An 86-year-old woman was transferred to our department for investigation of an abnormal enlarging pulmonary shadow with vascular convergence. She had no respiratory symptoms or laboratory data suggesting inflammatory disease. A pulmonary wedge resection was performed under video-assisted thoracic surgery. Pathology examination revealed that the tumor was organizing pneumonia and was composed of fibroblast-like spindle cells, macrophages, lymphoplasma cells, and collagen fibers. Immunohistochemical study revealed that the lesion was in the proliferative state with the relatively more Ki-67-positive fibroblast-like spindle cells. When a surgical resection is necessary for an enlarging abnormal pulmonary mass without any systemic inflammatory reaction or respiratory symptoms, a less invasive approach should be selected.

Hepatocellular blood plasma inclusions were demonstrated in conventional formalin-fixed paraffin-embedded liver tissue by the immunoperoxidase technique in 114 out of 197 liver specimens. They were usually round or elliptical in shape, their size varying from a few microns to about 30 microns in diameter. Albumin, fibrinogen, alpha 1-antitrypsin, IgG, IgM, IgA, ceruloplasmin and transferrin were demonstrated in the inclusions, in that order of frequency. A majority were negative with the periodic acid Schiff stain after amylase digestion, but a few were positive. Many of them seemed to correspond to vacuoles in the hepatocytes but some were not seen in HE-stained sections. The inclusions were frequently seen in autopsy liver specimens, but were rare in surgical ones. Most of the inclusions might develop at an agonal stage, probably as a result of hypoxia or circulatory disturbances in the livers.

An expression of ras p21 proteins on cholangiocarcinoma (CC) (intrahepatic bile duct carcinoma) cells was examined by an immunoperoxidase method using an appropriate dilution of mouse monoclonal antibody RAP-5, with which no positive staining was obtained in livers with normal histology. Of 44 CCs examined 39 were positive for the antigens; well-differentiated adenocarcinoma usually showed a diffuse weak, cytoplasmic staining in nearly all tumor cells with the same staining intensity, while in moderately and poorly differentiated adenocarcinoma the expression of p21 varied markedly in intensity from cell to cell in the same cell nest. The number of positive cells decreased with the grade of tumor, and no or little staining was observed in undifferentiated areas. These findings indicate that the expression of ras p21 antigens was lost with increasing dedifferentiation of tumor cells. Carcinoembryonic antigens (CEA) were positive in 42 of 44 CCS. Well-differentiated adenocarcinoma expressed CEA along the apical surfaces of the tumor glands. With the dedifferentiation of tumor cells, the expression of CEA became prominent not only at the apical surfaces but also on the basolateral surfaces and in the cytoplasms, and further in the surrounding stromal tissue. There was no clear-cut correlation between the expression of p21 antigens and the production of CEA in CCs.

Although solitary fibrous tumors (SFTs) of the pleura are not uncommon, intrapulmonary SFTs are extremely rare. A 72-year-old woman was admitted to our hospital for an investigation of an enlarging intrapulmonary tumor. Because a definitive diagnosis could not be readily established, a pulmonary wedge resection under video-assisted thoracic surgery was performed. Grossly, the tumor was white, well circumscribed, and separate from the pleural surface. Histologically, it consisted of spindle cells proliferating in a vague fascicular pattern, with many dilated capillaries, and intermingled glandular components. These findings suggested a differential diagnosis that included SFT and nonchondromatous pulmonary hamartoma. On immunohistochemical analysis, the spindle cells showed a strong positive reaction to the CD34 antigen. Interphase fluorescent in situ hybridization revealed an absence of HMGA-1 and -2 translocations. These results supported a diagnosis of SFT. A genetic approach may therefore be useful in the differentiation of SFT from nonchondromatous hamartoma.

A 47-year-old man underwent a low anterior resection of the rectosigmoid colon with en bloc cystoprostatectomy for vesicorectal fistula due to a locally advanced rectal cancer. Histopathological examination of the bladder revealed two additional primary malignancies: urothelial carcinoma and squamous cell carcinoma. To our knowledge, this is the first reported case of two histologically distinct urothelial malignancies that were diagnosed during a work up of vesicorectal fistula due to adenocarcinoma of the rectum.

This report is of an 82-year-old woman with a mass on the mandibular gingiva, elevated serum carcinoembryonic antigen, and a history of metachronous primary tumours of the endometrium and stomach. The histological diagnosis was tubulopapillary adenocarcinoma and the pathological features were similar to those of the gastric tumour Consequently, the gingival mass was diagnosed as a metastatic gastric adenocarcinoma.

to be avoided. Berthed and Rey (1) have also reported enormous crossreactivityof hydrocortisonehemisuccinate in the “Rianen” RIA kit for cortisol determination. An issue of Clinical Chemistry (1983;29:890-953) reports the commercial availability of(then)more than 27 cortisol RIA kits.Methodologically, these kits were divided into three groups according to the different antibodies used: antibodies against cortisol21-HS-BSA,antibodies against prednisolone-3-CMO-BSA, and antibodies against cortisol-6-hemisuccinate-BSA (2,3). The specificity for cortisol depends on the specificity of the antibodies used. Briefly, in the casedescribed above, kits in which antibodies against prednisolone-3-CMO-BSA and cortisol6-HS--BSA are used showed a significant cross-reactivity for methylpredrnsolone and prednisolone (3). However, kits in which antibodies against cortisol-21-HS--BSA are used show a signif. icant cross-reactivity for deoxycortisol, 21-deoxycortisol, 17a-hydroxyprogesterone, and corticosterone (4). This consideration should always be borne in mind, because misleading results may ensue.

NAD(P)H-oxidase activity was demonstrated in glutaraldehyde-fixed rat hepatocytes by a cerium technique. The activity was observed exclusively on the bile-canalicular plasma membrane of hepatocyte. No reaction product was formed in the absence of NAD(P)H as the substrate. The reaction was inhibited by pCMB (surface sulfhydryl group specific reagent), by heating, by anaerobic incubation and by catalase (H2O2 scavenger), but it was not inhibited by KCN or NaN3. The present results show that bile-canalicular plasma membrane produces H2O2 and the cerium technique for demonstration of H2O2 is therefore an useful method for the subcellular localization of NAD(P)H-oxidase activity in the glutaraldehyde-fixed hepatocyte.

Pancreatitis-associated protein (PAP) is almost absent in normal pancreas, but is strongly induced in acute pancreatitis. PAP mRNA is also expressed in cancer cells, including pancreatic ductal adenocarcinoma. However, the clinicopathological significance of PAP in human pancreatic cancer is not clear. We examined PAP expression in pancreatic tissues from individuals with pancreatic ductal adenocarcinoma using immunohistochemistry. PAP was overexpressed in 79% (30 of 38) of pancreatic ductal adenocarcinoma, 19% (7 of 36) of chronic pancreatitis, and 29% (2 of 7) of mucinous cystadenoma. PAP was found in malignant ductular structures in pancreatic carcinomas as well as in benign proliferating ductules and acinar cells in chronic pancreatitis. It was not expressed in normal pancreas. The incidence of PAP overexpression was significantly higher in pancreatic cancer than in the other pancreatic diseases ( P < 0.01). PAP overexpression was significantly correlated with nodal involvement, distant metastasis ( P < 0.05), and short survival ( P < 0.01) in pancreatic cancer. These results suggest that overexpression of PAP in human pancreatic ductal adenocarcinoma indicates tumor aggressiveness.

Malignant phyllodes tumor is an unusual breast neoplasm. A 22-year-old woman was admitted to the hospital because of a small lump (3×3cm) in the area AC of the left breast. As the lump was extirpated and found to be malignant phyllodes tumor, a wide resection was performed. The most important therapy for malignant phyllodes tumors of the breast is surgical resection, and mastectomy with lymph node dissection has been principally employed in former times. The tumor, however, hematogenously metastasizes and recurs locally with unsatisfactory resection, and lymph node metastasis rarely occurs. Recently breast conservative surgical method tends to be indicated. In this case, the tumor was relatively small as the phyllodes tumor and the patient was unmarried young woman, and we chose a conservative surgical method. After the operation, a total cross section confirmed that surgical margin was free. Because no effective chemotherapy for malignant phyllodes tumor has been established as yet, adjuvant chemotherapy was not employed. The patient is now doing well with no evidence of recurrence, as of 20 months after the surgery. However, careful follow-up study of local recurrence and distant metastasis would be mandatory.

We describe two advanced gastric cancers, a small-cell carcinoma and a moderately differentiated adenocarcinoma, which coexisted at separate sites in the stomach. A total gastrectomy with dissection of regional lymph nodes was performed. The small-cell carcinoma metastasized into regional lymph nodes, whereas the adenocarcinoma did not metastasize. The small-cell carcinoma was aneuploid, whereas the adenocarcinoma was diploid. Despite intensive chemotherapy, mediastinal lymph node metastasis progressed, and the patient died 21 months after the operation.

A 66-year-old woman wals seen at the hospital because of an abdominal pain and vomiting. There were previous histories of undergoing ileocecal resection 30 years and total hysterectomy with irradiation for uterine cancer 29 years earlier. Abdominal CT showed a shadow of foreign body, and balium enema revealed a filling defect in the ileum and stenosis at the anastomosis. In addition to these findings the patient deposed that she had ingested a seed of “ume” (Japanese apricot). The patient was diagnosed as intestinal obstraction due to the foreign body and underwent an operation. The postoperative course is good, however, this patient has many other disorders probable resulting from irradiation, such as stenosis of ureter, cutaneous pigmentation and tumor, adenoma of the rectum. Long term and periodic follow-up is important for the patient entertaining possible occurrence of other disorders and second cancer.

Two new cases of thymic carcinoma involving the thyroid gland and manifesting as thyroid tumors are presented. One tumor occurred within the thyroid gland and the other totally involved the thyroid gland. Microscopically they showed lobular architecture separated by fibrous bands and consisted of solid islands of squamoid to spindled epithelial cells with whorl formation resembling Hassall's corpuscle and variable amounts of lymphocytes. The squamoid to spindled epithelial cells were positive for cytokeratin but negative for thyroglobulin and calcitonin and the majority of lymphocytes showed a T-cell phenotype. One of the two cases had been diagnosed initially as squamous cell carcinoma of the thyroid. This type of thyroid carcinoma is relatively rare, but it should be differentiated from other types of thyroid carcinomas, especially squamous cell carcinoma, medullary carcinoma, or anaplastic carcinoma of the thyroid.

A 55-year-old man with Behcet's disease presented acute urinary retention due to Cryptococcus neoformans infection of the prostate. The disease was localized to the prostate. The infection was successfully treated only with fluconazole. The patient remains well without evidence of systemic or local infection at 32 months.

One complication of choledochal cyst in adulthood is the development of secondary carcinoma, usually well-differentiated adenocarcinoma. We report a case of extrahepatic bile duct carcinoma associated with choledochal cyst and presenting predominantly sarcomatous features. The patient was a 52-year-old female who presented with abdominal fullness and pain. Ultrasound (US), computed tomography (CT), and cholangiography revealed a choledochal cyst with a tumor. The resected choledochal cyst was 10 x 7.5 cm and contained a protruding, ulcerated tumor, measuring about 4.0 x 2.5 cm. Histologically, the tumor was composed of spindle-shaped or fusiform cells with occasional pleomorphic or bizarre giant cells and abundant fibrous stroma, similar to malignant mesenchymal tumors. However, further histologic and immunohistochemical examination revealed that the tumor was adenocarcinoma with prominent sarcomatous features. To our knowledge, sarcomatous change in extrahepatic bile duct carcinoma associated with choledochal cyst has not been previously described.

Esophageal carcinoma simulated Paget's disease in a 60-year-old Japanese man with 3 months of difficulty swallowing and pain. Results of an esophageal biopsy indicated undifferentiated carcinoma, but after esophagectomy and partial gastrectomy, the resected esophagus showed that the mucosa was diffusely indurated with irregular, reticulated erosions. There was no tumor mass or ulcer. Histologic examination showed an extensive intraepithelial growth of cancer cells without any glandular or squamous cell differentiation. Tumor cells were large and round and contained large nucleoli and ample, clear, or pale-staining cytoplasm, similar to the cells of Paget's disease. Tumor cells multifocally invaded into the mucosal and submucosal ducts where they formed papillary and tubular nests, indicating adenocarcinomatous differentiation, but there was no invasive growth beyond the basement membrane. Tumor cells in the epithelial layer were negative for periodic acid Schiff (PAS) and alcian blue, but partly positive for epithelial membrane antigen (EMA) and CEA, whereas those in the submucosal ducts and glands were strongly positive for PAS, alcian blue, carcinoembryonic antigen, and EMA, especially at their luminal surfaces. Tumor cells were negative for S-100, neuron-specific enolase, and melanin. These findings indicate that the tumor in the present case was a primary esophageal carcinoma with partial adenocarcinomatous differentiation, showing an extensive intraepithelial Pagetoid growth of its undifferentiated component. This is the first case of esophageal Paget's disease presenting as intraepithelial growth alone.

LiverVolume 13, Issue 1 p. 51-53 Smallest angiomyolipoma of the liver in the oldest patient Akitaka Nonomura M.D., Corresponding Author Akitaka Nonomura M.D.Pathology Section Kanazawa University Hospital School of Medicine Kanazawa University Takara-machi 13–1 Kanazawa 920 JapanSearch for more papers by this authorYuji Mizukami, Yuji MizukamiSearch for more papers by this authorMasatsugu Isobe, Masatsugu IsobeSearch for more papers by this authorMadoka Kurachi, Madoka KurachiSearch for more papers by this authorFujitsugu Matsubara, Fujitsugu MatsubaraSearch for more papers by this author Akitaka Nonomura M.D., Corresponding Author Akitaka Nonomura M.D.Pathology Section Kanazawa University Hospital School of Medicine Kanazawa University Takara-machi 13–1 Kanazawa 920 JapanSearch for more papers by this authorYuji Mizukami, Yuji MizukamiSearch for more papers by this authorMasatsugu Isobe, Masatsugu IsobeSearch for more papers by this authorMadoka Kurachi, Madoka KurachiSearch for more papers by this authorFujitsugu Matsubara, Fujitsugu MatsubaraSearch for more papers by this author First published: February 1993 https://doi.org/10.1111/j.1600-0676.1993.tb00605.xCitations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume13, Issue1February 1993Pages 51-53 RelatedInformation

Thirty-three thyroid specimens obtained from 28 patients with clinically and laboratory-proven iodine-induced hypothyroidism were examined clinically, histologically, immunohistochemically, and ultrastructurally. Twenty-eight specimens obtained during the hypothyroid phase showed common histological changes in the thyroid thought to be specific for this disease; hyperplastic change in the follicles with some papillary folding, cuboidal to columnar change of follicular cells with clear and vesicular cytoplasm, scanty or absent colloid material in the large distended follicles, and occasional dilatation of capillary vessels. Lymphocytic infiltration was present in about half of the specimens. No specimens showed either stromal fibrosis or parenchymal atrophy. Immunohistochemical and electron microscopic examination revealed that severe interference with thyroid hormone biosynthesis occurs in the follicular cells. In two patients who had a follow-up biopsy in the recovery (euthyroid) phase after iodine restriction, the histological involvement seen in the hypothyroid phase was no longer present. The histological changes in the thyroid gland seen in patients with iodine-induced hypothyroidism are characteristic. This disease can be diagnosed from laboratory tests, but thyroid biopsy is also a useful tool to differentiate this condition from other diseases causing hypothyroidism. Not only clinicians, but also pathologists, must pay attention to this type of hypothyroidism, because thyroid function may revert to normal by iodine restriction alone.

Esophageal carcinoma simulated Paget's disease in a 60-year-old Japanese man with 3 months of difficulty swallowing and pain. Results of an esophageal biopsy indicated undifferentiated carcinoma, but after esophagectomy and partial gastrectomy, the resected esophagus showed that the mucosa was diffusely indurated with irregular, reticulated erosions. There was ro tumor mass or ulcer. Histologic examination showed an extensive intraepithelial growth of cancer cells without any glandular or squamous cell differentiation. Tumor cells were large and round and contained large nucleoli and ample, clear, or pale-staining cytoplasm, similar to the cells of Paget's disease. Tumor cells multifocally invaded into the mucosal and submucosal ducts where they formed papillary and tubular nests, indicating adenocarcinomatous differentiation, but there was no invasive growth beyond the basement membrane. Tumor cells in the epithelial layer were negative for periodic acid Schiff (PAS) and alcian blue, but partly positive for epithelial membrane antigen (EMA) and CEA, whereas those in the submucosal ducts and glands were strongly positive for PAS, alcian blue, carcinoembryonic antigen, and EMA, especially at their luminal surfaces. Tumor cells were negative for S-100, neuron-specific enolase, and melanin. These findings indicate that the tumor in the present case was a primary esophageal carcinoma with partial adenocarcinomatous differentiation, showing an extensive intraepithelial Pagetoid growth of its undifferentiated component. This is the first case of esophageal Paget's disease presenting as intraepithelial growth alone.