[A case of pericardial malignant mesothelioma accompanied by primary lung adenocarcinoma].

A 63-year-old man was admitted to Jikei University Hospital, with anasarca, and dyspnea in May, 2004. Echocardiograms and CT scans showed massive pericardial effusion, nodules on the pericardium and a tumor in the lower lobe of the left lung. Pathological examination of the punctured pericardial effusions yielded a diagnosis of pericardial malignant mesothelioma. However, no pathogen or malignant cells were identified from multiple biopsy specimens of the lung tumor, which were obtained by brochoscopic techniques. Since he worked as a fisherman in a diesel-powered fishing boat, he was possibly exposed to asbestos. On autopsy, the lung tumor was diagnosed as a primary lung adenocaricinoma. Exposure to asbestos is an important risk factor for both mesothelioma and lung cancer. However, pericardial malignant mesothelioma in itself is rare among mesothelioma. This is only the second report of malignant mesothelioma with primary lung adenocarcinoma, to date.

[A case of lung adenocarcinoma with Marie-Bamberger syndrome that improved by chemotherapy].

A 68-year-old man was admitted with arthralgia in both knees. Chest CT showed a tumor 4cm in diameter with a cavity in the right lung. Clinical stage IV (T2N3M1) lung adenocarcinoma was diagnosed. The thickness of the fibular cortex was shown on the radiograph and distal symmetric accumulation of extremities was shown using bone scintigraphy. These results suggested that the knee-joint pain was caused by Marie-Bamberger syndrome. After chemotherapy with cisplatin plus gemcitabine, the tumor decreased, and the bone pain disappeared. This is a case that showed the correlation between tumor reduction and bone pain in Marie-Bamberger syndrome.

[Thymic carcinoma. A clinicopathological study of seven patients].

The treatment of seven cases of thymic carcinoma is reported. According to the Masaoka classification of the disease, there were five cases of stage III and two of stage IVb. Five were identified histopathologically as squamous cell carcinoma, one as undifferentiated carcinoma, and one as small cell neuroendocrine carcinoma. Surgery was performed during the course of chemotherapy and radiotherapy in 5 cases, and in 2, the organs infiltrated by neoplastic cells were partially excised together. Radiotherapy was performed as adjuvant therapy in one case of partial excision. In another case, after six years of chemotherapy and radiotherapy that yielded a partial response (PR), cancerous infiltration of the chest wall occurred, and partial removal of the chest wall became necessary. After the remaining case showed a PR to chemotherapy, complete macroscopic excision of the tumor was undertaken, but mediastinal lymph gland metastasis was present, and so radiotherapy was also initiated. In two cases, surgery was not performed. One of these was treated with chemotherapy alone, the other, only with radiotherapy. The mean survival period of the five patients who died as a result of their tumors was 44.8 months. One of the two who survived for over four years had squamous cell carcinoma, the other, undifferentiated carcinoma. The case of small cell neuroendocrine carcinoma was assessed as having a PR, and so complete extraction of the thymic neoplasm was carried out, and followed with radiotherapy. This patient is still alive.

True malignant histiocytosis with trisomy 9 following primary mediastinal germ cell tumor.

A 24-year-old Japanese man was admitted due to bloody phlegm in May 2002. A diagnosis of mediastinal germ cell tumor, mixed type involving seminoma, immature teratoma and embryonal carcinoma, was made by transthoracic needle biopsy. Three months later, his complete blood counts revealed pancytopenia with high fever. Examination of bone marrow revealed increased atypical large histiocytes (5.6%) with hemophagocytosis, and thus, hemophagocytic syndrome related to germ cell tumor was diagnosed. In addition, chromosomal analysis of the bone marrow cells revealed a 47, XY, +9 genotype. Chemotherapies for germ cell tumor and hemophagocytic syndrome were performed without any improvement, and he died of diffuse alveolar damage. Autopsy revealed diffuse infiltration of immature histiocytes with hemophagocytosis in the liver, spleen and bone marrow. The atypical histiocytes were positive for CD68 and lysozyme and negative for lymphoid markers, and the diagnosis of true malignant histiocytosis associated with mediastinal germ cell tumor was made. The rare chromosomal abnormality of trisomy 9, a marker for benzene-related leukemia, was seen in the present case without apparent benzene exposure.