Goroku Ohta

Pathologic features of hepatolithiasis in Japan

A national survey of pathologic features of hepatolithiasis was conducted in Japan. The significance of hepatobiliary lesions in the pathogenesis of hepatolithiasis was evaluated in 31 autopsy livers and 242 surgically resected livers. Eighty-two percent shared several morphologic and clinical features, eg, the presence of multiple calcium bilirubinate or brown pigment stones within the intrahepatic duct and a characteristic hepatobiliary morphology. These cases were distributed throughout Japan without distinct geographic differences. The stones were found in the left and/or right hepatic duct and/or their tributaries. The ducts that contained stones had uneven dilatation of their lumena with focal stenosis. The walls of the involved ducts were thickened mainly by fibrosis. The hepatic parenchyma associated with stones within intrahepatic bile ducts showed mild to severe atrophy and fibrosis. Histologically, the ducts that contained stones showed fibrosis, proliferation of mucous and serous glands, and inflammatory cell infiltration in their walls and the periductal tissue. A large amount of mucus secreted from the affected ducts was seen within the biliary sludge and calcium bilirubinate stones were found in the involved ductal lumena. These findings suggest that the large amount of mucus and the formation of unevenly dilated ductal lumena may be important in the formation of intrahepatic calculi because these factors may favor nucleation and promote local bile stasis, thereby accentuating the ductal changes and stone formation (a vicious cycle).

Quantitation and serial section observations of focal venocclusive lesions of hepatic veins in liver cirrhosis

The pathogenesis and functional significance of the venocclusive (VO) lesions in small hepatic veins occurring in liver cirrhosis, remain controversial. The present study, using quantitative examination and serial sections has disclosed that these lesions are present in 71.7% of 106 autopsy livers with alcoholic, HBsAg-positive, biliary or cryptogenic cirrhosis. The lesions were usually focal: their number in a liver section (10 cm2) was below 15 in 86.7% of the livers having them. The incidence and morphology of the lesions appeared similar in cirrhotic livers with different aetiology. Serial sections disclosed that the affected veins disappeared within the fibrous stroma at one side and were directly connected with the patent larger hepatic veins at other side, indicating that these veins had lost their function as a draining vein of the hepatic parenchyma. In addition, there was frequent recanalization within the VO lesions, and the recanalized vessels frequently communicated with neighboring thin-walled veins in cirrhotic stroma, suggesting an intrahepatic vein to vein anastomosis. In conclusion, VO lesions, when focal, may themselves be responsible to a lesser degree for obstruction of hepatic venous outflow in liver cirrhosis.

Comparative Study of the Three Nodular Lesions in Cirrhosis

A large number of livers bearing hepatocellular carcinoma (HCC) show cirrhosis [1], suggesting a close relationship between hepatocarcinogenesis and regenerative nodules [1–3]. Attempts to identify intermediate lesions between HCCs and regenerative nodules, particularly adenomatoid hyperplasia, have not been successful. Peters [1] in studying alcoholic cirrhosis with multifocal HCCs suggested that a carcinoma arises as a nodular lesion in a regenerative nodule. Anthony [2] reported that liver cell dysplasia, which is frequently found in liver cirrhosis associated with HCC, especially in hepatitis B surface antigen (HBsAg)-positive patients, might be a potential preneoplastic lesion. Other investigators [4] also proposed that iron-resistant areas within regenerative nodules have a preneoplastic significance in man as well as in experimental animals. Clustering of small dysplastic liver cells or Mallory’s body-containing cells in regenerative nodules might also have the same significance in nonalcoholics [3–5].

T CELL LYMPHOMA PRESENTING CLINICAL AND MORPHOLOGICAL FEATURES RESEMBLING POLYMORPHIC RETICULOSIS AND LYMPHOMATOID GRANULOMATOSIS

A male, 53 years old, complained of a mass on the left side of neck. The biopsy specimens revealed extensive necrotizing lesions with polymorphonuclear leukocyte Infiltration. About three years later a recurrence from the same site was noted and the reblopsy specimens showed features of malignant lymphoma of pleomorphic type. Subsequently multiple cutaneous nodules and then ulcerative lesions of the midfacial region developed and repeated biopsies were done. Immunological examination indicated that the lymphoid cells obtained from the skin lesion had predominantly T‐lymphocyte marker. He died of massive hemorrhage from the nasopharyngeal lesion 51 months after the first admission. Autopsy revealed multiple organ Involvements, including the nasopharynx, lungs, subcutaneous tissue, and adrenal gland. The morphological features In the present case were compatible with a diagnosis of lymphomatoid granulomatosis or polymorphic reticulosis (midline malignant reticulosis), and were thought to be best designated as T cell lymphoma.

Demonstration of Gamma Globulin in Vascular Lesions of Experimental Necrotizing Arteritis in the Rat.

Summary Experimental necrotizing arteritis was produced in female Sprague-Dawley rats by administration of large doses of DOCA and NaCl after unilateral nephrectomy. Presence of RGG in damaged vessel walls was demonstrated by fluorescence antibody technic of Coons. Gamma globulin is deposited in smooth muscle of damaged small arteries, especially in early phases of vascular damage, suggesting that antibody may not be required for this process.

Heparin-Like Substances in Cement Lines of Vascular Endothelium of Guinea Pigs.

Summary A heparin-like substance was demonstrated in the endothelial cement lines of the large vessels and cardiac valves of guinea pigs in vivo. Heparin present in blood increases staining of the lines, probably because of absorption of this substance from the circulating blood.

NODULAR HYPERPLASIA WITH A CENTRAL TELANGIECTATIC FIBROSIS IN THE LIVER OF NON‐CIRRHOTIC PORTAL FIBROSIS (IDIOPATHIC PORTAL HYPERTENSION)

Unusual nodules of hyperplastic hepatocytes were found In the liver of a 64‐year‐old woman with non‐cirrhotlc portal fibrosis (idiopathic portal hypertension). These nodules were subdivded by stellate fibrous tissues which, in the center of the nodules, contained conspicuous telangiectatic lesions with congestion. The latter was consisted of markedly dilated sinusoids and fibrosis of their walls either in a lack of hepatocytes or with severly atrophic hepatic column. The lesions were different from already described focal nodular lesions in the liver. No drugs and chemicals could be identified as the causative agents. The small arterial changes, namely, hyalinization and thickening of their walls and luminal narrowing or occlusion, were found In the nodular lesions and also in the remaining hepatic tissues, and might be a causative factor for the nodular lesions.

Rhabdomyolysis following Status asthmaticus

A case of rhabdomyolysis following an asthmatic attack is reported. A 71-year-old man was admitted because of wheezing and hypoxemia. Brown urine was present on admission. Although these symptoms completely disappeared with the treatment with aminophylline, salbutamol and corticosteroid, transiently elevated serum creatine phosphokinase and myoglobinuria were present. Rhabdomyolysis has rarely been reported in cases of bronchial asthma. This case represents an extremely rare case of rhabdomyolysis following status asthmaticus.

A case of splenic inflammatory pseudotumor

SummaryInflammatory pseudotumor of the spleen in a 50-year-old man was encountered in our surgical clinic. This splenic tumor is very rare and in the ninth of the cases in the literature. The removed spleen, weighting 255g, revealed the presence of a firm, circumscribed mass, measuring 4.5 × 4.0 × 4.5 cm, and histologically presenting marked lamination of collagen fibers around the small vessels associated with granulomatous lesions. The implications of its pathogenesis was analyzed with a review of the literature.Gastroenterol Jpn 1991;26.783-787.