Soichi Iijima

Metastases from occult thyroid carcinoma. An autopsy study from Hiroshima and Nagasaki, Japan

In an autopsy series in Hiroshima and Nagasaki, Japan, cervical lymph node dissections were performed in 128 autopsy cases in which occult papillary thyroid carcinoma had been found, and metastatic carcinoma was demonstrated in 20 cases (16%). These 20 cases with metastatic carcinoma, and an additional 25 occult papillary thyroid carcinomas previously known to have metastases, were compared with the 108 cases which had lymph node dissections negative for metastatic thyroid carcinoma. Significantly increased lymph node metastases occurred in association with the following changes in the the thyroid gland: multiple tumor foci, larger tumor size, greater tumor invasiveness, more than 50% papillary differentiation, and tumor psammoma bodies. Metastases were significantly more frequent in men than in women. In 5 of the 25 additional cases, only the cervical lymph node metastases and no tumor in the thyroid glands were found at routine autopsy. Special thyroid reexamination revealed the small primary carcinomas. In this autopsy series, no thyroid follicle inclusions have been found in cervical lymph nodes in the absence of a primary thyroid carcinoma. The metastases were generally occult, and sometimes multiple, contralateral, and bilateral. In the entire autopsy series, only one occult thyroid carcinoma was the cause of death; 517 other persons with occult papillary carcinoma of the thyroid reached the end of their lifespan without awareness or manifestation of the presence of the tumor.

LIGHT AND ELECTRON MICROSCOPIC STUDIES ON THE DEVELOPMENT OF PERIPORTAL BILE DUCTS OF THE HUMAN EMBRYO

In order to clarify the development of periportal bile duct in the human embryo, the liver tissue of a 13 week‐old human embryo was studied using the electron as well as light microscope.

Papillary carcinoma of the thyroid gland. Sizes of 525 tumors found at autopsy in Hiroshima and Nagasaki

Five hundred twenty‐five cases of papillary carcinoma of the thyroid, diagnosed at autopsy in Hiroshima and Nagasaki, Japan, were investigated for sex differences; 274 cases were found in 1,453 females, 251 in 1,614 males. The greatest dimensions of the tumors by sex have log‐normal distributions, with mean 0.20 cm for females and 0.13 cm for males. Tumors in females were, as a population, significantly larger than tumors in males (p < .001). The data are in agreement with the presence of a growth‐promoting factor which is greater in females than in males. Tumors initiated by radiation and those initiated by other causes seem to be equally promoted by this factor.

Immunohistochemical observation of lysozyme in macrophages and giant cells in human granulomas.

Lysozyme activity of macrophages and giant cells in various human granulomas were examined with immunoperoxidase bridge method in tissue sections. Various numbers of epithelioid cells and giant cells of epithelioid cell granulomas of tuberculosis, sarcoidosis and Crohns disease exhibited intense granular cytoplasmic lysozyme activity. Foreign body granulomas induced with various substances showed negative or faintly positive lysozyme stain. Macrophages and giant cells of aspergillus granuloma associated with thymus hypoplasia and T‐cell depression contained no lysozyme. The results suggest that cell‐mediated immunology plays an important role for the lysozyme synthesis of macrophages in granuloma.

On the chromaffin cells in dog adrenal medulla; with special reference to the small granule chromaffin cells (SGC cells).

SummarySmall granule chromaffin cells (SGC cells) were identified in the adrenal medulla of adult dogs. They were small in size and usually showed a high nucleo-cytoplasmic ratio. Cytoplasmic projections were occasionally observed in some of these cells. They contained a variable number of small secretory granules with diameters ranging from 70 to 300 nm, but mostly from 100 to 200 nm. The densities of the secretory granules were variable, ranging from highly dense to less dense. These adrenal SGC cells were rich in free ribosomes and polysomes, but were relatively poor in other cell organelles. Chromaffin cells which were intermediate in their characteristics (IM cells) between the SGC cells and the typical A and N cells were also identified. These IM cells contained both highly electron dense and less dense granules in various proportions. The IM cells were classified into two subgroups, according to the proportions of adrenaline type granules and noradrenaline type granules. One group resembled A cells (IM-A cells) and the other resembled N cells (IM-N cells). Light microscopic histochemical studies of A cells stained with the ammoniacal silver solution demonstrated that they contained a small number of darkly stained granules. Electron microscopic cytochemistry revealed that the electron dense granules in the SGC cells, IM cells and A cells reacted positively with both the potassium dichromate solution at pH 4.1 and the ammoniacal silver solution.

Enzyme Histochemical Investigations of Human Malignant Lymphomas

26 cases of malignant lymphomas and 23 other lymphoreticular conditions were investigated enzyme histochemically. Each type of malignant lymphoma revealed a different enzyme histochemical pattern characteristic of its type. These features are not only applicable to differential diagnosis but also suggest clues to the understanding of histogenesis and nature of malignant lymphomas.

IMMUNOHISTOCHEMICAL OBSERVATION OF LYSOZYME IN MACROPHAGES IN LEPROSY

Lysozyme activities of skin granulomas of 24 patients in leprosy were studied. Lepra cells of all 15 lepromatous leprosy showed strong lysozyme activity in cytoplasma. In the specimens stained with lysozyme and Ziehl‐Neelsens carbolfuchsin double stain conspicuous lysozyme activity around M. leprae were observed. One borderline case was negative. Lysozyme of epithelioid cells and giant cells of 10 tuberculoid types were completely negative. These results suggest that lysozyme plays only a small role in the disposal of M. leprae in macrophages and other mechanisms than bacteriolytic function of lysozyme are responsible for the defence against these bacilli.

ELECTRON MICROSCOPIC OBSERVATION OF HUMAN HYPERTROPHIED MYOCARDIUM

Hypertrophied muscle cells of the right ventricles obtained from 12 patients with congential malformation of the heart (VSD, TF, A‐V canal and AASV) have been studied by electron microscope.

ULTRASTRUCTURAL CHANGES OF THE DOG MYOCARDIUM IN EXTRACORPOREAL CIRCULATION

The effects of the cardiopulmonary bypass circulation on the cardiac muscle cells were studied electron microscopically. Subendocardial hemorrhage was commonly recognized in both ventricles. However, it appeared earlier and more severely in the right ventricle than In the left ventricle. Clear flocculent areas containing numerous filamentoue structures were originated from degradation of myofibrils. Degradation of myofibrils occurred within 1 hour after bypass circulation. Degenerative changes of myocardial cells such as zonal lesions, contraction bands and swelling or condensation of mitochondria appeared in both ventricles. Damages of myocardial cells In right ventricular wall were more severer as compared with those in the left throughout the period of observation. ACTA PATH. JAP. 27: 435–445, 1977.

Non-arteriosclerotic intramural coronary occlusion with myocardial infarct.

Among the causes of coronary occlusion of non-arteriosclerotic origin, coronary embolism is considered to be the m w common, but it is extremely rare to see an extensive myocardial infraction due to numerous small emboli in intramural branches of the coronary artery. In such cases, attention must be paid to the possibility of multiple arterial or arteriolar microthrombosis based on some vascular disorders of inthnmatory or allergic nature. Presented here are two autopsy cases of nonarteriosclerotic intramural coronary occlusion with myocardial infarct, which will be of great interest in studying the possible pathogenic mechanisms of multiple occlusions of intramural coronary artery.