Myron Tannenbaum

Ultrastructure of the human mammary ductule.

Terminal ductules of resting premenopausal breast were studied to determine the limits of normal ultrastructural variability. The lumen of the ductule is enclosed by columnar epithelial cells; and these, in turn, are enclosed by a discontinuous layer of myoepithelial cells. Some epithelial cells extend from the lumen through the discontinuities among the myoepithelial cells to the basement membrane. Usually, ductules with closely apposed cells have simple basement membranes, while those with separated cells have multiple basement membranes. Microvilli are present in clear spaces in lumens and between cells but are absent from occluded lumens. Some lumens contain orderly arrangements of filamentous material of maximum unit diameter of 410 Å. Both cell types vary in density from light to dark. Two types of nuclear inclusion are found. Position, smaller mitochondria, hemidesmosomes and dark patches on myofibrils distinguish myoepithelial from epithelial cells. The distinctions are quantitative rather than qualitative, and there are suggestions of an essential similarity between the 2 cell types.

Fibrous Histiocytomas of the Orbit

Fibrous histiocytomas are a complex group of tumors, that feature cells resemxad bling fibroblasts and histiocytes and that exxad hibit a distinctive but inconstant cellular arxad rangement referred to as a storiform (matted) or cartwheel pattern. This particuxad lar subgroup of soft tissue tumors was first identified and characterized by Stout and coworkers. Considerable confusion has enxad veloped these tumors as a result of their arxad cane terminology—fibrous histiocytoma, xanthofibroma, fibrous xanthoma, xanthogranuloma, dermatofibroma, atypical fibrous xanthoma, atypical fibrous histiocytoma, and storiform fibrous xanthoma. Since they are essentially localized tumors, they should not be regarded as relatives of the systemic reticuloendothelioses and other more widespread histiocytic disorders. The purpose of this communication is to report on the experience at the Edward S. Harkness Eye Institute with a group of relatively homogeneous orxad bital tumors that satisfy the criteria for fibrous histiocytoma.

Prognostic significance of nucleolar surface area in prostate cancer.

In an effort to define ultrastructural histologic features that might serve as predictors of tumor aggressiveness, a retrospective study was conducted on 52 patients with localized and metastatic adenocarcinomas of the prostate. Nucleolar surface area measurements were made by stereologically analyzing pictures obtained by the backscattered electron imaging (BEI) attachment to a scanning electron microscope (SEM). The data were compared with the Gleason grading system which is based on light microscopic glandular patterns. In patients with no evidence of disease three years or more after radical prostatectomy, the initial biopsy demonstrated nucleolar surface areas which averaged 1.28 micrometers2 (range 0.60 to 2.27 micrometers2) whereas, patients with metastases or dying of cancer exhibited an average nucleolar surface area of 5.17 micrometers2 (range 2.49 to 10.01 micrometers2). With a single exception in this 52-patient survey, progressive disease was always accompanied by nucleolar surface measurements larger than 2.40 micrometers2. There was close correlation in nucleolar surface measurements between the initial biopsy and the radical prostatectomy specimens; in contrast, Gleason grades varied by more than 30 per cent between the initial and final specimens in 70 per cent of the cases. Only 9 of 16 patients with aggressive disease ever demonstrated Gleason grades above 6. The development of an ultrastructural grading system may provide a means of determining prognosis in prostatic cancer in objectivity and specificity to light microscopic grading systems.

Carcinoembryonic Antigen and Bladder Carcinoma

The 24-hour urinary carcinoembryonic antigen determinations were performed on 61 patients with different stages of bladder carcinoma. Elevated titers were found in 81 per cent of the patients with active tumors and falsely positive studies were found in 7 per cent. High stage lesions were found to have high carcinoembryonic antigen levels. Plasma carcinoembryonic antigen determinations were elevated in only 45 per cent of the patients with active tumors but further study may be warranted in advanced bladder cancer cases. The 24-hour urinary carcinoembryonic antigen measurements yield the highest percentage elevations in bladder carcinoma and further investigation is required to better define its clinical application.

Acid phosphatase: New developments

Acid phosphatase was the first tumor marker to be measured in the blood, and over 40 years have passed since an elevation of the serum acid phosphatase level was observed in patients with prostatic carcinoma. However, significant elevations in the level of this enzyme have been observed in other diseases, as well as elevations of other tissue phosphatases. Many improvements in the colorimetric technique have been introduced, but none has been used successfully to detect the tissue origin of this ubiquitous enzyme. The finding that prostatic acid phosphatase is antigenically distinct from acid phosphatase of other tissues opened a new horizon in the measurement of acid phosphatase in prostatic cancer. On the basis of this immunochemical specificity, several immunoassays have been employed for determining the prostatic acid phosphatase level.

Leiomyoma. An unusual tumour of the orbit.

Leiomyoma of the orbit, a benign tumour of sniooth muscle, is exceedingly rare (Reese, I963; Offret and Haye, I97I). Furthermore, its diagnosis is suspect when one fails to demonstrate non-striated cytoplasmic filaments convincingly. The present case is reported for three reasons: (i) It is the only orbital leiomyoma in the files of the Eye Institute; (2) It has a well-documented clinical course spanning io years; (3) The tumour was initially misdiagnosed as a fibrous histiocytoma.

Localized amyloidosis of the glans penis: a case report and literature review.

Background:u2002 Primary localized cutaneous amyloidosis is an uncommon lesion with a varied pathogenesis.

Surgical Pathology of Benign Prostatic Hyperplasia

An understanding of the pathobiology of benign prostatic growth is obviously important when assessing prognosis for the individual patient. The prostate gland increases in size from the time of birth until puberty. At puberty rapid growth occurs, continuing until the third decade of life. The size of the prostate gland then remains constant until about age 45.6 At this time the prostate may develop clinical benign prostatic hypertrophy (BPH) (i.e., its volume increases at a rapid pace and continues to do so until death) or begins actively and progressively to decrease in size. Franks1 and others have noted that the human prostate develops certain evolutionary changes early in life, and therefore with aging there is an increased clinical incidence of BPH. Lytton et al.3 suggested that at age 40 the probability is approximately 10% that a man will require an operation for BPH if he lives to age 80.

THE PROSTATE CELL AS A SECRETORY FACTORY OF ACID PHOSPHATASE

In men over the age of 50, carcinoma of the prostate is one of the most prevalent cancers. There are varying degrees of differentiation, and a great majority of these tumors are adenocarcinomas. The clinical biological activity of these cancers demonstrates a broad spectrum of variation in different individuals. The cancers may be localized for many years without clinical manifestations and hormonal changes in the host, or they may spread extensively to various organ systems and cause enzyme elevations in the blood. In many instances, prostate cancer cells maintain their chemical activity and continue to be dependent on androgens for the maintenance of their secretory function as well as structural differentiation and growth. To increase our knowledge of these cancers, it is important that some type of structural-functional organization of the prostatic cancer cells be established and correlated with their secretory ability, i.e., in the clinically important cases of prostatic carcinoma, with the release of prostatic acid phosphatase either into the lumen of the gland or into the bloodstream where the elevated levels can be detected. At the present time, there have been no correlations with various histological patterns, e.g., the Gleason classification for prostatic carcinoma and prostatic acid secretions as detected by immunological means. However, there have been several clinical classifications of prostate cancers with respect to prostatic acid phosphatase secretion, as well as ultrastructural studies of prostate cancer cells as they relate to prostatic grade and clinical mal ignan~y.~

Bone Marrow Acid Phosphatase in Prostate Cancer: An Assessment by Immunoassay and Biochemical Methods

Comparisons of the bone marrow and serum acid phosphatase values obtained by counterimmunoelectrophoresis and the Roy biochemical test were made in 72 patients with and in 13 patients without prostatic cancer. The counter-immunoelectrophoresis test, when positive at more than 1 international unit per liter, showed only 4.4% falsely positive results. The Roy biochemical test, which uses sodium thymolphthalein monophosphate as the substrate, had 65% falsely positive bone marrow acid phosphatase levels. Conflicting reports regarding the value of bone marrow acid phosphatase determinations in patients with prostatic cancer result from the use of non-specific substrates in biochemical methods for measurement and from the trauma incidental to bone marrow aspiration, which releases many non-prostatic acid phosphatase enzymes. The use of immunoassay such as counter-immunoelectrophoresis minimizes this source of error.