Small multicentric pancreatic carcinoma usefully diagnosed by positron emission tomography.

Pancreatic carcinoma has a poor prognosis, and early detection is essential for potentially curative resection. Despite a wide array of diagnostic tools, pre-operative detection of small pancreatic carcinomas is difficult. We report a case of pancreatic carcinoma that was bicentric and small. The head mass was diagnosed by computed tomography (CT), while the tail mass, which was suspected but indeterminate on CT, was diagnosed by positron emission tomography (PET). Thus, total pancreatectomy was performed. The PET results prevented our patient from undergoing tail mass biopsy, multiple surgeries and non-curative operation.

Psoas abscess and bacterial peritonitis caused by urinary tract infection in a patient of liver cirrhosis and diabetes mellitus.

Prognosis of patients with diabetes mellitus or liver cirrhosis can be worsened by the development of a variety of infectious diseases. We describe a case of psoas abscess and bacterial peritonitis in a 58-year-old woman with type C liver cirrhosis and diabetes mellitus hospitalized after having an elevated temperature caused by urinary tract infection for 2 months. The cirrhosis had not been treated and daily self-administration of insulin had been discontinued for the previous 5 months. On day 2 of hospitalization, vomiting and decreased blood pressure developed. Abdominal computed tomography scan revealed ascites, pneumoperitoneum, and psoas abscess. Laparotomy revealed psoas abscess and bacterial peritonitis without gastrointestinal perforation and psoas abscess perforation. Surgical drainage of the abscess and peritoneal cavity was performed. Immediately after the operation, upper gastrointestinal bleeding, shock, hypoglycemia, and metabolic acidosis developed, followed by hepatic failure, renal insufficiency, and cerebral dysfunction. Death occurred on postoperative day 19. Upon autopsy, bacterial peritonitis residue of psoas abscess, and urinary tract infection were confirmed. We surmise that untreated liver cirrhosis and diabetes mellitus is a risk for urinary tract infection that may spread in iliopsoas and free peritoneal space.

Ovarian large cell neuroendocrine carcinoma.

Ovarian large cell neuroendocrine carcinoma (LCNC) is a rare disease that is commonly associated with a surface epithelial and germ cell neoplasm component. A 46-year-old woman presented with a pelvic mass measuring 15 cm in diameter. She underwent an exploratory laparotomy with resection of the pelvic mass. Diffuse and nodular intra-abdominal disseminations were observed. Stage III LCNC associated with squamous differentiation alone of the right ovary was diagnosed. The patient died of progressive disease 4 months postoperatively despite paclitaxel and carboplatin therapy. Ovarian LCNC associated with squamous differentiation component alone has never been reported, but its prognosis may be poor.

Effects of neonatally administered diethylstilbestrol on induction of mammary carcinomas induced by 7, 12-dimethylbenz(a)anthracene in female rats.

Various doses of diethylstilbestrol (DES) were administered to rats once at birth. Thereafter, at 50 days after birth, the rats in all groups were given 10 mg 7, 12-dimethylbenz[a]anthracene (DMBA) and undergone necropsy at 300 days after birth. The incidence of mammary carcinomas (MCs) were 50, 54, 91, 39, 19% at 175 days after birth, and 77, 87, 100, 85, 75% at necropsy in the 0, 0.1, 1, 10, 100 microg groups, respectively. The incidence of rats without corpus luteum were 0, 0, 0, 30, 100% at 50 days after birth, and 0, 40, 53, 93, 100% at necropsy in the 0, 0.1, 1, 10, 100 microg groups, respectively. Observation of the whole mount specimens showed a higher number of terminal end buds (TEBs) in the 1 microg group and a lower number in the 100 microg group compared with the control at 50 days after birth. It suggested that the administration of a relatively low dose (1 microg) of DES during neonatal period may increase TEBs, thus resulting in a stimulatory effect on the initiation of MCs.

Aggressive angiomyxoma of the vulva with a sole t(5;8)(p15;q22) chromosome change.

Aggressive angiomyxoma of the vulva is uncommon and the pathogenesis remains unclear. Recently, a few cytogenetic studies demonstrated chromosomal abnormalities in aggressive angiomyxoma of the vulva. A 45-year-old Japanese woman complaining of right-side vulva tumor measuring 3 cm in diameter was referred to our hospital. The mass was located at the right side of the rectovaginal septum and was closely adherent to the rectal serosa and the levator muscle ani. The tumor was completely resected. A pathological examination demonstrated aggressive angiomyxoma of the vulva. Chromosomal analysis of the tumor demonstrated a sole t(5;8)(p15;q22) translocation. This is the first case of an aggressive angiomyxoma of the vulva with a sole t(5;8)(p15;q22) translocation.

Isolated adenomyotic cyst associated with severe dysmenorrhea.

A case of a 23-year-old, nulliparous female with a very rare isolated adenomyotic cyst inducing severe dysmenorrhea was seen. Transvaginal ultrasonographic tomography and magnetic resonance imaging (MRI) showed a 3 x 3-cm cystic mass within the left anterior wall of the uterine corpus. The cystic space was filled with hyperintense fluid on T1-weighted images, which was surrounded by hypointense tissue beside the right uterine corpus on T2-weighted images. The case was preliminarily diagnosed using MRI as having cavitated rudimentary uterine horn. However, hysterosalpingography excluded the possibility of uterine anomaly. A hemorrhagic adenomyotic cyst measuring 3 cm within the left anterior wall of the uterine corpus was surgically removed. There was no evidence of diffuse adenomyosis uteri. Dysmenorrhea completely disappeared postoperatively.

Induction of sarcomas by a single subcutaneous injection of 7,12-dimethylbenz[a]anthracene into neonatal male Sprague-Dawley rats: histopathological and immunohistochemical analyses.

Animal experiments have shown that carcinogenicity of chemicals is higher in fetal or neonatal periods than adult. We investigated sensitivities to a carcinogen in peri-neonatal rats with a model of sarcomas-induction by a subcutaneous injection of chemo-carcinogen that has rarely done in neonatal rats. Neonatal male SD rats were injected with 7,12-DMBA 10, 100, and 500 microg, which resulted in sarcomas-induction in 0, 62, and 94% of rats. Male SD rats were injected with DMBA 500 microg at 0, 3, 7, 14, and 21 days, which resulted in sarcomas-induction in 94, 70, 64, 50, and 44% of rats. Although the induced sarcomas were occasionally in mixed morphological feature as previous reports for sarcomas of rat, each was immunohistochemically in almost monotonous pattern, and classification was feasible. The incidence of rhabdomyosarcomas was higher in rats neonatally injected with a higher dose of DMBA than a lower dose, and in rats injected at peri-neonatal periods than later periods. In histological observations for the site of injection before overt sarcomas develop, clusters of atypical mesenchymal cells emerged as previous studies, but also those were immunohistochemically differentiated into rhabdomyocytes and other mesenchymal cells. We consider these findings may contribute a little to elucidation of process of sarcomas-induction in rats.

Fatal splenic rupture caused by infiltration of adult T cell leukemia cells.

The spleen is an immunological organ commonly involved in both hematological and nonhematological diseases. Pathological rupture of the spleen has been described in a variety of diseases affecting the spleen. Infections have been cited in most cases involving splenic rupture, but are rare in hematological malignancies despite frequent involvement of the spleen. The present report describes a fatal case of splenic rupture caused by infiltration of adult T cell leukemia cells and reports the mechanism of splenic rupture. The importance of rapid diagnosis and surgery is emphasized.