Intratubular trophoblasts in the contralateral testis caused elevation of serum human chorionic gonadotropin following complete remission of stage II testicular tumor: a case report.

We report the case of a 22-year-old male who had a history of metastatic right testicular tumor successfully treated with chemotherapy and surgery. Twenty-one months after the initial treatment, the serum human chorionic gonadotropin started to increase gradually, but whole body imaging including the left testis revealed no abnormal finding except testicular microlithiasis. A biopsy of the left testis revealed intratubular germ cell neoplasia, unclassified type. After the human chorionic gonadotropin level reached 6.6 mIU/ml, he underwent left high orchiectomy. Histology demonstrated a small malignant germ cell tumor as well as intratubular germ cell neoplasia, unclassified type, both of which were negative for human chorionic gonadotropin staining. Besides these lesions, there were tiny foci of human chorionic gonadotropin-immunoreactive intratubular trophoblasts. Serum human chorionic gonadotropin normalized immediately after the orchiectomy, and he had no sign of recurrence at 6 months. The present case will provide new insight into the diagnosis of testicular tumor recurrence with isolated elevation of a serum tumor marker.

[Long-term survival with gemcitabine and docetaxel for renal leiomyosarcoma : a case report].

A 64-year-old woman who complained of abdominal pain underwent right radical nephrectomy under the clinical diagnosis of renal cell carcinoma in January, 2006. The pathological diagnosis was leiomyosarcoma originating from the kidney. Follow-up computed tomography revealed 2 small nodules in the left lung 15 months after nephrectomy. A lung nodule resected with video-assisted thoracic surgery (VATS) was identified as metastatic leiomyosarcoma. Since the pulmonary metastases progressed after VATS, systemic chemotherapy with gemcitabine and docetaxel (GD therapy) was started. The lung metastases responded well, and a durable partial response was achieved for 29 months. Subsequently, the patient developed new pulmonary metastases and pancreatic metastasis. Despite this disease progression, we elected to continue GD therapy, since the patient's performance status and quality of life were favorable during the treatment. So far, the GD therapy has been continued for another 23 months, for a total of 41 treatment cycles, with few adverse events. Although multiple metastases have slowly progressed, the patient has maintained good performance status in the outpatient clinic. In the present case, GD therapy seems to have been beneficial for survival, as metastatic renal leiomyosarcoma is considered to have an extremely poor prognosis.

Increased expression of OCIA domain containing 2 during stepwise progression of ovarian mucinous tumor.

Ovarian cancer immunoreactive antigen domain containing 2 (OCIAD2) has been reported to show cancer-specific expression in early invasive lung adenocarcinoma. OCIAD2 shows high homology with OCIAD1, which was originally immunoscreened from ascites of a patient with ovarian cancer and found to be a tumor-specific protein. Therefore, like OCIAD1, OCIAD2 is expected to show high immunoreactivity in ovarian tumors. In this study, we examined the expression pattern of OCIAD2 in 117 ovarian mucinous tumors, and confirmed that it was more highly expressed in borderline tumor and carcinoma (51/74 cases, 69%) than in adenoma (6/43 cases, 14%). The immunoreactivity of OCIAD2 in borderline tumor and carcinoma was more specific than that of OCIAD1 (adenoma, 21/43 cases, 49%), and more sensitive than that of CEA (borderline tumor and carcinoma, 35/74 cases, 47%). Like OCIAD1, OCIAD2 is a cancer-related protein and its expression level increases during the course of malignant progression and is thought to be a very useful marker for evaluating the malignancy of ovarian mucinous tumors.

Epiglottic cyst in an infant.

Epiglottic cyst is a rare cause of stridor and respiratory distress in newborns and infants. A 2-year-old girl was referred to our department for the treatment of an epiglottic cyst causing inspiratory stridor. Flexible fiberoptic laryngoscopy and a computed tomography (CT) scan revealed a cystic lesion on the lingual surface of the epiglottis. Frequent episodes of sleep apnea accompanied by desaturation had been observed during her sleep. Endoscopic deroofing was performed under general anesthesia. After the operation, stridor and sleep apnea disappeared.

Comparison between computed tomography (CT) and autopsy findings in cases of abdominal injury and disease.

We report 10 autopsy cases involving fatal pathological changes in abdominal organs, for which findings of computed tomography (CT) on admission or after death were compared with autopsy findings. Two of the cases were death due to natural causes and eight were death due to traffic accidents. From the findings at autopsy, the causes of death were considered to be rupture of an aortic aneurysm in one case, gastrointestinal bleeding due to gastric cancer in one case, retroperitoneal bleeding in two cases, laceration of the liver in three cases, and traumatic rupture of the small intestine in three cases. CT findings revealed ascites or retroperitoneal bleeding in eight cases. However, in the cases of small-intestinal rupture, CT findings on admission revealed no free air. Therefore, ascites on CT should be regarded as a useful indicator of blunt abdominal trauma. Hepatic portal venous gas, known to be a post-mortem change, was significantly evident on post-mortem CT in cases of traumatic liver or intestinal injury, and was also seen in cases where the period between the accident and CT examination was long.

Postmortem computed tomographic (PMCT) and postmortem magnetic resonance imaging (PMMRI) demonstration of fatal massive retroperitoneal hemorrhage caused by abdominal aortic aneurysm (AAA) rupture.

We report a case of fatal massive retroperitoneal hemorrhage caused by the rupture of an abdominal aortic aneurysm (AAA) in which postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMRI) provided clear delineation. In this case, the autopsy imaging system using PMCT and PMMRI was useful as a screening method to determine the cause of death as AAA rupture and became a guide for the subsequent autopsy.

Postmortem magnetic resonance imaging (PMMRI) demonstration of reversible injury phase myocardium in a case of sudden death from acute coronary plaque change.

We report a case of sudden death from acute coronary plaque change in which postmortem magnetic resonance imaging (PMMRI) detected reversible injury phase myocardium. Postmortem computed tomography (PMCT) of the chest showed diffuse ground-glass attenuation (GGA) in both lungs, suggesting pulmonary edema due to cardiac pump failure. T2-weighted imaging (T2WI) of PMMRI delineated the left anterior descending coronary artery (LAD) territory as showing high signal intensity relative to the remaining myocardium. Therefore, we presumed the cause of death was myocardial infarction (MI) of the LAD territory. Autopsy showed acute plaque change in the LAD, however, there were no indications of MI. In this case, autopsy imaging using PMCT and PMMRI was useful as a guide for autopsy.

Immunostaining for thyroid transcription factor 1, Napsin A, p40, and cytokeratin 5 aids in differential diagnosis of non-small cell lung carcinoma.

The present study aimed to examine the effectiveness of immunostaining of cytological specimens in discerning squamous from non-squamous cell carcinoma. Various combinations of six antibodies were examined in order to determine the optimal combination for use in differential diagnosis. Immunostaining was performed using tumor imprint smears obtained from 70 lung carcinoma cases. The results were scored based on positive area and intensity. For objective evaluation, scores for thyroid transcription factor 1 (TTF-1), napsin A, and CK CAM5.2 were expressed with positive values, while those for p40, cytokeratin (CK) 5/6 and CK5 were expressed with negative values. Histograms were produced to evaluate which combination was the most effective in differentiating squamous cell carcinoma from adenocarcinoma. The sensitivity for these molecules in adenocarcinoma was 88% for TTF-1, 85% for napsin A, and 100% for CAM5.2. In squamous cell carcinomas, sensitivity was determined to be 90% for p40, 86% for CK5, and 76% for CK5/6. The specificity for these molecules was calculated as 100%, 95%, 43%, 98%, 100% and 95%, respectively. Each combination was evaluated for scoring and the values were averaged. The most effective combination for mode and mean was TTF-1, napsin A, p40, and CK5, for which all adenocarcinomas had a score >1, and all squamous cell carcinomas scored <-2. Immunostaining scoring may therefore be useful for the differential diagnosis of these carcinomas when a limited number of tumor cells are present.

Basal cell adenoma arising in a minor salivary gland of the palate.

BACKGROUND: Basal cell adenoma is a benign neoplasm of the salivary glands. This tumor usually arises in the major glands, with the parotid being the most frequent site of occurrence, while it is rare in the minor salivary glands. We report a case of basal cell adenoma of a minor salivary gland on the palate. CASE: The patient was a 68-year-old man. Intraoral examination revealed a mass measuring 20 × 20 mm that was elastic-hard, dark violet, non-ulcerated, and covered the normal mucosa. Computed tomography scan and magnetic resonance imaging (MRI) both showed a mass situated in front of the soft palate. The T1-weighted MRI revealed tumor isointensity, and the T2-weighted image showed tumor hyperintensity. The clinical diagnosis was palate tumor, and excision was performed under general anesthesia. Histopathological examination revealed that an encapsulated mass had grown under the epithelium and indicated a diagnosis of basal cell adenoma. DISCUSSION: Although no recurrence has been detected in the 3 years and 6 months of follow up, there was a case of malignant transformation of a basal cell adenoma reported. Therefore, careful follow-up observation will continue to be important.