Stanley Lipper

Hemangiopericytoma: a light microscopic and ultrastructural study.

An ultrastructural study of three cases of hemangiopericytoma showed cells partially or completely enveloped by well‐formed basement membrane and basement membrane‐like material. The cells exhibited prominent cytoplasmic filaments, some showing dense body formation, interdigitating cytoplasmic processes, and pinocytotic vesicles. A review of the literature revealed only 19 other cases of hemangiopericytoma studied by electron microscopy, and these included seven cases of meningeal origin (“angioblastic meningioma”). The most consistent feature seen in all but two cases was the presence of a basal lamina or basal lamina‐like material either partially or completely surrounding tumor cells and separating endothelial cells from pericytes. The light microscopic diagnosis of hemangiopericytoma is difficult, and there is a tendency to append the diagnosis to a variety of other tumors with a prominent vascular pattern in which other specific diagnoses are not immediately evident. The presence, ultrastructurally, of well‐developed basement membrane, myogenic type filaments, and pinocytotic vesicles in a tumor with light microscopic features suggestive of hemangiopericytoma would consolidate the diagnosis and usually eliminate diagnostic uncertainty. Cancer 47:906–914, 1981.

Sweat gland carcinoma with syringomatous features: a light microscopic and ultrastructural study.

A 76‐year‐old man presented with a 10‐year history of a slowly enlarging lesion of his upper lip. An excisional biopsy revealed a diffusely infiltrating, well‐differentiated, sweat gland carcinoma with syringomatous features. The ultrastructural characteristics corresponded to those described for benign syringoma and normal eccrine ducts. A review of the literature emphasized the extreme rarity of this lesion. Sweat gland carcinomas tend to have an indolent history but often manifest aggressive behavior at the time of clinical presentation. The preponderance of anaplastic lesions accounts for a generally unfavorable prognosis.

Mucinous sweat gland adenocarcinoma of the eyelid

A 62-year-old woman developed a recurrent mucinous sweat gland adenocarcinoma of the eyelid. The clinical characteristics of this rare, primary adnexal neoplasm of skin in our patient were, to our knowledge, unique. The tumor mimicked a lacrimal sac tumor and had orbital extension demonstrated preoperatively by computed axial tomography. Orbital extension of the tumor mass was confirmed during a wide, en bloc, excisional biopsy.

Chondroid chordoma: Electron-microscopic study of two cases

Chondroid chordoma is an unusual tumor composed of an admixture of chondromatous and chordomatous tissue usually located in the spheno-occipital region. This tumor shares many of the clinical and histologic features of classic chordoma and chondrosarcoma and has been shown to have a better prognosis than either of these lesions. To the best of our knowledge, no ultrastructural studies have been performed in the 26 cases of chondroid chordoma published previously. We document the ultrastructural features of two examples of chondroid chordoma. Certain features such as prominent and dilated rough endoplasmic reticulum, intracytoplasmic glycogen aggregates, and abundant fibrillogranular matrix are common to chordoma, chondrosarcoma, and chondroid chordoma. The presence of well-formed tonofilament desmosome complexes as well as complexes composed of alternating profiles of rough endoplasmic reticulum and mitochondria were seen only in chordoma and chondroid chordoma, but not in cartilaginous tumors. Of particular interest was the finding of crystalline, tubular structures within the rough endoplasmic reticulum of both cases of chondroid chordoma, a finding not described previously. The distinction of chondroid chordoma from classical chordoma is said to be a difficult one at the light-microscopic level, and we suggest that these intraergastoplasmic tubular structures might constitute an extremely helpful differential marker.

High‐dose methotrexate in small cell lung cancer: Lack of efficacy in preventing CNS relapse

Few studies have incorporated high‐dose methotrexate (MTX) with leucovorin rescue in the treatment of small cell lung cancer (SCLC). Potentially therapeutic levels of MTX can be achieved in the central nervous system (CNS) by systemic administration of high doses of this drug. Utilizing a combination chemotherapy program of Adriamycin, vincristine, cyclophosphamide, and methotrexate, 31 patients were sequentially assigned to receive either low‐dose MTX (40 mg/m2), or high‐dose MTX (500 mg/m2) with leucovorin rescue. Radiation therapy to the primary site was also administered. At these dosage levels there were no statistically significant differences in response rate or survival between the two groups. High‐dose MTX did not prevent the appearance of CNS disease; there being 2/15 and 3/15 CNS relapses in the HD MTX and LD MTX treated groups, respectively. The occurrence of CNS disease did not significantly affect overall survival as compared to patients not similarly affected.

Chronic granulomatous disease of childhood presenting as gastric outlet obstruction.

A case of chronic granulomatous disease of childhood was first diagnosed when a 20-month-old infant developed gastric outlet obstruction. Because of the unusual clinical presentation and negative gastric mucosal biopsies, the diagnosis was delayed. A subsequent full thickness biopsy of the stomach wall which led to a correct diagnosis showed a granulomatous infiltrate in the muscularis propria. Characteristic yellow pigment-laden macrophages were seen in the gastric mucosa and pyloric lymph node. Early recognition of this chronic disorder is important not only for proper management but genetic counseling as well.

Leiomyosarcoma arising in a chronic venous stasis ulcer

Abstract A leiomyosarcoma developed in an elderly man at the site of a chronic venous stasis ulcer. No similar recorded instance of such a sarcoma complicating venous stasis disease could be found in the literature.

Malignant pulmonary lymphoproliferative angiitis. A monoclonal neoplasm

A 55‐year‐old female developed a rapidly fatal, infiltrative, bilateral pulmonary disease. Open lung biopsy and subsequent autopsy revealed diffuse involvement by a malignant lymphoproliferative condition showing a striking angiocentric and angioinvasive pattern. This feature, together with microscopic involvement of hilar lymph nodes, bone marrow, spleen, and other viscera suggested lymphomatous transformation of lymphomatoid granulomatosis (LYG). The paucity of necrosis and of the typical polymorphic infiltrate was at variance with the classical description of that condition; however, the bilaterality of the process and the distinctive angioinvasive growth pattern were unlike the typical primary pulmonary lymphoma. Plasmacytoid cells were observed both by light and electron microscopy. Immunohistochemical evaluation characterized this disease as a monoclonal lymphoproliferative malignancy.

Pedunculated fibrosarcoma: Unusual presentation of an intraabdominal fibrosarcoma arising from the greater omentum

A 50 year old man presented with lower abdominal pain and hypotension of sudden onset. Emergency laparotomy for a suspected ruptured abdominal aortic aneurysm revealed the source of hemorrhage to be a ruptured vessel in the vascular pedicle of a large, oval tumor. This tumor had a unique appearance, lying virtually free within the abdominal cavity except for a 17 cm long umbilical cord-like vascular attachment to the greater omentum and a single fibrous adhesion to the anterior abdominal wall. Histologic examination disclosed the features of fibrosarcoma with a prominent population of myofibroblasts. Review of the literature yielded no previous examples of a similar pedunculated fibrosarcoma.

Chorioretinal foreign body simulating malignant melanoma

A 37-year-old man underwent an enucleation of his left eye because of a lesion that demonstrated the clinical and fluorescein angiographic characteristics of a malignant melanoma. Histologic examination of the eye disclosed a chorioretinal inflammatory mass caused by refractile crystalline material.