A case of tumor-forming pseudoangiomatous stromal hyperplasia of the breast.

Pseudoangiomatous stromal hyperplasia (PASH), characterized by the presence of slit-like spaces embedded in a hyalinized stroma, is sometimes observed during pathologic examination of breast-tissue specimens. Because tumor-forming PASH is rare, we report a case of a 41-year-old woman admitted to our hospital with a tumor in her left breast. Ultrasonography and aspiration biopsy cytology revealed a benign tumor. After performing Mammotome(®) biopsy, the lesion was diagnosed as PASH of the breast based on characteristic findings of histology and immunohistochemical studies. Because PASH tumors do not usually become malignant, we decided to perform ultrasonographic follow-up without tumor excision.

[A case of gastric large cell neuroendocrine carcinoma (LCNEC) for whom chemotherapy of CDDP+CPT-11 proved very effective].

Large cell neuroendocrine carcinoma(LCNEC)is a relatively new category with biological behavior similar to small cell carcinoma. Thus, it is reportedly well treated by the same chemotherapy as for small cell carcinoma. We experienced a case of gastric large cell neuroendocrine carcinoma, treated very effectively by CDDP+CPT-11.60 mg/m(2) of CDDP was administered on day 1, and 60 mg/m(2) of CPT-11 on day 1, 8 and 15. An intermission after administration for 14 days made for one course. Four courses were carried out. A complete response was obtained for a primary gastric lesion and liver metastasis, and a partial response was obtained for lymph node metastases. So far it has showed no change for 6 months after chemotherapy. Both CDDP and CPT-11 are key drugs in the chemotherapy for common gastric cancer, and it is sometimes difficult to distinguish large cell neuroendocrine carcinoma from poorly-differentiated gastric cancer. We found this combination chemotherapy is a suitable regimen for the assumed existence of large cell neuroendocrine carcinoma at the gastric lesion.

Multiple somatostatin- and gastrin-containing carcinoids of the duodenum: report of a case treated by pancreas-sparing duodenectomy.

A 59-year-old Japanese man was incidentally discovered to have multiple polyps in the duodenum by endoscopy during a health checkup. Laboratory studies showed an elevated level of serum somatostatin. The mutation of the MEN1 gene was not observed. An endoscopic examination revealed multiple polypoid lesions in the bulbus and in the second portion of the duodenum. An upper gastrointestinal series also showed the multiple polypoid lesions in the bulbus, and in the descending and horizontal portions of the duodenum. The biopsy specimen showed small monotonous cells with round nuclei compatible with a carcinoid tumor. The tumor cells were positive for somatostatin and gastrin. Based on the clinical diagnosis of multiple carcinoids of the duodenum, a pancreas-sparing duodenectomy was performed. Macroscopic findings showed about 30 polypoid lesions throughout the duodenum. The biggest one was not over 10 mm in size. A histological examination revealed well-demarcated carcinoid tumors located in the submucosal layer. Immunohistochemically, the tumors were diffusely positive for somatostatin and were scatteringly positive for gastrin. The patient's postoperative course of treatment was uneventful and his postoperative serum somatostatin went down to normal range. The pancreas-sparing duodenectomy is a safe and effective treatment in patients with multiple carcinoids of the duodenum, that are smaller than 1 cm in size.