[9th Decade Female with Dementia, Who Had Anemia Pointed Out on a Routine Laboratory Check].

In this report, we reviewed the results of RCPC held at the 63rd national congress of the Japanese Society of Laboratory Medicine. The case was a 9th decade female with dementia, who had anemia pointed out on a routine laboratory check. The type of anemia was macrocytic(MCV>130 fL). The serum Vit.B12 and folate levels were markedly decreased. However, her anemia was not improved despite supplementation with Vit.B12 and folate (data on MCV were improved). The WBC increased gradually, but she subsequently died. Laboratory data were assessed by three doctors (DN, NM, and TT: blood cell counts, smear morpholo- gy of peripheral blood cells, and clinical chemistry, respectively). They diagnosed the patient with a hema- tological disorder, probably neoplastic hematological diseases; however, it was very difficult to make a further clinical diagnosis because of the necessary data not presented at this meeting. The final diagnosis was acute myeloid leukemia (AML-M4). The direct cause of death was rupture of her spleen due to the massive infil- tration of neonlastic cells. rReviewl.

Ciliated muconodular papillary tumor of the lung: A report of five cases.

Ciliated muconodular papillary tumor (CMPT) of the lung is a newly defined and extremely rare tumor characterized by a papillary growth pattern, consisting of ciliated columnar cells, mucous cells, and basal cells with abundant mucin production. Tumor definitions and clinicopathological features continue to be debated. Herein, we report five surgical cases of CMPT to characterize its radiographic, gross, and microscopic features. The five cases involved three male patients aged 80, 67, and 66 years, and two female patients aged 73 and 70 years. Three cases were discovered during health care screenings, and two cases were found during follow-up for another synchronous cancer. Histopathological examination revealed that the tumor tissue was composed of ciliated columnar cells, mucous cells, and basal cells with abundant mucin production. Neither nuclear atypia nor mitotic figures were observed. All patients had good prognoses. The benign histological features and clinical courses in these five cases suggest that CMPT is an independent and benign tumor of the lung.

Evaluation of endometrial cytology prepared with the Becton Dickinson SurePath™ method: a pilot study by the Osaki Study Group.

OBJECTIVE: To evaluate the sensitivity and specificity of the BD SurePath™ liquid-based Papanicolaou test for assessing the cytology of intrauterine endometrial samples according to newly devised cytological diagnostic criteria and a novel descriptive reporting format. MATERIALS AND METHODS: One hundred and twenty-two endometrial samples were analyzed. All samples were obtained directly from the intrauterine cavity using the Uterobrush or Honest Super Brush. The samples used for the histological examination and cytological tests were collected simultaneously. Our study group devised new cytological diagnostic criteria for examining endometrial samples: the Osaki Study Group method. In this study, histological diagnosis was considered to be the gold standard for cytological diagnosis. A novel descriptive reporting format was also used. RESULTS: Satisfactory cytological specimens were obtained in all cases. The sensitivity and specificity of the SurePath endometrial cytological examination method were 96.4 and 100%, respectively. CONCLUSION: These results indicate that the SurePath method is acceptable for clinical use. Since the SurePath method seems to be easier and allows greater preparation standardization than the conventional method, coupling it with our newly devised cytological diagnostic criteria and descriptive reporting format might represent a reliable diagnostic method for assessing endometrial specimens.

[A case of heterochrony and ectopic recurrence of a gastric signet ring cell carcinoma following partial gastrectomy].

A 53-year-old woman was referred to our hospital with a round, discolored lesion measuring 4mm in diameter that was identified as a minute gastric signet ring cell carcinoma. According to the Japanese classification of gastric carcinoma, it was graded as type 0-IIb. Seven years back, the woman had undergone pylorus-side gastrectomy for a small signet ring cell carcinoma, and the present lesion was assumed to result from heterochrony and ectopic recurrence. Endoscopic submucosal dissection was performed for the minute lesion. Clinicopathological findings revealed gastric mucosal cancer without invading lymph vessels or veins, similar to the previous lesion. We therefore report two very rare lesions in the same case. This case report demonstrates the importance of performing regular follow-up gastroduodenoscopy to detect recurrence in patients with these lesions.

[A case of calcifying fibrous tumor in the abdominal wall, morphologically resembling a gastric submucosal tumor].

We report an extremely rare case of a calcifying fibrous tumor (CFT) occurring in the abdominal wall. A 43-year-old woman was referred to our hospital because of a gastric submucosal tumor. Imaging findings revealed a gastric submucosal tumor with calcification. Endoscopic ultrasound-guided fine-needle aspiration was attempted to obtain a tissue specimen; however, the tumor was not adequately visualized because of calcification. Local excision was performed because of the tumor growth and the risk of progression to gastrointestinal stromal tumor. The tumor was histologically diagnosed as a CFT. We describe the imaging and pathological findings, and discuss the differential diagnosis and histogenesis of CFT.

[A case report of undifferentiated carcinoma of the sigmoid colon with rhabdoid features].

A 45-year-old woman with persistent abdominal pain was admitted to our hospital. Detailed examination revealed a type 4 lesion with circumferential narrowing, which was diagnosed as a poorly differentiated carcinoma following forceps biopsy and ascitic fluid cytology. Although the lesion was surgically resected, the ascites increased rapidly, and her general condition deteriorated in the postoperative period. She died 6 weeks after the appearance of her symptoms. Autopsy and histological examination confirmed a very rare undifferentiated colon carcinoma with rhabdoid features, which is a high-grade malignant lesion associated with a poor prognosis.

[A case of advanced gastric cancer with an invasive micropapillary carcinoma component].

A 62-year-old man was admitted for the evaluation of epigastric pain. Upper gastrointestinal endoscopy revealed a type 3 circumferential carcinoma in the gastric antrum. Distal gastrectomy was performed, and the lesion was histopathologically diagnosed as gastric cancer with an invasive micropapillary carcinoma component. Chemotherapy was administered after surgery; however, he died with multiple liver metastases after 39 months. Micropapillary carcinoma is a rare, high-grade, malignant histological subtype of gastric cancer that has not been described in detail till date. Here we describe this rare lesion and present a review of the relevant literature.

The Possibility of Acute Drug-Induced Liver Injury Associated With Prednisolone.

A female patient was referred to our hospital with complaints of liver injury. She had been treated for immunoglobulin (Ig)A nephropathy using prednisolone and other medications. Drug-induced liver injury (DILI) was suspected, as no evidence of viral infection or autoimmune liver disease was apparent. All medications except for prednisolone were discontinued, but liver enzyme levels remained elevated. Percutaneous liver biopsy showed the characteristics of DILI and drug lymphocyte stimulation testing yielded positive results for prednisolone. After stopping administration of prednisolone, liver enzyme levels recovered to near-normal. Prednisolone has immunosuppressive effects and is sometimes used to treat DILI. Some reports have revealed that high-dose corticosteroids can induce liver injury, but liver injuries associated with low-dose corticosteroid therapy have not been described. Prednisolone-induced liver injury is a rare phenomenon. When low-dose corticosteroids are used for treatment, care should be taken regarding the possibility of liver injury.

A giant liposarcoma originating from peripancreatic fat tissue with identification using 3D-CT angiography: a case report.

BACKGROUND: Liposarcoma originating from peripancreatic fat tissue is extremely rare. This case report presents a surgical case of a giant liposarcoma originating from peripancreatic fat tissue with origin identification using 3-Dimensional Computed Tomography Angiography (3D-CTA). CASE PRESENTATION: A 59-year-old female was referred to our hospital with a giant abdominal tumor. Computed tomography revealed a 34 cm tumor composed of fatty tissue, exerting pressure on the posterior aspect of the pancreas. Suspecting liposarcoma, we planned for surgery. At first, the tumor appeared to be intra-abdominal tumor, based on the identification of the tumor's feeding artery as a branch of the dorsal pancreatic artery using 3D-CTA, we concluded that the liposarcoma originated from the peripancreatic fat tissue and situated in the retroperitoneum. During surgery, we observed a well-capsulated, elastic, yellowish mass without infiltration into surrounding tissues. We carefully dissected the tumor from the greater omentum and transverse mesocolon while preserving the tumor capsule. We ligated the feeding artery at the border with the pancreatic parenchyma and successfully completed the excision of the tumor. The resected specimen weighted 2620 g and was pathologically diagnosed as a well-differentiated liposarcoma. There was no injury to the tumor's capsule, and the surgical margins were negative. CONCLUSIONS: In this report, we present an extremely rare case of a liposarcoma originating in the peripancreatic fat tissue. The use of 3D-CTA was instrumental in identifying the primary site of this giant tumor, enabling us to guide the surgery and achieve complete resection successfully.

Bleeding From a Ruptured, Extraluminally Growing Gastric Gastrointestinal Stromal Tumor Treated by Transcatheter Arterial Embolization: A Case Report.

A 49-year-old man with abdominal pain was referred to our hospital. Abdominal computed tomography showed an extraluminal tumor near the gastric anterior wall and intra-abdominal fluid collection. A ruptured intra-abdominal tumor was suspected, and emergency abdominal angiography was performed. Hemorrhage into the abdominal cavity was seen, and transcatheter arterial embolization (TAE) was performed, which stopped the bleeding. The tumor was surgically resected, and a diagnosis of an extraluminally growing gastric gastrointestinal stromal tumor was made. TAE should be considered for rare cases of extraluminally growing tumors with intra-abdominal hemorrhage.

[A case of pulmonary artery injury which might have been caused by a pulmonary artery catheter during the mitral valve replacement].

We experienced a pulmonary artery injury which might have been caused by a pulmonary artery catheter (PAC). A 66-year-old woman after mitral valve replacement, developped massive tracheal bleeding during weaning from the cardiopulmonary bypass. Transesophageal echocardiography revealed the air bell in the right pulmonary artery synchronized with ventilation. We speculated pulmonary artery injury and performed pulmonary artery angiography; however, it could not clarify the bleeding point. Surgical approach found the air leak from the erasure of the bronchus intermedius and the lobectomy led to lifesaving. A pulmonary artery injury caused by PAC is very rare, but life-threatening. In this case, she had some risk factors (i. e. 60 years or older, female, short statue, and mitral valve disease); however, it was hard to predict the pulmonary injury from these factors.

A case of primary renal oncocytic tumor: Chromophobe renal cell carcinoma or oncocytoma?

Introduction: "Other oncocytic renal tumors of the kidney" is a new category constituted by 2022 WHO classification and different in the point of morphology and immunohistochemistory from typical oncocytic/eosinophilic renal tumors including chromophobe renal cell carcinoma and oncocytoma. Case presentation: The patient was an 84-year-old woman in whom a left renal tumor was incidentally discovered. She underwent left nephrectomy, and the pathological specimens showed a borderline eosinophilic renal tumor between chromophobe renal cell carcinoma and renal oncocytoma. After all recognized oncocytic tumors were excluded, we diagnosed the tumor as other oncocytic renal tumor of the kidney. Conclusion: Other oncocytic renal tumor of the kidney is a provisional category. Therefore, further research and accumulation of similar cases are necessary.

Angiomatous meningioma associated with rapidly aggravated peritumoral leptomeningitis: A case report.

Background: A special type of meningioma is known to have infiltrated inflammatory cells within the tumor, associated with peritumoral inflammation. However, there have been no reports of meningioma with inflammatory response only around the tumor, without inflammatory cells within the tumor itself. Case Description: A 70-year-old woman presented with transient right hemiparesis due to an extra-axial tumor on the left frontal convexity. The tumor appeared hypointense on T1-weighted magnetic resonance images and hyperintense on T2-weighted images without peritumoral edema, and was homogenously enhanced associated with the peritumoral leptomeningeal enhancement. Cerebrospinal fluid examination showed an increase in the number of inflammatory cells with a predominance of mononuclear cells. During the following 1 month, the tumor size was unchanged, but the peritumoral leptomeningeal enhancement was remarkably enlarged with uncontrolled focal seizures. The tumor was subtotally removed and semisolid substances in the subarachnoid space were biopsied. Pathological examination with immunostaining revealed angiomatous meningioma: the tumor had no inflammatory cell infiltration within it, but was associated with the infiltration of immunoglobulin G4-negative lymphocytes into the border zone between the tumor and the dura mater, as well as numerous neutrophils and fibrinous exudates in the peritumoral subarachnoid space. The tumor removal rapidly improved the leptomeningeal enhancement and inflammatory reactions. Conclusion: The authors reported the first case of angiomatous meningioma associated with massive peritumoral inflammation without inflammatory infiltrates within the tumor itself.

Detection of Lymphadenopathy as a Precursor to Autoimmune Liver Diseases Before Clinical Hepatitis Became Apparent: A Report of Two Cases.

Two patients were incidentally diagnosed with intra-abdominal lymphadenopathy on imaging examinations. Although endoscopic ultrasound-guided fine needle aspiration of these areas of lymphadenopathy was performed, their causes remained undetermined. Neither patients had abnormal hepatic enzyme levels at the time lymphadenopathy was detected, but they developed hepatitis 20 months and five months later, respectively. The laboratory data and/or histopathological findings suggested primary biliary cholangitis/cirrhosis (PBC) and autoimmune hepatitis (AIH), respectively. These two patients were each started on appropriate treatment (ursodeoxycholic acid or prednisolone, respectively), their hepatitis ameliorated, and the hepatic enzyme levels recovered to within the normal ranges. These patients' clinical courses suggest that their lymphadenopathy was associated with PBC or AIH and appeared before the causative hepatitis became clinically apparent. We should consider the possibility of latent autoimmune hepatic diseases in cases with cryptogenic intra-abdominal lymphadenopathy even if there is no clinically apparent hepatitis.

[Incidence of string-like adhesion between thoracic wall and bullae observed during video-assisted thoracic surgery( VATS) for spontaneous pneumothorax].

It is not rare that string-like adhesion between lung apex and chest wall is observed during videoassisted thoracic surgery (VATS) for spontaneous pneumothorax. This adhesion may cause hemothorax which requires emergency operation, although the precise incidence of such cases is uncertain. We analyzed consecutive 120 spontaneous pneumothorax cases underwent VATS at Suzuka General Hospital from January 2005 to September 2008. Twenty-one out of 120 (17.5%) were such cases receiving partial resection of the lung including the adhesion after dividing it. Pathological study revealed the bullae close to the adhesion in all cases, suggesting that these adhesion caused after possible former pneumothorax. Thus, 21 cases might be recurrent pneumothorax. Even in clinically 1st onset pneumothorax, those cases may be good indication for VATS.

Diagnostic utility of lung echography for congestive heart failure performed by junior resident doctors.

Background: Dyspnea is a high priority symptom in the emergency department, with heart failure (HF) as one of its leading causes. Recently, the "comet tail sign (CTS)," a pulmonary ultrasonographic sign, has been proposed as an efficacious tool for detecting pulmonary edema. However, to the best of our knowledge, there have been no published data regarding its utility when performed by non-experts, including junior residents. Methods: Between September 2017 and December 2018, patients with dyspnea, who were admitted to the ER, were enrolled. CTS was evaluated by junior residents at the ER. All patients were evaluated by cardiologists independently, and clinical HF was defined as requiring pharmacological intervention by a cardiologist. At the end of this study, we investigated the results of CTS, laboratory data, and available radiological images. Results: A total of 95 patients were enrolled in the current study, wherein 42 patients were treated by cardiologists as those with clinical HF. Our results showed that CTS could identify clinical HF with a sensitivity of 71.4% and a specificity of 81.1%. The sensitivity of CTS against brain natriuretic peptide (BNP) (cut-off value, 100 pg/ml) was calculated at 92.5%. Furthermore, when evaluated together with peripheral edema, CTS identified clinical HF with a sensitivity of 96%. False positives for CTS included bilateral pneumonia, hypoalbuminemia, and interstitial pneumonitis. Conclusions: Our results indicate that CTS is a simple and effective tool for the use of non-experts, including junior residents.

Benzpyrimoxan: Design, synthesis, and biological activity of a novel insecticide.

Benzpyrimoxan (5-(1,3-dioxan-2-yl)-4-{[4-(trifluoromethyl)phenyl]methoxy}pyrimidine, NNI-1501) was discovered as a novel insecticide structurally characterized by a pyrimidine derivative substituted with 1,3-dioxanyl and 4-trifluoromethylbenzyloxy groups. The compound showed remarkable activity against nymphs of rice planthoppers, including strains resistant to existing insecticides. Furthermore, benzpyrimoxan had low adverse effects on pollinators and beneficial arthropods. Because of these features, benzpyrimoxan is expected to be a suitable part of an integrated pest management strategy. In this report, the history of the discovery to reach benzpyrimoxan and details of the structure-activity relationships are described.

[Anesthetic management using the arterial pressure-based cardiac output monitor and a central venous oximetry catheter for tricuspid valve replacement in a patient receiving hemodialysis].

A 64-year-old man receiving hemodialysis underwent a tricuspid valve replacement. We used an arterial pressure-based cardiac output (APCO) monitor and a central venous oximetry catheter instead of pulmonary artery catheter because the enlargement of the right ventricle caused by tricuspid valve regurgitation might make it difficult to insert the pulmonary artery catheter. Aortic calcification was so severe that an arterial cannula was sewn into the right subclavian artery. Therefore, we had to insert an arterial catheter into the shunt placed on his left upper limb, and connected it to the APCO monitor FloTrac (Edwards Life-sciences, U.S.A.). Anesthesia was induced with intravenous fentanyl, midazolam and rocuronium, and maintained with fentanyl and propofol. A triple lumen PreSep central venous oximetry catheter (Edwards Lifesciences, USA) was inserted via his right internal jugular vein. Under cardiopulmonary bypass beating tricuspid valve replacement was performed. Although a large amount of catecholamine was needed for weaning from cardiopulmonary bypass, it was performed referring to the cardiac index of APCO monitor. The operation was finished successfully. We concluded that cardiac function should be evaluated with the relative change of cardiac index from APCO monitor when the absolute value was uncertain from patient's pathology (e.g., valvular disease).

Malignant melanoma with a rhabdoid phenotype exhibiting numerous solid tumor masses: a case report.

We present a case of malignant melanoma with a rhabdoid phenotype in a 44-year-old female with a quite unique and aggressive clinical course. Rhabdoid features are defined by characteristics such as sheets or solid trabeculae of neoplastic cells with large, vesicular, round to bean-shaped nuclei, prominent centrally located nucleoli, and abundant eccentric cytoplasm. Although various histological differential diagnoses were cited for the present case that showed 'rhabdoid features', most of them were excluded on the basis of the clinical history, tumor location, clinical behavior, and a broad panel of immunohistochemical stains. In the present case, the immunohistochemical findings were positive for vimentin, S-100 protein, melan-A, and EMA, but negative for HMB45, cytokeratin, CD34 and desmin. In addition, the positive expression of BAF47 was also recognized. These findings lead to the conclusion that this quite unique aggressive soft tissue tumor should therefore be diagnosed as malignant melanoma with a rhabdoid phenotype.