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Carcinosarcoma of the liver with mesenchymal differentiation

World Journal of Gastroenterology 2007年第5期13卷 809-812页

作者： Shinichi Sumiyoshi Masataka Kikuyama yuji matsubayashi Fujito Kageyama Yoshihiro Ide Yoshimasa Kobayashi Hirotoshi Nakamura Department of Gastroenterology Hamamatsu Rosai Hospital Hamamatsu Japan Department of Pathology Hamamatsu Rosai Hos-pital Hamamatsu Japan Second Division Department of Internal Medicine Hamamatsu University School of Medicine Hamamatsu Japan

We report an extremely rare case where a mesenchymal differentiation, especially embryonal sarcoma, was demonstrated in cholangiocarcinoma. At autopsy, a yellowish-white tumor （15 cm× 12 cm） was found in the right hepatic lobe, and there were several daughter nodules in both hepatic lobes. Histologically, most of the main tumor and all of the daughter nodules examined showed sarcomatous changes （spindle cells, pleomorphic ceils and hyalization）. Histologic examination of a part of the main tumor disclosed a focus of adenocarcinoma within the tumor. The frequent transitions between the adenocarcinomatous areas and the sarcomatous areas suggested that sarcomatous transformation occurred in the cholangiocarcinoma and then spread rapidly. Immunohistochemically, the adenocarcinomatous elements were positive for cytokeratin, carcinoembryonic antigen （CEA） and epithelial membrane antigen, and negative in the sarcomatous cells. Vimentin was positive only in the sarcomatous elements. The findings of the present case support the view that carcinosarcomas represent carcinomas that develop sarcomatous elements via metaplasia of the epithelial element.

关键词： Cholangiocarcinoma Carcinosarcoma Mesenchymal differentiation

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Appendix is a priming site in the development of ulcerative colitis

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World Journal of Gastroenterology 2005年第31期11卷 4869-4874页

作者： Mitsunobu Matsushita Hiroshi Takakuwa yuji matsubayashi Akiyoshi Nishio Susumu Ikehara Kazuichi Okazaki Third Department of Internal Medicine Department of Gastroenterology Department of Gastroenterology and Endoscopic Medicine First Department of Pathology

AIM： The role of the appendix has been highlighted in the pathogenesis of ulcerative colitis （UC）. The aims of this study were to elucidate the immuno-imbalances in the appendix of UC patients, and to clarify the role of the appendix in the development of UC. METHODS： Colonoscopic biopsy specimens of the appendix, transverse colon, and rectum were obtained from 86 patients with UC： active pancolitis （A-Pan; n = 15）, active letf-sided colitis （A-Lt; n = 25）, A-Lt with appendiceal involvement （A-Lt/Ap; n = 10）, inactive pancolitis （I-Pan; n = 14）, and inactive left-sided colitis （I-Lt; n = 22）, and from controls. In the isolated mucosal T cells, the CD4/CD8 ratio and proportion of activated CD4＋ T ceils were investigated, and compared with controls. RESULTS： in the appendix, the CD4/CD8 ratio significantly increased in A-Lt and A-Lt/Ap. The ratio in the appendix also tended to increase in A-Pan. In the rectum, the ratio significantly increased in all UC groups. In the appendix, the proportion of CD4＋CD69＋（early activation antigen） T cells significantly increased in all UC groups. In the rectum, the proportion of CD4＋CD69＋ T cells significantly increased only in A-Pan. The proportion of CD4＋HLADR＋（mature activation antigen） T cells significantly increased only in the rectum of A-Pan, but not in the otherareas of any groups. CONCLUSION： The increased CD4/CD8 ratio and predominant infiltration of CD4＋CD69＋ T cells in the appendix suggest that the appendix is a priming site in the development of UC.

关键词： Appendix Appendectomy Ulcerative colitis Activated T cell CD4+ T cell

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