Hai X. Bui

Prediction of pathologic stage and postprostatectomy disease recurrence by dna ploidy analysis of initial needle biopsy specimens of prostate cancer

Background. DNA ploidy determination of carcinomas in radical prostatectomy specimens has shown significant correlation with patient outcome, but the predictive value of ploidy status of cancers obtained by transrectal ultrasound‐guided needle biopsies has not been studied extensively.

Sulfur-rich prostatic intraluminal crystalloids: A surgical pathologic and electron probe x-ray microanalytic study

Prostatic intraluminal crystalloids are irregular eosinophilic, non-birefringent structures increasingly recognized as potential indicators of prostatic malignancy. In a study of 250 randomly selected surgical pathology cases of prostatic tissues none of 50 cases of benign glandular hyperplasia (0%), one of 50 cases of atypical adenomatous hyperplasia, 18 of 50 cases of well-differentiated adenocarcinoma (36%), seven of 50 cases of moderately differentiated adenocarcinoma (14%), and none of 50 cases of poorly differentiated adenocarcinoma (0%) revealed intraluminal crystalloids. A histochemical and immunohistochemical staining panel indicated that the crystalloids were nonproteinaceous. Crystalloids were stained intensely with phosphotungstic acid hematoxylin and did not stain for prostatic-specific antigen or hemoglobin. Crystalloids were clearly differentiated from prostatic corpora amylacea on light microscopy, histochemistry, scanning, and transmission electron microscopy. Electron probe x-ray microanalysis of 10 cases of crystalloids revealed uniform high sulfur peaks and small sodium peaks. We conclude that intraluminal crystalloids are associated more frequently with low-grade prostatic adenocarcinoma, may occur in benign tissue bordering adenocarcinoma, are predominantly composed of inorganic sulfur, and their presence in benign and atypical prostate biopsies may be of pathologic significance and should warrant further clinical investigation and possibly repeat biopsy.

Intracytoplasmic eosinophilic hyaline globules in cartilaginous neoplasms: A surgical, pathological, ultrastructural, and electron probe x-ray microanalytic study

Hyaline globules (HGs), spherical intracytoplasmic eosinophilic droplets, have been associated with a variety of conditions, including hepatocellular carcinoma, lung adenocarcinoma, and Kaposis sarcoma, but they have not been described in cartilaginous tumors. In specimens of 60 cartilaginous neoplasms we found that 22 of 33 chondrosarcomas (67%), eight of 16 enchondromas (50%), and three of seven soft tissue chondromas (43%) exhibited HGs. HGs were seen more commonly in low grade chondrosarcoma (70%) and were relatively rare in high grade chondrosarcoma (25%). No HGs were identified in three osteochondromas, one synovial chondromatosis, or 15 normal cartilaginous tissues taken from various sites. Cartilage associated HGs ranged in size from 2 to 20 microns, were diastase resistant and periodic acid-Schiff (PAS) stain positive, demonstrated autofluorescence, and variably stained with Mallorys phosphotungstic acid-hematoxylin stain (PTAH). A panel of immunostains did not show any specific staining reactions with HGs. Ultrastructurally the HGs were spherical, non-membrane-bound bodies having complex architectural features associated with profiles of rough endoplasmic reticulum. Electron probe x-ray microanalytic (EPXMA) study showed significant peaks of sulphur and calcium. We conclude that HGs represent secretory products of probable glycoprotein nature, may accumulate in a variety of cartilaginous neoplasms, and may be seen more frequently in low grade chondrosarcomas.

Extragenital primary mixed malignant mesodermal tumor

Malignant mixed mesodermal tumors (MMMT) are infrequent neoplasms characteristically arising in the endometrium. Extragenital MMMTs are extremely rare, with but 11 cases reported in the literature. Previous extragenital MMMTs have been associated with endometriosis, Wolfian duct remnants, and ovarian cyst adenocarcinoma and have been presumed to arise from coelomic and subcoelomic structures. We report a case of a MMMT arising extragenitally in the cul-de-sac in a 54-year-old White female patient in whom disseminated intraperitoneal serosal papillary serous adenocarcinoma of the peritoneum was present. The histogenesis of this rare neoplasm is discussed along with a brief review of previously reported cases.

Selective expression of CD44 cell-adhesion molecule in thyroid papillary carcinoma fine-needle aspirates

Recent descriptions of numerous pitfalls in the cytologic diagnosis of thyroid papillary carcinoma on fine‐needle aspiration biopsy specimens have prompted studies of new ancillary diagnostic methods. We evaluated the potential use of immunocytochemical staining of thyroid fine‐needle aspiration biopsy specimens for CD44, a glycosylated cartilage link protein associated with extracellular matrix adhesion and lymphocyte homing. Fourteen of 16 (88%) classic, surgically confirmed, thyroid aspiration biopsies stained intensely positive for this marker, whereas 0 of 30 (0%) similarly‐processed benign aspirates from colloid nodules showed immunoreactivity for CD44 antigen. From this study, we conclude that most papillary carcinomas of the thyroid express the cell‐adhesion molecule CD44, which may be of clinical value in confirming the diagnosis on borderline fine‐needle aspiration specimens. Further study of CD44 expression may prove of significant interest in explaining the unusual mode of spread and clinical course of this disease. Diagn Cytopathol 1996;14:287–291.

E-cadherin cell-adhesion molecule expression as a diagnostic adjunct in urothelial cytology

E‐cadherin (E‐CD) is a cell‐adhesion molecule that has been associated with invasion and metastasis in a wide variety of human neoplasms. We have recently shown that, although decreased E‐CD expression is associated with increased bladder‐wall invasion and higher tumor grade of infiltrating transitional cell carcinomas (TCC), E‐CD expression in the exophytic portion of pure papillary and papillary‐infiltrating TCC is increased over that of normal transitional cells. To evaluate whether E‐CD levels could serve as a diagnostic adjunct in urinary cytology specimens, we stained 40 alcohol‐fixed bladder‐washing cytospin preparations with an avidin‐biotin‐peroxidase method using a monoclonal antibody to E‐CD (Sigma Chemical Co., St. Louis, MO). E‐CD expression level was defined as a high‐intensity or low‐intensity staining increase over background squamous cell staining for the transitional cells in 21 biopsy‐proven transitional cell carcinomas with papillary components, and in 19 benign or reactive control specimens. Twenty‐one of 21 TCC (100%) showed an increased E‐CD level over background, with 13 low‐intensity and 8 high‐intensity cases. Ten of 19 benign cases (53%) showed increased E‐CD staining over background, with 8 low‐intensity and 2 high‐intensity cases. This difference between malignant and benign specimens was statistically significant (chi‐square test, P = 0.001). We conclude that increased E‐CD expression in the papillary components of TCC can be identified in urinary cytology specimens, may reflect the physical and chemical structural makeup of papillary architecture, and warrants further study as a diagnostic adjunct in the interpretation of urine cytology specimens. Diagn Cytopathol 1996;14:310–315.