Acute idiopathic interstitial giant cell myocarditis. A histological and immunohistological study of a case.

The Authors report on a case of acute idiopathic giant cell myocarditis, which occurred in a young man without previous history of immunodeficiency or tumours, and displayed a rapidly fatal clinical course. Autoptic examination showed diffuse damage to the myocardium, with myocytolysis, granuloma formation and abundant giant cell reaction. No significant changes were observed in the other organs and systems . Immunohistochemistry revealed that the giant cells strongly reacted with the antibody KP1--raised to the macrophage-associated antigen CD68--whereas they did not stain with the monoclonal against the muscle-specific marker desmin. In the light of their findings and previous reports in the literature, the Authors discuss the possible origin of giant cells, along with the pathogenesis of the condition.     

Progressive multifocal leukoencephalopathy. A case report with special reference to SV40 etiology

Clinical, light- and electron microscopic, and immunohistochemical findings of a 44-year-old woman with progressive multifocal leukoencephalopathy were presented. Autopsy revealed a wide distribution of the demyelinating lesion in the cerebrum, cerebellum, brain stem and spinal cord, and intranuclear inclusion bodies and papova-like virions in transmission electron microscopy in the nuclei of oligodendrocytes. SV40 antigen was immunohistochemically detected in these inclusion bodies. The widespread extension of the lesions seemed to correlate with the duration of the patient's illness. The prolongation of the clinical course in this case may be dependent upon the lack of serious underlying diseases except for a small nodule of thyroid carcinoma, SV40 infection rather than JC virus infection and/or improved care of that kind of patient.     

Acute lymphoblastic leukaemia with giant intracytoplasmic inclusion--a case report

Acute Lymphoblastic Leukaemia (ALL) with intracytoplasmic inclusions is a rare and unusual subtype of acute leukaemia. Here we describe a case of ALL with intracytoplasmic inclusions in an adult female. These inclusions stained negative for Myeloperoxidase (MPO), Sudan Black B (SBB) and Alpha-naphthyl acetate estarase (ANAE) and positive for Periodic Acid Schiff (PAS). This case is being presented for its unusual occurrence and to recognise the characteristics of this subtype of ALL to avoid a misdiagnosis of AML (Acute Myeloid Leukaemia).     

Acute lymphoblastic leukaemia with giant intracytoplasmic inclusions--a case report

Acute Lymphoblastic Leukaemia (ALL) with intracytoplasmic inclusions is a rare and unusual subtype of acute leukaemia. Here we describe a case of ALL with intracytoplasmic inclusions in an adult female. These inclusions stained negative for Myeloperoxidase (MPO), Sudan Black E (SBB) and alpha-naphthyl acetate estarase (ANAE) and positive for Periodic Acid Schiff (PAS). This case is being presented for its unusual occurrence and to recognise the characteristics of this subtype of ALL to avoid a misdiagnosis of AML.     

Acute interstitial pneumonia in siblings: a case report

Acute interstitial pneumonia (AIP) is a rapidly progressive condition of unknown cause that occurs in a previously healthy individual and produces the histologic findings of diffuse alveolar damage. Since the term AIP was first introduced in 1986, there have been very few case reports of AIP in children. Here we present a case of AIP in a 3-yr-old girl whose other two siblings showed similar radiologic findings. The patient was confirmed to have AIP from autopsy showing histological findings of diffuse alveolar damage and proliferation of fibroblasts. Her 3-yr-old brother was also clinically and radiologically highly suspected as having AIP, and the other asymptomatic 8-yr-old sister was radiologically suspected as having AIP.     

Immunohistochemical and ultrastructural study of subacute thyroiditis, with special reference to multinucleated giant cells

Twenty-four cases of subacute thyroiditis were examined immunohistochemically and ultrastructurally, with special attention being directed to the multinucleated giant cells that characterize the lesions of this condition. Immunohistochemical study revealed that 99 per cent of the giant cells contained lysozyme, 82 per cent contained vimentin, 66 per cent contained alpha 1-antitrypsin, and 61 per cent contained thyroxine. Only 17 per cent contained thyroglobulin, 5 per cent contained keratin, 16 per cent contained epithelial membrane antigen, and 4 per cent contained leukocyte common antigen. Mononuclear cells infiltrating the follicular spaces showed a staining pattern similar to that of the multinucleated giant cells. Desquamated follicular epithelial cells were strongly positive for thyroglobulin and thyroxine, while regenerated epithelia that formed small follicles were positive for thyroglobulin but negative for thyroxine. Electron microscopic examination of cell ultrastructure revealed that most multinucleated giant cells had structures identical with those of infiltrating mononuclear cells, particularly with histiocytes, and that giant cells were formed by mononuclear cell fusion. These findings indicate the majority of multinucleated giant cells in subacute thyroiditis are derived from mononuclear-histiocyte cells.     

Mammary carcinoma with osteoclast-like giant cells: a case report

Mammary carcinoma with osteoclast-like giant cells is rare, and comprises less that 2% of breast carcinoma cases. Herein, we present a case of a 45-year-old woman who underwent breast lumpectomy and sentinel lymph node biopsy for a solitary well defined breast tumor. Histological examination revealed an invasive tumor composed of ducts, small nests and cribriform formations intermixed with a prominent osteoclast like giant cell component. The background stroma is hemorrhagic with conspicuous hemosiderin deposition. The paper will outline the clinico-pathologic characteristic features of this uncommon subtype as well as the current understanding on the pathogenesis of the osteoclast-like giant cells. The invasive carcinoma and the osteoclast-like giant cells staining patterns using immunohistochemical stains for estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, receptor activator of nuclear-kB, RANK ligand, and matrix metalloproteinase 1 are reported.     

Giant cell myocarditis after mitral valve replacement: case report and studies of the nature of giant cells

A 22-year-old man with Marfan's syndrome and a history of antinuclear antibody-positive hepatitis died 25 days after undergoing cardiac valve replacement surgery for mitral valve prolapse. Giant cell myocarditis was found at autopsy. The multinucleated giant cells were shown by immunoperoxidase techniques to contain lysozyme, but not myosin or creatine phosphokinase, suggesting that they were derived from macrophage, rather than myocyte, precursors.     

伴破骨细胞样巨细胞的胃癌一例

患者男,78岁.腹痛1年余伴有呕血,于2007年5月30日入院.体检:中腹部、右下腹及左上腹轻度压痛,无反跳痛.     

Hyperacute graft rejection during heart transplantation for giant cell myocarditis: A case report

We report the case of a patient with giant cell myocarditis who was bridged to transplantation with mechanical circulatory support and developed a fatal perioperative hyperacute rejection. The patient had received abundant transfusions that had raised her anti-HLA antibody titers. The cross-match test was positive. No pre-transplantation immunosuppressive therapy had been administered given concomitant infection. The severity and acuteness of the rejection in this case likely reflect the combined effect of preformed anti-HLA antibodies in the context of an active organ-specific immune process at the time of transplantation. This case raises the questions of the need for intensive immunosuppressive therapy before transplantation in giant cell myocarditis and of the management of patients with positive cross-match in the context of a giant cell myocarditis.     

Signal characteristics of EMG with special reference to reproducibility of measurements.

Reliability and constancy of recordings of EMG signal characteristics were investigated from the measurements taken with miniature size surface electrodes during submaximal and maximal contraction of the rectus femoris muscle. The following EMG variables were studied: integrated EMG (IEMG) various bandwidths of the power spectral density function, mean power frequency (MPF), and rise time, amplitude and number of spikes of the averaged motor unit potential (AMUP). The results indicated that for most of the variables studied the reproducibility of measurements was better within the test session (reliability) than between the different test days (constancy). The reliability values for IEMG, MPF and AMUP amplitude were rather high (r=0.77-0.93) and it is suggested that these parameters can be recommended for use in EMG studies where recordings are repeated over a period of several days.     

伴有破骨细胞样巨细胞的肝内胆管肉瘤样癌一例

患者女,74岁.持续性右上腹痛伴皮肤、巩膜黄染20余天,于2008年7月12日入院.全身皮肤瘙痒,尿色加深;近期体重减轻约4 kg.患者有慢性胆囊炎、胆结石以及高血压病史多年.B超提示肝内外胆管扩张,胆总管内实质性占位和多发结石.     

A histological study on experimental autoimmune myocarditis with special reference to initiation of the disease and cardiac dendritic cells

The precise mechanism of myosin-induced autoimmune myocarditis is unknown. The purpose of the present study was to define the immunohistological and ultrastructural characteristics of the infiltrating cells, especially in the initial phase of the myocarditis. It was demonstrated that OX6-positive dendritic cells first infiltrated the cardiocytes on day 13 after immunization. After day 17, OX6-positive cells, which possessed elongated irregular-shaped processes on the cell surface but contained few phago-lysosomes in the cytoplasm, were located at the margin of an inflammatory field and inserted their processes into the sarcoplasm of cardiocytes. The central portion of the inflammatory field was occupied by ED1-positive inflammatory macrophages, which were rich in phagosomes and which were in contact with degenerating cardiocytes. No evidence was obtained which suggested that lymphocytes directly injured the cardiocytes. These results demonstrated ultrastructural evidence that the type of infiltrating cell that first injures cardiocytes is the cardiac dendritic cell. Inflammatory macrophages thereafter serve as scavengers of degenerating cardiocytes.     

Benign intradermal melanocytic naevus with osteoclast-like giant melanocytes: a case report of an unusual morphological pattern

Multinucleated osteoclast-like melanocytes are a relatively common feature in malignant melanoma, however reported cases of benign melanocytic naevi with giant cells melanocytes are scarce. Herein, we present an unusual case of an intradermal melanocytic naevus with numerous benign giant cell melanocytes. A 42-year-old female presented with a small papule on the forehead which was excised. Histologically, the lesion was formed of an intradermal proliferation of benign melanocytes without junctional activity. The melanocytes were arranged in small nests and showed neither cytological atypia nor mitotic activity. There were numerous multinucleated osteoclast-like giant cells with abundant eosinophilic granular cytoplasm and several small open face nuclei. These multinucleated cells showed immune reactivity to melanocytic markers. This case represents a rarely described morphological pattern of a benign intradermal melanocytic lesion showing multiple benign giant cell melanocytes. Reporting such a case provides further evidence to support the presence of this morphological entity and would aid in further understanding its biology and clinical significance.     

Breast carcinoma with osteoclastic giant cells: case report and review of the literature

Breast carcinoma with osteoclastic giant cells (OGCs) are uncommon. Here, we report a 46-year-old woman with a painless lump in her left breast that has been proved clinically and radiographically. Microscopical examination showed OGCs accompanying invasive ductal carcinoma. Immunohistochemical assay revealed that OGCs derived from macrophages. Despite positive lymph node metastasis, the patient has been well without evidence of recurrence or metastasis one year after the operation. To date, the influence of OGCs on the prognosis of patients is still controversial. Our case may provide insights into further understanding beast carcinoma with OGCs.