Eisei Ishikawa

Early colorectal carcinoma with special reference to its development de novo

The growth type of early colorectal carcinoma was classified into two types. The first type is intramucosal polypoid growth (PG‐Ca) and the second type nonpolypoid growth (NPG‐Ca) which shows mainly massive infiltration of tumor cells below the submucosal layer. The incidence of adenoma‐carcinoma sequence was 72 of 75 lesions (96.0%) in pedunculated polypoid carcinoma, and 61 of 71 lesions (85.9%) in sessile and broad‐based polypoid carcinomas. Their average sizes were 15.0 and 18.7 mm, respectively. Submucosal invasive carcinoma (SM‐Ca) showed a low incidence. They were detected as microscopical or scattered lesions with a few lymphatic and venous permeation. The NPG‐Ca contained 32 lesions. Intramucosal carcinoma without adenoma showing slight depression consisted of ten lesions of which the average size was 5.1 mm. The other 22 lesions showed massive submucosal invasion with marked lymphatic and venous permeation. The average size was 10.3 mm being smaller than PG‐Ca. Histologically, NPG‐Ca was not accompanied with adenoma. The NPG‐Ca arose from de novo carcinoma less than 10 mm in diameter and invaded into the submucosal layer. In advanced carcinoma, the PG‐Ca showed a low incidence (21.8%), and almost all cases were of the NPG type (78.2%). The NPG advanced carcinomas increased in those over the size of 20 mm. It is concluded that nonpolypoid early colorectal carcinomas easily progress to advanced carcinoma, and de novo carcinoma occupied about 80% of colorectal carcinoma.

Ovarian atypical endometriosis: its close association with malignant epithelial tumours

The incidence of ovarian atypical endometriosis and its association with malignant epithelial tumours in a consecutive series of cases during the period 1987 to 1995 were studied. Atypical glandular changes were observed in four (1.7%) of 255 ovarian endometriosis cases and one patient with ovarian atypical endometriosis developed subsequent endometrioid carcinoma in the abdominal wall. Fifty‐four (24.1%) of the 224 ovarian cancers were associated with ovarian endometriosis; 21 with typical and 33 with atypical endometriosis. Clear cell carcinomas and endometrioid carcinomas were most frequently associated with endometriosis, with 54% (27 of 50 cases) and 41.9% (13 of 31), respectively. Atypical endometriosis was found in 18 clear cell carcinomas, in seven endometrioid carcinomas, in four serous carcinomas, in three mucinous borderline tumours, and in one serous borderline tumour. In 13 cases, the atypical endometriosis was in contiguity with malignant epithelial tumours. We consider that atypical endometriosis possesses a precancerous potential or is most frequently associated with clear cell and endometrioid carcinomas. Close screening of cellular atypia or hyperplasia in ovarian endometriosis and careful long‐term follow‐up of patients with atypical endometriosis is required.

Malignant solitary fibrous tumour of the peritoneum

Solitary fibrous tumour, formerly known as localized fibrous mesothelioma, may arise from the peritoneum in rare instances, whereas it commonly appears as a pleural neoplasm [1,2]. Solitary fibrous tumour of the peritoneum occurs in both sexes and in all age groups, but predominantly affects those between the 4th and 7th decades of life [1,2]. Unlike diffuse mesotheliomas, solitary fibrous tumour shows no relationship to asbestos exposure [1]. It tends to be asymptomatic or produces minor symptoms such as vague abdominal complaints [1]. Benign and malignant forms of the tumour occur, the benign variant being three to four times more common than the malignant. Solitary fibrous tumour of the peritoneum can be identified as a large mass [1,2], and needs to be distinguished from gynaecological tumours on imaging studies. We report here a case of malignant solitary fibrous tumour of the peritoneum. Computed tomography (CT) and magnetic resonance (MR) imaging findings are described.

Solitary fibrous tumor of the nasal cavity and orbit

Solitary fibrous tumors (SFT) are rare spindle cell neoplasms generally associated with the serosal surface, especially the pleura. Two SFT are reported arising in the nasal cavity and orbit, occurring in a 33 year old female and a 21 year old male, respectively. The lesions lacked the characteristic features of other recognized neoplasms that occur in these regions. Immunohistochemically, the tumors cells were diffusely and strongly positive for vimentin and CD34 and some or many tumor cells expressed neuron‐speciflc enolase and Leu‐7. Ultrastructurally, the tumor cells showed no distinct features although they were suggested to be primitive mesenchymal or fibroblast‐like cells. Both tumors were diploid by flow cytometry. The two patients have had benign clinical courses with limited follow‐up. Our findings suggest that SFT is of mesenchymal cell origin and support another location for SFT, indicating additional evidence against mesothelial origin. SFT should be included in the differential diagnosis of spindle cell tumors arising in the nasal cavity and orbit.

Atypical polypoid adenomyomas of the uterus

We performed a clinicopathological immunohistochemical, ultrastructural, and flow cytometric study on six cases of atypical polypoid adenomyoma of the uterus including one with an adenocarcinoma within it. The tumours occurred in nulliparous women aged 22–48 years (average, 33.0 years); three arose in the uterine corpus, and three in the endocervix. Histologically, they were composed of endometrial glands admixed with a stromal component of interlacing bundles of smooth muscle cells. The glands exhibited varying degrees of architectural and cytological atypia. Most of the stromal cells showed strong staining for HHF35, alpha‐smooth muscle actin, and vimentin, and some cells contained desmin. Electronmicroscopy, in one case, confirmed the presence of a well‐differentiated smooth muscle component. The stromal component may arise as a result of extensive metaplasia of endometrial stromal cells. Uninvolved endometrium showed ciliated cell metaplasia in three patients, and atypical complex hyperplasia in two. One patient had a well‐differentiated adenocarcinoma of endometrioid type arising in an endocervical atypical polypoid adenomyoma. All tumours had a diploid DNA content and relatively small S phase fraction (average, 6.23%). The follow‐up periods ranged from 4 to 42 months (average, 13.5 months), and all patients were alive and well. Although the histogenesis of atypical polypoid adenomyoma of the uterus remains uncertain, it is suggested that it may arise because of oestrogen‐related factors.

Histopathological Study of Human Cisplatin Nephropathy

The present study was conducted to obtain detailed information on the morphological changes in the human kidney as related to cisplatin therapy. The kidneys of ten autopsy cases showing impaired renal function following cisplatin therapy with hydration were examined histologically. Sporadic lesions of degeneration, necrosis, and regenerative changes were observed in the pars convoluta and pars recta of the proximal tubule, distal tubule, and collecting duct. Enlarged and pleomorphic nuclei in regenerated epithelial cells and hyperplasia of the collecting duct lining cells were considered to be specific histological findings in renal injury related to cisplatin therapy. Electron microscopic examination of a case receiving a large dose of cisplatin without signs of renal insufficiency showed an increased number of cytosomes containing electron dense granules in all tubular portions and conspicuous nuclear indentation in the thin limb of the loop of Henle and collecting duct. The platinum concentration in autopsy organs and biopsy cases was analyzed, but no correlation could be found between the concentration level of platinum in the kidney and impairment of renal function.

Kaposiform haemangioendothelioma associated with Kasabach‐Merritt syndrome

Kaposiform haemangioendothelioma is a very rare, but distinctive, vascular tumour first described by Zukerberg et al.. However, several similar tumours have been reported under a variety of names including Kaposi-like infantile haemangioendothelioma, locally metastasizing vascular tumour, haemangioma with Kaposi sarcoma-like features, or simply haemangioendothelioma. It usually occurs in the retroperitoneum, skin, or soft tissue of infants. This lesion is often complicated by Kasabach-Merritt syndrome of consumptive thrombocytopenia or coagulopathy associated with a vascular neoplasm, lymphangiomatosis, obstructive jaundice, or intestinal obstruction. Although this neoplasm histologically appears to be benign, it is locally aggressive and often extends into adjacent organs. To the best of our knowledge, there are only ten convincing reported cases occurring in the skin or soft tissue. We describe a case of Kaposiform haemangioendothelioma occurring in the thigh of a newborn female infant who had a Kasabach-Merritt syndrome.

Clear cell carcinoma of the ovary: light and electron microscopic studies.

Twelve cases of ovarian clear cell carcinoma were studied histologically. Four cases were examined electron microscopically and compared with other conditions. Five tumors were directly connected with ovarian endometriosis. They were histologically classified into a tubular type with hobnail cells and a solid type without tubular pattern or hobnail cells. Electron microscopic figures of the tumor cells are identical having large nuclei, abundant glycogen, lamellated RER, few lipid droplets, and sparse but well‐developed microvilli. The basophilic dark cells frequently encountered in the tubular type are morphologically quite similar to clear cells excepting for sparsity of glycogen and lipid droplets. Alveolar arrangement of 6 to 10 tubular structures (honeycomb structure) resembling alveolate structure seen in late secretory endometrium was found in tumor cells of one case. Ultrastructural feature of clear cell carcinoma closely resemble those of Arias‐Stella endometrium and clear cell carcinoma of endocervix suggesting their Muellerian origin. Cancer 40:3019‐3029, 1977.

Spindle cell hemangioendothelioma: An immunohistochemical and flow cytometric study of six cases

Six cases of spindle cell hemangioendothelioma (SCH) are presented with immunohistochemical and flow cytometric analyses. One case was associated with Maffuccis syndrome. All lesions were solitary or multifocal in the extremities, and prepresentation duration ranged from years to decades. One case recurred but none had metastases. Histologically, in four of the six cases the main lesions appeared to arise within vessels, predominantly muscular vessels. All lesions consisted of cavernous hemangiomalike areas and solid cellular areas resembling Kaposis sarcoma. Cellular atypia was minimal. At the periphery of the lesions, a cluster of large thick or thin walled, and probably malformed, vessels were observed. Immunohistochemically, factor‐VIII related antigen, CD34, vimentin, and lectin binding Ulex europaeus agglutinin 1 stained endothelial cells lining vascular channels, and vacuolated, or epithelioid cells. Spindle cells in the solid areas were negative for these endothelial markers except for vimentin, but showed divergent positive immunoreactions of HHF35, alpha‐smooth muscle actin, desmin, and collagen type IV. Five cases were diploid and one was aneuploid. There was no significant correlation among DNA ploidy, S‐phase fraction, and local recurrence in SCH although the number of cases examined was small. These results suggest SCH may be a benign lesion, probably a reactive process, rather than a low‐grade angiosarcoma.

Immunohistochemical Demonstration of Surface Antigen of Human Lymphocytes with Monoclonal Antibody in Acetone-fixed Paraffin-embedded Sections

Although the majority of reported studies have used fresh-frozen sections in detecting surface antigen of lymphocytes in tissue via monoclonal antibody, detailed histological figures can not be obtained by this method. Nor can the antigenicity be preserved for any length of time. A new method for detecting the surface antigen of lymphocytes using fixed and embedded material is presented. Human spleens were fixed in cold acetone, embedded in low melting point paraffin wax, and the thin sections treated with hyaluronidase. Anti-T lymphocyte monoclonal antibody (anti-Leu-1, anti-Leu-2, anti-Leu-3) and anti-HLA-DR were applied on these sections, and the antigen was detected by the ABC (avidin-biotin-peroxidase complex) method. The results were then compared with those of fresh-frozen sections. There was no great difference in detecting T and B cells or their subsets, but the histological figures were substantially better preserved in sections prepared by the present method. Furthermore, the antigenicity was retained in the materials fixed and embedded for more than two years.