Ryoichi Kamimura

Dynamic computed tomography during arterial portography: the most sensitive examination for small hepatocellular carcinomas

Surgicalhe efficacy of dynamic sequential CT with table incrementation during arterial portography (DSCTI-AP) in the detection of small hepatocellular carcinomas (HCC) (less than 3 cm in diameter and less than three in number) was analyzed in comparison with other imaging methods including radionuclide (RN) liver scans, ultrasound (US), CT, selective celiac angiography (SCA), and infusion hepatic angiography (IHA). The sensitivity of each study in detecting 19 cases of small HCC was as follows: RN, 16%; US, 63%; CT, 58%; SCA, 58%; IHA, 83%; and DSCTI-AP, 95%. Three of 19 cases were diagnosed only by DSCTI-AP and one case that could not be visualized by DSCTI-AP was opacified by IHA. Dynamic sequential CT with table incrementation during arterial portography was superior to IHA in visualizing small HCCs.

Partially covered Gianturco stent for tracheobronchial stricture caused by intraluminal tumor

Partially covered Gianturco stents were used successfully in two patients to treat tracheobronchial strictures caused by intraluminal tumor growth. The stents were accurately placed without complications. The covered portion of the stent compressed the tumor, and prevented tumor ingrowth until the patients’ deaths. This stent seems to act as effective palliation for tracheobronchial stricture caused by intraluminal tumor.

PRIMARY CARCINOID TUMOR OF THE LARYNX AND REVIEW OF THE LITERATURE

Primary carcinoid tumor of the larynx is very rare. This is the fifth case reported in the literature and the first autopsy case of laryngeal carcinoid. The early manifestation of the present case was multiple metastasis to the skin. At autopsy there was a laryngeal tumor associated with widespread visceral and cutaneous metastases. The tumor proved to be carcinoid tumor by histological, histochemical and electron microscopic findings.

Transient subpleural curvilinear shadow caused by pulmonary congestion

We present two cases of transient subpleural curvilinear shadows (SCSs) on CT caused by pulmonary congestion. Subpleural curvilinear shadows, which are usually visible in the middle or lower dorsal lung field on CT, have been reported as the initial finding of pulmonary fibrosis. But SCS is not a specific finding since pulmonary congestion may be one cause of it.

Demonstration of nucleolar organizer regions in lung carcinoma by silver staining

Nucleolar organizer regions (NORs) were investigated in lung carcinomas by silver staining. This method was applied to 111 lung carcinoma specimens, including 40 with squamous cell carcinoma (SCC), 42 with adenocarcinoma (ADENO), 8 with adenosquamous carcinoma (ADESQ), 8 with small cell carcinoma (SMCC), 6 with large cell carcinoma (LGCC), and 7 with typical carcinoid tumors (CAOID). The mean AgNOR counts of ADENO, SCC, ADESQ, SMCC, and LGCC were significantly higher than those of the normal bronchial surface and those of the glandular or alveolar epithelium. The mean AgNOR count of CAOID was significantly higher than those of the normal glandular and alveolar epithelium but not that of the surface epithelium. The mean AgNOR count of SCC was significantly higher than that of bronchial squamous metaplasia, and the count of SMCC was significantly higher than that of CAOID. Within the same cancer category, the mean number of AgNORs increased in parallel with the histological tumor grades. These results indicate that the AgNOR method is useful for differentiating lung carcinoma from its normal counterparts and for evaluating histological tumor grades in the same lineage of lung carcinoma.

Two Patients with Metastasis of Cancer to Other Neoplasm: A Thyroid Carcinoma Metastatic to a Lung Carcinoma and a Gastric Carcinoma Metastatic to a Thyroid Adenoma

Two patients with rare cancer-to-neopiasm metastasis are presented. One patient was a 69-year-old woman who had undergone gastrectomy for gastric cancer 10 months previously and died of generalized metastases. An autopsy revealed generalized metastases of the gastric carcinoma, together with a cystic, hemorrhagic thyroid tumor measuring 2.0 cm in diameter. Histologically, the thyroid tumor was an oxyphilic adenoma with multiple metastatic foci of gastric adenocarcinoma. Because no metastasis was found in the background thyroid tissue, this metastasis might have developed specifically and not by chance, most likely due to the rich vascularity and good circulation of the thyroid adenoma. The other patient was an 82-year-old man who had undergone total thyroidectomy for thyroid cancer 6 years previously. An abnormal lung shadow was found on a chest radiograph during postoperative follow-up. Transbronchial biopsy of the lung tumor revealed a squamous-cell carcinoma. The resected lung tumor measured 2.7 cm in diameter, with small foci of metastatic papillary carcinoma of the thyroid gland and multiple small metastases in the background lung tissue, indicating that the metastases to lung cancer had occurred by chance. Metastasis of cancer to other neoplasms is discussed, and a review of the literature is presented.

Distinguishing Central Type Lung Cancer from Secondary Changes by MRI. Significance of Mucous Bronchograms.

肺門部肺癌とその二次変化の鑑別にっき18例に対しMRIを施行した.そして, 腫瘍と二次変化を同定するためのMRIの有用性について信号強度とT2強調像での索状高度高信号 (mucous bronchograms) の点から検討した.MRIの信号強度のみでは18例中10例 (56%) が鑑別可能であった.mucous bronchogramsを検討したところ, 二次変化を持つ18例中11例に認められた.この徴候を呈し切除された6例でこれがmucoid impactionに一致していた.この徴候と信号強度によるとMRIでは18例中13例 (72%) で腫瘍と二次変化の鑑別が可能であった.これはCTでの14例中7例 (50%) よりも良好であったが有意差はなかった.mucousbronchogramsはmucoid impactionを反映しており腫瘍と二次変化の鑑別に有用である.

Thoracic tomography by CR: Investigation of bronchial shadows

In cases of suspected lesions on plain radiographs such as tuberclelike shadows in the lung field, thoracic tomography has many applications for use in daily clinical practice as a follow-up step to X-ray diagnosis, with the aim of confirming the presence of such lesions or analyzing their nature in detail. Even following the appearance of CT, this modality is still significant in view of its simplicity for verification of bronchial lesions, analysis of the nature of shadows, and so on. On the other hand, the characteristics of computed radiography (CR) include: (1) images with a wide latitude by tonal conversion, (2) edge enhancement by spatial frequency enhancement, and (3) reduction of exposure dose. Thoracic tomography with CR has been used in our hospital since April 1984, leading to the conclusion that it offers many advantages, such as evaluation of both the mediastinum and lung field with one image, which is especially useful in the diagnosis of bronchial lesions. In this chapter, a comparison is made between the ability to describe normal bronchial shadows obtained in thoracic CR tomography (CRT) and those obtained in conventional film/screen tomography (CFST); the clinical usefulness was investigated using actual cases.