Masatoshi Mogaki

A case of lymphoepithelioma-like carcinoma of the colon with ulcerative colitis

Follow-up colonoscopy of a 25-year-old Japanese man with ulcerative colitis (UC) who had undergone endoscopic mucosal resection twice for early colon cancers revealed the presence of a new 1.5-cm-diameter tumor in the sigmoid colon. It was diagnosed by preoperative biopsy as a poorly differentiated adenocarcinoma. Sigmoidectomy was performed, and the pathological findings revealed lymphoepithelioma-like carcinoma (LEC). In situ hybridization to detect Epstein-Barr virus (EBV)-encoded small RNAs showed positive signals in stromal lymphocytes, but weak signals in the tumor cells. The association between EBV and LEC was obscure in this case. Unlike typical UC-mediated colon cancers, the lesion was poorly differentiated, and negative for p53 signals immunohistochemically. These findings may hint at a novel mechanism of carcinogenesis in UC-mediated colorectal cancer.

Adult mesenchymal hamartoma of the liver mimicking bile duct cystadenoma.

We report a rare case of mesenchymal hamartoma in the cirrhotic liver of a 52-year-old Japanese male. The tumor, 3.5 cm in diameter, contained a cystic lesion and was located in the lateral segment. Bile duct cystadenoma was considered most likely preoperatively because of the patients age and the normal levels of tumor markers. However, since malignancy of the lesion could not be ruled out by preoperative imaging diagnosis, lateral segmentectomy was performed. Histological examination led to a diagnosis of mesenchymal hamartoma, since the lesion consiste of a multilocular abnormal bile duct accompanied by abundant myxomatous or loose collagen.

Glucagon responses in rabbits with obstructive jaundice and a low energy status in the liver

Glucagon has a choleretic effect and also stimulates energy-consuming reactions, such as gluconeogenesis and ureogenesis in the liver. The effect of glucagon on energy metabolism in the liver was analyzed in rabbits with obstructive jaundice that had severe liver damage, indicated by significantly lower hepatic energy charge levels. The gluconeogenetic responses to glucagon administration, as shown by increases in the plasma glucose levels, were usually observed in normal rabbits, but these responses were completely depressed after glucagon administration in rabbits with obstructive jaundice. The energy charge levels in the latter animals decreased even further after glucagon administration. Even though the energy consumption for gluconeogenesis after glucagon administration was limited in the jaundiced rabbits, it was sufficient to cause a deterioration in the hepatic energy balance. The above findings show that the administration of glucagon increases the amount of energy expended in the liver following a reduction in the hepatic energy charge in rabbits with obstructive jaundice. Therefore, even though glucagon has a choleretic effect, it should be administered carefully to patients with obstructive jaundice, especially in those with severe liver damage, such as in patients with cholangitis.

A case of sclerosing lymphocytic lobulitis of the breast associated with diabetes mellitus

AbstractBackground: The benign breast disease sclerosing lymphocytic lobulitis is thought to result from autoimmune diseases causing insulin-dependent diabetes mellitus (IDDM) due to insulinitis. In cases of sclerosing lymphocytic lobulitis accompanied by IDDM, the clinical term “diabetic fibrous breast disease” has been proposed. Methods: A case of sclerosing lymphocytic lobulitis of the breast is described. Results: The patient was a 43-year-old woman diagnosed with non insulin-dependent diabetes mellitus (NIDDM) 8 years previously. Insulin therapy was thought to be necessary because treatment with glibenclamide was not effective. She visited our facility complaining of a lump in her right breast that was 5 cm in diameter, painless, rock-hard, discrete, and irregularly outlined. Biopsy was performed because breast cancer was strongly suggested by its hardness and its irregular internal echo on ultrasonography. Histopathological findings demonstrated marked stromal sclerosis and lymphocyte infiltration in the perivascular and perilobular areas. Sclerosing lymphocytic lobulitis was diagnosed. Conclusions: Referring physicians should avoid performing unnecessary repeated biopsies by recognizing this disease entity, which often occurs bilaterally.

A possible prototype of multifocal recurrence after liver resection of hepatocellular carcinoma: report of a case.

The clinical course of a 68-year-old male with HCC is herein reported. In addition to two tumor nodules detected preoperatively, the resected surgical specimen disclosed macroscopically invisible tumor-cell clusters as well as intrahepatic metastatic foci. These clusters had no clear border and were more basophilic with small-sized cells, high cellularity, and a higher nuclear/cytoplasm ratio, which was suggestive of early HCC with a form of de novo occurrence. The postoperative course, characterized by an early recurrence of small nodules in the remnant liver suggested the presence of a similar invisible tumor mixture at the time of operation. This case can thus be regarded as a prototype of the multifocal recurrence type.

Islets of Langerhans in Various States of Glucose Intolerance

Hyalinization of islets of Langerhans is generally a characteristic finding in non-insulin dependent diabetes mellitus. However, hyaline material/amyloid is sometimes found in elderly nondiabetic pa

A Case of Extrahepatic-Growing Hepatocellular Carcinoma who Survived More than 5 Years without Recurrence, after Resection of Solitary Intrahepatic Metastasis which was Detected 18 Months after the Primary Resection.

症例は57歳の女性. 1992年7月14日, 肝外発育型肝細胞癌の診断で肝外側区域切除を施行した. 腫瘍は細い茎で肝外側区域と連続し, 最大径6.5cmの有茎型腫瘍で, 肝内に腫瘤性病変は認めなかった. 腫瘍は病理組織学的に中～低分化型肝細胞癌で, 茎の部分で腫瘍の脈管侵襲を認めた. 術後18か月目, 内側区域に径1.5cmの腫瘤を認め, 再切除術を実施した. 再発腫瘍は組織学的に初回切除腫瘍の組織型に類似した中分化肝細胞癌であり, 肝内転移再発と考えた. その後は5年以上無再発で生存中である. 肝外発育型肝細胞癌は有茎型であっても肝内転移を考慮した系統的肝切除術を選択する必要があることを示唆する症例である.

Expression of the Antimetastatic Gene nm23 in Human Hepatocellular Carcinomas

Expression of nm23 messenger RNA was investigated by primer extension-reverse transcription and polymerase chain reaction method (RT-PCR) in patients with hepatocellular carcinomas (HCC). Relative density units (RDU) of the expression of nm23 (Mean ± S.D.) in non-cirrhotic liver, cirrhotic liver and HCC were 0.86 ± 0.26, 0.84 ± 0.24 and 0.56 ± 0.38, respectively. RDU in solitary HCCs less than 5 cm in diameter with no portal thrombus or capsular infiltration and multinodular HCCs in the whole liver were 0.74 ± 0.51 and 0.38 ± 0.26 (p<0.05). Two years after gross resection of solitary HCCs, RDU in recurrent cases and in recurrence-free cases were 0.95 ± 0.57 and 0.49 ± 0.30, respectively (p<0.05). These results suggest that the expression of nm23 decreases during progression of HCC. It may be a useful factor for predicting the risk of intrahepatic metastasis from HCC in individual cases at the time of initial surgical treatment.

A case of thymic carcinoma.

今回比較的まれな胸腺癌の1例を経験したので, その細胞像を中心に報告する.症例は50歳女性の肝臓への転移を伴った縦隔腫瘍で以下の検討より下里らの提唱する胸腺癌と診断された.すなわち, 縦隔の穿刺吸引細胞診では, 比較的小型の異型性のある上皮細胞が認められ, 顕著な核小体を有していた.背景には, 特にリンパ球は認められなかった.また, 肝腫瘍生検の捺印細胞診でも同様な細胞所見が得られ, 組織診では腫瘍細胞の核分裂像が多数認められた.腫瘍細胞は免疫組織化学的にケラチン (+), Leu-7 (-) で, 電顕的には上皮性特有のトノフィラメントとデスモゾームが認められた.以上より, 本例の診断に細胞診上の細胞形態, 異型性の観察はもちろんであるが, リンパ球の有無などの背景の観察や免疫組織化学的所見が胸腺癌を確定または推定するうえで重要と考えられた.