Tsutomu Hatori

Malignant glomus tumor: a case report and review of the literature.

This report concerns a malignant glomus tumor, a rare soft tissue tumor that was examined immunohistochemically and ultrastructurally. It occurred in a 44-year-old male patient who had suffered from dull pain and stiffness in the right thigh for 10 months. Radiographic examination revealed a well-defined osteolytic lesion in the diaphysis of the right femur. Hypervascularity of the tumor was observed angiographically. Computed tomographic and magnetic resonance examinations showed an intramuscular mass invading the marrow space of the femur. Wide resection was performed after open biopsy. Histologically, round to polygonal tumor cells revealed a uniform appearance of round to ovoid nuclei with single large nucleoli and slightly eosinophilic cytoplasm, forming solid sheets of cells interrupted by vessels of varying size. A few mitotic figures and vascular invasion were observed. Immunohistochemically, vimentin and alpha-smooth muscle actin were stained intensely, and muscle actin was positive for tumor cells of the perivascular area. Tumor cells were negative for desmin, factor VIII-related antigen, S-100 protein, neurofilament, cytokeratin, and epithelial membrane antigen. Ultrastructurally, tumor cells were characterized by many cytoplasmic processes, pinocytotic vesicles, plasmalemmal dense plaques, and scattered microfilaments in the cytoplasm. Few cell junctions and focal basement membrane-like structures were observed. No recurrence or metastasis was noted 57 months after operation. This case was considered to be a malignant glomus tumor, that is, a glomangiosarcoma arising de novo.

Microvasculature of the human cerebral white matter: Arteries of the deep white matter

The vascular architecture of the human cerebral deep white matter was studied using soft X‐ray and diaphanized specimens, achieved by intra‐arterial injection of barium and vascular stain respectively, and also by electron microscopic examination of the corrosion cast of arteries in normal adult brains. The deep white matter arteries passed through the cerebral cortex with a few branches to the cortex and ran straight through the white matter. The arteries concentrated ventriculopetally to the white matter around the lateral ventricle. Anastomoses were noted around the ventricular wall at the terminals of the deep white matter arteries. No centrifugal branches irrigating the periventricular white matter from the lenticulo‐striate arteries were observed in the present study. The presence of anastomoses among the terminal branches of deep white matter arteries protects against ischemic change or infarction in this area from an occlusion of a single deep white matter artery. This may lead to development of terminal zone infarction from ischemia or vascular diseases, affecting multiple deep white matter arteries. The subcortical and deep white matter arteries had thick adventitial sheaths and large adventitial spaces in the white matter but not in the cortex. The presence or absence of the adventitial space is regarded as another characteristic difference between the arteries in the white matter and cortex. This difference may influence pathological changes in vascular lesions in these respective areas.

Analysis of Chromosome 19q13.42 Amplification in Embryonal Brain Tumors with Ependymoblastic Multilayered Rosettes

Recently, it was reported that ependymoblastoma and embryonal tumor with abundant neuropil and true rosettes (ETANTR) show 19q13.42 amplification at a high frequency, suggesting that these tumors may constitute a single entity. As ependymoblastic rosettes are the most prominent features in both subtypes, embryonal tumor with multilayered rosettes (ETMR) was proposed, for which 19q13.42 amplification represents a specific molecular hallmark. However, ependymoblastic rosettes are not specific to ependymoblastoma and ETANTR, and are also found in a few other embryonal tumors as well as immature teratomas, and knowledge on 19q13.42 amplification in these tumors is limited. In this study, we performed fluorescence in situ hybridazation (FISH) analysis and differential polymerase chain reaction (PCR), and detected 19q13.42 amplification in three out of four ETANTR, one ependymoblastoma and one medulloepithelioma with ETANTR components, whereas none of the two atypical teratoid/rhabdoid tumors (AT/RT) with ependymoblastic rosettes nor two immature teratomas with developing neuroectodermal structures showed such amplification, suggesting that medulloepitheliomas would possibly be included in ETMR, and ependymoblastic rosettes in AT/RT do not signify that these tumors constitute ETMR. Also, we found C19MC rather than miR‐371‐373 was amplified in one ETANTR, suggesting that C19MC miRNA cluster seems to be more closely linked to the pathogenesis of ETMR.

Microvasculature of the human cerebral meninges

In the present study, the human cerebral meninges were rich in blood vessels, but no capillaries were noted. The meningeal arteries ran over the veins where they crossed. Several arterial anastomoses existed on the cortical surface. The meningeal arteries were classified into four parts; the conducting artery approximately 700 µm in diameter, distributing artery approximately 200 µm in diameter, precortical artery approximately 60 µm in diameter and cortical artery approximately 30–40 µm in diameter. A single distributing artery supplied the area of approximately 3.5 × 2.0 mm on the brain surface. They further ramified into precortical arteries which stemmed cortical arteries. These precortical arteries had the distributing area of 1 mm2 and this distributing area was the same size as the width of human ocular dominant column of the visual cortex. Constriction, like a sphincter, was observed at the bifurcation of the distributing arteries. The cerebral blood vessels, which regulated the blood flow and reacted to autonomic nerve stimuli, seemed to correspond to the distributing arteries.

Comparison of metastatic brain tumour models using three different methods: the morphological role of the pia mater

As methods of cancer diagnosis and treatment progress, interest in metastatic brain tumours continues to increase. There are many studies using various methods of animal model and we considered that each model reflects different pathological processes because of the unique composition of the brain. We prepared metastatic brain tumour models using three different methods. In this study, we attempted to elucidate the roles of the pia mater in brain metastasis. The metastatic foci showed an angiocentric pattern, forming collars of neoplastic cells, and were designated ‘perivascular proliferations’. Furthermore, we observed neoplastic cells that infiltrated the brain parenchyma, the border of which had become indistinct. These were labelled ‘invasive proliferations’. The internal carotid artery injection model reflects haematogenous metastasis. In this model, both perivascular and invasive proliferations were observed. The intrathecal injection model reflects leptomeningeal carcinomatosis. In this model, metastasis to the meninges was observed. In the stereotactic injection model, the tumour proliferation at the injection site and the infiltration into the brain parenchyma were observed. The pia‐glial membrane serves as a scaffold when neoplastic cells spread to the perivascular space forming angiocentric pattern. The pia‐glial membrane is found between the brain parenchyma and blood vessels. Blood vessels penetrate the brain through tunnels known as perivascular spaces that are covered by pia mater. Three different methods which we prepared reflect three different pathological processes. Our findings suggest that the pia mater is a critical factor in brain metastasis.

The microvasculature of the spinal cord in the human adult

The microvasculature of the human spinal cord have been studied with scanning electron microscopy (SEM) on the corrosion casts of blood vessels, and light microscopy on the transparent after intra‐arterial injection of Indian ink and vascular staining specimens.

An experimental model of brain metastasis of lung carcinoma

Most metastatic brain tumors originate from lung cancers. However, there has been relatively little progress on developing an experimental model of metastasis of lung cancer to the brain. By injecting Lewis lung carcinoma cells into the right internal carotid artery of C57BL/6NCrj mice, we succeeded in developing a model of metastatic brain tumors. In this model, carcinoma cells proliferated in the choroid plexus of the right lateral ventricle and formed a nodular tumor mass, while carcinoma cells in the cerebral parenchyma multiplied along the perivascular sheath without forming a nodular mass. Twelve days after injection, carcinoma cells spread into the left hemicerebrum. Fifteen days after injection, carcinoma cells could be seen in both hemispheres, along with intraventricular tumor formation. The maximum life span of mice with metastatic brain tumors was 22 days. Our model essentially replicated the general process of metastatic cancer and may have a significant role in further research on brain metastasis of lung cancer.

The microvasculature of the human cerebellar meninges.

Abstract. The vascular architecture of the human cerebellar meninges was investigated. The surface meninges were poor in vasculature. In the sulci, the meninges were highly vascular but had few capillaries. The venous blood vessels gave long side branches at right angles to the parent vessels in a cruciform pattern, running horizontally along the cerebellar sulci. They were situated at the origin of the secondary or tertiary sulci. Anastomoses between these horizontal branches gave a crosshatched appearance. Short branches often extended to the bases of the sulci, terminating in T-shaped bifurcations with numerous tiny branches, like the roots of a tree. The arteries ran perpendicular to venous branches which were parallel to each other exclusively along the sagittal plane. These arteries bifurcated to straddle the horizontally running veins at the origin of the secondary or tertiary sulci. They gave off many small branches like teeth of a fork from each artery in the secondary or tertiary sulci after they bifurcated to straddle the venous branches and penetrated the cerebellar cortex at the bases of sulci. These fork-like ramifications in the bases of the sulci were most likely responsible for the ready development of pronounced ischemic state. They might also play an important role in the occurrence of ischemic damage at the bases of sulci in cases of severe generalized ischemia.

The fundamental architecture of the microvasculature of the basal ganglia and changes in senility

The microvascular architecture of the basal ganglia of human brains was studied on diaphanized specimens after intravascular barium injection and vascular stains. Observation by scanning electron microscope was also performed. The putamen and caudate nucieus showed dense capillary networks. Less dense capillary networks were noted in the capsula interna. The capillary network in the globus pallidus was less dense than that in the striatum but denser than that in the capsula interna. The lenticulostriate arteries ran through the putamen, across the internal capsule and reached the caudate nucleus. Though the arterial branches running within the putamen had many small branches, branching was minimal while crossing the capsula interna and began showing rich ramification again when they reached the caudate nucleus. There were retrograde ramifications in the putamen and caudate nucleus. They appeared to play a significant role in the regulation of blood pressure and are considered to play some role in the occurrence of circulatory disturbances which are prone to involve these structures. The fountain‐like ramifications were seen in the putamen and caudate nucleus, but their function is not clear. In the brains of senile patients, intertwining of the arterial blood vessels was noted in the fountain‐like rami. This structure began to appear in the patients over the age of 50. While the etiology of the intertwining of the arteries remains unknown, its increasing frequency with age supports a hypothesis that this represents a phenomenon correlated with aging or concomitant brain atrophy.

Diagnosis of systemic toxoplasmosis with HIV infection using DNA extracted from paraffin- embedded tissue for polymerase chain reaction: a case report

IntroductionToxoplasmosis can be a life-threatening disease when it occurs in patients with HIV infection. In particular, meningioencephalitis has been regarded as the most common toxoplasmic complication in such patients. However, toxoplasmic meningitis in a patient with HIV infection is extremely rare and purulent or tuberculous meningitis should be considered initially as a disease for differential diagnosis in Japan.Case presentationToxoplasmic meningitis in a patient with HIV infection is reported. A 36-year-old Japanese man presented with fever, pulsating headache, lumbago, nausea, and vomiting. No examinations suggested toxoplasmosis including cerebrospinal fluid examinations, images, and serological tests. The result of a polymerase chain reaction assay using paraffin-embedded section was regarded as the conclusive evidence for the diagnosis.ConclusionsWe wish to emphasize the usefulness of polymerase chain reaction assays with nucleic acid extracted from paraffin-embedded tissue sections processed for routine histopathological examination, if the section shows the infectious agents or findings suggesting some infectious diseases.