[Giant mediastinal thyroid follicular carcinoma with tracheal stenosis].

A 76-year-old female was admitted to the hospital with dyspnea and hypertention. She had the giant thyroid tumor which had been awared but not treated for 40 years. On a computed tomography (CT) scan and magnetic resonance imaging (MRI), the tumor was 14 x 10 cm and the tracheal stenosis was completely intrathoracic, which was 5 x 7 mm. Tracheal incubation was performed safety by using percutaneous cardiopulmonary support. A subtotal thyroidectomy was performed by midsternotomy with cervical incision. The weight of the resected specimen was 340 g and the pathological diagnosis was follicular thyroid carcinoma. The postoperative course was uneventful and the patient suffered no hoarseness and dyspnea.

[Postoperative penicillin-resistant streptococcus pneumonia in lung cancer patient].

A 78-year-old man underwent a left lower sleeve lobectomy and lymph node dissection for lung cancer. His postoperative course had been uneventful until postoperative day (POD) 3, but severe dyspnea occurred suddenly and the chest X-p showed infiltration shadow on POD 3. Streptococcus pneumonia antigen in the urine was elevated, suggesting pneumonia caused by Streptococcus pneumonia. The patient was treated with double dose of imipenem/cilastatin sodium and supported with a mechanical ventilator in an intensive care unit. Although the patient recovered from penicillin resistant Streptococcus pneumonia, he was suffered from Klebsiella sepsis and expired on the POD 26.

[Is adjuvant chemotherapy necessary for the peripherally located stage I adenocarcinoma of the lung?].

OBJECTIVE: This study was done for the purpose of picking out the cases of poor prognosis from the peripherally located stage I adenocarcinoma of the lung. METHODS: Between January 1989 and December 2004, 235 patients with peripherally located stage I adenocarcinoma of the lung were resected curatively in our hospital. Relation between the 5-year survival rate and lymphatic and/or blood vessel invasion (from now on ductal invasion) was examined in these cases. RESULTS: The 5-year survival rate was 99% in ly0v0 cases, 86% in ly0v1 cases, 85% in ly1v0 cases, 72% in ly1v1 cases, and 80% in ly2, 3 and/or v2, 3 (lyv 2-3) cases, respectively. Obviously the outcome of the cases without ductal invasion was good. The ratio of the cases without ductal invasion was 61% in stage IA, and 31% in stage IB. The 5-year survival rate was 99% in the cases without ductal invasion in stage IA, 100% in the cases without ductal invasion in stage IB, 90% in the cases with ductal invasion in stage IA, and 65% in the cases with ductal invasion in stage IB, respectively. And the 5-year survival rate without recurrence was 94% in the cases without ductal invasion in stage IA, 76% in the cases without ductal invasion in stage IB, 76% in the cases with ductal invasion in stage IA, and 54% in the cases with ductal invasion in stage IB, respectively. CONCLUSIONS: Ductal invasion is significant prognostic factor in stage I adenocarcinoma of the lung. Adjuvant chemotherapy is unnecessary for the case without ductal invasion in stage IA. But we think that adjuvant chemotherapy is necessary for the case with ductal invasion in stage IA and for the case in stage IB, because there is much recurrence.

[Pulmonary metastasis from hepatic epithelioid hemangioendothelioma; report of a case].

A 30-year-old female complaint of epigastralgia was diagnosed hepatic epitheloid hemangio endothelioma (EHE) by liver biopsy. The multiple nodules in bilateral lungs and liver were revealed on computed tomography (CT). The tumors of the left lung were resected under video-assisted thoracoscopic surgery. Pathologically these lesions were diagnosed as metastasis from EHE of the liver, and the patient was treated with interleukin-2 from hepatic artery for 12 months.

[Liposarcoma originating in the neck and the mediastinum after removal of mediastinal lipoma].

A 47-year-old man, who had undergone removal of an upper mediastinal lipoma 9 years previously, was referred to our hospital for swelling of the right neck and wheezing. The chest X-ray showed enlargement of the upper mediastinum. Contrast-enhanced chest computed tomography and magnetic resonance imaging demonstrated a tumor with fatty density extended from the upper mediastinim to the right side of the neck. Two-stage tumor resection was carried out. On gross pathological examination the tumor was soft and fatty. Microscopic examination revealed well differentiated liposarcoma. Postoperative radiation therapy (50 Gy) was carried out. The patient remains free of disease 3 years after radiation therapy.

[Resected cases with primary lung cancer after preoperative high dose irradiation].

After greater than 60 gray (Gy) irradiation, we performed the pulmonary resection in the 18 primary lung cancer cases. The mean irradiation dose to the tumor was 68.2 (range 60-101) Gy, and the mean irradiation dose to the bronchial stump was 47.1 (range 0-82) Gy. Median time from end of irradiation to surgical resection was 136 (range 20-894) days. One partial resection, 9 single lobectomies, 3 double lobectomies, and 5 pneumonectomies were done. Mainly, we closed the bronchial stump by the automatic stapling device and additional hand suturing. The bronchial stump was covered in the 12 cases by the owner stalk thymus, the intercostals muscular flap, the omentum flap, and et al. The major postoperative complications due to preoperative irradiation were not seen. Bronchopleural fistulas did not occur. Pathologically, the wall of the submucosal capillary vessels were getting thick in the patients operated more than 3 months later after irradiation. In such cases with the decrease of the blood flow, the bronchial stump should be covered. The pulmonary resection after the high dose irradiation was considered to be tolerable.

Lack of evidence for a role of Epstein-Barr virus in the increase of lung cancer in idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is known as an independent risk factor for lung cancer. Because Epstein-Barr virus (EBV) may be involved in the genesis of IPF as well as certain malignancies, we investigated whether EBV contributes to the increased incidence of lung cancer in IPF The formalin-fixed and paraffin-embedded lung sections were prepared from 22 lung cancer patients with IPF and 22 lung cancer patients without IPF All ofthe IPF patients pathologically showed usual interstitial pneumonia. In situ hybridization for EBV-encoded small non-polyadenylated RNAs failed to show positive signals in the cancer tissues of either IPF or non-IPF patients. This study did not provide evidence for an etiologic role of EBV in the development of lung cancer in IPF.

[Angiosarcoma arised from a solitary schwannoma of the chest wall].

Angiosarcomas rarely develop within a peripheral nerve or a peripheral nerve sheath tumor. A 68-year-old woman was admitted for right hemothorax. She had suffered from the left thoracic empyema and the right chest wall tumor which had been regarded as schwannoma clinically. Anemia got serious due to continuous bloody effusion. Although bleeding point was not detected by thoracotomy. The right chest wall tumor was resected. Postoperatively bloody effusion still drained continuously, she died ten days after the operation. Resected tumor was almost necrotized. The tumor was diagnosed as angiosarcoma pathologically, in which a part of schwannoma component resided. It is indicated that angiosarcoma in this case arised from degenerated schwannoma. It is necessary to consider angiosarcoma, rarely arised from degenerated schwannoma, during conservative, long-term observation on the care of schwannoma.

Serum gliostatin levels in patients with rheumatoid factor-negative and -positive rheumatoid arthritis and changes of these levels after surgical treatments.

Gliostatin/platelet-derived endothelial cell growth factor (GLS/PD-ECGF) has a potential for arthritogenic action. The aim of this study was to examine whether measurement of serum GLS can be used to evaluate symptomatic improvements after surgery (arthroplasty or synovectomy) as well as the aggressiveness of disease activity in rheumatoid arthritis (RA). Serum GLS levels were determined by enzyme immunoassay in rheumatoid factor (RF)-positive and -negative RA patients. In those undergoing surgery, levels were measured 3 months before and after the operations. Both RF-positive and -negative RA sera showed higher GLS levels than normal and osteoarthritis sera. Patients undergoing arthroplasty demonstrated a decrease in serum GLS levels after the operations, but patients undergoing synovectomy did not, reflecting the extent of remaining or reproliferating synovial tissues rich in GLS production. These findings suggest that the serum GLS level is a useful indicator for evaluation of synovitis and the systemic efficacy of surgical treatment.

Enantioselective metabolism of propanolol in isolated hepatocytes prepared from untreated, PB- or 3-MC-pretreated rats.

The present paper describes the metabolism of a chiral drug propranolol (PL) using isolated hepatocytes freshly prepared from untreated, PB- or 3-MC-pretreated rats. In order to examine not only the existence of enantioselectivity but also the effect of enzyme inducer (PB or 3-MC) on PL metabolism, 500 microM PL (RS-PL, R(+)-PL or S(-)-PL) was incubated at 37 degrees C using 8 x 10(6) cells/ml isolated rat hepatocytes. Then, the elimination amount of PL and the formation amounts of eight kinds of the metabolites including ring hydroxylated metabolites (4-OH-, 5-OH- and 7-OH-PL) and side chain metabolites (NDP, AcNDP, PGL, NLA and NAA) were simultaneously determined by HPLC. By 3-MC- and PB-pretreatment, a significant increase was noticed in PL elimination and also in the formation of PL metabolites, NDP, NLA and NAA. Furthermore, the presence of enantioselectivity was observed, i.e. the substrate R(+)-PL was always eliminated faster than the substrate S(-)-PL. Regarding the metabolite formation, NDP, AcNDP and NAA were dominantly produced from R(+)-PL, and NLA, PGL and the ring hydroxylated metabolites from S(-)-PL. In all cases of PL elimination and the metabolite formation, the amounts of the metabolites derived from RS-PL indicated the mean values of the respective amounts derived from R(+)-PL and S (-)-PL. Using the three kinds of isolated rat hepatocytes mentioned above, the kinetic parameters of NDP-formation at 37 degrees C for 10 min were calculated using RS-PL, R(+)-PL or S(-)-PL as a substrate. From the pseudo values of V'max/K'm (microliter/min.8 x 10(6) cells), the easiest formation of NDP from R(+)-PL was observed in the rat hepatocyte system pretreated with 3-MC.

Acute abdominal pain preceding cutaneous manifestations of varicella zoster infection after allogeneic bone marrow transplantation.

The current communication describes clinical findings in two recipients of allogeneic bone marrow transplantation (BMT) with varicella zoster virus infection who complained of acute severe abdominal pain preceding cutaneous manifestations. Physical examination, laboratory data and gastroscopic findings were nonspecific. In these cases, acyclovir was very effective for the symptoms. Varicella zoster virus infection should be suspected in BMT recipients who have rebellant acute abdominal pain but no characteristic skin eruptions.

Adrenal rest tumor of the liver: a case report with immunohistochemical investigation of steroidogenesis.

A case of adrenal rest tumor arising in the liver of a 62-year-old male with chronic hepatitis type C is reported. The tumor was clinically non-functioning and required distinction from hepatocellular carcinoma. The yellowish-brown tumor measured 25 x 18 x 15 mm and was located in the subcapsular portion of the right hepatic lobe. Histologically, the tumor presented features similar to those of the adrenal cortex and was predominantly composed of pale cells. Electron micrograph revealed lipid droplets and mitochondria with tubulo-vesicular cristae, consistent with the characteristics of steroid-producing cells. Immunohistochemically, the tumor expressed the adrenal 4 binding protein and a number of enzymes involved in the synthesis of adrenocortical steroids. At surgery, the right adrenal gland was present independently from the liver. This hepatic tumor was considered to be an adrenal rest tumor with steroidogenic capability.

A post-traumatic ligamentum flavum progressive hematoma: a case report.

STUDY DESIGN: A case report. OBJECTIVES: To understand a rare case of ligamentum flavum progressive hematoma. SUMMARY OF BACKGROUND DATA: Previously there were only two reports about ligamentum flavum hematoma. METHODS: A patient was surgically treated for ligamentum flavum hematoma causing progressive L5 radiculopathy. Clinical and neuroradiologic features were reported, and the literature was reviewed. RESULTS: The etiology of this case could not be defined except by minor back injury. In spite of conservative therapy, the symptoms were progressive for 7 months. Magnetic resonance imaging demonstrated the epidural mass lesion at L4-L5 that was continuous with the ligamentum flavum. The mass was hypointense in T1-weighted images and central hyperintense and marginal hypointense in T2-weighted images. The margin was well enhanced by Gd-DTPA administration. After removal of the mass lesion, the patient's symptoms completely resolved. Before surgery, accurate diagnosis was difficult even based on magnetic resonance imaging and was achieved after histologic examinations. CONCLUSIONS: Surgery could be a choice of the treatment modality to resolve symptoms in ligamentum flavum hematoma.

Autocrine induction of gliostatin/platelet-derived endothelial cell growth factor (GLS/PD-ECGF) and GLS-induced expression of matrix metalloproteinases in rheumatoid arthritis synoviocytes.

OBJECTIVE: The purpose of this study was to examine how gliostatin/platelet-derived endothelial cell growth factor (GLS/PD-ECGF) is involved in the molecular mechanism of cartilage degradation in rheumatoid arthritis (RA) with special reference to the GLS-induced gene expression and protein synthesis of matrix metalloproteinase (MMP)-1 (collagenase-1) and MMP-3 (stromelysin-1). METHODS: Fibroblast-like synoviocytes (FLSs) obtained from RA patients were cultured and stimulated by GLS. Changes in the expression levels of GLS, MMP-1 and MMP-3 were assessed by Northern blot analysis and reverse transcription-polymerase chain reaction (RT-PCR) for GLS, and by RT-PCR and enzyme-linked immunosorbent assay for MMPs and tissue inhibitor of metalloproteinase 1. RESULTS: GLS demonstrated a self-induction of mRNA in cultured RA FLSs. GLS evoked a dose-dependent induction of MMP-1 and MMP-3 mRNAs, and subsequently their extracellular secretion. CONCLUSION: These findings suggest that GLS is a plausible pathogenic factor causing the extensive joint destruction in RA mediated via MMPs.

[Two cases of solitary peripheral pulmonary arterial aneurysm].

We report two very rare cases of solitary peripheral pulmonary arterial aneurysm. Case 1: An 83-year-old man treated for myocardial infarction died of multiple organ failure and hemoptysis. Autopsy disclosed rupture of a pulmonary arterial aneurysm 1.5 cm in diameter in the right A3. Case 2: A 75-year-old man was found to have a pulmonary arterial aneurysm, 3 cm in diameter of the right A1. Surgical treatment was not indicated, because of severe pulmonary emphysema. The aneurysms in these two cases were idiopathic: (1) there were no histologic findings that would implicate specific chronic inflammation. (2) the period from the occurrence of secondary pulmonary hypertension to hemoptysis was short, and there was no (3) history of trauma.

[A case of pulmonary arteriovenous fistula beneath the surface of the lung].

A 19-year-old woman complaining of exertional dyspnea was admitted to our hospital with an abnormal shadow on the left side of the chest. Laboratory examination revealed polycythemia and hypoxemia. Pulmonary angiogram demonstrated a pulmonary arteriovenous fistula beneath the surface of the left S10. Partial resection of the left S10 was performed. The wall of the arteriovenous fistula was flimsy and seemed to rupture easily. The sister of this patient also had a peripheral pulmonary arteriovenous fistula and suffered from repeating epistaxis. Rendu-Osler-Weber disease was diagnosed in both, and the sister underwent partial resection of the right S7, which contained the fistula. Their postoperative courses were uneventful. Hemothorax and hemoptysis are lethal complications of arteriovenous fistulae. In order to avoid the rupture of fistulae, surgical resection is the most reliable treatment. Pulmonary arteriovenous fistulae beneath the surface of the lung should be resected.

[An operative case of primitive neuroectodermal tumor in the posterior mediastinum].

A primitive neuroectodermal tumor (PNET) is very rare and the prognosis of this tumor is poor. A 32-year-old woman complaining of dysphagia and back pain was admitted to our hospital for the posterior mediastinal tumor. The tumor originated from the muscle layer of esophagus and en bloc resection of the tumor combined with the affected part of esophagus was performed. Histopathological diagnosis of the resected tumor was PNET. She received adjuvant chemotherapy. Eight months after the surgery, recurrent tumors in the right mediastinum and the retrooperitoneal space was resected completely. But after the second surgery, dissemination occurred recurrently. These recurrent tumors revealed high sensitivity for radio-therapy. However, she died of rapid recurrence 22 months after the first surgery. In Japan, our case is the second case of PNET in the posterior mediastinum and the first case of PNET arising from the muscle layer of esophagus.

[A case of successful treatment with ganciclovir for cytomegalovirus pneumonia after pulmonary lobectomy].

The premortem diagnosis of cytomegalovirus (CMV) pneumonia is usually difficult, and mortality of it is high. A case of successful treatment with ganciclovir for cytomegalovirus pneumonia after pulmonary lobectomy is reported. The patient was a 76-year-old man. Under diagnosis as lung cancer, the right lower lobectomy was performed. After operation, pneumonia occurred on the nonoperated side and in a few days reticular shadows rapidly spread to the whole lung. Although pulse steroid therapy was performed, the interstitial pneumonitis improved only a little. Then intranuclear inclusion body-bearing giant cells were found in sputum obtained by bronchoscopy. So we diagnosed the interstitial pneumonitis as CMV pneumonia and ganciclovir was administrated. CMV pneumonia had improved for two weeks and the patient has no recurrence. When interstitial pneumonitis develop in patients after operation or steroid therapy, the differential diagnosis should include the possibility of CMV pneumonia.

[Liver metastases from breast cancer 14 years after radical mastectomy; successful treatment with hepatic arterial infusion chemotherapy and systemic endocrine therapy--a case report].

The patient was a 73-year-old woman who was admitted to our hospital for epigastric discomfort and body weight loss. She had undergone radical right mastectomy in March 1982. Ultrasonography and computed tomography revealed multiple tumors in the liver. Three of the tumor markers (CA-125, CA 19-9, and CA 15-3) were positive. US-guided fine needle aspiration biopsy of the liver tumor showed small atypical cells with solid cell nests. Immunohistochemical tests revealed estrogen receptor was positive. We diagnosed the patient as recurrent breast cancer metastatic to liver, 14 years postoperatively. The liver tumors were successfully controlled with the combination of intra-arterial infusion chemotherapy (5-fluorouracil, epirubicin, and mitomycin C) along with systemic endocrine therapy (medroxyprogesterone acetate and fadrozole hydrochloride hydrate).

Immunohistochemical studies on endothelial cell phenotype in hepatocellular carcinoma.

To examine the phenotype of the sinusoidal endothelial cells (SECs) surrounding tumor cells and the process of capillarization in hepatocellular carcinoma (HCC), 51 primary HCCs, 4 adrenal metastases, and 3 portal tumor thrombi were immunohistochemically stained with monoclonal antibodies (MAbs) for CD4, CD14 (lipopolysaccharide-binding protein complex receptors), and CD32 (Fc gamma receptor II), which are specifically found on the SECs in normal liver, but not on ordinary vascular endothelial cells (ECs). Immunostaining was also performed for CD36 (thrombospondin receptors), EN4 antigen (Ag) (a pan-vascular endothelial cell Ag), PAL-E Ag (a venous and capillary EC Ag), factor VIII-related Ag (FVIIIRAg), and laminin. MAb 25F9, which identifies macrophages, was simultaneously used with the other MAbs to distinguish macrophages from SECs in HCCs (HCC SECs). CD4, CD14, and/or CD32 were found on HCC SECs only in 12 well-differentiated primary HCCs showing a thin trabecular or pseudoglandular tumor cell arrangement. These 12 tumors were smaller than those without CD4-, CD14-, and/or CD32-positive SECs (P < .05). Among them, 7, 5, and 11 tumors were negative or only partially positive for laminin, PAL-E Ag, and FVIIIRAg, respectively. Staining for laminin and PAL-E Ag showed an inverse relationship to the expression of CD4, CD14, and CD32 on HCC SECs and the tumor differentiation. In conclusion, the phenotypes of the SECs in early and well-differentiated HCC are thought to be similar to those of the SECs in normal liver. With progressing tumor dedifferentiation the HCC SECs lose the phenotypes peculiar to liver SECs and acquire the characteristics of capillary ECs, though both types of phenotypical change occur independently of each other.