Masamichi Usui

Malignant granular cell tumor of the radial nerve. An autopsy observation with electron microscopic and tissue culture studies

Malignant granular cell tumor closely associated with the radial nerve in the left upper arm, was found in a 34‐year old man. The tumor increased rapidly in size, was locally invasive and showed recurrence and metastases to lymph nodes and the lungs. The tumor was composed solely of granular cells and its histological features were very similar to those of benign granular cell tumors. However, considerable variation of cellular size and shape, hyperchromatic plump nuclei, and some disordered cellular arrangement were thought to be significant indications of malignancy. Ultrastructural study of the tumor revealed many lysosome‐like dense granules in the cytoplasm. The presence of a few axon‐like cytoplasmic processes between granular cells and the intimate anatomical association of the tumor with the radial nerve seemed to support the concept of peripheral nerve origin of the malignant granular cell tumor.

Long-term results of Kienböck's disease treated by excisional arthroplasty with a silicone implant or coiled palmaris longus tendon+

Of 32 patients with Kienböcks disease, 19 had lunate silicone implant replacements, and 13 had coiled palmaris longus tendon replacement. The carpal height was measured and osteoarthritic changes were noted in plain x-ray films before and after the operation. Follow-up periods ranged from 3 to 11 years, with an average of 6 years 4 months. In patients in the mild stages of the preoperative carpal collapse, both excisional arthroplasties had good clinical results. The x-ray films showed that a silicone implant played a more important role in preventing further carpal collapse than a palmaris longus tendon replacement in patients in the early carpal collapse stage. However, the clinical results of the silicone implant replacement were unsatisfactory because of the postoperative progression of osteoarthritic changes or subluxation of the prosthesis in the advanced stages of carpal collapse. The palmaris longus tendon replacement gave satisfactory results in four of seven patients with advanced carpal collapse. These results suggest that silicone implant replacement is indicated primarily in patients with the early stages of carpal collapse, and replacement of the palmaris longus tendon is rarely recommended in either the early or late stages of carpal collapse.

Finger tendon rupture secondary to fracture of the hamate. A case report.

Rupture of the flexor tendon of a finger secondary to fracture of the hook of the hamate is extremely rare; only seven previous cases have been published. We report an additional case and discuss the functional anatomy, diagnosis and treatment.

Thumb reconstruction by free sensory flaps from the foot using microsurgical techniques

Four types of thumb reconstruction using microsurgical technique were performed in 23 cases; the dorsalis pedis flap, hemipulp (first web space) flap, wrap around flap, and toe-to-thumb transfer. The selection of which free sensory flaps should be used for thumb reconstruction is discussed. The selection of sensory nerves to be sutured as the donor and recipient nerves is based on the results of restoration of sensibility after free sensory flap transfers.

Restoration of sensibility in fingers repaired with free sensory flaps from the toe

The sensibility of 25 fingers reconstructed with three different types of free sensory flaps from the toe was evaluated. The relationships between sensory restoration and the patients age, type of sensory flap, selection of sutured nerves, and circulatory complications in the flap were analyzed. Wrap-around flaps were used in 5 fingers, hemipulp flaps in 11, and toe-to-finger transfers in 9. The follow-up period ranged from 16 to 79 months. Restoration of sensibility in the flap was closely related to the patients age and vascular insufficiency of the flap. Therefore, establishing and maintaining and adequate circulation in the flap at operation is essential for good sensory restoration.

The occurrence of soft tissue sarcomas in three siblings with Werner's syndrome

Werners syndrome, a relatively rare and autosomal recessive disorder, is well known to be characterized by a high frequency of malignant neoplasm. The occurrence of familial neoplasm in patients with this condition, however, has been recorded only once before in the literature. Reported are the findings with regard to the occurrence of sarcomas in three siblings with Werners syndrome. Two of the current three cases were of malignant fibrous histiocytomas, one in a 36‐year‐old man and one in a 32‐year‐old woman. The other case was of a leiomyosarcoma in a 26‐year‐old man. Two of the patients died of the tumors, although the third is still alive. The exact cause of the high incidence of malignant tumor in this family remains unknown, as is still so in other cases of Werners syndrome.

The in vivo effects of various immunoreactive treatments on allogeneic tendon grafts

The immunologic antigenicity of tendons after various treatments was investigated by means of the complement-dependent cytotoxicity test in two strains of inbred rats. Allogeneic tendons treated by various methods were grafted into rats, and the survival of the grafted tendons was observed macro- and microscopically. Paraformaldehyde-treated allogeneic tendons showed the least immunologic response. The remaining treated allogeneic tendons showed moderate to marked immunologic responses. These in vivo results correlated with those obtained in previous in vitro experiments.

Analysis of osteoid-forming activity of human osteosarcoma implanted into nude mice

SummaryThirty cases of human osteosarcoma were transplanted subcutaneously in BALB/c nude mice. Twenty-four tumours survived in animals and showed the histopathology of the original tumours. Growth of transplantable tumours was closely related to the amount of osteoid tissue and tumours with predominant osteoid tissue showed slow growth. Tumours whose osteoid-forming activity tended to diminish or disappear were likely to fail early during serial transplantation. Two osteosarcoma (SU and ISHI) were established into permanent transplantable strains and were maintained in nude mice for more than three years. These two strains showed striking differences in their growth capacity; SU grew rapidly and frequently formed pulmonary tumours after tail vein injection of tumour cells. Histologically, ISHI osteosarcoma cells continue to form osteoid tissue, whereas SU cells showed anaplastic changes and lost osteoid-forming activity. Alkaline phosphatase and Lactate Dehydrogenase (LDH) activities of tumour tissue were lower in ISHI than SU, and significant elevation of the relative value of Fraction III of LDH isozyme has been demonstrated in SU, and Fraction IV in ISHI.On this basis, the authors discuss the relation between the amount of osteoid formation or LDH isozyme patterns and the malignant potential of human osteosarcoma.Résumé30 cas dostéosarcome humain ont été implantés sous la peau de souris nues BALB/c. 24 de ces tumeurs ont survécu et reproduit lhistopathologie de la tumeur originale. La rapidité de croissance de la tumeur sest montrée nettement en relation avec la quantité de tissu ostéoïde: dans les tumeurs où ce tissu prédominait la croissance fut lente. Les tumeurs où lactivité ostéoïde tendait à diminuer et disparaître étaient aussi celles exposées à léchec de la transplantation en série. Cependant, deux ostéosarcomes (SU, ISHI) purent être obtenus en souches régulièrement transplantables et furent observés sur les souris nues plus de trois ans. Or ces deux souches montrèrent des différences frappantes: les cellules de ISHI avaient continué à former du tissu ostéoïde, alors que celles de SU, avec altération anaplastique, avaient perdu leur activité ostéoïde. SU présentait une croissance rapide et linjection de ses cellules dans les veines de la queue provoquait régulièrement des tumeurs pulmonaires. En outre lactivité des phosphatases alcalines et de lactate déhydrogénase (LDH) était plus faible dans ISHI que dans SU, une élévation significative de LDH isozyme portait sur la fraction III pour SU, sur la fraction IV pour ISHI.Sur ces bases les auteurs discutent la relation de lactivité ostéoïde et du LDH isozyme avec le potentiel de malignité, dans lostéosarcome humain.

Tissue culture studies on human giant cell tumour and osteosarcoma

SummaryBenign giant cell tumours showed a sharp chromosome number mode at 46 with a superficially normal diploid karyotype. Osteosarcomas, however, were characterised by having aneuploid modal numbers. LDH isozyme patterns of giant cell tumours showed a maximum activity in Fractions IV and V, whereas that of osteosarcomas apparently fell in a range of Fraction III.Thirty-three giant cell tumours and 22 osteosarcomas were cultured in vitro. In general, frequencies of polyploid and aneuploid cells increased with the accretion of in vitro generations, and LDH isozyme patterns showed a marked increased activity of Fraction V in the early subculture passages. Two permanent cell lines of giant cell tumours were successfully established; they showed striking morphological changes of cells and the modal chromosome number fell in a range of hypotriploidy. LDH isozyme pattern showed maximum activity in Fractions III and IV, respectively. An interesting fact is that these cell lines in later subculture generations, formed tumours by subcutaneous inoculations and tumour death occurred by intravenous inoculation. Histologically, the tumour nodules provided evidence for the presence of sarcomatous stromal cells. Furthermore, osteoid and chondroid tissues surrounded by sarcomatous cells occurred in subcutaneous tumours.RésuméLes tumeurs bénignes à cellules géantes ont un pic de fréquence chromosomique de 46 avec un caryotype diploïde apparemment normal. Par contre, les ostéosarcomes sont caractérisés par un pic de fréquence chromosomique aneuploïde. Les profils des isozymes de la lacticodéshydrogénase ont montré une activité maximum dans les fractions IV et V, tandis que celle des ostéosarcomes semblait appartenir à la Fraction III.Trente trois tumeurs à cellules géantes ainsi que vingt deux ostéosarcomes ont été cultivés in vitro. En général, la fréquence des cellules polyploïdes et aneuploïdes a augmenté au fur et à mesure des générations in vitro et les profils des isozymes de la lacticodéshydrogénase ont montré une nette augmentation de lactivité de la Fraction V pendant les transferts initiaux. Deux lignées permanentes de tumeurs à cellules géantes ont été établies. Ces cellules ont subi des changements morphologiques frappants et leur pic de fréquence chromosomique était dans la gamme dune hypotriploïdie. Lactivité maximum de la lacticodéshydrogénase des deux lignées a été retrouvée respectivement dans les Fractions III et IV.Il est intéressant de noter que, lors des générations ultérieures in vitro, ces lignées ont été capables de former des tumeurs par inoculation sous-cutanée et de provoquer la mort à la suite dinoculation intraveineuse. Du point de vue histologique, les nodules tumoraux montraient la présence dun stroma de cellules sarcomateuses. Par ailleurs, les tumeurs sous-cutanées étaient faites de tissu ostéoïde et chondroïde entouré de cellules sarcomateuses.