We report a case of mesenteric chylous cyst diagnosed preoperatively by ultrasonography (US) and computed tomography (CT). Both demonstrated a unilocular cystic mass with a fluid-fluid level. The CT number of the two components indicated fat density and water density and with shaking or positional changes, the contents displayed miscibility. The tumor changed its position during hospitalization. Both features are considered to be quite diagnostic of this condition.

Background. Intraductal mucin‐hypersecreting neoplasm of the pancreas (IMHN) is a unique tumor that has a tendency to spread intraductally. The clinical outcome of IMHN generally is far better than that of pancreatic ductal cell carcinoma. Because of the presence of various cell atypia within the same tumor, it sometimes is difficult to make an accurate histopathologic diagnosis and, therefore, predict its biologic behavior. It has been shown that overexpression of c‐erbB‐2 protein in breast cancer with lymph node metastases is related to a poor prognosis. Overexpression of c‐erbB‐2 protein has been reported as an infrequent event in pancreatic ductal cell carcinoma, but little is known in the case of IMHN. Methods. The expression of c‐erbB‐2 protein was immunohistochemically investigated in the formaldehyde‐fixed, paraffin‐embedded tissues of 17 cases of IMHN, and 14 cases of pancreatic ductal cell carcinoma (8 cases with lymph node metastasis), using polyclonal and monoclonal c‐erB‐2(p185) antibodies by the avidinbiotin method. Results. Both the polyclonal and monoclonal antibodies showed similar immunostaining for the c‐erbB‐2 product. Overexpression of the c‐erbB‐2 product was observed frequently in IMHN (13/17), especially in that with moderate‐ to high‐grade cell atypia (12/12), whereas it was detected in only 1 of 14 cases of pancreatic ductal cell carcinoma (1/14). Among eight cases of pancreatic ductal cell carcinoma with lymph node metastases, over‐expression of the c‐erbB‐2 product in metastatic lesions was detected in two, one of whose primary lesions also overexpressed the oncogene product. Conclusions. These observations suggest the genetic expression of c‐erbB‐2 is related to the pathogenesis of IMHN. Cancer 1993; 72:51–6.

The gallbladder is a suitable target of endoscopic ultrasound (EUS). However, the interpretation of the layer structure of the gallbladder wall delineated by EUS is still controversial. To confirm the relationship between the layers demonstrated by EUS and the histological structure, we performed a study using the pinning method. In most slices, the gallbladder wall was demonstrated to be a two‐or three‐layer structure, consisting of a low echoic layer, sometimes with an overlying hyperechoic layer, and a high echoic layer from the mucosal side. The slices were pierced with pins at random depths. Among the twelve pin echoes demonstrated in the low echoic layer, four were located in the muscularis propria, two in the border between the muscularis propria and the subserosa, three in the fibrous layer of the upper portion of the subserosa, and three in the adipose layer of the lower portion of the subserosa. The three sites where the pin echoes were seen at the border between the low echoic and high echoic layers were located in the fibrous layer, the border between the fibrous layer and the adipose layer, and in the adipose layer, respectively. The twelve sites at which pin echoes were observed in the high echoic layer were confirmed to be in the adipose layer. These results indicate that the inner hypoechoic layer includes not only the muscularis propria but also the fibrous layer of the subserosa. This should be kept in mind when assessing the depth of invasion of a gallbladder carcinoma.

The mucus producing tumor of the pancreas (MPT) is now drawing attention because of its characteristic clinical features. It is characterized by abundant secretion of mucin into the cystic cavity or the main pancreatic duct and relatively benign biological behavior. In this paper, endoscopic characteristics of MPT and the role of pancreatoscopy in the diagnosis of this entity are discussed. Eight cases of MPT with various histological backgrounds were examined with pancreatoscopy. Six cases underwent peroral pancreatoscopy and intraoperative pancreatoscopy was performed in four cases. The endoscopic findings of MPT are summarized as follows: 1) Granular change of the epithelium of the pancreatic duct. 2) Papillary tumor with dilatation of capillary vessles on its surface. 3) Irregularity or detachment of the epithelium of the pancreatic duct. The findings mentioned above in 1), 2) and 3) were obtained in three cases, two cases, and two cases, respectively. Except in one case, the border of the lesion with the neighboring normal mucosa was well identified. We conclude that pancreatoscopy is a quite useful diagnostic tool in cases of MPT, especially for determining the extent of the lesion.

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