Cerebral sparganosis: clinical manifestations, treatment, and outcome

Cerebral sparganosis is a rare parasitic disease caused by infestation by the plerocercoid larva of Spirometra mansoni. The authors retrospectively analyzed 17 cases of cerebral sparganosis treated at Seoul National University Hospital between 1986 and 1994. The patients' ages at diagnosis ranged from 6 to 57 years (median 32 years) and the male/female ratio was 13:4. Diagnosis was based on radiological findings, serological test results, operative findings, and histopathological examinations. Characteristic magnetic resonance (MR) findings consisted of widespread white matter degeneration and cortical atrophy, mixed-signal lesion (low in the central and high in the peripheral regions on T2-weighted images) with irregular dense enhancement of central foci and changes in the location and shape of the enhancing lesion in follow-up studies. Ten patients underwent surgical removal of the parasitic lesion, six received medical treatment alone (five with praziquantel and one with antiepileptic drugs), and one underwent insertion of a ventriculoperitoneal shunt and a course of praziquantel. Follow-up periods ranged from 13 to 111 months (mean 49 months). Seven patients who underwent complete removal of the lesion, live worm, or degenerative worm with surrounding granuloma showed a favorable course. Patients who received medical treatment alone or incomplete removal exhibited progression in their neurological deficits and their seizures could not be controlled. Medication with praziquantel seemed to have no killing effect on live worms. The authors conclude that MR imaging is the most valuable modality for the early detection of cerebral sparganosis and that complete surgical removal of granuloma together with worms, whether they are alive or degenerative, is the treatment of choice.

Prenatal development of cranial base in normal Korean fetuses

BACKGROUND

The cranial base is not only an end result of complex segmental growth of rostral end of axial skeleton but also has a tremendous impact on the development of the brain and facial structure. However, little is known about the method for the systematic analysis of the shape of the cranial base in the developing human fetus. We used roentgenograms of the cranial base and eviscerated bones for the assessment of the development of the cranial bony complex.

METHODS

The cranial base was removed from 64 normal human fetuses after 18-40 weeks of gestation. Roentgenograms were taken perpendicular to the cranial base. Major anatomical landmarks are defined as follows: the center of pituitary fossa of sphenoid bone (point S), the growth center of zygomatic bone, the anterior point of nasal septum, otic cartilage, and anterior and posterior growth centers of maxilla. The anterior cranial base angle, the middle cranial base angle, the posterior cranial base angle, the maxillary trapezoid area, the horizontal middle face area, and the occipital cranial base triangle area are defined from the landmarks, and the growth of each parameter was analyzed by gestational age.

RESULTS

The proportional growth of the anterior, middle, and posterior cranial fossae could be assessed by the angles around the center of the pituitary fossa (point S) and by the anterior, middle, and posterior cranial base angles. The anterior cranial base angle was relatively constant during the fetal period at 107.4-112.5 degrees, whereas the middle cranial base angle gradually increased, and the posterior cranial base angle decreased. With increasing gestational age, the horizontal middle face area increased rapidly, in contrast to those of the maxillary trapezoid area, occipital cranial base triangle area, or foramen magnum area.

CONCLUSIONS

The important keys in the structural development of the normal human cranial base are anterior, middle, and posterior cranial base angles. We could define the developmental pattern of human cranial base, which in turn provides a model of a standard growth pattern applicable to the study of the different malformations in the craniofacial structure.

Congenital quadrigeminal lipoma with osteocartilagenous element. A case report

A case of congenital tectal lipoma found incidentally at an autopsy is reported. This female fetus was a product of pregnancy termination at 24 weeks of gestational age after sonographic detection of hydrocephalus. Autopsy revealed a small mass in the periaqueductal portion. The mass was composed of adipose tissue, cartilage, and mature bony tissue with hematopoiesis. The resultant diagnosis was tectal lipoma with osteocartilagenous element. It is uncertain whether the lesion represents a teratoma or hamartoma or mesenchymal metaplasia. The osteocartilagenous component suggests the latter.

Immunohistochemical evaluation of transglutaminase C in tumours of salivary glands

Transglutaminase C (TGase C), a family of Ca(2+)-dependent enzymes and an essential component in the cross-linking of peptide bonds, has been found to be a marker of epithelial differentiation with a possible role in cellular apoptosis, extracellular matrix stabilisation and Ca2+ binding, thereby having a potential role in tumour growth, differentiation and invasive behaviour. The expression of TGase C was evaluated in normal human salivary glands and their neoplastic lesions which included pleomorphic adenoma (n = 30), Warthin's tumour (n = 5), adenoid cystic carcinoma (n = 10), acinic cell carcinoma (n = 5), mucoepidermoid carcinoma (n = 5) and control tissue specimens of normal oral mucosa and squamous cell carcinoma, using polyclonal antibody, the specificity of which was determined by Western blotting, generated by immunising rabbits with purified transglutaminase. The TGase C was observed in the epithelial cells in the control tissue specimens examined. Pleiomorphic adenoma revealed reaction products in luminal tumour cells, the non-luminal or modified myoepithelial cells and their plasmacytoid variants, squamous metaplastic cells and chondroid cells. Adenoid cystic carcinomas had tumour cells in the luminal cells of tubular and cribriform structures and the acinic cell carcinoma had from low to moderate immunoreactivity in the tumour cell component and a diffuse immunoreactivity in the stroma for TGase C. Mucoepidermoid carcinoma showed no reaction products in the mucous-producing cells, while intermediate and epidermoid cells had immunoreactivity in the cell cytoplasm. As the presence of TGase C in salivary gland tumours was confined to those tumour cells which form the predominant histomorphology in each tumour subtype, it may be suggested that these enzymes may have a potential role in the regulation of cellular function in neoplastic salivary tissues affecting tumour growth, differentiation and neoplastic behaviour.

Papillary ependymoma: its differential diagnosis from choroid plexus papilloma

Papillary ependymoma is a rare variant of ependymoma and often gives rise to confusion with choroid plexus papilloma because of topographic, light microscopic and ultrastructural similarities. Here, we report two cases of papillary ependymomas regarding their unique clinicopathologic features and differential points from choroid plexus papilloma. Brain MRI revealed a large mass in the left lateral ventricle in one case and a 3cm sized mass in the pineal area and the 3rd ventricle in the other. Microscopically, the tumor was characterized by papillary and tubular structures. Immunohistochemically, the tumor cells in both cases expressed cytokeratins(CK22 and CAM 5.2) but did not express glial fibrillary acidic protein(GFAP), vimentin, epithelial membrane antigen, and S100 protein. This is a very unusual immunohistochemical feature for papillary ependymoma. Ultrastructurally, the tumor showed a mosaic pattern of tumor cells with frequent intercellular microrosettes having a few stubby microvilli, a few cilia and zonulae adherentes. The cytoplasmic processes were markedly reduced compared to conventional ependymoma. The cytoplasm did not contain intermediate filaments. Interestingly, the mitochondria showed abnormal features with a pleomorphic shape and abnormal cristae in both cases. These ultrastructural features enabled differentiation between papillary ependymoma and choroid plexus papilloma in addition to the light microscopic findings.

Adamantinoma of tibia with predominant features of fibrous dysplasia--a case report

We report a case of adamantinoma of the tibia resembling fibrous dysplasia. The patient was a 55-year-old male, and complained of pain in the right lower leg. Roentgenographs showed a well demarcated osteolytic lesion with small foci of calcification and septation within the diaphysis of the distal tibia. The cortex was partially disrupted. Histologically, initial biopsy specimen showed fibrous connective tissue and trabeculae of immature woven bone, strongly suggestive of fibrous dysplasia. The lesion recurred and the second biopsy revealed nests of spindle cells and tubular epithelial structures embedded in granulation type-fibrous tissue. Immunohistochemically, both the nests of spindle cells and the tubular structures gave a positive reaction for cytokeratin. The present case emphasizes once again that histological diagnosis of fibrous dysplasia of the tibia should be made carefully with exclusion of the possibility of adamantinoma.

Primary intramedullary spinal cord primitive neuroectodermal tumor with intracranial seeding in an infant

Primary spinal cord primitive neuroectodermal tumor (PNET) is a rare entity. In all 13 cases have been reported in the literature, including 3 with intracranial seeding. A 3-month-old girl with involvement of the spinal cord below the mid-thoracic level is described. The brain MRI revealed findings indicative of seeding along the intracranial subarachnoid space. Biopsy, duraplasty and removal of laminotomy flap were done. In spite of a good response to the first cycle of postoperative "8-drugs-in-a-day' chemotherapy, further treatment was refused. She died 21 days after the onset of leg weakness, which reveals the rapid progression of untreated cases. To our knowledge, this is the first case of spinal cord PNET with parenchymal involvement that has been described in an infant.

Central neurocytoma: proliferative potential and biological behavior

The authors analyzed 13 central neurocytomas diagnosed at Seoul National University Hospital between January 1982 and December 1993 to clarify the proliferative potential and biological behavior of these tumors. The tumor was confined to the lateral and third ventricles in 12 cases and in one case extended from the posterior thalamus to the body and trigone area of the lateral ventricle. In all 13 cases, typical clinical and radiological findings were observed, and histological diagnosis was performed via craniotomy. The diagnosis was made using light microscopic examination, immunohistochemical staining for neuronal markers, and electron microscopic findings of neuronal differentiation. One patient died due to tumor progression with recurrence 26 months after subtotal removal plus radiation therapy. Another patient had a recurrence 18 months after total tumor removal. The remaining 11 patients are free of recurrent tumor after a follow-up period that ranged from 14 to 109 months (median 50 months). To predict the proliferative potential, immunoreactivity to proliferating cell nuclear antigen (PCNA), silver colloid staining for nucleolar organizing regions (AgNORs), and DNA flow cytometry were performed in 10 of the 13 cases. The proportion of PCNA-positive cells was less than 1% in all cases and the AgNORs score ranged from 1.11 to 2.0 (mean 1.67). The DNA flow cytometry revealed diploidy in all cases and the calculated proliferation index ranged from 5.1% to 9.6% (mean 7.8%). The one case of tumor recurrence, in which the authors performed the study of proliferative potential, and another case that demonstrated mild nuclear pleomorphism also showed low percentages of PCNA-positive cells, low AgNORs scores, and diploidy in DNA flow cytometry. It is suggested that most central neurocytomas follow a benign clinical course with low proliferative potential assessed by PCNA, AgNORs, and DNA flow cytometry; however, recurrence is possible within a relatively short time period.

Expression of bFGF and VEGF in brain astrocytoma

Neovascularization is an important factor in the prognosis of brain tumor and many angiogenetic factors have been evaluated for prognostic significance. Among them, basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) are known as potent angiogentic factors and mitogens. We evaluated seven cases of grade II brain astrocytoma. Four, group A, was diagnosed as anaplastic progression at their second operation, and three, group B, did not. Using monoclonal antibodies to bFGF and VEGF in paraffin embedded tissue from first operation, their immunoreactivity and differences between two groups were examined. The growth fractions of these tumor were also measured by Ki-67 monoclonal antibodies (MIB1). Immunostaining for bFGF in tumor cells were observed in both nuclei and cytoplasm, and for VEGF, mainly observed in the cytoplasm. Mean cell count number +/- standard deviation per high power field in each were as follows: 1) for bFGF, 20.08 +/- 6.38 in group A and 0.87 +/- 0.90 in group B (P < 0.01), 2) for VEGF, 43.75 +/- 17.09 in group A, and 0.8 +/- 1.06 in group B (P < 0.05) and 3) for the proliferation index with Ki-67 antibodies, 3.20 +/- 0.81 in group A and 0.77 +/- 1.03 in group B (P < 0.05). This data supports the assertion that angiogenetic factor such as bFGF and VEGF may contribute to progressive change of astrocytoma by tumor angiogenesis.

Fibrosing inflammatory pseudotumors involving the skull base: MR and CT manifestations with histopathologic comparison

PURPOSE

To describe the MR and CT features of fibrosing inflammatory pseudotumors of the skull base region, and to document the MR signal intensity of the lesions with histopathologic comparison.

METHODS

We reviewed the MR and CT studies of five patients with pathologically proved fibrosing inflammatory pseudotumor involving the skull base. Unenhanced spin-echo T1- and T2-weighted and contrast-enhanced T1-weighted MR images were obtained at 0.5 T in three patients and at 1.5 T in two patients. MR findings were correlated with histopathologic findings in all five cases, and the enhancement pattern was compared with CT findings in three cases.

RESULTS

In three cases, the cavernous sinus was involved unilaterally, with adjacent extracranial infiltrative masses. In one case, both orbits, the cavernous sinuses, and the tentorium were involved with diffuse infiltrative lesions. One patient had an infiltrative nasopharyngeal mass; and in all five patients, MR images showed localized involvement of the skull base, with bone marrow replaced by tumor. The soft-tissue lesions were hypointense on T2-weighted images in all five cases and showed homogeneous contrast enhancement. Histopathologic studies revealed scanty inflammatory cell infiltration with densely fibrotic background in all cases. The hypointensity of the lesions on T2-weighted images seemed to be related to the degree of fibrosis.

CONCLUSION

Fibrosing inflammatory pseudotumor shows characteristic MR findings of infiltrative lesion with bone destruction and hypointensity on T2-weighted images. The lack of mobile protons due to the fibrotic background and/or high cellularity of the lesions may be the reason for their hypointensity and weaker enhancement on MR images.

Proliferating cell nuclear antigen expression in Wilms' tumor: a comparative study of pre- and post-chemotherapy specimens

A total of 36 Wilms' tumors were immunohistochemically analyzed for proliferative (proliferating cell nuclear antigen-labeling) index (PI) with special reference to the effect of preoperative chemotherapy on the proliferative potential of tumors and differences in PI according to the histologic components (epithelial, blastemal and stromal). The cases were divided into two groups according to the status of chemotherapy at the time of surgical removal of the tumors. In group I (n = 12, cases with pre-operative chemotherapy), the mean PI +/- s.d. values of epithelial, blastemal and stromal types were 19.5 (n = 1), 10.1 +/- 5.28 (n = 8), and 16.2 +/- 13.49 (n = 3), respectively, and in group II (n = 24, cases without preoperative chemotherapy), 45.2 +/- 15.41 (n = 3), 28.5 +/- 16.92 (n = 10), and 23.2 +/- 4.45 (n = 2), respectively. The cases with mixed histology in group II (n = 9) had comparable PI values for each histologic component. The mean PI +/- s.d. was 12.1 +/- 7.76 in group I and 31.9 +/- 15.95 in group II. The PI value of group II was significantly higher than that of group I (P < 0.001). Alterations in the PI value following chemotherapy implied that the interpretation of tumor histology following chemotherapy should be more prudent because alteration of the PI, which reflects the proliferative potential of tumor cells, suggests modified biology of viable cells in pretreated cases as a consequence of chemotherapy.

Patterns of bcl-2 expression in placenta

A total of 39 placentas, whose gestational ages ranged from 8 to 41 weeks, were analyzed for bcl-2 expression using immunohistochemistry and immunoblotting. Immunohistochemically, both intracytoplasmic and nuclear expression of bcl-2 was observed in villous and extravillous trophoblasts, villous mesenchymal cells and capillary endothelial cells, villous macrophages, intermediate trophoblasts, amnionic epithelium, and even in decidua and endometrial glandular epithelium in early gestational periods. The degree of expression significantly decreased in the placentas after the gestational period of 32 weeks which coincides with the declining phase of placental increase. On immunoblotting lysates of 10(4) cells from single cell suspensions of fresh placentas, bcl-2 was detected in the placentas of 22 and 33 gestational weeks, but it was negligible or absent in three term placentas. The results of the present study suggest two possible implications on the role of bcl-2 in placenta: 1) it may be a type of proliferation or maturation-related marker, especially of trophoblasts, which show decreased expression along with terminal differentiation and maturation, and 2) because the primary role of bcl-2 is the inhibition of programmed cell death (PCD), the decrease in placental bcl-2 around term may be a parturition-associated biological change.

Primary ciliary dyskinesia: ultrastructural defects and clinical features

Primary ciliary dyskinesia is a genetically determined disorder characterized by immotility or poor motility of the cilia in the airways and elsewhere. Certain specific defects in the ciliary axoneme can be found, which are pathognomonic of the syndrome. The defects include missing dynein arms, abnormally short dynein arms, spokes with no central sheath, missing central microtubules, and displacement of one of the nine peripheral doublets. We have reviewed 19 cases of primary ciliary dyskinesia diagnosed by transmission and scanning electron microscopy. The age distribution ranged from five to 15 years, and there were six males and 13 females. All 19 cases had abnormal cilia which consisted of Ia (three cases), Ib (three cases), isolated Id (three cases), isolated II (one case), isolated III (two cases), and Id + other types (seven cases), according to Sturgess' classification. The most pronounced clinical manifestations are chronic paranasal sinusitis (52%) and chronic bronchiectasis (52%), followed by bronchopneumonia (26%), chronic bronchitis (21%), and nasal polyps (15%).

Mansonian schistosomiasis in rectum--report of a case

Schistosomiasis is a snail-transmitted trematodiasis acquired by immersion in water which contains the cercariae. In Korea, six imported cases of urinary schistosomiasis by Schistosoma haematobium and one case of imported cerebral schistosomiasis by S. mansoni were reported. Herein we report a case of S. mansoni infecting rectum of a 46 year-old Korean male, who had been to Saudi Arabia for two years. On colonoscopy for routine physical check up, a 0.4 cm polyp in the rectum was detected and biopsy was done. Microscopically, rectal mucosa showed several granulomas which were composed of macrophages, lymphocytes, neutrophils and eosinophils. The center of each granuloma showed an ovoid egg often containing miracidium. The eggs measured 130 x 60 microns in average size. They had yellowish-brown transparent shell with the characteristic lateral spine. This is the 8th imported case of schistosomiasis in Korea and the second one infected by S. mansoni.

Expression of transglutaminase C during the prenatal development of human submandibular glands

The involvement of transglutaminase C (TGase C) in morphogenesis and cytodifferentiation during glandular tubule formation was addressed by immunolocalization of the protein at different stages of prenatal human submandibular gland development in 100 fetuses and 20 adult salivary glands. Immunocytochemical detection was carried out using a monospecific antibody to TGase C. The results showed TGase C reactivity in both acini and ducts early in development (from 10 to 14 weeks), followed by a marked increase in ductal activity and a decline in acinar activity up to 32 weeks. During the peak of reactivity at 25 to 32 weeks, staining was concentrated in the apical ends of the columnar cells. In the adult, staining was weakly and diffusely distributed in the striated and excretory ducts. Western blot analysis of the cellular extracts of pooled samples from various stages of salivary gland development showed a single strong band at 76 kDa early in development. This band became weaker after 32 weeks of prenatal development and in the adult. These findings of transient high expression of TGase C, which coincide with the development of tubulo-alveolar structure, suggest that TGase C may play a role in morphogenesis in human salivary gland development.

An immunohistochemical analysis of mdr-1 and bcl-2 expressions in neuroblastoma

Among the differentiation-related changes in neuroblastoma are expressions of mdr-1 and bcl-2, which may be potentially related to the resistance to anticancer chemotherapy. In the present study, the authors performed an immunohistochemical analysis of mdr-1 and bcl-2 expressions in 30 neuroblastomas using monoclonal anti-P-glycoprotein(mdr-1 product) antibody and monoclonal anti-bcl-2 antibody to investigate the significance of their expression. The overall incidence of mdr-1 and bcl-2 expressions were 53.3% (16/30) and 93.3% (28/30), respectively. The expressions of mdr-1 and bcl-2 didn't seem to be related to the status of preoperative chemotherapy or stage of disease. The expression of mdr-1 was closely related to the differentiation of tumor cells (p < 0.01), especially to the neuronal differentiation. The bcl-2 expression was so common that it seemed to be indigenous to this neoplasm. The overall findings suggested that the expression of mdr-1 is one of the differentiation markers, while bcl-2 expression may partly explain the reasons for the relatively poor prognosis of neuroblastoma by the resistance to anticancer chemotherapy, which is a major therapeutic tool for this peculiar neoplasm.

Bone pathologic correlation of multimodality imaging in Paget's disease

The pagetic bones in the active phase of the disease with brisk lysis and sclerosis manifest intense tracer uptake on planar bone and SPECT images. Intense tracer uptake, however, can occur also in infections, dysplasias and metastases. Pinhole bone scintigraphy has been shown to portray specific diagnostic signs in a number of skeletal diseases. In an effort to identify useful bone scan signs, we prospectively carried out 99mTc-oxidronate pinhole bone scintigraphy of the skull, vertebrae, ribs, humerus, sacrum and ilium in two patients with Paget's disease of the bone. The pinhole bone scintigraphy findings correlated with radiographic, CT and MRI findings and in the vertebra with the pathological study. Interestingly enough, pinhole bone scintigraphy revealed intense tracer uptake preferentially in the bone cortex and the rim of the affected bones. Thus, the cranial inner table, humeral cortex and vertebral endplates and rims were the seats of characteristic tracer uptake, respectively creating a scintigraphic version of the radiographic "cotton wool" sign, "casket" sign and "picture frame" sign. The pagetic lesions in the sacrum and ilium also showed intense cortical and rim uptake. Correlation of pinhole bone scintigraphy with radiography, CT and MRI indicated that such cortical or rim uptake is characteristic of Paget's disease.

Histologic structure of antrochoanal polyps

The antrochonanal polyp (ACP) is defined as a maxillary sinus polyp that originates in the maxillary sinus, passes through the sinus ostia, and extends into the choana. The aim of this study was to compare the histologic findings of 40 cases of ACP with those of allergic and non-allergic nasal polyps, and so possibly to elucidate the pathogenesis of ACP. No allergy could be verified in any of the ACP patients. Inflammatory cell infiltration was significantly more severe in the ACP group than in the allergic polyp group. Eosinophilic infiltration was significantly less severe in the ACP group than in the allergic polyp group. Edema was not significantly different between the ACP, allergic, and non-allergic groups. In the ACP group, the presence of submucous glands was significantly less pronounced than in the ordinary nasal polyp groups. The fibrous type was present significantly more often than the infiltrative or granulating type in the ACP group. The histologic findings and clinical features of the ACP indicate that it has little causal relationship with nasal allergy but is all the more intimately associated with inflammatory processes. The paucity of submucous glands suggests that the ACP results from edematous hypertrophy of the respiratory epithelium rather than from distension of the glandular structures.

Morphological study of surgically induced open neural tube defect in old (14 and 21 days) chick embryos

As an experimental model for the research of open neural tube defect (NTD), the surgical model has several advantages over others, in spite of the fact that the pathogenetic mechanism is not compatible with the human intrauterine events. To make reproducible NTDs by surgery and to compare the surgically induced lesions with the human myeloschisis morphologically, we opened the neural tube for a length of 9-11 somites in Hamburger and Hamilton stage 16-19 chick embryos. Embryos which survived until the late in ovo life (total age 14 and 21 days) showed relatively reproducible open NTDs. Morphologically they are similar to human myeloschisis. This study suggests that the surgical model can be suitable for studies of open NTDs.

Expression of tenascin in hamster buccal pouch mucosa during experimental carcinogenesis

Experimental carcinogenesis by topical application of 7,12-dimethylbenz(a)anthracene (DMBA) in hamster buccal pouch mucosa was evaluated for expression of tenascin, an extracellular matrix glycoprotein expressed at the epithelial-mesenchymal interface during embryonic and fetal development, wound healing and in the stroma of various neoplastic lesions, by using immunohistochemical methods. The buccal pouch mucosa in normal hamsters showed immunoreactive tenascin either as a linear delicate band or without reactivity at the immediate vicinity of the basement membrane. During carcinogenesis, in the second to fourth week of application of DMBA, the hyalinous changes in the submucosal connective tissue had a weak but diffuse immunoreactivity for tenascin. The hyperkeratinised and hyperplastic mucosa following 5 weeks of application of DMBA showed focal areas of enhanced expression in the vicinity of the basement membrane. Subsequently, specimens showing hyperplasia, dysplasia, carcinoma in situ and invasive carcinomas had comparatively more widespread stromal immunoreactivity where the extent of enhanced reactivity positively correlated with the advancing lesion. These results compared with the results of expression in human normal mucosa, leukoplakia and squamous cell carcinoma of the oral cavity (Shrestha et al., Oral Oncol, Eur J Cancer 1994, 30, 132-137) suggest that the expression of tenascin in experimental carcinogenesis of hamster buccal pouch mucosa, as a model, faithfully mimics the same in human oral mucosa.

Differential expression of leukocyte common antigen in human fetal lymphoid organs

To investigate the differential expression of various types of leukocyte common antigen (LCA) isoforms during development, we analyzed human fetal lymphoid organs, including the thymus, liver, spleen, and bone marrow from 14 weeks to 29 weeks of gestational age by immunohistochemical and flow cytometric methods. In fetal thymus, over 90% of thymocytes throughout the entire fetal life expressed CD45RO and CD45RB, while CD45RA was expressed only in less than 5% of thymocytes. This expression pattern of LCA isoforms was established by a gestational age of 14 weeks or earlier, and persisted throughout the fetal period. The tissue distribution was different from each isoform; CD45RO-positive thymocytes were found in both the cortex and medulla at the 14th week with low intensity, but was localized in the cortex with increasing fetal age. CD45RB-positive thymocytes distributed mainly in the medulla from early gestational age. Among extrathymic lymphoid organs, a small portion of lymphoid cells expressing leukocyte common antigens appeared first in the liver at 10-12 weeks of gestational age and was followed by a small number in the spleen and bone marrow by 13-15 weeks. All lymphoid cells in these extrathymic lymphoid organs at this stage were CD19+ B cells. The number of these CD19+ cells increased abruptly during the early period of mid-gestational age. The pattern of tissue distribution of each LCA isoform in the fetal liver and spleen correlated well with the patterns of quantitative analysis by flow cytometry. In summary we found that different LCA isoforms expressed in cell-type-specific pattern and showed different tissue distribution during the period of fetal development, and that LCA was the earliest antigen expressed by lymphocytes in the thymus and extrathymic lymphoid organs in our series.

Cystic intrapulmonary lymphangioma: HRCT findings

We report a rare case of cystic intrapulmonary lymphangioma involving the left lung, which presented with pneumothorax and respiratory distress in a 6-month-old infant. Chest radiographs showed a multicystic lesion in the left lung mimicking the features of congenital cystic adenomatoid malformation of the lung. The lesion appeared on high-resolution CT (HRCT) as a multiseptate, air-filled cystic lesion in the left hilar area. Associated HRCT findings were thickening of interlobular septa and bronchovascular bundles in the left lung and the presence of peripheral pulmonary vessels within cystic lesions in the apex of the left lung. HRCT findings correlated well with histopathologic findings. We suggest that these associated findings may be helpful in distinguishing this condition from other cystic lung diseases and that this entity should be included in the differential diagnosis of multicystic lung lesions.

Malignant intraventricular schwannoma. Case report

The authors present the clinical, radiological, and pathological features of a malignant schwannoma occurring in the right lateral ventricle of a 40-year-old man. Metastasis to both cerebellopontine angles and to the cerebellum was found 7 months after subtotal removal of the tumor.

The prognostic significance of c-erbB-2 and p53 protein expressions in gastric carcinoma--a multivariate analysis of prognostic factors

152 curative gastrectomy specimens from patients with gastric carcinoma were examined in an attempt to assess the prognostic value of c-erbB-2 and mutant p53 protein expressions. The labeled streptavidin-biotin method was applied to routinely fixed and paraffin-embedded tissue sections, using the polyclonal and monoclonal antibodies against the c-erbB-2 protein and the mutant form p53 protein, respectively. In this examination, staining of c-erbB-2 protein was found in 9.2% of these carcinomas. The c-erbB-2 stained tumors were significantly associated with the tumors whose diameters were smaller than 5cm, and were more likely to be associated with serosal invasion and nodal involvement than the unstained ones. However, there was little association between staining of c-erbB-2 protein and clinicopathologic findings such as age, sex, location, histology, gross type, lymph node status, depth of invasion, and stage. The survival analysis of 104 patients with stage III gastric carcinoma revealed no significant association between c-erbB-2 staining status and survival duration. The 5-year survival rates of the c-erbB-2 positive group and its negative group were 21% and 28%, respectively. Positive p53 protein expression was observed in 46% of 152 carcinomas. There was no significant association between p53 expression and parameters such as age, sex, location, histology, gross type, and size. The p53 stained tumors were more likely to be associated with lymph node metastasis, serosal invasion than p53 unstained ones; but this did not reach significance. The 5-year survival rates of the p53 positive group and counter part group were 27% and 31%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)