Harvey Z. Klein

Mucinous carcinoid tumor of the vermiform appendix

Three examples of a distinctive, well‐differentiated, mucin‐secreting tumor of the vermiform appendix are described. Because of the presence of infiltrating groups of “signet ring” cells, these tumors have often been diagnosed and treated as adenocarcinomas. The demonstration of appreciable numbers of argentaffin cells, particularly in formalin‐fixed tissues, as well as the absence of mucosal glandular involvement by tumor tend to support the contention of previous workers that this unique tumor is histogenetically and biologically more akin to a carcinoid tumor. Most of these tumors are not apparent grossly, but are an incidental microscopic finding in an acutely inflamed appendix. In view of the lack of documented aggressive behavior of this lesion, the need for additional surgical treatment beyond appendectomy is questioned.

Glycogen-rich adenoma of the parotid gland. An uncommon benign clear-cell tumor resembling certain clear-cell carcinomas of salivary origin

An instance of glycogen‐rich adenoma of the parotid gland is presented. This lesion contains conspicuous numbers of clear cells, causing confusion with certain clear‐cell salivary carcinomas. In the glycogen‐rich adenoma, the clear cells form a peripheral mantle within tubular complexes and contain abundant glycogen, whereas similar appearing clear cells within acinic cell and mucoepidermoid carcinomas occur in nests and trabeculae, and lack glycogen. Although the precise nosologic position of this lesion is speculative, the admixture of epithelial and clear‐celled myoepithelial elements may justify placing this lesion in the broad category of mixed tumors, particularly those variants lacking a prominent stromal component elaborated by such myoepithelium. The presence of areas of cytologically atypical, locally invasive growth in the recurrent tumor are interpreted as evidence of malignant degeneration, and may have been related to prior radiotherapy.

Necrobiotic granulomas of the uterine cervix. A probable postoperative reaction.

Three cases of necrobiotic granulomas of the uterine cervix occurring in patients with a history of previous cervical surgery are described. This distinctive lesion histologically resembles a rheumatoid nodule but is not associated with infection or connective tissue disease. The clinicopathologic features of these cases are virtually identical to analogous postoperative lesions that have been described in the prostate. Such necrobiotic granulomas seem to be a result of prior surgery and should not be confused with other more portentous granulomatous diseases.

Pulmonary hyalinizing granulomas in a patient with malignant lymphoma, with development nine years later of multiple myeloma and systemic amyloidosis

In our patient, multiple bilateral nodular pulmonary densities appeared on a chest x‐ray at the time of diagnosis of stage IV diffuse lymphocytic lymphoma, After localized radiation therapy, the patient received no further systemic therapy. The pulmonary nodules slowly became larger and more numerous. Nine years later the patient developed proven multiple myeloma. Pulmonary hyalinizing granulomas have not heretofore been associated with proven lymphoreticular neoplasia, although this has long been suspected. The occurrence of two B‐cell tumors at different points in time associated with systemic amyloidosis is an extremely rare event. The authors discuss the possibility that these conditions represent an abnormality in a common cell of origin with differing expression over time. Coincidence, however, remains a likely explanation for the different immunopathies that occurred in our patient.

Mucinous transformation of synovium

A unique case of mucinous transformation of knee joint synovium associated with recurrent mucinous joint effusions and severe osteoarthritis is presented. The lesion probably represented an extreme pathologic expression of physiologic synoviocytic synthesis of hyaluronic acid. It did not appear to be related to other myxoid lesions that may occur in this area.