An unusual case of angiosarcoma

A case of angiosarcoma arising in an arm affected by chronic lymphoedema and treated initially by intraarterial cytotoxic perfusion chemotherapy and radiotherapy is described. The patient is still alive twenty years after presentation. This represents the longest reported survival for this condition.     

An autopsy case of adult neuroblastoma

The patient was a 31-year-old man with neuroblastoma of the right adrenal gland, which presented at first as metastatic spinal epidural tumor. Catecholamine and its products in the blood and urine and neuron-specific enolase in the blood were increased. Six months after right adrenectomy followed by chemotherapy, the patient died due to cachexia. Autopsy revealed widespread metastasis. By electron microscopy, the centers of the Homer-Wright rosettes were occupied by neuropil-like structures consisting of a number of cytoplasmic processes of tumor cells, but no cored vesicles were found either in the processes or perikaryons of the tumor cells.     

An autopsy case of quadruple carcinoma

Discussed is a case of male cancer patient whose initial lesion was a transitional cell carcinoma of the left renal pelves. A bladder tumor (TCC) was subsequently found 6 months after a left nephro-ureterectomy. After treatment of these tumors, the patient remained well for 8 years. An inoperable lung cancer (squamous cell carcinoma) then developed 6 months prior to death. The patient died of an aneurysmal rupture of the ascending aorta. At autopsy, 2 latent carcinomas were identified, one in the prostate and the their in the thyroid gland. If the renal pelvic and the bladder tumors and the lung carcinomas were all independent, this would seem to be a case of six-fold carcinoma.     

An autopsy case of malignant lymphoma of the pancreas

Case reports of malignant lymphoma of the pancreas are extremely rare. We experienced a 36-year-old man with malignant lymphoma involving the pancreas associated with obstructive jaundice, confirmed by autopsy. It is very difficult to differentiate between pancreatic carcinoma and pancreatic malignant lymphoma. Age, icterus, diffuse pancreatic enlargement, pathological findings and tumor markers may be useful in suggesting lymphoma. Trials of positive biopsy, appropriate radiotherapy and chemotherapy are necessary in patients who may have malignant lymphoma of the pancreas.     

An autopsy case of plasmacytoma of the thyroid gland

An autopsy case of a 75-year-old woman with plasmacytoma of the thyroid gland is presented. There were no toxic symptoms and no abnormal serum protein. On autopsy, a nodule measuring 5.5 X 4.5 X 8 cm was found in the left lobe of the thyroid gland. No myeloma lesions were found in the bone marrow or in other organs. Histologically, the marginal area of the nodule was occupied by typical plasmacytoma, whereas necrotic tissues resembling anaplastic carcinoma were present in the central portion. Chronic thyroiditis was not associated. Immunohistochemically, only the kappa-light chain was demonstrated in the cytoplasm of the tumor cells.     

An autopsy case of alveolar rhabdomyosarcoma of the prostate

A 48-year-old man who was diagnosed as undifferentiated malignant tumor by needle biopsy was treated with irradiation and anticancer drugs. Autopsy revealed alveolar rhabdomyosarcoma of the prostate with marked infiltration into periprostatic tissue and distant metastasis. Histological diagnosis was performed by special staining as well as the immunoperoxidase technique with myoglobin. This was the first case of alveolar rhabdomyosarcoma of the prostate in Japan.     

An autopsy case of extra-adrenal malignant pheochromocytoma

An autopsy case of an extra-adrenal malignant pheochromocytoma in a 34-year-old woman is reported. On laparotomy, many advanced stage malignant tumors originating from the paraganglia along the abdominal aorta were found to have invaded the lumbar vertebrae. After a partial resection, Co60 radiation therapy of the paraganglia was instituted, as well as of the metastatic lesions, with little effect. It was found that alpha-methyl-tyrosine was effective in controlling the plasma catecholamine, but had to be discontinued because of an untoward effect (anxiety). The patient subsequently developed intractable hypertension and a paralytic ileus from excess catecholamine secretion. As an alpha 1 adrenergic blocker was not effective, we had to use large doses of phentolamine to control these complications. Despite various intensive therapies, however, the patient died of heart failure resulting from 4 years of severe hypertension.     

An autopsy case of primary splenic hemangiosarcoma

A 28-year-old woman was admitted six months before her death because of abdominal pain, anemia and hepatosplenomegaly. Clinical diagnosis by biopsy examination was primary hepatic angiosarcoma. The autopsy revealed about 700 ml of bloody ascites. The spleen weighed 510 g, and was completely replaced by dark grayish-red tumors. The enlarged liver was 6,560 g and revealed multiple tumor nodules. Microscopically, the tumor cells formed irregular vascular spaces. Factor VIII-related antigens were stained in the tumor cells. Zonula adherens was observed also by electron microscopic observation.     

An autopsy case of malignant mesenchymoma of the diaphragm

An autopsy case of a huge tumor in the right thorax is reported. A 71-year-old man complained of dyspnea and died after three months of hospitalization. The tumor, consisting of a circumscribed mass measuring 24 X 24 X 8 cm and weight 3.7 kg, originated from the right diaphragm and had no metastasis. Histologically, the tumor comprised multiple mesenchymal elements of fibrosarcoma, rhabdomyosarcoma, osteosarcoma and chondrosarcoma, and there was no distinct border between these different components. This tumor fulfills the criterion of malignant mesenchymoma (Stout). The histogenesis of the tumor is discussed with a survey of literature.     

An autopsy case of malignant retroperitoneal paraganglioma

A case of an extra-adrenal malignant paraganglioma of the retroperitoneum is reported. A 33-year-old woman with a complaint of a dull pain in the right thigh was admitted. A CT scan revealed a large retroperitoneal mass situated between the right kidney and the aorta. A biopsied specimen of the right femur uncovered a metastatic focus of a paraganglioma. Subsequent chemotherapy and irradiation ultimately proved ineffective, and the patient died at the age of 37. Autopsy revealed a retroperitoneal mass 11 X 9 X 4 cm, and its metastatic foci in the vertebrae, ribs, sternum, and liver. Six cases of extra-adrenal malignant paragangliomas of the retroperitoneum that have been reported in Japan also are briefly reviewed.     

An autopsy case of metastatic thyroid tumor

In a survey of the thyroid glands of 621 patients with terminal malignant tumors, 50 (8.1%) were found to be associated with metastatic tumors. Examination of routine autopsy materials revealed this association in 11 out of 269 cases (4.1%); observations using multiple sections showed in this association 39 of 352 (11.1%) cases. The primary cancer sites most commonly associated with metastasis to the thyroid gland were the breast (8 of 25 cases, 32.0%), the lung (13 of 65. 20.0%), and the esophagus (3 of 16, 18.8%). Morphological observations showed the formation of regional nodules in 13 cases, diffuse infiltration into the whole thyroid gland in 17 and intravascular embolism alone in 20 patients. There changes were inferred to be due to hematogenous metastases.