Hideo Shibata

Recurrent cerebral infarctions and del(10)(p14p15.1) de novo in HDR (hypoparathyroidism, sensorineural deafness, renal dysplasia) syndrome

We report on a Japanese boy with HDR syndrome (hypoparathyroidism, sensorineural deafness, renal dysplasia) and recurrent cerebral infarctions in the basal ganglia. The patient experienced cerebral infarctions four times between age 7 months and age 20 months. Chromosome analysis of the patient demonstrated a 46,XY, del(10)(p14p15.1) de novo. This suggests that the putative gene responsible for HDR syndrome is located at 10p14-p15.1.

BREAST CANCER WITH OSTEOCLAST‐LIKE MULTINUCLEATED GIANT CELLS

A case of breast cancer containing osteoclast‐like multinucleated giant cells was examined cytologically, light and electron microscopically to find morphological evidences suggesting the origin of the giant cells. There were multiple evidences showing the same carcinomatous origin of each cell including osteoclast‐like multinucleated giant cells. ACTA PATHOL. JPN. 34: 1475–1484. 1984.

Serologically defined genotypes of hepatitis C virus among Japanese patients with chronic hepatitis C

Recently, Tsukiyama-Kohara et al. (1993) reported that most hepatitis C viruses (HCVs) in Japan can be classified into two types, type 1 and type 2, on the basis of the NS4 region nucleotide sequence. They developed a new assay in which antibodies against group-specific recombinant proteins of the NS4 region were measured by ELISA (serologically defined genotype, serotype). In the present study, we examined 306 patients with chronic liver disease due to HCV infection. The sensitivity of this assay was 98.7% (302/306). The serotype distribution of HCV was 230/306 (75.2%) for type 1, 65/306 (21.2%) for type 2, 7/306 (2.3%) for mixed, both being positive, and 4/306 (1.3%) indeterminate. The frequency of type 1 was significantly higher than that of type 2 (P < 0.01). There were no significant differences in clinical characteristics among the mixed and the indeterminate serotypes. Among the mixed-serotype patients, 4/7 (57.1%) showed seroconversion to a single serotype at 6 and 9 months later, although the serotypes of the indeterminate-serotype patients were also indeterminate at 6 and 9 months later. Using aliquots of the same serum samples, HCV genotyping was carried out by the reverse transcription polymerase chain reaction (RT-PCR) method using type-specific primers derived from the NS5 region of HCV to verify the specificity of this serotyping. The sensitivity of genotyping by RT-PCR was 167/183 (91.3%). The HCV genotypes determined by both methods were consistent in 161/183 (88.0%) of the cases, and there were no contradictory results for any sample between the two methods. These findings indicate that serological genotyping might be useful in determining the HCV genotype among Japanese patients with HCV infection.

ACTH-Induced Seizures in an Infant with West Syndrome

We report seizures induced by adrenocorticotropic hormone (ACTH), which were demonstrated clinically and electro-encephalographically, in a severely handicapped 7-month-old infant with West syndrome due to perinatal hypoxicischemic encephalopathy. Although tonic spasms (original seizures) decreased soon after starting ACTH treatment, new brief tonic seizures, somewhat more slowly motioned than the original tonic spasms, frequently appeared only during sleep after consecutive ACTH injections for 11 days, in place of the tonic spasms seen in the waking state. After discontinuation of ACTH therapy with the last injection on the 16th day, the brief tonic seizures began to decrease and finally disappeared in 8 days. Ictal EEG of new brief tonic seizures revealed diffuse fast spiky wave bursts, 50-150 microV and 10-20 c/s, with a duration of 0.5-4 seconds, which were different from attenuation associated with low voltage rhythmic fast activity corresponding to tonic spasms, the original seizures. Therefore, we considered that the new brief tonic seizures, which appeared only during sleep in the course of ACTH therapy, were ACTH-induced seizures.

Reliability of Cytological Grading of Prostatic Carcinoma Compared with Histological Grading

Thirty prostatic carcinomas diagnosed simultaneously by fine needle aspiration cytology and punch biopsy were graded into three groups according to their cytological and histological appearances. Among them 23 carcinomas were graded equally by both methods. Cytological examination appears to be suitable for grading prostatic carcinoma, thus being a possible indicator of the patients prognosis and response to hormonal therapy. In addition to the results obtained here, fine needle aspiration cytology has many advantages such as simplicity, quickness and safety. With increase of attention of urologists and pathologists to fine needle aspiration cytology, this evaluation will become comparable to the histological examination not only as a routine diagnostic tool.

Seroprevalence ofHelicobacter pylori and association with atrophic gastritis in patients with Sjögren’s syndrome

To investigate the association betweenHelicobacter pylori (HP) infection and atrophic gastritis in Sjögren’s syndrome (SS), we conducted an age-matched case-control study examining serum HP-IgG antibodies and pepsinogen (PG) I and II levels using ELISA. The sera of 82 primary SS (1-SS), and 57 secondary SS (2-SS) were studied, as well as 198 controls having a diagnosis of connective tissue disease (CTD), except for SS which were obtained according to age. The titers of HP-IgG in 1-SS were significantly much higher than those in either 2-SS or control. The HP-IgG level revealed an exclusively positive correlation with the serum PG II level and a negative correlation with the PG I/II ratio. Serum PG II levels and PG I/II ratios were associated with the positivity of HP-IgG antibodies. The age-specific seroprevalence rates of HP infection in SS patients compared with controls showed a high positivity in patients less than 49 years old, but no difference among the higher age groups because of increasing positive rates with advancing age in the control. The matched odds ratio with HP infection in all SS (1-SS and 2-SS) and in 1-SS were 2.33 (95% CI: 1.43–3.81) and 2.75 (95% CI: 1.50–5.05), respectively. However, the positive PG I/II ratio did not show a statistically significant odds ratio for SS. We conclude that SS patients have a highly positive association with HP infection and that atrophic gastritis with SS may occur as a result of HP infection.

Epithelia in both seminal vesicles and ejaculatory ducts as a pitfall in the cytologic diagnosis of prostatic carcinoma.

前立腺穿刺吸引細胞診で偽陽性の原因のひとつである精嚢上皮系の細胞について検討した.材料は前立腺穿刺吸引細胞診31症例, 術中迅速細胞診1症例および剖検時精嚢塗抹細胞診47症例を使用した.40歳以上の症例における精嚢上皮系細胞は, 核の大小不同が顕著で, クロマチン量が多く, クロマチンは粗顆粒状で, 核内に不均等に分布する細胞がみられるが, 同時に細胞質内色素顆粒・核内細胞質封入体, 核形不整, 核皺襞形成がみられ, 核小体は不明瞭なことが多い.前立腺腺癌細胞には細胞質内色素顆粒や核内細胞質封入体は認められないので, 異型細胞を注意深く観察すると, これら両者の鑑別は可能と考えられ, 精嚢上皮系細胞の混入に起因した偽陽性や疑陽性率の低下が期待される.

Advantages of the Mucopolysaccharide Stains in Differential Diagnosis of Adenocarcinoma Cells in Pleural and Peritoneal Effusions

In this report, the authors introduce an advantage of the mucopolysaccharide stains in differential diagnosis of adenocarcinoma cells in pleural and peritoneal effusions. Periodic acid-Shiff (PAS) positive materials are almost always detected in the cytoplasm of adenocarcinoma cells. There is, however, some differences in size, amount and distributions of PAS-positive materials among adenocarcinoma cells originated from different organs. They show reticular or granular pattern in papillary adenocarcinoma and accumulative pattern in tubular and poorly differentiated adenocarcinoma of the stomach, granular pattern in serous cystadenocarcinoma and diffuse, accumulative or reticular pattern in pseudomucinous cystadenocarcinoma of the ovary, reticular or granular pattern in papillotubular and medullary tubular carcinoma of the breast reticular pattern in adenocarcinoma of the lung, and reticular or granular pattern in adenocarcinoma of the gallbladder, colon and uterine cervix. Alcian blue stain findings are also described.The authors considered the polysaccharide stains as helpful and useful methods, not only for differentiation of carcinoma cells from other benign cells, but also for detection of a primary lesion and of a histological subtype of adenocarcinoma, in combination with Papanicolaou and Giemsa stains.