Yuzo Maruyama

Three cases of early stage carcinoma of the gallbladder

SummaryThree cases of early stage carcinoma of the gallbladder are reported. In two cases, radiolucent shadow was demonstrated on cholecystogram. The masses were papillary adenomas with foci of adenocarcinoma. In the third case, the cholecystogram did not reveal particular findings except for shadows of numerous tiny gallstones. The malignancy was completely unexpected clinically, even after gross inspection of the organ. It was an incidental finding of microscopic examination, which disclosed abundant Rokitanskγ-Aschoffs sinuses associated with foci of cytologically malignant cells in the muscular layer. It was explained as malignant change of epithelium on one of the sinuses.All three patients underwent simple cholecystectomy. So far they have been free from evidence of metastasis or recurrence. The diagnosis and treatment of early carcinoma of the gallbladder are discussed.

Gastric carcinoma metastatic to the breast diagnosed by mucosubstance histochemistry and electron microscopy.

Bilateral breast tumors with a histologically scirrhous pattern were conclusively diagnosed as gastric carcinoma metastatic to the breast using mucosubstance histochemistry and electron microscopy. The majority of the carcinoma cells gave histochemically positive reactions for galactose oxidase‐Schiff, stable class III con A, and high‐iron diamine‐alcian blue (HID‐AB). Also electron microscopically, numerous HID‐positive mucus droplets (sulfo‐mucin) were seen in the carcinoma cells. These findings invalidated the possibility that the carcinomas were primary breast cancer. The practical applications of distinctive patterns of mucus secretion are discussed. ACTA PATHOL JPN 38: 1353‐1361, 1988.

Improvement of unsatisfactory aspiration smears in breast diseases.

乳腺細胞診に占める判定不能例の現状把握とその改善を目的として, 19病院 (26人) の外科医を対象に穿刺方法, 標本作製などを中心にアンケートを試みた.全症例 (2,033例) に占める判定不能例は22.4%で, そのほとんどが細胞量の不足によるものであった.外科医別では吸引ピストル使用が約半数で, 残りはガラスやディスポ注射器を用いていた.針は21～22ゲージが約80%を占め, 穿刺方法はピストン法が半数, 一回受診時での平均穿刺回数は2.3回であった.塗抹は半数が技師によって施行され, 塗抹後の注射筒洗浄の実施は約40%であった.判定不能率20%以下を良好群, 60%以上を不良群として検討した結果, 穿刺回数では良好群が3.5回に対し, 不良群が2.1回であった.穿刺方法は腫瘤内で針先を微細に動かすピストン法, 塗抹は技師, 注射筒洗浄を励行している外科医に良好群が多かった.病院別での解析では, 同一施設内でも穿刺者によってその判定不能率に著しい差が認められることがあった.良好群の方法を参考にして不良群を中心に穿刺方法などを指導した結果, 著明な改善が認められた.病理・細胞診からの積極的なアドバイスと, 臨床医との密接な連携の必要性が示唆された.

Consideration of breast diseases diagnosed as class III by aspiration biopsy cytology : Comparison of class III a with class III b groups

過去7年3ヵ月間に長野県がん検診センターの乳腺外来で穿刺吸引細胞診 (ABC) を施行した乳腺疾患1,215例中の乳癌症例295例に対するABCの正診率は86.1%であり, 良性疾患917例の正診率は83.3%であったが, class III判定がおのおの14例, 4.7%および62例, 6.8%にみられた. class III症例76例をclass III a 51例とclass III b25例に分けて比較検討した結果 以下の結論を得た.1) class III症例中のclass III bの割合は乳癌が64.3%と最も多く, ついで乳腺症が40.9%で, 線維腺腫は9.5%と少なかった.2) class III a群中の乳癌比率は9.8%であり, class III b群では36.0%であった.3) 触診で乳癌と診断した群では差がみられなかったが, 乳腺症と診断した群ではclass III b群の方がclass III a群より乳癌比率が高かった.4) Mammography診断が良性 (I・II) で, ABCがclass III aの場合には乳癌はなかったが, class III bの場合には1/3強が乳癌であった. 悪性 (IV・V) の場合はclass III aでも乳癌の可能性が高かった.5) Echography診断が良性～疑診 (I～III) で, ABCがclass IIIaの場合には乳癌は少なかったが, class III bの場合には30%弱が乳癌であった. 悪性 (IV・V) の場合はclass III a, III bに関係なく乳癌であった.6) Thermography診断が良性 (I・II) で, ABCがclass III aの場合には乳癌は少なかったが, class III bの場合は1/3が乳癌であった. 悪性 (IV・V) の場合はABCがclass III bの場合は半数が乳癌であった.以上の成績からABCのclass III判定例をclass III aとclass III bに分ける意義が窺われた.

A CASE OF HETEROTOPIC OSSIFICATION ON LAPAROTOMY SCAR AFTER GASTRECTOMY

Recent experience with heterotopic ossification on the laparotomy scar in a 61-year-old man is described with some discussion on the etiology. There was a history of undergoing gastrectomy with an upper middle line incision 13 years before. About 5 years after the operation he had a nodular mass extending from the end-to-end of the incisional scar, and then about 8 years later the lesion was removed because it might cause disturbance of passage in the upper gastrointestinal tract. The removed specimen was 16×3.3×2.8 cm in size, and showed microscopically the bone and cartilagineous tissues with the marrow. Various hyposeses would offer various explanations on the etiology of this disease. From histopathological analysis we employed one that this heterotopic ossification was undertaken under the metaplastic origin. In other words, the old hyalinous scar tissues became calcified lesion as matrix for Ca-deposition and such calcified lesion developed to mature bone tissues due to metaplastic osteoblasts derived from regional immature mesenchyma cells.

Cervical Granulomatous Nocardiosis An Autopsy Case of Cervical Lymphnode Swelling Simulating Hodgkin's Disease

Clinical record: A farmer, 45 years of age was admitted to the hospital of our medical school on May 22, 1954, because of dyspnea caused by a slowly growing bilateral cervical mass of about 2 months’ duration. The patient noticed at first a retroauricular tumor on the left side. One month after the onset a mass, thought to be Hodgkin’s disease, was also noted on the other side. On admission, there was a firm indolent mass measuring about 7 . 0 ~ 10.0 cm. in the left and 5.0x6.0 cm. in the right cervical region. The temperature, since admission, relapsed between 38-39°C with no effect of penicillin. No remarkable sign in the chest by X-ray examination could be noticed. Tracheotomia was successfully performed to relieve the patient from dyspnea. On June 18, the patient suddenly fell into a state of vascular collapse and expired 3 months after the onselt of illness. X-ray was irradiated twice locally (200r in total) and then nitromin was used (300 mg. in total), but with no remarkable effect. Blood examination : Anemia (314-266 x lo* erythrocytes per cmm.) and leukocytosis (9,800 per cmm.) on admission. Leukocytes decreased gradually in number (8,200-6,500) and lymphopenia was always present. Blood culture was not performed. Autopsy jindings (No. S-155, 1954) Gross Examination: The spread of the cervical tumor mass consists of two parts ; one develops from the supraclavicular up to the parotid area and the other from the retropharynx into the cranial base. The former is made up mainly from conglomerated lymph nodes, grey-white in color and with no necrotic or hemorrhagic foci in granulomatous or fibrous parenchyma. The tumor mass on the left side invades further up to the retroauricular region destroying the greater part of the parotid gland and into the left lobe of thyroid on the other