Kunio Mizuguchi

Solitary fibrous tumor of the prostate.

Abstract An extremely rare case of solitary fibrous tumor of the prostate is presented. The patient underwent a radical retropubic prostatectomy and has remained well with no evidence of recurrence during the last 18 months. This is the fifth reported case of such a lesion arising in the prostate.

Cytologic Diagnosis of Signet-Ring Cell Carcinoma of the Breast

OBJECTIVE To examine the cytologic features of signet-ring cell carcinoma (SRCC), defined as carcinoma dominated by signet-ring cells, of the breast and to discuss problems that occur in cytodiagnosis. STUDY DESIGN Five cases of SRCC of the breast were examined cytopathologically. Signet-ring cells were subclassified into intracytoplasmic lumina (ICL) type and non-ICL type. ICL type had large ICL containing mucin. Non-ICL-type cells had wide, amorphous cytoplasm diffusely dispersed with mucin. RESULTS In cases 1 and 2, fine needle aspiration biopsy (FNAB) revealed many signet-ring cells (non-ICL type), suggesting SRCC. Histologic diagnoses were ductal SRCC containing many signet-ring cells (non-ICL type). In cases 3 and 4, signet-ring cells (ICL type) were found sporadically among carcinoma cells without signet-ring features. Signet-ring cells were not regarded as the major component of the cells; thus, the cytologic diagnoses were lobular carcinoma, not otherwise specified. Pathologic diagnoses were lobular SRCC. Signet-ring cells were mostly ICL type. In case 5, most carcinoma cells on the smears showed signet-ring features (non-ICL type), suggesting SRCC. The histologic diagnosis was lobular SRCC, and signet-ring cells were mostly non-ICL type. CONCLUSION Ductal SRCC yielded more cellular smears as compared with lobular SRCC; therefore, cytologic diagnosis was easier in the former.

DERMATOMYOSITIS ASSOCIATED WITH URACHAL ADENOCARCINOMA

Dermatomyositis affects children and adults, females more often than males, and is traditionally closely associated with internal malignancy. Approximately 30% of patients with dermatomyositis have a malignancy, most commonly of the lung, ovary, breast or stomach.1 Urogenital malignancies associated with dermatomyositis are relatively rare although several cases associated with transitional cell carcinoma of the bladder have been documented.2 To our knowledge we report the first case of dermatomyositis associated with urachal adenocarcinoma. CASE REPORT A 47-year-old female presented with a 4-month history of gross hematuria and edema of the upper body. The patient also reported a 10 kg. weight loss. Physical examination revealed erythema affecting the face, shoulders, chest and back. The face was especially swollen with edema and erythema. Cystoscopy and computerized tomography (CT) demonstrated a solid mass in the dome of the bladder (fig. 1). Biopsy of the skin and deltoid muscle showed epidermal atrophy with a thickened basement membrane, and perivascular and interstitial inflammatory infiltrates. The muscle revealed myofiber degeneration and atrophy, increased interstitial collagen and endomysial inflammatory infiltrates (fig. 2, A). These findings were consistent with dermatomyositis. Laboratory tests demonstrated increased creatine phosphokinase (937 units per l., normal 35 to 165), increased lactic dehydrogenase (1,027 units per l., normal 203 to 450) and increased carcinoembryogenic antigen (46.3 ng./ml., normal less than 5.0). Transurethral resection of the bladder tumor showed moderately differentiated adenocarcinoma invading the bladder wall (fig. 2, B). Consequently, the clinical diagnosis was dermatomyositis associated with urachal adenocarcinoma. For the treatment of dermatomyositis 1 mg./kg. prednisolone per day was administered, and an immediate effect was observed with regard to the skin and muscle symptoms. Total cystectomy was not recommended because of a lung metastasis detected on CT, and the patient instead underwent pelvic irradiation (total 50 Gy.) and 2 courses of systemic chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin. The response to these therapies was minimal. One year after diagnosis, the patient died of multiple metastases to the liver and lung. However, the characteristic symptoms of dermatomyositis were well controlled by prednisolone until the end of her life.

A case of hemophagocytic syndrome associated with B-cell lymphoma

A rare case of hemophagocytic syndrome (HPS) associated with B‐cell lymphoma is reported. A 38‐year old female with dyspnea and fever developed a subcutaneous nodule with purpuric erythema on her right thigh and consulted our department on September 2, 1991. The histologic picture of this nodule revealed a dense infiltration of atypical lymphocytes into the dermis and subcutaneous tissue. A surface marker study of these atypical cells were CD22, CD74, and HLA‐DR positive, indicating a B‐cell origin for these cells. Normal histiocytes phagocyting erythrocytes were mixed with the infiltrating cells. The patient also had pericardial effusion, liver dysfunction, hepatosplenomegaly, and bleeding tendencies. The diagnosis was HPS associated with B‐cell lymphoma. She died of DIC on November 8, 1991.

Pulmonary focal fibrosis associated with microscopic arterio-venous fistula manifesting as focal ground-glass opacity on thin-section CT

BackgroundFocal ground-glass opacity (GGO) on thin-section computed tomography (CT) may be seen in atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ that has recently been renamed from bronchioloalveolar carcinoma (BAC) and various benign conditions.Case presentationWe report a case of pulmonary focal fibrosis associated with microscopic arterio-venous fistula (AVF), which showed a focal area of GGO on thin-section CT. The patient was a 58-year-old woman with a GGO on thin-section CT which had increased in size over the period of 2 years. Slightly dilated vessels and thickened interlobular septa were also noted around the GGO. It was diagnosed preoperatively as adenocarcinoma in situ and a partial lung resection by video-assisted thoracic surgery (VATS) was performed. Pathological examination yielded a diagnosis of focal fibrosis associated with microscopic AVF.ConclusionWe speculate that the focal fibrosis was produced by a prolonged congestion due to the AVF and that the dilated vessels and thickening of interlobular septa on thin-section CT related to the AVF. Microscopic AVF may be one of the etiologies of focal fibrosis showing focal GGO on thins-section CT. Dilated vessels and thickened interlobular septa around the GGO might offer a clue to the diagnosis of this disease entity. In addition, it should be noted that focal fibrosis may increase in size.

Long-Term Survival of an Elderly Patient with Carcinosarcoma of the Gallbladder after Cholecystectomy.

Carcinosarcomas, often referred to as malignant mixed tumors, are rare neoplasm. We reported herein a carcinosarcoma of the gallbladder in an elderly patient with long-term survival (4 years). The operation carried out was open cholecystectomy under the preoperative diagnosis of chronic cholecystitis and tumor of the gallbladder. Anticancer chemotherapy after cholecystectomy was performed by oral low-dose FT therapy. He was alive with no evidence of disease 48 months after surgery. Long-term survival for only cholecystectomy treatment as in this case may be possible if oral low-dose FT anticancer therapy is effective against carcinosarcoma of the gallbladder.

A case of neuroendocrine carcinoma of the prostate.

背景:前立腺のまれな腫瘍である神経内分泌癌: Neuroendocrine carcinoma (以下NEC) を経験したので報告する.症例:患者は78歳, 男性, 頻尿を主訴に来院した. 前立腺針穿刺組織検査で高分化腺癌が認められた. 尿細胞診においても腺癌を疑う異型細胞がみられた. 治療を開始し経過観察を行った. その後尿細胞診では異型細胞の出現は認められなかったが, 3年5ヵ月後に排尿困難を訴えTURを施行, 組織学的に一部腺癌を含むNECが認められた. ほぼ同時に施行された尿細胞診では腺癌由来の細胞は認められなかったが, 小型でN/C比が高く, クロマチンの増量した裸核状異型細胞が小集塊, 孤立散在性, また一部ではインディアンファイル状配列を呈して認められ, NEC由来の腫瘍細胞と診断した. 免疫組織化学的にNECはneuron specific enolase (NSE), synaptophysin, chromogranin Aが陽性であり, 腺癌部分ではprostatic specific antigen (PSA), prostaticacid phosphatase (PAP) が陽性であった.結論:尿細胞診スクリーニングにあたっては腺癌の既往歴を有してもNEC細胞が出現する可能性のあることを考慮することが重要と思われた.

A case of malignant rhabdoid tumor in soft tissue.

Rhabdoid tumorは, 起源不明の悪性腫瘍で本来は小児の腎腫瘍として報告されたが, 軟部組織に発生することもある. 今回われわれは診断に苦慮した側胸部軟部組織発生の1例を経験したので報告する. 症例は45歳女性. 近医にて側胸部腫瘤を除去し, 摘出材料の捺印細胞診を依頼された. 細胞像からは, 第一に印環細胞癌の転移を考えた. しかし, 核縁肥厚に欠け比較的大型の核小体を有することなどから, 非上皮性悪性腫瘍も否定できないと思われた. 病理組織学的にはH-E所見, 免疫組織化学的検索, 電顕的検索などの結果, Malignant rhabdoid tumorの診断を得た.

Two cases of cecal volvulus.

は じめ に 盲 腸軸 捻 転 症 は1837年Rokitansky1)に よ り報 告 さ れ た比較 的 まれ な疾 患 で あ り,全 腸 閉塞症 の1%以 下, S状 結 腸 軸 捻 転 症 の10%以 下 の 発 生 率 と い わ れ る2)3).本邦 で は100例 あ ま りの報告 が あ る.盲 腸 軸捻 転 症 を2例 経験 したの で報 告 す る. 症 例 症例1:61歳,男 性. 主訴:右 下 腹部痛,嘔 吐,腹 部 膨満. 既往歴:51歳 の とき心 筋 梗塞. 家族歴:特 記す べ き こ とな し. 現病歴:不 整脈 で 当院 内 科入 院中,昭 和56年10月25 日,間 敏 性右 下腹部 疝痛 が 発生 した.鎮 痙 剤 の効果 が 弱 く,嘔 吐,腹 部膨 満 を ともな って きた. 現症:身 長162cm,体 重48kg,体 温37.0°C,血 圧126/ 80,脈 拍92/分,不 整 あ り.貧 血 や黄疸 は ない.腹 部 は 膨 隆 し,右 下 腹部 に圧 痛,筋 性 防衛 があ る. 検 査所 見:白 血 球数8,000/mm3,BUN 40mg/dlで, 他 の血液 生化 学検査 に異 常 を認 め なか った(表1).立