Chikao Torikata

Intranuclear tubular structures observed in the cells of an alveolar cell carcinoma of the lung

Intranuclear tubular structures observed in the cells of an alveolar cell carcinoma of the lung are described. The structures were composed of membraneous tubules, measured about 60 nm in diameter, and had an electrondense central core. These unusual structures were seen in the nuclei of neoplastic cells (Type II pneumocytes). The nature of the tubular structures remains unsolved, but morphologic characteristics and associated granulomatous reaction in the stroma imply the possibility of an unknown virus‐like infection.

Protein 1 and Clara cell 10-kDa protein distribution in normal and neoplastic tissues with emphasis on the respiratory system.

Thirty-six different normal tissues and 13 different malignant epithelial tumours, were examined immunohistochemically for the presence of protein 1 (P1) and Clara cell 10-kDa protein (CC10). Adenocarcinomas of the lung were also examined for the expression of pulmonary surfactant apoprotein using a monoclonal antibody (PE-10). The staining results of P1 and CC10 were almost identical both in normal tissues and in malignant tumours. In normal lung, Clara cells were strongly positive for both P1 and CC10. In addition, some goblet cells and non-ciliated non-mucus cells in the upper airways were moderately positive for both proteins. In the malignant tumours, some lung cancers were positive for P1 and CC10, both of which were positive in the same tumour cells on sequential sections. In 117 lung cancers, P1 and CC10 were positive in 10.2% of adenocarcinomas, 20.5% of squamous cell carcinomas, and 12.5% of large cell carcinomas. PE-10 stained positively in 65.3% of adenocarcinomas, a frequency significantly higher than that of P1 and CC10 (P<0.01). These results suggest that P1 and CC10 are nearly identical proteins, that both are useful markers of Clara cells, and that many pulmonary adenocarcinomas express surfactant apoprotein rather than Clara cell proteins.

Systemic Lupus Erythematosus Associated with Multiple Nodular Hyperplasia of the Liver

Three autospy cases of systemic lupus erythematosus with uinique association of multiple nodular hyperplasia (MNH) of the liver, portal hypertension, and hypertensive pulmonary vascular disease are reported. None of the patients had received oral contraceptive or androgenic steroid, but they were treated with glucocorticoids for 2 to 11 years. Raynauds phenomenon, sclerodactyly, and mild impairment of the kidney were the common clinical features. Macroscopically, MNH is characterized by many nodules scattered throughout the non‐cirrhotic liver, and histologically, each nodule is made up of normal‐appearing hepatocytes and not encapsulated. Portal tracts are scanty in the nodules. MNH seems to be a regenerative‐hyperplastic process, but its true nature still remains unclear. Relationships between MNH and portal hypertension, MNH and pulmonary hypertension, and collagen disease and pulmonary hypertension are discussed. A brief review of the literature concerning multiple benign hepatocellular tumors similar to MNH is also presented. ACTA PATHOL. JPN. 32: 547∼560, 1982.

So-called minute chemodectoma of the lung. An electron microscopic and immunohistochemical study.

So-called minute pulmonary chemodectoma is a curious, small lung tumour found mainly in women. The nature and origin of the proliferating cells are still obscure. In the first report on the tumour, the component cells were described as resembling chemoreceptor cells and the tumour was named chemodectoma. However, electron microscopic studies of the tumour have revealed no evidence of neuronal characteristics and have shown a close resemblance to meningothelial cells. In this study, the electron microscopic findings were similar to those previously reported but in one of the two cases, tumour cells were filled with abundant cytofilaments, giving them an occasional dense, patch-like appearance. Immunostaining for myosin and vimentin was positive in all tumour cells, but epithelial membrane antigen staining was not seen. These findings indicate that the tumour might have its origin from muscle cells.

Evaluation of the Malignant Grade of Thymoma by Morphometric Analysis

To determine the histologic grade of malignancy of thymoma, the nuclear areas of epithelial cells of 42 thymomas, 14 thymic hyperplasias, and ten normal thymuses were measured by morphometry and the results were compared with the extent of disease, association with myasthenia gravis (MG), and histologic subtypes of the thymomas. The nuclei of epithelial cells of thymomas were significantly larger than those of both of thymic hyperplasias and normal thymuses (P < 0.01). The nuclei of epithelial cells of invasive thymomas were significantly larger than those of noninvasive ones (P < 0.001). In the noninvasive group, the nuclei of epithelial cells of thymomas associated with MG were significantly larger than those without MG (P < 0.02), and were similar to those of invasive thymomas. These results confirm that invasive thymomas are morphometrically malignant tumors, and suggest that noninvasive thymomas associated with MG might have malignant potential.

Multiple pulmonary hyalinizing granulomas associated with systemic idiopathic fibrosis.

A 41 year‐old man with progressive nodular infiltration of the lung of about 2 years’duration died of cardiac and respiratory failure. Autopsy revealed bilateral multiple pulmonary hyalinizing granulomas (PHGs) diagnosed on the basis of the characteristic dense hyaline collagen bundles with nonspecific inflammatory infiltration. Constrictive pericarditis, retroperitoneal fibrosis, mediastinal fibrosis, fibrous thickening of the peritoneal and pleural surfaces, and fibrosis of soft tissue of the neck, flank, and hepatic hilar region were present, therefore, a diagnosis of systemic idiopathic fibrosis was made. The patient had anti thyroglobulin and anti‐thyroid microsomal antibodies and lymphocytic thyroiditis. The inflammatory process of PHG of the present case was active and the clinical course was progressive. PHG seems to be a lesion belonging to the systemic idiopathic fibrosis complex. Immunologic abnormalities may be related to PHG and systemic idiopathic fibrosis.

Malignant grading of cortical and medullary differentiated thymoma by morphometric analysis.

Forty‐seven thymomas were histologically classified into cortical, mixed, and medullary types, and the malignant grade of each subtype was evaluated by measuring the nuclear areas of epithelial cells. Fourteen normal thymuses and 23 thymic hyperplasias were used as controls. The cortical thymomas were more frequently invasive and associated with myasthenia gravis than the medullary type (P < 0.01 and 0.05, respectively). Cortical thymomas had larger epithelial cell nuclei than the medullary type (P < 0.001). Cortical and medullary thymomas had larger epithelial cell nuclei than the thymic cortex and medulla (P < 0.001 and 0.01, respectively). The thymic cortex had larger epithelial cell nuclei than the medulla (P < 0.001). These results confirm that the epithelial cell nuclei of cortical and medullary thymomas correspond morphometrically to the thymic cortex and medulla, respectively, and that most cortical thymomas have a higher malignant grade than the medullary type.

Abnormal cilia in the bronchial mucosa

Atypical cilia in the bronchial mucosa of non-smoking women and in guinea-pig lungs were studied by the electron microscope. In human cases, numerous compound cilia were observed in the main bronchi. The largest one contained about 40 axial filament complexes in a ciliary shaft. Occasionally, atypical basal bodies were also seen. In the experimental model in guinea-pigs, 50% oxygen at one atmospheric pressure damaged the bronchial surface and resulted in degeneration and reduction of cilia and pellicular structures. The injury was not sufficiently severe to initiate adaptation and reparative mechanisms in the bronchial mucosa, and rapid renewal of the surface structures was found. The human cases were associated with bronchogenic carcinoma but the experimental model suggested that atypical cilia were not always related to pulmonary carcinogenesis.

Nine Japanese patients with immotile-dyskinetic cilia syndrome: An ultrastructural study using tannic acid-containing fixation

Respiratory cilia and sperm flagella of nine Japanese patients with immotile-dyskinetic cilia syndrome were studied ultrastructurally by using a tannic acid-containing fixative. Respiratory cilia from two female patients with Kartageners syndrome and one male patient with situs inversus and sinobronchitis were completely immotile and lacked both dynein arms. However, approximately 30% of the spermatozoa from the male patient were weakly motile. In four patients with immotile cilia syndrome without Kartageners triad, immotile respiratory cilia generally lacked the inner dynein arms. Two clinically unusual cases, an 11-year-old boy and a 29-year-old woman with prolonged saccharin test, recurrent bronchitis, and bronchiectasia, possessed motile respiratory cilia. Ultrastructurally, both dynein arms were normal, but numerous defective central pairs (more than 50% and 70%, respectively) were seen, and the defect in the second case was similar to the transposition of microtubules reported by Sturgess et al (N Engl J Med 303:318-322, 1980). However, defects in the first case were unique and may be congenital. We propose a new type of dyskinetic cilia syndrome with defective central pairs. Additionally, nasal cilia from a 35-year-old man with immotile cilia syndrome contained excess large singlets within ciliary axonemes consisting of 17 protofilaments.

Ultrastructure of metaplastic ciliated cells in human stomach.

Intestinal metaplasia of the gastric mucosa occurs commonly in aged Japanese patients and has been discussed in relation to the high incidence of gastric cancer in Japanese. Ciliated cells in the gastric mucosa have frequently been found in association with intestinal metaplasia in the pyloric gland and rarely in the cardiac gland in many Japanese patients, and exceptionally in one Chinese and in one Swedish patient. Electron microscopic examination of 12 Japanese patients has revealed that these structures are not metaplastic stereocilia, but true cilia. Ciliated cells have been found in the basal part of the gastric glands and never in the surface epithelium. The fine structure of the gastric cilia was almost the same as that of normal respiratory cilia. However, in the gastric cilia, most dynein arms were inconspicuous even after tannic acid fixation, indicating that ciliary beating of the gastric cilia is problematic. Abnormal cilia and basal bodies also were found. Ciliated cells have always occurred in association with intestinal metaplasia, therefore this phenomenon might be a type of metaplasia and is named “ciliated metaplasia” of the gastric mucosa.