[Intermediate filaments]

The antibodies for intermediate filaments, including keratin, vimentin, desmin, GFAP and neurofilaments, have been much useful in routinely-processed immunohistochemical study for identifying characteristics of tumor cells or making the definite diagnosis. In general, when neoplastic transformation has taken place, the affected cells would reveal to some extent alterated immunolocalization of intermediate filaments in the cytoplasm. Whether the tumor cells are of epithelial or non-epithelial origin is significant from diagnostic points of view when utilizing those intermediate filaments as tumor markers. But there are many "exceptional" cases of epithelial tumors with expression of vimentin, or those of non-epithelial tumors with expression of keratin, indicating some "variants". Immunohistochemical application of the intermediate filaments is indispensable not only as "a diagnostic tool for surgical pathologists", but also a method for analyzing relationship between morphological changes and functional aspects of the tumor cells.

Cyclic Cushing's disease in long-term remission with a daily low dose of bromocriptine

A 56-year-old male patient with cyclic Cushing's disease remained in a state of remission for more than one year with a relatively low dose of bromocriptine (2.5-3.75 mg/day). It has been reported that bromocriptine treatment for cyclic Cushing's disease induces only a transient remission; in the most effective cases, a relatively high dose (40 mg/day) was necessary. In the hypercortisolemic state, plasma adrenocorticotropic hormone (ACTH) and serum cortisol were not suppressed by dexamethasone and did not respond to corticotropin-releasing factor (CRF). An antehypophysectomy was not effective, even though the resected tissue contained ACTH-positive microadenomas. The present observations thus indicate the effectiveness of bromocriptine for some patients with this rare disorder.

Acromegaly, diabetes insipidus, and visual loss caused by metastatic growth hormone-releasing hormone-producing malignant pancreatic endocrine tumor in the pituitary gland. Case report

The case of a 52-year-old woman with acromegaly, diabetes insipidus, and visual impairment caused by a metastatic growth hormone-releasing hormone (GRH)-produced pancreatic tumor is reported. Serum growth hormone (GH) and somatomedin C levels were elevated to 14 ng/ml (normal < 5 ng/ml), and 3.20 U/ml (normal < 1.88 U/ml), respectively. Paradoxical increases were observed in GH levels after glucose tolerance and thyrotropin-releasing hormone-stimulation tests. Biopsy of a pituitary tumor observed on computerized tomography scans and magnetic resonance studies revealed a metastatic cancer. When circulating GRH levels were measured, a marked increase in plasma GRH (1145 pg/ml; normal < 4-1 pg/ml) was observed. The patient died of cachexia due to metastases. Postmortem examination revealed that a primary tumor, a malignant endocrine lesion, was present in the pancreas, with metastatic tumors in the pituitary, lung, liver, and adrenal glands. Synthesis and production of GRH by the tumor was demonstrated by Northern blotting and immunohistochemical analysis. The pituitary gland showed hyperplastic, but not adenomatous changes. The authors stress the importance of both exploration for an ectopic source of GRH and the search for a GH-producing pituitary adenoma when unusual signs and symptoms are seen in patients with acromegaly.

Acute gastric mucosal lesions associated with cytomegalovirus infection in a non-immunocompromised host

A 75-year-old woman with epigastric pain and tarry stool was admitted to our hospital, where upper gastrointestinal endoscopic study revealed multiple gastric ulcers. The endoscopic biopsy specimens obtained on the seventh hospital day disclosed a few typical intranuclear cytomegalovirus inclusions. Cytomegalovirus-DNA was detected using polymerase chain reaction in a biopsy specimen. No immunologic abnormalities were demonstrated by any laboratory tests. While only a few cases of cytomegalovirus-associated gastric ulcer in non-immunocompromised hosts have been reported, this entity may be more frequently detected when careful histological examination is performed in the active stage rather than postponed until after healing of the ulcer.

Immunohistochemical localization of carcinoembryonic antigen as a predictor of lymph node status in submucosa-invasive colorectal carcinoma

PURPOSE

Submucosa-invasive colorectal carcinoma is a colorectal carcinoma extending only into the submucosal layer. To clarify the metastatic potential of submucosa-invasive colorectal carcinoma, we studied the relationship between the immunohistochemical staining pattern of carcinoembryonic antigen (CEA) and that of lymphatic invasion/lymph node metastasis.

METHODS

We investigated 49 submucosa-invasive colorectal carcinomas resected surgically or endoscopically. CEA distribution patterns of the neoplastic tissues were divided into three patterns: Pattern 1 = luminal type; Pattern 2 = apical cytoplasmic type; and Pattern 3 = diffuse cytoplasmic type. We also observed the submucosal stromal staining of CEA.

RESULTS

Lymphatic invasion and lymph node metastasis were found in 48.8 percent (21/43) and 11.6 percent (5/43) of the Pattern 2/Pattern 3 cases, whereas these were seen in none (0/6) of Pattern 1 cases. Lymphatic invasion and lymph node metastasis were found in 63.3 percent (19/30) (chi-squared = 21.94; P < 0.001) and 16.7 percent (5/30) of the positive stromal CEA cases, whereas these were seen in 10.5 percent (2/19) and none (0/14) of the negative stromal CEA cases, respectively.

CONCLUSION

Pattern 2/Pattern 3 and stromal CEA can be predictors of the lymph node metastasis with 11.6 percent and 16.7 percent risks.

Lymphocytic hypophysitis: case report

We report a rare case of lymphocytic hypophysitis in a 52-year-old man who presented with a combination of hypopituitarism and diabetes insipidus. Magnetic resonance imaging with a contrast medium revealed an expanding sellar mass and thickening of the pituitary stalk with homogeneous enhancement. These findings may be useful in differentiating lymphocytic hypophysitis from pituitary adenoma. The unique clinical and radiological features of this case are discussed.

Isolated adrenocorticotrophin deficiency associated with anti-pituitary antibodies, pituitary cyst, sphenoidal cyst and pineal tumor

This paper reports a rare case of isolated ACTH deficiency associated with anti-pituitary antibodies, pituitary cyst, sphenoidal cyst and pineal tumor. A 68-year-old man consulted our clinic for general fatigue. Laboratory data showed low plasma adrenocorticotrophin (ACTH) and cortisol levels with blunted responses to insulin-induced hypoglycemia and corticotrophin releasing factor (CRF). Urinary 17-OHCS was low but responded to ACTH-Z administration. No other pituitary functions were impaired. Antibodies to the cytoplasm of rat pituitary and the surface of GH3 cells were detected in the serum. The magnetic resonance imaging (MRI) showed a high signal intensity mass in the anterior pituitary and in the sphenoidal sinus in both T1 and T2 weighted images as well as a low signal intensity mass in a T1 weighted image of the pineal region. Transsphenoidal surgery was performed to resect the mass in the sphenoid sinus and in the pituitary. Pathological studies showed a benign cyst in the sphenoid sinus, and fibrous degeneration and decreased basophils in the pituitary. No infiltrative mononuclear cells were detected in the pituitary. Immunohistochemical studies revealed a decrease in the number of ACTH-producing cells in the pituitary. The patient was well maintained by glucocorticoid replacement without any growth of a possibly benign pineal tumor.

Incidental pituitary lesions in 1,000 unselected autopsy specimens

PURPOSE

To elucidate the frequency of false-positive results in imaging diagnoses of a functioning pituitary microadenoma, the authors studied various kinds of incidental lesions greater than 2 mm in diameter from a larger series of pituitary glands.

MATERIALS AND METHODS

One thousand pituitary glands were studied in a nonselected autopsy series. Most causes of death were acute diseases or accidents. Each gland was fixed in 10% formalin and was then cut horizontally into three or four pieces, which were prepared for usual light microscopy.

RESULTS

Of 178 glands found to have incidental lesions, 61 (34%) lesions were larger than 2 mm. Included were adenomas and hyperplasias (n = 20), Rathke cysts (n = 37), infarctions (n = 2), and hemorrhages (n = 2). Seventeen (74%) of 23 laterally localized lesions were adenomas, and 33 (87%) of 38 medially situated lesions were Rathke cleft cysts. These lesions were found in 5.8%-8.3% of subjects in every generation aged 30 years or older.

CONCLUSION

Incidental lesions should be considered a cause of false-positive findings (6.1%) when an imaging diagnosis is made of a functioning pituitary microadenoma.

Follow-up laparoscopy in patients with ovarian cancer

Between 1982 and 1990, two hundred and fourteen consecutive laparoscopies were performed on 75 patients with epithelial ovarian cancer when the disease appeared to be clinically in complete remission according to simultaneous CT scan or ultrasonography. Evaluation were based on macroscopic findings through the laparoscope, by cytologic examination of ascitic and peritoneal washings and by intraperitoneal biopsy. The results were positive in 34 laparoscopies for 19 patients, suspicious in 15 laparoscopies for 13 patients and negative in 164 laparoscopies. the intraperitoneal recurrence rate after negative second-look laparoscopy was 14.0% as a whole, and 4.5% in cases with more than two consecutive negative evaluations. Serum CA-125 levels exhibited and elevation in 28 of 34 positive laparoscopies before treatment and remained within the normal range in 22 (78.6%) of the 28 cases after treatment despite positive follow-up laparoscopies. The repeated laparoscopies offer the advantage of lowering the false negative rate. This will enable early detection of intraperitoneal recurrence, better prognoses and reduction of unnecessary laparotomies.

Effect of conformation of the substrate on enzymatic decarboxylation of alpha-arylmalonic acid

The configuration and conformation of a compound are critical factors that determine whether it can be accepted by an enzyme as a substrate or not. We have examined enzyme-catalyzed decarboxylation of some alpha-substituted malonic acids and proposed that the syn-periplanar conformation is required for the substrates to be bound to the active site of the enzyme. Theoretical calculation of potential energy surfaces also supports the conclusion from experimental results.

Origin of a sperm motility inhibitor from boar seminal plasma

We have investigated the origin of the sperm motility inhibitor (SPMI) from boar seminal plasma. SPMI was measured by its capacity to inhibit the motility of demembranated spermatozoa and by an enzyme-linked immunosorbent assay (ELISA). Among the various reproductive and now reproductive tissues and fluids tested, only the seminal vesicle fluid and seminal plasma contained significant amounts of SPMI biological activity and SPMI antigen. Like other seminal vesicle fluid proteins, SPMI is diluted 6- to 8-fold upon ejaculation. By immunohistochemical detection at the light microscope with antibodies obtained from rabbits immunized with SPMI purified from boar seminal plasma, SPMI was found in the cytosol and/or on the plasma membrane bordering the lumen of the seminal vesicles. At the electron microscope level, SPMI appeared to be present only on the surface of the secretory cells. The data indicate that SPMI originates from a single tissue, the seminal vesicle, and suggest that only the mature form present on the luminal surface of the gland can react with the antibody generated from rabbits immunized with the secreted form of SPMI.

Surgical resection of a second primary lung carcinoma in a survivor of small cell carcinoma

Resection of a second primary lung carcinoma in a long-term survivor of small cell lung carcinoma is reported. The patient had adenocarcinoma as the second primary tumor and underwent lobectomy with mediastinal node dissection. He was alive 99 months after the initial diagnosis of small cell carcinoma and 54 months after curative pulmonary resection for his second primary carcinoma.

Urinary bladder carcinoma producing granulocyte colony stimulating factor (G-CSF): a case report with immunohistochemistry

A rare case of urinary bladder carcinoma with granulocyte colony stimulating factor (G-CSF) production was reported. In an 83-year-old female, marked neutrophilia in the peripheral blood decreased from 132,500/mm3 to 3,300/mm3 after tumour resection. The tumour was a transitional cell carcinoma. The serum G-CSF level reduced from 238 pg/ml pre-operatively to normal (60 pg/ml) after the operation. Immunohistochemical investigation of the resected tumour with monoclonal antibody specific for G-CSF revealed positive staining in the carcinoma cells, confirming G-CSF secretion.

Pure yolk-sac tumor of the lung

The first case of a pure primary yolk-sac tumor of the lung is presented. The tumor developed in the right upper lobe of a 31-year-old man; preoperatively, the serum alpha-fetoprotein concentration was elevated. Treatment consisted of pulmonary segmentectomy with postoperative combination chemotherapy. The patient is alive and well 13 months after surgery with a normal serum alpha-fetoprotein concentration.

Checkup interval and cancers in automated multiphasic health testing and services

The purpose of this study was to disclose which types of cancer and how many persons with cancer were detected among the AMHTS examinees of our AMHTS center by using the hospital information retrieval system, and to study the relationship between cancer and the number of examinees, checkup intervals, and frequency in AMHTS. The examinees who had checkups more than twice were divided into three groups based on their checkup intervals: within one year, one to two years, and over two years. The relationship between cancer ratios and checkup intervals was evaluated in each group of examinees. In those having checkups within one year and from one to two years the cancer rate was 2.9 patients per 1,000 persons. However, in those having checkups after a two-year period or longer, the cancer rate was 4.3, clearly greater than the rate of the other two groups.

Production and secretion of endothelin by hepatocellular carcinoma

To clarify whether hepatocellular carcinoma (HCC) may produce and secrete endothelin (ET), we measured plasma levels of ET-1 and big ET-1, a precursor form of ET-1, in 30 patients with HCC. When compared to normal subjects, a substantial number of patients had elevated plasma ET-1 and big ET-1 levels, determined by specific enzyme immunoassays. The mean (+/- SD) plasma concentrations of ET-1 (1.7 +/- 0.9 pmol/L) and big ET-1 (6.1 +/- 4.8 pmol/L) in patients' group were significantly (P < 0.01) higher than those (1.0 +/- 0.3 and 2.0 +/- 0.8 pmol/L, respectively) in control group. There was a significant positive correlation between plasma big ET-1 and alpha-fetoprotein (r = 0.77, P < 0.01). Some of the 29 patients with liver cirrhosis also had modestly elevated plasma big ET-1 levels. The mean (+/- SD) plasma big ET-1 concentration (3.1 +/- 0.9 pmol/L) in patients with liver cirrhosis was significantly (P < 0.01) higher than that in control group, although there was no significant difference between the mean plasma ET-1 levels of both groups. Raised plasma big ET-1 and, less markedly, ET-1 levels in patients with HCC decreased after successful transcatheter arterial embolization concomitantly with a reduction in tumor sizes and a decrease in plasma alpha-fetoprotein levels. In six patients, an arteriovenous difference in ET-1 and big ET-1 levels across the tumor bed with a higher concentration in the venous circulation was found. Reverse-phase high performance liquid chromatography revealed that major portions of immunoreactive ET-1 and big ET-1 in hepatic venous plasma coeluted with synthetic ET-1 and big ET-1, respectively. Immunohistochemistry of HCC tissues from two patients demonstrated HCC cells positive for ET-1 and big ET-1, whereas no ET immunoreactivity was found in adjacent nontumorous hepatocytes. We conclude from these results that ET is produced by and released from a substantial number of HCC, which may stimulate proliferation of carcinoma cells as an autocrine or paracrine growth factor.

[Effect of epidural buprenorphine on postoperative respiratory function]

The effects of epidural buprenorphine on postoperative respiratory function were studied using respiratory inductive plethysmography (RIP) in two groups of patients [(1) 0.1 mg (2) 0.2 mg] after upper abdominal surgery. Buprenorphine 0.1 mg group showed decreased respiratory rate and increased tidal volume. Decreases in the respiratory rate and the tidal volume were seen in buprenorphine 0.2 mg group and continued for 3-4 hrs after the epidural administration. However, there was no severe respiratory depression in either group. It seems that 0.1 mg of epidural buprenorphine may give a satisfactory postoperative pain relief and less respiratory depression, and RIP is a useful method for the measurement of postoperative respiratory function.

Immunohistochemical and ultrastructural investigation of new membrane-associated placental tissue proteins (MP2 A, B, C, D, and E) in gynecologic neoplasms

New membrane-associated placental tissue proteins (MP2 A, B, C, D, and E) were investigated immunohistochemically by avidin-biotin immunoperoxidase technique and immunoelectron microscopy in various gynecologic neoplasms and normal gynecologic tissues. MP2 A and MP2 B were not specific for malignant tumors. MP2 C was present in 67-100% of ovarian carcinomas, 100% of benign dermoid cysts, and 77% of endometrial carcinomas. Except for endocervical adenocarcinomas, MP2 D was hardly detectable in gynecologic malignancies. Although MP2 E was hardly detectable in benign gynecologic tumors, this protein was present in ovarian carcinomas, uterine squamous carcinomas, endocervical adenocarcinomas, and endometrial adenocarcinomas. These results suggest a possible clinical application of these MP2 proteins as a new tumor marker for gynecologic malignancies.

[Immunohistochemical and clinicoendocrinological studies of gonadotropin producing pituitary adenomas]

In order to study the secretion of gonadotropins in clinically non-functioning pituitary adenomas, 83 cases were investigated by immunohistochemistry. Expression of one or more of gonadotropin subunits (alpha-subunit, follicle-stimulating hormone (FSH) beta, luteinizing hormone (LH) beta) was found in 38 (45.8%) of all adenomas studied. alpha subunit and FSH beta were positive in 28 (33.7%) and 27 (32.5%) cases respectively, whereas LH beta was detected in seven (8.4%) adenomas. The presence of both alpha subunit and FSH beta was found in 17 cases, while alpha subunit was singly positive in 11 cases and FSH beta, in 10 cases. LH beta was not detected alone, but was always accompanied by alpha subunit or FSH beta. By the double staining method, alpha subunit and FSH beta were not always colocalized in the same cells. Some cells were found to contain both alpha subunit and FSH beta, but others contained either alpha subunit or FSH beta. Clinical characteristics of gonadotropin positive adenomas (38 cases) were studied in comparison with null cell adenomas (37 cases), which were negative for all anterior pituitary hormones. The former (male 27, female 11) ranged in age from 21-74 years old (mean, 46.5 yr.), and the latter (male 16, female 21) from 28-68 yr (mean, 49.5 yr.). Gonadotropin positive adenomas tended to occur in middle-aged men. All 38 adenomas were macroadenomas, and 29 patients complained of visual failure. Clinical symptoms accompanied by hypersecretion of FSH was infrequent. Hypogonadism (amenorrhea, galactorrhea, loss of libido) were observed in 8 (9.6%) cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution and characterization of immunoreactive corticostatin in the hypothalamic-pituitary-adrenal axis

Using an antiserum against synthetic rabbit corticostatin-1 (CS-1), we established a specific RIA for CS-1 and examined its distribution in various tissues, including the hypothalamic-pituitary-adrenal axis. Among the tissues examined, the highest levels of CS-1-like immunoreactivity (-LI) were found in the lung and spleen. CS-1-LI was also detected at relatively high levels in the pituitary, adrenal medulla, and small intestine, while it was barely detectable in the hypothalamus. Immunocytochemical studies revealed the widespread distribution of CS-1 in these tissues. Plasma CS-1 levels averaged 7.8 ng/ml and increased to 185.4 ng/ml in the presence of infection. CS-1-LI in the adrenal gland, small intestine, and hypothalamus also increased in rabbits with active inflammation. These data suggest that CS-1 may modify the hypothalamic-pituitary-adrenal axis in an endocrine or paracrine manner in response to infection.