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GEOPATHOLOGY OF ENDEMIC PEDIATRIC LYMPH NODE KAPOSI'S SARCOMA IN WESTERN KENYA


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Title: GEOPATHOLOGY OF ENDEMIC PEDIATRIC LYMPH NODE KAPOSI'S SARCOMA IN WESTERN KENYA
Other Titles: 西部ケニアにおける小児の風土病型リンパ節型カポシ肉腫
Authors: Komuro, Satoru / Toriyama, Kan
Authors (alternative): 小室, 哲 / 鳥山, 寛
Issue Date: 15-Sep-1991
Publisher: 日本熱帯医学会 / Japanese Society of Tropical Medicine
Citation: 日本熱帯医学会雑誌, vol.19(3), pp.251-263; 1991
Abstract: 風土病型カポシ肉腫(KS)は赤道アフリカに多く見られ,比較的小児にも好発し,また,リンパ節に発生するものも多く認められてきた。今までの我々の調査でも,小児に発生するKSは,主にリンパ節に初発していた。しかし,これらのKSに関する組織学的検討は,ほとんどなされていない。今回我々は,小児KSのうちリンパ節に初発した症例22例を用いて,地理病理学的,組織学的,免疫組織学的な検索を行い,その民族,地理的分布,組織学的形態像,細胞の由来,発生機序に関して検討した。その結果1)風土病型KSの好発年齢には,小児期と中高年齢期の二峰性が見られ,初発部位は小児では主にリンパ節で,多発する傾向が見られ,中高年齢期では四肢の皮膚に多く見られた。2)小児リンパ節型KSは,成人皮膚型KSと同様にLuo族に多く見られ,高温で多湿なピクトリア湖周辺に多く,乾燥した地域にはまれであった。3)KSはリンパ節のpara-cortical areaより発生し,reticulin networkに沿って増生していた。4)KSの病変部はspindle-shaped cell,macrophage-like cell,immature endothelial cell-like cell,mature blood vessel,lymphatic vessel,postcapillary venuleなどの細胞からなっていた。5)悪性を示唆する細胞異型,異型核分裂像,腫療による増殖性懐死,リンパ節被膜外への浸潤像などは認められなかった。6)免疫染色およびレクチン染色では,内皮細胞のマーカーであるFactor-VIIIRa,UEA-1はmature blood vesselなどのendothelial cellに陽性で,spindle-shaped cell,macrophage-like cell,immature endothelial cell-like cellは陰性であった。間葉系細胞のマーカーであるVimentinは,spindle-shaped cell,immature endothelial cell-like cell,mature blood vesselなどのendothelial cellに陽性であった。macrophage-like cellはFactor-XIIIRaのみ陽性で,KSの病変部に多く見られたが,KSの構成成分の一種であるか,反応性の増生であるかは不明であった。これらの結果より,KSの発生には自然環境,生活様式などの因子とともに遺伝因子など,いくつかの因子が強い影響を与えていると考えられた。また,KSはparacortical areaのreticulin network近傍の多潜能なmesenchymal cellより発生し,悪性腫療というよりは良性腫虜,あるいは反応性疾患と考えられた。 / We conducted an epidemiological and histological analysis of the endemic lymph node-type Kaposi's sarcoma (KS) in African children (under 16 years old) in Western Kenya in order to determine the ethno-geographical distribution of the disease and to clarify its histological features and histogenesis during the 12-year period between 1979 to 1990. The age distribution of all endemic type KS in Western Kenya showed two age peaks; one in early childhood and the other in middle to advanced age. Most endemic KS in children initially occurred in the lymph nodes, while that of people of middle to advanced age showed a primary lesion in the skin. The male to female ratio of the endemic KS was 3.1 to 1 (in all pediatric types), 3.4 to 1 (in the pediatric lymph node-type) and 10.8 to 1 (in all adult types). A high incidence of the lymph node-type KS in children was observed in the Luo group ethnically and in Nyanza Province around Lake Victoria geographically. The lymph node-type KS originated at the paracortical areas and gradually grew along the reticulin network originating from the trabeculae. The lesion of KS histologically consisted of several types of cells, especially spindle-shaped cells, macrophage-like cells and immature endothelial cell-like cells and was accompanied by almost normal small blood vessels, lymphatic vessels and postcapillary venules. No abnormal mitoses were observed in any of the cells. There were no primary necroses due to tumor proliferation and also no extracapsular invasions. Immunohistochemically, spindle-shaped cells, immature endothelial cell-like cells and mature endothelial cells were positive for Vimentin, but only mature endothelial cells were positive for Factor-XIIIRa and UEA-1. Macrophage-like cells were positive for Factor-XIIIRa. These findings suggested that: 1) there are certain differences in the etiological co-factors of KS between the endemic lymph node-type KS in children and the endemic cutaneous type KS in adults, 2) KS cells originate from pluripotent mesenchymal cells and 3) KS might not be a malignant tumor, but rather a benign neoplasm, tumor-like lesion or reactive hyperplasia.
URI: http://hdl.handle.net/10069/22399
ISSN: 03042146
Rights: Japanese Society of Tropical Medicine
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/22399

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