Masanobu Kitagawa

Multiple Cystic Cavitary Alveolar-Cell Carcinoma!

A case of alveolar-cell carcinoma in a 47-year-old woman, manifesting diffuse multiple cystic cavitary lesions in the lung, is presented and the pathophysiologic mechanism of cyst formation is discussed. Central necrosis within nodules, emphysematous changes due to check-valves of carcinomatous infiltrates at the terminal bronchioles, and circulatory disturbances are considered to be responsible for the cyst formation.

A case of T-cell lymphoma accompanying marked eosinophilia, chronic eosinophilic pneumonia and eosinophilic pleural effusion. A case report.

A 57-year-old woman was admitted to our hospital for lumbago, weight loss and weakness of her right lower extremity. Leukocytosis was evident with marked eosinophilia (65.5 % = 46,000/mm3), and the chest roentgenogram showed diffuse reticular shadows throughout both lung fields and a left pleural effusion. The pleural effusion contained 22.4 % eosinophils with no immature cells. Biopsy of a thumb-sized mass on the chest wall revealed a T-cell lymphoma of pleomorphic type. The diffuse pulmonary shadow was diagnosed as chronic eosinophilic pneumonia by autopsy. This was a relatively rare case of T-cell lymphoma, in which an eosinophilic pneumonia and eosinophilic pleural effusion were observed.

Reappraisal of Bronchial Arterial Infusion Therapy for Advanced Lung Cancer

As preoperative adjuvant therapy for advanced lung cancer, bronchial arterial infusion (BAI) of a chemotherapeutic agent was administered to patients with stage IIIa and IIIb hilar lung cancer. The infusion modality was changed for each term, from a single drug infusion, to a two drug infusion and then a three drug infusion, and the combination of infused drugs was selected in accordance with cell types. A significant radiographic shrinkage was observed after BAI therapy by the single, two and three drug infusions, being noted as 40.7 per cent, 61.8 per cent and 83.9 per cent, respectively. The effect on squamous cell carcinoma was more prominent than on other cell types. Upon microscopic examination of the resected specimens, significant histo-pathological effects were observed in 57.7 per cent of the patients who received single or two drug infusions, while the rate increased to as high as 92.2 per cent in the patients who received the three drug infusion. The histological effects of BAI therapy were also most marked in squamous cell carcinoma. It is of special interest that 5 of the 10 patients who received the three drug infusion of Carboquone (CQ)+ Mitomycin C (MMC)+Nimustine-HCL (ACNU) for squamous cell carcinoma, showed complete disappearance of viable cancer cells at the tumor site; something which was never observed after the single and two drug infusions. It was therefore concluded that BAI therapy for advanced lung cancer should be reappraised through the modification of infusion methods.

Malignant pheochromocytoma with features suggesting the brown-séquard syndrome. A case report

A case of malignant pheochromocytoma arising from the abdominal preaortic chromaffin tissue is presented. Of particular note is that right hemiplegia associated with sensory disturbances, compatible with the Brown‐Séquard syndrome, was an outstanding early clinical manifestation. The patient finally developed signs of complete transection of the spinal cord which was caused by metastasis of the tumor to the cervical spines. The neurological abnormalities observed in the present case were so unusual in pheochromocytoma as to lead initially a diagnosis of cord tumor. Autopsy findings well supported the clinical diagnosis. Cases like this have not been reported so far. Cancer 40:402–405, 1977.

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.

Pseudocyst of the Pericardium Developing during Maintenance Hemodialysis

Two cases of pericardial pseudocyst which developed in the course of maintenance hemodialysis are reported. Both patients were usually free of complaints, although there was evidence of the previous pericarditis with recent accumulation of pericardial effusion. As a possible mechanism leading to pericardial pseudocyst formation, distension of a weak area of the thickened pericardium due to an increase in intrapericardial pressure was assumed. Therefore, pericardial pseudocyst is one of the likely complications of patients on maintenance hemodialysis.

A CASE OF TEMORAL ARTERITIS

定型的temporal arteritisの症例を経験し,ステロイド治療前後2回にわたり側頭動脈より生検を施行したので報告する. 1)症例は67才,男. 10年来の肩こりをみとめている.入院約1ヵ月前より頭痛が出現し,視力低下,体重減少を伴つた.側頭動脈は硬く怒張し,拍動は触れなかつた.第1回の右浅側頭動脈の生検では巨細胞を伴う肉芽腫性動脈炎を証明した.ステロイド薬1ヵ月投与後,臨床症状が改善し,側頭動脈の局所所見が全く正常化した時点で左浅側頭動脈より第2回生検を行なつた.その結果,高度の内膜肥厚,中外膜の線維化と新生血管の介在に加え,軽度の小円形細胞浸潤が残つており,ステロイド薬により臨床症状が改善しても組織像の反応は迅速でないと考えられた. 2)頭痛の激しい時期に視力低下をみとめたが,眼底はScheie H1S1-2と著変がなかつた. 3) polymyalgia rheumaticaかどうかは不明だが, 10年来の肩こりは下熱鎮痛剤に無反応でステロイド薬が著効を示し,頭痛と随伴して症状が出現するなどtemporal arteritisとの関連を強く示唆していた. 4)大動脈造影では大動脈弓およびその主幹動脈に著変はみとめず,腎生検像でも細小血管に異常はみとめられなかつた.