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Pulmonary sclerosing pneumocytoma (PSP) is pathologically classified as an adenoma and behaves in a benign manner. However, some cases of PSP displayed pathologically malignant behavior, such as lymph node metastasis and necrosis. A 64-year-old woman was referred to our hospital complaining of a cough and breathlessness. Histopathological analysis of the resected specimen by left pneumonectomy and lymph node dissection revealed a large PSP measuring 15 × 14 cm in size, with massive necrosis and vascular invasion. This case was the largest ever reported and suggested that clinico-histological presentation of PSP sometimes showed an aggressive phenotype like advanced lung cancer.

Pseudomonas aeruginosa exotoxin A (PEA) causes severe hepatotoxicity in experimental animals and is useful in investigations of immune-mediated liver injury. However, strain differences in the sensitivity to PEA-induced hepatotoxicity in rats remains be elucidated. In this study, we determined the severity of PEA-induced hepatotoxicity in six genetically different rat strains. Male LE (Long Evans), Wistar, F344, WKY, BN/SsN and LEW rats were administered a single intravenous injection of PEA (20 μg/kg). Significantly elevated serum ALT and AST levels, massive necrosis and hemorrhage, and numerous TUNEL-positive hepatocytes were observed in BN/SsN rats. In contrast, low levels of ALT and AST as well as mild changes in liver histopathology were observed in Wistar and F344 rats. Moderate levels of hepatic injuries were observed in LE, WKY, and LEW rats. Pro-inflammatory cytokines including TNF-α, IL-2 and IL-6 serum levels were markedly increased in BN/SsN rats compared to Wistar and F344 rats. However, the hepatic levels of low density lipoprotein receptor-related protein (LRP), which functions as the PEA receptor, were not significantly different in each strain. Taken together, we suggest that BN/SsN is the most sensitive rat strain, whereas Wistar and F344 were the most resistant rat strains to PEA-induced liver damage. The different genetic background of rat strains plays an important role in the susceptibility to PEA-induced epatotoxicity that may depend on immune-regulation but not LRP receptor levels.

Aim To evaluate if any association existed between the extent of hepatic necrosis in initial liver biopsies and patient survival. Methods Thirty-seven patients with fulminant liver failure, whose liver biopsy exhibited substantial necrosis, were identified and included in the study. The histological and clinical data was then analyzed in order to assess the relationship between the extent of necrosis and patient survival, with and without liver transplantation. The patients were grouped based on the etiology of hepatic necrosis. Each of the etiology groups were then further stratified according to whether or not they had received a liver transplant post-index biopsy, and whether or not the patient survived. Results The core tissue length ranged from 5 to 44 mm with an average of 23 mm. Causes of necrosis included 14 autoimmune hepatitis, 10 drug induced liver injury (DILI), 9 hepatitis virus infection, and 4 unknown origin. Among them, 11 showed submassive (26%-75% of the parenchymal volume) and 26 massive (76%-100%) necrosis. Transplant-free survival was worse in patients with a higher extent of necrosis (40%, 71.4% and 100% in groups with necrosis of 76%-100%, 51%-75% and 26%-50%, respectively). Additionally, transplant-free survival rates were 66.7%, 57.1%, and 25.0% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively. Even after liver transplantation, the survival rate in patients as a result of viral hepatitis remained the lowest (80%, 100%, and 40% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively). Conclusion Adequate liver biopsy with more than 75% necrosis is associated with significant transplant-free mortality that is critical in predicting survival.

According to recent reports from the World Health Organization (WHO), noma (or cancrum oris), a hideous, ancient disease primarily affecting children living in poverty in parts of sub-Saharan Africa, is increasing. Noma often starts as an ulcer on the oral mucosa or as acute necrotizing gingivitis and commonly starts after a bout of measles or other disease. It quickly develops into a massive necrosis, moving from the inside outward, often involving major portions of the face. Early treatment with antibiotics, rehydration, correction of electrolytic imbalances, and administering nutritional supplements will halt the disease. The high mortality rate, however, indicates that many children are not given care or brought for care in time. Surviving victims often display severe facial deformities that demand extensive reconstructive surgery. Current research has elucidated parts of the pathogenesis of noma. The WHO started the International Action Network Against Noma in 1992, with its official launch on the World Health Day in 1994; a five-point action plan was presented and current work follows that plan.

Two patients with lung cancer were successfully treated by Percutaneous Microwave Coagulation Therapy (PMCT) under CT guided condition. Using our CT guided device, PMCT can be carried out safely and accurately. The first patient survived for 15months after PMCT. At least 7 months he stayed home with his family. The second was followed by operation. The specimen resected revealed massive necrosis within whole tumor although a few residual cancer cells were observed around peripheral bronchiole. PMCT has the advantage of cost-benefit balance and also a minimal invasiveness treatment for patients. PMCT will be a potent option for lung cancer therapy.

Changes in bile ducts in cholestasis are characterized by activation of proliferation and hypertrophy of cholangiocytes and degenerative and necrobiotic changes in ductal epithelium. Long-term cholestasis led to massive necrosis of cholangiocytes. Inflammatory changes in the choledochal mucosa were most pronounced in patients with choledocholithiasis.

多形腺腫の穿刺吸引細胞診 (FNA) では多彩な細胞像が認められるが, 壊死物質を認めることはきわめてまれである. 今回われわれは, 広範な凝固壊死を伴った特異な多形腺腫の1例を経験した. 症例は40歳男性. 平成6年より左耳下腺部の腫瘤に気付き, 近医にて経過観察されていた. 平成9年9月頃より, 圧痛とともに腫瘤が急激に増大したため当院紹介となり, 穿刺吸引細胞診 (FNA) に引続き摘出術が施行された. FNAでは, 多量の壊死物質を背景に上皮細胞と問質細胞の大型集塊が多数, 混在して出現していた. 上皮細胞は不規則配列で強い重積性を呈し, 個々の細胞はクロマチン濃染性だが, N/C比は低く核小体は目立たなかった. 間質細胞は粘液変性を伴っているが整った配列を呈し, 異型性を認めなかった. 多量の壊死物質を認めるも上皮細胞の異型性が乏しいこと, 良性の間質細胞を多数認めることから, 多形腺腫が強く疑われた. しかし, その他の病変や悪性の可能性も否定できなかった. 摘出された腫瘍は径約3cm大で, その大部分は凝固壊死に陥っており, 残存腫瘍は被膜直下にのみ認められた. 腫瘍組織は, 充実性あるいは管状増殖を呈する細胞異型の乏しい2相性上皮成分と, 粘液腫状の問質成分が混在し, 多彩な像を呈していた. 広範な凝固壊死を伴った多形腺腫と診断された.

A case of malignant Triton tumor occurring in the leg of a 48-year-old woman with neurofibromatosis (von Recklinghausen's disease) is presented. The neoplasm was composed mainly of spindle-shaped cells forming interlacing fascicles with areas of massive necrosis. The important feature in this neoplasm was the presence of rhabdomyoblastic cells admixed with other cellular components. In addition, variable histologic features including solid, myxomatous, hemangiomatous, hemangiopericytomatous, epithelioid, and lymphomatous areas were identified. This variety has been recognized in malignant schwannomas, but not in malignant Triton tumors. There were discrete foci with each predominant histologic feature shown in a map of the neoplasm in which the distribution of those components is demonstrated based on the histology and immunohistochemistry. Satisfactory biopsy specimens are necessary for accurate diagnosis of malignant Triton tumor.

A structural, ultrastructural, and morphometric study was made of the liver parenchyma of 12 adult tench (Tinca tinca, L.) subjected to acute experimental copper sulfate poisoning. The lesions observed were characterized by the accumulation in the cytoplasm of large amounts of hemoglobinemic pigment produced by intense hemolysis, initially in Kupffer cells and by the last stage of the experiment in hepatocytes. This process became increasingly severe, and culminated in the massive necrosis of large areas of liver parenchyma, which led to the death of tench 12 days after the start of the experiment.

Biopsy-confirmed massive necrosis, involving 76%-100% of hepatic parenchymal volume in allograft, is a catastrophic complication after liver transplantation (LT). The prognosis of these patients has not been well evaluated. We retrospectively reviewed 7 liver transplant biopsies from 6 patients that exhibited …

Plantas hepatotóxicas são importantes causas de prejuízos em herbívoros no Brasil. Este trabalho relata uma hepatotoxicose aguda, ocorrida em 7 caprinos que morreram após a ingestão de folhas verdes de uma árvore de Trema micrantha que foi derrubada. Dois desses animais foram necropsiados e tecidos foram processados para exame histológico. O principal achado histológico foi observado no fígado, consistindo de necrose centrolobular a massiva, compatível com necrose hepática de origem tóxica. Todas as lesões observadas foram similares às descritas nas intoxicações experimentais por Trema micrantha em caprinos. Nenhuma outra planta hepatotóxica conhecida foi encontrada no local onde os caprinos permaneciam. Hepatotoxic plants are important cause of economical losses in farm animals in Brazil. This report concerns an outbreak of acute hepatic toxicosis, in which seven goats died after consumption of green leaves from a felled Trema micrantha tree. Two of these animals were necropsied and several tissues were processed for histological examination. Main histological finding was observed in the liver that showed centrilobular to massive necrosis consistent with an acute hepatic toxicosis. The overall picture was similar to those described in experimentally induced T. micrantha poisoning of goats. No additional known hepatotoxic plant was found in the paddock where the goats had been kept.

YPM had an acute toxic effect on BALB/c mice, which was dependent on the presence of T cells and correlated with the elevation of serum IFN-gamma. One monoclonal antibody (YSA8E3) rescued BALB/c mice from development of toxic shock after YPM injection.

A 72-year-old patient with a Warthin's tumor of the right parotid gland developed massive necrosis of the tumour associated with temporary facial palsy with subsequent macroscopic tumour disappearance.

The aim of this study was to investigate whether apparent diffusion coefficients (ADCs) could be used as measures of cell density and necrotic fraction of tumors. Tumors of four human melanoma xenograft lines were subjected to diffusion-weighted magnetic resonance imaging (DWI). ADCs were calculated from the images and related to cell density and necrotic fraction, as determined from histological sections. A significant correlation was found between the ADC of the viable tissue and cell density, regardless of whether tumors of different lines or different regions within individual tumors were considered. Necrosis was found in two of the lines. A single region of massive necrosis that could be differentiated from the viable tissue in ADC maps was found in one line, whereas a number of smaller necrotic regions that could not be identified in ADC maps were found in the other line. Tumor ADC was significantly correlated with the necrotic fraction of the former, but not of the latter line. Our results suggest that ADCs can be used as measures of cell density and necrotic fraction of some but not of all tumors, depending on whether the individual necrotic regions are large enough to be differentiated from the viable tissue with the obtained spatial resolution of the DW images. Magn Reson Med 43:828–836, 2000. © 2000 Wiley-Liss, Inc.

Among 100 cases of hepatic injury attributed to the administration of pemoline, 43 had sufficient accompanying information to permit analysis. All but two patients were less than 20 years old, and 80% were less than 12 years old. Males predominated the study. Injury appeared as early as 1 week or as late as greater than 1 year of taking the drug. The injury was uniformly hepatocellular as judged by the high values for aminotransferases and by death in massive necrosis in one patient. Mechanism was judged to be idiosyncratic, and the idiosyncrasy was probably metabolic rather than immunologic.

Methods: Six monochorionic diamniotic (MD) and eight dichorionic diamniotic (DD) pregnancies were studied for 30 min with transabdominal 4D sonography at 12–13 weeks’ gestation. The frequencies of no reaction (twins appear to touch each other but there is no clear reaction) and reaction (twins appear to touch each other and there is a clear reaction by the co-twin) movements were evaluated. Results: There was no significant difference in the rate of reaction movements between MD (median, 33.6%) and DD (median, 33.9%) twins. The median rate of reaction movements in all 14 twins was 33.9% (range, 27 to 64.1%). Conclusions: Our findings suggest that the incidence of reflex movement of the co-twin on being touched by the other twin late in the first trimester is more frequent than that assessed by conventional 2D ultrasound.

To the Editor: Hepatic-artery thrombosis early after liver transplantation is associated with a very high rate of graft loss and death.1 If urgent revascularization fails2 or if massive hepatic nec...

Carcinomas of the common bile duct are usually seen as dilatation of the bile duct proximal to a solid mass on CT. In the case reported here, the common bile duct cancer itself mimicked dilated common bile duct on CT because of massive necrosis. In a case of simulating dilated common bile duct on CT, and discrepancy between CT and ultrasonography or endoscopic retrograde cholangiopancreatography, a common bile duct cancer with massive necrosis should be included in the differential diagnosis.

A strain of Long-Evans rats (LEC), a new autosomal recessive mutant with hepatitis and severe jaundice [1–3], was established at the Cancer Institute, Hokkaido University School of Medicine, Sapporo, Japan. The mutant shows a sudden development of jaundice with a high rate of lethality around 4 months of age. The onset of jaundice is characterized by hyperbilirubinemia, elevation of serum glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) activities, with massive necrosis of hepatocytes. These clinical signs are almost identical with those of human fulminant hepatitis. It is also reported that survivors spontaneously develop liver cancer with time [4–6].

Emestrin (EMS) is an epidithiodioxopiperazine mycotoxin first described as a metabolite of Emericella striata 6 (Fig. 1). EQ-1 named by Maebayashi et al.3 for a toxic metabolite of E. quadrilineata and E. paravathecia was identified as EMS by Seya et al.6 Species of the genus Emericella are disibuted widely throughout tropical and subtropical countries. EMS-producing species have been isolated from various speices imported into Japan from several counries in Asia.7 In contrast to chemical studies and surveillance of food-born EMS-producing fungi, only limited information is available regarding the biological activities of EMS. In an in vitro system, K. Ishizaki and K. Kawai2 observed potent suppressive effects of EMS on the respiratory system in mitochondria. In an in vivo system, however, no precise toxicological studies have been reported regarding the target organs of experimental animals after administration of EMS. Our present study was undertaken to investigate the morphological changes in the target organs of mice after the administration of EMS.

• We report a case of acquired porphyrinemia in a liver transplant recipient. Thrombosis of the portal vein and hepatic artery led to massive necrosis of the patient's first donor liver, necessitating its removal. After an 18-hour anhepatic period, a second donor liver was transplanted. During this interval, the patient was warmed with an infrared heat lamp that emitted bright visible light. Following the anhepatic period, a photodistributed cutaneous erythema was noted. The level of total serum porphyrins during the anhepatic period was significantly elevated at 1.548 μmol/L (normal, ( Arch Dermatol. 1991;127:704-706)

Hepatic artery embolization with absolute ethanol (HAEE) was done in rats and rabbits with experimentally induced liver tumors, and its effects on liver parenchyma and tumors were analyzed microscopically in comparison with those of controls. HAEE with 0.1 ml in rats brought massive tumor necrosis and minimal damage to liver parenchyma. But HAEE with 0.15 ml in rabbits induced moderate to massive necrosis of liver parenchyma with minimal to moderate tumor necrosis. Damage to the intrahepatic bile ductules was also seen in both animals. Many problems should be resolved before clinical use.

Fulminant hepatic failure is an extremely rare coma syndrome resulting from massive necrosis of liver cells. A wide variety of etiologic agents have been identified, including viruses, drugs, and other toxic agents. Treatment focuses on reducing the ammonia load presented to the liver and on preventing or controlling complications, including sepsis, bleeding, cerebral edema, renal failure, and respiratory failure. With further research and identification of the specific toxins or metabolic derangements underlying the pathophysiology of this syndrome, more effective therapeutic measures may be devised.

A young man of 24 developed glandular fever, became jaundiced, and died in hepatic coma. At necropsy massive necrosis of the liver was found, thus emphasizing that all grades of severity of liver damage may occur in infectious mononucleosis.

SummarySuccessive feeding of 3MC 30 mg/ml for 2 days, 48 hours before DMBA administration inhibited completely the necrosis-inducing action of DMBA. The adrenal cortex in rats receiving 3MC prior to DMBA treatment appeared normal histologically. This remarkable protective phenomenon was also observed in rats pretreated with Metopirone, a compound which is known to suppress adrenal corticosterone synthesis by inhibiting 11 β-hydroxylation. The mechanism by which 3MC inhibited the necrosis-inducing action of DMBA was believed to be similar to that by which Metopirone inhibited it.

1. Biopsies of muscle were taken during the course of operation from sixteen patients with vascular injuries to the limbs. Three types of histological change were found. 2. In the first, there was massive necrosis of muscle fibres—a group of cases in which there had always been serious damage to the main artery of the limb or to the vessel supplying the affected muscles. 3. In the second type there was dense interstitial fibrosis, the muscle fibres sometimes being normal and sometimes showing necrosis or denervation—a group of cases in which the vascular injury varied from severance of the vessels by gunshot wounds to trivial damage, causing slow haemorrhage within fascial-bound spaces. 4. The third type showed scattered foci of necrosis together with patchy interstitial fibrosis—due to the pressure of tight plasters, crushing of the limb, fractures with arterial contusion, or slow haemorrhage or extravascular transfusion within fascial planes. The rise of tension within the muscles was probably sufficient to occlude the smaller arterioles with resultant patchy necrosis. 5. The vulnerability of certain muscles to vascular damage is partly related to the intramuscular vascular pattern, of which five types have been described. 6. In ischaemic muscles the intramuscular nerve trunks may be normal or they may show evidence of degeneration or necrosis; but in favourable circumstances there may be regeneration of axons. 7. In some cases there was evidence of regeneration of muscle fibres in man, the regeneration being dependent to some extent upon the efficiency of intramuscular anastomoses. 8. The prognosis, in cases of ischaemia of human voluntary muscle, depends upon the extent and the reversibility of damage to both muscle and nerve fibres and upon the extent of regeneration of muscle fibres.

Eleven patients underwent selective coronary and left ventricular cineangiography during intraaortic balloon pumping for acute myocardial infarction and cardiogenic shock. Studies were performed when the clinical and hemodynamic trend predicted in-hospital death. Angiograms were reviewed by dividing the left ventricle into six segments, each with its characteristic coronary perfusion. No patient with avascular and akinetic segments survived with or without surgery. One patient with residual perfusion of all segments showed massive necrosis at operation that eventually led to his death. In four patients the findings of residual contraction and perfusion of most segments suggested reversible ventricular dysfunction. Three of these underwent coronary surgery with two excellent survivors.