Nai-San Wang

Absence of carcinoembryonic antigen‐like material in mesothelioma An immunohistochemical differentiation from other lung cancers

This study is to examine the potential usefulness of immunohistochemical staining for carcinoembryonic antigen (CEA)‐like material in the differential diagnosis of mesotheliomas (12 cases) from other lung cancers (14 cases) that had been previously diagnosed by transmission and scanning electron microscopy and conventional light microscopy. Indirect immunofluorescent staining for CEA was carried out on formalin‐fixed paraffin‐embedded sections, and the slides were examined under code. All 9 cases of diffuse mesothelioma were negative, and all 12 cases of adenocarcinoma and bronchioloalveolar carcinoma were positive for CEA‐like material. Three localized mesotheliomas and a carcinoid tumor were also negative. A squamous cell carcinoma was positive. A positive immunohistochemical result for CEA‐like material in lung cancers will raise the possibility of its being of bronchial epithelial origin.

Endobronchial plasma cell granuloma (xanthomatous pseudotumor): A light and electron microscopic study

Plasma cell granuloma (xanthomatous pseudotumor) is polymorphic at light as well as electron microscopic examination. At light microscopy the endobronchial variant of this entity was rich in plasma cells and interwoven, whorl-like, or concentrically arranged spindle cells. Foamy histiocytes and macrophages usually abundant in the intrapulmonary variant were rare. At electron microscopy particles 20 to 50 nm. in size were found at the bronchial mucosal surface but not elsewhere in the lesion. Plasma cells near the bronchial surface contained cytoplasmic fibrils, mitochondria with concentric cristae, and inclusions that bore a close resemblance to adjacent extracellular crystallized hemoglobin. Those in the center of the lesion ordinary round inclusions and none of the other changes. Spindle cells in the interlaced areas were mostly fibroblasts or myofibroblasts, whereas those whorled around capillaries resembled pericytes with basement membranes and nuxes-like intercellular junctions. Year rings like multilayered basal laminae were frequently present between the pericyte-like cells and the endothelial cells of the capillaries. The ultrastructure of plasma cell granuloma, like the histologic and clinical aspects, differs from that of sclerosing hemangioma, pseudolymphoma, and malignant plasma cell tumor affecting the lung.

Further observations on carcinoma in situ of the urinary bladder: Silent but extensive intraprostatic involvement

Of seven patients with carcinoma in situ of the urinary bladder in the absence of an associated papillary carcinoma, five were found to have silent but extensive intraductal prostatic involvement. In three of these the carcinoma in situ was associated with microinvasion. The mean age at the time of diagnosis was 68 years. All had symptoms characteristic of carcinoma in situ, including hematuria, dysuria, and urgency. In three patients the prostatic involvement was diagnosed on transurethral resection. In two it was discovered only after radical cystectomy. The prostatic involvement was neither suspected clinically nor has it been previously emphasized. Although three patients are alive, apparently free of disease up to 15 months postcystectomy, two have died, one of disease. The importance of prostatic assessment in the evaluation of the patient with carcinoma in situ of the urinary bladder is emphasized.

On the ultrastructure of hibernoma

An electron‐microscopic study of hibernoma and a review of the histogenesis, development, and post‐natal structural composition of brown and white adipose tissue are presented. The ultrastructural features of hibernoma include multivacuolated and univacuolated cells containing variable numbers of lipid vacuoles, abundant moderately pleomorphic mitochondria with transverse cristae, lysosomes, lipofuscin granules, pinocytotic vesicles, well‐formed basal lamina, and prominent subplasmalemmal condensations. The latter have not been previously reported in hibernoma, brown adipose tissue or white adipose tissue, although gap junctions have been observed in brown adipose tissue of newborn mice. It is concluded that the ultrastructural observations support the concept proposed decades ago that hibernoma represents the neoplastic counterpart of brown adipose tissue.

A scanning electron microscopic study of diffuse mesothelioma and some lung carcinomas.

Seventeen cancers from lung and pleura were studied with scanning, transmission electron, and light microscopy (SEM, TEM and LM). Diffuse mesothelioma mimics bronchioloalveolar carcinoma at LM but shaggy microvilli were found on the cellular surface of the former, and short sprouts densely packed or loosely scattered, on that of the latter. Neolumen formation was found in both. Oat cell carcinoma had a smooth surface with occasional tiny projections and minute surface depressions. The cellular projections of squamous cell carcinoma were quite irregular. Differentiation between diffuse mesothelioma and bronchioloalveolar carcinoma appears feasible with SEM in tissue appropriately fixed either with formaldehyde or glutaraldehyde. The role SEM can play in diagnostic pathology is yet to be explored. Cancer 40:707–715, 1977.

Mineral dusts in lungs with scar or scar cancer

Five lungs with small scars and five lungs with small scar associated cancers, were studied by light and scanning electron microscopy and x‐ray energy dispersive spectrometry. Six hundred particles were photographed and their physical and chemical properties analyzed from scar, cancer, or normal alveolar tissue on carbon planchet‐mounted, deparaffinized and low temperature‐ashed sections. Amosite/crocidolite fibers were accumulated only in one cancerous lung. All other lungs shared similar types of mineral particles. The lungs with noncancer scars, however, showed an increase in the ratio of aluminum and calcium salts (non‐silicates), while the lungs with scar cances had a higher ratio of silicates. These patterns of particle distribution were similar in different areas of the same lung, despite the fact that particles accumulated heavily in the scar and scarcely in the normal alveolus. Although the mechanism is unclear, these results are consistent with the possibility that the pattern of mineral particle distribution in a lung may influence the formation of cancer in a scar.

Giant cell formation in small cell carcinoma of the lung.

Four patients with biopsy proven small cell carcinoma of the lung died rapidly following radiotherapy. At autopsy areas of prominent tumor giant cell formation were found at the primary site in all four and in the metastatic sites in three. Giant cell formation in a tumor may be from the development of another tumor, sublethal damage to the original tumor cells or presence of the two components from the outset. The light and electron microscopic appearances of the giant tumor cells and their existence in the nonradiated sites in our cases suggest that small cell carcinoma, as adenocarcinomas and squamous cell carcinomas, may be associated with giant cell carcinoma‐like components.

Immunohistologig study of thyroidal medullary carcinoma and pancreatic insulinoma

An indirect immunofluorescent antibody technique, preceded by trypsin digestion of the tissue sections, was applied to six cases of medullary carcinoma of thyroid (MCT) and three cases of insulinoma in order to examine the state of antigenic preservation of peptide hormones in tumor tissues, which had been fixed in formalin and embedded in paraffin for periods up to 18 years for MCT and 10 years for insulinomas. By this method both C‐cells of normal thyroid and tumors of MCT were shown to contain calcitonin. Other types of thyroid carcinoma did not contain calcitonin, and no increase in C‐cells was found in various thyroidal diseases. The tumor cells of MCT demonstrated a large amount of immunoreactive calcitonin, particularly in the medullary (solid) form, and a decreased amount in the amyloid form. Following trypsin digestion, specific immunofluorescence for calcitonin was also noted in the amyloid stroma. This might be related to the presence of entrapped secretory granules from cell debris in the amyloid substance. The immunohistochemistry can distinguish the poorly differentiated follicular carcinoma of thyroid from MCT, as illustrated in one case. Beta cells of normal pancreatic islets and tumor cells of insulinoma, but not the accompanied amyloid, were shown to contain insulin by indirect immunofluorescent stain. In the diagnosis of insulinoma, this method equals the electron microscopy for its sensitivity, and surpasses it for simplicity in technique. In general, the trypsin treated sections showed a significant improvement over the untreated preparations in the quality of immunofluorescence, thus facilitating microscopic interpretation on tumor tissues. The results did not appear to be affected by the duration of tissue preservation in the paraffin blocks. The improved immunohistologic method may be recommended for routine use in prospective and retrospective studies of certain endocrine tumors.

Case Report: Catecholamine-Secreting Paraganglioma of Glomus Jugulare Region

ABSTRACT A 43-year-old woman had clinical and biochemical evidence of a secreting paraganglioma of the glomus jugulare region. Catecholamine secretion was exacerbated during embolization of the tumor before surgery and resulted in a life-threatening vasomotor attack. Preoperatively, pharmacologic blockade of excessive catecholamine secretion with prazocin controlled her blood pressure, tachycardia, and symptoms. The tumor was resected and its catecholamine content measured. This case is reported to stress the importance of adequate preoperative assessment of patients with paragangliomas of the head and neck. The extreme rarity of catecholamine-secreting tumors of this region should not lead us to underestimate the morbidity and mortality of such patients undergoing surgery or any other invasive procedure whether the diagnosis is confirmed or only suspected.

Metastatic carcinoma: The lung as the site for the clinically undiagnosed primary

Of 387 patients who died with lung cancer, 28 cases were reviewed (7.2%) which were clinically undiagnosed. The male:female ratio was 3.6 and mean age was 64 years in the males, 47 years in the females. The most frequent presenting symptoms were neurologic. Prior to death, 21 patients had known or suspected metastatic disease (biopsy‐proven in 12), while a malignant diagnosis was not considered in seven patients. Mean survival was 3.5 months. Despite a mean tumor size of 2.8 cm, most of the chest x‐rays were not diagnostic even in retrospect. At autopsy, 65% of the tumors were adenocarcinomas (compared to 32% in the other 359 patients); 53% of these showed vascular and lymphatic invasion around the primary tumor, explaining their wide dissemination. In patients with small cell carcinomas (25% of the cases reviewed) or with solitary metastases (14% of the cases reviewed) therapeutic intervention could possibly have been beneficial.