Yoshiji Watanabe

Metastatic Malignant Meningioma of the Liver with Hypoglycemia : Report of a Case

We herein present the case of a 68-year-old male who suffered an episode of hypoglycemic shock 2 years after undergoing total removal of a bifrontal parasagittal malignant meningioma. Imaging studies revealed three giant hypervascular tumors with a cystic portion in the right lobe, but no confirmed preoperative diagnosis could be made. At laparotomy, liver tumors were found in the medial segment of the left lobe as well as in the right lobe, and thus an extended right lobectomy was performed. All the resected tumors were histologically diagnosed as metastatic malignant meningiomas of the liver. Despite subsequent transarterial chemoembolization for a recurrence in the residual liver, the patient died 11 months after surgery. To the best of our knowledge, only one other case of a hepatectomy for liver metastases from an intracranial malignant meningioma has been reported in the literature, but there has never been any report of surgical treatment for a metastatic meningeal tumor in the liver associated with hypoglycemia. Although our surgical treatment provided effective palliation, the prognostic significance of a surgical strategy for such patients has yet to be established.

Rapid intraoperative scrape cytology assessment of surgical margins in breast conservation surgery

Rapid intraoperative scrape cytologic examination for diagnosing surgical margin involvement of specimens obtained by breast conservation surgery was evaluated. Four surgical margins (nipple side, two lateral sides and distal side) of the removed breast tissue were cytologically examined and histologically compared following segmentectomy in 50 breast cancer patients (200 margins). Intraductal carcinoma had a tendency to spread most extensively to the nipple, compared with other margins. The margin positive rate of tumors with ductal spread (DS) of over 20 mm was significantly higher than in tumors with a DS under 20 mm (52.2% vs 7.4%) (P<0.001). Of 50 canditates 10 patients underwent total mastectomy due to positive margins on repeat cytologic examination after re-excision. Four of the 10 patients had an extensive intraductal component on microscopy. The sensitivity, specificity and accuracy of cytology were 96.4%, 90.7% and 91.5%, respectively. Scrape cytology is useful to determine surgical margin involvement after segmentectomy for breast cancer, although overestimation of involvement will tend to result.

A case of neurilemmoma of the breast

Neurilemmoma of the breast is rarely seen, although it is common at intracranial or peripheral sites. There have been only 14 cases described in the literature. We present the fifteenth case of a 64-year-old woman with neurilemmoma of the breast, the first to be diagnosed by fine needle aspiration cytology. Fibroadenoma must be distinguished from this tumor. Complete removal is the treatment of choice, considering the possibility of local recurrence and malignant change.

Diffuse schwannoma involving the entire large bowel with huge extramural development: Report of a case

Schwannoma of the large bowel is a rare clinical entity, which has reportedly been recognized to arise from one place with a submucosal tumor morphology. We present herein the unique case of a 25-year-old woman who suffered from a schwannoma diffusely involving the entire large intestine. The patient complained of abdominal distension and imaging studies revealed a giant tumor occupying the whole abdomen, but no confirmed preoperative diagnosis could be made. A laparotomy proved the huge tumor detected preoperatively to be the markedly wall-thickened entire large bowel itself due to the diffuse extramural development of a neoplasm, but no other organs were involved. Biopsy specimens from the tumor were histologically diagnosed as benign schwannoma. However, because of the possibility of malignancy, we later performed a total proctocolectomy followed by an ileal J-pouch-anal canal anastomosis. The final pathological diagnosis was also that of a benign schwannoma originating from the large intestine. The patient remains well without recurrence 15 months after surgery. To the best of our knowledge, no such case of a schwannoma in the entire large bowel has yet been reported in the literature, and the pathogenesis of its occurrence remains unknown.

Successful surgical resection of a huge gastrointestinal stromal tumor of the third portion of the duodenum

Journal of Gastroenterology and Hepatology 22 (2007) 282–287

Hemoperitoneum secondary to exophytic leiomyoma: Report of a case

We report herein the case of a 63-year-old male with hemoperitoneum secondary to exogastric leiomyoma. The patient had been receiving anticoagulation therapy for a cerebral embolism and complained of sudden, severe abdominal pain. A sonogram and computed tomography scan showed an exogastric mass and massive ascites. A peritoneal puncture proved the presence of an intraperitoneal hemorrhage. An emergency laparotomy revealed a pedunculated bleeding tumor, thus confirming the preoperative diagnosis of a ruptured exogastric tumor. A microscopic analysis of the excised tumor demonstrated gastric leiomyoma. Other authors have reported hemoperitoneum secondary to gastric myogenic tumors, but no cases of leiomyomas could be found in the literature.

Occult breast cancer: A case report and review of the literature

We report a case of a 44-year-old woman with occult breast cancer presenting as an axillary mass in whom sonography was able to detect an involved internal mammary node also, thus helping to establish a diagnosis of breast cancer. The patient underwent extended radical mastectomy, including internal mammary lymphadenectomy. Microscopy of the removed specimen failed to find a primary breast cancer lesion. Metastatic cancer was seen in the palpable axillary node, another resected axillary node and a removed internal mammary node. The estrogen and progesterone receptor analysis of the axillary node were negative. Since occult breast cancer was found highly potential for metastasizing to the infraclavicular or internal mammary nodes, it is reasonable to treat such patients in the same way as those with palpable breast cancer, with adjuvant chemotherapy.

Benign & malignant breast diseases with intraductal epithelial proliferation with special reference to a comparison of cytological features on fine needle aspiration biopsy.

乳腺穿刺吸引細胞診を行い細胞量が豊富に採取されたが, 個々の細胞が小円形を示し, 良悪の鑑別が困難であった良性病変10例 (上皮増生の強い線維腺腫, 乳管過形成を伴う乳腺症, 乳管内乳頭腫), 悪性腫瘍20例 (非浸潤性乳管癌, 乳管内増殖優位な乳頭腺管癌および充実腺管癌) について, その細胞像を検討した.(1) 良性病変では背景に間質成分, 裸核状細胞 (線維芽細胞) をみることが多い. 個々の上皮細胞は結合性が強く, 散在性に乏しい. また核形不整に乏しく, 染色質は細顆粒状を示しやすかった.(2) 悪性腫瘍では背景に若干の塊死, 間質成分などはみるものの大部分は上皮細胞のみで個々の上皮細胞は良性病変に比べ, 結合性が弱く, 散在性に強く, 核形不整, 染色質粗顆粒状を示す傾向にあった.(3) 配列, 核大小不同, 核分裂については特に明らかな違いがみられなかった.乳管内増殖が強いこれらの病変の細胞像は小型で異型が乏しいが, 以上のように背景出現細胞, 上皮細胞の結合性, 核形, 染色質所見などを中心に詳細に検索することが大切であった.

The clinical significance of ultrasonicaliy guided puncture of the gallbladder for the cases of non-visualized gallbladder by oral cholecystography and intravenous cholangiography.

胆嚢疾患に対して施行した排泄性胆道造影法の成績を検討し, さらに高率に認められる胆嚢像陰性例に対して, 超音波誘導下の胆嚢穿刺術の有効性について報告する.(1) 胆嚢疾患148例に対して排泄性胆道造影法を施行するに胆嚢像陰性例は102例 (68.9%) と高率に認められた.(2) 胆嚢像陰性例を中心に胆嚢穿刺術を行い145例中138例 (95.2%) に明瞭な胆嚢像を得た.(3) 胆嚢癌34例に対する吸引細胞診の成績は34例中28例 (82.4%) の診断率であった.(4) 胆嚢胆汁CEA濃度は良悪性鑑別の補助診断に成り得る.胆嚢穿刺術は胆嚢癌の早期発見および良悪性の鑑別診断に有効であり, とくに胆嚢像陰性例に対して不可欠の検査法である.