Suguru Kimura

Measurement of the Electrical Bio-Impedance of Breast Tumors

A new impedance analytical system was developed, and measurements were performed over a frequency range of 0-200 kHz by the three-electrode method. The three electrodes consist of a coaxial needle electrode inserted into the tumor and a large reference electrode on the upper abdominal wall. The electrical bio-impedance was measured in 54 patients with breast tumors. The biological tissue can be regarded electrically as an equivalent consisting of extracellular resistance (Re), intracellular resistance (Ri), and electrical capacitance of the cell membrane (Cm). These three parameters were calculated from the measured values of electrical bio-impedance by the curve-fitting technique using a computer program. It was found that Re and Ri of breast cancers were significantly higher than those of benign tumors (p less than 0.01), and that Cm of breast cancers was significantly lower than that of benign tumors (p less than 0.01). Measurement of the electrical bio-impedance of breast tumors may have value in the differential diagnosis of breast lesions.

Extrathymic malignancy in patients with myasthenia gravis

The presence of extrathymic malignancies was investigated in 296 thymectomised myasthenia gravis (MG) cases. In 5 of the 296 cases, extrathymic malignant tumours were observed. 4 of the 5 cases had thymomatous MG. 3 cases had malignant fibrous histiocytoma. Extrathymic malignancies were observed more frequently in thymomatous MG than in non-thymomatous MG. 59 cases (60 tumours), including our 5 cases, who had MG and extrathymic malignant tumours were compiled from the literature. In the 60 extrathymic malignancies, leukaemia and reticulo-endothelial sarcoma were the most frequent types.

Pulmonary varices: A case report and review of the literature

A case of a 47-year-old woman with pulmonary varix is reported herein. Saccular dilatation of the inferior pulmonary vein resembled a pulmonary perihilar mass which could not be palpated at the time of thoracotomy. Aneurysmal dilatation of the pulmonary vein, otherwise known as pulmonary varix, is rare. Only 71 such cases, including 17 cases in Japan, have been reported. Pulmonary varices may be classified into three types, namely: saccular type, tortuous type and confluent type. Most of the varices seen in patients with valvular disease have been of the confluent type (62 per cent), however tortuous type varices have also been seen in some cases (19 per cent). Pulmonary venous hypertension may be one of the major causes of confluent type pulmonary varices as regression of pulmonary varices after mitral valve replacement has been reported. None of the saccular type cases, however, were accompanied by valvular disease. This indicates that local factors may also be an important cause of saccular type varices.

Antitumour potential of pleural cavity macrophages in lung cancer patients without malignant effusion

The present study was undertaken to examine whether the presence of primary lung cancer could affect the antitumour activities of pleural cavity macrophages (PCM) and peripheral blood monocytes (PBM). PCM by pleural lavage and PBM were simultaneously obtained from 14 lung cancer patients not showing invasion of the pleural cavity. PCM and PBM were isolated by percoll gradient centrifugation and adherence. The lavage method yielded about 16.8 +/- 9.6 (s.e.) x 10(6) cells, which consisted of 80.7% PCM, 17.6% lymphocytes and 1.6% other cells. The cytotoxic activities of PCM and PBM against allogeneic melanoma (A375) cells were assessed by a 72h 125I-IUdR release assay. The lavaged PCM showed spontaneously high tumour cytotoxic activity which was dependent on the effector/target ratio. In 13 out of 14 cancer patients, PCM were significantly more cytotoxic to melanoma cells than PBM. In contrast, there were no significant differences in production of tumour necrosis factor (TNF-alpha) or interleukin 1 (IL-1) between PCM and PBM. When the abilities of PCM and PBM of the same patient to produce these monokines were compared, PCM produced much more TNF-alpha than PBM, thus indicating a correlation between the expression of spontaneous macrophage-mediated cytotoxicity and spontaneous TNF-alpha production by PCM. These results suggest that PCM may play an important role in host defence against invasion of the pleural cavity by cancer cells.

Hepatobiliary cystadenoma exhibiting morphologic changes from simple hepatic cyst shown by 11-year follow up imagings.

BackgroundA long-term follow up case of hepatobiliary cystadenoma originating from simple hepatic cyst is rare.Case presentationWe report a case of progressive morphologic changes from simple hepatic cyst to hepatobiliary cystadenoma by 11 – year follow up imaging. A 25-year-old man visited our hospital in 1993 for a simple hepatic cyst. The cyst was located in the left lobe of the liver, was 6 cm in diameter, and did not exhibit calcification, septa or papillary projections. No surgical treatment was performed, although the cyst was observed to gradually enlarge upon subsequent examination. The patient was admitted to our hospital in 2004 due to epigastralgia. Re-examination of the simple hepatic cyst revealed mounting calcification and septa. Abdominal CT on admission revealed a hepatic cyst over 10 cm in diameter and a high-density area within the thickened wall. MRI revealed a mass of low intensity and partly high intensity on a T1-weighted image. Abdominal angiography revealed hypovascular tumor. The serum levels of AST and ALT were elevated slightly, but tumor markers were within normal ranges. Left lobectomy of the liver was performed with diagnosis of hepatobiliary cystadenoma or hepatobiliary cystadenocarcinoma. The resected specimen had a solid component with papillary projections and the cyst was filled with liquid-like muddy bile. Histologically, the inner layer of the cyst was lined with columnar epithelium showing mild grade dysplasia. On the basis of these findings, hepatobiliary cystadenoma was diagnosed.ConclusionWe believe this case provides evidence of a simple hepatic cyst gradually changing into hepatobiliary cystadenoma.

Invasive thymoma with endobronchial polypoid growth

A rare case of invasive thymoma with endobronchial polypoid growth is presented. A 68-year-old woman presented with coughing and sputum. The chest X-ray and computed tomography (CT) findings demonstrated a large mass with a calcified lesion in the left hilar region. A bronchoscopic examination showed a polypoid tumor in the left B3b bronchus. The tumor was surgically resected and revealed a unique polypoid endobronchial extension. This tumor was pathologically diagnosed to be invasive thymoma.

A case of intralobar pulmonary sequestration with calcification and elevated serum values of carcinoembryonic antigen and carbohydrate antigen 19-9

Pulmonary sequestration is uncommon. We report a case with radiographically visible calcification and elevated serum values of the tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19–9.

Resection of an azygos vein aneurysm with thrombosis.

Aneurysm of the azygos vein is rare. We describe the case of a 51-year-old nonsmoking woman with a posterior mediastinal mass caused by a giant azygos vein aneurysm with subtotal thrombosis. Surgical resection of the azygos vein was offered to our patient as a treatment option owing to theoretical risks of rupture and pulmonary embolism. After taping the azygos vein proximally and distally, the aneurysm was resected with video-assisted thoracoscopy. Approximately 30 cases have been reported in the literature to date. Dynamic computed tomography and a videoassisted approach were useful for the diagnosis and treatment for this abnormality.

Intestinal perforation due to ingestion of blister-wrapped tablet in a press-through package

mitochondrial abnormalities such as polymorphism, including megamitochondria, moderately increased electron density of matrix, and the presence of numerous crystalline linear inclusions of unknown composition within the matrix. The average diameter of these structures was 10 nm and the average space between them 20 nm. They were especially evident in megamitochondria (Fig. 1). Occasionally the mitochondrial matrix contained single tiny fatty droplets. Other authors observed similar mitochondrial changes in NASH but in adult patients (5, 7). Like Caldwell et al. (7), we assume that abnormal mitochondria observed in nonalcoholic steatohepatitis, especially megamitochondria, and development of crystalline linear inclusions, may represent either an adaptive process in the cell or hepatocyte injury. We conclude that their detection may be useful in the diagnosis of NASH in pediatric as well as adult patients.

Lymphoepithelial cyst of the pancreas that was difficult to distinguish from branch duct-type intraductal papillary mucinous neoplasm: Report of a case

A 58-year-old woman was admitted to our hospital to optimize the management of her diabetes mellitus. A computed tomography (CT) scan showed a 30-mmdiameter, multilocular cyst in the head of the pancreas. The tumor markers, including DUPAN 2, SPAN-1, and carbohydrate antigen 19-9, were within the normal ranges. A contrast-enhanced CT scan showed a nonenhanced, multilocular cyst. Abdominal magnetic resonance imaging showed a multilocular cyst. Endoscopic retrograde cholangiopancreatography showed that the main pancreatic duct was normal. Based on these findings, we suspected a branch duct type intraductal papillary mucinous neoplasm. A distal pancreatectomy with a splenectomy was performed, since more of the mass was located on the dorsolateral side, inconsistent with the preoperative imaging results. On the resected specimen, a 4-cm-diameter, multilocular cyst containing serous fluid was found. Pathologically, the cyst wall was lined with squamous epithelium surrounded by abundant lymphoid tissue with follicles, consistent with a lymphoepithelial cyst of the pancreas, which is an unusual benign cyst.