Kazunori Iwasa

Spindle epithelial tumor with thymus-like differentiation (SETTLE) of the thyroid

Tumors of the so‐called intrathyroidal epithelial thymoma type are a rare group of thyroid neoplasm tumors. Of this type of tumor, spindle epithelial tumor with thymuslike differentiation (SETTLE) has been reported only 17 times in English literature.

Anaplastic thyroid carcinoma producing the granulocyte colony stimulating factor (G-CSF): report of a case.

We report herein the unusual case of a 60-year-old woman with an anaplastic thyroid carcinoma which produced granulocyte colony stimulating factor (G-CSF). She presented with large neck masses, respiratory difficulty, and a high fever. Laboratory examinations revealed marked leukocytosis of 43,200/mm3 with 85% granulocytes and an elevated G-CSF level of 67 pg/dl. Total thyroidectomy with bilateral node dissection and tracheostomy was performed, and a histological diagnosis of large-cell anaplastic thyroid carcinoma was confirmed. Immunohistochemical examination with a polyclonal antibody against G-CSF stained the tumor cells. Although the respiratory difficulty, fever, and marked granulocytosis subsequently improved, she died 1 month after undergoing surgery due to metastatic mediastinal disease.

Leiomyosarcoma of the colon presenting as acute suppurative peritonitis

A surgical case of leiomyosarcoma arising from the ascending colon, presenting as acute suppurative peritonitis, is herein described. A 70-year-old woman complaining of lower abdominal pain presented to our clinic on October 12, 1994. She was admitted with a tentative diagnosis of peritonitis. At emergency laparatomy, purulent intraabdominal fluid was present, and a fist-sized mass was seen in the ascending colon just proximal to the hepatic flexure. A right hemicolectomy was thus performed based on a diagnosis of perforating colon cancer. The histologic findings were consistent with leiomyosarcoma with abscess formation in and around the tumor. Five mitotic figures per field were observed at 10x magnification. Immunohistochemical studies revealed immunoreactivity for α-smooth muscle antigen (α-SMA), vimentin, and desmin. After reviewing the clinicopathologic characteristics of colon leiomyosarcoma as described in 78 Japanese cases and 70 cases from the foreign literature, we thus propose that colon leiomyosarcoma frequently arises from the transverse colon. In addition, our case also represents the only reported case in Japan in which an adult patient underwent a successful operation for perforated leiomyosarcoma of the colon.

A retrospective study on the efficacy of cervical lymph node dissection in well-differentiated carcinoma of the thyroid

The management of cervical lymph node metastases in well-differentiated carcinoma of the thyroid is controversial. In our department, from 1963 to 1972, node plucking was performed only in patients with cervical lymphadenopathy whereas, from 1973 to 1983, modified radical neck dissection was therapeutically or electively performed. In order to determine whether the more extensive dissection is adequate, a retrospective analysis was performed using two groups of patients who were managed differently with regard to the treatment of cervical lymph node metastases. From this series of 206 patients with more than five years follow-up, it was found that the rates of survival and lymph node recurrence did not differ between the two groups. However, since the well-differentiated carcinoma of the thyroid has relatively indolent biological behaviour, further long-term follow-up seems to be necessary for demonstrating the efficacy of neck dissection.

Internal Hernia Through a Defect in the Left Broad Ligament of the Uterus: A case report.

子宮広間膜に生じた異常裂孔に起因する内ヘルニアは極めてまれで, 本邦ではこれまで50例の報告しかない. 今回, 我々は異常裂孔に腸管が嵌頓し, イレウスとなった1例を経験したので報告する. 症例は開腹手術の既往がない44歳の女性で, 腹痛, 嘔吐を認め来院, イレウスと診断され入院した. CTでは子宮の左側に拡大した腸管がみられたが確定診断できず, 保存的に治療を行った. 第3病日に疼痛が増強したため, 原因不明のイレウスとして手術を施行したところ, 左子宮広間膜に異常裂孔が存在し, 回盲弁から80cm口側の回腸が嵌頓していた. このため25cm長の壊死腸管を切除し, 異常裂孔を閉鎖した. 本症は疾患の知識がないと術前に確定診断することは困難であるが, CTが診断の有力な手段となると考えられた. また, 開腹術の既往がないイレウス症例には, 子宮広間膜の異常裂孔等に起因する内ヘルニアを鑑別診断に加える必要があると考えられた.