Glomangioma in the nasal cavity and paranasal sinuses.

The glomangioma is a hyperplastic lesion of the glomus body. This uncommon tumor is seldom located in the nasal cavity or paranasal sinuses. We present what is to our knowledge the eleventh documented case of an intranasal glomangioma. The differential diagnosis of this lesion, its symptoms, pathogenesis and therapy are discussed. Complete excision is normally curative for this tumor.

Comparative assessment of cell proliferation and accumulation of extracellular matrix in nasal polyps.

In nasal polyps constantly associated with chronic inflammation, a dysregulation of epithelial cell proliferation has been described. Involvement of extracellular matrix accumulation is also suggested in the formation and growth of nasal polyps. In this study, we attempted to evaluate the activity of the proliferation of epithelial cells and fibroblasts and the relation between fibronectin accumulation and these cell proliferations in nasal polyps. The pathological specimens of 30 patients were examined which manifested proliferating cell nuclear antigen (PCNA) expression in epithelial cells and fibroblasts and in fibronectin expression. PCNA expression was quantified by calculating the index for each sample. No significant difference in PCNA index was found between epithelial cells and fibroblasts. However, a significant correlation was found between the epithelial and fibroblastic PCNA index. In addition, fibronectin immunopositivity was well correlated with the activity of proliferation of fibroblasts. Therefore, proliferation of fibroblasts is also an important factor in the growth of nasal polyps, and its relationship with fibronectin accumulation may play a role in the pathogenesis of nasal polyposis.

Hereditary ceruloplasmin deficiency with hemosiderosis.

Hereditary ceruloplasmin deficiency with hemosiderosis (aceruloplasminemia) is a new disease characterized by systemic hemosiderosis, diabetes mellitus, neurological abnormalities and pigment degeneration of the retina. Loss of the ferroxidase activity of ceruloplasmin results in systemic iron deposition and tissue damage. Neuroimaging studies reveal iron deposition in basal ganglia and in the red and dentate nuclei. Cerebellar ataxia, extrapyramidal signs and dementia develop after middle age. We report a patient with undetectable serum ceruloplasmin levels and the above clinical manifestations. Sequence analysis of the cDNA of ceruloplasmin from this patient revealed an insertion of adenine in exon 3; this produced a premature stop codon.

[Three cases of vas deferens calcification].

Three patients with calcification of the bilateral vas deferens, revealed by plain X-ray, pelvic computerized tomography and/or vesiculography, are reported. Although they came to our department because of acute left epididymitis, right ureteral calculus and right undescended testis respectively, these diseases were not the causative factors for the calcification. Since no other probable causes including tuberculosis and diabetes-mellitus were found, the cause of disease was unknown.

[Case report of miliary TB, with mediastinal TB involving the aorta, trachea and esophagus with death due to hemorrhage from perforation of aorta into the esophagus during treatment].

A 32-year-old male was diagnosed as having miliary tuberculosis in May 1990. In spite of antituberculosis chemotherapy, he developed tuberculous meningitis and intracranial tuberculoma in September 1990. Miliary shadows on chest X-ray disappeared in December 1990. However, he developed left atelectasis, and bronchofiberscopy revealed soft tumor in the left main bronchus in January 1991. He suddenly vomited large amounts of blood and expired in February 1991. At autopsy, tuberculous lymphadenitis and cavitation were noted in the mediastinum, through which the left main bronchus, esophagus and descending aorta communicated. The patient died of massive bleeding which resulted from the rupture of tuberculous aortitis into the esophagus. This is a very rare case of tuberculous aortic aneurysm rupturing into both the bronchus and esophagus.

[A case of genital tuberculosis occurring in the tunica albuginea and the tunica vaginalis].

We report a case of genital tuberculosis occurring in the tunica albuginea and the tunica vaginalis. A 29-year-old man came to our department with the complaint of a nodule in the right scrotum. The physical and radiological examinations revealed no signs of pulmonary or urogenital tuberculosis. The urine and the semen were clear and negative in culture of acid fast bacteria, but the tuberculin reaction was moderately positive. Surgical exploration revealed a white yellowish soybean sized nodule in the surface of the tunica albuginea of the right testicle apart from the epididymidis, and we therefore enucleated it. No abnormalities were found in other parts of the tunica vaginalis, epididymidis or the funiculus. Histopathological examination demonstrated typical tuberculomas in the tunica albuginea and the tunica vaginalis, but the seminiferous tubules were almost intact. We diagnosed this case as tuberculosis arising in the tunica albuginea and the tunica vaginalis and started antituberculosis therapy.

[Two cases of renal cell carcinoma accompanied with ossification].

We report two cases of renal cell carcinoma accompanied with ossification. Case 1: A 40-year-old male visited a physician with the complaint of epigastric pain. Examination of the stomach revealed compression of the greater curvature. Abdominal radiography and CT scan revealed a left renal mass with calcification, which was a hypovascular tumor on angiography. A transperitoneal left nephrectomy was performed. The resected kidney was 700g in weight and the tumor, which was 12 x 10 x 10 cm in size and located in the upper pole of the kidney, was enveloped with a hard capsule and was extensively necrotized. Histopathological diagnosis was renal cell carcinoma (papillary type, mixed subtype). Case 2: A 69-year-old female was occasionally pointed out to have a left renal mass in ultrasonic examination. It was accompanied with calcification in CT scan and a hypervascular tumor in angiography. A transperitoneal left nephrectomy was performed. The resected kidney was 320 g in weight and the tumor located in the lower pole of the kidney, was 6 x 6 x 6 cm in size and necrotized. Histopathological diagnosis was renal cell carcinoma (alveolar type, clear cell subtype). Microscopically in both cases, ossified tissue existed among the fibrous tissue in the necrotized lesion of the tumor, but not near the cancer cells and, it was accompanied by calcification. During the ossification process, the connective tissue proliferates after the necrosis of the tumor, and metaplasia occurred from its juvenile plastic cells to osteoblastic cells.

Isolated tuberculosis of the popliteal cyst.

We encountered a case of tuberculosis of a popliteal cyst in a 76-year-old man. He visited our department for treatment of the left knee pain which had not responded to treatment over the previous ten months. At first examination, local rubor, swelling and tenderness on a popliteal cyst were noted. Therefore, curettage of the lesion, including resection of the cyst, was performed. Six weeks later, an abscess had formed in the subcutaneous area over the lateral aspect of the knee, which was cleaned out. The abscess recurred in the same area four months later. At the third operation, curettage of the abscess together with a knee joint synovectomy was performed. Upon pathologic examination, a tuberculous lesion of the popliteal cyst and skin were recognised. However, no tuberculous lesion was detected in the synovia of the knee joint. It is generally agreed that it is possible for a popliteal cyst to be infected from synovial tuberculosis of the knee joint. However, in our case, based on the histopathological and clinical observations, the primary tuberculous lesion appeared to have been in the popliteal cyst, which is very rare indeed. Recent developments in preventative medicine and chemotherapy have markedly reduced the incidence of tuberculous arthritis. However tuberculous arthritis is still an important disease in the differential diagnostic of persistent monoarthritis of the knee. Approximately half of the popliteal cyst communicate with the knee joint. However, it is not frequent for tuberculosis to propagate from the knee joint into the popliteal cyst.(ABSTRACT TRUNCATED AT 250 WORDS)

[Central neurocytoma. Case report].

A 24-year-old female was hospitalized for progressive headache and nausea. Computed tomography showed a mass lesion in the left lateral ventricle near the foramen of Monro. On light microscopy, this tumor morphologically resembled an oligodendroglioma. However, ultrastructural examination disclosed synapses and neuronal differentiation. Review of the literature revealed 21 cases of intraventricular neuronal tumors in adults that were diagnosed as central neurocytoma or differentiated neuroblastoma. Fourteen of the 21 patients were males and seven were females. Their ages ranged from 16 to 52 years and averaged 30.7 years. All of the tumors were located near the foramen of Monro and the clinical symptoms were primarily headache and nausea. The outcome was generally good. Surgical removal was the most effective treatment, whereas the effect of radiation therapy was unclear. The diagnosis requires demonstration of neuronal differentiation. Generally, the diagnosis is neurocytoma if the neuronal tissue is mature, with complete synapses, and neuroblastoma if it is immature. However, the criteria for differentiation between these two tumors are still controversial.

[A case of rheumatoid arthritis associated with polyneuritis].

A 57-year-old woman suffered from polyarthralgia for 7 years, and was treated by using NSAID with the diagnosis of RA. From Jan. 20th 1987, she complained of back pain and numbness of both hands, and from May 7th 1987, she also complained of dysphagia and dysarthria, and she was not able to button up. Soon afterwards she could eat only one custard pudding a day, so she admitted to our hospital on March 17th 1987. The neurological examination showed hyporeflexia and muscle weakness of the four extremities; and hypesthesia of the 7th to 11th intercostal nerve area and both lateral sides of the dorsum pedis. The laboratory examination showed ESR 17 mm/h, gamma-glob 1.66 g/dl, CRP(+), RAHA 80 x, CH50 24.0 U/dl, HLA-antigen; DR 4(+). Cerebrospinal fluid examination showed cell 5/mm3, protein 63 mg/dl, IgG 13 mg/dl, IgG% 20.6%. X-ray examination indicated destruction of both wrists, left elbow, right 2-5th MTP, and left 5th MTP joints. A light microscopic examination of the left sural nerve showed perivascular infiltration with lymphocyte, occasional macrophages and giant cells at the epineurium, and no demyelination or Wallerian degeneration at the nerve fiber. These histological findings were the same as type-I arteritis in nerves in RA proposed by D.L. Conn. Clinical improvement was obtained after administration of prednisolone 30-60 mg/day.

Histochemical analysis of changes in lectin binding in murine glomerular lesions.

Lectin binding in diseased murine glomeruli was studied in MRL/1 mice, using seven different fluorescence- or peroxidase-coupled lectins: Griffonia simplicifolia I (GS-I), Ulex europaeus agglutinin I (UEA-I), Ricinus communis agglutinin I (RCA-I), wheat germ agglutinin (WGA), concanavalin A (Con A), peanut agglutinin (PNA), and Helix pomatia agglutinin (HPA). Lectin binding in diseased glomeruli of MRL/1 mice was different from that in normal glomeruli. Light and fluorescence microscopy showed that: 1. in mesangial proliferative lesions, the binding of RCA-I, WGA and Con A increased and that of GS-I and PNA appeared in the mesangium; 2. in other glomerular lesions, UEA-I binding appeared and RCA-I stained the altered membranes irregularly. Electron microscopy showed that: 1. GS-I stained the endothelial cell coat and the glomerular basement membrane covered by the endothelial cells; 2. GS-I strongly stained the dilated subendothelium in regions of mild mesangial interposition; 3. GS-I stained the cell coat of invasive macrophages; 4. GS-I and UEA-I stained the cell membrane-like material derived from degenerative endothelial cells; 5. RCA-I stained the epithelial and endothelial cell coats and the glomerular basement membrane. These results indicate that lectin-binding studies can be used for analysis of glomerular lesions.

A case of malignant histiocytosis.

Malignant histiocytosis, presenting initially with swelling and subcutaneous tumor in the lid, was reported in a 14-year-old boy. The diagnosis of malignant histiocytosis was made on the basis of light- and electron-microscopic findings.

Distribution of peanut agglutinin binding sites in rat lymphatic organs.

Distribution of peanut agglutinin binding sites was studied histologically with horseradish peroxidase labelled and fluorescein isothiocyanate labelled peanut agglutinin in terms of cell differentiation in rat lymphatic organs, (thymus, spleen, lymph nodes). In this study, alcohol-fixed paraffin-embedded tissue sections were used and proved to be useful for the histochemical study with peanut agglutinin. In the germinal center of the lymph node, cells were weakly positive for peanut agglutinin binding sites but not in the mantle zone of the lymph follicle. In the thymus, the cortical thymocytes were weakly positive for peanut agglutinin binding sites but not in the medulla. In the spleen, some cells on the periphery of the white pulp were weakly positive for PNA binding sites but cells around the central artery were not positive. Large cells with granular cytoplasma around the sinus of the spleen and lymph node, thought to be fixed macrophages, were strongly positive for PNA binding sites.