Baracchini P

Primary signet‐ring carcinoma of the large bowel report of nine cases

Nine cases of signet‐ring carcinoma have been observed from among 800 consecutive histologic cases diagnosed as adenocarcinoma of the colon during a period of 10 years (0.9%). This group of nine patients (Group A) has been matched for sex, age, and stage with a group of 45 patients affected by oridinary carcinoma of the colon (Group B). Clinical and histologic parameters, including symptoms, primary tumor site, free interval from primary surgery, histochemical investigation of intracytoplasmic mucins, and survival, were evaluated. The results of this investigation showed no clinical differences between signet‐ring carcinoma and ordinary carcinoma, and no statistically significant results were observed regarding the frequency of local recurrence and actuarial survival.

Squamous cell carcinoma with prominent myxoid stroma

Three cases of a squamous cell carcinoma with a prominent myxoid stroma are reported. One case in a 70-year-old woman had presented as a lump in the breast, the other two presented as polypoid lesions of the larynx and cervix uteri in a 65-year-old man and 61-year-old woman, respectively. The carcinomatous component was immersed in abundant extracellular mucosubstances. In addition to occasional squamous pearls, it displayed immunocytochemical evidence of high-weight keratin present in the neoplastic cells and, in one case, desmosomal attachment under electron microscopy. The extracellular mucosubstances proved to be similar to those seen in connective tissue. The differential diagnosis with histologically similar lesions has been taken into consideration, and it has been suggested that this newly described entity showing abundant myxoid stroma has to be distinguished from numerous benign and malignant myxoid soft tissue tumors.

Patterns of intestinal metaplasia in gastric biopsies. A comparison of different histochemical classifications

SummaryA total of 217 cases of gastric intestinal metaplasia (IM), out of 491 cases of consecutive multiple gastric biopsies, were examined using various histochemical methods. Three classifications were adopted (1) Jass and Filipes (1979), (2) Segura and Monteros (1983), and (3) our own distinguishing two types of small intestine IM (incomplete and complete) and two types of colonic IM (incomplete and complete). Our classification revealed (1) a group of ‘pure’ IM cases (44%), (2) a group of ‘combined’ IM cases (15%), either small intestinal or colonic, expressing a maturating line, and (3) a conspicuous group of mixed ‘mosaic’ IM cases (41%) consisting of all possible combinations between the basic IM types. No significant correlations were found between each IM type and associated diseases (i.e. gastritis, stump gastritis, ulcer, adenoma and adenocarcinoma). However, a suggestive association between colonic IM and malignancy was observed. Our results confirmed the heterogeneity of IM and indicated two differentiation cell lines (ileal and colonic), thus providing additional evidence of impaired maturation and aberrant differentiation along various cell lines, supporting Leblonds (1976) unifying theory on the origin of intestinal epithelial cells.

O-acetylated sialic acid variants in intestinal glandular metaplasia of the urinary tract.

Two cases of chronic cystitis, two of chronic ureteritis, one of chronic pyelitis and two transitional cell carcinomas of the urinary tract showed glandular metaplasia or focal mucin production. Positive staining for O‐acetylated sialic acid variants (sites 7 and 8) detected by the PB‐KOH‐PAS method was found in the two cases of cystitis, in one of chronic ureteritis and in one of chronic pyelitis. Positive staining was observed only in areas showing an intestinal type of metaplasia and in which goblet cells and argyrophil cells were also identified. These findings taken together with earlier studies on ovarian cystadenomas lead the authors to believe that O‐acetylated variants are markers of an intestinal type of epithelium. Evaluation of O‐acetylated sialomucins may be useful in further studies on the histogenesis of primary adenocarcinomas of the bladder.

Endometrial response in sequential cyclic therapy assessed with associated hysteroscopy and histology

A morphologic study was performed on the endometrium in 37 asymptomatic postmenopausal women under effects of cyclically administered oestrogens. Eighty-seven postmenopausal women were taken as control group. Medroxyprogesterone acetate (MPA), 10 mg daily, was administered in association with two types of oestrogen replacement therapy: conjugated equine oestrogens 0.625 mg (CEE) or transdermal 17 beta-oestradiol 0.05 mg (E2-TTS). Endometrial biopsies were taken under hysteroscopic control before treatment and on days 8-12 of combined therapy at the 6th month. Follow-up at 12 and 18 months was only performed in 8 and 5 patients, respectively, with transdermal 17 beta-oestradiol treatment. Various types of endometrial response were identified from atrophy to hyperplasia and secretory patterns. No atypical hyperplasia was found. All cases of simple or complex hyperplasia showed a regression after increased MPA dosage treatment (20 mg). This work is aimed at investigating the endometrial response during sequential cyclic therapy by using morphologic criteria based on hysteroscopy and histology. A large number of patients with hyperplasia can be detected with target biopsy under hysteroscopy, thus playing an important role in the management of patients during replacement therapy in research protocols.

O-acylated sialic acid variants in mucinous tumours of the ovary

O-acylated sialic acid variants (site 8) can be demonstrated histochemically by the PB/KOH/PAS method. They are secreted by goblet cells of the lower gastrointestinal tract, by colorectal adenocarcinomas, and by their metastases. Since the metastases are positive only when the primary tumour is positive, O-acylated sialomucins can be considered to be specific markers of colorectal adenocarcinomas if identified in metastases of a tumour of unknown origin. In our histochemical study we evaluated 29 mucinous cystomas of the ovary (23 benign and 6 malignant). We found that six cases were positive to PB/KOH/PAS. The positivity was observed in a limited number of cells and only in areas which presented an intestinal type epithelium. It was also more evident in malignant cystomas than in benign ones. We therefore think that the PB/KOH/PAS positivity can not only be considered a marker of colorectal adenocarcinomas, but also of all neoplasms which originate from an intestinal epithelium or appear to an “intestinal type epithelium”.

Effectiveness of immunohistochemical techniques in the detection of lymph node micrometastases of cervical squamous cell carcinoma

Out of a total of 1050 lymph nodes from patients with clinical squamous carcinoma, 58 lymph node metastases related to 18 patients were detected with H&E staining, while 61 lymph node metastases related to 19 patients were observed by immunohistochemical methods. However, by re-staining the original H&E sections with an anti-keratin antibody, the same 58 lymph node metastases were seen. Therefore, the three metastases emerged only in deeper sections which had been used for the immunohistochemical examination. It is suggested that the detection of micrometastases in lymph nodes may be improved by examining several sections at different levels rather than by immunohistochemical methods, even though these facilitate the observation of small groups of neoplastic cells.

Histochemical study of mucinous ovarian cystomas of intestinal and mixed types: O-acetylated sialomucin content in relation to biologic behavior.

The subgroup of mucinous ovarian cystomas of intestinal type containing site 8 O-acetylated sialomucins and its relation to malignant behavior were studied. Of 75 mucinous cystomas of the ovary from the files of the Institute of Pathological Anatomy and Histology (University of Genoa), 54 were endocervical, 19 were mixed, and 2 were intestinal. As regards their histologic pattern, the 54 mucinous endocervical cystomas were benign, whereas the 19 mixed type group included 8 benign, 5 borderline and 6 malignant; the 2 intestinal type tumors were borderline. According to histochemical investigations, the frequency of tumors with goblet cells containing site 8 O-acetylated sialomucins (positive to PB/KOH/PAS) was 47% In the mixed type cystomas and 100% in the intestinal type cystomas. Twenty-five percent of benign mixed cystomas, 60 % of borderline mixed cystomas, and 67 % of mixed cystadenocarcinomas were positive to PB/KOH/PAS. One hundred percent of the borderline cystomas of intestinal type were positive. Our results confirm that among mucinous ovarian cystomas, those containing intestinal type epithelium are the most likely to fall within the borderline or malignant categories. Moreover, of all ovarian cystomas of intestinal type, those characterized by site 8 O-acetylated sialomucins seem to be more aggressive and, in general, to have a more malignant behavior than the mucinous cystic tumors of müllerian or endocervical type.

Duodenitis and secretion of O-acetylated sialomucin variants.

KLUCK P, V A N MUIJEN GNP, V A N DER KAMP AWM, TIBBOEL D, V A N HOORN WA, WARNAAR SO, MOLENAAR JC. Hirschsprung’s disease studied with monoclonal antineurofilament antibodies on tissue sections. Lancet 1984; 1; 652-653. KLUCK P, TEN KATE FJW, V A N D E R KAMP AWM, TIBBOEL D, MOLENAAR JC. Pathologic explanation for post-operative obstipation in Hirschsprung’s disease revealed with monoclonal antibody staining. Am. J. Clin. Pathol. 1986; 86; 490-492. KLUCK P, T E N KATE FWJ, SCHOUTEN WR, BARTELS KCM, TIBBOEL D, V A N DER KAMP AWM, MOLENAAR JC, V A N BLANKENSTEIN M. The efficacy of antibody NF2F11 staining in the investigation of severe longstanding constipation: preliminary report. Gastroenterology 1987; 93; 872875. MACKENZIE JM, DIXON M. An immunohistochemical study of enteric neural plexi in Hirschsprung’s disease. Histopathology 1987; 11; 1055-1066.

Intestinal metaplasia in lower female genital tract

BENBOW EW, TAYLOR PM. Simultaneous xanthogranulomatous cholecystitis and primary adenocarcinoma of gallbladder. Histopathology 1988; 12; 672-675. CHRISTENSEN AH, ISHAK KG. Benign tumours and pseudotumours of the gallbladder. Report of 180 cases. Arch. Pathol. 1970; 90; 423-432. GOODMAN ZD, ISHAK KG. Xanthogranulomatous cholecystitis. Am. J . Surg. Pathol. 1981; 5; 653-659. ROBERTS K M , PARSONS MA. Xanthogranulomatous cholecystitis: a clinicopathological study of 13 cases. J . Clin. Pathol. 1987; 40; 412-417.