muramidase and Cholelithiasis

We describe a Paneth cell carcinoma arising within the ampulla of Vater in a 64-year-old man. The phenotype of virtually all neoplastic cells was consistent with that of Paneth cells, based on routine morphology and their strong positive immunostaining for lysozyme. Additional widespread positive immunostaining for carcinoembryonic antigen and CA 19.9 supports a totipotential cell as the origin of such neoplastic cells. This case, therefore, represents a true Paneth cell carcinoma, as opposed to inclusion of occasional neoplastic Paneth cells into a poorly differentiated adenocarcinoma. This pattern of differentiation is rare, and predictions regarding its ultimate biological behavior and malignant potential must be guarded.

Topics: Adenocarcinoma; Ampulla of Vater; Biomarkers, Tumor; CA-19-9 Antigen; Carcinoembryonic Antigen; Carcinoma; Cell Differentiation; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy, Laparoscopic; Cholelithiasis; Common Bile Duct Neoplasms; Diagnostic Errors; Humans; Male; Middle Aged; Muramidase; Neoplasm Proteins; Neoplastic Stem Cells; Pancreaticoduodenectomy; Paneth Cells; Totipotent Stem Cells

Lactoferrin and lysozyme have bactericidal activities and are responsible for mucosal defense against local bacterial infections. To assess the local defense mechanisms in the intrahepatic biliary tree, we studied the distribution of lactoferrin and lysozyme immunohistochemically in 14 normal autopsy livers and in 29 surgically resected and two autopsy livers of hepatolithiasis. In the latter, bacterial infection was constantly found. Lactoferrin and lysozyme were detected in low doses and in specific areas in the intramural and extramural glands of certain normal livers. In contrast, in hepatolithiasis, the incidence of lactoferrin- and lysozyme-positive cases significantly increased both in the intramural glands (94% and 77% of 31 cases, respectively) and in the extramural glands (72% and 48% of 29 cases, respectively) (p less than 0.01) in the stone-containing bile ducts. These glands proliferated considerably in the stone-containing bile ducts and were stained more widely and intensely than in normal livers. These data suggest that these proliferated peribiliary glands in the stone-containing bile ducts produce and secrete significant amounts of lactoferrin and lysozyme. Increased production and secretion of lactoferrin and lysozyme suggests activated local defense mechanisms against bacterial infection in the stone-containing bile ducts, and may be beneficial for inhibition of the growth of calculi and prevention of the suppurative inflammation.

Topics: Adult; Aged; Aged, 80 and over; Autopsy; Bile Duct Diseases; Bile Ducts, Intrahepatic; Cholelithiasis; Humans; Immunohistochemistry; Lactoferrin; Liver; Middle Aged; Muramidase; Statistics as Topic

A total of 89 gallbladders with various conditions were examined histologically and immunohistochemically to detect various kinds of metaplastic changes. The gallbladder mucosa of the fetus and normal gallbladder showed no metaplastic changes. In 32 cases of chronic cholecystitis, metaplastic changes, such as mucous gland metaplasia (23 cases), Paneth's cells (six cases), and goblet cells (four cases) were observed. All cases containing Paneth's cells or goblet cells showed simultaneous lysozyme immunoreactivity and also contained argyrophilic cells. Among 23 cases with mucous gland metaplasia, 15 cases showed lysozyme immunoreactivity, eight contained argyrophilic cells, and 16 showed lysozyme immunoreactivity and/or argyrophilic reaction. The other seven cases showed only mucous gland metaplasia without endocrine cells or lysozyme immunoreactivity. These results suggest that the presence of lysozyme and/or endocrine cells is a conventional marker of gastrointestinal metaplasia of the gallbladder mucosa. Using these markers, 14 (28.6%) of 49 cases of adenocarcinoma of the gallbladder contained endocrine cells; 18 (36.7%) showed lysozyme immunoreactivity; and 25 (51.0%) contained at least one marker of endocrine cells or lysozyme immunoreactivity. These results suggest that at least half of adenocarcinomas of the gallbladder might be derived from metaplastic changes.

Topics: Adenocarcinoma; Adenocarcinoma, Mucinous; Adolescent; Adult; Argyria; Child; Child, Preschool; Cholecystitis; Cholelithiasis; Fetus; Gallbladder; Gallbladder Neoplasms; Histocytochemistry; Humans; Immunoenzyme Techniques; Infant; Metaplasia; Muramidase; Precancerous Conditions; Serotonin; Staining and Labeling