Kenjiro Shirasawa

Widespread eczema vaccinatum acquired by contacts. A report of an autopsy case.

A4‐moth‐old male infant predisposed to allergic dermatitis acquired widespread eczema vaccinatum by contacts with a recently vaccinated sibling. He died of acute purulent peritonitis following a perforation of multiple duodenal ulcers. Fluorescence immunocytochemical and electron microscopic studies on the skin lesions revealed the presence of viral antigens and numerous virus particles compatible morphologically with those of the mature form from the same batch of smallpox vaccine given to the sibling. A large number of virus particles in the developmental form were also predominantly scattered in the cytoplasm of cells at the stratum malpighii of the epidermis as well as in neutrophils and macrophages in the skin lesions. The virus isolation from the skin lesions was done by using the HeLa cells and the human embryonic lung fibroblasts. No abnormal laboratory data were noted in immunoglobulins. On the basis of atrophy of the thymus and other lymphatic tissues and an appearance of large pyroninophilic cells in association with blastoid transformation, the authors discussed a possible participation of the disturbance of cellular immunity secondary to the virus infection in the development of the disease. ACTA PATH. JAP. 29: 435–455, 1979.

ACUTE LEUKEMIA OF MEGAKARYOCYTE LINEAGE WITH TUMOR FORMATION: An Autopsy Case of Patient with Down's Syndrome

In this report we present the autopsy findings of acute megakaryoblastic leukemia with tumor formation in a 2‐year‐old female infant with Downs syndrome. Chromosomal analysis of blast cells revealed constitutional anomaly of trisomy 21 and two other related types of abnormal clones. Flow cytometric examination revealed blast cells expressing Ia‐like or HLA‐DR antigens. Postmortem examination showed extensive inffltration of leukemic cells in most of the examined organs, including the bone marrow with myelofibrosis. Tumor masses in the maxillary, frontal and femoral bones and the atria of the heart had undergone massive infiltration of atypical blast cells with an increase in the reticulin network. The final diagnosis was confirmed by ultrastructural cytochemistry of the platelet peroxidase reaction as well as by immunological staining utilizing anti‐platelet glycoprotein IIb/IIIa, anti‐platelet factor 4 and anti‐β‐thromboglobulin antibodies for the blast cells. It seems likely that platelet‐derived growth factor, secondary to an increase in the reticulin network, plays a major role in myelofibrosis of acute megakaryoblastic leukemia with tumor formation. ACTA PATHOL JPN 38: 193–207, 1988.

Type iii glycogenosis with deposition of urate and amyloid

A case of a 44‐year‐old man with hepatic form of glycogenosis was presented. The patient had abdominal distension and muscular weakness. The glucose tolerance test showed a diabetic pattern, though he had hypoglycemia in fasting state. The fructose tolerance test showed an ability of conversion from fructose to glucose. The double glucagon test showed no rise of blood glucose in fasting state but a rise 2 hours after meal. These symptoms and laboratory data supported the clinical diagnosis of type III glycogenosis. At autopsy, glycogen was markedly deposited in the liver, and slightly in the kidneys and heart. The glycogen pooled in the hepatic cells histochemically showed a normal reaction to several glycogen stainings. Electron microscopy by using Thiérys method revealed that the pooled glycogen particles were clearly arranged as rosettes measuring 1.000Å in largest diameter composed of clustered monoparticulates. There were marked hyalinization of the islets of Langerhans containing amyloid. As to its pathogenesis, this change can be interpreted as a morphological expression of the hypofunction of β‐cells ascribed to long‐standing hypoglycemia.

Four autopsy cases of acute viral myocarditis

SummaryFour autopsy cases of acute idiopathic myocarditis were studied by means of immunofluorescent techniques and electron microscopy. All patients died of acute cardiac failure of sudden onset 2–7 days after the appearance of common cold symptoms. Postmortem examination revealed eccentric cardiac hypertropy and pericarditis in all cases. Two of the four cases showed severe necrosis of the myocardium with infiltration by mononuclear cells. Coxsackie B virus antigens were detected in three cases and virus particles were demonstrated electron-microscopically in three cases.

STUDIES ON THE INITIAL REACTIVE SITES FOR PLATELET ACTIVATION

The binding sites for cationized ferritin or ferritin‐conjugated wheat germ agglutinin on the cell surface were studied on platelets before or after fixation in glutaraldehyde. The effects of neuraminidase on the binding sites were also demonstrated after fixation of the platelets. Changes in the binding sites and distribution pattern due to exposure to these ligands were further investigated in the unfixed platelets under a variety of conditions such as incubation time and medium. The fixed platelets incubated with either ligand showed an even and continuous distribution of particles on the cell surface. In the unfixed platelets, the ligands were rapidly moved and aggregated probably by lateral migration after binding to the cell surface. The ligands were also bound to the membrane surface and simultaneously appeared in the interior of the open canalicular system. As the binding sites were moved on the cell surface as well as into the open canalicular system, morphological changes suggestive of platelet secretion occurred. The binding sites of either ligand were redistributed on the platelet cell surface. Glycoprotein lb, thought to be the receptor site for wheat germ agglutinin on the cell surface, contains sialic acids that contribute to the negative charge of platelets. Therefore, glycoprotein lb may play an important role as the initial reactive site for thrombotic stimuli.

FAMILIAL MEDULLARY CARCINOMA OF THE THYROID THROUGH 3 GENERATIONS

A family with high genetic penetrance of medullary carcinoma of the thyroid was reported. Seven proven (6 patients and one autopsy case) and 2 probable cases of medullary carcinoma were present in 25 members through 3 generations. An endogamy had intervened in the prior generation of these cases. Preliminary results in clinicopathological examinations of 7 proven cases were as follows; clinically, all of the cases showed B type blood group. Glycosuria was found in 2 cases, and diarrhea in one case. Serum thyrocalcitonin being estimated In two cases showed high levels. The autopsy cases coexisted with medullary carcinoma of the thyroid and pheo‐chromocytoma of the right adrenal. Pathologically, the majority of tumors occurred in both thyroid lobes, and were present from the middle to upper portion of the thyroid. The tumor showed a variety of histological features even in the same tumor. In the tumor cell, numerous membrane‐limited granules were seen with an electron microscope. Amyloid was demonstrated only In the tumor tissue.