Synchronous granular cell tumor of the bladder, endometrial carcinoma and endometrial stromal sarcoma

We describe a very rare case of synchronous granular cell tumor of the bladder, endometrial carcinoma and endometrial stromal sarcoma. A 55‐year‐old woman with a 4‐month history of genital bleeding was cytologically diagnosed with endometrial carcinoma. Imaging studies suggested concomitant bladder tumor with the possibility of direct invasion from endometrial carcinoma. Total abdominal hysterectomy with bilateral salpingo‐oophorectomy and transurethral resection of bladder tumor was performed. The bladder tumor comprised polygonal cells with abundant eosinophilic, finely granular cytoplasm, separated by collagenous tissue. Neither nuclear pleomorphism nor tumor necrosis was found. Immunohistochemical expression of neural markers of neuron‐specific enolase and S‐100 allowed the diagnosis of granular cell tumor (GCT) of the bladder. Microscopic examination of endometrium revealed endometrioid adenocarcinoma with squamous differentiation (EAC). Ill‐defined nodular lesion comprising endometrial stromal sarcoma (ESS) was accidentally found in myometrium. Postoperatively, the patient underwent radiotherapy. This is the first well‐documented case of synchronous triple tumors comprising GCT of the bladder, uterine EAC and ESS.     

A Study of Reflux Esophagitis in an Apparently Healthy Population

Abstract: To study reflux esophagitis in the general population, we reviewed the records of 64,171 apparently healthy Japanese adults, 48, 706 men and 15,465 women, who had undergone automated multiphasic health testing and services (AMHTS), a comprehensive routine medical health check, that includes double-contrast upper gastrointestinal roentgenograms. All subjects suspected of having gastrointestinal disease underwent a flexible fiberscopy as indicated. Reflux esophagitis was thus confirmed in 101 subjects. The prevalence of refla esophugitis was 0.20% among men and 0.04% among women (men vs. women p<0.001) and its frequency increased with age in both men (p<0.001) and women (p<0.05). Endoscopic classification according to the Savary-Miller criteria yielded 48, 27, 23, and patients in Stage I, II, III and IV, respectively. In this series, 49/101 (48.5%) of the esophagitis patients had concurrent upper gastrointestinal abnormalities. The incidence of heavy smoking and excessive drinking of alcohol was significantly higher in the patients with reflux esophagitis (p<0.001 and p<0.005, respectively) as compared with the normal population.     

Outcome analysis for conservative management of Peyronie''s disease

BACKGROUND: We retrospectively analysed the outcomes of conservative management of Peyronie's disease and determined the factors predicting successful outcome. METHODS: The study involved 31 patients with Peyronie's disease who were treated at our institute between 1985 and 2003. We assessed the efficacy of vitamin E for the improvement of the symptoms, and the factors which contributed to successful outcome with conservative management using multivariate analysis. RESULTS: There was no statistically significant difference in the relief rate between the vitamin E and no-medication groups. The overall estimated relief rate was 67.5% at 2 years from presentation. The multivariate analysis revealed plaque size to be the only significant factor predicting the relief from all symptoms in patients with conservative management. The rate was 100% in patients having a plaque size of 20 mm or smaller and 20.0% in those having a size of larger than 20 mm (P=0.005). CONCLUSIONS: We could not confirm the benefit of vitamin E for Peyronie's disease. Plaque size was the only significant factor predicting the relief from all symptoms. Patients with larger plaque might fail to respond to the conservative management.     

Blood Vessel Invasion in the Primary Site and Involved Lymph Nodes of Breast Cancer: Its Significance to Hematogenous Metastases

One hundred sixty-nine patients who had had radical mastectomywere investigated for blood vessel invasion in the primary tumorsites (TBVI); and 72 of these patients with regional lymph nodemetastasis were examined for blood vessel invasion within andin the vicinity of the involved lymph node (NBVI). Although distant metastases occurred more frequently in thepatients with blood vessel invasion in the tumor than in thosewith no blood vessel invasion, the differences were rather smallwithin respective negative and positive node metastasis subgroups. Analysis of blood vessel invasion in the involved lymph nodeshowed higher incidences of distant metastases in the subgroupswith positive blood vessel invasion in the lymph node than inthe subgroups with no such invasion; 42.1% 5s. 9.5% (negativeTBVI subgroup) and 47.4% 5s. 15.4% (positive TBVI subgroup). ^* This work was supported by a grant-in-aid for cancer researchfrom the Ministry of Health and Welfare.