Pathological Autopsy Cases Research Articles

HEPATITIS B SURFACE ANTIGEN IN CIRRHOSIS OF THE LIVER AND PRIMARY LIVER CARCINOMA IN NAGASAKI AREA

The annual of pathological autopsy cases in Japan indicate that out of 4, 760 autopsy cases at Nagasaki University during the period 1964 to 1973, 445 (9.3%) are cirrhosis of the liver and 240 (5.0%) are primary liver carcinoma (PLC), and that 392 (88.1%) of 445 cirrhosis are atrophic liver cirrhosis and 180 (45.9%) of 392 atrophic liver cirrhosis are accompanied with hepatocellular carcinoma and 218 (90.8%) of 240 PLC are hepatocellular carcinoma. The data show that atrophic liver cirrhosis and hepatocellular carcinoma are relatively higher in incidence in Nagasaki area than other parts of Japan as has been suggested before.Hepatitis B surface Antigen (HBs-Ag) of 353 autopsy cases of liver diseases during the same period, especially cirrhosis, PLC, and acute, subacute liver atrophy and chronic hepatitis was investigated by Shikata's staining method of HBs-Ag using orcein after formalin fixation and routine paraffin processing sections of liver tissues. HBs-Ag were detected in liver diseases as follows : 110 (52.9%) of 208 casesof atrophic liver cirrhosis, none of 10 cases of micronodular cirrhosis, none of 29 cases of specific types ofliver cirrhosis such as biliary, cardiac, parasitic cirrhosis and Wilson's disease, 82 (63.6%) of 129 casesof hepatocellular carcinoma, two (9.5%) of 21 cases of cholangiocellular carcinoma, one (20%) of five cases of combined type of PLC, none of 10 cases of acute liver atrophy, four (22.2%) of 18 cases of subacute liver atrophy, three (15.8%) of 19 cases of chronic hepatitis, active type, and one (14.3%) of seven cases of chronic hepatitis, inactive type.The incidence of HBs-Ag in atrophic liver cirrhosis without hepatocellular carcinoma showeda decrease over fifth decade and also decreased over seventh decade in atrophic liver cirrhosis with hepatocellular carcinoma. HBs-Ag was found over two times more in frequency in atrophic liver cirrhosis accompanied with hepatocellular carcinoma (74 of 104 cases; 71.2%) than those without hepatocellular carcinoma. HBs-Ag was demonstrated in eight (32%) of 25 cases of hepatocellular carcinoma without atrophic liver cirrhosis and not in any cases of cholangiocellular carcinoma without atrophic liver cirrhosis and combined type of PLC without atrophic liver cirrhosis. There was no difference in the presence of HBs-Ag between atrophic liver cirrhosis showing active pattern of stromalinflammatory reaction and those with inactive pattern, regardless of having PLC or not. Liver cell dysplasia was found more frequently in atrophic liver cirrhosis with hepatocellular carcinoma (39 of 104 cases ; 37.5%) than those without hepatocellular carcinoma (13 of 100 cases; 13%). There was significant relationship between the presence of HBs-Ag and the appearance of dysplasia in atrophic liver cirrhosis with hepatocellular carcinoma (32 of 39 cases ; 82.1 %) and without hepatocellular carcinoma (11 of 13 cases ; 84.6%). HBs-Ag was stained in nodular hyperplasia in several cases of atrophic liver cirrhosis. HBs-Ag was demonstrated as “inclusion body type” in tumor cells in two cases of well-differentiated hepatocellular carcinoma.These results showed that atrophic liver cirrhosis and hepatocellular carcinoma, which predominate in Nagasaki area, were associated with the presence of HBs-Ag histopathologically and that HBs-Ag may play a etiological role in most cases of atrophic liver cirrhosis and hepatocellular carcinoma.

Metastatic carcinoma in cirrhotic liver--Statistical survey of autopsies in Japan.

Autopsy records for the period of 1958-1972 in Japan as listed in 'The Annual of the Pathological Autopsy Cases' were reviewed and the incidence of metastatic neoplasms in the cirrhotic liver was surveyed. This included data from 240,377 patients of which 8,798 cases (3.66%) had liver cirrhosis excluding biliary and cardiac types. Those who had coexistent liver cirrhosis and extrahepatic malignant neoplasm totalled 737 (8.4% of the cirrhotics). Of these 737 patients, 194 had metastatic neoplasms to the cirrhotic liver (26.3% of those who had cirrhosis and neoplasms). The incidence of hepatic matastases in the non-cirrhotics was 38.3% during the period 1958-1959, and 43.2% in 1967-1968. The difference in incidence of metastasis to the cirrhotic as opposed to the non-cirrhotic liver is statistically significant. This finding supports the claim that metastatic neoplasms to the cirrhotic liver are less frequent than metastasis to the non-cirrhotic liver. However, they are by no means rare. These results may be due to that the patients with both cirrhosis and neoplasms can not live long enough for metastasis to develop.

Causes of death in 3151 diabetic autopsy cases.

The cause of death and the patho-anatomical changes of various organs were analyzed in 3, 151 diabetic autopsy cases, which were collected from Annual Reports of Pathological Autopsy Cases (1958-1970) published by the Japanese Society of Pathology. In 2, 754 primary diabetics, the causes of death were as follow: diabetic coma 4.5%, arteriosclerotic cardiovascular diseases 41.2% (renal 19.3%, cerebral 11.1%, coronary 6.5%), infections 19.4% (tuberculosis 4.6%, lung 5.8%, urinary tract 3.3%, biliary tract 1.0%), malignant neoplasms 15.9% (stomach 3.9%, lung 3.7%), miscellaneous 15.2%. Diabetic coma was most common in the first decade and decreased with age. Infections were high in the third and fourth decades but showed no tendency to increase with age. Among the infections, the highest was purulent pulmonary disease. The arteriosclerotic cardiovascular disease was not seen in the first and the second decade as the main cause of death. They appeared at the third decade and increased with age. As compared with the reports from American and European countries, a high incidence of diabetic nephropathy and a low incidence of ischemic heart disease are characteristic of this series. As a cause of the low incidence of ischemie heart disease, the low consumption of fat in this country was proposed. Diabetic glomerulosclerosis was high in the third to sixth decades, especially in females. The incidence of cerebral infarction in this diabetic series was significantly higher than that in the general population, but that of cerebral hemorrhage was not different from that in the general population. 397 cases were classified as secondary diabetes (12.6%). These consisted of 96 pancreatic cancer, 25 pancreatitis, 175 liver cirrhosis, 22 hemochromatosis, 16 endocrine diseases and 63 steroid diabetes.

Natural history of the idiopathic cardiomyopathy.

Natural history of the idiopathic cardiomyopathy was studied. In part I idiopathic cardiomyopathy, excluding hypertrophic obstructive cardiomyopathy, familial cardiomyopathy, endocardial fibroelastosis seen in infant and secondary cardiomyopathy, was sub-jected. Subjects reported in Part I were classified into type I with 3 subdivisions and type II by histological findings of the heart and incidence and natural history of each type were discussed with comparing each other. Natural history is variable and different in each type such as fluminating and chronic. Calculated survival rate at 5th year was 75%. In part II familial cardiomyopathy was sub-jected. In this group onset of initial symptoms was most frequent at 2nd decade that was earlier than the other non-familial group reported in part I. Age of death was variable in each case. In part III endocardial fibroelastosis seen in infant obtained from the Annual of the Pathological Autopsy Cases in Japan was subjected. Majority of this group died within one year. 76% of the cases died within 6 months were accompanied by another heart anomalies but in the survived cases over 6 months or more complication of another heart anomaly was rather rare. Major causes of death through each type of cardiomyopathy reported in part I and II were sudden death and intractable chronic congestive heart failure. In familial cardiomyopathy sudden death had occured at the rate of 75% that was much more frequent than the rate of 40% observed in the non-familial idiopathic cardiomyopathy reported in part I.