NEUROFIBROMA OF THE GALLBLADDER SEEN AS A PAPILLARY POLYP

A case of neurofibroma of the gallbladder in a 44-year-old woman without von Recklinghausen neurofibromatosis but with right hypochondralgia is reported. The tumor was seen preoperatively as a polypoid lesion and in the resected gallbladder as a papillary polypoid growth over the main intramural tumor mass. Microscopically, the tumor was identified as a neurofibroma with many tactile corpuscle-like structures (Wagner-Meissner bodies), which were found by electron microscopic and immunohistochemical examination to consist of Schwann cells. Twelve cases of non-epithelial neoplasms arising in the gallbladder are also reviewed. ACTA PATHOL JPN 38: 259–268, 1988.     

HETEROTRANSPLANTATION OF AN ALPHA-FETOPROTEIN-PRODUCING HUMAN GALLBLADDER CARCINOMA INTO NUDE MICE

An alpha-fetoprotein (AFP)-producing human gallbladder carcinoma showing direct invasion into the liver was transplanted into BALB/c-nu/nu nude mice. Although patient serum levels of AFP and carcinoembryonic antigen (CEA) were within normal limits, they were elevated to 1,040 ng/ml and 22.1 ng/ml, respectively, after cholecystectomy. Prominent liver metastasis was demonstrated by diagnostic imaging techniques shortly after the operation. Pathologically, the resected tumor consisted of papillotubular adenocarcinoma and the part which had Invaded the liver showed a solid growth pattern with no papillo-tubular structure. The transplanted tumor showed both papillo-tubular and solid growth patterns, in which positive reactions for AFP, CEA, ferritin (FER), carbohydrate antigen 19-9 (CA 19-9), albumin (ALB) and fibrinogen (FIB) were confirmed by the avidin-biotin-peroxidase complex method. Serum levels of AFP, CEA, CA 19-9, β₂-microglobulin (BMG) and FER were elevated in the nude mice bearing tumor transplants. Twenty-five percent of the serum AFP from nude mice with tumor transplants bound with concanavalin A (Con A), suggesting that the tumor was of gastrointestinal rather than hepatic origin.     

IgG-KAPPA-PRODUCING PRIMARY PLASMACYTOMA OF THE THYROID GLAND WITH PREOPERATIVE SERUM M PROTEIN

A case of primary plasmacytoma of the thyroid gland which occurred in a 63-year-old woman is reported. Histologic and ultramicroscopic examination revealed that the excised thyroid tumor was plasmacytoma superimposed on lymphocytic thyroiditis. Immunohistological study showed that the tumor cells produced intracytoplasmic immunoglobulin (IgG-kappa). Electropho-retic and immunoelectrophoretic studies disclosed the presence of monoclonal immunoglobulin (IgG-kappa) in samples of the patient's serum which had been obtained preoperatively. After completion of irradiation therapy to the neck following tumor removal, the serum monoclonal immunoglobulin disappeared. The patient is currently alive and well without any evidence of the tumor three years after surgery.     

DIFFUSE PAPILLOMATOSIS OF THE GALLBLADDER COMPLICATED WITH TUBERCULOSIS

A rare case of diffuse papillomatosis of the gallbladder complicated with tuberculosis is reported. The mucosa of the gallbladder displayed a diffuse papillary pattern composed of excrescences that varied in size and height. The proliferative glands contained many Paneth cells, and the diffuse papillomatosis appeared to be derived from metaplastic-type epithelium. Tuberculous granulomas were observed in the serous layer of the gallbladder. The relationship between diffuse papillomatosis and tuberculosis of the gallbladder is discussed. ACTA PATHOL JPN 38: 1473–1480, 1988.     

HISTOLOGICAL CLASSIFICATION OF EPITHELIAL POLYPOID LESIONS OF THE GALLBLADDER

Thirty epithelial polypoid lesions in 24 surgically resected gallbladders were examined histologically and immunohistochemically and then classified into two types according to the characterstics of the epithelium. One type consisted of proliferation of ordinary gallbladder epithelium without any metaplastic change while the other type was characterized by proliferation of metaplastic epithelium, such as mucous glands, endocrine cells and lysozyme-immuno-reactive cells. Moreover, each lesion was subdivided into non-neoplastic epithelial polyp or neoplastic adenoma. We therefore classified the non-neoplastic epithelial polyps into hyperplastic polyps and metaplastic polyps, and the adenomas into ordinary type and metaplastic type. Moreover, we found that atypical glands within metaplastic-type adenoma were not infrequently observed, and that these lesions also presented metaplastic changes. From these results, the possibility of an adenoma-carcinoma sequence was discussed. ACTA PATHOL JPN 38: 181–192, 1988.     

ENDOGENOUS PEROXIDASE ACTIVITY IN PRIMARY CULTURE OF HUMAN THYROID CELLS Localization and Measurement

Intracellular localization of and an assay method for endogenous peroxidase (PO) activity were studied using primary culture of thyroid cells obtained from patients with hyperthyroidism. PO activity was visualized by cytochemical reaction and was located mainly in perinuclear cisternae and rough endoplasmic reticulum. With increased culture time, the number of cells showing positive PO activity and amount of the enzyme reaction product in individual cells showed a parallel decrease. For measurement of PO activity, cultured thyroid cells were frozen and thawed and then incubated with citric acid buffer solution containing o-phenylenediamine (opd) and hydrogen peroxide. After incubation, the optical density (OD) of the solution colorized by endogenous peroxidase was measured at 405 nm using a microplate reader. About 1 × 10⁴ cells were sufficient for assay of PO activity. Using the above method to assay PO activity and sandwich enzyme immunoassay for thyroglobulin (TG), chronological changes in the PO activity and TG concentration in the culture medium were examined. Although the cells showed no decrease in number, PO activity and TG concentration decreased chronologically. When the ratio of PO activity to TG concentration was calculated, in 3 cases the ratio was almost constant, and in the remaining two, it decreased chronologically. The present biochemical method thus seems useful for determining peroxidase activity of cultured thyroid en masse.     

ADENOMYOEPITHELIOMA OF THE BREAST

We treated a 62-year-old woman with adenomyoepithelioma of the breast, an extremely rare tumor, which showed a bicellular pattern of ductal and myoepithelial elements bearing some histologic resemblance to pleomorphic adenoma of the salivary gland. The tumor was made up of cells positive for actin and S-100 protein, and some positive for epithelial membrane antigen (EMA). Thus, this tumor showed biphasic differentiation towards myoepithelial cells and to duct epithelial cells. Compared with findings in related tumors reported in the literature, the myoepithelial cells in the present tumor were less frequently spindle-shaped and had abundant eosinophilic or clear cytoplasm. A simple mastectomy was done and at the time of writing 20 months later there has been no recurrence. Adjuvant chemotherapy was not prescribed.     

胆囊传入神经的节段性分布——CT-HRP法研究

将CT—HRP注入胆囊壁游离面,取脊神经节、迷走神经结状节作TMB法反应。结果是(1)胸2—13和腰1节段的脊神经节内有大量的标记细胞,右侧者数量占优势,左右胸7—10节标记细胞数量为高峰节段。(2)仅在右颈5—7脊神经节中发现不同数量的标记细胞,出现率约占实验动物的1/3,切断右侧膈神经后在颈部脊髓神经节中不出现标记细胞。(3)双侧迷走神经结状节中均发现标记细胞,左右侧在数量上无明显差异。脊神经节或结状节的标记细胞均以中小型为主,也有少最大型细胞。     

MALACOPLAKIA OF THE ENDOMETRIUM An Unusual Case Studied by Electron Microscopy and a Review of the Literature

A rare case of malacoplakia (MKP) of the endometrium in an 88-year-old Japanese woman is presented. By light microscopy, typical Michaelis-Gutmann bodies (M-G bodies) could be identified. Electron microscopic findings revealed M-G bodies in various stages of development. These features suggested that M-G bodies were derived from round electron-dense granules that coalesced to form phagolysosomes. Early-stage M-G bodies were manifested as small, irregular, needle-shaped areas of calcification in phagolysosomes. The present paper reviews 6 cases of endometrial MKP, 5 of which have previously been reported in the literature, and this case being the sixth, to our knowledge.     

P53在胆囊癌临床预后中的预测意义

目的 探讨P53在胆囊癌患者中表达情况与胆囊癌患者术后临床治疗之间关系。方法 采用免疫组化法检测我院自2010年~2016年47例胆囊癌患者的P53阳性表达情况,并且采用统计学方法比较其临床意义。结果 P53阳性表达与性别、年龄无关（P＞0.05）,与肿瘤大小、手术方式、TMN分期存在密切关系（P＜0.05）;并且P53表达阳性与肿瘤大小、手术方式、TMN分期呈正相关（P＜0.05）,差异有统计学意义。结论 P53可作为胆囊癌患者术后病情预测评估指标之一,对其后续治疗做出指导。     

CHORIOCARCINOMA OF THE ESOPHAGUS PRODUCING CHORIONIC GONADOTROPIN

An autopsy case of primary esophageal choriocarcinoma in a 42-year-old Japanese male Is reported. The tumor was pure choriocarcinoma typical hemorrhagic and necrotic nature occupying almost the entire circumference of the mid-esophagus. The choriocarcinoma had metastasized to the liver, lung and lymph nodes. In the esophageal tumor, immunohistochemical staining showed the presence of mainly human chorionic gonadotropin (HCG), with human placental lactogen (HPL) in a few syncytiotrophoblastic cells. Only 3 cases of extragonadal choriocarcinoma originating in the esophagus have been reported up to now. The possible pathogenesis and pathological characteristics of primary esophageal choriocarcinoma are discussed.     

CONDYLOMA ACUMINATUM OF THE BLADDER IN TWO AUTOPSY CASES

Condyloma acuminatum is a very rare lesion occurring in the bladder. We report two cases of condyloma acuminatum of the bladder found at autopsy, one in a 96-year-old woman and the other in an 80-year-old man. Both had papillary or polypoid tumorous lesions in the trigone and neck of the bladder. The lesions were composed of nodular or papillary growths of squamous epithelium. The epithelium exhibited koilocytosis and the nuclei showed immunohistochemical staining for human papillomavirus antigen.     

BENIGN CLEAR CELL TUMOR OF THE LUNG A Histopathologic Study

Benign clear cell tumor of the lung is extremely rare, and its histogenesis is still in dispute. We experienced a case of this neoplasm in the lung of a 28-year-old man, and carried out a study using both light and electron microscopy and immunohistochemistry. Histologically, the tumor was composed of sheets of large round or polygonal cells with abundant clear cytoplasm surrounded by thin-walled blood vessels. Electron microscopy showed granules (180 nm in diameter) in the cytoplasm. Immunohistochemically, S-100 protein-positive tumor cells were seen, but other neural markers and the markers for epithelial, muscular, vascular, histiocytic and endocrine cell origins were negative. The histogenesis of this pulmonary neoplasm could not be definitively determined, but its neural cell origin remains a possibility.     

SO-CALLED SCLEROSING HEMANGIOMA OF THE LUNG

Sclerosing hemangioma of the lung (SHL) was investigated immunohistochemlcally, histochemically and ultrastructurally with reference to cellular components associated with the histologic pattern: cuboidal cells in the papillary type, round cells in the solid type, flat cells in the hemorrhagic type and stromal cells in the sclerotic type. immunohistochemically, cuboidal cells were positive for CEA, cytokeratin and EMA, whereas other cells were positive for EMA and vimentin. immunoreactive factor-VIII-related antigen was confined to endothelial cells. Histochemically, cuboidal cells displayed alkaline phosphatase activity, but round cells showed ATPase activity. However, in spite of these different histochemical and immunohistochemical properties, morphological continuity was clearly revealed in immunostained sections; direct connection of spaces lined by cuboidal and fiat cells, direct contact between cuboidal and stromal cells, and EMA expression of round cells associated with luminal structures were evident Ultrastructurally, cuboidal cells were like alveolar cells. Flat and stromal cells showed microvillous protrusions and a discontinuous basement membrane, but some cells contained lamellar bodies. Solid cellular sheets consisted of various cells intermediate between cuboidal and flat or stromal cells. Direct apposition among these cells was evident This morphological continuum confirms that each of these cell types are components of SHL as a whole. SHL may thus be merely sclerotic hemorrhagic alveolar cell tumor.     

SQUAMOUS CELL CARCINOMA OF THE GALLBLADDER ASSOCIATED WITH SQUAMOUS METAPLASIA AND ADENOCARCINOMA IN SITU OF THE MUCOSAL COLUMNAR EPITHELIUM

A case of well-differentiated squamous cell carcinoma of the gallbladder is presented. Unlike most previously reported cases, the tumor developed in association with squamous metaplasia as well as dysplastic and in situ adenocarcinomatous changes of the gallbladder epithelium. The significance of these lesions is discussed in relation to the histogenesis of squamous cell carcinoma or adenosquamous carcinoma of this organ.     

AN AUTOPSY CASE OF DIFFUSE MYELOMATOSIS ASSOCIATED WITH SYSTEMIC KAPPA LIGHT CHAIN DEPOSITION DISEASE (LCDD) A Patho-anatomical, Immunohistochemical and Immunobiochemical Study

A case of systemic light chain deposition disease in a 48-year-old man is presented. Clinically, the patient showed the signs of multiple organ (liver, heart and kidney) failure, but multiple myeloma was not diagnosed. Autopsy revealed generalized deposition of hyaline, a Congo red-negative substance, especially in the arterial walls of various organs. In the bone marrow, myelomatous proliferations of plasma cells positive for kappa light chain were recognized. The deposited substance was ultrastructurally different from amyloid fibrils, and was identified as kappa light chain by immunohistochemistry. A liver tissue extract was immunobiochemically examined and the deposited substance was confirmed to consist of kappa light chain, its molecular weight being approximately 14,000 to 17,000 Da.     

AN AUTOPSY CASE OF IDIOPATHIC ENLARGEMENT OF THE RIGHT ATRIUM, AND A REVIEW OF THE LITERATURE

A 69-year-old man in whom idiopathic enlargement of the right atrium was revealed at autopsy is described. The patient had had cardiomegaly of at least 19 years'duration prior to his death, even though cardiac symptoms were absent. Cause of death was pancreatic carcinoma. Postmortem examination revealed marked and diffuse dilatation of the right atrium and moderate dilatation of the left atrium. Measurement of the cardiac chambers showed that the right and left atria were 7.6 and 4.7 times as large as those of normal hearts, respectively. The volume of either ventricle was about twice the normal value. Histologically, widespread cardiac muscular degeneration and necrosis, diffuse fibrosis, and focal lymphocytic infiltration were found in the right atrium and also, to a lesser degree, in the left atrium. Such pathologic changes were not found in either of the ventricles. The etiology of these muscular changes, which might have been related to atrial enlargement, was unclear. The present case was thought to be consistent with idiopathic enlargement of the right atrium, and a brief review of the literature is given.     

原发性痛经发病机制及口服药物治疗进展

原发性痛经是妇科常见病之一,如何有效防治原发性痛经是医学界关注的热点问题,中西医对其都有较深入研究。现结合近几年相关文献报道,从中西医两个方面对原发性痛经发病机制及口服药物治疗进展进行综述,为临床治疗原发性痛经提供参考。     

胆维他片对肝纤维化大鼠肝中抗氧化体系的影响

目的 探讨胆维他片对肝纤维化大鼠肝中抗氧化体系的影响。方法 选取30只大鼠按照随机数字表法分为肝纤维化模型组、胆维他片组和正常对照组,每组10只。除正常对照组外,其余各组均要求制备大鼠肝纤维化模型。正常对照组和肝纤维化模型组不给药,胆维他片组于造模开始给予灌胃给药,其余组给予蒸馏水灌胃,于第12周测定肝中丙二醛（MDA）、抗氧化体系的过氧化氢酶（CAT）、超氧化物歧化酶（SOD）、谷胱甘肽（GSH）,同时采用Masson's染色肝组织胶原行纤维半定量评估纤维化的程度。结果 纤维化模型组和胆维他片组CAT、SOD、GSH低于正常对照组,MDA高于正常对照组,差异有统计学意义（P＜0.05）;胆维他片组CAT、SOD、GSH均高于纤维化模型组,MDA低于纤维化模型组,差异有统计学意义（P＜0.05）。纤维化模型组和胆维他片组肝纤维化分期高于正常对照组,差异有统计学意义（P＜0.05）;胆维他片组肝纤维化分期低于纤维化模型组,差异有统计学意义（P＜0.05）。结论 胆维他片能有效降低肝纤维化肝内的脂质过氧化,促进肝内氧化及抗氧化体系的恢复,具有减轻肝纤维化的作用。