bluuebunny/crossref_metadata_2025 huggingface dataset:
A profile analysis of personality disorders: Beyond multiple diagnoses
Authors: Nakao Kazuhisa , Takaishi Jyo , Tatsuta Kenji , Katayama Hisanori , Iwase Madoka , Yorifuji Kazuhiro , Shinosaki Kazuhiro , Takeda Masatoshi
Published: March 2003

The authors applied cluster analysis and multidimensional scaling to the analyses of 59 patients with personality pathology. Cluster analysis yielded eight typologies of patients: detached, anankastic, phobic, dramatic, erratic, emotional, milder emotional, and masochistic negativistic. Multidimensional scaling identified the dimensions of classifying patients: anxious rumination versus behavioural acting out, overall severity of personality pathology, and assertiveness versus withdrawal. Considering the distinction between personality disorder (dysfunctional personality) and abnormal personality (extreme personality), the following changes in current classification system are proposed: use of a hierarchy and exclusion criteria in a categorical‐type model or use of a personality profile in a dimensional‐trait model, in either case, with a dimensional rating for severity of psychopathology to define personality ‘disorder’.
Depression among caregivers of the disabled elderly in southern Japan
Authors: Washio Masakazu , Arai Yumiko
Published: March 2003

The present study was conducted in an attempt to investigate factors related to depression of caregivers who looked after the disabled elderly residing in a community in southern Japan. A questionnaire survey was carried out of 45 pairs of caregivers and the disabled elderly who received regular visits from a practice nurse, who was located in Onga County, Fukuoka, in southern Japan. Twenty‐four out of 45 caregivers (53.3%) scored above the conventional cut‐off of the Center for Epidemiologic Studies Depression Scale (CES‐D). The proportion of children‐in‐law caregivers was significantly smaller (0%vs 23.8%, P = 0.01) and the proportion of caregivers who had consulted a physician within 1 month prior to the study was greater in the depressed than that in the non‐depressed (79.2%vs 47.6%, P = 0.03). The elderly whose caregivers were depressed (group 1) had more behavioural disturbances than those of the non‐depressed caregivers (group 2) (1.92 ± 2.38 vs 0.52 ± 0.87, P = 0.01) A multiple logistic regression analysis revealed that only behavioural disturbance was positively related to depression (odds ratio: 4.29, 95% confidence interval: 1.28–14.37). More behavioural disturbances led the caregivers to depression or the depressed caregivers failed to take care of the elderly, which resulted in an increase in the number of the behavioural disturbances of the elderly.
Secondary personality change in psychiatric in‐patients
Authors: Tsai Shih‐Jen , Hsiao Yu‐Hua
Published: March 2003

Secondary personality change (SPC) can be caused by various medical conditions and is rarely reported. We retrospectively investigated the prevalence, characteristics, clinical features and treatment response in psychiatric in‐patients with a primary diagnosis of SPC. Ten cases of SPC were diagnosed in a series of 5774 patients. Head trauma was the leading cause of SPC. Impulsivity, affective lability and aggression were commonly found in these SPC patients. After medication treatment, all SPC patients had mild to moderate improvement. Secondary personality change is rarely diagnosed in psychiatric in‐patients and responds poorly to medication treatment.
Novel intronic polymorphisms in the presenilin‐2 gene and a case‐control association study of Alzheimer’s disease
Authors: Honda Masahiro , Kaname Tadashi , Igata‐Yi Ruriko , Igata Tomohide , Hitoshi Yasuyuki , Ogomori Koji , Miyakawa Taihei , Yamamura Ken‐Ichi
Published: March 2003

Several alleles of introns or untranslated regions in the presenilin‐1 (PS‐1) and presenilin‐2 (PS‐2) genes have been reported to behave as risk factors for senile Alzheimer’s disease (AD). On the other hand, mutations in the three presenile AD genes also have been identified in a small number of sporadic presenile AD and senile AD cases. The present study evaluated the genetic contributions of PS‐2 exons and introns to 56 senile and 18 Japanese cases of presenile AD using polymerase chain reaction single‐strand conformation polymorphism analysis. In the PS‐2 gene, one exonic polymorphic site without amino acid substitution, 9 intronic polymorphic sites, and 2 intronic variant sites were detected. However, in all cases, amino acid substitutions in exons between 4 and 12 of the PS‐2 gene were not observed. The risk factors of senile and presenile AD were evaluated using a population‐based study of restriction cleavages between patients and controls in introns 3, 4, 10 and 11. Regarding PS‐2, there was no association between AD and intronic polymorphisms.
A case of small cerebral cyst and pericentric inversion of chromosome 9 that developed schizophrenia‐like psychosis
Authors: Miyaoka Tsuyoshi , Seno Haruo , Itoga Motoi , Ishino Hiroshi
Published: March 2003

A case of schizophrenia‐like psychosis (psychotic disorder not otherwise specified according to the DSM‐IV criteria) with pericentric inversion on chromosome 9 [inv.(9) (p11; q13)] is reported. In this case, a minor brain anomaly, a small cyst in the left subcortex, was observed on magnetic resonance imaging of the brain. In the clinical course, prominent chronic hallucinations were observed; however, there was no evidence of the disorganization of personality, delusion, and deterioration in level of functioning that are usually seen in schizophrenia. This case and a review of the literature indicate that the pericentric region of chromosome 9 might be a potential areas of interest for the aetiology of psychiatric disorders. The phenotype–karyotype relationship of pericentric inversion on chromosome 9 and its relationship to psychosis are discussed.
Characteristics of epilepsy in severely mentally retarded individuals
Authors: Amano Kouichiro , Takamatsu Junichi , Ogata Akira , Miyazaki Chihiro , Kaneyama Hisakazu , Katsuragi Shouichi , Deshimaru Motonori , Sumiyoshi Shiro , Miyakawa Taihei
Published: March 2003

In order to clarify the characteristics of epilepsy in patients with severe mentally retarded (SMR) subjects, we analyzed 52 SMR subjects with epilepsy from the institute for SMR subjects at Kikuchi National Hospital, Kumamoto, Japan. A total of 61.5% patients had uncontrolled seizures which were resistant to treatment. The most common combinations of seizure types in those not responding to conventional anticonvulsants were generalized tonic–clonic seizures (GTCS) with tonic seizure and GTCS with atypical absence. Their clinical features were characterized by spastic paralysis associated with a slower background electroencephalogram and abnormal computed tomography scans of the head, suggesting the involvement of cortical damage. These findings suggest that a large proportion of epilepsy in SMR subjects does not respond to treatment and that the severity of organic brain damage may therefore affect the natural course of epilepsy in such patients.
Quantitative analysis of paradoxical inward rib cage movement during sleep in children
Authors: Kohyama Jun , Sakuma Hiroshi , Shiiki Toshihide , Shimohira Masayuki , Hasegawa Takeshi
Published: March 2003

Paradoxical inward rib cage movement in children is quantified by the labored breathing index (LBI) on the respiratory inductive plethysmography. Labored breathing index during rapid eye movement sleep (REMS) in 59 children without obvious sleep disordered breathing (SDB) declined with age, and decreased to the mature low level at 35 months of age. The LBI was also found to reflect well the severity of SDB. Paradoxical inward rib cage movement, which was quantified by LBI, is concluded to be an important finding in diagnosing SDB in child patients.
A case report of comorbid eating disorder and factitious disorder
Authors: Mizuta Ichiro , Fukunaga Tomoko , Sato Hiroshi , Ogasawara Masayuki , Takeda Masatoshi , Inoue Yoichi
Published: March 2003

Abstract A review of the literature on comorbid eating disorder and factitious disorder reveals that they are very rare. In this report the authors present the case of a 26‐year‐old Japanese female, who, in the midst of treatment for eating disorder, was found to be fabricating her physical symptoms, by injecting unclean water into her intravenous bottle. As a result she was diagnosed with factitious disorder.
Hypomanic switching caused by the psychological effects brought on by a change in environment due to hospital admission: Two cases of bipolar II patients who showed a hypomanic switch
Authors: Abe Takaaki , Kato Satoshi
Published: March 2003

Abstract Hypomanic episodes in two cases involving depressed patients (bipolar II) were observed after admission to an open psychiatric ward. The patients had not exhibited any prior (hypo)manic episodes during outpatient treatment. Thus, manic switching was thought to have been caused by the psychological effects brought on by the change in environment due to hospital admission. Hospital admission was believed to have been an unloading from their stressful lives, given that the affective state of both patients prior to admission was characterized by depression resulting from work‐related stress. The close relationship between the patients and the predominantly female nursing staff may have triggered a psychological regression in both patients. These factors appear to have led to the hypomanic switching.
Interpeak latency of auditory event‐related potentials (P300) in senile depression and dementia of the Alzheimer type
Authors: Sumi Noriaki , Nan'no Hisashige , Fujimoto Osamu , Ohta Yoshitaka , Takeda Masatoshi
Published: March 2003

Abstract Most studies on event‐related potentials (ERP) in psychiatric illness or dementia have focused on the single‐peak latency of ERP components. In the present study, not only peak latencies of ERP components (N1, P2, N2, and P3) but also interpeak latencies (IPL; N1–P2, P2–N2, and N2–P3) were analyzed using the auditory oddball task. Thirty‐five senile depressed patients and 34 patients with dementia of the Alzheimer type (DAT) were compared to 39 age‐matched healthy volunteers. The mean latencies of P2 and P3 were shorter in patients with senile depression than in controls. In DAT patients, the N2 and P3 latencies were longer. When the IPL was assessed, however, only the mean IPL of N1–P2 was shorter in patients with senile depression, while the P2–N2 IPL were longer in those with DAT. The IPL results suggest that in senile depression the early cognitive process is hastened and in DAT the middle process is disturbed. Based on these results, we conclude that IPL of the auditory ERP might be used to reveal the disturbed steps within the cognitive process.
Delirious episodes induced by intravenous administration of clomipramine associated with an acute increase in its plasma concentrations
Authors: Ueda Nobuhisa , Yoshimura Reiji , Eto Seiji , Terao Takeshi , Nakamura Jun
Published: March 2003

Abstract The aim of this paper is to describe two cases of clomipramine‐induced delirium. One 61‐year‐old and one 67‐year‐old female depressive patients became delirious after beginning intravenous clomipramine injections in addition to their oral clomipramine administrations. Their plasma levels of both clomipramine and its metabolite, desmethylclomipramine, were acutely increased about twofold during delirium. The intravenous clomipramine administrations were discontinued. Their delirious state was gradually improved after stopping the intravenous clomipramine administrations. These findings suggest that acute increases of plasma levels of clomipramine and desmethylclomipramine after intravenous clomipramine injections might be related to the appearance of the delirious episodes.
Spatio‐temporal EEG power spectral patterns during a short daytime nap
Authors: Luo Zili , Honda Kazuki , Inoué Shojiro
Published: March 2003

This is an approach to investigate topographic changes in electroencephalographic (EEG) spectral power during pre‐ and post‐nap wakefulness as well as stages 1 (S1) and 2 (S2) NREM sleep in 12 subjects. Delta‐ and theta‐band power significantly increased in the frontal and central regions during S1 and S2 with an increase in inter‐ and intra‐hemispheric correlations. Beta‐band power significantly increased in the frontal, central and parietal regions during S2 with an increase in interhemispheric correlation. In contrast, alpha‐band power significantly decreased in the parietal‐occipital regions during S1 and S2 with a decrease in interhemispheric correlation. Thus, daytime nap modulated spatio‐temporal patterns of EEG power spectral patterns in wide scalp regions.
Two auto‐detection methods for eye movements during eyes closed
Authors: Suzuki Hiroyuki , Matsuura Masato , Moriguchi Kazuhiko , Kojima Takuya , Hiroshige Yoshiharu , Matsuda Tetsuya , Noda Yuji
Published: March 2003

Eye movements during closed eyes closely reflect changes of the arousal level during transition from wakefulness to sleep. Because they contain both rapid and slow eye movements (REM and SEM), it has been difficult to detect them automatically. Hiroshige recently developed the method of linear regression analysis for automatic detection of the two types of eye movements, and we have developed a template matching method for autodetection. The aim of the present study was to compare both auto‐detection methods and visual scoring for REM and SEM. The results revealed high agreement between the two quantitative methods and the visual scoring, indicating that auto‐detection of eye movements is useful for quantitative evaluation of arousal level.
Effects of combination psychotropic drug treatment on heart rate variability in psychiatric patients
Authors: Ikawa Makoto , Tabuse Hideaki , Ueno Sachiko , Urano Takashi , Sekiya Michiharu , Murakami Toshihito
Published: March 2003

Abstract The aim of this study was to evaluate the effects of combination psychotropic drug treatment on heart rate variability (HRV), which was mainly controlled by the parasympathetic nervous system. Mean R–R intervals (mRR) and coefficient of variation (CV), an index of HRV, were studied in 22 psychiatric patients and 21 age‐ and sex‐matched healthy controls. Next, in the patient group focusing on both anticholinergic and antidopaminergic properties, combination psychotropic drug daily doses were converted into biperiden milligram equivalents (BPDeq) and chlorpromazine milligram equivalents (CPZeq), respectively. The relationship between mRR and CV and these equivalent dosages was examined. A significant reduction in both mRR (P < 0.05) and CV (P < 0.05) was found in the patient group. In addition, significant negative correlations were observed between the dose of BPDeq and mRR (P < 0.05), and between the dose of BPDeq and CV (P < 0.005). In contrast, no significant correlations were observed between the dose of CPZeq and either parameter. These findings suggest that the effects of combination psychotropic drug treatment on HRV are mainly due to their anticholinergic properties. Therefore, CV is a useful indicator to assess the parasympathetic activity of psychiatric patients under combination psychotropic drug treatment.
Changes in auditory P300 with clinical remission in schizophrenia: Effects of facial‐affect stimuli
Authors: Yamamoto Masashi , Morita Kiichiro , Waseda Yoshihumi , Ueno Takefumi , Maeda Hisao
Published: March 2003

Abstract The auditory P300 is affected by arousal and emotion. We examined the effect of drawings expressing sadness or pleasure on auditory event‐related potentials (ERP) during recovery from schizophrenia. Oddball‐paradigm auditory ERP were recorded while presenting one of these drawings to nine patients with paranoid schizophrenia and seven patients with other types of schizophrenia during the acute stage and again during remission. P300 parameters (amplitude, area, and latency), reaction time, and symptom scores were evaluated. P300 amplitude and area were significantly greater in the recovery than in the acute phase. Increases were larger when viewing drawings that expressed sadness than when viewing drawings that expressed pleasure. In paranoid‐type patients, P300 when viewing pleasurable drawings was similar to that when viewing sad drawings during the acute phase; in remission, P300 was significantly larger when viewing sad drawings than when viewing pleasurable drawings. In non‐paranoid patients, P300 while viewing pleasurable drawings was significantly larger than that while viewing sad drawings during the acute phase; this difference disappeared during recovery. P300 latency and reaction time were not influenced by facial‐affect stimuli or recovery. A significant negative correlation was noted between amplitude and negative symptom scores. P300 amplitude and area may be useful state markers during recovery in schizophrenic patients. Effects involving attention resources and emotional arousal are also involved.
Risperidone failed to improve polydipsia‐hyponatremia of the schizophrenic patients
Authors: Kawai Nobutoshi , Baba Atsuomi , Suzuki Toshihito
Published: March 2003

Abstract The effect of risperidone on polydipsia‐hyponatremia was evaluated in six hospitalized schizophrenic patients. The normalized diurnal weight gain (NDWG), urine‐specific gravity (USG), urine and plasma osmolarity, and serum sodium were monitored during 9 months of risperidone treatment. The dose of risperidone (mean ± SD = 8.0 ± 1.0, range = 6–9 mg/day) was determined as approximately half of the haloperidol‐equivalent dose of previous neuroleptics. Before risperidone treatment, the mean (± SD) BPRS score was 23.5 ± 7.1; no significant improvement was observed after risperidone (22.0 ± 7.5). The subjects showed relatively high serum prolactin before risperidone treatment (mean ± SD = 16.5 ± 9.7 ng/mL), that was not significantly decreased by risperidone (14.2 ± 7.9 ng/mL). The monthly means (± SD) of NDWG and USG before risperidone were 5.5 ± 1.5 (%) and 1.002 ± 0.001, respectively. These and other indices did not significantly improve throughout the study period. Although the sample size is relatively small, our preliminary data showed that risperidone might not be effective on polydipsia‐hyponatremia of schizophrenic patients.
Situation and problem of administration methods and the intermission of hypnotics
Authors: UCHIMURA NAOHISA , TAKEUCHI NOBORU , KUWAHARA HIROO , NOSE IWAO , HASHIZUME YUJI , SHIRAKAWA SHINICHIRO , OHYAMA TETSU , MAEDA HISAO
Published: March 2003

Abstract The results of a questionnaire survey suggested four problems that might prolong the administration of benzodiazepine hypnotics without suspending the medication. First, psychiatrists did not actively consider the necessity of suspension of medication with hypnotics. Second, the period between improvement of insomnia and initiation of dose reduction was long, whereas the period between initiation of dose reduction and discontinuation was short. Third, to suspend medication of a hypnotic, every‐other‐day administration was used for the very short‐acting and short‐acting types, and substitution of the intermediate‐acting or long‐action type for the drugs with a short half‐life were performed frequently. Finally, dose reduction and intermission of medication induced rebound insomnia, withdrawal symptoms, and recurrence of insomnia.
Morningness–eveningness preference and mood in Japanese junior high school students
Authors: TAKEUCHI HITOMI , MORISANE HIROMI , IWANAGA AKIRA , HINO NATSUMI , MATSUOKA AYA , HARADA TETSUO
Published: March 2003

Abstract The relationship between morningness–eveningness (M‐E) preference and mood in Japanese students aged 12–15 years (690 boys and 649 girls) was investigated. No significant difference in M‐E preference was seen between genders. Girls became gloomy more frequently than boys, whereby the girls who experienced melancholy more frequently tended to prefer evening. The correlation between mood and M‐E preference, which was demonstrated only by girls, might be linked to a rapid shift to evening preference by girls in the past couple of years.
Pathogenesis of schizophrenia: Part I. Symptomatology, cognitive characteristics and brain morphology
Authors: Kurachi Masayoshi
Published: March 2003

Abstract The objective of the present study was to provide a pathophysiological model of the development of schizophrenia. The method used was a selective review of recent findings, including those in our own department, concerning the clinical symptoms, cognitive characteristics and morphological brain changes in schizophrenia. A four‐syndrome classification was proposed in which ‘alienation syndrome’ is separated from delusion syndrome. Memory organization deficit in schizophrenia patients was correlated with reduced activation of the left inferior frontal regions. Magnetic resonance imaging and statistical parametric mapping analysis revealed that volume reduction in the temporal lobe was seen in both schizotypal disorder and schizophrenia patients, but schizophrenia patients had additional changes in the medial and dorsolateral frontal regions. In conclusion, a temporo‐frontal dual pathology of schizophrenia was suggested.
Psychological factors and survival after bone marrow transplantation in patients with leukemia
Authors: Akaho Rie , Sasaki Tsukasa , Mori Shin‐Ichiro , Akiyama Hideki , Yoshino Miyo , Hagiya Katsuko , Nakagome Kazuyuki , Sakamaki Hisashi
Published: March 2003

Abstract Psychological factors may be associated with the outcome of cancer treatment, including bone marrow transplantation (BMT). However, studies on the issue have provided controversial results. In the present study, effects of mood status on the outcome was studied through a follow‐up period of 1–3 years as well as in shorter periods (3 and 8 months) post‐BMT in 72 Japanese patients with leukemia. Psychological status was evaluated 2 weeks before BMT using Profile of Mood States (POMS). The most major factor abstracted from the POMS subscales (Factor 1, mainly comprising anxiety, depression, anger, fatigue and confusion) was associated with disease‐free survival rate at 3 months post‐BMT. However, the factor most significantly associated with the outcome was gender. Females had better outcome than males through the period of 1–3 years as well as at 8 months post‐BMT. When analyzed by gender, Factor 1 was associated with poor prognosis at 3 and 8 months in males. In females, however, Factor 1 was not significantly associated with the prognosis. The present results suggest an association between mood status pre‐BMT and prognosis post‐BMT in a gender‐specific manner.
α1‐Antitrypsin deficiency and toxic shock: A Japanese autopsy case
Authors: Nakade Osamu , Kasai Kiyoshi , Satoh Masaaki , Yamamura Miyuki , Kakiuchi Hideki , Kaku Tohru , Mori Michio
Published: March 2003

A 74‐year‐old Japanese female presented with the sudden appearance of hemorrhagic purpuric ecchymoses on her lower extremities and with fever and chills, and died on the fifth day of hospitalization. A diagnosis of α1‐antitrypsin (AT) deficiency was made postmortem. The liver weighed 1260 g. Histological sections from the liver revealed rather severe fatty changes of the hepatocytic parenchyma and partial loss of the normal hepatic architecture with fibrosis. The hepatocytes contained periodic acid‐Schiff (PAS)‐positive, diastase‐resistant and α1‐AT‐positive intracytoplasmic globules. There was markedly increased inflammatory infiltration with severe edema and congestion, accompanied by fibrous, thickened pulmonary alveolar walls with fibrin deposition in the lungs (right, 410 g; left, 280 g), which suggest findings similar to those seen in multiple organ failure. Mild pulmonary emphysema was also present in the upper lobes of the lungs. Histological sections from the hemorrhagic necrotic ecchymoses of the skin showed marked neutrophil infiltration over the subcutaneous tissue with bleeding and blistering. A finding of thrombophlebitis was also found in the subcutaneous tissue. No bacteria were detected in the ecchymoses, the urine or the blood. Plasma protein analysis revealed a lower level (9.5 μmol/L) of α1‐AT and a higher level (330 U) of anti‐streptolysin O (ASO). These findings suggest that the patient died of toxic shock‐like syndrome and that α1‐AT deficiency might have facilitated the development of the toxic shock. To our knowledge, this is the first case of toxic shock associated with α1‐AT deficiency.
Anitschkow cells in the human heart
Authors: Satoh Fumiko , Tsutsumi Yutaka
Published: March 2003

A case of multiple myeloma, who died of congestive heart failure of unknown cause, is presented. Microscopically, Anitschkow cells with caterpillar and owl‐eyed nuclei were scattered in the interstitium of the myocardium. To know the pathological significance of their appearance, histological observations of normal, developing and autoimmune disease‐bearing heart specimens were made. A few Anitschkow cells were commonly seen in the interstitium of the adult heart with or without autoimmunity, and fetal cardiomyocytes often showed Anitschkow‐type nuclear configurations. Moreover, squamous cancer cells metastatic to the myocardium exhibited Anitschkow‐type nuclei. No Anitschkow‐type nuclei were observed in extracardiac locations. In conclusion, formation of Anitschkow‐type nuclear features in the human heart is not necessarily specific to the autoimmune status, but can be regarded as being ubiquitously provoked by the continuous contraction of heart muscle cells.
Interstitial invasion of well‐differentiated hepatocellular carcinoma and subsequent tumor growth
Authors: Miyao Yoichi , Ozaki Daisuke , Nagao Toshitaka , Kondo Yoichiro
Published: March 2003

Pathological processes of interstitial invasion of hepatocellular carcinoma (HCC) were investigated in 125 autopsy and seven surgical cases, where selection focused on those occurring in well‐differentiated HCC. The invasive pattern of well‐differentiated HCC was characterized by the formation of streaks of tumor cell cords running along connective tissue fibers, referred to as a streak pattern. These cell cords were unaccompanied by reticulin frameworks and type IV collagen, which are consistent components of HCC parenchyma. The typical streak pattern was observed only in HCC cases and could be useful in differential diagnosis. Following progressive accumulation or proliferation of the tumor cells within the interstitium, many capillaries appeared between the cell cords while collagen fibers tended to disappear. The tumor cell cords then showed branching and were accompanied by reticulin frameworks, type IV collagen and sinusoidal blood spaces. In the setting of interstitial invasion of well‐differentiated HCC, it is suggested that interstitial tissue is converted into HCC parenchyma via the aforementioned steps.
Infantile disseminated visceral giant cell arteritis presenting as sudden infant death
Authors: Kagata Yutaka , Matsubara Osamu , Ogata Sho , Lie J. T. , Mark Eugene
Published: March 2003

The rare clinicopathological entity ‘disseminated visceral giant cell arteritis’ (DVGCA) was first described in 1978. It is characterized by widespread small‐vessel giant cell angitis and extravascular granulomas. A normal and healthy 7‐month‐old boy who presented unexpectedly with sudden infant death syndrome (SIDS) is reported. Histological examination at autopsy revealed giant cell angitis of the aorta, common carotid, coronary, pulmonary, celiac, mesenteric and common iliac arteries. There were also granulomas in the tracheal wall and liver. To our knowledge, this is the first documented case of DVGCA occurring in an infant younger than 12 months of age. A review of the literature on DVGCA is presented in this report, and the differential diagnosis is discussed.
Cutaneous granulocytic sarcoma mimicking immunoblastic large cell lymphoma
Authors: Sadahira Yoshito , Sugihara Takashi , Yawata Yoshihito , Manabe Toshiaki
Published: March 2003

A peculiar case of cutaneous granulocytic sarcoma without leukemic manifestation (so‐called aleukemic leukemia cutis) that developed in the skin of the back of a 69‐year‐old man is reported. A skin biopsy specimen showed atypical cells with a prominent nucleolus proliferating around dermal blood vessels and along adnexa without epidermotropism. Atypical cells similar to those of the skin had infiltrated diffusely into the interfollicular area of an inguinal lymph node. Flow cytometric and immunohistochemical studies with a panel of monoclonal antibodies revealed neoplastic cells that had a biphasic phenotype of myeloid and T cell precursors. They expressed CD13, CD15, CD33, lysozyme, CD3ɛ, CD4, CD7 and terminal deoxynucleotidyl transferase (TdT). Gene analysis showed no rearrangement of the immunoglobulin heavy chain or T cell receptor β and γ genes. Ultrastructurally, the tumor cells exhibited a few intracytoplasmic electron‐dense granules and well‐developed rough endoplasmic reticulum with an occasional whorling arrangement. The initial diagnosis was immunoblastic large cell lymphoma, and the patient was treated with six courses of ProMACE‐CytaBOM. In spite of the high‐grade cytological characteristics of this tumor, the patient has been free of disease for 5 years.
Expressions of cyclin E, A, and B1 in Hodgkin and Reed–Sternberg cells: Not suppressed by cyclin‐dependent kinase inhibitor p21 expression
Authors: Ohshima Koichi , Haraoka Seiji , Fujiki Takehiro , Yoshioka Shingo , Suzumiya Junji , Kanda Motomu , Kikuchi Masahiro
Published: March 2003

p21 Is involved in the control of the mammalian cell cycle through the binding and inhibition of cyclin‐dependent kinases. The cyclins are dependent on the phases of the cell cycle, and divided into two classes: mitotic cyclins (A, B1, B2) and G1 cyclins (C, D1, D2, D3, E). The product of the p21 gene is a potent downstream effector of the p53 tumor‐suppressor gene function. The Hodgkin and Reed– Sternberg (H & RS) cells in Hodgkin’s disease are reported to frequently express p53, p21, and nuclear proliferative activity (Ki‐67). To clarify the relationship of p21, p53 and cyclins, we performed the immunohistochemistry of p53, p21, Ki‐67, cyclin D1, cyclin E, cyclin A and cyclin B1, using 11 cases with Hodgkin’s disease. In addition, we performed p53 gene sequencing of exon 5–8, and in situ hybridization of Epstein‐Barr virus (EBV) EBER‐1 region, whose products have reported to induce the expression of cyclin D. In this study, in all cases, Ki‐67 was expressed in almost all H & RS cells, and p53 and p21 were expressed in H & RS cells. No p53 gene mutations were detected in any case, and p53 protein overexpression did not correlate with p53 gene mutations. The number of p21‐positive H & RS cells was significantly related with that of the p53‐positive cells. The cyclins E, A, B1 and D1 were also expressed in H & RS cells. Unexpectedly, the expression of the cyclins was not suppressed by p21 and p53 expression. In addition, the existence of EBV was not related to the expression of cyclins. It is considered that H & RS cells are, indeed, in cell cycle and commonly express the cell cyclins, and that the cell cycle of H & RS cells may not be specifically fixed in the G1, S, G2 or M phases.
An autopsy case of a malignant pericardial mesothelioma in a Japanese young man
Authors: Watanabe Masatoshi , Suzuki Hideo , Fukutome Kazuo , Enoki Akiko , Yamada Norikazu , Nakano Takeshi , Shiraishi Taizo , Yatani Ryuichi
Published: March 2003

An autopsy case of a malignant pericardial mesothelioma in a 27‐year‐old man with no history of exposure to asbestos is reported. He was admitted for heart failure due to pericardial effusion of unknown origin and surgically drained, but later died. The diagnosis of a malignant pericardial mesothelioma was made on the basis of histologic, immunohistochemical and ultrastructural findings. The tumor was located on the pericardium, but autopsy revealed that it had spread extensively in the mediastinum and the lungs. Microscopically, the tumor cells were epithelial like and contained histochemically demonstrable glycogen and hyaluronic acid. Immunohistochemical studies of the tumor demonstrated positive immunoreactivity for cytokeratin 19, muscle actin HHF35, epithelial membrane antigen, CA125, p53 and p21WAF1/CIP1 whereas the tumor was negative for cytokeratins 10 and 17, carcinoembryonic antigen, vimentin, epithelial antigen BerEP4, S‐100, c‐erbB2 and bcl‐2. A high MIB‐1 labeling index was noted. Under the electron microscope the tumor cells exhibited long, thin villi. The operation and autopsy findings thus revealed this to be a very rare case of malignant pericardial mesothelioma in a young man.
Heterotopic pancreatic tissue associated with intra‐ and extrahepatic choledochal cysts
Authors: Suzuki Koyu , Uchida Toshikazu , Nakayama Hisashi , Ugajin Wakato , Inaniwa Yoshimi , Sugitani Masahiko , Mori Yoshiomi
Published: March 2003

A case report of heterotopic pancreas in intra‐ and extrahepatic biliary tracts in a 36‐year‐old female who suffered from intra‐ and extrahepatic choledochal cysts with an anomalous pancreatobiliary duct system. Histologic examination of the resected specimen showed pancreatic tissues located along the wall of the biliary tract with choledochal cysts. The pancreatic tissue consisted of acinar cells and duct elements without Langerhans’ islets; the acinar cells were positive immunohistochemically for α‐amylase and negative for endocrine hormones. Ultrastructural study revealed zymogen granules in the acinar cells. In the present case the heterotopic exocrine pancreatic tissue seems to be etiologically related to choledochal cysts as well as to the anomalous arrangement of the pancreatobiliary duct.
Breast cancer with choriocarcinomatous features: A case report with cytopathologic details
Authors: Murata Tetsuya , Ihara Shinji , Nakayama Tsuyoshi , Nakagawa Shun‐ichi , Higashiguchi Takashi , Imai Takazumi , Nakano Hiroshi , Shiraishi Taizo , Kuroda Makoto , Moriya Takuya
Published: March 2003

A case of breast cancer with choriocarcinomatous features (BCCF) is reported. The patient was a 38‐year‐old Japanese female with a long history of schizophrenia. Her nursing staff noticed a palpable mass in her right breast, which showed rapid growth. Following cytopathologic confirmation of a malignant breast tumor, she underwent mastectomy with ipsilateral axillary lymph node dissection. Histologic examination revealed BCCF, which was positive for placental alkaline phosphatase and human chorionic gonadotropin (HCG) by immunohistochemistry. The serum HCG level was high. She died 7 months postoperatively, with multiple metastases of BCCF to the chest wall, lung and liver.
A clinical and pathological study on the characteristics and factors influencing the prognosis of crescentic glomerulonephritis using a cluster analysis
Authors: Sasatomi Yoshie , Kiyoshi Yasuhiro , Takabeyashi Shigeo
Published: March 2003

Crescentic glomerulonephritis (CrGN) is expressed by a rapidly progressive lesion. However, there is no unanimous view on the factors that affect the prognosis. We carried out a follow‐up study of 109 CrGN patients consisting of 54 males (age 55.3 ± 15.7) and 55 females (age 54.0 ± 16.3) by a cluster analysis using pathomorphological parameters at the time of biopsy, and thus found two categories which were significantly different regarding the speed of progress (P = 0.0249). The component factors of rapidly progressive CrGN included a combination of several factors such as: (i) a high frequency of crescents; (ii) frequent sclerosis and hyalinosis in the glomeruli with crescents; (iii) extensive tubulo‐interstitial damage (cellular, fibrocellular and fibrous) in the renal cortex; (iv) hyperproteinuria; (v) high mean blood pressure; and (vi) anemia. Thus, the prognosis of CrGN is regulated by no single factor but instead by a complex combination of mutually associated factors.
Type VI collagen immunoreactivity in skeinoid fibers in small intestinal stromal tumors
Authors: Tsutsumi Yutaka , Tazawa Kenichi , Shibuya Makoto
Published: March 2003

By immunoperoxidase analysis for types I to VI collagen, elastin, cytoskeletal components and some glycoproteins, we found type VI collagen immunoreactivity in amorphous eosinophilic deposits (skeinoid fibers) in three small intestinal stromal tumors. Negative results were obtained for types I, II, III, IV and V collagen, elastin, laminin, ubiquitin, intracellular filaments such as actin, desmin, vimentin, calponin and caldesmon, and glycoprotein such as lysozyme, factor XIIIa, β2‐microglobulin, α1‐antitrypsin and α1‐antichymotrypsin. In two lesions, the periodic acid‐Schiff‐positive skeinoid fibers were also focally labeled for amyloid P component.
Lipoma of the adrenal gland
Authors: Büttner Andreas
Published: March 2003

A rare case of a lipoma of the adrenal gland is reported with a review of the literature. The tumor was incidentally found at autopsy in a 50‐year‐old man who died from severe head trauma after a traffic injury. At autopsy, an oval‐shaped, soft yellow nodule measuring 1.1 cm in diameter was found in the right adrenal cortex. Histological examination revealed a lesion consisting of mature adipose tissue partially surrounded by a thin fibrous capsule. On serial sections there was no evidence of hematopoiesis nor of adrenal medulla cells. To the best of our knowledge, this is the eighth case described in the English literature. With the increasing use and the high resolution of modern imaging techniques, these unsuspected adrenal masses may become more prevalent.
Mucinous carcinoma of the breast: A multifaceted study with special reference to histogenesis and neuroendocrine differentiation
Authors: Kato Noriko , Endo Yasushi , Tamura Gen , Katayama Yousei , Motoyama Teiichi
Published: March 2003

Although mucinous carcinoma (MC) of the breast is considered to originate from ductal carcinoma, it is not known whether mucinous growth begins in the intraductal carcinoma or later in the invasive carcinoma. In this study, 33 MC (16 pure without any ductal components, 10 mixed Type I with an intraductal component, seven mixed Type II with a common invasive ductal carcinoma (IDC) component)) were examined to clarify the time when mucinous growth begins. Histochemical and immunohistochemical examinations of mucin revealed that mucinous growth can begin in the intraductal carcinoma and in the common IDC. Histological transition and clonality analysis using microsatellite markers supported that some MC originate from common IDC. The pure type of MC probably originates from the intraductal carcinoma, showing a micropapillary feature. Neuroendocrine differentiation, known to be associated with MC, seemed to create the main progress in the typical MC. Moreover, we analyzed the factors of a worse prognosis of mixed MC Type II, which was strongly suggested by the lymph node status. However, no explainable differences on the cell proliferating ability, or c‐erbB‐2 and p53 protein overexpression were found.
Ossifying fasciitis
Authors: Doğan A. Işın , Gedikoˇglu Gökhan , Demircin Metin , Ruacan Şevket
Published: March 2003

A case of ossifying fasciitis occurring in the left femoral region of a 57‐year‐old male is reported. The patient complained of pain in his left lower extremity which was the site of previous catheterization. During a left femoropopliteal by‐pass, a firm and cylindric mass measuring 5 × 3 × 2.5 cm in size was found and extracted from the left groin. Histologically, a reactional lymph node and an irregularly shaped lesion extended into the perinodal fat tissue which is composed of proliferating fibroblasts with occasional mitotic activity. Within this fibroblastic proliferation, immature woven bone composed of osteoid with calcification and chondroid differentiation were seen. Metaplastic bone is an uncommon finding in cases of nodular fasciitis, parosteal fasciitis, cranial fasciitis and florid reactive periostitis. Ossifying fasciitis is known as an uncommon variant of nodular fasciitis. It is an uncommon post‐traumatic benign lesion of subcutaneous tissue with an unclear etiology of ossification which is neither related with a bony structure nor contains any muscle tissue. This lesion has been reported only once previously, in the femoral region after a trauma history of catheterization.
Semiquantitative immunoblot analysis of nm23‐H1 and ‐H2 isoforms in adenocarcinomas of the lung: Prognostic significance
Authors: Sato Yuichi , Tsuchiya Benio , Urao Takeshi , Baba Hideo , Shiku Hiroshi , Kodama Tetsuro , Kameya Toru
Published: March 2003

Total amounts of nm23 protein and relative levels of H1 and H2 isoforms were studied in 27 fresh‐frozen samples of pulmonary adenocarcinoma and adjacent non‐neoplastic tissues that were obtained at surgery. Semiquantitative immunoblotting with a monoclonal antibody (Pan‐242) against nm23 protein demonstrated both isoforms, recognized as 20.5 kDa for H1 and 18.5 kDa for H2, to be present in all cases. Both H1 and H2 levels in neoplastic tissues were higher than in the corresponding non‐neoplastic samples. Expression of H2 was usually greater than of H1. The H2/H1 ratio varied from 1.9 to 14.1 (mean value 5.2) in non‐neoplastic tissues and 1.0–5.9 (mean value 2.5) in neoplastic tissues, although this ratio did not correlate with any prognostic factor like tumor size, nodal status or distant metastasis (TNM tumor stage). H1 and H2 levels were significantly lower (mean values 4.3 and 2.4) in well‐differentiated than in moderately and poorly differentiated adenocarcinomas (8.3 and 3.0) (P< 0.03 and P< 0.05, respectively). These data indicate that H1 and H2 isoform levels correlate with histological differentiation, but not the metastatic potential or stage of pulmonary adenocarcinoma.
Fine mapping of thymus enlargement gene 1 (Ten1) in BUF/Mna rats
Authors: Ye Chunlin , Murakumo Yoshiki , Higo Kyoko , Matsuyama Mutsushi
Published: March 2003

Two polymeric autosomal loci, Ten1 and Ten2, regulate thymus enlargement in BUF/Mna (B) rats. Previously, we mapped Ten1 on chromosome (Chr) 1 to a 20 cM region between Myl2 and D1Mgh11, and Ten2 on Chr 13. To further characterize the precise position of Ten1, 34 and 37 microsatellite markers, that have a polymorphism between the B and WYK (W) and between the B and MITE (M) strains, were used for linkage analysis of thymus enlargement in 105 (WBF1 × B) blackcross (BC) and 78 (B × BMF1) BC rats, respectively. Our data showed that the D1Rat168, D1Rat112, D1Rat323, D1Got186, D1Got187 and D1Got188 markers each gave a peak logarithm of odds (LOD) score of 10.68 for linkage to the thymus ratio in (WBF1 × B) BC rats, and that the D1Rat168, D1Rat197, D1Got184, D1Got186 and D1Got188 markers each gave a peak LOD score of 7.82 in (B × BMF1) BC rats. The two LOD score peaks are coincident in the position of the rat genetic map. All of the markers mentioned above are located in the region between Igf2 and D1Mgh11, in which synteny is conserved with human 11q15.5 and the distal end of mouse Chr 7 or with human 11q13 and the proximal end of mouse Chr 19. Genes existing in these regions are discussed as candidate genes for Ten1.
Adult‐onset giant juxtaglomerular cell tumor of the kidney
Authors: Kuroda Naoto , Moriki Toshiaki , Komatsu Fumito , Miyazaki Eriko , Hayashi Yoshihiro , Naruse Keishi , Nakayama Hirofumi , Kiyoku Hiroshi , Hiroi Makoto , Shuin Taro , Enzan Hideaki
Published: March 2003

The juxtaglomerular cell tumor (JGCT) of the kidney is a rare neoplasm which commonly secretes renin. This tumor often occurs in teenagers. This paper documents the 14th adult‐onset (over 30‐years‐old) case with a giant JGCT which measured 9.0 × 8.0 × 7.5 cm. Histologically, this tumor was composed of both vascular and tubular components. Immunohistochemically, the vascular component reacted with renin, cytokeratin 7, ulex europaeus agglutinin‐1, vascular endothelial growth factor (VEGF) and Flk‐1 (VEGF‐R2), whereas the tubular component was positive for renin, epithelial membrane antigen (EMA), cytokeratin 7, α‐1‐antitrypsin, VEGF and Flk‐1. This finding suggests that both vascular and tubular components of JGCT may promote neoplastic proliferation via an autocrine mechanism through the action of VEGF.
Adenocarcinoma of the rectum with various grades of atypia in association with Crohn’s disease: A case report and immunohistochemistry of p53 and Ki‐67
Authors: Koda Kenji , Yoshino Goro , Honda Satoshi , Watanabe Fumitoshi , Sugimura Haruhiko
Published: March 2003

A case of adenocarcinoma of the rectum in a 41‐year‐old woman, in association with Crohn′s disease is presented. The patient had suffered diarrhea and constipation, and Crohn’s disease was suspected. Although the endoscopy did not reveal the presence of any tumors, biopsy specimens demonstrated adenocarcinoma. A Miles’ operation was performed. The adenocarcinoma was composed of various grades of atypia and had invaded the non‐peritonealized perirectal tissues. The infiltration of lymphocytes and plasma cells was moderate at the perimeter of the carcinoma and mild in the distant regions. Epithelioid cell granulomas were found. The p53 labeling index (LI) increased with the grade of atypia over the entire length of the carcinomatous gland. In carcinomas with high grade atypia, the p53 LI was high in both the upper and the lower halves of the gland. In carcinomas with low or moderate grade atypia however, the p53 LI was high in the lower half and low in the upper half of the gland. The Ki‐67 LI over the entire gland was higher in carcinomas with high grade atypia than in carcinomas with low or moderate grade atypia.
Bronchial granular cell tumor with osteopontin and osteonectin expression: A case report
Authors: Jin Yulan , Kuroda Naoto , Kakiuchi Satoshi , Yamasaki Yoshikazu , Miyazaki Eriko , Hayashi Yoshihiro , Toi Makoto , Naruse Keishi , Hiroi Makoto , Enzan Hideaki
Published: March 2003

The case of a 52‐year‐old Japanese man with bronchial granular cell tumors with osteopontin and osteonectin expression is reported here because there have been few investigations of their expression in benign tumors. He was admitted because of sudden hematemesis. A bronchoscopic examination revealed a lobulated polypoid tumor located in the left and right bronchi. Histologically, most tumor cells had abundant granular eosinophilic cytoplasm and were immunoreactive for S‐100, neuron‐specific enolase (NSE), CD68 and vimentin. Moreover, osteopontin‐positive tumor cells were randomly distributed in the tumor tissue, but few stromal cells were positive. In contrast, osteonectin was mainly expressed in the peripheral tumor cells and was also distributed in the stromal cells. Blood vessels at the tumor border in which osteonectin‐positive tumor cells were distributed, proliferated moderately. These results suggest that osteopontin and osteonectin may play a role in the progression of granular cell tumors and in the interaction between the tumor and host or angiogenesis around the tumor, respectively.