[An autopsy case of intracranial and intraspinal hematoma due to widespread metastasis of adenocarcinoma (author's transl)].
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Biomedical subjects
Publications and source records attributed to M Abe.
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The effect of high-protein pyridoxine-deficient diet on the localization of lysosomes and acid phosphatase activity in the rat liver was studied using light and electron microscopy. Numerous lysosomes containing lipid droplets appeared to arise directly from GERI (Golgi apparatus, endoplasmic reticulum and lysosomes) near bile canaliculi and thereafter large crystal clefts were frequently found in these lysosomes. The increase appearance of lysosomes in hepatocytes was compatible with increased lipid droplets and represented an indication of breakdown of stored lipids. Acid phosphatase activity was localized almost exclusively in lysosomes with or without lipid droplets. We postulated that one of the causes of accumulation of lipid in hepatocytes, including that of triglyceride and cholesteryl ester, might be associated with a relative deficiency of intralysosomal digestion in these conditions.
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The patient, a 53-year-old man, was admitted to the Department of Neurosurgery, Nagasaki University Hospital in August 1979, because of a painful tumor in the lt-parieto-occipital region. Physical examination on admission revealed a fist-sized tumor in the lt-parieto-occipital region. The liver edge was palpable at two finger breadths beneath the right costal margin, but the liver itself was not palpable as a mass. Liver function was almost good except for GOT and ChE. Plain craniography showed an osteolytic change of about 10 cm X 10 cm in size without marginal hyperostosis and spicular formation. Bilateral external carotid angiography demonstrated a hypervascular mass, which was fed by the bilateral superficial temporal arteries and occipital arteries. CT scan also demonstrated a fist-sized tumor originating from the diploë with destruction of the skull bone. Tumor was strongly enhanced. A radical removal of tumor was performed. Tumor was solid with profuse bleeding and adhered tightly to the dura and the skin. The postoperative course was uneventful and postoperative CT scan demonstrated complete removal of the tumor. Histological diagnosis was hepatocellular carcinoma and the skull tumor was considered to be metastatic. CT scan of the liver showed a circumscribed low density area with ring enhancement at the posterior ventral site. As no metastasis was found in other organ except the skull, so primary lesion was radically removed at the Second Department of Surgery. The incidence of metastasis to the bone in hepatocellular carcinoma in autopsy studies has been considered rarely approximately from 4 to 14%. Moreover, the common sites of skeletal metastasis are the vertebral column, the ribs, the long bones and so on. Metastases to the skull bone was exceptionally rare and all cases hitherto reported had multiple metastases in other organ(s) and no literature was found about the distant metastasis to the skull bone only.
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Recent advances in the chemotherapy of malignant diseases, particularly, in hematopoietic malignancies, has opened oncologists' eyes in wonder, whereas the chemotherapy of solid malignant diseases including the carcinoma of the lung is not satisfactory compared with the results of other modalities such as radiotherapy and surgery. The chemotherapy, however, gradually becomes a great importance because the majority of the cases of lung cancer is that of advanced one. Between June, 1974 and December 1980 we experienced 54 inoperable cases of lung cancers among which there were 11 cases diagnosed as an anaplastic carcinoma. The combination chemotherapy of vincristine (1 mg/body, iv, day 1), methotrexate (30 mg/body, iv, day 1 and 5), ACNU (100mg/body, iv, day 2) and adriamycin (40mg/m2, iv, day 2) was employed. Vincristine and methotrexate were given every 3 weeks and ACNU and adriamycin were repeated every 9 weeks. If the moderate degree of neuropathy due to vincristine occurred it was suspended and methotrexate was stopped if WBC was less than 2000/mm or if patients were suffered from stomatitis which disturbed their swallowing. According to the response criteria of Koyama-Saito 4, cases were responded and one of them survived 17 months after the initiation of above 4-drug combination chemotherapy, although she received another combination chemotherapy because of the relapse of disease. The combination chemotherapy of ACNU and adriamycin was tried to utilize the advantage of their time different effects on the bone marrow suppression and to cover heterogenous histopathological diagnosis of anaplastic carcinoma. The heterogeneity of anaplastic carcinoma included undifferentiated squamous cell carcinoma, adenocarcinoma, large cell carcinoma and even small cell carcinoma. In taking consideration of these points, the drug-combination was designed. Clinically, however, the long resting period made the tumor regrow in some cases due to severe delayed myelosuppression by the combination of ACNU and adriamycin. Thus, more cautiously-designed combination should be considered.
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