Ectopic thymoma presenting as a giant intrathoracic tumor: A case report

Ectopic thymoma rarely presents as an intrathoracic tumor. We report a case of ectopic thymoma presenting as a giant right intrathoracic tumor that was treated with resection. The patient was a 50-year-old Japanese woman who presented with the chief complaint of chest pain. Detailed examination revealed a solid tumor measuring 15 × 10 × 8 cm in diameter, with a clear border. The Imaging findings suggested a solitary fibrous tumor, and surgery was performed. At surgery, the tumor was found to beadherent to the diaphragm, mediastinal pleura, and lower lobe of the lung, although it could be dissected with relative ease and was removed. Pathological diagnosis indicated a type B1 tumor with no capsular invasion according to the World Health Organization classification, and a diagnosis of Masaoka stage I thymoma was made. No continuity with the normal thymus tissue was seen, and the thymoma was considered to be derived from ectopic thymic tissue in the pleura

Mucoepidermoid carcinoma of the lung: a case report

Mucoepidermoid carcinoma of the lung (MEC) is a tumor of low malignant potential of bronchial gland origin. MEC and adenoid cystic carcinoma are both considered to be salivary gland-type neoplasms. MECs are comparatively rare with an incidence of all lung cancers. We recently encountered a case of this type of lung cancer. A 60-year-old man was found to have an abnormal shadow in the left lower lung field on a regular check-up for lung cancer at his company. Chest radiography and CT revealed a mass shadow measuring 30 mm in diameter in the left lower lung field. Bronchoscopy revealed a protuberant tumor in the S9 bronchus, leading to a diagnosis of low-grade MEC by transbronchial lung biopsy. He underwent left lower lobe resection and mediastinal lymph node dissection using VATS. Tumor cells had a scattering of mucus-producing epithelial components in papillary growth of stratified squamous epithelia with anisokaryosis and minimal pleomorphism, indicating a diagnosis of MEC. Because the postoperative course was good and the tumor was low-grade, no adjuvant treatment was administered. The patient has had no signs of tumor recurrence for 9 months, to date, since resection of the tumo

Alpha-fetoprotein-producing primary lung carcinoma: A case report

Alpha-fetoprotein (AFP)-producing lung adenocarcinoma is a rare type of lung cancer, with its characteristics not yet fully clarified. We recently encountered a case of this type of lung cancer. The patient was a 69-year-old man who consulted an internist with the chief complaint of epigastric pain. Chest X-ray and CT revealed a lobulated mass measuring 70 mm in diameter in the right lower lung field and a metastasis in the right hilar lymph nodes. Of the tumor markers, the serum AFP was elevated (4620 ng/ml), and the serum carcinoembryonic antigen and carbohydrate antigen 19-9 were also slightly elevated. Transbronchial lung biopsy revealed the diagnosis of lung cancer. Under thoracoscopic assistance, right lower lobectomy + mediastinal lymph node dissection was carried out. Immunostaining showed the tumor cells to be AFP-positive. The tumor was thus diagnosed as an AFP-producing lung adenocarcinoma. The patient followed an uneventful clinical course after the surgery, with serum AFP decreasing to the normal range by about 2 weeks after the surgery. As of this writing, no sign of tumor recurrence has been noted. This case is presented here with a review of the literature

Neurobiological Basis of State-Dependent Control of Motor Behavior

The definitive version is available at www.blackwell-synergy.comThe importance of an appropriate combination of excitability for the higher (neocortex, basal ganglia, and limbic system) and lower (brainstem–spinal cord) motor systems could be necessary for normal behavior during wakefulness and REM sleep. Neurotransmitters such as acetylcholine, the monoamines, GABA, and the orexins regulate the background excitability of the higher and lower motor systems so that an interaction of these systems can be appropriately maintained. Pathophysiological mechanisms of sleep deficiency may be induced, not only by an organic disturbance of brain structures (hardware), but also by dysfunctioning of the neurotransmitter systems (software). From these considerations, this review provides a hypothetical model for "state-dependent interaction of the higher and lower motor systems" for understanding normal behavior and pathophysiological mechanisms of sleep-related disorders such as narcolepsy and the REM-sleep behavioral syndrome

Thyroid-stimulating hormone induces interleukin-18 gene expression in FRTL-5 cells: immunohistochemical detection of interleukin-18 in autoimmune thyroid disease.

Copyright 2002 Mary Ann Liebert, Inc. publisherInterleukin(IL)‐l8 is a cloned cytokine that was identified originally as a factor having potent interferon(IFN)‐γ-inducing activity on Kupffer cells. First, we analyzed lL-18 gene expression by reverse transcription-polymerase chain reaction(RT-PCR) in rat thyroid FRTL-5 cells and human thyroid tissue samples. The expression of IL-18mRNA in FRTL-5 cells was enhanced by thryoid-stimulating hormone(TSH) in a dose-dependent manner. 8-Bromo-cyclic adenosine monophosphate(cAMP） also increased in lL-18 mRNA levels. Furthermore, TGCT clones that exhibited an increase in intracellular cAMP accumulation showed an increased IL-l8 mRNA signal when compared to controls. Taken together, these data suggested that the effect of TSH on IL-18 gene expression was mediated by activating protein kinase A. Treatment of FRTL-5 cells with the antithyroid drug, methimazole(MMI), suppressed this stimulatory action of TSH on IL-18 gene expression. Next, we examined IL-18 expression in human thyroid tissue derived from patients with autoimmune thyroid diseases(ATD). RTPCR and immunohistology demonstrated that human thyroid follicular cells expressed lL-18. Especially in thyroid tissue from a patient with Hashimoto's thyroiditis, expression was more diffuse and extensive, generally observed in close relation to a lymphocytic infiltrate. Also, IL-18 protein was distributed in the same follicles that express Fas-L and HLA-DR. This study is the first to demonstrate the detection of lL-l8 in the thyroid gland. The frequent expression of IL-l8 in thyrocytes suggests that IL-18 itself might be a secreted immunomodulator in ATD

Correlation of EEG, neuroimaging and histopathology in an epilepsy patient with diffuse cortical dysplasia

This is the author-created version of SPRINGER VERLAG, Hashizume, K; Kiriyama, K; Kunimoto, M; Maeda, T; Tanaka, T; Miyamoto, A; Miyokawa, N; Fukuhara, M, CHILD'S NERVOUS SYSTEM, 16(2), 2000, 75-79. The original publication is available at www.springerlink.com. authorThe correlation between scalp EEG, intraoperative electrocorticogram, neuroimaging and histopathology was examined in a epilepsy child with diffuse cortical dysplasia. A 6-year-old girl with moderate mental retardation had suffered from intractable complex partial and generalized epilepsy since 2-year-old. MR images demonstrated unilateral large macrogyria/polymicrogyria and schizencephaly in the right occipital lobe. The epileptic focus was detected on the macrogyria by EEG and single-photon emission tomography. However, intraoperative electrocorticogram showed frequent spikes from the polymicrogyria and no paroxysmal activity in the macrogyria. The polymicrogyria was resected including the macrogyria using an image-guided system. The histological findings revealed that the macrogyria was covered and separated with glial bundles. It has been reported that epileptogenisity was produced from abnormal neurons and their arrangement in cortical dysplasia, however in this case, the major dysplastic lesion had no epileptogenisity, rather the focus might be in polymicrogyria around the lesion

Decreased expression of retinoid X receptor isoforms in human thyroid carcinomas

Endocrine Society, Takiyama, Yumi ; Miyokawa, Naoyuki ; Sugawara, Akira ; Kato, Shizuo ; Ito, Koichi ; Sato, Keisuke ; Oikawa, Kensuke ; Kobayashi, Hiroya ; Kimura, Shoji ; Tateno, Masatoshi, Journal of Clinical Endocrinology & Metabolism, 89(11), 2004, 5851-5861. authorRetinoid X receptors (RXRs) are ligand-inducible transcription factors that belong to the superfamily of nuclear hormone receptors. Because RXRs heterodimerize with thyroid hormone receptor, retinoic acid receptor, vitamin D(3) receptor, and peroxisome proliferator-activated receptor, they play central roles in regulating a number of signaling pathways. To understand the roles of RXRs in human thyroid carcinogenesis, we have investigated the immunohistochemical expression of RXRs in normal and neoplastic thyroid tissues. Whereas nontumorous human thyroid cells exhibited distinct nuclear staining for the RXRs, thyroid carcinomas showed decreased nuclear expression of all three RXR isoforms. In particular, some thyroid carcinoma cells showed intense RXR-alpha cytoplasmic staining accompanied by decreased immunoreactivity in their nuclei. This subcellular localization of RXR-alpha was confirmed by Western blot analysis, which showed both lower nuclear expression levels of RXR-alpha and a cytosolic presence of RXR-related protein in neoplastic regions. We present here, for the first time, the histological distribution of each RXR protein (alpha, beta, and gamma) in human thyroid follicular cells. In addition, we found that the nuclear expression of RXRs was lower in thyroid carcinomas than in normal tissue. The differential expressions of these RXRs in thyroid carcinomas might be implicated in the pathogenesis of thyroid cancers

A case of mucinous carcinoma of Vater’s ampulla with a unique extension along the main pancreatic duct

The original publication is available at springerlink.com authorWe report a case of mucinous carcinoma of Vater's ampulla with a unique extension along only the main pancreatic duct (MPD) and microinvasion to the pancreas. A 52-year-old man was referred to our hospital for the evaluation and treatment of acute pancreatitis. Abdominal computed tomography (CT) demonstrated swelling in the head of the pancreas with a mass in the duodenum. Hypotonic duodenography and endoscopic examination revealed a well-defined mass, measuring about 25 mm in size, in Vater's ampulla. A biopsy specimen of the tumor showed moderately differentiated adenocarcinoma. A pylorus-preserving pancreaticoduodenectomy with a regional lymphadenectomy was performed, under a preoperative diagnosis of adenocarcinoma of Vater's ampulla with direct invasion into the head of the pancreas. The resected specimen of the duodenum confirmed the presence of the mass, which measured 22 × 15 mm in size, in Vater's ampulla. Microscopically, the tumor consisted of two components: moderately differentiated adenocarcinoma in the peripheral region of the tumor Vater's papilla and mucinous carcinoma in the central region of the tumor. The mucinous carcinoma component uniquely extended along only the MPD with microinvasion to the pancreas. Immunohistochemically, both the moderately differentiated adenocarcinoma and the mucinous carcinoma were positive for cytokeratin 20 (CK20) and negative for cytokeratin 7 (CK7) which is the pattern of intestinal-type carcinoma of Vater's ampulla. We concluded that the original site of this tumor may have been the duodenal epithelium of Vater's ampulla originally moderately differentiated adenocarcinoma―which subsequently changed to mucinous carcinoma that extended along only the MPD with microinvasion to the pancreas

Isolated iliac artery aneurysm caused by fibromuscular dysplasia: report of a case

The original publication is available at springerlink.comFibromuscular dysplasia (FMD) can develop in many different arteries, but iliac artery aneurysms are rare. A 69-year-old Japanese woman was admitted to our hospital for treatment of a right common iliac artery aneurysm. Aortography revealed aneurysms in both the right common iliac artery and the left internal iliac artery. Notably, the right common iliac artery aneurysm had a string-of-beads appearance. At surgery, the aneurysms were resected, and replaced with Y-shaped vascular prostheses. The histopathological diagnosis was fibromuscular dysplasia (FMD). We report this case of common iliac artery aneurysm caused by FMD due to its rarity