Endoscope-Assisted Microsurgical Removal of an Epidermoid Tumor within the Cavernous Sinus

Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient''s headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.     

Epidermoid cyst of the spleen: a cytokeratin profile with comparison to other squamous epithelia

The stratified squamous epithelium of a splenic epidermoid cyst was studied with a battery of monoclonal antibodies to cytokeratin (CK) proteins. CKs 10 and 11 were found in the suprabasal layers of the stratified squamous epithelium, while staining for CK 13 was focal or diffuse throughout. CKs 18 and 19 decorated individual squamous cells or stained the entire thickness of the epithelium. These results were compared with those previously obtained by us in stratified squamous epithelia of ovarian mature cystic teratoma, fetal epidermis, adult epidermis and squamous metaplasia in a peritoneal cyst. From these comparisons it emerges that the epidermoid splenic cyst is either of teratomatous derivation or originates from inclusion of fetal squamous epithelium. Squamous metaplasia of mesothelium or inclusions of mature squamous epithelium appears to be an unlikely source of origin of these cysts.     

Peptide Tyrosine Tyrosine-positive Ovarian Carcinoid Tumor Arising from a Dermoid Cyst

A case of ovarian carcinoid tumor of the trabecular type is presented. The small carcinoid tumor was found incidentally in a resected dermoid cyst. Histologically, the tumor was surrounded by a smooth muscle layer with focal stromal invasion. Non carcinoid papillary mucosa and a few small glands, simulating the mucosa of the fallopian tube and remnant miillerian glands, respectively, were also present adjacent to the carcinoid tumor and enclosed by the same smooth muscle layer. The tumor cells revealed argyrophilia, and were positive for peptide tyrosine tyrosine (PYY) in the cytoplasm and for CEA in part of the luminal surface. This case was considered to be a rare ovarian carcinoid tumor arising from a dermoid cyst, without association of struma ovarii. PYY may be a potential marker for determining the histogenesis of ovarian carcinoid tumors.     

伴有破骨细胞样巨细胞的胰腺未分化癌1例报道及文献复习

目的：探讨伴有破骨细胞样巨细胞的胰腺未分化癌的临床病理特点.方法：观察1例伴有破骨细胞样巨细胞的胰腺未分化癌的形态学特征,并进行免疫组织化学染色.结果：伴有破骨细胞样巨细胞的胰腺未分化癌肿瘤主要有两种细胞组成,一种为单核细胞,分为组织细胞样单核细胞和梭形或多形性瘤细胞两型;另一种为多核巨细胞,分为非肿瘤性的破骨细胞样巨细胞和瘤巨细胞两型.免疫组织化学研究显示,这两种细胞Vimentin均阳性,均不表达cytokeratin（AE1/AE3）,CK5/6,CEA,CgA;其中破骨细胞样巨细胞、组织细胞样单核细胞CD45,CD68阳性,而瘤巨细胞和梭形瘤细胞阴性.结论：伴有破骨细胞样巨细胞的胰腺未分化癌是一种罕见恶性肿瘤,可能为胰腺未分化癌的一个亚型.诊断需与胰腺恶性纤维组织细胞瘤、转移的骨巨细胞瘤或黑色素瘤等鉴别.     

Basal cell carcinoma arising from a keratinous cyst of the skin: a case report and review of the literature

Although keratinous cysts of the skin are frequently seen, malignant transformation is a rare event. Here we report a case of basal cell carcinoma arising in the wall of the keratinous cyst, and we review 12 other such Japanese cases.     

Hepatocellular carcinoma arising from ectopic liver tissue in the spleen producing insulin-like growth factor II

We report a case of splenic tumor associated with severe hypoglycemia. The patient was a 69-year-old man with a large splenic tumor. He had suffered from relapsing hypoglycemic attacks and the lowest serum glucose level (4 mg/dl). He died 34 months after the onset of symptoms of left abdominal pain. Autopsy revealed large tumors in the spleen, 3 medium sized tumors in the lungs, and several small tumors in the liver. Microscopic studies of the splenic tumors revealed a hepatocellular carcinoma which showed a strongly positive reaction against anti-PIVKA-II and anti-“hepatocyte” antibodies. Several bile ductules thought to be heterotopic remnants of the liver tissues were found in the capsule of the spleen, adjoining the splenic tumor. It was suggested that the tumor originated from one of these ductules. Electron microscopic analysis showed numerous endocrine-like granules of every tumor cell, and 87-165 times stronger mRNA expression of insulin-like growth factor-II was measured in the tumor tissues when compared with normal liver tissue. Owing to these results, we believe that this is the first report of hepatocellular carcinoma that had developed from a liver tissue in the spleen.     

Solid and Cystic Tumor of the Pancreas in an Adult Male

A solid and cystic tumor (SCT) was located at the head of the pancreas in a 43-year-old Japanese male, and pancreatoduodenectomy was performed on the suspicion of papillary carcinoma or cystadenocarcinoma of the pancreas. The lesion, which measured 4.5 X 4.5 X 4.0 cm, was clearly demarcated by connective tissue. The cut surface showed solid grayish-white areas with central cystic degenerative changes. The solid areas consisted of small round cells proliferating in a small solid or a pseudopapillary pattern. The tumor cells partially invaded the surrounding normal pancreatic parenchyma. Immunohistochemical studies revealed positive staining for alpha-1-antitrypsin and neuron-specific enolase, but no staining for known pancreatic hormones. Moreover, ultrastructural studies showed the absence of zymogen granules and the presence of anullate lamellae and neurosecretory granules. On the basis of these findings, a diagnosis of SCT of the pancreas was established. In order to clarify the histogenesis and biological behavior of the tumor, it is necessary to accumulate and analyze similar cases, an endeavor which in turn will contribute to the successful management of this disease. Acta Pathol Jpn 41: 763-770, 1991.     

A Small Aneurysmal Bone Cyst Restricted to the Cortical Bone of the Femur Resembling So-called Subperiosteal Giant Cell Tumor or Subperiosteal Osteoclasia

We report a 16-year-old Japanese girl with a cystic lesion restricted to the cortical bone under the periosteum of the diaphysis of the left femur. Roentgenograms showed a long, oval translucent lesion in frontal view and an eccentric erosive lesion in lateral view. Computed tomography showed a distinct intracortical lesion. The lesion, which was excised en bloc , measured 3×2×2 cm. The outer layer of the cortical bone was eroded eccentrically. From the margin of the eroded bone, thin fragile bony tissue and preserved periosteum extended like the roof of a dome. Multicystic structures, filled with blood, were lined with fibrous granulation and occasional giant cells. Histologically, this lesion falls within the category of aneurysmal bone cyst. However this case is of a rare type, since the lesion was relatively small, and showed a very specific intracortical location, in marked contrast to typical aneurysmal bone cyst. Additionally, this lesion is similar to so-called subperiosteal giant cell tumor or subperiosteal osteoclasia described in the literature. Acta Pathol. Jpn. 39: 539∼544, 1989.     

Bronchogenic cyst in the hepatogastric ligament masquerading as an esophageal mesenchymal tumor: a case report

Lesions occur in hepatogastric gap is common, but most of these lesions are from stomach, lower esophagus and pancreas lesions extending or transferring to the gap. Lesions occurred in the hepatogastric ligament are rare, especially bronchogenic cysts in the hepatogastric ligament. So far, there were no relevant cases reported. Here, we report a case of bronchogenic cyst in the hepatogastric ligament that masquerading as an esophageal mesenchymal tumor. A 24-year-old young man presented with abdominal bloating was diagnosed as esophageal mesenchymal tumor in previous hospital by gastroscopy, endoscopic ultrasonography (EUS) and computed tomography (CT) examination. For the sake of endoscopic submucosal dissection (ESD), the man was transferred to our hospital. During surgery, we found no lesions in lower esophagus, but external pressure ridge lesions in the distal esophagus right side wall. Then laparoscopic surgery and pathology confirmed as bronchogenic cyst in the hepatogastric ligament. We report what is, to the best of our knowledge, the first case of a bronchogenic cyst in the hepatogastric ligament masquerading as an esophageal mesenchymal tumor.     

Epithelial inclusion cysts in an intrapancreatic accessory spleen

A 38 year old male underwent distal pancreatectomy for benign cystic pancreatic tumor. The pancreas tall contained a 2.3 x 2.1 cm accessory spleen associated with multiple epithelial inclusion cysts. The cysts were of varying sizes (max: 1.4 cm), lined by non-keratinizing squamous epithelium with a few mucin-producing cells, and filled with serous material. This is the fifth reported case of so-called'epidermoid'cysts in the intrapancreatic accessory spleen.     

Crystals and Alpha-1-Antitrypsin-Reactive Globoid Inclusions in an Islet Cell Tumor of the Pancreas

An islet cell tumor of the pancreas with unusual light microscopic, ultrastructural, and immunocyto-chemical features is reported. In addition to secretory granules and positive immunostaining for pancreatic polypeptide, the tumor contained globoid intracytoplasmic inclusions by light and electron microscopy, which correlated with a positive immunoreaction for alpha-1-antitrypsin, and Reinkelike crystals.     

老年糖尿病人胰岛A,B细胞功能与血脂变化

对１９９２年１月～１９９４年１月收治的老年糖尿病２１０例，作者观察了胰岛Ａ、Ｂ细胞功能与血脂及血粘度的变化。老年ＮＩＤＤＭ的口服葡萄糖耐量试验各时相血糖值均显著增高（Ｐ＜０．０１）；胰岛素释放试验及Ｃ肽释放试验中，除空腹胰岛素及Ｃ肽值正常外，其余各时相值均明显降低，但其中有２０例呈高胰岛素血症（９．５％）；胰高糖素释放试验中，空腹与１８０分钟的胰高糖素值正常，其余各时相值均明显升高（Ｐ＜０．０１）。老年ＮＩＤＤＭ的ＧＨｂＡ＿（１ｃ）及ＧＨｂＡ＿１值显著增高（Ｐ＜０．０１），血胆固醇，甘油三脂，低密度脂蛋白，极低密度脂蛋白和全血粘度平均值均显著增高（Ｐ＜０．０１）．而高密度脂蛋白及血浆粘度等无明显变化。老年ＮＩＤＤＭ胰岛Ａ、Ｂ细胞功能失调，并经常有高血脂及高粘血症，少数有高胰岛素血症，容易并发心、脑、肾、眼或足的并发症，因此治疗老年糖尿病时，还应加强治疗高血脂症及高粘血症，以减少致残或死亡。     

来源于胚胎干细胞的嵌合体小鼠自发性肿瘤观察

目的观察胚胎干细胞（ES细胞）囊胚腔注射的方法构建嵌合体小鼠自发性肿瘤。方法连续80周每周观察嵌合体小鼠的肿瘤发生情况,选取同龄相关品系小鼠各10只作为对照组。处死发生肿瘤的小鼠并且病理学检查,提取肿瘤组织的基因组DNA,用PCR方法检测性别决定区（SRY）基因判断肿瘤的品系来源。结果13只嵌合体小鼠中有3只（全为雌性）发生自发性肿瘤,分别为腺癌、皮下恶性畸胎瘤、淋巴瘤。肿瘤细胞来源于注射的ES细胞而非受体囊胚。对照组野生型小鼠未见肿瘤发生。结论ES细胞囊胚腔注射的方法构建嵌合体小鼠具有较高的自发肿瘤发生率,可作为自发性肿瘤动物模型。     

Retrospective Assessment of the Validity of Robotic Surgery in Comparison to Open Surgery for Pediatric Choledochal Cyst

Purpose

We evaluated the validity of robotic surgery (RS) for pediatric choledochal cyst (CC) in comparison to open surgery (OS).

Materials and Methods

From January 2009 to April 2013, clinical data from 79 consecutive pediatric patients with CC, who underwent RS (n=36) or OS (n=43) performed by a single pediatric surgeon, were analyzed retrospectively.

Results

In the RS group, the age of the patients was significantly older, compared to the OS group. Operation and anesthesia times were significantly longer in the RS group than the OS group. Fluid input rates to maintain the same urine output were significantly smaller in the RS group than the OS group. The American Society of Anesthesiologists (ASA) physical status, length of postoperative hospital stay, and the incidence of surgical complications did not differ significantly between the two groups.

Conclusion

Although early complications could not be avoided during the development of robotic surgical techniques, RS for pediatric CC showed results comparable to those for OS. We believe that RS may be a valid and alternative surgery for pediatric CC. After further development of robotic surgical systems and advancement of surgical techniques therewith, future prospective studies may reveal more positive results.     

内镜下经下鼻道开窗治疗上颌窦囊肿的临床研究

目的：观察内镜下经下鼻道开窗治疗上颌窦囊肿的治疗效果。方法对2012年4月~2013年10月,我院收治的单纯性上颌窦囊肿患者43例,应用内镜下经下鼻道开窗对其进行治疗,并观察其治疗效果。结果平均随访1年,未见1例患者复发。结论内镜下经下鼻道开窗治疗单纯性上颌窦囊肿疗效好,不良反应少。     

Carcinoid tumor arising in a duplication cyst of the duodenum

Reported herein is a case of carcinoid tumor arising in a duplication cyst of the duodenum in a 34-year-old woman. Ultrasonography at a health check-up revealed a 10 cm cystic mass located in the retroperitoneum adjacent to the third portion of the duodenum. Macroscopically, it had a smooth surface without communication with other organs and was filled with brownish necrotic fluid. More than half of the inner wall was occupied by a white, irregular, and solid nodule, which protruded into the lumen. The nodule was diagnosed as a carcinoid tumor invasive to the deep muscular layer. The non-neoplastic cyst wall had bowel structures including mucosa, submucosa and double layers of smooth muscle, indicating that the lesion was a duodenal duplication cyst. Most of the mucosa was eroded by marked inflammation. The remaining mucosa consisted of various types of epithelium, the major type having the nature of primitive gastric mucosa. Of interest was the presence of hamartomatous components in the wall. Furthermore, the non-neoplastic mucosal lining cells around the carcinoid tumor expressed neuroendocrine antigens and had minimal proliferative activity, suggesting that part of the cyst wall provided a microenvironment for accelerated differentiation of epithelial cells to an endocrine phenotype and transformation to neoplasia.     

Accessory cells in physiological lymphoid tissue from the intestine: an immunohistochemical study

We report a study of the organization of accessory cell populations, in normal mucosal lymphoid tissue from small intestine (8 cases), large intestine (6) and appendix (9) using a panel of monoclonal antibodies and polyclonal antisera in paraffin-embedded tissue. Two populations were identified in dome areas, one positive for acid cysteine proteinase inhibitor and HLA class II (WR18) only and the second positive for S-100 protein, CD68, and WR18 and negative for acid cysteine proteinase inhibitor and factor XIIIa. Superficial colonic mucosal and small intestinal villous tip macrophages stained positively with CD68 and WR18 only, while deeper cryptal and submucosal populations exhibited additional positivity for factor XIIIa, but both populations were negative for acid cysteine proteinase inhibitor and S-100 protein. Germinal centre macrophages were positive for CD68, WR18 and acid cysteine proteinase inhibitor and negative for factor XIIIa, and S-100 protein. T zone dendritic cells included a population which stained positively for S-100 protein, WR18 and were negative for factor XIIIa, CD68 and acid cysteine proteinase inhibitor, an immunophenotype typical of interdigitating dendritic reticulum cells. This distribution of phenotypically identifiable accessory cell subpopulations was apparent at all three sites examined. We suggest that the specialized subpopulations of dendritic cells staining for S-100 protein and for acid cysteine proteinase inhibitor which are restricted to the dome areas, may have a potential role in the transfer of antigen across the epithelium to the germinal centres, while factor XIIIa appears to identify a tissue macrophage population with a potential role in stromal modulation distant from direct antigen challenge.     

Exophytic cavernous hemangioma arising from the right ventricle: Report of a rare case

Cardiac hemangioma is relatively rare, accounting for approximately 1–3% of all primary heart tumors. This benign tumor may be an incidental lesion, but can also cause arrhythmias, pericardial effusion, congestive heart failure or outflow obstruction. We report a rare case with exophytic cardiac hemangioma arising from the right ventricle. Echocardiography showed an approximately 40 mm round protruding mass on the anterior wall of the right ventricle. Cardiovascular magnetic resonance demonstrated isointense and hyperintense signals on T1- and T2-weighted images, respectively. These imaging studies suggested a pericardial cyst. Perioperative findings indicated a globular, exophytic mass, vascular in nature, arising from the right ventricle. The lesion was resected directly, and the space left by defect in the right ventricular wall was covered with a bovine pericardial patch. Cardiac hemangiomas are generally endoluminal tumors, but we must keep in mind that the differential diagnoses include various pericardial lesions by medical images.