[Solid follicular bronchiolitis].

A 64-year-old man presented a nodular shadow in the right lower lobe on a chest computed tomography (CT) scan. The nodule had grown remarkably in 3 years and was suspected to be a lung cancer. An open lung biopsy showed a solid lesion adjacent to lung abscess, and histopathological examination of a biopsy specimen revealed follicular bronchiolitis. Follicular bronchiolitis is a rare condition and is reported to occur mainly in association with connective tissue disorders or immunodeficiency syndromes. In such conditions, it generally exhibits bilateral, diffuse, small nodular lesions or ground-glass opacities. The present case was not associated with such underlying diseases and was thought to have occurred in association with lung abscess. Few cases of follicular bronchiolitis caused by non-specific airway infection have been reported in Japan.

Ga-67 tumor scan in malignant diffuse mesothelioma--comparison with CT and pathological findings.

Malignant diffuse mesothelioma is characterized by more difficult diagnosis and worse prognosis than other pleural tumors. In the Department of Thoracic Surgery, Hyogo Medical Center for Adults, 11 patients underwent panpleuropneumonectomy for this disease between January, 1988 and March, 1993. In 7 of these cases, Ga-67 scans were obtained before the operation. To clarify the factors affecting Ga-67 uptake in the pleural tumor, we compared Ga-67 uptake on the involved side of the thorax with CT and the pathological findings of the tumor. Regarding the use of Ga-67 scan imaging for the diagnosis of this disease, a number of related findings must be considered, such as an encircled wide Ga-67 uptake in the thickened pleural involvement and a diffuse slight Ga-67 uptake on the affected side with very slight involvement of the pleura. When the involved pleural thickness was over 6 mm, a definite correlation was found between the degree of Ga-67 uptake and the macroscopic thickness of mesothelioma in resected specimens. Thickness of the pleura on CT images demonstrates the real tumor thickness in the case of thickened involvement but in the case of thin involvement the real thickness of active mesothelioma could not be identified. No definite correlation was found between the degree of Ga-67 uptake and the histological type, or among microscopic findings, such as the extent of tumor parenchyma, interstitial volume and tumor vascularity. Our results suggest that the Ga-67 scan is very useful for revealing the extent of pleural involvement, especially when this involvement is more than 6 mm thick.

A case of intraductal papilloma of breast in advanced age.

Breast tumors have their various biological characteristics as to advanced age of patients. Intraductal papilloma is a benign tumor of the breast which is known to occur in the premenopausal young females. Tumors of the breast in the senile females are found mainly to be breast cancers. No any cases of intraductal papilloma over 80-years were reported in Japan to date. We have recognized mammary tumors in old aged patients to be cancers, but it is necessary to put it into mind there are a few intraductal papillomas even if advanced in age. In this report, we present the most senile case with intraductal papilloma in our institute.

Coexistence of choriocarcinoma and adenocarcinoma in the rectum: molecular aspects.

Choriocarcinoma, a malignant tumor of usually placental origin, in divided into two groups; the gestational and non-gestational types, the latter being rare. Non-gestational choriocarcinoma occurs in the lung, mediastinum, kidney, stomach, and small intestine, but rarely appears in the large intestine. We treated a 29-year-old woman with choriocarcinoma of the rectum with adenocarcinoma. Despite the rarity of the condition and the obscurity of the histogenesis, reports of similar cases and the occurrence of the tumors in the digestive tract suggest that the condition constitutes a clinical entity of a digestive tumor.

Partial spontaneous regression of Bowen's disease.

BACKGROUND: Although the lesions of Bowen's disease often show conspiciously irregular configurations, there have been no studies performed to elucidate what these clinical features imply. Of 90 patients with Bowen's disease, 34 (group 1) had such irregular lesions with patches of normal-appearing interlesional skin. Their clinical backgrounds were compared with those of 56 patients without irregular lesions (group 2). Specimens of lesional, interlesional, and perilesional skin from 17 patients in group 1 were examined to evaluate the histopathologic evidences of regression. OBSERVATIONS: The lesions of group 1 patients were more commonly located on the trunk, larger in size, and of longer duration than those of group 2 patients. The specimens of lesional skin from the 17 group 1 patients revealed amyloid deposition (12 patients), melanophages (three patients), increased vascularity (15 patients), and inflammatory cell infiltrates (17 patients). The interlesional skin also exhibited amyloid deposition (12 patients), melanophages (six patients), increased vascularity (15 patients), dermal fibrosis (16 patients), inflammatory cell infiltrates (15 patients), and epidermal atrophy (eight patients). The perilesional skin showed no amyloid depositions, melanophages, or increased vascularity. CONCLUSION: These histopathologic findings in normal-appearing interlesional skin may represent partial spontaneous regression of Bowen's disease.

Hemorrhagic colitis with unusual colonoscopy features, complicated with chronic graft-versus-host disease after allogeneic bone marrow transplantation.

A 32-year-old man was admitted after bone marrow transplantation because of hematochezia. He had history of chronic graft-versus-host disease (GVHD) of the skin and the liver, and cytomegaloviral pneumonia. Barium enema and colonoscopy showed multiple colon ulcers in the ascending and transverse colon. This feature is very rare in chronic GVHD and resembles the feature in autoimmune disease such as periarteritis nodosa. Thus, this ulceration is thought to be caused by vasculitis due to an autoimmune reaction in chronic GVHD.

A case of low-grade fibromyxoid sarcoma of the thigh.

A case of low-grade fibromyxoid sarcoma in the thigh of a 21 year old female is described. The patient had a fist-sized well-defined mass in her left thigh that enlarged over a 6 month period. Histologically, the neoplasm showed contrasting fibrous and myxoid areas with a swirling growth pattern. Cellularity was low to moderate, and the stromal cells were benign looking without mitoses or nuclear pleomorphism. The tissue was not noticeably vascular. Some stromal cells were aggregated around the blood vessels. The stromal cells were immunoreactive to vimentin, but were negative to keratin, desmin, alpha-smooth muscle actin, actin HHF35, S-100 protein, neuron-specific enolase, and epithelial membrane antigen. Ultrastructural examinations of the stromal cells revealed well-developed rough endoplasmic reticulum, mitochondria, pinocytotic vesicles, and numerous intermediate-sized filaments in the cytoplasm. These findings seem to indicate that the stromal cells were fibroblastic in origin. The occurrence of the tumor in a young adult, its location and its large, well defined borders together with the characteristics revealed through histological investigation, indicated that it was in fact what has been termed by Evans as a low-grade fibromyxoid sarcoma.

Demonstration of primary tracheobronchial amyloidosis by 99mTc-HMDP bone SPECT.

A case of primary tracheobronchial amyloidosis is reported. A 61-year-old man presented with a 2-year history of intermittent hemoptysis. Chest X-ray and CT scanning showed tracheobronchial thickening. Bronchoscopic examination revealed diffuse tracheobronchial narrowing, and tracheobronchial biopsy detected amyloid deposits. Both 99mTc-HMDP planar and SPECT images were obtained in this patient. Coronal SPECT images revealed more precisely that the activity was not in the thoracic cage but in the bilateral hilar region. Localization of the amyloid deposits could be better determined on SPECT images than on planar images.

Mesenteric fibromatosis presenting as fever of unknown origin.

We report a case of fibromatosis, soft tissue tumors that are benign histologically, but exhibit behavior intermediate between benign and malignant diseases. Mesenteric fibromatosis grows vigorously without a general inflammatory reaction, and its symptoms are the result of obstruction and/or compression of the intestine. However, in our case, the general inflammatory reactions of fever and C-reactive protein (CRP) elevation was present at an early stage. Because this inflammatory reaction disappeared after surgical resection, it may have been induced by some inflammatory factors produced in the tumor, such as those produced in inflammatory fibrous histiocytoma. We found that computed tomography was useful in the detection of the cause of fever of unknown origin, and suggest that it should be recommended in cases of long-lasting unexplainable fever.

[Small sized non-small cell lung cancer in advanced stage].

Eighteen cases of non-small cell, small sized advanced lung cancer, out of 362 operated cases for 6 years excluding 7 cases of small cell lung cancer, 60 of preoperative treated and 27 of inoperable cases, were discussed. A small sized tumor was defined as a tumor within 8,000 mm3 in its volume, calculated by multipling three lengths measured on the resected specimens. There were fourteen cases with stage 3 and 4 (A), and four cases with N1 disease (B). In group A, three cases of twelve with N2 diseases showed the tiny skipping lesion in the mediastinum with negative regional nodes. Remaining two had a lesion of dissemination and pulmonary metastasis. In group B, they showed unusual way of N1 spread, in which two of them with left upper lobectomy had metastatic lymph nodes on the non-bearing lobe, the lower lobe, and other two cases took regional lymph nodes metastasis without invasive growth of the main tumor. Predominant histologic type was adenocarcinoma, but the subtype and the differentiation of it were not specific. The level of CEA was low below 5 ng/dl in most of them except three cases, in which it suggested massive positive nodes and pulmonary metastasis. Seven patients died of the disease in two years. Remainders are alive, 4 with and 7 free from the tumor with the longest period of 3 years and a half. N2 diseases of small sized tumor were found in the cases with the volume of 3 cm3 and more at almost same ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of epidural granulocytic sarcoma preceding acute leukemia.

A 20-year-old male developed both coccygeal and leg pain and followed by rectocystic disturbance. Disc herniation between L5 and S was suspected and laminectomy was performed. At surgery, an easily curretable tumor occupied the epidural space from L5 to the end of the sacrum. In part, the tumor spread out of the vertebral canal and invaded the surrounding muscle tissue. This muscle tissue and part of the lamina were checked histologically. Initial blood analysis revealed 5% blast-like cells, but failed to confirm them as leukemic cells. Histologically, the tumor cells had round or oval nuclei with large nucleoli and scanty cytoplasm without granulocytic differentiation. Malignant lymphoma or Ewing's sarcoma was initially suspected, but the definite diagnosis was uncertain. Immunohistochemical staining with the PAP method and enzyme histochemistry revealed that the tumor cells were positive for lysozyme and naphthol ASD chloracetate esterase. Thus, granulocytic sarcoma was finally diagnosed. Electron microscopic findings supported this diagnosis. Subsequent karyotyping of bone marrow cells revealed 8; 21 translocation, thus the final diagnosis of this patient was myelodysplastic syndrome, refractory anemia with excess blast cells in transformation or acute myelogenous leukemia, M2, by the FAB classification.

Hematoma of the interatrial septum associated with complete atrioventricular block.

A 70-year-old man who had been treated for tongue cancer began to suffer from repeated syncopal attacks. His electrocardiogram indicated complete atrioventricular block. A permanent pacemaker was implanted. He was well for about 2 years after which time he developed dyspnea, suffered from general fatigue, and then suddenly died. A postmortem examination revealed a hematoma approximately 4 x 4. cm in size in the interatrial septum, connected to a noncoronary sinus and rupture of the noncoronary leaflet, which compressed the tricuspid and aortic valves. This hematoma might have been related to the conduction disturbance caused by destructive compression on the conduction system, and his death by the rupture of the noncoronary leaflet.

Contents of tissue CEA and CA19-9 in colonic polyp and colorectal cancer, and their clinical significance.

In precancerous states or early cancer, the serum levels of tumor markers are almost not detectable. Therefore, the tissue contents of CEA and CA19-9 were measured in 48 colonic polyps, 8 colorectal cancers and 5 normal colonic mucosa. These tissue specimens were obtained by endoscopic polypectomy, surgery or autopsy, and homogenated in normal saline (10 ml/wet g of tissue). After centrifugation, the supernatant was assayed by enzyme or radioimmunoassay. There was no correlation between serum levels and tissue contents of CEA or CA19-9 in colonic adenomas and colorectal cancers. The mean contents of tissue CEA and CA19-9 in colonic polyp and colorectal cancer were significantly higher than normal colonic mucosa, and the highest contents of CEA and CA19-9 were found in colorectal cancer. The contents of tissue CEA and CA19-9 in cancerous regions were markedly increased as compared with noncancerous regions. In adenomas, there was a relationship between the degree of histological dysplasia and the tissue content of CEA. Relationships were also found between macroscopic findings and tissue tumor markers in adenomas. These results suggest the possibility that the measurement of tissue tumor markers may be useful for borderline colonic lesions.

[Mammary fibroadenoma showing osseous metaplasia: a case report].

Discussed is a 33-year-old premenopausal woman who noted a mass in her right breast. On palpation, the tumor was determined as being 3.5 x 2.5 cm in size, well circumscribed, of a firm consistency, and freely movable. Mammography showed a well-defined oval lesion which contained a coarse calcification in the upper external quadrant. An ultrasound study revealed a well-defined oval low echoic lesion with a high echoic portion in the internal echo. The tumor was extirpated and a gross inspection found it to be an ordinary fibroadenoma, 3.2 x 2.5 x 1.5 cm in size. Histologically the lesion was a hyalinized fibroadenoma showing osseous metaplasia. A review of the literature has not revealed cases of a benign breast tumors showing an osseous and/or cartilagenous metaplasia. Notable however is that many reports show mammary osteosarcomas as originating from a fibroadenoma. Thus, this tumor also might have possibly developed into a osteosarcoma.

[A case of bilateral renal metastases from non Hodgkin's malignant lymphoma].

A patient with bilateral renal metastases from non Hodgkin's malignant lymphoma originating in the aortocaval abdominal lymph nodes was treated with chemotherapy. Initially, methotrexate (20 mg/m2), vincristine (0.6 mg/m2), cyclophosphamide (500 mg/m2), adriamycin (20 mg/m2), and bleomycin (30 mg/m2) were given on day 1, cisplatinum (50 mg/m2) was given on day 2, and prednisolone (20 mg/body) was given from day 1 to 3 (MVP-CAB regimen). Since the patient was 74 years old and had slight renal dysfunction, for the first and second courses of this therapy, methotrexate and cisplatinum were administered at 60% of the usual dose and the other 4 anticancer agents at 70% of the usual dose. Only prednisolone was given at the full dose. From the third course the 6 anticancer agents were used at 70% of the normal dose. Administration was performed every 4 weeks until the third course, and every 8 weeks after the fourth course (total number of cycles of MVP-CAB: 8 cycles). A marked improvement of the general state and a reduction of the tumor size were noted following treatment. Since regrowth of the residual tumor occurred, as second line chemotherapy cytosine arabinoside (100 mg/m2) on day 1, ifosfamide (1 g/m2) on day 1 to 2, etoposide (100 mg/m2) plus prednisolone (20 mg/body) on day 1 to 3 were administered (AraC-VIP regimen). The timing of administration was similar to that of the MVP-CAB regimen. More than 50% tumor reduction was obtained with this regimen. The total survival time since the beginning of chemotherapy is 2 years to date.

Endoscopic studies on the superficial spreading type of early gastric cancer.

Twenty eight cases out of 230 cases of early gastric cancer showed the superficial spreading type of early gastric cancer. Seventeen stomachs (60.7%) were compatible to the endoscopic finding of spreading cancerous regions, even to macroscopic and microscopic ones. Other 11 cases were not corresponded clinicopathologically to the infiltrated lesions. These 11 cases were studied on the superficial spreading lesions respectively. They were divided into three groups and compared each other micro- and macro-scopically and endoscopically. Group I contained 6 cases, compatible to micro- and macro-scopic findings but not to endoscopic ones. Endoscopic overdiagnosis may be redness and overflow of white fur and underestimate by a few cancer cells superficially in the mucosae, slight difference in height at the margin of II c and cancer without exposure. Group II was similar microscopic and endoscopic findings but not compatible macroscopically. Both cases in group II were overestimated macroscopically at the infiltrated edge because of color change in mucosae but endoscopically diagnosed by changes of color and gastric area. Group III contained 3 cases of microscopic characteristics and not compatible to macroscopic and endoscopic ones. Endoscopic underdiagnosis may be based on a few cancer cells superficially in normal mucosae and on less depressed lesions. These clinicopathological studies might be worthy to clarify the endoscopic and pathologic discrepancies of infiltrating areas by early gastric cancer, and might improve endoscopic techniques of the gastric mucosal observation.