Robert E. Fechner

Serous surface papillary carcinoma. A clinicopathologic study of 10 cases and comparison with stage III-IV ovarian serous carcinoma.

We compared 10 patients with serous surface papillary carcinoma (SSPC) to a control group of 16 patients with serous ovarian papillary carcinoma (SOPC). By definition, the ovaries were of normal size and shape in SSPC. In six cases, however, at least one ovary had focal surface irregularities. Microscopically, SSPC and SOPC differed only in the nature of their ovarian involvement. SSPC was confined to the ovarian surface or showed focal minimal invasion. Four patients with SSPC had coexistent, nonperitoneal serous-type carcinomas; three had superficial endometrial adenocarcinomas; and one had intramucosal adenocarcinoma of the fallopian tube. There were no associated carcinomas in the SOPC group. SSPC had a significantly worse prognosis than SOPC, as measured by median disease-free interval (SSPC: 3 months, SOPC: 9 months), median survival (SSPC: 12 months, SOPC: 24 months), and predicted 5-year survival (SSPC: all dead at 52 months, SOPC: 22.7%). SSPC is a clinicopathologically distinctive variant of serous carcinoma. Because of its more aggressive clinical course, it should be distinguished from conventional SOPC with peritoneal implants.

Endometrial adenocarcinoma in stein-leventhal syndrome

Endometrium microscopically indistinguishable from well differentiated adenocarcinoma was obtained from four women ranging from 21 to 34 years of age with sclerocystic ovaries. Two were immediately treated with hysterectomy, which disclosed the lesions to be confined to the endometrium. One patient was treated with wedge resection of the ovaries. Re‐establishment of menses resulted, and she remains well 12 years later. The fourth patient had adenocarcinoma on a biopsy, and menses temporarily resumed after wedge resection and clomiphene therapy. However, metromenorrhagia again supervened, and hysterectomy was performed 2 years after the initial diagnosis. An adenocarcinoma was present which superfically invaded the myometrium. In no case was there deep invasion nor spread beyond the uterus, and the patients are well 1, 4, 5, and 12 years after the original diagnosis. A conservative approach is suggested for the patient with Stein‐Leventhal syndrome who has morphological changes of well‐differentiated endometrial adenocarcinoma. The lesion may be reversible when treated by curettage plus therapy directed toward re‐establishment of ovulation. Even if an irreversible, persistent invasive lesion is present that eventually requires ablative therapy, there is no evidence that delay is harmful to the survival of the patient.

Choriocarcinoma and adenocarcinoma of the esophagus with gonadotropin secretion

A 44‐year‐old man died of disseminated choriocarcinoma. The esophagus was verified as the apparent primary source at postmortem examination. The esophageal tumor, but not the metastases, also contained well‐differentiated adenocarcinoma. Similar cases of mixed adenocarcinoma and choriocarcinoma have been reported to occur in the stomach. We believe that the basic lesion was an adenocarcinoma which underwent metaplasia to form cells morphologically and functionally indistinguishable from trophoblasts. This explanation would supplant the traditional idea of “embryonic rests” as the source of extragenital choriocarcinomas of the viscera. The literature is reviewed on the uncommon involvement of the gastrointestinal tract by choriocarcinoma.

Ultrastructure of bronchial oncocytoma.

A bronchial neoplasm consisted of cells with abundant, finely granular, eosinophilic cytoplasm. Ultrastructurally, this granularity was due to mitochondrial hyperplasia thus fulfilling the criterion of a true oncocyte. Although the terms “pulmonary oncocytoma” and “oncocytic carcinoid” have been used in the past, this is apparently the first pulmonary tumor in which mitochondrial hyperplasia has been demonstrated thereby confirming the accuracy of the term oncocytoma in this particular instance. The bronchial mucosal glands adjacent to the tumor contained numerous foci of oncocytes and are considered the most likely source of the neoplasm.

Ductal carcinoma involving the lobule of the breast. A source of confusion with lobular carcinoma in situ.

A review of 205 consecutive breast carcinomas of ductal type disclosed that 45 concomitantly involved the terminal ducts of the lobule. Carcinoma presumably invaded the lobule by intraluminal extension from lactiferous ducts. The presence of this type of lobular involvement may be mistaken for lobular carcinoma in situ and is especially confusing when found in the breast remote from the grossly detectable ductal neoplasm. The diagnosis of lobular carcinoma has important therapeutic implications for the second breast because of the high frequency of bilaterality in that disease compared with ductal carcinoma. In our group of ductal carcinomas with lobular invasion, short term follow‐up and examination of tissue from the opposite breast in 10 patients indicates that the frequency of bilaterality for lobular carcinoma is not attained. Therefore, it is important to sharply separate lobular carcinoma in situ from lobular invasion by ductal carcinoma. Carcinoma in a lobule is not necessarily lobular carcinoma.

Acinic cell tumor of the lung. A histologic and ultrastructural study

This is the first description, to our knowledge, of a primary neoplasm of the lower respiratory tract having the cytologic appearance of a salivary gland acinic cell tumor. When examined by light microscopy, the cells have cytoplasmic granules which are positive with PAS and negative with mucicarmine, alcian blue, and Masson‐Fontana stains. Ultrastructurally, two cell types are seen: a dark cell resembling the normal serous cell of the bronchial submucosal gland and a light cell similar to the cells of previously reported acinic cell tumors of the parotid. It seems likely that the lesion described herein originated from the serous cell of the bronchial submucosal gland and can be designated as an acinic cell tumor analogous to that occurring in the salivary gland. Salivary gland acinic cell tumors are histologically distinctive neoplasms which may have their metastases appear more than 10 years after removal of the primary. Our patient is well nearly 2 years after lobectomy.

Intraarticular synovial sarcoma.

A 43-year-old man presented with decreased range of motion in his left knee and a painful medial joint mass that was grossly visible. Arthroscopy demonstrated a mobile, flat mass 3 cm in diameter in the knee joint that seemed to be loosely tethered to the synovium. The mass was excised, and light microscopic examination demonstrated a biphasic synovial sarcoma. There was no transition with the attached normal synovium. Immunohistochemically, the epithelial component was intensely positive for epithelial membrane antigen and cytokeratins (CAM 5.2 and AE 1/AE 3), and the spindle cell component was focally positive for these markers. The patient has no evidence of disease 9 years after only local excision. Although the term synovial sarcoma suggests a relationship to normal synovium, only rarely has truly intraarticular disease been reported.

Infiltrating lobular carcinoma without lobular carcinoma in situ

Seventeen patients had breast carcinoma with cell populations and histologic growth patterns identical to the infiltrating lobular carcinomas associated with lobular carcinoma in situ (CIS). However, no lobular CIS was demonstrable in the breasts. Nonetheless, seven of the 17 patients have had carcinoma identified in the second breast either synchronously or metachronously. These contralateral carcinomas include infiltrating lobular carcinoma with lobular CIS (two cases), lobular CIS alone (one case), comedocarcinoma and infiltrating ductal carcinoma (one case each). The frequency of lobular CIS in the contralateral breast is similar to that reported when the ipsilateral breast contains lobular CIS alone. This is interpreted as indirect evidence that lobular CIS was probably present in the breast with infiltrating cancer but was destroyed by the neoplasm or missed due to sampling deficiencies. We conclude that the diagnosis of infiltrating lobular carcinoma can be made in the absence of lobular CIS. The clinical importance of recognizing this specific carcinoma lies in the high risk for invasive cancer in the second breast as well as the occurrence of lobular carcinoma in situ.

Inverted papilloma of the lacrimal SAC, the paranasal sinuses and the cervical region

A 22‐year‐old woman presented with a lacrimal sac mass which on biopsy was an inverted papilloma. Two years later an ipsilateral cervical mass was removed, which contained inverted papilloma with a histologically typical pattern. Subsequently, the patient had a medial maxillectomy and remains well 5 years later. The cervical mass may represent inverted papilloma arising in a branchial cleft cyst or it may be a metastasis of benign papilloma to a regional lymph node. This is the second such case reported and the first with substantial followup.

Fibrocystic disease in women receiving oral contraceptive hormones

Breast tissue with the diagnosis of fibrocystic disease has been examined from 25 women taking oral contraceptives. Slides from these cases were coded and mixed with slides from patients of the same ages having fibrocystic disease who denied hormone usage. Various epithelial alterations were tabulated without knowledge of hormone therapy. The patients receiving oral contraceptive hormones presented a spectrum of epithelial alterations qualitatively and quantitatively similar to their controls. Neither specific nor bizarre epithelial alterations were recognized.