Crohn disease: early recognition and progress of aphthous lesions

PURPOSE

To clarify the radiographic appearance of the initial change an dprogression in Crohn disease.

MATERIALS AND METHODS

Between 1984 and 1992, nine patients (seven men and two women, aged 16-34 years; mean, 20 years) with Crohn disease, who had evidence of only aphthous erosions or ulcers at the initial examination, underwent repeated radiography for up to 7 years 11 months (median, 4 years).

RESULTS

In all patients, the stomach, duodenum, small intestine, and colorectum were involved, and the esophagus was affected in three patients. Subsequently, four of the nine patients had lesions that progressed from aphthous lesions to overt Crohn disease, including ileitis in two patients, colitis in one, and ileocolitis in one. Time intervals between the first visit and the progression varied from 9 months to 3 years 6 months. In all eight patients who underwent nutritional treatment, regression of the lesions was recognized, but three of the lesions progressed during interruption of the nutritional diet.

CONCLUSION

Crohn disease may initially appear as diffuse aphthous lesions in the gastrointestinal mucosa.

Mechanism of pain and cytoskeletal properties in angioleiomyomas: an immunohistochemical study

Angioleiomyoma is a solitary subcutaneous tumor characterized by pain in about half of patients with this tumor, and the pathogenesis of this pain has been a cause of much debate. To clarify the mechanism of pain and cytoskeletal property of tumor cells, 50 angioleiomyomas were studied clinicopathologically and immunohistochemically. The tumors occurred preferentially on the extremities, particularly the lower leg (46%), and the female to male ratio was 1.9:1. They were classified into three histological subtypes: (i) solid (30 cases); (ii) venous (15 cases); and (iii) cavernous (five cases). The pain and/or tenderness were present in 26 out of 49 patients (52%), in which small nerve fibers immunoreactive for S-100 protein and PGP9.5 were identified within the capsule of 20 tumors (77%) and the tumor stroma of 18 (69%), irrespective of the histological subtypes. In 24 patients where the pain was absent or unknown, nerves were observed within the capsule of 19 tumors (79%) and tumor parenchyma of 10 (42%). Many cells in all 50 tumors were positive for alpha-smooth muscle actin, and a relatively large number of cells in many tumors were positive for vimentin, desmin and collagen type IV. Also, cytokeratin (CAM5.2) reactivity was scattered in a few cells of four tumors. From these findings, the peculiar pain of angioleiomyomas could be mediated by the nerve fibers especially located within the tumor parenchyma. Although the expression of intermediate filaments in angioleiomyomas was heterogeneous, the overall cytoskeletal features were of smooth muscle cell differentiation.

Gastrointestinal manifestations of Cowden's disease. Report of four cases

Four patients with an established diagnosis of Cowden's disease underwent barium meal study, upper gastrointestinal endoscopy, barium enema examination, and colonoscopy. In three, the esophagus was affected by small protrusions, which were diagnosed as glycogenic acanthosis. Numerous hyperplastic polyps were found in the stomach in three patients, and in one an inflammatory fibroid polyp was also detected. Either lymphangiectasia or lymphoid polyps were found in the duodenum in two patients. In all patients, the colon showed polyps that varied in histology and included adenoma, hamartomatous polyp, and ganglioneurofibroma. In addition, jejunal lymphangiomas were found in one of the three patients in whom the small intestine could be precisely evaluated. These findings suggest that the gastrointestinal involvement in Cowden's disease is characterized by various benign lesions, especially esophageal glycogenic acanthosis, numerous gastric hyperplastic polyps, and multiple hamartomatous polyps in the rectosigmoid colon. Detection of these gastrointestinal manifestations may lead to early diagnosis of this potentially malignant disease.

Cancer in Peutz-Jeghers syndrome

BACKGROUND

Peutz-Jeghers (P-J) syndrome has been found to be associated with an increased risk of malignant neoplasia.

METHODS

The authors reviewed the clinical courses of eight patients with P-J syndrome (four male and four female patients, ranging in age from 8 to 55 years), who had been followed up for as long as 12 years. The diagnosis of this syndrome was based on the evidence of characteristic mucocutaneous pigmentations and gastrointestinal hamartomatous polyposis.

RESULTS

Four cases of malignant neoplasm among the eight patients were found. In a 25-year-old woman, an extremely well-differentiated adenocarcinoma of the uterus cervix was found at the initial examination. A gastric cancer in a 32-year-old woman, duodenal cancers in a 43-year-old man, and a pancreatic cancer in a 60-year-old man also were identified 12, 10, and 5 years after the time of initial examinations, respectively. Two of these patients died of the effects of the tumor soon after.

CONCLUSION

The authors' experience confirms a veritable malignant potency in P-J syndrome and suggests that an intensive follow-up of gastrointestinal and extra-gastrointestinal sites is needed in patients with this syndrome.

Giant cell tumor of tendon sheath. An immunohistochemical observation on the characteristics and the capacity of proliferation of tumor cells

To investigate character and proliferation of tumor cells of giant cell tumor of tendon sheath (GCTTS), we studied 25 cases of GCTTS by light and electron microscopic immunohistochemistry. Mononucleated stromal cells (SC) of GCTTS could be divided into three types according to their antigenic features. The first type was the histiocytic SC expressing antigens recognized by KP1, Mac387 and Ham56. The second type was the fibroblastic SC showing fibronectin immunoreactivity. The third type was the intermediate SC expressing both KP1 and fibronectin. The presence of intermediate SC suggested that the different types of SC of GCTTS would be of common origin, i.e. from the mesenchymal cells of the synovium and represented different functional phases or phenotypic alterations. The expression of proliferating cell nuclear antigen (PCNA) was observed only in SC and occasionally, in binucleated cells, but multinucleated giant cells (GC) were negative for PCNA, suggesting that GC were non-dividing cells.

[The life spans, cause of death and pathological findings of Fukuyama type congenital muscular dystrophy--analysis of 24 autopsy cases]

The case cards for autopsied patients with Fukuyama type congenital muscular dystrophy (FCMD) which included clinical data and pathological findings were filled in 10 national hospitals and 2 other institutes in Japan. The cards of 24 patients who died between 1978 and 1991 were collected and analysed for this study. The ages at death ranged from 2 to 27 years with a mean of 14.29 +/- 6.18 years and represented a nearly unimodal distribution. The age at death in the 12 patients who died before 1983 ranged from 2 to 21 years and averaged 11.58 +/- 5.11 years, whereas the 12 patients who died after 1984 ranged from 3 to 27 years of age and averaged 17.00 +/- 6.44 years. The latter group lived significantly longer than the former (p < 0.05). Pulmonary infection was a more frequent cause of demise in the group of patients who died before 1983 than in those who died after 1984 (83.3% vs 25.0%). On the other hand, cardiac failure was a more common cause of death in the latter group (8.3% vs 50.0%). These data on the life spans and cause of death of FCMD were similar to those studied of Duchenne muscular dystrophy by Mukoyama et al (1984, 1986, 1987).(ABSTRACT TRUNCATED AT 250 WORDS)

Natural history of fundic gland polyposis without familial adenomatosis coli: follow-up observations in 31 patients

PURPOSE

To clarify the natural history of fundic gland polyposis (FGP) without familial adenomatosis coli (FAC).

MATERIALS AND METHODS

Thirty-one FGP patients without FAC (six men and 25 women) were followed up with radiography and endoscopy for 1-13 years (mean, 4.3 years).

RESULTS

In eight of 11 patients who initially had a single polyp, the polyp disappeared, probably due to endoscopic forceps biopsy. Of 20 patients with multiple polyps, seven (one man and six women with a mean age of 40.6 years at initial diagnosis) had obvious changes in the number of polyps, including complete disappearance in three patients, a decrease in one, transient disappearance followed by recurrence in two, and an increase in one. These patients were younger and had a greater number of polyps at initial diagnosis than the remaining 16 patients without any remarkable change.

CONCLUSION

FGP without FAC is characterized by spontaneous decrease or increase in the number of polyps, especially in middle-aged female patients with a large number of polyps.

The innervation of intradermal nevi. On the nevus-axon relations

In the study of the histogenesis of intradermal nevi, the nevus cell-Schwann cell relationship has been a matter of long debate. We have demonstrated a dense axonal supply in the intradermal nevi by protein gene product 9.5 (PGP 9.5) immunohistochemistry. There were small nerve bundles between nevus cell nests and numerous individual axons in the nests of all the intradermal nevi studied. The distribution of these axons was more dense in the deeper and middle portions than in the superficial portion of the nevi. The significance and morphogenesis of this rich axonal supply in the intradermal nevi remain obscure, but this nevic neurotropism suggests an intimate mutual interaction between nevus cells and axons: possibly, some activities of nevus cells stimulating axonal proliferation, or nevus cell migration into the preexisting nerves. The presence of the proliferated axons may have some influences upon Schwannian transformation of the nevus cells. The mode of contact between nevus cell and axon, the presence of true Schwann cells surrounding the proliferated axons and the demonstration of myelin structure should be investigated by further electron microscopic study.

Cancer in Peutz-Jeghers syndrome

BACKGROUND

Peutz-Jeghers (P-J) syndrome has been found to be associated with an increased risk of malignant neoplasia.

METHODS

The authors reviewed the clinical courses of eight patients with P-J syndrome (four male and four female patients, ranging in age from 8 to 55 years), who had been followed up for as long as 12 years. The diagnosis of this syndrome was based on the evidence of characteristic mucocutaneous pigmentations and gastrointestinal hamartomatous polyposis.

RESULTS

Four cases of malignant neoplasm among the eight patients were found. In a 25-year-old woman, an extremely well-differentiated adenocarcinoma of the uterus cervix was found at the initial examination. A gastric cancer in a 32-year-old woman, duodenal cancers in a 43-year-old man, and a pancreatic cancer in a 60-year-old man also were identified 12, 10, and 5 years after the time of initial examinations, respectively. Two of these patients died of the effects of the tumor soon after.

CONCLUSION

The authors' experience confirms a veritable malignant potency in P-J syndrome and suggests that an intensive follow-up of gastrointestinal and extra-gastrointestinal sites is needed in patients with this syndrome.

Neoplastic transformation arising in Peutz-Jeghers polyposis

PURPOSE AND METHODS

To clarify the potential for malignancy of Peutz-Jeghers polyposis, we investigated 75 gastrointestinal polyps resected surgically or endoscopically from seven patients with this syndrome.

RESULTS

There were 19 polyps in the stomach, 18 in the duodenum, 22 in the small intestine, and 16 in the large intestine, and these were histologically composed of 1 pyogenic granuloma, 1 cancer in adenoma, 2 adenomas, and 71 Peutz-Jeghers polyps. Nine of these Peutz-Jeghers polyps were accompanied by an adenomatous component, and, in addition, two of these showed a cancerous transformation with stalk invasion. A total of 12 neoplastic polyps (16 percent) were found in three relatively young patients (aged 20, 25, and 43 years), all of which were pedunculated and located either in the duodenum or in the jejunum. There was no statistical significance in size between the neoplastic polyps (mean +/- SD, 20.1 +/- 10.8 mm) and the completely hamartomatous polyps (mean +/- SD, 15.8 +/- 9.0 mm). Moreover, the configuration of these types of polyps seemed similar.

CONCLUSION

Neoplastic transformation is not a rare event, and our results may indicate evidence of a hamartoma-adenoma-carcinoma sequence in Peutz-Jeghers polyposis.

Immunohistochemical analysis of myoblast proliferation and differentiation in experimental skeletal muscle regeneration

We investigated the onset and duration of DNA synthesis and differentiation of muscle precursor cells in the early stage in muscle regeneration after bupivacaine induced muscle necrosis using monoclonal anti-PCA and anti-desmin antibodies. The first positive PCNA reaction indicating the commencement of proliferating cycle of muscle precursor cells appeared at 24 hours after injury, and were most prominent at 60-72 hours after injury. Thereafter the reaction for PCNA disappeared as the maturation of regenerated myofibers progressed. Some nuclei of regenerated myotubes in the early stage were positive for PCNA contrary to the generally accepted concept that myonuclei after fusion were out of cell cycle. The first desmin expression was observed in mononuclear presumptive myoblasts at 48 hours after injury, some of which were also positive for PCNA in the double immunostained sections for desmin and PCNA. This result suggested that differentiation of presumptive myoblasts could already initiate during their proliferative phase.

Transforming growth factor alpha and CD68 immunoreactivity in giant cell tumours of bone: a study on the nature of stromal and giant cells, and their interrelations

To clarify the nature of neoplastic cells, 17 giant cell tumours of bone were studied histologically and immunohistochemically. L1 antigen and S-100 protein were not detected in the tumour giant cells and stromal cells, although present in non-neoplastic macrophages. The giant cells in all the lesions, some stromal cells, and osteoclasts in the normal bone showed CD68 and transforming growth factor alpha (TGF alpha) immunoreactivity. Fibrohistiocytic antigen, factor XIIIa, was expressed in large numbers of stromal cells in all lesions. Some stromal cells expressed alpha-smooth muscle actin and osteocalcin. These immunohistochemical results suggested that the stromal cells of giant cell tumours of bone showed histiocytic and occasional myofibroblastic and osteoblastic differentiation. Proliferating cell nuclear antigen was demonstrated in the nuclei of the stromal cells only, indicating that these were the sole proliferating elements. TGF alpha produced by the giant cells and some stromal cells may play a role as a mediator for the attraction and/or proliferation of the precursor cells, and may suppress the activity of osteoblastic stromal cells, resulting in restricted bone formation in giant cell tumours.

Autopsy analyses of the muscular dystrophies

Life span, causes of death, weight of heart, liver, brain, and main pathological changes of internal organs were analysed on 329 autopsy cases of muscular dystrophies. These included 249 cases of Duchenne muscular dystrophy (DMD), 3 Becker muscular dystrophies (BMD), 14 limb-girdle muscular dystrophies (LGMD), 3 fascioscapulohumeral muscular dystrophies (FSH), 18 Fukuyama type congenital muscular dystrophies (FCMD) and 17 myotonic dystrophies (MyD). In DMD the life span has definitely prolonged in recent years. Pulmonary infection, which was once the major cause of death, has greatly decreased in recent years. Instead, respiratory and cardiac failures caused by dystrophic changes of respiratory and cardiac muscles were more closely related to the causes of death in many recent cases. Myocardial fibrosis was observed in most of the patients with DMD, BMD, LGMD, FCMD and MyD. The distribution of cardiac lesions was similar in BMD, LGMD and FCMD as in DMD. In MyD the disorders involved more frequently conductive muscles resulting in arrhythmias. The dystrophic cardiomyopathy seemed to be a part of the essential changes in all types of muscular dystrophy, although different in intensity and rate of morbidity. Alzheimer's neurofibrillary changes were observed in the brain of some cases of FCMD and MyD, suggesting the possibility of precocious aging of the brain in some patients of the muscular dystrophies.

A newborn case of extrarenal malignant rhabdoid tumor

Malignant rhabdoid tumor is initially differentiated from renal tumors and characterized by extremely rapid growth. We report a newborn case of extrarenal malignant rhabdoid tumor and review the literature.

Mechanism of pain in osteoid osteomas: an immunohistochemical study

Osteoid osteoma is a benign bone tumour characterized by pain which is relieved by non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin. To clarify the mechanism of the pain, five osteoid osteomas were studied immunohistochemically using polyclonal antibodies against prostaglandin E2 (PGE2), S-100 protein and protein gene product 9.5 (PGP 9.5). In all five cases, the pain had been relieved by NSAIDs. Nerve fibres positive for S-100 protein and PGP 9.5 were observed in the fibrous zone, especially close to the blood vessels, around the nidus in all the lesions and also within the nidus in three lesions. PGE2 immunoreactivity was variably positive in the nidus of three lesions. In one case a large number of actively proliferating osteoblasts reacted with this antibody. The other cases showed unevenly distributed PGE2 positivity which tended to be prominent in the plump osteoblasts. As control material we examined fibrous dysplasia (3 cases), osteosarcomas (3) and giant-cell tumours of bone (3). The plump osteoblastic tumour cells of three osteosarcomas and the bone-forming cells in two cases of fibrous dysplasia gave a positive reaction for PGE2. No S-100 or PGP 9.5 immunoreactive nerve fibres were seen in these lesions. It is concluded that the presence of nerve fibres alone might play a more important role in mediation of pain in osteoid osteomas than some effects of osteoblast-produced PGE2 on the nerves and proliferated blood vessels.

Solitary infantile myofibromatosis of bone. An immunohistochemical and ultrastructural study

A rare case of solitary infantile myofibromatosis of bone in an 11-month-old boy is reported. Radiographically the lesion of parietal bone was round, well-circumscribed, and osteolytic with a sclerotic rim. Histologically the tumor was made up of nodules that were hyalinized or cellular and containing plump, spindle-shaped cells that were intermediate in appearance between fibroblasts and smooth-muscle cells, arranged in short bundles or whorls. Another typical feature was the presence of distended, cleft-shaped vascular spaces around the nodules. The microscopic features of this tumor were consistent with those of infantile myofibromatosis of other sites, such as the skin and deep soft tissue. The tumor cells showed immunoreactivities for vimentin and alpha-smooth muscle actin. Microfilaments with dense bodies were observed in the fibroblast-like tumor cells. In addition, many tumor cells stained for collagen type IV and were covered by incomplete external laminae, indicating infantile myofibromatosis has more advanced smooth-muscle differentiation than conventional fibromatosis.

Osteosarcoma with epithelioid features. An immunohistochemical study

We report a case of osteosarcoma with coexpression of epithelial and mesenchymal markers immunohistochemically of the second lumbar vertebra in a 49-year-old man. Histologically, the tumor largely showed typical patterns of osteosarcoma with lacelike osteoid deposition and chondroblastic and fibroblastic areas. Immunoreactivity for osteocalcin (human bone gamma-carboxyglutamic acid-containing protein) was demonstrated in most of these tumor cells. Both primary and recurrent tumors contained areas that were composed of epithelioid cells with an alveolar pattern and a trabecular arrangement that resembled carcinoma. Some of the epithelioid cells gave positive reactions for cytokeratin and epithelial membrane antigen. On extensive examination, no other site of malignancy was detected. There have been a few reports of osteosarcomas with epithelioid cells, but to our knowledge, the immunohistochemical properties of this type of tumor have not been reported previously. This is an unusual case of osteosarcoma with epithelioid features.

An animal model of longitudinal ulcers in the small intestine induced by intracolonically administered indomethacin in rats

The ulcerogenic effect of intracolonically administered indomethacin was evaluated in rats. Conventionally fed rats aged from 5 to 10 weeks were treated by 8, 16, 24, or 32 mg/kg of intracolonic indomethacin for two days, and any damage to the stomach, small intestine and the colon was investigated. Longitudinal ulcers and scattered small ulcers were found in the small intestine at all doses of indomethacin, and the length of the longitudinal ulcers increase dose-dependently, but this was unrelated to the body weight of the rats. The cecum was frequently affected by irregularly shaped ulcers, and the incidence increased as the dose of indomethacin increased. The colon, other than the cecum, was not involved macroscopically. In contrast, the stomach was affected by only large doses of indomethacin (24 or 32 mg/kg), and the size of gastric ulcers increased according to the body weight of the rats. These findings suggest that intracolonic indomethacin in relatively young rats causes ulcers predominantly in the small intestine and the cecum, which are the frequent site of involvement of human Crohn's disease, and that this animal model may be suitable for investigation of the pathophysiology of inflammatory bowel disease.

Epitopic heterogeneity of the CD36 antigen expressed by normal and neoplastic endothelial cells. An immunohistochemical study with a novel monoclonal antibody 8C9

Phenotypic and functional heterogeneity of endothelial cells (ECs) is being recognized with increasing frequency. Here we report a novel murine monoclonal antibody (MoAb), named 8C9, that detects a unique epitope on the leukocyte differentiation antigen CD36 (platelet glycoprotein IV or IIIb) expressed by both normal and neoplastic ECs. In immunohistochemical and flow-cytometric studies, 8C9-immunoreactivity was detected on capillary ECs, adipocytes, monocytes, platelets and a human monocytoid cell line U-937, which are known to express the CD36 antigen. Blocking experiments using U-937 cells and studies on cryostat sections revealed that a murine MoAb OKM5, which detects the CD36 antigen, blocked the binding of 8C9 to its antigen. Immunoblot analysis showed that 8C9 bound to a 97-kDa membrane protein expressed by U-937 cells treated with phorbol ester. These results indicate that 8C9 detects the CD36 antigen. However, the findings that some OKM5-positive normal ECs in the liver, spleen and lymph nodes as well as neoplastic ECs in a cutaneous angiosarcoma did not react with 8C9, together with the fact that the CD36 antigen does not form a complex or associate with other proteins, suggest epitopic heterogeneity of the CD36 antigen expressed by these tissues.

Hashimoto's thyroiditis in HTLV-I carriers

We describe two HTLV-I virus carriers who have biopsy-proven Hashimoto's thyroiditis. The first patient, a 64-year-old female, has had goiter and hypothyroidism since the age of 56. The second patient, a 66-year-old male, developed hyperthyroidism and goiter at the age of 44, but at present he is hypothyroid. Both patients are positive for anti-thyroid antibodies and anti-HTLV-I virus antibody. Findings of the thyroid biopsy specimens were consistent with Hashimoto's thyroiditis. These data suggest that Hashimoto's thyroiditis develops in HTLV-I carriers who have no clinical evidence of HAM/TSP.

Immature gastric teratoma in an infant

A 45 day old boy presented with progressive abdominal distension, tarry stools and anemia. A plain roentgenogram of the abdomen showed irregular, coarse calcifications in the left upper quadrant. The ultrasonography and computerized tomography of the abdomen revealed a large heterogeneous tumor with calcified parts in the left hemiabdomen. At operation, a 12 cm x 11 cm x 10 cm, multilobular, exogastric and endogastric tumor, including a portion of the anterior wall of the stomach, was extirpated. The pathological examination revealed a gastric teratoma with immature neural elements. Eight years after the total excision of the tumor there has not been any recurrence. This study includes a review of 88 cases (including the present case) of gastric teratoma reported in the English and Japanese literature.

Malignant peripheral nerve sheath tumors: an immunohistochemical study in relation to ultrastructural features

The constituent cells in malignant peripheral nerve sheath tumors were examined by studying the expression of immunohistochemical markers for Schwann cells and perineurial cells in relation to ultrastructural features in 12 malignant peripheral nerve sheath tumors. Ultrastructural studies demonstrated mixed proliferation of Schwann cells, perineurial cells, fibroblastic cells, and primitive cells in many malignant peripheral nerve sheath tumors. Expression of S-100 protein was well correlated with Schwann cell-like differentiation of tumor cells. However, Leu-7 and epithelial membrane antigen, which have been considered to be specific to Schwann cells and perineurial cells, respectively, were common to Schwann cells, perineurial cells, and primitive cells. The common immunophenotypic expression suggests a close relationship among these cell types. The unusual expression of cytokeratin could be explained by the plasticity of intermediate filament expression.

[A case of metastatic intracerebral malignant schwannoma]

A 53 year old male complaining of headache and left hemiparesis was referred to our hospital on November 11, '89. He had no evidence of von Recklinghausen's disease. He had been operated on because of a well circumscribed tumor in the left paravertebral muscle on July 11, '87, and metastasis in the lower lobe of the left lung on April 20, '88. The pathological diagnosis of both the primary and the metastatic lung tumor was malignant peripheral nerve sheath tumor showing peripheral cell differentiation (malignant schwannoma). Contrast enhanced CT demonstrated an irregularly enhanced mass in the right parietal lobe just before admission. On the night of admission November 12, '89, he suddenly had severe headache and this progressed to hemiparesis. Repeat CT examination was done immediately and revealed intratumoral hemorrhage. On November 19, '89, the tumor was totally removed. His symptoms disappeared postoperatively. The pathological findings of the tumor were the same as those made previously. The patient received radiotherapy to the brain (local 50 Gy and whole brain 30 Gy) and chemotherapy with nitrosourea (MCNU 150mg). He was discharged without neurological deficits. However he had two operations to remove metastatic tumors in the soft tissue of the hip on January 12, and August 17, '90. A very rare case of metastatic intracerebral malignant schwannoma is reported, and the literature on this point is reviewed.

A rare case of fibroadenoma in a tubular adenoma of the breast

We report herein a case of a 31 year old housewife who underwent an excisional biopsy for a well-circumscribed lump in her breast. The lump contained 2 histological patterns, namely, fibroadenoma and tubular adenoma. These patterns had no transitional zone, were distinct and changed abruptly. This case was histologically diagnosed as "a fibroadenoma in tubular adenoma of the breast, benign", with no other such case ever having been reported in Japan. The histological findings of this case, convinced us that tubular adenoma is closely related to fibroadenoma.