Masao Kojima

Myxoid leiomyoma of the vulva mimicking aggressive angiomyxoma

A case of vulvar leiomyoma with extensive myxoid change in a 40 year old female is described. The tumor had a unique connection with a non‐degenerative leiomyoma that compressed the rectum and the bladder. Scattered smooth muscle cells in a loose myxoid stroma were immunoreactive for desmin. Fibroblast‐like spindle cells were immunoreactive for vimentin but not for desmin. The initial, although incorrect, pathological diagnosis of the tumor was aggressive angiomyxoma based on the similarity in both clinical and pathological aspects with this more invasive tumor. Myxoid vulvar leiomyoma should also be differentiated from angio‐myoflbroblastoma. The key to the differential diagnosis is the presence of interlacing smooth muscle cells and an awareness of tendency toward myxoid change in vulvar leiomyomas.

Percutaneous transgastric intestinal decompression: The management of malignant bowel obstruction without nasal intubation

We inserted a long intestinal tube via the percutaneous transgastric route in three patients with an inoperable malignant bowel obstruction. The percutaneous endoscopic gastrostomy technique facilitated this method. The main purpose of our procedure is to achieve direct intestinal de-compression without nasal intubation, which is not always possible by venting gastrostomy alone. Palliative intestinal decompression proved to be effective in all patients. This alternative therapeutic strategy for managing bowel obstruction in terminal cancer patients is herein presented.

ADENOCARCINOMA IN SITU ARISING FROM THE ECTOPIC SUBMUCOSAL CARDIAC GLANDS OF SHORT-SEGMENT BARRETT'S EPITHELIUM

Adenocarcinoma of the esophagocardiac junction is a condition difficult to define. It is often necessary to differentiate between esophagocardiac junctional adenocarcinoma and carcinoma in Barretts esophagus. We herein report a case of an 83‐year‐old Japanese man with adenocarcinoma in situ arising from ectopic submucosal cardiac glands in short‐segment Barretts epithelium, associated with squamous cell carcinoma. Despite the visualization of a nodule in short‐segment Barretts epithelium, we diagnosed the present case as one of esophagocardiac junctional cancer arising from ectopic submucosal cardiac glands, using Alcian‐blue staining.