Paul W. Gikas

Occult metastasis from occult papillary carcinoma of the thyroid

A patient underwent a total thyroidectomy after the incidental discovery of normal appearing thyroid tissue in a scalene lymph node. When the thyroid was examined by a subserial technique, which provided a section for examination at every 50μ, a minute primary carcinoma measuring 0.2 × 0.3 × 0.6 mm was found. A postoperative 131I scan of the neck revealed residual radioactivity in the neck, some of which may be neoplastic. A primary thyroid carcinoma should be considered as the source of thyroid follicles in a cervical lymph node unless serial sectioning of the entire thyroid fails to reveal the primary carcinoma. In none of the reported cases of so‐called “benign inclusions” of thyroid in cervical lymph nodes has the histologic examination been adequate to rule out a focus of carcinoma as small as the one noted in the present case. The authors know of no other case of thyroid cancer with metastasis in which the primary lesion was smaller than in the present case.

Prolactin and growth hormone-producing pituitary adenomas. An immunohistochemical and ultrastructural study.

ABSTRACTThirteen prolactin and five growth hormone-producing pituitary adenomas were studied by immunohistochemistry and electron microscopy. The immunohistochemical localization of prolactin and growth hormone correlated well with elevated serum levels of pituitary hormones in all cases. Ultrastructural characterization by granule density and secretory activity was studied in relation to the serum levels of pituitary hormones and the sizes of the tumors. This indicated that markedly elevated serum hormone levels were related to larger tumors with high secretory activity, as indicated by abundant endoplasmic reticulum and well-developed Golgi complexes rather than to the numbers of cytoplasmic granules in the tumors.Two patients with prolactin-producing adenomas had been treated with bromocryptine before surgery. Both tumors showed evidence of degeneration, including cytoplasmic vacuolization. In one case the tumor had an increased number of secretory granules, while in the other case there were few viable cells and an abundance of amyloid deposits. The effects of bromocryptine therapy on pituitary tumor morphology in these two cases include an increased number of pituitary granules, and cellular degenerative changes.

Reversal of renal allograft rejection with intravenous methylprednisolone “pulse” therapy☆☆☆

Abstract Intravenous administration of large doses of methylprednisolone sodium succinate was demonstrated to modify rejection in both canine and human renal allografts. One dose of intravenous methylprednisolone 30 mg./kg. administered during acute rejection in dogs resulted in an increase in urine volume and osmolality, and a decrease in serum and urine LDH. In two dogs treated with a single dose and in one dog treated with four consecutive daily doses histologic evidence of reversal of rejection with reduction of cellular infiltrate was achieved. Ninety-two percent of rejections encountered in 100 consecutive human recipients of renal allografts were halted or reversed with intravenous methylprednisolone 30 mg./ kg. given every 48–72 hours to a maximum of three or four doses. No significant side effects were observed either in dogs or humans with this therapy. The mean circulating half-life of intravenous methylprednisolone was determined to be 3.48 ± 0.7 hours in dogs. Intermittent intravenous administration of methylprednisolone has the potential advantage of being associated with fewer side effects than frequent oral administration and has been shown to be an effective method for modifying rejection.

Florid hyperplasia of mesonephric remnants involving prostate and periprostatic tissue: possible confusion with adenocarcinoma

Two cases of florid hyperplasia of mesonephric remnants occuriring in the prostate are described. One case was originally interpreted as invasive adenocarcinoma on transurethral resection (TUR), resulting in radical proslatectomy. In the second case, a TUR specimen was diagnostic for adenocarcinoma, which was confirmed in the radical prostatectomy specimen, Florid mesonephric hyperplasia in the second case was an incidental finding. The TUR specimen in the first case and sections of the prostatectomy specimens in both cases contained a proliferation of tubules, which ranged from aggregates of microacini to dilated structures containing a characteristic colloid-like material. The location of these lesions in the base of the prostate gland and periprostatic soft tissue suggests that these may be mesonephric remnants that have become hyperplastic. This type of lesion shares many features with mesonephric hyperplasia occurring in the female genital tract, including the presence of eosinophilic intratubular material and a lobular arrangement of microacini lined by a single layer of epithelium with prominent nucleoli. However, the latter feature, along with the apparent permeation of the prostatic fibromuscular stroma, periprostatic soft tissue, and even neural spaces, closely mimicked prostatic adenocarcinoma. In both cases, the proliferating tubules reacted with keratin 903 and were negative for prostate-specific antigen and prostate acid phosphatase, thereby excluding the diagnosis of prostatic adenocarcinoma. We concluded that lobular hyperplasia of mesonephrie remnants is a distinct histologic entity that may occur in the prostate and periprostatic soft tissues and closely mimic prostatic adenocarcinoma.

Urothelial carcinoma occurring within an inverted papilloma of the ureter

Only 5 cases of inverted papilloma of the ureter with a malignant component have been reported previously. We add case 6 to the literature. The incidence of concomitant malignancy in ureteral inverted papillomas is 3 times that found in similar lesions occurring in the bladder.

Alveolar soft part sarcoma of the uterine cervix.

Alveolar soft part sarcoma is a histologically distinctive neoplasm of uncertain histogenesis. Since its initial description in 1952, more than 200 cases have been reported. The extremities are most often the sites of involvement; the tongue, bones, and the orbit have been less commonly involved. The present paper describes a case of alveolar soft part sarcoma which was present only within the uterine cervix of a 37-year-old woman. Histologically, the tumor cells were arranged in the characteristic alveolar pattern; diagnostic PAS-positive diastase-resistant needle-shaped crystals were observed within the cytoplasm of the tumor cells. After the initial biopsy, the patient underwent a radical hysterectomy and pelvic lymph node dissection. Although no residual tumor was found within the cervix, a microscopic focus of tumor was detected in an obturator lymph node. The patient is at present clinically free of disease.

Effect of vesical overdistention on bladder mucin

Abstract Histochemical staining of bladder tissue demonstrates a discrete layer of mucopolysaccharide (mucin) on the surface of human and rabbit bladders. Studies have shown that an intact mucin layer may be important in helping the bladder to resist bacterial infections. This report correlates vesical overdistention with destruction of the mucin layer in the rabbit bladder. These findings suggest that vesical overdistention may predispose to urinary tract infection because of bladder mucin disruption.

Arteriography of renal transplants.

Arteriograms were reviewed in 60 cases of renal transplant dysfunction and correlated with the final diagnosis. Angiographic refinements included selective injections, 2-4X direct magnification, and flow-dependent injection rates. Angiography permitted recognition of common causes of post-transplantation dysfunction, including acute vasomotor nephropathy (AVN), acute refection (AR), chronic rejection, and obstruction of the ureter, renal artery, or renal vein. In 28 patients with AVN or AR who had technically adequate cortical microangiograms, classification was correct in 57%, indeterminate in 36%, and erroneous in 7%. In addition to its diagnostic value, angiography provides some prognostic information in AR, permitting prediction of functional return when the pattern suggests AVN and lack of return when cortical necrosis is indicated.

Angiographic findings in renal medullary cystic disease.

Medullary cystic disease of the kidney (familial juvenile nephronophthisis) is characterized by anemia, azotemia, excessive renal sodium loss, normal blood pressure and urinary sediment, and innumerable small renal cysts, primarily at the corticomedullary junction. Selective renal angiography with 2× magnification enabled presumptive diagnosis in 4 of 5 cases. Characteristic features included marked cortical thinning and multiple cysts (1–40 mm in diameter) which spared the outermost cortex.

Carcinosarcoma of bladder Evaluation by electron microscopy and immunohistochemistry

A case of carcinosarcoma of the urinary bladder characterized by electron microscopy and immunohistochemistry is described. The use of these studies in poorly differentiated bladder neoplasms and in suspected cases of carcinosarcoma is encouraged. Increased accuracy in characterizing these tumors will permit a better understanding of their natural history and response to therapy.