Paraganglioma of the gastrointestinal tract is an uncommon, usually benign neoplasm. It usually occurs in the second section of the duodenum. A review of the literature reveals 73 reported cases. We studied a case of paraganglioma by hypotonic duodenography (HDG), computed tomography (CT), angiography and histological examination. The rare occurrence of this neoplasm and the first comparative study using HDG, CT and angiography justify this case report. A 65-year-old Japanese woman had been in excellent health until she presented to her physician with tarry stool. The bleeding site was not determined. Seven months later, she visited another physician because of general fatigue, and was found to be anaemic and bleeding from the gastrointestinal tract. She was referred to the Kawasaki Medical School Hospital for further evaluation. On admission, she was moderately anaemic but not jaundiced. The abdomen was flat and soft without rebound tenderness. A slightly rough-surfaced, gooseegg sized mass was palpable in the right upper quadrant of the abdomen which moved with respiration but was not tender. Routine laboratory examination showed no abnormalities except anaemia. A hypotonic duodenogram showed a relatively smoothedged filling defect with a deep and irregular niche on the lateral wall of the second portion of the duodenum (Fig. 1). Contrast-enhanced CT revealed an inhomogeneous mass of soft-tissue density along the lateral aspect of the duodenum. This study was carried out with Gastrografin so that the mass could be easily demonstrated (Fig. 2).

We report a case of columnar cell carcinoma of the thyroid. A 47-year-old Japanese man had a nonencapsulated thyroid mass that infiltrated the surrounding tissues extensively. Seventeen months after thyroidectomy he died of respiratory failure resulting from tracheal invasion. An autopsy showed distant metastases to the liver, lung, esophagus, and pancreas. Histologically, the thyroid mass consisted of tall columnar atypical cells with marked nuclear stratification, About one-fifth of tumor cells were immunopositive for M18-1. The MIB-1 -positive index of our case was extremely high, compared with that of ordinary papillary carcinoma. This case indicates that biological growth activity in columnar cell carcinoma may be similar to that of undifferentiated carcinoma of the thyroid, since the MIB-1 -positive index is close to each other.

Metastatic lingual tumors are very rare, and hematogenous myocardial metastasis is also relatively uncommon. We report a case of lung adenosquamous carcinoma with metastases to the tongue and the myocardium. A 65-year-old man underwent a partial upper lobectomy for a primary lung cancer in June 1997. He developed a local recurrence and received two courses of radiotherapy, in March and September 1998. A follow-up computed tomography (CT) scan showed a myocardial tumor, suggestive of cardiac metastasis. In October 1998, he began to complain of anginalike chest oppression and showed ischemic changes on electrocardiogram (ECG), and he also developed lingual, subcutaneous, and brain metastases. He died of respiratory failure in December 1998, 20 months after the initial diagnosis of primary lung cancer; metastases to the tongue and myocardium were confirmed by autopsy.

Two cases of breast carcinoma metastatic to uterine leiomyoma are presented. A review of literature disclosed fourteen cases of extrapelvic carcinoma with a metastasis to uterine leiomyoma, ten of which were of breast carcinoma. The high incidence of breast carcinoma among such tumors (75%) suggests some intimacy between these two tumors. It is speculated that the common property of their development by estrogenic stimulation may be responsible for the establishment of such an assodation.

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