Toshiya Matsuyama

A case of hepatoblastoma occurring in an adult.

We present herein a rare case of hepatoblastoma occurring in an adult male. The patient was 22 years old and his laboratory investigations on admission showed a marked elevation of α-fetoprotein in the serum. CT scan and other examinations revealed a primary tumor, 6.5 cm in size, in the left hepatic lobe with metastasis in the head of the pancreas. Thus, left hepatic lobectomy and pancreaticoduodenectomy were performed, but metastasis to the right hepatic lobe, left lung and abdominal skin were found 2 months later. Despite repeated courses of chemotherapy with adriamycin and cisplatin, the patient died 9 months after his operation. Pathological findings revealed poorly differentiated type hepatoblastoma. A review of the literature revealed only twelve other such cases.

Relation between Estrogen Receptor and Malignancy of Thyroid Cancer

The relationship between the histological grade of dedifferentiation of thyroid cancer and estrogen receptors (ER) was examined immunohistochemically. Thyroid cancers were from postmenopausal females of almost the same mean age (69‐73 years old) and within the same period of time (1974–1983). ER immunoreactivity located in the nucleus of the epithelium was found in all 6 well differentiated papillary cancers, and 5 of them (83.3%) showed ER‐immunoreactive (ER‐IR) cells amounting to 20 or more per visual field (x 100) under a light microscope. Of the 6 cases of poorly differentiated papillary cancer, 5 (83.3%) had 1‐19 ER‐IR cells per visual field. ER‐IR cells were negative in 5 out of 6 cases (83.3%) of anaplastic cancers. Thus, the number of ER‐IR cells tended to decrease with the degree of atypism of thyroid cancer (P < 0.001).

The significance of immunochemically staining calcitonin and CEA in fine-needle aspiration biopsy materials from medullary carcinoma of the thyroid.

A review of ten surgical cases of medullary carcinoma of the thyroid (MCT) demonstrates the usefulness of establishing a preoperative cytological diagnosis through the immunochemical staining of calcitonin (CT) and CEA in fine-needle aspiration (FNA) biopsy smears. If MCT is suspected after routinely performing May-Grünwald-Giemsa stained cytology of an FNA biopsy in the outpatient clinic, then CT and CEA staining is recommended for confirmation of MCT. The advantages of this immunochemical staining include that it can be carried out in the outpatient clinic within one day and also that it is much less costly than measuring serum CT and CEA.

A parathyroid cyst effectively treated with a sclerosing agent

Sclerosing solution was injected into a parathyroid cyst through a needle used for aspiration biopsy cytology. One year has passed without a recurrence and a cure is expected.

Aspiration biopsy cytology a highly diagnostic procedure for assessing neck masses, excluding thyroid tumors.

Aspiration biopsy cytology (ABC) was done on one hundred and forty-five patients with cervical tumors, excluding primary tumors of the thyroid and local metastasis of thyroid cancer, during the period of 44 months from 1981–85. Surgery was done on a total of fifty-five patients with lesions evaluated to be malignant and requiring resection. A correlation was determined between the histological diagnosis based on permanent paraffin sections and the diagnosis made by aspiration biology cytology in order to evaluate ABC in terms of accuracy together with its complications and limitations. The false positive rate was 6.6 per cent and the false negative rate was 8.3 per cent. Histologic diagnosis was predictable by ABC in eighty per cent of cases, but difficulty was experienced in predicting the histologic diagnosis in cases of a poorly differentiated malignancy. A few cases of slight subcutaneous bleeding occurred, but seeding implantation of cancer cells was nil. It was confirmed that ABC is a highly diagnostic procedure for assessing cervical tumors. The method is simple, safe and economical.

Bilateral resection and reconstruction of internal jugular vein for thyroid carcinoma

Two patients with thyroid carcinoma infiltrating bilateral internal jugular veins were treated. In reconstruction of the internal jugular vein by implantation of an autogenous venous segment or Gore-Tex artificial vessel, the repaired area soon became obstructed. The repaired area with the Impra-Flex artificial vessel became obstructed again one month after the implantation. In the reconstruction by ipsilateral end-to-end anastomosis between the internal and external jugular veins, good circulation was apparent even 2 years after the operation. The internal-external jugular vein anastomosis is expected to increase the safety of single-stage bilateral excision of the internal jugular vein, as an adjunct to total thyroidectomy, in the surgical treatment of thyroid carcinoma.

Clinical Significance of PIVKA-II Measurement in Patients with Resected Hepatocellular Carcinoma.

肝細胞癌切除例106例を対象に, PIVKA-II測定の臨床的意義についてalphafetoprotein (AFP) と比較することにより検討した.術前にPIVKA-IIおよびAFPを測定した症例はそれぞれ106例, 29例で, 術前陽性率はPIVKA-II58.6%, AFP64.2%であった.PIVKAHIIは腫瘍径が5cmをこえると全例陽性であった.腫瘍径2cm以下の小肝細胞癌においては, PIVKA-IIは陽性率37H5%と低率であったが, 陽性の場合, 脈管侵襲または肝内転移を全例に認め, すでに進行癌と認識する必要があった.予後規定因子との関係では, AFP陽性例の49.2%が脈管侵襲陽性であったのに対して, PIVKA-IIは70.6%と有意に高率であった (p<0.01).被膜浸潤についても同様の傾向がみられた.このようにPIVKA-IIは腫瘍進行度, 特に脈管侵襲, 被膜浸潤の有無をよく反映していた.

Breast cancer in a man treated effectively with a large dose of tamoxifen citrate

Breast cancer in males is comparatively rare. A 41-year-old man visited our hospital with a complaint of left breast tumor. Initial examination showed remarkably diffuse metastatic lesions in the lung field and small metastatic lesions in the surrounding skin. Modified radical mastectomy, including the surrounding metastatic skin lesions, and incisional biopsy of the lung were performed. Estrogen receptor was positive in both the primary breast cancer and metastatic cancer lesions in the lung. Postoperative medication of tamoxifen citrate, an estrogen receptor blocking agent, in a dose of 30 mg/day, was given together with fluorouracil, BCG, cyclophosphamide, and methotrexate. No evident change could be seen in the lung field six months after the operation. The metastatic lesions in the lung disappeared two years after the operation when the dose of tamoxifen citrate was increased to 60 mg/day. At this writing, thirty months after the operation, the patient is in good health.

Diagnosis of breast lesions by aspiration biopsy cytology

From November 1981 to the end of August 1984, 456 patients with breast lesions underwent aspiration biopsy cytology (A.B.C.). This study includes 109 for whom the diagnosis was histologically confirmed at surgical biopsy. Seventy-five lesions were histologically proven to be malignant and 34 were benign. The accuracy of diagnoses with A.B.C. was; true positive 86.7 per cent (65/75) of the time, true negative 82.6 per cent (28/34) of the time, false negative 5.3 per cent (4/75) of the time and false positive 5.7 per cent (2/34) of the time. Unsatisfactory or inadequate aspirated tissue made A.B.C. diagnosis difficult in 5.5 per cent (6/109) of the cases. Three out of 7 with malignant tumors, who were wrongly diagnosed as benign by A.B.C., had tumors with a diameter of 1.0 cm or less. Two benign cases which were falsely diagnosed as malignant also had small tumors about 1.0 cm in diameter. Although A.B.C. is more reliable than other conventional supplementary diagnostic techniques (mammography, ultrasonography, etc.), it is important to carefully follow clinically questionable cases which appear negative, using A.B.C.