Development of pseudolymphoma of liver following interferon-alpha therapy for chronic hepatitis B

A 42-year-old woman with biopsy-proven chronic hepatitis B, who had been treated with human leukocyte-derived interferon-alpha (huLe-IFN alpha) therapy for two months was found to have liver tumors on routine abdominal ultrasonography examination. She underwent laparotomy, and partial hepatectomy was performed under the clinical diagnosis of hepatocellular carcinoma. The lesions were diagnosed histologically as pseudolymphoma based on the massive infiltration of small mature lymphocytes and the presence of hyperplastic lymph follicles with germinal centers. Immunohistochemistry revealed polyclonal origin of the involved lymphocytes. The possible association between IFN alpha treatment and chronic hepatitis B with the development of pseudolymphoma is discussed.

Radical removal of craniopharyngioma: a long-term follow-up

Radical removal of craniopharyngiomas was attempted as the primary treatment in 12 adult and six child patients. No postoperative radiotherapy was given to patients undergoing total removal, while those undergoing subtotal removal received 50-60 Gy. Overall evaluation showed 15 cases of total removal and three of subtotal removal. One patient died of septicemia 2 months postoperatively and another developed a recurrent tumor which was removed totally at a second operation. The mean follow-up period was 7 years. The quality of life was "excellent" in 10 patients, "good" in five, and "fair" in two. Visual losses were minimized and endocrinological disturbances treated medically. These satisfactory results indicate that radical surgical removal is the first choice for treatment of craniopharyngioma irrespective of the age of patients.

Follow-up examination schedule of postoperative HCC patients based on tumor volume doubling time

The tumor volume doubling time of 27 recurrent hepatocellular carcinoma nodules measuring < or = 2.0 cm in diameter discovered after hepatectomy in 19 patients was analyzed by ultrasonography for 31 to 331 days. The tumor volume doubling time ranged from 39 to 420 days before specific treatment, with a mean of 112 days and a median of 80 days. It correlated with age and intrahepatic site of recurrence, which was sometimes the same lobe as that of the prior hepatocellular carcinoma, sometimes not. The tumor volume doubling time also tended to correlate with hepatitis C antibody status and initial tumor diameter. The tumor volume doubling time was, however, independent of sex, hepatitis B surface antigen status, number of recurrent tumors, initial serum alpha-fetoprotein level, interval between hepatectomy and recurrence detection, and associated liver disease. On the basis of the shortest tumor volume doubling time of the recurrent hepatocellular carcinoma nodules, we recommend that US and/or CT be performed at least every four months to screen for small recurrent carcinomas in postoperative patients.

[A case of granulomatous hypophysitis]

The patient was an unmarried, 25-year-old woman who presented herself with amenorrhea and lactation as her chief complaints. Radiography revealed a tumor in the sella turcica. Upon neurological examination at the time of admission, there were no abnormal findings affecting the field of vision or visual acuity, and no abnormalities were seen in the fundus oculi. In endocrinological tests, the basal plasma values of pituitary hormones were normal except for that of prolactin, which was 69.1 ng/ml. The preoperative diagnosis was nonfunctioning pituitary adenoma, and this neoplasm was resected by the transsphenoidal approach. Postoperative histological investigation showed vermiculous destruction of the anterior lobe of the pituitary gland, and also scattered lymph follicles accompanying infiltration by numerous lymphocytes and multinucleated foreign-body giant cells, and deposition of calcium. These findings, together with the epithelioid cells gathered around them, pointed to a diagnosis of granulomatous hypophysitis. The causes of granulomatous hypophysitis are known to include syphilis, tuberculosis, sarcoidosis, mycotic granuloma, and foreign-body granuloma due to the rupturing of a Rathke's cleft cyst, but no evidence of any of these was found in this patient. Another known source of inflammatory lesions in the hypophysis is lymphocytic hypophysitis, which resembles Hashimoto's autoimmune disease of the thyroid gland, and which is characterized both by the formation of lymph follicles and by extensive lymphocyte infiltration. In relation to the cause of granulomatous hypophysitis, thinking that it might possibly be an autoimmune disease, we conducted an immunological investigation, and also made a serological study of autoantibodies, but obtained no positive results.(ABSTRACT TRUNCATED AT 250 WORDS)

Pleomorphic xanthoastrocytoma: some new observations

Fourteen cases of pleomorphic xanthoastrocytoma (PXA) occurring in Japan were investigated to evaluate its various pathological features. The patients were generally young (average: 19 years), the tumor was superficially located and CT revealed well circumscribed contrast enhancing mass which was often accompanied by a cyst. Histopathological study revealed that the PXA is a pleomorphic and frequently desmoplastic astrocytic tumor characterized by chronic degenerative changes including lipidization of tumor cells. The desmoplasia was assumed to secondary proliferation of meningeal fibroblasts. Although the general consensus is that pial astrocytes are the most likely origin of PXA, "ordinary" astrocytoma may well develop into PXA by invading overlying meninges and inducing desmoplasia.

Comparison of hepatectomy and transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma: necessity for prospective randomized trial

Transcatheter arterial chemoembolization is now widely used in cases of surgically unresectable hepatocellular carcinoma. However, it is unclear whether patients with surgically resectable hepatocellular carcinoma should always be treated with hepatectomy as opposed to transcatheter arterial chemoembolization. Sixty-six patients with hepatocellular carcinoma underwent hepatectomy, whereas 29 patients with more advanced hepatocellular carcinoma were treated with transcatheter arterial chemoembolization at our hospital from 1984 to 1990. All cases were associated with cirrhosis of Child class A or B. All of them underwent hepatectomy or transcatheter arterial chemoembolization for the first time. Their outcomes were determined on March 31, 1991. The backgrounds and survival curves for hepatectomy and transcatheter arterial chemoembolization were compared in both Child A and Child B patients. For both Child A and B patients, no significant difference was found between hepatectomy and transcatheter arterial chemoembolization with respect to age, sex, cause of underlying cirrhosis, liver function assessed by indocyanine green test and maximum diameter of the main tumor. The incidence of multiple hepatocellular carcinoma, more advanced hepatocellular carcinoma (TNM stage III or IV) or both was significantly higher in the transcatheter arterial chemoembolization group than in the hepatectomy group for both Child A and Child B patients. The survival curves of both the hepatectomy and the transcatheter arterial chemoembolization groups showed no significant difference for both Child A and Child B patients. A prospective study is therefore warranted to elucidate whether hepatectomy or transcatheter arterial chemoembolization is more effective for treating resectable hepatocellular carcinoma associated with cirrhosis.

Periodicity of insulin secretion comprises multiple cycles with different duration in perfused rat islets

Insulin secretion from pancreatic islets has been found to be periodic by in vivo and in vitro experiments. The pacemaker which regulates the periodicity may be localized in the central nervous system or in the pancreas, though the precise location and the mechanisms of generating pacing have not been determined. In order to solve these problems, we examined the period of secretory cycles of insulin in isolated islets using a prolonged perfusion system, and investigated the effects of glucose and other agents on these periods. Isolated islets from male Wistar rats were enclosed in a millipore holder and were perfused with MEM containing 1 mg/ml glucose at a flow rate of 0.3 ml/min for 240 min. The effluent was collected at 1-min intervals to measure insulin secretion. The results were analyzed by the maximum entropy method to demonstrate the periodicity of insulin secretion. When islets were perfused with 1 mg/ml glucose, the periodicity comprised five cycles with different duration: 71.5 +/- 14.6 min, 29.8 +/- 3.4 min, 19.2 +/- 1.5 min, 11.6 +/- 2.1 min and 4.3 +/- 0.4 min. This indicates the presence of a pacemaker within the islets, although, in vivo, participation of a higher center to control periodicity has to be taken into account. Further, the presence of a long cycle (71.5 +/- 14.6 min) of insulin secretion which previously has only been observed in vivo was first demonstrated in this in vitro study. The cycles were consistent even in islets which were desensitized to glucose by cultivating in a high glucose medium for 5 days before perfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of dural sarcoidosis]

A 26 year-old man, who was treated for meningitis in our hospital previously, was rehospitalized 1 year later because he developed disturbance of consciousness, gait disturbance and urinary incontinence. Blood examination revealed accelerated ESR, elevated GPT, slight elevation of serum Ca, strong positive CRP, and a decrease in PHA and Con A. ACE was within normal range and tuberculin reaction was negative. Lumbar puncture revealed that the initial pressure was 310 mmH2O, cells were 152/3, and protein was 343 mg/dl. Bilateral hilar lymphadenopathy was absent in chest X ray film. Head CT revealed enlarged lateral ventricles and irregularly enhancing nodular lesions in the anterior half of the falx cerebri, and abnormally strong enhancement of the choroid plexus. Ventriculoperitoneal shunt was performed. As a diagnosis was difficult to obtain from the clinical data, biopsy of the nodular lesions was performed. The histopathologic diagnosis was sarcoidosis. Steroid hormone was administered thereafter, and the nodular lesions of the falx disappeared in the follow-up. In the literature, only 8 cases of sarcoidosis of the dura mater have been reported. Since intracranial sarcoidosis is a part of systemic sarcoidosis, its diagnosis is not difficult in most cases. However, in cases difficult to diagnose as in our case, biopsy may be necessary. When nodular lesion occurs in the dura mater, sarcoidosis must be included as a possibility in the differential diagnosis in addition to the usual meningioma, lymphoma, and metastatic brain tumor.

Primary intraosseous meningioma: case report

A case of 72-year-old Japanese woman with a rare intraosseous meningioma is presented. The tumor was located in the right frontoparietal region, involving the coronal suture. The tumor was excised totally and the pathological diagnosis was meningioma. Similar cases reported in the past literature are reviewed and the possible histogenetic mechanism of the tumor is discussed.

Hepatic resection for minute hepatocellular carcinoma

Twenty-three patients with minute hepatocellular carcinoma, defined as a solitary lesion less than or equal to 2 cm, underwent hepatectomy at our institute during the 10 years between January, 1979 and December, 1988. Hepatitis B surface antigen was positive in 4 patients and the preoperative serum alpha-fetoprotein level was within the normal range in 7 patients and slightly elevated (20-200 ng/mL) in 14 patients. Liver cirrhosis was present in 16 patients and chronic hepatitis in 6 patients. The diagnosis was first suspected from the results of periodic examinations, including echography and the measurement of alpha-fetoprotein, in all except one patient. Minor hepatic resection was performed in 22 patients, and lobectomy in one patient in whom the tumor was located centrally in the liver. Three patients died of hepatic failure in hospital following surgery, and the survival rates of the other 20 patients at 1, 3, and 5 years were 90, 79, and 61 percent, respectively. The prognostic factors that influenced long-term survival were investigated by comparing the survival curves. The only factor associated with a significant difference in survival was the severity of concomitant liver disease. Thus, severe cirrhosis is the main obstacle against the long-term survival of patients with minute hepatocellular carcinoma.

Marked and prolonged depression of factor XIII after esophageal resection

Anastomotic leakage is one of the most common complications of esophagectomy and, since Factor XIII is required for normal wound healing, we investigated the temporal changes in plasma Factor XIII following esophagectomy and hepatectomy. A control group of patients undergoing other abdominal operations was also studied. Factor XIII activity was determined before surgery and on postoperative days (POD) 1, 3, 7 and 14. The plasma levels of acute phase protein were also measured. The plasma Factor XIII activity decreased significantly in both the hepatectomy and control groups until POD 7, reaching the lowest level on POD 3. In contrast, the esophagectomy group showed significant decreases in Factor XIII levels throughout the postoperative study period, with a nadir with an average activity of 56 per cent on POD 7. Preoperative transferrin levels had a positive correlation with Factor XIII levels measured on POD 3 and there was also a positive significant correlation between Factor XIII activity and alpha 2-macroglobulin levels on POD 3. These results suggest that there is a marked and prolonged depression of plasma Factor XIII activity following esophagectomy which may be attributed to accelerated tissue demands, inadequate synthesis or increased degradation. Moreover, the severe and sustained decrease in Factor XIII activity may be related to poor wound healing after esophagectomy.

A continuous cell line (KK-2) from a supratentorial primitive neuroectodermal tumor

Tumor tissue located in the occipital lobe with hemorrhage was obtained from a 19-year-old patient. Histological examination indicated it to consist of undifferentiated small, round cells without neuronal or glial differentiation, and possibly to be a type of primitive neuroectodermal tumor. The tumor cells were cultured for 3 years and a continuous cell line (KK-2) was established. KK-2 was transplantable to nude mice. With immunocytochemistry, neuron-specific enolase, protein gene product 9.5, vimentin, TUJ1 (a monoclonal antibody specific for neuron-associated class III beta-tubulin isotype) and 6H7 (a monoclonal antibody to NCAM produced by us) were detected. None of the following could be found: glial fibrillary acidic protein, S-100 protein, neurofilament and synaptophysin, calcitonin gene-related peptide, gastrin releasing peptide corticotropin-releasing factor, substance P, somatostatin, chromogranin, aromatic L-amino acid decarboxylase and tyrosine hydroxylase. The original tumor and KK-2 cells obtained after 3 years of culture and transplants in nude mice displayed essentially the same ultrastructural and immunohistochemical characteristics. KK-2 cells showed no differentiation to mature neuronal, glial or ependymal cells. This cell line may possibly serve as a useful model for studying cellular differentiation of human neuroectodermal tumors and normal neuronal development.

Homer Wright rosettes in ependymoma

A brain tumor in the fourth ventricle of a 26-year-old woman displayed numerous Homer Wright rosettes by conventional histology, but immunostaining and electron microscopy revealed the tumor an ependymoma. Since the presence of Homer Wright rosettes in ependymoma has not been well appreciated in the past, the diagnostic importance of this finding is discussed.

Surgical experience with nonparasitic cysts of the liver--the characteristics and constituents of cyst fluid

Fifteen patients with nonparasitic hepatic cysts underwent surgery to relieve abdominal complaints, at the First Surgical Department, Tokyo University Hospital between 1966 and 1989. Total removal of the cyst was carried out in 14 of the patients, while puncture and aspiration only were performed in the other patient in whom a cyst had ruptured spontaneously, after which hemoperitoneum was observed at emergency laparotomy. The size of the cysts varied from 7-19 cm with a mean of 12.4 cm. Histological study revealed a congenital cyst in 14 patients and a cystadenoma in one. The epithelium lining of the internal surface of the congenital cysts was highly atrophic and desolated and often disappeared. Examination of the cyst fluid revealed the same concentration of electrolytes as in the serum. Hepatic enzyme levels were usually lower than in the serum, but lactic dehydrogenase and aminotransferase levels were elevated in a few cases. Tumor marker levels of the cyst fluid were higher than those in the serum in four of five patients examined.

Malignant hemangiopericytoma of the liver: report of a case

A 30 year old female was admitted with right upper abdominal pain and fever. Ultrasonography and computed tomography revealed a large cystic mass in the right lobe of the liver, and aspiration bacteriology was negative. A right hepatic lobectomy was performed for a suspected cystadenocarcinoma, however, the tumor was histologically diagnosed as a hemangiopericytoma with prominent venous invasion. The patient died within a short time of multiple pulmonary metastases. Primary hepatic hemangiopericytoma is extremely rare, and according to our research, this is only the 4th case reported in the literature.

Meningiomas differentiating to arachnoid trabecular cells: a proposal for histological subtype "arachnoid trabecular cell meningioma"

Three cases of meningiomas which had abundant small vacuoles in the tumor tissue are reported. By electron microscopy, the tumor cells exhibited long and thin processes, the tips of which were united by desmosomes. The tumor tissue was revealed to have wide extracellular spaces which corresponded to the vacuoles observed by light microscopy. In previous literature, various terms have been used when referring to this meningioma, such as microcystic meningioma or vacuolated meningioma. Since the ultrastructure of the tumor showed similarity to that of normal arachnoid trabecular cells, we propose to call the tumor "arachnoid trabecular cell meningioma" denoting its morphological nature clearly.

Comparison of bovine, sheep and goat milk lactoferrins in their electrophoretic behavior, conformation, immunochemical properties and lectin reactivity

1. The biochemical properties of bovine, goat and sheep lactoferrin were compared. Molecular weights of the three lactoferrins were estimated to be 78,000 to 80,000 as determined by SDS-PAGE. By IEF, microheterogeneity was observed for all of them. 2. Partial antigenic identity was observed between bovine lactoferrin and goat or sheep lactoferrin by immunodiffusion method. 3. CD spectra at the u.v. region of the three lactoferrins suggested their similar secondary and tertiary structural profiles. 4. Reactivities with peroxidase-conjugated lectins showed that the carbohydrate compositions of the three ruminants' lactoferrin were the same but not identical with that of human lactoferrin.

[Results of prophylactic intra-arterial infusion chemotherapy after hepatic resection in colorectal metastases]

Fourteen colorectal cancer patients with metastatic liver metastases who received prophylactic intra-arterial infusion chemotherapy (IAIC) after curative resection for liver metastases at the National Cancer Center Hospital from May 1987 to December 1989 were reviewed. 5-fluorouracil (5-FU) (15 mg/kg) and mitomycin C (MMC) (0.1 mg/kg) were infused through implantable ports weekly or every two weeks. Five patients (35.7%) developed recurrent tumors in the residual liver during 3-12 months after hepatic resection. The se five patients had more than two metastatic lesions in the liver at hepatectomy. Four patients with solitary metastatic tumor had no recurrent liver diseases. The most serious complication was sclerosing cholangitis which occurred in two patients (14%) in this series. Both cases needed drainage PTCD, but one of them died from gastro-intestinal bleeding due to hepatic failure and the other from pneumonia. These two cases showed no recurrent liver cancers.

A new toxic neoanisatin derivative from the pericarps of Illicium majus

A new toxic neoanisatin-derivative (1) was isolated from the pericarps of Illicium majus. The structure of this compound was elucidated by spectroscopic data, including the 2D COSY NMR technique. The toxicity of compound 1 is also described.

Postoperative recurrence of hepatocellular carcinoma

Sixty-nine patients with hepatocellular carcinoma underwent curative hepatic resections as primary cases from 1981 to 1986. Seven patients died in the hospital after operation. The other 62 patients left the hospital and were closely followed for 25 to 78 months. Recurrence of carcinoma became obvious in 41 (66%) of 62 patients. The clinical and pathologic features of these 41 patients were not significantly different from those of the other patients. Recurrent tumors were found in the residual liver in 38 patients (93%), in the bone in 2 (5%), and in the lung in 1 (2%). Recurrence was diagnosed within 1 year, between 1 and 2 years, and more than 2 years after the operation in 22 (56%), 10 (26%), and 7 (18%) patients, respectively. It was difficult to determine the exact time of recurrence in two patients. There was a significant negative correlation between the size of primary tumor and time until recurrence; the larger the primary tumor, the shorter the time until recurrence. Among the 29 patients who underwent local excisions for their primary tumors, 19 recurrences were observed. Eighteen were found in the residual liver, in the same segment as the primary tumor, or in one near it. Larger hepatic resection for primary tumors is thus advocated to prevent recurrence.

[Blunt injury of the vertebral artery: report of three cases]

The authors reported three cases, whose vertebral arteries had been injured by blunt trauma to the neck which was followed by cerebello-brainstem infarctions. Case 1: a 32-year-old man, who developed severe vertigo and nausea 7 days after a traffic accident. He showed neck pain and horizontal nystagmus on admission. Three days later, he became drowsy. CT scan of the head demonstrated right-side cerebellar infarction, and the angiography revealed an occlusion of the right vertebral artery at C4-5 level. After the removal of the right cerebellar hemisphere, he recovered neurologically and was discharged from the hospital, able to walk. Case 2: a 47-year-old man, who suddenly became comatose 6 hours after an accident. Plain CT demonstrated a highly dense basilar artery. Angiography revealed the occlusion of the left vertebral artery, and severe stenosis of the right vertebral artery. The basilar artery was not visualized. Anticoagulant therapy was started immediately. He survived, but he developed locked-in syndrome. Case 3: a 53-year-old man, who developed transient apnea after an injury. On admission, neurological examination showed horizontal nystagmus, weakness of his right upper limb, and sensory disturbance in the left side of the body. Neck traction was done for spinal C1 and C2 fractures. Twenty-one hours after the injury, he became comatose suddenly. The four-vessels angiography revealed the occlusion of both vertebral arteries. The basilar artery was visualized through the posterior communicating arteries. He died on the 6th day after the trauma.(ABSTRACT TRUNCATED AT 250 WORDS)

A newly designed flow-regulating device in shunt therapy of hydrocephalus

A new flow-regulating device for shunting in hydrocephalus was designed to limit an excess flow by a pressure-head between the cerebral ventricle and the abdominal cavity in a standing position. The device has two diaphragm valves connected to each other by two lines: one is a shunting line to transfer cerebrospinal fluid and the other is a control line filled with a control fluid with a higher density than cerebrospinal fluid. The performance of the model device with a natural rubber sheet diaphragm was tested in a mock system, using glycerol for the control fluid and water for the transfer fluid in vitro. Results show that device decreases the excess flow when the pressure-head between two valves exceeds 35 cm.

Cranial burr hole for revascularization in moyamoya disease

Currently, superficial temporal artery-middle cerebral artery (MCA) anastomosis, encephalomyosynangiosis (EMS), and encephalo-duro-arterio-synangiosis are used to treat moyamoya disease and are reported to effectively improve ischemic symptoms. All are methods of reversing the flow of blood from the external carotid artery system into the cortical branches of the MCA. As moyamoya disease advances, these operations alone will predictably not correct the deterioration in blood flow in the territory of the anterior cerebral artery. It was noted in a case of moyamoya disease with intraventricular hemorrhage that a burr hole, made in the frontal region for drainage purposes, induced marked neovascularization. Since then, similar frontal burr holes have been made in five juvenile cases of moyamoya disease; this procedure involved making a burr hole in both frontal bones and incising both the dura and the arachnoid membrane. In two cases a frontal burr hole in both frontal bones and incising both the dura and the arachnoid membrane. In two cases a frontal burr hole was placed simultaneously with EMS, and in the others the frontal burr hole was made following EMS. The clinical symptoms improved after the frontal burr hole was made, and dynamic computerized tomography revealed improved circulation in the frontal regions. Together with conventional surgical therapy for juvenile cases of moyamoya disease, this operation is considered beneficial both to the circulation in the frontal region and for the protection of frontal brain function.

The beneficial effect of superoxide dismutase on the rat liver graft

We performed orthotopic liver transplantation in male Wistar rats and investigated the effect of superoxide dismutase (SOD) on the liver graft. Animals were divided into the four following experimental groups. Group I was an untreated control group, group II received oxygen, group III received SOD and group IV received both oxygen and SOD. The dose of SOD was 3 mg/kg which was injected intravenously into both donors and recipients during the operation. Oxygen was given through an oxygen inhaler to both donors and recipients during the operation. The preservation time of the liver graft ranged from 4 hours and 41 minutes to 5 hours and 40 minutes. The survival after liver transplantation was compared among groups I, II, III and IV. Group IV showed a significantly higher survival rate than groups I and II by two weeks after liver grafting, but there was no statistical difference in the survival rates between groups III and IV. These results indicate the beneficial effect of SOD on the rat liver graft and may implicate oxygen free radicals in the pathogenesis of ischemia/reperfusion injury in liver grafts.

Clear cell ependymoma. A histological variant with diagnostic implications

Four cystic brain tumours, one from the frontal lobe, one in the third ventricle and two in the cerebellum, were studied histologically including immunostaining and electron microscopy. Anatomically, all the tumours were located within or adjacent to the ventricular system. By light microscopy, the tumours had a largely honeycomb pattern and were made up of clear cells. Some of the clear cells showed positive for GFAP. Leu 7, Factor VIII and NSE were negative. Electron microscopy of the areas with clear cells revealed densely packed polyhedral cells with clear cytoplasm. They had well developed intercellular junctions, microvilli and some cilia which confirmed their ependymal derivation. Perivascular pseudorosettes or papillary features were only seen in limited areas, where GFAP was strongly positive in the tumour cell processes. As these tumours mimic oligodendroglioma and cerebellar haemangioblastoma, they are called as "clear cell ependymoma" to obviate such errors in diagnosis.