Shosuke Moriwaki

Clinicopathological study on combination therapy consisting of arterial infusion of lipiodol-dissolved SMANCS and transcatheter arterial embolization for hepatocellular carcinoma*

SummaryCombination therapy (LpTAE) consisting of arterial infusion of a lipophilic anticancer drug, SMANCS, dissolved in an oily lymphographic agent, lipiodol (LPD), and transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) was studied with special reference to the pathological findings. A total of 32 patients were subjected to surgical resection after LpTAE. The pattern of LPD deposition in the tumor was examined by CT scan (Lipiodol CT, LpCT) at 7 days and/or 1 month after LpTAE. The resected materials were examined radiographically with soft X-rays and histologically. LPD was deposited in tiny daughter nodules with a diameter of less than 5 mm and in tumor thrombi as well as in the main tumors, which showed necrotic change. Part of the LPD flowed out from the main tumor via the drainage vein and was deposited in the capsular invasion, resulting in necrosis. LPD accumulated almost exclusively within the blood spaces of trabecular-type HCC, creating a pattern corresponding to a cast of the tumor vessels, which showed prominent necrossi. On the other hand, LPD was not deposited in scirrhous, compact, or well-differentiated HCC, which showed little or no necrosis. It was demonstrated that LpCT images, which accurately depicted the existence and the extent of LPD deposition and necrosis in peutic effect. Our findings indicate that LpTAE and LpCT are valuable for the diagnosis and treatment of HCC and should play a central role in systemic therapeutic approaches to this disease.

Aggressive angiomyxoma of the vulva. Report of a case.

A case of aggressive angiomyxoma of the vulva is reported. A 43 year‐old woman presented initially in 1987 with a left vulvar mass which clinically was thought to be a lipoma or a Bartholin gland cyst. Local excision was performed after a 27 month follow‐up without any change in size. The resected tumor measured 2.7x2.0x2.0cm and had a smooth, glistening and myxoid cut surface. Histologically, the lesion was composed of spindle shaped or stellate neoplastic cells, which were loosely textured in the fibromyxoid matrix, and a prominent vascular component characterized by randomly distributed vascular channels of variable caliber. Immunohistochemically, the tumor ceils were positive for vimentin, but not for desmin and myosin. The fine structure of the neoplastic cells was compatible with that of fibroblasts rather than myofibroblasts. These findings suggest the fibroblastic differentiation of this tumor. The patient is currently well with no evidence of recurrence, 7 months after excision of the tumor. Acta Pathol Jpn 40: 927–934, 1990.

PLASMA CELL GRANULOMA OF THE STOMACH COMBINED WITH GASTRIC CANCER

An autopsy case of plasma cell granuloma of the stomach combined with gastric cancer is reported. Plasma cell granuloma presumably occurred independently of adenocarcinoma in the stomach, and nodular or diffuse infiltration of plasma cells containing many Russell bodies was observed in the gastric wall, intermingled with lymphocytes. Infiltrating plasma cells were polyclonal in nature as seen by peculiar meshwork patterns of positive immunofluorescence against human γ, and λ chains. Ultrastructurally, globular Russell bodies, 1‐7 μm in diameter, were located in the rough endoplasmic reticulum and could be divided into two types, smooth‐or rough‐surfaced one.

HISTOLOGICAL OBSERVATION OF THE BRAIN OF TAY-SACHS DISEASE WITH SEIZURE AND CHRONIC DPH INTOXICATION

The patients was a 3‐year‐old boy with psychomotor retardation and attacked by seizures since 8 months of age. On funduscopy, the maculla presented a cherry‐red spot. Serum hexosaminidase A activities were as low as 8.2%. Both parents were carriers. The patient was diagnosed as classical Tay‐Sachs disease by neurological examination. Diphenylhydantoin was continuously given for 2 years and 2 months till his death. Autopsy revealed swelling of the cerebrum, atrophy and sclerosis of the cerebellum, hepatomegaly and mild enlargement of the lymph nodes. Histologically, the cerebrum showed ballooned swelling of nerve cells, slight gliosis and demyelination, while cerebellar Purkinjes cells and granular cells were degenerated and disappeared. The cerebellar cortex showed small focal spongy degeneration. By electron microscopy, membranous cytoplasmic bodies were found in the nerve cells. The change of brain observed in this case were interpreted as a combined result of (i) essential change to classical Tay‐Sachs disease, (ii) ischemic change due to frequently repeated seizures, (iii) chronic toxicity by long‐term anticonvulsant administration.

Proliferation of Osteoclast-Like Giant Cells in a Metastatic Bone Tumor from Stomach Cancer : Report of a Case and Analysis of the Autopsy Findings

A 70-year-old man who had undergone esophagectomy with reconstructive surgery using a portion of the stomach 5 years earlier for esophageal cancer was admitted to our hospital after a routine endoscopy and histological examination of a biopsy specimen revealed poorly differentiated adenocarcinoma in the stomach. A gastrectomy and intrathoracic esophagojejunostomy was performed on January 20, 1993; however, the patient suffered a cerebral infarction and died of septic shock on April 9, 1993. At autopsy, metastatic tumors were macroscopically observed in various organs, including a bone tumor measuring 1.0 cm in diameter in the L4 vertebra. To clarify the origin of the bone tumor, we conducted histological and immunohistochemical examinations. Histological examination revealed a mixture of osteoclast-like giant cells (OGCs) and poorly differentiated adenocarcinoma cells, although no histologic features of OGCs were observed either in a primary site or in any of the multiple metastatic lesions. On immunohistochemistry, adenocarcinoma cells in the bone stained positively for the carcinoembryonic antigen (CEA), whereas no staining for CEA was observed in the OGCs which demonstrated negative staining for all the antigens of epithelial markers. These findings led us to conclude that this bone tumor had metastasized from the stomach cancer and that the OGCs may have originated from mesenchymal cells reacting to the adenocarcinoma cells.

Suppression of Estrogenic Activity by Medroxyprogesterone Acetate in Tamoxifen-treated Patients after Surgery for Breast Cancer to Reduce the Risk of Endometrial Cancer Development.

BackgroundPostoperative adjuvant tamoxifen (TAM) therapy in breast cancer patients may lead, albeit rarely, to endometrial cancer. Preventive measures are urgently needed.MethodsThe study subjects were postmenopausal women who had undergone surgery for breast cancer. The control group (n=10) received no further therapy. Patients who had completed adjuvant TAM therapy were assigned to a medroxy-progesterone acetate (MPA; 400 mg/day orally for 4 weeks) group (n=15) or no MPA treatment group (no MPA group) (n=15). Uterine cervix cytodiagnosis was performed after completing the TAM therapy (initial), and 4 (4-week) and 16 (16-week) weeks later. The serum 17β-estradiol (E2) and progesterone concentrations were measured initially and at 4 weeks. The karyopyknotic index (KPI), eosinophilic index (EI) and maturation index (MI) were calculated from Papanicolaou-stained specimens.ResultsThe background parameters showed no biases. There were no differences in the KPI or EI between the no MPA and MPA groups. However, regarding the MI, after 4 weeks in the MPA group, the intermediate cells were significantly increased, while the superficial cells tended to be significantly decreased. Regarding the percent change from the initial value, after 4 weeks in the MPA group, the KPI and superficial cells were significantly decreased, and the intermediate cells were significantly increased. The estrogen activity level and the progesterone concentration were significantly lower in the MPA group compared with the no MPA group. Conclusions. The MPA administration clearly lowered the estrogenic activity, indicating that MPA therapy should be effective in reducing the risk of TAM-associated endometrial cancer.

A trial of the intraperitoneal administration of recombinant interferon-.BETA. for the prevention of the postoperative peritoneal recurrence in gastric cancer with serosal invasion.

漿膜露出胃癌の腹膜再発防止の目的でRecombinant interferon-β (IFN-β) の術後腹腔内投与を試みた.胃癌癌性腹水10例では著効2例, 有効4例 (奏効率60%) を得た. 特に低分化腺癌, 印環細胞癌に強い効果を認めた. 発熱以外の重篤な副作用はなく, 剖検例の検索で癒着を促進するような刺激作用は認めなかった. 漿膜露出胃癌13例に対する術後腹腔内投与では, 縫合不全, イレウスなどの合併症は無く治癒手術例では腹膜再発を認めていない.S2, 肉眼的治癒手術例を対象にIFN-βの術後腹腔内投与の有無での比較試験を行っており, 術後補助療法としての本法の評価を明らかにしたいと考えている.

Case report of Raeder's syndrome caused by the cervical tumor.

Raeders syndrome is defined as a part of Homers syndrome, in which only the 3rd sympathetic nerve is damaged. The 3rd nerve arises from the superior cervical ganglion and goes to the eyes. Raeders syndrome lacks the anhidrosis of the face and the heterochromia iridis present in Homers syndrome. We have examined two patients with Raeders syndrome, a 62-year-old female with malignant lymphoma and a left cervical mass, and a 40-year-old male with a Schwannoma of the left side of the neck. Two cases of squamous cell carcinoma with marked cervical metastasis in the terminal stage and similar symptoms of Raeders syndrome are also discussed. The most reliable method of differentiating the two syndromes is the pupillary drug test with sympathomimetic drugs. We used 1 % phenylephrine. In Raeders syndrome, marked dilatation of the pupils and improvement of ptosis were noticed. When we see Homers syndrome patients with a cervical mass, this test should be used to better locate the tumor.