Astroblastoma of pure type.

A rare case of astroblastoma of the pure type occurring in the left occipital lobe of a 54-year-old female is reported. The predominant histologic feature was that of perivascular pseudorosettes. The tumor tissues were not stained by the Mallory's phosphotungstic acid-hematoxylin, but the perikarya of some tumor cells were positively stained for the glial fibrillary acidic protein.

A diffuse alveolar hemorrhage in a human T-lymphotropic virus type I carrier with acute cerebellar ataxia and interstitial pneumonitis: an autopsy case report.

A 76-year-old HTLV-I-positive male with acute cerebellar ataxia was suffering from dyspnea on exertion. Chest CT suggested interstitial pneumonitis. Methylprednisolone pulse therapy improved his symptoms and chest CT findings. Twelve months after discharge, when the prednisolone dose was tapered to 5 mg every other day, his lung lesion recurred. The lesion responded initially to steroid therapy. However, hypoxemia intractable to steroid pulse therapy developed and the patient died of respiratory failure. The autopsy revealed diffuse alveolar hemorrhage with no finding of vasculitis. This is the first case report of diffuse alveolar hemorrhage in an HTLV-I carrier.

Neuropathology of auditory agnosia following bilateral temporal lobe lesions: a case study.

Our patient was first diagnosed with auditory agnosia following his second cerebral vascular accident (CVA) in 1975 when he was 37 years old. Comprehensive follow-up examinations of auditory function were periodically conducted until his sudden death 15 years later. His brain was studied postmortem for neuropathology. Initial pure-tone audiometry revealed moderate sensorineural hearing loss in the right ear and mild sensorineural hearing loss in the left ear. However, repeated pure-tone audiometry revealed that thresholds became progressively poorer over time, bilaterally. Speech audiometry of both ears consistently revealed that the patient was unable to discriminate any monosyllabic words (i.e. speech intelligibility scores were 0%, bilaterally). In general, speech and hearing tests demonstrated that he could not comprehend spoken words, but could comprehend written commands and gestures. Postmortem neuropathological study of the left hemisphere revealed total defect and neuronal loss of the superior temporal gyrus, including Heschl's gyrus, and total gliosis of the medial geniculate body. In the right hemisphere, examination revealed subcortical necrosis, gliosis in the centre of the superior temporal gyrus and partial gliosis of the medial geniculate body. The pathological examination supports clinical results in which the patient's imperception of speech sounds, music and environmental sounds could be caused by progressive degeneration of bilateral medial geniculate bodies.

Auditory brainstem response and temporal bone and brainstem pathology in brainstem death, with special reference to autolysis of red blood cells.

We studied the pathological changes in the temporal bone and brainstem, with particular attention to the autolysis of red blood cells in and around the blood vessels, in six cases of brainstem death determined by auditory brainstem responses (ABRs). Our findings showed that the cochlea, the visceral organs and the spinal cord below a certain level of the cervical segments continued to live after brainstem death. Red blood cells in the vessels of the brainstem and cerebellum exhibited severe autolysis, whereas most red blood cells in the cochlea were preserved. Our findings of autolytic changes in red blood cells in the brainstem, and the preservation of red blood cells in the cochlea, imply initial loss of brainstem function and delayed loss of cochlear function after prolonged absence of ABRs.

Temporal bone pathology of acoustic neuroma correlating with presence of electrocochleography and absence of auditory brainstem response.

The temporal bone pathology of a 74-year-old female affected by vestibular schwannoma was compared with findings of auditory brainstem response and electrocochleography. At age 71, she complained of hearing loss in the left ear in which pure tone audiometry revealed threshold elevation in the middle- and high-frequency range. Temporal bone CT scanning revealed a medium-sized cerebellopontine angle tumour in the left ear. ABR showed no response in the left ear, but the electrocochleography showed clear compound action potentials. Three years later, at age 74, she died of metastatic lung cancer and sepsis. The left temporal bone pathology consisted primarily of a large vestibular schwannoma occupying the internal auditory meatus. The organ of Corti was well preserved in each turn. In the modiolus, the numbers of spiral ganglion cells and cochlear nerve fibres in each turn were decreased. These histological findings suggest that clear compound action potentials were recorded from the distal portion of the cochlear nerve in spite of the presence of the vestibular schwannoma, but ABR could not be detected because of the blockade of the proximal portion of the cochlear nerve by the vestibular schwannoma.

[A case of congenital brain tumor diagnosed during follow-up of neonatal intracranial hemorrhage].

We describe a three-year-old girl whose growing congenital brain tumor may have been responsible for her perinatal intracranial hemorrhage. The patient, born after an uneventful pregnancy and delivery, had an intracranial hemorrhage in the right frontal area, including the basal ganglia, as a newborn. Her only symptoms at that time were vomiting and fever. She improved both, clinically and neuroradiologically during the following weeks, and except for mild left hemiparesis, the patient developed with no other apparent neurological deficits. However, a follow-up brain CT scan at 3 years of age, disclosed a heterogeneous tumor with a 5 cm diameter in the same right frontal area as the neonatal hemorrhage. The tumor was surgically removed, and diagnosed as a benign mixed tumor composed of differentiated astrocytoma and meningioma elements. It is conceivable that the brain tumor may have been growing rather slowly since an early fetal stage. This case indicates the need of being aware that neonatal intracranial hemorrhages may be caused by bleeding of congenital brain tumors.

What makes the renin-angiotensin system a pathogenic factor?

Three types of renal hypertension in the rat have been compared with respect to blood pressure increase, activity of the RAS, and secretion of aldosterone and corticosterone: type I - unilateral stenosis of the renal artery in the presence of an intact contralateral kidney; type II - unilateral stenosis of the renal artery after contralateral nephrectomy; type III - bilateral stenosis of the renal arteries. Blood pressure rose more rapidly and reached higher values in type II and type III hypertension than in type I hypertension. In the latter group, the activity of the RAS was more stimulated than in types II and III. The marked stimulation of the RAS in type I hypertension is ascribed to the negative fluid and sodium balance, which is the consequence of a pressure-induced diuresis of the unclamped contralateral kidney. Suppression of the activity of the RAS by a 4-week pretreatment with DOC-TMA and saline or by the administration of DOCA and saline as from the induction of renal artery stenosis did not prevent the development of hypertension caused by the clamping of one renal artery (type I). In spontaneously hypertensive rats of the stroke-prone substrain, high dietary salt intake caused higher blood pressure values and a higher incidence of cerebral lesions than normal dietary salt intake. Low salt intake was followed by a marked stimulation of the RAS, but blood pressure rose only slightly and no symptoms of cerebrovascular lesions were observed. It is concluded that neither in hypertension induced by renal artery stenosis nor in spontaneously hypertensive rats, the RAS contributes significantly to the increase in blood pressure nor does it play a major part in the pathogenesis of vascular lesions. These seem to be related to the retention of sodium, which may be obtained by renal artery stenosis, by excessive salt intake, or by the administration of a mineralocorticoid and salt.

Primary intracranial choriocarcinoma arising from the pituitary fossa. Report of an autopsy case with literature review.

A 12-year-old Japanese girl with a primary intracranial choriocarcinoma arising from the pituitary fossa is reported. There was a markedly high level of serum human chorionic gonadotropin (HCG) throughout the clinical course. Postmortem examination revealed metastatic lesions found in the cerebellum, dura mater, skull (clivus, sphenoidal bone), and lungs. Immunohistochemical characteristics of the primary intracranial tumor and lung lesions disclosed positive stainings for HCG and HCG-beta in the neoplastic syncytiotrophoblastic cells.

Autoradiographic investigation of cell proliferation in the brain of spontaneously hypertensive rats.

Cell proliferation in the brain of spontaneously hypertensive rats (SHR) and control Wistar rats of various ages was autoradiographically investigated using [3H]thymidine. The brain of SHR showed an increase in labeled cells. The increase of labeled cells was seen in the early stage of the development of hypertension when there were still no definite morphological changes in the cerebral vessel walls or brain parenchyma. The labeled cells tended to increase in number with the age of the animals. The distribution of these cells corresponded with areas of increased vascular permeability and cerebrovascular lesions, that is, water-shed regions. The labeled cells consisted of endothelial and adventitial cells of the intracerebral arterioles and pial arteries as well as glial cells. Arachnoid cells, subarachnoid cells, medial smooth muscle cells of the pial arteries were also labeled, though less intensely. The significance of labeled endothelial cells in the development of cerebrovascular changes and sequential parenchymal changes is discussed.

Benign pedunculated intraluminal tumor of the esophagus.

Benign pedunculated intraluminal tumor of the esophagus is extremely rare. Although the correct diagnosis of this tumor is difficult, it should be extirpated early because, if untreated, it may result in death of the patient by progressive emaciation, bleeding from erosions, or acute airway obstruction. We present a case rescued from suffocation caused by regurgitation of a giant esophageal tumor. In the discussion on the difficulty of diagnosis, the necessity of repeated examination is emphasized. The classification of benign esophageal tumors is also discussed.

Changes in vascular permeability in stroke-prone spontaneously hypertensive rats studied with peroxidase as a tracer.

Cerebrovascular permeability in stroke-prone spontaneously hypertensive rats (SHR) at various ages was histologically studied using horseradish peroxidase as a tracer and such was related to the cerebrovascular lesions in the animals. An increase in permeability was demonstrated in the brain of SHR, particularly in those animals with an extremely high blood pressure. Increased cerebrovascular permeability occurred in some animals without any organic vascular change or severe parenchymal changes, although edema was present. Histologically, the SHR brain with an increase in permeability showed mild focal edema, rarefaction of tissue and necrosis with cyst formation. Thus a transitional progress was evident. Localization of the increase in permeability corresponded well with the predilection sites of cerebrovascular lesions in SHR. Constrictions and dilatations of intracerebral arterioles and small arteries were also demonstrated by the peroxidase method, and the dilated arterial walls did reveal a darker staining. From these results it is strongly suggested that certain cerebrovascular lesions, especially necrosis with cyst formation in SHR are sequelae of the increased cerebrovascular permeability caused by a chronic hypertensive state.

Local bone resorption induced by serially transplantable human renal cell carcinoma in nude mice.

The high incidence of metastatic bone disease in urological cancer makes it necessary for clinicians to look for a valid experimental model to investigate the basic interactions between cancer cells and bone in order to improve the treatment. A new model of bone resorption was defined, namely the subcutaneous injection of tumor cell suspensions of serially transplanted renal cell carcinoma in nude mice after disruption of the periosteum of the calvaria. The tumor induced osteolysis associated with osteoclast proliferation with reactive bone formation. The X-p film from nude mice calvaria showed the same multiple osteolytic punched-out lesions as those of the patient's skull.

An immunohistochemical study of intracranial germ cell tumours.

Histologically verified intracranial tumours, mainly germ cell tumours of the pineal and suprasellar regions, were studied immunohistochemically using anti-serum of alpha fetoprotein (AFP), human chorionic gonadotropin (HCG), carcinoembryonic antigen (CEA), human placental lactogen (HPL), pregnancy specific beta-1 glycoprotein (SP-1), glial fibrillary acidic protein (GFAP), S-100 and neuron specific enolase (NSE). In germinomas, HCG positive cells were occasionally demonstrated in cells presenting as syncytiotrophoblastic giant cells (STGC), and GFAP and S-100 positive cells were found in the surrounding gliotic lesions. Teratomas were positive for CEA in their epithelial components. Endodermal sinus tumours were positive for AFP, choriocarcinomas for HCG and SP-1, and embryonal carcinomas for AFP, HCG and SP-1. HCG and SP-1 positive cells were demonstrated in STGC. As for the relationship between serum AFP level and tissue localization, many cases presenting a serum AFP level exceeding 220 ng/ml were positive for AFP in tumour tissue.

General pathology of Kawasaki disease. On the morphological alterations corresponding to the clinical manifestations.

Systemic pathological alterations were studied in thirty-seven autopsied patients with Kawasaki disease. Systemic vasculitis was the most characteristic pathological finding and was present in all the patients. In addition to the vasculitis, there was a high incidence of inflammatory lesions in various organs and tissues: in the heart, endocarditis, myocarditis, and pericarditis; in the digestive system, stomatitis, sialoduct-adenitis, catarrhal enteritis, hepatitis, cholangitis, pancreatitis, and pancreas ductitis; in the respiratory system, bronchitis and segmental interstitial pneumonia; in the urinary system, focal interstitial nephritis, cystitis, and prostatitis; in the nervous system, aseptic leptomeningitis, choriomeningitis, gangliontis, and neuritis; in the hematopoietic system, lymphadenitis, splenitis, and thymitis. Dermatitis, panniculitis or myositis were also observed in some patients. Therefore, Kawasaki disease is a systemic inflammatory disease which mainly affects the cardiovascular system. These systemic inflammatory lesions are considered to correspond to the variegated clinical manifestaitions. The relationship between Kawasaki disease and infantile polyarteritis nodosa (IPN) were discussed, based on the clinicopathological characteristics.