Kazuhiko Nakagami

Scirrhous argyrophil cell carcinoma of the stomach with multiple production of polypeptide hormones, amine, CEA, lysozyme, and HCG.

Sixteen argyrophil cell carcinomas in 59 gastric scirrhous carcinomas were examined histologically, ultrastructurally, and immunohistochemically for polypeptide hormones, CEA, lysozyme, and HCG. In nine of these 16 tumors, polypeptides such as gastrin, somatostatin, and glucagon were demonstrated. Six of these nine tumors contained all three hormones, and three of these six tumors also had argentaffin cells. In all of these 16 tumors CEA were observed. Eight of them had CEA, lysozyme, and acid mucin synchronously. Of the above six tumors containing three peptides, three produced focal HCG. Ultrastructurally, several types of secretory granules were noted. Histologically, these 16 tumors showed poorly differentiated adenocarcinomas or signet ring cell carcinomas. Macroscopically, generalized type was 11 and localized type five. No hormonal syndrome was detected in any of the patients. It was suggested that these scirrhous argyrophil cell carcinomas of the stomach with the multifunction originate from totipotent immature cells of endodermal origin.

Partial portal arterialization for the prevention of massive liver necrosis following extended pancreatobiliary surgery: Experience of two cases

Massive liver necrosis, which is a severe and highly fatal complication after extended pancreatobiliary surgery, may occur due to an interruption of the hepatic arterial flow caused by such events as an excision of the hepatic artery invaded by cancer, a ligation of the postoperatively ruptured hepatic artery, or a thrombotic obstruction of the reconstructed hepatic artery. In order to improve this ischemic state of the liver, we have performed a partial arterialization of the portal vein by making an arteriovenous shunt at the mesenteric vascular branches in two cases. Although a sufficient pathophysiological investigation could not be fully conducted, partial portal arterialization was considered to be effective in one patient, while no clinically noticeable adverse effects were revealed in the other patient.

Lysozyme in human gastric carcinoma: a retrospective immunohistochemical study.

A total of 171 gastric carcinomas comprising 69 advanced cancers and 102 early cancers were examined immunohistochemically for lysozyme. Tumour cells containing lysozyme were detected in 65 cases or 38% of the 171 gastric cancer cases. The incidence of these cells did not differ remarkably by histological type and infiltrative growth of gastric carcinoma. Of the foregoing 65 cases, two well‐differentiated adenocarcinomas and three signet ring cell carcinomas had numerous lysozyme‐containing tumour cells, 13 had many argentaffin or argyrophil cells, and 40 had various amounts of several types of mucin. In addition, tumour cells containing both lysozyme and mucin could be identified. No correlation could be observed between lysozyme immunoreactivity in the tumour cells and cellular infiltration of granulocytes or macrophages around the tumour. The lysozyme appeared to be produced by tumour cells. The two year survival rates indicate a tendency for advanced gastric cancers containing lysozyme to have a poor prognosis.

DISTRIBUTION OF COLLAGEN TYPES I, III, AND V IN FIBROTIC AND NEOPLASTIC HUMAN LIVER

The distribution of collagen types I, III, and V in normal and fibrotic human livers and hepatocellular carcinoma was studied by indirect immunofluorescence procedure using type specific antibodies. Type I collagen as well as type III collagen was present in normal liver within the portal tracts and along the perisinusoidal spaces. Basement membrane collagen, type V collagen, was demonstrated only around the bile ducts and vessels of the portal tracts and central veins. In fibrotic liver, both type I and III collagens were found in increased amounts in fibrotic areas. In fibrous septa of active cirrhosis, however, type I collagen as well as type III collagen was abundant, whereas in inactive cirrhosis type I fibers were predominant. Type V collagen was observed in the walls of proliferative bile ductules and vessels in the fibrotic liver, and also along the sinusoids in the periportal areas. In hepatocellular carcinoma, each type of collagen was distributed regularly along the sinusoid‐like vascular channels within the tumor.

Distribution of collagen types I and III and basal lamina in human gastric carcinoma: an immunohistochemical and electron microscopic study

Collagen types I and III were examined immunohistochemically in 32 cases of gastric carcinoma classified as poorly differentiated adenocarcinoma with scirrhous stroma, well differentiated adenocarcinoma with intermediate stroma, or poorly differentiated adenocarcinoma with medullary stroma. In the stroma of scirrhous carcinoma, types I and III collagens were distributed abundantly in fibrillar or granular patterns with little difference in the intensity of staining. In well differentiated adenocarcinoma, type I collagen was diffusely distributed in the stroma with type III collagen distributed sparsely. In poorly differentiated adenocarcinoma with medullary stroma, the two types of collagen were only found around capillaries, constituting the tumor interstitium. Electron microscopic examination of scirrhous carcinoma showed tumor cells partially covered with fibroblasts, and discontinuous basal lamina, collagen fibers and microfibrils present between tumor cells and fibroblasts. In well differentiated carcinoma, tumor cells were surrounded by fibroblasts, and well developed basal lamina was observed beneath the tumor cells. In poorly differentiated carcinoma with medullary stroma, the stroma consisted of capillaries and very few fibroblasts with discontinuous basal lamina occasionally being present between tumor cells and fibroblasts.

Induction of carcinoids in the glandular stomach of rats by N-methyl-N′-nitro-N-nitrosoguanidine

SummaryA total of 30 inbred Wistar rats were orally administered 70 μg/ml solution of N-methyl-N′-nitro-N-nitrosoguanidine (MNNG) for 35 weeks and then tap water for the following 20 to 30 weeks. Four of the 20 females and two of ten males developed carcinoids in the glandular stomach, but no metastasis could be found. Carcinoids developed most frequently in the fundic portion along the greater curvature. Histologically, these tumors were medullary anaplastic carcinomas containing two different endocrine cell populations. The first cell type was argentaffin having electron-dense, somewhat pleomorphic secretory granules (437–810 nm) and the second type was argyrophil having round granules with a dense core and a pale halo (550 nm). None of these tumors showed endocrine immunoactivity for gastrin, somatostatin, insulin, glucagon, and enkephalin. One of these gastric tumors developed into scirrhous carcinoma, but differentiated adenocarcinoma could not be seen in the glandular stomach.ZusammenfassungDurch orale Applikation von MNNG (N-methyl-N′-nitro-N-nitrosoguanidin) wurden Carcinoide im Drüsenmagen von Ratten erzeugt. Dreißig Wistar-Ratten wurde eine 70 μg/ml Lösung von MNNG 35 Wochen lang verabreicht, dann erhielten die Tiere 20–30 Wochen lang Leitungswasser. Bei vier von 20 weiblichen und zwei von zehn männlichen Tieren wurden Carcinoide im Drüsenmagen gefunden, Metastasen wurden nicht beobachtet. Die Tumoren waren vorwiegend im Fundusbereich entlang der großen curvatur lokalisiert. Histologisch zeigten die Carcinoide medullär-anaplastische Strukturen, die aus zwei Typen endokriner Zellen bestanden. Der erste Typ war Argentaffin und hatte elektronendichte, mäßig irreguläre Sekretgranula (437–810 nm); der zweite zeigte eine argyrophile Reaktion und hatte runde Sekretgranula mit elektronendichtem Core unter Ausbildung eines Halo (550 nm). Immunhistologische Untersuchungen (PAP-Methode) ergaben keine positiven Reaktionen am Zytoplasma der Tumorzellen gegenüber Antiseren von Gastrin, Insulin, Glucagon und Enkephalin. Einer dieser endokrinen Tumoren entwickelte sich weiter zum scirrhösen Carcinom; ein differenziertes Adenocarcinom des Drüsenmagens wurde nicht festgestellt.

Clinico-pathological studies on ovarian metastasis from gastric cancer.

Thirty autopsied female patients with gastric cancer were investigated clinico-pathologically, regarding ovarian metastases. According to the histological pattern of the ovarian metastases, there were five types; nometastasis in five, capsular type (cancer involvement confined to the capsule) in three, hilar type (carcinoma is evident in the hilus but not in the cortex or medulla) in four, multifocal type (multifocal growth of cancer in the cortex and/or medulla) in eight and diffuse type (diffuse proliferation of cancer) in ten. Although marked peritoneal dissemination was noted in 27, the capsule of the ovaries was usually intact. These results suggest that in the development of ovarian metastasis, cancer cells first reach the hilus, then spread into the medulla or cortex multifocally, and later grow diffusely. While cancer cells reach and cover the capsule of the ovary in many instances, they seldom break and invade it. All seven patients, except one unknown patient, with no-metastasis and with the capsular type were postmenopausal, while one hilar, two multifocal and five diffuse type women were premenopausal. This indicates an “affinity” of ovarian tissue for cancer cells, in younger patients.

Comparative studies on cytological and histological evaluations of disseminating peritoneal metastasis in gastric cancer

Macroscopic disseminating peritoneal metastasis of gastric cancer (P) was investigated in relation to its compatibility with microscopic findings (p) in 52 (P1 19, P2 21, P3 12) cases among 240 gastrectomized cases by cytological, histological, clinical and postmortem findings. In total, numbers of the evaluations for yes (P is p), probable (P is probably p), possible (P is possibly p), probably not (P is probably not p) and no (P is not p) were 28 (53.8%), 8 (15.4%), 14 (26.9%), 2 (3.8%) and 0, respectively. These results indicate that macroscopic disseminating peritoneal metastasis is compatible with microscopic findings, in most cases. Although histology is the most contributory factor for the evaluation of peritoneal dissemination, cytology of lavaged saline from the Douglas pouch also is important.