rameters of PGCs were described in some of these reports, most of the conclusions were unreliable because of the small number of PGC cases analyzed.In the present study, we conducted a pooled analysis of 53 PGC cases, including 2 patients treated at the National Cancer Center Hospital East (NCCHE), to clarify the tumor characteristics and prognostic parameters of patients with PGC. Case reports Case 1A 74-year-old man complaining of loss of appetite and loss of body weight, for 9 months, visited the NCCHE. Laboratory data showed anemia (RBC, 369 ¥ 10 4 /mm 3 ; hemoglobin [Hb], 8.4 g/dl; hematocrit [Hct], 28.5%), hypoalbuminemia (serum albumin, 3.0 g/dl), and high serum carcinoembryonic antigen (CEA; 31.2 ng/ml; normal, 0-5 ng/ml).A gastrointestinal X-ray examination revealed an ulcerated lesion with a distinct elevation occupying the lower third of the stomach and invading the duodenum. The lesion was endoscopically diagnosed as a gastric cancer, and a biopsy specimen taken from its margin revealed well-differentiated tubular adenocarcinoma. A computed tomography (CT) scan and echography showed no evidence of liver metastasis at this time.A radical subtotal Billroth II gastrectomy with lymph node dissection, omentectomy, and partial resection of the pancreatic head was performed. Macroscopically, no signs of liver metastasis or retroperitoneal invasion were observed.The resected tumor was 11.5 ¥ 8.5 ¥ 5.0 cm in size. The tumor had extended to the serosa (T3) and had directly invaded the duodenum. A metastasis was found in one of the supragastric lymph nodes (N1). Grossly, the tumor was fungating (Fig. 1). Histologically, the tumor Abstract Primary gastric choriocarcinoma (PGC) is a rare tumor. In total, approximately 140 cases of PGC have been reported in the international medical literature. However, the clinical behavior, tumor characteristics, and prognostic parameters of PGC have not been clearly described. We conducted a pooled analysis to clarify the tumor characteristics and prognostic parameters in 53 patients with PGCs, including 2 patients treated at our hospital. The following variables were examined as potential prognostic factors: (1) sex, (2) age, (3) depth of invasion, (4) size, (5) histology, (6) nodal metastasis, (7) distant lymph node metastasis, (8) synchronous liver metastasis, (9) residual tumor, and (10) chemotherapy (not given or given). Univariate and multivariate analyses showed that the presence of residual tumor and synchronous liver metastasis and the absence of chemotherapy were significantly associated with an increased hazard rate (HR) of short overall survival (OS). Pooled analysis, including the two patients with PGC treated at our facility, demonstrated that the presence of a curative operation and chemotherapy, and the absence of synchronous liver metastasis were the strongest indicators of a favorable clinical course in patients with PGC.

Although mucinous carcinoma (MC) of the breast is considered to originate from ductal carcinoma, it is not known whether mucinous growth begins in the intraductal carcinoma or later in the invasive carcinoma. In this study, 33 MC (16 pure without any ductal components, 10 mixed Type I with an intraductal component, seven mixed Type II with a common invasive ductal carcinoma (IDC) component)) were examined to clarify the time when mucinous growth begins. Histochemical and immunohistochemical examinations of mucin revealed that mucinous growth can begin in the intraductal carcinoma and in the common IDC. Histological transition and clonality analysis using microsatellite markers supported that some MC originate from common IDC. The pure type of MC probably originates from the intraductal carcinoma, showing a micropapillary feature. Neuroendocrine differentiation, known to be associated with MC, seemed to create the main progress in the typical MC. Moreover, we analyzed the factors of a worse prognosis of mixed MC Type II, which was strongly suggested by the lymph node status. However, no explainable differences on the cell proliferating ability, or c-erbB-2 and p53 protein overexpression were found.

A 31-year-old woman presented with multiple pulmonary leiomyomatous hamartoma (MPLH) with secondary ossification. She had a past history of parosteal osteosarcoma. The pulmonary lesions were composed of spindle-shaped cells arranged in interlacing fascicles, among which glands or duct-like spaces were scattered. As some lesions contained bony tissues, it was unclear whether or not the pulmonary lesions were metastases of parosteal osteosarcoma. However, the majority of spindle-shaped cells were positive for alpha-smooth muscle actin, including cells proliferating around the bony tissues. Clonality analysis using a target of human androgen receptor (HUMARA) gene disclosed that the pulmonary nodules were polyclonal. These findings do not indicate that the lesions were metastatic. We would like to emphasize that MPLH can show osseous metaplasia.

A case of a 63-year-old man with ameloblastoma with basal cell carcinoma (BCC)-like features clinically emerging as a nasal polyp is reported. The left nasal cavity was filled with a solid mass, which seemed to be a sinusitis-associated nasal polyp. The polyp was covered by parakeratotic squamous epithelium which was directly connected to the BCC-like tumor nest. The BCC-like features gradually changed to adamantinoid features. The polyp was connected with a huge mass filling the maxillary sinus and the molar area, which consisted of conventional ameloblastoma features. Although the tumor was finally diagnosed as an ameloblastoma of the maxilla, the biopsy specimen forced us to face the problem of differential diagnosis, ameloblastoma with BCC-like features or adamantinoid basal cell carcinoma (BCC). Immunohistochemical examination revealed that tumor cells of the ameloblastoma reacted with anticytokeratin antibody KL-1 but not with antiepithelial antibody Ber-EP4, and these reaction patterns were completely contrary to those of BCC. It is emphasized that immunohistochemical examination using anticytokeratin antibody KL-1 and antiepithelial antibody Ber-EP4 is a good tool for distinguishing ameloblastoma with BCC-like features from adamantinoid BCC.

Juxtaglomerular cell tumors are rare. This report presents a case of juxtaglomerular cell tumor without hypertension. All previously reported cases showed marked hypertension, whereas this is the first case of juxtaglomerular cell tumor without hypertension. The immunohistochemistry and ultrastructure of this case are discussed.