Immunohistochemical localization of gonadotropin-associated peptide (GAP) in the human hypothalamus.

GAP was immunohistochemically localized for the first time in the human hypothalamus. GAP-immunoreactivity was present in the cytoplasm of neuronal cells in the arcuate nucleus. GAP-immunoreactive nerve fibers were also present in the primary plexus around capillaries in the infundibular region. No GAP-immunoreactive neurons were detected in the paraventricular nuclei or supraoptic nuclei.

Precancerous lesions of the gallbladder mucosa.

To elucidate the morphological characteristics and the incidence of precancerous lesions of the gallbladder, 200 gallbladders removed for presumed benign diseases were examined histopathologically. Dysplastic epithelia with distinct cellular and structural atypia were graded into either mild or moderate to severe degree. Twenty-nine (14.5%) of 200 cases showed dysplasia; 5 (2.5%) was to moderate to severe degree and 24 (12%) to mild degree. Carcinoma in situ was found in 4 cases (2%) and occult invasive carcinoma in 2 cases (1%). Simple hyperplasia was seen in 54 cases (27%). Abnormal epithelia showed a male preponderance in consistent with the previous report on cancer epidemiology in Japan. Dysplasia and hyperplasia were found to have close association with chronic cholecystitis, but not with gallstones per se. It was postulated that the progression of dysplasia or carcinoma in situ into invasive carcinoma may occur in the sixties to seventies.

Sinus histiocytosis with massive lymphadenopathy. A histogenic analysis of histiocytes found in the fourth Japanese case.

The present paper deals with immunohistochemical and ultrastructural study of the lymph nodes of sinus histiocytosis with massive lymphadenopathy (Rosai and Dorfman, SHML) of a 12-year-old Japanese boy. This is the fourth case in Japan. Osseous manifestation was also found in the bilateral ulnae. With hallmarks of S-100 protein and interdigitating cytoplasmic extensions, the phagocytizing histiocytes proliferating in the sinuses were considered to be derived mostly from interdigitating cells in the paracortex or T cell dependent area, which have heretofore been regarded as nonphagocytizing. Furthermore, it is most interesting that lymphoid cells bearing thymic cortical cell-antigen (OKT 6) were increasingly recognized in the patient's peripheral blood. These results suggested that SHML is a specialized reactive histiocytosis analogous to histiocytosis X and histiocytic medullary reticulosis.

Giant hyperplasiogenous polyp of the stomach simulating malignant polyp.

A surgical case of giant hyperplasiogenous polyp of the stomach with unusual radiological and pathological findings is presented. Radiological and endoscopical examinations revealed characteristic papillary (villous) features simulating either true adenoma or malignant polyp of the antrum. Complete serial sections from the resected stomach disclosed no malignant area anywhere in and out of the polyp. The pathomorphological nature and radiological characteristics of this rare lesion are discussed.

Pulmonary hypertension associated with liver cirrhosis and hepatitis-B antigenemia.

An autopsy case of pulmonary hypertension in a 29-year-old Japanese female with macronodular, posthepatic liver cirrhosis and hepatitis-B antigenemia was presented. No recognizable known cardio-pulmonary disease or portal thrombosis was obtained. Hepatitis-B antigen was demonstrated in the cirrhotic hepatocytes by a specific peroxidase antiperoxidase method. Characteristic pulmonary arterial changes including plexiform lesions with varying developmental stages were widely observed throughout the lungs. Complication of these two distinct disease processes seems to be rarely encountered in the literature. Discussion was focused on the possible interrelationship between the liver cirrhosis with hepatitis-B antigenemia and pulmonary hypertension. Proposed were presumptive underlying humoral, particularly immunological, abnormalities common to these diseases rather than mere incidental complications.

Dysplasia and carcinoma in situ of the exocrine pancreas.

To clarify the morphological aspect of precancerous and related lesions of the exocrine pancreas, histological studies were carried out according to a systematized protocol. The pancreas, its head, body and tail including the papilla and adjacent duodenal mucosa and the distal common bile duct from 206 unselective autopsy cases, excluding those of pancreatic carcinoma, were systematically examined. Histological grading of dysplasia was performed based on structural (SAT) and cellular (CAT) atypia which were evaluated by coding 0, 1, 2, and 3. Dysplasia and related changes were encountered in 75 cases (36%) including 6 carcinoma in situ. 1 occult invasive carcinoma (3%), and 10 moderate to severe dysplasias (5%). Of these 75, 46 were associated with parenchymal fibrosis but 29 were not. Simple epithelial hyperplasia and squamous metaplasia were observed in 90 cases (44%), and 34 cases (17%), respectively. Among 90 hyperplasias, 61 were associated with fibrosis, but 29 were not. The incidence of these epithelial abnormalities was higher than that reported in the previous papers. Both dysplasia and hyperplasia showed characteristic age, sex and site preponderances. An intimate relationship between dysplasia and chronic pancreatitis, and possible transition from dysplasia into carcinoma in situ and then invasive cancer were emphasized.

Autopsy findings in a case of acute paraquat poisoning with extensive cerebral purpura.

An autopsy case of paraquat poisoning in an adult male died on the 6th day of intoxication was presented. Histological and electron microscopic observations demonstrated interstitial pneumonia with distinct interstitial fibrosis and the initial stage of alveolar fibrosis with coexisting edema and hyaline membrane formation. Striking hemorrhagic leukoencephalopathy, i.e. 'purpura cerebri,' was noted throughout the central nervous system involving almost exclusively the white matter. It consisted of focal hemorrhages of various stages accompanied by demyelinating processes of various extent. Globular and/or amorphous proteinaceous materials of uncertain nature were demonstrated in the vascular lumina throughout the brain.

Evaluation of esophageal dysplasia by cytofluorometric analysis.

In order to grade objectively and characterize dysplastic and precancerous esophageal epithelium its DNA content was measured by cytofluormetric methods and compared to normal and cancerous esophageal epithelium. This yielded the following results. With transition of the esophageal eipthelium from mild dysplasia to severe dysplasia and finally to in situ carcinoma, Feulgen-DNA values showed patterns characteristic of a tetraploid population. They lacked prominent peaks which were usually observed with invasive carcinomas. Dominant near-tetraploid population and definite tetraploid-octoploid populations were characteristic of severe dysplasia or carcinoma. The mean Feulgen-DNA values were significantly larger in severe dysplasia than in the lesser grade of dysplasia as well as the normal epithelium. However, this was not the rule in the full blown carcinomas. It would appear that the esophageal cytophotometric patterns are analogous to those previously observed in the skin and uterine cervix.

Epithelial dysplasia in cancerous and noncancerous esophagi.

Subserial examinations of the noncancerous esophagus from 86 autopsy materials (male 47, female 39) in Kagoshima Prefecture revealed epithelial dysplasia in 54 instances (63%); 32 males (68%) and 22 females (57%). Higher grades of dysplasia were shown in 17 males (36%) and 3 females (8%). Histologically a formation of the rete ridge-like elongation of basal epithelium was characteristically conspicuous in these materials. Tabacco and alcohol intakes were regarded as promoting factors of dysplasia. Distribution and severity of dysplasia around carcinoma were histologically examined on semiserial blocks in 100 surgical materials under the consideration of preoperative treatment. A coexistence of carcinoma with extensive dysplasia was found in 24 instances and that with multifocal dysplasia in 46. Multicentric in situ carcinoma was found in 19 patients. These in situ carcinomas were frequently surrounded by severe dysplasia and occasionally showed gradual transition to the latter. The lesion of invasive carcinoma sometimes did not show sharp demarcation from the surrounding mucosa, especially in cases of well differentiated squamous cell carcinoma. The results indicate that dysplasia plays a significant role on carcinogenesis of the esophagus as a precursor lesion.

Comparative studies on dysplasia of esophageal epithelium in four prefectures of Japan (Miyagi, Nara, Wakayama and Aomori) with reference to risk of carcinoma.

Distal two-thirds of the esophagus without macroscopically detectable malignant lesions from a total of 248 autopsy cases were examined for epithelial dysplasia on histological sections from serial blocks. The autopsy specimens had been obtained from Miyagi. Nara and Wakayama prefectures known for high incidence of esophageal carcinoma in Japan, and Aomori prefecture where the incidence of the disease is low. Epithelial dysplasia was classified into mild, moderate, and severe including carcinoma in situ according to the grade of epithelial atypism. Of 248 cases 91 (36.7%) had epithelial dysplasia and 30 (12.1%) had moderate and severe dysplasia. In one of the cases of severe dysplasia, in situ carcinoma was diagnosed. Lesions of dysplasia of the resected specimen were displayed in a diagram for the distribution of the abnormal epithelium. Cases of higher grade dysplasia tended more extensive in area and were slightly dominant in the distal third of the esophagus. Possible relationships of dysplasia with long-standing irritation to the esophagus and with precancerous lesions were discussed.