A case of intrahepatic clear cell cholangiocarcinoma

Intrahepatic clear cell cholangiocarcinoma is very rareonly 8 cases have been reported.A 56-year-old Japanese man with chronic hepatitis B infection was diagnosed with a 2.2 cm hepatocellular carcinoma on imaging,and hepatic segmentectomy was performed.Histopathologically,the tumor cells had copious clear cytoplasm and formed glandular structures or solid nests.These pathological findings suggested the tumor was a clear cell variant of intrahepatic cholangiocarcinoma.Particular stains and radiological images suggested that the cause of the clear cell change had been glycogen,not mucin nor lipid.On immunohistochemical staining,cytokeratin(CK)7 and CK19 were positive,whereas CK20 was negative.Vimentin was detected on the cell membranes,and CD56 was focally positive.The patient was given adjuvant chemotherapy and is currently free from the tumor 7 mo postoperatively.Careful follow-up with adequate postoperative supplementary chemotherapy is necessary because the characteristics of this type of tumor are unknown.

Mucosa-associated lymphoid tissue lymphoma of the transverse colon: A case report

We herein present a case of a 75-year-old female with mucosa-associated lymphoid tissue （MALT） lymphoma of the transverse colon with the stage IE （Ann Arbor classification）. Colonoscopy revealed the tumor＇s appearance as a IIa plus Ⅱ c-like early colon cancer as defined according to the macroscopic classification of the Japanese Research Society for Cancer of Colon, Rectum and Anus, measuring less than 2 cm in diameter. Histologically, the tumor was diagnosed as MALT lymphoma because of the presence of lymphoepithelial lesions consisting of diffuse proliferation of atypical lymphocytes and glandular destruction. The majority of these lymphocytes immunohistochemically stained for the B-lymphocyte marker. The patient first underwent H pylori eradication therapy with Lansap. However, the tumor size gradually increased over the next 4 mo and the patient eventually underwent surgical resection. The operative procedure included a partial colectomy with dissection of the paracolic lymph nodes. The tumor measured 45 mm × 30 mm in diameter and histological examination showed that the lymphoma cells had infiltrated the muscle layer of the colon without nodal involvement. The patient has had no recurrence postoperatively without any chemotherapy.

Small bowel anisakiosis: A report of two cases

Small bowel stenosis is a serious complication of intestinal anisakiosis. The aim of this report is to investigate whether severe stenosis of the small intestine can be conservatively managed. We treated two patients with severe stenosis of the small intestine caused by anisakiosis. Surgical intervention was eventually performed on the 23^rd and 35^th in the hospital, respectively. Histopathological examination of the resected specimens revealed that the intestinal wall had been completely damaged by the inflammatory reaction of anisakiosis, and that the damage was irreversible, thereby suggesting that laparotomy is needed in cases of severe small bowel stenosis caused by intestinal anisakiosis, even if a long period of conservative treatment for the intestinal anisakiosis allowed the patient to pass successfully through the acute phase.

Hyperplastic polyposis associated with two asynchronous colon cancers

We report a patient with hyperplastic polyposis who had two asynchronous colon cancers, a combined adenoma-hyperplastic polyp, a serrated adenoma, and tubular adenomas. Hyperplastic polyposis is thought to be a precancerous lesion; and adenocarcinoma arises from hyperplastic polyposis through the hyperplastic polyp-adenoma-carcinoma sequence. Most polyps in patients with hyperplastic polyposis present as bland- looking hyperplastic polyps, which are regarded as non- neoplastic lesions; however, the risk of malignancy should not be underestimated. In patients with multiple hyperplastic polyps, hyperplastic polyposis should be identified and followed up carefully in order to detect malignant transformation in the early stage.

A case of mucin producing liver metastases with intrabiliary extension

A 75-year-old man was admitted to our hospital with a diagnosis of liver metastases from colon cancer. He underwent right hemicolectomy for cecal cancer eight years ago, and had a metastatic liver tumor in segment 8 （S8）, which was surgically resected about 4 years after the initial operation. Histopathological examination of the resected specimens from both operations revealed a well-differentiated adenocarcinoma with mucinous carcinoma. Four months after the second operation, computed tomography demonstrated a low-density lesion at the cut surface of the remnant liver. Although it was considered to be a postoperative collection of inflammatory fluid, it formed a cystic configuration and increased in size to approximately 5 cm in diameter. With a tentative diagnosis of a recurrence of metastatic cancer, partial hepatectomy of S8 was performed. Histological examination of the resected specimens also revealed mucinous adenocarci- noma, which had invaded into the biliary ducts, replacing and extending along its epithelium. Immunohistochemi-cally, the tumor cells were positive for cytokeratin （CK） 20, but negative for CK7. Therefore, the tumor was diagnosed as a metastatic adenocarcinoma from colonic cancer. Liver metastases of colorectal adenocarcinoma sometimes invade the Glisson＇s triad and grow along the biliary ducts.

Destructive granuloma derived from a liver cyst: A case report

We herein report the case of an idiopathic liver cystic mass which aggressively infiltrated the thoracoabdominal wall. A 74-year-old woman who had a huge cystic lesion in her right hepatic lobe was transferred to our hospital for further examinations. Imaging studies revealed a simple liver cyst, and the cytological findings of intracystic fluid were negative. She was followed up periodically by computed tomography （CT） scans. Seven years later, she complained of a prominence and dull pain in her right thoraco-abdominal region. CT revealed an enlargement of the cystic lesion and infiltration into the intercostal subcutaneous tissue. We suspected the development of a malignancy inside the liver cyst such as cystadenocarcinoma, and she therefore underwent surgery. A tumor extirpation was performed, including the chest wall, from the 7th to the 10th rib, as well as a right hepatic Iobectomy. Pathologically, the lesion consisted of severe inflammatory change with epithelioid cell granuloma and bone destruction without any malignant neoplasm. No specific pathogens were evident based on further histological and molecular examinations. Therefore the lesion was diagnosed to be a destructive granuloma associated with a long-standing hepatic cyst. Since undergoing surgery, the patient has been doing well without any signs of recurrence.

Ossified thoracic spinal meningioma with hematopoiesis: A case report and review of the literature

Meningiomas account for 25% of spinal tumors, and they are often located in the thoracic spine. The ossified subtype is even rarer, and those with hematopoiesis are rarely described. The mechanism of bone formation has not yet been clarified. A case of ossified spinal meningioma with hematopoiesis occurring in a 78-year-old woman is described. Magnetic resonance imaging revealed a lesion with a dural tail sign at the T9 level located dorsal to the spinal cord. Computerized tomography revealed a high density lesion, as high as the bone signal. Total resection was performed, and the symptoms improved. Pathological findings revealed many psammoma bodies (PBs), bone formation, and bone marrow with hematopoiesis. Both PBs and bone seemed to be based on the same background of calcified structures. This report is the second dealing with ossified spinal meningioma with hematopoiesis. The hardness of the tumor can make the operation more difficult, so that the operation should be performed carefully to avoid injuring the spinal cord.

Solitary Retinal Astrocytoma: A Case Series

Background: Astrocytic tumors of the retina are rare. We report and discuss the clinical features of two cases of retinal astrocytoma along with presenting a current literature review. Case Presentation: Case 1 was a 46-year-old Japanese female who became aware of her decreased visual acuity. A fundus photograph indicated the presence of a 5 mm hemispherical yellow-white tumor, retinal edema and hard exudate around the tumor. In case 2, a 36-year-old Japanese female became aware of her myodesopsia, and presented with a retinal tumor and vitreous hemorrhage in her right eye. Since the tumors occurred in the peripheral retina in both cases, endoresections were performed. Histological examination showed that the tumors were composed of spindle-shaped cells with small nuclei, which was consistent with astrocytes. Conclusion: Pathologically, it can be difficult to differentiate astrocytic tumors. Therefore, when making a diagnosis, it is important that comprehensive examinations be done in conjunction with the clinical findings. Since retinal astrocytoma has a favorable prognosis, provided proper treatment is administered, utilization of endoresection for peripheral astrocytoma may be advantageous in this patient group.