A Case of Warthin’s Tumor Together with IgG4-Related Sialadenitis

Warthin’s tumor is the second most frequent neoplasm next to pleomorphic adenoma in the salivary gland. The tumor contains the epithelial oncocyte cells with the presence of rich-mitochondria and their surrounding abundant lymphocytes. A relatively new disease entity of IgG4-related disease frequently occurs in the salivary gland. However, the coexistence of Warthin’s tumor and IgG4-related disease is scarcely observed. We have recently experienced a rare case of Warthin’s tumor with IgG4-related sialadenitis. A 51-year-old man presented to our hospital, complaining of a mass with right submandibular tenderness and spontaneous pain. A computed tomography scan of the cervical region revealed a suspicion of lymph node proliferative disease, including malignant lymphoma. Elevated serum levels of IL-2R: 1843 U/ml (reference value 122 - 496 U/ml), IgG: 3430 mg/dl (reference value 861 - 1747 mg/dl), and IgG4: 3140 mg/dl (reference value 11 - 121 mg/dl) were observed. Other laboratory data showed within normal ranges. The cervical tumor was diagnosed as Warthin’s tumor by the findings of fine-needle aspiration cytology and biopsy examination. Immunohistochemistry revealed numerous IgG4- and IgG-positive cells with fibrosis surrounding the epithelial component of Warthin’s tumor, suggesting IgG4-rerated sialadenitis. Finally, we diagnosed the cervical tumor as Warthin tumor with IgG4-related sialadenitis. This is the second report describing a case of Warthin’s tumor with possible involvement of IgG4-related sialadenitis.

A Case of Ewing’s Sarcoma Arising in the Cervical Spine with an Elevation of Serum ProGRP

We experienced a case of small, round-cell malignant neoplasm diagnosed by touch smear cytology and histopathology when an open biopsy was performed in a 50-year-old Japanese woman. She was suspected of having a cervical spine tumor after surgery for cervical spine foraminal stenosis. After consent, the cervical spine tumor histologically diagnosed by an open biopsy was confirmed to be Ewing sarcoma (EWS) by genetic testing. EWS belongs to a group of small, round-cell tumors that are morphologically similar and often difficult to differentiate. After the open biopsy, the present patient received radiotherapy, and her plasma level of Pro-Gastrin-Releasing-Peptide was decreased (217.2 pg/ml before surgery to 30.3 pg/ml;reference value: 0 - 80 pg/ml). We herein report the process for making the final diagnosis by focusing on the intraoperative cytology, histopathology, and immunohistochemical findings. Our diagnosis was validated by karyotyping and a fluorescence in-situ hybridization analysis.

Primary Fallopian Tube Adenocarcinoma Discovered with the Vaginal Cytology: A Case Report with Pathological and Immunohistochemical Investigation

Background: Primary fallopian tube cancer is an extremely rare gynecological malignancy. Aim: To discuss, through a case report, the diagnostic process by means of cytology immunohistochemistry. Case Presentation: A 47-year-old Japanese woman, who also had lung cancer, presented with enlarged para-aortic lymph node without any symptoms. Based on the vaginal cytology report suggestive of gynecologic malignant tumor (possibly fallopian tube adenocarcinoma), primary surgery comprised of total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathology and immunohistochemistry examinations revealed primary fallopian tube carcinoma with metastasis of para-aortic lymph node. She is free from recurrence and metastases 9 months after the surgery and chemotherapy. Conclusion: Although primary fallopian tube cancer is a rare gynecologic malignancy, vaginal cytology may be useful for detecting fallopian tube carcinoma.