Makoto Motoi

Familial juvenile Polyposis of the Stomach

Innumerable polyps of the stomach were recognized in a 13-yr old girl. She had no extragastric polyps on roentgenographic and endoscopic studies. Her elder brother received a subtotal gastrectomy because of gastric polyposis at 14 yr of age. Their mother died of gastric cancer at 37 yr of age. Only these three subjects in this family had unusual brown hair and were low in normal intelligence. Polyps produced chronic and severe loss of both blood and protein, which resolved after a subtotal gastrectomy at 18 yr of age. Macroscopic and histologic observations of polyps in the resected stomach confirmed the diagnosis of juvenile polyposis. Both siblings are now in good health. Classification of this hereditary syndrome as a newly recognized entity, familial juvenile polyposis of the stomach, is proposed.

Immunohistochemical studies on human brain tumors using anti-Leu 7 monoclonal antibody in paraffin-embedded specimens

SummaryUsing the four-step peroxidase-antiper-oxidase (PAP) method, the presence of the antigen recognized with anti-Leu 7 monoclonal antibody was investigated in paraffin-embedded human brain tissue and tumors. The antigen was demonstrated in the myelin sheaths, oligodendrocytes, and some choroid plexus cells in normal brain and in oligodendrogliomas, some astrocytomas and choroid plexus papillomas. The technique can be used to identify hormal and neoplastic oligodendrocytes.

INDUCTION OF UNDIFFERENTIATED TUMORS BY JC VIRUS IN THE CEREBRUM OF RATS

Newborn Sprague‐Dawley rats were inoculated intracranially with JC virus (Tokyo‐1), a human polyomavirus, which had been isolated by Nagashimaet al. from the autopsied brain of a patient with progressive multifocal leukoencephalopathy in Japan. Twenty‐one to 70 weeks later, 21 of 27 rats developed brain tumors in the cerebrum, but not in the cerebellum. Most of the tumor cells were of an undifferentiated neuroectodermal nature and showed nuclear palisades and pseudorosettes. In some tumor cells glial flbrillary acidic protein was positive immunohistochemically, and many glial filaments were demonstrated ultrastructurally. Neuronal differentiation was not proved. Two continuous lines of cultured tumor cells were established, and T antigen of JCV (Tokyo‐1) was present in both cell lines. Glial differentiation was confirmed also in the tumors produced by subcutaneous transplantation of cultured tumor cells.

Immunohistochemical studies on cellular character of microtumors induced by ethylnitrosourea in the rat brain utilizing anti-Leu 7 and anti-glial fibrillary acidic protein antibodies.

SummaryTo clarify the chronologic changes in the cellular morphology of ENU-induced rat brain tumors, microtumors in the early stage were examined ummunohistochemically in comparison with macrotumors in the advanced stage. The tumor cells composing microtumors were negative for glial fibrillary acidic protein (GFAP), a specific marker of astrocylic cells, and Leu 7, a marker of oligodendrocytes, while cells of macrotumors were positive for either GFAP or Leu 7, showing characteristics of mature glial cells. The results suggested that the small round cells in the early devolopmental stage, generally thought to resemble mature oligodendrocytes, are not differentiated oligodendrocytes or astrocytes.

MALIGNANT FIBROUS HISTIOCYTOMA OF THE MAXILLARY SINUS

A case of malignant fibrous histiocytoma arising primarily in the left maxillary sinus is described. The patient, a 39‐year‐old male, who had suffered from sinusitis for 20 years, began to have paresthesia or sharp pain of the left side of the face and toothaches of the left maxilla. At operation a white fibrous tumor developing extensively from the lateral wall to the upper and medial walls of the left maxillary sinus and into the ethmoidal sinus was noted. Following gradual progression of dyspnea, he died approximately one year after the onset in spite of radiation therapy and anticancer chemotherapy. An autopsy revealed recurrence of the tumor in the left maxillary sinus with wide‐spread metastases to the lungs, pleurae, pancreas, kidneys and bone marrows. The direct cause of death was respiratory failure due to extensive growths of the pulmonary and pleural metastases.

AN IMMUNOHISTOCHEMICAL STUDY ON THE DISTRIBUTION OF GLIAL FIBRILLARY ACIDIC PROTEIN, S-100 PROTEIN, NEURON-SPECIFIC ENOLASE, AND NEUROFILAMENT IN MEDULLOBLASTOMAS

In order to clarify the differentiation of medulloblastomas, the authors studied on the morphological features and immunohistochemical expression of glial flbrillary acidic protein (GFAP), S‐100 protein, neuron‐specific enolase (NSE), and neuroftlament (NF) in 31 medulloblastomas. GFAP was detected only in a small number of tumor cells of 5 medulloblastomas; S‐100 protein in both small tumor cells and some so‐called spongloblastic cells in 16 medulloblastomas; NSE in the more abundant tumor cells and the matrix in 28 medulloblastomas; NF in a few tumor cells of 12 medulloblastomas; GFAP and NF in 2 medulloblastomas, but each of them in different tumor cells. These results suggest that medulloblastomas have a capacity of differentiation along neuronal and/or glial lines. The conventional morphological markers of differentiation in medulloblastomas such as spongioblastic cells and Homer Wright rosettes were not necessarily compatible with expression of immunohistochemical markers such as GFAP or NF. NSE and S‐100 protein seem less valuable markers of differentiation because they were detected in both neuronal and glial elements. But NSE, which was observed in most medulloblastomas, might have a value as a marker for medulloblastomas.

Gastric carcinoma with psammomatous calcification after Billroth II reconstruction : Case report and literature review

A case of gastric carcinoma with psammomatous calcification arising in the remnant stomach after Billroth II reconstruction is reported. Borrmann type 1 gastric carcinoma was detected in the remnant stomach of an 82‐year‐old woman, who had a past history of distal partial gastrectomy for a perforated gastric ulcer, with Billroth II reconstruction at 40 years of age. Histologically, the tumor was a tubular adenocarcinoma that invaded the muscularis propria. Numerous psammoma bodies were found in the lumens of the tumor glands. Dystrophic calcification of gastric cancer is rare and psammomatous calcification of gastric cancer has only been reported in five cases previously. To our knowledge, this is the first case of gastric carcinoma with psammomatous calcification arising in the remnant stomach. We also review previously published reports regarding gastric carcinoma with psammomatous calcification.

Aggressive angiomyxoma of the vulva. Report of a case.

A case of aggressive angiomyxoma of the vulva is reported. A 43 year‐old woman presented initially in 1987 with a left vulvar mass which clinically was thought to be a lipoma or a Bartholin gland cyst. Local excision was performed after a 27 month follow‐up without any change in size. The resected tumor measured 2.7x2.0x2.0cm and had a smooth, glistening and myxoid cut surface. Histologically, the lesion was composed of spindle shaped or stellate neoplastic cells, which were loosely textured in the fibromyxoid matrix, and a prominent vascular component characterized by randomly distributed vascular channels of variable caliber. Immunohistochemically, the tumor ceils were positive for vimentin, but not for desmin and myosin. The fine structure of the neoplastic cells was compatible with that of fibroblasts rather than myofibroblasts. These findings suggest the fibroblastic differentiation of this tumor. The patient is currently well with no evidence of recurrence, 7 months after excision of the tumor. Acta Pathol Jpn 40: 927–934, 1990.

MULTIPLE CARCINOID TUMOR COMBINED WITH MUCOSAL CARCINOMA IN THE STOMACH

A case of gastric multipe carcinoid tumor combined with mucosal carcinoma in a 63‐year‐old female is reported. The carcinoid tumors, larger than 0.5 mm in diameter, and endocrine cell micronests, smaller than 0.5 mm in diameter, were mostly located in areas of chronic atrophic gastritis. Their distribution was coincident with that of multiple carcinoid tumor in type A gastritis. The majority of the tumor cells were positive for human chorionic gonadotropin (HCG) and Leu 7 by immunohistochemistry and contained various numbers of intracytoplasmic secretory granules as revealed by electron microscopy. Two mucosal carcinoma foci did not show endocrine characteristics. These carcinoid tumors were thought to have originated in HCG‐producing argyrophil cells which had been stimulated by hypergastrinemia accompanying chronic atrophic gastritis. The mucosal carcinomas were regarded as incidental.

Isolation of virus-producing transformants from human gastric cancer cell line, HGC-27, infected with human T-cell leukemia virus type I.

A human anaplastic gastric cancer cell line, HGC‐27, showed marked degeneration with formation of multinucleated syncytia and cell detachment of nearly all cells which began 24 hr after and reached a maximum 2 to 3 days after co‐cultivation with X‐irradiated MT‐2 cells, HTLV‐I producing human cord leukocytes. Less severe degeneration without formation of syncytia was also observed in the cultures inoculated with cell‐free MT‐2 culture media. Morphologically altered cells began to proliferate and formed piled up colonies in some of the cultures co‐cultivated with X‐irradiated MT‐2 cells after a long culture period. The two clones designated HGC/MT2 (Cl‐1) and HGC/MT2 (Cl‐2) were separated by cell cloning. HGC/MT2 (Cl‐1) and HGC/MT2 (Cl‐2) cells were positive for HTLV‐I gag proteins (p19 and p24) and pX gene products, p40x, as demonstrated by immunohistochemistry and immunoblotting analysis, contained HTLV‐I provirus DNA, and consistently produced type C virus particles.