Shintaro Terahata

Thyroid calcifications: Sonographic patterns and incidence of cancer

We investigated the incidence of cancer in surgically resected 151 thyroid nodules in 101 patients according to their calcification patterns on preoperative ultrasonography (US). Calcification was detected in 57 (38%) nodules, 31 (54%) of which was histologically diagnosed as cancer. According to the calcification types, 9 of 11 nodules with microcalcifications, 15 of 29 nodules with intranodular coarse calcification, 6 of 14 nodules with peripheral calcification and 1 of 3 calcified spots without surrounding tumor were diagnosed as cancer.

Nodular hidradenoma of the breast : Report of two cases with literature review

Two cases of nodular hidradenoma of the breast with possibly different origins are reported. Case 1 is of a 58 year‐old female wlth a breast mass in the left, outer lower‐quadrant. A histogenetical origin in the skin adnexal glands was suspected due to its superficial location and immuno‐histochemical findlngs. Case 2 is of a 44‐yearold male with a subareolar nodule and nipple discharge. Histological examlnation demonstrated that the tumor was located deep in the breast tissue, was surrounded by dilated mammary ducts and exhibited intraductal extenslons, which are all features mlmicking those of breast cancer. Immunohlsto‐chemical positivity against gross cystic disease fluid protein‐15 was weakly Identified and negativity for endo‐plasrnic reticulum was observed. This case can be interpreted as arising In the mammary ducts. It is well known that various kinds of skin adnexal tumors arise in the breast tissue; however, nodular hidradenoma of the breast is still a rare benign neoplasm. Cllnically, nodular hidradenoma of the breast tends to occur in the nipple or subareolar region of the female breast. It should be kept in mind that nodular hidradenoma may occur in mammary ducts and it should be included when differential diagnoses are made of subare olar breast tumors.

Adenoid cystic carcinoma of the esophagus: Report of a case and review of the Japanese literature

We report herein the case of a 79-year-old man with adenoid cystic carcinoma (ACC) of the esophagus. The tumor had a polypoid appearance and was covered by thin esophageal mucosa. As the biopsy specimens suggested a diagnosis of poorly differentiated adenocarcinoma, the patient underwent subtotal esophagectomy with reconstruction of the gastric tube via the posterior mediastinum. Histologically, the carcinoma contained basaloid cells, cribriform foci, and a certain amount of eosinophilic hyaline substance. Some of the basaloid cells were stained immunohistochemically for keratin, muscle actin, and S-100 protein, a pattern which was identical to the pattern of immunoreactivity of the myoepithelium. We reviewed 36 other cases of ACC of the esophagus reported in Japan, with special reference to the criteria for histological diagnosis.

Multiple Ileal Diverticula Causing an Ileovesical Fistula: Report of a Case

Abstract.We report a case of multiple ileal diverticula causing an ileovesical fistula in an 85-year-old man. The patient was admitted for investigation and treatment of intractable urethrocystitis, which he had suffered for 5 years. Cystography showed an ileovesical fistula, and contrast study of the small bowel revealed about 80 diverticula in the ileum. The segment involved by diverticula was resected and a pathological diagnosis of diverticulitis leading to ileovesical fistula was confirmed. His postoperative clinical course was uneventful.

Pontine glioma with osteoblastic skeletal metastases in a child

BACKGROUND The development of systemic metastases from primary intracranial gliomas is rare. We report here a rare case of pontine glioma with osteoblastic skeletal metastases. CASE This 12-year-old boy presented with a 4-month history of hoarseness, dysphagia, and a progressively ataxic gait. Cranial computed tomography (CT) and magnetic resonance imaging (MRI) revealed a brain stem tumor that was diagnosed as a low grade glioma by stereotactic biopsy. Twelve months later following chemotherapy and radiotherapy, neurologic examination and neuroradiologic studies disclosed a recurrence of the pontine glioma. Skeletal roentgenograms revealed widespread osteoblastic metastases in the skull, vertebral bodies, pelvis, and long bones. A specimen from the iliac bone demonstrated cells that were immunoreactive glial fibrillary acidic protein (GFAP). DISCUSSION The mechanism of how glioma cells determine their biologic behavior at bony metastatic sites is not known. Infratentorial gliomas, which occur frequently in young patients and demonstrate active bony metabolism, may stimulate osteoblastic cells, and induce osteoblastic changes.

PRIMARY MUCIN‐PRODUCING ADENOSQUAMOUS CARCINOMA OF THE THYROID GLAND

A rare case of mucin‐producing adenosquamous carcinoma of the thyroid gland is reported in a 57‐year‐old woman. Light microscopically, much of the tumor showed a feature of mucin‐producing adenosquamous carcinoma; squamous cells and mucous signet ring cells. In the lower portion of the tumor, a calcified area containing small foci of follicular carcinoma and its squamous cell metaplasia was accompanied. Histochemically, neutral, non‐sulphated and sulphated acid mucins were found in the mucous cells, and no thyroglobulin or calcitonin was detected in the tumor cells. Electron microscopically, some tonofibrils and mucin production were observed concomitantly in the tumor cells. These findings suggested the possibility that this mucin‐producing adenosquamous carcinoma originated from squamous cell metaplasia of pre‐existing follicular carcinoma. ACTA PATHOL. JPN. 37: 1157 ‐1164, 1987.

Thallium-201 brain SPECT to diagnose aggressiveness of meningiomas

This investigation was conducted to determine the ability of201Tl brain SPECT with respect to preoperative prediction of lesional aggressiveness of meningioma. Fifty-nine lesions in 42 patients were examined. Early (15 min) and late (3h) SPECT were obtained. Early uptake ratio (ER; lesion to normal brain average count ratio), late uptake ratio (LR) and the ratio of LR to ER (L/E ratio) were calculated. Twenty-three lesions exhibited malignant features based on histologic or clinical course such as recurrence or skull invasion. Both ER and LR of malignant meningiomas were significantly higher than those in thirty-six benign lesions. Benign lesions were classified into two groups for further analysis: meningotheliomatous type, which is the most common histology, and benign lesions other than the meningotheliomatous (other benign) type. ER in other benign type was lower than the meningotheliomatous and the malignant type. LR afforded differentiation of the malignant type from the two benign types. These two benign types could be distinguished on the basis of the L/E ratio. These results indicate that high pre-operative ER and LR values in patients with meningioma are indicators of the aggressiveness of lesions, i.e., malignant meningioma, recurrence or skull invasion.

Massive intestinal bleeding caused by an ileal arteriovenous malformation: report of a case.

We report herein the case of a 43-year-old man in whom gastrointestinal bleeding was found to be caused by a large arteriovenous malformation (AVM) in the ileum. Emergency angiography proved invaluable in disclosing the AVM as the bleeding source, after which the patient was successfully treated by surgery. Although the number of reports of AVM has recently been increasing, ileal AVMs are still relatively rare. Moreover, according to the Japanese literature, no other patient has had such marked and large feeding arteries and draining veins as those in the patient described in this report.

Primary leiomyosarcoma of the ureter.

Malignant tumors of the ureteral smooth muscle are rare and the prognosis is not clear. This is a report of a patient with primary leiomyosarcoma of the ureter surviving 9 years and 9 months postoperatively without any evidence of recurrence. Malignancy of the ureter was suspected on the basis of angiography and radical nephro-ureterectomy was performed without positive cytology results.

A case of glycogen-rich clear cell carcinoma of the breast.

乳腺glycogen-rich clear cell carcinoma (以下GRCCと略す) は, 腫瘍細胞全体の90%以上が胞体内に多量のグリコーゲンを含んだ淡明細胞からなる乳腺腫瘍と定義され, 発生頻度は乳癌全体の約0.9～3.0%とまれである. 今回われわれはGRCCの1典型例を経験したので, その穿刺吸引細胞診像の特徴について報告する.症例35歳女性.平成8年1月初旬左乳房腫瘍を自覚し当院受診. 触診にて乳腺A領域にφ2×2cm大の硬い腫瘤が触知され, 画像診断上悪性が疑われた. 穿刺吸引細胞診でClass 4と診断され, 3月9日乳房扇状切除および腋窩リンパ節郭清術が実施された.組織学的には乳管内および浸潤部で, 胞体内に豊富なグリコーゲンを貯留する淡明細胞の増殖が認められ, GRCCと診断された.本例の穿刺吸引細胞診では, 境界が明瞭, 胞体は淡明で泡沫状から細穎粒状, 核は大小を示すが類円形, また単個で大型, 赤みを帯びた核小体の出現などが認められ, GRCCの典型とされる細胞診像に一致していた.GRCCの疾患独立性や分類の意義を疑問視する意見も存在し, その発生頻度の低さも加わって, GRCCの穿刺吸引細胞像はあまり一般には認識されていない.穿刺吸引細胞診によるGRCCの術前診断は不可能ではないと考えられるが, 今後さらに症例の積み重ねによりGRCCの診断意義, および独立性に関して検討する必要がある.