Brett H. Woodard

Correlation of estrogen and progesterone receptors with histologic differentiation in mammary carcinoma.

Using a modification of the histologic grading system of the NSABP, we observed a trend towards higher levels of estrogen (E2R) and progesterone receptor (PR) content in well (grade I) and moderately (grade II) differentiated mammary carcinomas. This relationship between receptor content and histologic grade is enhanced by considering estrogen and progesterone receptor simultaneously. The rank correlation between the quantitative levels of E2R and PR was 0.74 among histologic grade I tumors and 0.64 among histologic grade II tumors. Among the grade III carcinomas, the majority of tumors displayed either a paucity of measurable receptor or a divergence between levels of estrogen versus progesterone receptor (r = 0.19). The use of ultrastructural evaluation of features of differentiation is discussed in the evaluation of grade III tumors and in the evaluation of specific histologic types of mammary carcinoma.

Comparison of biochemical and histochemical techniques for estrogen receptor analyses in mammary carcinoma

Three histochemical techniques for estrogen binding localization in tissue sections were compared to sucrose density gradient analyses for estrogen receptor in 186 breast carcinomas. Apparent localization to epithelial elements was noted using 6‐BSA‐Fluor‐CMO‐17β‐estradiol, 17‐BSA‐Fluor‐TSC‐estrogen, and polyestradiol phosphate/anti‐estradiol antibody methods. The correlation between the histochemical methods and standard sucrose density gradient techniques was poor for the polyestradiol antibody method and the 6‐BSA‐Fluor‐CMO‐17/β‐estradiol technique. While an improved correlation was observed with the 17‐BSA‐Fluor‐TSC‐estrogen compound, the compounds binding was not effectively blocked by preincubation with diethylstilbestrol. This failure to show convincing saturability of binding, combined with problems of extraction of soluble receptor proteins in the aqueous incubation media and washes from cells rendered permeable by cryostat sectioning, indicates that several areas will require clarification before histochemical techniques can begin to be considered as a method for estrogen “receptor” analyses in the clinical evaluation of breast neoplasms.

Adrenocorticotropin production by a mammary carcinoma

A patient with clinical hypercortisolism and an infiltrating ductal carcinoma of the right mammary gland is presented. Provocative testing of adrenal function demonstrated the pattern of ectopic adrenocorticotropic hormone (ACTH) production. Ultrastructural analysis of the tumor revealed 150–200 nm electron‐dense granules that when primarily fixed in OsO4 appeared as membrane‐bound, centrally dense cored granules. ACTH was extracted from the tumor tissue and immunocytochemically localized in the tumor cell cytoplasm. A clinically significant level of estrogen receptor protein was present in the tumor tissue (120 fmol/mg protein). This case confirms the ability of mammary carcinoma to produce the ectopic ACTH syndrome.

Incidence and nature of primary granulomatous inflammation in surgically removed material.

A large number of cases (303) of primary granulomatous inflammation, present in surgically removed specimens from a broad range of locations, were reviewed and examined in detail. The granulomas were characterized as to morphology, location, and etiology. Epithelioid granulomas without necrosis were most frequently due to sarcoidosis and mycobacterial infection, while epithelioid granulomas with necrosis were most commonly due to mycobacterial infection, fungal infection, rheumatoid arthritis and sarcoidosis. Mature granulomas, most of which did not contain necrosis, were generally due to foreign bodies. The responsible etiologic agents were generally identified in granulomas due to fungi, bacteria, or foreign bodies (92%). However, mycobacteria were infrequently identified in granulomas, even when the lesions were examined by the auramine-O technique (31%). Overall, the majority of the granulomas (76%), were due to five causes: sarcoidosis, mycobacterial infection, particulate inclusions, fungal infection, and rheumatoid arthritis. The frequency of a given etiology, however, varied widely depending on the location of the lesion. By classifying granulomas morphologically and knowing their location, useful predictive information concerning the etiology of a given granuloma, beyond that obtained by histochemical stains, could be derived.

Comparison of sex steroid receptor analyses and carcinoembryonic antigen with clinical response to hormone therapy

This study corroborates previous reports which suggested the efficacy of estrogen receptor (ER) analysis in predicting responses of patients with metastatic mammary carcinoma to hormonal therapeutic manipulation. The predictive value of multiconcentration titration and sucrose density gradient analyses of ERs and progesterone receptors (PRs) are compared. The predictive value of ER analyses can be improved by the discrimination of 8S versus 4S binding species or by the use of PR analysis in combination with ER analysis. The tumor‐associated antigen, carcinoembryonic antigen (CEA), is evolving as an important quantitative aid in evaluating the clinical responses of patients receiving hormonal therapy.

Mucoepidermoid carcinoma of the esophagus: a case report.

The eighth reported case of mucoepidermoid carcinoma of the esophagus is described by light microscopic and ultrastructural examination. The reason of such a paucity of reports, the probable origin, and the natural history of this neoplasm are examined through our observations and reference to the literature.

Ceruminous gland adenocarcinoma. A light and electron microscopic study

Tumors of ceruminous gland origin in the external auditory canal are rare in man. A case is described in which such a tumor presented as an invasive vascular temporal bone neoplasm, mimicking a glomus jugulare tumor. Light and electron microscopic study of this tumor confirmed a diagnosis of ceruminous gland adenocarcinoma. Tumors of ceruminous gland origin appear to have a distinctive clinical behavior by virtue of their unique anatomical location in the external auditory canal. Our experience with this case establishes another clinical picture characterizing the histologic type of ceruminoma designated as a ceruminous gland adenocarcinoma. We feel that the generic term „ceruminoma,”︁ with its implied histologic subgroups, is useful to the clinician when he encounters a tumor arising from the modified sweat glands of the external auditory canal.

Multicentric Renal Oncocytoma

Renal cell oncocytomas are benign tumors of tubular epithelial origin. They usually occur as single nodules and may be confused clinically with renal cell carcinoma. We report an unusual case of multiple, discrete renal cell oncocytomas. The characteristic gross and light microscopic, and ultrastructural features are described. The potential of multicentricity is confirmed and its implications for therapy are discussed.

Late intrascrotal metastases from renal cell carcinoma

A case of bilateral epididymal metastases appearing sixteen years after nephrectomy for renal cell carcinoma is reported. A literature review of intrascrotal metastases from renal cancer reveals that they are uncommon. The possible mechanisms of spread are discussed.

Multiple Congenital Septal Atresias of the Intestine: Histomorphologic and Pathogenetic Implications

Congenital atresias of the gastrointestinal tract are usually single and divided into three forms on a morphologic basis. The septal or diaphragmatic type (type I) is the least common. We report an infant with multiple type I atresias involving both the small and large intestine and describe the unique histologic features of the septa: fragmentation of muscularis mucosa, multiple septal cysts lined by columnar epithelium, circular and longitudinal muscular layers, and absence of inflammation. This infant had a sibling who died with multiple intestinal atresias of the septal type. The histologic features suggest that type I gastrointestinal atresias may be due to failure of complete recanalization rather than result from healing of vascular of inflammatory events.