A histochemical and ultrastructural study of adenocarcinoma of the lung.

Twenty-five cases of solitary nodular adenocarcinoma of the human lung were studied histochemically and ultrastructurally and their morphological characteristics were compared to the cells observed in the control lungs. Adenocarcinoma cells of the human lung may be classified into following four types: Type A--cells resembling the bronchial goblet cell; Type B--cells resembling the mucous cell of the bronchial gland; Type C--cells resembling the type II alveolar lining cell; and Type D--cells resembling the nonciliated bronchiolar cell. Twenty-one cases belonging to Type D (84%) and two cases to Type B (8%), and one case each to Types A (4%) and C (4%). For the histogenesis of adenocarcinoma of the human lung, nonciliated bronchiolar epithelium may be the most important. A comparison of 10 cases of bronchiolo-alveolar carcinoma with 15 cases of ordinary (acinar and papillary) adenocarcinoma revealed no clear differences either histochemically or ultrastructurally.

Cysticercosis in Nepal: a histopathologic study of sixty-two cases.

Human cysticercosis, an infection caused by larvae of Taenia solium, is a major public health problem in many developing countries. Sixty-two of 23,402 biopsy cases have been detected as cysticercosis in the last 5 years in Patan Hospital. Most (82%) of the patients presented with solitary skin nodules, another 10% with nodules in the oral mucosa, and 8% in the breast. Forty cases were identified from the Kathmandu valley and the rest from outside Kathmandu. Most patients were younger than 30 years of age (mean, 21+/-11 years). Statistically, there was no difference between males (0.28%) and females (0.24%). The average size of cysticercosis was 19 mm in diameter, and the histology of cysticercosis showed fibrous walled cysts covered by several layered epithelioid cells with a few Langhans' giant cells and infiltration of eosinophils without caseous necrosis. These cysticercosis findings from an endemic area will be helpful for doctors who examine immigrant patients in nonendemic areas.

Minute squamous cell carcinoma arising in the wall of a congenital lung cyst.

A case of minute squamous cell carcinoma arising in a congenital lung cyst is reported. Two aspects of this case were notable. First, we were able to make the diagnosis of squamous cell carcinoma by bronchial lavage at an early stage. Second, to our knowledge, this is the first case of probable de novo origin of squamous cell carcinoma in a congenital lung cyst.

Muddy lung.

A 31-year-old man, a racing car driver, was submerged in muddy water as the result of an accident. He died from respiratory failure after a 17-day clinical course. Foreign body granulomatosis and massive fibrosis of the lung were revealed at autopsy. The crystalline foreign bodies mainly were composed of silicon and ranged in size from 20 micron to 500 micron in diameter (average, 90 micron). Their distribution in the lungs corresponded to the areas of lung carnification. In this study, the authors demonstrate that near drowning in muddy water causes pulmonary silicate granulomatosis associated with carnificating fibrosis of the lung and term the pulmonary changes "muddy lung."

Selective and persistent deposition and gradual drainage of iodized oil, Lipiodol in the hepatocellular carcinoma after injection into the feeding hepatic artery.

The selective and long-term deposition of iodized oil in the hepatocellular carcinoma (HCC) and its gradual drainage were clinicopathologically analyzed in 13 cases. All patients were Japanese and had an intrahepatic arterial injection of Lipiodol (LIP) mixed with Mitomycin C. The comparison among the follow-up computerized tomography (CT) findings, the observation of the soft x-ray radiogram, and histopathologic studies of the surgical or autopsy materials revealed that the selective deposition of LIP in HCC lasted for a long term, particularly in cases treated by LIP combined with transcatheter arterial embolization (TAE). Also revealed was an extremely gradual decrease of LIP from the HCC. It was thus postulated that, mainly, the accumulated macrophages surrounding LIP around the necrotic cancer tissue and, partially, the intrahepatic lymphatic system itself contributed to this drainage. Further, in histologic sections with lipid staining, x-ray microanalysis proved that the lipid droplets in the cancer tissue included highly concentrated iodine, as a deposition of LIP.

Alteration in surface structure of Clara cells and pulmonary cytochrome P-450b level in rats exposed to ozone.

Changes in the surface structure of Clara cells in the terminal bronchioles following exposure of rats to 0.4 ppm ozone (O3) for 14 days were evaluated and compared to the content of pulmonary cytochrome P-450, an enzyme active in xenobiotic metabolism. Exposure to O3 caused a striking alteration of Clara cells in the terminal bronchiole. After 6 h exposure apical protrusions of Clara cells enlarged and these Clara cells formed clusters. However after 24 h exposure, the Clara cells decreased in number and flattened. They increased in number and enlarged again during the subsequent period of exposure. By the 14th day of O3 exposure the number of Clara cells had increased significantly. The content of cytochrome P-450b (IIB1), a main isozyme of pulmonary cytochromes P-450 of rats, was determined by an immuno-blotting method using anti-cytochrome P-450b antibody. The cytochrome P-450b in the rats exposed to O3 increased significantly to 1.37- and 1.81-times that of the control on the 7th and 14th days, respectively. Immuno-electron microscopy demonstrated that cytochrome P-450b was localized abundantly in endoplasmic reticulum of Clara cells. Morphological alterations in Clara cells appear to be closely related with changes in the cytochrome P-450b content of the lung.

Squamous cell carcinoma of the foot arising in chronic ulcers in leprosy patients.

Squamous cell carcinoma (SCC) of the foot is a rare sequelae of chronic ulceration secondary to leprosy neuropathy. Most of the tumours are relatively slow growing and tend to metastasize late. Survival after local excision is generally good. In this series of 17 patients so far there have been 3 deaths attributable to SCC, all of whom presented with locally advanced tumours and lymph node metastasis.

Interstitial lattice shadow and mediastinal lymphadenopathy with an elevation of carcinoembryonic antigen in severe pulmonary alveolar proteinosis.

A case of severe pulmonary alveolar proteinosis (PAP) with interstitial involvement, mediastinal lymphadenopathy and an elevation of carcinoembryonic antigen (CEA) in the bronchoalveolar lavage (BAL) fluid and the serum is presented. Alveolar macrophages may play a major role in these rare and seemingly unrelated findings.

Hypersensitivity pneumonitis induced by hexamethylene diisocyanate.

A case of hypersensitivity pneumonitis (HP) induced by hexamethylene diisocyanate (HDI) is described. Serial determinations of the lymphocyte surface phenotypes by two-color assay revealed the following: 1) increased activated cytotoxic T lymphocytes in the bronchoalveolar lavage fluid (BALF), and 2) increased percentage and absolute number of non-major histocompatibility complex (MHC)-restricted natural killer (NK) cells in the peripheral blood (PB) during the recovery phase of the disease. These findings were considered to be related to the activity of the disease.

[Hodgkin's disease associated with Tolosa-Hunt syndrome].

A thirty-eight-year-old man developed gradually progressing right retro-orbital pain, diplopia on the left lateral gaze, and left ptosis. On examination paresthesia was present on the first division of right trigeminal nerve. Orbital venography revealed obstruction of right superior orbital vein on the entering portion to the cavernous sinus. A daily administration of 30 mg of prednisolone resulted in a rapid improvement of the symptoms. Diagnosis of Tolosa-Hunt syndrome was made on the basis of neurological symptoms, roentgenographic findings and responsiveness to prednisolone. One year later, weakness of right leg accompanied with left cervical and axillary lymphadenopathy was developed. A biopsy specimen of cervical lymph node was identical with the Hodgkin's disease, lymphocyte predominance type. He was treated with COPP regimen; lymphadenopathy decreased in size. We reported a rare case of Hodgkin's disease preceded by Tolosa-hunt syndrome which might be caused by the extranodal lesions.

[A case of endobronchial minute leiomyoma and literature review of the 66 cases of endotracheal and endobronchial leiomyoma reported in Japan].

A case of endobronchial minute leiomyoma successfully treated by bronchoscopically directed forceps biopsy is described. A 42-year-old male with a 20 pack-year smoking history was admitted for dry cough occurring at night. Chest X-ray showed no abnormal shadows. The tumor, measuring 2 by 2 mm, was located in the right B7. The clinical characteristics of the 66 cases of endotracheal and endobronchial leiomyoma reported in Japan are also discussed. The male to female ratio of this disease was 2:3. Middle-aged people were most, commonly affected. Usually, obstructive pneumonia or atelectasis, which develops distal to the lesion, causes respiratory symptoms and chest X-ray abnormality. However, 10% of cases were asymptomatic and 30% had a negative chest X-ray. There were 7 cases of endobronchial minute leiomyoma, measuring less than 10 mm in diameter. Of these, three cases had only hemoptysis and had no chest X-ray abnormality. In such cases fiberoptic bronchoscopy is may be the only useful procedure for the diagnosis of this disease.

Terminal plate fracture in vertebrae of the aged.

The terminal plate fracture of human vertebrae was studied morphologically on midsagittal specimens from 92 autopsy cases which included 82 patients over 60 years. 1. Histologically, the terminal plate fracture was classified into three types by its representative histology. (a) Fracture with intervertebral disk (ID) prolapse: a healed fracture characterized by the presence of the prolapsed ID at the fractured site. ID prolapse in the marrow cavity may or may not be present. The group includes the typical case of the Schmorl's nodule. (b) Fracture with the granulation tissue: The fracture site was embedded by the granulation tissue. Callus and ID prolapse, if any, were insignificant. (c) Diffuse replacement of the hyaline cartilage layer by osteoid tissue: The alteration is seen often at a concaved surface of the terminal plate of significantly deformed vertebrae. 2. The fracture may be classified by the depth of the ID prolapse. (a) Grade 1: ID prolapse may be seen within the fracture aperture, but, not in the marrow cavity. (b) Grade 2: ID prolapse is confined to a labyrinth of subcortical trabeculae. (c) Grade 3: ID prolapse extends to a deep marrow space. The typical Schmorl's nodule belongs to this group. 3. In the present study, the terminal plate fracture was noted in 78% of the patients over 60 years. The female group was affected more often (68% in male, 86% in female). Grade 2 was more often seen in atrophic vertebrae than Grade 1. However, in Grade 3, the fracture appeared unrelated to the atrophy of the vertebrae. 4. The terminal plate fracture was more often seen in the lower deck than the upper deck at the site of two-thirds dorsal from the ventral edge of the vertebral body. The site corresponds roughly to the nucleus pulposus. 5. Histologic variations of the terminal plate fracture and of ID prolapse may relate to senescence of both vertebrae and ID.

A case of 'bronchial string'--a rare anomaly of the bronchus.

An incidental string-like structure spanning the lumen of the intermediate bronchus was found during bronchoscopy in an 18-year-old woman. We consider that the lesion may be a rare fibrous anomaly of the bronchus and may be closely related to a bronchial web. We have named this unusual structure 'bronchial string'.

Gamma heavy chain disease; report of an autopsy case with a review of the literatures.

An autopsy report of a 76 years old Japanese male, who had suffered from gamma- HCD, was presented. This is the fifth case of gamma-HCD in Japan and this communication is the first autopsy report made on gamma-HCD in our country. The primary pathological alteration of this disorder is a neoplastic proliferation of atypical lympho-plasmacytes extending throughout the entire hematopoietic and parenchymatous organs. Pathological characteristics of our case were compared with the same disorders reported in the world literatures.

A cytophotometrical study on the centenarian hepatocyte.

Size alterations, both of cell and nucleus, of the centenarian hepatocyte followed a pattern proportionate to aging which was observed in the hepatocyte of non-centenarian groups and clearly followed nonagenarian in location on the graph. When size alterations of the hepatocyte were considered as an aging parameter, the present observation suggests that the centenarian could be a group next to the nonagenarian. The results obtained by present cytomorphometrical analysis do not favor a hypothesis that the centenarian is a select population in terms of longevity.

Bronchial carcinoid with multiple aerogenous implanted foci.

A case of bronchial carcinoid with intrapulmonary dissemination was demonstrated. A right upper lobectomy was performed because of an abnormal shadow in the lung detected by an X-ray mass survey. A carcinoid tumor originated from the spur region of the right upper lobe bronchus. The tumor protruded into the bronchial lumen and also extensively expanded into the surrounding alveolar tissue. The tumor showed typical histological features of bronchial carcinoid with a mixed insular, trabecular, and glandular pattern. Multiple implanted foci of tumor cells were found in the periphery of the lobe. The implanted tumor cells replaced the alveolar epithelium without destruction of the alveolar structure, which suggests the possibility of aergenous spread of bronchial carcinoid. This is the first report on bronchial carcinoid with aerogenous spread.

Histopathology of typhoid enteritis: morphologic and immunophenotypic findings.

Enteric fever is a systemic illness caused by Salmonella infection, with S. typhi, S. paratyphi, and S. enteritidis being the most common serotypes. Humans are the only reservoir for S. typhi, and its predilection for the ileum is due to the fact that organisms enter the body by translocation across specialized Peyer's patch epithelium and then proliferate in the mucosal macrophages. The lesions in bowel and mesenteric lymph nodes are distinctive and mimic Kikuchi-Fujimoto disease and Rosai-Dorfman disease as well as infections caused by some non-salmonella bacteria. The four cases presented in this report, two culture-confirmed, all exhibited ileal mucosal hypertrophy caused by a neutrophil-poor monocyte/macrophage-rich hyperplasia. Though diffuse areas were present, much of the lesional proliferation was nodular, representing macrophage infiltration and colonization by the monocytes and macrophages. Immunophenotypic studies, which showed a CD68+, lysozyme+, UCHL-1+, OPD4-, CD4-, s100- profile, were helpful in distinguishing these lesions from other processes, including Kikuchi-Fujimoto disease and Rosai-Dorfman disease. Although rare in developed countries, enteric fever should be considered in any patient with recent travel to endemic areas and in the context of illness thought to be related to contaminated foods.

Element analysis of Lewy and adrenal bodies in Parkinson's disease by electron probe microanalysis.

Two possible interpretations of the origin of Lewy bodies and adrenal bodies found in Parkinson's disease are now under discussion: a disorder of (1) catecholamine metabolism or (2) sphingomyelin lipidosis. From the electron probe microanalysis of Lewy bodies and adrenal bodies, we find that the Lewy body contains sulfur, calcium, and phosphorus, and the adrenal body also contains these three elements. Furthermore, a positive correlation was obtained between the X-ray intensity of the sulfur and the diameter of adrenal body. For Lewy bodies, this correlation was not obtained. The results suggest that a common mechanism may exist for the production of Lewy and adrenal bodies, although they differ somewhat in their accumulation of sulfur. It is considered that both structures may originate, in part, from degenerated protein containing sulfur.