Hitoshi Sugiura

Anatomic Properties of Myocardial Bridge Predisposing to Myocardial Infarction

Background— A myocardial bridge (MB) that partially covers the course of the left anterior descending coronary artery (LAD) sometimes causes myocardial ischemia, primarily because of hemodynamic deterioration, but without atherosclerosis. However, the mechanism of occurrence of myocardial infarction (MI) as a result of an MB in patients with spontaneously developing atherosclerosis is unclear. Methods and Results— One hundred consecutive autopsied MI hearts either with MBs [MI(+)MB(+) group; n=46] or without MBs (n=54) were obtained, as were 200 normal hearts, 100 with MBs [MI(−)MB(+) group] and 100 without MBs. By microscopy on LADs that were consecutively cross-sectioned at 5-mm intervals, the extent and distribution of LAD atherosclerosis were investigated histomorphometrically in conjunction with the anatomic properties of the MB, such as its thickness, length, and location and the MB muscle index (MB thickness multiplied by MB length), according to MI and MB status. In the MI(+)MB(+) group, the MB showed a significantly greater thickness and greater MB muscle index (P<0.05) than in the MI(−)MB(+) group. The intima-media ratio (intimal area/medial area) within 1.0 cm of the left coronary ostium was also greater (P<0.05) in the MI(+)MB(+) group than in the other groups. In addition, in the MI(+)MB(+) group, the location of the segment that exhibited the greatest intima-media ratio in the LAD proximal to the MB correlated significantly (P<0.001) with the location of the MB entrance, and furthermore, atherosclerosis progression in the LAD proximal to the MB was largest at 2.0 cm from the MB entrance. Conclusions— In the proximal LAD with an MB, MB muscle index is associated with a shift of coronary disease more proximally, an effect that may increase the risk of MI.

Histopathological predictors of regional lymph node metastasis at the invasive front in early colorectal cancer

Akishima‐Fukasawa Y, Ishikawa Y, Akasaka Y, Uzuki M, Inomata N, Yokoo T, Ishii R, Shimokawa R, Mukai K, Kiguchi H, Suzuki K, Fujiwara M, Ogata K, Niino H, Sugiura H, Ichinose A, Kuroda Y, Kuroda D & Ishii T
(2011) Histopathology59, 470–481

Crystalloids in angiomyolipoma: 1. A previously unnoticed phenomenon of renal angiomyolipoma occurring at a high frequency

We present a description of unique crystalloids in renal angiomyolipoma that have not previously been reported. The crystalloids cannot be identified by hematoxylin-and-eosin staining. Detailed observation after diastase treatment followed by PAS staining revealed needle- and rodlike crystalloids, which were clearly seen even by light microscopy, in 11 of 17 patients. Their appearance was characterized by the following phenomena: (a) They appeared mainly in large epithelioid smooth-muscle cells; (b) they appeared at a relatively high frequency at sites where smooth-muscle cells showed diffuse proliferation and where a hemangiopericytic pattern was observed; (c) they were often detected easily even at a site with a sarcomatous appearance; and (d) PAS-positive, diastase-resistant granules were often observed by light microscopy in the vicinity of crystalloids in all 17 patients. Electron-microscopic observation of one patient also revealed characteristic crystalloids. Prior to our study, only one patient had been reported to show crystalloids by electron microscopy, and the crystalloids were interpreted as renin. However, our study used Bowies staining and immunohistochemistry to prove they were not renin. The nature of the crystalloids still needs to be elucidated. The fact that they closely resemble structures seen in alveolar soft part sarcoma provides one clue to their identification.

Invasive lobular carcinoma arising in phyllodes tumor of the breast

Phyllodes tumor is an uncommon breast tumor that accounts for less than 1% of all breast tumors [10]. The tumors are usually benign, but they may undergo malignant transformation, which usually occurs in the stromal component of the tumors. Although malignant transformation of the epithelial component of phyllodes tumors of the breast is extremely rare, it has been reported in several cases of ductal carcinoma in situ, infiltrating ductal carcinoma, and lobular carcinoma in situ [1, 5, 6, 7, 11]. We report the first case of infiltrating lobular carcinoma arising in phyllodes tumor of the breast. A 47-year-old Japanese woman was referred to the Keio University Hospital in July 1993 because of a painless mass in her right breast that the patient had first noticed 10 years previously. Her past history was uneventful, and her family history was unremarkable. Ultrasonography of the tumor showed a huge, low-echoic lesion without calcification, and a mammogram revealed a homogeneous, well-circumscribed mass. Physical and radiological examinations of her left breast for neoplastic lesions were unremarkable. Based on these findings, the preoperative diagnosis was benign phyllodes tumor. In August 1995, right subcutaneous mastectomy was performed, and no evidence of recurrence or metastasis has been detected during the 9 years since the operation. After macroscopic examination of the resected tumor, it was fixed in 10% formalin. Paraffin sections were prepared and stained with hematoxylin and eosin and with Schiff’s solution and hematoxylin for periodic acid– Schiff (PAS) staining. Sections were immunostained according to the avidin-biotin peroxidase method with anti-cytokeratin AE1/AE3 antibody (Dako Japan, Tokyo; 1:100 dilution), anti-estrogen receptor antibody (Dako Japan; 1:100 dilution), and anti-progesterone receptor antibody (Dako Japan; 1:50 dilution). Macroscopic inspection revealed a grayish-white, elastic, firm mass 17 16 8.5 cm in size. The tumor was not encapsulated, but its margin was well defined. The tumor was composed of lobulated nodules of various size and cystic areas (Fig. 1A). No satellite neoplastic lesion was found in the surrounding tissue. Microscopically, the tumor had a very heterogeneous appearance and was characterized by combined proliferation of ductal epithelium and stromal cells. At low magnification, the tumor exhibited a phyllodes pattern, i.e., slit-like ductal structures lined mainly by pseudo-stratified or columnar epithelial cells (Fig. 1B), but some areas of the tumor consisted of fibrous and myxoid stroma, and most of the stromal component exhibited high proliferative activity. Phyllodes tumors must be differentiated from giant fibroadenomas, and these findings indicated that the tumor was not a giant fibroadenoma. The stromal component was composed of collagen fibers and fibroblast-like stromal cells without atypia or mitoses, indicating that the stromal component was benign. The epithelial cells lining the ductal structures also displayed benign features in most areas; however, small epithelial cells with large nuclei were observed in the epithelial component of the lobulated clefts. These atypical cells had formed solid islands of tumor cells, which frequently spread to the ductal epithelium (Pagetoid spread), and thus the lesion was diagnosed as lobular carcinoma in situ (Fig. 1C, D). The carcinoma cells were PAS-positive (data not shown), and, although they were mainly confined to the ducts, they had also invaded the stroma of the tumor (Fig. 1E), where an “Indian-file” pattern was T. Kodama · Y. Okada Department of Pathology, Keio University School of Medicine, Tokyo, Japan

Giant Cell Fibroblastoma: A Case Report and lmmunohistochemical Comparison with Ten Cases of Dermatofibrosarcoma Protuberans

A 7 year old boy with giant cell fibroblastoma (GCF) of the skin and subcutaneous tissue of the right chest wall is described. To date, the histogenesis of GCF has not been clarified. The reason for the diversity of immunohistochemical data among various authors may be because the specimens studied were from only part of the lesion, or reduction of antigenicity through the preparation process. However, our findings based on studies of many specimens from various parts of the tumor for accurate immunohistochemical evaluation suggest that GCF may be a myofibro histiocytic tumor. Recently, the suggestion that GCF is a juvenile form of dermatofibrosarcoma protuberans (DFSP) has been reported. In addition to the present case, we performed immunohistochemical examination of 10cases of definitely diagnosed DFSP for comparison. The immunohistochemical characteristics of these two neoplasms were concordant. However, from clinical and morphological viewpoints, it seems premature to recognize GCF as a juvenile form of DFSP. Acta Pathol Jpn 41: 552–560, 1991.

Primary non‐Hodgkin's lymphoma of the main hepatic duct junction

A rare case of primary non-Hodgkins lymphoma of the main hepatic duct junction is reported. A 71-year-old man was admitted for treatment of obstructive jaundice. Radiological examination revealed stenosis of the main hepatic duct junction. Biliary drainage was not necessary because total bilirubin decreased spontaneously. A left hepatic and caudate lobectomy, combined with resection of bile ducts and lymph node dissection, was performed with the preoperative diagnosis of cholangiocarcinoma of the main hepatic duct junction. Macroscopic examination of the resected specimen revealed tumorous growth in the main hepatic duct junction. Histological and immunochemistry findings disclosed a mucosa-associated lymphoid tissue (MALT) lymphoma. The patient received three courses of combination chemotherapy [cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP)], and there was no evidence of recurrence 45 months after the surgery. Although primary non-Hodgkins lymphoma of the main hepatic duct junction is extremely rare and difficult to diagnose preoperatively, aggressive surgery followed by chemotherapy, as here, is a possible curative option.

A case of invasive group A streptococcal infection associated with chronic granulomatous interstitial pneumonitis

A 52-year-old man with chronic granulomatous interstitial pneumonitis suffered from invasive group A streptococcal infection. His chest x-ray showed bilateral interstitial shadows in the lower lung fields since childhood. He was admitted to Keio University Hospital because of fever, productive cough, and necrosis of the distal extremity. The chest radiographic appearance worsened and he developed low blood pressure, liver dysfunction, thrombocytopenia, and lymphocytopenia. Blood culture yielded T-11 strainStreptococcus pyogenes, which generated type B and C pyrogenic exotoxins. This may be the first report to confirm T-11Streptococcus pyogenes as the causative organism for invasive group A streptococcal infection in Japan. The patients condition improved after treatment with panipenem and subsequent combination therapy with high-dose penicillin G and gentamicin. An immunodeficiency state associated with the chronic granulomatous lung disease was strongly suspected.

Calcifying tendinitis in twy mouse.

A morphological and biochemical study of calcifying tendinitis in twy mouse was carried out. Calcification of the aponeurosis plantaris was first observed at the 7th week of age. Thereafter multinucleated giant cells and histiocytes were seen around the calcium deposits. Infiltration of polymorphonuclear leukocytes followed. These inflammatory cell reaction confined to the tendon. Then, proliferation of capillaries and fibroblasts was observed, and lacunar formation around the calcium deposits was sometimes observed. In later stage, inflammatory cell infiltration subsided, and fibrous scar and calcium deposits were recognized in the tendon. Deposition of hydroxyapatite was confirmed in the tendon by X-ray powder analysis.These changes resemble those of man, and calcifying tendinitis in twy mouse is thought to be a valuable model of the corresponding disease in man.