Kazuo Hamaya

Solid Adenosquamous Carcinoma of the Liver A Case Report and Review of the Literature

This is a report of a fatal case of a primary and solid adenosquamous carcinoma (ASC) of the liver in a 58‐yearold Japanese woman. There was no association with biliary cysts. Histochemistry and immunohistochemistry support the contention that the neoplasm arose from squamous metaplasia of a mucus‐secreting adenocarcinoma (MSA) of intrahepatic biliary duct epithelium.

Primary Amyloid Tumors of the Jejunum Producing Intestinal Obstruction

The proximal jejunum, containing four separate amyloid tumors, was resected from a chronically constipated 71‐year old male exhibiting 1gG lambda monoclonal gammopathy. Amyloid was deposited in the jejunal wall, mesentery and regional lymph nodes, but was not seen in gastric and rectal biopsy samples. Two years after surgery, the patient is well, but the monoclonal gammopathy persists. Acta Pathol. Jpn. 32: 207∼211, 1989.

Neuroendocrine carcinoma of the larynx presenting as a primary unknown carcinoma

OBJECTIVE The case of an 80-year-old man showing a metastatic cervical small cell neuroendocrine carcinoma is presented. RESULTS The primary site could not be found at first; it took 8-10 months to detect the primary lesion in the larynx. CONCLUSION (18)F-deoxyglucose positron emission tomography (FDG-PET) was useful to find the submucosal lesion. Despite surgical treatments and chemotherapy, the patient survived for only 21 months.

A case of traumatic neuroma of the gallbladder in the absence of previous surgery and cholelithiasis.

We experienced a patient with traumatic neuroma of the gallbladder with no history of gallbladder surgery or cholelithiasis. A 74-year-old man was referred to our department after a gallbladder tumor was incidentally discovered during a preoperative screening examination for prostate hypertrophy. Ultrasonography, MRI, CT and endoscopic retrograde cholangiography revealed a protuberant lesion of the gallbladder. Laparoscopic cholecystectomy was attempted but adhesion between the liver and duodenum forced us to convert to open laparotomy. Cholecystectomy and adjacent liver tissue resection was performed. Diagnosis was made by frozen histology during operation. It revealed no malignancy. Postoperative pathological examination revealed traumatic neuroma associated with inflammation. To our knowledge, this is the first reported case of gallbladder neuroma without a history of gallstones or surgery in the English and Japanese literature since 1980. This traumatic neuroma should be considered in a differential diagnosis in treating gallbladder neoplasm, even in the absence of an operative history or cholelithiasis.

Epithelial hyperplasia of the larynx a clinical follow-up study

In this retrospective study, the records of 40 patients with epithelial hyperplasia of the larynx, seen between 1980-1991, were reviewed to determine the incidence of malignant transformation during long term follow-up. The mean follow-up time was 58.6 months. The initial pathological diagnoses were hyperkeratosis in one case, parakeratosis in one, dyskeratosis in 12 and dysplasia in 26. During follow up, nine patients developed carcinoma in situ and/or invasive carcinoma. Of these, two patients had been diagnosed with dyskeratosis without dysplastic cells at the initial biopsy. It is therefore important to follow up patients with epithelial hyperplasia of the larynx even when no dysplastic cells are found at the time of diagnosis.

FINGERPRINT-LIKE STRAIGHT CRYSTALLOID MICROFILAMENTS IN LOBULAR GLOMERULONEPHRITIS

This 64‐year‐old male presented edema and proteinuria. With increasing renal insufficiency and persistent fever, he died 7 months after the onset of illness, complicated with terminal miliary tuberculosis. All the glomeruli showed sclerotic nodular lobulation and mesangial circumferential interposition with positive immunoglobulin and complement predominantly along the capillary, consistent with lobular glomerulonephritis (LGN) or terminal stage of membranoproliferative glomerulonephritis (MPGN). Electron microscopy revealed subepithelial straight crystalloid microfilaments in the amorphous deposits. These structures possibly represent IgG or its fragment as a component of immune complex crystallized in some particular condition. ACTA PATHOL. JPN. 35 : 767–773, 1985.

Malignant melanoma of the nasal cavity.

We report a case of amelanotic melanoma arising in the nasal cavity and paranasal sinuses, that could not be positively diagnosed as malignant melanoma before the patients death in spite of repeated biopsies both from primary and metastatic lesions, including ultrastructural examination and immunohistochemical staining for S-100 protein with usual polyclonal antibody. The patient died of rapid wide-spread dissemination of the tumor. In autopsy specimens, melanin pigment was detected, for the first time, by the Fontanas silver stain. The posthumous diagnosis of malignant melanoma was immunohistochemically confirmed for the specific antibodies, anti alpha-subunit of S-100 protein antibody and SK-46 (original antibody for melanoma made at the Department of Pathology, University of Gunma School of Medicine) from specimens obtained while alive. The application of a specific antibody for S-100 protein is recommended as useful for the diagnosis of malignant melanoma even when routine immunohistochemical procedures fail to demonstrate S-100 protein.

Disseminated Atypical Mycobacteriosis

Two cases of disseminated infection caused by Mycobacterium intracellulare were reported and discussed.

Time study of macroscopic identification of experimental cerebral infarction in rat.

Cerebral infarctions were induced in rats by injection of Sephadex G‐200 into the internal carotid artery. Unfixed slices of brain were stained with nitro blue tetrazolium (nitro‐BT). Tissue dehydrogenase in normal regions reacts with this chemical and changes from a pale yellow color to dark blue consequent to formation of formazan. However, the color changes do not develop in infarcted tissue as there is depletion of tissue dehydrogenase in these regions. Ischemic lesions are identifiable by this method in over half the brain 2 to 4 hours after the embolization, but are seen in all brains 6 hours or more following the embolization. The procedure is simple, requires 30 minutes, and is useful for identification of small or acute cerebral infarction.

Frank melena in a patient with fallopian tube pregnancy

We present herein a case of a young woman who experienced lower intestinal hemorrhage caused by ischemic necrosis of the small intestine induced by the compression of a Fallopian tube hematoma in an ectopic pregnancy. All accessible preoperative attempts to clear the site of the bleeding were unsuccessful and an exploratory laparotomy was indicated seventeen days after the development of melena. An ileocecal resection and right salpingectomy finally had to be performed.