[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.

[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.

[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.

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.

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.