Mamoru Mochizuki

Cardiac tamponade as an initial manifestation of well-differentiated pulmonary adenocarcinoma diagnosed by pericardial effusion cytology. A case report.

We describe a case of malignant pericardial effusion as an initial presentation of well-differentiated pulmonary adenocarcinoma. A 68-year old Japanese man was brought the emergency department because of dyspnea and chest oain. An echocardiogram demonstrated the presence of a Iarge pericardial effusion. Cytological examination of the aunctuated effusion showed many cell aggregates composed of papillary cell clusters. The neoplastic cells had centrally located round nuclei, coarse granular nuclear chromatin, and abundant clear cytoplasm. Postmortem examination revealed pericardial dissemination of pulmonary adenocarcinoma. We suggest that the morphological variety of cells is an important finding to help distinguish pulmonary adenocarcinoma from malignant mesothelioma.

Multiple liver metastases from a minute carcinoid tumor of the rectum diagnosed by fine needle aspiration cytology. A case report.

原発腫瘍の大きさが10rnm以下の微小直腸カルチノイド腫瘍から, 多発肝転移をきたしたまれなる1症例を経験した. 転移巣の穿刺吸引細胞像を報告する. 症例は73歳, 男性.転移性肝腫瘍の精査目的で入院. エコーガイド下肝生検・穿刺吸引細胞診で転移性カルチノイド腫瘍と診断. 患者は今回入院の5年半前に早期胃癌で胃部分切除術を施行されている. その2年半後に残胃早期癌で残胃全摘術と, 直腸カルチノイド腫瘍の経肛門的腫瘍切除術を施行されている. 切除標本上, カルチノイド腫瘍の大きさは約3mm. 穿刺吸引標本中には, 小型類円形核を有する腫瘍細胞が重積性を示す細胞集塊を形成するものと, 孤立散在性に出現するものが混在していた. 腫瘍細胞の核クロマチンは明るく繊細で, 小型明瞭な核小体を持っていた. N/C比は高く, 軽度の核形不整を認めた.壊死巣・核分裂像はなかった. 穿刺吸引細胞診は核所見の詳細な観察が可能である点で, カルチノイド腫瘍の診断に特に有用であると考えた.

Bizarre cells on imprint materials in a case of renal angiomyolipoma.

We describe the imprint cytologic findings of primary renal angiomyolipoma, incidentally found in an autopsy case, presenting many bizarre neoplastic cells. Post-mortem examination of an 83-year-old Japanese woman revealed intestinal obstruction due to transverse colon cancer, and a right renal tumor measuring 1 cm. The imprint materials obtained from the renal tumor showed a mixture of four kinds of cells as follows: 1) scattered bizarre smooth muscle cells, 2) typical spindle-shaped cells, 3) mature adipose cells, and 4) endothelial cells of benign capillaries. This case suggests that cytopathologists should be alert to the existence of these hamartomatous neoplasms.

SPONTANEOUS ANTIBODY-SECRETING CELLS IN THE STOMACH OF GASTRIC CANCER PATIENTS

The gastric mucosa has been regarded as an active site of humoral immunity since the discovery ofHelicobacter pylori. The present study was conducted to determine the in vivo activity of gastric B cells in 53 gastric cancer patients. B-cell activity was measured by protein-A plaque assay, in which IgA-, IgM-, and IgG-plaque-forming cells (PFC) were counted. The number of PFC was associated with the stage of cancer, but the response of lymphocytes in a non-tumorous area (NML) and tumor-infiltrating lymphocytes (TIL) differed. PFC in both sites were decreased compared to n0 cancer in n1 lymph node metastasis-positive cancer, while only NML showed raised PFC in n2+ (P<0.05, vs TIL). Cancer cells penetrating the submucosa caused the PFC of TIL (but not of NML) to decrease. Invasion of the intratumor capillary (V) or lymphatic (Ly) vessels also caused PFC to change, showing differences of Ig class; there was a decrease of PFC in V2 (IgG-and IgM-PFC) and in Ly2 (all Ig-PFC). IgA-PFC in Ly1 differed in TIL (decrease of PFC) and NML (increase). PFC also differed in TIL and NML in cancer cells, as follows: TILNML in papillary and signet ring cell adenocarcinoma. Changes in lymph node (LNL) and blood lymphocytes were similar to those in gastric PFC whose IgA value was 10 times as much as that of LNL. The 5-year survival rate was significantly better in patients with lower rather than higher PFC such as 89% vs 68%. Gastric B cells thus appear to be active and to reflect gastric mucosal immunity.

Retroperitoneal paraganglioma with multiple pulmonary metastases detected six years after complete resection of the primary tumor

Multiple pulmonary metastases from a retroperitoneal non-functional paraganglioma developed in a 69-year-old woman, who had been operated on for complete resection of a primary tumor about 6 years previously. An open-lung biopsy specimen revealed tumor cells possessing round or oval vesicular nuclei, numerous nucleoli and abundant, granular eosinophilic cytoplasm. Tumor cells showed small nests surrounded by distinct fibrovascular stroma. Upon electron microscopic examination, tumor cells were found to consist of chief cells that contained many mitochondria, a small number of dense-core granules and synapse-like structures. This case was worth reporting in order to emphasize the value of long-term follow-up, even after successful resection, and the usefulness of electron microscopic examination.