Michael D. Lagios

Mammographically detected duct carcinoma in situ: frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence

Seventy‐nine patients with mammographically detected foci of duct carcinoma in situ (DCIS) of histologically confirmed extents of 25 mm or less, were treated by tylectomy without irradiation or axillary dissection. Adequacy of excision was confirmed histologically, by radiographic‐pathologic correlation and by postoperative mammographic examination. Eight patients (10.1%) have recurred locally in the immediate vicinity of the biopsy site. Four patients developed recurrent in situ disease identified mammographically, and all were initially treated by reexcision. One of these patients subsequently elected to undergo mastectomy; no residual in situ or invasive disease was detected in the breast or in axillary lymph nodes. Four patients developed recurrent invasive disease; 50% of these recurrences were detected mammographically. All patients were treated by mastectomy with node dissection. Three had confirmed minimal invasive carcinomas and were N0, one patient had a 13‐mm invasive lobular carcinoma with a single Group I micrometastasis. All patients, including those treated for a recurrence, are presently free of disease but three patients died of heart disease. Nuclear grade would appear to identify subsets of DCIS more likely to produce local failure after tylectomy alone. Duct carcinoma in situ with high‐grade nuclear morphology and comedo‐type necrosis was associated with a 19% local recurrence rate after an average interval of 26 months; only one of ten patients with intermediate‐grade DCIS developed a local recurrence at 87 months; and none of 33 patients with DCIS of micropapillary/nonnecrotic cribriform type and low‐grade nuclear morphology developed local recurrence in the follow‐up period.

Multicentricity of breast carcinoma demonstrated by routine correlated serial multicentric breast carcinoma subgross and radiographic examination

Occult multicentric foci of carcinoma, separate from the tumor that directed biopsy (reference tumor), were documented in mastectomy specimens with a correlated serial subgross and radiographic method of examination (Egan et al2). The relative frequencies of histologic types, sizes and calculated volumes of invasive tumors, and clinical data among patients with a single focus and with multicentric foci of breast carcinoma were compared. Multicentric foci of carcinoma occurred in 18 of 85 cases (21%). Half of the occult lesions were second invasive carcinomas, and in three cases the occult second invasive tumor was larger and/or more poorly differentiated than the reference tumor. However, in no instance was a metastasis documented from an occult carcinoma. On the average, the invasive carcinomas in breasts with multicentric foci of cancer were significantly smaller in diameter and calculated volume was than that of unicentric invasive carcinomas. Patients with multicentric breast carcinoma were more likely to have a positive family history of breast cancer and to have had contralateral cancer than were patients with a single focus of disease. Compared with other types of invasive cancers, tubular carcinomas were significantly more likely to be associated with multicentric invasive carcinomas in this study; half of the reference tubular carcinomas were so associated. Duct carcinoma in situ (DCIS) less than 25 mm in extent was unassociated with occult invasive or significant in situ multicentricity, whereas more diffuse DCIS frequently was associated with occult invasive carcinoma. These latter data suggest an association between the extent of the in situ lesion and the likelihood of occult invasive carcinoma.

Endometrial (papillary) carcinoma of the prostatic utricle—response to orchiectomy. A case report

A case of papillary duct carcinoma of the prostate, termed “endometrial carcinoma of the prostatic utricle,” is presented. The bladder trigone and ureteral orifices were involved by tumor producing a nonfunctioning right kidney and left hydronephrosis. Orchiectomy produced objective regression in the tumor mass with return of right renal function, decrease in left hydronephrosis, and marked clinical improvement. The tumor displayed androgen dependence, despite the suggestion that such tumors are estrogen‐dependent derivates of the median Müllerian remnant in the prostatic urethra (the utriculus masculinus).

The pituitary gland of the coelacanth Latimeria chalumnae Smith

Abstract Pituitary structure in the coelacanth Latimeria, the surviving member of the Crossopterygii, demonstrates features both shared and unique amongst the bony fishes. The neurohypophysis contains three areas of specialized neural contact. The anterior neurohypophysis comprises both a neurohemal organ—a median eminence—and an area of more direct, interdigitate contact with the pars distalis reminiscent of Amia. The predominant axon type of the median eminence contains a small monaminergic-type, dense-cored vesicle of 950 A diameter. A neurointermediate lobe complex consists of branching tubular processes of the posterior neurohypophysis and follicles of the pars intermedia. The former contain peptidergic-type axons with large dense-cored vesicles of 1960 A diameter which stain strongly as elementary neurosecretory granules (Knowles Type A). The saccus vasculosus is incompletely separated from the peptidergic posterior neurohypophysis. The tripartite pars distalis shows a more marked tendency toward compartmentalization relative to the lower Actinopterygii and the Dipnoi. Two major divisions of the pars distalis are evident on the basis of vascularization. The more orthodox proximal division is closely associated with the neurointermediate lobe and the portal vessels which appear to represent the major blood supply to this area. It comprises a purely acidophilic dorsal lobe (orangeophils and erythrosinophils), and a posterior lobe of mixed-cell type (orangeophils and basophils) which has a limited area of direct interdigitate neurohypophysial contact. The elongate extension of the pituitary so peculiar to the coelacanth comprises the rostral division which is connected only by a tubular hypophysial cavity to the remainder of the distalis. This virtually separated lobe has a substantial direct arterial supply derived from the internal carotids and contains relatively few chromophilic cells of basophil type in this immature female. The organization of the neurohypophysis in Latimeria is similar to that of other jawed fishes, particularly some relic actinopterygians. In contrast, the tripartite division of the pars distalis, the histologically separated rostral division with its direct arterial supply, basophil cell type, and close association with the carotid anastomosis, are unique features among the Osteichthyes, but are strongly reminiscent of the elasmobranch ventral lobe. Pituitary organization in Latimeria contrasts markedly with that of the lungfishes. The significance of this disparity in terms of the relationship of the two Orders of the Sarcopterygii (Romer) to each other, and of the unique features of the coelacanth in terms of its position as a sister group to the Rhipidistia, is discussed.

Follicle boundary cells in the adenohypophysis of the chondrostean and holostean fishes: An ultrastructural study of their relationship to the follicular lumen, to endocrine cells, and to the hypophysial cleft

Abstract A specialized class of nonendocrine epithelial cell borders both the follicles of the partes distalis and intermedia and the hypophysial cleft of the chrondrostean fishes Polyodon and Acipenser , and the rostal pars distalis follicles of the holostean Amia . Follicle boundary cells in these fishes appear to be homologous with the similar follicular and stellate cells of mammalian pars distalis, and the bordering cells of the hypophysial cavity in tetrapods. They form a complete barrier in the chondrostean follicles and in the hypophysial cavities of these fishes and tetrapods, and are a conspicuous feature of the follicular lumina in Amia but intercalate with endocrine cells about the luminal surface. Small numbers are reported in the rostral pars distalis follicles of the primitive teleost Anguilla but could not be demonstrated in typical percomorphs. Follicle boundary cells share many characteristics of organization and ultrastructure with gut-derived follicular cells described for some ultimobranchial and pancreatic tissues. The elaborate glycocalyx, microvilli, tripartite junctional complexes, and particularly the colloid dropletlike, bristle and smooth-coated endocytic vesicles characteristics of follicle boundary cell luminal surface in these fishes are reminiscent of specializations seen in absorptive epithelia and suggest a role for active exchange between the cells and the follicular content, as has been demonstrated for their mammalian counterparts. The close anatomical relationship and contact between follicle boundary and endocrine cells suggests a supportive function for the follicle boundary cells.

Granular epithelioid (juxtaglomerular) cell and renovascular morphology of the coelacanth Latimeria chalumnae smith (Crossopterygii) compared with that of other fishes

Abstract The larger arteries of the coelacanth Latimeria contain a specialized secretory smooth muscle component, the granular epithelioid (juxtaglomerular) cell. There is, however, no associated specialized distal tubular segment or macula densa. Endothelial cells in the renal arteries of this crossopterygian relic also exhibit an apparent secretory specialization similar to that reported previously in certain amphibians and mammals. In this investigation, the renovascular morphology of the coelacanth is compared with that of teleosts, primitive actinopterygians, and elasmobranchs. Despite the problematic and conceivably quite different functions which may pertain to granular epithelioid cells within the three major groups of the Osteichthyes, they appear to be homologous with the juxtaglomerular cells of tetrapods.

Ultrastructure du parenchyme sécréteur de la glande postanale du cælacanthe, Latimeria chalumnae Smith

Latimeria chalumnae Smith, the only surviving crossopterygian, possesses a well-developed, unpaired, postanal gland whose function is as yet undocumented. The availability of tissue

Ultrastructure and ATPase activity of the rectal gland of the chondrichthyean fish Hydrolagus colliei (Holocephali)

SummaryThe anatomy, histology, ultrastructure and ATPase activity of the intramural rectal gland of the chondrichthyean Hydrolagus colliei, are described. The cells of the rectal gland of Hydrolagus demonstrate the same well developed lateral and basal cisternae, elongate mitochondria and luminal border as those of their elasmobranch counterparts. ATPase activity within the rectal gland of Hydrolagus is as intense as that in a number of elasmobranchs examined in the course of the study. Despite its primitive intramural location the rectal gland of Hydrolagus respresents a homolog of the more specialized and better known elasmobranch gland and appears as well suited for cation excretion.