Tsuneko Ikeda

Successful Treatment with Cyclosporin A in Tocilizumab-resistant TAFRO Syndrome.

Thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly (TAFRO) syndrome is a unique clinicopathologic variant of multicentric Castlemans disease that has recently been identified in Japan. Previous reports have shown that affected patients typically respond to immunosuppressive therapy, such as prednisolone and tocilizumab. However, the optimal treatment for refractory TAFRO syndrome, which can be fatal, remains unclear. We herein report a case of tocilizumab-resistant TAFRO syndrome successfully treated with cyclosporin A, indicating that cyclosporine A may be an alternative therapy for refractory TAFRO syndrome.

Development of Liver Metastasis in Colorectal Carcinoma

The development of hepatic metastases in 344 patients with colorectal carcinoma was examined for correlation with the presence of both venous invasion by the primary tumor and basement membranes in the tumor tissue. The former was detected by Victoria blue and hematoxylin eosin staining and the latter by antilaminin antibody. A significant difference in the incidence of venous invasion was noted between patients with and those without liver metastasis at surgery. Basement membrane deposition was found in half of all cases of well differentiated adenocarcinoma, which was significantly high compared with other tumor types. This was more distinct in metastatic foci in the liver and lymph nodes than in the primary lesion, but less marked in intravascular tumor tissue. Basement membrane deposition was seen more frequently in Dukes’A tumors than in B tumors, although this was not statistically significant. No relationship was found between basement membrane laminin positivity and five‐year survival, nor was there any correlation between the incidence of liver metastasis and tumor histologic type. Venous invasion was considered to be intimately related to the development of liver metastasis. Deposition of laminin‐positive basement membrane was dependent on the grade of tumor differentiation, whereas it had no direct relation to the development of liver metastasis.

The clinical significance of venous invasion in cancer of the stomach

Specimens from 235 surgically treated cases of gastric cancer were examined for venous invasion in order to investigate its clinical significance. A total of 87 (37.0 per cent) cases showed histologic evidence of venous invasion, with the incidence being 48.3 per cent of 180 cases, after the exclusion of 55 cases where cancerous invasion was limited to the mucosa. The frequency of venous invasion varied with the gross type of tumor, the depth of penetration and the degree of differentiation, being highest in tumors of type 2 and moderately differentiated adenocarcinoma. It increased proportionately dependeing upon the depth of penetration and the incidence increased in cases where there was evident lymphatic invasion or lymph node metastasis. The long term survival rate significantly decreased in patients with venous invasion when compared to those without it. In this report, we also discuss the marked difference in the incidence of liver metastasis between gastric and colorectal carcinomas in relation to venous invasion of the primary tumor. Double staining with Victoria blue and hematoxylin-eosin for elastic fibers proved useful for detecting venous invasion in the carcinomatous tissue, though endothelial markers have great specificity for differentiating small veins from lymphatics.

Bilateral epididymal sarcoidosis. Case report.

A 59-year-old man presented with a four-month history of almost painless bilateral scrotal swellings. Histological examination of a biopsy specimen confirmed sarcoidosis. He was well two months later, the mass had not increased, and he was receiving no treatment. This is the nineteenth reported case to our knowledge, and the eighth with bilateral disease.

Giant cell phlebitis: a potentially lethal clinical entity

An 83-year-old woman presented to us with a 4-week history of general malaise, subjective fever and lower abdominal pain. Despite the intravenous infusion of antibiotics, her blood results and physical condition worsened, resulting in her sudden death. Autopsy study revealed that the medium-sized veins of the mesentery were infiltrated by eosinophil granulocytes, lymphocytes, macrophages and multinucleated giant cells; however, the arteries were not involved. Microscopically, venous giant cell infiltration was observed in the gastrointestinal tract, bladder, retroperitoneal tissues and myocardium. The final diagnosis was giant cell phlebitis, a rare disease of unknown aetiology. This case demonstrates for the first time that giant cell phlebitis involving extra-abdominal organs, including hearts, can cause serious morbidity.

A CASE OF INTRAHEPATIC CHOLELITHIASIS WITH CHOLANGIOCARCINOMA SURVIVING FOR MORE THAN THREE YEARS AFTER OPERATION

It has been known that intrahepatic cholelithiaiss is frequently associated with cholangiocarcinoma and the prognosis is very poor in that case. We have experienced such a case surviving for more than three years after operation. A 55-year-old woman complaining of an upper abdominal pain was found having intrahepatic gallstones by endoscopic retrograde cholangiography and abdominal computed tomography. The lateral segment of the left lobe of liver was resected and histologic sections revealed associated chlangiocarcinoma whitch extended to surgical margin. Forty-three days later, the medial segment of the left lobe was resected to remove residual carcinoma, though cancerous tissue was not detected histologically. The patient has been well for more than three years after the operation. Significance of exact clinical investigation and pertinent operation should be emphasized in the management of intrahepatic cholelithiasis with a long history of the disease, especially in a case with recurrent infections.

Two Cases of Goblet Cell Carcinoid of the Vermiform Appendix.

今回われわれは虫垂杯細胞カルチノイドの2例を経験したので報告する.症例は46歳の男性と41歳の男性である.2例とも虫垂炎の診断で虫垂切除術を行った.術後の病理検査で虫垂杯細胞カルチノイドと診断されたため, ともに右半結腸切除術を追加した.しかし, 切除標本には腫瘍細胞を認めず, リンパ節転移も認めなかった.2例は術後約2年2か月, 約2年を経過しともに再発の徴候はない.虫垂の杯細胞カルチノイドはまれな疾患である.本邦ではわれわれの症例を含めて31例が報告されている.多くの症例は急性虫垂炎の診断で手術されているが進行した症例では回盲部腫瘍と術前に診断されていた症例も認められる.治療は虫垂切除術のみで経過観察されている症例と回盲部切除術や右半結腸切除術が行われた症例に分けられるが, 転移, 再発を認めた症例が多く, 病期によっては積極的な外科治療が必要と考えられる.

Venous invasion in cancer of the stomach. With a special reference to method of histological examination.

臨床病理学的に種々の点で近似した2群の胃癌, A群235例, B群115例の切除胃について静脈侵襲を検索した. 病理組織学的検査は, A群で平均1.7枚, B群で3.8枚の組織片について, ビクトリアブルー-ヘマトキシリン・エオジン染色, 第VIII因子関連抗原およびラミニン染色を行い検索した. 癌が粘膜層のみに限局している症例を除くと, 静脈侵襲はA群48.3%, B群56.0%に認められ, 癌の深達度, リンパ管侵襲およびリンパ節転移の程度に平行して増加し, これらとの間に正の相関が認められたが, 組織型ではとくに有意差は認められなかった. ビクトリアブルー-ヘマトキシリン・エオジン染色は静脈の識別に, 基底膜染色は小静脈の判別に有用であるが, 細静脈とリンパ管の鑑別には内皮細胞染色が必要であった. また, 検索は腫瘍中心部および末梢部より採取した組織片, 少なくとも4個について行うのが適切と思われた.

A case of lymphangioma in the transverse mesocolon presenting as panperitonitis.

入院時検査所見 :赤血球数498×104/mm3,自血球数 43,900/mm3,ヘ マ トク リット値436%,血 小板 数 58.8×104/mm3と著明な白血球増多を認めたが,肝 機 能検査および電解質は正常範囲内であった. 腹部単純 X線 撮影所見 :右上腹部にはガスを認め ず,上行結腸および下行結腸は尾側へ圧排されていた。 腹部超音波検査所見 :右上腹部を占める低エコ ーの 襲状腫瘤を認め,内 部には大小多数の隔壁があり蜂巣 状構造を呈していた。腎臓および胆嚢 との境界は明瞭 であったが,際臓 との関係は描出できなかった(図 1). 腹部 computed tomography(CT)所 見 :右上腹部 を占めるlow densityの腫瘤を認め,左 縁は正中を越 えていた。内部構造はほぼ均 一であるが一部隔壁形成 を認めた。造影 CTで は,腫 瘤の辺縁および隔壁が明 瞭に造影されたが,越 音波検査で認められた蜂巣状構 造は認められなかった。また膵臓は体尾部は同定でき たが,頭部は不鮮明で腫瘤 との連続性が示唆された(図 2 ) 。 以上の所見から,腹 腔内の リンパ管腫または陣頭部 に発生した嚢胞性腫瘤の破裂による腹膜炎をもっとも A CASE OF LYMPHANGHOMA IN THE TRANSVERSE MESOCOLON