Pathology InternationalEarly View LETTER TO THE EDITOR Recurrence of gastric adenocarcinoma of fundic-gland mucosa type with black spots after endoscopic submucosal dissection and oral proton pump inhibitor discontinuation Akihiro Shioya, Akihiro Shioya orcid.org/0000-0002-1863-5368 Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Kahoku, Ishikawa, Japan Department of Diagnostic Pathology, Tonami General Hospital, Tonami City, Toyama, JapanSearch for more papers by this authorShintaro Terahata, Shintaro Terahata Department of Diagnostic Pathology, Tonami General Hospital, Tonami City, Toyama, JapanSearch for more papers by this authorTakahiko Nakajima, Takahiko Nakajima Department of Diagnostic Pathology, Tonami General Hospital, Tonami City, Toyama, JapanSearch for more papers by this authorToshiko Kakiuchi, Toshiko Kakiuchi Department of Diagnostic Pathology, Tonami General Hospital, Tonami City, Toyama, JapanSearch for more papers by this authorMotona Kumagai, Motona Kumagai Department of Pathophysiological and Experimental Pathology, Kanazawa Medical University, Kahoku, Ishikawa, JapanSearch for more papers by this authorJia Han, Jia Han Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Kahoku, Ishikawa, JapanSearch for more papers by this authorSohsuke Yamada, Sohsuke Yamada orcid.org/0000-0003-2662-0024 Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Kahoku, Ishikawa, JapanSearch for more papers by this author Akihiro Shioya, Akihiro Shioya orcid.org/0000-0002-1863-5368 Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Kahoku, Ishikawa, Japan Department of Diagnostic Pathology, Tonami General Hospital, Tonami City, Toyama, JapanSearch for more papers by this authorShintaro Terahata, Shintaro Terahata Department of Diagnostic Pathology, Tonami General Hospital, Tonami City, Toyama, JapanSearch for more papers by this authorTakahiko Nakajima, Takahiko Nakajima Department of Diagnostic Pathology, Tonami General Hospital, Tonami City, Toyama, JapanSearch for more papers by this authorToshiko Kakiuchi, Toshiko Kakiuchi Department of Diagnostic Pathology, Tonami General Hospital, Tonami City, Toyama, JapanSearch for more papers by this authorMotona Kumagai, Motona Kumagai Department of Pathophysiological and Experimental Pathology, Kanazawa Medical University, Kahoku, Ishikawa, JapanSearch for more papers by this authorJia Han, Jia Han Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Kahoku, Ishikawa, JapanSearch for more papers by this authorSohsuke Yamada, Sohsuke Yamada orcid.org/0000-0003-2662-0024 Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Kahoku, Ishikawa, JapanSearch for more papers by this author First published: 20 June 2022 https://doi.org/10.1111/pin.13254 This paper is based on a presentation at the 83rd Annual Meeting of the Japanese Society of Pathology, Chubu Division, in 2019. Its presenter, Akihiro Shioya, the first author of this paper, was given a Slide Conference Young Researchers' Award, Chubu Division of the Japanese Society of Pathology, for this presentation. Read the full textAboutPDF 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 No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

症例は42歳男性．2015年，アルコール性肝硬変と診断された際に腹部造影CTで肝S8に8 mm大の結節性病変を指摘されていた．2018年2月，肝S8の結節性病変が14 mmと増大を認め，CTやMRIなどの造影検査で早期濃染を認め肝細胞癌が疑われた．肝S8，内側区域一部切除および胆囊摘出術が施行された．病理組織学的な最終診断は一部に浸潤癌を伴った胆管内乳頭状腫瘍（IPNB）であった．局在が肝末梢であった点や慢性肝疾患を背景としている点および画像所見がIPNBとしては非典型的であり術前診断が困難であった．

Primary extradural spinal melanoma is a very rare lesion. Here, we report a thoracic extradural malignant melanoma in a 77-year-old male. MRI showed a dorsal spinal extradural tumour at the T6-T8 level. The tumour showed hyperintensity on T1W imaging and mixed hypointensity and hyperintensity on T2W imaging. Gadolinium-enhanced MRI showed high enhancement on the lesion. Information on imaging findings for extradural spinal melanoma appears very limited. We discuss the MRI findings from this case, which can be considered typical of extradural spinal melanoma and review the literature.

Nasal spindle cell rhabdomyosarcoma is very rare. The tumor is sometimes confused with other spindle cell tumors. We herein report a case of nasal spindle cell tumor in a 62-year-old woman. The patient first presented herself to a medical doctor's office after an episode of left epistaxis. An intranasal tumor was found and resected. The tumor was composed of spindle cells, and she was diagnosed with desmoid-type fibromatosis. Five years after the initial episode, an intranasal tumor was found again. The tumor showed a fascicular growth pattern with high cellularity and was predominantly composed of spindle cells. Scattered eosinophilic rhabdomyoblasts were also observed. She was diagnosed with spindle cell rhabdomyosarcoma. This is a unique case report not only because nasal spindle cell rhabdomyosarcoma is very rare but also because the tumor was initially diagnosed as desmoid-type fibromatosis. It is important to consider spindle cell rhabdomyosarcoma as a differential diagnosis of nasal spindle cell tumors.

若年発症の乳腺偽血管腫様過形成（pseudoangiomatous stromal hyperplasia:PASH）の1例を経験したので報告する．症例は12歳の女児で，左乳房腫大を主訴に当科を受診した．マンモグラフィでは左乳房全体を占める境界明瞭な腫瘤を認め，乳房超音波検査では内部不均一の低エコーの腫瘤を認めた．乳房造影MRIではT2強調で内部不均一な高信号，T1強調で等信号，内部一部造影不良な腫瘤であった．針生検では筋線維芽細胞で裏打ちされたスリット状の裂隙構造が認められPASHが示唆されたため，腫瘤摘出術を施行した．病理組織学的所見では葉状構造を示す間質増生部分と類臓器型線維腺腫様の像を示す部分が見られ，間質部分には腫瘍全体で広くPASHの像がみられたことから，葉状腫瘍様変化や線維腺腫様変化をきたしたPASHと診断した．免疫染色では，Vimentin（+），SMA（+），Desmin（-），CD34（+），CD31（-），D2-40（-），Factor VIII（-），PgR（-）であった．術後1年の時点で再発所見はなく，整容性も保たれている．

Pathology InternationalVolume 69, Issue 2 p. 119-121 Letter to the Editor Superficial spread of cervical squamous cell carcinoma to the upper genital tract and dissemination to the omentum Takahiko Nakajima, Takahiko Nakajima Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this authorHideki Hatta, Hideki Hatta Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this authorTakeshi Nishida, Takeshi Nishida Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this authorTakashi Minamisaka, Takashi Minamisaka Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this authorShigeharu Miwa, Shigeharu Miwa Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this authorShintaro Terahata, Shintaro Terahata Department of Clinical Pathology, Tonami General Hospital, 1-61 Shintomi-cho, Toyami, Toyama, 939-1395 JapanSearch for more papers by this authorJohji Imura, Johji Imura Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this author Takahiko Nakajima, Takahiko Nakajima Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this authorHideki Hatta, Hideki Hatta Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this authorTakeshi Nishida, Takeshi Nishida Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this authorTakashi Minamisaka, Takashi Minamisaka Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this authorShigeharu Miwa, Shigeharu Miwa Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this authorShintaro Terahata, Shintaro Terahata Department of Clinical Pathology, Tonami General Hospital, 1-61 Shintomi-cho, Toyami, Toyama, 939-1395 JapanSearch for more papers by this authorJohji Imura, Johji Imura Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 JapanSearch for more papers by this author First published: 29 January 2019 https://doi.org/10.1111/pin.12754Citations: 1Read the full textAboutPDF 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 onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume69, Issue2February 2019Pages 119-121 RelatedInformation

症例は83歳の女性で，心窩部痛の精査目的に当院へ紹介となった．腹部CTで肝左葉外側区先端に径5 cm大の辺縁不整な腫瘤を認め，辺縁はリング状に造影されていた．明らかなリンパ節腫大や腹水，遠隔転移は認めなかった．肝内胆管癌を疑い肝外側区域切除術を施行した．術中，胃体上部前壁に径1.5 cm大の粘膜下腫瘍が疑われ同部を含め部分切除した．病理組織学的検索で肝外側区の腫瘤は粘表皮癌で，胃の腫瘤はその転移と診断された．手術関連合併症は認めないものの，発熱，食欲不振が続いたためCTを施行したところ，多臓器転移を認めた．肝内胆管由来の粘表皮癌は極めてまれであり，多臓器転移により予後不良とされる．手術施行例においても長期生存例は少なく，早期に発見し治療を行うことが重要と考えられた．

骨髄異形成症候群の経過で胃癌が発見され，根治切除を行った1例を経験したので報告する．症例は87歳の女性で，3年前に骨髄異形成症候群（myelodysplastic syndrome；以下，MDSと略記）（RCUD/RA）と診断され当院血液内科に通院中であったが腹部CTを契機に胃角部に胃癌が発見され，臨床病期はcT4aN2M0 cStage IIIBであった．高齢であったが本人と家族は手術を希望され根治切除を行った．好中球減少に対する支持療法として周術期にG-CSFは1日のみ投与し，抗菌薬は執刀直前と執刀後3時間後，帰室4時間後にcefazolin sodium 1 g/回を投与した．切除標本の病理結果はpT3N2M0 pStage IIIAであった．術後経過は良好で術後16日目に自宅退院した．MDSを合併した消化器癌症例に対する手術治療の報告は少なく，貴重な症例と考え報告する．

Herein, we report a case of retropharyngeal hemorrhage. A 48-year-old woman was referred to our hospital with sore throat. At first, retropharyngeal abscess was suspected, and the patient was referred to our department. Treatment with antibiotics was ineffective. MRI was performed, which suggested retropharyngeal hemorrhage caused by a parathyroid. We drained the hematoma and performed parathyroidectomy. Histological examination of the resected specimen showed the hemorrhage from parathyroid cyst. Hemorrhage from a parathyroid cyst is rare and there have been no reports of cases diagnosed before surgery. In cases of sore throat, careful diagnosis and prompt treatment are needed. Parathyroid can be a origin of retropharyngeal hemorrhage. Moreover, cases of hemorrhage from a parathyroid cyst should be treated taking into consideration the functional status of the cyst.

Chondromyxoid fibroma is a rare cartilaginous tumor, accounting for only 1% of all bone tumors. In most cases, these tumors arise from the tubular bones, and cases of the tumor arising from the skull base are extremely rare.

A solid pseudopapillary neoplasm (SPN) is an uncommon pancreatic tumour that usually occurs in young women. Tumours outside the pancreas (e.g. in the ovary, retroperitoneum or omentum) are rare. We report a case of an SPN arising from the greater omentum in a 78-year-old male who presented with a month-long history of abdominal pain and a palpable abdominal mass. Laboratory data showed inflammation and anaemia. CT and magnetic resonance imaging revealed a well-defined encapsulated mass measuring 18 cm in the upper right abdomen. The tumour was completely removed via surgery, and pathologic examination confirmed a diagnosis of an SPN in the greater omentum.

A woman in her 70s was diagnosed with a protruding mucosa-associated lymphoid tissue (MALT) lymphoma during a secondary health examination. After eradication of Helicobacter pylori, a biopsy revealed gastric follicular lymphoma (FL) and the lesion was still protruding one year later. 18F-fluorodeoxyglucose positron emission tomography showed focal nodular hypermetabolic activity, suggesting that FL may have transformed into a diffuse large B-cell lymphoma. Upper gastrointestinal endoscopy, colonoscopy, and capsule endoscopy showed no other lesions in the gastrointestinal tract, and bone marrow biopsy showed no permeation into the marrow. Therefore, this lesion, which appeared as a submucosal tumor, was limited to the stomach. Laparoscopy and endoscopy cooperative surgery was performed, because it allows for correct pathological diagnosis while removing only a minimal portion of the stomach wall. Histological findings showed follicular structures consisting of abnormal lymphoid cells. Immunohistochemical analysis revealed that neoplastic cells were positive for CD20, CD79a, Bcl-2, CD10, and c-MYC, but negative for CD3, CD5, and cyclin D1. Finally, we diagnosed this lesion as a primary gastric FL.

Calcifying fibrous tumours (CFTs) are rare benign lesions that usually affect the soft tissues, the mesentery and the peritoneum. Gastric CFT is particularly rare. Here, we report a CFT found incidentally in a 31-year-old male. The mass was well circumscribed and showed partial calcification on the CT scan, with dark signal intensity seen on T2 weighted MRI. To the best of our knowledge, there is very limited published information concerning imaging findings of CFTs. We discuss the CT scan and MRI findings of this patient, which can be considered typical for gastric CFT, and present a review of the limited literature available.

Hepatoma Research is an open access journal and focuses on all topics related to hepatoma. The following articles are especially welcome: pathogenesis, clinical examination and early diagnosis of hepatoma, complications of hepatoma, and their preventions and treatments, etc.

背景 : 今回われわれは性交未経験の若年女性に発症した子宮頸部粘液性腺癌の 1 例を経験したので, その細胞診所見, 組織所見の特徴を含めて報告する.症例 : 16 歳, 性交経験なし. 過多月経と不正性器出血のため近医で加療されていたが, 大量の性器出血を認め当院に救急搬送となった. 腟鏡診で子宮腟部は腫瘍に置換されており, 骨盤 MRI では子宮頸部に最大径 6 cm の腫瘤を認めた. 子宮腟部擦過細胞診では乳頭状～篩状構造を示す異型細胞集塊を認め腺癌と判定し, 生検でも腺癌と診断した. 子宮頸部腺癌ⅠB2 期の術前診断で広汎子宮全摘術＋両側付属器切除術＋骨盤リンパ節郭清術を施行した. 組織学的には子宮頸部の腟側は主として乳頭状増殖を認め, 内頸部側では明調な胞体を有する管状構造を主体とした腺癌で, 両者は連続移行していた. 管状増殖部分は MUC6 陽性で胃型形質を発現していた. また骨盤リンパ節に転移を認めた. 術後化学療法を行ったが再発し, 手術から 1 年 4 ヵ月で永眠した.結論 : 胃型形質をもつ子宮頸部粘液性腺癌は HPV 非依存性で予後不良と報告されており, 性器出血が持続する場合は若年女性であっても病理学的検査が必要である.

症例は46歳の閉経前女性．2010年7月頃より右乳房の腫瘤を自覚したが放置していた．2011年1月に同部位に疼痛を認め当科受診．視触診で右C領域に1.5cmの可動性良好な硬い腫瘤を触知し，マンモグラフィで同部位に非対称陰影を認めた．超音波検査で同部位に周辺組織の引き込みを伴う4mmと6mmの低エコー腫瘤を2個認めた．乳癌を疑い針生検を施行したが，病理検査で線維腫症を疑う所見であった．約1年の経過観察中に皮膚にえくぼ様所見や腫瘤の増大を認め，11月に乳房部分切除を施行した．病理結果は乳腺線維腫症であった．線維腫症は線維芽細胞の浸潤性増殖を伴う良性の腫瘍性疾患であり，触診や画像診断からは乳癌との鑑別が非常に困難である．治療は外科的切除が第一選択であるが，腫瘍切除後局所再発を起こすことがあるため，厳重な経過観察が必要である．非常に稀な乳腺線維腫症の1例を経験したので文献的考察を含め報告する．

Chromophobe renal cell carcinoma (ChRCC) with neuroendocrine differentiation/morphology (NED/NEM) is exceedingly rare. We present three cases of ChRCC with NED/NEM, two of which showed positivity for neuroendocrine markers on immunohistochemical analysis. Patients ranged in age from 49 to 79 years (mean: 64.3 years). One of the three patients died of metastatic disease to multiple organs. Of the remaining two patients, one is currently alive without disease and the other is alive with disease. Histologically, all three tumors were composed of conventional ChRCC and NEM showed glandular and rosette formation. Immunohistochemically, tumor cells were positive for CK7, KAI1, E-cadherin, and c-kit in both ChRCC and neuroendocrine areas in three cases. CD56 and synaptophysin immunoreactivity were detected in two cases; in only the neuroendocrine area in one case and in both components in the other. Neuroendocrine granules were ultrastructurally observed at both neuroendocrine and conventional areas of ChRCC. Array comparative genomic hybridization (CGH) study indicated losses of chromosomes 1, 2, 6, 10, 17, 21, and Y in both conventional ChRCC and NED in one case. In addition, losses of chromosomes 1, 2, 4, 6, 9, 10, 13, 16p, 17, and 21 were observed in both components of the remaining one tumor. Furthermore, loss of chromosome 5 was identified only in the neuroendocrine area in this case. We concluded that the neuroendocrine area may reflect dedifferentiation within ChRCC. It is possible that losses of chromosomes 4, 5, and 16p may be involved in the neuroendocrine differentiation or progression of ChRCC.

症例は60歳，男性．嘔吐と腹痛および腹部膨満感を主訴に近医にてイレウスと診断され入院となった．CTで下行結腸に限局した狭窄部位を認めた．大腸癌イレウスが疑われ，内視鏡検査を施行したが明らかな腫瘤を認めなかった．注腸検査で下行結腸からS状結腸にかけて腸管の伸展不良を認めた．保存的加療を行うも症状の改善はなく，手術を施行した．術中所見でS状結腸に痙性変化が強い部分を認め，S状結腸切除術を施行した．病理検査ではAuerbach神経叢およびMeissner神経叢の萎縮を認め，後天性のsegmental hypoganglionosisを誘因としたイレウスと診断した．術後の経過は良好であり，その後同様の症状を認めていない．成人における大腸hypoganglionosisの症例は稀であり，今回手術加療が奏効した1症例を経験したので報告する．