Sarcoid reaction in primary tumor of bronchogenic large cell carcinoma accompanied with massive necrosis.

A 49-year-old woman consulted our hospital for evaluation of a tumor with cavitation in the S6 segment of the right lung. She was given a diagnosis of pulmonary tuberculoma because percutaneous needle aspiration cytology revealed epithelioid cells with a background of necrosis. However, a diagnosis of large cell carcinoma with central necrosis (p-T2NOM0) was established by thoracoscopic lung biopsy six months later. Pathological findings of surgical resection specimens showed that epithelioid cell granulomas adjacent to the neoplasm had a sarcoid reaction and the necrosis was related to the rapidly growing tumor because there was no clinical evidence of systemic sarcoidosis and pulmonary mycobacterial or fungal infection. This is the first report in which sarcoid reactions were recognized in a primary large cell carcinoma.

Inflammatory pseudotumor of the spleen: report of a case.

A case of a 45-year-old Japanese man with a splenic inflammatory pseudotumor is described. This benign lesion is rarely reported in the world literature. We preoperatively could not rule out the possibility of a malignant neoplasm, due to the fact that the tumor had grown in size after a 2-year observation. However, after performing a splenectomy, a histological examination of the mass revealed an inflammatory process. Inflammatory pseudotumors often pose diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The clinical and pathological features of such previously reported cases are also reviewed.

Intraductal papillary tumors of the pancreas. Histopathologic correlation of MR cholangiopancreatography findings.

PURPOSE: To evaluate MR cholangiopancreatography (MRCP) findings of intraductal papillary tumors of the pancreas and correlate them with histopathology. MATERIAL AND METHODS: Seventeen patients with intraductal papillary tumor of the pancreas underwent MRCP before surgery. MRCP findings were correlated to histopathology with regard to the presence of septa and excrescent nodules in the cystic lesion, communication between the cystic lesion and the main pancreatic duct (MPD), degree of dilatation of MPD, and dilatation of the common bile duct (CBD). RESULTS: MRCP demonstrated septa in 17 cases (100%), excrescent nodules in 8 cases (47.1%), communication between the intraductal papillary tumor and the MPD in 14 cases (82.3%), dilatation of MPD over 50% in 6 cases (35.3%), and dilatation of CBD in 3 cases (17.6%). These findings showed excellent correlation with histopathology. The septum on MRCP corresponded with a layer of connective tissue with pancreatic duct epithelium. Excrescent nodules in the carcinomas consisted not only of malignant cells, but also of dysplasia and adenoma. Excrescent nodules in adenomas were consistent not only with minimal papillary growth of adenoma, but also with proliferation of fibrosis, and hematoma and organized fibrin with minimal fibrosis. Pancreatic tissue was affected by chronic pancreatitis in all cases. Cases with dilatation of CBD on MRCP were due to microscopic invasion by the carcinoma. CONCLUSION: MRCP appearances of intraductal papillary tumors are well correlated with the findings at histopathology.

[A long-term survivor of extensive-stage small cell lung cancer].

A 53-year-old man was admitted for evaluation of multiple hepatic tumors. A thoracic CT scan revealed a mass lesion in the right middle lobe. Transcutaneous needle aspiration cytology from the lung tumor and transcutaneous hepatic tumor biopsy were performed, from which the cytohistological diagnosis was small cell lung cancer with liver metastasis. The patient was treated with 3 courses of high dose cisplatin with vindesine and mitomycin and 5 courses of carboplatin with etoposide, and achieved a complete response. We herein report a long-term survivor of extensive-stage small cell lung cancer.

[Primary pulmonary cryptococcosis diagnosed by medical examinations in 12 patients].

Primary pulmonary cryptococcosis is thought to be relatively less common than other lung mycoses, but recently there has been an increase in reports of patients with this disease. Our report covers 12 cases of primary pulmonary cryptococcosis in which the diagnosis was based on medical examinations. The patients consisted of 11 men and 1 woman, aged 27 to 58 years. Only 3 exhibited subjective symptoms. Roentgenograms showed cavitating tumor shadows in the lungs of 2 of the patients with subjective symptoms, and nodular shadows with diameters of 1.0 to 2.8 cm in all patients without subjective symptoms, indicating the possibility of lung cancer. The disease was diagnosed in 3 patients on the basis of transbronchial biopsy findings, and in 9 on the basis of needle aspiration biopsy findings. One patient was diabetic, but the others did not exhibit malignancies or other immunocompromised states. Antifungal drugs significantly reduced or eliminated the nodular shadows in 10 patients. Because patients with primary pulmonary cryptococcosis frequently lack subjective symptoms, prompt diagnosis is critical, particularly in view of the need to distinguish the disease from lung cancer.

Correlation of 99mTc-GSA hepatic scintigraphy with liver biopsies in patients with chronic active hepatitis type C.

99mTc-DTPA-galactosyl human serum albumin (99mTc-GSA) liver scintigraphy was performed in 230 patients with chronic active hepatitis type C, and its quantitative indices were compared with histological findings. 99mTc-GSA findings correlated well with four indices of the histology activity index (HAI), especially with the fibrosis score. Ninety patients were given interferon treatments, and 99mTc-GSA findings were compared with the results of the treatments. We classified the effects of interferon treatment into three groups according to clinical outcome: group 1: good effect (HCV-RNA negative, n = 34), group 2: moderate effect (HCV-RNA positive, but the value of GPT was normal for six months after the end of treatment, n = 19) and group 3: no effect (n = 37). Quantitative indices of 99mTc-GSA showed significant differences between groups. Follow-up study with 99mTc-GSA scintigrams was obtained in eight patients. The results of 99mTc-GSA improved in three patients in group 1 and deteriorated in five patients in group 3. There is a possibility that 99mTc-GSA scintigraphy can be used to predict the clinical outcome of chronic active hepatitis type C after interferon treatment.

Small cell carcinoma of the stomach: a case report.

A case of a gastric small cell carcinoma discovered incidentally by screening ultrasonography is presented. Ultrasonography demonstrated a subcardial metastatic lymph node and multiple hepatic metastatic lesions. Upper GI series and gastroendoscopy revealed a large ulcerated tumor in the cardia of the stomach, and a Borrmann type II tumor, 4 x 2.5 cm, was found in the resected stomach. We describe the radiological findings of the upper GI series, ultrasonography, CT, and gastroendoscopy, and review the literature.

[Thoracoscopy with two bronchoscopes in 50 patients with pleural effusion of unknown origin].

When performing thoracoscopy in patients with pleural effusion of unknown origin, we used two bronchoscopes simultaneously, one for observation and one for biopsy. A total of 50 patients with pleural effusion of unknown origin were studied. In all of those studies, pleural effusion was exudative, lymphocyte-dominant, had a low level of adenosine deaminase, no malignant cells, and no tuberculosis or other bacteria in pleural effusion smears. Fourteen were out-patients. A catheter was inserted into the pleural space under local anesthesia, and 300 ml to 500 ml of pure oxygen was injected to create a pneumothorax. Two flexible fiberoptic bronchoscopes were used simultaneously, one for observation and one for biopsy. Approximately 1 hour after the examination, the out patients were able to return home. Lesions in the pleural cavity were found in 42 of these 50 patients, and histological diagnosis was possible in 46. This is a simple procedure with no major side effects. The equipment required is familiar to pulmonary physicians, and the diagnostic yield is high.

Immunohistochemical localization of group II phospholipase A2 in human pancreatic carcinomas.

The immunohistochemical localization of group II phospholipase A2 (PLA2) in normal fetal and adult human pancreases, 5 chronic pancreatitis, and 30 pancreatic ductal carcinomas was investigated. Furthermore, pancreatic carcinoma cases were correlated with histologic type, tumor size, vascular involvement, lymphatic involvement, perineural invasion, lymph node metastasis, amount of interstitial tissue in the tumor, growth pattern of the tumor, and clinical stage. In the normal pancreases, almost all of acinar cells and a few cells of small and large ducts were immunoreactive in a supranuclear pattern. In chronic pancreatitis, immunoreactivity was retained in several acini, islet cells, and ductal cells, but the staining was diminished in acinal cells of atrophic lobules. A strong immunoreactivity was found in the cells of hyperplastic ducts. In pancreatic ductal carcinomas, the immunoreactivity was observed in 25 cases (83%). Eighteen of 25 (72%) immunoreactive cases showed a cytoplasmic granular or luminal surface pattern, both of which were not observed in the normal pancreas. Among the clinicopathological parameters of pancreatic cancer, the incidence of expression of this enzyme was significantly higher in infiltrative type cancers than in expansive and localized tumors. Furthermore, the expression of group II PLA2 was significantly higher in the tumor with larger amount of interstitial tissue than in that with smaller amounts of interstitial tissue. These results suggest that expression of group II PLA2 in human pancreatic ductal carcinomas is possibly involved in the proliferation of interstitial tissue directly or indirectly through prostaglandin production.

[An autopsy case of pulmonary metastasis of cholangiocellular carcinoma associated with marked fibrotic change of the lungs].

An autopsy case of pulmonary metastasis of cholangiocellular carcinoma is presented. A 44-year-old woman was admitted to our hospital because of dyspnea, general fatigue and a sense of abdominal fullness on February 5, 1990. In November 1986, at an other hospital, she had been diagnosed as having diffuse metastatic lung tumor and multiple bone metastases, by transbronchial lung biopsy and other examinations. During the clinical course, she was not received chest irradiation and chemotherapy which induced fibrotic change of lungs. Chest X-ray film on December 21, 1986 showed diffuse nodular shadows in both lung fields. Chest X-ray film on February 4, 1990 showed diffuse reticular shadows with marked shrinkage of lung fields. She died two months after admission. The primary site of the carcinoma was not determined clinically, but was revealed by autopsy to be cholangiocellular carcinoma of the liver, with generalized metastasis. Microscopic findings of the autopsied lung showed markedly increased connective tissue around bronchi and blood vessels, in areas where microtubular adenocarcinoma was scattered. This is a very rare case of pulmonary metastasis of cholangiocellular carcinoma, associated with marked fibrotic change of the lungs during about 3.5 years. To our knowledge, this is the first reported case.

[Hepatic reticuloendothelial failure: report of a young heavy-drinker case].

A 27-year-old-male with hepatic reticuloendothelial failure was reported. He was proved by laparoscopy as having alcoholic liver cirrhosis. In spite of the absence of hepatic colloid uptake, hepatobiliary scan with Tc-99m HIDA and Ga-67 citrate produced satisfactory liver images.

Follicular thyroid carcinoma with clear cell change showing unusual ultrastructural features.

We report a case of follicular thyroid carcinoma with clear cell change displaying unusual ultrastructural features. Light microscopy revealed a metastatic neoplasm in the 12th thoracic vertebra that was composed of nests consisting mainly of clear cells. The tumor was interpreted as a metastasis of a clear cell type of thyroid carcinoma, based on positive immunohistochemical staining for thyroglobulin. However, unlike the metastatic bone lesions, the primary tumor in the thyroid consisted mainly of neoplastic follicular cells with lightly eosinophilic cytoplasm. A distinct follicular formation was noted throughout the tumor. In a portion of the tumor, a solid or stratified disposition of the cells was also observed. The primary tumor contained only a few clear cells similar to those seen in the metastatic bone lesions. In addition, we noted a transition between the follicular cells and the clear cells. Thus, this neoplasm was diagnosed as a follicular thyroid carcinoma with clear cell change, but not a specific type of thyroid neoplasm. Electron-microscopic examination revealed that the cells corresponding to clear cells under light microscopy had abundant cytoplasm characterized by varying degrees of dilation of rough endoplasmic reticulum (RER), which might reflect increased synthesis, storage of secretory products, or both.

An adhesive glycoprotein from rat ascites hepatoma cells potentiates natural cytotoxic activity by rat spleen cells.

In a previous paper, we have described a cell-surface associated adhesive glycoprotein (AF) that has been separated and highly purified from rat ascites hepatoma AH136B cells. AF was found to induce the aggregation and adhesiveness of hepatoma cells. AF was also shown to have a mitogenic activity on rat T lymphocytes, and to stimulate them to produce a lymphokine chemotactic for macrophages. In the present paper, we have examined the effects of AF on natural killing (NK) activity by rat spleen cells against NK-sensitive YAC-1 cells using 51Cr-release cytotoxicity assay. NK activity of spleen cells was potentiated by AF treatment in a dose-dependent manner. A short incubation with AF was sufficient for the potentiation of NK activity, whereas the potentiation by OK-432, which is well known as a potentiator of anti-tumour activity, required a longer stimulation. Macrophage depletion from spleen cells resulted in the decreased potentiating effects of OK-432, whereas the depletion failed to influence the effects of AF. IN subsequent experiments, it was found that AF could potentiate NK activity of the NK-cell enriched fraction. We further found that culture supernatants from spleen cells and peritoneal exudate cells treated with OK-432 potentiate the NK activity, whereas those from AF-treated cells fail. It was thus suggested that AF acts directly on the cells responsible for NK activity, and that the mechanisms of AF-induced potentiation of NK activity differ from those of OK-432-induced potentiation.

An immunoelectron microscopic study on the distribution of a cell surface-associated adhesive glycoprotein synthesized by rat ascites hepatoma cells.

As previously described, a cell surface-associated adhesive factor (AF) was separated from differentiated rat ascites hepatoma AH136B cells (forming cell islands in vivo) and highly purified by chromatography. AF synthesis by the cells was investigated by means of ultrastructural immunoperoxidase cytochemistry. Its synthesis and localization in vivo were observed in the perinuclear spaces, the rough endoplasmic reticulum, the Golgi apparatus, the smooth-membranous vesicles, and the contact region of basolateral cell surfaces of the cells in the islands, and also in the intercellular spaces. No AF synthesis was detectable in the nucleus, the free ribosomes, the mitochondria or the apical non-contacting cell surfaces. Similar features of AF synthesis and localization were also induced by dissociated AH136B cells in vitro. Upon adhesion of such recovered cells, AF was also localized at the contact surface of the adjacent cells, but not at the non-contacting free surface.