Impaired antigen-specific lymphocyte priming in mice after Toll-like receptor 4 activation via induction of monocytic myeloid-derived suppressor cells

In sepsis, the pathology involves a shift from a proinflammatory state toward an immunosuppressive phase. We previously showed that an agonistic anti-TLR4 antibody induced long-term endotoxin tolerance and suppressed antigen-specific secondary IgG production when primed prior to immunization with antigen. These findings led us to speculate that TLR4-induced innate tolerance due to primary infection causes an immunosuppressive pathology in sepsis. Therefore, the mechanism underlying impaired antigen-specific humoral immunity by the TLR4 antibody was investigated. We showed, in a mouse model, that primary antigen-specific IgG responses were impaired in TLR4 antibody-induced tolerized mice, which was the result of reduced numbers of antigen-specific GC B cells and plasma cells. Ovalbumin-specific CD4 and CD8 T-cell responses were impaired in TLR4 antibody-injected OT-I and -II transgenic mice ex vivo. Adoptive transfer studies demonstrated suppression of OVA-specific CD4 and CD8 T-cell responses by the TLR4 antibody in vivo. The TLR4 antibody induced Gr1⁺ CD11b⁺ myeloid-derived suppressor cell (MDSC) expansion with suppression of T-cell activation. Monocytic MDSCs were more suppressive and exhibited higher expression of PD-L1 and inducible nitric oxidase compared with granulocytic MDSCs. In conclusion, immune tolerance conferred by TLR4 activation induces the expansion of monocytic MDSCs, which impairs antigen-specific T-cell priming and IgG production.

[Decreased growth hormone secreting cells of the hypophysis in senile cachexia]

Basic morphometry of the pituitary gland in aged patients with cachexia was performed. In 10 control specimens, growth hormone(GH) cells accounted for 42.9 +/- 3.4% of the total, compared with 33.8 +/- 7.0%(p < or = 0.01) in patients with severe cachexia senilis. ACTH cells accounted for 16.0 +/- 7.4% in the control group and 14.1 +/- 9.0% in the senile cachexia group(p > or = 0.1). The mean pituitary weight was 0.60 g in control cases and 0.46 g in cases of extreme cachexia(p < or = 0.01). In the hypophyses of patients with senile cachexia, atrophy of GH cells and increase of the fibrous stroma were also prominent. The ratio of the summarized value for total GH cells in cachexia senilis patients and controls was 1:2.2. The difference was regarded as sufficiently large to be a causative factor in the establishment of cachexia senilis.

A case of malignant fibrous histiocytoma after breast conserving therapy for breast cancer

A 45-year-old woman with malignant fibrous histiocytoma (MFH) of the breast following breast conserving therapy (BCT) is described. She noticed a lump in her left breast 52 months after BCT for breast cancer. The lump was excised and nodular fasciitis was initially diagnosed. However, the tumor recurred locally 4 times in the next 18 months. MFH was finally diagnosed. This case is considered to be radiation-induced sarcoma. The risk of radiation-induced sarcoma after BCT seems to be very low, however careful follow-up is necessary.

Mucosal morphological changes in the ileal neobladder

OBJECTIVE

To determine the ultrastructural changes in the mucosa of intestinal segments used as a neobladder.

MATERIALS AND METHODS

Biopsy specimens from the ileal neobladders of eight men (mean age 62 years, range 52-68) who had undergone radical cystectomy were assessed by light and electron microscopy from 1 month to 5 years after operation. The morphology was compared with that in control specimens obtained from three patients of similar age during construction of an ileal neobladder after radical cystectomy.

RESULTS

Light microscopy showed shorter mucosal villi and fewer goblet cells. Marked oedema was found in all ileal neobladder walls. Electron microscopy revealed fewer and shorter microvilli and fewer filamentous core rootlets; cell borders were irregular, there were few senile cells in the tip of the villi and more desmosomes.

CONCLUSIONS

The absorptive and secretory function of the intestinal mucosa was probably decreased; the oedema of transferred ileal mucosa seemed to be associated with an inflammatory cell reaction. The cellular dynamics of the mucosa of the ileal neobladder changed with time, thus the ileal mucosa in the substitute bladder apparently adapted well to the new environment, i.e. urine retention, and neobladder expansion and contraction.

[Native aortic valve thrombus revealed by routine echocardiography: a case report]

A 75-year-old man presented with palpitations due to atrial flutter. Transthoracic echocardiography revealed a mobile aortic valve mass (17 mm in diameter) attached to the non-coronary cusp of the aortic valve. There was no evidence of hypercoagulative state. Computed tomography showed old cerebral infarction in the territory supplied by the right middle cerebral artery. The mass was surgically resected. The aortic valve was preserved because there were no organic changes in the valve. Histological examination demonstrated an organized thrombus. Only three cases of thrombus attached to the normal native aortic valve have been reported. Native aortic valve thrombus may be important in the differential diagnosis of aortic valve mass.

Ischemic cardiomyopathy without significant coronary stenosis. A case report

The authors present a rare case of myocardial infarction in a fifty-eight-year-old man without significant coronary artery stenosis apparent on the emergency coronary angiogram. However, a second angiogram two days later revealed a total occlusion of the left anterior descending artery. Intracoronary thrombolytic therapy was performed with a successful outcome. The patient was subsequently readmitted with an acute myocardial infarction, and the coronary angiogram again failed to demonstrate significant stenosis. Thereafter, the patient's left ventricular function deteriorated progressively, with the occurrence of another myocardial infarction and frequent bouts of symptoms related to congestive heart failure. He died of ischemic cardiomyopathy about seven years later. Findings including an autopsy report showed that myocardial ischemia was involved in the pathogenesis of what initially appeared to be primary dilated cardiomyopathy, based on emergency angiograms.

Pseudolymphoma of the kidney: a case report

We report a case of pseudolymphoma of the kidney. Examination of a surgically resected specimen showed that the lesion was localized in the renal parenchyma. It was impossible to achieve an accurate preoperative diagnosis clinically or radiologically because there were no characteristic findings. To the best of our knowledge no previous case of a pseudolymphoma localized in the renal parenchyma has been reported.

Late cardiac strangulation due to an iatrogenic pericardial defect

A 14-year-old boy developed broad posterolateral myocardial infarction. During cardiac surgery at age five, a small pericardial window had been made. Autopsy revealed an extensive left-sided pericardial defect and necrosis of the left ventricular free wall, which had herniated and strangulated through the enlarged pericardial defect.

Early stage of development in testicular choriocarcinomas

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.

[Flow cytometric analysis of the DNA content of sclerosing hemangioma of the lung]

DNA ploidy and DNA content of two surgically resected sclerosing hemangioma of the lungs were examined by flow cytometry. Cell kinetics were analyzed by using DNA index and the proliferation index. Both cases were diploid, and their proliferation indices were 22.91 and 25.53, respectively, suggesting that they are benign tumors.

New nonradioactive microspheres and more sensitive X-ray fluorescence to measure regional blood flow

We developed new nonradioactive microspheres and used more sensitive X-ray fluorescence spectrometers than used previously to measure regional blood flow in the heart and other organs. We demonstrated the chemical stability of eight kinds of heavy element-loaded microspheres and validated their use for regional blood flow measurement by comparing duplicate flows measured with radioactive and/or nonradioactive microspheres in both acute and chronic dog experiments. The wavelength-dispersive spectrometer (Philips PW 1480) has a higher sensitivity than the previously described X-ray fluorescent system and reduced the number of microspheres required for accurate measurement. The fine energy resolution of this system makes it possible to increase the numbers of different kinds of microspheres to be quantitated, but at present only eight kinds are available. We also used a synchrotron radiation-excited energy dispersive spectrometer. The monochromatic synchrotron radiation allowed us to obtain much higher signal-to-background ratios of X-ray fluorescence spectra than with the wavelength-dispersive system (50 dB more for Zr-loaded microspheres) and will enable analysis of fluorescent activity in smaller regions (< 20 mg) than the radioactive method does.

[Antitumor effect of combined use of purified human natural tumor necrosis factor (N-TNF) and cis-diamminedichoroplatinum (II) (cisplatin) on the implanted bladder carcinoma (MBT-2) in mice]

The antitumor effect of tumor necrosis factor (TNF) in combination with Cis-diammine-dichloroplatinum (II) (Cisplatin) upon implanted bladder carcinoma (MBT-2) in mice was analysed together with the toxicity. Mice were implanted into the bladder wall with about 10(4) cells MBT-2 viable cells. TNF was the purified human natural tumor necrosis factor. The antitumor effects were evaluated by the volume of the tumor thus implanted and the drug-toxicity by the body weight of mice and microscopic as well as macroscopic findings of the main organs. As a result, 1) The toxicity of TNF to mice was not enhanced in a dose-dependent fashion when combined with Cisplatin. 2) The antitumor effect by combination of TNF and Cisplatin was significantly increased compared to control group. 3) The effects of TNF was enhanced in a dose-dependent fashion when combined with Cisplatin. 4) The antitumor effects was confirmed by pathological findings. These results suggest that the combined use of n-TNF and Cisplatin is promising as a clinically effective treatment against bladder cancer in human.

Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study

Histopathologic examination was done on 18 cases after percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma. In eight cases, the lesion was treated by PEIT alone; in the other ten cases, PEIT was combined with transcatheter arterial embolization. The lesion was completely necrotic in 13 cases, 90% necrotic in four cases, and 70% necrotic in the rest. In addition, PEIT seemed to be effective against intercapsular, extracapsular, and vascular invasions. In the four cases of incomplete necrosis, the viable cancer tissue remained in small tumor nodules around the main tumor, in portions isolated by septa, or along the edge of the lesion. Therefore, ethanol should be injected not only into the center of the lesion, but also into sites close to its edge. Ethanol did not damage noncancerous liver parenchyma distant from injected sites. Local dissemination of the cancer cells was not found in any case. Therefore, PEIT seems to be a valuable therapy and may be an alternative to surgery in some cases.

Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study

Histopathologic examination was done on 18 cases after percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma. In eight cases, the lesion was treated by PEIT alone; in the other ten cases, PEIT was combined with transcatheter arterial embolization. The lesion was completely necrotic in 13 cases, 90% necrotic in four cases, and 70% necrotic in the rest. In addition, PEIT seemed to be effective against intercapsular, extracapsular, and vascular invasions. In the four cases of incomplete necrosis, the viable cancer tissue remained in small tumor nodules around the main tumor, in portions isolated by septa, or along the edge of the lesion. Therefore, ethanol should be injected not only into the center of the lesion, but also into sites close to its edge. Ethanol did not damage noncancerous liver parenchyma distant from injected sites. Local dissemination of the cancer cells was not found in any case. Therefore, PEIT seems to be a valuable therapy and may be an alternative to surgery in some cases.

Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study

Histopathologic examination was done on 18 cases after percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma. In eight cases, the lesion was treated by PEIT alone; in the other ten cases, PEIT was combined with transcatheter arterial embolization. The lesion was completely necrotic in 13 cases, 90% necrotic in four cases, and 70% necrotic in the rest. In addition, PEIT seemed to be effective against intercapsular, extracapsular, and vascular invasions. In the four cases of incomplete necrosis, the viable cancer tissue remained in small tumor nodules around the main tumor, in portions isolated by septa, or along the edge of the lesion. Therefore, ethanol should be injected not only into the center of the lesion, but also into sites close to its edge. Ethanol did not damage noncancerous liver parenchyma distant from injected sites. Local dissemination of the cancer cells was not found in any case. Therefore, PEIT seems to be a valuable therapy and may be an alternative to surgery in some cases.

[A model of orthotopic transplantation in mice using MBT-2]

We attempted to produce a malignant urinary bladder carcinoma in mice by transplanting MBT-2 cells. MBT-2 carcinoma about 3.0 x 10(3) cells/0.02 ml were successfully transplanted into the bladder wall with an incidence of 80% (20/25) after three experimental weeks. Inoculated tumor cells grew expansively into the bladder cavity from the bladder submucosa, and invaded the muscle layer. We observed that tumors caused gross hematuria and bilateral hydronephrosis. This malignant tumor model in which a tumor is implanted into its original organs seems to be useful for predicting clinical effectiveness in experimental cancer therapy.

Comparative study between the gastroepiploic and the internal thoracic artery as a coronary bypass graft. Size, flow, patency, histology

Ninety-two gastroepiploic artery (GEA) and 322 internal thoracic artery (ITA) grafts which underwent postoperative angiography (0.5-24 postoperative months, mean 2.0 months) were compared. The sites of GEA anastomosis were 5 left anterior descending, 3 diagonal, 16 circumflex and 68 right coronary arteries and for ITA grafts, 241 left anterior descending, 40 diagonal, 36 circumflex and 5 right coronary arteries. Patency rates were 96% (88/92) of GEA and 98% (314/322) of ITA, respectively. No focal stenosis in the graft trunk was found in both GEA and ITA except occasional spasm in GEA. Six (6%) GEAs were opacified via the superior mesenteric artery. Mean diameter of grafts just proximal to the anastomosis measured by angiogram was 2.3 mm in GEA and 1.9 mm in ITA (P less than 0.01). Free flow after intraluminal papaverine injection was 90.6 ml/min (50-300 ml/min) in 48 GEAs and 81.3 ml/min (50-150 ml/min) in 98 ITAs. Histology showed normal to mild intimal sclerotic changes in 58 of 63 (92%) GEAs and in 94 of 95 (99%) ITAs. From these results, we concluded that GEA is a suitable conduit and good long term patency similar to ITA grafting can be expected in coronary artery bypass grafting.

[Histological grading of alveolar type renal cell carcinoma based on architectural variation]

Ninety-two of a total 107 renal cell carcinomas excluding papillary, sarcomatoid and other uncommon histological types were classified into 3 groups based on architectural variations. Statistically analyses were carried out for prognostic significance. Histological criteria of 3 groups were defined as follows. Group I consists predominantly of tubular formations with characteristic cystic change. Group III shows solid proliferation without tubular formations, and Group II shows small alveolar or trabecular structures with inconspicuous tubular formations. According to the survival curves (Kaplan-Meier method), the prognosis of Group I was significantly better than II and III. Ten year survival rate of each group was 88 +/- 7.8% in Group I, 39 +/- 8.8% in Group II, and 0% in Group III. The distribution of T and V stages in the 3 groups were not significantly different. Nuclear grading of Group I and II was not so different, though high grade cases predominated in Group III. Therefore, the present grading of alveolar type renal cell carcinoma based on architectural atypia was considered to be a useful prognostic parameter.

Arteriosclerosis of the gastroepiploic and internal thoracic arteries

Arteriosclerosis of the right gastroepiploic artery (GEA) and the internal thoracic artery (ITA) were compared by pathological observation. Specimens were obtained from 35 patients who underwent coronary artery bypass grafting with simultaneous use of these two kinds of arterial grafts. Degree of arteriosclerosis was classified in five categories: 0, normal; 1, luminal narrowing less than 25%; 2, luminal narrowing between 25% and 50%; 3, luminal narrowing greater than 50%; and 4, overt atherosclerosis with ulceration or calcification. The number of arteries with degree 0, 1, 2, 3, and 4 was 16 (46%), 15 (43%), 3 (9%), 0, and 1 (3%) in GEA and 27 (77%), 8 (23%), 0, 0, and 0 in ITA, respectively. Incidence of degree 0 was higher in ITA, but differences were not significant. The mean wall thickness was 0.30 +/- 0.13 mm in GEA and 0.21 +/- 0.07 mm in ITA (p less than 0.05). In 23 patients who underwent postoperative angiography, all 46 arterial grafts were patent without focal stenosis. We conclude that GEA has slightly more intimal thickening than ITA, but significant luminal narrowing caused by arteriosclerosis is rare. Gastroepiploic artery can be expected to be a suitable conduit for coronary artery bypass grafting.

Primary fibrosarcoma of the liver. Immunohistochemical and electron microscopic studies

An autopsy case of primary fibrosarcoma occurring in the liver of a 75-year-old female is presented. The tumor, arising from the lateral upper portion of the right lobe, measured 14 cm in greatest dimension. Light microscopy of the tumor revealed homogeneous, spindle-shaped cells with abundant collagen fibers showing a classic herring-bone pattern. Immunoreactive vimentin was found in the tumor cells. Electron microscopically, the tumor cells were rich in rough endoplasmic reticulum without a basement membrane, and were surrounded by large amounts of collagen fibers. The fibroblastic character of the tumor cells was suggested by light and electron microscopy. This may be the first reported case of primary hepatic fibrosarcoma examined by immunohistochemistry and electron microscopy.

Clinical significance of cerebral aneurysm in renovascular hypertension due to fibromuscular dysplasia: two cases in siblings

Two cases, in siblings, of renovascular hypertension caused by fibromuscular dysplasia (FMD) of the renal artery associated with cerebral aneurysms are reported. Both of the cases were found to have cerebral aneurysm, as well as multiple stenotic or occluded lesions in arteries such as renal, mesenteric, celiac, and internal carotid arteries. One case died of subarachnoid hemorrhage and the other case was successfully operated on for the aneurysm. This report suggests that FMD should be considered to be a systemic angiopathy including the cerebral artery, as well as the renal artery. Thus, cerebral angiography is recommended to detect the association with cerebral aneurysm, at least, in cases with multiple lesions of FMD. Occurrence of FMD in siblings also indicates that a genetic factor might be involved in the pathogenesis of FMD.

A case report of "lipomatous hypertrophy of the cardiac interatrial septum", with a proposal for a new term "lipomatous hamartoma of the cardiac atrial septum"

An autopsy case of "lipomatous hypertrophy of the cardiac interatrial septum" (LHIS) combined with marked stenosis and calcification of the aortic and mitral valves due to fibrous valvular endocarditis, malignant lymphoma, and mucin-producing cancer of the pancreas is reported. LHIS and mucin-producing cancer of the pancreas were incidental findings at autopsy. Microscopically, the LHIS in this case consisted of proliferation of mature fat cells, brown fat cells and cardiac muscle cells. Since these three cell types are normal structural components of the interatrial septum, it was considered that the LHIS was a hamartomatous rather than hypertrophic lesion, of the cardiac atrial septum. Accordingly it was concluded that the term "lipomatous hamartoma of the cardiac atrial septum" was more appropriate for this lesion in the case presented here. As far as we know, this is the first reported case of LHIS in Japan.

Establishment of a human megakaryoblastic cell line (T-33) from chronic myelogenous leukemia in megakaryoblastic crisis

A megakaryoblastic cell line, termed T-33, was established from the peripheral blood of a patient with Philadelphia chromosome-positive chronic myelogenous leukemia in megakaryoblastic crisis. T-33 cells have been maintained in RPMI 1640 medium containing 10% fetal calf serum in a single cell suspension with a doubling time of 24-36 h for over 2 years. Giemsa-banded karyotypes were female hyperdiploid with a modal chromosomal number of 51, all cells including Philadelphia chromosome. The cells showed strong positivity for periodic acid-Schiff and alpha-naphthyl acetate esterase, and weak for alpha-naphthyl butyrate esterase, but were negative for myeloperoxidase. Flow cytometric analysis of cell surface markers showed the existence of HLA-DR, MY-7, MY-9, and a platelet antigen (Yukb), and no markers for T- or B-lymphocytes. Most of the cells fixed with acetone were positive for Factor VIII, platelet glycoprotein IIb-IIIa, IIIa (Yukb), and Ib, but negative for glycophorin A and hemoglobin. Ultrastructural platelet peroxidase was demonstrated in 2-3% of cells and the percentage of positive cells increased up to 20% after the treatment with 12-O-tetradecanoylphorbol-13-acetate. The cells contained small dense granules negative for platelet peroxidase, their number increasing threefold after 12-O-tetradecanoylphorbol-13-acetate treatment. Such treated cells frequently showed a complex of the demarcation membrane in the cytoplasm. T-33 responded thrombin to exhibit calcium influx. This cell line may be useful for the study of the early stage of megakaryocytic differentiation in human megakaryopoiesis.

Hepatic epithelioid hemangioendothelioma in a young female

Epithelioid hemangioendothelioma in a young female is reported. Her symptoms were right upper quadrant pain and low-grade fever. Laboratory examinations showed an increased number of white blood cells and an elevated erythrocyte sedimentation rate. Plasma factor VIII:C was increased. The hepatic lesions were demonstrated as low-density areas by CT scan, and multiple nodules with central depression on the surface of the liver were identified by peritoneoscopy. The biopsy specimens showed spindle-shaped tumor cells set in the fibrous and myxohyalinous tissue. The tumor cells were positive for factor VIII-related antigen and Weibel-Palade bodies. The patient received transcatheter arterial embolization therapy using Gelfoam and mitomycin C following which the plasma level of factor VIII was normalized and regression of the tumors was observed.

Percutaneous ethanol injection in the treatment of liver neoplasms

The effectiveness of percutaneous ethanol injection therapy was investigated in 30 patients who had hepatocellular carcinoma (18 had a single lesion and 12 had multiple lesions). In patients who had a single lesion, ethanol injection was especially effective. Histopathologic examination, performed in nine cases in this group, showed that the tumor was completely necrotic in six cases, 90% necrotic in two cases, and 70% necrotic in the remaining case. In eight other cases with a single tumor, follow-up angiography showed complete disappearance of the tumor stain. In the other case, CT showed the nonenhanced low-density area. In the 12 patients with multiple lesions, ethanol injection was performed as part of an integrated treatment plan. Eleven were still alive at the end of the study (the mean follow-up period was 5.8 months). We conclude that ethanol injection may be a valuable treatment for hepatocellular carcinoma.

[Pseudoaneurysm of the left ventricle serially demonstrated from on-set using two-dimensional echocardiography: a case report]

A case of so-called pseudoaneurysm of the left ventricle without pericardial adhesion, serially demonstrated by two-dimensional echocardiography, was reported. A 76-year-old man developed congestive heart failure 10 hours after gastrectomy, and was diagnosed as having acute myocardial infarction. Two-dimensional echocardiography on the 21st day after onset revealed moderate pericardial effusion and an echo-free space in the posterolateral myocardium of the left ventricle. The echo-free space gradually expanded exteriorly and formed an aneurysm, which remained unchanged after the resolution of the pericardial effusion. Clinical diagnosis of pseudoaneurysm of the left ventricle was made by left ventriculography and coronary angiography. At autopsy, there was an aneurysm measuring 2.3 X 3.0 X 5.0 cm which communicated with the left ventricle via two small ostia, 5 mm each in diameter. There was a loose fibrous adhesion between the pericardium and the epicardium. The wall of the aneurysm consisted of organized fibrous tissue without any elements of the myocardium. Both myocardium and fibrous tissue were located at the junction of the left ventricular wall and the aneurysm. It is surmised that dissection of the infarcted myocardium expanded so greatly as to form an aneurysmal cavity, resulting in the formation of a so-called pseudoaneurysm of the left ventricle after fibrous changes of the outer wall in the infarcted myocardium. Therefore, this aneurysm might be termed a "dissecting" aneurysm of the left ventricle. The hypothesis that a pseudoaneurysm is derived from a localized hemopericardium should be reconsidered.

[Echocardiographic manifestations of nonrheumatic aortic regurgitation]

Recently, the frequency of nonrheumatic aortic regurgitation (AR) has apparently increased, accompanied by a decrease in frequency of rheumatic fever. The purpose of the present study was to ascertain the echocardiographic features of nonrheumatic AR. We had 24 surgically- or autopsy-proven cases of nonrheumatic AR admitted during a two year period. These were 10 cases of infective endocarditis (IE), five with ventricular septal defect of type I, three with syphilis, and two with prosthetic valve malfunctions, and the remainder five were difficult to diagnose clinically. These five were three men and two women, whose ages ranged from 40 to 67 years and averaged 50 years, and their final diagnoses were annulo-aortic ectasia (AAE), Behcet's disease, and the aortitis syndrome (Takayasu's arteritis), and two other cases were of unknown etiology. The echocardiographic manifestations were compared with the operative, autopsy, and pathological findings. Echocardiographically, there were few or no increased intensities of aortic valvular echoes, and aortic roots had a tendency to dilate, leading to the failure of coaptation of valve leaflets, for a relative lack of valvular surface area to cross-sectional area of the aortic ring. Three of the five had flail aortic valves and three had associated MVP. Three were diagnosed as floppy aortic valves at the time of surgery. Excised valves revealed little hyperplasia or sclerosis grossly. Fibrinoid necrosis or mucoid degeneration were noted by light microscopy. Some specimens of aortic walls also revealed cystic medial necrosis or disruption of elastic fibers. All these findings were based on degenerative processes of connective tissue, and not on inflammatory processes. These pathological findings and the coexistence of mitral valve prolapse (MVP), which were not regarded as coincidental, suggest that connective tissue fragility--congenital or acquired--may play an important role in the genesis of nonrheumatic AR.

Diffuse hepatic calcification as a sequela to shock liver

A 31-yr-old Japanese woman who was on chronic hemodialysis for 3 yr died of intractable congestive heart failure. Three years before death, the patient was in a state of shock for 48 h due to ventricular tachycardia and gastrointestinal bleeding, which was followed by marked elevation of serum transaminase. Four months later, abdominal plain radiography demonstrated diffuse hepatic calcification. At autopsy, microscopic examination of the liver revealed parenchymal necrosis and tiny calcifications in the central to midzonal area of the lobule. Calcification in the degenerative area of the hepatic lobule occurred subsequent to parenchymal ischemia after overt shock that lasted for 2 days. Although a definitive explanation for the calcification was not obtained, it may be related to the disturbances of intracellular Ca2+ homeostasis as a result of ischemic liver injury or it may be related to an elevated calcium-phosphorus product in the uremic state.

[Solid and cystic tumor of the pancreas--report of a case in a 13-year-old girl]

A case of adenocarcinoma of the body of the pancreas in a 13-year-old girl is reported. The gross appearance of the tumor revealed apparent encapsulation, cystic degeneration and hemorrhagic necrosis. Microscopically, the tumor resembled an islet cell tumor, but immunohistochemically there was no evidence of endocrinic activities. Ultrastructurally, tumor cells contain numerous mitochondria but no secretory or zymogen granules. This peculiar type of tumor usually arises in young women and shows a favorable prognosis. Diagnosis should be established immunohistochemically and ultrastructurally.

Parathyroid carcinoma of the oxyphil cell type. A report of two cases, light and electron microscopic study

Parathyroid adenomas are subdivided into chief cell and oxyphil cell variants. However, the parathyroid carcinomas described thus far have been only of the chief cell type. Two cases of oxyphil cell carcinoma of the parathyroid gland are reported, with light and electron microscopic study. The patients presented apparent clinical hyperparathyroidism with x-ray finding of generalized fibrous osteitis and palpable parathyroid tumors. Initially, a pathologic diagnosis of parathyroid adenoma was made in both of them. However, in due course, pulmonary metastases developed in one patient and a local recurrence occurred in the other, 5 and 8 years after the primary operation, respectively. Review of the microscopic slides showed that both primary tumors met the criteria of parathyroid carcinoma. A matter of interest in both cases is that the neoplasms were composed principally of oxyphil cells. Electron microscopic study confirmed the existence of typical oxyphil cells packed with numerous mitochondria.

Cellular characteristics of neoplastic angioendotheliosis. An immunohistological marker study of 6 cases

Neoplastic angioendotheliosis (NAE) is a rare, mostly fatal disease characterized by proliferation of large blastoid cells in small vessels of various organs. The origin of neoplastic cells remain undetermined. In this study, cell markers were studied immunohistologically on paraffin sections of six cases of NAE, by applying avidin-biotin-peroxidase (ABC) method and five antibodies which can demonstrate marker antigens on formalin fixed and paraffin embedded specimens. It was shown that the neoplastic cells were heavily stained with an anti-B lymphocyte monoclonal antibody LN-1 (6/6), moderately stained with another anti-B lymphocyte antibody LN-2 (5/6) and heavily stained with a monoclonal antibody which reacts with all levels of leukocytes (Dako-LC) (6/6). The cells did not show positive reaction with an anti-myelomonocytic antibody anti-Leu M1. The reaction against anti-Factor VIII, which can depict endothelial cells, was mostly negative, and if positive, was faint and indefinite, leading to an assumption that the reaction was against antigens in serum and not against neoplastic cells. These results suggest that the neoplastic cells of NAE are in the B lymphocyte lineage.

Increased acidophils of the hypophysis in liver cirrhosis

The percentage of cell number of 3 types of male anterior pituitary cells was counted in autopsy cases with liver cirrhosis and cases that died of other conditions. These cases were then compared. In liver cirrhosis, acidophils (somatotrophs and mammotrophs) showed a tendency to increase in cell percentages. Immunocytochemistry also revealed the increase in the number of somatotrophs and mammotrophs in liver cirrhosis. Comparison of protein synthesis in cirrhotic liver and in healthy liver, in vitro, revealed that in the cirrhotic liver tissue protein synthesis was markedly depressed and GH for protein synthesis became more necessary than in a non-cirrhotic state. The disturbed protein synthesis and hypoproteinemia were suggested as causative factors of increased acidophils of the anterior lobe of the hypophysis.