Esophageal metastasis of renal cell carcinoma resected by endoscopic submucosal dissection: a case report

Background: Esophageal metastasis of renal cell carcinoma (RCC) is extremely rare. We have described herein a case of a 59-year-old man with esophageal metastasis of RCC that was endoscopically resected.Case presentation: The case was a 59-year-old man who had undergone left nephrectomy for renal clear cell carcinoma 17 years ago and splenectomy for splenic metastasis 3 years ago. Esophagogastroduodenoscopy (EGD) performed 9 years ago revealed a small reddish elevated lesion with a smooth surface in the middle esophagus; this lesion increased in size 4 years ago. However, no biopsy was performed. The lesion continued to grow in size and was found to have become nodular during the present observation. Biopsy revealed clear cell carcinoma. Endoscopic ultrasound (EUS) revealed that the lesion had not invaded the submucosa, and contrast-enhanced computed tomog-raphy did not reveal any other metastasis. The lesion was successfully removed en bloc via endoscopic submucosal dissection (ESD). Pathologically, the tumor was detected in the subepithelium with focal infiltration of the muscularis mucosa. It consisted of monotonous cells with small nuclei and a clear cytoplasm. Immunohistological findings indi-cated that the tumor was a metastasis of RCC. The lateral and vertical margins were noted to be free.Conclusions: We have presented herein a case of esophageal metastasis of RCC that had progressed over 9 years and was then resected en bloc through endoscopic submucosal dissection

Molecular Pathological Characteristics of Thyroid Follicular-Patterned Tumors Showing Nodule-in-Nodule Appearance with Poorly Differentiated Component

Thyroid follicular-patterned tumors (TFTs) showing nodule-in-nodule (NN) appearance with poorly differentiated component (PDc) but neither invasion nor metastasis are diagnosed as benign nodules. Although PDc exhibits histologically aggressive features relative to the outer nodule (Out-N), its pathological significance remains unclear. TP53 binding protein-1 (53BP1) is a DNA damage response (DDR) molecule that rapidly localizes at DNA double-strand breaks. Using dualcolor immunofluorescence with Ki-67, the profile of 53BP1 expression is shown to be significantly altered during diverse tumorigenesis. In this study, we aimed to elucidate the malignant potential of PDc at the molecular level. We analyzed the profile of 53BP1 expression and NRAS codon 61 and TERT-promoter (TERT-p) mutations in 16 cases of TFTs showing NN with PDc compared to 30 adenomatous goiters, 31 follicular adenomas, 15 minimally invasive follicular carcinomas (FCs), and 11 widely invasive FC cases. Our results revealed that the expression level of abnormal type 53BP1 and incidence of NRAS and TERT-p mutations in PDc were comparable to FCs, suggesting a malignant potential. Because co-expression of 53BP1 and Ki-67 can be an indicator of altered DDR, the development of PDc in NN may be associated with DDR impairments after harboring NRAS and TERT-p mutations

A refractory pleural effusion caused by a pleural capillary hemangioma

A 69-year-old man presented with a left pleural effusion. Even after repeated drainage, the pleural effusion had been increasing for more than two years. Thoracoscopy unexpectedly showed a pleural mass on the parietal pleura, and it was completely removed. The diagnosis was pleural capillary hemangioma, and the effusion has not recurred after the resection. Pleural hemangioma is one of the crucial differential diagnoses of refractory pleural effusion

Transthyretin amyloidosis of the myocardium in a patient with monoclonal gammopathy of undetermined significance

A 73-year-old Japanese man was admitted with heart failure due to AL amyloidosis caused by left ventricular hypertrophy and IgA-kappa monoclonal gammopathy. However, endomyocardial biopsy revealed eosinophilic amorphous material in the myocardium, which was positive for Congo red staining and transthyretin (TTR), but negative for the kappa chain. The patient was diagnosed with wild-type amyloid TTR (ATTR) amyloidosis and monoclonal gammopathy of uncertain significance. Among the different types of amyloidosis including AL amyloidosis (primary amyloidosis from an abnormality of plasma cells), AA amyloidosis (secondary amyloidosis in association with chronic inflammatory disease), and dialysis-related amyloidosis (deposition of beta-2 microglobulin), ATTRwt amyloidosis is a slowly progressive disease that affects most commonly the hearts of elderly in elderly patients who sometimes have other diseases. Thus, pathological examination is important for the diagnosis of amyloidosis.Acta medica Nagasakiensia, 67(2), pp.91-94; 202

Fulminant Myocarditis 24 Days after Coronavirus Disease Messenger Ribonucleic Acid Vaccination

A 60-year-old Japanese woman was hospitalized for cardiogenic shock 24 days after receiving the second dose of the coronavirus disease 2019 BNT162b2 vaccine. Impella CP left ventricular assist device implantation and venoarterial peripheral extracorporeal membranous oxygenation were immediately initiated along with inotropic support and steroid pulse therapy, as an endomyocardial biopsy specimen showed myocarditis. Three weeks later, her cardiac function had recovered, and she was discharged. An immune response associated with the presence of spike protein in cardiac myocytes may be related to myocarditis in the present case because of positive immunostaining for severe acute respiratory syndrome coronavirus 2 spike protein and C4d in the myocardium

A New Indicator to Differentiate Thyroid Follicular Inclusions in Cervical Lymph Nodes from Patients with Thyroid Cancer

Nodal metastasis is crucial for determining the stage of well-differentiated thyroid cancer (WTC) in patients older than 55. Well-formed thyroid follicular inclusions (TFIs) are occasionally encountered in the cervical lymph nodes (LNs) of patients with papillary thyroid carcinoma (PTC), and it is difficult to determine whether they are true nodal metastases or ectopic thyroid tissues (ETT). This study aimed to elucidate the impact of the expression of the DNA damage response molecule TP53-binding protein 1 (53BP1) using immunofluorescence (IF) as a biomarker to differentiate TFIs in cervical LN by comparing the mutation analyses of primary thyroid cancers. The data demonstrated the necessity for the differential diagnosis of true metastases from ETT among TFIs in cervical LNs. PTC-like nuclear features using hematoxylin–eosin staining combined with immunohistochemistry for conventional biomarkers of PTC, including BRAFV600E protein, were most helpful in identifying metastatic follicular-patterned carcinomas. In conclusion, IF analysis of 53BP1 expression could be an excellent ancillary technique to distinguish metastatic carcinoma or ETT from TFIs in LNs, particularly in cases other than BRAFV600E-mutated PTC

Fulminant Myocarditis and Acute Appendicitis after COVID-19 Vaccination

A 19-year-old Japanese man was hospitalized for cardiogenic shock 28 days after receiving a second dose of the coronavirus disease 2019 (COVID-19) mRNA-1273 vaccine. He had had a high fever for three days with vomiting and abdominal pain before arriving at our hospital. The patient visited a local hospital and was diagnosed with heart failure and acute appendicitis. An endomyocardial biopsy specimen showed myocarditis. Thereafter, Impella CP left ventricular assist device implantation and venoarterial peripheral extracorporeal membranous oxygenation were initiated immediately along with inotropic support and steroid pulse therapy. Given these findings, he was finally diagnosed with multiple inflammatory syndrome and fulminant myocarditis

Granulomatosis with Polyangiitis Presenting as a Choroidal Tumor

Granulomatosis with polyangiitis (GPA) sometimes involves the eye orbit; however, choroidal involvements in GPA had been rarely reported. We report a rare case presenting with a choroidal mass in an 83-year-old Japanese woman who presented with left eye pain. Diagnostic biopsy revealed necrotizing vasculitis with infiltrates of inflammatory cells. Diagnosis was localized granulomatosis with polyangiitis. Combined treatments with corticosteroid plus azathioprine resolved the choroidal mass region. Although treatment with corticosteroid and immunosuppressive agents improves the prognosis of the disease, ocular morbidity is still well recognized. Clinicians should consider a differential diagnosis of GPA in patients with inflammatory choroidal tumors

Resection of medullary carcinoma of the colon arising in the ascending colon: a case report

Background: Medullary carcinoma of the colon, formerly classified as poorly differentiated adenocarcinoma, was classified as a special type as a new concept in the 8th edition of the Japanese Code of Treatment of Colorectal Cancer, revised in July 2013. The prognosis is relatively good, with a high degree of microsatellite instability and a predilection for the right-sided colon. Case presentation: A 90-year-old woman was referred to our hospital for a semi-peripheral type 2 tumor that was found in the ascending colon after a lower gastrointestinal endoscopy was performed by a local doctor to investigate slowly progressive anemia. Histopathological examination of the biopsy specimen revealed adenocarcinoma. Contrast-enhanced computed tomography of the thorax and abdomen showed irregular wall thickening and contrast effect in the ileocecal region, with no obvious extramural extension, enlarged lymph nodes, or distant metastasis. She underwent laparoscopic ileal resection + D3 dissection for cT2N0M0 cStage I ascending colon cancer. The postoperative course was good, and the patient was discharged on postoperative day 11. Postoperative histopathological examination revealed a well-defined, enlarged nucleolus within a large, stained nucleus, hyperplastic linear epithelium with acidophilic cytoplasm, and numerous tumor-infiltrating lymphocytes, leading to a diagnosis of colorectal medullary carcinoma pT3N0M0 pStage IIa. The patient is currently alive and recurrence-free 1 year after surgery. Conclusion: We report a rare case of resection of medullary carcinoma of the colon arising in the ascending colon. The histology has a characteristic clinical presentation and prognosis, requiring appropriate diagnosis and follow-up.Acta medica Nagasakiensia, 67(2), pp.95-99; 202