Thyroid involvement by malignant histiocytosis of Langerhans' cell type

Involvement of the thyroid gland by Langerhans' cell histiocytosis is quite rare. We describe the case of a 58-year-old man referred for treatment of a progressively enlarging goitre. The trachea was severely stenotic and adjacent structures such as the left carotid vein and the thyroid cartilage were also involved. Central diabetes insipidus and severe combined immunodeficiency were associated. Although fine needle aspiration biopsy of the thyroid was initially interpreted as papillary carcinoma, anaplastic thyroid cancer was suspected. Treatment with prednisolone, doxorubicin and irradiation controlled the tracheal compression. A diagnosis of thyroid Langerhans' cell histiocytosis was finally made on the basis of the presence of Birbeck granules and CD1a and CD4 antigen in the thyroid tumour cells. Furthermore, positive staining for CD68 and lysozyme suggested that the tumour cells may have had the character of phagocytic cells in addition to their dendritic cell nature. This is the first case of thyroid involvement by malignant histicytosis of Langerhans' cell type with unusual phagocytic markers.     

Serum amino acid levels in patients with hepatocellular carcinoma

Serum amino acid concentrations in cirrhotic patients with and without hepatocellular carcinoma (HCC) were investigated. Elevation of serum aromatic amino acids (AAA) and methionine levels observed in cirrhotic patients without malignancy was not apparent in cirrhotic cases with HCC, and thus the ratio of branched chain amino acids (BCAA) to AAA was not so diminished in the latter cases. Development of hepatic encephalopathy in cirrhotic patients with HCC led to only a slight change in the serum aminogram characteristic of hepatic failure. In patients who underwent operations, tissue amino acid compositions of hepatocellular, gastric, and colon cancers were compared with each other and their respective surrounding epithelia. Amino acid contents in the tumor tissue were generally higher than those in the respective nontumorous parts, especially in the case of HCC. The methionine, tyrosine, and phenylalanine contents in HCC were much higher than in cirrhotic or normal liver. Serum aminograms in rats with ethionine-induced HCC were similar to those in cirrhotic patients with HCC. Amino acid contents in HCC were much higher than those in the surrounding cirrhotic liver tissue of rats. Serum and liver tyrosine and isoleucine contents rose significantly in rats 5 to 6 weeks after the initiation of a 0.25% ethionine-containing diet. After the 20th week of the experiment, by which time well-differentiated HCC had developed, liver tyrosine and isoleucine contents increased whereas serum isoleucine concentrations decreased. The results suggest that the serum amino acid patterns characteristic of cirrhotic patients with HCC may result from the increased consumption of amino acids by HCC. Determinations of the amino acid levels are also useful for estimating the prognosis and discovering imminent hepatic encephalopathy in cirrhotic patients with HCC.     

Herpes encephalitis and paraneoplastic limbic encephalitis

Pathological examination of four autopsy cases of herpes simplex virus encephalitis reconfirmed that the inflammatory necrotizing lesions occurred predominantly in the limbic system. This site predilection can be explained by the viral spread via the olfactory pathway, or along the meningeal branches of the trigeminal nerves and by the localization of specific herpes virus receptors. Case studies of non-herpetic paraneoplastic limbic encephalitis were briefly introduced and the results suggest that a specific protein recognized by antibody exists in the limbic system. Thus, both virological and immunological evidence suggests that the human limbic system has specific proteins which are unique in the human brain.     

NMDA receptor antagonists potently suppress the spontaneous withdrawal signs induced by discontinuation of long-term diazepam treatment in Fischer 344 rats

The present study investigated the effects of the NMDA receptor antagonists dizocilpine (MK-801) and ifenprodil on the appearance of diazepam withdrawal signs caused by discontinuation of long-term diazepam treatment using a drug-admixed food (DAF) method in Fischer 344 rats. The total withdrawal score was significantly decreased by after-withdrawal treatment with dizocilpine or ifenprodil. Dizocilpine, in particular, markedly suppressed the motor withdrawal signs and body weight loss, while ifenprodil suppressed the motor and emotional withdrawal signs. Furthermore, the decrease in the food intake during withdrawal (anorexia) was significantly reduced by dizocilpine, but not by ifenprodil. These behavioral results indicated that the activation of NMDA receptors during withdrawal may play an important role in the appearance of withdrawal signs (in particular motor withdrawal signs) caused by discontinuation of chronic diazepam treatment, and that inhibitory agents for NMDA receptors may be effective in alleviation of the appearance of benzodiazepine withdrawal signs.     

Glial and neuronal localization of neuronal nitric oxide synthase immunoreactivity in the median eminence of female rats

Localization of neuronal nitric oxide synthase-immunoreactivity (nNOS-IR) in the median eminence of female rats (n=4) was examined by electron microscopy to explore the possibility that nitric oxide is involved in the terminal regulation of neurosecretory peptides such as GnRH. Under light microscopy, a dense distribution of nNOS-IR was observed in this region. Electronmicroscopically, nNOS-IR was found in glial elements and nerve terminals containing dense-core vesicles. We also found a few nNOS-immunopositive synapses, in which intense immunoreactivity was found on the postsynaptic density and mitochondrial membrane. The localization of nNOS-IR in nerve terminals and glial elements in the median eminence might indicate that nNOS plays a role in regulating the release of neurosecretory peptide.     

Multiple basilar trunk aneurysms and bilateral internal carotid artery hypoplasia

We describe a case of a 32-year-old woman with bilateral hypoplastic internal carotid arteries who presented with subarachnoid haemorrhage and was found to have two basilar trunk aneurysms. Carotid angiography showed that both internal carotid arteries were narrowed at their origin and terminated at the cervical segment. Vertebral angiography demonstrated a dilated vertebrobasilar system which supplied sufficient blood flow for both cerebral hemispheres through the posterior communicating arteries. The patient was successfully treated by multiple operations.     

A Case of Superficial Spreading Melanoma In situ 2.5 mm in Diameter

A 60-year-old woman with superficial spreading melanoma in situ, measuring 2.5 mm in diameter, was examined. She had noticed a very small pigmented lesion 1.2 mm in diameter on her left lower leg in April of 1989. By April of 1990, it had grown to 2.5 mm in diameter. Its edge was irregular, and its color was variegated black to brown. Skin surface markings had disappeared in the center portion. Histopathologically, the lesion was asymmetrical. Atypical large cells nested in the lower epidermis and were scattered singly in the mid and upper epidermis, as seen in Paget's disease. At the periphery of the lesion, single large tumor cells were scattered in the mid epidermis. The tumor cells reacted to monoclonal anti-melanoma antibody HMB-45.     

Blockade of dopamine D1 receptors by SCH 23390 antagonizes discriminative stimulus effects of pentazocine

The purpose of this investigation was to test the hypothesis that the discriminative stimulus properties of pentazocine are mediated through an interaction with dopamine receptors. Rats were trained to discriminate s.c. injections of pentazocine (3.0 mg/kg) from vehicle in a two-choice discrete trial avoidance paradigm. SCH 23390 (0.003–0.056 mg/kg), a selective antagonist of dopamine D₁ receptors, inhibited the discriminative stimulus effects of pentazocine in a dose-dependent fashion, whilst the selective D₂ receptor antagonist sulpiride (20.0–80.0 mg/kg) did not antagonize them. It appears that the dopamine D₁ receptors play an important role in the discriminative stimulus effects of pentazocine.     

Regeneration of myelinated fiber after crush injury is retarded in sciatic nerves of mutant Japanese quails deficient in neurofilaments

Regeneration of myelinated fibers in the sciatic nerve 2 weeks after crush injury was studied morphometrically in mutant Japanese quails deficient in neurofilaments and in normal quails (controls). There were fewer regenerated myelinated fibers per nerve at 10 mm (R₁) and 20 mm (R₂) distal to the crush site in mutants than in controls (P < 0.05). Both median and maximum diameters were smaller (P < 0.01) in mutants than in controls. On electron microscopy, transverse axonal area and axonal circumference were smaller (P < 0.001) at both R₁ and R₂ in mutants than in controls. The number of myelin lamellae was less (P < 0.01) in mutants than in controls at R₁, but was similar at R₂. There were fewer myelin lamellae in relation to axonal area in mutants than in controls at R₁ (P < 0.0001) and R₂ (P = 0.0032). The results indicate a retardation of both radial growth of axons and myelination around axons of the same size in mutants compared with controls. Such retardation may be explained by the deficiency of neurofilaments and the altered relationship between Schwann cell and axon in the mutant. Received: 18 December 1995 / Revised, accepted: 20 May 1996