福嶋 敬宜

Purpose: Endocrine cell carcinoma, according to the Japanese classification criteria for colorectal cancer, corresponds to neuroendocrine carcinoma (NEC) and mixed adenoneuroendocrine carcinoma (MANEC), as defined in the 2010 World Health Organization (WHO) classification. We retrospectively reviewed the clinical features of patients with these tumors diagnosed and treated at our institution. Methods: The clinicopathological features of endocrine cell carcinomas of the colon and rectum diagnosed by neuroendocrine markers from January 2000 to December 2012 were retrospectively evaluated in 12 patients. Results: Surgical specimens were obtained from eight of the 12 patients. MANEC was diagnosed in six patients and NEC in one. One tumor was unclassifiable. The tumors were not resected in four patients, and all died within 3 months. Of the eight patients who underwent resection, four received an R0 resection, two of whom underwent adjuvant chemotherapy and survived more than 5 years. One patient who underwent an R2 resection and continuous chemotherapy survived for 53 months. One patient with NEC underwent surgery and radiotherapy, and died 17 months later. Conclusion: Most endocrine cell carcinomas of the colon and rectum reviewed were MANECs. Though their prognosis was generally poor, chemotherapy may be effective in some patients.

Introduction Neuroendocrine tumors of the colon and rectum are relatively rare compared to sporadic colorectal carcinoma. There are few reports of neuroendocrine tumors of the colon and rectum in patients with ulcerative colitis. Presentation of case A patient with sigmoid colon carcinoma with focal neuroendocrine features is presented. A 32-year-old man, who had been followed for ulcerative colitis for 14 years, was found to have carcinoma of the sigmoid colon on routine annual colonoscopy, and he underwent laparoscopic total colectomy. Pathologic examination showed sigmoid colon adenocarcinoma with focal neuroendocrine features. Discussion Most colorectal carcinomas associated with inflammatory bowel disease are histologically similar to the sporadic type, and tumors with neuroendocrine features are very unusual. Conclusion Very rare case of sigmoid colon carcinoma with neuroendocrine features arising in a patient with UC was described.

We herein report an asymptomatic 65-year-old male with localized pleural amyloidosis mimicking malignant pleural mesothelioma. He had a history of exposure to asbestos and was admitted for investigation of an abnormal pleural thickness detected by chest radiography. Positron emission tomography showed elevation of standardized uptake value corresponding to the pleural thickness. Partial pleurectomy including the tumor was performed for the purpose of diagnosis and local disease control. The pathological examination showed that the tumor was pleural amyloidosis. The tumor was diagnosed as localized primary amyloidosis, because serum monoclonal protein concentration did not increase. Pleural amyloidosis should be considered as a differential diagnosis from pleural mesothelioma.

Although size criteria have been proposed to identify lymph node metastases in patients with rectal cancer, size may not be an accurate predictor. Specimens from consecutive rectal cancer patients who underwent curative-intent radical surgery were examined. The long and short axes of lymph nodes were measured on the glass slides using micrometer calipers. The pathologic diagnosis was used as the reference. The diagnostic accuracy of metastatic status according to lymph node size was evaluated. Overall, 1283 lymph nodes from 78 patients were reviewed. The metastatic rate correlates with the length of both the long and short axes. However, metastases were present even in 1-mm lymph nodes, and the metastatic rate exceeds 5 per cent in lymph nodes measuring 3 mm along both axes. Cutoff values of ≥4 mm and ≥3 mm for the long and short axes result in a sensitivity of 76 per cent and 79 per cent, and a specificity of 36 per cent and 33 per cent, respectively, for each axis. Size criteria alone do not accurately predict the N-stage of rectal cancer. Diminutive lymph nodes, which are not seen on imaging studies, can contain metastatic disease.

International experts met to discuss recent advances and to revise the 2004 recommendations for assessing and reporting precursor lesions to invasive carcinomas of the pancreas, including pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm, and other lesions. Consensus recommendations include the following: (1) To improve concordance and to align with practical consequences, a 2-tiered system (low vs. high grade) is proposed for all precursor lesions, with the provision that the current PanIN-2 and neoplasms with intermediate-grade dysplasia now be categorized as low grade. Thus, high-grade dysplasia is to be reserved for only the uppermost end of the spectrum (carcinoma in situ-type lesions). (2) Current data indicate that PanIN of any grade at a margin of a resected pancreas with invasive carcinoma does not have prognostic implications; the clinical significance of dysplasia at a margin in a resected pancreas with IPMN lacking invasive carcinoma remains to be determined. (3) Intraductal lesions 0.5 to 1 cm can be either large PanINs or small IPMNs. The term incipient IPMN should be reserved for lesions in this size with intestinal or oncocytic papillae or GNAS mutations. (4) Measurement of the distance between an IPMN and invasive carcinoma and sampling of intervening tissue are recommended to assess concomitant versus associated status. Conceptually, concomitant invasive carcinoma (in contrast with the associated group) ought to be genetically distinct from an IPMN elsewhere in the gland. (5) Intraductal spread of invasive carcinoma (aka, colonization) is recommended to describe lesions of invasive carcinoma invading back into and extending along the ductal system, which may morphologically mimic high-grade PanIN or even IPMN. (6) Simple mucinous cyst is recommended to describe cysts >1 cm having gastric-type flat mucinous lining at most minimal atypia without ovarian-type stroma to distinguish them from IPMN. (7) Human lesions resembling the acinar to ductal metaplasia and atypical flat lesions of genetically engineered mouse models exist and may reflect an alternate pathway of carcinogenesis; however, their biological significance requires further study. These revised recommendations are expected to improve our management and understanding of precursor lesions in the pancreas.

Although size criteria have been proposed to identify lymph node metastases in patients with rectal cancer, size may not be an accurate predictor. Specimens from consecutive rectal cancer patients who underwent curative-intent radical surgery were examined. The long and short axes of lymph nodes were measured on the glass slides using micrometer calipers. The pathologic diagnosis was used as the reference. The diagnostic accuracy of metastatic status according to lymph node size was evaluated. Overall, 1283 lymph nodes from 78 patients were reviewed. The metastatic rate correlates with the length of both the long and short axes. However, metastases were present even in 1-mm lymph nodes, and the metastatic rate exceeds 5 per cent in lymph nodes measuring 3 mm along both axes. Cutoff values of >= 4 mm and >= 3 mm for the long and short axes result in a sensitivity of 76 per cent and 79 per cent, and a specificity of 36 per cent and 33 per cent, respectively, for each axis. Size criteria alone do not accurately predict the N-stage of rectal cancer. Diminutive lymph nodes, which are not seen on imaging studies, can contain metastatic disease.

We report a case of sarcomatoid carcinoma of the skin in a 63-year-old man who was treated with the carbon dioxide snow freezing method for a huge congenital pigmented nevus that extended from the right upper extremity to the right trunk during childhood. He had an exophytic red tumor on the nevus in the right upper extremity that grew slowly for 4years and rapidly recently. Histological and immunohistochemical studies revealed both epithelial and mesenchymal malignancy in the same tumor. The epithelial component was composed of basaloid cells forming multiple nests with peripheral palisading, positive for keratins and BerEP4, implying basal cell carcinoma. The mesenchymal component was composed of spindle-shaped cells negative for keratins and positive for vimentin, suggesting sarcoma. This is, to our knowledge, the first report of sarcomatoid carcinoma arising in the primary pigmented nevus that had been treated by the carbon dioxide snow freezing method.

Rosai-Dorfman disease (RDD) is a benign histiocytic proliferative disorder characterized by the accumulation of histiocytes in lymph nodes and various other organs. RDD seldom involves the central nervous system, and cases of purely intracranial RDD are particularly rare. We report a case of purely intracranial RDD involving the brainstem that was diagnosed at autopsy. A 68-year-old woman visited our hospital because of visual disturbances and loss of energy. Magnetic resonance imaging revealed an obscure mass in the brainstem. Despite exhaustive work-ups, the etiology of the intracranial mass remained unclear. The patient died of respiratory depression, and an autopsy was performed for pathological investigation. Macroscopically, a pink pale mass 2.5cm in diameter was found in the brainstem, with no attachment to the dura. Histologically, it was composed of histiocytic cells with incorporation of small lymphocytes (emperipolesis). Immunohistochemical staining revealed that the cells were positive for CD68 and S100 and negative for CD1a, consistent with a diagnosis of RDD. Purely intracranial RDD is extremely rare and considered benign. To date, nine cases (including ours) have been reported. To our knowledge, this is the first case of intracranial RDD with autopsy. Although generally considered benign, RDD involving the brainstem might be lethal.

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are primary pancreatic neoplasms that can act as precursors to invasive adenocarcinoma of the pancreas. The peritumoral stroma has been increasingly recognized to play an important role in many types of tumors. Therefore, to investigate the clinicopathological significance of the peritumoral stroma in IPMNs, we examined the histological features of the peritumoral stroma in each subtype and histological grade of IPMNs. Eighty-two patients with IPMN, who underwent surgical resection, were reviewed clinicopathologically. Intraductal papillary mucinous neoplasms (86 lesions in total) were histologically subclassified into gastric (n = 51), intestinal (n = 22), pancreatobiliary (n = 11), and oncocytic (n = 2) subtypes. Peritumoral histological features between the gastric and intestinal subtypes were evaluated by each histological grade. The results showed that subepithelial edema and inflammatory cell infiltration were more commonly observed in the gastric subtype (74% and 79%, respectively) than in the intestinal subtype (12% and 25%, respectively) of low-grade IPMNs. On the other hand, mucus lakes were more commonly observed in the intestinal subtype (100%) than in the gastric subtype (0%) of high-grade IPMNs. In addition, pancreatobiliary subtype IPMNs tended to exhibit acute inflammation such as neutrophil predominance. This study showed that peritumoral histological features differed among subtypes of IPMNs from low-grade tumors. These differences suggest the possibility that each subtype of IPMNs has a distinct mechanism from an early stage of tumor progression, which is reflected in the properties of the peritumoral stroma. (C) 2015 Elsevier Inc. All rights reserved.

Background: Blue nevus is a benign dermal melanocyte tumor that mainly arises from the skin. We report an extremely rare case of blue nevus in a pediatric patient with extensive progression from the middle ear and inner ear to the nasopharynx through the Eustachian tube. Case Report: A 2-year-old girl with blue tympanum was referred to our department. Computed tomography scans and magnetic resonance imaging were performed, followed by a tissue biopsy and histopathologic evaluations. Radiologic examinations revealed that the lesion had progressed beyond the middle ear into the inner ear and the nasopharynx through the Eustachian tube. Subsequent histopathologic examinations indicated dermal dendritic melanocytic proliferations, but no evidence of malignancy. Based on the clinical and histopathologic findings, we concluded that the lesion was consistent with blue nevus. Discussion: Blue nevus is a relatively common skin lesion. However, no prior reports have described the extension of blue nevus from the auditory organ to the nasopharynx in a pediatric patient. Despite the benign nature of the lesion, the patient experienced profound hearing loss in the affected ear, which necessitates continued monitoring as the lesion may expand with patient growth.

We hypothesized that a reduction in the size of the lymph nodes after neoadjuvant therapy for locally advanced rectal carcinoma would be associated with decreased lymph node metastases and/or a better prognosis. Between March 2006 and April 2012, 71 patients with primary rectal cancer received neoadjuvant chemoradiation therapy (CRT). For all lymph nodes 5 mm or larger in size, the major and minor axes were measured on CT scan images, and the product was calculated. The lymph node size was determined before and after CRT. The patients were divided into three groups based on the lymph node size before and after treatment. Group A exhibited a reduction in size of 60 % or more, Group B a reduction of less than 60 % and Group C had no lymph node enlargement before treatment. The incidence of lymph node metastases on pathological examination was 15 % in Group A and 50 % in Group B (p = 0.006). The five-year disease-free survival in Group A was 84 % compared with 78 % in Group B (log rank p = 0.34). The five-year overall survival in Group A was 92 % compared with 74 % in Group B (log rank p = 0.088). A reduction in the size of enlarged lymph nodes after neoadjuvant therapy may be a useful prognostic factor for recurrence and survival.

Intravascular large B-cell lymphoma (IVLBCL) is classified as a rare type of non-Hodgkin's B-cell lymphoma by the World Health Organization. It is characterized by the presence of lymphoma cells in the lumens of the small vessels of several organs, most notably the skin. Diagnosis of IVLBCL is difficult because of the lack of lymphadenopathy and because lesions need to be histologically confirmed via a biopsy of the affected organs. Random skin biopsy (RSB) of normal-appearing skin is a useful and apparently safe means of evaluating IVLBCL. However, patients with IVLBCL often exhibit thrombocytopenia, and we describe a case in which a patient with thrombocytopenia experienced hemorrhagic shock and died shortly after RSB. For this reason, we reviewed cases of RSB performed at our hospital and found that the middle adipose tissue contained a higher percentage of atypical lymphoid cells than other layers of the skin. On the basis of our findings, we propose a strategy for the safer performance of RSB in IVLBCL patients with thrombocytopenia and coagulation abnormalities.

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Direct fast scarlet 4BS（以下，DFS）はアミロイド物質を特異的に染色するが，時としてアミロイドの染色不良や膠原線維への共染を経験する。これらの予防策として，塩を添加することによる染色液の調整法がこれまでいくつか報告されている。本検討では塩の種類・組み合わせに焦点を当て，DFS染色液調整法の検討を行った。DFS染色液に塩化ナトリウム，炭酸ナトリウム，硫酸ナトリウムの3種類の塩をそれぞれ添加した。さらに，これらの塩から任意の2種類を組み合わせて添加したもの，塩を添加しないコントロールを含む計7系列の染色液を作製した。全身性アミロイドーシス（AA型）と診断された剖検例の肝臓パラフィンブロックの連続切片を作製し，各系列のDFS染色液で染色した。染色した切片に対して，（1）アミロイドの染色性，（2）膠原線維への共染の程度を評価した。染色性の評価は，目視に加え，色の差を数値化す

Mucinous cystic neoplasms (MCNs) of the pancreas are primary pancreatic cyst-forming neoplasms that can be a precursor to invasive adenocarcinoma of the pancreas. MCNs occur almost exclusively in the distal pancreas of middle-aged women. MCNs typically show a "cyst-in-cyst" pattern of growth and are well encapsulated by a thick fibrous wall. MCNs are composed of mucin-producing neoplastic epithelial cells and "ovarian-type" subepithelial stroma. The epithelium is dysplastic and the grade can range from low to high grade; some MCNs have an associated invasive carcinoma. It is this associated invasive carcinoma that determines prognosis. MCNs harbor several characteristic genetic and epigenetic alterations, some of which are shared with conventional invasive pancreatic ductal adenocarcinoma. Furthermore, several studies reveal characteristic patterns of gene expression in the ovarian-type stroma that suggest steroidogenesis in the ovarian-type stroma. Better knowledge of the molecular alterations could help in the management of patients with this type of precursor of invasive carcinoma. (C) 2014 Elsevier Inc. All rights reserved.

A 54-year-old Japanese woman was referred with a gallbladder tumor. Based on the results of the computed tomography scan, endoscopic retrograde cholangiopancreatography, and magnetic resonance cholangiopancreatography, a mucin-producing neoplasm of the gallbladder associated with pancreaticobiliary maljunction was diagnosed. Extended cholecystectomy, extrahepatic bile duct resection, and choledochojejunostomy were performed, and she remains free of recurrence 24 months after resection. Histopathological examination revealed that the papillary component of the lesion was an intracystic papillary neoplasm with diverse characteristics of pancreaticobiliary epithelium and intestinal epithelium including mucin. In this component, most of the papillary lesion was a high-grade intraepithelial neoplasm, but also showed slight invasion into the muscular layer. The nodular component consisted of both poorly differentiated biliary type adenocarcinoma and large cell neuroendocrine carcinoma. We report a rare case of a mixed adenoneuroendocrine carcinoma arising from an intracystic papillary neoplasm associated with pancreaticobiliary maljunction. As for the histogenesis of this tumor, based on the histopathologic appearance, transdifferentiation from poorly differentiated biliary type adenocarcinoma to large cell neuroendocrine carcinoma is considered the most possible histogenesis of this tumor.

Adrenocortical oncocytomas are rarely reported, occur almost exclusively in adults, and are mostly nonfunctional. Here, we report an interleukin-6 (IL-6)-producing adrenocortical oncocytoma in an 11-year-old girl presenting with fever, body weight loss, and increased levels of inflammatory markers and serum IL-6. Imaging studies revealed a 4-cm mass in the left adrenal gland. After complete resection, laboratory findings returned to normal. Histology was consistent with adrenocortical oncocytoma, and the tumor cells stained positive for IL-6. Conclusion: IL-6-producing adrenocortical oncocytoma should be included in the differential diagnosis and imaging studies should be performed in patients presenting with persistent fever of unknown origin and high levels of inflammatory markers.

This report documents 3 pediatric papillary thyroid carcinoma cases with associated Hashimoto thyroiditis. In all 3 cases, hypoechoic nodules accompanied by multiple echogenic spots were noted on sonography of the thyroid. Hashimoto thyroiditis was suspected on the basis of positive thyroid autoantibody test results and pathologic examinations of thyroidectomy specimens, which revealed chronic thyroiditis with lymphocytic infiltration as the background of papillary thyroid carcinoma development. The potential for papillary carcinoma development warrants close follow-up, and meticulous sonographic examinations must be performed in children with Hashimoto thyroiditis.

The purpose of this study was to evaluate the clinical features, pathology, and etiology of adenocarcinoma in patients with anal fistulae.We identified seven patients diagnosed with adenocarcinoma associated with anal fistulae from a retrospective chart review.Five patients were diagnosed with primary adenocarcinoma associated with anal fistulae. Two patients were diagnosed with secondary adenocarcinoma associated with anal fistulae originating from rectal cancer on the proximal side. The primary adenocarcinomas included cancers arising from long-standing anal fistulae fulfilling established diagnostic criteria in two patients, and cancer arising from short-duration anal fistulae in three patients. Excision of the fistula was performed based on the initial diagnosis of the anal fistula for all five patients. Increased suspicion of cancer was due to the existence of gelatinous material in the anal fistula in three patients and induration in the resected specimens in two patients. The etiologies of the secondary adenocarcinomas associated with anal fistulae included implantation in the anal fistula from rectal cancer and fistula formation originating due to the progression of rectal cancer.Anal fistulae are commonly seen in the coloproctology clinic, but special attention to similar conditions associated with malignant disease is needed.

Objective We retrospectively investigated the clinical features of pulmonary aspergillosis associated with interstitial pneumonia. Methods We reviewed the medical records of all patients treated for interstitial pneumonia with or without pulmonary aspergillosis at our institution between April 2006 and August 2012 and evaluated the clinical features as well as risk and prognostic factors for pulmonary aspergillosis associated with interstitial pneumonia. Results Among 539 patients with interstitial pneumonia, 15 who suffered from pulmonary aspergillosis were identified. The median age was 69.2 +/- 7.0 years, and fourteen patients were men. The subtypes of pulmonary aspergillosis were chronic pulmonary aspergillosis (n=14) and invasive pulmonary aspergillosis (n=1). The forms of interstitial pneumonia included idiopathic pulmonary fibrosis (n=9), rheumatoid arthritisrelated interstitial pneumonia (n=4) and pleuroparenchymal fibroelastosis (n=2). The underlying conditions were emphysema (n=9) and a history of oral corticosteroid and/or immunosuppressive use (n=4). Home oxygen therapy (HOT) was administered in 11 patients. Following the diagnosis of pulmonary aspergillosis, all patients were treated with antifungal drugs. Ten patients (66.6%) died. A comparison of the interstitial pneumonia patients with and without pulmonary aspergillosis showed that the presence of emphysema, use of HOT and death were significantly associated with pulmonary aspergillosis. Conclusion Pulmonary aspergillosis is one of the major complications of interstitial pneumonia and its prognosis is poor. Therefore, providing careful monitoring and proper treatment is extremely important.

Numerous reports have demonstrated the usefulness of bioresorbable materials, but few have described severe complications caused by delayed degradation. The authors present the case of an intracranial foreign body granuloma caused by plates made of unsintered hydroxyapatite (uHA) particles and poly-L-lactide (PLLA; Super Fixsorb MX, Takiron) after cranioplasty. This 1-month-old boy presented to the authors' department with Pfeiffer syndrome. He had multiple-suture synostosis causing turribrachycephaly, Chiari malformation Type 1, and obstructive sleep apnea syndrome. At 6 months old, the child was treated with multidirectional cranial distraction osteogenesis. The uHA-PLLA plates were applied as base stones to reinforce the pins. After 16 days of distraction and 3 weeks of consolidation, the pins were removed. Seventeen months postoperatively, the plate on the right temporal bone showed passive intraosseous translocation (PIT), and by 2 years postoperatively, the plate was completely left behind in the cerebrum. At 3.5 years postoperatively, MRI disclosed a contrast-enhanced mass with surrounding brain edema at the site of the plate. The lesion was resected. The clinical history and histological specimens led to a diagnosis of foreign body granuloma surrounding the nonabsorbed resorbable plate in the dura mater. Resorbable plates are clearly useful resources in cases in which delayed absorption will not prove problematic, but careful application and follow-up is required when dealing with the growing skull given the possibility of intracranial displacement after PIT.

A solid pseudopapillary neoplasm (SPN) of the pancreas has distinct histopathological features. A solid pattern of growth with pseudopapillary structures that result from degeneration is observed. On rare occasions, the tumor may vary from being entirely solid to completely cystic. The present study describes two unique cases of SPN. A 25-year-old male presented with a pancreatic tumor showing a predominantly solid pattern with no degenerative change, although the pre-operative cytological specimens that were obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed pseudopapillary structures. The second case was of an 11-year-old female who presented with a pancreatic tumor with prominent degeneration. Nests and cords of the remaining neoplastic cells were located only at the periphery, with perineural invasion. An immunohistochemical analysis revealed that the tumor cells in the two cases were positive for CD10 and beta-catenin and negative for trypsin. An awareness of the broad morphological variability of SPN and an immunohistochemical panel that includes CD10, beta-catenin and trypsin are useful for establishing an accurate diagnosis.

Lynch syndrome, also referred to as hereditary nonpolyposis colorectal cancer, is the most common form of hereditary colorectal cancer, and is associated with a high incidence of multiple primary neoplasms in various organs.A 79-year-old woman (patient 1) diagnosed with ascending colon cancer had a history of previous carcinomas of the uterus, stomach, uroepithelial tract, and colon. One year later, she developed a brain tumor (glioblastoma). A 54-year-old female (patient 2) was diagnosed with endometrial cancer and sigmoid colon cancer. Both patients underwent genetic evaluations independently.No mutations were found in an exon-by-exon analysis of genomic DNA by polymerase chain reaction (PCR) and reverse transcription (RT)-PCR. However, multiplex ligation-dependent probe amplification (MLPA) identified genomic duplication spanning from exon 7 to exon 14 of the MSH2 gene in both patients. Due to the presence of this characteristic gene duplication, their pedigrees were investigated further, and these showed that they are paternal half-sisters, consistent with paternal inheritance.Large genomic duplication from intron 6 through intron 14 in MSH2 is a very rare cause of Lynch syndrome and is difficult to identify with conventional methods. MLPA may be an alternative approach for detecting large-scale genomic rearrangements.