A case of mammary-type myofibroblastoma of the inguinal region

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Mammary-type Myofibroblastoma of the Inguinal Region is very rare.

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Prognosis of this disease is good after surgical resection.

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The correct diagnosis and treatment is important.

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We think that it is useful to share knowledge widely about this disease.

Introduction

Myofibroblastoma is usually occurred in the breast and extra-mammary disease is rare.

Presentation of case

A 38-year-old man was admitted to our hospital for further examination of the left inguinal tumour, present and enlarging for 16 months. The tumor was 50 mm in diameter, well-circumscribed, firm, and painless. Ultrasonogaphy, computed tomography(CT) and magnetic resonance imaging (MRI) could not provide the definitive diagnosis. Surgical exploration confirmed a 50 mm tumour with a clear surface with a thin capsule. Complete excision was achieved. Histopathology confirmed the tumor had oval and spindle shaped fibroblastic cells with rich collagen deposition. It stained positive for ER, CD34, desmin and CD10 but negative for -smooth muscle actin and S-100. A mammary-type myofibroblastoma was diagnosed based on these results.

Discussion

An extra-mammary myofibroblastoma is very rare and first reported in 2001. Since then, over 160 cases have been reported. On immunohistochemistry, these lesions are characteristically positive for CD34 and desmin, with variable staining for α-smooth muscle actin. Once the diagnosis is made, regardless of size or location, this tumour behaves in a benign fashion after surgical excision reported so far.

Conclusion

This case is rare, but the correct diagnosis and treatment is important for good prognosis.

[A case of isolated CNS sarcoidosis with diffuse confluent high intensity lesions at bilateral deep white matter]

We reported a 60-year-old woman who suffered from isolated neurosarcodosis. She was presenting comprehensive dysfunction and intermittent high fever. In several months she gradually developed dysorientation, amnesia, dementia. However, no focal sign such as paralysis or sensory disturbance was demonstrated. Her blood chemistry showed normal including ACE (angiotensin converting enzyme) and lysozyme. Cerebrospinal fluid revealed elevated mononuclear cells, protein, and decreased glucose level. At first we treated with antibiotics including antiviral drugs in suspect of the infectious encephalomeningitis. But no improvement was observed. The elevation of ACE in spinal fluid made us suspect of neurosarcoidosis. So intravenous predonizoron (1,000 mg) was given, improving. Her high fever and mental disturbance improved. Second spinal fluid showed improvement. During the course her brain MRI revealed new bilateral diffuse confluent high intensity lesions at the deep white matters. Brain biopsy of deep matter at the right anterior lobe showed noncaseating granuloma. Since systemic work-up to detect sarcoidosis did not reveal lesions other than CNS, we considered this patient as having isolated CNS sarcoidosis.

Intracaval and intracardiac extension of malignant thymoma

A case of malignant thymoma presenting as the superior vena cava syndrome is reported. A 56-year old male was admitted with superior vena cava syndrome. CT and NMR-CT scan showed a solid homogenous superior mediastinal mass; which filled the lumen of the superior vena cava and the right atrium. A biopsy of the right atrial mass showed myxoma, and operation was performed. Histopathologically the tumor was diagnosed as thymoma. Intracaval and intracardiac extension of a thymoma is very rare.

[Neurilemmoma of lesser omentum]

A very rare case of neurilemmoma of lesser omentum was reported. The tumor was circumscribed and solid. And it had necrotic parts within it. Echography and X ray CT revealed its inner structure. Angiography showed similarity of benign solitary neurogenic tumor in other sites.

A case of primary malignant lymphoma of the brain with high uptake of 123I-IMP

In general the 123I-IMP SPECT image of a brain tumor is visualized as a defect. Tumor cases with high IMP uptake have been rarely reported. We encountered a case of primary malignant lymphoma of the brain with high IMP uptake on both early and late scans corresponding to the CT lesions. Previously reported positive cases seemed to be confined to the early scan. For the present the exact behaviour of IMP is incompletely understood, but the mechanism of high uptake has been accounted for by increased extraction and increased amine receptors at the tumor sites. We need further information to establish whether these SPECT findings are specific for primary malignant lymphoma of the brain.

Left precentral gyrus and Broca's aphasia: a clinicopathologic study

We describe an autopsied case in which a circumscribed lesion involving the left precentral gyrus caused mild but lasting Broca's aphasia. The patient developed nonfluent speech and writing disturbances (consistent with mild Broca's aphasia) following malignant lymphoma of the brain. After subtotal resection of the tumor and whole brain irradiation, his language disturbances continued without remarkable change for 3 years until his death. A neuropathologic study indicated that the lesion responsible for the patient's aphasia was restricted to the lower one-third of the precentral gyrus in the left hemisphere. As for the relationship between the left precentral gyrus and Broca's aphasia and its allied syndrome (ie, aphemia), we concluded that in Broca's aphasia the lower part of the precentral gyrus plays a more important role than previously assumed.

201Tl and 67Ga uptake in malignant fibrous histiocytoma of the heart

A patient with malignant fibrous histiocytoma of the heart is described who was initially presented with a left atrial tumor. Subsequent 201Tl and 67Ga scintigraphy showed massive uptake of the tracers by the tumor and the pattern of uptake was thought to reflect underlying necrosis and hemorrhage within the tumor.

Giant seminoma of undescended testis in Down syndrome

A giant seminoma of undescended testis in a forty-one-year-old Japanese male with Down syndrome is reported as is a review of the literature. The relationship between Down syndrome and testicular cancer are discussed. To our knowledge this is the largest seminoma of undescended testis (weight 3,500 Gm) so far recorded.

Chromium-induced pulmonary cancer. Report of a case and a review of the literature

A 57-year-old man, whose occupational history was that of a chromate worker for about 35 years, suffered nasal perforation during and died due to pulmonary cancer. In the autopsy materials, the concentration of chromium in the lung tissues was very high, being about 90 times the amount found in normal lungs. The chromium particles in the lung tissues could not be detected by analytical electron microscope, but they could be found in the anthoracotic lesions of the lungs by means of an X-ray microanalyser. The present case was judged to be a case of chromium-induced pulmonary cancer since all the pathologic data obtained were similar to those found in similar cases reported in the literature.

A case of multiple endocrine neoplasia type II b: endocrinological evaluation and family screening

The case of a 27 year-old woman with typical manifestations of multiple endocrine neoplasia type II b is reported. Medullary carcinoma of the thyroid was detected on the occasion of an operation for goiter when she was 22 years of age. Constipation due to megacolon caused by intestinal neuroma had persisted since childhood. Neuroma of the tongue and lips, hypertrophic corneal nerve and Marfanoid habitus were also found. The presence of pheochromocytoma was suggested in view of the positive cold pressor and results of glucagon loading tests, but this remains inconclusive. There was prolonged and exaggerated response of growth hormone and luteinizing hormone after provocative tests for anterior pituitary gland, in spite of normal basal levels. Screening of her family members for medullary carcinoma of the thyroid was carried out by measurement of immunoreactive calcitonin. Two siblings were shown to be hypercalcitoninemic, presumably due to occult medullary carcinoma of the thyroid. This case appeared to be the first in Japan showing multiple endocrine neoplasia type II b accompanied by familial hypercalcitoninemia.

Cellular localization of AFP, hCG and its free subunits, and SP1 in embryonal carcinoma of the testis and ovary

An immunohistological study of AFP, hCG and its free subunits, and SP1 was investigated in 10 cases of non-seminomatous germ cell tumors of the testis and ovary. AFP was demonstrated in mononuclear embryonal tumor cells within embryonal carcinoma in a narrow sense, frequently in association with yolk sac tumor. AFP was more consistently demonstrated in vacuolated or elongated cells of yolk sac tumor, in which continuous transformation from tubular patterns of embryonal carcinoma was shown with positive reactions for AFP. The hCG was demonstrated in syncytiotrophoblastic giant cells scattered among the embryonal carcinoma, but rarely in mononuclear large cells. The occurrence of hCG and beta subunit was more frequently observed than a subunit or SP1, suggesting the unbalanced synthesis of hCG and free subunit in choriocarcinomatous element associated with embryonal carcinoma. These findings support the view that embryonal carcinoma has a developmental potential to the extra-embryonic components of both choriocarcinoma and yolk sac tumor.

Effects of thyrotropin-releasing hormone on sleep and sleep-related growth hormone release in normal subjects

Effects of TRH on sleep and sleep-related growth hormone (GH) release were examined in four normal volunteers. A bolus of 500 microgram of synthetic TRH was injected iv at the onset of sleep, followed by continuous iv infusion of 1000 microgram of TRH dissolved in saline for 3 h on two nights. Saline alone was infused on two control nights in each of these subjects. Polygraphic sleep records showed that TRH transiently interrupted sleep on both nights in all of the four subjects. The arousal phenomenon was observed from 80 to 151 min after the start of TRH administration until 20 to 212 min after the end of TRH infusion. The mean (+/-SE) percentage of awakening on the nights of TRH administration was significantly larger than on the control nights (36.4 +/- 1.9% vs. 1.3 +/- 0.8%, P less than 0.001). Plasma GH increased in close relationship to the initial appearance of slow wave sleep (SWS) within 40 min after sleep onset on both control nights in all four subjects. On nights of TRH administration, however, plasma GH levels during the initial 80 min of sleep were significantly lower (P less than 0.005) than on control nights, whereas SWS was demonstrated before the interruption of sleep. On nights when sleep was interrupted by forced wakefulness 1 h after sleep onset, plasma GH rose to levels comparable to those on control nights during early sleep periods in all subjects examined. These results suggest that TRH inhibits sleep and sleep-related GH release in normal subjects.

Sleep-related growth hormone release following 2-bromo-alpha-ergocriptine treatment in acromegalic patients

Plasma growth hormone (GH) concentrations were measured over 24 h in seven acromegalic patients before and during treatment with 2-bromo-alpha-ergocriptine (CB-154). Before treatment basal plasma GH levels were consistently elevated but no significant change was observed between the mean plasma GH levels during sleep and during waking in five of the seven patients examined. The daily administration of CB-154 (5 to 10 mg, orally) for 14 days resulted in a significant fall in the 24 h mean plasma GH levels in six of the seven patients. In all of the six patients who responded to CB-154 treatment, the mean plasma GH concentrations during sleep were significantly greater than during waking. Daytime sleep was associated with a significant rise in plasma GH in both of the two patients examined. It is concluded that CB-154 treatment resulted in a significant decrease in plasma GH levels with sleep-related increase in some acromegalics although the mechanism responsible for this sleep-related GH rise remains to be further investigated.