A case of small round and spindle cell sarcoma with neuronal differentiation and oncocyte‐like features is presented. The tumor was encountered in a 32 year old Japanese woman with an initial presentation of palpable tumor in the left lateral region of the thorax. The resected tumor was a partially well encapsulated whitish medullary one and consisted of small round and spindle tumor cells, together with so‐called rhabdoid cells in the small round cell area. Although pseudorosettes were often observed, true rosette formation could not be detected anywhere. Ultrastructurally, despite a histologic variety of tumor cells, most tumor cells possessed numerous mitochondria, some of which occasionally contained abnormal filamentous or crystalloid structures. Various amounts of microfilaments were present in most tumor cells and microtubules were present in a few. A minority of small round cells possessed a small number of neurosecretory granules, especially in short cytoplasmic processes. A positive immunoreaction for neuron specific enolase was found by immunohistochemical examination in several small round tumor cells and for neurofilaments in lesser numbers. Despite the lack of S‐100 protein, MB2 was detected in both small round and spindle cells. On the basis of these findings, the tumor of the present case corresponds to malignant peripheral nerve sheath tumor with neuronal differentiation and oncocytic features.
A 66-year-old woman visited our hospital because of right flank pain. Computed tomography (CT) revealed a cystic mass with some enhanced areas, located between the liver and ascending colon. As she had multiple liver cysts, the mass was suspected to be one of the liver cysts, with intracystic hemorrhage. Several days later, repeated CT revealed that the cystic mass had become smaller and closer to the ascending colon. The CT also revealed thickening of the wall of the transverse colon. Colonoscopy was performed, thereby an advanced cancer of the transverse colon was found. Right hemicolectomy was performed. The specimen showed a type 4 tumor, 33×30 mm in diameter, SE with depth of invasion, mainly with poorly differentiated adenocarcinoma. The cystic mass was revealed as to be an intramural hematoma, 35 mm in diameter, located from the subserosal space to the submucosal layer of the ascending colon. Cancer cells were also found in the subserosal space of the hematoma. The transverse colon cancer implanted to the ascending colon and thus might cause hemorrhage in the intramural space of the colon. Intramural hematoma of the colon is rare and mostly caused by trauma or bleeding. We report an extremely uncommon case of intramural hematoma associated with colon cancer. Key words:intramural hematoma,colon cancer,poorly differentiated adenocarcinoma
We report a case of advanced gallbladder cancer in a 37-year-old man who presented in June 1993 with malignant obstructive jaundice. After percutaneous transhepatic biliary drainage and several diagnostic imaging examinations, the patient underwent laparotomy under a diagnosis of extremely advanced gallbladder cancer involving the confluence of the hepatic ducts. The tumor, however, was judged to be unresectable because of its massive spread into the liver along Glisson's sheath, and because of histologically proven peritoneal dissemination. After exploratory laparotomy, one course of anticancer chemotherapy (cisplatin, 100mg/body IV, on day 1, and 5-fluorouracil, 1000rag/body, on days 1-5, by continuous infusion) was administered and the completely obstructed hepatic duct was dramatically re-canalized. Four courses of chemotherapy were administered over a 16-month period until jaundice recurred. For these 16 months, the patient's quality of life was well maintained without biliary drainage. He died of increased peritoneal dissemination approximately 2 years after the first course of anticancer chemotherapy.
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