Michito Mori

Increased mast cell infiltration in varicose veins of the lower limbs: A possible role in the development of varices*

BACKGROUNDnThis study shows increased infiltration of mast cells in the walls of varicose veins in the lower limbs as an explanation of the pathogenesis of varix formation.nnnMETHODSnGreat saphenous veins exhibiting varicosity were histologically examined after vein stripping surgery, and the numbers of mast cells in the varicose lesions were estimated in 20 high-power fields (x400). Normal-looking regions of the veins were referred to as controls, and normal saphenous veins were prepared during coronary artery bypass grafting and designated baseline controls.nnnRESULTSnThe varicose lesions showed a greater extent of mast cell infiltration (15.0 +/- 8.4 cells; mean +/- standard deviation), whereas control veins (5.9 +/- 4.0) and baseline control veins (4.4 +/-2.9) had a smaller number of mast cells.nnnCONCLUSIONSnThe study suggests that increased mast cell infiltration contributes to the development of varicose veins.

Localization of vascular endothelial growth factor in synovial membrane mast cells: examination with "multi-labelling subtraction immunostaining".

Abstractu2002Mast cells are believed to play a novel part in the development of destructive synovial pannus in rheumatoid arthritis (RA). This study was undertaken to investigate the localization of vascular endothelial growth factor (VEGF) in the synovial membrane using a unique immunostaining technique. Synovial specimens of RA patients were examined immunohistochemically and were compared with specimens from non-RA controls. Multi-labelling subtraction immunostaining, a modification of double- and triple-labelling immunostaining, revealed that the VEGF-positive cells were identical to tryptase-positive cells (mast cells). No other cell types were found to be positive for VEGF. The synovium of RA patients showed a larger number of VEGF-positive mast cells than that of non-RA controls (P<0.001). The study suggests that mast cell-derived VEGF may contribute to the development of synovial pannus in RA.

Fibroadenoma of the gallbladder with borderline malignancy: a poorly recognized gallbladder tumor

Fibroadenoma of the gallbladder is extremely rare tumor, with only two cases reported in the world. It is characterized by abundant loose edematous connective tissue, glandular structure, polypoid structure covered by epithelia, and a filamentous pedicle. We report a case of 78-year-old woman histopathologically diagnosed after surgery. Macroscopically, the tumor was a dark-greenish solid mass with a short stalk, filling the gallbladder cavity, and it measured 11.5 x 4.0 x 3.5 cm in diameter. Microscopically, the tumor was composed of abundant loose stroma and a glandular component. Some of the glandular cells had hyperchromatic nuclei with disturbed polarity and were positively stained by p53 (30%) and Ki-67 (30-40%). Part of the stromal component revealed hypercellularity with an irregular nucleus, mitosis (2-3 cells/10 high-power fields), and positivity for Ki-67 (20%) and p53 (50%). We diagnosed this peculiar tumor as fibroadenoma of the gallbladder with borderline malignancy. We present the details of this extremely rare case and discuss the pathological findings, comparing them to those in the two previously reported cases and to carcinosarcoma of gallbladder.

Diagnostic difficulty in intrabiliary growth type of hepatocellular carcinoma-a case report-.

症例は62歳, 男性. 黄疸を主訴として当院紹介入院となった. HCV抗体: 陽性, AFP正常値, HBs抗原: 陰性. 血管造影およびCT, MRIの造影では肝左葉全体が不均一に造影され腫瘍像を特定できず, 胆管造影では左右肝管から総胆管内にかけて腫瘍陰影を認めた. 肝門部胆管癌を疑い尾状葉切除を伴う拡大左葉切除, 肝外胆管合併切除及び肝内胆管空腸吻合を施行した. 切除標本ではB2根部を取り巻くように径1cmの結節状腫瘍が認められ, 術後病理診断では同腫瘍は高分化型肝細胞癌で胆管内に進展発育していることが確認された. 各種画像診断の進歩により胆管内発育型肝細胞癌の早期診断も可能になってきたといわれているが, 主腫瘍の存在部位, 大きさによって腫瘍像が描出されないことがある. 術前診断が困難であった胆管内発育型細小肝細胞癌の1症例を経験したので報告した.