Implication of ZOG protein (zona glomerulosa-specific protein) in zone development of the adrenal cortex

The three zones of adrenal cortex are thought to arise from a single multipotential stem cell. Immunohistochemical studies of fetal and adult adrenals using an antibody against a previously-cloned ZOG protein, a rat homolog of Pref-1, were conducted to explore its roles in the differentiation of cortical tissues. At the early embryonic stage, ZOG was already expressed in adrenogonadal primordial cells. The ZOG-positive cells gradually formed the adrenal primordium by E14.5. By E17.5 the expression was repressed in the inner part of the aggregate and these cells began to express CYP11B1. The ZOG-positive cells at this stage existed at the periphery of the aggregate but they did not express CYP11B2 yet. Not until E20.5 did the aldosteronogenic cells appear among the ZOG-positive cells at the outermost part of the gland. Based on these and the other findings the zonal development of the adrenal cortex is discussed.

Cloning of a membrane-spanning protein with epidermal growth factor-like repeat motifs from adrenal glomerulosa cells

The three zones of adrenal cortex are thought to arise from a single multipotential stem cell, but the mechanisms underlying the zonal differentiation during embryonic development of adrenal cortex are poorly understood. Employing subtraction cloning strategy, we isolated three distinct clones that were specifically expressed in the rat glomerulosa zone. One clone, named zona glomerulosa specific clone, encoded a membrane-spanning protein with a signal peptide at the N-terminus, six epidermal growth factor-like repeat motifs, and a transmembrane domain near the C-terminus. It was identified as a rat homolog of preadipocyte factor-1 (Pref-1), a factor involved in maintaining the undifferentiated status of preadipocyte. Immunohistochemical studies confirmed the presence of Pref-1 protein in the glomerulosa zone. Detailed examination revealed that the zone is divided into two layers; the first is a few-cells-thick layer present underneath the capsule (expressing both Pref-1 protein and aldosterone synthase cytochrome P450), and the second layer is beneath the first (containing Pref-1 protein but not aldosterone synthase). Moreover, another cell layer was found beneath the second layer and above the fasciculata zone, whose cells contained no Pref-1 protein, aldosterone synthase, or 11beta-hydroxylase. These findings suggest that a recently reported aldosterone synthase- and 11beta-hydroxylase-less cell layer between the two zones is composed of two kinds of cell: Pref-1 protein-positive and -negative cells. The level of Pref-1 message in the adrenal glands of animals having various pituitary-adrenal axis activities, as well as various plasma salt concentrations, correlated with the total number of glomerulosa cells. However, the specific content of Pref-1 message in a cell was fairly constant. When the adrenal gland was surgically enucleated and the remaining capsule regenerated, the level of Pref-1 transcript was significantly suppressed at the early phase. At this phase, only a minor population of the cortical cells expressed Pref-1 protein, most of these cells already expressing a fasciculata/reticularis-specific marker, inner zone antigen. These findings suggest that the capsular cells, mostly composed of the glomerulosa cells, may have potential for differentiating into other zones' cells, and the down-regulation of Pref-1 expression may be an important step in the adrenal zonal differentiation.

[Diffuse B-cell lymphoma associated with hemophagocytic syndrome]

The patient was a 49-year-old woman who came to our hospital with a chief complaint of fever. She was admitted due to hepatosplenomegaly and pancytopenia. We diagnosed hemophagocytic syndrome based on histological examination of the bone marrow. She was treated with antibiotics and the CHOP regimen, resulting in solution of her condition. Two months later, lymphadenopathy and pancytopenia were recognized. Pathological examination of a lymph node revealed diffuse large B-cell lymphoma. B-cell lymphoma with hemophagocytosis was diagnosed. We present here a rare case of B-cell lymphoma associated with hemophagocytic syndrome.

Polyadenylation-mediated translational regulation of maternal P450(11beta) mRNA in frog oocytes

Northern blot analysis of bullfrog tissues using a cDNA probe of cytochrome P450(11beta) showed that a large amount of message was present in the ovary as well as in the adrenal tissue. Two kinds of mRNA of different sizes were found in the ovary. Sequence determination of the two cDNAs and analysis by reverse-transcription polymerase chain reaction indicated that the protein encoded by the larger mRNA was identical to the adrenal enzyme, while the protein encoded by the smaller had a truncated sequence lacking an extension peptide necessary for the protein transport to the mitochondria. The mRNAs were present in the oocytes but not in the follicular cells, and their content in an oocyte varied little during its maturation. Immunoblot analyses of the mitochondrial fraction of oocytes failed to demonstrate the presence of P450(11beta) protein. In contrast the eggs were found to contain a large amount of enzymatically active protein. Interestingly the mRNA has a cis-element called cytoplasmic polyadenylation element at its 3' untranslated region. When poly(A) tails of the message prepared from eggs and oocytes were examined by RNase H digestion or reverse-transcription polymerase chain reaction, those of eggs were about 150 nucleotides longer than those of oocytes. These results suggest that translation of the message is stimulated during the oocyte maturation as a result of enhanced polyadenylation at its 3'-end. Finally a finding is presented that progesterone was converted to 11beta-hydroxyprogesterone by the frog P450(11beta), implying that the enzyme expressed in eggs may control a level of progesterone which is needed to initiate the oocyte maturation.

Simultaneous expression of ferredoxin, ferredoxin reductase and P450 in COS7 cells

cDNA fragments encoding mouse ferredoxin and ferredoxin reductase were simultaneously introduced into COS7 cells by using an expression vector, pUC-SR alpha plasmid. When using the mitochondrial fraction prepared from the transfected cells, cytochrome-c reductase activity was detected. This activity was highest when 7.5 micrograms of the ferredoxin expression plasmid (pSR alpha F) and 2.5 micrograms of the ferredoxin reductase expression plasmid (pSR alpha FR) were transfected into COS7 cells. In this system, NADPH could be replaced by NADH as a cofactor for the reduction of cytochrome-c although the cytochrome-c reductase was more dependent on NADPH than NADH at a low concentration. When CYP24 expression plasmid was transfected into COS7 cells along with both pSR alpha F and pSR alpha FR, the transfected cells revealed a 3-fold higher 25-hydroxyvitamin D3-24-hydroxylase activity than COS7 cells transfected with CYP24 expression plasmid.

Inhibition of human pancreatic cancer growth in nude mice by boron neutron capture therapy

Immunoliposomes were prepared by conjugating anti-carcinoembryonic antigen (CEA) monoclonal antibody with liposomes containing [10B]compound. These immunoliposomes were shown to bind selectively to human pancreatic carcinoma cells (AsPC-1) bearing CEA on their surface. The cytotoxic effects of locally injected [10B]compound, multilamellar liposomes containing [10B]compound or [10B]immunoliposomes (anti-CEA) on human pancreatic carcinoma xenografts in nude mice were evaluated with thermal neutron irradiation. After thermal neutron irradiation of mice injected with [10B]solution, 10B-containing liposomes or [10B]immunoliposomes, AsPC-1 tumour growth was suppressed relative to controls. Injection of [10B]immunoliposomes caused the greatest tumour suppression with thermal neutron irradiation in vivo. Histopathologically, hyalinization and necrosis were found in 10B-treated tumours, while tumour tissue injected with saline or saline-containing immunoliposomes showed neither destruction nor necrosis. These results suggest that intratumoral injection of boronated immunoliposomes can increase the retention of 10B atoms by tumour cells, causing tumour growth suppression in vivo upon thermal neutron irradiation. Boron neutron capture therapy (BNCT) with intratumoral injection of immunoliposomes is able to destroy malignant cells in the marginal portion between normal tissues and cancer tissues from the side of 4He generation.

[A case of hemolysis induced by lansoprazole]

Hemolytic anemia and possible aplastic crisis with symptoms including jaundice, general fatigue and dark urine developed in a man being treated only by lansoprazole. Five days later, he was treated with antibiotics. The next day, he was admitted to our hospital because of jaundice. On admission, the hemoglobin was 14.0 g/dl, reticulocyte count 8/1000, platelets 79 x 10(9)/l and total bilirubin 12.4 mg/dl (indirect bilirubin 9.5 mg/dl). The above medications were discontinued. The direct Coombs antiglobulin test was positive. Examination of the complement revealed a C3 fiter at the upper limit of normal and an increased C4 and CH50. Three days after admission, he had a severe anemia. The hemoglobin was 3.3 g/DL. We thought it possible that aplastic crisis had followed the hemolytic anemia induced by lansoprazole. He was treated with blood transfusions and corticosteroids. He recovered from anemia within three weeks. Exhaustive studies to identify the cause of the hemolytic anemia were undertaken with negative results. We detected IgG antibody to lansoprazole. We believe that the hemolytic anemia was induced by lansoprazole.

Fish testicular 11beta-hydroxylase: cDNA cloning and mRNA expression during spermatogenesis

We isolated and characterized a cDNA encoding testicular 11beta-hydroxylase, cytochrome P450(11beta) from the Japanese eel (Anguilla japonica) testis. The cDNA contains an open reading frame that encodes a protein of 511 amino acids. The predicted amino acid sequence shares 38-48% homology with those of adrenal P450(11beta) from mammals and frog. Transient expression in COS 1 cells confirmed that the protein encoded by this cDNA had P450(11beta) activity. Northern blotting revealed a single 1.8 kb long transcript of P450(11beta). This transcript was not found in immature eel testes prior to an injection with human chorionic gonadotropin (hCG), but it was present in eel testes after hCG injection.

Cytochrome P450(11 beta): ectopic expression in oocyte and its physiological implication

Cytochrome P450(11 beta) (steroid 11 beta-hydroxylase) catalyzes an essential step for biosynthesis of glucocorticoid as well as mineralocorticoid, and therefore is believed to exist specifically in the adrenocortical mitochondria. We previously isolated a complementary DNA clone encoding this enzyme from bullfrog (Rana catesbeiana) adrenal tissues and characterized the enzyme expressed in COS cells. To explore the tissue distribution of the enzyme we performed Northern blot analysis. Unexpectedly we found that a large amount of the mRNA exists in the ovary as well as the adrenal gland. It was present in oocytes, but not in follicular cells. The P450 protein was not found during early stages of oocyte development, and at the final stage of maturation the message appeared to be translated. Evidence was obtained that the stage-dependent translation of the mRNA was due to the regulated polyadenylation at its 3'-end. In oocytes of various organisms several maternal mRNAs are known to add poly(A) tails in the cytoplasm during the progesterone-induced maturation.

[Assay of specific anti-Chlamydia pneumoniae antibodies by ELISA method. 2. studies on clinical usefulness and serological diagnostic standards]

We measured anti-Chlamydia pneumoniae (C. pneumoniae) specific antibody titers by means of a newly-developed enzyme-linked immunosorbent assay (ELISA) method using an anti-C. pneumoniae specific antibody detection reagent. The clinical usefulness of this method was hereby evaluated. The IgG, IgA and IgM titers in 418 serum specimens obtained from patients with respiratory tract infections were measured by this new ELISA method, and the results were compared with the titers determined for the same specimens with the micro immunofluorescence (Micro-IF) method. The results showed good correlation coefficients for IgG, IgA and IgM. The two assay methods showed high agreement rates for positivity and for negativity. Specimens which did not yield the same results with the ELISA method and the Micro-IF method were subjected to analysis by the Western blot method, and the rates of agreement with the ELISA results were high. In addition, the child (0 approximately 15 yrs old; n = 122) and adult (16 approximately 90 yrs old; n = 133) cases were classified on the basis of being antigen-positive or antigen-negative at the initial examination, and their antibody-positive rates were determined. The adults showed no statistically significant differences in the antibody-positive rates for either IgG or IgA antibodies as a function of the pretreatment antigen status. However, the children showed statistically significant (p < 0.001) differences in the antibody-positive rates for both IgG and IgA antibodies as a function of the antigen status in the antigen-positive group compared with the rates in the antigen-negative group. Furthermore, the IgM-positive rates for the children were high in the antigen-positive group compared with the rates in the antigen-negative group, and the difference was statistically significant (p < 0.001). The IgM-positive rates in the adults were also significantly (p < 0.05) different between the antigen-positive group and the antigen-negative group. The Micro-IF method was applied to 34 specimens from antigen-positive patients, and 22 specimens were found to show an IgG titer of > or = 512 or an IgM titer of > or = 16. The diagnoses of these patients were acute respiratory disease in sixteen, pneumonia in four. Application of the ELISA-method to those 22 specimens showed all of them to exhibit IgG absorbance of > or = 0.6 and IgA absorbance of 0.2. The results described above indicate the clinical usefulness of our new ELISA method for the detection of antibodies specific for C. pneumoniae. The significance of this ELISA method for serological diagnosis of C. pneumoniae infections and the criteria for diagnosis of acute infections were also discussed.

Angiotropic B-cell lymphoma presenting with progressive dementia: an autopsy case and review of the literature in Japan

We report an autopsy case of angiotropic lymphoma and review the literature in Japan. A 68-year-old female presented with transient right facial nerve palsy, right hemiplegia and progressive dementia. Laboratory studies showed raised erythrocyte sedimentation rate, C-reactive protein and serum lactate dehydrogenase. Computed tomography of the brain did not show any abnormal density areas but on T2-weighted magnetic resonance imaging high signal areas were recognized at the basal ganglia. She was diagnosed as having dementia caused by cerebrovascular insufficiency. She soon developed a febrile state and died of respiratory failure within three months of presentation. Postmortem examination showed widespread angiotropic B-cell lymphoma.

Metachronous liver metastasis of colorectal cancer: timing of occurrence and efficacy of adjuvant portal chemotherapy

We estimated the time of occurrence of metachronous liver metastasis in colorectal cancer patients from tumor diameter and doubling time. Micro-metastasis was present prior to operation in most patients and a few metastatic cases could have been initiated by the surgical procedure. Portal chemotherapy is more effective against liver metastasis than intravenous infusion because a higher drug concentration in the liver can be obtained. This efficacy of portal chemotherapy on survival was also observed in a rat model. Thus perioperative adjuvant treatment should be undertaken for metastasis which already existed before the operation and adjuvant chemotherapy via portal vein is the treatment of choice. The no touch isolation technique is also needed to avoid spreading of tumor cells during surgery.

Cytochrome P450(11 beta): structure-function relationship of the enzyme and its involvement in blood pressure regulation

Cytochrome P450(11 beta) is deeply involved in the final steps of biosynthesis of mineralocorticoids. This paper deals with following issues about this enzyme. (1) The structure and function of the enzymes of various animal species are discussed. By making alignment of amino acid sequences of the enzymes, we identified peptide domains essential for the enzyme actions such as a putative steroid binding domain and a heme binding region. Estimates of molecular similarity among the P450(11 beta) family enzymes suggested that the enzymes having both 11 beta-hydroxylation activity and aldosterone (ALDO) synthetic activity of certain animals such as frog, cattle and pig are more similar to the ALDO synthases of the other animals, such as rat, mouse and human, than the 11 beta-hydroxylases of these animals. (2) The molecular nature of the P450(11 beta) family enzymes of genetically hypertensive rats as well as adrenal regeneration hypertension (ARH) rats is examined. (i) Mutation was found in the P450(11 beta) gene of Dahl's salt-resistant normotensive rat. Steroidogenic activity expressed by the mutated gene accounted well for abnormal plasma levels of steroid hormones in this rat. (ii) 11 beta-, 18- and 19-Hydroxylation activities of adrenal mitochondrial prepared from spontaneously hypertensive rat (SHR), Wistar-Kyoto rat (WKY), and stroke-prone (SP)-SHR were not significantly different from each other. Levels of mRNA of ALDO synthase in adrenal glands of 50-week-old SHR was significantly lower than those of 10-week-old SHR, WKY and SHR-SP. (iii) No significant difference in 19-hydroxylation activity was found between adrenal mitochondria prepared from ARH rat and those from control rat. The level of message of ALDO synthase was lower in adrenal glands of ARH rat.

Frog cytochrome P-450 (11 beta,aldo), a single enzyme involved in the final steps of glucocorticoid and mineralocorticoid biosynthesis

A cDNA for cytochrome P-450(11 beta,aldo) was cloned from a library of bullfrog interrenal tissue (tissue corresponding to the mammalian adrenal gland). The 1919-bp cDNA encoded a protein of 517 amino acids. Its amino acid sequence was highly similar to the sequences of bovine P-450(11 beta) and rat P-450(11 beta,aldo) when P-450(11 beta) family enzymes reported to date were examined. The enzyme expressed in COS7 cells had the 11 beta-hydroxylation, 18-hydroxylation activities and aldosterone synthetic activity. Northern-blot and immunoblot analyses suggested that a single P-450(11 beta) enzyme was expressed in bullfrog interrenal tissue. These results suggest that a single enzyme catalyzes the final steps of glucocorticoid and mineralocorticoid biosynthesis in bullfrog interrenal tissue as in bovine adrenal gland. A phylogenetic tree of CYP11B genes suggests that the frog enzyme diverged at an earlier evolutionary time from other vertebrate enzymes. Immunohistochemical and in situ hybridization studies indicated that steroidogenic cells existed in the outer region of interrenal tissue more densely than in the inner region, whereas some medullary cells made clusters like islets. Most of the cells were diffusely distributed in the tissue.

Colorectal cancer after irradiation for cervical cancer--case reports

Three patients with colorectal cancer after irradiation for cervical cancer are described. One patient had two colorectal cancers. Three of the four cancers in these patients were located in the rectum and one in the sigmoid colon; all were within the irradiation field. Microscopic radiation proctocolitis was observed in all specimens. The interval between irradiation and the diagnosis of colorectal cancer was 20-24 years. It is important to consider patients who have undergone pelvic irradiation as being in a high risk group for the development of colorectal cancer. Close and long-term surveillance may be useful in these patients.

Cloning and expression of cytochrome P450(11 beta) of porcine adrenal cortex

Four cDNA clones were isolated from a porcine adrenal gland library by using a bovine cytochrome P450(11 beta) cDNA fragment as a probe. Nucleotide sequences of the four clones overlapped with each other. The deduced amino acid sequences indicated that these clones were derived from a porcine P450(11 beta) cDNA. Consecutive alignment of these clones covered almost 70% of a coding region of the cDNA, but its 5'-terminus was missing. The adrenal mRNA was reverse-transcribed, and polymerase chain reaction was used to obtain a cDNA fragment including the 5'-terminus. A cDNA constructed from this fragment and the isolated four fragments covered the entire apparent open reading frame of the enzyme, which was thus concluded to comprise 503 amino acids including a putative extension peptide of 24 amino acids at the NH2-terminus. The amino acid sequence was 82% identical to that of bovine P450(11 beta)-3. The cDNA was transfected into COS-7 cells, and steroidogenic activity of the cells was measured. The cells not only converted 11-deoxycorticosterone to corticosterone and 18-hydroxycorticosterone, but also produced aldosterone. Thus we conclude that the primary sequence of porcine P450(11 beta) which plays a role in the biosynthesis of glucocorticoids as well as mineralocorticoids was determined.

Metabolism of 11-deoxycortisol by cytochrome P450(11 beta): identification of reaction products by 1H-NMR and LC/MS-APCI method

A hitherto-unidentified steroid produced in the reaction mixture of 11-deoxycortisol with bovine cytochrome P450(11 beta) reconstitution system was purified by repeated HPLCs, and subjected to 1H-NMR analysis. The result suggested that the new metabolite was 19-oxo-11-deoxycortisol. This was further confirmed by a new analytical technique using LC/MS equipped with atmospheric pressure chemical ion (APCI)-analyzer.

Effects of ebelactone B, a lipase inhibitor, on intestinal fat absorption in the rat

Ebelactones A and B, natural products from Streptomyces aburaviensis are potent inhibitors of pancreatic lipase. Lipase is the key enzyme required for the absorption of dietary triglycerides (TG). Ebelactone B inhibited, in a dose-dependent manner, the intestinal absorption of fat after fat-feeding in the rat. The most effective inhibition was observed when the inhibitor was administered at 60 min prior to fat-feeding. When ebelactone B (10 mg/kg) was administered, the serum levels of TG (58%) and cholesterol (36%) were decreased. Since ebelactone B effectively inhibitors absorption of dietary fat, if may provide a promising means for prophylaxis or therapeutics of hyperlipidemia and obesity.

Endoscopical segmental piecemeal tumorectomy for nodular elevation of colorectal tumor: applicability and patient's quality of life

Endoscopical segmental piecemeal tumorectomy (ESPT) for nodular elevation of colorectal tumor is advantageous in terms of minimizing both surgical invasion and postoperative burden to the patients. Nodular elevation of colorectal tumors is said to occur when the body of the tumor is adenomatous and the surface of the focal cancer grows more horizontally into the lumen than vertically. We report here four cases of nodular elevation of colorectal tumors which were each treated by different surgical procedures.

KF17837 ((E)-8-(3,4-dimethoxystyryl)-1,3-dipropyl-7-methylxanthine), a potent and selective adenosine A2 receptor antagonist

8-(3,4-Dimethoxystryryl)-1,3-dipropyl-7-methylxanthine exhibited high affinity and selectivity for adenosine A2A receptors in binding assay using rat striatal A2A receptors labeled with [3H]2-[p-(2-carboxyethyl)-phenethylamino]-5'-N-ethylcarboxamido adenosin e (CGS21680). The affinity was stereo selective: the E isomer, KF17837, showed a Ki value of 1.0 +/- 0.057 nM for the A2A receptors, whereas the Z isomer showed much lower affinity. KF17837 had 62-fold selectivity for the A2A receptors versus rat forebrain A1 receptors labeled with [3H]N6-cyclohexyladenosine (CHA). KF17837 was rapidly photoisomerized to form a stable equilibrium mixture (18% E - 82% Z), KF17837S, which showed Ki values of 7.9 +/- 0.055 nM and 390 +/- 68 nM for the A2A and A1 receptors, respectively. The inhibition type was competitive for [3H]CGS21680 binding. In rat pheochromocytoma PC12 cells KF17837S antagonized cAMP accumulation induced by 1 microM CGS21680 via the A2A receptors, with an IC50 value of 53 +/- 10 nM. cAMP accumulation induced by 10 microM 5'-N-ethylcarboxamidoadenosine via the A2B receptors in Jurkat cells (human T-cell line) was inhibited by KF17837S with an IC50 value of 1500 +/- 290 nM. These results indicate that KF17837S (and hence KF17837) is a highly potent and selective adenosine A2A receptor antagonist.

Ovarian metastasis in patients with colorectal carcinoma

The records of 159 patients who underwent surgical resection of colorectal cancer were reviewed to assess the incidence of ovarian metastasis and to define the role of oophorectomy. Four of these patients presented with metachronous metastases, and one patient had synchronous ovarian involvement. The incidence of ovarian involvement was higher in younger patients. While most patients with ovarian involvement had the primary tumor located at the rectosigmoid region, a similar distribution of the primary tumor was observed in patients without ovarian metastasis. The histological type and degree of differentiation was similar regardless of whether or not ovarian metastasis was present. Of the patient without ovarian metastasis, 57% presented with nodal metastases and 3.2% with peritoneal dissemination, while all patients with ovarian metastasis had nodal and peritoneal involvement. Our results suggest that histological type and degree of differentiation of the primary tumor do not influence likelihood of ovarian metastasis. However, the exposure of the tumor to the serosal surface and the subsequent peritoneal dissemination may be an important route by which malignant tumor cells reach the ovaries. However, due to the wide lymphatic involvement in patients with ovarian metastasis, the lymphatic route may be important as well. Thus, we consider that oophorectomy should be performed in all postmenopausal women, when the ovaries are macroscopically affected, and in premenopausal patients with Astler-Coller B2 tumors or over.

[Null-cell non-Hodgkin's lymphoma presenting with a mass in the chest wall after tuberculous pyothorax]

A 59-year-old male, who was treated with artificial pneumothorax for pulmonary tuberculosis 42 years previously, presented with a painful mass in the left lateral chest wall and lymph node swelling in the left neck. A chest CT-scan revealed a tumor shadow extending from the outer chest wall to the pleural cavity containing pus surrounded by calcified pleura. 67Ga scintigraphy showed accumulation of the radionuclide in the left lateral chest and left neck. Biopsy specimen obtained from both the chest tumor and cervical lymph node revealed diffuse large cell lymphoma. Immunostaining failed to demonstrate CD1, CD3, CD4, CD8, CD13, CD20, immunoglobulin, alpha, gamma, mu, delta, kappa and lambda chains, indicating null cell characteristics. Chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, prednisolone and bleomycin and irradiation resulted in a temporary decrease of the tumor and lymph nodes, but the patient died of pneumonia 14 months after the onset of disease. Since the levels of serum lactate dehydrogenase and immunosuppressive acidic protein varied in parallel to the disease activity, they appeared to be useful for the assessment of therapeutic effects during the clinical course. Approximately 100 cases of non-Hodgkin's lymphoma developing after tuberculous pyothorax have been reported in this country, among which the incidence of null cell type is exceedingly rare.