Katsuhiko Aoyama

Malignant fibrous histiocytoma of the heart

An autopsied case of malignant fibrous histiocytoma (MFH) in the left atrium of the heart of a 29‐year‐old Japanese woman was reported light and electron microscopically, and immunohistochemically. Metastasis was found in the adrenal, jejunum, and cervical regions. This is the fourth case of MFH of the heart in the literature. The tumor consisted of undifferentiated mesenchymal cells and histiocytoid cells, including giant cells and xanthomatous cells. Dense patches were commonly detected in all tumor cells. On frozen sections, histiocytoid cells formed EA and EAC rosettes, while fibroblastic cells formed EA rosettes only. Difference between them was also recognized in activity or amount of marker enzymes of histiocytes. These analyses suggested that MFH is a mesenchymal cell tumor with binary differentiation into histiocytoid cells and fibroblastic cells.

AN ELECTRON MICROSCOPIC STUDY OF ACUTE PROMYELOCYTIC LEUKEMIA WITH CHLOROMA

Tumor forming acute promyelocytic leukemia (APL) is rare and only three cases have been documented. However, there are no reports on either the chloromatous character or electron microscopical analysis. The present paper dealt with a light, electron microscopic and histochemical study of the tumor of APL in a 55‐year‐old Japanese male. The tumors found in the anterior mediastinum and right lower extremity. He died from respiratory disturbance and hydrothorax due to obstruction of the pulmonary truncus by the mediastinal tumor. In electron microscopy, the tumor cells showed dilatation, eolloracious pattern and honey‐comb‐like structure of rough endoplasmic reticula (RER) and parallel array‐arrangement of smooth endoplasmic reticula (SER). These abnormalities of ER are the same as those recently recognized in leukemic cells in APL. Furthermore, the intercellular junctions composed of opposing dense patches of the cytoplasmic plasmalemma were frequently found between the more immature tumor cell of the mediastinum.

Surgery of giant bulla with tube drainage and bronchofiberoptic bronchial occlusion

A case of emphysematous bullae and right lung cancer is presented. At first, left giant bulla was managed by minithoracotomy and tube drainage combined with bronchofiberoptic bronchial occlusion to preserve the respiratory function. Four weeks later, right lung cancer was successfully resected.

Sinus histiocytosis with massive lymphadenopathy. A histogenic analysis of histiocytes found in the fourth Japanese case.

The present paper deals with immunohistochemical and ultrastructural study of the lymph nodes of sinus histiocytosis with massive lymphadenopathy (Rosai and Dorfman, SHML) of a 12‐year‐old Japanese boy. This is the fourth case in Japan. Osseous manifestation was also found in the bilateral ulnae. With hallmarks of S‐100 protein and interdigitating cytoplasmic extensions, the phagocytizing histiocytes proliferating in the sinuses were considered to be derived mostly from interdigitating cells in the paracortex or T cell dependent area, which have heretofore been regarded as nonphagocytizing. Furthermore, it is most interesting that lymphoid cells bearing thymic cortical cell‐antigen (OKT 6) were increasingly recognized in the patients peripheral blood. These results suggested that SHML is a specialized reactive histiocytosis analogous to histiocytosis X and histiocytic medullary reticulosis.

BENIGN HISTIOCYTOSIS X OF STOMACH Previously Undescribed Lesion

Histiocytosis X of the stomach of a 47‐year‐old Japanese woman, who underwent subtotal gastrectomy following a clinical diagnosis of scirrhous carcinoma, was studied by light and electron microscopy as well as by immuno‐histochemistry. The histiocytoid cells proliferated monotonously in the lamina propria mucosae of the atrophied mucosa covering the body and fornix. They were arranged in a sheet‐ or pavement stone‐pattern and included some giant cells. The histiocytoid cells had a reniform to irregularly indented nucleus and conspicuous cytoplasm. Ultrastructurally, they were characterized by interdigitating cytoplasmic extensions and abundant tubulovesicular structures including Langerhans granules. S‐100 protein, α1‐antitrypsin, and α1‐antichymo‐trypsin were immunohistochemically identified in the cytoplasm. Endoscopic biopsies of the extragastric digestive tract, a biopsy of the lymph node, and bone marrow aspiration excluded a systemic disorder. The case is regarded as benign localized histiocytosis X of the stomach, a previously undescribed gastric lesion.

Second Primary Digestive Cancer After Resection of Lung Cancer

PurposeWe evaluated the clinical findings of patients with second primary digestive cancers (SPDC) after the resection of lung cancer.MethodsAmong 772 patients who underwent resection of primary lung cancer at Saitama Cardiovascular and Respiratory Center between 1993 and 2002, 10 (1.3%) were diagnosed with SPDC during follow-up. These ten patients were classified into two groups based on whether the SPDC was incidentally (group I) or symptomatically (group S) diagnosed.ResultsThe median interval to the detection of SPDC was 17 months in group I and 66 months in group S, and the disease was at an earlier stage in group I than in group S (P = 0.008). Comparing body weight at the time of lung resection to that at the time of abdominal surgery, significant weight loss was evident in group S (P = 0.009). The postoperative disease-specific survival rate was 100% in group I. No long-term survivor died of lung cancer.ConclusionSpecial attention must be paid to the possibility of SPDC after the resection of lung cancer to improve the prognosis of patients with lung cancer.

A Case of A Long Survival After Resection of A Large Cell Lung Carcinoma Invading the Diaphragm.

背景. 横隔膜に浸潤した肺癌の治療成績は, 一般に不良である. 我々は, 長期生存している横隔膜に浸潤した肺大細胞癌症例を経験したので報告する. 症例. 症例は61歳の男性で血痰を主訴として来院した. 胸部単純写真では左下肺野に心陰影と重なり径5cm大の腫瘤影を認めた. 胸部CTと胸部MRIでは横隔膜への直接浸潤像を認めた. 気管支鏡下の生検で悪性細胞を確認し, 左下葉切除術, 横隔膜・脾臓合併切除術, ND2aリンパ節郭清術を施行した. 術後病理診断は大細胞癌で, リンパ節転移を認めず, pT3N0M0であった. 術後5年目に第2癌 (腺癌) に対して右肺下葉部分切除術を施行した. 結論. 初回手術から6年6ヶ月経過した現在, 再発の所見なく元気に社会生活を送っており, 横隔膜合併切除術が有用であった.

A Case of Mediastinal Schwannoma Invading the Carina.

症例は47歳の女性で, 検診で胸部異常影を指摘され, 精査治療目的に入院した.主訴は咳徽, 呼吸困難で, 胸部単純写真では左肺門部に腫瘤影を認めた.胸部CT, MRIでは気管分岐部に5.8×4.5cmの充実性腫瘍を認め, 気管, 左主気管支との境界は不明瞭であった.気管支鏡では気管下部左側後壁から左主気管支にかけて, 内腔をほぼ閉塞する粘膜下腫瘍を認めた.生検では確定診断に到らなかったが, 臨床症状が進行性であったため, 気管気管支壁への浸潤をともなう悪性縦隔腫瘍を疑い, 左管状肺摘除術を施行した.術後病理診断では, 組織学的には良性の神経鞘腫と診断された.