太田 昌幸

類上皮血管肉腫(EA)は血管肉腫の亜型である。今回,低分化な癌との鑑別が困難であった小腸原発のEAを報告する。44歳の男性が腹部CTと内視鏡検査で低分化腺癌を疑われ,小腸部分切除術を受けた。手術検体での詳細な組織形態の観察と免疫染色により,EAと診断した。消化管発生の血管肉腫は類上皮形態を伴う頻度が高く,診断には複数の血管内皮マーカーの確認が有用である。消化管の生検で低分化な上皮様パターンを示す場合は,EAも考慮すべきである。(著者抄録)

Mycobacterium goodii, a rapidly growing non-tuberculous mycobacterium, rarely causes pulmonary diseases. A patient was admitted to our hospital with a fever and cough. Chest radiography revealed consolidation in the right middle lung. As he had previously been treated for organizing pneumonia (OP), he was diagnosed with OP recurrence and administered systemic corticosteroids. Although initial improvement was observed, the pulmonary consolidations worsened. Transbronchial lung cryobiopsy revealed an OP pattern. M. goodii was identified in sputum acid-fast bacilli cultures. The patient was diagnosed with M. goodii pulmonary disease and secondary OP. Although intravenous imipenem-cilastatin, amikacin, and ciprofloxacin led to initial improvement in pulmonary consolidations, the consolidations re-worsened. Systemic corticosteroids were initiated, resulting in improvement in the consolidations. The dose of systemic corticosteroids was tapered; oral antimycobacterial therapy was continued. M. goodii can cause pulmonary disease and induce OP; antimycobacterial therapy and systemic corticosteroids can be effective.

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been used to diagnose and stage lung cancer. Acquire™ Pulmonary and Expect™ Pulmonary dedicated EBUS-TBNA needles were introduced as the Franseen and Lancet needles, respectively. It is still unclear whether the Franseen or Lancet needles yield a higher quality specimen especially focusing on next-generation sequencing-based molecular testing. METHODS: A single-center, prospective study performed at the Chiba University Hospital randomly assigned patients to two groups: Group A, wherein the first and second EBUS-TBNA were performed using Lancet and Franseen needles, respectively, and Group B, wherein the first and second EBUS-TBNA were performed using Franseen and Lancet needles, respectively. Each specimen was compared and analyzed pathologically. The primary outcome was the histological tissue area except blood clot and the cellularity of each sample. We also examined the success rate of molecular testing. RESULTS: Twelve patients who underwent EBUS-TBNA between November 2022 and February 2023 were enrolled in this study. The tissue area of the specimens obtained by the Franseen and Lancet needles was 13.3 ± 6.4 mm2 and 10.6 ± 6.3 mm2, respectively (P = .355). The tumor cellularity in the specimens obtained using the Franseen and Lancet needles was 54.0 ± 30.3 and 46.2 ± 36.3%, respectively (P = .608). The success rate of molecular testing using the single-pass sample by Franseen needle was 85.7 and 57.1% by Lancet needle. No serious complications were reported. CONCLUSIONS: The Franseen needle tended to show a greater amount of specimen with higher tumor cellularity than the Lancet needle which may contribute higher success rate of molecular testing. Further studies must be conducted to validate the results of this study. KEY FINDINGS: What is known and what is new?  What is the implication, and what should change now?

Rectal metastases of prostate cancer are rare and may be difficult to diagnose. In this report, we describe a case in which an extramural growth-type rectal tumor was resected and pathologically diagnosed as prostate cancer metastasis. A 70-year-old man on hormone therapy for prostate cancer with seminal vesicle invasion and pelvic lymph node metastasis was referred to our department after an imaging scan showed an extramural growth-type rectal tumor. Endoscopic ultrasound-guided fine needle aspiration was considered for diagnosis, but the patient preferred an early resection without the exam, so surgery was performed. Histopathological examination revealed that the lesion was in the adventitia of the rectum and metastasis of prostate cancer. Metastatic lesions of prostate cancer are not indicated for resection. A detailed preoperative study with the possibility of prostate cancer metastasis in mind is necessary because it is relevant to choosing the treatment strategy.