A partial defect in technetium-99m pyrophosphate image suggesting cardiac rupture following acute myocardial infarction.

We present the case of a 70-year-old woman with acute myocardial infarction who died of cardiac rupture on the 2nd hospital day. Dual isotope single photon emission computed tomography (SPECT) using thallium-201 chloride and technetium-99m pyrophosphate (PYP) performed on the 2nd hospital day showed a large perfusion defect in the anteroseptal wall on 201Tl image and a increased accumulation on 99mTc-PYP image in the anterior area consistent with a partial defect. Autopsy performed 1 h after death revealed a tear in the left ventricular anterior wall consistent with the defect on the 99mTc-PYP image. We propose that the finding of a partial defect in 99mTc-PYP is an interesting finding which may be associated with cardiac rupture following acute myocardial infarction.

Small cell carcinoma of the gallbladder combined with adenocarcinoma.

A rare case of small cell carcinoma (SCC) of the gallbladder combined with adenocarcinoma is reported. The patient was a 70-year-old Japanese man, who died of the disease shortly after the onset of symptoms. Autopsy disclosed a small tumor (1.0 cm in longest diameter) in the fundus of the gallbladder, with widespread metastasis. Histochemically, the tumor cells showed negative reactions for argyrophilic and argentaffin stainings, a weak immunohistochemical reaction only for neuron-specific enolase, and negative reactions for all of the other neurosecretory markers used, including neurofilament, chromogranin, somatostatin, gastrin and leu-7. However, electron microscopic examination revealed a few typical neurosecretory granules (NSG) in the cytoplasm of some tumor cells. We suggest that: 1. The presence of NSG in the cytoplasm of tumor cells is the most reliable diagnostic criterion for SCC. 2. SCC, at least the combined type, arises from a multipotential stem cell.

Schwannoma of the lesser omentum.

A case of solitary benign schwannoma of the omentum is detected by CT, ultrasonography and angiography, as a solid mass containing cystic regions.

[A case report of concurrent esophageal and gastric double cancer successfully treated by surgery and the effectiveness of the oral administration of polyacrylate pasta (PANA kayaku) and bleomycin oil in esophageal carcinoma].

The patient was a 65-year-old male who came to our hospital with a complaint of dysphagia. He was admitted to hospital following a diagnosis of combined tumor in the esophagus and stomach as revealed by X-ray fluoroscopy. For preoperative chemotherapy, he was given oral administration of BLM-polyacrylate pasta, 30 mg/day for 25 days and 15 mg/day for 5 days, up to a total dose of 825 mg. This regimen successfully reduced the tumor in the esophageal area. No signs of pulmonary dysfunction, changes in blood cell count and blood chemistry of any other abnormalities in his general status were seen as side-effects of the BLM-polyacrylate pasta. Thoracic-esophagectomy and total gastrectomy were performed on November 7, 1983. He has been maintaining a good quality of life without any signs of recurrence of the tumor for the last two years and six months after the operation. The esophageal tumor was identified as moderately differentiated squamous cell carcinoma with A0N0M0Pl0 and grade of invasion "mp", while the gastric tumor was moderately differentiated adenocarcinoma with H0P0S0N0 and invasion grade "m" in the early stage of IIa + IIc type.