Acta pathologica japonica最新文献

The clinicopathologic features of two patients with mixed gonadal dysgenesis are presented, with specific reference to the relationship between endogenous sex hormones and the endometrium and the development of neoplastic disease. One patient, whose immature gonad contained granulosa cells and theca cells, had elevated serum estrogen levels and an endometrium with frequent ciliated metaplasia and squamous metaplasia. Another patient had elevated serum testosterone levels and atrophic endometrium. Both had gonadal tumors, more specifically, germinomas, which contained many calcified nodules within the tumor. These findings suggest that these germinomas arose from a gonadoblastoma.

Using an immunohistochemical study and an immunoblot analysis, the expression of cellular oncogenes of the human salivary glands such as c-myc, ras p21, and p53 tumor-suppressor gene in pleomorphic adenomas and its malignant form, carcinoma in pleomorphic adenomas was examined to evaluate a differential biological significance, in comparison with that in normal salivary gland tissues. Immunohistochemically, the c-myc product was detected in 42% of the pleomorphic adenomas and in 56% of the carcinomas in pleomorphic adenoma. The ras p21 expression was observed in 24% of pleomorphic adenomas, and in 50% of carcinomas in pleomorphic adenoma. The p53 protein was detected in 18% of the pleomorphic adenomas and in 67% of the carcinomas in pleomorphic adenoma. Although there was no significant difference between the benign and malignant forms for the expression of c-myc, a statistical significance in ras p21 and p53 expression was found between the pleomorphic adenoma and its malignant form (P < 0.05) and P < 0.001, respectively). An immunoblotting assay clearly demonstrated the expression of c-myc and p53 gene products in both the benign and malignant forms of the pleomorphic adenoma, and that of ras p21 in the malignant form. These results indicate that activation of c-myc and ras p21 proto-oncogenes and the involvement of p53 mutation may play important roles in the malignant transformation of salivary gland pleomorphic adenoma.

Three hundred and twenty autopsy cases of sarcoidosis during a 32 year period were collected from the Annuals of the Pathological Autopsy Cases in Japan, published yearly since 1958, and from a literature survey. A statistical analysis of these reviewed autopsy cases was carried out on the epidemiological features of the disease and on the causes of death. The proportion of sarcoidosis autopsy cases relative to the total autopsy cases had increased during this 32 year period. The increase of sarcoidosis autopsies during this period was chiefly due to the increase in aged females; the total number of female cases was approximately two times more than that of males. As over half of the total cases had only a pathological diagnosis and not a clinical diagnosis for sarcoidosis, the actual morbidity from sarcoidosis that was estimated from the autopsy data and corrected by autopsy rate was over five times higher than that of the clinically recognized cases. Age and sex distribution of these cases peaked in the thirties for both sexes, while another very high peak was noted in females over 50 years of age. In approximately 60% of the sarcoidosis autopsies, the cause of death related to sarcoid lesions in the heart, lung or nervous system, the majority of which involved cardiac sarcoidosis. In the remaining 40% of the cases, the cause of death was from non-sarcoidosis diseases.

An 82 year old man with a unilateral epididymal mass was found, on histopathologic examination of a surgically removed specimen, to have a primary papillary adenocarcinoma of a clear cell variant which mimicked renal cell carcinoma. Repeated imaging studies confirmed the absence of renal cell carcinoma. Because the present case had great similarities in histologic appearance and anatomical location to papillary cystadenoma of the epididymis, it may be a malignant counterpart of the latter type of tumor.

An immunohistochemical study of HBV-associated antigen in the liver of 16 Japanese infants with biliary atresia revealed positive findings in 13 of the cases for HBc and/or HBs antigens. The positive cells were mainly small liver cells distributed in the peripheral zone of the lobule, and a few lymphocytes were observed in contact with or around the positive liver cells for HBV-associated antigen. Again, HBc antigen was demonstrated almost exclusively in the cytoplasm of positive liver cells. As these findings suggest the possibility of destruction and drop-out of cells constituting the interlobular bile duct in the junctional area by an immunological mechanism, the probability of HBV infection being an important factor in causing and accelerating biliary atresia cannot be denied. Positive findings for HBV-associated antigen similar to those found in biliary atresia are also seen in neonatal hepatitis and choledochal cysts. These conditions are therefore presumed to belong to the same category.

From 1980 to 1990, 174 peripheral T cell lymphomas were studied morphologically and immunophenotypically with a panel of monoclonal antibodies which were reactive with T cell differentiation antigens in cryostat sections and/or cell suspensions. Histologically, 57% of the lymphomas were categorized into low-grade tumors according to the updated Kiel classification, while 41% were high-grade tumors. By immunologic studies, 50% of the lymphomas were of helper/inducer (CD4) phenotype, 6% were of cytotoxic/suppressor (CD8) phenotype, 3% expressed both CD4 and CD8, 3% lacked both CD4 and CD8, and 36% were phenotypically undetermined because of an admixture of a fairly even number of CD4 and CD8-positive cells. The phenotypically undetermined cases were more frequently noted in the low-grade groups than in the high-grade group, and the latter often showed a loss of pan-T antigens, although there was no definite correlation between the histologic category and the immunophenotype. CD25, which is strongly manifested in anti-HTLV-1 antibody-positive cases, was negative or only weakly expressed in anti-HTLV-1 antibody-negative cases. Anaplastic large cell lymphomas (LC-Ana) strongly expressed CD30, which was also detectable in only large blast-like cells in the low-grade tumors. Seventy-one per cent of the lymphomas expressed Ia antigens. In this series, the clinical data were available on 154 patients. For individual markers, the expression of CD30 and HLA-DR were associated with a longer actuarial survival (P < 0.01 and P < 0.05 by the generalized Wilcoxon test). The absence of CD25 or the presence of CD3 on tumor cells correlated with a relatively favorable prognosis, but not significantly. The detection of CD4 and CD8 had relatively little prognostic value. In the cases excluding LC-Ana, a significant difference was also recognized between the groups with and without CD25, CD30 and HLA-DR (P < 0.05 by the generalized Wilcoxon test). These results suggest that the immunophenotypic analysis of peripheral T cell lymphoma provided its use as an adjunct to a histopathologic diagnosis and was related to prognostic prediction.

Three hundred and twenty autopsy cases of sarcoidosis in Japan were analyzed to determine the pathological changes in the early stage, the mode of progression in each organ and the changes in the final stage of the disease. The lung and the mediastinal lymph nodes were affected in most of the cases, while the lesions were limited to the lung and intrathoracic nodes in some of the cases. It was suspected that early changes developed in the lung and in the hilar, and then in the mediastinal lymph nodes. The progression of sarcoid granulomas in the lung was classified into three patterns: (i) probably of a disseminated hematogenous nature; (ii) of an interstitial lymphogenous nature; and (iii) of a local expansive nature. These three patterns were observed also in the heart. In the brain, perivascular granuloma formation was a prominent feature. In the other organs in which sarcoid lesions were not malignant nor disseminated and conglomerated, no interstitial patterns were observed. In chronic cases, repeated dissemination and particularly the interstitial spread of granulomatous changes led to a prominent interstitial fibrosis and dysfunction of the organs, finally resulting in death of the individual. In such long-standing cases, the mediastinal nodes deteriorated by hyalinous degeneration of the granulomas, and many active granulomas were formed in the intra-abdominal or body surface lymph nodes. These lymph nodes were likely to continue supplying sensitized lymphocytes to the whole body. A persistence of active change in the lymph nodes and the lymphogenous spread of granulomas in organs would appear to be key factors in the prognosis of sarcoidosis.

The pathomorphologic features of hypertrophic cardiomyopathy simulating dilated cardiomyopathy in the late stage (HCM-DCM) were compared with those of ordinary hypertrophic cardiomyopathy (HCM). Seven autopsied hearts with HCM-DCM and 11 with HCM were assessed quantitatively using an image analyzer. Unlike HCM, significant left ventricular enlargement and wall thinning were observed in HCM-DCM, and the percentage areas of massive fibrosis and disarray were significantly greater. In HCM-DCM, the disarray was distributed diffusely, whereas massive fibrosis was distributed more intensively in the ventricular septum and anterior wall than in the lateral and posterior wall. Narrowing of intramyocardial small arteries was observed more frequently in HCM-DCM, especially in the ventricular septum and anterior wall, than in HCM. These results suggest that the enlargement and wall thinning of the left ventricle in HCM-DCM are attributable to non-uniform progression of massive fibrosis, which is closely related to small-arterial lesions.

Choriocarcinoma is the most malignant among germ cell tumors in the testis. However little is known about the early stage of its development. To understand the development of testicular choriocarcinomas, twenty cases of testicular choriocarcinoma were studied histologically and immunohistochemically. It was found that in the early stage of development, choriocarcinomas imitate the morphologic or functional differentiation of normal trophoblasts. It was also found that some choriocarcinomas regress spontaneously in the early stage. The majority of choriocarcinomas seemed to develop by first going through the embryonal carcinoma phase. However, there were some choriocarcinomas that showed no relationship with embryonal carcinoma.