Yoshio Aida

Myxoid Variant of Epithelioid Leiomyosarcoma of the Uterus

A rare case of myxoid variant of epithelioid leiomyosarcoma of the uterus in a 76‐year‐old woman is reported. Palpation and computed tomography revealed an enlarged uterus. Total hysterectomy and bilateral salpingo‐oophorectomy were performed, and a hemispheric tumor, measuring 2.7 X 2.5 X 1.8 cm, was found protruding into the uterine cavity of the upper uterine segment. The tumor contained a prominent myxoid stroma and epithelioid tumor cells, which were round and polygonal in shape and showed positive immunoreactivity for desmin and vimentin. High mitotic activity was observed in the tumor cells. Electron microscopic examination revealed bundles of filaments in the cytoplasm and fine reticular material in the extracellular matrix. Histochemically, the myxoid stroma contained abundant acid mucopolysaccharide. The tumor cells were considered to originate from smooth muscle cells, while the myxoid stroma expressed varying differentiation of uterine mesenchymal cells. The patient is currently well with no evidence of recurrence or metastasis one year after the operation. Acta Pathol Jpn 41: 778‐783, 1991.

Papillary Adenocarcinoma of the Ureter Producing Carcinoembryonic Antigen and Carbohydrate Antigen 19-9

CASE REPORT A 69-year-old Japanese woman presented with a history of right lower abdominal pain. Computerized tomography of the pelvis showed a lesion at the distal end of the right ureter protruding into the bladder. No masses were identified in the liver, pancreas, common bile duct or gallbladder. Cytological examination of the urine revealed clusters of atypical cells with a high nuclear-to-cytoplasmic ratio, which were suggestive of adenocarcinoma. Serum levels of CEA and carbohydrate antigen 19-9 were 24.5 ng./ml. (normal less than 2.5) and 313.3 units per ml. (normal less than 37), respectively. Although the lesion was not biopsied, total nephroureterectomy was performed for a clinical diagnosis of ureteral cancer. A 3.5 3.2 1.7 cm. milky white papillary tumor was observed at the distal end of the ureter. The tumor was diagnosed as papillary adenocarcinoma, which infiltrated the muscle layer (fig. 1). Minute foci of glandular metaplasia of the transitional epithelium were observed in the ureteral epithelium. Immunohistochemically the tumor cells were positive for CEA, carbohydrate antigen 19-9 and cytokeratins 8, 18 and 20 but negative for cytokeratins 7 and 10, and Leu-M1 (fig. 2). Postoperative course was uneventful, and serum levels of CEA and carbohydrate antigen 19-9 returned to normal (1.5 ng./ml. and 8.3 units per ml., respectively). No evidence of recurrence or metastasis was detected during 1-year followup.

Increased transforming growth factor-β1 and tubulointerstitial fibrosis in rats with congenital hydronephrosis

Abstract Objectives: Most of our knowledge concerning renal obstruction has been derived from experimental animal models, and it is not yet well defined in spontaneous hydronephrosis. The aim of our study is to evaluate the roles of transforming growth factor‐β1 (TGF‐β1) and apoptosis in congenital hydronephrotic kidneys in comparison with experimental models.

A patient who showed a pathologically complete response after undergoing treatment with XELOX plus bevacizumab for synchronous liver metastasis of grade H2 from sigmoid colon cancer

We herein report the case of a patient who showed a pathological complete response after undergoing chemotherapy with capecitabine, oxaliplatin and bevacizumab. The patient presented with synchronous solitary liver metastasis from sigmoid colon cancer. The maximum diameter of the liver deposit was 5.7 cm and the grade of the liver metastasis was H2 according to the Japanese classification. Deferred hepatectomy after sigmoidectomy was performed, followed by the administration of neoadjuvant chemotherapy. After undergoing sigmoidectomy, the patient received 1,000 mg/m(2) of capecitabine and 130 mg/m(2) of oxaliplatin without bevacizumab as the first cycle of chemotherapy followed by eight cycles of chemotherapy with bevacizumab (7.5 mg/kg) every three weeks. The liver deposit was reduced to 2.2 cm in diameter and the patient showed a partial response to chemotherapy. The patient then underwent metastasectomy of segment 8 of the liver instead of the central hepatectomy that was possibly needed before chemotherapy. Histopathologically, the tumor consisted of fibrous tissue, and no cancer cells were detected in the resected specimen. A pathological complete response in a patient with H2 liver metastasis is considered rare and suggests that capecitabine, oxaliplatin and bevacizumab are efficacious as neoadjuvant chemotherapy.

Nuclear inverse polarity papillary lesions lacking myoepithelial cells: A report of two cases

Here, cases of a 68‐ (Case 1) and a 44‐year‐old (Case 2) female are presented. They had an abnormality in the breast, and came to our hospital for further examination and treatment. Radiologically, malignancy could not completely excluded so breast excision was performed. Histologically, both cases revealed papillary neoplastic lesions lined by fibrovascular core and nuclear inverse polarity without atypia. Loss of myoepithelial cells was observed by HE, p63, and calponin. Previous report indicate CK5/6, ER, p63 and MUC3 are important for distinguishing between papillary lesions according to the differential index (based on Allred score) of ([ER total score] + [MUC3 total score])/([CK5/6 total score] + [p63 total score] + 1). Based on this analysis, our two cases had benign lesions. However, based on immunopositivity for cell‐cycle marker Cyclin‐D1, Case 1 was negative, and Case 2 was about 70% positive. Additionally, the Ki‐67 index was <1% in both cases, and no evidence of disease was observed after a maximum 62 months of follow‐up in both cases, despite lack of additional treatment. Thus, we propose that lack of myoepithelial cells in papillary lesions do not necessarily indicate malignancy and are thought to be, at the most, uncertain malignant potential.

A case of paraganglioma of the bladder

背景:膀胱に発生する傍神経節腫はきわめてまれである.症例:39歳, 男性. 残尿感を主訴として来院した. 超音波検査, 骨盤部CTならびにMRI検査で膀胱左尿管口後部に約3cm大の腫瘤を認めたため, 腫瘍摘出術が施行された. 捺印細胞診ではきれいな背景に弱い結合性を示す腫瘍細胞がシート状ないし散在性に出現していた. これらの細胞は比較的広く, ライトグリーンに淡染する細胞質を有し, 細胞境界は不明瞭であった. 核は円形～類円形で大小不同を示し, クロマチンは粗顆粒状で軽度増量していた. また, 小型の核小体が1, 2個みられた.組織学的に腫瘍は多角形細胞が線維性隔壁により蜂巣状ないし島状に配列する, いわゆるZellballen patternを示し, NSE, chromogranin A, 陽性を示した. また, 電顕像では神経内分泌顆粒に相当する構造物を認めた.結論:膀胱発生の傍神経節腫はまれではあるが, 本腫瘍の存在も念頭におく必要があると思われる.

A case of sebaceous carcinoma of the eyelid.

We report a case of sebaceous carcinoma of the left upper eyelid in a 57-year-old man. Imprint cytology of the tumor revealed large and small clusters composed of large and atypical cells with a high N/C ratio, small and hyperchromatic nucleoli, and well-demarcated small vacuoles in cystoplasm. Histologically, the tumor consisted of irregularly lobules of different sizes. Each lobule consisted of cells exhibiting cytoplasmic vacuolation. Sudan III and sudan black demonstrated the presence of fat within tumor cells.

A case of autoimmune hepatitis with a subcapsular epithelioid cell granuloma.

症例は40歳, 女性. 転居を機会に近医を受診, 肝機能障害の既往があるため精査を行った. 血液生化学検査で, 赤沈は軽度亢進, トランスアミナーゼの中等度の上昇とγ-GTPの軽度の上昇を認めた. また, γ-グロブリンは2.16g/dlと上昇し, 抗核抗体は80倍であり, 肝生検組織像では, 著明な肝実質障害像がみられ, 採取された生検肝組織の被膜下に類上皮細胞性肉芽腫を認め, 国際AIHスコアは17点を呈した. 経過観察中にトランスアミナーゼは改善傾向にあったためコルチコステロイドの投与はせず, ウルソデオキシコール酸300mg/日を開始した. 臨床的にはAIH様の所見を呈したが, 組織学的には肝被膜直下に類上皮細胞性肉芽腫の出現を認め, 実質炎の強いタイプのPBCに類似しており, 診断に難渋した1例を経験したので報告する.

Cytologic features in two cases of malignant cystosarcoma phyllodes

乳腺悪性葉状嚢胞肉腫2例の捺印細胞像ならびに病理組織学的所見について報告する.症例は47歳ならびに39歳の女性で, 右乳房に巨大な腫瘤が潰瘍を形成し, 出血が著しいため当院を受診した.乳癌の診断で入院, 定型的乳房切断術を施行した.腫瘍の捺印標本では, 異型性に乏しくシート状配列を示す上皮様細胞と紡錘形細胞からなる良性像と, 類円形～紡錘形と多種多彩な異型細胞が出現する悪性像が認められた.病理組織学的には, いずれの症例も葉状嚢胞肉腫の良性像と悪性像が混在しており, 悪性像を呈する部分は複数の肉腫成分から構成されていた.葉状嚢胞肉腫においては明らかな良性像と悪性像が混在することがあり, 特に生検および細胞診断に際しては, その採取部位について細心の注意が必要であると思われる.

A clinicopathological study of asymptomatic primary biliary cirrhosis in three aged patients

SummaryThe 3 cases suffering from asymptomatic primary biliary cirrhosis (aPBC) were all older than 70 and female. Case 1, 2 and 3 were respectively 77, 72 and 70 years old. The final diagnosis was made on the basis of clinical observation and liver biopsy. Case 1 was diagnosed as CAH-PBC mixed type from histological findings and classified as stage II-III according to Scheuer’s classification. Case 2 was stage I and exhibited morphological features of PBC with arteriosclerotic change. Case 3 was stage I and had dysplasia-like large nuclei in some hepatic cells. Clinically, all cases were AMA positive. Elevation of serum ALP and IgM values was recognized in 2 cases, but serum transaminase and ALP values were not elevated in Case 2 for 1 year. In the follow-up observation during 5 years, Case 1 remained asymptomatic except for gradual elevation of serum ALP value. AMA, which was positive at the time of diagnosis, is now negative after 5 years, but now produces high potency ANA. The incidence of PBC in those aged older than 70 in Japan accounts for only 2–3% of all PBC cases. According to some reports, the prognosis of PBC deteriorates with age. In 3 cases reported here, however, the clinical course did not deteriorate even in untreated cases. This suggests the possibility that some aPBC cases diagnosed at an age older than 70 may have a favorable prognosis.