CT findings of tuberculous peritonitis.

INTRODUCTION: The diagnosis of tuberculous peritonitis is still challenging and very important. Early and accurate diagnosis leads to an effective therapy and good survival rates. With the widespread use of computed tomography (CT) in the abdomen, it is important to be familiar with the spectrum of CT appearances seen in tuberculous peritonitis. Our retrospective study aims to describe the common CT features of this disease. METHODS: Abdominal CT images in 17 patients with tuberculous peritonitis in our institution from January 2002 to December 2005 were retrospectively reviewed. CT findings were evaluated for the presence of ascites, the abnormal patterns of mesentery, omentum and peritoneum. RESULTS: Ascites and mesentery involvement were present in all patients. The most common pattern of mesenteric changes was thickened soft tissue strands with crowded vascular bundles (65 percent). The involvement of the omentum was present in 15 patients (88 percent), and the most common type was smudged pattern (82 percent). Peritoneal involvement was present in 15 patients (88 percent). Smooth uniform thickening pattern was the most common type (76 percent). CONCLUSION: Common features in the patients with tuberculous peritonitis include the combination of free ascites, thickened strands with crowded vascular bundles within the mesentery, smudged pattern of the omental involvement and smooth uniform thickening of the peritoneum.

Computed tomography of biliary cystadenoma and biliary cystadenocarcinoma.

INTRODUCTION: Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare biliary ductal neoplasms of the liver. This study aims to describe the computed tomography (CT) findings of these neoplasms and to distinguish between both entities. METHODS: We retrospectively reviewed the CT findings of five patients with proven BCA and seven patients with proven BCAC at our institution from July 2000 to August 2006. The CT parameters were analysed, including number, size, location, and characteristics of the cystic lesion: presence and number of internal septation, calcifications and enhanced mural nodule. RESULTS: All 12 patients had a solitary, large well-defined intrahepatic cystic lesion. Lesions in all five patients with proven BCA (100 percent) and six patients with proven BCAC (86 percent) had a multilocular appearance. The remaining patient with proven BCAC had a unilocular lesion. Smooth, thin septa and walls were found in five patients with BCA (100 percent). The enhanced mural nodule at the septum or wall was identified in seven patients with BCAC (100 percent) but was not found in the BCA patients (p-value is less than 0.001). The other parameters including size, location and number of septa had no statistically significant differences between BCA and BCAC. CONCLUSION: BCA and BCAC should be considered in the differential diagnosis, when a solitary large well-defined multilocular intrahepatic cystic lesion is detected in a middle-aged woman. The presence of an enhanced mural nodule is the most important finding to suggest BCAC.

Hypotensive effect and toxicology of the extract from Coscinium fenestratum (Gaertn.) Colebr.

The water extract from Coscinium fenestratum (Gaertn.) Colebr. (CF extract) was tested for hypotensive and vasorelaxant effects. Acute and subchronic toxicity as well as motor activity of CF extract were also evaluated. The present study demonstrates that CF extract is effective in reducing blood pressure in anesthetized normotensive rats. This effect is shown to be dose-related and rapid in onset. The extract showed an endothelium-dependent and independent vasorelaxant activity in isolated aortic rings precontracted with phenylephrine (1 microM) and KCl (60 mM). The capacity of L-NAME (100 microM), an inhibitor of nitric oxide synthase, to reduce the vasorelaxant action of the extract indicates the involvement of nitric oxide. In the acute toxicity test, an oral dose of 5000 mg/kg of the CF extract did not produce mortality or significant changes of the general behavior of animals and gross appearance of internal organs of rats. Similarly, in the subchronic toxicity test, an oral dose of 2500 mg/kg/day of the CF extract given to rats for 90 days did not cause any significant change of any of the parameters observed when compared with those of the control animals. Moreover, the CF extract did not produce any effect on the central nervous system when spontaneous motor activity in rats was assessed. However, because some average hematological and blood chemistry values were found to be statistically different, further studies, including chronic toxicity test, should be done to confirm the safety of this plant when it is used over a long period of time.

Toxicity of crude rhizome extract of Kaempferia galanga L. (Proh Hom).

The ethanolic rhizome extract of Kaempferia galanga L. (Zingiberaceae) was studied by conventional pharmacological methods including the Hippocratic screening test, and acute and subacute toxicities in rats. The hexane fraction was tested for dermal irritation in rabbits. The ethanolic extract, when tested by the Hippocratic screening test, demonstrated signs that indicated CNS depression such as a decrease in motor activity and respiratory rate, and a loss of screen grip and analgesia. In the acute toxicity test, oral administration of 5 g/kg of Kaempferia galanga produced neither mortality nor significant differences in the body and organ weights between controls and treated animals. Moreover, both gross abnormalities and histopathological changes were not comparatively detectable between all controls and treated animals of both sexes. In subacute toxicity studies, no mortality was observed when varying doses of 25, 50 or 100 mg/kg of ethanolic Kaempferia galanga extract were administered orally per day for a period of 28 days. There were no significant differences in the body and organ weights between controls and treated animals of both sexes. Hematological analysis showed no differences in any of the parameters examined (WBC count, platelet, hematocrit and hemoglobin estimation) in either the control or treated groups of both sexes. However, the differential leukocyte counts showed a slight but significant decrease of lymphocyte count in the 50 and 100 mg/kg male rat groups. In the blood chemistry analysis, no significant change occurred in the blood chemistry parameters, including glucose, creatinine, blood urea nitrogen (BUN), aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (Alk-P), total protein and albumin of both sexes. Pathologically, neither gross abnormalities nor histopathological changes were observed. No sign of irritation was observed during the dermal irritation test of the hexane fraction of Kaempferia galanga.

Acute and subacute toxicities of the saponin mixture isolated from Schefflera leucantha Viguier.

Acute toxicity of the bronchodilator saponin mixture isolated from Schefflera leucantha Viguier leaves was investigated in comparison with the methanol and the water extract of this plant. Oral doses of 5000 mg/kg of the methanol extract, the water extract and the saponin mixture did not produce mortality or significant changes in the general behavior and gross appearance of internal organs of rats. Subacute toxicity of the saponin mixture was evaluated with the dose of 1000 mg/kg, orally for 14 days. An extra group (satellite group) was given saponin mixture and kept for a further 14 days after treatment. All animals did not show signs of toxicity during the experimental period. Liver weights of the saponin-treated and the satellite male groups were higher whereas testis weight were lower than those of the control group which received distilled water. However, the histological examination of various organs revealed that there were no differences between the control and the treated rats. BUN, Cr, AST, ALT and ALP levels increased in saponin-receiving rats. It is possible that the saponin mixture directly impacts on the liver and the kidney functions.

Eosinophilic enteritis caused chronic partial small intestinal obstruction: a case report and review of the literature.

This is the case-report of a rare cause of chronic small intestinal obstruction by eosinophilic enteritis. A 53-year-old woman presented with an 8-month history of severe intermittent abdominal colick associated with malnutrition, weight loss, and bowel habit change. Several investigations were done but failed to demonstrate the cause. Exploratory laparotomy was therefore performed and the cause of partial small bowel obstruction was found to be eosinophilic enteritis.

Quantitative estimation of renin-containing cells in the juxtaglomerular apparatus in Bartter's and pseudo-Bartter's syndromes.

Our colleagues have previously observed the number of renin-immunoreactive juxtaglomerular apparatus (JGA) in renal specimens from patients with Bartter's and pseudo-Bartter's syndromes and from the normal individual. The question we have is to what extent the renin-containing cells actually increased their cell number. It is easy to count the number of renin-positive JGA in the specimens. The data showed that the number of renin-positive glomeruli was 10-17 times more frequent in both syndromes than in the normal control. A geometrical calculation simply indicated that the probability of detection of a cell mass in a thin cross-section is proportional to the length of the target structure. The number of renin-containing cells per JGA is proportional to the increased rate of detection of renin-immunoreactive JGA per unit area, namely 10-17 times. This is true when we assume that renin-containing cells are solely located along the afferent arteriole, where differentiation toward renin-secreting cell occurs in a few layers just outside the arteriole in a longitudinal direction.

Antimutagenicity of lemon grass (Cymbopogon citratus Stapf) to various known mutagens in salmonella mutation assay.

Lemon grass (Cymbopogon citratus Stapf) was extracted with 80% ethanol. The extract was not found to be mutagenic in the Salmonella mutation test with or without metabolic activation. However, the extract was found to possess antimutagenic properties towards chemical-induced mutation in Salmonella typhimurium strains TA98 and TA100. Mutagenicity of AFB1, Trp-P-1, Trp-P-2, Glu-P-1, Glu-P-2, IQ, MNNG and AF-2, was inhibited by the extract of lemon grass in a dose-dependent manner, but no effect was found on the mutagenic activity of benzo[a]pyrene.

Neuroendocrine carcinoma of the urinary bladder: case report and review of the literature.

A 63-year-old Japanese man complained of hematuria and pollakisuria for several months. Computed tomography and cystography disclosed an infiltrative tumor mass in the irregularly thickened apical and posterior walls of the urinary bladder. Narrowing of the vesical lumen and posterior extension of the tumor into the pelvic cavity were also noted. After palliative ureterocutaneostomy, 60 Gy irradiation was given locally. The patient died of cachexia seven months later. Autopsy revealed neuroendocrine carcinoma of the urinary bladder with extensive invasions and metastases to the pelvic and peritoneal cavities, liver, lungs, vertebrae, left kidney and retroperitoneal lymph nodes. Histologically, atypical tumor cells with eosinophilic cytoplasm formed solid nests and anastomosing cords with pseudoglandular structures. No other histologic tumor components were included. An intact urachal remnant was found at the vesical apex while features of metaplastic cystitis were absent. In addition to positive carcinoembryonic antigen and cytokeratin, the argyrophilic cancer cells were immunoreactive for neuron-specific enolase, chromogranin A, serotonin, neuropeptide Y, glicentin, somatostatin, neurotensin and calcitonin. Ultrastructurally, neurosecretory-type granules, with a mean diameter of 166 nm, were identified in the cytoplasm of the tumor cells. To discuss the histogenesis of the tumor, 44 previously reported cases of neuroendocrine carcinoma of the urinary bladder were reviewed.

B-cell lymphoma with vimentin-positive cytoplasmic inclusions.

A 60-year-old woman complaining of cervical lymphadenopathy was admitted to Keiyu General Hospital, Yokohama. Malignant lymphoma involving systemic lymph nodes and the bilateral tonsils was suspected by computed tomography. The biopsy diagnosis of the cervical lymph nodes was B-cell lymphoma, diffuse medium-sized cell type. The cleaved centrocytic lymphoma cells were immunoreactive for CD20 and CD22 but negative for immunoglobulins. Characteristically, a considerable number of neoplastic lymphocytes possessed eosinophilic round inclusions in the cytoplasm. The inclusions were green in color by Papanicolaou staining, whereas they appeared vacuole-like in Giemsa-stained preparations. Ultrastructural study confirmed the presence of aggregates of intermediate-sized filamentous structures mainly in the perinuclear area. The rough endoplasmic reticulum and Golgi apparatus were poorly developed. Immunocytochemical staining using cytologic specimens and fresh-frozen sections disclosed that the inclusions were composed of vimentin filaments. Morphologic similarities to signet ring cell lymphoma are discussed.

Different effects of carbon tetrachloride on carcinogen-induced hepatocellular carcinoma and normal liver of the rat: lowered lipid peroxidation and accelerated necrosis in cancer.

To investigate molecular responses to lipid peroxidative stimuli in neoplastic cells, lipid peroxidation was induced in liver of rats bearing 3'-methyl-4-dimethylaminoazobenzene-induced hepatocellular carcinoma by injecting a high dose of carbon tetrachloride (CCl4), a strong lipoperoxidative reagent. Normal rat livers with or without CCl4 treatment served as controls. CCl4 administration markedly provoked fatty metamorphosis, visualized by oil red O staining, in normal livers while minimal fatty changes were seen in hepatocellular carcinomas, where necrosis was often observed instead. After CCl4 treatment, the thiobarbituric acid values (representing levels of lipid peroxides in the tissue) were increased two-fold in the untreated normal liver, but were unchanged in the cancer tissue. Levels of vitamin C, an acutely reactive antioxidant, measured by high-performance liquid chromatography were not influenced by the CCl4 injection in the cancer tissue whereas a significant decrease was evident in normal livers. The total fatty acid content, measured by gas chromatography, was significantly lower in the cancer tissue than in the normal liver while the ratio of polyunsaturated fatty acids (PUFAs) in total fatty acids was little changed. Resistance of hepatocellular cancer cells to fatty metamorphosis and their susceptibility to necrosis induced by free radicals may be due to the paucity of the target PUFAs in their cell membrane fraction, resulting in low levels of lipid peroxides. Peroxidation of PUFAs might act as a "shock absorber" against free radical-induced toxic cell death in normal cells.

Latent perianal Paget's disease associated with mucin-producing rectal adenocarcinoma. Report of two cases.

Two cases of latent perianal Paget's disease associated with mucin-producing papillary adenocarcinoma of the rectum are described. In both cases, the rectal tumors appeared as polypoid lesions located just above the dentate line. The adjacent anal squamous mucosa showed lateral invasion of alcianophilic mucin-containing Paget cells. Mucin histochemistry revealed the presence of O-acylated and non-O-acylated sialic acids in both neoplastic goblet cells in the adenocarcinomas and Paget cells in the anal mucosa. The Paget cells were immunoreactive diffusely for low-molecular-weight cytokeratin (CAM 5.2) and carcinoembryonic antigen, and focally for CA19-9, epithelial membrane antigen and CA15-3. All these substances were also expressed in the rectal adenocarcinomas but were negative or showed limited expression in the anal squamous epithelium. These findings indicated secondary epidermotropic infiltration of neoplastic goblet cells from the rectal adenocarcinomas.

Alpha-fetoprotein-producing urachal adenocarcinoma.

A 45-year-old Japanese male with a history of macroscopic hematuria for more than 6 months presented multiple metastatic lesions in the lungs. Cystoscopic examination demonstrated a large tumor mass protruding from the dome of the urinary bladder. Ultrasonography and CT highlighted a solid and cystic urachal tumor continuous from the vesical dome to the navel. Serum levels of alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) were elevated to 17,100 ng/ml and 17.7 ng/ml, respectively. He underwent palliative curettage of the vesical dome tumor twice, followed by chemotherapy with little effect. One year after admission, he died of progressive metastases to the lungs, left pleura, liver and brain. Final serum levels of AFP and CEA were 86,200 ng/ml and 60.9 ng/ml, respectively. The tumor was histologically classified as adenocarcinoma with a medullary growth pattern. Both papillotubular and solid (hepatoid) components were observed. The cancer cells were rich in glycogen and were immunoreactive diffusely for AFP and focally for CEA. CA15-3, CA19-9, epithelial membrane antigen and cytokeratin were also positive. In addition, argyrophilic cancer cells with immunoreactivities of neuron-specific enolase, chromagranin A and peptide YY were demonstrated. To our knowledge, this is the first reported case of AFP-producing adenocarcinoma of urachal origin.

An unusual form of chronic myeloproliferative disorder. Aleukemic basophilic leukemia.

A 52-year-old Japanese man manifested various clinical signs and symptoms such as vomiting, high fever, dyspnea, cough, sweating, palpitation, eosinophilic leukocytosis and hepatosplenomegaly. These histamine-related clinical manifestations showed a dramatic response to steroid therapy. After 10 months of hospitalization, he suddenly succumbed to candidal septicemia at the end of the third cycle of steroid therapy. Autopsy revealed neoplastic proliferation of immature basophils in various internal organs without involvement of the skin. The neoplastic cells, positive immunohistochemically for leukocyte common antigen, possessed lobulated nuclei and weakly metachromatic cytoplasmic granules, predominantly of the basophil type, which exhibited weak naphthol ASD-chloroacetate esterase activity. Mast cell-type granules were also observed ultrastructurally. The neoplastic infiltration was associated with fibrosis in the liver, spleen and bone marrow and with extramedullary hematopoiesis in the liver, spleen, lymph nodes and perihypophyseal tissue. The bone marrow showed uneven and multifocal involvement. Despite the lack of leukemic manifestations and the results of chromosomal analysis, the most suitable diagnosis was aleukemic basophilic leukemia within the category of chronic myeloproliferative disorder. Kinship of this neoplasia to systemic mastocytosis is discussed.

Functional interpretation of the kidney juxtaglomerular apparatus using renin immunohistochemistry in Bartter's, pseudo-Bartter's and Conn's syndromes.

A comparative study of renin immunoreactivity in the juxtaglomerular apparatus of the human kidney was performed using the indirect immunoperoxidase method on a random microscopic sections. In renal biopsies taken from a case of Bartter's syndrome and a case of pseudo-Bartter's syndrome, the number of renin-positive juxtaglomerular apparatus (JGA) and the number of renin-positive cells in each JGA were significantly greater than in five renal specimens from control autopsy cases. In Conn's syndrome, none of the glomeruli contained renin-immunoreactive JGA. The number of renin-positive cells/mm2 in the renal cortex in cases of Bartter's and pseudo-Bartter's syndromes were 17.5 and 20.3, respectively, while in the control group, the range was 0.78-1.77 (mean 1.08). Together with other histochemical findings routinely examined in renal specimens, renin immunohistochemistry on random sections may be helpful in diagnostic renal pathology.

Suppression of messenger ribonucleic acid for glutathione peroxidase in chemically induced rat hepatocellular carcinoma and its biological significance.

Deviations of the enzyme activity, immunoreactivity and messenger ribonucleic acid (mRNA) levels of glutathione peroxidase (GSH-PO) in 3'-methyl-4-dimethylaminoazobenzene- induced hepatocellular carcinoma of the rat were investigated. Enzyme activities of GSH-PO were significantly lower in hepatocellular carcinomas than those in the normal control rat liver. Immunohistochemically, GSH-PO was strongly localized in normal hepatocytes, but was only faintly stained in hepatocellular carcinoma cells. Heterogeneous staining patterns of GSH-PO were observed among individual cancer cells. In Northern blot analysis, GSH-PO mRNA in the cancer tissue was decreased to two thirds of the level in normal hepatocytes. It was suggested that suppressed expression of GSH-PO in carcinogen-induced hepatocellular carcinomas occurred at the level of mRNA transcription.

Rectal carcinoid tumor metastasizing to the thyroid and pancreas. An autopsy case exploiting immunohistochemistry for differentiation from tumors involving multiple endocrine organs.

A 58-year-old male patient with rectal carcinoid tumor is presented. The tumor extensively involved the lymph nodes and liver, and multiple tumors were also recognized in the pancreas and thyroid. Grossly, it was uncertain whether the latter were metastases from the rectal carcinoid or all were coincident primary tumors involving multiple endocrine organs, so-called multiple endocrine neoplasia (MEN) syndrome. Histologic, histochemical and electron microscopic examinations of the tumors in both the pancreas and thyroid showed similar features to those of the rectal carcinoid. The neoplastic cells in all involved organs commonly expressed positive immunoreactivity for somatostatin, but negativity for carcinoembryonic antigen, calcitonin, calcitonin gene-related peptide, thyroglobulin, insulin, glucagon and pancreatic polypeptide. These immunohistochemical results confirmed that the tumors observed in multiple endocrine organs were indeed metastatic from the rectal carcinoid, rather than being a new combination of MEN syndrome. Some neuroendocrine tumors may develop widespread metastasis, sometimes creating problems with differentiation from multiple primary endocrine tumors. Immunohistochemistry may be of great help in setting this issue.

An autopsy case of so-called midline malignant reticulosis followed by extensive dissemination with immunohistochemical evidence for its T cell malignancy.

An autopsy case of malignant midline reticulosis (MMR) is reported. The patient, a 42-year-old Japanese male, died after a clinical course of 22 months. Autopsy revealed extensive infiltration of generalized organs by the tumor cells, suggesting that the disease was highly malignant in nature. Staining with monoclonal antibodies against T-cell surface antigens Leu 4 on frozen sections and UCHL1 on paraffin-embedded sections enabled us to examine the phenotype of the tumor cells with good morphological preservation and to verify the T cell nature of the tumor.

C cell carcinoma of the thyroid. Follicular variant.

A case of C cell carcinoma of the thyroid with an unusual follicular growth pattern of the cancerous C cells is described. The primary tumor consisted of a mixture of medullary and follicular features while the metastatic foci in the lymph nodes and liver displayed only a medullary arrangement. Histochemical study disclosed numerous argyrophilic cells in both the follicular and medullary parts. These cells were immunohistochemically positive for calcitonin, calcitonin gene-related peptide (CGRP) and other peptides as well as carcinoembryonic antigen (CEA), but negative for thyroglobulin. Radioimmunoassay done on the tissue extract revealed a high content of calcitonin. Electron microscopy showed small intracytoplasmic secretory granules and, in the follicular lining cells, formation of microvilli. A minor component consisting of glandular structures has been reported in medullary carcinoma of the thyroid, suggesting a potentiality for glandular differentiation of the C cells. In equivocal cases, immunohistochemical examination for calcitonin and thyroglobulin is essential for accurate diagnosis of thyroid carcinoma.

Gastric carcinoma with lymphoid stroma. Analysis using mucin histochemistry and immunohistochemistry.

A total of 626 surgically resected gastric carcinomas were reviewed, and 24 cases (3.8%) of "gastric carcinoma with lymphoid stroma" were identified. The tumour cells were consistently arranged in an anastomosing trabecular or alveolar pattern and were densely infiltrated by lymphoid cells. The specimens were studied using mucin histochemistry and the indirect immunoperoxidase method to determine the histochemical properties of this form of gastric carcinoma. The tumour cells were consistently positive for concanavalin A paradoxical staining, class III and almost devoid of acidic mucins, features demonstrating preferential differentiation toward pyloric glands or pseudopyloric glands. Immunohistochemically, positive reactions for Leu M1 and lysozyme, marker substances of (pseudo)pyloric gland cells, were often observed. Carcinoembryonic antigen was positive in focal areas without (pseudo)pyloric glandular patterns. Secretory component was focally positive. HLA-DR was strongly expressed in most cancer cells and 17 tumours (71%) showed positivity for interleukin 1 (IL-1). The lymphoid stroma contained a high percentage of UCHL1-reactive T cells both within and around the cancer cell nests, while SL26-reactive B cells clustered in lymphoid follicles. A considerable number of T-lymphoid cells were also reactive for IL-1. A number of plasma cells with a predominance of IgG-type were distributed around the cancer cell nests. S-100 protein-positive dendritic cells were not identified. We speculate that the prominent lymphoid stroma including intraepithelial lymphocyte-like T cells with IL-1 receptors is possibly induced by IL-1 related mediators released from the HLA-DR-positive gastric cancer cells of the (pseudo)pyloric gland-type.