Ｇａｎｄｙ‐Ｇａｍｎａ結節の再検討

Abstract

Gandy-Gamna nodules and focal hemosiderin depositions in the spleens obtained from 4 patients with idiopathic portal hypertension (IPH), 5 with liver cirrhosis (LC), and one with extrahepatic portal vein obstruction (EHO) were examined histologically. In all patients except one with IPH, full-scale, large, cross-cut sections stained by the Perls iron reaction were examined. In one patient of each disease group, serial sections were also used for three-dimensional observation. The Gandy-Gamna nodules are caused by hemorrhage and connective tissue proliferation in the periarteriolar lymphocyte sheath (PALS). Hemosiderin deposition extended to the trabecula via the lymphatic flow in the PALS, which is the reverse of that of blood in the arteriole. Although calcium deposition is observed later, it is not considered to be essential to the formation of a Gandy-Gamna nodule. Three-dimensional observation revealed that Gandy-Gamna nodules are not spherical, but spindle-shaped or branched, as a result of their formation along the central arterioles; however, they give the appearance of being two-dimensionally round in a single section.Gandy-Gamna nodules are concluded to be characteristic of the spleen of patients with portal hypertension. The definition of Gandy-Gamna nodules as nodules composed of proliferating connective tissue and hemosiderin deposition with calcification are not sufficient, and their location and histogenesis are also important considerations in this definition.