Shojiro Takayama

MALIGNANT GANGLIOGLIOMA OF THE SPINAL CORD

A case of tumor of the spinal cord with a long clinical history was described. At autopsy, the tumor was composed of a mixture of two elemental cells, i.e. matured but neoplastic ganglionic cells and anaplastic glial cells. The clinical manifestations suggested that the tumor in this case developed in a benign form with malignant evolution occurring during the latter part of its clinical course. The malignant evolution, however, was due to aggressive and anaplastic growth only of the elemental glial cells, while the cytologic features of the elemental ganglionic cells remained always benign.

Adenoid squamous cell carcinoma of the oral mucosa. Report of two autopsy cases

Two autopsy cases of adenoid squamous cell carcinoma of the oral mucosa proper are presented. Consecutive histologic examinations confirmed that adenoid transformation had occurred directly from within the pre‐existing usual squamous cell carcinoma during the course of the disease. The adenoid pattern was reproduced in the lymph node metastases in both cases. The behavior and autopsy findings were not significantly different from those of usual squamous cell carcinoma of the oral mucosa.

Intraductal spread of esophageal squamous cell carcinoma

In order to determine the pathways of tumor dissemination in esophageal carcinoma, 175 lesions of squamous cell carcinoma of the esophagus were studied histopathologically and by electron microscope in relation to the intraepithelial spread and involvement of the esophageal glands by the carcinoma. The study compared vessel invasion and lymph node metastasis. Intraepithelial spread was seen in 111 lesions (63%) and gland duct involvement in 33 lesions (19%). Gland duct involvement was observed in 30% of the lesions positive for intraepithelial spread. In the intramucosal carcinomas, gland duct involvement was observed in 24%. Even in a very small carcinoma 7 × 5 mm in size, ductal spread was detected. This carcinoma did not reach the submucosa through stromal invasion. Patients with intramucosal carcinoma showed low incidence (20%) of lymphatic and/or blood vessel invasion and no incidence of lymph node metastasis. Examination by electron microscope showed that the cancer cells of the intraepithelial spread entered the duct by raising the normal ductal epithelium in the ductal cavity although the basal lamina was retained. Normal gland duct cells and cancer cells were either attached with desmosomes directly or were separated by degenerated epithelial cells. A high incidence of ductal involvement of the esophageal glands was seen in squamous cell carcinoma of the esophagus, indicating its possible importance as a route to the deep tissue in the early stage of this carcinoma.

Hemophagocytic syndrome complicating T-cell acute lymphoblastic leukemia with a novel t(11;14)(p15;q11) chromosome translocation

A case of hemophagocytic syndrome that developed in a patient with T‐cell acute lymphoblastic leukemia (ALL) with a novel chromosome translocation involving 14q11 is reported. A 15‐year‐old boy with T‐cell ALL in relapse showed leukemic cells with an abnormal karyotype of 46, XY,—15, t(11;14)(p15;q11), +der(15)t(15;?)(p11;?). Pancytopenia and extensive hemophagocytosis by macrophages in the bone marrow were observed after reinduction chemotherapy and again at the terminal stage. At autopsy, infiltration of such cells was also found in other organs. The findings suggested occurrence of hemophagocytic syndrome probably associated with cytomegalovirus (CMV) infection. The t(11;14)(p15;q11) may be a novel translocation specific for T‐cell ALL, and conceivably, the association of T‐cell ALL with the histiocytosis in this patient may not have been coincidental.

Invasive ductal carcinoma with a predominant intraductal component arising in a fibroadenoma of the breast

A rare case of invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma of the breast in a 42 year old Japanese female was investigated by light microscopy. The patient, who had a well‐defined, rubbery breast tumor measuring 2.0 X 3.0 cm, had undergone a tumorectomy 21 months after she noticed the tumor. Histologically, the fundamental architecture of the tumor showed an intracanalicular‐type of fibroadenoma, but extensive proliferation of atypical cells was noticed in the lumen of the ducts. Tumor cells in the canaliculi had characteristics of ductal carcinoma, such as solid, comedo and cribriform patterns. As most of the ducts were occupied by carcinoma cells with several foci of microinvasion in the stroma of the fibroadenoma, it was diagnosed as invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma. This coexistence of in situ proliferation and invasive lesions of carcinoma within a fibroadenoma suggest the origin of the carcinoma to have been in the epithelial component of the fibroadenoma. In addition, this study clarifies the fact that carcinoma cells may proliferate and spread along the lumen of pre‐existing ducts of the fibroadenoma and speculates that the duct system of the fibroadenoma has complete continuity.

Immunohistochemical characterization of undifferentiated carcinomas of the ovary

Immunohistochemical characteristics of undifferentiated carcinomas of the ovary were examined using formalin-fixed, paraffin-embedded tissues with an avidinbiotin staining approach. Eight cases were collected from the pathology files of our Institute from a total of 214 recorded malignant ovarian tumors. For immunostaining, antibodies reacting with epithelial membrane antigen (EMA), pankeratin, vimentin, CA 125, CA 19-9, carcinoembryonic antigen (CEA), α-fetoprotein (AFP), α-l-antitrypsin (AT), epidermal growth factor receptor (EGFR), c-erbB-2,bcl-2 and p53 proteins were used. All the cases examined were positive for EMA and pankeratin, specific markers for epithelial tumors, negative for the non-epithelial tumor marker, vimentin, and also positive for EGFR. Interestingly, only one case was positive for CA 125, despite it being one of the commonest reported indicators of ovarian cancer. CA 19-9 was positive in 7 cases, CEA in 5, AFP in 2, AT in 6 and c-erbB-2 protein in 4. Two cases were positive for p53 protein, and in 1 of these positive staining forbcl-2 was also observed. These results indicate that the epithelial nature is well preserved in undifferentiated ovarian carcinomas, although consistently positive reactions were not observed within the cases for some antigens. They further celarly show that a negative signal for CA 125 can not be considered to exclude the possibility of a primary ovarian tumor.

Electron microscopic observation of Ewing's sarcoma;A case report

Ewings sarcoma originating from the 2nd lumbar vertebra, found in an autopsy case of a 12‐year‐old girl was investigated histologically and electron microscopically. The distinguished features of neoplastic cells of this case were phagocytosis, desmosomes, and abundant glycogen in their cytoplasm. The origin of neoplastic cells is assumed to be immature reticulum cells.

Stromal Melanocytic Foci (“Blue Nevus”) in Step Sections of the Uterine Cervix

Stromal melanocytic foci (SMF) of the uterine cervix, which are known as extracutaneous blue nevus, were examined in step sections of the cervix. A total of 189 uterine specimens surgically excised for leiomyoma, adenomyosis etc., were studied. The over‐all incidence of SMF of the cervix was 28.6% (54/189 cases). The incidence of these lesions increased with age, and they were most prevalent in the sixth decade of life (12/30 cases, 40%). SMF were presented more often in the anterior wall than in the posterior wall. Most of the lesions were less than 1 mm in size. No case of SMF demonstrated expansive tumorous growth. Six of 54 cases of SMF displayed consecutive spread of SMF in almost all step sections of the cervix. The histological findings confirmed that SMF of the cervix is quite common existence among Japanese women. It is speculated that the mucosal region near the skin and/or cutaneus region near the mucosa may have stromal melanocytosis; malignant melanoma could develop from SMF of the cervix, which did not have junctional activity because of stromal melanocytic origin. Acta Pathol Jpn 41: 751‐756, 1991.

Proliferative and apoptotic status in endometrial adenocarcinoma.

The contribution of cell proliferation and apoptosis to growth patterns in endometrial adenocarcinoma were investigated. Immunohistochemical staining was carried out by an antibody for Ki-67 proliferative antigen, Ley apoptotic antigen, and oncogene products bcl-2 and p53. Forty cases of endometrial adenocarcinoma were classified as exophytic, endophytic, and mixed exo- and endophytic in light of their vertical growth pattern, and, in each case, the carcinomatous area was divided into three layers by its vertical axis. In all but one case, no zonal distribution of the antigen expression was observed. In one case, an exophytic tumor, Ki-67 expression was intense in the surface layer and Ley expression in the deep layer was also intense, suggesting a correlation between macroscopic growth pattern and cellular growth and apoptotic potential. However, in general, zonal distribution of cell proliferation and apoptosis could not explain the growth morphology of endometrial adenocarcinoma of the uterus and it was suggested that factor(s) other than cell proliferation and apoptosis determine macroscopic growth patterns.

Chromosome abnormalities in malignant histiocytosis.

Chromosome and pathologic studies were performed on two patients (a 12‐year‐old boy and a 62‐year‐old woman) with malignant histiocytosis (MH). Both patients had chromosome abnormalities in their neoplastic cells: the boys karyotype was 45,Xp+,‐Y,9p+,18q‐, and the womans 48,XX,+16, inv(1),mar(5),6p‐,10p+,12q+,i(18q),+i(18q). The boy had typical clinical and pathologic findings of MH, and died without achieving remission by chemotherapy. At the initial stage the woman had the clinical and hematologic findings of MH. Chemotherapy was given, but had no beneficial effects. At the terminal stage the bone marrow (BM) biopsy and aspirate, and the autopsy findings, were consistent with those of non‐Hodgkin lymphoma, diffuse large cell type, although some histiocytes or abnormal cells in monocyte‐macrophage lineage remained in the BM and the autopsied lymph nodes. This study and a review of data on six other cases have failed to establish any specific chromosome changes in MH.