Munehiko Ohya

Testicular seminoma with human chorionic gonadotropin production

Testicular seminoma with elevated serum human chorionic gonadotropin level (hCG‐positive seminoma) is regarded as more malignant than marker‐negative seminoma, although Its prognosis is still unclear. To clarify the malignant potential of seminoma with hCG production, the serum levels of the beta subunit of hCG (β‐hCG) and lactic acid dehydrogenase (LDH) were examined in 35 and 40 patients, respectively, and the Immunohistochemical expression of β‐hCG examined in 45 tumors. The elevation of the LDH serum level correlated to the Invasive status, metestatic status and poor outcome, while that of the serum β‐hCG level correlated only to the metastatic status. Immunohistochemical expression of β‐hCG was observed in syncytiotrophoblastic giant cells in 11 tumors and a few mononuclear seminoma cells In 36 tumors. Expression was not associated with the malignancy potential, except where the expression In mononuclear cells Inversely correlated to the invasive status. These results suggest that most seminomas produce a slight amount of hCG; that an elevated hCG serum level Indicates the pressnce of metastatic tumors and mainly reflects an increase in tumor volume but not in cellular malignancy potential; and that the LDH serum level, rather than hCG, is more useful as a prognostic indicator for patients with seminoma.

Plasma nitrotyrosine concentration relates to prognosis in human septic shock.

Interrelation of plasma nitrotyrosine (NT) concentrations in patients of septic shock and their prognosis was examined. Blood samples were obtained from 12 patients during the first episode of septic shock at hospitalization, and their plasma NT concentrations were measured. Five patients died within five days after hospitalization, but seven patients recovered. Plasma NT concentrations (means ± SE) of the non-survivors and survivors were 0.68 ± 0.13 nmol/mL (n = 7), and 0.21 ± 0.05 nmol/mL (n = 5), respectively, the former being significantly higher than the latter. The present results suggest that plasma concentration of NT relates to prognosis in human septic shock, although further studies with a larger patient population are necessary for confirmation of the suggestion.

Immunohistochemical analysis of the nm23 gene products in testicular seminoma.

The nm23 gem, has been ldenwied as a metastasis suppressor gene. To clam the role of nm23 as a metastasis sup pressor gene In testicular seminoma, the expression of the nm23‐Hl and ‐H2 proteins (human nucleoside‐dlphosphate kinase‐A and ‐B) was Immunohistochemically examined in 43 patients. Thirty‐six (84%) and 21 (49%) of the 43 primary tumors were posithre for the nm23‐H1 and ‐H2 proteins, respecthrely. There was no significant difference in either nmH1 or ‐H2 expression between the 24 primary non‐invashre tumors and the 19 primary invasive tumors, or between the 31 primary tumors without metastasis and the 12 primary tumors with metastasls. In all, and 5 of 6 meta‐static tumors, the expression of nm23H1 and ‐H2 proteins was obsenred, respectively, and the expression was not decreased in the metestetlc tumors, compared to the primary tumors. In conclusion, the lmmunohistochemlcal expression of both the nm23‐Hl and ‐H2 gene products is not associated with the metastatic status or the invasive status of testicular seminoma, and it Is unlikely to be a useful non‐metastatic Indicator for testicular seminoma. Further studies are needed to elucidate the biological role of nm23.

A man case with thiopronine induced hepatopathy showing advanced interlobular bile duct elimination image.

症例は46歳, 男性で, 長期間にわたり高度肝内胆汁うっ滞を呈した. 本例はアルコール性肝障害に対してTiopronin (N-2-mercaptopropionyl-glycine) の投与を受けており (総量: 9, 600mg), Tiopronineに対するDLSTが陽性を示したことからTiopronin誘導性の薬剤性肝障害例と考えられた. 本例にみられた高度胆汁うっ滞の成因について病理組織学的検討を行ったので報告する. 肝生検組織には著明な肝内胆汁うっ滞像がみられるとともにリンパ球浸潤を伴う小葉中心性の壊死炎症反応が強くみられた. 門脈域にはpiecemeal necrosisを伴う中等度のリンパ球浸潤像をみるとともに小葉間胆管上皮細胞の変性像や小葉間胆管消失像を多数認めた. 肝細胞と小葉間胆管上皮細胞におけるβ2-microglobulin (β2-MG) やHLA-DRの発現態度を免疫組織化学的に検討した結果では, 小葉中心性の壊死炎症巣周囲の肝細胞や門脈域周囲の肝細胞, さらには小葉間胆管上皮細胞にもβ2-MGの発現増強を認めたが, これら上皮細胞でのHLA-DRの異所性発現はみられなかった. また, 門脈域や小葉内壊死炎症巣に浸潤するリンパ球は主としてMT-1陽性のT細胞より構成され, UCHL-1陽性の活性型T細胞が多数認められた. 以上の所見から本例における持続性高度胆汁うっ滞の成因として小葉問胆管の炎症性破壊が重要な役割を果したことが, さらに, Tiopronin誘導性の肝細胞の壊死炎症反応および小葉間胆管の炎症性破壊に細胞性免疫を介する細胞障害機序が関与した可能性が示唆された.