Frozen section diagnosis of hypertensive pulmonary vascular changes at surgery for congenital heart anomalies

Frozen sections of lung biopsy were prepared in 30 cases of congenital heart anomalies with pulmonary hypertension, and evaluation of severity of the pulmonary vascular changes was made during the surgery. Statistically, significant differences was not found between the diagnosis made by frozen sections and those made by paraffin sections. It is concluded that rapid and accurate diagnosis of pulmonary vascular changes can be made by means of frozen section diagnosis. This method will prove to be clinically important by assisting during operation in rapid assessment of indication for total correction of congenital heart anomalies.

Intramedullary spinal cord germinoma producing HCG and precocious puberty in a boy

Extremely high concentrations of human chorionic gonadotropin in the cerebrospinal fluid were found in a 5-year-old boy presenting sexual precocity and leg pain. An intramedullary spinal cord tumor was revealed by myelogram and metrizamide computerized tomography, and a biopsy specimen taken at laminectomy. Histologically, the tumor showed germinoma with syncytiotrophoblastic giant cells. The tumor remitted for 5 months after irradiation of 3500 rad and chemotherapy, but recurred in spite of adding 7500 rad and more aggressive chemotherapy. No relapse has been seen for 1 year after amputation of the spinal cord at the T7 level.

Particular cases of Cushing's syndrome--one with adrenocortical carcinoma and the other with double adenomas

Two particular cases of adrenocortical tumors associated with Cushing's syndrome were documented. In the first case, the steroid pattern suggested a malignancy, and the histology of the excised tumor confirmed it. In the second case, the left adrenal had two distinct tumors; one dark-brown, and the other yellow in color. Recent trends in the diagnosis and treatment of Cushing's syndrome were discussed.

Ultrastructure of pigment in adrenocortical pigmented adenomas of Cushing's syndrome and in non-functioning pigmented nodules with respect to tissue steroid analyses

Ultrastructural and morphometrical analysis of brown pigment in pigmented (black) and non-pigmented adrenocortical adenomas of Cushing's syndrome and non-functioning pigmented adrenocortical nodules was performed in reference to tissue concentrations and in vitro production of steroids by the adenoma tissue. Pigment in pigmented adenomas was of membrane-bound lysosomal nature, while that of pigmented nodules contained membrane-unbound droplets of lipoid character. The morphometrical study showed little difference among individual adenomas. There was no difference between pigmented and non-pigmented adenomas in the amount of production and tissue concentrations of steroids. The steroid concentrations in a pigmented nodule were lower than those in an adenoma of Cushing's syndrome, but not significantly. Discussion is focused on the difference of pigment of lysosomal nature and of lipoid peroxidation.

[Histopathology of testicular germ cell tumors]

The most common type of testicular tumor is the germ cell tumor, which shows peculiar histological and biological features. The histopathology of germ cell tumors of the testis is illustrated here according to the WHO classification except for extremely rare polyembryoma and teratoma with malignant transformation. The tumors are divided roughly into 2 groups, one histological type including seminoma, spermatocytic seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma and teratoma, and more than one histological type including many possible combinations of one histological type. Seminoma and spermatocytic seminoma show some similar features to the germ cell line, while embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma show differentiation toward a variety of structures appearing at any stage of embryogenesis instead of the original testicular tissue. The histology of the metastatic disease may or may not be the same as that of the primary lesion. The reasons for the occurrence of histological differences between primary and metastatic tumors is discussed. Two major tumor markers of the germ cell tumor, HCG and AFP, are analyzed using immunohistochemical procedure, and the significance of immunostaining for these markers in clinicopathological study is stressed.

A retroperitoneal endocrine carcinoma

A case of endocrine carcinoma in the retroperitoneal cavity of a 41-year-old woman is reported. Tumor cells were negative for argentaffin and positive for argyrophil reactions. Immunohistochemically, vasoactive intestinal polypeptide, hCG-alpha, and somatostatin were identified. Electron microscopically, numerous secretory granules measuring 210 to 280 nm in diameter and with distinct limiting membranes were seen in the tumor cells. Discussion was focused on the origin of endocrine tumor cells in the retroperitoneal cavity.

Immunohistochemical localization of brain-gut hormones in gastric carcinoma with relation to argyrophil cells

A total of 87 surgical cases of gastric carcinoma including 3 carcinoid tumors were investigated with the methods of silver reaction and immunoperoxidase stain for 8 different brain-gut hormones. Argyrophil (AP) cells were demonstrated in 38 cases (44%), argentaffin (AF) cells in 18 (21%) and endocrine cells in 13 (14%). The occurrence of endocrine cells had no relation with histological types. Glicentin cells were demonstrated in 10 cases, somatostatin in 7, motilin in 3, beta-endorphin in 2 and gastrin in one. Endocrine cells appeared generally in small numbers except one carcinoid tumor which had numerous somatostatin cells. No single cell positive for more than two kinds of hormones could be demonstrated. Two undifferentiated carcinomas looking like carcinoid tumors had argyrophil cells and endocrine cells of either somatostatin or beta-endorphin. These results suggest that carcinoid-like carcinoma or endocrine cell carcinoma may lie on the intermediate state between carcinoma and carcinoid tumor.

Immunoreactive corticotropin and corticotropin-releasing factor in human hypothalamus, adrenal, lung cancer, and pheochromocytoma

Immunoreactive corticotropin-releasing factor (I-CRF) and ACTH (I-ACTH) were examined using RIA, immunoaffinity chromatography, and gel filtration chromatography in human hypothalamus, adrenal (cortex and medulla), lung cancer, and pheochromocytoma. I-CRF and I-ACTH were present in these tissues. Gel filtration of I-ACTH in the adrenal, pheochromocytoma, and lung cancer showed the presence of larger amounts of I-ACTH with large molecular weight forms in contrast to the hypothalamus. Gel filtration of I-CRF in these tissues showed the main peak eluted at the position of synthetic rat CRF. High performance liquid chromatography of this main peak showed two components which eluted in the positions of synthetic rat CRF and oxidized CRF. These elution positions were the same in all tissues and identical with those in the hypothalamus. These results suggest the presence of I-ACTH and I-CRF in these tissues and that CRF outside the brain is identical to hypothalamic CRF.

Immunocytochemical identification of CRF in the human hypothalamus

Immunoreactive ovine corticotropin-releasing factor (CRF) was revealed in the cell bodies of parvocellular neurons in the paraventricular nucleus of the human hypothalamus by an immunocytochemical technique. The immunoreactivity was negative in magnocellular neurons. Immunoreactive nerve fibers were found in the subependymal layers of the third ventricle and in the perivascular space of the primary plexus in the lower hypothalamus. No CRF immunoreactive cell bodies were found in the supraoptic nucleus.

Peritoneal implantation of endodermal sinus tumor of the pineal region via a ventriculoperitoneal shunt. Cytodiagnosis with immunocytochemical demonstration of alpha-fetoprotein

A 17-year-old male developed an endodermal sinus tumor in the pineal region that metastasized to the peritoneal cavity via a ventriculoperitoneal shunt and caused ascites. Neoplasm was diagnosed by cytologic examination of the peritoneal fluid, and the precise histologic nature of the neoplasm was confirmed by immunocytochemistry, which demonstrated alpha-fetoprotein in the neoplastic cells.

Ultrastructural localization of hCG in the placenta and in testicular germ cell tumors

Human chorionic gonadotrophin(hCG)-producing cells in the human placenta and in testicular germ cell tumors have been investigated by ultrastructural immunohistochemistry using labeled Fab'fragments of anti-hCG-alpha and anti-hCG-beta. Most reaction products were demonstrated in the rough endoplasmic reticulum (rER) and perinuclear spaces of syncytiotrophoblastic giant cells ( STGC ) occurring in embryonal carcinomas and in syncytial cells observed in choriocarcinomas and in normal placenta. The rER of placental and choriocarcinomatous syncytial cells was highly developed and invariably showed a positive reaction. However, the rER of STGCs varied both with regard to its degree of development and its immunoreactivity with hCG. Localization of hCG in the Golgi apparatus and in cytoplasmic granules was indefinite. Mononuclear cells reacting positively with anti-hCG-alpha or -beta were also demonstrated. Cytotrophoblast-like cells which failed to react with anti-hCG-alpha or -beta were noted adjacent to sTGCs and the significance of these cells is discussed.

Adrenal and extra-adrenal pheochromocytomas: an ultrastructural and formaldehyde-induced fluorescence study with catecholamine content

Twenty-one adrenal and 6 extra-adrenal pheochromocytomas were studied by light and electron microscopy, and formaldehyde-induced fluorescence (FIF). These morphological findings were compared to the content of tumor catecholamines. Based on predominancy of the cell types, pheochromocytomas were classified into three groups: basophilic, chromophobic and oxyphilic (oncocytic) types. The basophilic type was characterized by basophilic cytoplasm of the tumor cells with hematoxylin and eosin (H & E) stain, green cytoplasmic fluorescence with FIF and numerous epinephrine type of electron dense granules with electron microscopy. Its epinephrine content was compatible to the normal adrenal medulla. The basophilic type was only of adrenal origin. Chromophobic and oxyphilic tumors contained predominantly norepinephrine, and showed yellow-green or light brown cytoplasmic fluorescence by FIF. By electron microscopy, various granules of different sizes and shapes of the norepinephrine type were noted. Extra-adrenal pheochromocytoma cells demonstrated dark brown cytoplasmic fluorescence by FIF. Morphological findings of the extra-adrenal tumor corresponded to those of chromophobic type adrenal pheochromocytoma. The tumors contained only norepinephrine.

Stromal cells of the fibroadenoma of the human breast. An immunohistochemical and ultrastructural study

Fourteen fibroadenomas of the human breast were examined by light and electron microscopy, and by immunohistochemistry for actin. They were classified into 3 groups according to their stromal patterns; myxoid, fibrous-cellular and sclerotic. Actin immunohistochemistry revealed that the stromal areas were strongly positive in the fibrous-cellular group and weakly positive in the myxoid and sclerotic groups. By electron microscopy the stromal cells in most cases of the myxoid and fibrous-cellular groups were fibroblasts, containing varying amounts of microfilaments, 5-7 nm in diameter (actin type filaments). However, a dense body was not usually present suggesting these stromal cells were variants of myofibroblasts. The amount of microfilaments in fibroblasts was greater in the fibrous-cellular group than in the myxoid group. This was consistent with the results of actin immunohistochemistry. In 3 cases of the fibrous-cellular group peculiar structures simulating Z-lines of striated muscles were noted in some stromal cells. Since no myosin filaments were detected, they were regarded as intermediate structures between Z-lines of striated muscles and dense bodies of smooth muscles. In the sclerotic group, stromal fibroblasts were sparse and had fewer organelles.

Human chorionic gonadotropin and alpha-fetoprotein in testicular germ cell tumors. An immunohistochemical study in comparison with tissue concentrations

The relation between immunohistochemical demonstration and tissue concentration of humanchorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) was examined in 17 testicular germ cell tumors. There was a good correlation between their results; e.g., a tumor with high hCG concentration contained numerous hCG positive cells, and vice versa. The immunoperoxidase localization of hCG and AFP was investigated in 57 tumors including above 17. HCG was revealed in syncytiotrophoblastic giant cells of seminoma or embryonal carcinoma as well as syncytial cells of choriocarcinoma, and on rare occasion in mononuclear cells. AFP was localized in tumor cells of yolk sac tumor or embryonal carcinoma and occasionally hyaline globules. No cell was stained concomitantly with hCG and AFP. Pathogenetical significance of cells positively stained was discussed.

An immunohistochemical study of hepatoblastoma producing human chorionic gonadotropin

High tissue concentrations of human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) were revealed by radioimmunoassay in a hepatic tumor which was surgically removed from a two-year, eight-month-old boy manifesting sexual precocity. Histologically the tumor showed an embryonal type hepatoblastoma admixed with multinucleated tumor giant cells. The localization of native hCG and hCG-beta subunit was immunohistochemically demonstrated in some of the above giant cells, while that of alpha-fetoprotein was diffusely in the tumor cells of hepatoblastoma of embryonal type. Ultrastructural features of the giant cells were also presented.

Stromal cell changes in human colorectal adenomas and carcinomas. An ultrastructural study of fibroblasts, myofibroblasts, and smooth muscle cells

Structural changes in stromal cells during the development of human colorectal carcinomas were studied by light and electron microscopy. The results were as follows: Stromal cells of the lamina propria in control subjects consisted principally of resting fibroblasts. Stromal fibroblasts were mildy activated in adenomas with mild -moderate atypia, and more markedly in adenomas with severe atypia (carcinoma in situ). In invasive adenocarcinomas, (a) desmoplastic reaction was induced, (b) stromal fibroblasts proliferated significantly and were activated showing enlarged nuclei and abundant rough endoplasmic reticulum, and (c) some smooth muscle cells were endowed with well-developed rough endoplasmic reticulum in their axial cytoplasm, resulting in a similar appearance to "myofibroblasts". Stromal fibroblasts in ulcerative colitis and proctitis were also activated. Morphometric analysis revealed that activated fibroblasts significantly increased the areas of their nuclei and cytoplasm, and the perimeter of rough endoplasmic reticulum. These activated fibroblasts suggested a higher production of collagen and other connective tissue proteins. Bundles of microfilaments of actin type were readily found in fibroblasts in all cases examined. These filaments were most remarkable in the fibroblasts in the desmoplastic stroma of invasive adenocarcinoma and were considered to be one of the basic components of these cells. Relationships between fibroblasts, "myofibroblasts", and smooth muscle cells are discussed.

Mass survey of gastric cancer and leukemia in Miyagi Prefecture, Japan

A little more than 20,000 examinees of x-ray mass survey of gastric cancer and the controls were followed up from 1960 to 1977. Cumulative doses of x-rays were calculated for each examinee, and a collective dose in person-year-rads was constructed. Incidence of leukemia was ascertained from Miyagi Prefectural Cancer Registry. Seven cases of leukemia were found out of 242,689 person-year-rads in the irradiated population, and 9 cases out of 273,344 person-years in the controls. Incidence rate in the two groups was identical. Therefore, the risk of this mass survey was disproved.

Hepatic alveolar echinococcosis invading pancreas, vertebrae, and spinal cord

A case of hepatic alveolor echinococcosis with contiguous invasion of the pancreas, vertebrae, and spinal cord and intrathecal metastases to the brain stem is reported. The long course after a hemihepatectomy may be a factor in the modification of the natural course of the disease and in the induction of this unusual mode of spread.

Development of parathyroid adenoma in a case of chronic renal failure suggesting tertiary hyperparathyroidism

A case of tertiary hyperparathyroidism with a parathyroid adenoma and hyperplasia was described as the first report in Japan. A 24-year-old man manifesting hypercalcemia had been treated with hemodialysis for 9 years. On admission, clubbed fingers richitic rosaries and a palpable node in the neck were the major physical findings. Laboratory examinations revealed hypercalcemia had elevated levels of plasma parathyroid hormone (PTH) in a c-terminal assay. Nevertheless the levels of PTH found by a n-terminal assay disclosed an only small increase. The PTH levels were scarcely decreased after a bolus injection of calcium gluconate. A large tumor corresponding to the palpable node was resected. Histologically, the tumor was an adenoma with thick fibrous capsule and interparenchymal bands. Other parathyroid glands showed secondary clear cell hyperplasia without signs of cellular hyperactivity.

Endometrial carcinoma in Miyagi Prefecture, Japan: histopathologic analysis of a cancer registry-based series and comparison with cases in American women

Cases of endometrial carcinoma (104) from the Cancer Registry of Miyagi Prefecture, Japan, during the period from 1966--1977 have been reviewed histologically. The most impressive differences between tumors in this low-risk population and those reported in American women are higher frequencies of the mixed adenosquamous histology, myometrial vascular invasion, and lymphoid infiltration within and around the tumors in the Japanese cases. The possible significance of these observations, both clinical and epidemiologic, is discussed in detail.

Follicular reconstruction and hormone production by human adenomatous goiter cells in culture

Morphological and functional properties of dispersed cells of human adenomatous goiter and those of the thyroid tissue adjacent to and distant from the nodular lesion (normal control) were investigated. In the presence of TSH, reconstructive arrangement of adenomatous goiter cells into a three-dimensional follicular structure occurred in a similar manner to that of normal controls. An addition of thyrotropin (TSH) to culture resulted in the secretion of thyroid hormones in control cells, but adenomatous goiter cells showed no response to TSH. It was found that the ratio of rT3, T3, the ratio of an inactive to an active form, was about three times higher in adenomatous goiter than in normal control. These findings suggested that conversion from T4 to rT3 is increased in adenomatous goiter.