Chik-Kwun Tang

Trabecular carcinoma of the skin. An ultrastructural study

We report the electron microscopic studies of three trabecular carcinomas of the skin. The presence of neurosecretory granules in all three tumors suggests that trabecular carcinoma originates from one of the neurocrest derivatives, most probably, Merkel cells. The ultrastructural findings confirm Tokers original concept that trabecular carcinomas comprise a distinct group of skin tumor. The recognition of these tumors would enable one to make such a diagnosis on frozen section, which, in turn, might provide an opportunity for more specific cytochemical and immunofluorescent characterization. Cancer 42:2311–2321, 1978.

Unusual cutaneous carcinoma with features of small cell (oat cell-like) and squamous cell carcinomas. A variant of malignant Merkel cell neoplasm.

Three unusual primary neoplasms in the skin that occurred in elderly patients (64, 77, and 69 years of age) are presented. Two histologic components were found in each of the three neoplasms, one being small cell or oat cell-like carcinoma and the other squamous cell carcinoma. Study by electron microscopy revealed neurosecretory granules, though few, in the small cell component. The lack of clinical evidence of oat cell carcinoma elsewhere, the autopsy finding of two histologic components in one patient, and the findings by conventional and electron microscopy lead us to conclude that these three neoplasms are primary in the skin and of Merkel cell origin. We suggest further that small cell carcinoma of the skin represents a poorly differentiated counterpart of trabecular carcinoma. The spectrum of malignant Merkel cell neoplasm is, therefore, expanding. Two of our three patients died of their neoplasms 2 and 2 1/2 years, respectively, after the initial diagnosis.

Glomangioma of the lung.

An unusual pulmonary tumor was identified on the basis of light and electron microscopic findings as glomangioma. The ultrastructural findings of intracytoplasmic fibrils with dense bodies, electron-dense plaques, pinocytotic vesicles, and basement membranes are consistent with smooth muscle origin. The differential diagnosis between our tumor and other unusual tumors is discussed. The occurrence of a glomangioma in the lung may indicate the existence of pulmonary glomera.

Stromomyoma of the uterus

We present a solitary uterine tumor that occurred in a 28‐year‐old woman who complained of vaginal bleeding. Grossly, the tumor was well circumscribed and composed of lobulated tissue that varied from yellow, tan and soft, to white and rubbery. At the light microscopic level, areas identical to those described and interpreted as sex‐cord differentiation in a group of closely similar uterine tumors were found and obtained for electron microscopic study. Ultrastructurally, there were two basic types of cells, neither of which can be interpreted as sex‐cord derivatives. Cells that closely resembled the predominant components of Clement and Scullys group I tumors were similar to the normal endometrial stromal cells. Cells that formed plexiform cords demonstrated features diagnostic of smooth muscle cells. Cellular contents in cells comprising the tubular structures resembling that interpreted as indistinguishable from that of a Sertoli‐cell tumor (tubular androblastoma) were probably smooth muscle cells. We propose the term “Stromomyoma” to designate this peculiar uterine tumor. The similarity between our tumor and those reported in the literature raises the possibility that “uterine tumor resembling ovarian sex‐cord tumors” are actually stromomyomas.

Angiosarcomas of the uterus and ovary: Clinicopathologic report

The clinicopathologic features of Angiosarcomas of the uterus and ovary are described. Extensive review of world literature shows only eight reported cases of angiosarcoma arising in the uterus and two in the ovary. Clinically, both patients presented with nonspecific symptoms. The tumors were found at surgery, and confirmed as angiosarcomas on histologic examination. The ultrastructure of both tumors is also presented. The association with mucinous cystadenoma in the second tumor raises the possibility that this may be a mixed Mullerian tumor. Both tumors behaved in an aggressive fashion.

Are all adenomatoid tumors adenomatoid mesotheliomas

The ultrastructure of three histologically typical adenomatoid tumors of the epididymis is presented. Two of the three tumors showed morphologic features of mesothelium similar to those reported in the literature. The third tumor demonstrated a multilayered basal lamina and Weibel-Palade bodies, both of which have been found consistently in sclerosing hemangiomas. Although the ultrastructure of the first two tumors confirms the theory of a mesothelial origin of adenomatoid tumors, the findings of the third tumor indicate that a histologically typical adenomatoid tumor may not necessarily be a mesothelioma and that electron microscopy is indispensable in establishing their nature. These findings also lead us to suggest that the term adenomatoid tumor should remain in use for light microscopic diagnosis, and that the term adenomatoid mesothelioma should be applied only when the mesothelial nature of an adenomatoid tumor is proven by electron microscopy. For those that show ultrastructural evidence of endothelial origin, the term adenomatoid angioma seems to be appropriate and accurate. It is possible that the adenomatoid angioma represents a variant of the histiocytoid hemangioma.

Management of adenoid cystic carcinoma of the uterine cervix (cylindroma): report of six cases and reappraisal of all cases reported in the medical literature.

We report 6 new cases of adenoid cystic carcinoma (cylindroma) of the uterine cervix (5, invasive cancer and 1, in situ cancer). All 6 patients were elderly women and 5 were hypertensive. Additionally, 3 (Patients 1, 2, and 4) were obese and 1 (Patient 3) had diabetes mellitus. Three patients were seen because of post‐menopausal vaginal bleeding and 3 were found to have malignant cells on routine exfoliative cytologic examination. Histologically, the tumor cells were relatively uniform, with scanty cytoplasms and a palisading pattern at the periphery of the tumor masses. Round cystic spaces were found in all 6 cases and hyaline nodules were present in some of the cystic spaces in 2. The tumors were found in Stages IA, IB, IIB, IIB, and IIIB (cases 1–4 and 6 respectively), and were treated with irradiation only. There have been only 38 cases of invasive adenoid cystic carcinoma of the cervix reported in the world medical literature. We review the treatment and survival for all 38 cases previously reported and add 5 new cases.

Unusual cystic epithelial choristoma in a celiac lymph node

With the exception of müllerian-like glandular inclusions in women, reports of nonendometriotic benign glandular inclusions in abdominal lymph nodes are uncommon. We report the case of a 50-year-old woman with an apparently unique, non-müllerian, benign cystic epithelial choristoma in a celiac lymph node found incidentally at cholecystectomy. This case further expands the spectrum of benign lesions that must be differentiated from metastatic adenocarcinoma. Possible histogenesis is discussed.

Anaplastic carcinoma of urinary bladder with oat cell features

Anaplastic carcinoma of the urinary bladder, with oat cell-like components, is rare. We report such a tumor in a fifty-nine-year-old man, who died of rapidly disseminated carcinoma in one year despite postoperative radiotherapy and chemotherapy.

Angiosarcoma developing in a patient with neurofibromatosis (von Recklinghausen's disease)

The authors present an angiosarcoma of the scrotum and penis. The disease occurred in a 61‐year‐old man with a long history of neurofibromatosis (von Recklinghausens disease). The histologic and ultrastructural features are described. The authors speculate that the angiosarcoma, which developed in a location without histologic evidence of neurofibromatosis, possibly represents an expression of an abnormal genome in vascular tissue. The angiosarcoma responded to radiation therapy only temporarily, recurred after surgery, and did not respond to Adriamycin, dactinomycin or cis‐platinum. The patient died three years after the onset of his angiosarcoma. Cancer 47:950–954, 1981.