Mikio Kanda

Intraductal papillary neoplasms of the pancreas. A clinicopathologic study of six patients.

A clinicopathologic study was conducted on six patients with intraductal papillary neoplasms of the pancreas. The patients were of both sexes and their ages ranged from 64 to 79 years. Three patients had a long history of symptoms mimicking chronic pancreatitis. The tumors involved the main pancreatic duct in the head‐‐body region either diffusely or focally. Histologic examination showed papillary proliferations of well‐differentiated, mucus‐secreting cells that occasionally stained for carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19‐9). The proliferations filled the main pancreatic duct, and extended into smaller ducts in some cases. In three patients, the lesions contained foci of pronounced to severe cellular atypia and carcinoma in situ. None of our series or any similar cases reported in the literature has shown invasion into peripancreatic tissue, metastasis, or tumor recurrence after pancreatectomy. Because of their favorable prognosis, intraductal papillary neoplasms should be considered low‐grade malignancies that must not be confused with the common ductal adenocarcinoma.

Immunocytochemical markers of uncommon pancreatic tumors. Acinar cell carcinoma, pancreatoblastoma, and solid cystic (papillary‐cystic) tumor

Nine acinar cell carcinomas of the pancreas, 2 pancreatoblastomas, 16 solid‐cystic (papillary‐cystic) tumors, and 20 ductal adenocarcinomas were immunocytochemically investigated using antisera against four pancreatic enzymes (alpha‐amylase, lipase, trypsinogen, chymotrypsinogen), four pancreatic hormones, neuron specific enolase (NSE), alpha‐1‐antitrypsin (AAT), carcinoembryonic antigen (CEA), and CA 19–9. Lipase, trypsinogen, and chymotrypsinogen, but no alpha‐amylase were detected in all acinar cell carcinomas and pancreatoblastomas. In contrast, solid‐cystic tumors (SCT) were negative for pancreatic enzymes but 2 of 16 stained with NSE. No neuroendocrine granules or pancreatic hormones could be demonstrated. AAT was found in all tumors except ductal adenocarcinomas, which stained with CEA and CA 19–9. The study established pancreatic enzymes (except alpha‐amylase) as immunocytochemical markers for acinar cell carcinomas and pancreatoblastomas. There is as yet no marker specific for SCT, which would elucidate the obscure histogenetic origin and phenotypic differentiation of these tumors. Cancer 59:729‐747, 1987.

Epidermoid Cyst Derived from an Accessory Spleen in the Pancreas

A rare case of splenic epidermoid cyst (SEC) of the pancreas discovered in a 32‐year‐old Japanese female is reported. The lesion, 5x6cm in size including caseous material and serous fluid in the lumen, was discovered by ultrasonography and computed tomography at the tail of the pancreas and was easily removed. Histopathologically, the cystic wall consisted of three components: the inside was lined by mature squamous epithelium with keratinization, the middle layer consisted of splenic pulp with a sinus structure, and the peripheral layer was dense fibrous connective tissue in which some involutional pancreatic ducts and islets were recognized. The literature about SEC of the pancreas is discussed in comparison with other types of epidermoid cyst including lymphoepithelial cyst and dermoid cyst in the pancreas. Acta Pathol Jpn 41: 916 921, 1991.

Cytoplasmic microfilaments in endothelial cells of flow loaded canine carotid arteries

SummaryTo observe cytoplasmic microfilaments in the endothelial cells of flow-loaded arteries, an arteriovenous shunt was constructed between the common carotid artery and the external jugular vein in 26 dogs. After measuring the flow rates of the arteries, the endothelial layer was examined ultrastructurally with a transmission electron microscope at three different times: 1 week (acute experiments), 2–4 weeks (subacute experiments), and 4–7 months (chronic experiments).Six-to seven-nanometer microfilaments were found forming bundles, which usually ran longitudinally along the long axis of the vessel. In the acute experiments, the bundles increased in the endothelial cells of the flow-loaded arteries. They showed incomplete striation and were mostly located close to the basal cell membrane. In the subacute experiments, they showed an increase with the development of cross-striation. The half-desmosomal structure of the basal cell membrane had developed a close connection to the bundles. In the chronic experiments, the bundles were especially conspicuous around the intercellular junction. Tennanometer microfilaments increased in the endothelial cells of the flow-loaded artery in the subacute and chronic experiments. We consider that the bundles of 6- to 7-nm microfilaments might be structures developed to combat wall shear stress corresponding to actin filament stress fibers.

A statistical survey of deep mycoses in Japan, with particular reference to autopsy cases of cryptococcosis

Two thousand four hundred and fifty‐four autopsy cases of various mycoses were reported during the twelve‐year period from 1958 to 1969. These account for 1.203 % of all cases reported in the Annual of the Pathological Autopsy Cascs in Japan during the said period.

On the Histogenesis of Experimental Pancreatic Endocrine Tumors an Immunocytochemical and Electron Microscopical Study

In order to identify the early stage of the development of experimental pancreatic endocrine tumors, Wistar rats were treated with streptozotocin and nicotinamide. One to 11 months after the treatment, the pancreata were examined for neoplastic lesions, using immunocytochemistry and electronmicroscopy. The earliest changes consisted of focal adenomatous proliferation of small ducts, occasionally including endocrine cell clusters. They occurred in the same frequency throughout the whole period examined, regardless whether the pancreata contained tumors or not, and were also present, though in lower numbers, in controls. Immunocytochemistry revealed no true budding off of endocrine cells from ductular epithelium. Thus the histogenetic relationship of the ductal proliferations to the endocrine tumors remains unclear. The earliest tumors were recognized at the fourth month. At the eleventh month 31% of the animals beared tumors. Insulin‐positive cells predominated in the tumors, followed by somatostatin‐, glucagon‐ and PP‐positive cells. The multihormonal appearance of the neoplasmas is well comparable with the findings in human insulinomas.

Multiple Carcinomata Associated with Anomalous Arrangement of the Biliary and Pancreatic Duct System

Two rare cases of multiple neoplasms occurring in association with anomalous arrangement of the pancreatobiliary duct system (PBD) are reported. Ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography revealed cholecystic tumor in the first case, and multiple choledochocholecystic tumors in the second case. In the first case, pancreatic tumor was discovered two years after cholecystectomy. In the second case, a pancreatic tumor was discovered incidentally in the removed pancreatic head after the operation. The histology of all of these biliary and pancreatic tumors revealed papillary adenocarcinoma in both patients, and additionally small pancreatic endocrine tumors were found in the first case. Postoperative prognosis was comfortably favorable in both patients. In a literature survey, two other cases of double carcinomata associated with anomalous PBD were found, in which the tumors showed the same histology of papillary adenocarcinoma and the postoperative prognoses were also good. These mutual clinicopathological features appear to suggest that this abnormal condition acts as a carcinogenetic risk factor in the pancreatic duct and the biliary duct system, and may finally cause multiple carcinomata in the PBD. Acta Pathol Jpn 40: 755‐763, 1990.

ENDOTHELIAL SURFACE OF THE BLOOD FLOW LOADED CANINE CAROTID ARTERY

In order to study the ultrastructural changes of the endothelial surface induced by blood flow change, an arterio‐venous shunt was constructed between the common carotid artery and the external jugular vein in 10 dogs. Blood flow rate was measured before anastomosis, after anastomosis, and after 1 week. After the final measurement (1 week), the arteries were fixed under normal pressure by 2.5% glutaraldehyde solution in phosphate buffer (pH 7.4) and were examined with scanning and transmission electron microscopes. Protrusion of nucleic parts of the endothelial cells, microvilli‐like surface projections, and disturbance of pinocytotic vesicles predominated in the shunted arteries exposed to elevated blood flow. No significant ultrastructural changes could be defined in the intercellular junction of the endothelial cells which supported the increased permeability through the junction. It was suggested that the wall shear stress exerted a reactive change on the endothelial cells as well as a direct mechanical deformative effect in the endothelial plasma membrane.

Amylase producing lung cancer

A case of the lung cancer associated with marked elevation of serum (7820 IU/l) and of urinary amylase (2225 IU/l) was autopsied. Material was examined histopathologically, electronmicroscopically and biochemically. The pulmonary tumor tissues showed histological pattern of papillary adenocarcinoma. In addition to the small round bodies which were very similar to secretory glanules, many large round bodies were noticed, diffusely distributed in the tumor cell. These large round bodies ranged from 0.2 to 0.7 μm in diameter and showed a lamellar or annular pattern. The soluble phase of the homogenized pulmonary tumor tissues had an amylase level of 11,300 IU/g of protein, which consisted of S-type isoamylase with minor components. Cholesterol, triglyceride and phospholipid were also present at greater concentration in the tumor tissue than the normal pulmonary tissue. The large round bodies appeared too, to be amylase including bodies from the electronmicroscopical and biochemical findings.

Siblings with carbamyl phosphate synthetase i deficiency

This paper concerns with two autopsied cases of siblings who died from cerebral disturbances. In these patients hyperammonemia developed in the neonatal phase due to carbamyl phosphate synthetase I (CPS I) deficiency. The patient in Case 1 was admitted 2 days after birth because of oliguria and vomiting. Hyperammonemia developed and she died on the 43rd day. In Case 2 hyperammonemia developed from the 2nd day after birth and she expired on the 42nd day. In both cases the diagnosis of CPS I deficiency was established from autopsy findings of the liver. Acta pathol. jpn. 34: 901∼910, 1984.