Masao Hada

Simultaneous Bilateral Spontaneous Pneumothorax Secondary to Metastatic Angiosarcoma of the Scalp: Report of a Case

Angiosarcoma is a highly malignant neoplasm, which most often develops on the scalp or face of elderly people. Common distant metastatic sites include the lung, liver, lymph nodes, and skin. We report a case of angiosarcoma manifesting as simultaneous bilateral spontaneous pneumothorax secondary to pulmonary metastases in an 86-year-old man. The pneumothorax preceded the diagnosis of angiosarcoma. Chest computed tomography showed multiple thin-walled cavitary metastatic pulmonary lesions, which increased in size as new lesions appeared over the clinical course of several months. This case suggests that a finding of simultaneous bilateral spontaneous pneumothorax may indicate a serious parenchymal lung disorder.

Stratifying the risk of lymph node metastasis in undifferentiated-type early gastric cancer

AIM To study how lymph node metastasis (LNM) risk is stratified in undifferentiated-type early gastric cancer (undiff-EGC) dependent on combinations of risk factors. METHODS Five hundred and sixty-seven cases with undiff-EGC undergoing gastrectomy with lymphadenectomy were examined retrospectively. Using clinicopathological factors of patient age, location, size, an endoscopic macroscopic tumor form, ulceration, depth, histology, lymphatic involvement (LI) and venous involvement (VI), LNM risk was examined and stratified by conventional statistical analysis and data-mining analysis. RESULTS LNM was positive in 44 of 567 cases (7.8%). Univariate analysis revealed > 2 cm, protrusion, submucosal (sm), mixed type, LI and VI as significant prognostic factors and > 2 cm and LI-positive were independent factors by multivariate analysis. In preoperatively evaluable factors excluding LVI, sm and > 2 cm were independent factors. According to the depth and size, cases were categorized into the low-risk group [m and ≤ 2 cm, 0% (LNM incidence)], the moderate-risk group (m and > 2 cm, 5.6%; and sm and ≤ 2 cm, 6.0%), and the high-risk group (sm and > 2 cm, 19.3%). On the other hand, LNM occurred in 1.4% in all LI-negative cases, greatly lower than 28.2% in all LI-positive cases, and LNM incidence was low in LI-negative cases even in the moderate- and high-risk groups. CONCLUSION LNM-related factors in undiff-EGC were depth and size preoperatively while those were LI and size postoperatively. Among these factors, LI was the most significantly correlated factor.

Prognostic and therapeutic implications of the MIB-1 labeling index in breast cancer

BackgroundAssessment of tumor proliferative activity is considered to be the most powerful prognostic factor aside from axillary lymph node status. The purpose of this study is to assess the clinical value of measurement of proliferative activity using the MIB-1 labeling index in patients with breast cancer.MethodsSurgical specimens from 36 patients with benign breast disorders and 146 patients with breast cancer were investigated. The MIB-1 labeling index was determined on the specimens stained by immunohistochemical methods as much as possible. Clinical factors associated with the MIB-1 labeling index were reviewed.ResultsThe MIB-1 labeling index for non-proliferative disorders, proliferative disorders, and breast cancer was 3.4±1.9%, 8.9±6.2% and 20±12%, respectively. The MIB-1 labeling index and tumor size, lymph node metastasis status, and clinical stage according to the TNM classification correlated significantly. Survival rate was inversely correlated with the MIB-1 labeling index. No patient with an MIB-1 labeling index of less than 10% had lymph node metastases, and all are alive without recurrence. Patients with an MIB-1 labeling index of over 30% had an extremely poor prognosis.ConclusionsThe MIB-1 labeling index is very useful for predicting both either extremely good or extremely poor prognosis, and axillary lymph node metastasis.

Thoracoabdominal Aortic Aneurysm in an Infant Treated by Thromboexclusion with Thoracoabdominal Aortic Bypass A Case Report

A case of a huge thoracoabdominal aortic aneurysm in an eighteen-month-old boy is reported. Surgical treatment was successfully performed by thromboexclusion of the aneurysm with thoracoabdominal aortic bypass using a low-porosity woven Dacron graft 10 mm in diameter and of sufficient surplus length. During the early postoperative period, he developed moderate hydronephrosis, owing to compression of the left ureter by the graft, but no further deterioration was seen. Follow-up angiographies performed four and six years after surgery revealed straightening of the graft and slight stretching of the aorta at the distal anastomosis, but no stenosis was found. Now, seven and a half years after surgery, he has no pressure gradient between upper and lower extremities.

Spontaneous hemothorax caused by intrathoracic synovial sarcoma.

Synovial sarcoma, which is a soft tissue malignancy, primarily affects the extremities in the para-articular regions in adolescents and young adults. Synovial sarcoma of the pleural cavity is extremely uncommon, and there have been only a few reports in the literature. We report here an unusual case of left-sided spontaneous hemothorax as a presenting manifestation of intrathoracic synovial sarcoma in a 33-year-old pregnant woman. Spontaneous hemothorax, unrelated to trauma, is a very unusual clinical presentation, but we must consider entities with a physical risk assessment promptly because of the possible need for urgent management based on the hemodynamic condition of the patient. We should always be aware of possible causes of spontaneous hemothorax.

Report of a case with a spontaneous mesenteric hematoma that ruptured into the small intestine

Highlights • This article reports an extremely rare case of spontaneous mesenteric hematoma that ruptured into the jejunum. The etiology of this condition was not revealed by detailed pathological examinations.

Report of a case with gallbladder carcinoma: P53 expression of the peritumor epithelium might predict biliary tract recurrence

Highlights • The over-expression of P53 protein in gallbladder carcinoma is a biomarker correlating with a poor survival. However, the significance of P53 expression in peritumor tissues is unknown. We report a case of gallbladder carcinoma where the operative specimen showed over-expression of P53 on the peritumor epithelium, and early recurrence developed at the biliary tract.• The immunohistochemical staining of the GB wall or surgical stump for a surgical specimen of GBC may be crucial to predict the bile duct recurrence.

Report of a case with T1a gallbladder poorly differentiated adenocarcinoma, solid type, which developed into lymph node metastases

We experienced a case with gallbladder carcinoma growing limited to the mucosa (T1a), which developed massive lymphatic vessel spread and lymph node metastases.A 72-year-old man was referred to our hospital for the swelling of his gallbladder during a routine ultrasound sonography checkup. We diagnosed the patient with gallbladder carcinoma with lymph node metastasis according to the radiographic findings and performed the open cholecystectomy and lymph node dissection. A histological examination showed poorly differentiated adenocarcinoma, solid type, and the tumor was limited to the mucosa. The number of lymphatic vessels was increased in the tumor and peritumor areas, and cancer cells were observed in the lymphatic vessels, which were detected via D2-40 immunohistochemistry. A careful histological examination and follow-up is required for T1a gallbladder carcinoma.

A Surgical Procedure and Prognosis for Gallbladder Carcinoma According to the Extent of the Tumor Invasion-A Retrospective Case Series Study at a Japanese Hospital

Purpose: To analyze the prognostic effects of our selecting surgical procedures for gallbladder carcinoma based on the extent of tumor invasion. Methods: We reviewed 35 patients with gallbladder carcinoma who underwent the surgical treatment in our hospital. We divided the patients into three groups (8 with T1, 15 with T2, and 12 patients with T3) according to the pathological extent of the tumor invasion. Results: Although 8 patients with T1 group had been achieved curative operation (R0), 2 patients developed an unexpected recurrence regardless the kinds of surgical procedures. Regarding the 15 patients in T2, the prognosis of 11 patients with T2n- was satisfactory. Of the 4 patients with T2n+, only 3 patients who underwent an extent cholecystectomy (ExC) and lymph node dissection (LND) with Extra Hepatic Bile Duct Resection (EHBDR) had no recurrence. Of the 12 patients in T3, 5 patients were under the limited operation. Although, remaining 6 patients were expected to achieve curative operation (R0), all patients died. Conclusions: Our data indicated ExC+LND with the EHBDR achieved survival cases in T1/T2 group who had an expected LN metastasis. However, all patients in the T3 group died from distant metastases and peritoneal disseminations, suggesting that the surgical treatment is insufficient to overcome T3 gallbladder