A pathological study of fulminant hepatic disease

Among 4,030 autopsies, 67 cases of fulminant hepatic failure were selected and studied from a pathological viewpoint. No sex difference in incidence was seen and the patients' age ranged very widely from 3 months to 78 years, showing comparatively high risk in the 20 s and 30 s in both sexes. Hepatitis virus was the most common cause, followed by toxic chemicals, shock, etc. Histopathological study revealed severe and extensive hepatic cell necrosis as the most conspicuous and common change of the liver, which was pathomorphologically quite similar to that experimentally produced by focal intravascular coagulation in rabbit. This evidence, as well as pathological findings of the other organs obtained at autopsy and the patients' reported clinical course, including laboratory data, were consistent with our proposal of a pathological disease entity, fulminant liver disease, which corresponds to the clinical symptom-complex known as fulminant hepatic failure. It is suggested that the characteristic feature of acute, severe and extensive hepatic cell necrosis which is seen in such cases is probably a result of an anoxic state caused in most instances by intrahepatic circulatory disturbances. Besides, we consider that fulminant liver disease can be regarded as a group of systemic diseases with the main focus of illness in the liver, rather than a specific disease of a single organ, the liver.

A study on renal papillary necrosis experimentally produced by the Shwartzman mechanism in rabbits

To produce renal papillary necrosis experimentally by means of the Shwartzman mechanism in rabbits, E. coli endotoxin was injected into the renal pelvis unilaterally through the ureter as a preparative procedure after pretreatment by local administration of alcohol, and the same endotoxin was given again 24 hours later, but intravenously this time via the ear vein, as a provocation. Marked necrosis was produced in the renal papillae, where many intravascular fibrin thrombi were found histologically. Such papillary necrosis was largely prevented by heparin administration, and this lesion was considered to be the univisceral Shwartzman reaction occurring in the renal papillae. The lesion produced in the new experimental system of renal papillary necrosis described here has a good similarity to that of human cases in etiology, pathogenesis and morphology. The present system may therefore be a good model of human renal papillary necrosis, and should be useful for future studies.

Long term effects of thorium dioxide (thorotrast) administration on human liver. Ultrastructural localization of thorium dioxide in human liver by analytical electron microscopy

The ultrastructual localization of thorium dioxide was examined in liver biopsy specimens from two patients injected more than 30 years before with thorotrast. An energy dispersive X-ray microanalysis spectrometer (Kevex 5100) was used to identify thorium in the liver tissue. By electron microscopy, most of the thorium particles were found in the cells of the reticuloendothelial system, such as macrophages of the portal triad and Kupffer cells in the hepatic sinusoid. Thorium dioxide particles were mainly located within the phagosomes, but larger aggregates existed in the cytoplasma with no visible limiting membrane. In addition, the deposition of thorium granules in a few hepatocytes was also confirmed by electron microscopy. This fact indicates that two main pathways of elimination are still functioning in the late period, but the hepatocytic pathway appears to be less effective than the reticuloendothelial system.

Detection of hepatitis B virus DNA in hepatocellular carcinomas in Japan

Hepatitis B virus (HBV) DNA in hepatocellular carcinoma (HCC) and/or cirrhotic livers of Japanese patients in Japan was investigated by molecular hybridization utilizing a 32P-labeled cloned HBV DNA of adr subtype. Among 24 HCC cases, 9 (37.5%) were positive for serum HBsAg and 10 (41.7%), including 2 cases which were negative for serum HBV markers, were positive for tissue HBsAg in noncancerous portions of the liver. In the latter 10 cases, integrated HBV DNA was detected in HCC. The restriction pattern of integrated viral DNA was different from one case to another. In the noncancerous portion of these 10 HCC cases, free (3/10), random integration (2/10), or clonal integration (1/10) of viral DNA was demonstrated; no hybridization was detected in the remaining 14 HCC cases, either in cancerous or noncancerous portions. Of 6 cases of liver cirrhosis, 2 were positive for serum and histochemical HBsAg; viral DNA was in free state. Viral DNA was not detected in pancreatic tissue in 5 HBsAg-positive cases. The present results are in agreement with previous reports indicating a high frequency of integrated viral DNA in HBV-associated HCC and heterogeneity in the mode of integration. Our results differ in finding no HBV DNA in HCC cases not associated with HBV markers and in finding clonal populations of hepatocytes with integrated HBV DNA less frequently in the noncancerous portion of the liver of HBsAg carriers.

Orcein positive hepatocellular material in the liver. With special reference to its relationship with human lipofuscin

Histopathological relationship between orcein positive hepatocellular material (ophm) reported by Sipponen and human lipofuscin (hlp) was investigated. Ophm was found to be very similar to hlp of the liver as well as of heart muscle cell morphologically and histochemically, and it seems to be quite rational to consider that ophm may be a substance which belongs to the lysosome series comprising hlp and prelipofuscin. Ophm has been discussed often from a view point of copper contents, which was considered to be one of its specific characters, but it has become clear that hlp can also possess copper according to our investigation and to some reports of other researchers. This fact throws a doubt on the significance of the specific relation between ophm and copper, as well as the usability of orcein stain for detecting copper in histological specimens. Victoria blue stain is quite useful for the detection of hlp including ophm, since it gives a blue color for it with a good contrast against red colored cytoplasm and nucleus. However, this can not be considered as a method for specific stain of copper either.

Possibly unique subunit(s) of human ferritins responsible for tissue specificity

The biochemical characteristics of human placental and hepatic ferritins were compared. By DEAE cellulose column chromatography, placental ferritin was found to contain more acidic isoferritins, while hepatic ferritin was richer in basic isoferritins. The electrofocusing patterns of subunits revealed that placental ferritin contained at least one unique subunit on the acidic side and might lack one subunit on the basic side as compared with hepatic ferritin. It is hypothesized that microheterogeneities, immunological as well as biochemical, existing between placental and hepatic ferritins cannot be explained merely in terms of different proportions of known acidic and basic subunits, but appear to have resulted from the existence of the unique acidic subunit of placental ferritin and possibly also a unique basic subunit of hepatic ferritin.

Morphological lesions of the pancreatic ducts. Significance of pyloric gland metaplasia in carcinogenesis of exocrine and endocrine pancreas

Morphological lesions of the pancreatic ducts were studied in 113 control autopsy cases, and 84 cases of primary pancreatic carcinoma. The lesions were classified into pyloric gland metaplasia, focal pseudo-proliferation, goblet cell metaplasia, squamous metaplasia, and atypical proliferation. Diabetes mellitus or glycosuria, alcohol intake, and smoking do not seem to have any close associations with these lesions or pancreatic carcinoma. Pyloric-gland and squamous metaplasias were found at nearly comparable incidences both in control and carcinoma cases, but marked atypical proliferations, which were indistinguishable from carcinoma in situ or intraductal spreading of carcinoma, were more frequently observed in the carcinoma cases. Pyloric gland metaplasia was the most common among the various lesions, and considered to represent nonspecific change of the pancreatic duct. However, it was suggested that some of the metaplastic lesions might be transformed into atypical proliferations and further into carcinoma in situ. The expected latent period from the appearance of in situ lesion to overt pancreatic carcinoma may be a clue to early diagnosis and effective surgical treatment, but possible multiplicity of carcinoma in situ or intraductal spreading of carcinoma even at its early stage will burden further problems on its treatment. On rare occasions, argyrophil cells were found in the pyloric gland metaplasia, and its significance was discussed in relation to the genesis of Zollinger-Ellison tumor.

Atypical acinar cell nodules of the human pancreas

The earliest morphological evidence of altered growth potential of pancreatic acinar cells of the rats treated with carcinogen, such as azaserine, is the development of nodules of atypical acinar cells, some of which are considered to appear, eventually, as acinar cell carcinomas. On the other hand, there exist nodular lesions in the human pancreas, which are similar to atypical acinar cell nodules of the rats, in the sense of nodularity, multiplicity, size, and cytological features, such as pale cytoplasm. To clarify the plausibility of the human nodular lesions as a precursor of acinar cell carcinoma of the pancreas, light and electron microscopical studies were performed, using pancreases of 115 semi-consecutive series of autopsy cases and 20 surgical cases. Multiple nodular lesions were found in 3 autopsy cases and one surgical cases. Ultrastructurally, markedly dilated cysterna of rough-surfaced endoplasmic reticulum and intracisternal granules were the most prominent characteristics of the atypical cells of the nodules. These features are neither reported in chemically induced atypical acinar cell nodules and carcinomas nor in human acinar cell carcinomas. The human lesions were considered to be of degenerative nature rather than neoplastic.

Morphological behavior of carcinoma of the pancreas. 2. Argyrophil cells and Langerhans' islets in the carcinomatous tissues

The incidence and the behavior of endocrine cells in carcinomatous tissues were studied in 84 autopsy cases and 10 surgical or autopsy cases of pancreatic carcinoma, by light and electron microscope, respectively. It was found that the islets persistently survived in the carcinomatous tissues. In large duct type carcinomas, the islets showed unique familiarity with the carcinomatous ducts, which may be interpreted as suggesting interactions between ductal cells and islet cells in pancreatic carcinogenesis. Aside from these survivor islet cells, carcinomas exhibited different degree and kind of differentiation to endocrine cells, depending upon their histological types. Namely, neoplastic argyrophil cells were found at the incidence of 82% (large duct type carcinoma), 39% (small duct), 43% (adenosquamous), and 18% (undifferentiated one). Moreover, argyrophil cells with their apexes stretching far to the neoplastic lumen were found only in large duct type carcinoma and cystadenocarcinoma. In three cases of carcinoid or oat cell type carcinoma, argyrophil cells were diffusely scattered and irregular in shape. These findings further justify the classification, reported in the previous article. The differentiation to endocrine cells was confirmed also by electron microscope.

Morphological behavior of carcinoma of the pancreas. 1. Histological classification and electron microscopical observation

A total of 84 autopsied and 10 operative pancreatic carcinoma cases were studied to investigate their morphological behavior, by light and electron microscopies. The autopsied materials were classified into 70 duct cell carcinomas, 11 undifferentiated carcinomas including 2 giant cell carcinomas simulating giant cell tumor of bone, and 3 endocrine cell carcinomas which might be called carcinoid or oat cell carcinoma. No acinar cell carcinoma was found. Duct cell carcinomas were further subclassified into 37 large and 24 small duct-forming adenocarcinomas, 8 adenosquamous carcinomas, and 1 cystadenocarcinoma. The majority of undifferentiated carcinomas were considered to be of ductal or ductular cell origin. Rare tumors, such as cystadenocarcinoma, giant cell carcinoma, and endocrine cell carcinoma, were shown as case presentations. Electron microscopic features of duct cell carcinoma and its related findings were also presented. These studies should be pursued, because it may be important clinically and disclose, in the future, possible differences in etiology or effective therapeutic agents among the categories, although the classification, made from a viewpoint of histogenesis, did not reflect prognostic differences at the present.

Pituitary-adrenal axis in pinealoma

Autopsy series of 19 patients with pineal and anterior third ventricle (suprasellar) tumors were analyzed with regard to shift in pituitary-adrenal axis. Germinomas formed the most common subgroup in this series (79%). Metastatic tumor growth in the pituitary gland caused adrenal atrophy in 4 cases. Some patients with pineal neoplasms had larger adrenals in weight compared with age- and sex-matched controls of Japanese. In three patients with sexual precocity, adrenal weight was larger. It is concluded that clinical importance exists in anterior pituitary insufficiency with adrenal atrophy, but hyperfunction of the hypophyseoadrenal system might occur during the course of the disease.

Acute hepatic cell necrosis experimentally produced by viral agents in rabbits

Acute and extensive hepatic cell necrosis was produced experimentally in rabbits by means of the Shwartzman mechanism using adeno- and hepatitis B viruses. The change that occurred in the liver was quite severe, namely, areas of hemorrhagic necrosis of various sizes in gross appearance and lytic-coagulative necrosis with hemorrhage and leukocyte-mononuclear cell infiltration histologically. Thrombi formation was noted in and around the necrotic areas, and it was not unusual to see necrosis of an entire lobe. This seems to be a model, to some extent, for human fulminant hepatitis caused by hepatitis virus infection, and suggested that some nonspecific reaction such as intravascular clotting may also play an important role in causing or complicating acute, severe, and extensive necrosis of the liver in human cases. Heparin administration very effectively prevented such hepatic necrosis, which supports the view that the change we observed in the liver was really the Schwartzman reaction; further, it is reminiscent of the fact that heparin administration is sometimes effective in fulminant hepatitis treatment if given at te appropriate stage of the disease.

The Shwartzman reaction: a review including clinical manifestations and proposal for a univisceral or single organ third type

The Shwartzman reaction was first described more than 50 years ago and two types, the generalized and the localized, were established in the early 1930s. Studies were mostly related to experimental pathology or immunology, and its significance in clinical medicine was initially obscure though thought to be obstetrically relevant. It is thought that the generalized type has a relation to human disease and that disseminated intravascular coagulation in man is really the counterpart of the generalized Shwartzman reaction in animals. The localized type on the other hand does not have obvious practical clinical pathological significance and tumor necrosis may be the only real example which is commonly seen. Further studies on the Shwartzman reaction relevant to human pathology have, however, suggested that it could be applied to several diseases, the pathogenesis of which was still obscure. The significance seems, however, different from either the generalized or localized type of reaction and so a proposal of the incidence of a third type--'univisceral' or 'single organ' Shwartzman reaction is made. Acute liver necrosis, Waterhouse-Friderichsen's syndrome, haemolytic uraemic anemia, idiopathic pulmonary haemorrhage, acute pancreatitis, acute pituitary necrosis and pseudomembranous colitis all seem to have features suggesting that they could be clinical manifestations of this type of Shwartzman reaction with focal intravascular coagulation.

Victoria blue-nuclear fast red stain for HBs antigen detection in paraffin section

Hepatitis B surface antigen, in paraffin embedded sections, can be stained by victoria blue and recognized easily against the background, including the cytoplasm and nucleus, stained by nuclear fast red. This new staining method has many merits such as easy staining procedure, long stability of dye solution, negative stainability of ordinary bile pigment, etc., and seems to be quite useful for routine as well as research works in hepatology.

Successful preparation of cobalt(II)-substituted hemocyanin

The cobalt(II)-substituted hemocyanin was first prepared by dialysis of apohemocyanin against Tris-HCl buffer (pH 8.0) containing cobalt(II) ion. The amount of cobalt(II) introduced into apohemocyanin reached 47% of the total sites for copper ion in native hemocyanin, being estimated as nearly complete formation of the half-filled cobalt(II)-hemocyanin (Co(II)-Hc). The Co(II)-Hc did not bind oxygen molecule even under O2-atmosphere. The spectral data indicated that the Co(II) is in tetrahedral geometry (high-spin state).

A light- and electron-microscopic study of the so-called uni-visceral Shwartzman reaction

A morphological study was made on a particular model of Shwartzman reaction which was so designed as to occur mainly in the liver with minimal influence to the other parts of the body. The study was mainly focused on its mechanism; the role of the granulocytes, Kupffer cells, platelets and precipitated fibrin. It was revealed that Kupffer cells were severely damaged by the first, preparative injection and the most conspicuous finding after the second, provocative injection was marked granulocytic infiltration followed by massive hepatic cell necrosis. The infiltrating granulocytes sticked to the endothelium, degenerated Kupffer cells, or other granulocytes and, often aggregated around precipitated fibrin. The erythrocytes in the sinusoid also showed aggregation after the provocative injection of the endotoxin, which was, however, rather loose and easily washed out from the sinusoid by perfusion. It is suggested from the above observations that aggregation of granulocytes as well as precipitated fibrin plays an important role to disturb blood stream mechanically and leads to massive necrosis in the liver.

Pathology of hepatocellular carcinoma

Rather rapid and brief over-view of pathology of hepatocellular carcinoma has been made, where the connection between morphology and virology or biochemistry is stressed as the main focus of today's pathology. Thus, existence of some relation between hepatitis virus and hepatocellualr carcinoma seems to be definite for us. However, it is still very difficult to decide whether the relationship is a direct or indirect one. High incidence of hepatocellular carcinoma also in Budd-Chiari's cirrhosis and schistoma-induced cirrhosis seems to suggest existence of the high risk type of cirrhosis for hepatocellular carcinoma development, irrespective of the cause of cirrhosis itself, although HB antigen might be playing some role in these cases especially in the latter.