広汎な転移を来した両側副腎褐色細胞腫の一剖検例

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The patient was a female, 60 years of age, who had suffered from the pulsating pain in the occipital region 20 days prior to the admission. Her physical condition became progressively worse in association with vomiting, diplopia, incontinentia and unconsciousness. The clinical impression was at first encephalitis japonica or meningitis. Routine laboratory studies revealed the hypochromic anemia and leucocytosis with neutrophilia. Serologic tests for syphilis were positive in blood and negative in liquor. The blood pressure was 100/60. The cerebrospinal fluid was hemorrhagic with the positive globulin reactions. During the course of hospitalization, the patient remained somnolent and died suddenly 43 days after the onset of symptoms. Thus the intracranial tumor was suspected. II. Autopsy findings i) Macroscopic findings. Both adrenals were diffusely enlarged. (left: measuring 7 by 4.5 by 2.4 cm, weighing 40g right: 8.5 by 6.0 by 2.4 cm, 72g). The adrenal medullae were completely replaced by the tumor tissue,which converted the adrenal cortex to be a paper-thin capsule. At one end of the left tumor, a rim of compressed adrenal cortical tissue was seen. On cut surface, tumor tissue was fragile, showed neither softening nor cyst formation. Ground color of the tumor was grayish-white, mottled by the points of red hemorrhages and yellow coagulation necrosis. Metastasis of the tumor was observed in the cerebellum (both hemisphere), colon (40cm anal from ileocoecal region), all lymph nodes but mesenteric nodes. ii) Microscopic findings. The neoplasm was composed of cells which varied greatly in size and shape and were arranged for the most part diffusely without assuming any regular pattern. There were also alveolar structure,rosette formation, palisade and pseudofollicular arrangement in some areas. In general cell boundaries were indistinct. Some of the cells underwent hydropic change. Numerous mitotic figures were encountered throughout the section. The occurrence of multinucleated cells and large syncytial cells were characteristic in the tumor. There was a moderate amount of necrosis and hemorrhage. The tumor cells were demonstrated to contain no fat and P.A.S. positive granules. A portion of the tumors was placed in Orth's solution in order to demonstrate the possible chromaffinity of the cells.But the result was negative. The staining of the formalin-fixed tissue with azocarmine, as recommended by Gomori, gave also negative result. The brown coarse granules, negative for iron reaction and not bleached by hydrogen peroxide, were observed in the peripheral portion of the tumor, to which great attention had been drawn by Dietrich and Siegmund as characteristic to pheochromocytoma. It was most interesting for us that the droplets ranging in size from nucleolus to nucleus were stained reddish, yellowish by azan-staining, which were first described by Oberndorfer (1909) to appear under the infectious condition in adrenal medullary cells. These droplets can be stained with high specificity by the carbol fuchsin. The occurrence of Oberndorfer's droplets are strongly suggestive of the origin of the tumors from the adrenal medullary cells in spite of negative chromaffin reaction.
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広汎な転移を来した両側副腎褐色細胞腫の一剖検例

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