William W. L. Chang

Primary sarcoma of the liver in the adult

Primary undifferentiated saroma of the liver is a rare tumor, being documented primarily in the pediatric age group. This report describes the occurrence of such a tumor in a 55‐year‐old white woman with Meyenburg‐s complexes of the liver and the CRST syndrome. The clinicopathologic features of the tumor in the adult are characterized and the literature is reviewed.

Primary synovial sarcoma of the kidney

Abstract

Solitary intestinal fibromatosis: A rare cause of intestinal obstruction in neonate and infant

A 5-month-old white boy infant exhibited remarkable growth retardation and subsequently developed ileal obstruction, which was found to be due to solitary intestinal fibromatosis. This rare lesion has an excellent prognosis if it is completely excised. This is in contrast to cases of congenital fibromatosis with multiple lesions, which carries a poor prognosis.

Morphological basis of multistep process in experimental colonic carcinogenesis

SummaryCarcinogenesis has been shown to be a multistep process. However, the morphological basis of the multistep process in colonic carcinogenesis has not been adequately investigated. In the distal colon of adult female CF-1 mice given weekly injections of DMH, we are able to demonstrate that colonic adenocarcinomas develop and evolve in four distinct but continuous steps on morphological grounds.(1) A colonic neoplasm develops in a single crypt. A given crypt is first repopulated by atypical epithelial cells which have either originated at the cryptai base or occurred as an outpocketing pouch in the proliferative zone of the crypt. (2) In the atypical crypt thus repopulated by atypical cells, the epithelial lining becomes invaginated and/or evaginated in the upper half to form an earliest identifiable neoplatic glandular lesion there. (3) The neoplastic lesion thus formed keeps invaginating, evaginating and expanding in various directions by unceasing proliferation of neoplastic cells, giving rise to a polypoid or a discoid lesion. (4) As the neoplasm grows, its leading downward edge would eventually penetrate the muscularis mucosae, and the malignant behavior of the neoplasm becomes apparent with further invasion into the submucosa, muscularis externa and serosa. In the due process, we have also explored the mode of villous formation in some neoplasms and analyzed the possible regulatory mechanisms in the various steps of colonic carcinogenesis.

Immunocytochemical expression of the 70 kD heat shock protein in ischaemic bowel disease.

Heat shock proteins (HSPs) are a family of polypeptides which are induced in response to diverse forms of cell injury including hyperthermia, anoxia, ethanol, heavy metals, and others, with a presumably protective function. Among several species of HSPs, the 70 kD protein (HSP70) is the most abundant and consistently induced in mammalian cells. Anti‐HSP70 monoclonal antibody and a standard immunocytochemical method were used to study the expression of HSP70 in 28 surgical specimens of small and large intestines from patients with ischaemic bowel disease. Strong immunoreactivity was observed in viable, regenerating cells of both the crypt and surface epithelium within or adjacent to the necrotic foci in 86 per cent of the ischaemic bowel specimens. Staining was mostly cytoplasmic, but focally both cytoplasmic and nuclear. Smooth muscle cells of the muscularis mucosae in the ischaemic areas of some cases also showed immunoreactivity. On the other hand, HSP70 was not expressed in control specimens of small and large intestine or in colonic specimens of Crohns disease, ulcerative colitis, and adenocarcinoma. These findings suggest a possible role of HSP70 in intestinal epithelial and smooth muscle cell response to ischaemic injury, especially in the recovery phase.

Crypt Alterations and Collagen Deposition in Hyperplastic Polyps of Colorectum

In order to investigate the nature of hyperplastic polyps in the colorectum, 44 longitudinally sectioned crypts from biopsied polyps were analyzed morphometrically and compared with 81 control crypts. Although the crypts in hyperplastic polyps were longer and wider, containing more cells, their cell density was less, particularly in the serrated epithelium. In these crypts, both the tall and short epithelial cells contained cytoplasmic vacuoles, even in the surface epithelium. These cells exhibited increased expression of carcinoembryonic antigen. The subepithelial collagen table was of similar thickness in the polyp and control colonic mucosa, but it extended down along the cryptal wall to a greater depth in the polyp. These and other data indicate an aberrant differentiation of cryptal epithelial cells in the polyp. On upward migration to the surface, these cells appeared to undergo an arrested maturational process. Hence, the hyperplastic polyp may be considered a disease of epithelial cell differentiation.

Degenerative behavior of epithelial cells in the colonic crypt of the mouse following administration of colonic carcinogen, 1,2-dimethylhydrazine.

The degenerative behavior of cells following administration of 1,2-dimethylhydrazine was analyzed in its target organ, the distal colon of the mouse. Within 3-6 h after carcinogen treatment, an increasing number of epithelial cells in the proliferative compartment of the crypt degenerated. Degenerating cells were present most frequently as phagosomes in the neighboring epithelial cells, and infrequently as pyknotic nuclei being extruded from the epithelial lining in the crypt. Epithelial cells prelabeled with [3H]thymidine degenerated first, followed by those not prelabeled, indicating that the carcinogen-induced degeneration of cells occurred after passage of cells through the DNA synthesis phase.

Gastric schwannoma found incidentally 19 years after a horizontal gastroplasty for morbid obesity.

This report represents the first known case of a gastric schwannoma in a patient subsequent to a gastric stapling and partitioning procedure for morbid obesity. The submucosal tumor found in the collapsed distal portion of the stomach was merely an incidental finding and it appeared that all of the patients ongoing symptomatology (nausea and vomiting after meals) was a reflection of the chronic obstruction that was present at the gastric partitioning staple-line. No correlation between gastric stapling and partitioning and the development of gastric schwannoma is known or is suggested in this report.