Biomedical subjects
Publications and source records attributed to S Morinaga.
Parameatal urethral cyst is very rare. Although 15 cases have been reported in Japan, no case of parameatal urethral cyst with calculi has previously been reported. We report the first case of parameatal urethral cyst with calculi in a 22-year-old female patient.
We studied four cases who died of post-operative pneumonia occurring more than one month after surgery for lung cancer, despite a satisfactory post-operative course. All cases were male and smoker over 70 years old, who were performed of operation through posterolateral thoracotomy. As a control, we used 11 cases over 70 years old and smoker undergoing surgery for lung cancer through posterolateral thoracotomy, who returned to everyday life without a problem. The body mass index of all pneumonia cases was less than 20, which was significantly lower than that of control cases in both pre- and post-operative time (p < 0.05 and p < 0.01). Post-operative serum total protein and albumin in pneumonia cases was significantly lower than in control cases (p < 0.01). As a result, we suggest that males and smokers over 70 years old with lung cancer, whose body mass index were less than 20, require careful nutritional care over a long period after surgery.
The patient was a 75-year-old male who had a right empyema with bronchopleural fistula, which had developed after right upper lobectomy for pulmonary tuberculosis performed 18 years previously. He also had diabetes and renal dysfunction. The fistula failed to close 5 months after open drainage thoracotomy. Accordingly, closure was performed by the intrathoracic transposition of an omental and muscle flaps obtained from the right latissimus dorsi, pectoralis major, and pectoralis minor. At 70 days after the closure, the fistula reopened due to his poor nutritional state, but it closed again spontaneously following intravenous hyperalimentation. In those patients who have empyema with bronchopleural fistula associated with diabetes or renal dysfunction, long-term postoperative care, especially nutritional management, is necessary because of their poor general health condition.
The patient was a 79-year-old male. On CT of the chest, a mass shadow of the anterior mediastinum was found. He did not complain of symptoms, and there were no clinical signs of myasthenia gravis (MG) before surgery. The tumor and the thymus was completely resected. The pathological diagnosis was non-invasive thymoma, and his postoperative course was satisfactory. However, 2 months after the operation, the patient complained of ptosis, diplopia, dysphagia, and muscle weakness, which deteriorated rapidly. The titer of anti-acetylcholine receptor antibody was high at 91.0 nmol/l. By medication of anti-cholinesterase drug and predonin, the symptoms of MG improved. After resection of thymoma, postoperative follow-up with considering the possibility of postoperative MG is necessary.
The patient was a 36-year-old male, who complained of anterior chest pain and dyspnea. A chest X-ray showed a cardiac enlargement and widened tracheal carina. A cardiac echography showed an intra-pericardial simple cyst which was fixed and did not move with cardiac motion. CT showed a cyst, measuring to 10 cm between the left atrium and vertebra. An angiography revealed that the left atrium and right main pulmonary artery were compressed in the anterior direction. Because his symptoms deteriorated suddenly, an emergency operation was performed. The intrapericardium was explored through the right postero-lateral thoracotomy, and the cyst was resected. A microscopic examination revealed that the cystic wall was lined with ciliated columnar epithelium and contained cartilage and bronchial gland. Review of the literatures indicated that the most of the intra-pericardial bronchogenic cysts were revealed as cardiac enlargement by chest X-ray film, and that the cyst compressing the atrium or main pulmonary artery should be resected without delay, because of a risk of sudden death or cardiac failure.
A 57-year-old male presented with palpitations and dyspnea on exertion. Examination of the peripheral blood and bone marrow showed pancytopenia with marked red cell aplasia. Hypogammaglobulinemia was also recognized. Chest X-ray and CT showed a mass in the anterior mediastinum. A biopsy showed thymoma. Two months after admission, the patient died of sepsis secondary to worsening pancytopenia and hypogammaglobulinemia. Autopsy showed non-invasive spindle cell type thymoma and a marked decrease of hematogenous cells. Review of the literature indicates that pancytopenia associated with thymoma is resistant to all forms of treatment and its prognosis is poor.
A 69-year-old man with an enlarged spleen, found by computed tomography scan to be multicystic, underwent a splenectomy. Pathological examination revealed a Low-grade mucinous cystadenocarcinoma that was histologically analogous to a mucinous tumor of the ovary. The serum level of tumor markers carcinoembryonic antigen (CEA)and CA19-9 were elevated preoperatively and returned to normal after the operation. In the absence of a primary tumor elsewhere, we considered this tumor to be primary in the spleen, and it was presumed that the tumor arose either from invaginated capsular mesothelium of the spleen or from heterotopic pancreatic or enteric tissue within the spleen.
Two cases of malignant pleural tumor producing human chorionic gonadotropin, one confirmed at surgery and autopsy and the other by biopsy, are reported. Both of the patients had bilateral gynecomastia with high levels of serum human chorionic gonadotropin. The first patient underwent panpleuropneumonectomy because of diffuse malignant pleural tumor, but died five months later due to recurrent disease. The histological diagnosis was diffuse, malignant, monophasic mesothelioma of the epithelial type. Immunostaining for alpha-, beta-human chorionic gonadotropin and human placental lactogen was positive in syncytiotrophoblast-like cells. The second patient had diffuse pleural tumor with massive effusion. A pleural biopsy specimen showed diffuse proliferation of epithelioid large cells. Immunostaining for alpha, beta-human chorionic gonadotropin and human placental lactogen was positive in mono- and multinucleated bizarre giant cells mimicking trophoblasts. A diagnosis of malignant mesothelioma with trophoblastic differentiation seemed most likely in both cases in view of the clinical and pathological findings. In both cases, results of mucin histochemistry and various immunohistochemical stains for antigens or with antibodies were consistent with diagnosis of mesothelioma except in a few cells in the choriocarcinomatous portion. This may be the first report describing human chorionic gonadotropin-producing malignant mesotheliomas of the pleura.
The effects of injection of n-3 polyunsaturated fatty acids (PUFAs) on the delayed-type hypersensitivity (DTH) response was investigated in mice. Mice were immunized with sheep red blood cells (SRBCs). Six days later 50 microliters of a 20% SRBC suspension was injected into the right hind footpad of each mouse. Just before the challenge of SRBCs, various amount of a trieicosapentaenoyl-glycerol emulsion (10%) was injected through tail veins (5 mice per each dose). Then 24 hr later the dorsoventral thickness of the right hind footpad was measured and compared with that of the left hind footpad. The difference in thickness between both footpads was regarded as the DTH response. The effect of the emulsion on DTH was dose-dependent; the DTH responses (in mm) in the control group (injected with 0.5 ml of a 2.5% glycerol solution through tail veins) and EPA-injected groups (with 5 mg, 10 mg, and 20 mg) were 1.53 +/- 0.16 (mean +/- SEM), 1.09 +/- 0.14, 0.43 +/- 0.07 (P less than 0.005), and 0.36 +/- 0.13 (P less than 0.005), respectively. The DTH response was also depressed by the injection of a tridocosahexaenoyl-glycerol emulsion. Consequently, n-3 PUFA emulsions have clinical implication in DTH-related diseases such as rejection of allografts.
A rare case of epithelial-myoepithelial carcinoma of the parotid gland, which occurred in a child, is reported. An 8-year-old boy presented with swelling of the right parotid gland. He underwent total parotidectomy followed by irradiation for a parotid gland tumor. Three years after the operation, a recurrent tumor invading the base of the skull and the brain and metastases in the lung were noted. The patient expired in spite of extirpation of the intracranial recurrent tumor. The resected tumor showed a characteristic histologic feature: double-layered tubular structures composed of inner dark cells (epithelial cells) and outer clear cells (myoepithelial cells). This patient may be the youngest one with the epithelial-myoepithelial carcinoma reported in the literature.
Intraperitoneal and pleural immunotherapy has been used as an effective therapy for malignancy. Recently we treated two patients with peritonitis and pleuritis due to cancer by intraperitoneal and pleural administration of IFN-gamma, OK-432 and antitumor agents. One patient with gastric cancer (stage IIIb) was treated with intraperitoneal administration of IFN-gamma and OK-432 in combination with intraarterial infusion of MMC, ADM, 5-FU and CDDP. Two months later, ascites and pleural fluid diminished. Another patient with ovarian carcinoma (stage IV), was administered IFN-gamma, OK-432 and CDDP into ascites with general medication of CDDP and Epi-ADM. Two months later, her ascites and tumor size decreased. This patient was treated with palaplatin every two months for the ten months and hysterosalpingecctomy and tumorectomy of Douglas pouch were performed at the sixteenth month. The histopathological examination of resection from this patient showed complete necrotic tissue of tumor. Endogenous cytokine therapy with intraperitoneal and pleural administration of IFN-gamma for priming and OK-432 for eliciting in combination with antitumor agents may be effective treatment for malignant peritonitis and pleuritis.
Fifty-six cases of surgically resected adenosquamous carcinoma of the lung were studied clinicopathologically, and their outcome was compared with that of adenocarcinomas and squamous cell carcinomas of the lung. The frequency rate of adenosquamous carcinoma was 2.6% of 2160 primary lung cancers resected in the National Cancer Center Hospital (Tokyo, Japan). The survival curves of patients with adenosquamous carcinomas, adenocarcinomas, and squamous cell carcinomas indicated that the outcome of adenosquamous carcinoma was poorer than that of adenocarcinomas and squamous cell carcinomas, particularly in Stages I and II. The amount of adenocarcinoma component did not affect the survival rate, although the histologic features of metastatic lymph nodes was somewhat influenced by the histologic type of the primary tumors. The histologic subtype of adenosquamous carcinoma was one of the independent prognostic determinants.
Percentage of RNA-rich (High fluorescence Ratio, HFR), RNA-middle (Middle Fluorescence Ratio, MFR) and RNA-low (Low Fluorescence Ratio, LFR) reticulocytes was estimated by Sysmex R-1000 reticulocyte counter during the chemotherapy of 27 cases with acute leukemia and malignant lymphoma (36 courses). In the beginning of marrow suppression, HFR and/or MFR were decreased faster than LFR, neutrophils or platelets in 14 courses (38.9%). Simultaneous decrease of HFR, MFR and other blood cells were observed in 57.2%. In the recovery phase of bone marrow, faster increase of HFR and/or MFR was noted in 52.8% and simultaneous increase of these reticulocytes with other blood cells was observed in 9 courses (25%). Appearance rate of RNA-rich younger reticulocytes is a sensitive parameter for the prediction of bone marrow suppression and recovery during the chemotherapy for hematologic malignancy.
Autoantibodies reacting with human pancreatic exocrine cells were investigated by immunofluorescent techniques in 107 patients with Type 1 (insulin-dependent) diabetes mellitus, 20 first-degree relatives of the Type 1 diabetic patients, 347 patients with Type 2 (non-insulin-dependent) diabetes, 34 with alcoholic pancreatitis, 26 with rheumatoid arthritis and 107 normal control subjects. Both immunoblotting analysis and double-immunostaining methods were used to characterize the antigens targeted by the pancreatic exocrine cell autoantibodies. Sera positive for human pancreatic exocrine cell cytoplasm, producing a "fine fibrillar" pattern, were found in 21% (23/107) of the Type 1 diabetic patients. The autoantibodies were present in 39% (15/38) of Type 1 diabetic patients diagnosed within 3 months, and the prevalence decreased with duration of diabetes. The antibodies were of the IgM class in 87% (13/15) of recent-onset Type 1 diabetes cases, but IgG-autoantibodies became more prevalent with increasing duration of diabetes. Three out of 347 (0.9%) Type 2 diabetic patients and 4 of 20 (20%) first-degree relatives of Type 1 diabetic patients had autoantibodies targeted against pancreatic exocrine cells. None of the patients with alcoholic pancreatitis or rheumatoid arthritis and none of the control subjects had these antibodies. Immunoblotting analysis and double-immunostaining demonstrated that the autoantibodies reacted with 40 kilodalton cytokeratin in pancreatic exocrine cell cytoplasm. The antibody was absorbed by the Triton X-100-insoluble fraction of pancreatic extract. These results indicate the presence of distinct autoantibodies to pancreatic exocrine cells in Type 1 diabetes. This suggests the provocative concept that the cytoskeletal system of pancreatic exocrine cells is involved in the pathogenetic process of Type 1 diabetes.
In 18 patients with decreased platelet production proved by reduced platelet turnover, the numbers of megakaryocytes in clot section of marrow aspirate were counted. Platelet counts ranged from 19,000 to 128,000/microliters. The sternal marrow showed decrease of megakaryocytes only in 3 out of 18 cases while megakaryocytes in the iliac marrow were reduced in 6 out of 11 cases. Only one of 11 cases showed decrease of megakaryocyte in both marrows examined. On the contrary, four cases showed normal number of megakaryocytes at both sites. Of 9 cases with normal or increased number of megakaryocytes in sternal and/or iliac marrow, no case showed morphologically abnormal megakaryocytes and only one case had the reduced number of platelet-forming megakaryocytes. Results suggested that the number of megakaryocytes in bone marrow especially in the sternum was not reliable for establishing the diagnosis of decreased platelet production, and that about 50% of patients with thrombocytopenia due to hypoproduction of platelets could be diagnosed pertinently only after the study of platelet kinetics.
In each case of primary or metastatic lung cancer, CT reveals multiple pulmonary nodules in addition to primary or metastatic lesions. All of these small pulmonary nodules were approximately 5 mm in size and were located in the subpleural region of a lower lobe of the lung. It was difficult to differentiate these small nodules from lung metastases. We were able to confirm that these nodules were subpleural intra-pulmonary lymph nodes by open thoracotomy. It should be noted that small pulmonary nodules in the subpleural region of a lower lobe of the lung might be intra-pulmonary lymph nodes.
By in vitro labeling with bromodeoxyuridine (BrdU) and immunohistochemical staining with anti-BrdU monoclonal antibody, the tumor cell kinetics were investigated in 52 resected pulmonary adenocarcinomas. The values of the BrdU labeling index (LI) varied widely among cases of adenocarcinoma in comparison with four cases of small cell carcinoma and ten cases of squamous cell carcinoma examined as controls. The LI was below 3.0 in 60% of the adenocarcinomas. When the LI was analyzed according to the cytologic subtypes of adenocarcinoma, the values were low for goblet cell type and type II alveolar cell type, whereas the values for the bronchial surface epithelial cell type varied widely (average, 5.2) and those for the Clara cell type were intermediate (average, 1.8). A comparison of the LI with TNM classification, histologic differentiation, degree of nuclear atypia, and mitotic cell count showed a correlation between the LI and each of these prognostic factors. Thus, the possibility of the BrdU LI being a useful new prognostic factor of pulmonary adenocarcinomas was suggested.
An extremely rare solitary mast cell tumor of the lung was studied histologically, immunohistochemically, and ultrastructurally. The histologic features of the tumor included nodular growth of well-differentiated mast cells and clear cells with no granules. The current case is the third case of a solitary mast cell tumor (granuloma) of the lung in the literature. Clinicopathologic features of this tumor are compared with the other two cases reported previously in the international literature, and the nature of the clear cells is discussed.