溝口 良順

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.

患者は79歳,男性.検診にて胃癌および肝障害を指摘され,当院入院.上部消化管造影および内視鏡検査にて胃上中部小彎に3型胃癌を認めた.腹部CTにて#12リンパ節転移および門脈本幹腫瘍塞栓を認めたが,肝実質は僅かな濃染のムラを認めるもののSOLは認められなかった.術前検査中,吐下血からショック状態となり止血目的に緊急に脾摘を伴う胃全摘を施行した.病理組織では脈管侵襲傾向の強い高分化腺癌で深達度はse, intermediate type, INFβ, ly3, v2であった.術後より急速にDIC状態となり翌日出血性ショックにて死亡した.剖検の結果,門脈腫瘍栓があり,転移巣は肝,骨髄,前立腺と,肺門および肝門部リンパ節へ転移を認め,剖検上の死因としては,肝転移および門脈腫瘍栓による急激に進行した肝不全とDICに伴う出血性ショックによると診断された.術前CTで指摘できなかった肝転移は腫瘤を形成しない腫瘍細胞のび漫性転移であった.これら肝を含めた転移先では,腫瘍は小細胞癌様で免疫組織化学染色では高分化腺癌の像を呈する原発巣,門脈腫瘍栓がchromogranin A, CD56 (NCAM)染色で陰性であったのに対して,門脈周辺リンパ節および肝転移巣は陽性であった. H-E染色所見上脈管形成傾向がみられた部分もあったことから原発巣の高分化腺癌の転移巣における小細胞癌への脱分化と考えられた.

原発性気管癌は稀な疾患である。症例は58歳の男性で、1997年3月初めに血痕が出現し、耳鼻科でポリープ様声帯と診断され通院中であった。同年8月交通薯故で某病院に入院し、血痕の喀疲細胞診で、classIIIと診断され、精査目的で9月6日当院に転院した。入院時理学的所見、血液検査、胸部単純X線写真には異常を認めなかった。胸部CTでは、気管内に突出した腫瘤を認めた。気管支鏡検査で、気管内にポリープ状の腫瘤を認め、生検で扁平上皮癌と診断された。頭部および腹部CT、骨シンチ、Gaシンチでは転移巣は認めなかった。10月21日第4〜8気管軟骨輸を環状切除、端々吻合術を施行した。病理組織検査ではCarcinoma in Situの中等度分化扁平上皮癌で、免疫組織化学検査、およびIn Situ Hybridization法の結果よりHuman papiuomavirusの関与が強く示唆された。

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.

45歳女性,乳房腫瘤を自覚し当院を受診,左乳房A領域に無痛性孤立性の腫瘤を触れ,超音波検査では辺縁ほぼ整,内部はほぼisoechoic massを,乳腺撮影でも淡く球状,辺縁もsmoothなtumorを認めた.病理組織上,摘出標本は1.5×1.2cm大で,割面は乳白色調で硬く,弱拡大像で,被膜形成を認めない比較的境界不鮮明な限局性の腫瘍が既存の腺管をやや周辺に圧排し,強拡大像では腺管周囲及び間質に平滑筋束あるいは神経束様の構造がみられたが,腺管自体には二相性が明らかで,腺管及び周囲の細胞とも細胞学的な核異型や核分裂像は認められなかった. muscle-actin, α-smooth muscle actin染色では腺管周囲の腫瘍細胞の細胞質に強陽性であった.以上より平滑筋上皮細胞の増殖を主体とした限局性腫瘍でありmuscular hamartomaと診断した.