Masayuki Sumitomo

Malignant peripheral nerve sheath tumor (MPNST) showing perineurial cell differentiation.

We report a malignant peripheral nerve sheath tumor (MPNST) showing the unusual immunohistochemical feature of epithelial membrane antigen (EMA) immunoreactivity in a 52-year-old man. The tumor, located in the left paravertebral muscles, was composed of both cellular and myxoid areas. Spindle-shaped tumor cells were arranged in longitudinal cell cords, in a storiform pattern, and in whorled structures. Ultrastructurally, the tumor cells had many interdigitating cell processes, primitive cell junctions, and discontinuous external laminae. These histological and ultrastructural features were most consistent with those of an MPNST; but on immunohistochemistry, the tumor cells reacted for epithelial membrane antigen rather than for S-100 protein or Leu-7. Because EMA-immunoreactivity was recently demonstrated in perineurial cells, we concluded that the tumor was an MPNST mainly composed of tumor cells showing perineurial cell differentiation.

A dose‐response relationship between the frequency of p53 mutations and tobacco consumption in lung cancer patients

Mutations of the p53 tumor suppressor gene are frequent in lung cancers. It is suggested that p53 mutations are associated with smoking‐induced lung carcinogenesis. We examined p53 mutations in 53 lung cancers by analyzing reverse transcription‐polymerase chain reaction‐single strand conformation polymorphism (RT‐PCR‐SSCP) to ascertain the association between p53 mutations and smoking. Twenty‐five (47%) of 53 lung cancers carried p53 mutations. A discriminant analysis showed that the Brinkman index (0.156) and gender (0.140) significantly influenced p53 mutations. Furthermore, there was a dose‐response relationship between the quantity of cigarettes consumed and the frequency of p53 mutations in lung cancer patients (P < 0.001). In patients with adenocarcinoma, the frequency of p53 mutations correlated with the amount of the tobacco smoked (P < 0.05). We suggest that the p53 gene is a target of particular carcinogen in tobacco smoke.

Difference in cytokine production in acute and chronic rejection of rat lung allografts

Abstract  In Brown Norway to Lewis rat lung transplantation, short‐term administration of cyclosporine produces permanent adoption of allografts; however, the adopted grafts show symptoms of chronic rejection. To clarify the difference in cytokine production in acute an chronic rejection of the allografts, an immu‐nohistochemical study was performed. In acute rejection, positive cells for respective cytokines were observed in infiltrating cells, increasing in number as the days after transplantation passed, and reaching a maximum on the fifth day. The strongest reactivity was observed perivenously. In chronic rejection, TNF‐α positive cells were observed in the perivascular and peribron‐chial regions, especially around class II positive epithelia. The number of positive cells was, however, less than that in the vascular phase of acute rejection. Few cells were positive for IL‐lβ, IFN‐γ and, unexpectedly, for IL‐4. These facts indicate the functional difference of infiltrating cells between acute and chronic rejection.

Management of postpneumonectomy syndrome by intrapleural injection of sulfur hexafluoride

Left postpneumonectomy syndrome was managed by injection of sulfur hexafluoride (SF6) into the pleural space. This measure permitted irradiation of a contralateral, second primary lung cancer without resulting pulmonary fibrosis. Such use of SF6 may be an option for prophylaxis against postpneumonectomy syndrome.

Epithelial Differentiation in Synovial Sarcoma Correlation with Histology and Immunophenotypic Expression

The epithelial properties of the cells in six cases of synovial sarcoma, five biphasic and one monophasic, were examined. Epithelial cells formed well demarcated glandular nests with a multi or single layered lining, poorly defined nestlike clusters, or appeared as scattered single plump cells in a spindle cell stroma. Keratinization was seen in multi‐layered epithelia, and was suggested in single layered epithelia from the presence of some enlarged eosinophilic cells. Immunohistochemically, epithelia lining glands showed reactivity for both low and high molecular weight (MW) cytokeratins, and the reactions for both were strongest in keratinized cells. Clustered or single plump cells showed low MW cytokeratin reactivity. All epithelial cells were negative for the largest cytokeratin (no. 1), and occasionally stained positively for vimentin. Spindle‐shaped stromal cells usually stained positively for vimentin only. Type IV collagen was distributed linearly around well circumscribed epithelia, but not around poorly defined epithelia or plump cells. Epithelial membrane antigen was distributed linearly along glandular spaces and irregularly or granularly in clustered plump cells. The immunophenotypic epithelialization in synovial sarcoma was restricted, but showed considerable correlation with the histological grade of differentiation. Acta Pathol Jpn 39: 381 387, 1989.

Invasive thymoma with endobronchial polypoid growth

A rare case of invasive thymoma with endobronchial polypoid growth is presented. A 68-year-old woman presented with coughing and sputum. The chest X-ray and computed tomography (CT) findings demonstrated a large mass with a calcified lesion in the left hilar region. A bronchoscopic examination showed a polypoid tumor in the left B3b bronchus. The tumor was surgically resected and revealed a unique polypoid endobronchial extension. This tumor was pathologically diagnosed to be invasive thymoma.

Cat scratch disease: an epidemiological and ultrastructural study of lymphadenitis caused by Warthin-Starry positive bacteria

The aetiological agent of cat scratch disease (CSD) has been unknown for more than 30 years. Recently, a micro-organism clearly shown with Warthin-Starry silver (W-S) stain was found and thought to be a possible cause of the disease. In this study, 32 cases of regional lymphadenopathy histologically compatible with CSD and 20 contrasting cases of lymphadenopathy were examined retrospectively with W-S stain. W-S positive pleomorphic organisms were clearly demonstrated in 20 of the 32 suspected cases of CSD, but in none of the other cases. The onset of disease in these 20 cases with W-S positive organisms occurred between July and January. This seasonal variation in the onset of disease was highly significant (P<0.005) and was not due to a single epidemic. Moreover, some characteristic morphological features of the organism were found by electron microscopic observations. Ultrastructurally, the organism was a bacterium showing a chain-like arrangement, septal formation, branching and clubbed ends.The aetiological agent of cat scratch disease (CSD) has been unknown for more than 30 years. Recently, a micro-organism clearly shown with Warthin-Starry silver (W-S) stain was found and thought to be a possible cause of the disease. In this study, 32 cases of regional lymphadenopathy histologically compatible with CSD and 20 contrasting cases of lymphadenopathy were examined retrospectively with W-S stain. W-S positive pleomorphic organisms were clearly demonstrated in 20 of the 32 suspected cases of CSD, but in none of the other cases. The onset of disease in these 20 cases with W-S positive organisms occurred between July and January. This seasonal variation in the onset of disease was highly significant (P less than 0.005) and was not due to a single epidemic. Moreover, some characteristic morphological features of the organism were found by electron microscopic observations. Ultrastructurally, the organism was a bacterium showing a chain-like arrangement, septal formation, branching and clubbed ends.

Intractable chest pain in a patient whose postpneumonectomy space was managed with sulfur hexafluoride.

A 50-year-old man who had undergone right pneumonectomy 1 year previously was referred to our department following the sudden onset of severe chest pain. Since the operation, his postpneumonectomy space had been managed with sulfur hexafluoride. On admission, the pressure in the postpneumonectomy space was found to be more than +60 cmH2O. The chest pain was relieved after the sulfur hexafluoride had been drained and the pressure released. Thus, it is advisable to inject sulfur hexafluoride stepwise into the postpneumonectomy space of patients with long-standing fluid accumulation.

Regulation of LAK Activity from Pleural Cavity Lymphocytes and Peripheral Blood Lymphocytes by Pleural Cavity Macrophages in Lung Cancer Patients without Malignant Effusion.

癌性胸水を伴わない肺癌患者を対象に, 胸腔内リンパ球 (PLY)・末梢血リンパ球 (BLY)・胸腔内マクロファージ (PCM) および末梢血単球 (Mo) を分離し, PLY・BLYのLAK細胞のinduction phaseにおけるPCMのLAK活性の調節能を検討した. 細菌内毒素 (LPS) 非刺激PCM・LPS刺激PCMはPLY・BLYのLAK細胞のinductionphaseに添加することによって, PLY・BLYのLAK活性をPLY・BLY単独のLAK活性に比して有意に増強した. MoはLPS非刺激MoのみLAK活性をBLY単独のLAK活性に比して有意に増強した. しかし, LPS非刺激, 刺激MoはともにPLYのLAK活性に有意な影響を与えなかった. 以上より, PCMはBLY, PLYのLAK活性を常に増強し, 胸腔内における重要な免疫担当細胞として機能していることが示唆された.

Application of Sulfur Hexafluoride into Pleural Space Reduced Pulmonary Shunt in Chronically Atelectatic Lobe After Sleeve Resection—A Case Report

A seventy-three-year-old man had undergone right sleeve upper lobectomy. The bronchial anastomotic site occluded because of granulation that had been treated with yttrium aluminum garnet (YAG) laser initially. He refused reopera tion or YAG laser surgery at the time of reocclusion of the anastomotic site. He complained of exertional dyspnea, and his blood gas analysis showed hypoxe mia. The authors injected sulfur hexafluoride into pleural space of the patient to reduce pulmonary shunt in chronically atelectatic lobes. Blood gas analysis just after injection of sulfur hexafluoride gas into pleural space showed increase of oxygen tension, suggesting decrease in shunting. With the management of pleu ral space through use of sulfur hexafluoride, he leads a normal daily life without exertional dyspnea.