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ABSTRACT: Atypical spindle cell/pleomorphic lipomatous tumor is categorized as a benign lipomatous tumor, but various MRI findings pose accurate diagnostic challenges. In our case, both MRI and PET/CT scans indicated the possibility of atypical lipomatous tumor/well-differentiated liposarcoma or dedifferentiated liposarcoma. Needle biopsy suggested benign to low-grade malignancy; hence, we opted for the wide resection. The final diagnosis of atypical spindle cell/pleomorphic lipomatous tumor was confirmed through histopathology analysis, including immunohistochemistry and fluorescence in situ hybridization. Since achieving an accurate diagnosis solely through imaging can be challenging, histopathology remains essential.
Subject(s)
Lipoma , Magnetic Resonance Imaging , Thigh , Humans , Thigh/diagnostic imaging , Thigh/pathology , Diagnosis, Differential , Lipoma/diagnostic imaging , Lipoma/pathology , Positron Emission Tomography Computed Tomography , Male , Liposarcoma/diagnostic imaging , Liposarcoma/pathology , Middle Aged , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Although bone and soft tissue sarcoma is recognized as a rare cancer that originates throughout the body, few comprehensive reports regarding it have been published in Japan. PATIENTS AND METHODS: Bone and soft tissue sarcomas were tabulated from the Cancer Registries at eight university hospitals in the Chugoku-Shikoku region. Prognostic factors in cases were extracted in a single facility and have been analyzed. RESULTS: From 2016 to 2019, 3.4 patients with bone and soft tissue sarcomas per a general population of 100,000 were treated at eight university hospitals. The number of patients who underwent multidisciplinary treatment involving collaboration among multiple clinical departments has been increasing recently. In the analysis carried out at a single institute (Ehime University Hospital), a total of 127 patients (male/female: 54/73) with an average age of 67.0 y (median 69.5) were treated for four years, with a 5-year survival rate of 55.0%. In the analysis of prognostic factors by multivariate, disease stage and its relative treatment, renal function (creatinine), and a patient's ability of self-judgment, and a patient's mobility and physical capability were associated with patient prognosis regarding bone and soft tissue sarcomas. Interestingly, age did not affect the patient's prognosis (> 70 vs ⦠70). CONCLUSIONS: Physical and social factors may affect the prognosis of patients with bone and soft tissue sarcomas, especially those living in non-urban areas.
Subject(s)
Bone Neoplasms , Sarcoma , Soft Tissue Neoplasms , Humans , Male , Female , Aged , Prognosis , Japan/epidemiology , Bone Neoplasms/epidemiology , Bone Neoplasms/therapy , Sarcoma/epidemiology , Sarcoma/therapy , Soft Tissue Neoplasms/epidemiology , Soft Tissue Neoplasms/therapy , Retrospective StudiesABSTRACT
Objective: To provide appropriate treatment for patients, early diagnosis of the primary origin of skeletal metastases of unknown primary origin is important. This study aimed to assess the examination strategy effective for identifying the primary origin of skeletal metastases of unknown primary origin. Methods: Sixty-one patients with skeletal metastases of unknown primary origin were reviewed. The primary origin was examined via physical examination, blood test including tumor markers, chest radiography, thoracoabdominal computed tomography scan, positron emission tomography-computed tomography scan, metastatic lesion biopsy, and other assessments. Examination methods considered effective for the diagnosis of the primary origin in a specific type of cancer were investigated. Results: The lung was the most common primary origin site, followed by the lymph nodes, prostate, and breast. Meanwhile, biopsy was the most effective examination, followed by positron emission tomography-computed tomography scan and thoracoabdominal computed tomography scan. Blood tests are useful for detecting hematological malignancies and prostate cancer. Computed tomography scans can be used to identify cancers in the lung, breast, and kidney, which are the common primary origins. Forty-one (67.2%) of the 61 patients with skeletal metastases of unknown primary origin were diagnosed via the first four steps, that is, physical examination, blood test, chest radiography, and thoracoabdominal computed tomography scan. Finally, two patients were diagnosed with skeletal metastases of unknown primary origin. Conclusion: The examination steps used in this study, including physical examination, blood test including tumor markers, chest radiography, thoracoabdominal computed tomography scan, positron emission tomography-computed tomography scan, biopsy, and other assessments were effective in determining the primary origin of skeletal metastases of unknown primary origin during the initial visit.
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BACKGROUND: The pathology of Preiser disease remains controversial, and treatment for Preiser disease has not yet been standardised. Preiser disease itself is rare, and although it can be found in children, its presentation is even rarer; therefore, the treatment of paediatric patients with Preiser disease is more unclear than adult cases. CASE PRESENTATION: A 10-year-old boy who complained of left wrist pain was diagnosed with Preiser disease from osteosclerosis and segmentation on plain radiography and computed tomography, and low signal intensity on both T1- and T2-weighted images on magnetic resonance imaging. Because the patient was a child whose scaphoid was immature and pre-ossified, we chose a conservative immobilisation treatment with a thumb spica cast followed by an orthosis. After 3 months of immobilisation, the distal pole of the scaphoid showed remodelling. One year after the initial visit, plain radiography showed remodelling of the whole scaphoid, although magnetic resonance T1-weighted image showed that the recovery of intensity change was only observed in the distal pole. Two years after the initial visit, both plain radiography and magnetic resonance imaging showed a normal appearance and 5 years after the initial visit; the scaphoid bone showed normal development. CONCLUSIONS: This is the first case report of Preiser disease before complete ossification of the scaphoid; therefore, we cannot say anything definitive about the treatment strategy. However, our experience suggests that conservative treatment may provide a cure for Preiser disease in children with immature ossification of the scaphoid without carpal collapse.
Subject(s)
Scaphoid Bone , Adult , Child , Humans , Magnetic Resonance Imaging , Male , Osteogenesis , Radiography , Scaphoid Bone/diagnostic imaging , Upper ExtremityABSTRACT
Several studies have reported the prognostic factors for soft tissue sarcoma. Although serum lactate dehydrogenase (LDH) levels are associated with poor prognosis in several types of cancer, their role in soft tissue sarcomas remains unclear. Therefore, the present study evaluated the association between serum LDH levels and the clinical characteristics and prognosis of soft tissue sarcoma. A total of 103 patients diagnosed with primary soft tissue sarcoma between 2003 and 2019 were retrospectively examined, and the association between serum LDH levels at the first visit and clinical characteristics were analysed. In high-grade soft tissue sarcoma, the association between survival and clinical characteristics, including stratified LDH levels, was also analysed. Serum LDH levels were stratified (>253 and ≤253 IU/l) according to the standard values used at our institution. High serum LDH levels were significantly associated with the presence of metastasis and histological grade (P<0.001 and 0.040, respectively). In both the univariate and multivariate analyses, disease-specific survival (DSS) was significantly worse in patients with high-grade soft tissue sarcoma and high serum LDH levels than in patients with normal serum LDH levels (univariate analysis: P=0.025; multivariate analysis: Hazard ratio, 4.60; 95% confidence interval, 1.16-18.2; P=0.030). In conclusion, high serum LDH levels at the first visit predicted the presence of distant metastasis, high histological grade and worse DSS in patients with high-grade soft tissue sarcoma. Therefore, in patients with high serum LDH levels at the first visit, these risks should be considered during pretreatment examinations and post-treatment follow-up.
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HYPOTHESIS: This study aimed to investigate the results, indications, and limitations of absorbable pin fixation for osteochondritis dissecans of the humeral capitellum in the separation stage. METHODS: This study included 35 patients (mean age, 14.0 years). Patients were divided into two groups: Group A included those who obtained complete union within 6 months and Group B included those who did not observe complete union within 6 months. The clinical findings were compared between the groups. RESULTS: There were 26 and 6 patients in Groups A and B, respectively. Two patients did not obtain complete union. Clinical outcomes improved after the procedure. In univariate analysis, delayed union was associated with larger major diameter (P = .0004) and more depth (P = .03) of the osteochondral fragment measured by computed tomography, the presence of osteosclerosis in the subchondral bed on X-ray imaging (P = .003), and the presence of comminution of subchondral bone on ultrasound imaging (P = .01). In multivariate analysis, there was a significant difference only in the major diameter of the osteochondral fragment (P = .03). Receiver operating characteristic curves analysis shows that if the major diameter of the osteochondral fragment is 11 mm or less, 85% of patients achieve complete union of the osteochondral fragments within 6 months. CONCLUSION: Absorbable pin fixation may be considered for the osteochondral fragments with major diameter of 11 mm or less and should not be considered for patients who demonstrate osteosclerosis in the subchondral bed or comminution of subchondral bone.
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PURPOSE: The spectrum of diagnoses and clinical features of hand tumors differ from those of tumors in other body parts. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study aimed to elucidate the diagnostic distribution and the clinical features of hand tumors undergone surgery in our institute. PATIENTS AND METHODS: A total of 235 lesions in 186 patients diagnosed with hand tumors between 1978 and 2020 were reviewed. Age at surgery, gender, chief complaint, tumor location, and pathological diagnosis were analyzed. RESULTS: There were 121 benign bone tumors, 98 benign soft tissue tumors, and 16 malignant tumors. Chondroma and tenosynovial giant cell tumor were common benign bone and soft tissue tumors at the proximal phalanx of the ring finger and the palm, respectively. Meanwhile, chondrosarcoma and synovial sarcoma were common malignant tumors at the dorsal part of the hand. Local pain and painless mass were the chief complaints in patients with benign bone and soft tissue tumors, respectively. Most patients with malignant tumors were referred after unplanned resection. When patients were classified into two categories by tumor size according to maximal diameter, tumors larger than 19 mm had a significantly higher risk of malignant (p = 0.031) despite being smaller than other tumors in different body parts. CONCLUSION: When a tumor malignancy is suspected, the patient should be referred to a specialist to avoid unplanned resection or delayed diagnosis due to misdiagnosis. Knowing the distribution and clinical features should help in diagnosing hand tumors.
Subject(s)
Bone Neoplasms/diagnosis , Chondroma/diagnosis , Chondrosarcoma/diagnosis , Giant Cell Tumor of Tendon Sheath/diagnosis , Hand , Soft Tissue Neoplasms/diagnosis , Adult , Bone Neoplasms/surgery , Chondroma/surgery , Chondrosarcoma/surgery , Female , Giant Cell Tumor of Tendon Sheath/surgery , Humans , Male , Middle Aged , Retrospective Studies , Soft Tissue Neoplasms/surgeryABSTRACT
BACKGROUND: Glomus tumors are soft tissue neoplasms comprised of glomus cells, vasculature, and smooth muscle cells, which occur commonly in a single subungual area of the digits, and their main clinical features include severe paroxysmal pain, localized tenderness, and cold hypersensitivity. CASE PRESENTATION: A 47-year-old Japanese man had suffered from chronic progressive paroxysmal shooting pain in his right leg since childhood. He avoided putting weight on his right foot whenever he walked. The frequency of paroxysmal pain and the number of tender points both gradually increased with age, and his right leg gradually atrophied. Magnetic resonance imaging of the lower extremity demonstrated multiple gadolinium-enhanced nodules that corresponded with his tender points. Excisional biopsy relieved his pain and provided a histopathological diagnosis of glomus tumors. CONCLUSION: This case suggests that small glomus tumors located in deep tissue may cause disuse atrophy because of their long delay before diagnosis. Clinicians should consider the potential for glomus tumors when patients exhibit unilateral lower limb muscular atrophy with pain.
Subject(s)
Glomus Tumor , Soft Tissue Neoplasms , Atrophy , Child , Foot , Glomus Tumor/complications , Glomus Tumor/diagnosis , Glomus Tumor/surgery , Humans , Magnetic Resonance Imaging , Male , Middle AgedABSTRACT
The accurate diagnosis of soft tissue tumors may be difficult. Simple clinical characteristics or laboratory data that can predict tumor malignancy can be useful tools for diagnosing soft tissue tumors. Between 2003 and 2018, 588 patients with primary soft tissue tumors were retrospectively reviewed. Their clinical characteristics and laboratory data were evaluated to determine their association with the diagnosis of benign, intermediate, or malignant tumor. Multivariable analysis revealed that tumor size ≥ 5.6 cm (odds ratio (OR), 6.15; p < 0.001), white blood cell (WBC) count ≥ 5700/µL (OR, 2.49; p = 0.002), hemoglobin (Hb) count ≤ 12.4 g/dL (OR, 2.56; p = 0.004), C-reactive protein (CRP) level ≥ 0.17 mg/dL (OR, 2.64; p < 0.001), and lactate dehydrogenase (LDH) level ≥ 240 IU/L (OR, 4.94; p < 0.001) were significant predictive factors for sarcoma. The sensitivity and specificity in the presence of three or more predictive factors for detecting malignant tumors were 0.58 and 0.90 respectively, and it was an appropriate threshold with the maximum Youden's index of 0.49. Simple clinical and laboratory data were useful tools for predicting whether the tumor is malignant. Patients with soft tissue tumors that meet any three or more predictive factors should be referred to a specialist.
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BACKGROUND: Synovial sarcoma is a relatively rare type of soft tissue sarcoma. The commonly observed symptom is a deep-seated palpable mass accompanied by pain or tenderness. Thus, it is considered a soft tissue sarcoma and rarely occurs primarily in bone. However, only few studies have been reported on intraosseous synovial sarcoma, and reports on cases with cytogenetic or molecular confirmation are even rarer. We report a case of intraosseous synovial sarcoma of the distal ulna that has been confirmed using histopathological examination and molecular analysis. CASE PRESENTATION: A 77-year-old female was referred to our hospital with a 1-month history of right wrist pain after housework. Clinical and imaging findings suggested a benign bone tumor that was enhanced by Gd-DTPA. It was thought that the tumor was possibly an enchondroma. Initially, we planned to evaluate the benignancy of the tumor with intraoperative frozen section, followed by curettage and bone graft at one stage However, when considering carefully, characteristics of the tumor did not perfectly match those of any diagnostic categories including enchondroma. Therefore, an incisional biopsy was performed and revealed that the tumor was synovial sarcoma. Following an elaborate plan, the patient underwent a wide resection of the tumor at the distal part of the right ulna. Reverse transcription-polymerase chain reaction (RT-PCR) from the resected specimen and sequencing of RT-PCR products demonstrated a chimeric SYT-SSX1 transcript, confirming the diagnosis of synovial sarcoma. CONCLUSIONS: Synovial sarcoma is seldom considered in differential diagnosis of bone tumors because it is difficult to line up such an unusual diagnosis as a differential diagnosis. When the lesion does not perfectly fit into any diagnostic category, when the initial image diagnosis appears unconvincing, biopsy and pathology are indicated, recalling Jaffe's triangle. According to these diagnostic processes, the patient successfully completed the treatment for this rare intraosseous synovial sarcoma, following a careful plan based on the preoperative diagnosis.
Subject(s)
Bone Neoplasms/diagnosis , Sarcoma, Synovial/diagnosis , Ulna/pathology , Aged , Biomarkers, Tumor/genetics , Bone Neoplasms/genetics , Bone Neoplasms/pathology , Bone Neoplasms/surgery , Diagnosis, Differential , Female , Humans , Oncogene Proteins, Fusion/genetics , Sarcoma, Synovial/genetics , Sarcoma, Synovial/pathology , Sarcoma, Synovial/surgery , Treatment Outcome , Ulna/surgeryABSTRACT
Schwannoma is a common benign soft tissue tumor. Although schwannomas can be theoretically enucleated without nerve damage, neurological complications occasionally develop following enucleation. The aim of this study was to elucidate the incidence of and risk factors for postoperative neurological complications following schwannoma enucleation. Ninety-eight schwannomas from 95 patients that were treated by surgical excision between January 2003 and December 2014 were included in this retrospective case series study. Patients were 49 men and 46 women with a median age of 60.5years (range, 22-87years). The incidence of postoperative neurological complications was evaluated in all the patients, and characteristics, such as age, tumor size, sex, preoperative symptoms, MRI findings, tumor location, and the nerve of origin, were compared between the cases with or without complications at the last follow-up. In our study population, postoperative neurological complications were observed in 18.4% of the cases. In univariate analysis, preoperative sensory disturbance, tumor location, and the nerve of origin were associated with the incidence of postoperative neurological complications (p<0.001, p=0.034, and p=0.003, respectively). In multivariate analysis, tumors showing preoperative sensory disturbance and tumors located in the proximal aspect of the limbs were identified as independent risk factors for postoperative neurological complications (p<0.001 and p=0.014, respectively). A certain percentage of schwannoma cases undergoing enucleation would show postoperative neurological complications. Therefore, patients with schwannoma, in particular, those with risk factors for postoperative neurological complications, should be informed regarding the possibility of postoperative complications. In cases of schwannoma enucleation, the procedure should be meticulously performed to minimize the damage to the affected nerve of origin.
Subject(s)
Neurilemmoma/surgery , Neurosurgical Procedures/adverse effects , Postoperative Complications/epidemiology , Soft Tissue Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Incidence , Male , Middle Aged , Postoperative Complications/etiology , Retrospective Studies , Risk Factors , Young AdultSubject(s)
Blood Transfusion , Bone Neoplasms/surgery , Femur/surgery , Giant Cell Tumor of Bone/surgery , Knee Prosthesis , Osteotomy/methods , Adult , Bone Neoplasms/diagnostic imaging , Combined Modality Therapy , Female , Femur/diagnostic imaging , Femur/pathology , Follow-Up Studies , Gestational Age , Giant Cell Tumor of Bone/diagnostic imaging , Humans , Knee Joint/diagnostic imaging , Knee Joint/pathology , Pregnancy , Pregnancy Complications, Neoplastic/diagnostic imaging , Pregnancy Complications, Neoplastic/surgery , Prosthesis Implantation , Religion , Treatment Outcome , Treatment RefusalABSTRACT
BACKGROUND: Endoprosthetic reconstruction of the proximal humerus is one of the standard procedures after resection of tumors of the proximal humerus and has been considered a reliable method to reconstruct the proximal humerus in recent reports. However, instability of the shoulder joint caused by loss of the rotator cuff and deltoid muscle function is often observed after such an endoprosthetic reconstruction. METHODS: We performed the endoprosthesis suspension method with polypropylene monofilament knitted mesh. This suspension method, by which the endoprosthesis is suspended from the bone structure, was used after resection of tumors in 9 patients. We assessed postoperative stability of the shoulder joint by comparing these patients with 12 patients who underwent the conventional surgical technique, by which the mesh-wrapped endoprosthesis is attached only to soft tissue. RESULTS: In radiographic and physical evaluation, 4 of the 12 patients in the soft tissue reconstruction group showed shoulder joint instability. No patient in the suspension method group showed subluxation of the humeral prosthesis. The mean shoulder flexion was 35° and 65° and the mean shoulder abduction was 40° and 40° for the soft tissue reconstruction group and the suspension method group, respectively. DISCUSSION: Shoulder joint subluxation sometimes occurs because of elongation of the attached soft tissue in the conventional reconstruction with mesh, whereas no shoulder joint subluxation occurs after endoprosthetic reconstruction in the suspension method because the bone structure has no leeway for elongation. Excellent stability of our new method enables exercise of the surgical shoulder at an early stage, leading to improved range of shoulder joint motion.
Subject(s)
Bone Neoplasms/surgery , Joint Instability/etiology , Postoperative Complications/etiology , Prosthesis Implantation/methods , Shoulder Joint/surgery , Adolescent , Adult , Aged , Deltoid Muscle/surgery , Epiphyses , Female , Humans , Humerus , Joint Instability/diagnostic imaging , Male , Middle Aged , Polypropylenes , Postoperative Complications/diagnostic imaging , Prosthesis Implantation/instrumentation , Radiography , Range of Motion, Articular , Rotator Cuff/surgery , Shoulder Joint/diagnostic imaging , Shoulder Joint/physiopathology , Surgical Mesh , Treatment Outcome , Young AdultSubject(s)
Giant Cell Tumor of Bone/genetics , Giant Cell Tumor of Bone/pathology , Neoplasms, Second Primary/genetics , Sacrum , Spinal Neoplasms/genetics , Spinal Neoplasms/pathology , Adult , Cytogenetic Analysis , Female , Giant Cell Tumor of Bone/therapy , Humans , Neoplasms, Second Primary/pathology , Neoplasms, Second Primary/therapy , Spinal Neoplasms/therapyABSTRACT
We report a rare case of polyostotic fibrous dysplasia on endocrine hyperfunction with elevated human growth hormone and normal serum level of prolactin. There were some differential points of gender, gigantism, endocrine function, and GNAS gene from McCune-Albright syndrome. Malignant transformation was suspected in the pelvic tumor from imaging because rapid growth of the tumor by imaging was observed; however, no malignant change occurred in this case.
Subject(s)
Fibrous Dysplasia, Polyostotic/complications , Fibrous Dysplasia, Polyostotic/diagnosis , Human Growth Hormone/blood , Pelvic Neoplasms/complications , Pelvic Neoplasms/surgery , Acromegaly/diagnosis , Adult , Bone Diseases, Endocrine/complications , Bone Diseases, Endocrine/diagnosis , Bone Neoplasms/diagnosis , Chromogranins , Diagnosis, Differential , Fibrous Dysplasia, Polyostotic/blood , GTP-Binding Protein alpha Subunits, Gs/metabolism , Gigantism/diagnosis , Humans , Male , Pituitary Diseases/complications , Prolactin/bloodABSTRACT
Synovial hemangioma has been reported to be relatively rare, and usually occurs in childhood and adolescence. However, there are a few reports of the disease in infants. In this report, we diagnosed synovial hemangioma in a 3-year-old girl who had swelling and pain in her left knee. Gadolinium-enhanced magnetic resonance imaging revealed abnormal intensity in an intra-articular lesion. We performed arthroscopy, and arrived at a final diagnosis based on a scopic biopsy. Synovial hemangioma should be considered as a possible diagnosis in infants with swelling and pain in the knee.
Subject(s)
Hemangioma/diagnosis , Knee Joint/pathology , Soft Tissue Neoplasms/diagnosis , Synovial Membrane/pathology , Arthralgia/diagnosis , Arthralgia/etiology , Arthroscopy/methods , Biopsy, Needle , Child, Preschool , Female , Follow-Up Studies , Gadolinium , Hemangioma/surgery , Humans , Immunohistochemistry , Magnetic Resonance Imaging/methods , Monitoring, Physiologic/methods , Rare Diseases , Risk AssessmentABSTRACT
A case of osteosarcoma of the talus is reported. Osteosarcoma of the talus is very rare. The patient is alive and she has been continuously disease free for five years after surgery. This is the first case of osteosarcoma of the talus with reconstruction using a frozen bone method, an autograft containing tumor treated with liquid nitrogen. This is a rare case report of osteosarcoma of the talus without extrainvasion of the talus.
Subject(s)
Bone Neoplasms/pathology , Bone Neoplasms/surgery , Osteosarcoma/pathology , Osteosarcoma/surgery , Talus/pathology , Talus/surgery , Adolescent , Female , HumansABSTRACT
Primaly giant cell tumor of bone (GCT) in the proximal femur is relatively rare, and can prove difficult to diagnose, and can require therapeutic methods. Subjects comprised 10 patients (8 males, 2 females). Mean patient age was 27.5 years, and mean follow-up was 89.9 months. Tumors in the present study were limited to H1 and H2 according to the International Society of Limb Salvage (ISOLS) system. All patients received surgical treatment only. Second surgery after preoperative open biopsy was performed for two patients, while the remaining eight patients received excisional biopsy to determine treatment methods using rapid intraoperative pathological examination of frozen sections. The mean functional score was 28.2 out of 30 (93.9%). Local recurrence was observed in two patients. The long-term follow-up reveals that one of the important problem is pre-operative diagnosis. Excisional biopsy is effective for surgery of GCT in the proximal femur.
Subject(s)
Femoral Neoplasms/diagnosis , Femoral Neoplasms/surgery , Giant Cell Tumor of Bone/diagnosis , Giant Cell Tumor of Bone/surgery , Adult , Arthrodesis , Arthroplasty, Replacement, Hip/methods , Biopsy , Bone Cements/therapeutic use , Female , Femur/pathology , Femur/surgery , Hip Joint/surgery , Humans , Male , Neoplasm Recurrence, Local , Osteolysis/etiologyABSTRACT
Differences in sugar distribution between the villous epithelium and follicle-associated epithelium (FAE) were compared using lectins in the rabbit small intestine. In every portion, villous columnar epithelial cells primarily exhibited a positive reaction to the GalNAc, GlcNAc, galactose, and oligosaccharide. In the ileal Peyer's patch (PP), whereas microvillous epithelial cells exhibited positive reactions, M cells tended to be negative. The villous epithelial reaction to the fucose group was negative, but M cells and microvillous epithelial cells showed a positive to the fucose. No epithelium had a positive reaction to the mannose and glucose. The variety of lectin-binding properties of villous epithelial cells and M cells may reflect specificity for the recognizing luminal substances such as antigenic molecules and bacterial elements.