Cyril Toker

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.

Metastatic renal oncocytic neoplasm with benign histologic appearance.

We present a case of malignant renal oncocytoma which displayed a benign histologic appearance in the primary renal tumor and in metastases to the spine and liver. The case demonstrates the difficulty that may be encountered in distinguishing benign renal oncocytomas from malignant renal oncocytomas. Whereas, the accepted criteria will enable a distinction in the majority of instances, occasional instances may be encountered in which a benign histology does not provide an accurate reflection on the clinical course.

Syringomatous tumors of minor salivary gland origin

Two intraoral tumors that appear histologically indistinguishable from syringoma of the skin are discussed. The two patients with these tumors have shown no evidence of recurrence during 36 and 16 months of observation, respectively. We propose that syringomatous tumors of minor salivary gland origin may constitute a pathologically and clinically distinct category of intraoral tumors.

An ultrastructural study of angiomatoid fibrous histiocytoma

We studied the electron microscopy of two tumors which clinically and histologically conformed to what has been described as angiomatoid fibrous histiocytoma, a tumor thought to be of fibrohistiocytic origin. The ultrastructure of one tumor was that of a cellular angioma and the second tumor a vascular lesion with fibroblasts and histiocyte‐like mononuclear cells. Our findings suggest that angiomatoid fibrous histiocytomas are basically vascular tumors with fibroblasts and other cells as secondary participants in some lesions. The behaviour of angiomatoid fibrous histiocytoma cannot be predicted from histology. Our findings of different ultrastructural components in histologically non‐separable tumors lead to a question whether different ultrastructural composition is correlated with different biological behavior of these tumors. Further studies of similar cases are required if tumor morphology is to be correlated with clinical behavior.

Müllerian adenosarcoma of the uterine cervix

We present a tumor of the uterine cervix that was composed of histologically benign glandular epithelium and a malignant stromal component, justifying the term müllerian adenosarcoma. Ultrastructurally the stromal cells resemble the endometrial stromal cells, the tumor cells of an endolymphatic stromal myosis of the uterine cervix, and the stromal cells of a stromomyoma of the uterus. In addition there is evidence strongly suggesting a differentiation toward smooth muscle. The patient exhibited no evidence of disease one year after surgery.

Postirradiation carcinosarcoma of the nasal cavity.

Malignant teratoma of the nasopharyngeal area is a rare tumor which usually exhibits various mesenchymal components (smooth muscle, fibroblasts, and cartilage) admixed with epithelial (squamous and columnar) and primitive neurogenic elements in various combinations. These are histologically similar to malignant teratomas of gonadal origin. 1-4 A true carcinosarcoma, composed of an epithelial (columnar or squamous) element and only one type of mesenchymal element, is extremely rare in the nasal or paranasal areas. The case under discussion is unique in that it showed an adenoid cystic epithelial component with a primitive fibromyxoid sarcomatous element. In addition, this tumor occurred 12 years after radiation treatment in the same area.

Basaloid tumor of the sigmoid colon

A second case of basaloid carcinoma arising in the midsigmoid colon is reported. By light microscopy the tumor was seen to be composed of islands of small, poorly differentiated cells separated by cellular connective tissue. Also seen were small foci of keratinized cells, Ultrastructure study confirms the largely basal character of the tumor and also shows some cells containing tonofilament bundles, representing a more squamoid differentiation. The similarity of this tumor to basaloid tumors arising in the transitional epithelium of the anal canal is discussed, and the suggestion that the tumor arises from a pluripotential basal cell is made.