No abstract available.
Classification*

Since the discovery of hepatitis B virus as one of the causes of hepatitis, liver and hepatocellular carcinoma, many hepatitis B viral markers that appear in infected individuals have been discovered and many efforts to understand the relationship between the emergence of viral markers and the progression of hepatitis have been performed. Gudat (1975) compared the expression of HBcAg and HBsAg in various conditions and stages of hepatitis but the pattern of expression of viral markers and its significance have not been understood. Recently it was found by mierocytotoxicity assay that HBcAg might be the target of T lymphocytes. This study attempted to identify any correlation of the tissue expression rate and pattern of HBcAg and HBsAg with the histologic activity of 46 cases of liver cirrhosis using immunohistochemical staining. The expression rate and pattern of HBcAg and HBsAg in relation to the nodular size and positivity of serum HBeAg were also compared. The results were as follows; 1) The expression rate of HBcAg in the liver was 41.3% (19/46). and that of HBsAg was 67.4% (31/46). 2) The histologic activity of liver cirrhosis appeared to be correlated with the expression of HBcAg, especially cytoplasmic HBcAg. 3) The positivity of serum HBeAg was significantly higher in active liver cirrhosis. 4) There was no relationship between the tissue expression of HBsAg and the histologic activity of liver cirrhosis. relationship existed between the nodular size and expression rate and pattern of HBcAg and HBsAg. This study suggests that the tissue HBcAg, especially the cytoplasmic HBcAg is the most likely factor determining the histologic activity of liver cirrhosis, and that the cytoplasmic HBcAg may be the ultimate cause and target of most host immune response.
Carcinoma, Hepatocellular

This is to report a case of collision tumor of the urinary bladder, which was composed of papillary transitional cell carcinoma(PTCC) and osteosarcoma. Grossly the tumor was located at left antero-lateral wall and was a fungating, gray yellow, bony hard mass with papillary configuration of the luminal surface. Histologically the tumor was composed of PTCC confined to the mucosa and sarcomatous component not intermixed with the overlying PTCC. The sarcomatous area had features of classic osteosarcoma with anaplastic tumor cells and haphazardly arranged osteoid matrix, and was positive for osteonectin but entirely negative for cytokeratin or epithelial membrane antigen. Ultrastructural study demonstrated the tumor cells to be osteoblast which had rich rERs and a few lipid vesicles in plump cytoplasm without any evidence of epithelial ongin. The case is thought to be an example of collision tumor because there was no evidence of transition between PTCC and osteosarcoma.

To pursue a desirable format for the pathological diagnosis of liver cirrhosis, the authors attempted to classify 369 biopsy-proven cirrhosis on the basis of etiology and made effort to find out the morphological characteristics of each category. About 735 of total cases were HBsAg seropositive postnecrotic cirrhosis. Alcholic cirrhosis ws the second most frequent type, although accounted only 6.8%. In about 15%, the etiology was not known. Excluding the congenital biliary atresia, chronic biliary obstruction appeared to be a rare cause of cirrhosis among these biopsied cases. Of the HBsAg positive postnecrotic cirrhosis, the eAg seropositive cases tended to be micronodular and to show a higher necroinflammatory activity, in contrast to eAg seronegative cases and those complicated by hepatocellular carcinoma (HCC), suggesting that the loss of eAg is followed by a decrease of the destructive activity, active regeneration of hepatocytes and finally the development of HCC. alcoholic cirrhosis was micronodular in 64% and revealed histologic evidences of alcoholic liver disease in most cases. The results indicate that etiological diagnosis can be made in most cases of cirrhosis by the morphological characteristics and the precise clinical informations, including those on the NANB virus and the inborn error of metabolism, and that the pathological diagnosis should be more comprehensive, implicating the etiology, the nodular size and the necroinflammatory activity.
Carcinoma, Hepatocellular

Cases sharing features of both primary biliary cirrhosis and autoimmune hepatitis have been reported as a mixed type, overlap syndrome, immunocholangitis and autoimmune cholangiopathy. A primary biliary cirrhosis- autoimmune hepatitis overlap syndrome is unusual and characterized by overlapping features; cholestasis, high titer of alkaline phosphatase, bile duct damage and granulomas in the liver biopsy, high antinuclear antibody, increased IgG and IgM and intra-acinar hepatitis with piecemeal necrosis. Autoimmune mechanisms are thought to play a major role in the pathogenesis of the overlapping syndrome and the bases of immunosuppressive therapy. A 58-year-old female patient shows overlapping clinical and laboratory findings, chronic active hepatitis in initial liver biopsy which transits to primary biliary cirrhosis with cholangitis and granulomas. This is a case of hepatobiliary lesion showing overlapping features of both primary biliary cirrhosis and autoimmune hepatitis over 3-year period.
Alkaline Phosphatase ; Antibodies, Antinuclear ; Bile Ducts ; Biopsy ; Cholangitis ; Cholestasis ; Female ; Granuloma ; Hepatitis* ; Hepatitis, Autoimmune ; Hepatitis, Chronic ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Liver ; Liver Cirrhosis, Biliary ; Middle Aged ; Necrosis

Hepatic veno-occlusive disease (VOD) is a rare disease due to occlusion of the terminal hepatic venules and/or sublobular veins, which is a result of endothelial damage from pyrrolizidine alkaloids in herbal teas, irradiation of the liver, or chemotherapy particularly in association with bone marrow transplantation. We recently experienced three cases of VOD developed after radiation therapy. Two cases occurred in hepatocellular carcinoma patients of a 37-year-old man with B viral chronic hepatitis and a 22-year-old man with B viral cirrhosis and the other in a 64-year-old patient with esophageal squamous cell carcinoma. For the treatment of hepatocellular carcinoma, chemoembolization with lipiodol and adriamycin, and external irradiation on the liver mass were done. The total radiation dose was 5400 cGy and 3000 cGy in each case. Five months and 3 months after irradiation, respectively, the resected liver masses showed extensive necrosis due to pre-operative treatment. To treat esophageal carcinoma, pre-operative concurrent chemotherapy of 5-FU and radiation of 4500 cGY were done. One month after irradiation, the radical esophgectomy and wedge biopsy of the liver were done. The liver of all 3 cases showed a dark red appearance with severe congestion in contrast to the pale brown normal liver, which was not included in the radiation field. On micoscopic examination, the terminal hepatic venules and sublobular veins showed subintimal edema, fibrin deposition, and partial or total luminal occlusion by loose fibrous tissue. The centrizonal sinusoids were markedly dilatated and congested with atrophy of hepatocytes.
Adult ; Atrophy ; Teas, Herbal ; Biopsy ; Bone Marrow Transplantation ; Carcinoma, Hepatocellular ; Carcinoma, Squamous Cell ; Doxorubicin ; Drug Therapy ; Edema ; Estrogens, Conjugated (USP) ; Ethiodized Oil ; Fibrin ; Fibrosis ; Fluorouracil ; Hepatic Veno-Occlusive Disease* ; Hepatitis, Chronic ; Hepatocytes ; Humans ; Liver ; Middle Aged ; Necrosis ; Phenobarbital ; Pyrrolizidine Alkaloids ; Rare Diseases ; Veins ; Venules ; Young Adult

This report presents a case of an atypical nodule arising in a hepatocellular adenoma(HCA) in a non-cirrhotic liver of a 42-year-old man. The patient had been relatively healthy until he developed right upper abdominal pain. Abdominal sonography and computerized tomogram revealed a 7.5x7cm sized mass in the right inferior segment of liver. The mass revealed the histologic features of HCA. At near center of the HCA, was found a I cm sized discrete nodule, a nodule within a nodule. The nodule revealed higher cellularity than the HCA and was composed of monotonous hepatocytes with an increased nuclear-cytoplasmic ratio, resembling atypical adenomatous hyperplasia. Interestingly, the atypical nodule showed a focal pseudoacinar arrangement of tumor cells. The histologic features of the atypical nodule arising in HCA may the morphological sequence of transformation from HCA to hepatocellular carcinoma
Carcinoma, Hepatocellular

Unstable microsatellite repeat sequences or DNA replication errors(RER) due to defective mismatch repair genes have been reported in a subset of sporadic colorectal tumors and in most tumors of patients of hereditary nonpolyposis colorectal carcinoma(HNPCC). To elucidate the clinicopathological correlation of these RER-positive cancers, we examined 16 cases of colorectal carcinoma of different histologic subtypes(6 cases of carcinoma with no gland formation, 5 cases of mucinous carcinoma and 5 cases of gland forming carcinoma). We detected RER in five cases. The patients with RER-positive cancers had a marked preponderance of carcinoma with no gland formations out of 6 carcinomas with no gland formation were RER-positive cancers) and of cancers proximal to splenic flexure(all of the RER-positive cases were proximal colon carcinomas). We conclude that RER-positive cancers have wiique pathologic features that may be useful for the screening and counselling of patients with hereditary colon cancers.

In order to clarify the preneoplastic nature of large regenerative nodules without dysplastic change, we analysed the clonality of hepatocellular carcinomas (HCCs) and large nodules, diameter > or =0.5 cm, of cirrhotic liver by X-linked human androgen receptor (HUMARA) gene assay, using the principle of random X chromosome methylation and inactivation in female. Ten cases of HCC and 5 cases of large nodules without dysplasia from 9 female patients were selected. All the tumors, large nodules and paired normal control cells were selectively microdissected from deparaffinized hematoxylin and eosin stained slides. Genomic DNA was isolated and digested with HhaI. Polymerase chain reaction(PCR) amplication of the HUMARA locus was performed using 32P-a-dCTP containing PCR mixtures. The PCR amplified products were separated by gel electrophoresis and analysed by autoradiography. Nine HCCs from 8 patients were monoclonal and 1 case was polyclonal and the remaining 1 case was not polymorphic at the HUMARA locus. The HCC case which showed polyclonality contained many inflammatory cells. All the large nodules were polyclonal by HUMARA assay. These results suggest that all or most of the cells composing the large regenerative nodules without dysplasia are polyclonal. This assay may be informative for the differentiation between regenerative and preneoplastic nodules in cirrhotic liver and the size of nodule may be not important in hepatocarcinogenesis.
Autoradiography ; Carcinoma, Hepatocellular* ; DNA ; Electrophoresis ; Eosine Yellowish-(YS) ; Female ; Fibrosis ; Hematoxylin ; Humans ; Liver ; Methylation ; Polymerase Chain Reaction ; Receptors, Androgen ; X Chromosome

A case of clear cell adenocarcinoma arising in the female urinary bladder, which is accompanied by endometriosis of the urinary bladder and the uterus, is reported. The carcinoma protruded into the vesical lumen as a fungating mass, and had a tubulocyotic pattern. The tumor cell had intracytoplasmic glycogen and electron microscopically short microvilli on their surface, resembling clear cell acenocarcinoma of the female genital tract including ovary. This is the fourth case report of clear cell adenocarcinoma complicating vesical endometriosis, and may support the view that clear cell carcinome arises from endometriosis which, in turn, from the Mullerian remnant.
Female ; Humans ; Adenocarcinoma