Wellington Jao

Amphicrine cells, dysplasias, and neoplasias

The existence of epithelial cells displaying synchronous features of exocrine and endocrine differentiation has been well established. Sporadic descriptions of neoplasms comprising or including such cells have also been recorded. The authors investigated eight cacinomas (lung, two; stomach, two; colon, one; appendix, one; esophagus, one; and pancreas, one). By conventional light microscopy, all eight neoplasms appeared as moderately to well‐differentiated adenocarcinomas. Mucosubstance stains showed positive material within well‐defined lumina and as intracytoplasmic droplets. Argyrophil stains were positive in seven of the eight neoplasms. The esophageal tumor was a predominantly solid carcinoma; it compromised small to intermediate cells with focal mucosubstance positivity and squamous pearls. By electron microscopy, all these carcinomas including cells displaying variable complements of neurosecretory granules, which were concentrated in the basal pole or in cytoplasmic processes. The granule population was often heterogeneous. The pancreatic carcinoma also showed typical zymogen granules. In all cases, many of the neoplastic cells had true lumina or intracytoplasmic lumina, as well as arrays of filaments; secretory granules were also observed in cells with true or intracytoplasmic lumina. Immunohistochemical studies revealed in all cases either serotonin or one of a spectrum of neuropeptides. Five tumors contained more than one immunoreactive material. The authors conclude that synchronous exocrine and endocrine differentiation may be comparatively frequent in a spectrum of tumors that may be properly termed “amphicrine” carcinomas. This demonstrable heterogeneity of malignant cell populations, however variably expressed, may prove to have considerable significance in the diagnosis and management of these neoplasms.

Neuroendocrine carcinoma of the cervix: Implications for staging and therapy

Abstract Ultrastructural examination of four cases of small cell carcinoma of the cervix demonstrated neuroendocrine granules. In each of these cases, distant metastases became evident within 3 months of the initial diagnosis. The sites of metastases included liver, brain, bone marrow, and supraclavicular lymph nodes. Because of light microscopic, ultrastructural, and clinical similarities to pulmonary neuroendocrine carcinoma, three of these patients received combination chemotherapy effective in neuroendocrine tumors arising in the lung. One patient experienced remission of bulky pelvic tumor and supraclavicular metastases which lasted 11 months.

Ultrastructure of the basal cell adenoma of parotid gland

Electron microscopic examination of two classical examples of so‐called basal cell adenoma of parotid gland disclosed four distinct cellular types: the squamous epithelial cells with tonofilaments and prominent desmosomes predominantly located at the central portion of neoplastic mass; the basally located secretory cells with numerous secretory granules; the occasional intermediate cells with scanty cytoplasmic microfilaments; and the peripherally situated attenuated myoepithelial cells. The neoplastic clusters are surrounded by highly replicated basal laminae with microfibrils in their interstices. This information about its component cells suggests that basal cell adenoma arises from the secretory duct, in particular the intercalated duct, of the parotid gland. The term basal cell adenoma appears appropriate for its designation. It is interesting that the secretory cells and the multilayered basal laminae illustrated in the present study are reportedly seen in adenoid cystic carcinoma of the salivary gland; this finding would suggest a common cellular origin for these two neoplasms.

Ultrastructure of anaplastic (spindle and giant cell) carcinoma of the thyroid

Three anaplastic (spindle and giant cell) carcinomas of the thyroid were studied by light and electron microscopy; two of the tumors also included foci of recognizable follicular carcinoma. The follicular carcinoma cells displayed prominent mitochondria and rough endoplasmic reticulum, and showed evidence of secretory activity. Desmosomes and complex cellular inter‐digitations were evident. Basal laminae were present, with conspicuous reduplication in the well‐differentiated foci. However, some epithelial clusters were surrounded by basal lamina, showing focal discontinuities through which epithelial cells protruded into the stroma. The pleomorphic spindle and giant cells showed cytoplasmic and nuclear characteristics similar to the better differentiated carcinomatous follicular elements, but showed rare desmosomes and no basal laminae. The basic ultrastructural similarity between follicular and anaplastic tumor cells confirms their common epithelial origin. However, while partially retaining their secretory capability, the anaplastic cells progressively lose their capacity to synthetize basal lamina and develop complex cellular attachments.

Paragangliomas of the Head and Neck: Ultrastructural and Immunohistochemical Analysis

Eighteen head and neck paragangliomas were studied by light microscopy and light microscopic immunohistochemistry by the peroxidase technique for the presence of NSE (neuron-specific enolase), serotonin, and a battery of neuropeptides. Seven of these tumors were also studied by electron microscopy. All 18 cases demonstrated immunostaining for NSE; 10 of the 11 carotid body tumors had immunostaining for multiple hormones. Considering all 18 cases, the most frequently demonstrated hormonal substances were in order: serotonin, leu-enkephalin, gastrin, substance P, vasoactive intestinal polypeptide (VIP), somatostatin, bombesin, calcitonin, and alpha MSH. In several tumors, adjacent-step sections stained for different hormonal substances strongly suggested reactivity for more than one hormone in given tumor cells. By electron microscopy, all 7 cases studied displayed considerable heterogeneity of the neurosecretory granules with respect to size, shape, and electron density. This demonstrated that branchiomeric paragangliomas are capable of producing a spectrum of neuropeptides in addition to their known amine content. The presence of immunoreactive serotonin in most of these neoplasms was confirmed. In addition to these findings, neurofibrils within the substance of carotid body paragangliomas demonstrated immunoreactivity for somatostatin and a gastrinlike neuropeptide. The significance of the neuropeptides in these neoplasms and their possible presence and role in normal and hyperplastic paraganglia remain to be defined.

Comparative ultrastructure of tubular carcinoma and sclerosing adenosis of the breast.

The innocuous histologic appearance of tubular carcinoma of the breast and its superficial histologic resemblance to sclerosing adenosis will occasionally present diagnostic problems. A comparative ultrastructural analysis of two tubular carcinomas and three cases of sclerosing adenosis was made that showed definite differences in the pattern of myoepithelial cell differentiation and basal lamina deposition in these two entities. Prominent myoepithelial cells and basal lamina reduplication were both conspicuous features of sclerosing adenosis that appeared to be absent in tubular carcinoma. Intracytoplasmic “pseudo‐cysts” were frequently found in sclerosing adenosis, but not in tubular carcinoma. Conversely, intracytoplasmic lumina and incomplete tubular structures were present in tubular carcinoma and seemingly absent in sclerosing adenosis. Such basic ultrastructural differences may help to differentiate these two mammary lesions when diagnostic problems occur at the conventional light microscopic level.

Nephrotic syndrome in two patients with cured Hodgkin's disease

Two cases of lipoid nephrosis (minimal change glomerulonephritis) in patients cured of Hodgkins disease are reported and the literature is reviewed. Cases reported to date have shown a close temporal relationship between this renal lesion and the presence of Hodgkins disease. The patients reported are 11 and 9 years without evidence of active malignancy after successful treatment for Hodgkins disease. Each had abnormal immunologic parameters, depressed T4 (helper) cells and increased T8 (suppressor) cells, which may predispose to the development of the nephrotic syndrome. However, the advent of this complication is not necessarily a harbinger of recurrent lymphoma.

Large-cell calcifying Sertoli cell tumor of the testis : A case report with ultrastructural study

Large-cell calcifying Sertoli cell tumor (LCCSCT) is a rare histologic variant of Sertoli cell tumor. Recently we observed a case of LCCSCT of the testis with no associated endocrine abnormality. Our ultrastructural findings of rows of tight junctions, numerous intracytoplasmic filaments, and abundant rough endoplasmic reticulum in whorled formations support the Sertoli cell origin of this neoplasm.

Mediastinal yolk sac tumor: ultrastructural and immunofluorescent studies.

Primary mediastinal yolk sac tumor is rare. In this report, a case of a 32-year-old male with a mediastinal yolk sac tumor was studied by light, electron, and immunofluorescent microscopy. A positive immunofluorescent reaction to alpha-fetoprotein (AFP) correlated with the PAS-positive hyaline globules and electron-dense deposits seen in intracellular and extracellular locations. Serum AFP is a useful tumor marker for monitoring the results of therapy. Review of the literature indicates that the prognosis for patients with yolk sac tumor is generally poor.