Thymic cyst with elevated SLX levels in serum and cystic fluid]

A 24-year-old man was admitted to our hospital in June 1996 with complaints of anterior chest discomfort. Chest X-ray films on admission showed an abnormal mediastinal shadow with well-defined margin. Chest X-ray examinations about 6 weeks earlier had not detected any abnormalities. Laboratory tests on admission showed a high serum concentration of Siaryl Lewis X-i antigen (SLX). A computed tomographic scan of the chest showed a large (6 x 6 x 12 cm) homogeneous mass in the right anterior mediastinum. The mass was removed completely and histologically diagnosed as a thymic cyst. Biochemical analysis of fluid from the cyst revealed remarkably high levels of SLX, CA 19-9, and CEA. In immunohistochemical studies, epithelial cells from the cystic walls stained positive for SLX, CA 19-9, and CEA. After the operation, the level of serum SLX returned almost to normal.     

A case of thymic cyst with elevated CEA in the cystic fluid

A 66 year-old male was admitted on October 31, 1987 because his chest X-ray film revealed a well-defined round shadow in the right inferior mediastinum. Chest CT showed a large homogenous mass in the right anterior mediastinum. The mass was identified as a cyst on echogram. Surgical removal of the cyst was done with right thoracotomy. The cyst was 15 cm in size and contained about 500 ml of grayish white fluid. Pathological examination showed a thymic cyst and no malignancy. Biochemical analysis of the cystic fluid revealed increased CEA value of 223.2 ng/dl in spite of normal CEA level in serum. CEA was demonstrated in the epithelium of the surface and Hassall's corpuscles by PAP stain. It is conceivable that this elevated CEA observed in the cystic fluid might be correlated with CEA-like antigens such as NCA, NFA and BGP.     

A case of mediastinal teratoma with elevated serum tumor marker levels]

A 27-year-old man complaining of cough was admitted to our hospital because of a giant mediastinal tumor on the chest radiograph. Chest CT and MRI revealed a giant polycystic mediastinal tumor. Chest radiographs on admission showed left pleural effusion due to perforation of the cyst. Laboratory data showed high serum and pleural fluid concentrations of CA 125, CA 19-9, SLX and others. The mediastinal mass was resected and diagnosed pathologically as a mature teratoma. It is reported that patients with mediastinal teratomas often have pleural fluid as a result of self-digestion by pancreatic enzymes, and some mediastinal teratomas have high serum tumor marker levels. We suspected that the high serum tumor marker levels in our case were caused by the high concentrations of tumor markers in the pleural fluid. We suggest that serum tumor marker levels may be useful in the preoperative differential diagnosis of anterior mediastinal cystic tumors.     

A case of bronchogenic cyst in the subdiaphragmatic region]

A surgical case of subdiaphragmatic bronchogenic cyst is presented. A 44-year-old female was admitted because of a radiological abnormality of a mass lesion at the left diaphragm. Laboratory examinations did not reveal any significant abnormalities. Chest CT revealed the mass lesion with smooth margin, whose density was higher than that of water. Both MRI T1-weighted and T2-weighted images showed a relatively high intensity of the mass. On endoscopic ultrasonography, the lesion consisted of a thin wall with highly echoic contents, and its shape changed during respiratory movement. On the basis of the findings of these imaging modalities, the diagnosis was considered to be bronchogenic cyst. The mass was resected via laparotomy, and its histologic diagnosis was bronchogenic cyst containing turbid fluid. Subdiaphragmatic bronchogenic cyst is reported rarely. The characteristic findings of CT, MRI and endoscopic ultrasonography enable the diagnosis of a cyst with turbid contents.     

腹膜后支气管源性囊肿1例报告

支气管囊肿（bronchogenic cysts,BC）是源于胚胎早期发育过程中原始前肠异常发育所致的一种少见的先天性囊性疾病^（[1]）。具体的发病机制尚不明确。任何由原始胚胎前肠发育而成的器官（食管、胃、十二指肠上部、肝脏、胰腺和胆囊）或附近均可发生此类疾病,通常好发于胸腔（特别是后纵隔）和肺实质^（[2]）,也可发生于胸腔外。而腹膜后支气管源性囊肿（retroperitoneal bronchogenic cyst,RBC）是极其罕见的,     

罕见腹膜后支气管囊肿1例

支气管囊肿属于先天性病变, 是一种良性的囊性病变。通常发生在胸部, 在腹膜后极为罕见。术前诊断困难, 超声内镜的诊断优势越来越显著, 最终诊断依赖于组织病理学检查。本文报道了1例超声内镜辅助诊断腹膜后支气管囊肿, 旨在帮助临床医师提高对该疾病的认识。     

A case of malignant pleural mesothelioma with infectious bronchogenic cyst

A 47-year-old man was admitted with a cough on January 4, 1986. A chest X-ray film showed a mass shadow in the left lower lung, which was revealed to be a bronchogenic cyst by CT scanning and ultrasonography. Thoracotomy was performed on March 3, 1986 because cytologic tests on the fluid in the cyst suggested malignancy. A cyst, two tumors on the diaphragm and pleural thickening were revealed. Microscopic examination showed a benign bronchogenic cyst and a mixed-type malignant mesothelioma. In spite of chemotherapy (ADR, Cis-DPP, 5-fluorouracil) and immunotherapy (OK-432, PSK), the pleural thickening progressed, as was demonstrated by CT scanning and ultrasonography. Although cardiac tamponade due to invasion by the malignant mesothelioma developed, this was improved by cardiocentesis. The patient died of pneumonia on March 28, 1987. We studied the concentration of mineral fibers in lung and tumor tissues of this case by Energy Dispersive X-ray Analyser because asbestos or non-asbestos inorganic fibers might cause malignant mesothelioma. This case of malignant pleural mesothelioma accompanied by a bronchogenic cyst is very rare.     

A case of Heerfordt's syndrome with an elevated serum TNF alpha]

A 27-year old man who had developed uveitis, swelling of the right parotid gland, right facial nerve paralysis and fever, was admitted to our hospital. A chest X-ray film showed bilateral hilar lymphadenopathy. Serum levels of angiotensin-converting enzyme and lysozyme were elevated. Histological findings of transbronchial lung biopsy specimens showed non-caseous epithelioid cell granulomas. Therefore, sarcoidosis was diagnosed. This case also fulfilled the criteria for Heerfordt's syndrome. Adiministration of prednisolone (PSL) initially improved the patient's symptoms, but rapid tapering of PSL worsened his symptoms. Thus, administration of high-dose PSL for a long time was required. He also showed elevated levels of TNF alpha in serum.     

Markedly elevated serum neopterin levels in patients with hemophagocytic histiocytosis]

The authors measured serum neopterin by HPLC in 3 patients with hemophagocytic histiocytosis (HH) with DIC which occurred during the clinical course of T cell malignant lymphoma (T-ML). Extremely high levels of serum neopterin (754.3 +/- SD 467.3 pmol/ml) were found in the patients, about 200, 13 and 10 times higher than that of normal subjects, non-HH DIC patients and non-HH/DIC T-ML patients. Moreover their serum soluble interleukin-2 receptor levels were markedly elevated. These results indicate that markedly raised serum neopterin would be a sensitive parameter for activation of the mononuclear phagocyte system closely associated with T-cell activation and may serve as a useful diagnostic marker for HH.     

Endosonographic and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours: A multicentre case series

BackgroundPancreatic neuroendocrine tumours are uncommon neoplasms which may rarely be cystic. Differentiation from other more common cystic neoplasms may be difficult.AimsTo describe the morphologic, cytologic, and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours.MethodsRetrospective analysis of consecutive patients referred for endosonographic evaluation of pancreatic cysts at four centres.Results27 patients (12 males) with cystic pancreatic neuroendocrine tumours were identified. Prior to endosonography, this tumour was suspected in only 2 patients based on presenting symptoms (7.4%). The median cyst size was 35 mm (range 8–80 mm). Wall thickening was identified in 13 cases. The median carcinoembryonic antigen level was 1.25 (range 0.6–500). Fine needle aspiration cytology in 17 of 24 patients confirmed neuroendocrine tumour (71%). In 8 of 9 patients who had needle targeting of the cyst wall, cytology was consistent with neuroendocrine tumour (88.9%). 18 patients underwent surgical resection.ConclusionsCystic pancreatic neuroendocrine tumour was rarely suspected, including by cross-sectional imaging. Wall thickening was identified in approximately half of cases on endosonography. Cyst fluid was typically non-viscous with very low carcinoembryonic antigen levels. Targeting the wall during fine needle aspiration had a high diagnostic yield and should be performed.     

A paraesophageal bronchogenic cyst with esophageal communication

Paraesophageal bronchogenic cysts are a rare developmental anomaly of the upper digestive tract. Although often asymptomatic, their growth can cause severe symptoms and complications because of the location. The diagnosis is difficult and is mostly by histopathologic findings after extirpation of the cyst. The authors present a case of a paraesophageal bronchogenic cyst, of typical histologic structure (ciliated epithelium and hyaline cartilage) connected with the esophageal lumen by a narrow canal composed of stratified squamous epithelium. According to the available literature, only three cases of bronchogenic paraesophageal cysts with esophageal communication have been reported.     

A case of coexistent bronchogenic carcinoma with pulmonary tuberculosis]

A 79-year-old housewife complaining of shortness of breath presented with a LUL mass lesion on chest roentgenogram. Bronchofiberscopic biopsy and curettage revealed adenocarcinoma as well as acid-fast bacilli of Gaffky-4. Further investigations showed increased ESR, CRP levels and positive RF. PPD skin test was positive measuring 55 x 43 mm. A left upper lobectomy with mediastinal lymph node dissection was performed. The mass was in S1+2 and measured 2.7 x 2.5 x 1.5 cm. Histologically caseaous necroses and spotted granulomas of tuberculosis were surrounded by bronchioloalveolar cell carcinoma. Recent discussion concerning the simultaneous occurrence of pulmonary tuberculosis and bronchogenic carcinoma suggests a higher coexistence of both diseases. However, the coexistence of active tuberculosis with carcinoma in the same region, as in our case, is quite rare and suggests an etiological closer relationship between both diseases.     

A case of nephrotic syndrome associated with bronchogenic carcinoma]

A 58-year-old fisherman was admitted because of an abnormal chest X-ray shadow on the right side. Bronchoscopic examination revealed tumor of right B7. Transbronchial biopsy showed squamous cell carcinoma. He was treated with four courses of CDDP and PEP. Two years later, he developed nephrotic syndrome and relapse of lung cancer. Proteinuria and pedal edema continued. Renal biopsy revealed the characteristic light and immunofluorescent microscopic features of membranous nephropathy. Oral administration of low dose etoposide resulted in reduction of the carcinomatous lung lesion and a decrease in proteinuria as well as pedal edema.     

A case of desmoplastic malignant mesothelioma with elevated serum CYFRA 21-1]

A 70-year-old woman was admitted to our hospital for medical evaluation of a right side pleural effusion, which was pointed out at another hospital. Chest CT revealed a right pleural effusion with diffuse and irregular pleural thickening. Percutaneous pleural biopsy showed hypocellular collagenous tissue without malignant cells. Though she received antituberculosis therapy, the pleural thickening progressed and the serum CYFRA 21-1 level was elevated. Chest pain and dyspnea appeared, and she was readmitted. However, pneumonia was present as a complication, and she died. At autopsy, the right pleura was thickened and invasion of the lung and the chest wall was observed. Microscopic findings showed increased amounts of hyalinized collagen fibers forming a storiform pattern. At the tumor foci, atypical cells with distinct nucleoli were observed. Desmoplastic malignant mesothelioma, which is rarely reported in Japan, was diagnosed.