Shinichi Iwanaga

Gastric carcinosarcoma (sarcomatoid carcinoma) with rhabdomyoblastic and osteoblastic differentiation

A rare case of carclnosarcoma (sarcomatoid carcinoma) with rhabdomyoblastic and osteoblastic differentlatlon occurrlng in the gastric remnant is reported. A 69‐year‐old Japanese man who had undergone a partial gastrectomy for a duodenal ulcer 30 years earlier, presented with anemla, eplgastralgia, and an abdominal mass. The diagnosls of gastric carcinosarcoma was made based on the findings of endoscoplc biopsies. The patient was thus scheduled to undergo a surgical operatlon, but he died of respiratory failure. At autopsy, a huge polypoid tumor measurlng 2Ox18times8 cm was located on the greater curvature of the gastric remnant. Microscopically, the tumor conslsted of Intimately mixed tubular adenocarcinoma and heterologous mesenchymal elements contalning rhabdomyosarcoma and osteosarcoma. Between these components, a morphological transition from the adenocarclnoma element to the sarcomatous element was observed. Ultrastructually, rhabdomyoblastlc dlfferentlation was conflrmed In the sarcomatous areas. lmmunocytochemlcal expresslons of epithelial markers includlng epithelial membrane antlgen and cytokeratlns (35bHll and 34bE12) were recognlzed not only in the carclnomatous cells but also In the sarcomatous cells. These findlngs suggest that carclnomatous cells appear to transform Into cells wlth sarcomatous features.

Intraductal tubular adenoma of the pancreas, pyloric gland type: a clinicopathologic and immunohistochemical study of 6 cases.

Abstract:The intraductal tubular adenoma (ITA), pyloric gland type, of the pancreas is an uncommon benign tumor, akin to the pyloric gland type adenoma of the gallbladder. We report 6 cases of ITA of the pancreas: 3 male and 3 female aged 50 to 79 years (mean, 63.5 years; median, 65 years); all were examined clinicopathologically. Four patients showed no symptoms, but appetite loss and/or general fatigue presented in two. Grossly, all tumors formed a localized polypoid mass protruding into the lumen of the dilated pancreatic duct. Five of the six tumors were found within the main duct, and the other arose within the branch duct of the pancreas. Microscopically, the tumors were composed of closely packed tubular glands resembling pyloric type glands. They were lined by columnar or cuboidal epithelial cells with foci of mild to moderate dysplastic change. In 2 cases, the adjacent pancreas showed foci of intraductal papillary-mucinous adenoma. Histochemically, the tumors largely showed neutral mucin with a lesser amount of acidic mucin made up mainly of sialomucin. Endocrine cells were found in five tumors. Immunohistochemically, all tumors were labeled with M-GGMC-1 and MUC6, whereas MUC1 and MUC2 stains were negative. Pepsinogen II was positive in 5 tumors; thus, the results displayed a pattern of differentiation similar to those of ordinary gastric pyloric or metaplastic pyloric glands. DPC4 expression was maintained in all tumors and p53-positive nuclei were hardly encountered. All patients are alive with no evidence of disease 3 to 10.5 years after surgical resection.

Spindle cell carcinoma of the breast: A case report and an immunohistochemical study including p53 and Ki‐67 expression

A rare case of spindle cell carcinoma (SpCC) of the breast occurring In a 51‐yearold Japanese woman Is reported. A firm and well‐circumscribed tumor, measuring 9times8.5times8.5 cm, was located on the upper lateral region of the right breast. Microscopically, the tumor consisted of sheets of both malignant spindle cells and poorly differentiated ductal carcinoma containing squamold islands with gradual transition to the spindle cell component. The Immunocyto chemical expression of epithelial markers was recognized in the spindle cells, as well as in the carcinomatous cells. Moreover, the spindle cell component expressed vimentin, α‐smooth muscle actln and S‐100 protein. Ultrastructurally, in addition to the features of adenocarcinoma, squamous or rnyoeptthelial differentiation was confirmed in the spindle cell component. These findings thus suggest an epithelial origin with squamous differentiations and myoepithellal participation In the genesis of SpCC. In a comparative study, the expression of p53 protein and KI‐67 as a proliferation marker In each component of this tumor was also Investigated. The mean p53 labeling index (LI) in both the carcinomatous and spindle cell area was similar, however the mean MIB‐1 LI in the spindle cell area was significantly higher than that in the carcinomatous area. The results indicate that p53 over‐expression is Involved In the tumorigenesis of both components in the SpCC, and the spindle cell component shows a higher degree of proliferative activity than the carcinomatous component.

Survival and Quality of Life after Pancreatic Resection for Carcinoma of the Pancreas.

長期予後とquality of life (QOL) という観点から, 浸潤性膵管癌の治療戦略について検討した. 1984年4月より1998年2月までに膵切除術を行った通常型膵管癌88例 (切除術41.5%) を対象とした. 占居部位は膵頭部62例, 体部15例, 尾部4例, 2区域以上7例であった. この中から術後3年以上生存したものを長期群 (15例), 1年未満で再発死亡したものを短期群 (26例) とした. 2群間の臨床像と病理組織像を比較すると, 長期群では膵酵素高値例が80%を示し, ERCPで診断される例が多かった. 組織像において長期群は膵周囲浸潤が軽微な症例に限られ, 門脈内腔に癌の露出した症例に長期生存はなかった. 術直後からの化学療法は短期死亡を減少させ, 生存率で一定の効果が得られた. 画期的な治療法が望めない現状では正確な進展度診断に基づいて, 長期予後とQOLを考慮した細かい治療方針の設定が必要である.