We report an autopsy case of hepatocellular carcinoma (HCC) with sarcomatous change arising in the context of primary biliary cirrhosis (PBC) in a 79-year-old man. Primary biliary cirrhosis was diagnosed (stage I according to Scheuer's classification) by findings on blood biochemical analysis, laparoscopy, and liver biopsy at age 69 years. Five years later, (at age 74 years), a mass lesion was detected in the S6 region of the liver by abdominal ultrasonography, and target biopsy revealed well differentiated HCC. Blood biochemistry, ultrasonography, and computed tomography findings showed that the PBC had progressed to stage IV (cirrhotic stage). Percutaneous ethanol injection therapy (PEIT) was administered to the HCC several times over a 5-year period; however, the patient died of liver failure in February, 1994 (at age 79 years). Viral markers for hepatitis B and C were negative during the course, and hepatitis C virus RNA was not detected by polymerase chain reaction. Autopsy findings showed liver cirrhosis and diffuse involvement of spindle-shaped sarcomatoid cells in the liver, particularly in the S6 region, associated with several nodules of trabecular HCC cells. A zone of transition between the sarcomatoid cells and the trabecular hepatocellular carcinoma cells was observed. The sarcomatoid cells were diffusely disseminated in the peritoneal cavity and had metastasized to multiple organs. Immunohistochemically, the cells were positive for fibrinogen, as were the coexisting trabecular hepatocellular carcinoma cells. The HCC had been treated several times with PEIT. Of interest, PEIT may be an important factor in this type of tumor progression.

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Abstract:Changes in the secretory proteins of the rat submandibular saliva and its amino acid composition, brought about by a single dose of the parasympathomimetic drug, Pilocarpine, were studied.After collecting unstimulated saliva, the secretion was elicited by Pilocarpine and the saliva was collected at 10-minute intervals.Unstimulated saliva could be separated into seventeen components by SDS-electrophoresis, the stimuli were separated into twenty-six components both at 1 hr and 2 hr. The carbohydrate-protein complex of stimulated saliva observed eleven components in contrast with unstimulated saliva which had eight components.Both unstimulated and stimulated saliva were consisted of aspartic acid, glutamic acid and proline-rich residues and with a given stimuli, the amino acid composition had a tendency to increase the basic amino acid residues.The low molecular bands in electrophoretogram contained in the cytosol fraction of the submandibular gland were absent from stimulated cytosol at 1 hr and 2 hr, and Pilocarpine administration was effective in increasing the high molecule proteins in the cytosol at 1 hr and 2 hr.These results suggested that Pilocarpine brings about the discharge of salivary granule components into saliva and the differences in the secretory components with Pilocarpine stimuli and unstimuli, were evidenced.

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