Saul Kay

Carcinoma of the gallbladder: staging, treatment, and prognosis.

Sixty‐six cases of carcinoma of the gallbladder treated at The Memorial Hospital, Danville, Virginia, and the Medical College of Virginia, Richmond, were staged according to depth of invasion and spread and graded histologically; the findings were correlated with survival. Results from the two hospitals were essentially identical and the survival figures correlated well with 399 reported cases in the medical literature which could be staged according to the depth of invasion. A simple method combining staging and histologic grading of cancer of the gallbladder, which can easily be applied to all cancers of the gallbladder removed surgically and which should prove useful in the management of this disease, is described. Essentially all of the carcinomas of the gallbladder in the series were incidental findings at surgery for gall stones which may explain a relatively high proportion of superficial carcinomas which are cured by the removal of the gallbladder.

A comparative ultrastructural study of mesenchymal chondrosarcoma and myxoid chondrosarcoma

This electron microscopic study concerns an extraskeletal mesenchymal chondrosarcoma and a myxoid chondrosarcoma of bone. The well‐differentiated cartilaginous cells of mesenchymal chondrosarcoma and myxoid chondrosarcomatous cells showed many features common to chondrocytes, such as abundant rough endoplasmic reticulum, multiple well‐developed Golgi complexes, and microvillous and scalloped cytoplasmic membranes. Glycogen deposit was more abundant and more frequently found in the myxoid chondrosarcoma. The extracellular matrix of well‐differentiated areas of mesenchymal chondrosarcoma consisted of amorphous material, electron‐dense granules, tropocollagen fibrils, and collagen fibrils. The matrix of the myxoid chondrosarcoma, however, contained only the first three elements, but not collagen fibrils. The undifferentiated portion of mesenchymal chondrosarcoma showed primitive mesenchymal cells and fibroblast‐like cells. This finding confirms the suggestion of Lichtenstein and Bernstein19 that undifferentiated elements of mesenchymal chondrosarcoma are in fact “precartilage mesenchyme.” Cancer 33:1531–1542, 1974.

Is subependymoma (subependymal glomerate astrocytoma) an astrocytoma or ependymoma?: A comparative ultrastructural and tissue culture study

A fourth ventricle lesion containing both areas of typical ependymoma and subependymoma has been studied with the electron microscope. Both foci show ependymal and astrocytic elements. In the subependymoma, a larger number of astrocytes, more frequent cytoplasmic degeneration, and increased glial filaments in the ependymal cells are found. These cellular changes in the subependymoma yield a distinctive light microscopic appearance. However, at the ultrastructural level, the similarity of cellular components, i.e. ependymal and astrocytic cells, makes us believe that subependymoma is a variant of ependymoma and not pure astrocytoma. Tissue culture study and further electron microscopic observation of these in vitro cells have also confirmed the presence of both ependymal and astrocytic cells. Like in vivo ependymal cells, these in vitro ependymal cells form not only glial filaments but also rosettes with specialized cell junctions, microvilli, and cilia. Perivascular pseudorosette formation is also described in detail.

Carcinoma of the pancreas infantile type. A light and electron microscopic study

A case of pancreatic carcinoma in a 4‐year‐old child is presented. The tumor was studied by light and electron microscopy. This tumor has a pattern which suggests by light microscopy that it may derive in part from islet tissue, though this case and others previously reported have no endocrine function. Electron microscopy suggests that this is a tumor of duct cell origin with some differentiation toward acinar cells and centro‐acinar cells.

Carcinoma of the breast. Histologic and clinical features of apocrine tumors.

Our experience with so‐called apocrine carcinoma of the breast is reviewed. In a 16‐year period 19 apocrine carcinomas of the breast were found in 18 patients. Two patients had nonsimultaneous bilateral cancer of the breast. In one case both tumors were of the apocrine type and in the other case one tumor was apocrine and the second primary a nonspecific infiltrating duct cancer. When our 18 patients were matched carefully with a control series of nonspecific duct carcinomas of the breast, median survival was 2 years longer for the group with apocrine carcinoma. The ultimate outcome in both groups, however, was identical. Investigation of the origin of these tumors by use of the iron reaction as described by Richter for identifying true apocrine glands showed that all cases were negative. The resemblance of apocrine carcinoma of the breast to true apocrine glands would seem to be a morphological one only. There is no long‐term prognostic significance associated with this morphological variant of mammary cancer.

p53 tumor suppressor oncogene expression in squamous cell carcinoma of the hypopharynx

Background. Although abnormalities of the p53 tumor suppressor oncogene system are being detected in many human cancers, the frequency and prognostic significance of such events in squamous cell cancer of the head and neck remain unknown.

Ultrastructural observations on a gingival granular cell tumor (congenital epulis)

A congenital epulis from a 1‐hour‐old female infant was subjected to ultramicroscopic observations. The lesion was found to be quite similar to the usual granular cell tumors as previously studied. The finding of junctional complexes between some of the granular cells suggested that these cells may be of epithelial origin. This, however, is not entirely conclusive and further avenues for future studies are suggested.

Pulmonary blastoma: A light and electron microscopic study.

A case of pulmonary blastoma studied with the electron microscope showed two distinct cell types, i.e., epithelial and mesenchymal elements. The former demonstrates the differentiation toward ciliated bronchial cells, and the latter, cartilage. In view of these findings, coupled with the current understanding of pulmonary morphogenesis, the pulmonary blastoma is more likely to be a carcinosarcoma than a true blastoma. However, the separation between pulmonary blastoma as usually employed and the so‐called pulmonary carcinosarcoma seems to be desirable because of different clinicopathologic features.

Mucoepidermoid carcinoma of the esophagus. Report of two cases.

Two cases of mucoepidermoid carcinoma of the esophagus are presented. The tumors are presumed to have arisen from the excretory ducts of the submucosal mucosal glands of the esophagus, though this is not proved beyond question. Previous probable cases from the literature are reviewed and discussed. The terms adenoacanthoma, adenocarcinoma with squamous metaplasia, mixed squamous and glandular carcinoma, and mucoepidermoid carcinoma are also contrasted and evaluated with suggestions as to their use. The similarity of the cases presented to mucoepidermoid tumors of the salivary gland is noted. While theoretically the esophageal mucoepidermoid carcinomas should offer a better prognosis than the usual squamous carcinomas, no dogmatic statement concerning this point is justified due to the paucity of cases reported.

Cervical dysplasia and cancer developing in women on immunosuppression therapy for renal homotransplantation

A study of cervical changes has been made of 28 female patients over the age of 11 years who have received renal transplants for end‐stage kidney disease. Three of these patients have shown cellular abnormalities on Papanicolaou smears. One patient showed mild dysplasia in only one smearbut the other 2 have shown persistent atypicalities and one of the 2 developed in‐situ epithelioma proven by cervical conization. While definite proof that the cervical changes are due to immunosuppressive therapy is lackinga plea is made to subject all transplanted patients to routine cervical smears and to record all features of dysplasia and frank malignancy in order that proper assessment of their significance may be made in the future.