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Differential Diagnosis between Organic and Inorganic Mercury Poisoning in Human Cases-The Pathologic Point of View
Komyo Eto
National Institute for Minamata Disease, Minamata City, Kumamoto, Japan, kometo{at}nimd.go.jp.
Yukio Takizawa
National Institute for Minamata Disease, Minamata City, Kumamoto, Japan
Hirokatsu Akagi
National Institute for Minamata Disease, Minamata City, Kumamoto, Japan
Koichi Haraguchi
National Institute for Minamata Disease, Minamata City, Kumamoto, Japan
Shigeyuki Asano
Department of Pathology, Iwaki Kyoritsu General Hospital, Fukushima, Japan
Naohiko Takahata
Department of Psychiatry and Neurology, Sapporo Medical University, Hokkaido, Japan
Hidehiro Tokunaga
Department of Surgical Pathology, Kumamoto University School of Medicine, Kumamoto, Japan
Differences in pathology were found between acute and chronic exposure to methylmercury, mercury vapor, and inorganic mercury. Characteristic pathologic changes produced by organic mercury in the brain have previously been described in patients with Minamata disease. The brains of patients who presented with acute onset of symptoms and died within 2-mo showed loss of neurons with reactive proliferation of glial cells, microcavitation, vascular congestion, petechial hemorrhage, and edema in the cerebral cortices, predominantly in the calcarine, pre- and postcentral, and transverse temporal cortices and in the cerebellar cortex. The neuropathologic changes in the patients with acute onset of symptoms who survived for a long period (> 10 yr) were also included neuronal loss with reactive proliferation of glial cells in similar anatomic locations. The neuropathologic changes in patients with inorganic mercury poisoning are quite different. Autopsies performed on 3 individuals with fatal cases of acute inorganic mercury poisoning who were exposed to mercury vapor for about 2 wk revealed diffuse organized pneumonia, renal cortical necrosis, disseminated intravascular coagulopathy, and infarctions in the brain and kidneys. In 2 other patients who worked in mercury mines for about 10 yr and who suffered from chronic inorganic poisoning, no specific lesions were demonstrated in the brain. However, the assay and the histochemistry of mercury revealed that inorganic mercury was present in the brain in all 3 groups irrespective of the brain lesions and the duration of clinical signs.
Key Words: Methylmercury • inorganic mercury • Minamata disease • human autopsy cases • pathology
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Toxicologic Pathology, Vol. 27, No. 6,
664-671 (1999)
DOI: 10.1177/019262339902700608
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