Histomorphological aspects of TNM-classification of carcinoma of the lung

This prospective study evaluates the histopathological findings on 613 patients undergoing curative resection of a bronchus carcinoma and operated on between January 1982 and September 1984. The WHO rules for tumor classification and grading, and the 1979 pTN classification rules of the UICC were followed. Taking into account the biological properties of the tumors and the patient survival times, the prognostic value of histopathological data is discussed. Apart from the clear general dependence of the average survival time on the tumor cell type, it was found that tumor volume is of greater prognostic value with respect to patient survival than tumor diameter.     

A case report of mediastinal paraganglioma and a review of the literature in Japan]

Paraganglioma is a tumor arising from the extra-adrenal paraganglion system and is rarely observed in the mediastinum. The authors experienced a case of nonfunctioning paraganglioma of the upper posterior mediastinum. The patient was a 40-year-old female in whom abnormal shadows were noted in chest X-ray films taken in March, 1989. She was examined at our hospital with a diagnosis of mediastinal tumor in June of the same year. CT of the chest revealed a tumor in the upper posterior mediastinum and it was shown to be hypervascular by a DSA study. Urinary hormone levels were normal. The tumor was resected in May, 1990. The tumor, measuring 6.8 X 4.0 X 3.5 cm, was encapsulated, appeared dark red and had relatively clear borders. A histopathologic diagnosis of paraganglioma was made. The patient remains disease-free at present, 6 months after operation. Problems concerning diagnosis and treatment of mediastinal paraganglioma were evaluated with a review of cases reported in Japan.     

A case of endocrine cell carcinoma of the ileum: sonographic findings and clinical outcome]

A 56-year-old man, who had been complaining of diarrhea for several months, was admitted for further examination of a hepatic tumor. A needle biopsy of the hepatic tumor suggested metastatic carcinoid tumor. The primary tumor was found in the ileum by extracorporeal sonographic examination and a barium meal study. We performed a partial excision of the ileum, lymph node resection, wedge biopsy of the liver, and catheterization from the right iliac artery to the hepatic artery for intraarterial chemotherapy. The pathological diagnosis was endocrine cell carcinoma of the ileum and local lymph nodes and hepatic metastasis. After surgery, the patient has been treated with continuous intraarterial infusion of CDDP and 5FU. The liver tumors almost disappeared. As of 20 months after the surgery, the patient is well and is being followed in the outpatient clinic.     

Incidence trends and predictors for cost and average lengths of stay in colorectal cancer surgery

AIM:To evaluate the changing trends and outcomes of colorectal cancer(CRC)surgery performed at a large single institution in Taiwan.METHODS:This study retrospectively analyzed 778patients who received colorectal cancer surgery at E-Da Hospital in Taiwan from 2004 to 2009.These patients were from health examination,inpatient or emergency settings.The following attributes were analyzed in patients who had undergone CRC surgical procedures:gender,age,source,surgical type,tumor number,tumor size,number of lymph node metastasis,pathologic differentiation,chemotherapy,distant metastases,tumor site,tumor stage,average hospitalization cost and average lengths of stay(ALOS).The odds ratio and95%confidence intervals were calculated to assess the relative rate of change.Regression models were employed to predict average hospitalization cost and ALOS.RESULTS:The study sample included 458(58.87%)males and 320(41.13%)females with a mean age of64.53 years(standard deviation,12.33 years;range,28-86 years).The principal patient source came from inpatient and emergency room(96.02%).The principal tumor sites were noted at the sigmoid colon(35.73%)and rectum(30.46%).Most patients exhibited a tumor stage of 2(37.28%)or 3(34.19%).The number of new CRC surgeries performed per 100000 persons was12.21 in 2004 and gradually increased to 17.89 in 2009,representing a change of 46.52%.During the same period,the average hospitalization cost and ALOS decreased from$5303 to$4062 and from 19.7 to 14.4 d,respectively.The following factors were associated with considerably decreased hospital resource utilization:age,source,surgical type,tumor size,tumor site,and tumor stage.CONCLUSION:These results can be generalized to patient populations elsewhere in Taiwan and to other countries with similar patient profiles.     

Cavernous hemangioma of the stomach: A case report and review of the literature

A cavernous hemangioma of the stomach in a 41-year-old Japanese man was reported. The patient had numerous hemorrhagic telangiectasias in the skin and was also diagnosed as having a submucosal tumor of the stomach by an incidental upper gastrointestinal X-ray study. Wedge resection of the stomach was performed. The tumor was located in the submucosal, proper muscular and subserosal layers. The resected specimen showed proliferation of vascular spaces lined with a layer of endothelial cells and filled with red blood cells together with a partially calcified thrombus. The histopathologic diagnosis was cavernous hemangioma of the stomach with calcified thrombus. The patient has been doing well for twenty years. We report the case and briefly review the literature. This study is supported in part by a Grant from Federation of National Public Service and Affiliated Personnel Mutual Aid Association, Tokyo, Japan.     

Unusual cause of gastrointestinal bleeding in a cirrhotic patient:hepatocellular carcinoma with gastric invasion

BACKGROUND:Upper gastrointestinal(GI)bleeding is a common complication of portal hypertension in cirrhotic patients,and hepatocellular carcinoma(HCC)is the most common tumor in cirrhotic livers.Bleeding from tumor erosion into the GI tract is very rare.A patient with HCC and gastric tumor invasion was described and the previously reported cases were reviewed. METHOD:A patient with upper GI bleeding was treated in a tertiary hospital. RESULTS:A cirrhotic patient with a HCC invading the stomach leading to upp...     

Castleman’s disease arising from the gallbladder neck causing difficulty in the differential diagnosis

We report a patient with Castleman’s disease arising from the gallbladder neck, which caused difficulty in making the differential diagnosis against gallbladder malignancies. A 50-year-old woman presented to our institution with epigastric pain. An abdominal computed tomography scan (CT) and magnetic resonance cholangiopancreatography (MRCP) study showed a 20-mm tumor located in the gallbladder neck for which malignancy could not be completely ruled out. For the definitive diagnosis and treatment, cholecystectomy was performed. In the operation, the main tumor and resection margins of the cystic duct were submitted for frozen section. The tumor was composed of a proliferation of lymphoid tissue with no signs of dysplasia. The ductal margin was free of tumor. The final histopathological diagnosis was unicentric Castleman’s disease, a hyaline vascular variant that developed in the gallbladder. The patient is currently in good condition without any signs of recurrence 28 months after the operation. This is the first detailed report of Castleman’s disease of the gallbladder. Making a correct diagnosis was very difficult before the operation, and only a surgical approach enabled confirmation of the diagnosis for this patient.     

Gastrointestinal stromal tumor of the rectal mesentery

We report a case of gastrointestinal stromal tumor (GIST) arising from the rectal mesentery. GIST of the large intestine is a rare tumor that accounts for only 0.1% of all colorectal cancers. The patient presented to our hospital with constipation and abdominal distension. Computed tomography (CT) revealed a huge mass in the pelvic cavity, and laparotomy disclosed diffuse peritoneal dissemination from the primary tumor. Radiochemotherapy was commenced, but the patient became too ill to complete it and died of the disease 2 months after surgery. A large high-grade tumor with diffuse dissemination was recognized as an indicator of poor survival in this patient. Received: September 3, 2001 / Accepted: January 18, 2002 Reprint requests to: T. Nakayama     

Basaloid-squamous cell carcinoma of the esophagus: diagnosis based on immunohistochemical analysis

Basaloid-squamous cell carcinoma of the esophagus (BSCC) is an extremely rare tumor. Histologically, this tumor should be differentiated from adenoid cystic carcinoma (ACC) and small cell undifferentiated carcinoma (SCUC). Biologically, this tumor is very aggressive, with a propensity for distant metastasis. We report a 64-year-old male with esophageal BSCC. The patient complained of dysphagia and was found to have a torous lesion in the esophagus on radiological examination. Upper gastrointestinal fiberscopy showed a localized ulcerative type tumor, which was diagnosed as squamous cell carcinoma (SCC) on biopsy. Surgery resulted in curative resection. A histological examination of the resected tumor showed features of BSCC. Immunohistochemical examination demonstrated AE3/1- and CAM 5.2-positive tumor cells, and laminin-positive cells in the periphery of the nests. These data were useful in differentiating this tumor from ACC and SCUC. Six months after surgery, the patient developed hepatic metastases, which were successfully treated by regional chemotherapy via the hepatic artery by using fluorouracil. The patient is currently being followed up at the outpatient clinic and shows no signs of any recurrence.     

Echocardiographic detection of a left ventricular tumor after myocardial infarction (author's transl)

A mobile left-ventricular tumor was detected by echocardiography in a 28-years-old patient, who has sustained an anteroseptal infarction four years before. The patient was admitted to hospital because of arterial embolism. The echocardiographic finding was validated by left-ventricular angiography. In open-heart surgery a pedunculated tumor was excided, in microscopic study the tumor revealed the findings of an organized thrombus. The echocardiographic and angiographic findings are shown, the echocardiographic differential diagnosis is pointed out.     

Clinical implication of (18)F-FDG PET/CT in carcinoma of unknown primary

The value of (18)F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in the detection of carcinoma of unknown primary (CUP) differs among the studies. This study aimed to evaluate the role of (18)F-FDG PET/CT in CUP. Fifty-one patients (19 women, 32 men) with metastasis confirmed by histopathology from an unknown primary tumor were included in this study. Patients received 370 MBq of (18)F-FDG intravenously, and PET/CT was performed at 60 minutes after injection. Primary tumor sites were detected in 5 of 51 patients (9.6%): in 2 patients with carcinoma of the lung, in 1 patient with carcinoma of the gallbladder, in 1 patient with carcinoma of the esophagus, and in 1 patient with carcinoma of the stomach. No primary tumor was discovered in the remaining 46 patients (90.4%) during the follow-up. The sensitivity, specificity, and accuracy of (18)F-FDG PET/CT were 100%, 80.4%, and 82.4%. The positive and negative predictive values were 35.7 and 100%, respectively. Based on the data presented, (18)F-FDG PET/CT has a clinical implicative value in detecting the primary tumor of CUP. PET/CT can be useful to rule out the possibility of detecting the primary tumor during the follow-up.     

The role of pancreatoscopy in the preoperative evaluation of intraductal papillary mucinous tumor of the pancreas

BACKGROUND: Intraductal papillary mucinous tumor of the pancreas is a rare neoplasm managed by operative resection of the affected segment of the pancreas. GOALS: To evaluate the role of peroral pancreatoscopy in the diagnosis and preoperative localization of the affected region of the pancreatic duct and to undertake the appropriate operation for each patient. STUDY: Five patients with suspected intraductal papillary mucinous tumor of the pancreas were studied using endoscopic retrograde cholangiopancreatography, computed tomography of the abdomen, endoscopic ultrasonography, and peroral pancreatoscopy. The findings from these studies were compared, and operative resection was performed in each patient based on pancreatoscopic findings. RESULTS: Of the five patients with suspected intraductal papillary mucinous tumor, only four had histologically confirmed tumor, and the remaining one patient had a retention cyst of the pancreas. Pancreatoscopy correctly identified all four patients with the tumor while excluding the diagnosis of papillary tumor in one. CONCLUSION: Peroral pancreatoscopy is valuable in the preoperative evaluation of intraductal papillary mucinous tumor of the pancreas, especially in the localization of such tumor.     

Testicular metastasis from ileal carcinoid: report of a case

PURPOSE: This report presents a patient with testicular metastasis from an ileal carcinoid. METHODS: This was a retrospective case review with literature review. RESULTS: The patient underwent right orchiectomy for a solid mass. Pathology revealed carcinoid tumor. Octreotide scan showed increased concentration in the right lower quadrant of the abdomen. Computerized tomography results were negative. Colonoscopy with biopsy revealed carcinoid of the terminal ileum. The patient underwent an elective resection of the terminal ileum and the right colon. Pathology revealed carcinoid tumor with vascular and lymphatic invasion present, and eight lymph nodes were positive. The patient had adjuvant treatment with octreotide. CONCLUSION: Carcinoid tumors have been reported to metastasize to numerous areas. This is the first report of testicular metastasis from ileal carcinoid. Primary carcinoids of the testicle have been reported also. The clinician should be aware of this rare metastatic event. When pathology reveals carcinoid of the testicle, metastatic disease should be excluded before the tumor is identified as primary.     

Primary plasma cell leukemia: a case report of successful responder to a combination chemotherapy of vincristine, doxorubicin and dexamethasone

A patient with primary plasma cell leukemia is described. Immunoelectrophoresis revealed a monoclonal IgG/lambda protein and Bence Jones protein. Hematological data showed numerous immature plasma cells in peripheral blood and bone marrow. Cytogenetic study of tumor cells revealed a complex karyotypic abnormality. Subcutaneous involvement by tumor cells was found. The patient was treated with a combination of vincristine, doxorubicin, dexamethasone (VAD) and achieved a complete remission with disappearance of tumor cells, monoclonal protein and extramedullary involvement after 6 cycles of VAD. This regimen should be encouraged in treatment of primary plasma cell leukemia.     

Peliosis hepatis complicated by portal hypertension following renal transplantation

Peliosis hepatis (PH) is a vascular lesion of the liver that mimics a hepatic tumor. PH is often associated with underlying conditions, such as chronic infection and tumor malignancies, or with the use of anabolic steroids, immunosuppressive drugs, and oral contraceptives. Most patients with PH are asymptomatic, but some present with abdominal distension and pain. In some cases, PH may induce intraperitoneal hemorrhage and portal hypertension. This study analyzed a 46-year-old male who received a transplanted kidney nine years prior and had undergone long-term immunosuppressive therapy following the renal transplantation. The patient experienced progressive abdominal distention and pain in the six months prior to this study. Initially, imaging studies revealed multiple liver tumor-like abnormalities, which were determined to be PH by pathological analysis. Because the hepatic lesions were progressively enlarged, the patient suffered from complications related to portal hypertension, such as intense ascites and esophageal varices bleeding. Although the patient was scheduled to undergo liver transplantation, he suffered hepatic failure and died prior to availability of a donor organ.     

Tuberculosis of the Esophagus

A case of tuberculosis of the esophagus is presented in a patient with pulmonary tuberculosis. The patient, complaining of dysphagia, had esophagoscopic examination which showed a submucosal tumor with central ulceration. Tissue biopsy, under direct vision from the tumor mass, confirmed the diagnosis of tuberculosis. The patient has been asymptomatic under treatment. Both esophageal and pulmonary lesions are largely improved.
The rarity of the lesion and necessity of taking biopsy are emphasized.     

Primary hepatic carcinoid tumor with metachronous lymph node metastasis after long-term follow up

A case of hepatic carcinoid tumor occurring in a 71-year-old man is reported. The tumor was diagnosed initially as a hepatocellular carcinoma, and was then shown after resection histologically to be a carcinoid tumor. The tumor cells formed small nests and trabeculae separated by fibrous septa and were positive for Grimelius staining. Immunohistochemically, most of the tumor cells stained positive with chromogranin A and neuron-specific enolase. After a follow up for 5 years and 7 months, the patient developed tumors in lymph nodes between the remnant liver and the lesser curvature of the stomach with no tumors in other organs. Histologically, the tumor cells in the lymph nodes demonstrated a pattern of the immunostainings consistent with carcinoid tumor. After lymphadenectomy, the patient is free from recurrence in the regional lymph nodes for more than 1 year. This case is con-sidered to be a primary hepatic carcinoid tumor with metachronous lymph node metastasis.     

经胃镜保留浆膜层切除上消化道固有肌层起源肿瘤技术初探

目的 探讨经内镜浆膜下肿瘤切除术（ESSD）对上消化道黏膜下肿瘤切除的安全性及有效性。方法 收集2016年10月至2017年2月在南京鼓楼医院接受ESSD的6例黏膜下肿瘤患者资料,分析手术时间、手术成功率、术后病理、并发症等。结果 纳入的6例患者均完整切除肿瘤,其中1例患者发生浆膜面穿孔。肿瘤平均大小（27.5±10.0）mm,手术平均耗时（49±18）min。术后病理均提示为低危险度间质瘤。6例患者均顺利出院,未发生严重并发症。结论 ESSD作为一种新兴的内镜下治疗方法,对固有肌层起源肿瘤安全可靠。