Kazuo Kazama

Nucleolar organizer regions and PCNA expression in prostatic cancers

Argyrophilic nucleolar organizer regions (AgNOR) of 79 prostatic adenocarcinomas, and an immunohistochemical stain using a monoclonal antibody against proliferating cell nuclear antigen (PCNA) of 54 prostatic adenocarcinomas, obtained by needle biopsy and transurethral resection of the prostate between 1986 and 1989, were investigated. A morphological classification was devised to count silver dots based on the relations between intra‐ and extra‐nucleolar AgNOR (type A, B, C and D). Total AgNOR counts were significantly higher in carcinoma (4.2 ± 1.57) than in the benign prostatic lesions (1.90 ± 0.24). Count differences of AgNOR were evident in histological differentiation, nuclear anaplasia, and presence of nucleoli, mitosis, lymphatic invasion and vascular invasion. Higher total AgNOR counts were almost always associated with type B and C AgNOR (intra‐nucleolar AgNOR), but were not associated with type A (nucleolus without small dot) nor type D (extra‐nucleolar AgNOR). This study shows the diagnostic value of AgNOR in prostatic cancer, and the importance of morphological classification of AgNOR. The survival of patients with higher AgNOR counts (≧4.3) was significantly poorer than survival of those with lower AgNOR counts (< 4.3). Significantly more PCNA positive cells were identified in cancer by immunohistochemical stain and correlated with the presence of mitosis, but there was no significant difference in survival rate groups classified by PCNA positivity. It is also suggested that PCNA can be a useful marker of cell proliferation in prostatic lesions, but the AgNOR counts were diagnostically and prognosticate more valuable than immunohistochemical PCNA in prostatic lesions. The correlation between AgNOR and PCNA Immunoreactivity was not significant.

Malignant Lymphoma Developing from Chronic Empyema Wall.

A 74-year-old male, who had been treated with artificial pneumothorax for pulmonary tuberculosis 38 years before, was admitted with fever on May 1992. Chest X-ray revealed the presence of scarred empyema in the right thorax, whereas the abdominal computed tomography indicated the presence of tumor extending from the pleural wall to the liver. The aspirated pleural effusion was suggestive of malignant lymphoma. He died in september 1992. Autopsy revealed non-Hodgkins malignant lymphoma of pleural origin involving lower half of right pleura, right diaphragm and right upper abdominal cavity including the right lobe of the liver. Histologically was diffuse large cell type non-Hodgkins lymphoma according to the LSG classification, showing B cell phenotype on immunohistologic studies. In addition, Epstein-Barr virus (EBV) genome, EBERs, EBNA2 (strong) and LMP (weak) proteins were detected by PCR, in situ hybridization and immunology, respectively, indicating the association of EBV with lymphomagenesis in this case.

Two cases of mammary secretory carcinoma of the breast.

50歳代の成人女性にみられた乳腺分泌癌の2症例について, その穿刺吸引細胞像を中心に報告した.2症例ともに主訴は乳腺腫瘤であった.乳腺分泌癌の細胞像の特徴は, 細胞集塊内外に, いわゆる粘液球状様の構造物 [mucous globular structure (以下MGSと略す)] 様の構造物がみられることで, その他, 印環細胞型の細胞や粘液空胞を有する細胞も認められた.今回の2症例の細胞像を比較すると, 症例1は細胞採取量は多いが, 核異型はむしろ弱く,“MGS”類似の構造を含む「ぶどうの房状」の集塊が多数みられた.組織学的にはきわめて典型的な乳腺分泌癌の像を示した.症例2は核異型が強いために乳癌の診断はむしろ容易であったが, 細胞採取量は少なく,“MGS”様の構造はうかがわれるものの, 典型的な「ぶどうの房状」の集塊は少なく, 印環細胞様の細胞がやや目立った.したがって, 分泌癌の細胞診断はやや困難と思われた.組織学的には典型的な分泌癌の像と混在して, 印環細胞癌様や硬癌様の像がみられた.しかし, 以上の2症例はともに“MGS”様の構造に注目して鏡検することにより, 乳腺分泌癌の細胞診断は可能であると思われた.

A case of acute myeloid leukemia with preceding leukemic infiltration to the uterus and vaginal cytology.

末梢血液中に白血病細胞が出現する以前の膣細胞診および子宮筋腫で摘出された子宮の組織標本に白血病細胞を認め, 3ヵ月後に末梢血液中にも白血病細胞が出現し, 骨髄生検などにより急性骨髄性白血病と診断された非常にまれな症例を報告した.52歳女性, 50歳で閉経. 昭和61年10月9日, 他医にて子宮筋腫の診断で単純子宮全摘術を受け, 組織診で「小円形細胞肉腫」とされた. このときの術前の膣スミアおよび内膜スミァを見直すと組織標本と同様の異常細胞があった. 同年12月24日当院産婦人科入院時の膣断端スミァに穎粒球系由来と思われる異常細胞を認めたが, 末梢血液像は昭和62年1月7日まで異常なかった. 昭和62年1月9日以降, 末梢血液中に骨髄芽球がみられ, 同年1月20日の骨髄穿刺で白血病細胞の増殖が確認された. 1月23目死亡したが, 剖検は行っていない.膣スミアは末梢血液中に白血病細胞が出現する以前に施行したもので, 穎粒球系由来と考えられる白血病細胞を多数認め, 核は類円形～楕円形, N/Cは大, 核内クロマチンは変性のため不明瞭だが, 1～3個の核小体を認めるものもあり, 細胞質は類円形, 一部裸核状や紡錘形であった. 摘出子宮にはASD-クロロアセテート・エステラーゼ陽性, LCA陰性の白血病細胞の浸潤が子宮頸部を中心に一部子宮体部にもみられた.