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Glycogen storage disease associated with Niemann-Pick disease: histochemical, enzymatic, and lipid analyses
T Narita1, H Nakazawa, Y Hizawa
1Department of Pathology, Hirosaki University School of Medicine, Japan.
Insights
This case report details a patient with Type IA glycogen storage disease who developed multiple hepatic adenomas and Niemann-Pick disease, highlighting the complex interplay of these rare conditions.
Area of Science:
- Hepatology
- Genetics
- Pathology
Background:
- Glycogen storage disease Type IA (GSD Ia) is a rare inherited metabolic disorder.
- Hepatic adenomas are benign liver tumors that can occur in patients with GSD Ia.
- Niemann-Pick disease is a group of rare inherited metabolic disorders affecting lipid metabolism.
Observation:
- A female patient diagnosed with GSD Ia at birth developed a hepatocellular adenoma at age 12.
- At age 18, she presented with hepatomegaly, jaundice, and was diagnosed with Niemann-Pick disease.
- Autopsy revealed a significantly enlarged liver with multiple hepatocellular adenomas and spleen with infarctions.
Findings:
- Histological and electron microscopy confirmed hepatocellular adenomas and characteristic foamy cells of Niemann-Pick disease in multiple organs.
- Foamy cells, indicative of lipid accumulation, were identified in the spleen, liver, bone marrow, lymph nodes, kidneys, and lungs.
- The patient died at age 19 due to pneumonia and cardiac tamponade.
Implications:
- This case underscores the potential for multiple hepatic adenomas and Niemann-Pick disease to co-occur in patients with GSD Ia.
- Understanding these complex co-morbidities is crucial for comprehensive patient management and prognosis.
- Further research may elucidate shared pathways or predispositions contributing to these concurrent conditions.
Abstract:
A case of glycogen storage disease associated with multiple hepatic adenomas and Niemann-Pick disease is reported. Type IA glycogen disease was diagnosed soon after birth in a female patient, and she was treated at our clinic. At the age of 12 yr, the patient was found to have a hepatic tumor, which was surgically extirpated. Histological examination showed that the tumor was a hepatocellular adenoma. Increasing hepatomegaly and jaundice were noted when the patient was 18 yr of age. She died of pneumonia and cardiac tamponade at the age of 19. The liver weighed 3310 g, and showed severe jaundice and many nodules measuring up to 8 cm in diameter. These nodules were composed of mature hepatocytes without atypia and were diagnosed as hepatocellular adenomas. In addition, many adenomatous lesions were found at the microscopical level. The spleen weighed 1310 g, and showed two small infarctions at the upper part. A histological examination showed a diffuse infiltration of large foamy cells in the splenic red pulp. These cells were 20 to 100 microns in diameter and weakly positive for periodic acid-Schiff (PAS) staining, positive for lipid staining with Sudan black B, and positive for Pearce's phospholipid staining. Electron microscopy showed many lamellar bodies in the cytoplasm that were characteristic of Niemann-Pick disease. These foamy cells were also found in liver, bone marrow, lymph nodes, kidneys, and lungs.(ABSTRACT TRUNCATED AT 250 WORDS)