Nana Takahashi

Nodular fasciitis of the breast clinically resembling breast cancer in an elderly woman: a case report

BackgroundNodular fasciitis is a benign reactive proliferative lesion of fibroblast cells, which can occur throughout the body. However, it has rarely been reported in the breast of an elderly woman.Case presentationOur patient was an 88-year-old Asian woman who had noticed a mass in her right breast for 1 month before presentation to our hospital. The mass was elastic-hard and 20 mm in size. No qualitative diagnosis was made by core needle biopsy. Because of potentially malignant findings on mammography and ultrasonography, she underwent an excisional biopsy. Microscopically, spindle cell proliferation with abundant elastic fibers were observed. The tumor cells were positive for α-smooth muscle actin and negative for pancytokeratin, β-catenin, and cluster of differentiation 34. Based on these morphological and immunohistochemical features, a diagnosis of nodular fasciitis was made. All resection margins in the specimen were tumor-free. The patient has been disease-free for over 12 months.ConclusionsNodular fasciitis shows clinical features and imaging findings similar to those of breast cancer. To avoid unnecessary surgery, nodular fasciitis should be taken into consideration when there is spindle cell proliferation found by biopsy.

Non-islet cell tumor hypoglycemia caused by intrathoracic solitary fibrous tumor: a case report

BackgroundNon-islet cell tumor hypoglycemia (NICTH) is defined as a form of hypoglycemia caused by an extrapancreatic tumor. Solitary fibrous tumor (SFT) associated with hypoglycemia is rare.Case presentationA 76-year-old woman, who had frequently experienced hypoglycemic symptoms such as presyncope for the prior 6 months, visited our hospital to undergo detailed examinations. Her fasting glucose level was low at 49 mg/dl. The blood levels of IRI and C-peptide were also low at 0.2 μU/ml and 0.21 ng/ml, respectively. Chest computed tomography revealed a mass measuring 15 cm in the left thoracic cavity. Percutaneous needle biopsy yielded a diagnosis of intrathoracic SFT associated with NICTH. The tumor was removed by video-assisted thoracoscopic surgery. Histological examination showed a tumor composed of simple spindle-shaped cells with an irregular arrangement. Immunohistochemical staining was positive for CD34, bcl-2, and vimentin and negative for alpha SMA and mesothelin. These results confirmed the diagnosis of SFT. Her hypoglycemic symptoms resolved rapidly after surgery. The clinical course has since remained favorable with no signs of recurrence.ConclusionWe report a case of non-islet cell tumor hypoglycemia caused by intrathoracic SFT. The high-molecular-weight IGF-II produced by the tumor has been regarded as the cause of NICTH.

Photodynamic diagnosis of visceral pleural invasion of lung cancer with a combination of 5-aminolevulinic acid and autofluorescence observation systems

BACKGROUND Visceral pleural invasion (PL) is a prognostic factor in lung cancer. In the lung, lymph flows along the pleura, in addition to the flow toward the pulmonary hilum just as the pulmonary arteries and veins run toward it. Even with the same tumor diameter, a PL1 or higher level of pleural invasion is indicative of a more advanced disease stage. Final diagnosis based on the PL level is made by pathological examination of excised specimens. However, if an intraoperative diagnosis can be established, proper selection of the surgical procedure can be made, and unnecessary surgeries for disseminated lesions can be avoided. We investigated optical diagnostic techniques for identifying the presence or absence of visceral pleural invasion in lung cancer by capitalizing on the phenomenon of 5-amino-levulinic acid (5-ALA) being metabolized to a photosensitizing substance or protoporphyrin IX within malignant tumors, generating red luminescence in response to excitation light. METHOD This study included 38 patients with primary lung cancer who underwent surgery. They received 5-ALA (20mg/kg) orally 4h before surgery and then we assessed the presence or absence of pleural invasion using an autofluorescence observation system. At visceral pleural invasion sites, we were able to confirm tumor sites visualized in red with a clear border in contrast to the green autofluorescence generated in normal tissues. RESULT Red luminescence could be confirmed in 100% of PL1-PL3 patients (14/14) and 41.6% of PL0 patients (10/24) with primary lung cancer. PL0 patients in whom visualization was possible were preoperatively diagnosed as having PL1 and many of them showed vascular channel invasion. The sensitivity, specificity, positive predictive value, and negative predictive value of this diagnostic technique were 100%, 58.0%, 63.1%, and 100%, respectively. Red fluorescence emission was observed significantly more often in pleural invasion cases. CONCLUSION Accurate intraoperative diagnosis for visceral pleural invasion in lung cancer may contribute to determining the indications for limited operations such as segmental resection. In addition, accurate local diagnosis has the possibility of being applicable to photodynamic therapy.