Cecilia M. Fenoglio

Distribution of Human Colonic Lymphatics in Normal, Hyperplastic, and Adenomatous Tissue: Its relationship to metastasis from small carcinomas in pedunculated adenomas, with two case reports

Prompted by 2 cases of lymphatic metastasis from focal carcinoma in the head of pedunculated adenomas, lymphatics were studied in the colonic mucosa in normal, hyperplastic, and adenomatous tissue utilizing light and electron microscopic techniques. In all three tissues there is a lymphatic plexus associated with the muscularis mucosae, but there are no lymphatics above this level. This explains why lymphatic metastases from superficial intramucosal foci of carcinoma in adenomas do not occur. In lobules of adenomatous tissue, the total distance between the free surface and the muscularis mucosae may be considerably increased, and a focus of carcinoma in adenomatous tissue must at least reach the muscularis mucosae and its lymphatics in order to metastasize. This lack of lymphatics contrasts with the profusion of blood capillaries at the mucosal surface. This may be an example of a more general biological phenomenon in that other sites also concerned with water and ion transport, such as the renal glomerulus, the gallbladder mucosa, choroid plexus, and ciliary body lack lymphatics but exhibit a rich blood capillary network at their transporting surfaces.

Comparative Electron Microscopic Features of Normal, Hyperplastic, and Adenomatous Human Colonic Epithelium: Variations in cellular structure relative to the process of epithelial differentiation

Abstract Electron microscopic studies of the epithelium of normal human colonic mucosa, hyperplastic polyps, and adenomatous lesions confirm and extend our previous studies of these tissues. In this study the cytology of well defined examples of the three types of epithelium is compared at several crypt levels. The normal epithelium exhibits a regular pattern of differentiation as cells migrate from the base of the crypt to the free surface. Progressive maturation is seen from undifferentiated cells in the base of the crypt to intermediate and immature goblet and absorptive cells in the midcrypt and, finally, to fully mature and even senescent goblet and absorptive cells in the upper one-third of the crypt and at the free surface. The hyperplastic epithelium exhibits a similar progression, the primary difference being that most of the morphological features of maturing and mature cells are found either lower in the crypt or in exaggerated form at the same level of the crypt when compared with normal mucosa of the same colon. The adenomatous epithelium, however, rarely differentiates past the intermediate, partially differentiated cell stage, retaining both the morphological and replicative characteristics of this immature cell type.

The anatomical precursor of colorectal carcinoma

The very common hyperplastic polyp is not a neoplasm and is unrelated to either adenoma or carcinoma. Adenomas, which are only one‐tenth as common, may occur grossly as adenomatous polyps or papillary adenomas. Be they large or small, pedunculated, sessile, or flat, they are true neoplasms—non‐invasive and thought of as benign. Depending on size, and probably related to a sessile mode of growth, in adenomas one may readily observe intramucosal carcinoma and/or „early”︁ invasive cancer. On the other hand, although microscopic examination has been performed on many thousands of minute mucosal lesions (e.g. 5 mm or less), „early”︁ cancer, defined as intramucosal carcinoma with or without microinvasion, does not seem to occur unassociated with adenoma. Since colorectal carcinoma is so common, one should easily find many examples of „early”︁ cancer as defined above if the majority of ordinary adenocarcinomas arose directly from normal crypts of Lieberkühn. (Of course the unusual anaplastic undifferentiated colonic cancers or carcinomas arising in ulcerative colitis remain in an area of unknown morphogenesis). The apparent non‐existence of small foci of intramucosal carcinoma, with or without micro‐invasion, in normal mucosa, and their frequency in adenomas, are two fundamental pathologic facts. They seem to disprove the proposition that cancer cells ordinarily arise de novo from the normal cells of the crypt of Lieberkühn without the interposition of a stage in the neoplastic process that we recognize as adenoma.

Sclerosing papillary proliferations in the female breast. A benign lesion often mistaken for carcinoma

The occurrence of foci of fibrosis in benign intraductal papillary proliferations in the female mammary gland can lead to extreme distortion with a pseudo‐invasive pattern that is still often mistaken for carcinoma. The histologic diagnostic criteria which differentiate between this benign lesion and true carcinoma are described in detail in this report. In a series of 30 cases with adequate followup, the benign nature of this lesion was confirmed.

Mucinous tumors of the ovary. Ultrastructural studies of mucinous cystadenomas with histogenetic considerations

On the basis of light microscopic and scanning and transmission ultrastructural observations, we have classified benign mucinous ovarian neoplasms into two types: a pure endocervical type and a mixed intestinal endocervical type. We have also reviewed the literature pertinent to the histogenetic origin of the ovarian mucinous cystoma and found convincing support for a mesodermal, coelomic epithelial, rather than a teratomatous, derivation.

Detection of herpes simplex RNA in human sensory ganglia.

Human paravertebral ganglia were examined for the presence of viral-specific RNA by in situ cytological hybridization using a nick-translated 3H-labeled herpes simplex virus-2 DNA probe. Ganglia from several locations (lumbar, thoracic, etc.) were obtained from seven patients at autopsy. In two cases HSV RNA was detected in all of the ganglia assayed. The autoradiographic grains were localized in the neurons (ganglions cells), and only a fraction of the neurons in any one ganglion were synthesizing viral-specific RNA. These results argue that the HSV genome can be active in the latent state.

A new compllication of AIDS Thoracic myelitis caused by herpes simplex virus

Progressive thoracic myelopathy occurred in a patient with AIDS. Concurrent opportunistic infections included disseminated systemic cytomegalovims, aspergillosis, and cutaneous herpes simplex virus (HSV). At autopsy, immune stains indicated that the myelopathy was caused by HSV type 2 infection of the spinal cord.

Endometrial hyperplasia and carcinoma: Are ultrastructural, biochemical and immunocytochemical studies useful in distinguishing between them?

Endometrial hyperplasia and carcinoma represent different points in a disease continuum which may be difficult to distinguish using standard histologic criteria. The role of ancillary biochemical, ultrastructural and immunocytochemical techniques in understanding the normal physiologic responses to hormonal stimuli is briefly considered in order to serve as a basis for an analysis of abnormal proliferative states. Not surprisingly, the ultrastructural and biochemical features of hyperplastic and carcinomatous endometria demonstrate a progressive continuum of abnormalities. The role of the immunohistologic detection of CEA, HCG, Casein, and other markers in distinguishing between the various endometrial diseases is discussed. The endometrium represents one of the more spectacular of endocrine target organs in which marked morphologic and ultrastructural changes occur throughout a womens lifetime. Such changes include those accompanying the menarche and the menopause as well as the extensive remodelling which occurs during the reproductive years. During the latter period, the endometrium cyclically proliferates, undergoes secretory differentiation, regresses, degenerates and regenerates. These regularly occurring changes are distinctive and have been described in histological detail, (Noyes et al., 1950, Noyes, 1973, Dallenbach-Hellweg, 1974), as well as ultrastructurally (Cavazos and Lucas, 1973, Ferenczy and Richart, 1974, Ferenczy, 1977). Morphological studies, coupled with advances in knowledge of steroid biochemistry, have confirmed that the cyclic morphological alterations are under the regulatory role of estrogens and progesterone.

The effect of age on the number of pituitary cells immunoreactive to growth hormone and prolactin

The results of a combined immunocytochemical, morphometric, and clinicopathologic analysis of growth-hormone-producing and prolactin-producing pituitary cells in 28 subjects ranging in age from 16 to 90 are reported. There was a significant age-related decline in the number and size of growth-hormone-producing cells, which was most marked in the transition from youth to middle age. There was also a significant age-related decline in the number of pituitary parenchymal cells but not in pituitary weight. Prolactin cells did not show a significant decline in number with age.

Intraepithelial squamous lesions of the vulva: Biologic and histologic criteria for the distinction of condylomas from vulvar intraepithelial neoplasia

We reviewed 65 intraepithelial lesions of the vulva and distal vagina and compared the presence of koilocytosis, abnormal mitoses, and parabasal or basal nuclear enlargement with DNA microspectrophotometric distribution patterns and the presence of human papillomavirus antigen as determined by immunoperoxidase. Abnormal mitoses and cytologically atypical nuclear enlargement were specific predictors of aneuploidy and were reliable for distinguishing vulvar intraepithelial neoplasia (VIN) from condylomas. Koilocytosis was present in 100% of condylomas and 71% of aneuploid (VIN) lesions, but there were qualitative and quantitative differences in the distribution of koilocytic cells in the two classes of lesions. On the basis of these findings, criteria for distinguishing between VIN and condyloma are proposed.