Nobukazu Tomichi

A Case of Superficial Epithelioma with Sebaceous Differentiation

Superficial epithelioma with sebaceous differentiation developed on the left cheek of a 58‐year‐old man over a three‐year period. Biopsy of the lesion demonstrated plate‐like lobules of basophilic basaloid cells with broad attachments to the overlying epidermis. Clusters of or solitary sebaceous cells were present within the lobules. Three tumor types were considered; a subtype of sebaceoma growing in the epidermis, an acanthotic seborrheic keratosis subtype with sebaceous differentiation, or a tumor of the follicular infundibulum with sebaceous differentiation.

Comparison of Surface Antigens on Eosinophils from Patients with Eosinophilia

Recent studies have suggested that there may be heterogeneity among human eosinophils. To study this further, surface antigens on blood eosinophils from patients with eosinophilia (23 bronchial asthma, 6 eosinophilic pneumonia, 1 Kimuras disease and 1 adult T-cell leukemia) and from 8 control subjects were examined using a new direct method for fluorescence detection of eosinophils. HLA-DR+ and CD4+ eosinophil counts were higher in patients with bronchial asthma and adult T-cell leukemia (ATL) than in patients from other groups and in control subjects. CD11b+ eosinophil counts in Kimuras disease and ATL were smaller than those in the other groups. CD45RO+ eosinophil counts in bronchial asthma and eosinophilic pneumonia were significantly higher (p < 0.05) compared with Kimuras disease, ATL and control subjects. CD44+ eosinophil counts in eosinophilic pneumonia were significantly higher (p < 0.05) compared with the other groups and control subjects. These results suggest the existence of functional heterogeneity in the different eosinophilic diseases, with eosinophils in bronchial asthma and eosinophilic pneumonia being more highly activated in migration, activation and immunoregulation. On the other hand, eosinophils in Kimuras disease and ATL might be functionally down-regulated. This heterogeneity of eosinophils may reflect differences in the pathogenesis of various eosinophilic diseases.

Surface Antigens on Eosinophils in Bronchial Asthma and Eosinophilic Pneumonia

Surface antigens on peripheral blood eosinophils from 23 patients with bronchial asthma, 6 with eosinophilic pneumonia and 8 controls were examined using a new direct method. Peripheral blood eosinophils in bronchial asthma and eosinophilic pneumonia showed higher complexity and/or granularity than those from controls. The percentage expression of HLA DR, CD4 and CD45RO on peripheral blood eosinophils from patients with bronchial asthma were increased compared with those from patients with eosinophilic pneumonia and from the controls. These results suggest that peripheral blood eosinophils in bronchial asthma may play a role in immunoregulation via the expression of human leukocyte antigens, such as HLA-DR, CD4 and CD45RO, that interact with lymphocytes, and may function as antigen-presenting cells. Furthermore this study suggests that there may be different phenotypes of eosinophils with differing surface antigens and intercellular reactions between eosinophils and lymphocytes.

Autopsy case of acute liver failure due to scrub typhus

Scrub typhus (Tsutsugamushi disease) is an acute febrile disease caused by infection with Orientia tsutsugamushi transmitted by mites. Although patients with scrub typhus commonly display mild liver injury, few die of acute liver failure. We describe herein an autopsy case of acute liver failure due to scrub typhus, which was complicated by disseminated intravascular coagulation and showed rapid progression of liver injury just before death. Histopathological findings revealed submassive hepatocellular necrosis, inflammatory cell infiltration in Glisson’s capsules, and sporadic fibrin thrombi in the hepatic sinusoids. Cause of death was primarily associated with acute liver failure related to disseminated intravascular coagulation.

Juvenile polyposis coli. A case report.

We report a case of juvenile polyposis coli in a 13 year old girl who initially complained of rectal bleeding and prolapse of polyps. Tube feeding with an elemental or a low residue diet and total parenteral nutrition were prescribed to treat the hypoproteinemia and anemia. A modified Soave’s operation was successfully performed. The polyps appeared in several different stages of development. A single dilated gland of the colonic mucosa, which was not grossly visible, was presumed to be the site of the initial lesion which developed into a typical juvenile polyp. Adenomatous tubules were found in some juvenile polyps. In this case of immunologic deficiency, it is not clear whether such was a primary or secondary phenomenon.

A Case of Intraosseous Well-differentiated Osteosarcoma of the Rib With Long-term Survival

背景. 骨内分化型骨肉腫は, 長期の臨床経過をたどる低悪性度骨腫瘍として最近知られるようになった骨肉腫の1亜型である. その肋骨原発は非常に稀であり, 今回報告する. 症例. 45歳男性, 38歳時 (昭和63年) より胸部X線写真上, 右胸壁の異常影を指摘されていた. 平成7年4月近医を再受診した際, 腫瘤影の増大が認められ, 同年6月当科紹介となった. 胸部X線写真上では, 右胸壁より上肺野に突出する4cm大の辺縁整の腫瘤影を認めた. 胸部CTでは右第4肋骨に内部不均一な腫瘍を認めた. 悪性骨腫瘍の可能性を考慮し同年7月18日手術を施行, 右第4肋骨の部分切除および上下肋間筋の合併切除を施行した. 術後の病理組織検査にて右第4肋骨原発の骨内分化型骨肉腫と診断された.術後は化学療法や放射線療法を施行しなかったが, 約7年経過した現在, 再発なく生存中である. 結論. 骨内分化型骨肉腫の組織診断は困難であるが, 本例では組織学的に骨周囲組織への浸潤像がfibrous dysplasiaとの重要な鑑別点となった. さらに, 腫瘍を完全切除できたことが, 初回発見時より14年という長期生存に寄与したものと考えられた.

On Farmer's Lung.

農夫肺は, 酪農従事者 (サイロでの干し草, 堆肥作成作業など) に認められる, 過敏性肺 (臓) 炎の一種である。欧米では, 最も古くから知られている過敏性肺 (臓) 炎である。本邦では北海道, 岩手県, 北陸に多発する。発症の季節は, 主に11月から3月の冬季間に集中する。病因抗原は好熱性放線菌 (Thermoactinomyces) で, 主としてMicropolyspora faeniやThermoactinomyces vulgarisである。以前に比べて, 最近では, 予防のための数々の工夫, 例えば枯草を出来るだけ乾燥させビニール容器で包み密閉するなどの方法により, 枯れ草の発酵による発熱を防ぎ, 好熱性放線菌の繁殖を防ぐなどの環境改善がなされ, 罹患率が著しく低下した。しかしながら, 現在低容量慢性曝露による肺線維症が農村人口の高齢化と相俟って酪農地域の健康問題になりつつある。この線維化の進行を予防するには, 早期診断と継続的な職場の管理, および定期的な検査などによる健康管理が必要とされる。さらにまた, 近年新たな形の酪農に関係する職業環境汚染が生じつつあり, 看過出来ない。