[Show abstract][Hide abstract] ABSTRACT: A 68-year-old man, with a history of hypertension, angina pectoris, chronic heart failure, surgery of axillo-femoral bypass for arteriosclerosis obliterans and left renal excision for stenosed renal artery, and chronic renal failure, was referred to our hospital due to right lower abdominal pain. CT showed portal venous gas and thickened walls in the transverse colon with lower mucosal enhancement. Nine hours after admission, he presented with high fever and watery diarrhea. Colonoscopy revealed 3 segments of necrosis in the right side of the colon, therefore extended right hemicolectomy followed by ileocolostomy was performed. Twelve months after a favorable recovery, he was readmitted due to left upper abdominal pain. CT showed portal venous gas and thickened bowel wall around the ileocolostomy. Colonoscopy showed necrosis of the ileum in the anastomosis, and bowel resection of the anastomosis was performed. Fortunately, he had a complete recovery. Because necrotic ischemic enteritis is a serious disorder with possible recurrence, recurrence prevention, such as maintaining a stable condition, appropriate and mild control of circulatory dynamics, and avoiding dehydration and elevation of bowel pressure, should be considered.
[Show abstract][Hide abstract] ABSTRACT: Mucins are implicated in survival in various cancers, but there have been no report addressed on survival in appendiceal carcinoma, an uncommon disease with different clinical and pathological features from those of other colon cancers. We aimed to investigate the clinical implications of expression of mucins in appendiceal carcinoma.
Expression profiles of MUC1, MUC2, MUC3, MUC4, MUC5AC, MUC6, MUC16 and MUC17 in cancer tissue were examined by immunohistochemistry in 108 cases of surgically resected appendiceal carcinoma.
The following relationships of mucins with clinicopathologic factors were identified: MUC1 with positive lymphatic invasion (p = 0.036); MUC2 with histological type (mucinous carcinoma, p<0.001), superficial invasion depth (p = 0.007), negative venous invasion (p = 0.003), and curative resection (p = 0.019); MUC3 with non-curative resection (p = 0.017); MUC5AC with histological type (mucinous carcinoma, p = 0.002), negative lymphatic invasion (p = 0.021), and negative venous invasion (p = 0.022); and MUC16 with positive lymph node metastasis (p = 0.035), positive venous invasion (p<0.05), and non-curative resection (p = 0.035). A poor prognosis was related to positive lymph node metastasis (p = 0.04), positive lymphatic invasion (p = 0.02), positive venous invasion (p<0.001), non-curative resection (p<0.001), and positive expression of MUC3 (p = 0.004). In multivariate analysis, positive venous invasion (HR: 6.93, 95% CI: 1.93-24.96, p = 0.003), non-curative resection (HR: 10.19, 95% CI: 3.05-34.07, p<0.001) and positive MUC3 expression (HR: 3.37, 95% CI: 1.13-10.03, p = 0.03) were identified as significant independent prognostic factors in patients with appendiceal carcinoma.
Expression of MUC3 in appendiceal carcinoma is an independent factor for poor prognosis and a useful predictor of outcome in patients with appendiceal carcinoma after surgery.
[Show abstract][Hide abstract] ABSTRACT: We report here a rare case of undifferentiated carcinoma of the pancreas mimicking main-duct intraductal papillary mucinous neoplasm. In an 80-year-old woman, an approximately 8-mm papillary mass was incidentally detected at the downstream edge of a dilatated main pancreatic duct lumen on CT and MRI. Main pancreatic duct dilatation in the pancreatic body and tail and parenchymal atrophy were observed in the upstream of the mass. Histopathologically, the tumor protruded into the downstream edge of the dilatated main pancreatic duct lumen in the pancreatic body. The tumor cells had highly atypical nuclei and abundant polymorphic structures, and showed positive staining for granulocyte colony-stimulating factor, which led to the diagnosis of undifferentiated carcinoma. A total of 13 cases of undifferentiated carcinoma with intraductal tumor growth have been reported to date. The case report by Bergmann et al. has been the smallest in histopathological specimen, and the present case is the smallest in size detected by radiological images. Since early undifferentiated carcinoma of the pancreas can resemble those of main-duct intraductal papillary mucinous neoplasm in cross-sectional images, we have to consider undifferentiated carcinoma in the differential diagnosis of the solitary and papillary mass with low contrast enhancement in early phase in the main pancreatic duct.
[Show abstract][Hide abstract] ABSTRACT: Primaly solid pseudopapillary neoplasm (SPN) of the ovary is a rare tumor; recently 6 cases have been reported. Its pathogenesis, however, remains largely unclear. We report an additional case of primary ovarian SPN of an 18-year-old girl. The aim of this study is to define the difference between pancreatic and ovarian SPN by histological and molecular examination. Microscopically the tumor predominantly showed a solid pattern and focally a pseudopapillary pattern. The tumor cells showed two patterns of abundant eosinophilic cytoplasm and intracytoplasmic vacuoles. Immunohistochemistry of the tumor was positive for β-catenin (nuclear and cytoplasmic reactivity), α1-antitrypsin, vimentin, CD56, synaptophysin (focal weak), CD10. Mutation analyses revealed a point mutation, c.110C >T, in exon 3 of the the β-catenin gene (CTNNB1), which causes the replacement of serine with phenylalanine at codon 37. A Ser37 point mutation is known to be one of the oncogenic somatic mutations in pancreatic SPN and the major oncogenic β-catenin mutation. Ovarian SPN of our case was similar to pancreatic SPN histologicaly and had the same genomic characteristics. We expected that both ovarian and pancreatic SPNs shared the same oncogenesis related to Wnt/β-catenin pathway for tumorgenesis.
No preview · Article · Oct 2014 · Pathology International
[Show abstract][Hide abstract] ABSTRACT: A 56-year-old man came to our hospital with abdominal distension and pain. A swollen spleen was palpable in the left upper abdomen. Blood examination showed leukocytosis, thrombocytopenia and elevation of serum IL2 receptor, IgM and IgA. Peripheral blood smear revealed atypical lymphocytes with irregular villi on the cell surface corresponding to villous lymphocyte. CT showed a remarkably swollen spleen. FDG-PET CT showed diffuse high FDG uptake in the spleen. Bone marrow smear showed nodular proliferation of atypical lymphocytes with irregular villi on the marginal cytoplasm. Tartrate-resistant acid phosphatase staining of the bone marrow was negative. Flow cytometry of peripheral blood lymphocytes indicated positive findings for CD20 and CD11c, but negative for CD5 CD10, CD25, and CD103. From these findings, we diagnosed this case as splenic marginal zone lymphoma. Because the patient had abdominal pain and thrombocytopenia, splenectomy was performed. Histopathological finding of the resected spleen showed diffuse proliferation of small to moderate size atypical lymphocytes invading the red pulp by replacing marginal zones. SMZL is one of the low grade non-Hodgkin lymphomas; however, there have been only 9 reported cases in Japan, including the present case, which was the first case with accurate preoperative diagnosis.
No preview · Article · Jan 2014 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: An 86-year-old woman who had developed a swelling in the left groin since her pregnancy about 50 years ago, came to our hospital because of left inguinal pain. She did not have symptoms suggesting ileus, however, computed tomography showed a well-circumscribed low density mass located caudal to the left inguinal ligament. The mass had continuity with the intra-abdominal small intestine, therefore incarcerated femoral hernia was diagnosed, and we performed an emergency operation. When opening the hernia sac, a diverticulum of the small intestine was found. The diverticulum was located on the opposite side of the mesentery and had its own mesentery. It was ischemic, so segmental resection of the small intestine and McVay inguinal hernia repair were performed. Histologically, the diverticulum was located in the ileum, and had all layers of the intestine indicating a true diverticulum. We diagnosed this case as femoral hernia with strangulated Meckel’s diverticulum. It should be noted that Meckel’s diverticulum in femoral hernia usually does not lead to ileus symptoms, however the symptom duration may be long resulting in no surgery within 24 hours after symptom onset, and might also be associated with necrosis or perforation.
No preview · Article · Jan 2014 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: Inflammatory myofibroblastic tumor is a rare tumor deriving from mesenchymal tissue. Approximately 50% of inflammatory myofibroblastic tumors harbor an anaplastic lymphoma kinase fusion gene. Pulmonary inflammatory myofibroblastic tumors harboring tropomyosin3-anaplastic lymphoma kinase or protein tyrosine phosphatase receptor-type F polypeptide-interacting protein-binding protein 1-anaplastic lymphoma kinase have been reported previously. However, it has not been reported that inflammatory myofibroblastic tumors harbor echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene which is considered to be very specific to lung cancers. A few tumors harboring echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene other than lung cancers have been reported and the tumors were all carcinomas. A 67-year-old man had been followed up for a benign tumor for approximately 3 years before the tumor demonstrated malignant transformation. Lobectomy and autopsy revealed that an inflammatory myofibroblastic tumor harboring echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene had transformed into an undifferentiated sarcoma. This case suggests that echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion is an oncogenic event in not only carcinomas but also sarcomas originating from stromal cells.
Preview · Article · Nov 2013 · Japanese Journal of Clinical Oncology
[Show abstract][Hide abstract] ABSTRACT: The best treatment for recurrent granulosa cell tumor(GCT)is considered to be surgical resection, because the effects of chemotherapy or radiation on GCT are obscure. The common site of recurrence is the pelvic cavity, including the surface of the liver and intestine as tumor-dissemination-patterns. Between June 1988 and June 2011, we treated 15 patients with GCT at our hospital. The median follow-up time was 56(22-286)months. Ten patients were stage I, 3 were stage II, and 2 were stage III. No patients had residual lesions at the primary surgery area. Six patients have recurred, and the median disease free survival(DFS)was 85(15-128)months. Six patients had relapses in the pelvic cavity, 2 in the retroperitneal lymph nodes, and 1 in the upper abdomen. Two patients relapsed more than twice; however, the rapid detection of recurrence and surgical resection have kept all patients alive. Thirteen patients have no evidence of disease(NED), 2 are alive with disease(AWD), and no one has died of the disease(DOD). We suggest that maximal debulking surgery to achieve complete cytoreduction of recurrent GCT is the most important treatment for prolonging survival.
No preview · Article · Feb 2013 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: A 40-year-old woman visited our hospital for examination of a pancreas body mass. Abdominal ultrasonography showed a low echoic mass with relative clear margin and some tiny high echo spots. Contrast enhanced CT showed a mass 10 mm in diameter with minute calcifications and slight contrast enhancement in the pancreas body. The distal pancreas had-80 Hounsfield units of CT-value and some linear structures, suggesting fat replacement. Endoscopic ultrasonography showed a well demarcated low echoic mass 15 mm in diameter with a small high echoic spot in the pancreatic body. Under the preoperative diagnosis of low grade malignancy, laparoscopic central pancreatectomy was performed; however, gastrointestinal reconstruction for the pancreas tail was not performed. Histological examination of the pancreas body mass revealed localized fibrosis, infiltration of lymphocytes and calcification, indicating localized pancreatitis. Islet of Langerhans were found in the adipose tissue of the pancreas tail. Postoperative pancreatic exocrine and endocrine deterioration were not observed. The stenosis of the main pancreatic duct was thought to be the main cause of fat replacement, because circulatory disturbance was not found in the distal pancreas.
No preview · Article · Jan 2013 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: Plasmablastic lymphoma (PBL) is a rare B-cell neoplasm with an aggressive clinical behavior that predominantly occurs in the oral cavity of human immunodeficiency virus (HIV)-positive patients. However, it has recently been recognized that PBLs can also affect individuals without HIV infection, and suggested that these neoplasms show different clinicopathological characteristics between HIV-positive and -negative patients. Herein we describe a case of gastric PBL in a female HIV-negative patient. The tumor was composed of a diffuse and cohesive proliferation of large neoplastic cells, which resembled immunoblasts or plasmablasts with a starry sky appearance. Immunophenotypically, the neoplastic cells were diffusely positive for CD138, MUM1, IgM, and BOB-1, and negative for CK, LCA, CD3, CD20, CD79a, Pax5, kappa, lambda, CD30, ALK, S-100, HMB-45, MPO, and HHV-8. The MIB-1 index was nearly 100%. Epstein-Barr virus-encoded RNA in situ hybridization was negative. A monoclonal immunoglobulin heavy chain gene rearrangement was detected in polymerase chain reaction (PCR) and heteroduplex analyses. A combination of PCR-based analysis of immunoglobulin gene rearrangement and immunohistochemistry can be useful to substantiate the diagnosis by utilizing routine paraffin-embedded tissue sections, because PBL in the setting of extra-oral localization and immunocompetence is a diagnostic challenge, given its rarity, morphology, and absence of CD20 expression.
No preview · Article · Nov 2012 · Pathology International
[Show abstract][Hide abstract] ABSTRACT: An 84-year-old man, who had taken aspirin for cerebral infarction, visited our hospital with abdominal pain. His abdomen was hard and board-like. Computed tomography showed a low dense inhomogeneous mass, ascites, and free air in the pelvic cavity. Emergency laparotomy revealed a subserous hematoma, elastic soft mass, and pus in the sigmoid colon, indicating a perforation of the intestine. Partial resection of the sigmoid colon was performed. Macroscopic findings of the resected specimen showed a submu-cosal tumor 3 cm in diameter with small central erosion. Histological examination disclosed a mucosal defect, a hematoma within the inner muscular layer, and disruption of the wall structure. The perforation was considered to have taken place due to the disruption of the intestinal wall by mechanical compression from the hematoma caused by coagulopathy with aspirin. There have been 15 reports of idiopathic intramural hematoma of the colorectum in Japanese literature, however, this case is the first associated with perforation. Generally, idiopathic hematoma of the intestine is treated conservatively; however, further examination may be required to detect possible perforation.
No preview · Article · Jan 2012 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: A 33-year-old woman was given a diagnosis of Peutz-Jeghers syndrome at the age of 2 years, and had undergone laparotomy 4 times due to abdominal pain and/or intussusception. She had abdominal distention and visited the department of gynecology of our hospital. Computed tomography showed massive ascites and a right ovarian tumor, and cytology of the ascites indicated adenocarcinoma. Ovarian cancer with peritoneal dissemination was diagnosed. Gynecologists performed a right salpingo-oophorectomy, however, an intestinal tumor 100 cm distal to the Treitz ligament was found. Partial resection of the small intestine was performed by gastrointestinal surgeons. The intestinal tumor was a papillary semipedunculated mass 6 cm in diameter and exposed to the serous membrane. Pathological examination revealed moderately differentiated adenocarcinoma concomitant with adenoma and hamartoma components. The ovarian tumor was histologically diagnosed to be metastasis from the carcinoma of the small intestine. Twelve cases of Peutz-Jeghers syndrome associated with small intestinal carcinoma have been reported in Japanese literature, and most of their carcinomata are thought to have originated from polyps of the small intestine. Patients with Peutz-Jeghers syndrome should be closely followed up, taking care of malignancy of the gastrointestinal tract and other organs.
No preview · Article · Jan 2012 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: A 73-year-old man was admitted to our hospital for epigastric pain and jaundice. He had undergone en-doscopic mucosal resection for an adenoma of the papilla of Vater at 66 years old. He had suffered from malignant lymphoma at 68 years old, but had complete remission after chemotherapy. On admission, en-doscopic retrograde cholangiography revealed common bile duct stones and stricture of the middle bile duct. Endoscopic lithotripsy, nasobiliary drainage and biopsy were performed. Because histopathological examination of the biopsy specimen revealed adenocarcinoma, pancreaticoduodenectomy was performed. Macroscopically, the bile duct tumor showed papillary invasive type with granular superficial spreading. Histopathological examination of the resected specimen disclosed squamous cell carcinoma invading the subserosal layer in the papillary invasive lesion and adenosquamous cell carcinoma invading the mucosa and fibromuscular layer in the superficial spreading lesion of the upper and lower bile duct. The adenosquamous cell carcinoma showed bipolar differentiation to adenocarcinoma and squamous cell carcinoma. In addition, a small flat invasive type carcinoma of the gallbladder was found. To the best of our knowledge, there has been no report of adenosquamous cell carcinoma of the extra-hepatic bile duct showing bipolar differentiation in the mucosal layer in the 42 Japanese reported cases. So our case is very rare and valuable for investigating the histogenesis of adenosquamous cell carcinoma of the extrahepatic bile duct.
No preview · Article · Jan 2011 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: The chromosomal 1p/19q state was analyzed in 16 low-grade meningiomas and 7 atypical meningiomas using fluorescent in situ hybridization (FISH) analysis. Chromosome 1p aberrations were observed in all atypical meningiomas, but in only one low-grade meningioma. Atypical meningiomas showed 19q deletion or imbalance, suggesting chromosomal instability of 19q. A small group of low-grade meningioma showed 19q aberrations. FISH 1p/19q deletion/imbalance analysis is a sensitive method for detecting chromosome aberrations of meningiomas and provides useful information for grading of meningiomas. Patients with low-grade meningioma with chromosomal instability of 1p/19q should be followed up carefully. Assessment of the chromosomal state by FISH might be of crucial importance in the clinical management of meningiomas.
No preview · Article · Jan 2010 · Neurologia medico-chirurgica
[Show abstract][Hide abstract] ABSTRACT: A 16-year-old man with lower abdominal pain and fever, lower abdominal tenderness, and muscular guarding was found in blood tests to have an elevated inflammatory response and in abdominal computed tomography (CT) to have a mass-like dilated intestine containing air, fluid, calcification, and ascites at rectovesical pouch, necessitating emergency surgery in November 2006. Laparotomy showed turbid ascites and the Meckel's diverticulum located 90cm oral from the terminal ileum. The diverticulum was 4.5cm in size and had neck stenosis together with perforation necessitating diverticulectomy. The diverticulum contained two enteroliths composed of bile acid. Pathological examination showed that ectopic gastric mucosa were present in the diverticulum and the perforation was located in ileal mucosa near gastric mucosa. We judged the perforation to be due to acid secretion from ectopic gastric mucosa, stagnation and retention of intestinal content in the diverticulum by the neck stenosis, and direct mechanical stimulation by enteroliths.
No preview · Article · May 2009 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: Intestinal transplant-associated microangiopathy (i-TAM) is an important complication after allogeneic hematopoietic SCT. From 1997 to 2006, 87 of 886 patients with diarrhea after transplantation received colonoscopic biopsy. i-TAM, GVHD and CMV colitis were diagnosed histopathologically. The median duration from transplantation to the onset of diarrhea was 32 days (range: 9-130 days) and that from the onset of diarrhea to biopsy was 12 days (range: 0-74 days). The median maximal amount of diarrhea was 2 l/day (range: 130-5600 ml/day). Histopathological diagnosis included i-TAM (n=80), GVHD (n=26), CMV colitis (n=17) and nonspecific findings (n=2) with overlapping. Among 80 patients with i-TAM, abdominal pain was a major symptom, and only 11 patients fulfilled the proposed criteria for systemic TAM. Non-relapse mortality (NRM) among patients without resolution of diarrhea was 72% and i-TAM comprised 57% of NRM. NRM was 25% among patients without intensified immunosuppression, but was 52, 79 and 100% among those with intensified immunosuppression before diarrhea, after diarrhea, and before and after diarrhea, respectively. In conclusion, i-TAM is a major complication presenting massive refractory diarrhea and abdominal pain, which causes NRM. Avoiding intensified immunosuppression that damages vascular endothelium until the resolution of i-TAM may improve transplant outcome.
Full-text · Article · Feb 2009 · Bone marrow transplantation
[Show abstract][Hide abstract] ABSTRACT: We investigated the results of cervical cytology, pathology of colposcopic biopsy and surgical specimen among 765 women suspected to have cervical intraepithelial neoplasia (CIN). Significantly more patients with cervical cytology class III b than class III a were diagnosed in CIN grade 3 on colposcopic biopsy. The concordance rate of colposcopic biopsy and surgical specimen was 79.8%, but we preoperatively diagnosed CIN grade 3 or more at 96.1% with colposcopic biopsy. In time course observation, CIN regressed in 26.3% of all patients, progressed in 19.3% and did not change in 54.4%. Many patients of CIN grade 2 progressed to grade 3 in two years. Significantly more patients of CIN grade 1 or 2 with cervical cytology class III b progressed than with class III a (p<0.05).
No preview · Article · Oct 2008 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: Thrombotic microangiopathy (TMA) is one of the severe complications after stem cell transplantation (SCT) and is associated with graft-versus-host disease (GVHD) prophylaxis including FK506. In this study, we experimented on rats using FK506 to demonstrate the occurrence of intestinal TMA. FK506 was administrated into Wistar/ST rats intraperitoneally for 7 days. Rats were examined histopathologically after FK506 injection using light and electron microscopy and immunohistochemistry. FK506 concentrations in whole blood were measured by enzyme immunoassay. In the acute phase, hemorrhagic lesions with multifocal erosions and crypt loss were found in the small intestines of all treated rats. Capillary vessels were dilated, and a few platelet thrombi were found. Electron microscopy demonstrated degenerative swelling of endothelial cells and platelet aggregates adhering to the vessel walls. In the later phase, epithelial regenerative failure, characterized by crypt ghosts, was found in the affected mucosa. Apoptotic epithelial cells were increased in number. The extent of intestinal injury was proportional to the whole blood levels of FK506. The intestinal lesions in rats were consistent with TMA and induced by the injection of FK506 alone. Apoptotic enteropathy was also observed and similar to intestinal GVHD. In this study, we established an intestinal TMA model induced by immunosuppressant (Tacrolimus) only without irradiation.
Full-text · Article · Apr 2007 · Bone Marrow Transplantation