Eio Atari

Intestinal Behçet's disease--pathognomonic changes in intramucosal lymphoid tissues and effect of a "rest cure" on intestinal lesions.

To clarify the pathognomonic changes of intestinal lesions of Behçet’s disease and to determine effective therapeutic measures, we recruited 13 patients with the intestinal form of this disease for study. We performed pathology studies on the resected specimens of 7 patients and treated 5 of the other 6 patients with a low-residue diet. Pathology examination revealed that 6 of the 7 had inflammatory ulcerations in the ileocecal region. The ileal ulcers were mainly on the antimesenteric side. We observed remnants of Peyer’s patches at the margins of the major ulcerative lesions in 2 of 2 patients examined. There were aggregations of lymphocytes resembling destroyed lymph follicles in the superficial layer at the mouths of small fissuring lesions, and ulcer scars were also noted in Peyer’s patches in 4 of 5 other patients. X-ray and endoscopic examinations revealed the disappearance of intestinal lesions in 5 patients within 1 month during, or following the low-residue diet treatment. We found the intestinal lesions of Behçet’s disease at sites coinciding with intramucosal lymphoid tissue. The “rest cure” for the affected bowel was effective, i.e., there was significant alleviation of gastrointestinal symptomas and the intestinal lesions disappeared. We speculated that acute exudative inflammation, abscess formation, and consequent ulceration may occur in these tissues by the same mechanisms as those that operate in the positive needle-prick reactions seen in patients with Behçet’s disease.

Case Report: Distinctive Diffuse Duodenitis Associated with Ulcerative Colitis

There are numerous and varied complicat ions in the natural course of ulcerative colitis, and the extracolonic manifestations of this disease have been described in many reviews and case reports (1± 3). Wellknown bowel complications include toxic megacolon (4, 5), colitis cystica profunda (6), backwash ileitis (7, 8), and postcolectomy pouchitis (9, 10). The extension of pathologi cal changes of ulcerative colitis in a retrograde manner through the ileocecal valve into the ileum, responsible for backwash ileitis, only reaches a short distance into the ileum, and the upper small intestine, particularly the duodenum, is not affected (7). We report here a surgical case of diffuse ulcerative duodeniti s accompanying ulcerative colitis without backwash ileitis and discuss its pathogenesis.

Myxoid sarcoma arising from the pulmonary trunk.

We reported a case of a myxold sarcoma of the pulmonary trunk in a 40‐year‐old women. On light and immunohistochemical studies, spindle‐shaped tumor cells revealed the nature of smooth muscle origin.

Mucin‐producing bile duct carcinoma originating at the hepatic hilus

We describe a mucin-producing bile duct carcinoma that was resected and analyzed pathologically. Endoscopic retrograde cholangiography disclosed amorphous filling defects in the dilated extrahepatic bile duct, suggesting that a large amount of mucin was excreted from the tumor. An intraductal amorphous filling defect showed shape change at different examination times. Pathology examination revealed a papillary tumor which showed mucus production, in the right hepatic duct. The cut section of the resected specimen showed a protuberant papillary lesion, measuring 14×14mm in diameter, forming a cystic mucous lake within the duct wall. Many cancer cells were also found in the mucous lake, the contents of which were strongly positive for mucin stain. The mucous lake developed laterally and communicated with the peribiliary glands, suggesting that the tumor had originated in these glands.

Three Cases of Sebaceous Glands in the Esophagus

Abstract: Three cases of patients with sebaceous glands in the esophagus are described in this study.

Follow-up Study of Early Colorectal Cancer After Endoscopic Resection

Abstract: This study was conducted to determine the significance of long‐term follow‐up observation of early colorectal cancer following endoscopic resection. The subjects included 100 patients who had undergone early colorectal cancer resection by endoscopic polypectomy with prior injection of the base (73 patients with mucosal carcinoma (m cancer), 24 Patients with submucosal carcinoma (sm cancer), and 3 patients with multiple early colorectal cancers. Posttherapeutic observation was carried out by endoscopy. The results were, briefly, as follows: 1) No cases of local recurrence or metastasis were observed during the follow‐up observation period for up to a period of 14 years. 2) 3 cases (3%) of metachronous carcinoma were detected, 2 of these patients had early carcinoma and 1 had advanced carcinoma. The mean period which elapsed before the detection of metachronous cancers was 35.0 ± 15.3 months. 3) The incidence of adenoma during the follow‐up period was 40%, the frequency of newly detected adenoma was relatively high among the patients with coexisting adenoma at the time of treatment for early carcinoma and among the elderly patients aged 60 years or over, 4) No cancer was detected after establishing a clean colon, and the incidence of adenoma in such cases was relatively low, i. e., 14.5%. The mean period of time which elapsed until the detection of the adenoma was 24.4 ± 18.0 months. The results of this study indicated that endoscopic examination is necessary and useful for surveillance of local recurrence or metachronous carcinoma as well as the detection of adenoma.

A case of common bile duct adenoma diagnosed by exfoliative cytology of bile juice.

術前に, 胆汁の細胞診で, 総胆管に発生した管状腺腫と診断された73歳, 女性の1例を経験したので報告する.術後5年の経過をとっているが, 良好である.本腫瘍の細胞学的および病理組織学的な所見を報告したい.腺腫の腫瘍細胞は大型で, 核・細胞質比が増大し, 核クロマチンは増量しているが細胞異型は少ない.大型腫瘍細胞で, ほぼ均一の大きさを呈する異型細胞所見は胆汁中の腺腫細胞の細胞診断に重要な所見である.

Focal nodular hyperplasia of the liver: A patient with two concurrent lesions that manifested different behavior on radiographic imaging tests

Focal nodular hyperplasia (FNH) of the liver is a relatively uncommon pathology, with only 68 cases having been documented to date in Japan. Here, we describe an interesting case; the patient had two concurrent lesions of FNH in segments three (S3) and five (S5), respectively. The two lesions differed from each other in their behavior on various radiographic imagings, i.e., computed tomography, magnetic resonance imaging, and hepatic angiography, leading to a misdiagnosis of hepatocellular carcinoma for the S3 lesion. The patient underwent left lateral hepatic resection, along with excision of the S5 lesion. Histological examination confirmed that these two lesions were FNH. Retrospective assessment of the correlation between the radiographic imagings and the morphological architecture suggested that the architectural differences between the two lesions (i.e., that, in the S3 lesion, the central scar was more developed than in the S5 lesion and was more prominent in the periphery than in the central area of the lesion) had contributed to the misdiagnosis.

Proceedings Of The 21St Autumn Meeting From October 15th-17th, 1979-Maebashi, Japan

When the peripheral blood lymphocytes from patients with various types of hepatitis were stimulated in vitro with liver specific protein, lymphocyte transformation and MIF production were detectable in many cases, especially in chronic active hepatitis. The macrophage activating factor (MAF), a kind of lymphokines, was also detected in the culture medium of activated lymphocytes from patients who showed positive blastogenesis. The activated macrophages by MAF were shown to be cytotoxic to the separated liver cells causing the marked inhibition of albumin synthesis. MAF-containing culture supernatants of these active lymphocytes activated guinea pig macrophages which inhibited the albumin biosynthesis of the isolated liver cells. These observations suggest that the macrophagemediated cytotoxicity may play and role in pathogenesis of chronic active hepatitis.