Anna-Luise A. Katzenstein

Allergic aspergillus sinusitis: Concepts in diagnosis and treatment of a new clinical entity

The clinical features in 15 young adult patients with allergic Aspergillus sinusitis includes a history of asthma, recurrent nasal polyps, and radiographic evidence of pansinusitis. Multiple surgical procedures were performed on 12 patients.

Proliferative serous tumors of the ovary. Histologic features and prognosis.

ABSTRACTIn reviewing all proliferative serous tumors of the ovary seen at Barnes Hospital from 1950 to 1974, we quantitated histologic characteristics and defined criteria for diagnosis in 55 borderline tumors, 13 well-differentiated cystadenocarcinomas, and 15 cystadenomas with unusual proliferative areas. This last type with focal proliferation behaved in a benign fashion and should be considered a variant of a simple cystadcnoma. Stromal invasion was the only histologic feature which consistently distinguished carcinomas from the borderline tumors. The presence in some borderline tumors of severe cellular atypia, marked epithelial disorganization, frequent mitoses, and cribriform glands in the stroma neither signified carcinoma nor indicated poor prognosis. No patient with a Stage I borderline lesion died of tumor. Although the mortality of patients with Stage IIb or Stage III borderline tumors is high, tumor-related deaths rarely occurred before 5 years, and three patients lived more than 10 years. Borderline serous tumors arc low-grade malignant neoplasms which differ from overt carcinomas in the excellent prognosis of Stage 1 lesions and in long survival even with widespread abdominal disease.

Pathologic findings in allergic aspergillus sinusitis: A newly recognized form of sinusitis

The pathologic findings are described in seven cases of allergic aspergillus sinusitis, a newly recognized form of sinusitis. Grossly, the sinuses are filled with firm, white-tan mucoid material. Microscopically this material consists of mucincontaining numerous eosinophils, sloughed respiratory epithelial cells, cellular debris, Charcot-Leyden crystals, and scattered fungal hyphae resembling aspergillus species. This histologic appearance is identical to mucoid impaction occurring in bronchi in allergic bronchopulmonary aspergillosis. Allergic aspergillus sinusitis and allergic bronchopulmonary aspergillosis may represent different manifestations of aspergillus hypersensitivity in the respiratory tract. Implications for treatment of allergic aspergillus sinusitis and a possible relationship between it and allergic bronchopulmonary aspergillosis are discussed.

Solitary necrotizing granulomas of the lung: differentiating features and etiology.

&NA; The clinical and pathologic features of 86 roentgenographically solitary pulmonary granulomas were reviewed to determine etiology and to provide guidelines for histologic evaluation. Fungal or acid‐fast organisms were identified within the tissue in 60 cases (70%) and fragments of a helminth were found in one. The organisms were almost always present in the center of necrotic granulomas, and examination of two blocks containing active granulomas was usually sufficient for their identification. Microbiological cultures were less productive than direct examination of the tissue. In 25 cases an infectious etiology could not be identified: two were diagnosed as hyalinizing granuloma, one as Wegeners granulomatosis, and 22 were not further classified. A prominent overlapping spectrum of histologic features was found between infectious granulomas and Wegeners granulomatosis, suggesting that the latter may represent an abnormal immune response to an infectious agent that is no longer identifiable within the tissue. Caution is urged in diagnosing limited Wegeners granulomatosis and other pulmonary angiitides in patients with roentgenographically solitary granulomas. Am J Surg Pathol 4: 13‐28, 1980.

Müllerian adenosarcoma of the uterus: an ultrastructural study of four cases.

Four cases of uterine müllerian adenosarcoma, a distinctive form of mixed müllerian tumor, were studied by light and electron microscopy. All tumors showed the characteristic histologic pattern of benign neoplastic glands within sarcomatous stroma. Ultrastructurally, both mesenchymal and epithelial cells were seen. The mesenchymal cells showed some features of endometrial stromal cells, including the presence of intracytoplasmic collagen fibers. The epithelial cells formed glands, which resembled benign endometrial glands and were separated from the stroma by a well‐defined basal lamina. No transitional cells between the epithelial and mesenchymal cells were seen. The ultrastructural features of these tumors suggest that the sarcomatous portion is of endometrial stromal origin. The glandular portion may arise, along with the stroma, from multipotential stem cells, or the glands may be non‐neoplastic entrapped endometrial glands stimulated by the stroma and thus appearing to form an integral part of the tumor.

Major peripheral arterial occlusion due to malignant tumor embolism. Histologic recognition and surgical management

Four cases of major peripheral arterial occlusion due to malignant tumor emboli are reported. All of the emboli originated from primary lung carcinomas, three following resection of the lung tumor, and the fourth occurring spontaneously before discovery of the lung primary. Each patient underwent successful embolectomy and was discharged without any related deficits. Their survival ranged from three to seven months. These cases emphasize the possibility of tumor embolism either spontaneously or following surgical manipulation. Early pulmonary vein ligation and, if indicated, intrapericardial ligation should be performed at the time of resection to try to prevent this complication. Cancer 42:2009‐2014) 1978.

Interpretation and significance of pathologic findings in transbronchial lung biopsy

We evaluated the pathologic features and clinical significance of 50 transbronchial lung biopsies from 45 immunosuppressed patients (Group I) and 41 from 39 nonimmunosuppressed patients (Group II). Specific diagnoses were established in only 36% of Group I, and of these two-thirds were infections. Expected inflammatory reactions to infection were absent in most of these immunosuppressed patients. Nonspecific pathologic changes were found in 40%, of which diffuse alveolar damage and interstitial pneumonitis were the most common. The mortality was highest for Group I patients with infections (50%) and with diffuse alveolar damage (56%). In Group II patients specific diagnoses were made in only 7%, although histologic abnormalities were found in an additional 61%. This study emphasizes several important differences which should be considered in evaluating transbronchial lung biopsies from immunosuppressed and nonimmunosuppressed patient. This biopsy procedure is most useful in diagnosing infection in immunosuppressed patients but the histology may be difficult to interpret since the usual inflammatory reactions are often absent. This procedure is also useful in evaluating non-immunosuppressed patients, although open biopsy may be necessary when clinical and pathologic features do not correlate.

Wegener granulomatosis Unusual cause of necrotizing urethritis

We report a case of Wegener granulomatosis presenting as a destructive urethral mass. The initial clinical impression was carcinoma, and a urinary diverting procedure was considered before the correct diagnosis was established. The importance of recognizing this unusual disease and its dramatic response to appropriate therapy are emphasized.

Benign histiocytic tumor of lung. A light- and electron-microscopic study.

We describe an unusual benign pulmonary neoplasm which was composed entirely of histiocytes and a few chronic inflammatory cells and which posed difficult diagnostic problems. The differential diagnosis is discussed, and the usefulness of electron microscopy in interpreting unusual pulmonary tumors is emphasized.