Non-invasive diagnosis of a Schwannoma by ultrasonography: a case study.

A 52-year-old female came to this institution complaining of a right leg mass lesion. Ultrasonography showed a 16 x 12 x 20mm hypoechoic solid mass lesion in the right leg. The patient underwent surgery during the diagnosis of Schwannoma. Preoperative diagnosis of Schwannoma is difficult by examination. Computerized tomography and magnetic resonance imaging, showed the origin of Schwannoma. However, the lesion was noted to be in a direct continuity with the cord-like echogenic structure consistent with a nerve by echography. We prefer to conduct preoperative examination by ultrasonography in patients with Schwannoma. In conclusion, we have reported a case of Schwannoma diagnosed by non-invasive ultrasonography.

[Clinico-pathological study of xanthogranulomatous cholecystitis].

Xanthogranulomatous cholecystitis (XGC) is an uncommon lesion which may form a tumor-like mass in inflamed gallbladders. In a review of 44 cases there were 40 associated with gallstones which had been incarcerated in the neck of the gallbladder, 10 with past histories of abdominal surgeries, 15 with diabetes mellitus, three with carcinomas in the neck of the gallbladder and four with carcinomas in the other organs. Radiologically the differential diagnosis of gallbladder cancer and XGC was difficult in several cases. Thirty five cases of XGC have been diagnosed as chronic cholecystitis and 7 have been mistaken for feature of XGC in the contrast enhancement CT that is, detection of an intramural low density mass with continuously enhanced internal membraneous layer of the gallbladder wall. In view of the clinico-pathological findings of XGC, the lesions appear to result from intramural extravasation of bile and subsequent xanthogranulomatous reaction under obstructive conditions in the neck of the gallbladder. We conclude that XGC is not an uncommon special type of cholecystitis but an accompanied lesion sometimes seen in a kind of cholecystitis.

[Surgical experience with tracheoplasty].

We have had experience with 31 tracheoplastic procedures. Underlying diseases consisted of primary tumor, cancer invasion from carcinoma of the thyroid gland and the esophagus, traumatic rupture and post-tracheostomy and tuberculous stenoses. During operation, respiratory support has been satisfactorily established by using the intubation method via the operative field and/or high frequency ventilation instrument. Furthermore, development of absorbable suture material like Dexon and Vicryl benefited by minimizing granulation stenosis at anastomosis due to less foreign body reaction. The prognosis for carcinomatous involvement from surrounding organs was much worse according to advanced cancer stages. However, surgical outcome of this procedure was satisfactory in terms of relieving respiratory distress.

[Clinical trial of CSF-HU (colony-stimulating factor derived from human urine: P-100) on granulocytopenia induced by anticancer therapy in urogenital cancer patients].

We examined the value of the CSF-HU preparation (colony-stimulating factor derived from human urine: P-100) to prevent or treat granulocytopenia induced by anticancer chemotherapy. Subjects were urogenital cancer patients who underwent two courses of the same chemotherapy regimen. Among these patients, we selected the subjects whose leucocyte counts were decreased to less than 2000/mm3 after the first course of anticancer chemotherapy. P-100 was administered from the following day of the end of the second course of chemotherapy at a dose of 8,000,000 units/day by intravenous drip infusion for 7 successive days. According to the global evaluation by consideration of changes in leucocyte and granulocyte counts, the utility rate by physicians was 52.4% (22/42), and that by a committee was 50.0% (18/36). No difference was seen in utility rate and efficacy rate according to P.S., cancer types and antineoplastic drugs used. Side effects were noted only in 2.3% (1/44) which was mild and transient fever. These findings suggest that P-100 is a very useful drug for prevention and/or treatment of granulocytopenia following cancer chemotherapy.

[Retroperitoneal schwannoma: a report of two cases and review of the literature].

Two cases of retroperitoneal schwannoma, one malignant, and the other benign, are herein reported. The first case was a 71-year-old female with a complaint of dull right flank pain. CT scan showed a large mass, which occupied almost the whole right half of the abdominal cavity extraperitoneally, accompanied by a low density portion in its central part. Angiography showed several feeding arteries, such as intercostal arteries, lumber arteries, and so on. Many tortuous and thin irregular vessels were seen. Tumor excision was performed under the diagnosis of malignant retroperitoneal tumor. No surrounding invasion or metastasis were seen. The tumor had a thick capsule, and cut surface showed lobulated appearance. No adjuvant therapy was done. Histological diagnosis was low grade malignant schwannoma. She is alive and well 17 months postoperatively. The second case was a 64 year-old male. His tumor was found incidentally, when he underwent a close examination of his gastric ulcer. According to CT scan, it was located behind the left kidney, and had a diameter of 3.0 X 2.5 cm. The tumor was removed including the fascia of lateral edge of quadratus lumbolum muscle, where it was firmly attached to. Surgical specimen showed a doughnut like appearance, because of its marked central necrosis. It had a white and thick capsule. Histological diagnosis was benign schwannoma of two different types, Antoni A and B. He remains well 13 months after operation. The 113 benign cases and 55 malignant cases reported in Japan, including our cases, were reviewed and discussed.

[Intrascrotal malignant fibrous histiocytoma: a case report and review of the literature].

A 75-year-old man visited our clinic on November 11, 1982 with the complaint of a painless mass in the right scrotum. The mass was hen's egg sized and hard. Surgery was performed under the diagnosis of testicular tumor. Right hemiscrotectomy with right inguinal orchiectomy was performed because of a scrotal skin invasion of the tumor. The spermatic cord, testis and epididymis were grossly normal. The tumor was located just beneath the testis, and it was considered to be scrotal tunicus in origin. The tumor was elastic and hard, and the cut surface showed a yellowish white and lobulated appearance. The histological diagnosis was malignant fibrous histiocytoma. Postoperatively, radiotherapy for a total dosage of 4,910 rads was given. The patient is alive and well without any sign of recurrence 19 months after operation. The 20 cases reported in Europe, America and Japan, including our case, were tabulated and some discussion is made.

Pathological study on livers with noncirrhotic portal hypertension and portal venous thromboembolic occlusion: report of seven autopsy cases.

Seven adult autopsied cases with noncirrhotic portal hypertension and thromboembolic occlusion of the large extra- and intrahepatic portal veins are presented. There were two types of portal venous occlusion: old thromboembolic occlusion (group A, two cases) and fresh thromboembolic occlusion (group B, five cases). In group A the occlusion was complete and the affected veins, which were identified clearly by elastic fiber stains, were characteristically shrunk to cause a long-standing portal hypertension. Extra- and intrahepatic collaterals were prominent. In group B the extra- and, sometimes, intrahepatic larger portal veins with fresh thromboemboli revealed variable degrees of phlebosclerosis, probably resulting from organization of repeated portal venous thromboemboli. These sclerotic changes further extended into the medium-sized and smaller intrahepatic portal veins. The latter and other hepatic morphology resembled those of idiopathic portal hypertension without larger portal venous occlusion (group C). Thus, in group B the widespread involvement of the portal venous system by thromboembolic events, particularly the smaller ones, might be important not only for the development of portal hypertension but also for understanding the hepatic pathology of idiopathic portal hypertension.