Minoru Morimatsu

Acute focal demyelinating disease simulating brain tumors: histopathologic guidelines for an accurate diagnosis.

The object of the present study was to determine the histopathological guidelines for accurate diagnosis of cases of acute focal demyelinating disease that simulates brain tumors. The surgical pathology of three such cases is assessed. Histopathological keys to the diagnosis of such cases are as follows. First, a pattern of sheets of atypical gemistocytic astrocytes in the white matter that show well‐formed processes and that are adequately distanced from each other argues against a diagnosis of neoplasm. Second, uniform distribution of foamy macrophages aligned along axons, with occasional focal collections surrounding blood vessels and in the absence of any associated coagulative necrosis argues against the presence of a tumor. Third, perivascular chronic inflammatory infiltration, especially a mixture of lymphocytes and macrophages, favors the diagnosis of demyelination plaque. In such cases the lymphocytes will be predominantly T cells. Fourth, pleomorphic astrocytic proliferation with a lack of vascular endothelial proliferation should raise the suspicion that the lesion may not be a brain tumor. These diagnostic keys should be followed when diagnosing cases that are suspected to be demyelination processes rather than brain tumors. The presence of demyelination plaque should then be confirmed by imaging modalities such as staining with myelin‐and axon‐specific stains.

Pineal malignant rhabdoid tumor with chondroid formation in an adult.

A pineal tumour in a 27‐year‐old male is presented with the characteristic histological features of a pineal malignant rhabdoid tumor (MRT) with chondroid formation. Occasionally, tumor cells contained a single well‐demarcated hyaline globular inclusion within the cytoplasm adjacent to the nucleus. The stroma of these tumors tends to be densely hyalinized and become chondroid. Immunohistochemical staining was positive for vimentin, epithelial membrane antigen, chromogranin A, synaptophysin, neuron‐specific enolase, S‐100 protein, and muscle actin. Despite surgery and radiochemotherapy, the tumor recurred in the pineal region and metastasized to the lower lobe of right lung. The patient died 2 years after the initial diagnosis. This is the second published case of central nervous system‐MRT appearing in an adult. The clinical and pathological features of pineal MRT in this patient are presented.

Familial adult T-cell leukemia.

Two siblings who developed adult T‐cell leukemia (ATL) are presented. The patient and 7 of 26 healthy family members examined had the serum antibodies against ATL‐associated antigens (ATLA). This family study shows that two main routes of transmission of human T‐cell leukemia virus (HTLV) may be involved: one is the route from parents to children and the other is horizontal transmission among spouses, especially from husband to wife; the anti‐ATLA‐positive family is considered to be a high‐risk group for ATL.

Clinicopathological study of pleomorphic xanthoastrocytoma: Correlation between histological features and prognosis

The correlation between histopathological characteristics and prognosis was studied in six cases of pleomorphic xanthoastrocytomas (PXA) found in five patients. With regard to the duration from onset to the resection of the tumor, and the postoperative course, three cases had a favorable prognosis, although one case fatally recurred and in another, serial CT showed rapid tumor growth for 3 years. The histological characteristics of the favorable group of PXA comprised remarkable degeneration, low mitotic activity and a low MIB‐1 labeling index. In contrast, the characteristics of the latter two cases of PXA rarely showed degeneration, had atypical mitoses, increasing mitotic activity and a higher MIB‐1 labeling index, which indicates that the findings of degeneration, atypical mitoses, mitotic activity and MIB‐1 labeling index correlate with the biological behavior of PXA. However, with regard to histological appearance and clinical course, PXA are tumors with a wide range of biological behavior.

Elastase digestion and biochemical analysis of the elastin from an elastofibroma

Elastin from both elastofibroma and control skin samples was analyzed by means of pancreatic elastase digestion and subsequent biochemical studies, such as for elastin content and amino acid composition. Elastin of elastofibroma was more resistant to elastase digestion than that of controls. Elastin content was increased almost twice (wet weight) or three times (dry weight) in elastofibroma. The amino acid composition had the characteristics of elastin; however, the cross‐linking amino acids such as desmosine, isodesmosine, and lysinonorleucine were increased in elastofibroma when compared with controls. An electron microscopic study showed that the interspersed cells had prominent intermediate filaments without any periodicity, pinocytotic vesicles, rough endoplasmic reticulum, and other organelles. These cells were considered to be fibroblasts not myofibroblasts. Therefore, it could be supposed that fibroblasts newly form an elastin that has a slightly different amino acid composition from that of controls. Cancer 58:1070‐1075, 1986.

Decreased surfactant level in the lung with oligohydramnios: A morphometric and biochemical study

with our experience, in which all four cases of gramnegative sepsis in infants given antibiotics through the catheter were cured. Our success rate may be spuriously elevated by the small numbers in which treatment was attempted, and because physicians may have selected patients on clinical grounds in whom treatment was likely to fail with the catheter in place, and removed these catheters immediately. Our experience is similar to that of others with respect to fungemia in the presence of catheters; no infections were successfully treated with the catheter in place. This report is limited by its retrospective nature; the next logical step is to confirm these observations in prospective studies. Until more is known, clinicians caring for infants who have had bowel resected should maintain a high index of suspicion for sepsis. Initial empiric antibiotic therapy for suspected episodes of sepsis should include an antibiotic effective against gram-negative organisms in addition to one against staphylococcal organisms.

LONG TERM SURVIVAL CASE OF SMALL (OAT) CELL CARCINOMA OF THE RECTUM

A long term survival case of small (oat) cell carinoma of the rectum in a 39‐year‐old female is presented. She complained of anal pain and occasional anal bleeding. The tumor was located at the anterior wall in the lower rectum. Biopsy specimens revealed a carcinoid tumor. She underwent trans‐anal local resection for the first time in December, 1980. Macroscopic findings of the resected specimen showed a small nodule, 0.4 by 0.4 by 0.5 cm, with yellowish cut‐surface. Microscopically, the tumor deeply invaded the submucosal layer. The appearances were indistinguishable from pulmonary small (oat) cell carcinoma. Since lymphatic permeations were moderately recognized in the tumor, she underwent radical operation (Miles operation) with lymphadenectomy. Microscopic findings of the resected rectum revealed an intramural metastatic lesion with marked lymphatic permeations in the submucosal layer 2 cm distant from the primary lesion. Up to date, there is no evidence of local recurrence or liver metastasis. Small (oat) cell carcinoma of the rectum easily metastasizes lymphogenously through the lymph system from an early stage of the development. Wide surgical resection will be needed to give a long term survival even if the tumor is extremely small.

Angiomatous variant of pleomorphic xanthoastrocytoma in a patient with a 20‐year history of epilepsy

The angiomatous variant of the pleomorphic xantho‐astrocytoma (PXA) is a morphological subtype of PXA that is characterized by the presence of large numbers of tiny blood vessels with variable wall thicknesses. A case of an angiomatous variant of PXA occurring in the temporal lobe of a 43‐year‐old man is presented. The patient had a 20‐year history of seizures. Considering the clinical course and intra‐operative electro‐encephalography findings, it appears that this tumor was the epileptic focus in this patient and that it had been present for 20 years. Histopathologically, various degenerative changes, such as microcystic changes, calcification and hyaline thickening of vessel walls were seen in the tumor. In particular, obvious vascularity in the tumor and secondary vascular degenera‐tion should be related to gradual growth and benign clinical course of an angiomatous variant of PXA.

A case of basal cell epithelioma of the breast cytologically suspected ductal carcinoma.

乳腺の穿刺吸引細胞診にて乳管癌が疑われた乳房部原発基底細胞上皮腫の1例の細胞像について報告した.症例は65歳, 女性, 右乳房C領域に1.5×1.5cmの腫瘤が認められ10年来大きさは不変であった.Mammography, 超音波などの画像診断にて乳管癌が疑われ外来受診時に穿刺吸引細胞診が施行された.細胞診所見は出血像を背景に腫瘍細胞は大小の結合性の強い細胞集塊で出現し, 細胞の配列は不均等で細胞の重積性が認められた.核は類円形小型で核クロマチンの増量がみられ, 乳管癌も否定できず術中迅速病理組織診断が行われた.病理組織にて基底細胞上皮腫と診断された.基底細胞上皮腫の一般的な細胞学的所見としては大小の細胞集塊での出現, 細胞は小型類円形で大小不同性に乏しく, 細胞集塊の辺縁に柵状配列が認められることであると思われるが, 乳房部に発生する基底細胞上皮腫は非常にまれであり, 本症例では術前の穿刺吸引細胞診での確定診断は困難であった.

A case of the primary urethral malignant melanoma with an appearance of tumor cells in urine.

尿中に腫瘍細胞が出現した男子尿道原発悪性黒色腫について報告した.症例は64歳男性で尿道球部に発生した悪性黒色腫であった.尿細胞診では腫瘍細胞は孤立散在性に出現し, 一部疎な結合を示す集塊で出現した細胞では移行上皮癌細胞との鑑別が困難であったが, 少数の細胞には明らかなメラニン顆粒が認められた.これら尿中の腫瘍細胞は免疫組織化学染色においてS-100蛋白が陽性を示し, 摘出腫瘤の病理組織標本ではMasson-Fontana染色陽性, 鉄染色陰性, 免疫組織化学染色ではS-100蛋白陽性さらにNSE (Neuron-specifi cenorase) も陽性であった.また, 電顕にて腫瘍細胞の細胞質に多数のmelanosomeが確認された.