THREE CASES OF GRANULOMATOUS MYOCARDITIS WITH GIANT CELLS

Three autopsy cases of granulomatous myocarditis were presented, which showed numerous multinucleated giant cells and diffuse proliferation of collagenous tissue. The first case revealed limited lesions only in the myocardium and classified as isolated myocarditis. The second and third cases disclosed classical generalized sarcoidosis with emphasis of myocardial involvement. The interrelationship between these two entities was discussed. Giant cell myocarditis, a disease entity, should be differentiated from the myocardial manifestation of sarcoidosis. ACTA PATH.JAP. 17: 503–515, 1967     

IMMUNOGLOBULIN ALLOTYPES IN PATIENTS WITH GIANT CELL ARTERITIS AND POLYMYALGIA RHEUMATICA

Several Gm, A2m, and Km allotypes were examined in Caucasian patients with giant cell arteritis and polymyalgia rheumatica. No significant associations were found for any of the allotypes tested.     

GIANT CELL PNEUMONIA IN LETTERER-SIWE DISEASE

An 8-month-old girl suffered from Letterer-Siwe disease since one week after birth. During the chemotherapy, giant cell pneumonia caused by measles virus infection developed and led rapidly to her death. Histopathologically, alveolar spaces were lined by multi-nucleated giant cells with intranuclear and intracytoplasmic eosinophilic inclusion bodies. Electronmicroscopical examination of the lung revealed intranuclear inclusion bodies full of rod-shaped structures characteristic to paramyxoviruses, and irregular electron-dense materials compatible with nucleocapsid protein antigens in the cytoplasm. Additionally these giant cells were observed in the salivary glands, thyroid gland, thymus and lymph nodes. The measles virus antigen was detected immunohistochemically in these giant cells in the lungs and other organs. The specific antibody of measles virus is helpful to study the pathogenesis of giant cell pneumonia.     

IMMUNOGLOBULIN (Gm) ALLOTYPE FREQUENCIES IN PATIENTS WITH GIANT CELL ARTERITIS AND POLYMYALGIA RHEUMATICA

Fifty-five Caucasoid patients with polymalgia rheumatica (PMR) or giant cell arteritis (GCA) were immunoglobulin (Gm) allotyped for this study. Forty-four of these patients had been previously HLA-A,B,C and DR locus allotyped. The incidence of the immunoglobulin allotypic marker Glm(2) was significantly increased in the GCA group (50.00% v. controls 18.75%, P= <0.01). There was a similar but insignificant rise of this Gm marker in the PMR group (27.24% v. 18.75%, NS). The increase in Glm(2) in the GCA group was not accompanied by a corresponding rise in the number of people homozygous for Glm(2), i.e., all the increase could be attributed to patients with the Glm(1,2,3): G3m(5,10,21) phenotype.     

EXPRESSION OF VASCULAR CELL ADHESION MOLECULE-1 IN MURINE HEARTS WITH ACUTE MYOCARDITIS CAUSED BY COXSACKIEVIRUS B3

Cell-mediated autoimmunity has been strongly implicated in the pathogenesis of the myocardial cell damage involved in viral myocarditis. Using a murine model of acute myocarditis caused by Coxsackievirus B3 (CVB3), perforin-expressing killer cells have been shown to infiltrate the heart, and intercellular adhesion molecular-1 (ICAM-1) together with major histocompatibility complex (MHC) antigen was induced on myocardial cells in acute viral myocarditis. To clarify the immunological mechanisms in more detail, the expression of vascular cell adhesion molecular-1 (VCAM-1) has been examined in the heart of acute myocarditis and on cultured cardiac myocytes treated with interferon-gamma (IFN-γ) and tumour necrosis factor-alpha (TNF-α). The effects of in vivo antibody treatment to VCAM-1 on myocardial damage involved in acute myocarditis were also analysed. CVB3-induced myocarditis resulted in enhanced expression of VCAM-1 on myocardial cells. VCAM-1 expression was also induced on cultured cardiac myocytes by treatment with IFN-γ and TNF-α. The in vivo antibody treatment to VCAM-1 decreased the myocardial damage to some extent, but the effects were not statistically significant. These data suggest that the expression of VCAM-1 on myocardial cells may play at least a partial role in the myocardial damage involved in acute viral myocarditis.     

HYALINOID GIANT CELL GASTRITIS

A rare case of degenerative and inflammatory lesion of the stomach occurring in a 34-year-old woman is reported. Clinically, the lesion simulated gastric carcinoma because of the extensive involvement of the mucosa and submucosa by the process. Histologically, it was characterized by eosinophilic hyalinoid degeneration of smooth muscles in the muscularis mucosae as well as mucosal and submucosal blood vessels accompanied with foreign body giant cells and other inflammatory cells. The lesion occurred in association with chronic peptic ulcers, and a small submucosal nodule histologically compatible with inflammatory fibroid polyp coexisted within the area of this lesion. The patient has had no systemic disease and has been well for 4.5 years postoperatively. These clinical features suggest a localized nature of the lesion limited to the stomach. The term "hyalinoid giant cell gastritis" is proposed to describe this distinctive form of gastritis. ACTA PATHOL. JPN. 35 : 749–758, 1985.     

CARDIOVASCULAR AMYLOIDOSIS WITH GIANT CELL REACTION—TWO AUTOPSY CASES—

Two autopsy cases, a 77-year-old man and a 66-year-old woman, of cardiovascular amyloidosis with many giant cells were reported. These cells were always found adjacent to amyloid masses which were deposited mainly in small arteries and arterioles, and some of them contained amyloid substance in their cytoplasms. The incidence of these cells was high in the heart and in the kidneys of both cases, and in the latter case the cells were found in the majority of the organs varying in degree. The significance of the giant cells, which probably originated from macrophages, were discussed and that giant cells might appear as a foreign body reaction to amyloid substance was presumed.     

A HIGH-GRADE MALIGNANCY BRONCHIAL MUCOEPIDERMOID CARCINOMA WITH FEATURES OF GIANT CELL CARCINOMA

A high-grade mucoepidermoid carcinoma associated with giant cell carcinoma of the bronchus was found in a 41-year-old man. Light and electron microscopic examinations showed glandular and squamous elements. The histology of the giant cell carcinoma was similar to those of previously reported giant cell carcinomas. It was assumed that the giant cell carcinoma in the present case is the result of transformation of mucoepidermoid carcinoma originating in the bronchial gland.     

ULTRASTRUCTURE OF THE GIANT CELL IN DE QUERVAIN'S SUBACUTE THYROIDITIS

The author made an electron microscopic observation on multinucleated giant cells which appear in the thyroid gland in subacute thyroiditis (de Quervain). Numerous typical desmosomes, which intermingled with myriad of mitochondria and small electron dense granules, were found in the cytoplasm of giant cell. Desmosome is one peculiar to the intercellular junction of follicular epithelium of the thyroid gland, and the fact that many desmosomes were found in the cytoplasm is one of the proofs showing this giant cell to be possibly derived from the follicular epithelium.     

DISSEMINATED VISCERAL GIANT CELL ARTERITIS

Autopsy findings of disseminated visceral giant cell arteritis in a 78-year-old man who was in chronic renal failure for two years were presented. Arteritis had not been suspected clinically and definite diagnosis was made after the autopsy. Only small arteries and arterioles were Involved. The arteritis was characterized by granulomatous lesion with exclusively multinucleated giant cells. Fibrinoid necrosis with polymorphonuclear leukocyte infiltration was found only in one arteriole of the stomach. The arteritis was distributed in the heart, lungs, kidneys, gastrointestinal tract, liver, gallbladder, pancreas, prostate, and lymph nodes, but not in the aorta and brain. This peculiar type of arteritis was reported only by LIE AND the entity was designated as disseminated visceral giant cell arteritis.     

频谱心电图检查在儿童心肌炎诊断中的应用

目的:分析心电图和频谱心电图检查在儿童心肌炎诊断中的临床价值。方法:临床拟诊心肌炎病儿515例,采用Wilson连接方式,分别做心电图和频谱心电图。应用北京美高仪软件技术有限公司研制、生产的ECG-LAB2.0Gold型心电综合分析系统进行分析。结果:心电图和频谱心电图同时异常者69例(13.4%);心电图(ECG)异常者79例(15.3%);频谱心电图(FCG)异常者195例(37.8%);频谱心电图的异常率大于心电图的异常率(P<0.05)。心电图和频谱心电图异常者最终确诊为心肌炎的86例,其中10例为心电图正常而频谱心电图异常者.结论:频谱心电图对心肌炎的早期诊断比心电图更敏感,可避免部分心肌炎的误诊诊断,但有一定的假阳性。     

A NEUROENDOCRINE (MERKEL) CELL CARCINOMA WITH COEXISTING INTRAEPIDERMAL SQUAMOUS CELL CARCINOMA OF THE SKIN

A case of neuroendocrine (Merkel) cell carcinoma with coexisting intraepidermal squamous cell carcinoma of the skin was studied histologically, immunohistochemically and ultrastructurally as well as with tissue-culture and transplantation into nude mice. The primary tumor found in the lower leg of a 68-year-old Japanese man had remained thumb-sized for five years and, after contusion, had begun to enlarge rapidly up to 5 cm in size during one month. The patient died of metastatic neuroendocrine cell carcinoma nine months after excision of the primary tumor. Histologically the primary tumor was composed of neuroendocrine cell carcinoma extending down to subcutaneous adipose tissue and a small amount of intraepidermal squamous cell carcinoma, not associated with a wide range of necrosis, hemorrhage, granulation tissue or fibrosis. The tumor cells of the former were diffusely positive for neuron-specific enolase. They contained a few secretory granules, 100 nm in diameter. The tumor cells both cultured in media and transplantated into nude mice died two months later. The present case is the first report of Merkel cell carcinoma in which the growth accelerated by an extrinsic factor was proved. Histogenesis of neuroendocrine cell carcinoma with coexisting squamous cell carcinoma is also discussed.     

GIANT CELL CARCINOMA OF THE PANCREAS

A case of giant cell carcinom of the pancreas is reported herein. The patient is a 67-year-old Japanese woman complaining of ascites, general fatigue, loss of weight, abdominal distention, nausea, and vomiting. Cytological diagnosis of ascites revealed adenocarcinoma. At autopsy, a whitish tumor measuring around 5 cm in diameter was found at the head of the pancreas. Metastasis was seen only in the liver. Histological examination displayed bizarre multinucleated giant cells occasionally phagocytosing the tumor cells and neutrophils.     

病毒性心肌炎患儿心率变异指标变化的临床研究

目的研究病毒性心肌炎患儿心率变异(HRV)的变化特点。方法:选用74例儿童为研究对象,分为正常对照组和心肌炎组,进行心率变异检测分析。结果:与正常儿童比较,心肌炎患儿心率增快,心率变异指标降低。结论:心肌炎患儿HRV降低源于心肌缺血及相关炎性因子作用导致心脏自主神经系统总体功能受损,其病变对副交感神经系统的影响比交感神经系统更明显。     

OSTEOCLAST-LIKE GIANT CELL TUMOR OF THE LIVER

A 66-year-old male with osteoclast-like giant cell tumor of the liver that arose in the non-cirrhotlc liver is presented. The liver tests were almost normal, and plasma levels of alpha-fetoprotein and carcinoembryonic antigen were within normal limits. The findings of liver scan by ^99mTc phytate, celiac angiography, and CT scans are described for the first time for this rare neoplasm, showing a large, unresectable liver tumor. Histologically, the tumor mainly consisted of osteoclast-like giant cells and mononuclear cells, which were focally arranged in a vaguely trabecular pattern and sarcomatous pattern. By an electromicroscopic study, however, no definitive evidence was obtained whether it arose from epithelial cells or nonepithellal cells. Various clinicopathological features were described and compared with previously reported cases including two cases arising in the liver.     

实验动物皮肤和睾丸细胞动力学的研究

本文用氚-胸腺嘧啶核苷(~3H-thymidinc)和碳-14-胸腺嘧啶核苷(~(14)C-thymidine)双标记放射自显影方法,观察了青年(日龄40天)和老年(月龄16个月)小鼠及成年(月龄7.0～7.5个月)大鼠背部皮肤表皮细胞的细胞周期,以及青年和老年小鼠睾丸曲细精管精原细胞的细胞周期。结果表明,青年和老年小鼠皮肤表皮基底细胞的细胞周期,及其有关参数分别为:细胞标记指数(LI)=1.0％,1.5％;核分裂指数(MI)=0.4％,0.4％;DNA合成期时间(Ts)=3.5,4.2小时;细胞周期时间(Tc)=20.3,17.5天。大鼠的分别为3.0％,0.3％,4.7小时和8.3天。大鼠皮肤表皮基底细胞的细胞周期比小鼠的明显缩短(P<0.01)。青年及老年小鼠睾丸曲细精管精原细胞LI分别为14.6％,7.7％;MI为4.0％,2.7％;Ts为5.0,4.2小时;Tc为42.6,77.1小时。青年及老年小鼠睾丸精原细胞Tc未见明显差别(P>0.50)。     

SMALL CELL CARCINOMA OF THE SKIN "NON-MERKEL CELL TYPE"

An 81-year-old Japanese woman developed small cell carcinoma of the skin, which was different from trabecular carcinoma or neuroendocrine carcinoma of the skin. The tumor was composd of spindle-shaped or fusiform cells with scanty cytoplasm and numerous mitoses. The tumor cells were arranged in a streaming pattern and not in anastomosing trabecular fashion at all. No granules were detected by Grimelius'stain either. Immunoperoxidase staining for neuron specific enolase (NSE) did not reveal any activity. Ultrastructural study showed scanty organelles in the cytoplasm which contained a few round mitochondria, rough endoplasmic reticulum, and free polysomes. Occasionally, filamentous bundles, desmosomes, and intracyto-plasmic canaliculi were recognized in the cytoplasm, but neurosecretory granules were not found throughout the cytoplasm. Electron microscopic features suggest that this tumor originated from the embryonal stratum germinativum. The present tumor can be distinguished from trabecular carcinoma or neuroendocrine carcinoma of the skin, and may be regarded as "small cell carcinoma" of the skin. ACTA PATHOL, JPN. 35 : 1029–1036, 1985.     

ASSOCIATION OF MHC CLASS I WITH SPONDYLOARTHROPATHIES IN KUWAIT

This study is the first to assess the prevalence of HLA B27 in Kuwaiti patients with ankylosing spondylitis (AS) or related spondyloarthropathies compared to healthy controls. Positive HLA B27 was found in nine (25.7%) of 35 patients, but only in 22 (4%) of 544 controls (P = 0.000). A significant difference in Cw2 and Cw6 between patients and controls was also found (P < 0.01 and 0.000, respectively), suggesting a linkage disequilibrium between B27 and Cw2 (P < 0.000) in the Kuwaiti population. These findings suggest that B27-positive Kuwaitis are at high risk of developing AS and spondyloarthropathies, especially if they carry Cw2 and Cw6. The importance of HLA Cw loci is becoming increasingly apparent in disease association studies.     

DRUG-INDUCED LYSOSOMAL CHANGES and NEPHROTOXICITY IN RATS

Lysosomal involvement In renal tubular lesions was studied mainly by electronmicroscopy after single and repeated administrations of cephacetrile, cephalothin, cephaloridine, gentamicin or leupeptin and combine administrations of cephalothin and gentamicin or gentamicin and leupeptin in female Wistar rats. Large cytosomes of high density were increased due probably to either reabsorption and secretion of drugs or their metabolites. These cytosomes displaying acid phosphatase activity were demonstrated histo-chemically and were identified as heterolysosomes. In rats treated with cephaloridine, gentamicin or leupeptin, disruption of lysosomal membrane was noted and regional cytoplasmic destruction'was seen in the vicinity of the disrupted heterolysosomes. Necrotic epithelial cells and renal insufficiency were observed in these animals. On the other hand, neither destruction of lysosomes nor cell lesion was found in rats treated with cephacetrile or cephalothin. It was speculated that lysosomal destruction might be the cause of the cell lesions found in cephaloridine, gentamicin or leupeptin treated rats.