Yoshikazu Mizoguchi

A case of composite lymphoma (CL) arisen in the parotid gland in a 58-year-old male is reported. Histologically, most of the tumor region was follicular lymphoma (FL), grade 2. However complicating classical Hodgkin lymphoma (CHL) was noted inside the lesion. There have been a few reports of composite lymphoma, complicated by multiple histologic types in the same organ. Extra-nodal cases are particularly rare. This is a very significant case with regard to differences between B cell-derived non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) and its histological origin. (C) 2003 Elsevier Ireland Ltd. All rights reserved.

A 79-year-old man was admitted to the hospital because he was pointed out having gastric cancer and hepatic impairment. Upper gastrointestinal fluoroscopy and endoscopic study disclosed type 3 gastric cancer on the lesser curvature of the upper and middle portion of the stomach. Abdominal CT scan showed # 12 lymph node metastasis and tumor embolism at the portal trunk, but SOL was not especially confirmed though the hepatic parenchyma was revealed as slight uneven staining. During preoperative examinations, the patient went into shock after hematemesis and anal bleeding so that an emergency total gastrectomy with splenectomy was performed for hemostasis. Histopathologically, it was well differentiated adenocarcinoma with a strong tendency of vascular invasion, tumor invasion depth of se, intermediate type, INFβ, ly3, and v2. The patient rapidly went into DIC state and died of hemorrhagic shock on the next day. Autopsy revealed metastases to the liver, bone marrow, prostate, and lymph nodes of the hili of the lung and liver, other than portal tumor embolism. Based on the autopsy findings, he died from suddenly progressed hepatic failure due to hepatic metastasis and portal tumor embolism as well as hemorrhagic shock associated with DIC. The hepatic metastasis which could not be demonstrated by preoperative CT was found to be diffuse metastasis of tumor cells which forms no tumor. In all metastatic foci including hepatic metastasis, tumors looked like small cell carcinoma. On immunohistologic stainings, the primary foci and portal tumor embolism which manifested well differentiation were negative for chromogranin A and CD56 (NCAM) stainings, but periportal lymph nodes and hepatic metastasis were positive. On H-E stainings, there were areas showing vascular forming tendency. We consequently considered that dedifferentiation to small cell carcinoma in metastatic foci from well differentiated adenocarcinoma of the primary foci might occur.

Primary tracheal carcinoma is rare. A 58-year-old man had hemoptysis in early March, 1997 and was treated for a polypoid vocal cord by an otorhinolaryngologist. When he was admitted to another hospital on Aug. 23 because of a traffic accident, he expectorated bloody sputum, a cytological examination of which revealed class 111 cells. He was referred to our hospital for more examinations on Sep. 6. Bronchoscopy demonstrated a polypoid tumor in the trachea and a biopsy revealed squamous cell carcinoma. There was no metastasis. Tracheal resection from the 4th to 8th tracheal ring and end-to-end anastomosis was performed on Oct. 21. Pathological examination demonstrated a moderately differentiated squamous cell carcinoma in situ and immunohistochemical examination and in situ hybridization showed positive stainings. A relationship with human papillomavirus was strongly suspected. The postoperative course was uneventful.

A 15-year-old boy had metastasis to the spinal cord and then to the lung after an operation to remove a primary medulloblastoma. A medulloblastoma developed at the age of 10 years. The tumor was completely resected, and the brain and spinal cord were irradiated. At the age of 13 years, metastasis to the sacral spinal cord developed and was treated with radiotherapy and intramedullary injection of methotrexate. At the age of 15 years, metastasis to the lung developed and was treated with chemotherapy (CBDCA, VP-16) followed by radiotherapy. Three months after the end of that therapy, the disease recurred but another course of radiotherapy and chemotherapy (VCR) was successful. Chemotherapy and radiotherapy were effective against metastatic lesions of medulloblastoma. With improvement in the survival rate among patients with medulloblastoma, we can expect incidence of extraneural metastases to increase. In addition to recurrence of the primary lesion and intramedullary disemination, these metastatic lesions also require attention.

The monoclonal antibody Ki-67 reacts with a human nuclear cell proliferation-associated antigen that is expressed in all active parts of the cell cycle and is well established as a marker of cell proliferation.(1) However, the Ki-67 method requires fresh frozen material, Recently, MIB1 has been reported to give an immunohistochemical staining pattern identical to Ki-67 on paraffin-embedded tissue sections, frozen sections and cytological samples.(2) This proliferation-associated antigen is apparently localized in the nucleus, Recently, we performed immunohistochemical staining using the monoclonal MIB1 antibody upon a variety of tumors and non-neoplastic conditions of the thyroid, Tumor cells of hyalinizing trabecular adenoma revealed an intense cytoplasmic immunopositivity for MIB1, In contrast, cytoplasmic immunostaining for MIB1 was negative in all other thyroid tumors and non-neoplastic lesions. Because of this unusual staining pattern, we repeated the staining of all cases and found the results to be reproducible, Therefore, we believe that positive cytoplasmic immunostaining for MIB1 is a characteristic finding of hyalinizing trabecular adenoma and is useful in differentiating it from other thyroid tumors.

A 45-year-old woman presented with a left breast mass. The painless solitary tumor was palpated in the A region of the left breast. Ultrasonography revealed an internally isoechoic mass with a regular margin. Mammography visualized a light spherous tumor with a smooth margin. Histopathologically, the excised specimen was 1.5×1.2cm in size and the section was milk-white in hue and hard. At low magnification, the tumor was relatively illdefined and localized but with no capsule. Mild compression of surrounding glandular ducts was also observed. At high magnification, smooth muscle fascicular or nerve fascicular structures were seen surrounding the ducts and framework. A biphasic pattern was clear in the duct itself and neither a cytological heterotype nucleus nor mytosis was seen in the duct and surrounding cells. Muscle-actin and α-smooth muscle actin staining showed strong positive responses in the cyto-plasms of tumor cells in the vicinity of the duct. These findings confirmed that this localized tumor, growing mainly in smooth muscle cells, was a muscular hamartoma.