Yoshihiro Imaeda

Epithelial inclusion cyst (epidermoid cyst) formation with epithelioid cell granuloma in an intrapancreatic accessory spleen

The histologic characteristics of a case of epidermoid cyst formation with an epithelioid cell granuloma that developed in intrapancreatic accessory spleen were investigated, with the aim of clarifying its origin as well as etiologic factors. The patient, a 48‐year‐old male, was found to have a cystic lesion in the tail of the pancreas and renal cell carcinoma (clear cell carcinoma) during a medical check up. The pancreatic mass appeared to be a so‐called ‘mucinous tumor’ on imaging, and combined resection of the body and tail of the pancreas and the spleen was performed together with a left nephrectomy. The lesion in the tail of the pancreas was then demonstrated to have accessory splenic tissue with cyst formation in its central region. The cystic wall was covered with stratified squamous epithelium and ductal epithelium with squamous metaplasia, and pancreatic islet cells were evident at various sites within the accessory spleen. Formation of epithelioid cell granuloma tissue was observed around the cysts. The epithelium of the cyst was positive for CA19‐9 and negative for antibodies against mesothelial cells, whereas the pancreatic island cells were positive for insulin. These results suggested that cystic epithelium in the accessory spleen could be derived from pancreatic duct epithelium. Frequent recurrence of chronic inflammation and epitheloid cell granuloma formation may have resulted from an aberration of the ectopic remaining pancreatic tissue in the spleen.

Expression of topoisomerase II alpha, Ki-67 and p53 in early stage laryngeal carcinomas not featuring vocal cord fixation.

Aim. To determine whether topoisomerase II alpha (topolla) expression is an additional prognostic marker for less advanced stage laryngeal cancers first treated without surgery. Ki‐67 and p53 protein levels were also assessed for comparison. Experimental design. Formalin‐fixed, paraffin‐embedded tumor material from 63 cases of squamous cell carcinoma (SCC) of the larynx (glottis, stages 0,1,2) was immunohistochemically stained for topolla, Ki‐67 (MIB‐1) and p53 (DO‐7) and the results were compared with clinicopathologic findings. Results. There were 7 stage 0 (TisNOMO), 33 stage I (T1N0M0), and 23 stage II (T2N0M0) SCCs with the TNM classification. Significant differences between carcinomas and normal mucosa were found for the topoIIa‐LI, Ki‐67‐LI, and topolla‐to‐Ki‐67 ratio. Regarding histologic grade, a significant difference in topoIIa‐to‐Ki‐67 ratio was evident between well or moderately and poorly differentiated lesions. There were 19 cases of recurrence and 44 cases of nonrecurrence, but no significant differences were found for either of the indices or their ratio. No significant variation with p53 positivity was evident with reference to histologic differentiation, T‐factor, clinical course, or proliferation. Conclusions. The results demonstrate that the topoIIa‐to‐Ki‐67 ratio is a more sensitive parameter reflecting proliferation, for histologic grading of less advanced laryngeal SCCs, than topolla‐ or Ki‐67‐LIs.

Laparoscopic sigmoidectomy combined with uterus excision for colouterine fistula caused by sigmoid colon diverticulitis: A case report

A case of colouterine fistula caused by colonic diverticulitis that was successfully treated laparoscopically is presented. A 74‐year‐old woman visited us with lower abdominal discomfort and vaginal excretion with minor fecal contamination. Mild tenderness was observed in her lower abdomen. Blood examinations revealed elevated white blood cell count and C‐reactive protein. Sigmoid colon diverticulitis was revealed on CT, and her condition was diagnosed as colouterine fistula. Hinchey classification was stage I. After 2 weeks of conservative therapy, her symptoms were reduced, and the white blood cell count and C‐reactive protein level decreased. However, fecal contaminated vaginal excretion continued. The patient underwent laparoscopic sigmoidectomy combined with uterus excision, and she has been in good health for the 3 years since the operation. Although colouterine fistula is usually treated with open surgery, patients with controlled and well‐localized inflammation may be good candidates for a laparoscopic approach.

A Case of Segmental Stricture due to Ileitis and Cholecystitis Treated by Single-incision Laparoscopic Surgery

症例は 81歳の女性で,門脈ガス血症,腸管気腫症,腸閉塞の診断にて入院となった.受診時には,腹部 所見および発熱などの炎症所見が軽度であったため保存的治療を選択し,イレウスチューブを挿入して腸 管減圧を行った.翌日には門脈ガス血症,腸管気腫症,腸閉塞の所見は改善するも腹部 CTでは回腸の一 部に壁肥厚を認めた.この部位を中心として小腸内視鏡検査とカプセル内視鏡検査にて精査を行い特発性 限局性回腸炎と診断した.入院 1か月後に施行した腹部 CTでは回腸の同部位に壁肥厚が残存し,同時期 の小腸内視鏡検査にて潰瘍の残存と小腸狭窄部位を認めたため,単孔式による腹腔鏡下小腸部分切除術を 施行した.同時に経過中に発症した無石胆囊炎に対し経皮経肝胆囊ドレナージ(PTGBD)チューブを留置 後に,腹腔鏡下胆囊摘出術も併施した.単孔式腹腔鏡下手術は小腸疾患が限局しており術前に場所が同定 できれば,有用な治療のオプションになりえると考えられた.

Cytologic diagnosis of solid acinic cell carcinoma of salivary gland.

目的:腺房細胞癌は多彩な細胞形態を示す一方で, 正常腺房細胞に類似して異型性が乏しいため, 確定診断に苦慮することが多い. そこで腺房細胞癌の診断に有用な細胞所見について検討した.方法:充実型腺房細胞癌の細胞像を細胞集塊の構造および構成細胞を中心に検討し, その細胞学的特徴を病理組織学的所見と対比した.成績:細胞学的に, 出現していた細胞集塊は腺房様集塊, ロゼット様集塊, 腺腔および乳頭状様構造を示す集塊, 血管結合織を含む集塊に分類された. 病理組織学的に全例が充実型の腺房細胞癌と診断されたが, 一部に腺腔形成や嚢胞がみられた. 嚢胞を形成する部分では, 内腔に腫瘍細胞が偽乳頭状に増殖していた. 再発例では腫瘍細胞が周囲組織に浸潤していた. 免疫組織化学的検索では, 腫瘍細胞はアミラーゼ染色陽性, CD34染色で毛細血管が多数確認できた. Ki-67染色陽性率は原発例が5%未満であるのに対し, 再発例では約10%であった.結論:検討した5種類の細胞集塊を観察することが腺房細胞癌を診断する上で役立つと考えられた. 唾液腺腺房細胞癌の細胞診断は, 個々の細胞異型よりも, 細胞の出現様式, 細胞集塊の構造および構成細胞所見を総合的に判定することが肝要である.

A case report of mucoepidermoid carcinoma of the bronchus detected by chance in the course of pneumonia.

The patient was a 26-year-old man. During the detailed work-up after the development of pneumonia, he was diagnosed as having a mucoepidermoid carcinoma of the bronchus by transbronchial biopsy and cytology. The smear demonstrated single and loosely aggregated squamous cells, intermediate cells containing a vacuole in their cytoplasm and mucus-producing glandular cells. Histological examination of the resected tissue specimens showed cancer cells spreading discontinuously to the muscle layer. Therefore, careful follow-up was considered necessary even ofter radical operation.