamped, and a longitudinal incision was made in the aneurysm. The proximal end of the RYG was inserted into the aorta and blood flow was resumed. Finally, the left limb of the graft was anastomosed to the left common iliac artery or external iliac artery. The mean aortic cross-clamp time was 9 minutes (range: 8–18 minutes). There were no cardiac complications during surgery. The mean operating time was 3:34 hours (range: 3:05–4:35 hours), and the blood loss averaged 1156 ml (range: 200–2000 ml). None of the patients developed postoperative complications and all of them have remained well after discharge. Retrograde anastomosis using RYG is one type of surgery that could be used in cases of high-risk patients with AAA.

Ringed grafting for an abdominal aortic aneurysm in a 92-year-old patient : report of a case

We report herein the case of a 92-year-old man with an abdominal aortic aneurysm who underwent successful surgical resection using a ringed graft. His postoperative course was uneventful, and he was discharged after 42 days, following which he attended the outpatient department twice a month for regular check-ups. He finally died of pneumonia which developed from an upper respiratory tract infection 6 months after his operation. Thus, surgical treatment should always be considered when an aneurysm is detected, even in very aged patients for whom the activities of daily living are possible.

Idiopathic Retroperitoneal Fibrosis

We treated a patient with idiopathic retroperitoneal fibrosis accompanied by right ureteral constriction. Pyelography, ureterography, and abdominal CT scan were pertinent diagnostics. Close collaboration between the surgeon and the urologist is required when attempting to treat such patients.