Abstract
In 4 of 76 TB cases autopsied recently in our sanatorium, amyloid degeneration, which is regarded as very rare occurrence in Japan, was found in spleen. It is well known fact that the tuberculosis in Japan tends to lose its characteristics and takes European type tuberculosis. However, it may be said, from the literature, that amyloid degeneration has the tendency of increase in these years.
After detailed histological studies on 4 cases, some interesting findings, which are rare in our country, were obtained, and the author investigated the pathogenesis.
In case I and case II, the amyloid lesions showed the typical sago spleen type. In case III, the slight deposition of amyloid with concomitant miliary tubercles were found around the blood vessels and in the follicles. In case IV, the lesions were found in the walls of vessels and their surrouuding tissues only. In one case (case II), degeneration lesions in the spleen were abundant and the kidney and lymphnodes were also involved with amyloid, while in another cases amyloid were found only in the spleens.
Hypertrophied reticulum cells and elastic fibers, which indicated the previous structure of capillaries were frequently observed in amyloid degeneration lesions. The slight amyloid degeneration seems to begin at the periphery or in the central part of the follicles and around the elipsoids in the pulps, with proliferation of reticulum cells. These locations of amyloid degeneration agree with that of the tubercles in spleen. It is quite likely that the amyloid deposition has close connection with reticulum cells. Tubercle bacilli in the amyloid lesions were found in all the 4 cases. Giant cells of Langhans's type and bleedings were seen in some cases.
Thus some resemblances in histological findings between amyloid and tubercle in spleen, i. e., sites of focus lesions, presence of tubercle bacilli, erythrocytes and giant cells and close relation with reticulum cells, can be pointed out. The author believes that amyloid in tuberculosis patients is the result of the antigen-antibody reaction in which the tubercle bacilli act as antigen. Accordingly, it can be said that the striking rarity of amyloid degeneration in Japan has been nothing but an appearance of TB type in Japan.
It is conceivable that chemotherapeutics have a influence on the development of amyloid degeneration, but it is not clear enough whether the recent increase of amyloid degeneration instances depends only upon the administration of chemotherapeutics.
