Gastrointestinal Obstruction due to Solitary Lymph Node Recurrence of Alpha-Fetoprotein-Producing Gastric Carcinoma with Enteroblastic Differentiation.

We report an unusual case of alpha-fetoprotein (AFP)-producing gastric carcinoma with enteroblastic differentiation. A 75-year-old woman was admitted to our hospital with occasional upper abdominal discomfort. We performed gastroscopy and observed a type 2 tumor, primarily in the pyloric region. Histological examination of biopsies confirmed gastric adenocarcinoma. Based on these findings, we diagnosed gastric adenocarcinoma and performed laparoscopic distal gastrectomy with lymph node dissection. Histological examination revealed an invasive lesion composed of adenocarcinoma with a tubulopapillary growth pattern. Tumor cells were cuboidal in shape with characteristically clear cytoplasm rich in glycogen. Two regional lymph node metastases were seen microscopically. Immunohistochemically these cells were positive for AFP, carcinoembryonic antigen, caudal-type homeobox transcription factor 2 and common acute lymphoblastic leukemia antigen. The final diagnosis was AFP-producing gastric carcinoma with enteroblastic differentiation. 26 months after initial surgery, the patient was readmitted to our hospital for gastrointestinal obstruction due to lymph node recurrence.

Changes of Tight Junction Protein Claudins in Small Intestine and Kidney Tissues of Mice Fed a DDC Diet.

DDC (3,5-diethoxycarbonyl-1,4-dihydrocollidine)-fed mice are widely used as a model for cholestatic liver disease. We examined the expression of tight junction protein claudin subspecies by immunofluorescent histochemistry in small intestine and kidney tissues of mice fed a DDC diet for 12 weeks. In the small intestine, decreases in claudin-3, claudin-7 and claudin-15 were observed in villous epithelial cells corresponding to the severity of histological changes while leaving the abundance of these claudin subspecies unchanged in crypt cells. Nevertheless, the proliferative activity of intestinal crypt cells measured by immunohistochemistry for Ki-67 decreased in the mice fed the DDC diet compared with that of control mice. These results suggest the possibility that DDC feeding affects the barrier function of villous epithelial cells and thus inhibits the proliferative activity of crypt epithelial cells. On the other hand, in the kidney, remarkable changes were found in the subcellular localization of claudin subspecies in a segment-specific manner, although histological changes of renal epithelial cells were quite minimal. These results indicate that immunohistochemistry for claudin subspecies can serve as a useful tool for detecting minute functional alterations of intestinal and renal epithelial cells.

Goblet cell carcinoid of the rectum with lymph node metastasis: report of a case.

We report an unusual case of goblet cell carcinoid (GCC) of the rectum. A 75-year-old man was admitted to our hospital with anal bleeding, and a hard tumor was felt on the anterior wall of the lower rectum during rectal examination. We performed colonoscopy, and found a 30-mm type 2 tumor in the lower rectum and anal canal. Histological examination of biopsies revealed rectal adenocarcinoma. Based on these findings, we diagnosed rectal adenocarcinoma and performed Miles' operation with lymph node dissection. Histological examination revealed an invasive lesion composed of signet-ring-like cells. Seven regional lymph node metastases were seen microscopically. The tumor produced copious mucin, which was stained with Alcian blue. Immunohistochemistry was positive for synaptophysin, chromogranin A, CD56, carcinoembryonic antigen, p53, Ki-67, E-cadherin, and cytokeratin 20. The final diagnosis was GCC of the rectum.

Progressive liver fibrosis in late-onset argininosuccinate lyase deficiency.

A 4-month-old boy, with late-onset argininosuccinate lyase (ASL) deficiency with hepatomegaly, was treated by protein restricted diet and arginine supplementation; he was followed for 3 years. Hepatomegaly and mild liver dysfunction persisted without significant hyperammonemia. He maintained normal psychomotor development to the age of 12 months, but, at 3 years of age, his developmental status is in the borderline normal range. Liver biopsy performed at 12 months of age demonstrated swollen and pale hepatocytes with abnormal glycogen deposition and mild periportal fibrosis. A subsequent liver biopsy at 3 years of age showed progressive liver fibrosis in the periportal and central areas, which extended into the liver lobule. These findings suggest that liver impairment in ASL deficiency may advance without significant hyperammonemia and underline the importance of repeated liver biopsy in this disorder, even when the plasma ammonia level is well controlled.

SS1 Helicobacter pylori disrupts the paracellular barrier of the gastric mucosa and leads to neutrophilic gastritis in mice.

Helicobacter pylori induces severe neutrophilic infiltration in the lamina propria of the stomach, which leads to gastritis in humans. The possible involvement of a paracellular route for bacterial nutrients and etiologic agents that may play an important role in colonization of the bacteria and cause gastritis has been suggested. To study the functions of the paracellular barrier of gastric surface epithelium, SS1, a strain of H. pylori adapted to the murine stomach, was inoculated into the stomachs of C57BL/6 mice. At 4 months after inoculation, SS1 had achieved a high level of colonization (10(6)-10(7) colony-forming units/g tissue) associated with neutrophilic infiltration in the lamina propria of the junctional zone. Disruption of the paracellular barrier was observed in the SS1-infected stomachs, as revealed by the invasion of a lanthanum tracer into the paracellular space of the surface epithelium. Only 2% of junctions were permeable in control stomachs, whereas 72% of the paracellular barrier was disrupted in the SS1-infected gastric epithelia. Furthermore, distribution of tight junction-related molecules such as 7H6 antigen, occludin, and cortical actin was affected in the surface epithelium by SS1 infection. The linear expression pattern of occludin was disrupted and became irregular or punctuated. The 7H6 antigen accumulated as aggregates in the apical portion of the surface epithelium and cortical actin became irregular and punctuated. Taken together, these results indicate that infection by SS1 directly or indirectly caused an increase in paracellular permeability and altered the localization of tight junction-related molecules of the gastric surface epithelium. This observation suggests that the paracellular pathway may play a significant role in establishing H. pylori-induced gastritis in the clinical setting.

Bile canalicular barrier function and expression of tight-junctional molecules in rat hepatocytes during common bile duct ligation.

Tight junctions of hepatocytes form the intercellular barrier between the blood circulation and bile flow. We focused on early stages of common bile duct ligation to observe changes in tight junctions without the irreversible changes seen after lengthy ligation. Common bile ducts of 12-week-old male rats were ligated for 6 h because, at this time point, no histological changes were observed. Serum bilirubin and bile acid levels began to increase 3 h after ligation and were restored to the control level immediately after surgical removal of the ligation. To examine the barrier of hapatocytes, horseradish peroxidase was injected via the femoral vein, and bile was collected for the first 10 min. A four-fold elevation of the secretion and concentration was observed in the bile of ligated rats compared with that of control animals. We next examined lanthanum permeability by perfusion fixation of the liver. At 6 h after ligation, both dilation of the bile canaliculi and partial loss of microvilli were commonly observed. There were dense deposits of lanthanum in almost all bile canaliculi of ligated rats. In control animals, neither dilation of the bile canaliculi nor loss of microvilli was detected, and only 44% of bile canaliculi exhibited deposits. An apparent increase of occludin mRNA expression was detected in livers after 6 h ligation, whereas the expression of claudin-1, -2, and -3 was not influenced by ligation. These results indicate that regulation of occludin gene expression is different from that of claudin-1, -2, and -3. The early phase of bile stasis employed in this study is thought to be an indispensable approach for understanding the precise regulation of tight junctions.

Occludin modulates organization of perijunctional circumferential actin in rat endothelial cells.

The tight junction is not a constitutional junctional apparatus in endothelial cells, but develops in a particular lineage of endothelia, such as the capillary endothelia in the brain and retina, and thus is considered to be pivotal for the maintenance of the blood-tissue barrier. Occludin is an integral membrane component of tight junctions, but the role of occludin in the endothelial cell function remains to be elucidated. We have cloned and transfected rat full-length occludin cDNA into a rat endothelial cell line (RLE) that expressed only a trace amount of occludin with no fine circumferential actin bundles at the cell border in native conditions. Occludin was expressed at the cell border of RLE cells, and circumferential fine actin bundles developed in close relation to the sites of occludin localization. Even under subconfluent culture conditions, fine circumferential actin bundles were formed at the sites where occludin-positive cell-cell contact was achieved. In immunoelectron microscopy, occludin was localized at distinct areas of the plasma membrane, always in association with the cytoplasmic actin filaments. On the other hand, actin bundles were not seen in occludin-negative juxtaposing plasma membranes. Collectively, these data strongly suggested a possible determinant function of occludin for the organization of actin in endothelial cells.

Electron microscopic and immunohistochemical studies of gastrointestinal stromal tumors.

Sixteen gastrointestinal stromal tumors (GISTs) were studied by immunohistochemical analysis and an ultrastructural procedure. The tumor locations were as follows: esophagus (2), stomach (7), small intestine (3), and large intestine (4). Four of the lesions were classified as malignant, 2 as borderline, and 10 as benign. On the basis of the immunohistochemical analysis, the tumors were classified as follows: 1 as myogenic type, 2 as Schwann cell type, 8 as Cajal cell type (including 2 gastrointestinal autonomic nerve tumors, GANTs), and 5 as mixed-cell type. In each subtype the phenotype was compared to the ultrastructural findings. Myogenic and Schwann cell type revealed ultrastructurally smooth muscle differentiation and schwannian tumor. All 8 tumors of the Cajal cell type revealed interdigitating cytoplasmic processes with occasional clusters of filopodia. Two tumors were subdivided as GANT. Five tumors of mixed-cell type were composed of a mixture of cells with variable myogenic features or variable neural differentiation. We confirmed in this study that immunohistochemical analysis reflected electron microscopic findings.