<b><i>Background:</i></b> Seromucinous borderline tumor (SMBT) is a rare neoplasm which was newly defined in the 2014 WHO classification. Although the clinical and histopathological characteristics of SMBT have been well described, its cytological characteristics have not. We recently experienced 2 cases of SMBT which were defined by cytological findings of ascites. <b><i>Case Presentation:</i></b> Case 1 was a 65-year-old Japanese woman. Preoperative imaging studies revealed abundant ascites and a cystic tumor, with a solid component measuring 13 cm on the left ovary. Radical surgery was performed during the intraoperative diagnosis of ovarian borderline tumor, made by histological examinations of frozen tumor sections. The cytological smears of preoperatively and intraoperatively collected ascites showed many atypical cells resembling reactive mesothelial cells. Alcian-blue staining of cell block sections revealed intracytoplasmic mucin, and the results of immunohistochemistry were consistent with SMBT. The final pathological diagnosis of tumor was SMBT. Case 2 was a 28-year-old Japanese woman. Preoperative imaging studies revealed a small amount of ascites and cystic tumors with solid components in the bilateral ovaries. She initially underwent fertility preservation surgery. SMBT was suspected by cytological examination of smears of intraoperatively collected ascites and the findings of cell block. She underwent additional radical surgery based on a final pathological diagnosis of SMBT. <b><i>Conclusion:</i></b> In our experience, the tumor cells of SMBT in ascites mimicked reactive mesothelial cells. The nuclear atypia of SMBTs was intermediate between that of reactive mesothelial cells and serous carcinoma. The immunohistochemistry and mucin staining using cell block were very helpful for facilitating the cytodiagnosis of SMBT.

Cerebral infarction (CI) severely affects the prognosis of patients with malignancy. The aim of the study was to compare the pathology of CI between cases with and without malignancy focusing on intracranial Mönckeberg’s atherosclerosis. Among 778 autopsy cases of craniotomy, 53 cases of “cerebral infarction without malignancy group” (CI group), 50 cases of “malignant tumor without CI group” (MT group), and 39 cases of “cerebral infarction with malignancy group” (CM group) were identified. Mönckeberg’s atherosclerosis was mainly found in the basal ganglia and its prevalence in the CM group (38.5%) was significantly higher than in the MT group (12.0%, p = 0.005), and apparently higher than in the CI group (18.9%, p = 0.057). The CI group was significantly older, had higher BMIs, and a greater prevalence of hypertension and atrial fibrillation compared to the CM group. In addition, the prevalence of chronic renal disease was significantly lower in the CM group (2.6%, p = 0.012) than in the CI group (20.8%). Our results indicated that Mönckeberg’s atherosclerosis was often found in the basal ganglia of CM cases and that intracranial Mönckeberg’s atherosclerosis is a potential risk factor for CI in patients with advanced stage malignancy.

IntroductionCerebral small vessel disease (SVD) is one of the leading causes of stroke; each neuroimaging marker of SVD is correlated with vascular risk factors and associated with poor prognosis after stroke. However, longitudinal studies investigating the association between comprehensive SVD burden scoring system, “total SVD score” – which encompasses the established neuroimaging markers of lacunae, cerebral microbleeds (CMBs), white matter hyperintensities (WMH) including periventricular hyperintensities, and perivascular spaces in basal ganglia– and clinical outcomes are limited. The aim of this study is to determine the association between SVD burden and long-term prognosis in patients with ischemic stroke.Methods and designThis prospective, single-center, observational study enrolled patients with acute ischemic stroke, including cerebral infarction and transient ischemic attack. Magnetic resonance imaging scans were performed, and then total SVD score (range, 0–4) was calculated. We recorded baseline characteristics and evaluated the relationships of long-term outcomes to SVD neuroimaging markers and total SVD score. Stroke recurrence was thought as primary outcome. Hazard ratios (HRs) of events during follow-up were calculated using Cox proportional hazards modeling with adjustments for age, sex, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and smoking. Cumulative event rates were estimated using the Kaplan–Meier method.ResultsConsecutive 564 acute ischemic stroke patients were enrolled according to inclusion and exclusion criteria. A total of 467 participants with first-ever ischemic stroke were analyzed (median age 75.0 [interquartile range, 64.0–83.0] years, 59.3% male). Total SVD score was 0 point in 47 individuals (12.0%), 1 point in 83 (21.2%), 2 points in 103 (26.3%), 3 points in 85 (21.7%), and 4 points in 73 (18.7%). Twenty-eight recurrent stroke events were identified during follow-up. Total SVD score ≥ 2, presence of CMBs, and moderate-to-severe WMH were associated with increased risk of recurrent stroke events (HR 9.31, 95% confidence interval [CI] 2.33–64.23; HR 2.81, 95% CI 1.08–7.30; HR 2.90, 95% CI 1.22–6.88, respectively).ConclusionThe accumulation of SVD biomarkers as determined by total SVD score offered a reliable predictor of stroke recurrence. This study established a firm understanding of SVD prognosis in clinical settings.

飯田紘太郎 1) 藥師寺祐介 1) 2) 井手 俊宏 1) * 鶴岡ななえ 3) 七條 千佳 4) 原 英夫 1) 要旨：症例は 61 歳の男性．橋右側，右被殻の脳梗塞のため当院へ紹介となった．血液検査で好酸球増加があ り，造影 CT で深部静脈に血栓あり抗凝固療法を開始した．心内血栓や右左シャントはなく，胃粘膜生検で好酸球 浸潤をみとめた．特発性好酸球増加症候群(idiopathic hypereosinophilic syndrome，以下 idiopathic HES と略 記)による多発穿通枝梗塞と診断し，発症第 10 日目よりプレドニゾロンを開始した．発症第 19 日目に左被殻に 新規梗塞を再発したが，プレドニゾロンで速やかに好酸球は減少し以降脳梗塞の再発はなかった．idiopathic HES では穿通枝領域に限局した多発梗塞の報告は稀である．本例は脳梗塞巣が穿通枝領域にある場合でも idiopathic HES を鑑別疾患として念頭におく必要があることを示した．