Tsutomu Karasawa

Report of Nine Cases

Nine cases of peliosis hepatis are reported; five of these were associated with the administration of androgen or anabolic androgenic steroids and a sixth with large doses of medroxy‐progesterone acetate. In five instances, neoplasm was present as an underlying disease. Antemortem evidence of liver disease was detected in six of seven cases but was not severe and had not contributed to death. The pathogenesis of blood‐filled cystic cavities is discussed and the literature reviewed. Angiopathy of hepatic sinusoida in patients with wasting diseases or in those receiving androgens in coexistence with passive congestion of the liver appear to be factors in the pathogenesis of pleiosis hepatis. ACTA PATH. JAP. 29: 457–469, 1979.

Light Microscopic Localization of Hepatitis B Virus Antigens in the Human Pancreas Possibility of Multiplication of Hepatitis B Virus in the Human Pancreas

Hepatitis B virus has been considered to be strictly organotropic and to infect and multiply only the hepatocytes of humans and chimpanzees. The localization of hepatitis B surface antigen in extrahepatic tissues has been regarded as due to deposition or phagocytosis of hepatitis B surface antigen circulating in the blood. In the present study, however, we demonstrated hepatitis B virus antigens in the pancreases of autopsied subjects with hepatitis B surface antigenemia by Shikatas orcein stain, and immunoperoxidase, immunofluorescent studies; hepatitis B surface antigen and hepatitis B virus core antigen were localized within the cytoplasm of pancreatic acinar cells in 18 and 6 cases, respectively, out of 30 cases studied. In contrast, 25 autopsy cases with no hepatitis B surface antigenemia failed to stain hepatitis B surface antigen or hepatitis B core antigen in the pancreas and liver. Therefore, it may be reasonable to assume that hepatitis B virus can infect and replicate in the human pancreatic acinar cells; however no convincing hepatitis B virus-associated ultrastructures were detected in the present study. Although there were some cases demonstrating chronic inflammatory reaction or fatty necrosis, or both, in the pancreas with hepatitis B virus antigens, the causal relationship between these pathologic changes and hepatitis B virus infection awaits further clarification.

SQUAMOUS CELL CARCINOMA OF GALLBLADDER

Two cases of a well‐differentiated keratinizing squamous cell carcinoma of the gallbladder were reported. Pathologic analysis of this rare neoplasm was made in conjunction with cases of the gallbladder carcinoma of a squamous cell variety reported in literatures. The squamous cell carcinoma is characterized by a well‐localized growth and a rarity or lack of metastasis. These characteristics make a good contrast with an adenosquamous carcinoma of the gallbladder which usually infiltrates rather extensively and metastasizes widely. Thus the adenosquamous carcinoma should be sequestered from group of squamous cell carcinoma. Radical operative procedures may well be encouraged on selected cases of squamous cell carcinoma.

Polymyositis and toxoplasmosis.

Extensive severe polymyositis in a patient with toxoplasmosis was presented. Toxoplasmosis was serologically substantiated by a serial two‐tube rise in a toxoplasma‐antibody titer by a hemagglutination test. What appeared to be toxoplasma gondii was detected in areas of myositis. Toxoplasma gondii was found in a single small area of hepatic necrosis, but no other organ or tissue was involved. Thus, the present case was peculiar in respect that skeletal muscles were the major target of toxoplasmosis. A causal relationship between toxoplasmosis and polymyositis was discussed and the literatures were reviewed. Serological investigation and histopathological search for toxoplasma gondii should be done in every case of polymyositis not only for the appropriate therapy but also for the further elucidation of the relationship between toxoplasmosis and polymyositis.

Localized Hepatic Necrosis Related to Cytomegalovirus and Toxoplasma Gondii

An unusual hepatic lesion due to both cytomegalovirus and Toxoplasma gondii was described in a patient with angio‐immunoblastic lymphadenopathy treated by predonin. The lesion was a single well‐defined area measuring 1.5 × 1.0 × 0.5 cm of confluent severe hepatic necrosis with multiple cytomegalic inclusion cells and numerous toxoplasmas. The reamining liver had no liver‐cell necrosis, inflammatory cell infiltration, or evidence of either cytomegalovirus infection or toxoplasmosis. These findings suggested us the possibility of symbiosis and synergism of cytomegalovirus and toxoplasma gondii in the liver. Additionally, this was the first demonstration of cytomegalovirus in liver cells by electron microscopy.

LEIOMYOSARCOMA OF THE HEART COLLIDING WITH ATRIAL MYXOMA

An autopsy case of a primary cardiac leiomyosarcoma of the left atrium colliding with a myxoma in the same chamber was presented. Cardiac signs and symptoms were remarkably silent. She died with multiple systemic metastasis of the leiomyosarcoma. As far as we are aware of, this is the first report of a case with double primary cardiac tumors in collision.

ULTRASTRUCTURAL STUDIES ON LIVER CELL NECROSIS AND LYMPHOCYTES IN EXPERIMENTAL HEPATITIS B

Ultrastructural studies on liver cell necrosis and the interaction of lymphocyte and liver cell were carried out in experimental hepatitis B in chimpanzees. Two types of liver cell necrosis were identified. One was a lytic necrosis, and the other was a coagulation necrosis. Both types of liver cell necrosis were closely associated with the apposition of lymphocytes. The interaction (or close contact) of lymphocyte and non‐necrotic liver cell infected with HBV was also detected. There were two distinct patterns of the contact. One was the direct contact, and the other was the contact with the intervention of electron‐dense fuzzy material containing 20 to 22 mu spherical particles and 51 to 55 mu double‐layered spherical particles. The ultrastructural characteristics of lymphocytes in each pattern of the contact were different. The results suggested that the pathogenesis of liver cell necrosis in hepatitis B was closely associated with the action of lymphocytes, and two modes of lymphocytic reaction were conceivable. ACTA PATHOL. JPN. 35 : 1359 ‐1374, 1985.

HBV‐ASSOCIATED ULTRASTRUCTURES IN THE CHIMPANZEES’LIVERS WITH EXPERIMENTAL HEPATITIS B

An electron‐microscopic study was carried out using chimpanzees’livers infected with experimental hepatitis B for the elucidation of intracellular development of HBV‐associated ultrastructures and extracellular release of HBV. Core particles were first detected in the nucleus of liver cells at around the time of the first seropositiveness for HBsAg, and then in the cytoplasm. Subsequently, their budding into endoplasmic reticular cisterna was seen together with other core particles in the surrounding cytoplasm. Dane‐like particles were seen in the cisterna, and also extracellularly nearby a liver cell with a marked proliferation of microvilli at the onset of liver cell injury. Thereafter, core‐like particles were seen within electrondense amorphous material at the site of the contact between liver cell and lymphocyte. The above sequence of features suggested us the assembly of core particles and surface envelope at the cisternal membrane of endoplasmic reticulum, and a reversed pinocytosis whereby Dane or HBV particles were released extracellularly. The filamentous structures within endoplasmic reticular cisternae, which were thought to be HBsAg, were never detected. ACTA PATHOL. JPN. 35: 1333–1342, 1985.

ULTRASTRUCTURAL CHANGES OF THE BILE SECRETORY APPARATUS AND BILE DUCTULE IN EXPERIMENTAL HEPATITIS B WITH NEITHER APPARENT BIOCHEMICAL NOR LIGHT‐MICROSCOPIC CHOLESTASIS

An ultrastructural study on the hepatic bile secretory apparatus and bile ductules was carried out using liver biopsy specimens of six chimpanzees with experimental hepatitis B. Although biochemical cholestasis was very mild or lacking and light‐microscopic evidence of cholestasis was not evident, various ultrastructural changes which had been described in association with cholestasis were detected. The significance of these ultrastructural changes in relevance to cholestasis was difflcult to determine, nevertheless electron‐microscopic examination could possibly be the most sensitive means for the diagnosis of cholestasis. These ultrastructural changes appeared to be indifferent to the necrotizing process of liver cells in experimental hepatitis B. ACTA PATHOL. JPN. 35 : 1343–1358, 1985.

A report of an infant with asymptomatic HBs antigenemia: Transmission of hepatitis B virus from her father by a blood transfusion

先天性心疾患を有する女児が,その根治手術直前にHBs抗原およびHBe抗原陽性のasymptomatic carrierであった父親より緊急にて,新鮮血約48mlの輸血を受けた.その結果,約2週間後に持続性HBs抗原血症を呈するようになり,その後呼吸不全にて死亡するまで約120日間,HB抗原は持続した.一方母親はHB抗原抗体系は陰性であり,母親よりの感染ではなく,輸血後の父親よりの水平感染によるものであった.肝機能検査上,および剖検による肝の組織学的検索にても肝炎の発症は認められなかった.このHBVのHBs抗原持続陽性と化した6カ月乳児の剖検例を報告し,asymptomatic carrierの発生機序と肝炎の成因について検討を加えた.