Metastatic lung choriocarcinoma resected nine years after hydatidiform mole.

A 38-year-old woman with metastatic choriocarcinoma of the lung had been treated for a hydatidiform mole nine years previously. During the interval she had conceived and given birth to a child. Following lobectomy she has been metastasis-free for five years.

A case of malignant Triton tumor of the lung.

The present paper reports a 28-year-old male with an asymptomaticmalignant Triton tumor of the lung. Chest radiographs revealed a mass in the left hilum. The left lower lobe including the tumor and the mediastinal lymph node was resected. There was no metastasis or tumor recurrence during the one-year period following the surgical procedure. To our knowledge, this is the first case report of a primary pulmonary malignant Triton tumor.

Intrathoracic malignant peripheral nerve-sheath tumour associated with lipoma.

A 76-year-old woman presented with an intrathoracic malignant peripheral nerve-sheath tumour accompanied by mediastinal lipomas. The tumours were resected, but the schwannoma recurred 4 months later. The patient died of pneumonia after a second operation. To our knowledge, this is the first published case of malignant intrathoracic tumour of nerve-sheath origin associated with lipomas.

[A case report of invasive thymoma presenting as a solitary metastatic lesion of the lung].

A 66-year-old woman visited our hospital for further investigation of a coin-shaped lesion in the right lower lung field. After admission, CT-scan revealed an anterior mediastinal tumor. Thymoma and lung metastasis from thymoma were suspected. At thoracotomy, an invasive thymoma involving the left phrenic nerve, the left upper lobe, and the pericardium was found, and the diagnosis of lung metastasis was made. Postoperative pathological findings showed a predominantly lymphocytic thymoma with round and oval-shaped epithelial cells, and the metastatic lung lesion revealed the same findings. Postoperative radiotherapy (4000 rads) and chemotherapy with a combination of CDDP, VDS, and CPA were administered. The metastasis of thymoma is not rare, but most often it is found after operation. In this case the diagnosis of metastatic thymoma was made pre-operatively from a solitary lung lesion.

Pancreatoblastoma with marked elevation of serum alpha-fetoprotein. An autopsy case report with immunocytochemical study.

The autopsy findings in a pancreatoblastoma in a 7-year-old Japanese girl is reported. The tumour was in the head and body of the pancreas, and was associated with diffuse carcinomatous peritonitis and hepatic and pulmonary metastases. There was marked elevation (more than 10,000 ng/ml) of serum alpha-fetoprotein (AFP). Histopathologically the tumour was composed of solid epithelial elements with fibrous stroma, showing acinar arrangement, squamoid clusters and tubular structures. The epithelial elements contained numerous fine PAS positive granules in the cytoplasm. Immunocytochemical results suggested epithelial differentiation with positivity to alpha-1-antitrypsin (AAT), keratin, CA19-9, and AFP. No endocrine elements were recognized. Characteristic feature of this tumour are discussed and compared with previous reports.

[Fulminant autoimmune hemolytic anemia with multiple organ failure].

We report a rare case of fulminant autoimmune hemolytic anemia (AIHA) with multiple organ failure (MOF). A 40-year-old man was emergently admitted to our hospital because of conscious disturbance and jaundice. The peripheral blood revealed RBC 68 x 10(4)/microliter, Hb 3.5 g/dl, Ht 8.9%, Ret 30% (20,400/microliter), WBC 20,300/microliter, Plts 16.9 x 10(4)/microliter, indirect bilirubin 9.4 mg/dl. Both direct and indirect Coombs test were positive and the IgG autoantibody was identified. Bone marrow aspiration revealed hypercellularity with increased megakaryocytes and erythroid hyperplasia. The patient was diagnosed as having idiopathic warm type of AIHA and the therapy was started with prednisolone 80 mg/day from the first day of admission but hemolysis with reticulocytopenia was so rapidly progressive that he was in acutely life-threatening state and MOF (acute renal failure, adult respiratory distress syndrome, congestive heart failure, liver dysfunction, rhabdomyolysis) appeared on the third hospital day. Plasma exchange therapy and hemodialysis were started and high dose methylprednisolone was given soon after rapid administration of sufficient blood transfusion. Dramatic improvement of hemolysis was noted and MOF was controlled after starting these therapies, but he died of exacerbation of MOF probably due to sepsis 40 days later.

[Two cases of Creutzfeldt-Jakob disease with high neuron-specific enolase level in cerebrospinal fluid].

Because neuron-specific enolase (NSE), one of the distal branch enzyme of Embden-Myerhof glycolytic pathway is abundant in the neuronal cytoplasm and axons, the measurement of its level in cerebrospinal fluid (CSF) would be useful in diagnosis and consideration of pathophysiology in various neurological diseases. The Creutzfeldt-Jakob disease (CJD) in which neuronal destruction is usually prominent pathologically, has so far been thought to reveal no abnormalities in CSF. In the two cases of CJD, we conducted the time sequential measurement of NSE level in CSF and compared it with serum NSE and CSF lactate levels. We found that the CSF NSE level was high in the early stage of this disease, at which time the brain CT showed no or minimal abnormalities, followed by gradual increase up to the maximum level when myoclonus and periodic synchronous discharge appeared in electroencephalogram. Then, the CSF NSE level decreased in parallel with the progression of brain atrophy in CT scan and finally on the late stage, the CSF NSE level fell within normal range. Serum NSE and CSF lactate levels were mildly elevated in all stages of this disease, but were not parallel to the disease activity. This implies that the CSF NSE level can serve as a marker for the presence of active process in neuronal destruction. Again the CSF NSE level was elevated in both cases even from the very early stage when the typical clinical manifestations of this disease were absent. Therefore, the results of this study provided us with an important indicator for the early stage diagnosis of CJD.

High neuron-specific enolase level of cerebrospinal fluid in the early stage of Creutzfeldt-Jakob disease.

The measurement of neuron-specific enolase level in serum and cerebrospinal fluid was conducted time-sequentially in an autopsy confirmed patient with Creutzfeld-Jakob disease. The level was markedly high in the early stage of the disease at which time the brain CT showed no or minimal abnormalities, while falling into the normal range in the advanced stage. This is the first report of the elevated level of neuron-specific enolase in Creutzfeldt-Jakob disease.

CT findings in hepatic and splenic amyloidosis.

In a patient with biopsy proven focal amyloidosis of the liver CT showed a uniform decrease in attenuation, with a focal large low-density lesion in the right hepatic lobe. Following intravenous contrast medium injection, there was poor contrast enhancement.

A case of ovarian dermoid cyst with malignant transformation perforated into the rectosigmoid colon and small intestine.

A 72-year-old female was admitted to hospital with diarrhea containing hair. The abdominal plain film showed teeth-like structures in the right lower quadrant. Barium enema and endoscopic examination were performed, and the results indicated a possible dermoid cyst perforated into the rectosigmoid colon and small intestine. The operation revealed a dermoid cyst of the right ovary perforated into the rectosigmoid colon and small intestine. Histopathologically, a dermoid cyst and in part well-differentiated squamous cell carcinoma invading the rectosigmoid and small intestine were demonstrated.