Two rare anomalies of the brachial plexus

Morphological variations of the brachial plexus and variants in the distribution of the anterior division of the middle trunk are relatively frequent. Two of the rarest anomalies occurred in the left brachial plexus of a 62-y-old Japanese male, 1 of 104 plexuses dissected between 1996 and 1997 at Kanazawa University Faculty of Medicine. The superior trunk of the brachial plexus was formed by the anterior primary division of C5 and C6 and a thin branch (0.5 mm in diameter) from C4, the middle trunk by the C7, and the inferior trunk by C8 and T1 (Fig.). We could not determine whether there was a branch derived from T2 to T1, since the subject had died of lung carcinoma. The entire anterior division of the middle trunk crossed the axillary artery and joined the medial root of the median nerve which was the continuation of the medial cord after the cord branched off the ulnar nerve. The lateral cord pierced coracobrachialis and divided into the musculocutaneous nerve and the lateral root of the median nerve just after emerging from the muscle, finally joining the medial root of the median nerve superficial to the brachial artery ∼115 mm distal to the lower border of latissimus dorsi to form the median nerve. The musculocutaneous nerve gave rise to the nerves to biceps brachii, brachialis, and the long head of biceps brachii and finally continued as the lateral cutaneous nerve of the forearm. The branch to coracobrachialis had already been cut and its course could not be traced.     

Immunohistochemical demonstration of epidermal growth factor and c-myc oncogene product in normal, benign and malignant thyroid tissues

The expression of epidermal growth factor (EGF) and c-myc oncogene product was studied immunohistochemically in 65 benign and malignant human thyroids. Normal thyroid tissues were usually negative with each antibody. Benign and malignant neoplastic thyroid tissues demonstrated a high percentage of stained cells. However, there was no significant difference in positivity between benign and malignant neoplastic tissues. In Graves' disease 25% of the cases were positive for EGF, and 100% for c-myc product. The effect of EGF or c-myc expression on prognosis was also examined in 42 patients with papillary thyroid carcinoma. When the cases were divided into two groups with regard to their EGF staining score (highly-expressed and poorly-expressed groups), the frequency of highly-expressed tumours was significantly higher in the recurrence-positive group compared with the recurrence-free group (86% vs 57%), but there was no significant difference between the groups in respect of c-myc expression.     

A clinical case of neuro-Behçet syndrome without mucocutaneo-ocular symptoms: Relationship with brain stem encephalitis

Abstract The case of a 50 year old man with personality changes, dementia, and brain stem symptoms is presented. Magnetic resonance imaging (MRI) disclosed high signal areas mainly in the brain stem. Both a positive skin prick test and an HLA-B51 were demonstrated. These clinical findings were suggestive of neuro-Behçet syndrome, although there were no mucocutaneo-ocular symptoms characteristically associated with this disease. The relationship between neuro-Behçet syndrome and brain stem encephalitis, including a discrimination from multiple sclerosis, is discussed.     

Absence of the musculocutaneous nerve with innervation of coracobrachialis, biceps brachii, brachialis and the lateral border of the forearm by branches from the lateral cord of the brachial plexus

Anomalies of the brachial plexus and its terminal branches are not uncommon. Variations in the course and branches of the musculocutaneous nerve have been noted (Clemente, 1985; Bergman et al. 1988) and its absence was reported by Le Minor (1990). Several anomalies were present in the left plexus of a 59-y-old Japanese man (Fig.). There were no anterior and posterior divisions of the middle trunk, although there were communications between the posterior, medial and lateral cords. The musculocutaneous nerve was absent (Le Minor, 1990) and the medial and lateral roots of the median nerve did not unite in the axillary fossa but in the upper arm about 5 cm distal to the lower border of latissimus dorsi (Adachi, 1928; Buch-Hansen, 1955). The hitherto unreported findings were branches arising directly from the lateral cord to supply coracobrachialis, both heads of biceps brachii and brachialis. The lateral cutaneous nerve of the forearm was derived from the lateral cord with a small contribution from the medial root of the median nerve. Since there were communications between the posterior cord (a continuation of the middle trunk) and the medial and lateral cords, it is theoretically possibly, but not proven, that the root values of branches innervating the flexor muscles of the arm and forearm and the skin of lateral border of the forearm were normal.     

Papillary thyroid carcinoma in Kanazawa, Japan: prognostic significance of histological subtypes

A retrospective analysis of 183 papillary thyroid carcinomas was made in order to assess the prognostic factors related to survival. The following factors were found to adversely affect the prognosis: trabecular subtype of papillary carcinoma, the extent of the primary tumour, regional lymph node involvement, the presence of distant metastases, old age, male sex and the extent of the neck dissection. The presence of the follicular variant of papillary carcinoma and the extent of the thyroidectomy did not influence the prognosis. The trabecular subtype of papillary carcinoma is characterized by a trabecular or solid arrangement of follicular cells with nuclei of ground-glass appearance. Univariate and multivariate analysis indicated that patients with this type of thyroid tumour had a poorer prognosis than those with the well-differentiated or follicular variants of papillary carcinoma. In our opinion the trabecular subtype of papillary carcinoma should be included as a separate entity in the WHO classification of thyroid tumours.     

Sporadic medullary microcarcinoma of the thyroid

Two cases of medullary microcarcinoma of the thyroid are reported. The tumours were identified incidentally in a 60- and a 66-year-old woman each with a thyroid adenoma. These tumours were 0.8 cm and 0.5 cm in size, respectively, and located in the central portion of the right lateral lobe. In neither patient was there a family history of medullary thyroid carcinoma. Although medullary microcarcinoma with associated C-cell hyperplasia in familial form has been reported, sporadic medullary microcarcinoma is rare.     

A Case of Ileal Malignant Lymphoma Presenting with Intussusception

Abstract: A-66-year-old male presented with a chief complaint of intermittent abdominal pain. Colonoscopy and barium enema indicated intussusception of a submucosal tumor of the ileum into the ascending colon. Surgery was thus carried out. The tumor was located 25 cm from the ileocecal junction, measured 4.1 × 3.2×2.3 cm, and showed intraluminal growth. Histopathologic examination of the resected specimen revealed a diffuse mixed cell type malignant lymphoma, and the tumor had invaded the subserosal layer. Intussusception due to malignant lymphoma is relatively rare in adults. We reviewed 43 cases of ileal lymphoma involving intussusception, reported in Japan over the preceding 12 years, and these cases are discussed along with the present case.