Histologic classification of endoscopically removed flat colorectal polyps: a multicentric study

A total of 594 flat colorectal polyps, removed at endoscopy, were histologically classified into non-neoplastic (n = 49) and neoplastic (n = 545) polyps. Non-neoplastic polyps were subdivided into metaplastic (n = 45) and hyperplastic (n = 4), whereas neoplastic polyps were subdivided into adenomas (n = 481), intramucosal carcinomas (n = 28) and invasive adenocarcinomas (n = 36). Several adenoma phenotypes were discerned: tubular (n = 375), serrated (n = 59), villous (n = 39), mixed (n = 7) and fenestrated (n = 1). Intramucosal carcinomas were subdivided into tubular (n = 26) and serrated (n = 2), and invasive adenocarcinomas into tubular (n = 32), serrated (n = 3) and fenestrated (n = 1). The microscopic characteristics of each histologic phenotype described in this communication are defined and illustrated.

Evidence of direct recognition subset in xeno-reactive helper T cells

There are two functional subsets of alloreactive helper T cells: one recognizes the alloantigens on self-antigen-presenting cells (APCs), and the other recognizes the alloantigens on allo-APCs. In this study, we analyzed which specific Th cells have a possible effect on concordant-xenograft rejection responses and how Th cells recognize xeno-antigens. In the proliferative response stimulated with spleen cells obtained from rats (r-SPC), mouse T cells (m-Tc) were not inhibited by GK1.5 (CD4) or 2.43 (CD8) antibodies. In a xeno-mixed lymphocyte reaction, m-Tc that included APC (APC(+)) proliferated when stimulated with r-SPC APC(+) or APC(-). In contrast, B6 T cell APC(-) proliferated only when stimulated with r-APC(+)SPC but not when stimulated with APC(-). The m-Tc lines responded to F344 SPC APC(+) but not to SPC APC(-); however, the m-Tc line did not respond to SPC from another rat strain. We hypothesize that both CD4+ Th and CD8+ Th are included in the concordant xeno-reactive Th; there are both xeno-APC-restricted Th and self-APC-restricted Th; and xeno-APC-restricted Th recognizes xeno-major histocompatibility complexes.

Image quantitation of intestinal metaplasia in entire gastrectomy specimens from Swedish and Japanese patients

The aim of this work was to investigate the extension of intestinal metaplasia (IM), as well as to quantitate various components of IM (namely sialomucins, sulfomucins and Paneth cells), in entire gastrectomy specimens from Swedish and Japanese patients. The length of the gastric mucosa was assessed by morphometry. The percent of sections with IM was regarded as the extension of IM in the specimens. Histochemically labeled sialomucins, sulfomucins and Paneth cells (the 3 main findings in gastric IM) were quantified in separate sections with the aid of an image analyzer. In total, 1,321 sections corresponding to 6 gastrectomy specimens were quantified. Sialomucins and sulfomucins were more extensively distributed in the 4 specimens with carcinoma than in the 2 without carcinoma (one having a peptic ulcer and the other, hereditary gastric cancer syndrome (HGCS) without carcinoma). On the other hand, quantitative analysis in Swedish specimens indicated that the highest values for sialomucins, sulfomucins and Paneth cells were present in HGCS. When Swedish and Japanese specimens with adenocarcinoma were compared, only sulfomucins (denoting Types II and III IM) were significantly higher in those carrying an intestinal-type carcinoma (ITC) than in those with diffuse-type carcinoma (DTC). The results substantiate those obtained with gastric biopsies by other authors. On the other hand, the mucosal extension and the amount of sulfomucins are not comparable parameters (since that mucin was not equally distributed, but "concentrated" in certain areas in the mucosa). One possible conclusion is that the focal distribution of acidic mucins and of Paneth cells in the gastric mucosa may strongly influence their detection rate in gastric biopsies. Thus, haphazard biopsy of the gastric mucosa may fail to sample areas with sulfomucins in population studies aiming to detect individuals at risk. Such sampling errors in gastric biopsies may explain the conflicting results on this subject appearing in the literature.

Primary malignant melanoma (clear cell sarcoma) of bone: report of a case arising in the ulna

BACKGROUND

To the authors' knowledge, there has been no previous report of primary malignant melanoma of bone.

METHODS

A 33-year-old woman presented with a tumorous lesion in the olecranon of the right ulna. The histologic diagnosis was malignant melanoma with close similarity to clear cell sarcoma. To exclude the possibility of malignant melanoma metastatic to the bone, clinical investigations including gallium 67-citrate scintigraphy, brain, chest, and abdominal computed tomography, and upper and lower gastrointestinal endoscopic examinations were performed. Conventional histopathologic, immunohistochemical, and electron microscopic studies were also performed.

RESULTS

Clinical investigations showed no lesion suggestive of a primary melanoma other than that in the right ulna. Histologically, the tumor was comprised of polygonal or fusiform cells with clear or granular cytoplasm and vesicular nuclei containing one or two prominent nucleoli. The features were similar to those of clear cell sarcoma (malignant melanoma of soft parts). Fontana preparations and immunohistochemical staining for S-100 protein and HMB-45 (melanoma specific antigen) also revealed that the tumor cells had the characteristics of malignant melanoma. The patient has remained alive and well for more than 5 years after the initial treatment.

CONCLUSIONS

The clinicopathologic findings in this case strongly suggested that the lesion was a primary malignant melanoma of bone. Therefore, this is the first report to indicate that malignant melanoma and related diseases can occur even in bone tissue.

[A method to calculate the probability of paternity between relatives--a paternity case where the putative father was a deceased granduncle]

To test paternity in a case where the putative father was a deceased uncle of mother (plaintiff's granduncle), we designed a new method to calculate the probability of paternity likelihood. The putative father's genotypes of red cell antigens, HLA and short tandem repeat (STR) polymorphism were estimated from those of mother and sister of the plaintiff. When the probability was calculated from the frequencies in the unrelated individuals (the standard method), a significant bias might be introduced since the putative father and the plaintiff were likely to have the same alleles come from their common ancestry. Therefore, we designed a new method to calculate the likelihood ratio from the frequencies in the group of mother's uncles estimated from mother's genotypes. The probability (0.9299) calculated with our method was found to be lower than that (0.9992) done with the standard method indicating that the new method could remove the bias introduced from the incest.

Histopathological study of stromal smooth muscle cells in fibroadenoma of the breast

Smooth muscle cells are extremely rare stromal components of fibroadenoma. Eighty-five cases of fibroadenoma were reviewed in order to investigate the frequency of smooth muscle cells and to discuss its origin. Of the 85 cases, four (4.7%) cases showed smooth muscle cells in the stroma. Distribution in terms of age and tumor size did not show any difference from other cases. Three cases were classified as an intracanalicular subtype, and one was a mastopathic subtype. The cells possessed most of the ultrastructural characteristics of smooth muscle cells, but poor indentation of nuclear contours suggested the last remnant of fibroblasts. It was therefore easy to recognize the cells derived from fibroblasts. In two of four cases, smooth muscle cells were observed in the stroma, which had marked hyalinization and calcification. Therefore, it was supposed that smooth muscle cells could appear in the stroma of long-standing tumors.

Flat serrated adenomas of the colorectal mucosa in Japanese patients

While reviewing the histological sections of 319 flat colorectal polyps at three different Hospitals in Tokyo, 7 cases of flat serrated adenomas were found. Flat serrated adenomas differ histologically from flat tubular adenomas. In the former the dysplastic cells are found initially at the lower part of the crypts of Lieberkuhn, and the epithelium of the sides of those crypts have serrated infoldings without dysplastic cells. In flat tubular adenomas, however, the dysplastic cells are initially found in the upper part of straight crypts (i.e. without epithelial infoldings). Six of the 7 serrated adenomas had low grade dysplasia (LGD) and the remaining one high grade dysplasia (HGD). Atypical mitosis were present in the dysplastic epithelium of serrated adenomas. Depending upon the topographic distribution of the dysplastic epithelium within the crypts flat serrated adenomas were divided into Type I, where the dysplastic epithelium was limited to the lower half of the serrated crypts, and Type II where the dysplastic epithelium was present even in the superficial half of the serrated crypts. Of the 7 serrated adenomas, 3 were Type I and the remaining 4 Type II lesions. The dysplastic epithelium seemed to have originated at the base of the crypts and progressed upwards, replacing the scalloped, serrated epithelium. Flat serrated adenomas appeared as benign lesions upon endoscopy (their pit pattern being identical to flat hyperplastic polyps), but in a previous survey of Swedish patients 3 of 47 flat serrated adenomas had invasive adenocarcinoma (i.e. with submucosal extension). Whether serrated adenomas evolved into invasive carcinoma in the Japanese should be assessed in a larger series of cases.

Solitary pancreatic metastasis occurring eight years after nephrectomy for renal cell carcinoma. A case report and surgical review

CONCLUSION

Pancreatic metastasis from renal cell carcinoma is extremely rare. The average time between nephrectomy and the diagnosis of metachronous metastases is reported to exceed 10 yr. Therefore, the initial diagnosis may be neglected in the cases of prolonged disease-free interval. When it does occur simultaneously or metachronously, aggressive surgical resection, when possible, seems to be the most effective treatment for this metastatic lesion.

BACKGROUND

An 81-yr-old female patient, who 8 yr previously had undergone right radical nephrectomy for renal cell carcinoma, presented with solitary pancreatic metastasis, which was successfully treated with a distal pancreatectomy. Only 66 cases of clinically diagnosed renal cell carcinoma metastatic to the pancreas are reported in the world literature and 49 of the patients (including ours) underwent a definitive surgical resection. Our case, treated by distal pancreatectomy, and a review of the relevant literature including all reported cases of renal cell carcinoma metastatic to the pancreas, are presented.

RESULTS

The patient was well without any evidence of recurrence at 22 mo after the operation.

Bacteria closely resembling Helicobacter pylori detected immunohistologically and genetically in resected gallbladder mucosa

A microorganism with close immunohistological and genetic resemblance to Helicobacter pylori was found in the resected gallbladder mucosa of a 41-year-old woman. The woman was admitted to hospital complaining of fever and right hypochondrial pain. Cholecystectomy was carried out under the diagnosis of gallstones and cholecystitis. A microorganism resembling H. pylori (stained with H&E, Giemsa, and Wartin-Starry) was detected incidentally on pathological examination. The microorganism was also positive for immunohistochemical staining. An amplification reaction was seen on genetic examination by the polymerase chain reaction (PCR) method (urease beta-genes). Our findings suggest that H. pylori may be present in tissues other than gastric mucosa.

Anti-tumor effects of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in seborrheic keratosis

1,25-dihydroxyvitamin D3 (1,25(OH)2D3) is a drug with potent antiproliferative action on keratinocytes that have nuclear receptors for 1,25(OH)2D3. We investigated the effects of 1,25(OH)2D3 on widespread seborrheic keratoses in 51 patients with these tumors. The data indicated that resolution of these tumors was dependent on both tumor size and dose of 1,25(OH)2D3. Among 15 patients treated with a high dose (0.5 microgram/d) of oral 1,25(OH)2D3, the lesions of widespread seborrheic keratoses changed from brown-black papules to brownish papules with erythema and/or crust as early as 2 wk after the start of treatment. The tumors finally developed into an atrophic scar or brownish pigmented macule. Histologically, vacuolation of the spinous cells, vesicle formation, and liquefaction degeneration of the basaloid cells were observed. Numerous lymphocytes had infiltrated in the papillary dermis. Among 36 patients treated with a low dose (0.25 microgram/d) of 1,25(OH)2D3, brownish papules became pale to normal in color and reduced in size, without erythematous change. Histologically, acanthosis of the epidermis was reduced, but degenerative change of the tumor cells was not observed. These data suggest that oral therapy of 1,25(OH)2D3 is an acceptable method well suited to the removal of seborrheic keratoses, especially those that are predominantly small tumors.

Analysis of PIG-A gene in a patient who developed reciprocal translocation of chromosome 12 and paroxysmal nocturnal hemoglobinuria during follow-up of aplastic anemia

The relationships between paroxysmal nocturnal hemoglobinuria (PNH), aplastic anemia (AA), and myelodysplastic syndrome (MDS) are not clear. Here we describe a patient, J20, who developed a reciprocal translocation of chromosome 12 and PNH during follow-up of AA. All metaphases in CD59-deficient bone marrow mononuclear cells had the translocation, whereas none of the CD59-deficient cells had it, indicating that the PNH clone coincided with a cell population bearing the chromosomal aberration. We found a somatic single-base deletion mutation in the PIG-A gene of this patient's peripheral blood cells. This is the first patient with PNH with a PNH clone containing a chromosomal translocation.

Percentage of reversibly and irreversibly sickled cells are altered by the method of blood drawing and storage conditions

We previously reported that the percentage of reversibly and irreversibly sickled cells (RSC and ISC, respectively) in the blood of patients with sickle cell disease is strongly influenced by the method of blood drawing (PNAS 91:12589, 1994). We now document the effect of blood storage conditions on the percentage of RSC and ISC. The percentage of RSC was lowest when blood was stored at 0 degree C, while the percentage of RSC was highest in specimens kept at 37 degrees C. At room temperature, the percentage of RSC increased slightly over 8 hours. The percentage of ISC was also temperature dependent and was reduced significantly upon cooling. Our results showed that many ISC reverted to a discoidal shape after 3 hrs of cooling after treatment of blood with oxygen or carbon monoxide. Since no Hb S polymers were detected in ISC treated with oxygen or carbon monoxide, the time required for shape restoration may be attributed to the membrane. We measured ISC levels of 10 patients with consideration of storage temperature and compared the values with those determined by the conventional method and also with those published previously.

Calcitonin-like polypeptides without apparent biological activity in a patient with recurrent medullary thyroid carcinoma

A 51-year-old male with a recurrent medullary thyroid carcinoma (MTC) showed high serum levels of calcitonin (CT) and carcinoembryonic antigen (CEA) but with concomitant normocalcemia. The CT activities of the patient's serum in vivo (hypocalcemic activity in rats) and in vitro (cyclic AMP-increasing activity in cultured human mammary tumor, T47D) were much lower than those expected from the patient's CT level. High performance liquid chromatography (HPLC) with radioimmunoassay (RIA) detection gave a broad spectrum of molecular weights of CT-like polypeptides in the 3 kDa to 200 kDa range with separation from CEA, suggesting that the mechanism for CT production in MTC is an obscure one.

Histochemical demonstration of different types of poly-N-acetyllactosamine structures in human thyroid neoplasms using lectins and endo-beta-galactosidase digestion

Blood-group-related antigens expressed in papillary carcinomas and other types of neoplasm of the human thyroid glands have been shown to be carried by poly-N-acetyllactosamines containing a linear domain susceptible to endo-beta-galactosidase digestion. To make clear more precisely the backbone poly-N-acetyllactosamine structures, labelled lectins specific to different types of these structures and specific to core structures with beta 1-6GlcNAc branching of N- and O-linked glycoproteins were employed in conjunction with prior endo-beta-galactosidase digestion on formalin-fixed, paraffin-embedded neoplasms of the human thyroid glands. In papillary carcinomas, Datura stramonium agglutinin (DSA) and succinyl wheat germ agglutinin (Suc-WGA) reacted most consistently and frequently with papillary carcinomas from all the individuals examined. Pokeweed mitogen (PWM) likewise stained the cells of papillary carcinomas from all the individuals examined, but in some individuals the number of lectin-reactive cells were very small. Lycoperscion esculentum aggultinin (LEA), Solanum tuberosum agglutinin (STA), Phaseolus vulgaris agglutinin L (PHA-L) and Artocarpus integrifolia agglutinin (jacalin) similarly bound to the cancer cells from most of the individuals, and in these cases the number of reactive cells was usually much more restricted than was the case with DSA or PWM. In adenoma and other types of carcinoma, such as follicular carcinomas, these lectins specific to poly-N-acetyllactosamine exhibited slight or no reactivity with the cells, whereas PHA-L and jacalin similarly bound to the cells of adenomas and carcinomas from most of the individuals examined. Prior digestion with endo-beta-galactosidase completely eliminated or markedly reduced the reactivity with PWM and LEA in papillary carcinomas. Reactivity with DSA, Suc-WGA, STA, PHA-L and jacalin was slightly reduced or not at all affected by enzyme digestion. These results confirmed that poly-N-acetyllactosamine species found in papillary carcinomas are quite different from those in other types of thyroid neoplasm, suggesting that at least three different types of poly-N-acetyllactosamine, that is, linear unbranched short and long sequences and highly branched ones are produced in these cells.

Comparison of the in vitro skin penetration of propiverine with that of terodiline

This study was designed to clarify the relationship between the properties of propiverine and skin penetration, and to compare the in vitro penetration characteristics of propiverine and terodiline through rat skin. Propiverine in both hydrochloride and free forms penetrated across the skin extremely slowly, with a 2.6 times higher flux in the hydrochloride than that in the free base, in the absence of enhancers. Various enhancers failed to enhance the penetration of propiverine hydrochloride, whereas the same agents slightly increased the flux of the free form, these being due to the slow release rate of the free form from the gel formulations, an extremely high lipophilicity (log Poct/water > 4.97), much less solubility (0.141 mg/ml) and a large partition capacity of the drug to skin components. Terodiline in both forms was able to rapidly penetrate through the skin, even in the absence of enhancers, with 20.2 and 9.8 times higher fluxes respectively, than the corresponding forms of propiverine. The high penetration characteristics of terodiline would be due to a suitable lipophilicity, low binding property as well as the structural masking from the binding to the epidermal components. Propiverine hydrochloride penetrated through the stratum corneum 4.4 times and viable skin 3.1 times higher than through full-thickness skin, while the fluxes of terodiline through the stratum corneum and viable skin were similar to each other, with high penetration rates for each form.

Histochemical differences of the lectin affinities of backbone polylactosamine structures carrying the ABO blood group antigens in papillary carcinoma and other types of thyroid neoplasm

Endo-beta-galactosidase from Escherichia freundii cleaves linear polylactosamine structure as follows: R-GlcNAc-beta 1-3Gal-beta 1-4GlcNAc-beta 1-R' + H2O-->R-GlcNAc-beta 1-3Gal + GlcNAc-beta 1-R'. Staining with Griffonia simplicifolia agglutinin II (GSA-II) following enzyme digestion reveals the distribution of R-GlcNac-beta 1-3Gal-beta 1-4GlcNAc-beta 1-R' structures in tissue sections. In this study, the procedure was applied to formalin-fixed, paraffin-embedded tissue sections from 26 cases of papillary carcinomas including 2 follicular variants, 8 follicular carcinomas, 7 adenomas, 1 anaplastic carcinoma and 1 medullary carcinoma in order to investigate whether different types of polyactosamine-containing structure are produced in these thyroid neoplasms. Simultaneously, the susceptibility of the ABH antigens expressed in these neoplastic cells to endo-beta-galactosidase digestion was examined. Most of the papillary carcinoma cells from all the individuals examined were strongly stained by GSA-II following enzyme digestion. Without enzyme digestion, little or no reactivity with GSA-II was observed. Among other types of neoplasms, only one case of follicular carcinoma exhibited reactivity with GSA-II following enzyme digestion. ABH antigens were expressed in 22 cases of papillary carcinomas, 2 adenomas, 5 follicular carcinomas and 1 anaplastic carcinoma, and their expression was dependent on the ABO blood group of the patients. Endo-beta-galactosidase digestion resulted in the elimination of these antigens not only in papillary carcinomas but also in other neoplasms.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant melanoma with mesenteric metastasis causing an intrapelvic abscess: report of a case

We present herein the case of a 66-year-old woman with disseminated malignant melanoma in whom a metastasis in the ileal mesentery ruptured into the peritoneal cavity causing an acute abdomen. The patient suddenly developed lower abdominal pain and a computed tomography (CT) scan of the pelvis confirmed the presence of an intrapelvic abscess. At emergency laparotomy, a 10 x 10 cm ruptured metastatic melanoma was found in the ileal mesentery, which demonstrated no communication with the ileum itself. To our knowledge, no other case of an acute abdomen being caused by the rupture of mesenteric metastatic melanoma lacking any communication with the bowel lumen has ever been reported.

Bone marrow transplantation for erythroleukemia: a case report

A 2 year old girl was diagnosed as having erythroleukemia (EL; M6 according to the French-American-British classification). After one course of low-dose cytosine arabinoside (Ara-C), complete remission was obtained. After three courses of low-dose Ara-C for consolidation, allogeneic bone marrow transplantation was performed from HLA-identical sibling. The course of post-transplantation was uneventful. Two years after transplantation, she continues to have durable engraftment and remission. In children with EL, conventional chemotherapy appears to be inadequate for producing durable long-term disease-free survival. Bone marrow transplantation should be considered in children with EL, in cases where suitable donors are available.

[A case of inflammatory breast cancer successfully treated with 5'-DFUR and MPA]

A 67-year-old female with extensive inflammatory breast cancer was treated with oral chemoendocrine therapy using 5'-deoxy-5-fluorouridine (5'-DFUR) 1,200 mg and medroxyprogesterone acetate (MPA) 1,200 mg before intra-arterial infusion chemotherapy, which made the extensive inflammatory skin lesion improve remarkably. Sequential intra-arterial infusion made the skin lesion completely disappear. But the main tumor remained, so extended mastectomy was performed. These findings suggested that this therapy was effective for the prevention of extension of the skin lesion on the inflammatory breast cancer, and also served as induction therapy for this modality.