Yutaka Hirano

Lymphoepithelioma-Like Carcinoma of the Stomach with Epithelioid Granulomas.

An 83-year-old Japanese man was admitted to our hospital for gastric adenocarcinoma mimicking a submucosal tumor in the gastric body. Considering his general condition, partial resection of the stomach and dissection of regional lymph nodes were performed; a dome-shaped tumor that was largely covered by normal mucosa and having a shallow central stellate ulcer was removed. Histopathologically, the carcinoma cell nests were surrounded by prominent lymphoid stroma. Sarcoid-like epithelioid granulomas were noted both in the tumor stroma and in the regional lymph node with metastasis. Epstein-Barr virus (EBV)-encoded RNA (EBER) in situ hybridization showed an intense and diffuse positive reaction in the carcinoma cells and no reaction in the surrounding gastric and lymphoid tissues. While the presence of lymphoid stroma is a characteristic finding in EBV-associated lymphoepithelioma-like carcinoma, sarcoid-like epithelioid granulomas might be associated with latent EBV infection.

Primary adenocarcinoma of the fourth portion of the duodenum: "A case report and literature review".

INTRODUCTION Primary adenocarcinoma of the 4th portion of the duodenum is reported less frequently than those other portions of the duodenum. Therefore, few reports discuss the diagnosis and treatment of this malignancy. PRESENTATION OF CASE A 54-year-old woman was admitted to our hospital with a complaint of nausea and vomiting after a meal. Upper gastrointestinal examination and a duodenogram revealed a Type 2 tumor of the 4th portion of the duodenum, which was diagnosed as well-differentiated tubular adenocarcinoma by endoscopic biopsy. Partial resection of the duodenum and jejunum was performed on the basis of intraoperative evaluation of negative lymph node metastasis around the pancreas and proximal duodenum with no macroscopic invasion toward the pancreas and proximal duodenal margin. Her postoperative course was uneventful without any sign of recurrence 5 years later. DISCUSSION Primary adenocarcinoma in the 4th portion is relatively less common. It is not easy to diagnose this disease. Patients with primary duodenal adenocaricinoma, who are medically fit to undergo surgery, should be given the option of aggressive resection. Duodeno-cephalo-pancreatectomy remains the standard treatment for adenocarcinomas of the 1st and 2nd portion of the duodenum. Partial resection is the preferred surgical method for patients with adenocarcinoma of the 3rd and 4th portions of the duodenum. CONCLUSION This report describes a rare case of primary adenocarcinoma of the 4th portion of the duodenum, successfully treated by partial resection of the duodenum and jejunum. However, larger studies are required to clarify the indications for the preferred surgical method for this malignancy.

A Case of Solitary Non-Parasitic Hepatic Cyst with Intracystic Hemorrhage

70歳女子の嚢胞内出血を来した孤立性非寄生虫性肝嚢胞の1例を報告した.本例は甲状腺機能亢進症で入院中何ら誘因なく激しい腹痛を来し,心窩部に手拳大の表面平滑な腫瘤を触れた.肝機能検査ではアルカリフォスファターゼ及びLDH値が異常高値であったが,血清ビリルビン及びトランスアミナーゼ値などは正常であった.超音波検査,肝シンチグラフィー,腹腔動脈造影及び腹腔鏡検査により孤立性肝嚢胞と診断され,またOchterlony法による寄生蠕虫血清検査は陰性で色虫性嚢胞は否定された.腹痛が持続するため肝左葉外側区域切除術により嚢胞を摘除した.嚢胞壁内面には凝血塊が附着し,嚢胞内容液は黄褐色で沈渣に赤血球が多数認められ,またその成分は血清のそれとほぼ同じであった.組織学的には嚢胞壁は厚いcollagen bandで形成され,一部小胆管の増生もみられ,出血が著明であった.嚢胞の内腔面はやや圧排されたbrush borderを有する一層の円柱上皮から成っていた.

A case of fulminant hepatitis accompanied with hyperamylasemia, hypoglycemia and death from generalized fungus infection

症例は27歳の経産婦で,妊娠末期に黄疸と下肢の浮腫が出現し,昭和50年9月21日生児を分娩直後に昏迷状態に陥り,翌霞当院へ入院した.頻回の交換輸血により意識は完全に清明となったが,経過中高アミラーゼ血症,痙攣李発作,低血糖を伴った.黄疸の増強,無尿,消化管出血が36病日より持続し,42病日に死亡した.剖検にて真菌(アスペルギルス,カンジダ)の全身性感染による敗血症と診断され,巨細胞封入体もいくつかの臓器に認められた.これらの感染症はステロイド使用による免疫抑制効果のためと考えられた.肝臓は亜急性肝壊死による肝線維症を示し,膵は慢性膵炎の像で,交換輸血中にみられた高アミラーゼ血症の原因と考えられた.

A case of constitutional ICG excretory defect with special

患者は消化性潰瘍のため入院した45歳の男性で,肝機能検査および肝生検所見では著変はみられなかったが,ICGとBSPの著明な解離(R15 ICG74.8%,R45 BSP4%)を認め,体質性ICG排泄異常症と診断された.ICG血中消失曲線では18分と28分にステップ形成を認め,SephadexG-200ゲル濾過によるICGと血清蛋白との結合様式についての検討では,正常者に較べて19S分画に結合するICGをより多く認めた.肝生検組織の電顕的観察では,Disse腔のreticulum fiberの増生,滑面小胞体の小空胞化および粗面小胞体の減少を認めた.ミトコンドリアは変形あるいは腫大を示し,paracrystalline封入体を認めた.リポフスチン顆粒の増加も認められた.さらに体質性および肝炎後ICG排泄異常症との相違について検討を加えた.