Tetsuo Itoh

Hepatoid adenocarcinomas of the stomach: an analysis of seven cases

Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. They usually produce large amounts of alpha‐fetoprotein (AFP) with a Concanavalin A‐binding property of hepatic type. In this study, these carcinomas occurred in older persons, with the antrum being a common site. Observed grossly, growth of the tumors was nodular and massive. Prognosis was poor because of frequent liver metastases. In the cytoplasms of tumor cells, various serum proteins were identified, including AFP, alpha‐1 antitrypsin (AAT), alpha‐1 antichymotrypsin (ACT), albumin, and prealbumin. Localizations of ferritin, prothrombin, and transferrin were demonstrated with less frequency. Adenocarcinomatous foci were composed of well‐differentiated, intestinal‐type epithelial cells and often contained carcinoembryonic antigen. These adenocarcinomatous and hepatoid areas were often intermingled with each other. There were extensive venous involvements by tumor cells. The poor prognosis of the tumors may be attributed to these involvements as well as to production of AFP and presence of AAT/ACT, which have immunosuppressive and protease‐inhibitory properties, respectively. Cancer 58:119–126, 1986.

IgA Nephropathy: Clinicopathology and Immunopathology

In a total of 283 biopsies, 100 (35%) were found to be IgA nephropathy. The incidence reached 40% among primary glomerulonephropathies. On the basis of histopathologic changes in glomeruli, these biopsies were classified into 3 groups. The criteria employed correlated well with clinical, laboratory and immunofluorescent findings. Immune complex pathogenesis was discussed in relation to our findings.

GANGLIONEUROBLASTOMA ASSOCIATED WITH MALIGNANT MESENCHYMOMA

A case of ganglioneuroblastoma associated with malignant mesenchymoma is reported. The tumor originated from the retroperitoneum and was comprised not only of neuroblastoma and ganglioneuroma, but also of typical rhabdomyosarcoma, liposarcoma, undifferentiated mesenchymoma, as well as cartilaginous tissue. No distinct border existed between these different components. The histogenesis of the tumor is discussed. We suggest that the tumor derived from a remnant of neural crest (ectomesenchyme).

Primary intracranial yolk sac tumor. Immunofluorescent demonstration of alpha‐F etoprotein synthesis

An autopsy case of 20‐year‐old male with primary intracranial yolk sac tumor (endodermal sinus tumor) is reported. Whereas the biopsy specimen obtained from the pineal region showed diffuse proliferation of atypical tumor cells, the metastatic subdural tumor removed from lumbar spinal region had the characteristic histologic appearance of yolk sac tumor. The histologic diagnosis was intracranial yolk sac tumor originating in the pineal gland. The elevated amount of alpha‐fetoprotein in the cerebrospinal fluid and in the serum further supported the diagnosis. At autopsy, only metastatic tumor was present in the posterior fossa. The immunofluorescence study demonstrated the presence of intraand extracellular alpha‐fetoprotein globules in the tumor tissue. The intra‐ and extracellular distribution of alpha‐fetoprotein, in general, appeared to coincide with that of the PAS‐positive hyaline globules in the tumor.

Immunofluo rescent demonstration of alpha-fetoprotein and other plasma proteins in yolk sac tumor

All seven pure yolk sac tumors of gonadal and extragonadal origin tested showed a bright positive fluorescence for alpha‐fetoprotein in the tumor tissue. A positive reaction was seen in both the tumor cells and the hyaline globules. In all cases, however, the positive fluorescence was distributed in some focal areas of the tumor tissue. Certain tumor cells showed a strong granular intracytoplasmic fluorescence, whereas others showed a weak or a negative fluorescence. The fluorescence‐positive tumor cells were located mainly in the areas rich in fluorescence‐positive hyaline globules. Besides alpha‐fetoprotein, certain plasma proteins–‐albumin, alpha‐1 antitrypsin, and transferrin–‐were also demonstrated in all five yolk sac tumors tested. The pattern of the distribution of positive fluorescence was basically similar to that of alpha‐fetoprotein. Other plasma proteins–‐orosomucoid, haptoglobin, Gc‐globulin, alpha‐2 macro‐globulin, hemopexin, and ceruloplasmin–‐were present in certain tumors, and were distributed mainly in a limited number of hyaline globules. Both igG and IgA were present in two tumors of ovarian origin. The immunoglobulins were for the most part present in extracellular hyaline globules, suggesting that these are taken up from the circulation. Test for fibrinogen, beta‐lipoprotein, IgM, IgE, beta‐1C/beta‐1A and beta‐1E globulins were negative or questionable. In a hepatoblastoma, tests for alpha‐fetoprotein were positive, but those for other plasma proteins were negative. Fine granular fluorescence was seen in each hepatocellular tumor cell. Mesenchymal elements were virtually unstained.

A case of primary B‐cell lymphoma of the breast. Light and electron microscopy, and immunologic cell markers

A case of primary non‐Hodgkins lymphoma of the breast was studied with light and electron microscopy and for immunologic cell markers. With light microscopy, the tumor was seen to be a poorly differentiated lymphocytic lymphoma, diffuse, according to Rappaports classification. With electron microscopy, the tumor was seen to consist of a cytologically uniform cell population. The cells were characterized by irregularly shaped nuclei with infrequent cytoplasmic projections and “microvilli‐like” structures, mimicking small cleaved follicular center cells. The immunologic cell marker study showed that the cells were positive for surface IgA and HLA‐DR antigen; negative for SRBC receptors, Leu 1, Leu 2a, and Leu 3a antigens. The collective evidence indicated the tumor was of B‐cell origin.

CHONDROID SYRINGOMA (MIXED TUMOR OF THE SKIN)

The clinicopathology of 13 cases of chondroid syringoma were examined. The ages of the patients ranged from 26 to 86 years, with an average of 48 years. There were eight males and five females. Ten tumors out of the thirteen appeared on the face. Only one patient out of ten was suspected of recurrence in follow‐up information. Histologically, all tumors consisted of epithelial cells, chondroid or myxoid matrix, and other strumal elements. The tumors were histologically classified into two types; twelve tumors had tubular and cystic lumina lined by two layers of epithelial cells, and only one case had small lumina lined by only a single layer. By an immunohistochemical study with a PAP method, positive stainings of keratin were observed in all cases, and S‐100 protein in all but one. Ultrastructurally, the tumor cells showed features of an epithelial cell. Some ultrastructural differences were noted between two types of chondroid syringoma. Type I tumor cells had many tonofilaments in cytoplasm, but cytoplasmic filaments in type II were of the intermediate‐type.

IMMUNOPATHOLOGICAL STUDIES OF AN AUTOPSY CASE WITH GOODPASTURE'S SYNDROME AND SYSTEMIC NECROTIZING ANGIITIS

A rare autopsy case of Goodpastures syndrome with systemic necrotizing angiitis is reported. The patient, a 56‐year‐old male, died of respiratory failure with massive pulmonary hemorrhage and renal failure. The autopsy showed widespread hemorrhage In both lungs, diffuse crescentic glomerulonephrltis, and systemic necrotizing angiitis in the small arteries. Immunofluorescence studies demonstrated a linear deposition of IgG along the glomerular basement membrane (GBM) as well as the alveolar basement membrane. A granular deposition of C3 was also found along the GBM. Electron microscopy showed that the GBM was Irregularly thickened and wrinkled, but electron‐dense deposits were indistinct. Anti‐GBM antibody activity was detected in the patients serum and had cross reactivity with normal alveolar basement membrane. The renal eluates contained IgG antibody activity for normal human GBM. These results suggest that glomer‐ulonephritis and pulmonary hemorrhage in the present case were mediated by anti‐basement membrane antibodies. We also discussed whether antibasement membrane antibody is involved in the pathogenesis of systemic necrotizing angiitis.

Comparative immunopathologic studies of thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome and disseminated intravascular coagulation.

The vascular lesion of thrombotic thrombocytopenic purpura was characterized by two distinct types of changes in the arteriole of the heart and brain: (1) multiple incomplete vascular occlusions due to the subendothelial deposits composed of a homogeneous fibrin fibrinogen‐like substance and platelets without the formation of polymerized fibrin; (2) vascular wall thickening due to the intramural granular deposits of IgM and β1C.

Clinicopathology and Immunopathology of 80 Biopsy Cases

The clinicopathology and immunopathology of 80 cases of lupus nephritis in a total of 1,187 biopsies were presented. Histologically, they consisted of 11 cases of mesangial lupus nephritis (13.8%), 51 cases of diffuse proliferative lupus nephritis (63.7%), and 18 cases of membranous lupus nephritis (22.5%). No cases of focal proliferative type, minimal changes or end‐stage kidneys were included. Ten cases were male and they had no qualitative and quantitative differences with female ones in any respects. The microtubular structures were found in glomerular endothelial cells with a 70% frequency and in the interstitial endothelial cells with a 46% frequency. In the latter case, microtubular structures tended to be localized in the perinuclear space as well as in the endoplasmic reticulum. Spherical microparticles were found in 46% of all cases and the incidences were significantly higher in the membranous type. Organized deposits with straight parallel microfilaments were found only in a single case. Electron‐dense deposits with fingerprint pattern were not seen. Immunohistochemically, various immunoglobulins, complement components, and fibrinogen were found deposited more frequently in diffuse proliferative lupus nephritis. IgG was the predominant immunoglobulin deposited in capillary loops in membranous types, and IgA in the mesangium in mesangial types. Extraglomerular deposition of immunoglobulins and complements were found in 26.3% of all cases.