Frederick G. Zak

Clinical-Pathological determinants in prognosis of fibrous histiocytomas of head and neck†‡

Review of the literature reveals 76 cases of fibrous histiocytoma of the deep structures of the head and neck. To this we have added 11 of our own cases, and analyzed the total group to determine clinical and histological features of a high risk population. Age, sex, presence of pain, location of tumor, size of tumor, and local invasion appear to be important clinical criteria. Bizarre giant cells, numerous and atypical mitoses, necrosis, and inflammation appear to be important histologic features. The treatment of choice is wide local excision. Chemotherapy appears to produce tumor regression.

Cholangiocarcinoma: A clinicopathologic study of five cases with ultrastructural observations

Abstract Five cases of intrahepatic bile duct carcinoma seen at one institution over the past 13 years are reviewed to reassess their clinical and pathologic features. Two of these patients, having undergone partial hepatectomy, remain alive two and 13 years following resection. Hepatic function test in these cases were within normal limits, save for elevation of the serum alkaline phosphatase level, in contrast with the usual experience with hepatocellular carcinoma, in which associated cirrhosis and consequent hepatic dysfunction are generally the rule. In addition, the serum alphafetoprotein assays were negative. Radionuclide scanning combined with hepatic arteriography, on the other hand, was found to be of considerable diagnostic value. Proper interpretation of the liver biopsy is the critical diagnostic procedure, the main problem being the differentiation of this tumor from metastatic adenocarcinoma. In addition to the classic ductal and ductular adenocarcinoma, we have observed two variant histologic patterns of intrahepatic bile duct carcinoma. The first is the mixed ductular-trabecular type, which may closely mimic hepatoma, the distinguishing features of which are the presence in the former of extreme desmoplasia and basement membrane-like material confirmed by electron microscopy. Second is the carcinoidal variant. Presumably arising from argentaffin cells of the intrahepatic biliary epithelium, this element, present in two cases, may be the predominant histologic expression of the tumor, a phenomenon that may account for the cases of primary hepatic carcinoid occasionally reported.

Radiation-induced cardiac fibrosis.

Abstract Three cases of cardiac fibrosis are presented in which radiation is suggested as the cause. In one, death occurred as a result of fibrosis involving the conducting system twenty-three years after radiation; in another, rupture of the apex of the heart occurred fourteen months after radiotherapy. It is suggested that the diagnosis of radiation-induced cardiac fibrosis be entertained in radiated patients who exhibit unusual clinical or electrocardiographic evidence of heart disease.

Torulopsis glabrata septicemia

Abstract Necropsy findings in a case of Torulopsis glabrata septicemia arising from aspiration bronchopneumonia are reported. Central nervous system manifestations were in part caused by this infection.

Toxic epidermal necrolysis (Lyell): The scalded skin syndrome

Abstract Toxic epidermal necrolysis (Lyell) is an acute disorder with a high mortality which, in its fully developed form, grossly resembles scalding. A history of drug intolerance can be elicited in some cases; in others there appears to be a relation to an infectious disorder, most often of the respiratory tract. Toxic reactions to drugs are usually implicated but without convincing proof. The histopathologic appearance of epidermal necrosis is distinctive and thus permits separation from other bullous disorders. Occasionally, however, only the upper portion of the epidermis shows mild damage. While there may be a clinical resemblance to Stevens-Johnson syndrome, the dearth of microscopic alterations in the dermis in toxic epidermal necrolysis permits separation of these two entities. A review of the literature reveals reports of some 140 cases. Three additional instances of this disorder are reported. In one, which proved fatal, isoniazid or penicillin appears to have been the offending drug.

Histiocytic medullary reticulosis

Abstract The case presented fulfills the clinical and morphologic requirements of histiocytic medullary reticulosis as laid down by Bodley Scott and Robb-Smith [1]. This invariably and apparently rapidly fatal disease of adults is characterized morphologically by a diffuse proliferation of phagocytic histiocytes and their precursors in lymph nodes, spleen, liver, bone marrow and other organs. The striking erythrophagocytosis, particularly in the spleen, is diagnostic. Wasting, fever, moderate lymph node enlargement, hepatosplenomegaly, hypersplenism and icterus are found.

Role of Cell Proliferation in Hepatic Carcinogenesis.

Summary Primary hepatic carcinoma, without accompanying cirrhosis or fibrosis of the liver, was induced in rats with diethyl-nitrosamine. Hyperplastic nodules and nodular cytoplasmic alterations were found in the same livers. Autoradiographs after administration of tritiated thymidine showed no increase in DNA synthesis in morphologically normal areas or in foci of cytoplasmic alterations, but a striking increase in both hyperplastic nodules and carcinoma. It is concluded that primary hepatic carcinoma in the non-cirrhotic liver may arise through stages of increased nodular regeneration.

Stenosing Coronary Arteritis: Its Possible Role in Coronary Artery Disease

1. S., a man, 27 years old, (Adm. No. 447634) was admitted to the hospital because of sudden onset of severe substernal pain accompanied by cold sweat, weakness and vomiting. The pain ‘vas partially relieved by a hypodermic injection. He had contracted scarlet fever in childhood and seven years ago had been told he had a murmur. He smoked 20 cigarettes daily. Physical examination revealed an apprehensive, pale young man with soft, thud-like heart sounds and a soft systolic murmur, temperature 97, pulse rate 128, blood pressure 130 systolic, 90 diastolic. There was evidence of acute tonsillitis. Laboratory findings: Hgb. 105 per cent, red blood cells 5.9 million, white blood cells, 29,200. Blood Wasserman reaction, negative; blood sugar 105 mg per 100 ml, serum cholesterol 250 mg per 100 ml, blood urea nitrogen, 23 mg per 100 ml. The electrocardiogram revealed changes characteristic of acute anterior wall infarction. The course seemed, at first, satisfactory. The blood pressure was 112 systolic and 84 diastolic on the second day, the temperature 102. Death occurred suddenly on the third day. Autopsy ( ~ 11306) revealed a well developed and nourished body. The heart weight was 350 gm. The myocardium of the entire anterior wall of the left ventricle, of the anterior half of the septum and of the apical portion of the posterior wall showed a yellowish-grey discoloration best seen on cut surface with extensive irregular bluish-red areas. Similar changes were also present in the left anterior papillary muscle. A small, red, mural thrombus was seen in the apex of the left ventricle. The coronary ostia were patent. The coronary arteries disclosed a mild degree of atherosclerosis. The left anterior descending branch was occluded by

Pale cell acanthoma.

Pale cell acanthoma, an entity recently established by French investigators, is characterized by a lesion, usually solitary, and commonly on the lower extremities of adults. The appearance is that of a round, reddish, elevated, occasionally bleeding, or crusted growth not larger than 20 mm, but often smaller. If untreated it has been known to remain for as long as 25 years. Treatment is surgical. Recurrences are unknown. The microscopic appearance is unique and reveals regular acanthosis with striking pale prickle cells, rich in glycogen, and edematous vascularized papillae. A sprinkling of various inflammatory cells in dermis and epidermis and parakeratosis are noted with regularity. A sharp border between normal and abnormal epidermis is typical. Six pertinent cases are recorded, two of which have been followed for ten and three years respectively.

Intracellular Bile Canaliculi in the Rabbit Liver

Summary With the aid of the histochemical phosphatase stain, intracellular bile canaliculi can be demonstrated in the normal rabbit liver. These intracellular branches become considerably more pronounced following experimental biliary obstruction.