摂食障害と多発性自己破壊行動という特徴を有した症例における行動の遺伝学的研究について

Among a group of patients (n=65) , the majority of whom had been introduced to us by　eating-disorder specialists elsewhere because of difficulties in their treatment, we defined a　subgroup (n=39) characterized by eating disorders and multiple behavioral problems. In addition　to the disordered eating behavior, problematical behavior relating to the use of alcohol and other substances, shoplifting, promiscuity, and suicidal tendencies were seen in 74%, 36%, 33%, and 15% of the patients, respectively. Further, this subgroup showed an extremely worse outcome, when compared with the subgroup of patients with pure eating disorders (n =26). With regard to the intrafamilial traits examined among the first- and second-degree relatives, 49% of the patients had the trait for alcohol dependence, 28% had the trait for problematical behaviors. The physically or socially self-destructive types of behavior, which seemed to be attributable to vigorous and uncontrollable intrinsic impulses of the patients, tended to emerge in the respective patients in revolving or alternating manners. Therefore, enduring efforts should be taken to support the personality development of such patients rather than to struggle with respective problematical behaviors, which may be considered merely as facets of a single disorder. 多発性問題行動を有する摂食障害(EDMUL)39例を対象とし,標記検討を行った。これら症例は純粋な摂食障害に比べ予後不良であった。家族内形質としてはアルコール依存性を49%,問題行動を28%で認めた。EDMULにおける問題行動は身体的,社会的観点からの自己破壊行動であり,コントロールできない固有の衝動に基づいている可能性を示唆した。よってEDMULではそれぞれの問題行動に取り組むよりも,むしろ人間性の成長を支援する努力をすべきであると考えた

Perivascular epithelioid cell tumor of the descending colon mimicking a gastrointestinal stromal tumor: A case report

Background: We present a case of perivascular epithelioid cell tumor (PEComa), which clinically and histologically mimics a gastrointestinal stromal tumor (GIST). Case presentation: A 42-year-old woman was found to have a mass in the left flank during her annual medical checkup. Computed tomography examination revealed a submucosal tumor of the descending colon. Surgeons and radiologists suspected that the lesion was a GIST, and left hemicolectomy was performed without biopsy. Microscopic examination showed that the lesion was composed of spindle and epithelioid cells, which were immunohistochemically negative for c-kit and positive for platelet-derived growth factor receptor (PDGFR) α. Initial diagnosis of PDGFRα-positive GIST was made. However, gene analysis did not reveal mutations in PDGFRα. Additional immunohistochemistry showed that tumor cells were positive for human melanin black 45 (HMB45), melanA, and the myogenic marker calponin. A final diagnosis of PEComa was made. Conclusion: PEComa should be included in the differential diagnosis of PDGFRα-positive spindle cell tumors in the wall of the gastrointestinal tract