[Three cases of eosinophilic cholecystitis].
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Adult↗
Biomedical subjects
G Ohta
Publications and source records attributed to G Ohta.
Hepatic calcification in the course of hemodialysis.
Hepatocellular calcification is extremely rare and only one case has been recorded in the literature. The patient, a 74-yr-old Japanese woman, received hemodialysis for 5 months because of uremia due to chronic glomerulonephritis. Four months before death, she was once in a state of shock which lasted for 4 h due to massive hemorrhage from the shunt vein for hemodialysis. She died of disseminated intravascular coagulopathy and respiratory failure due to uremia. Postmortem liver biopsy showed centri- and midzonal necrosis associated with septal fibrosis where intracellular and extracellular calcification were noted. The calcifications were round or rod shaped and single or multiple in distribution. The calcification was thought to occur as the result of shock, which caused hepatocellular damage, due to consumption of a high calcium-phosphorus product.
Aged↗
Nodular hyperplasia of the liver in primary biliary cirrhosis of early histological stages.
Twenty-six patients with the clinical and histologic diagnosis of primary biliary cirrhosis were reviewed. Nodular hyperplasia of the liver without fibrous rims, not reported hitherto in patients with primary biliary cirrhosis, was found in several patients with early histological stages. These changes resembled "nodular regenerative hyperplasia of the liver" and were usually present as multicellular thickness in zones 1 and 2 of the hepatic lobules. Such lesions were preferentially found in patients with esophageal varices, suggesting that the nodular hyperplasia may occur in relation to a disturbance of portal venous blood flow within the liver in primary biliary cirrhosis in early histological stages.
Adult↗
Expression of Mallory bodies in hepatocellular carcinoma in man and its significance.
Evidence has been accumulating that Mallory body (MB) is a heritable phenotype of hepatocellular carcinoma (HCC) and is closely related to hepatocarcinogenesis in some carcinogen-fed animals. This prompted us to try to evaluate the MB phenomenon in human HCCs, in which its significance remains unclear to date. Whole liver slices were obtained from 28 autopsied livers in which MB-positive HCC was found, and distribution of MBs within the HCC was examined. There were three distribution patterns: clustering, diffuse, and sparse types. The clustering type was the most frequent and was found in 21 of the 28 cases. In this type, there was a formation of groups of the MB-containing cells within the HCC, and the cluster of MB-positive cells was variable in number, size, and shape. There was often a sharp border line between MB-positive clusters and the surrounding MB-negative HCC cell areas where a collision line could occasionally be seen. Some of the MB-containing HCC cells were positive for gamma-glutamyl transpeptidase and alpha-fetoprotein. These data led the authors to speculate that MB-positive HCC cells in human livers are capable of proliferation to form the clusters and that therefore, MBs are expressed as a kind of heritable phenotype in such clusters.
Carcinoma, Hepatocellular↗
Human chorionic gonadotropin in primary liver carcinoma in adults. An immunohistochemical study.
Production of human chorionic gonadotropin (hCG) by extragonadal tumours is not a rare phenomenon. In the liver, similar results have been reported in hepatoblastomas. The present study was attempted to survey hCG level in serum and hCG-immunoreactivity in primary liver carcinoma in adults. Although hCG was elevated in serum in 2 (22.2%) of 9 autopsied cases with hepatocellular carcinoma (HCC), the hCG-reactivity of carcinoma cells was found in 2 (2.1%) of 95 HCC cases. Carcinoma cells positive for immunoreactive hCG was found in 2 (15.4%) of 13 cases with cholangiocarcinoma (CC). The patients with hCG-immunoreactivity in carcinoma and/or elevated serum level of hCG failed to reveal distinct clinical and endocrinological disturbance due to excess hCG. The hCG-positive cells were focal within the carcinoma and showed poor histological differentiation in both HCC and CC, and there were no trophoblastic cells. It is suggested that hCG is one of the hormones produced by primary liver carcinoma in adults and can be localised immunohistochemically in a small number of poorly differentiated carcinoma cells.
Adenocarcinoma↗
A case of Venoplant-induced hepatic injury.
The first case of hepatic injury induced by Venoplant, extracts of Aesculus Hippocastanum, having antiinflammatory activities, was described. A 37 yr-old man was admitted for treatment of pathological fracture of the left brachial bone. He had been received 65 mg Venoplant at another hospital several hours before admission. 17 days later, a liver function test showed mild abnormality and 60 days after injection, he complained of pruritus and jaundice. Laboratory studies revealed moderate elevation of total bilirubin, ALP, gamma-GTP and mild eosinophilia. CT studies and ERC showed no signs of extrahepatic obstructive jaundice. The lymphocyte stimulation test was positive. The liver biopsy demonstrated marked cholestasis with zonal necrosis in the centrilobular areas but showed little or no changes in the portal tracts. These features are consistent with drug-induced hepatic injury.
Adult↗
Hepatocellular carcinoma with metastatic gastric cancer simulating Borrmann type 2 and hyperlipidemia.
A case of hepatocellular carcinoma with metastasis to the stomach and hyperlipidemia as a paraneoplastic syndrome was presented. The patient, a 69-year-old man, was admitted to Kurobe City Hospital with a complaint of epigastralgia. He was diagnosed as having hepatocellular carcinoma by an increased plasma AFP and the abnormalities of hepatic scintigram and abdominal angiography. Endoscopic examination of the stomach revealed an ulcerative lesion suggesting Borrmann type 2 gastric cancer and the gastric mucosal biopsy was interpreted as tubular adenocarcinoma. At autopsy, the liver was enlarged and weighed 4,170 g without liver cirrhosis. Histologic finding of the liver tumor was hepatocellular carcinoma of Edmondson's grade 2 and the gastric tumor with bile production was identical to that of liver tumor. The tumor architecture of the stomach, however, was mixed with trabecular pattern and tubular pattern near the site of gastric mucosa, and was concordant with the findings of gastric mucosal biopsy. Multiple tumor thrombi in the portal system suggested that hepatocellular carcinoma retrogradely metastasized to the stomach through the portal system.
Adenocarcinoma↗
Correlation of morphologic subtypes of liver cirrhosis with excess alcohol intake, HBV infections, age at death, and hepatocellular carcinoma. A study on 234 autopsy cases in Japan.
Two hundred thirty-four autopsy cases of liver cirrhosis were examined to correlate the tissue HBV markers and excess alcohol intake with the type of liver cirrhosis, and the incidence of hepatocellular carcinoma (HCC). The following four groups were classified as follows: (1) HBV marker-positive alcoholic group A, (2) HBV marker-negative alcoholic group B, (3) HBV marker-positive non-alcoholic group C, and (4) HBV marker-negative non-alcoholic group D. Macronodular cirrhosis predominated in groups, A, C, and D, while in group B macronodular and micronodular cirrhosis were almost of the same frequency. The mean age at death of the patients with macronodular cirrhosis of HBV-positive alcoholic group A was similar to that of HBV-positive non-alcoholic group C but lower than that of HBV-negative alcoholic group B, suggesting a longer survival of alcoholics without HBV infection than that with HBV infection, when patients had macronodular cirrhosis at autopsy. In HBV-negative alcoholic group B, patients with macronodular cirrhosis had a higher mean age than those with micronodular cirrhosis, while in HBV-positive alcoholic group A, the mean age of patients with either cirrhosis was similar. This suggested that in the absence of HBV infection, macronodular cirrhosis in alcoholics may be related to the increased life span that allows a conversion of micronodular cirrhosis into macronodular one, and in HBV-positive alcoholics it may arise in relation to HBV infection. HCC was frequently associated with macronodular cirrhosis, regardless of the presence or absence of alcohol abuse or HBV infection, but rare in micronodular cirrhosis.
Age Factors↗
Lymphomatoid granulomatosis-like lesions in malignant lymphoma.
Eighty five cases of malignant lymphoma were surveyed for the presence of angioinfiltrative and angiodestructive growth pattern of lymphoid cells with areas of necrosis and granulomatous appearance simulating lymphomatoid granulomatosis (LYG). LYG-like changes were observed in 13 of 85 cases (15%). The most frequent histology was diffuse large cell lymphoma which occurred in 8 cases (4 non-cleaved, 3 cleaved, and one immunoblastic), followed by three diffuse pleomorphic lymphoma, one diffuse medium-sized lymphoma, and one Hodgkin's disease of mixed cellularity. The most frequent involving site was the lung, as well as the soft tissue. Composition of lymphoid infiltrate varied markedly from case to case and from area to area in the same case. One was solely composed of monotonous atypical cells, other pleomorphic cells including benign lymphocytes, plasma cells, leukocytes, and histiocytes with a varied number of atypical reticuloendothelial cells. The latter histologic appearance was just similar to LYG. Veins were more frequently affected than arteries. The present study indicates that, although the angioinfiltrative and angiodestructive growth pattern of atypical lymphoreticular cells with granulomatous appearance is considered necessary for the diagnosis of LYG, it often occurs in malignant lymphoma. Therefore, one should consider the possibility of malignant lymphoma before making the diagnosis of LYG, especially in the specimens taken from the lung and soft tissue.
Adult↗
Cytoplasmic hyalins resembling Mallory's alcoholic hyalins in pulmonary carcinoma cells.
Two cases with Mallory body (MB)-like cytoplasmic hyalins in cells, which were quite uncommon as MB-having cells, were presented. The cases were 61-and 59-year-old males. MB-like hyalins were found in large cell carcinoma cells of giant cell type of the lung. The cells containing MB-like hyalins frequently showed a hydropic swelling of the cytoplasm with pyknotic, or wrinkled nuclei. Histochemical properties of the hyalins were just similar to those of hepatic MBs in alcoholic liver diseases. Electromicroscopically, the hyalins were composed of granular, or homogeneous electron dense materials with the peripheral meshwork of randomly oriented fibrils measuring about 100A in diameter. These were stained with anticytokeratin antibodies, suggesting the relateness of the hyalins to intermediate-sized filaments of the cytokeratin type.
Carcinoma↗
Atrophy and ductopenia of the right hepatic lobe in a patient with choledocholithiasis.
An extremely rare case of atrophy and extensive ductopenia of the right hepatic lobe is presented. The surgically resected atrophic right lobe (100 g) did not show cholestasis or cirrhosis. The right hepatic bile duct revealed sclerosis with luminal obliteration and marked diminution of its branches. The extrahepatic bile duct contained a single cholesterol stone. The right portal vein branches showed luminal narrowing. Disturbance of biliary drainage following sclerosing cholangitis and impediment of portal venous flow in the right hepatic lobe were considered responsible for atrophy of the lobe. Although choledocholithiasis presumably played an important part in the pathogenesis of the sclerosing cholangitis and ductopenia, the reason for selective involvement of the right biliary tree remains nuclear.
Aged↗
Renal and prostatic malakoplakia associated with submassive hepatic necrosis. A case report with immunocytochemical, ultrastructural and X-ray analytical observations.
An autopsy case of malakoplakia involving the kidney and prostate was reported. The case was a 58-year-old Japanese male with submassive hepatic necrosis of three and half months' duration. He received 20 to 40 mg of prednisolone daily during the course of the disease (total 2,700 mg). Malakoplakic lesions were incidentally found in the right renal parenchyma and prostate at autopsy. The lesions were characterized microscopically by an accumulation of macrophages with PAS-positive intracytoplasmic granules and with intracytoplasmic inclusions of owl's eye appearance called Michaelis-Gutmann bodies and, electronmicroscopically, by numerous phagolysosomes with varying numbers of bacteria. Immunocytochemical stain revealed that the bodies were positive for lysozyme, indicating that the Michaelis-Gutmann bodies are of lysosomal origin. No calcium, phosphorous, and iron were demonstrated in them by X-ray microanalysis, suggesting that they are of immature form in which a mineralization does not take place as yet. Malakoplakia has not been previously described in association with submassive hepatic necrosis. Administration of a large amount of steroid for the treatment of submassive hepatic necrosis was suspected to be implicated in the development of the malakoplakia in the present case.
Electron Probe Microanalysis↗
Studies on the pathogenesis of hepatocellular carcinoma in HBV-negative alcoholic cirrhotics.
Ninety five cases of HBV marker-negative cirrhosis with excess alcohol intake were examined clinicopathologically to obtain some clues and insights into the pathogenesis of hepatocellular carcinoma (HCC). The following data were obtained: cases were divided morphologically into 37 cases of macronodular cirrhosis (MacCir), 16 mixed cirrhosis (MixCir), and 42 micronodular cirrhosis (MicCir), the mean age at death was the oldest in MacCir (61 yrs), the youngest in MicCir (51 yrs), and intermediate in MixCir (59 yrs), association of HCC was common both in MacCir and MixCir (78 and 63%, respectively) but infrequent in MicCir (17%), all livers of MicCir with HCC had broad collapse and a small number of macronodules in non-cancerous areas and the mean age of them was older than that of MicCir without both the collapse and macronodules (56 vs 48 yrs), in total cases, the mean age at death of patients with HCC was 7 years older than that without HCC (60 vs 53 yrs), the mean liver weight was the largest in MicCir (1,211 g), the smallest in MacCir (829 g), and intermediate in MixCir (1,022 g), the incidence of MacCir was significantly higher in patients who had given up alcohol for more than one year before death than those without abstinence, and neither the subtypes of cirrhosis nor the incidence of HCC was significantly related to the total amount of alcohol intake. These data indicate that the development of HCC in HBV-negative alcoholics with cirrhosis occurs in relation to the development of macronodules and loss of liver weight, most likely along with the prolongation of the life span.
Adult↗
Pulmonary cytoplasmic hyalin resembling Mallory's alcoholic hyalin in the liver.
Sixty-three consecutive autopsy cases of interstitial fibrosis of the lung, 6 cases of organizing pneumonia, 14 of pneumocystis pneumonia, and 20 of acute bacterial pneumonia complicating as a terminal illness listed in our Department of Pathology during a period from 1978 to 1983 were surveyed for Mallory body-like cytoplasmic hyalins in the alveolar cells. We found the hyalins in 10 of 63 cases (15.9%) with interstitial fibrosis of the lung and one of 6 cases with organizing pneumonia. Seven of the former 10 had an associated malignancy; 3 esophageal cancers, 2 lung cancers, and 2 leukemias. Five of the seven patients received an irradiation for treatment of their malignancies, subsequently developed interstitial fibrosis of the lung. Among the remaining 3 of the 10, one showed diffuse interstitial fibrosis associated with rheumatoid arthritis and two had an idiopathic type of diffuse pulmonary fibrosis. There was only one case in which the pulmonary hyalins were found in the absence of extensive interstitial fibrosis within small organizing foci of peribronchial and subpleural location. Pulmonary hyalins showed the same conventional staining properties and ultrastructural features as Mallory's alcoholic hyalins found in the liver, but did not reveal a simultaneous association with the hepatic hyalins. Pulmonary hyalins frequently stained positively with monoclonal anti-cytokeratin antibodies, more strongly at their periphery. Pulmonary hyalins were considered to be a non-specific reaction of alveolar cells to injuries, mostly in association with the pulmonary fibrosis of any etiology but not the hepatic hyalins.
Adult↗
Histological and ultrastructural examination of the intrahepatic biliary tree in primary sclerosing cholangitis.
Intrahepatic bile ducts were examined histologically and ultrastructurally in wedge-biopsied liver specimens from three patients with primary sclerosing cholangitis. Bile ducts with periductal concentric fibrosis, which is a characteristic finding in primary sclerosing cholangitis, revealed ultrastructurally finger-like projections or fine undulations of the basal free surfaces with markedly duplicated basal lamina. The lamina was collared by a layer of elongated fibroblasts and thickened bundles of collagen fibers outwards. These changes were consistently found in all sizes of ducts examined, and might be related to progressive periductal fibrosis. Serial section observations showed that some severely affected ducts actually disappeared when accompanying severe periductal fibrosis. It would therefore appear that progressive periductal fibrosis may interrupt fluid and nutrient exchange between the bile duct epithelia and peribiliary capillary plexus, followed by obliteration of the biliary lumina. Although the bile ducts showed segmentally periductal lymphocytic infiltration and, ultrastructurally, point contacts between infiltrating lymphocytes and biliary epithelial cells were observed occasionally, the exact role of infiltrating lymphocytes in the pathogenesis of primary sclerosing cholangitis remains unclear.
Adult↗
Immunohistochemical study on bile ductular proliferation in various hepatobiliary diseases.
Proliferation of the two types of bile ductules, typical and atypical, in the portal and periportal areas was examined in various liver diseases other than cirrhosis to determine any difference in their immunohistochemical properties and presumed histogenesis. While the typical ductules with a well-formed lumen were frequently seen in a large spectrum of diseases, atypical ductules with a poorly defined lumen were encountered much more frequently in prolonged biliary diseases, including primary biliary cirrhosis and primary sclerosing cholangitis, than in nonbiliary hepatic diseases. Immunocytochemically, cytoplasmic keratin was intensively positive in typical ductules, and the degree of its intensity and extent was variable in atypical ductules. Simultaneously, some of the periportal hepatocytes revealed weak staining for keratin. Luminal borders of typical ductules usually revealed an expression of both carcinoembryonic antigen and epithelial membrane antigen, while atypical ductules and periportal hepatocytes lacked epithelial membrane antigen. The atypical ductules, together with the adjoining hepatocytes, appeared on occasion to form anastomosing cords in prolonged biliary diseases. Thus, atypical ductules seem likely to originate from ductular transformation of the periportal hepatocytes and the typical ductules might result from the proliferation of preexisting interlobular bile ducts and ductules.
Bile Duct Diseases↗
A case of primary biliary cirrhosis associated with generalized morphea.
A 50-year-old female with primary biliary cirrhosis associated with generalized morphea is reported. She had suffered from multiple painful indurated plaques on the trunk which was diagnosed as generalized morphea; subsequently, primary biliary cirrhosis was diagnosed on the basis of her hepatic dysfunction. Although progressive systemic sclerosis has been reported to occur in patients with primary biliary cirrhosis, this localized form of cutaneous sclerosis has not previously been reported. Since generalized morphea is one of the most common manifestations of chronic graft-versus-host disease, and primary biliary cirrhosis is known to have a hepatic histology resembling chronic graft-versus-host disease, this case report may represent evidence in support of a common pathogenesis for the two entities.
Female↗
Is mallory body formation a preneoplastic change? A study of 181 cases of liver bearing hepatocellular carcinoma and 82 cases of cirrhosis.
The hypothesis that Mallory body formation by hepatocytes is a sign of preneoplasia was tested. This hypothesis was based on animal experiments but has not been tested in man. The authors studied the livers of 181 human autopsies in which hepatocellular carcinoma (HCC) was present and 82 cirrhotic livers from patients with alcoholism, HB viral infection, or cryptogenic cirrhosis. The frequency of Mallory bodies in nonneoplastic hepatocytes was 40% in the HCC-bearing livers with cirrhosis (LC). In HCC-bearing livers with pre-cirrhotic changes (PC), 25% showed Mallory body formation by nonneoplastic hepatocytes. In the cases of HCC, where there was no accompanying PC or LC, Mallory bodies were never found in the nonneoplastic hepatocytes. When the 82 cirrhotic livers without HCC and the 116 cirrhotic cases with HCC were combined, it was found that HCC was present in 70% of cirrhotic livers when the nonneoplastic liver cells contained Mallory bodies. When no Mallory bodies were found in the nonneoplastic liver cells, HCC was present in 53% of cases. The difference between the two groups was significant (P less than 0.05). The difference was significant for both HB viral hepatitis and cryptogenic cirrhosis but not for alcoholic cirrhosis. Likewise, when nonneoplastic hepatocytes formed Mallory bodies in cirrhotic livers, there was a statistically significant increase in the number of HCC cells that formed Mallory bodies (P less than 0.01). When nonneoplastic hepatocytes occurred in groups of Mallory body forming cells, the hepatocellular features were atypical and characteristic of dysplastic cells. The evidence indicates that when Mallory body formation was observed in HBsAg-positive and cryptogenic cirrhotic livers, they were associated with an increased frequency of HCC formation in man.
Adult↗