Recurrent mediastinal desmoid tumor treated by surgical resection ; report of a case

We report a rare case of mediastinal desmoid tumor in a 17-year-old man. The patient was a 17-year old man who had underwent surgery for mediastinal tumor at our hospital 2 years before. The tumor was diagnosed as a solitary fibrous tumor of the mediastinum. After 2 years, chest computed tomography(CT) and magnetic resonance imaging( MRI) showed a mass at the previously resected site. Surgery was performed again under the diagnosis of recurrent tumor. The tumor densely adhered to the superior vena cava, right innominate vein, pericardium, and the right lung. The tumor was completely resected with the aid of the partial extracorporeal circulation. Finally, both previously resected tumor and the recurrent tumor were diagnosed pathologically as desmoid tumors.     

Diagnosis of the upper urothelial tumor using a rigid ureteroscope

We preoperatively diagnosed four cases suspected as malignant urothelial tumor of upper urinary tract using a rigid ureteroscope. In three cases of ureter tumor, biopsy was successful and showed low grade malignancy. Nephroureterectomy was performed in two cases with upper ureteral tumor. The tumor was fulgurated ureteroscopically in a case of lower ureteral tumor. In one case of renal pelvic tumor, biopsy was unsuccessful though the tumor was observed as a papillary configuration. Successively, biopsy using a flexible ureteroscope was performed and the tumor was treated by fulguration. Ureteroscopy is very useful for preoperative diagnosis of ureteral tumor and selection of treatment.     

A case of giant cell tumor originating from the rib

We have experienced a case of giant cell tumor originating from the rib. A 45-year-old male was admitted to our hospital because of a mass in the left chest wall. A tumor shadow was observed in the left side of chest X ray. Chest CT, bone scintigram showed tumor originating from the left 4th rib. The tumor was suspected giant cell tumor of bone by needle biopsy examination. The tumor was completely resected with chest wall surrounding the tumor. The defect of chest wall was reconstructed with Marlex mesh and the Latissimus dorsi muscle flap. The pathological diagnosis was a giant cell tumor of bone. The patient has been well for two years and one month since surgery, with no signs of recurrence.     

Retroperitoneal ganglioneuroma. Report of a case]

Retroperitoneal ganglioneurom is a primitive, rare and benign tumor originating in the neural sheath. We report the case of a 27-years old man. An abdominal sonography had revealed accidentally a 60 mm, well demarcated tumor. The left renal vein was compressed an forced back. This tumor was located in front of and internal to the left kidney. The CT scan confirmed this tumor. A left subcostal laparotomy was done. The tumor was soft and movable. A total exeresis was performed. The pathology examination had conclude in a benign ganglioneuroma. The follow-up was six years and half. Retroperitoneal ganglioneuroma is a benign tumor with a good prognosis. The treatment is surgical.     

Solid-pseudopapillary tumor of the pancreas – a rare and frequently misdiagnosed neoplasm

Introduction: We describe a young woman with an unusual pancreatic tumor. Findings and discussion: Intraoperatively, a smoothly demarcated and encapsulated tumor was exposed. It was large (5 cm×4 cm) and of solid consistency, with a small stalk attached to the uncinate process. The tumor was partially surrounded by the pancreatic head. The macroscopic appearance suggested a benign tumor. Frozen sections revealed a benign pancreatic tumor, most likely of endocrine nature. Based on these findings, tumor enucleation was performed. The patient recovered rapidly from the intervention and was discharged from hospital after 2 weeks. One year after surgical treatment, the patient is without recurrence. The final diagnosis of the tumor was a solid pseudo-papillary tumor. Received: 9 July 1998 Accepted: 14 September 1998     

The giant schwannoma in the pelvic cavity: a case report

A 62-year-old man presented with a giant tumor in the pelvic cavity that was incidentally revealed by abdominal ultrasonography. Abdominal magnetic resonance imaging showed the heterogenous tumor in the pelvis with cystic components. The tumor was 10.8 × 10.5 × 11.7 cm in diameter and adhered to the sacral wall. The tumor was extirpated following diagnosis as a benign neurogenic tumor by needle biopsy. The pelvic cavity was occupied by the tumor rigidly adhered to the sacrum. The histopathological diagnosis of the specimen was benign schwannoma, type Antoni A.     

Adenoid cystic carcinoma of lower lobe of right lung: report of a case

A 69-year-old male was admitted to the hospital for further examination of an abnormal shadow in the right lower lung fields. He was previously under medical treatment for right thoracic empyema. Chest computed tomography (CT) showed a solitary mass, 4.5 cm in diameter and broncofiberscopy evidenced a tumor in the right lower bronchus. The biopsy was performed and the tumor was diagnosed as a pleomorphic adenoma. Intraoperativefinding showed the tumor was 6 cm in gross, extended to the left atrium, and a daughter tumor was palpable in the middle lobe. The middle and lower lobe were resected. The tumor was located in S9, S10, 6 x 4 x 3.5 cm in size, 2 daughter tumor was found in the middle lobe, the pulmonary vein was thickened by tumor invasion. Pathohistologically, main tumor and daughter tumor showed malignant feature, were compatible with adenoid cystic cancer. Four years after operation, he is still now alive with home oxygen therapy.     

双侧睾丸间质细胞瘤1例报告并文献复习

目的 探讨睾丸间质细胞瘤的诊断和治疗经验.方法 报告1例双侧睾丸间质细胞瘤患者的临床资料并文献复习.结果 根据患者临床表现及相关检查,术前诊断考虑为双侧睾丸间质细胞瘤,术中快速冰冻病理检查示双侧睾丸间质细胞瘤,行睾丸肿瘤剜除术.术后随访6个月未见肿瘤复发或转移.结论 睾丸间质细胞瘤是一种较为罕见的睾丸肿瘤.术前诊断较为困难,睾酮、雌二醇等性激素水平升高及男性乳房发育等症状对睾丸间质细胞瘤的诊断有重要意义,确诊仍需依赖病理组织学检查.传统的手术方法采用根治性睾丸切除术,然而对于青春期前患者、双侧睾丸间质细胞瘤等患者,可以施行保留睾丸的肿瘤剜除术.     

Gastric stromal tumor treated by laparoscopic surgery

The authors describe a 59 years old female patient, with a gastrointestinal stromal tumor located on the posterior wall of the gastric funds, who was treated successfully by laparoscopic wedge resection (with clear resection margins), through an anteriorly placed gastrotomy, thus allowing an endoscopic linear cutter Endo GIA, to excise the tumor with a cuff of normal gastric tissue. The anterior gastrotomy was performed with Ultra-Shears. Delivery of the tumor through the gastrotomy is essential for success. The operative time was 110 minutes. The tumor was diagnosed as a gastrointestinal stromal submucosal tumor (of low-grade malignancy) and immunohistochemicaly, this tumor was positive for CD 34. CONCLUSION: Posterior gastric tumor can be removed using laparoscopic surgery.     

Tumor hypoxia correlates with metastatic tumor growth of pancreatic cancer in an orthotopic murine model

BACKGROUND: The role of tumor hypoxia has become a major focus in cancer research since it influences both local and systemic tumor growth. Oxygen measurements taken in human pancreatic cancer have shown extremely low oxygen tension. The aim of this study was to develop an orthotopic model for pancreatic cancer that mimics the specific tumor microenvironment and to evaluate the role of tumor oxygenation in local tumor growth and systemic dissemination in this model. MATERIALS AND METHODS: We used two established human pancreatic cancer cell lines for xenobiotic tumor induction. After subcutaneous tumor formation one small tumor piece was transplanted into the pancreatic parenchyma of mice of the different study groups. Upon orthotopic tumor induction tumor oxygenation was measured with the Eppendorf histograph. Histological evaluation was performed with pimonidazole, an in vivo marker of hypoxia. RESULTS: The tumor take rate was 100% in this model. Metastatic tumor dissemination occurred within the abdominal cavity, and distant metastasis were observed in the lung parenchyma. Oxygen measurements taken in various abdominal organs and xenograft tumor showed a high variation between different organs and xenografted tumors. Tumor oxygenation correlated well with the metastatic score in this model. Furthermore hypoxia was found both in the tumor center and also at the rim of a growing tumor mass. A high number of hypoxic cells were detectable in metastases located in the lung parenchyma. CONCLUSION: This study provides experimental evidence that tumor hypoxia influences metastatic disease progression and supports recent assumptions that tumor hypoxia is actively involved in progression of pancreatic cancer. It further demonstrates that tumor hypoxia is not only found in the center of a tumor mass, but also occurs at the invasion front.     

A case of congenital mesoblastic nephroma growing with a polypoid pattern in the renal pelvis and ureter

Congenital mesoblastic nephroma (CMN) is an unusual renal tumor, similar in some respects to Wilms' tumor and reported only in infants. We report a case of CMN in a 2-year-old boy. He was referred to us with a right abdominal mass. Excretory urogram, arteriogram and computed tomogram revealed a large malignant renal tumor on the right side. With a clinical diagnosis of Wilms' tumor of the right kidney, he received radiation and chemotherapy. After radiation and chemotherapy, tumor size was decreased. Right nephrectomy was performed on April 22, 1982. The kidney and tumor weighed 270 g and measured 12 X 7 X 5 cm. The tumor extended to the renal pelvis and the ureter with polypoid growth pattern. Microscopically, the tumor was composed of compact interlacing bundles of elongated fibromyomatous cells. Islands of entrapped glomeruli and tubules were also detected within the tumor. He was well and had no signs of recurrence of tumor at the age of 3 years.     

Desmoid tumor of the abdominal wall preoperatively suspected as urachal tumor: a case report]

A case of desmoid tumor of the abdominal wall which was preoperatively suspected as urachal tumor is presented. The patient was a 56-year-old man, who was referred to our clinic for further examination of the mass detected incidentally in the ventral region of the urinary bladder by computed tomography. Ultrasonography showed that the mass had a heterogenous and hypoechogenic content. An urachal tumor was suspected and surgery was performed to remove the tumor. During the operation we found that the tumor was completely separated from the urinary bladder and that it had originated from the left rectus abdominal muscle. The pathological diagnosis was desmoid tumor of the abdominal wall. Since urachal tumor has no characteristic findings on the imaging examinations, it is difficult to differentiate desmoid tumor of the lower abdominal wall from urachal tumor, preoperatively.     

人肝门部胆管癌转移动物模型的建立及生物学特性研究

目的利用人肝门部胆管癌细胞系（FRH-0201）接种裸鼠脾脏，建立肝、肺转移模型。方法将FRH-0201细胞系（120代）接种于7只Balb／c裸小鼠脾脏。出现转移时，将转移瘤行组织病理学及超微结构观察。将转移的肿瘤行细胞培养，再次接种裸鼠脾脏，观察转移成瘤情况。结果脾脏局部成瘤率为100％（7／7），转移瘤发生率14．3％（1／7）。转移瘤细胞再次接种于裸小鼠脾脏，转移发生率100％。转移瘤电镜显示典型恶性细胞特征。转移瘤细胞染色体众数19条，主流范围18～44条。结论该实验所建立的肝门部胆管癌转移瘤，符合恶性肿瘤的特点，与人肝门部胆管癌生物学特性一致。     

Primary cardiac synovial sarcoma —A case report—

We report a case of cardiac synovial sarcoma, a very rare primary tumor of the heart. The patient was a 29-year-old man with chief complaint of dyspnea. On echocardiography, a tumor 42 mm in diameter occupying the most space of the left atrium was found. The tumor was obstructed the opening of the mitral valve. He was diagnosed with heart failure due to disturbance of the pulmonary venous return and hemodynamic mitral valve stenosis, and underwent surgery. The tumor was a 5-cm sphere originating in the left atrial posterior wall, and was covered with a sheath and solid. The atrial posterior wall was covered with a peel that appeared to be tumor tissue, and this tissue expanded toward the openings of the pulmonary veins bilaterally and the posterior cusp of the mitral vavle. The tumor was resected together with the posterior wall. On pathologic examination, the tumor was diagnosed as a synovial sarcoma. Since no other primary focus was found, this tumor was judged to be a primary sarcoma of the heart. The patient was discharged with elimination of symptoms. The sarcoma recurred after 4 months, and the patient underwent a second operation. The recurrent tumor began from the site of resection of the previous operation and expanded up to the inferior pulmonary veins bilaterally. A wide area of the left atrial wall including the tumor was resected, and he was discharged again. The sarcoma recurred again, and he died of progression of heart failure and aggravation of general conditions after 8 months from the first operation.     

A resected case of malignant peripheral nerve sheath tumor (MPNST) necessary to distinguish from Askin tumor

We have treated a patient with malignant peripheral nerve sheath tumor (MPNST) for 7 years by interdisciplinary therapy. The diagnosis and treatment are reported with the clinical course so far. A 20-year-old man underwent surgical resection of a tumor on the left side of the chest in 1990, and a diagnosis of Askin tumor was made. In 1993, the disease recurred in the left axilla and was surgically resected. The surgical specimen was investigated histologically, and a diagnosis of MPNST was made instead of Askin tumor. Recently, a tumor began to grow in the left pleural cavity and was surgical resected. The tumor tissue contained both cells with oval and long spindle nuclei, which were intermingled with each other. Immunohistochemically, the tumor cells were positive for vimentin and some of them were positive for S100 protein. Because electron microscopy showed cytoplasmic processes on the tumor cell and basal lamina-like structures, a diagnosis of recurrent MPNST was made. Because this lesion resembled Askin tumor in its clinical manifestations and histological characteristics, differential diagnosis from Askin tumor was necessary. When a malignant soft tissue tumor arising from the mediastinum or chest walls is detected, immunohistochemical and electron microscopic studies should be performed. The diagnosis should be based on the overall findings including the location and clinical data.     

Total laparoscopic excision of retroperitoneal ganglioneuroma using the hanging method and a vessel-sealing device

An 11-year-old girl presented with a homogeneous right retroperitoneal tumor 5 cm in diameter. Nonfunctioning benign neurogenic tumor was suspected, and a laparoscopic resection was performed. The inferior vena cava ran just behind the tumor, and there were small vessels between the tumor and inferior vena cava. To create a space behind the tumor, we suspended the tumor by using a traction suture, and to obtain adequate hemostasis, we used a vessel-sealing device. The tumor was safely removed and the pathological diagnosis was benign ganglioneuroma. The postoperative recovery was uneventful, and the patient left her bed and started a regular diet on the postoperative day 1. Laparoscopic surgery is a safe, feasible method for the diagnosis and treatment of benign retroperitoneal tumors, such as ganglioneuroma.     

A case of abdominal desmoid tumor that was difficult to differentiate from urachal tumor

A 76-year-old male patient complained of frequent urination. Computed tomographic and magnetic resonance imaging scans revealed a heterogeneous mass involving his bladder, prostate and Sigmoid colon. He was diagnosed with an invasive urachal tumor and surgery was performed due to severe tumor adhesion to adjacent organs. Partial resection of the tumor was performed with partial cystectomy and sigmoidectomy. A post-operative pathological diagnosis revealed the tumor was a desmoid abdominal wall tumor. The desmoid abdominal wall tumor was not easily differentiated preoperatively from an urachal tumor.     

Teratoid Wilms' tumor: a case report with literature review

Teratoid Wilms' tumor is an unusual histologic variant of nephroblastoma in which the heterologous tissue predominates. The treatment for this tumor has not been established because of its rarity and varying tumor components. The authors report a case of localized teratoid Wilms' tumor in a 4-month-old female infant successfully treated with nephrectomy only. The tumor originated from the right kidney with multiple cysts and calcifications; renal teratoma was suspected preoperatively, and the operation was performed. The tumor was excised completely, and the specimen weighed 340 g. Histopathologic examination showed that various teratoid elements occupied most of the tumor with sparse islands of triphasic nephroblastoma, which was consistent with teratoid Wilms' tumor. Anaplastic elements, tumor capsule invasion, renal sinus soft tissue invasion, or tumors in intrarenal vessels were not observed. The patient was disease free for 3 years after surgery without receiving chemotherapy. We selected this therapeutic approach because of the chemoresistance of this tumor and the excellent prognosis in small (<550 g) stage I/favorable-histology classical Wilms' tumor diagnosed at less than 24 months of age. Therefore, nephrectomy alone may be an acceptable treatment of this stage of tumor in patients with teratoid Wilms' tumor.     

Malignant fibrous histiocytoma of perirenal tissue: a case report

A 75-year-old woman was admitted to our hospital with an extremely large retroperitoneal tumor that had been detected with ultrasound on a routine health check. She had no complaint except lumbar pain. Computed tomography revealed a heterogenous tumor located outside the right kidney which was enhanced gradually. Doppler ultrasound showed mild vascularity in the tumor. We performed tumorectomy and right nephrectomy because the tumor was adherent to the right kidney. The tumor was 16 x 11 x 7 cm in size and weighed 621 g. The histopathological diagnosis was malignant fibrous histiocytoma. The tumor was considered to have arisen from perirenal tissue.     

The radiation sensitivities of R3327-H and R3327-AT rat prostate adenocarcinomas

Dunning R3327-H and R3327-AT tumors growing subcutaneously in the flanks of Fischer X Copenhagen rats were irradiated with 137Cs gamma-rays at volumes of approximately 300 mm. The effects of various doses of radiation were estimated by measurements of subsequent tumor growth as well as by histological evaluation. The well-differentiated, hormonally-responsive R3327-H tumor was more radiosensitive than the anaplastic R3327-AT tumor. The reasons for this increased radiation sensitivity of the R3327-H tumor include a greater "apparent" radiation sensitivity of tumor cells and the absence of tumor hypoxia. The presence of hypoxic tumor stem cells was inferred from significant radiosensitization of tumor growth delay by 0.5 mg./gm. misonidazole and by a technique which utilizes radioactively-labelled misonidazole as a marker for hypoxic cells. The persistence of a mass of R3327-H tumor tissue after aggressive radiotherapy was not indicative of tumor cells. Furthermore, the rapid increase in volume of R3327-AT cells after aggressive radiotherapy was attributed to limited proliferation of tumor cells which were destined to ultimately die. Possible implications of these findings for the management of human prostatic adenocarcinoma are discussed.