Mucinous cystadenoma of appendix concomitant with perityphlic granuloma

We describe a case of mucinous cystadenoma of the appendix with perityphlic granuloma. The patient developed a hard palpable mass in the right lower quadrant and barium enema induced irregular bowel wall at the cecum. Based on a preoperative diagnosis of carcinoma of the appendix, we performed a laparotomy. On operation, we found a tumor mass in the region of the appendix; the mass adhered strongly to the retroperitoneum and cecum. Right hemicolectomy was carried out on a diagnosis of carcinoma of the appendix. Microscopic examination revealed mucinous cystadenoma of the appendix with perityphlic granuloma. Mucinous cystadenoma in the appendix is a rare tumor. In this patient, the tumor was accompanied by granuloma formation in adjacent tissues because of mucin expelled from the appendix. This case emphasizes that granuloma formation can make of difficult to differentiate mucinous cystadenoma in the appendix from cancer.

Transient abnormal myelopoiesis accompanied by hepatic fibrosis in two infants with Down syndrome

Two necropsy cases of Down syndrome are reported. These showed transient abnormal myelopoiesis accompanying characteristic hepatic sinusoidal fibrosis. Numerous megakaryocytes were found in the liver of one case, but not in the other. Only eight cases of Down syndrome with simultaneous occurrence of hepatic fibrosis and transient abnormal myelopoiesis have been reported. The cases described here showed slight fibrotic changes in the hyperplastic bone marrow, which were not found in the previously reported cases of transient abnormal myelopoiesis.

Expression of type IV collagen and its degrading enzymes in squamous cell carcinoma of lung

We examined the in situ distribution of basement membrane collagen (Col IV), matrix metalloproteinase (MMP)-2, MMP-9 and tissue inhibitor of metalloproteinase-1 (TIMP-1) by immunohistochemistry and their mRNA levels by Northern blot analysis in 14 cases of squamous cell carcinoma of the lung. Elevated mRNA levels of MMP-2 and Col IV were demonstrated in all the cases examined and were associated with in situ disruption of basement membranes around the tumor nests. In contrast, TIMP-1 mRNA levels were not altered. MMP-2, MMP-9 and TIMP-1 were localized in tumor cells, stromal fibroblasts and endothelial cells. There were no significant correlations between these parameters and clinical staging. The results suggest that the degrading enzymes of basement membrane collagen play an important role in the invasion and metastasis of human squamous cell carcinoma of the lung.

[Measurement of human thyroid peroxidase autoantibodies by enzyme immunoassay using recombinant human TPO]

An EIA for measuring anti-TPO autoantibodies (rhTPO-EIA) was developed using recombinant human TPO expressed in CHO cells and was compared with MC-HA generally used in laboratory routine work. rhTPO-EIA showed a satisfactory reproducibility in the intra-assay test and did not have an accidental error of lots. Almost equal number of healthy females and males were measured for their IgG binding to TPO to define a normal range of anti-TPO autoantibodies. After setting 20 IU/ml as an upper limit of normal range, sera from patient with thyroid disorders were measured for their anti-TPO autoantibodies. Chronic thyroiditis and Graves' disease were highly positive, while adenoma, thyroid cancer, SLE, and RA were low in their positivity. The positive rate of anti-TPO autoantibodies was compatible to those of previous reports in each disorder. Seventy-two sera from patients with chronic thyroiditis or Graves' disease were measured for their autoantibodies by both rhTPO-EIA and MC-HA and the results were compared between both methods. A correlation coefficient was 0.486. Following absorption with thyroglobulin, sera were measured again and as the results, the correlation coefficient increased to 0.723. Therefore, MC-HA was thought to be influenced in the presence of anti-thyroglobulin autoantibodies. Since rhTPO-EIA is excellent in quality and not affected by anti-thyroglobulin antibodies, it is useful and applicable to clinical diagnosis and observation of thyroid disorders.

Characterization and amino-terminal sequence of phospholipase A2-II from the venom of Agkistrodon bilineatus (common cantil)

1. Phospholipase A2 was isolated from the venom of Agkistrodon bilineatus by Sephadex G-75 and CM-Cellulose column chromatographies. 2. The purified phospholipase A2 gave a single band on disc polyacrylamide gel electrophoresis, sodium dodecyl sulfate polyacrylamide gel electrophoresis and ODS-HPLC. 3. The enzyme preparation had a mol. wt of 14,000, isoelectric point of pH 10.12 and possessed 121 amino acid residues. 4. The enzyme hydrolyzed the phospholipids phosphatidyl choline, phosphatidyl ethanolamine, phosphatidyl inositol and phosphatidyl serine. 5. The contraction of mouse diaphragm was inhibited by phospholipase A2-II. 6. Phospholipase A2 activity of this preparation was inhibited by ethylenediamine tetraacetic acid, ethyleneglycol (beta-aminoethyl) N,N,N',N'-tetraacetic acid, p-bromophenacyl bromide or N-bromosuccinimide, but not by iodoacetic acid or diisopropyl fluorophosphate. 7. The amino-terminal sequence of the PLA2-II was determined.

Effect of long-term treatment with a new aldose reductase inhibitor, (2S,4S)-6-fluoro-2',5'-dioxospiro-[chroman-4,4'-imidazolidine]-2-carbox amide (SNK-860), on peripheral neuropathy in streptozotocin-induced diabetic rats

We studied the long-term effects of a new aldose reductase inhibitor, (2S,4S)-6-fluoro-2',5'-dioxospiro-[chroman-4,4'-imidazolidine]-2- carboxamide (SNK-860), on functional, biochemical, and structural changes in peripheral nerve of streptozotocin (STZ)-induced diabetic rats. During the experimental period of 26 weeks, the delayed motor-nerve conduction in diabetic rats was significantly prevented by SNK-860 treatment, and elevated sorbitol levels and reduced myo-inositol levels were normalized to 100% and 71% of control levels, respectively. Teased nerve fiber studies demonstrated that the frequency of abnormal fibers was significantly reduced in treated diabetic rats. Morphometric analysis of myelinated fibers also disclosed prevention of axonal atrophy, distorted axonal circularity and preservation of large-sized fibers following SNK-860 treatment. These results suggest that long-term treatment with SNK-860 has a beneficial preventive effect on the development of experimental diabetic neuropathy.

Peripheral neuropathy in the WBN/Kob rat with chronic pancreatitis and spontaneous diabetes

BACKGROUND

To elucidate the mechanisms of peripheral nerve damage in diabetic neuropathy, various animal models have been studied. The WBN/Kob rat is a new animal model that develops chronic pancreatitis and spontaneous diabetes. It remains unestablished whether spontaneously diabetic rats of this strain develop peripheral neuropathy, comparable to the human diabetic neuropathy.

EXPERIMENTAL DESIGN

In the present study, we examined electrophysiologic, biochemical, and structural changes of peripheral nerve in 12- and 20-month-old diabetic WBN/Kob rats.

RESULTS

All the WBN/Kob rats showed slowing of motor nerve conduction and temporal dispersion of compound muscle action potential. Biochemical measurement revealed increased sorbitol and decreased myoinositol levels in the sciatic nerve. Structurally, de- and remyelination was the major abnormality in the sciatic and tibial nerves in 12-month-old rats. Twenty-month-old rats showed in addition, structural changes indicative of axonal degeneration and dystrophy. Morphometric analysis demonstrated reduced myelinated fiber occupancy and decreased mean myelinated fiber size. These structural changes appeared to be the most conspicuous around the endoneurial vessels. They were less severe in the sural nerve.

CONCLUSIONS

The WBN/Kob rat develops demyelinating, predominantly motor neuropathy, later accompanied by axonal changes. The neuropathic manifestations are unique as compared with those found in other spontaneously diabetic animal models. Late appearing axonal changes may correlate to diabetic dysmetabolism but the mechanism of early demyelination remains to be determined.

Effect of bilineobin, a thrombin-like proteinase from the venom of common cantil (Agkistrodon bilineatus)

A thrombin-like proteinase, named bilineobin, was isolated from Agkistrodon bilineatus venom by Sephadex G-75, DEAE-Sephacel and Heparin-Sepharose CL-6B column chromatography. The purified enzyme has a mol. wt of 57,000 and catalysed the hydrolysis of arginine esters and thrombin substrates Boc-Val-Pro-Arg-MCA and Boc-Asp(OBz)-Pro-Arg-MCA. Although bilineobin converted fibrinogen into fibrin resulting in the production of fibrinopeptides, the activity was relatively low (0.65 NIH units/mg). Fibrinopeptides released upon hydrolysis by this proteinase were identified as fibrinopeptide A (FpA) and fibrinopeptide B (FpB) by measuring fast atom bombardment (FAB) mass spectra and amino acid sequence. This indicates that bilineobin hydrolyses the Arg(19)-Gly(20) bond in the A alpha chain and the Arg(21)-Gly(22) bond in the B beta chain of the bovine fibrinogen molecule. Kinetic study of FpA and FpB release reveals that bilineobin has a preference for cleaving the B beta chain. In addition, bilineobin is resistant to thrombin inhibitors such as hirudin. These suggest that the mechanism of action of bilineobin is similar but not identical to that of thrombin. It was demonstrated that the NH2-terminal region of bilineobin has significant similarities in sequence with thrombin-like proteinases from other snake venoms; however, only three residues were common with thrombin up to residue number 24.

Cystic pancreatic glucagonoma in contact with insulinoma found in a hypoglycemic patient

Cystic glucagonoma in contact with insulinoma was found in the pancreas of a 28-year-old female patient with characteristic hypoglycemic syndrome. Among six tumors in total detected in the tail of the resected pancreas, the largest solid tumor (2.5 cm in diameter) consisted mostly of insulin-containing cells with conspicuous amyloid deposition. Contiguous to this tumor, the second largest nodule, measuring 1.8 cm in diameter, showed cystic changes and consisted of glucagon-containing cells. High concentration of immunoreactive glucagon was demonstrated in the cystic fluid. In addition to the cystic changes of endocrine pancreatic tumors, simultaneous occurrence of glucagonoma in contact with insulinoma appears to be extremely rare and repeated episodes of hypoglycemia may contribute to its pathogenesis.

Gastric polyposis caused by multifocal histiocytosis X

A rare case of gastric polyposis caused by infiltration of Langerhans' cells is reported. A 53 year old Japanese woman complaining of vague abdominal discomfort, was found at endoscopy to have numerous polyps all over the gastric wall. An endoscopic biopsy specimen showed characteristic infiltration of Langerhans' cells in the lamina propria of the mucosa. Functional abnormalities such as impaired gastric acid secretion or malabsorption were not associated with this lesion and the patient was treated conservatively. During follow up over two years, she had a cutaneous eruption with infiltration of histiocytes and osteolytic lesions in the skull. However, no progressive changes occurred in the stomach. This probably benign self-limiting lesion of gastric histiocytosis X may be one of the manifestations of multifocal histiocytosis X, but its aetiology and appropriate treatment have not yet been determined.

Primary mesenchymal chondrosarcoma of the lung. A case report with immunohistochemical and ultrastructural studies

A case of primary pulmonary mesenchymal chondrosarcoma is reported. The tumor occurred first in the lower lobe of the right lung of a Japanese female aged 45. Three years after the first operation it metastasized to the upper lobe of the left lung. The tumors were highly cellular and composed of undifferentiated mesenchymal cells and interspersed islands of well-differentiated cartilaginous tissue. Immunohistochemistry failed to detect S-100 and vimentin in the undifferentiated cells. In contrast, Leu-7 and blood coagulation factor XIIIa were positive in these cells. Electron microscopically, undifferentiated mesenchymal cells had narrow cytoplasm with sparsity of organelles, but no intermediate-sized filaments were detected. In the transitional areas between undifferentiated cells and cartilaginous components, thin intracytoplasmic filaments were sometimes observed in the tumor cells. The differentiation toward cartilaginous cells of undifferentiated mesenchymal cells was suggested by immunohistochemistry and electron microscopy. This is the first case of mesenchymal chondrosarcoma occurring in the lung with long-term follow-up.

Identification of thyroiditogenic epitope on porcine thyroid peroxidase for C57BL/6 mice

C57BL/6 mice show thyroid lesions when immunized with porcine thyroid peroxidase (pTPO) emulsified in CFA. We attempted to clarify a thyroiditogenic epitope on pTPO. Thyroid peroxidase treated with cyanogen bromide was fractionated by reverse phase chromatography, and six fractions (A to F) were obtained. Two of these fractions (D and E) stimulated lymph node cells (LNC) primed with pTPO in vitro and induced thyroiditis in vivo. Tricine-SDS-PAGE and rechromatography showed that fraction D consisted solely of a fragment of Mr 9500 Da and that fraction E contained mainly fragments of Mr of 5400 and 9500 Da. The fragment of fraction D was rechromatographed and 20 NH2-terminal amino acids were analyzed. This segment was found to correspond to residue 726-745 of pTPO deduced from cDNA at a probability of 80%. Four peptides ranging from residue 746-827 were first synthesized and tested for their thyroiditogenicity. Only Pep-2 (29 amino acids) could stimulate LNC primed with pTPO and induce thyroiditis. Pep-2 was divided into two smaller peptides (Pep-2-1 and -2-2) and their thyroiditogenicity was tested again. Pep-2-1 corresponding to residue 774-788, GPA-QITCTPRGWDSP, had thyroiditogenicity as well as the ability to stimulate LNC. It was thought that this segment was at least one of the thyroiditogenic epitopes on porcine thyroid peroxidase for C57BL/6 mice.

Identification of thyroiditogenic epitope on porcine thyroid peroxidase for C57BL/6 mice

C57BL/6 mice show thyroid lesions when immunized with porcine thyroid peroxidase (pTPO) emulsified in CFA. We attempted to clarify a thyroiditogenic epitope on pTPO. Thyroid peroxidase treated with cyanogen bromide was fractionated by reverse phase chromatography, and six fractions (A to F) were obtained. Two of these fractions (D and E) stimulated lymph node cells (LNC) primed with pTPO in vitro and induced thyroiditis in vivo. Tricine-SDS-PAGE and rechromatography showed that fraction D consisted solely of a fragment of Mr 9500 Da and that fraction E contained mainly fragments of Mr of 5400 and 9500 Da. The fragment of fraction D was rechromatographed and 20 NH2-terminal amino acids were analyzed. This segment was found to correspond to residue 726-745 of pTPO deduced from cDNA at a probability of 80%. Four peptides ranging from residue 746-827 were first synthesized and tested for their thyroiditogenicity. Only Pep-2 (29 amino acids) could stimulate LNC primed with pTPO and induce thyroiditis. Pep-2 was divided into two smaller peptides (Pep-2-1 and -2-2) and their thyroiditogenicity was tested again. Pep-2-1 corresponding to residue 774-788, GPA-QITCTPRGWDSP, had thyroiditogenicity as well as the ability to stimulate LNC. It was thought that this segment was at least one of the thyroiditogenic epitopes on porcine thyroid peroxidase for C57BL/6 mice.

Effect of aminoguanidine on functional and structural abnormalities in peripheral nerve of STZ-induced diabetic rats

Nonenzymatic glycosylation of structural proteins and the formation of advanced glycosylation end products (AGEs) have been involved in the pathogenesis of diabetic complications. We examined the effect of aminoguanidine, a potent inhibitor of AGE formation, on functional and structural abnormalities in peripheral nerve of streptozocin-induced diabetic rats. Diabetic rats were treated with daily injections of 25 mg/kg body wt s.c. aminoguanidine (AG)-sulfate for 16 wk and compared to untreated diabetic rats. AG treatment improved motor nerve conduction velocity in 12- and 16-wk diabetic rats despite no changes in body weight, blood glucose, and HbAIc levels. AG treatment inhibited an accumulation of fluorescent AGE in diabetic nerves, and morphometric analysis of the sural nerve showed a partial effect on myelinated fiber size and axonal atrophy. These findings suggest that AG may have a beneficial effect on diabetic neuropathy and nonenzymatic glycosylation of peripheral nerve proteins.

Primary alveolar soft-part sarcoma of stomach

A case of primary gastric alveolar soft-part sarcoma is presented. The tumor was found in the gastric remnant of a 67-year-old male who had undergone partial gastrectomy due to hemorrhagic gastric ulcer 13 years before. It was located mostly in the submucosa arising from the muscularis propria. The large eosinophilic cells showed the characteristic alveolar compartmentalization and contained intracytoplasmic periodic acid-Schiff-positive granules and typical crystals. Numerous electron-opaque secretory granules in the tumor cell cytoplasm, in addition to crystals of 9 nm periodicity, were confirmed at the ultrastructural levels. Immunostaining failed to detect muscle-related antigens. In contrast, methionine-enkephalin and neuropeptide Y appeared positive in the tumor cells. Interstitial spindle cells showed an occasional positivity to S-100. This is the first case of such a tumor occurring in the gastrointestinal tract, and the findings suggest that gastric alveolar soft-part sarcomas may have a different origin from those arising in the skeleton.

Pulmonary mucormycosis presenting as massive fatal hemoptysis in a hemodialytic patient with chronic renal failure

A 38 year old female patient died following massive hemoptysis occurring during maintenance hemodialysis for chronic renal failure. In addition to renal dysfunction, laboratory data showed low levels of serum immunoglobulins; chest X-rays did not reveal any abnormal shadows. For the last 11 months, the patient had not received deferoxamine. At autopsy, major bronchi were plugged with coagulated blood. Irregular thickening of the right main bronchial wall close to the lung hilus was noted. Light microscopic examination disclosed mycotic granulomata in the bronchial wall, where the pulmonary arterial wall was also involved. Immunostaining using specific antibody identified Mucor hyphae. The mucormycosis is a serious complication of chronic renal failure and hemodialysis. In the current case, it is likely that immune dysfunction rather than deferoxamine was the important predisposing factor to the growth of the fungus.

[An autopsy case of chronic germanium intoxication presenting peripheral neuropathy, spinal ataxia, and chronic renal failure]

We report here an autopsy case of chronic germanium intoxication with major pathological changes in the central and peripheral sensory nervous systems. The patient was a 4-year-old girl who had suffered from gait disturbance and generalized muscle weakness for 22 months. She had been given orally germanium compounds (containing germanium dioxide, 225-450 mg/day) for the previous 28 months. In addition to the findings of chronic renal failure and anemia, she presented characteristic neurological symptoms exemplified by diffuse muscle atrophy, tongue fasciculation, sensory impairment and truncal ataxia as well as areflexia. Median and ulnar sensory nerve conduction velocities were also reduced. On the 17th hospital day, she died of renal failure. In addition to conspicuous degeneration of renal tubular cells, pathological studies revealed marked nerve fiber loss, degeneration and gliosis in the dorsal column of the spinal cord, which were most conspicuous in the thoracic and cervical cord. Axonal degenerative changes were also conspicuous in the sural and sciatic nerves. High concentration of germanium was detected in the brain, cerebellum, spinal cord, sciatic nerve, liver and kidney. It was suggested that the neural involvement in the current case was caused by chronic toxicity of germanium.