[A probable case of adult Williams-Campbell syndrome incidentally detected by an episode of atypical mycobacterial infection]

A 39-year-old woman was admitted to our hospital because of dry cough. She had been quite well until 1 month before admission. She had no history of chronic sinusitis. Chest X-ray film showed a thin-walled cavity in the superior segment of the left lower lobe of the lung. Curettage biopsy of the cavity wall revealed granulomatous change. Mycobacterium intracellulare-avium complex was identified on sputum culture. Anti-tuberculous therapy was given and the cavity disappeared in 3 months. Since atypical mycobacterial infection is quite unusual for a healthy woman to contract, we performed high-resolution CT (HRCT) in search for occult abnormalities of the lung. HRCT detected a lot of thin-walled cystic lesions, and bronchography showed that they were consistent with cystic dilatation of relatively large bronchi, which ballooned up during inspiration, and collapsed during expiration. Airways peripheral to these dilatations were also visible, and were quite different from usual cystic bronchiectasis formed by acquired recurrent infections. Her bronchiectasis is most likely congenital in its etiology, and might be considered as an adult case of Williams-Campbell syndrome.

[A clinical study of terminal pneumonia]

A total of 210 cases of terminal pneumonia were studied out of 1183 autopsied cases at Tenri Yorozu Hospital from 1978 to 1985. Underlying diseases included lung cancer (77 patients), gastric cancer (26 patients), leukemia (24 patients). There was no statistical significance between the time from death until autopsy and the bacterial examination of autopsied lung and blood. P. aeruginosa and Klebsiella sp. were the most frequently isolated organisms. Seventy percent of isolated organisms were gram negative bacilli. In spite of administration of antibiotics, bacteria isolated from specimens before death were sometimes the same as the one isolated from specimens after death. In addition it was recognized that multiple intensive examinations of sputum are necessary for rapid diagnosis of pneumonia. It was also noted that the longer the duration of antibiotic administration, the more frequently P. aeruginosa was isolated. Finally the possibility of pneumonia should be kept in mind in compromised hosts.

Mitotic activity in uterine leiomyomas during the menstrual cycle

To investigate the role of the menstrual cycle in the growth of uterine leiomyomas, the mitotic count per 100 high-power fields and the relation of this to the patient's age (30 to 54 years) were examined in tissue sections of leiomyomas from 181 surgically removed myomatous uteri. The mean mitotic count in the secretory phase (12.7 per 100 high-power fields) was significantly higher than that of the proliferative phase (3.8 per 100 high-power fields) (p less than 0.01) or menses (8.3 per 100 high-power fields) (p less than 0.05). We found the highest mitotic count (54 per 100 high-power fields) in a leiomyoma at the early secretory phase. In the secretory phase, the younger age group exhibited a significantly higher mitotic count than the older group. Increased mitotic activity in leiomyomas under the hormonal milieu of the secretory phase of the menstrual cycle suggests that the growth of these tumors is affected by progesterone level. In addition, this study defined the range of mitotic counts occurring in the tissue sections of typical leiomyomas during the menstrual cycle.

Immunohistochemical localizations of CA 125, carcinoembryonic antigen, and CA 19-9 in normal and neoplastic glandular cells of the uterine cervix

Immunohistochemical reactivities with CA 125, carcinoembryonic antigen (CEA), and CA 19-9 were studied in 15 cervixes without histologic abnormalities, ten with microglandular hyperplasia, nine adenocarcinomas in situ, ten adenocarcinomas with an invasion of less than 5 mm in depth, and 25 frankly invasive adenocarcinomas of the uterine cervix. The glandular cells of the normal cervix and microglandular hyperplasia always exhibited reactivity with anti-CA 125 in the luminal surfaces and the secretory products within the lumina, but there was usually no reactivity with either anti-CEA or anti-CA 19-9. In the neoplastic glandular cells (adenocarcinoma in situ and invasive adenocarcinoma), the reactivity with anti-CA 125 was negative or was not in the luminal surface, but in the perinuclear region of the cytoplasm as accumulations of atypical coarse granules. In addition, the positive reaction with anti-CEA and anti-CA 19-9 was seen in 78% and 0% of adenocarcinomas in situ, in 80% and 40% of adenocarcinomas less than 5 mm in depth, and in 84% and 56% of frankly invasive adenocarcinomas, respectively. Therefore, neoplastic cervical glandular cells show an unusual staining pattern with anti-CA 125, which may be associated with impaired production and/or the intracytoplasmic transport of CA 125, and they begin to produce antigens recognized by anti-CEA and/or anti-CA 9-9, which are usually negative in the normal tissue.

[Analysis of the levels of CA125, CEA and CA19-9 in the cervical mucus samples obtained at various phases of the menstrual cycle and with inflammatory diseases of the uterine cervix]

Recently, normal cervical glandular cells have been reported to synthesize and secrete CA125 as a common constituent of normal cervical mucus. However, the levels of CA125 in the cervical mucus samples during the menstrual cycle and with cervical inflammatory diseases have not been determined. Therefore, we measured CA125 in cervical mucus samples in various phases of the menstrual cycle and in patients with cervical polyp or vaginitis. In addition to CA125, CEA and CA19-9 were also examined in the same samples. CA125 levels in the mucus samples of women (45 cases) without any gynecologic disorders (control) were 102,200 +/- 8,600 (M +/- S.E.) U/ml. Significantly higher levels were noted in the samples obtained in the follicular phase than in the luteal phase. CA125 levels in the mucus with atrophic vaginitis (12 cases) were significantly lower than those of controls. CEA and CA19-9 levels in the control samples were 3,400 +/- 550 ng/ml and 3,470 +/- 500 U/ml, respectively, and both of these showed no significant difference between the follicular and luteal phases. However, both CEA and CA19-9 levels in the cervical mucus with cervical polyps (15 cases) or vaginitis were much higher than in the controls. Accordingly, the present study revealed that CA125 in the cervical mucus fluctuates during the menstrual cycle, probably under the influence of ovarian sex steroids. In addition, CEA and CA19-9 in the cervical mucus samples obtained from women without any gynecologic disorders showed low levels, but those with inflammatory diseases were high, and this suggested that inflammatory diseases in the cervix and/or vagina may affect the constituent of the tumor-associated carbohydrate antigens in the cervical mucus.

Analysis of the levels of CA125, carcinoembryonic antigen, and CA19-9 in the cervical mucus for a detection of cervical adenocarcinoma

To verify whether analysis of the levels of CA125, carcinoembryonic antigen (CEA), and CA19-9 in the cervical mucus is effective for a detection of cervical adenocarcinomas or not, simultaneous measurement of these three tumor markers in the cervical mucus samples from women without gynecologic disorders, with leiomyoma, with cervical squamous cell carcinomas, and with cervical adenocarcinomas was performed. Extremely high levels of CA125 with low levels of both CEA and CA19-9 were demonstrated in the cervical mucus samples from women without gynecologic disorders and with leiomyoma. The cervical mucus samples from cervical adenocarcinomas showed low CA125 levels with extremely high CEA and/or CA19-9 levels. Therefore, analysis of the levels of these three tumor markers in the cervical mucus possibly helps in the diagnosis of cervical adenocarcinomas if CEA and/or CA19-9 show extremely high levels. When a ratio of (CEA + CA19-9)/CA125 was calculated, all women without gynecologic disorders and with leiomyoma showed a ratio less than 0.5, whereas ten of 11 cases of cervical adenocarcinomas had a ratio greater than or equal to 0.5. Only one case of microinvasive adenocarcinoma showed a ratio less than 0.5. Accordingly, the ratio greater than or equal to 0.5 strongly suggested an existence of cervical adenocarcinoma, although it included some cases of squamous cell carcinomas (four of 17 cases).