[Solitary capillary hemangioma in the lung: report of a case].

We report a case of pulmonary solitary capillary hemangioma of 59-year-old woman who visited our hospital for an abnormal chest shadow. She had no symptoms, but a computed tomography (CT) revealed a small irregular nodule at the periphery of right S9. Early lung cancer was suspected. Video-assisted thoracic surgery (VATS) was performed for the difinitive diagnosis and treatment in January, 2008. Macroscopically, the nodule showed ill defined margin and irregular in shape. Partial resection of the lung was performed and the histopathological diagnosis was solitary capillary hemangioma. Postoperative course was uneventful and there is no signs of recurrence.

[Clinical evaluation of fundic gland polyps and hyperplastic polyps].

We performed a retrospective review of 477 cases of fundic gland polyps compared with 562 cases of hyperplastic polyps, which were detected endoscopically during the past 8 years between January, 1989 and December, 1996. All lesions were histologically confirmed by endoscopic biopsy or the examination of polypectomy specimens. Fundic gland polyps were more prevalent in middle aged-female, and were not associated with gastric adenomas and gastric cancers. These results suggested that the background mucosa of patients with fundic gland polyp was different from that of patients with hyperplastic polyp. Fundic gland polyps in 55 patients were followed up. No change was observed in the polyps of the about half subjects, the polyps of 12 cases (21.8%) decreased in size and number or resolved completely. Cases decreased in size and number or resolved completely were much more in fundic gland polyps than hyperplastic polyps. There were no malignant transformation of fundic gland polyps. We claimed that fundic gland polyps were benign and distinct from hyperplastic polyps which had a possibility of malignant transformation.

Fluid-fluid levels in giant cavernous hemangioma of the liver: CT and MRI demonstration.

Fluid-fluid levels were observed in a case of giant cavernous hemangioma on computed tomography (CT) and magnetic resonance (MR) imaging. The fluid-fluid level may be attributed to the separation of blood cells and serous fluid due to the extremely slow flow in cavernous hemangioma of the liver.

Salivary gland tumors among atomic bomb survivors, 1950-1987.

BACKGROUND: Malignant and benign tumors of the salivary glands have been associated with exposure to ionizing radiation from various sources, including the atomic bombings in Hiroshima and Nagasaki. However, questions remain unanswered regarding the nature and size of the risk and specific types of tumors involved. METHODS: The incidence and pathology of malignant and benign tumors of the salivary glands was studied in the Life Span Study cohort of atomic bomb survivors followed by the Radiation Effects Research Foundation (RERF) in Hiroshima and Nagasaki, Japan. Incident cases diagnosed during the period 1950-1987 were ascertained from the tumor and tissue registries of Hiroshima and Nagasaki and supplemented by additional case findings from autopsy, biopsy, and surgical specimens maintained at RERF and other institutions. Pathology slides and medical documents were reviewed by a panel of four pathologists who classified tumors using the World Health Organization classification scheme. Analyses were performed of histologic features associated with radiation exposure. RESULTS: Of 145 tumors of the salivary glands identified (119 of the major and 26 of the minor salivary glands), 120 (83%) were histologically confirmed by the current investigators. Among 41 malignant tumors, the frequency of mucoepidermoid tumor was disproportionately high at high radiation doses (P = 0.04); among 94 benign tumors, the frequency of Warthin's tumor increased with increasing radiation dose (P = 0.06). The nature of the tumor was undetermined for the remaining ten cases. Mortality from malignant tumors of the salivary gland was inversely related to radiation dose, reflecting the predominance of mucoepidermoid carcinoma at high dose levels in this series. In one case with high radiation exposure, mucoepidermoid carcinoma of the parotid gland was accompanied by a preexisting or coexisting Warthin's tumor. CONCLUSIONS: These findings, supported by population-based analyses in a companion study reported elsewhere, suggest a causal role for ionizing radiation in salivary gland tumorigenesis, particularly for mucoepidermoid carcinoma, and in the induction of one type of benign tumor (Warthin's tumor).

[The usefulness of percutaneous transhepatic cholecyst puncture (PTCCP) with ultrasoundimage control for acute cholecystitis].

Percutaneous transhepatic cholecyst puncture (PTCCP) is a unique treatment for acute cholecystitis by using of 21 gauge PTC needle with ultrasoundimage control. The procedure is as follows. A percutaneous transhepatic puncture of the gallbladder is made with ultrasonic guidance. After suction removal of the contents of the gallbladder, saline with antibiotics is injected. Finally PTC needle is removed after removal of the injected saline. We carried out PTCCP in 35 patients with acute cholecystitis, and compared its clinical effect with those of PTCCD (46 cases) or conservative treatment of antibiotics administration (38 cases). The treatment of PTCCP removed the clinical symptoms of acute cholecystitis rapidly compared with the conservative treatment and it made the hospitalization shorter compared with the treatment of PTCCD. PTCCP was also performed without any severe complications for patients with underlying diseases. The curative rate of PTCCP was the same as those of other former treatments. It was concluded that PTCCP is a safe, convenient, and useful treatment of acute cholecystitis.

Incidence of salivary gland tumors among atomic bomb survivors, 1950-1987. Evaluation of radiation-related risk.

A wide-ranging search for benign and malignant tumors of the major and minor salivary glands among members of the Life Span Study sample of the Radiation Effects Research Foundation identified 41 malignant and 94 benign incident tumors, including 14 malignant and 12 benign tumors of the minor salivary gland, plus 10 major gland tumors of unknown behavior. Dose-response analyses found statistically significant increases in risk with increasing A-bomb dose for both cancer and benign tumors. Estimated relative risks at 1 Sv weighted tissue kerma (RR1Sv, with 90% confidence interval in parentheses) were 4.5 (2.5-8.5) for cancer and 1.7 (1.1-2.7) for benign tumors. When analyzed by histological subtype within these two broad groups, it appeared that most of the dose response for malignant tumors was provided by an exceptionally strong dose response for mucoepidermoid carcinoma [11 exposed cases with dose estimates, RR1Sv = 9.3 (3.5-30.6)], and most or all of that for benign tumors corresponded to Warthin's tumor [12 cases, RR1Sv = 4.1 (1.6-11.3)]. There was a marginal dose response for malignant tumors other than mucoepidermoid carcinoma [RR1Sv = 2.4 (0.99-5.7)] but no significant trend for benign tumors other than Warthin's tumor [RR1Sv = 1.3 (0.9-2.2)]. Re-examination of the original data from published studies of other irradiated populations may shed new light on the remarkable type specificity of the salivary tumor dose response observed in the present study.

Report of a case of benign cystic mesothelioma.

A 32-yr-old man was admitted to Anjo Kosei Hospital for the examination of a cystic peritoneal lesion. This patient had a past medical history significant for an appendectomy. Ultrasonography and computed tomography revealed multiple cysts in the abdominal and pelvic cavities. An exploratory laparotomy was performed on July 1, 1993, revealing numerous thin-walled and translucent cysts in the serosal tissues of the parietal and visceral abdominal peritoneum. These cysts were excised surgically because of clinical suspicion of pseudo-myxoma peritonei. Microscopic examination revealed cysts within the thin cyst wall that were composed of fibrous connective tissue and lined by a single layer of cuboidal or flattened epithelium. Immunohistochemical and ultrastructural studies demonstrated that the lining cells were of mesothelial origin, and the diagnosis was benign cystic mesothelioma. In this paper, we present appropriate diagnostic and treatment procedures for benign cystic mesothelioma and discuss the particular usefulness of using immunohistochemical methods to achieve a histological diagnosis.

[Atypical chronic myeloproliferative disorder with translocation (12;13) (p13;q12) and tumor formation].

A 49 year-old man was admitted to our hospital in May 1989, with a cervical tumor and leukocytosis. He had been pointed out leukocytosis for last two years. Peripheral blood examinations demonstrated an increase of leukocytes (39,500/microliters) with low neutrophil alkaline phosphatase, eosinophilia and immature cells. Examination of bone marrow revealed normoplasia with 5.6% eosinophils, 1.4% myeloblasts, 2.6% promyelocytes and 250/microliters megakaryocytes. Cytogenetic analysis disclosed 46, XY, t (12;13) (p13;q12). Southern blot analysis showed no BCR rearrangement. The tumor cells had infiltrated the lymph nodes. Pathological finding agreed with the specimen of the lymph node as in the clot section of bone marrow. He was diagnosed as having a chronic myeloproliferative disorder with tumor formation and was treated with anti-leukemia drugs, including BH-AC, THP, VDS, MTX, VP-16, BUS, 6MP and uvenimex. He showed hematological remission, temporary, but he did not reach cytogenetical remission and died in April 1990. Further study in a large series is necessary to define whether the abnormality of the chromosome with t(12;13) (p13;q12) is characteristic in cases with tumor formation.

Pulmonary infiltration with eosinophilia and increased serum levels of squamous cell carcinoma-related antigen and neuron specific enolase.

We report a case of pulmonary infiltration with eosinophilia (PIE), associated with increased serum levels of squamous cell carcinoma-related antigen (SCC) and neuron specific enolase (NSE). The diagnosis of PIE was confirmed by examination of bronchoalveolar lavage fluid and specimens of transbronchial lung biopsy. It was suggested that PIE was probably induced by a course of amoxicillin for a sore throat. Corticosteroid therapy resulted in clinical improvement of symptoms, resolution of pulmonary infiltrates on chest roentgenogram and reduction in serum levels of SCC and NSE.

Case report: intracranial extramedullary haematopoiesis in postpolycythemic myelofibrosis.

Extramedullary haematopoiesis (EMH), which may occur in various types of haemodyscrasia and dyshaematopoiesis, is generally seen in the spleen, liver and lymph nodes, but rarely within the cranium. This is a case of intracranial EMH in a patient with secondary myelofibrosis which developed after the treatment of polycythaemia rubra vera.

[Treatment of hemobilia after percutaneous transhepatic cholangiography and drainage (PTCD)].

PTCD was performed in 206 of our patients during the past 6 years and 7 months. Of the 206, hemobilia occurred in 14 patients (6.8%). The hemorrhage was completely stopped by irrigation of the bile duct in 3 patients, compression with a larger catheter in 7 patients, and transcatheter anterior embolization (TAE) in 4 patients. TAE was performed on the patients whose hemobilia could not controlled by the compression with a larger catheter. In TAE, either a steel coil or a sponge was used as an embolus. Rebleeding occurred in one patients for whom the right hepatic artery was chosen as a embolization site. Therefore, it was decided that the embolization was going to be done in all the hepatic arteries when the blood stream in the portal vein and preserved functions of the liver of the subjected patients including the one with rebleeding were fully normal. A complete control of the hemorrhage was obtained in all patients. The PTCD root caused hemobilia was removed after TAE in considering the possibility of rebleeding from the root, and a new PTCD root was made.

[A case of sarcoidosis with hypercalcemia, urolithiasis, nephrocalcinosis and renal insufficiency].

A sixty nine-year-old woman was admitted to the hospital because of further examination of hypercalcemia. On July 1990, she complained of general fatigue and loss of appetite. She was pointed out to have hypercalcemia (15.1mg/dl), urolithiasis, and renal insufficiency. CT films of the chest showed swelling of the mediastinal lymphnodes and CT of the abdomen nephrocalcinosis. Ga-scintigraphy demonstrated an abnormal accumulation of gallium in the mediastinum. Levels of the parathyroid hormone was normal. Levels of the serum calcium (13.7mg/dl), angiotensin converting enzyme (30.4IU/L) and 1.25 (OH)2D (87PG/ml) were elevated. Giant cells were found in the biopsy specimen of the lung. A significant relationship between the serum calcium and creatinine were observed (r = 0.76, p < 0.02). Proximal fractional reabsorption of sodium showed to be suppressed (47.7%), and distal fractional reabsorption of sodium showed to be normal (88.4%). From these findings hypercalcemia and urolithiasis was suggested to result from sarcoidosis. The hypercalcemia and renal insufficiency improved with corticosteroid therapy.

Urethral narrowing due to ectopic prostatic tissue in the bulbar urethra.

Ectopic prostatic tissue in the bulbar urethra is a rare disorder. A case of urethral narrowing due to such tissue is presented. The tissue specimen from the urethral narrowing was positively stained immunohistochemically by the prostatic specific antigen. Urethrocystographic findings are also discussed.

[Temporary spontaneous remission in Ki-1 (CD30) lymphoma with gastric lesion].

A case of 56 year-old man with Ki-1 (CD30) lymphoma is reported. He noticed cervical lymph node swelling and was admitted with temporary diagnosis of gastric adenocarcinoma in February 1986. His physical examination showed several from 1 to 4 cm size enlarged cervical and axillary lymph nodes. His first lymph node biopsy demonstrated the histological picture of malignant lymphoma. After 20 days his second lymph node biopsy demonstrated the picture of necrosis. Second gastric biopsy showed the picture of neither gastric cancer nor malignant lymphoma, in spite of his first gastric biopsy finding with adenocarcinoma that turned out to be malignant lymphoma by later reinvestigation. After word those lymph nodes disappeared and have not been palpable for about ten months. In October 1987, elevated LDH value, lymph node swelling and gastric lesion were again observed and sixth gastric biopsy demonstrated the picture of malignant lymphoma. He was treated with anti-lymphoma drugs. After his partial remission, he died of gastrointestinal bleeding in April 1988. Specimens of both first lymph node biopsy and sixth gastric biopsy were examined with cell markers for infiltrated cells and were positive for Ki-1/Ber-2H. His final diagnosis was Ki-1 lymphoma.

Incidence of skin cancer among Nagasaki atomic bomb survivors (preliminary report).

Among a total of 65,268 Nagasaki atomic bomb survivors recorded in the Scientific Data Center of Atomic Bomb Disaster, Nagasaki University School of Medicine, 140 cases with skin cancer were collected from 31 hospitals in Nagasaki City from 1961 through 1987. Subsequently, these cases of skin cancer in Nagasaki atomic bomb survivors were statistically analyzed in relation to the estimated distance from the hypocenter by age, sex, histology and latent period. The results were as follows: 1. A high correlation was observed between the incidence of skin cancer and the distance from the hypocenter. 2. The incidence of skin cancer in Nagasaki atomic bomb survivors now appears to be increasing in relation to exposure distance. 3. Among 140 cases, basal cell epithelioma was observed in 67 cases (47.9%) and squamous cell carcinoma in 43 cases (30.7%).

Primary choriocarcinoma of the stomach presenting as gastrointestinal hemorrhage: report of a case.

A case of primary choriocarcinoma of the stomach presenting as gastrointestinal hemorrhage in a 58-year-old postmenopausal woman is presented. Arteriographic features included a large hypervascular gastric mass and multiple liver masses with vascular poolings, mimicking those of cavernous hemangioma. Postcontrast CT including delayed scan showed a large central nonenhanced area with marginal peripheral contrast enhancement. Close observation of the angiographic findings revealed peripheral vascular poolings and central avascularity, which are characteristic of uterine choriocarcinoma. Human chorionic gonadotrophin (HCG) titer was significantly elevated, and extragenital choriocarcinoma of the stomach was confirmed by autopsy.

Papillary cystic tumor of the pancreas: an immunohistochemical and ultrastructural study of 14 patients.

We report herein the clinicopathological, immunohistochemical and ultrastructural studies on 13 female patients and one male patient with papillary cystic tumors of the pancreas. Their ages ranged from 12 to 60 (mean 25) years. Most patients complained of abdominal mass or abdominal pain. Following complete resection of the tumor, all have remained well for between 3 months and 19 years (maen 5 years). In one patient the tumor was malignant and, 10 years after the initial partial resection, there was a recurrence with involvement of the colon, metastasis to the lymph nodes and venous invasion. Immunohistochemically, most tumor cells were positive for neuron specific enolase, synaptophysin, alpha-1-antitrypsin and vimentin and sometimes for the estrogen receptor related antigen, ER-D5, and the oncogen product of c-Ha-ras, c-Ha-ras P21. Ultrastructurally there were zymogen-like intracytoplasmic granules, intercellular junctions and intercellular spaces. These results support the hypothesis that the tumor originates from undifferentiated cells capable of differentiation toward acinar, endocrine or ductular cells. Estrogen and the c-Ha-ras oncogene presumably are linked to the development.