Development of immunoglobulin variable heavy chain gene consensus probes with conjugated 3' minor groove binder groups for monitoring minimal residual disease in childhood acute lymphoblastic leukaemia

AIMS

To develop immunoglobulin heavy chain variable (VH) gene probes that are shorter and more flexible in position for monitoring minimal residual disease (MRD) in childhood leukaemia (ALL), using minor groove binder (MGB) technology.

METHODS

All VH germline sequences registered in the database were aligned and the consensus regions were determined. The reliability of the MGB probes was compared with non-MGB probes in all 24 cases of ALL.

RESULTS

Ten MGB probes (16 to 18 mers) were designed that enabled all the germline sequences on the database to be analysed, whereas the conventional non-MGB probes (21 to 27 mers) did not allow the analysis of four of the VH1 and five of the VH3 germline sequences. The sequencing results in five of the 24 cases of ALL were not matched to the non-MGB probes.

CONCLUSIONS

MGB technology allows shorter probes to be designed, enabling MRD to be detected in childhood ALL. This would provide a considerable reduction in cost for a large MRD study.

Consensus primers for detecting monoclonal immunoglobulin heavy chain rearrangement in B cell lymphomas

AIMS

To demonstrate the usefulness of polymerase chain reaction (PCR) methodology with both the FR2A/LJH/VLJH and the FR1c/LJH/VLJH primer sets for detecting monoclonal immunoglobulin heavy chain (IgH) gene rearrangement in B cell non-Hodgkin lymphomas (B-NHLs).

METHODS

Eighty three patients with B-NHL were enrolled in this study. DNA was isolated from paraffin wax embedded sections and amplified by PCR to determine the sequences of the rearranged IgH gene. Each PCR product was subcloned. Cycle sequences and sequence analyses were done to determine the clone specific IgH variable region (VH) sequences.

RESULTS

Clonal IgH gene rearrangements were detected in 45 cases with FR2a/JH/VLJH and in 14 of the remaining cases with FR1c/JH/VLJH. Most of the cases detectable with FR2a/JH/VLJH were derived from VH3 and VH4 families. Five of six cases in the VH1 family and one in the VH7 family were amplified with the FR1c/JH/VLJH primer set only.

CONCLUSION

The detection rate of IgH rearrangement in B-NHLs can be increased by using both FR2A/LJH/VLJH and FR1c/LJH/VLJH, and these two primer sets are suitable for routine PCR methodology. Moreover, each primer set appears to be closely related to VH family specificity.

A case of recurrent hepatocellular carcinoma treated with laparoscopic microwave coagulation therapy after minimally invasive hepatic surgery

A case of hepatocellular carcinoma (HCC) in which the patient repeatedly underwent minimally invasive hepatic procedures is reported. The patient was a 71-year-old man who underwent transthoracic microwave coagulation therapy (MCT) for initial HCC nodules in segment VIII and subsequent laparoscopic MCT for small intrahepatic recurrent nodules in the left hepatic lobe. At this writing, the patient was alive and well without tumor recurrence 29 months after the initial surgery. Minimally invasive hepatic surgery alleviates perihepatic adhesion and allows subsequent laparoscopic surgery in the case of intrahepatic HCC recurrence.

A case of complex hepatolithiasis successfully treated with a systematic approach

A systematic approach is required to treat complex hepatolithiasis. A 45 year-old female patient with hepatolithiasis had bilateral intrahepatic stones, biliary strictures at the right hepatic duct and segment IV duct, cholangitic abscess, and shrinkage of the right hepatic lobe. Six sessions of lithotomy were carried out under the guidance of percutaneous transhepatic choledochoscopy using a dye-laser lithotriptor through the segment III duct. Although stones were eradicated from the common bile duct and segment III duct, stones remained in other segments where cholangioscopic access was not feasible. Biliary bilirubin concentration increased and the liver abscess was resolved. Thereafter, the patient underwent right hepatectomy and choledochojejunostomy. After surgery, percutaneous transhepatic cholangio-drainage and balloon dilatation of the segment IV duct was performed. The patient underwent 11 more sessions of cholangioscopic lithotomy through 2 transhepatic routes and the bilioenteric bypass. Thereafter, the patient became almost stone-free. After discharge, biliary tracts were irrigated with saline through a subcutaneously placed reservoir. The patient is alive and well and had been without stone recurrence for 3 years. This report shows the efficacy of the vigorous combination therapy, including repeated cholangioscopic lithotomy through multiple routes using laser lithotripsy, surgery, and long-term biliary irrigation.

Blood-flow route from the hepatic artery and portal vein to the sinusoid in normal human liver observed by confocal laser scanning microscopy

OBJECTIVE

To observe the microvasculature in normal human liver.

STUDY DESIGN

Four autopsy livers cut into 50-micron-thick sections were observed by confocal laser scanning microscopy. Immunofluorescence was performed using anti-alpha smooth muscle actin (alpha-SMA) antibody. In addition, double immunofluorescence was performed on the other sections using antilysozyme antibody. The routes from the portal vein branches and hepatic artery branches to the sinusoids were defined as follows: portal venule, septal branch, inlet venule, hepatic arteriole and terminal hepatic arteriole.

RESULTS

The reactivity of the walls of septal branches and inlet venule was positive for alpha-SMA. Lysozyme-positive cells (Kupffer cells) were dense in the sinusoids but were sparse in the septal branches and absent from the inlet venules. Terminal hepatic arterioles were observed along the septal branch, and the anastomoses between them were observed at the peripheral portion. No routes opening directly from the terminal hepatic arteriole into the sinusoids or arterioportal anastomoses in the portal tract were observed on alpha-SMA-stained sections.

CONCLUSION

Regulation of the microcirculation in human liver may be performed by the smooth muscle layer of both peripheral portal and hepatic arterial routes.

Electron microscopic examination of oligocilia in naevus of Ota

The structure of the cilia present in dermal melanocytes of 14 patients with naevus of Ota was examined by electron microscopy. Cilia and basal bodies were found in 10 and 9 lesions, and in 39 and 18 dermal melanocytes, respectively. In each case, 1-12 cells with a single cilium or multiple cilia were observed. In a total of 3 dermal melanocytes from 2 cases, two cilia per cell were observed. The cilia contained 7, 6, 5 and 4 pairs of doublet microtubules in the periphery and no central microtubule. Another pattern with several pairs of doublet microtubules in the periphery and one or two centrally located doublet microtubules were also observed. The latter were not bona fide central microtubules but one and two doublets, which seemed to be displaced to the centre from the periphery of the cilium.

Changes in lymph vessels and portal veins in the portal tract of patients with idiopathic portal hypertension: a morphometric study

Little is known about the effects of the pathological process associated with idiopathic portal hypertension (IPH) on hepatic lymph vessels or lymph flow. We used morphometric analysis to examine IPH-associated changes in lymph vessels and branches of the portal vein, with use of immunohistochemical staining for alpha smooth muscle actin. We also quantitated these changes using an image analysis system. The study was conducted with use of liver wedge biopsy material from 10 patients with advanced IPH and 10 control samples from patients with gastric carcinoma without liver disease. The number of lymph vessels, identified by a lack of smooth muscle layer in the wall, and the ratio of the total area of these vessels to that of the portal tract were higher in IPH samples than in the control samples, but the ratio of the area of a single lymph vessel to that of the portal tract in IPH samples was not different from control samples. The number of portal vein branches, characterized by hypertrophy of the smooth muscle layer in IPH samples was not different from control samples. The ratio of the total area of these branches to that of the portal tract, and the ratio of a single portal vein branch to that of the portal tract, were lower in IPH samples than in the control samples. Our results suggest that these morphometric changes in IPH may be associated with a reduction in portal blood flow and increased lymph flow, and that the latter may in turn reduce the high portal vein pressure in idiopathic portal hypertension.

Renal small cell carcinoma (neuroendocrine carcinoma) without features of transitional cell carcinoma

Seventeen cases of renal small cell carcinoma have been reported in the literature. Approximately half of the reported cases show combined features of transitional cell carcinoma. Presented herein is a case of renal small cell carcinoma in a 37-year-old Japanese male who had been treated for 10 years with famotidine for duodenal ulcer. He suffered from sudden-onset chest pain at presentation and myxoma of the right atrium was suspected. He was treated by atriotomy and a tumor was removed from the right atrium and pulmonary artery. Histological examination, however, revealed it to be small cell carcinoma. Accordingly, a radical operation was performed for the removal of a tumor found in the right kidney. Histological examination of the tumor confirmed the presence of renal small cell carcinoma without any features of transitional cell carcinoma. It is reported that long-term administration of an histamine 2 (H2) receptor antagonist may produce carcinoid tumors in rodents and enterochromaffin-like cell hyperplasia in humans. The possible relationship between neuroendocrine carcinoma and H2 receptor antagonist therapy is discussed.

[Hemophagocytic syndrome due to miliary tuberculosis in the course of aplastic anemia]

We report a 63 year-old female with aplastic anemia (AA) who was complicated with hemophagocytic syndrome induced by systemic miliary tuberculosis. Two years before admission to our hospital, she was diagnosed as AA and had been treated with granulocyte colony-stimulating factor, erythropoietin and methenolone acetate. In May, 1996, She was transferred to our hospital because of high fever and exacervation of pancytopenia. She showed severe pancytopenia, and an increase in macrophages showing remarkable erythrophagocytosis and decrease in hemopoietic cells in the bone marrow. In initial examination, high titer of IgM antibody to herpes simplex virus type I was identified and methylprednisolone pulse therapy was started under the diagnosis of virus associated hemophagocytic syndrome. Ten days later, however, she died for intestinal hemorrhage followed by multiorgan failure. In autopsy, multiple epitheloid cell granulomas with acid-fast bacilli were found in bone marrow, lungs, liver, spleen and kidneys.

How thick are the paraffin-embedded tissue sections routinely prepared in laboratory? A morphometric study using a confocal laser scanning microscope

In order to evaluate the differences between cut and measured thicknesses of formalin-fixed, paraffin-embedded tissue sections, formalin-fixed, paraffin-embedded blocks of liver tissue were prepared from four male Wistar rats. The sections were cut at preselected thicknesses of 3, 6, 9, 12, 15 and 18 microns, and observed under confocal laser scanning microscopy. The maximum and minimum section thicknesses were measured using a vertically cut section image constructed by the software incorporated in the microscope. The surface of the section was not smooth but showed fine undulations in addition to a slight inclination. The mean and range of the section thicknesses measured were 4.3 +/- 1.3, 7.0 +/- 1.7, 9.8 +/- 2.1, 12.0 +/- 2.6, 14.1 +/- 3.0, and 17.7 +/- 3.8 microns for the preselected cut thicknesses of 3, 6, 9, 12, 15 and 18 microns. It is stressed that the evaluated parameters of the section (volume or surface densities) include standard errors of up to 10% caused by the differences between the cut and real thicknesses.