Long-term follow-up of 5 patients with intracranial germinoma initially treated by chemotherapy alone

BACKGROUND

High rates of overall- and event-free survival have been reported in patients with intracranial germinoma treated by radiotherapy. We report the long-term results after treatment initially with chemotherapy, but without radiation.

PATIENTS AND METHOD

Five patients with an intracranial germinoma were treated with 2 cycles of etoposide and cisplatin, without radiotherapy. All achieved complete remission; 3 suffered recurrence within 2 years and were again treated with 2 cycles of etoposide and cisplatin followed by radiotherapy.

RESULTS

At long-term follow-up, each of the 5 patients was in complete remission without further recurrence. Each patient with a neurohypophyseal germinoma who presented with endocrinopathy had initially recovered endocrinological function.

CONCLUSION

In a patient with a germinoma chemotherapy, and restriction of radiation to those with recurrence may allow restoration of hypophyseal function damaged by the intracranial germinoma without compromising long term survivial.

Konjak mosaic virus: the complete nucleotide sequence of the genomic RNA and its comparison with other potyviruses

Konjak mosaic virus (KoMV) belongs to the genus Potyvirus, family Potyviridae. The complete nucleotide sequence of KoMV F isolate (KoMV F) was determined. The genome is 9,544 nucleotides long excluding the 3' terminal poly A tail and encodes a typical potyviral 350-kDa polyprotein of 3,087 amino acids. Phylogenetic analysis using known potyvirus polyproteins shows that KoMV constitutes a branch with yam mosaic virus, close to another branch including Japanese yam mosaic virus, turnip mosaic virus, scallion mosaic virus and lettuce mosaic virus. The 3' terminal 1,842 nucleotides of a different isolate of KoMV, K-2, was also determined, covering the C-terminal 292 amino acids of the nuclear inclusion protein b (NIb), coat protein (CP), and the 3' untranslated region. The amino acid sequences of the KoMV F CP and the nucleotide sequences of the KoMV F 3' untranslated region showed 92.5 and 90.5% identity to the corresponding genes of K-2, 88.7-96.8 and 92.7-94.4% to those of Zantedeschia mosaic virus (ZaMV) isolates, 87.5-89.7% and 85.5-90.3% to those of Japanese hornwort mosaic virus (JHMV) isolates. These results showed that KoMV is a distinct potyvirus and that KoMV, ZaMV, and JHMV are members of the same potyvirus species. Considering that KoMV was the first of these to be described, ZaMV and JHMV may be considered isolates of KoMV.

A novel heterozygous missense mutation in the vasopressin moiety is identified in a Japanese person with neurohypophyseal diabetes insipidus

The autosomal dominant familial neurohypophyseal diabetes insipidus (adFNDI) is caused by diverse mutations in one allele of the gene that encodes the arginine vasopressin (AVP) precursor protein, AVP-neurophysin II (AVP-NP II). Most of the mutations identified so far are located in either the signal peptide or NP II moiety. Two recently published mutations in the AVP gene identified in kindreds with adFNDI predict a substitution of histidine for tyrosine at position 2 and a deletion of phenylalanine at position 3 in AVP. They are unique among adFNDI mutations in that they are the only adFNDI mutations that affect amino acid residues in the AVP moiety of the pro-hormone. Here, we report a novel heterozygous missense mutation in the AVP moiety of the AVP-NP II gene in a Japanese person with neurohypophyseal diabetes insipidus (DI). This mutation occurs at position 2 in AVP and predicts a substitution of serine for tyrosine (Y21S). It is expected to interfere with normal binding of AVP with NP II, and thus result in misfolding of the precursor proteins. The data of this study support the notion that mutations affecting the AVP moiety can result in the initiation of the pathological processes.

Magnetic resonance imaging of the hypothalamic-neurohypophyseal system

Magnetic resonance imaging (MRI) is a revolutionary advance in diagnostic imaging of the hypothalamic-neurohypophyseal system (HNS). The detailed anatomy of the sellar and parasellar region is clearly visible using MRI, because it has no bony artifacts and multidirectional capability. The posterior lobe of the pituitary gland displays a characteristic bright signal on the MR T1-weighted image (T1WI), and is distinctly separated from the anterior lobe. The bright signal is absent in patients with central diabetes insipidus, and is thought to reflect normal vasopressin storage in the posterior lobe. The signal intensity ratio of the posterior lobe to the pons on T1WI is strongly correlated with vasopressin content in the posterior lobe. In addition to the morphological evaluation, MRI provides unique information concerning the function of the HNS. The MRI findings of the HNS (normal condition, central diabetes insipidus, a depleted posterior lobe, an ectopic posterior lobe, and a damming-up phenomenon of the neurosecretory vesicles in the pituitary stalk) are demonstrated in this article.

Evaluation of pituitary adenomas by multidirectional multislice dynamic CT

PURPOSE

Multidetector-row CT is a new technology with a short scanning time. Multislice dynamic CT (MSDCT) in various directions can be obtained using the multidetector-row CT with multiplanar reformatting (MPR) technique.

MATERIAL AND METHODS

We evaluated the initial results of sagittal and coronal MSDCT images reconstructed by MPR (MSDCT-MPR) in 3 pituitary adenoma patients with a pacemaker.

RESULTS

In a patient with microadenoma, the maximum contrast between the normal anterior pituitary gland and the adenoma occurred approximately 50 s after the start of the contrast medium injection. A microadenoma was depicted as a less enhanced area relative to normal pituitary tissue. The macroadenomas were depicted as a less enhanced mass with cavernous sinus invasion in 1 patient and as a non-uniformly enhanced mass in another patient. Bone destruction and incomplete opening of the sellar floor during previous surgery were clearly detected in 2 patients with macroadenomas. These pituitary adenomas were removed via the transnasal route based on information from the MSDCT-MPR images only. The findings were verified surgically.

CONCLUSION

The MSDCT-MPR provided the information needed for surgery with good image quality in the 3 patients with pacemakers. MSDCT-MPR appears to be a useful technique for patients with a pituitary adenoma in whom MR imaging is not available. This is the first report, to our knowledge, of the MSDCT-MPR technique being used to demonstrate pituitary disorders.

Evaluation of pituitary adenomas by multidirectional multislice dynamic CT

PURPOSE

Multidetector-row CT is a new technology with a short scanning time. Multislice dynamic CT (MSDCT) in various directions can be obtained using the multidetector-row CT with multiplanar reformatting (MPR) technique.

MATERIAL AND METHODS

We evaluated the initial results of sagittal and coronal MSDCT images reconstructed by MPR (MSDCT-MPR) in 3 pituitary adenoma patients with a pacemaker.

RESULTS

In a patient with microadenoma, the maximum contrast between the normal anterior pituitary gland and the adenoma occurred approximately 50 s after the start of the contrast medium injection. A microadenoma was depicted as a less enhanced area relative to normal pituitary tissue. The macroadenomas were depicted as a less enhanced mass with cavernous sinus invasion in 1 patient and as a non-uniformly enhanced mass in another patient. Bone destruction and incomplete opening of the sellar floor during previous surgery were clearly detected in 2 patients with macroadenomas. These pituitary adenomas were removed via the transnasal route based on information from the MSDCT-MPR images only. The findings were verified surgically.

CONCLUSION

The MSDCT-MPR provided the information needed for surgery with good image quality in the 3 patients with pacemakers. MSDCT-MPR appears to be a useful technique for patients with a pituitary adenoma in whom MR imaging is not available. This is the first report, to our knowledge, of the MSDCT-MPR technique being used to demonstrate pituitary disorders.

Replication of Tomato spotted wilt virus After Ingestion by Adult Thrips setosus is Restricted to Midgut Epithelial Cells

ABSTRACT If acquisition access feeding (AAF) is first given after adult eclosion, none of the nine thrips species able to serve as tospovirus vectors can become infective. The previous cellular investigations of this phenomenon, carried out only in Frankliniella occidentalis, suggested that infectivity was prevented because the type member of the tospoviruses, Tomato spotted wilt virus (TSWV), was unable to enter the midgut of adult thrips. The present study extends a cellular view of tospovirus-thrips interactions to a species other than the western flower thrips, F. occidentalis. Our findings show that TSWV enters and replicates within the midgut of adult Thrips setosus, but does not infect cells beyond the midgut epithelia. After AAF as adult, TSWV replicated in T. setosus midgut cells as indicated by significant increases in nucleocapsid (N) protein detected by double-antibody sandwich enzyme-linked immunosorbent assay, and the presence of inclusions containing the S RNA-encoded nonstructural and N proteins revealed by microscopic observations. Electron microscopic observations of adult insects showed that no infection occurred in cells beyond the midgut epithelia, and insects subsampled from the same cohorts could not transmit TSWV. In contrast, electron microscopy observations of larval T. setosus revealed that TSWV infected the midgut and muscle cells, and adult insects developing from these cohorts had infected salivary glands and were able to transmit TSWV. Mature virions were observed only in the salivary glands of adults developing from infected larvae. Our findings suggest that the barrier to infectivity in T. setosus adults differs from that shown for F. occidentalis adults.

An archetypical extradiol-cleaving catecholic dioxygenase: the crystal structure of catechol 2,3-dioxygenase (metapyrocatechase) from Ppseudomonas putida mt-2

BACKGROUND

Catechol dioxygenases catalyze the ring cleavage of catechol and its derivatives in either an intradiol or extradiol manner. These enzymes have a key role in the degradation of aromatic molecules in the environment by soil bacteria. Catechol 2, 3-dioxygenase catalyzes the incorporation of dioxygen into catechol and the extradiol ring cleavage to form 2-hydroxymuconate semialdehyde. Catechol 2,3-dioxygenase (metapyrocatechase, MPC) from Pseudomonas putida mt-2 was the first extradiol dioxygenase to be obtained in a pure form and has been studied extensively. The lack of an MPC structure has hampered the understanding of the general mechanism of extradiol dioxygenases.

RESULTS

The three-dimensional structure of MPC has been determined at 2.8 A resolution by the multiple isomorphous replacement method. The enzyme is a homotetramer with each subunit folded into two similar domains. The structure of the MPC subunit resembles that of 2,3-dihydroxybiphenyl 1,2-dioxygenase, although there is low amino acid sequence identity between these enzymes. The active-site structure reveals a distorted tetrahedral Fe(II) site with three endogenous ligands (His153, His214 and Glu265), and an additional molecule that is most probably acetone.

CONCLUSIONS

The present structure of MPC, combined with those of two 2,3-dihydroxybiphenyl 1,2-dioxygenases, reveals a conserved core region of the active site comprising three Fe(II) ligands (His153, His214 and Glu265), one tyrosine (Tyr255) and two histidine (His199 and His246) residues. The results suggest that extradiol dioxygenases employ a common mechanism to recognize the catechol ring moiety of various substrates and to activate dioxygen. One of the conserved histidine residues (His199) seems to have important roles in the catalytic cycle.

Supra- and extrasellar pituitary microadenoma as a cause of Cushing's disease

There has been accumulating evidence that pituitary adenomas which cause Cushing's disease are located not only in sella turcica but also in various extrasellar and intracranial regions. We describe a case of Cushing's disease caused by a supra- and extrasellar ACTH-producing microadenoma, which originated in the anterior pituitary and extended upward without connecting to the stalk. The pituitary microadenoma was identified and removed by transsphenoidal microsurgery. After the surgery the patient experienced complete remission. This type of pituitary microadenoma is considered to be rare, but in order to accomplish successful surgical treatment, it is necessary to consider that pituitary adenomas which cause Cushing's disease may be located in such an unusual position.

Posterior lobe of the pituitary gland: correlation between signal intensity on T1-weighted MR images and vasopressin concentration

PURPOSE

To correlate the signal intensity on magnetic resonance (MR) images in the posterior lobe of the pituitary gland with the vasopressin content.

MATERIALS AND METHODS

Fourteen rabbits were studied: 12 water-deprived rabbits (two each at 48, 74, 96, 120, 144, or 168 hours of deprivation) and two control rabbits. Sagittal T1-weighted MR images were obtained before and after water deprivation. The signal intensity ratio of the posterior lobe to the pons was correlated with the vasopressin content in the posterior lobe, which was measured by means of radioimmunoassay.

RESULTS

Before water deprivation, high signal intensity in the posterior lobe was demonstrated clearly in all rabbits. The signal intensity ratio and vasopressin content in the posterior lobe gradually decreased with water deprivation. The signal intensity ratio correlated strongly with the vasopressin content in the posterior lobe (Pearson correlation coefficient, .809; P < .001).

CONCLUSION

The signal intensity ratio on T1-weighted MR images may be used as an indicator for the quantitative evaluation of the vasopressin content in the posterior lobe. The results strongly suggest that the origin of the high signal intensity in the posterior lobe on T1-weighted MR images is the vasopressin-neurophysin II-copeptin complex.

Plasma and neurohypophyseal content of vasopressin in diabetes mellitus

Vasopressin (VP) hypersecretion is known to occur in diabetes mellitus. Using magnetic resonance (MR) imaging, we evaluated the VP content of the posterior lobe of the pituitary gland in 22 patients with uncontrolled noninsulin-dependent diabetes mellitus. The mean VP level and hemoglobin A1c value were elevated; 6.8 +/- 6.8 pg/mL (normal, 0.3-3.5) and 11.7 +/- 2.1% (normal, < 6%). The signal intensity ratio of the posterior lobe to the pons was calculated on a MR T1-weighted image where the signal intensity reflects VP content and the posterior lobe has a characteristic hyperintense signal under normal conditions. The mean signal intensity ratio (1.34 +/- 0.22) was lower than that in 20 healthy subjects (1.56 +/- 0.13; P < 0.01). In 7 cases, the signal intensity ration was markedly decreased, and the hyperintense signal was absent. The hyperintense signal appeared after diabetic control in all 6 subjects who underwent follow-up MR examinations within 1-2 months. The VP content in the posterior lobe was decreased in patients with uncontrolled diabetes mellitus, which was thought to be caused by persistent VP hypersecretion. The persistent elevation of plasma VP might have some role in the initiation and progression of diabetic complications.

[Highly effective preoperative intraarterial infusion chemotherapy with CDDP for progressive uterine corpus cancer with a Sister Mary Joseph's nodule]

A 57-year-old female patient complained of atypical genital bleeding and a noxious emanation from her navel. A histological examination of the uterine body and the navel area confirmed a diagnosis of adenocarcinoma. We diagnosed it as IVb stage of uterine corpus cancer with a Sister Mary Joseph's nodule. We selectively administered intraarterial injection chemotherapy (Cisplatin 120 mg, Pirarubicin 40 mg) in the uterus and navel area (three times, once every three weeks) prior to surgery. The isolated uterus showed that the cancerous tissue had been eradicated, and we judged the cancer to be grade 3 following histopathological effective grading standards. The metastasis exhibited extreme shrinkage, but affirmed changes in the tumor quality. Currently, the patient is receiving maintenance therapy of 600 mg of Hysron H, and 600 mg of UFT. There are no indications of recurrence, and the patient is progressing well.

[A case of sacral neuroblastoma in an adult successfully treated with combination chemotherapy]

A 35-year-old woman was admitted with complaints of severe posterior femoral pain and was diagnosed as having sacral neuroblastoma by tumor open biopsy. After admission, combination chemotherapy consisting of CDDP, etoposide, CPA, and THP was started intra-arterially and intravenously. After 2 courses of chemotherapy, her symptoms markedly improved and the tumor size was reduced. Now, after completion of 16 courses of chemotherapy, she is in a state of partial remission. Hereafter, we intend to reconsider the treatment strategy including surgical therapy.

[Huge leiomyosarcoma of the mesentery: a case report]

A patient, a 63 year-old-man, was admitted suffering from discomfort in the left abdominal area; this proved to be a case of leiomyosarcoma of the mesentery. An upper gastrointestinal series revealed stenosis in the 3rd portion of the duodenum, and shift of the entire intestine to the right side. Computed tomography showed a giant mass lesion with a central necrosis. Selective arterial angiography showed a heterogeneous tumor stain with several feeders and drainage veins. A partial resection of the intestine around the Treitz's ligament and left hemicolectomy was required due to the tumor's invasion of the intestinal wall and transverse colon. The operation was successfully performed supported by the angiographic findings. The resected tumor was 23 cm in diameter, 2330 g in weight, and was filled with blood. The histological diagnosis was leiomyosarcoma of the mesentery. The patient has been doing well during the 6 months postoperative period.

Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus

BACKGROUND

Central diabetes insipidus may be familial, secondary to hypothalamic or pituitary disorders, or idiopathic. Idiopathic central diabetes insipidus is characterized by selective hypofunction of the hypothalamic-neurohypophysial system, but its cause is unknown.

METHODS

We studied 17 patients with idiopathic diabetes insipidus, in whom the duration of the disorder ranged from 2 months to 20 years. Only four patients had been treated with vasopressin before the study began. All the patients underwent endocrinologic studies and magnetic resonance imaging (MRI) with a 1.5-T superconducting unit, and two patients had biopsies of the neurohypophysis or the pituitary stalk.

RESULTS

Nine of the 17 patients had thickening of the pituitary stalk, enlargement of the neurohypophysis, or both and lacked the hyperintense signal of the normal neurohypophysis. In the remaining eight patients, the pituitary stalk and the neurohypophysis were normal, although the hyperintense signal was absent. The abnormalities of thickening and enlargement were seen on MRI only in the patients who had had diabetes insipidus for less than two years, and the abnormalities disappeared during follow-up, suggesting a self-limited process. In addition to vasopressin deficiency, two patients had mild hyperprolactinemia and nine had impaired secretory responses of growth hormone to insulin-induced hypoglycemia. The two biopsies revealed chronic inflammation, with infiltration of lymphocytes (mainly T lymphocytes) and plasma cells.

CONCLUSIONS

Diabetes insipidus can be caused by lymphocytic infundibuloneurohypophysitis, which can be detected by MRI. The natural course of the disorder is self-limited.

Acquired growth hormone deficiency due to pituitary stalk transection after head trauma in childhood

Two patients are reported with growth hormone deficiency due to head trauma in childhood. Although their injuries were outwardly only slight and there was no loss of consciousness and no subsequent neurological deficits, they exhibited gradual growth retardation from the time of the trauma. Provocative endocrinological tests showed growth hormone deficiency and MRI showed transection of the pituitary stalk. These findings suggest that ordinary head trauma, as well as perinatal insult and congenital abnormalities, could be a cause of growth hormone deficiency.

Radiation therapy for juvenile pilocytic astrocytoma of the pituitary stalk. Case report

A case of juvenile pilocytic astrocytoma of the pituitary stalk is reported. The patient presented with diabetes insipidus and growth retardation. Magnetic resonance (MR) imaging was useful in diagnosing the lesion. Although the tumor could not be completely removed by surgery, radiotherapy was effective and the residual tumor disappeared 6 months after irradiation. The patient's condition has remained stable and no recurrence has been observed by MR imaging in the 4 years since radiation therapy.

Magnetic resonance imaging of neurohypophyseal germinomas

The authors reviewed magnetic resonance (MR) images in seven cases of germinoma in the hypothalamoneurohypophyseal axis (HNA). The intrasellar portions were clearly identified in six germinomas. Two small germinomas of these six were located only in the neurohypophysis. The major parts of the four large germinomas were located below the optic chiasm, and the large intrasellar portions were demonstrated. The remaining one small germinoma was localized from the pituitary stalk to the third ventricular floor. These findings strongly suggest that the primary site of germinomas in the HNA is the neurohypophysis. In the four large germinomas, the tumor shape was similar to that of pituitary adenoma. The authors believe that age (limited to first three decades), symptoms (diabetes insipidus), MR findings (absence of normal hyperintense signal of the posterior pituitary on T1-weighted (T1WI) images, and homogeneous hypointensity to the pons on T1WI images/isointensity on T2-weighted images are important in differential diagnosis.

Hepatic abscess secondary to a fishbone penetrating the gastric wall: CT demonstration

Preoperative diagnosis of hepatic abscess due to foreign bodies penetrating the gastrointestinal tract is uncommon with conventional imaging methods. This report describes and illustrates a case of hepatic abscess secondary to a fishbone penetrating the gastric antrum wall which was diagnosed preoperatively by CT and confirmed at surgery. The value of CT in the preoperative diagnosis of cases of this kind is emphasized.

Neurohypophyseal function of an ectopic posterior lobe in patients with growth hormone deficiency

We studied the neurohypophyseal function of 20 patients with complete GH deficiency owing to pituitary stalk transection by means of the water deprivation and the hypertonic saline infusion test. In T1-weighted magnetic resonance images, high-signal intensity of the posterior lobe of the hypophysis was missing in all the patients. An ectopic posterior lobe was observed at the proximal stump of the transected stalk in 17 patients, whereas the 3 patients without ectopic posterior lobe had overt diabetes insipidus or intractable nocturnal enuresis. After water deprivation, 3 patients with large ectopic posterior lobes (length along the pituitary stalk axis exceeding 5 mm) showed urinary osmolality and plasma AVP levels as high as those of 13 patients with partial GH deficiency in whom magnetic resonance images revealed no abnormalities. On the other hand, 14 patients with small ectopic posterior lobes (length less than 5 mm) showed significantly lower urinary osmolality and plasma AVP levels than the patients with large ectopic posterior lobes (p less than 0.01 and p less than 0.01, respectively) and the patients with partial GH deficiency (p less than 0.01 and p less than 0.01, respectively). Urinary osmolality in the patients with small ectopic posterior lobes, however, was higher than that in 3 patients without ectopic posterior lobes (p less than 0.01). During the hypertonic saline infusion test, peak plasma AVP levels in the patients with small ectopic posterior lobes were significantly lower than those in the patients with partial GH deficiency (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Modulation of immune response against tumor cells by the in vivo administration of an autoreactive Th clone

The immunization of C3H mice with irradiated syngeneic MM48 tumor cells induced specific tumor-neutralizing cells (TNC). The TNC activity was mediated by the L3T4+, Ly-2- T cell population, and the generation of TNC coincided with the appearance of delayed-type hypersensitivity response against MM48 antigen. The administration of an auto-I-Ak reactive T helper cell clone MS202 to normal C3H mice resulted in the facilitation of growth of MM48 tumor due to the induction of T suppressor (Ts) cells. Splenic T cells from animals given this T cell clone inhibited the TNC activity of immunized mice resulting in the escape of MM48 from the TNC effect. The surface phenotype of the Ts cells was L3T4+, Ly-2-. The Ts cells induced by the clone MS202 were totally antigen-nonspecific, and were able to suppress both the effector and inductive processes of TNC. The results suggest the presence of a physiological MHC-restricted T cell circuit that regulates immune responses against the growing tumors.

Gamna-Gandy bodies of the spleen: evaluation with MR imaging

The authors retrospectively evaluated magnetic resonance (MR) images obtained in 64 patients with portal hypertension. Multiple low-intensity nodules were noted within the spleen in eight patients. In all eight cases, these nodules were most apparent on images obtained with the GRASS (gradient-recalled acquisition in the steady state) technique, which is known to be more sensitive to heterogeneity of the magnetic susceptibility, usually caused by hemosiderin deposition. In one of these cases, ultrasonography demonstrated diffuse hyperechoic spots that had been reported to represent Gamna-Gandy bodies of the spleen (ie, organized hemorrhage caused by portal hypertension). Although there was no pathologic proof in their series, the authors believe these low-intensity nodules seen on MR images may represent the hemosiderin deposits of Gamna-Gandy bodies.

Primary intrasellar microgerminoma detected by magnetic resonance imaging: case report

A case of primary intrasellar germinoma in a 24-year-old woman is presented. Her initial symptoms were diabetes insipidus and headaches. The neurological examination found no abnormalities, but the endocrinological examination disclosed a deficiency in growth hormone secretion. Her skull x-ray revealed a normal sella turcica, and a computed tomographic scan revealed no abnormal mass in the pituitary fossa, but a slightly enlarged stalk. Magnetic resonance imaging revealed a small tumor in the posterior lobe. Transsphenoidal exploration revealed a germinoma in the posterior pituitary lobe. Six cases of primary intrasellar germinoma, including our case, were reviewed. Our case is considered to be the smallest intrasellar germinoma yet reported.

Hyperintense signal of the posterior pituitary on T1-weighted MR images: an experimental study

The origin of the hyperintense signal (HIS) of the pituitary gland posterior lobe (PL) on T1-weighted magnetic resonance (MR) images was investigated. Six rabbits were imaged on a 1.5 T device before and after 2 weeks' feeding of hypertonic saline solution (phase I). Two were killed soon after the second imaging; the pituitary gland was examined histochemically for neurosecretory granules containing antidiuretic hormone (ADH). The other four rabbits were given regular water for another 2 weeks (phase II) and then were again imaged. The plasma ADH level was monitored at each imaging session. In all subjects, the signal intensity of the PL decreased at the end of phase I, and the HIS reappeared at the end of phase II. The neurosecretory granules in the PL significantly diminished in number in phase I. Plasma ADH levels significantly increased in phase I and returned to their normal range in phase II. These clear correlations between MR findings and hormonal and histochemical results strongly suggest that the source of the HIS of the PL is the neurosecretory granules containing ADH.

Enlarged uterus: differentiation between adenomyosis and leiomyoma with MR imaging

The potential of magnetic resonance (MR) imaging in differentiation of adenomyosis from leiomyoma was evaluated in 93 patients who had a palpable enlarged uterus that was suspect for leiomyoma or adenomyosis. In all cases, MR images were correlated with surgical/pathologic findings. Pathologic findings showed that 71 enlarged uteri were due to leiomyoma, including one leiomyosarcoma, and 16 were due to adenomyosis. The other six patients were shown to have an enlarged uterus attributable to simultaneous involvement of both lesions. On T2-weighted images, adenomyosis appeared as an ill-defined, relatively homogeneous low-signal-intensity area embedded with sparse high-intensity spots. In contrast, leiomyomas were well-circumscribed masses with a spectrum of signal intensity. The cause of uterine enlargement was correctly diagnosed with MR images in 92 of the 93 cases. It is concluded that MR imaging is highly accurate in helping to distinguish between adenomyosis and leiomyoma in cases of enlarged uterus.

Ectopic posterior lobe of the pituitary gland and intractable nocturnal enuresis in a case with pituitary dwarfism

An 11 5/12-year-old girl with pituitary dwarfism had intractable nocturnal enuresis. Magnetic resonance imaging revealed pituitary stalk transection and the formation of an ectopic posterior lobe. The results of responses to dehydration, infusion of hyperosmolar NaCl solution, and 1-desamino-8-D-arginine vasopressin showed that the nocturnal enuresis in the present case was due to a partial vasopressin deficiency. We suggest that the ectopic posterior lobe is one cause of nocturnal enuresis.

Carcinoma of the cervix: staging with MR imaging

Demonstration and staging of carcinoma of the cervix with magnetic resonance (MR) imaging was evaluated prospectively in 67 patients with histologically proven lesions. Findings were correlated with surgical/pathologic results obtained within 2 weeks. MR imaging had an accuracy of 95% in demonstrating invasive disease (stage IB or higher). It was capable of depicting the location and extent of tumor invasion of cervical stroma and helped detect tumor beneath relatively normal epithelium or within the endocervical canal that had not been detected by means of colposcopic biopsy. The overall accuracy of MR imaging in staging carcinoma of the cervix was 76%, and in demonstrating parametrial status, the overall accuracy was 89%. In 39 patients with proven invasive disease, the accuracy in demonstrating parametrial status was 82%. In 13 of these 39 patients the low-signal-intensity stromal ring of the cervix on MR images was completely preserved and there were no false-positive results. MR imaging is a highly promising method for directly demonstrating and staging carcinoma of the cervix and seems to be capable of providing answers to crucial questions regarding mode of therapy.

Post-transcriptional allelic exclusion of two functionally rearranged T cell receptor alpha genes

We cloned and sequenced T cell receptor (TCR) alpha and beta chain cDNA from a lambda gt10 library obtained from a murine I-Ak autoreactive helper T cell clone MS202. Two types of cDNA clones for the alpha chain and one for the beta chain were obtained. The two alpha chain transcripts used two different V alpha genes: V alpha 4, joined to J alpha 11.2; and V alpha 5, J alpha TA13. The four V alpha 4 cDNA clones obtained did not have a complete sequences, lacking the leader portion. The V alpha 4 genomic gene segment of MS202 was revealed to contain two exons corresponding to the V alpha 4.MD13 cDNA sequence, and the potential RNA splicing signals between the two exons were intact. Both of the alpha chain cDNA clones showed in-frame rearrangements. Immunoprecipitation of 125I-surface-labeled lysate of MS202 with anti-TCR antiserum and subsequent electrophonetic analyses indicated that only one of the alpha chain polypeptides was expressed on the cell surface. Thus, allelic exclusion of the alpha chain in MS202 is achieved by post-transcriptional regulation rather than rearrangements.

[Magnetic resonance imaging of the thorax]

We examined thirty-five patients with various chest diseases with cardiac gated Magnetic Resonance Imaging (MRI) at 1.5 tesla. Major advantages of MRI of the thorax are its abilities to display sagittal and coronal planes and to disclose vessels clearly without contrast media. We conclude MRI is useful in evaluating, 1) masses at the lung apex or base, 2) chest wall invasion, 3) hilar and mediastinal lymphadenopathy, 4) aortic aneurysm, and 5) bronchogenic cyst.

Hypothalamic-pituitary function in growth hormone-deficient patients with pituitary stalk transection

We compared 1.5 T magnetic resonance (MR) image findings with hypothalamic-pituitary function in 11 patients with idiopathic pituitary dwarfism, each of whom had a history of perinatal abnormalities, and 1 patient with posttraumatic pituitary dwarfism. MR imaging revealed transection of the pituitary stalk in all patients and the formation of an ectopic posterior lobe at the proximal stump in 9 patients, none of whom had polydipsia or polyuria. Three patients without an ectopic posterior lobe had diabetes insipidus. The 5 patients who had small pituitary glands (less than 2 mm in height) had hypothyroidism with low serum TSH concentrations and low serum cortisol responses to insulin-induced hypoglycemia; however, 7 patients with normal-sized pituitary glands had normal thyroid and adrenal function. The serum GH response to GHRH did not correlate with the size of the pituitary gland. The patients with small pituitary glands had delayed or prolonged serum TSH responses to TRH and impaired serum LH and FSH responses to GnRH; 4 of the patients with normal-sized pituitary glands had normal serum TSH, LH, and FSH responses. Only 2 patients had high basal serum PRL concentrations. The endocrinological data suggest that reestablishment of the hypothalamo-hypophyseal portal circulation, which cannot be seen by MR imaging, may occur. We suggest that the primary cause of idiopathic pituitary dwarfism in many patients is injury to the pituitary stalk at birth.

Spinal arteriovenous malformation: MR imaging

Ten patients with spinal arteriovenous malformations (AVMs) were examined with high-field-strength (1.5-T) magnetic resonance (MR) imaging and a surface coil (eight patients) or head coil (two patients). Four AVMs were intramedullary, and six were extramedullary. There was one case of Foix-Alajouanine disease (subacute necrotizing myelitis; thrombosed AVM). Three important pathologic findings--myelomalacia, total thrombosis, and wall thickening of the draining vein--were clearly demonstrated at MR imaging and confirmed at autopsy. A flow-sensitive sequence was valuable in the depiction of one intramedullary AVM as hyperintense, the postoperative evaluation of AVM, and the differentiation of nidus from old intramedullary hematoma. In other AVMs, cord edema, periradicular hematoma, and reversible changes of cord scalloping after surgery were demonstrated. MR imaging demonstrated various pathologic changes of the spinal cord that could not be detected with any other imaging method.

MR imaging of a group I case of Hallervorden-Spatz disease

Magnetic resonance (MR) imaging of a case of Hallervorden-Spatz disease (HSD) using a 1.5 T system is described. The patient showed progressive spastic diplegia with equinovarus deformity of the feet, dystonic postural movements, dysarthria, dysphagia, mental deterioration, optic nerve atrophy, and peripheral neuropathy. These clinical features were compatible with HSD. Symmetrical, decreased signal intensity was seen on both proton density weighted and T2-weighted spin echo images in the globus pallidus as well as in the substantia nigra (Group I). This MR finding suggests an increased iron deposition in these subcortical nuclei, which is characteristic of HSD. The characteristic MR imaging, together with the relevant clinical features, was considered to be useful for establishing the diagnosis of HSD.

Thyroid masses: MR imaging and pathologic correlation

The authors explored the capability of high-field-strength surface coil magnetic resonance (MR) imaging in disclosing the gross pathologic characteristics of thyroid masses (especially pseudocapsular and hemorrhagic degeneration). Twenty-four patients were examined, including 12 with papillary carcinoma, eight with adenoma, and four with adenomatous goiter. All patients underwent surgery within 2 days after MR imaging. Specimens were cut and correlated directly with MR images. The appearance of the pseudocapsule was classified into four types: A, intact and even thickness around the tumor; B, only partially present or even absent; C, intact but with uneven thickness; D, partially destroyed by tumor. MR imaging findings corresponded precisely with those of gross pathologic examination in all cases but four of adenoma. Type A pseudocapsules were found only in adenoma and type D only in papillary carcinoma. Although the number of cases in the series was limited, the authors conclude that MR images reflect gross pathologic findings well and that some characteristic findings are suggestive of benign or malignant disease.

Hemochromatosis of the pituitary gland: MR imaging

Magnetic resonance imaging of the pituitary gland in a patient with secondary hemochromatosis is described. On T1-weighted images, the anterior lobe had almost no signal intensity, and only the high-signal posterior lobe was seen. These findings are compatible with the distribution of iron deposition and clinical symptoms in hemochromatosis.

MR imaging of the sellar spine

Magnetic resonance images of two cases of sellar spine are reported. The sellar spine is an anatomical variant characterized by an osseous spine that arises in the midline from the dorsum sellae and protrudes into the pituitary fossa. On short repetition time/short echo time (T1-weighted) images the sellar spine is demonstrated as a hypointense structure within the high intensity posterior pituitary. We suggest that the sellar spine is the ossified remnant of the cephalic tip of the notochord.

Epitopes associated with major histocompatibility complex (MHC) restriction site of T cells. IV. I-J epitopes on MHC-restricted cloned T cells

We studied the expression of an I-Jk epitope on class II-restricted cloned L3T4+ T cells established from H-2k, H-2b, F1 and semiallogeneic radiation bone marrow chimeras by the inhibition of antigen-induced T cell proliferation and in vitro secondary antibody response, and by the direct immunofluorescence with a monoclonal anti-I-Jk. Both I-Ak- and I-Ek-restricted T cells were shown to carry the identical I-Jk epitope regardless of their genotypic origins, antigen specificity, and helper or suppressor function. None of the I-Ab-restricted clones derived from similar animals showed the I-Jk epitope. This isomorphism, regardless of the restriction specificity for I-Ak or I-Ek, contradicts the idea that I-J is an idiotypic determinant on class II-restricted T cell antigen receptor (TcR). In fact, the I-Jk epitope was not comodulated with TcR/T3 complex when incubated with an anti-T3 antibody, indicating that I-J is a new isomorphic receptor for self different from TcR alpha/beta heterodimers.

Analysis of two distinct B cell activation pathways mediated by a monoclonal T helper cell. II. T helper cell secretion of interleukin 4 selectively inhibits antigen-specific B cell activation by cognate, but not noncognate, interactions with T cells

A single monoclonal T helper (Th) clone can activate B cells in two distinct pathways; a cognate pathway requiring a major histocompatibility complex (MHC)-restricted T-B cell interaction, and a noncognate pathway not requiring an MHC-restricted T-B cell interaction. The present study was undertaken to investigate whether Th cells mediating a given immune response provide further regulatory function to B cells other than helper function. It was demonstrated that conditions of high antigen concentration which activate a noncognate B cell activation pathway simultaneously inhibit IgG responses. The inhibition is shown to be mediated by the T cell factor interleukin 4, produced by activated cloned Th cells. The inhibitory effect of this factor is directed to B cells and is MHC-unrestricted, antigen-nonspecific, and IgG class-specific. In addition to being susceptible to the effects of augmenting cells and suppressor cells, cloned Th cell populations can therefore themselves function as regulatory cells to inhibit IgG responses when stimulated with high dose of specific antigen. These results indicate that Th cells function to regulate B cells both positively and negatively, depending upon the activation conditions.

Analysis of two distinct B cell activation pathways mediated by a monoclonal T helper cell. II. T helper cell secretion of interleukin 4 selectively inhibits antigen-specific B cell activation by cognate, but not noncognate, interactions with T cells

A single monoclonal T helper (Th) clone can activate B cells in two distinct pathways; a cognate pathway requiring a major histocompatibility complex (MHC)-restricted T-B cell interaction, and a noncognate pathway not requiring an MHC-restricted T-B cell interaction. The present study was undertaken to investigate whether Th cells mediating a given immune response provide further regulatory function to B cells other than helper function. It was demonstrated that conditions of high antigen concentration which activate a noncognate B cell activation pathway simultaneously inhibit IgG responses. The inhibition is shown to be mediated by the T cell factor interleukin 4, produced by activated cloned Th cells. The inhibitory effect of this factor is directed to B cells and is MHC-unrestricted, antigen-nonspecific, and IgG class-specific. In addition to being susceptible to the effects of augmenting cells and suppressor cells, cloned Th cell populations can therefore themselves function as regulatory cells to inhibit IgG responses when stimulated with high dose of specific antigen. These results indicate that Th cells function to regulate B cells both positively and negatively, depending upon the activation conditions.

Tonsillar herniation on magnetic resonance imaging

To evaluate the risk of tonsillar herniation, the caudal pole of the cerebellar tonsil in posterior fossa mass lesions and anomalies was investigated with magnetic resonance imaging. The cerebellar tonsil was clearly demonstrated in relation to the surrounding structures on T1-weighted images in the paramedian or midline sagittal plane. In 78% of a control group of 50 cases, the tonsil was located just on or close to the upper border of the posterior lip of the foramen magnum. It was close to the line of the foramen magnum in 4 cases (8%), but displacement below this line was not observed in any case. In 18 cases of posterior fossa mass lesions, the tonsil tended to be in a lower position than in the control group, and tonsillar displacement below the foramen magnum was noted in 3 cases. Two of these cases had anterior medullary displacement with loss of the cerebrospinal fluid (CSF) space anterior to the tonsil; these patients had either rapid clinical deterioration or severe papilledema. In the remaining case and in 3 additional cases of Chiari malformation, the tonsils were displaced into the cervical canal with preservation of the CSF space, and the patients showed no signs of rapid clinical deterioration or increased intracranial pressure. The present study suggests that tonsillar displacement through the foramen magnum with associated anterior medullary displacement and loss of the CSF space anterior to the tonsil can be regarded as a sign of tonsillar herniation.

Adenomyosis: diagnosis with MR imaging

Magnetic resonance (MR) imaging characteristics of adenomyosis were studied in eight women (aged 37-49 years) who underwent hysterectomy, and detailed radiologic/pathologic correlation was conducted in all cases. Adenomyosis produced diffuse and smooth uterine enlargement. The extent of the lesion was clearly identified on images obtained with long repetition time and long echo time; a diffuse, low-intensity area accompanied by tiny high-intensity spots was seen subjacent to the endometrium. The area appeared as a localized or diffuse thickening of the junctional zone because it was often isointense with this zone. Pathologic examination confirmed that the extent of adenomyosis correlated well with the low-intensity region on MR images and that both hemorrhagic areas and nonbleeding endometrial tissue corresponded to the high-intensity spots. The lesion consisted of distorted and compacted smooth muscle cells, but microscopic studies failed to explain the definitive difference in intensity between areas of adenomyosis and myometrium.

Transection of the pituitary stalk: development of an ectopic posterior lobe assessed with MR imaging

Magnetic resonance (MR) imaging was performed in ten patients with pituitary stalk transection who had idiopathic pituitary dwarfism. Contiguous sagittal T1-weighted images were obtained in all cases, and, in some, axial or coronal images were taken for further evaluation. On MR images, normal anterior and posterior lobes of the pituitary gland can be clearly differentiated because the posterior lobe has a characteristic high intensity on T1-weighted images. In the ten patients, the high-intensity posterior lobe was not seen, but a similar high signal intensity was observed at the proximal stump in seven patients. This high-intensity area is the newly formed ectopic posterior lobe, which secretes antidiuretic hormone just as the posterior lobe would. When the ectopic lobe completely compensates for the impaired posterior lobe, endocrinologic data indicate normal posterior lobe function. However, MR imaging can reveal the transection of the pituitary stalk and formation of the ectopic lobe.

Metastatic nodules of hepatocellular carcinoma: detection with angiography, CT, and US

Accurate detection of intrahepatic metastases, or daughter nodules, of primary hepatocellular carcinoma is of crucial importance. Due to the introduction of infusion hepatic angiography, computed tomography (CT) after Lipiodol (iodized oil) infusion, and intraoperative ultrasound (US), tumors less than 10 mm in diameter are now frequently found. We compared the diagnostic accuracy of these three modalities in the detection of nodules in 45 patients who had hepatocellular carcinoma (confirmed by biopsy). CT with Lipiodol was superior to hepatic angiography in demonstrating nodules when they were overlapped by the primary tumor or very small in size. Intraoperative US demonstrated nodules in four avascular or hypovascular hepatocellular carcinomas, which both hepatic angiography and CT failed to demonstrate. In cases associated with severe liver cirrhosis, differentiation of small nodules from regenerating cirrhotic nodules was sometimes difficult with intraoperative US. The combined use of these three modalities is indispensable for the accurate detection of small nodules of metastatic hepatocellular carcinoma.

Thyroid gland: MR imaging

Magnetic resonance (MR) imaging was performed in eight healthy volunteers and 30 patients with histologically and endocrinologically proved thyroid diseases. The use of a surface coil greatly improved spatial resolution, and normal anatomic structures were well demonstrated. In thyroid tumors, the margin, pseudocapsule, and lymph nodes were easily detected. Smooth margins, lobulated margins, and pseudocapsules were found in both adenoma and papillary carcinoma, whereas unclear margins were found only in papillary carcinoma. An unclear margin between the tumor and adjacent normal thyroid tissue seemed to reflect an ill-defined tumor border on gross pathologic examination. Metastatic lymph nodes as small as 3 mm were seen. Identification of small vessels enabled detection of dilated vessels in thyroid parenchyma in patients with Graves disease. Hemorrhage (hemorrhagic degeneration) was often found in adenoma, papillary carcinoma, and adenomatous goiter, resulting in variable signal intensity.