Frank B. Johnson

Detection of titanium in human tissues after craniofacial surgery.

&NA; Generally, titanium fixation plates are not removed after osteosynthesis, because they have high biocompatability and high corrosion resistance characteristics. Experiments with laboratory animals, and limited studies of analyses of human tissues, have reported evidence of titanium release into local and distant tissues. This study summarizes our results of the analysis of soft tissues for titanium in four patients with titanium microfixation plates. Energy dispersive x‐ray analysis, scanning electron microscopy, and electrothermal atomic absorption spectrophotometry were used to detect trace amounts of titanium in surrounding soft tissues. A single metal inclusion was detected by scanning electron microscopy and energy dispersive x‐ray analysis in one patient, whereas, electrothermal atomic absorption spectrophotometry analyses revealed titanium present in three of four specimens in levels ranging from 7.92 to 31.8 &mgr;g/gm of dry tissue. Results from this study revealed trace amounts of titanium in tissues surrounding craniofacial plates. At the atomic level, electrothermal atomic absorption spectrophotometry appears to be a sensitive tool to quantitatively detect ultra‐trace amounts of metal in human tissue.

Lipase-secreting acinar cell carcinoma of the pancreas with polyarthropathy. A light and electron microscopic, histochemical, and biochemical study

A functional acinar cell carcinoma of the pancreas is reported. The tumor was found in a middle‐aged, chronic alcoholic whose most persistent complaint was of polyarthropathy, especially of the lower extremities. A malignant tumor of acinar cell origin metastatic to the liver was diagnosed pre‐mortem by electron microscopy. The patient had a pancreatic tumor with extensive liver metastases at autopsy. The tumor contained abundant zymogen granules, and by histochemical and biochemical examination was seen to contain abundant lipase activity. The authors think that electron‐microscopy should be used routinely in the diagnosis of exocrine as well as endocrine tumors of the pancreas regardless of whether the specimen is obtained at surgery or autopsy.

Angiomatosis retinae. An ultrastructural study and lipid analysis.

A nonfamilial case of agiomatosis retinae (retinal hemangioblastoma) was studied by electron microscopy. In addition to the three major types of cells previously identified within the tumor (endothelial cells, pericytes, heavily lipidized stromal cells), fibrous astrocytes in different stages of lipidization were also found. The endothelial cells were fenestrated, providing the basis for the extravasated exudate that is characteristic of the tumor. The pericytes were completely surrounded by basement membranes and displayed no significant lipidization; in a cellular plaque of vascular tissue at the base of the lesion, however, some of the multilaminar pericytes showed evidence of early smooth muscle differentiation. The stromal cells contained abundant lipid vacuoles and a few organelles, and exhibited granular degeneration of cytoplasmic filaments between the lipid vacuoles. There was spotty basement membrane formation where the stromal cells abutted on the vascular elements. No interconversion could be demonstrated among the endothelial cells, pericytes, and stromal cells. A source for the stromal cells was discovered in the early lipidization of fibrous astrocytes. Analysis of the extracted lipid from the tumor by means of infrared spectroscopy, lipid chromatography, and x‐ray diffraction disclosed that the lipid was mostly cholestrol stearate, a plasma lipid. It is suggested that in the retinal lesions the leaky (fenestrated) capillaries of the tumor allowed the passive imbibition of plasma lipid by the fibrous astrocytes, leading to their gradual transformation into the fully lipidized stromal cells.

Cutaneous mercury granuloma: A clinicopathologic study and review of the literature*

Cutaneous mercury granulomas are rarely encountered. Clinically they pose difficulty in diagnosis when there is no clear history of penetrating injury by objects containing metallic mercury. Histologic, chemical, and scanning electron microscopic studies of such cutaneous lesions were performed on four cases from the Armed Forces Institute of Pathology files. Reported cases from the literature were reviewed. Metallic mercury in tissue sections appears as dark, opaque globules, usually spherical in shape and of varying sizes and numbers. A zone of collagen necrosis often surrounds the mercury globules. A granulomatous foreign body-giant cell reaction and a mixed inflammatory cellular infiltrate composed of neutrophils, lymphocytes, histiocytes, plasma cells, and occasional eosinophils are usually present. Epidermal and dermal necrosis, with or without ulceration or pseudoepitheliomatous hyperplasia, is also a common finding. The gold lysis test and energy-dispersive x-ray analysis confirmed the presence of metallic mercury in the tissue. Following cutaneous injury from mercury, systemic toxicity may develop and death may even occur. An approach to clinical management is discussed.

Silica reaction simulating fibrous histiocytoma

An unusual foreign body reaction to silica (quartz), resembling fibrous histiocytoma, is described in 7 patients (age range 22 to 71 years). These lesions occurred in the inguinal region (4 cases) or the abdominal wall (3 cases), and in 5 instances were associated with a history of injection at the same site 10 to 41 years previously. Most commonly the injection consisted of the administration of a sclerosing agent for the repair of a hernia. Microscopically these lesions contained broad sheets of histiocytes separated by bands or concentrically lamellated nodules of collagen. Intra‐ and extra‐cellular birefringent crystals, identified by x‐ray diffraction as silica (quartz), were present in all cases and served to distinguish this process from a true neoplasm. Although the injection therapy for hernia is now obsolete, it was formerly practiced in the United States with a variety of sclerosing agents including silica (quartz). Since these lesions are often confused with a benign or malignant fibrous histiocytoma it is recommended that fibro‐histiocytic lesions associated with a previous hernia or injection at the same site be examined for the presence of silica. Cancer 42:2738–2743, 1978.

Cutaneous reaction from a broken thermometer

A cutaneous and soft tissue reaction that resulted from a broken thermometer inside the mouth of a 10-year-old boy is described. Metallic mercury globules and glass pieces were identified in the excised tissue. On histologic examination, a zone of necrosis, polymorphonuclear leukocytes, macrophages, and multinucleated giant cells surrounded metallic mercury that appeared as dark opaque globules. Dense fibrosis and reactive lymphoid hyperplasia were also noted in the dermis and deeper tissues. The gold lysis test, scanning electron microscopy, and energy-dispersive x-ray analysis confirmed the presence of mercury in the tissue. A literature review on cutaneous mercury granuloma illustrates its unpredictable course. The cutaneous reaction may remain localized, but some cases are associated with an elevated mercury level in blood and urine, pulmonary embolism, mercury poisoning, and even with fatal outcome. Various manifestations of mercury poisoning and guidelines for the management of cutaneous mercury granuloma are discussed.

Microscopic Identification of Silicone in Human Breast Tissues by Infrared Microspectroscopy and X-Ray Microanalysis

Fourier transform infrared (FT-IR) microspectroscopy has been employed for the identification of silicone fragments in human breast tissue. Tissue specimens were mounted on aluminum-or gold-coated microscope slides and analyzed by employing the reflectance capabilities of the infrared microscope. Scanning electron microscopy (SEM) and energy-dispersive x-ray microanalysis (EDXA) were also used to establish the elemental composition and location of the foreign material. Infrared absorptions originating from the Si-O bond were easily identified at 1097 and 1017 cm−1, whereas the methyl group (-CH3) symmetric deformation mode arising from the Si-CH3 group was observed at 1260 cm−1. Being a nondestructive technique, infrared microscopy may serve as a highly suitable tool for the routine and accurate identification of silicone particles in various pathological specimens.

The Effect of Glass as an Intermediate Target on Bullets: Experimental Studies and Report of a Case

It is well known that intermediate targets may influence the distribution of pellets in fatal injuries by shotguns [1–3] and that a variety of objects, including glass, window screens, and articles of clothing, may serve as intermediary targets for bullets, may cause ricochet of bullets, or may become secondary missiles [4,5]. Although methods are available for examination and comparison of glass fragments, recent textbooks do not consider the potential effect of glass as an intermediate target on the characteristics of the wound of entrance. The results of experimental ballistic studies with glass, as well as a medico-legal case, are discussed in this report.

Applications of vibrational microspectroscopy to pathology specimens

Vibrational spectra of tissue and cytology specimens recorded using infrared microscopes operating in the reflectance mode have provided information for identifying relevant chemical species. Examples include a cephalosporin antibiotic derivative, calcium oxalate, talc, silicone, polymethylmethacrylate (PMMA), and polyethylene. The specimens in question ranged in size from 10 to 100 μm, and their spectra were compared to those of authentic compounds to confirm their identities. Identifying these materials contributes additional data to the pathologists tasked with providing medical diagnoses.

The Selective Staining of Curious Bodies in Lymph Nodes of Patients as a Means for Diagnosis of Sarcoid

Paraffin sections of formalin-fixed tissue from some human lymph nodes manifesting the characteristic lesions of sarcoid contain minute bodies 3-15 μ in diameter. These bodies can be stained by direct application -of Schiffs reagent adjusted to pH 3-3.5, without prior hydrolysis or oxidation. They react positively to the naphthoic acid hydrazide procedure for aldehyde, and their reactivity to both these reagents was blocked by aniline and dimedone. These reactions indicate that the peculiar bodies in sarcoid tissues contain reactive aldehydes, present either before or after the processing of the tissue.