Inflammatory Polyp of the Gallbladder Mimicking Early Polypoid Carcinoma

We treated a 69-year-old male with a 16-mm polyp of the gallbladder. Enhanced computed tomography demonstrated marked enhancement. With a tentative diagnosis of early polypoid cancer of the gallbladder, open cholecystectomy was performed. Intraoperative ultrasound showed hyperechoic spots on the surface of the polyp with an inner echopenic area. The histological diagnosis was an inflammatory polyp that manifested nonneoplastic, edematous stroma, and infiltration of lymphcytes and plasmacytes

Solitary Fibrous Tumor Arising from the Sphenoid Sinus

Solitary fibrous tumor (SFT) is an uncommon neoplasm that usually arises from the pleura. To our knowledge, only 30 cases of SFTs in the nasal cavity and paranasal sinuses have been reported in the literature. We describe an SFT that arose from the right sphenoid sinus and extended to the nasal cavity and epipharynx. The tumor was completely removed by endoscopic sinus surgery without complication. The patient is taking an uneventful course without any evidence of recurrence of the disease 8 months after surgery now

Dysplasia Epiphysealis Hemimelica of The Trochlear Epiphysis

Dysplasia epiphysealis hemimelica is an uncommon disorder primarily involving the epiphyes of the lower extremities. We report imaging findings of a case of dysplasia epiphysealis hemimelica involving the trochlear epiphysis of the humerus. Conventional radiography showed irregular ossification in the area of trochlear epiphysis, the finding thought to be diagnostic of this discorder. However, other imaging modalities, such as double contrast arthrography, computed tomography and MR imaging, provided valuable information about the nature and extent of the epiphyseal pathology

Upregulation of CA 19-9 in the Mouse Kidney Following Unilateral Ureteral Obstruction

High serum levels of carbohydrate antigen19-9 (CA19-9) have been detected in patients with pancreatic cancer and described in several recent case reports of patients with hydronephrosis. However, the mechanism of high serum levels of CA19-9 among hydronephrosis cases remains to be elucidated. In this study, we established a mouse unilateral ureteral obstruction (UUO) model to investigate the expression of CA19-9 protein in renal tissue. To investigate the progression of hydronephrosis following UUO, MR urography and pathological analysis were performed. CA19-9 expression was examined by immunohistochemistry and western blot analysis. MR urography revealed that the grade of pelvic dilatation increased in a time dependent manner. Pathologically, both interstitial cellular infiltration and fibrosis were detected from the second to the fourteenth day after surgery in UUO mice. CA19-9 was detected in the UUO kidney after the second day. The immunoblot analysis revealed that the elevated expression of CA19-9 was demonstrated at an early stage of obstructive nephropathy. Our study shows that the ureteral obstructed kidney is dominated by cell infiltration and induced fibrosis. The selective expression of CA19-9 was detected in renal fibrous tissue. Based on these findings, the level of CA19-9 might be a good indicator for onset of renal fibrosis induced by obstruction

A Large Periureteral Lipoma Associated with Renal Lithiasis and Hydronephrosis.

A rare case of large periureteral lipoma in a 66-year-old woman is reported. The tumor measuring 16×7×7cm in size was located from the upper portion of the right ureter to the renal pelvis. It is considered that the severe hydronephrosis and renal lithiasis occurred as a result of stenosis in the upper urinary tract due to compression by the tumor. Although the differential diagnosis was difficult radiologically, the tumor was easily diagnosed as lipoma by hi stop athological investigation

Positivity for cancer stem cell markers, CD44 and CD133, is a useful biomarker for predicting the outcomes of patients with advanced gastric cancer

Background; The CD44 and CD133 expressions have been identified to be putative cancer stem cell (CSC) markers. Some reports have revealed a correlation between these CSC markers and a poor prognosis in the clinical setting. However, clinical impact of combined use of these markers has not been determinated in advanced gastric cancer.Methods; Specimens were obtained from 73 patients with gastric cancer with invasion beyond the muscularis (T3/4a) who underwent curative gastrectomy. Immunohistochemically, tumors with more than 5% CD44-positive cells or at least one CD133-positive cancer cell were regard as being CSC marker-positive.Results; Forty patients were CSC marker-positive. There were significant correlations between the CSC marker expression and the extent of lymphatic (p=0.04) and vessel invasion (p<0.001). The CSC marker-positive patients exhibitedpoor prognoses in both the overall (p=0.006) and disease-free survival analyses (p=0.019). Based on the results of the univariate analysis, the peritoneal CEA value, the extent of lymph node metastasis and CSC marker positivity were analyzed in the multivariate analysis. The results revealed that the extent of lymph node metastasis (p<0.001) and CSC marker positivity (p=0.04) were significant risk factors.Conclusion; CSC marker positivity is an independent prognostic factor in patients with T3/4a gastric cancer

A Case of Intraductal Papillary Neoplasm of the Bile Duct with Stromal Invasion

Intraductal papillary neoplasm of the bile duct (IPNB) represents biliary papillary tumors mainly growing and is considered to be of relatively low-grade malignancy. Here we report a case of IPNB in whom the poorly differentiated component deeply infiltrated the bile duct wall. A 77-year-old male had an invasive carcinoma of the bile duct 3 cm in size. He underwent right hemihepatectomy with combined resection of the extrahepatic bile duct. Papillary growing tumor was observed in the common bile duct and the right posterior Glisson's pedicle was invaded. Histologic finding showed papillary adenocarcinoma in the surface layer superficially extending to the epithelium of the surrounding bile duct. In the subserosal layer, the tumor represented poorly differentiated adenocarcinoma. The tumor was diagnosed as invasive bile duct carcinoma arising from IPNB

Peyer’s Patches in the Terminal Ileum in Ulcerative Colitis: Magnifying Endoscopic Findings

Peyer’s patches (PPs), a major component of the gut-associated lymphoid tissue, serve as important antigen entry sites in mucosal immunity. PPs may play a role in the extension of ulcerative colitis (UC) into the terminal ileum. We sought to clarify the magnified endoscopic findings of the PPs in the terminal ileum of UC patients. Eighteen UC patients underwent magnifying chromoendoscopy before initial treatment to evaluate the follicle-associated epithelium (FAE) on the PPs domes and the surrounding villi. In 8 UC patients, as in healthy controls, the PPs’ domes were slightly elevated, covered with the regular FAE lining, and surrounded by dense and bulky villi; however, in 10 UC patients, the PPs’ domes were irregular, and the surrounding villi were sparse and atrophic. These abnormal findings within the PPs were associated with minimal mucosal lesions but not with backwash ileitis; both electron microscopy and magnifying endoscopy confirmed that these lesions were reversible following remission with prednisolone-mesalazine therapy. Similar to Crohn’s disease patients, UC patients commonly had abnormalities in the FAE on PPs’ domes and the surrounding villi on magnifying endoscopy

Interstitial Pneumonia Associated with Linear Immunoglobulin A/Immunoglobulin G Bullous Dermatosis

A 76-year-old man with interstitial lung disease was admitted to our institution after developing persistent dyspnea upon effort. He also had a relapse of bullous eruptions on the skin of the trunk and extremities, previously diagnosed as vesicular pemphigoid. Direct immunofluorescence of a skin biopsy specimen using fluorescence microscopy showed the linear deposition of immunglobulin A (IgA), IgG and C3 along the basement membrane. These findings indicated a definitive diagnosis of linear IgA/IgG bullous dermatosis. Chest computed tomography, bronchoalveolar lavage and transbronchial lung biopsy findings suggested nonspecific interstitial pneumonia. Direct immunofluorescence of the lung biopsy specimens using fluorescence microscopy also showed a deposition of IgA, IgG and C3 along the epithelial cell membranes and basement membranes of the bronchioles and alveoli. Lung disorders associated with linear IgA/IgG bullous dermatosis are extremely rare and, to our knowledge, this is the first report of such a case of interstitial pneumonia.著者版でのFigure 1は非公開。出版社版はDOIリンクを参照のこと