[An autopsy case of extraneural metastases of giant cell glioblastoma with intracerebral hemorrhage].

We report a case in which a 71-year-old man with a giant cell glioblastoma who had a spontaneous intracerebral hematoma including subarachnoid hemorrhage and extraneural multiple metastases followed by the craniotomy 9 months later. He had complained of nausea and vomiting on 20, October, 1981 and admitted to the Ohara hospital. For that reason, he was admitted to our hospital on 29, October, 1981 and a CT scan showed a large subcortical high dence mass accompanied by adjacent edema in the right frontal lobe. Gradually he got worse with Korsakoff's syndrome and motor weakness of the left side. Total removal of the hematoma and adjacent tissue by transcortical route on 24, November, 1981 was performed, followed by 60Co radiation therapy to the local area, chemotherapy and immunotherapy. The surgical specimen showed typical features of giant cell glioblastoma with intratumoral hemorrhage. After 9 months of the operation, he had complained of the subcutaneous tumor in the supraclavicular region and swelling of the right arm. After the second admission on 30, August, 1982, a biopsy of the tumor revealed malignant tumor cells resembling intracerebral giant cell glioblastoma. He died on 29, November, 1982. At autopsy, extraneural metastases were revealed at some lymph nodes, organs and bones. However, a primary tumor was not found in the other organs. Lymph node: cervical, supraclavicular, mediastinal, bronchial, pancreaticoduodenal, hepatic hilus, mesenteric, retroperitoneal, and parastomach. Organ: esophagus, Ileum, jejunum, adrenal gland and kidney. Bone: vertebra (thoraco-lumbar), sternum, rib. Positive reaction to GFA protein antibody was demonstrated in the tumor cells in the periphery of the surgical specimen of the brain tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intracerebral metastasis of esophageal carcinoma--a case report and review of literature].

We encountered a case of brain metastasis from asymptomatic esophageal cancer. A 50-year-old man presented with right hemiparesis and bilateral choked discs. The brain CT scan demonstrated ring-like, enhanced tumor with perifocal edema in the left parietal lobe. The chest X-ray showed no abnormalities. The histology of the brain tumor that was totally removed after irradiation, showed a poorly differentiated squamous cancer. By the following study, an esophageal cancer of Borrman II type and 8 cm in length at the middle third segment detected. The histology of biopsy specimen showed findings similar to those of the brain tumor. He was not operated on, and received irradiation and chemotherapy. The esophageal carcinoma was reduced markedly, then he fully recovered in social life taking maintenance therapy for cancer. Seven cases of metastatic brain tumor from esophagus have been reported in literature. Esophagus carcinomas with brain metastasis were situated at the lower third in 6 cases with the exception of one without description, although esophageal carcinomas in general most frequently occur in the middle third. In any of the cases so far reported, no lung tumor was demonstrated by the chest X-ray, so the route of metastasis via vertebral vein system as proposed by Batson (1940) may explain the fact.

[Intracranial chordoma--report of two cases with cytochemical study].

Intracranial chordoma is very uncommon. We report two cases of intracranial chordoma with cytochemical studies. Case 1: A 66-year-old housewife was admitted on February 10, 1981, complaining of disturbance of visual acuity and bitemporal hemianopsia. A plain skull film showed normal finding with no calcification. CT showed a spherical ring contrast enhancement with intraluminal low density area in the suprasellar cistern. Pneumoencephalogram showed a suprasellar mass with filling defect of the anterior part of the third ventricle. On February 28, 1981, the tumor was intracapsually removed by transfrontal approach. The tumor had re-brown-turbid fluid. On March 16, she was discharged with no disturbance of visual acuity and visual field. But she again complained of visual disturbance and was hospitalized on October 26, 1981. Second operation was performed through trans-frontal route. The tumor with pus-like fluid was resected subtotally and postoperative radiation was given with 4,500 rads. Histologically the tumor had physaliferous cells cytomorphologically. Cytochemical study: cytoplasm and matrix were detected positively with PAS stain, Mucicarmine stain, Alcian blue stain, and Colloid-Iron stain. Mucinous glycogen was positive by PAS stain after diastase digestion test. These mucinous material was not stained with Sudan stain. Case 2: A 36-year-old man was admitted with paresthesia on right lower face on September 27, 1983. In the past history he complained of diplopia for several months in 1978 and 1982. A tomography of the skull showed a spherical soft mass in the sphenoid sinus and a calcified lesion from the posterior clinoid process to the floor of the third ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

The islets of Langerhans in uremic patients receiving chronic hemodialysis.

Ten autopsied cases of uremia (none with diabetes mellitus) who had been treated with hemodialysis were studied histopathologically. Hyaline replacement of islets of Langerhans was found in 6 out of 10 cases, while such a change was observed in only 1 of 15 control non hemodialzyed controls. These 6 cases had received hemodialysis therapy for a duration of more than 2 years and 10 months. The hyaline material in the islets of Langerhans was confirmed as the presence of amyloid by electron microscopy. Clinically, urinary glucose was present in 1 out of 3 patients and the blood glucose level was moderately elevated in 2 other cases. Therefore, it should be emphasized that care should be taken about glucose tolerance in uremic patients receiving chronic hemodialysis.

[Autopsy case of extra-neural metastasis of suprasellar pineal germinoma].

A 19-year-old boy was admitted with a suprasellar tumor. On May, 1980 he underwent craniotomy and subtotal tumor removal. The pathological diagnosis was germinoma. In July, 1981, a solitary angiomatous tumor appeared in the left back skin and was resected. The pathological diagnosis was choriocarcinoma, thus, a final diagnosis of suprasellar choriocarcinoma was made. At the first admission, his LH was 100 miu/ml; FSH, 2.4 miu/ml, while; at the second admission, LH was 500 miu/ml; FSH, 9.9 miu/ml, HCG, 13000 miu/ml. Irradiation combined with chemotherapy brought no improvement of his symptoms and he died. At autopsy, multiple metastatic foci were recognized in the lungs, liver, kidney, intestine, skin and brain.

A histopathological study of the liver in paraquat poisoning--an analysis of fourteen autopsy cases with emphasis on bile duct injury.

Fourteen autopsy cases of paraquat poisoning were studied. Seven of the eight patients who died within 4 days after the ingestion of paraquat showed hepatocytic injury, and three of them revealed bile duct injury. Hepatocytic injury was similar to that of carbon tetrachloride intoxication. Bile duct injury consisted of epithelial changes of the bile ductules and bile ducts. Cholestasis in the bile ducts was produced by the injury. The affected bile ductules and ducts had hydropic and necrotic epithelium, associated with the infiltration of neutrophils and histiocytes in the intraductal and periductal tissues. The severity of bile duct injury increased gradually from the bile ductules to the septal bile ducts. The extrahepatic biliary tract showed the same injury as the septal bile ducts in one case. It is considered that bile duct injury was produced by a direct corrosive effect of paraquat. Five of the six patients who survived more than 8 days revealed intrahepatic cholestasis, the pathogenesis of which was not clearly understood.