Yao-Shi Fu

Malignant soft tissue tumors of probable histiocytic origin (malignant fibrous histiocytomas): General considerations and electron microscopic and tissue culture studies

Correlated light and electron microscopic study of four fibrous histiocytomas of proven malignancy has confirmed the presence of histiocyte‐like and fibroblast‐like cells in this tumor. In addition, an undifferentiated cell type, giant cells, xanthomatous cells, and rare cells with morphological characteristics intermediate between those of histiocytes and fibroblasts were seen. “Nuclear body” type inclusions were commonly present in both principal cell types in all four cases, as were the somewhat less common cytoplasmic inclusion bodies. Electron microscopic study of a tissue culture of one of these tumors demonstrated only fibroblast‐like, histiocyte‐like, and xanthomatous cells. The possibility is suggested that both principal cell types in this tumor may derive from the same undifferentiated stem cell.

Non-epithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx: A clinicopathologic study. II. Osseous and fibro-osseous lesions, including osteoma, fibrous dysplasia, ossifying fibroma, osteoblastoma, giant cell tumor, and osteosarcoma

In a study of non‐epithelial tumors involving the nasal cavity, paranasal sinuses, and nasopharynx, 256 lesions, 156 benign and 100 malignant, were identified. Of these, 64 were osseous and fibro‐osseous lesions. Included in this group were osteomas, fibrous dysplasia, ossifying fibromas, benign osteoblastoma, giant cell tumors, and osteosarcomas. The problem of diagnostic terminology and categorization in this group of lesions is discussed. For each type of lesion, clinical features, histologic findings, and results of treatment are presented and clinicopathologic correlations are made.

Non‐epithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx: A clinicopathologic study. I General Features and Vascular Tumors

Two hundred fifty‐six non‐epithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx have been identified in the records of this department; 156 were benign and 100 malignant. The histologic classification and distribution of these lesions are presented. Vascular neoplasms were the most common, with 85 of the 256 cases being found in this category. The clinical findings related to the vascular tumors are discussed and their histologic features presented. Results of treatment are reviewed, and clinicopathologic correlations are made.

Non‐epithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx: A clinicopathologic study(III. Cartilaginous tumors (chondroma, chondrosarcoma))

In a review of non‐epithelial tumors involving the nasal cavity, paranasal sinuses, and nasopharynx, 256 lesions, 156 benign and 100 malignant, were identified. of these, 17 were cartilaginous neoplasms, 7 chondromas and 10 chondrosarcomas. The clinical findings associated with these cartilaginous tumors are described, the histologic features illustrated, results of therapy presented, and clinicopathologic correlations made. Chondromas were small asymptomatic incidentally found nodules which were successfully treated by limited local resections. The prognosis of the chondrosarcomas depended upon: 1) the location and extent of the lesion; 2) the adequacy of the surgical therapy; and 3) the degree of differentiation of the tumor.

Lymphosarcoma of the small intestine. A clinicopathologic study

In this series of 38 patients with lymphosarcoma of the small intestine, 26 had no previously diagnosed lymphoma (Group A), and 12 had a histologically proven malignant lymphoma elsewhere in the body before diagnosis and resection of the bowel tumor (Group B). The clinical and pathologic features of these tumors are presented and correlations between the two are made. The overall 5‐, 10‐, and 15‐year survival rates in Group A were 48, 35, and 17%. Pathologic features which seemed to correlate with prognosis included gross type of tumor; size; microscopic type; lymph node involvement; presence of perforation; fistula formation, and multicentric lesions. We believe the preferred treatment is a wide segmental resection of the lesion and adjacent bowel, as well as resection of the continguous mesenteric lymph nodes. Radio therapy is recommended if any of the following unfavorable features are present: lymph node involvement; tumor on the margins of resection; perforation; fistula, and multicentric tumors. Patients in Group B have similar clinical manifestations and pathologic findings. In contrast to Group A, however, all of these patients died.

Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx: A clinicopathologic study. IV. Smooth muscle tumors (leiomyoma, leiomyosarcoma)

In a review of nonepithelial tumors involving the nasal cavity, paranasal sinuses, and nasopharynx, 256 lesions, 156 benign and 100 malignant, were identified. Of these, 8 were smooth muscle neoplasms, 2 leiomyomas, and 6 leiomyosarcomas. The clinical findings associated with these smooth muscle tumors are described, their histologic features illustrated, results of therapy presented, and clinicopathologic correlations made. The leiomyomas were small lesions found incidentally within polypectomy specimens, and were successfully treated by polypectomy. Leiomyosarcomas could not be eradicated easily by surgery, recurred frequently, did not respond well to radiotherapy, and carried a poor prognosis.

Primary malignant melanocytic tumors of the sympathetic ganglia, with an ultrastructural study of one

Three cases of melanocytic tumors arising in the sympathetic chain were studied. A metastasis from one of them was studied with electron microscopy. Both light and electron microscopy demonstrated the presence in these tumors of true melanogenesis and autophagic activity in melanocytes as well as phagocytosis of mature melanin by associated histiocytes. Review of the embryology, biochemistry and in vitro culture of sympathetic nervous tissue showed a close relationship between it and pigmented cells in other parts of the body which are also derived from neural crest. These findings support the clinical and morphological conclusion that these rare pigmented tumors are true melanocytic tumors originating from the sympathetic chain. The malignant potential of these tumors is emphasized by the fact that the two patients who survived initial surgery later died of metastatic disease.

Nonepithelial tumors of the nasal cavity paranasal sinuses, and nasopharynx: a clinicopathologic study. V. Skeletal muscle tumors (rhabdomyoma and rhabdomyosarcoma).

In a study of nonepithelial tumors involving the nasal cavity, paranasal sinuses, and nasopharynx, 19 lesions (three rhabdomyomas, 16 rhabdomyosarcomas) showed skeletal muscle differentiation. The clinical findings associated with these neoplasms are reviewed, the histologic features are illustrated, results of treatment are presented, and clinicopathologic correlations are discussed. The rhabdomyomas grew as localized masses in the nasopharynx, were excised locally, and behaved clinically like benign tumors. The rhabdomyosarcomas were found predominantly in children and were associated with a poor prognosis; most of the patients died within 2 years following diagnosis.

Epithelioid sarcoma. A light and electron microscopic study suggesting a synovial origin

Two cases of “epithelioid sarcoma” were studied by light and electron microscopy. In both cases, the tumor consisted of a collagen‐rich fibrous stroma with nests of large epithelial‐like cells with acidophilic cytoplasm, giving the neoplastic tissue a biphasic pattern. The ultrastructural study showed that the tumor cells were of three types: “clear” and “dark” cells (recalling those of the synovium and synovial sarcoma) with distorted nuclei and abundant cytoplasm, and a less common, more immature cell. The histologic and ultrastructural features of the neoplastic cells, as well as those of the ground substance, indicate that the tumor is neither of chrondroid nor of histiocytic origin. The cells of the epithelioid islands are similar to the stromal component of synovial sarcoma. It is suggested that epithelioid sarcoma may be a variant of this tumor.

Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. VI. Fibrous tissue tumors (fibroma, fibromatosis, fibrosarcoma).

In a study of 256 nonepithelial neoplasms involving the nasal cavity, paranasal sinuses, and nasopharynx, 23 lesions were classified as fibrous tissue tumors, including four cases of “fibroma,” six of fibromatosis, and thirteen of fibrosarcoma. The clinical findings associated with these lesions are described, their histologic features illustrated, results of therapy presented and clinicopathologic correlations made. The “fibromas” presented as small localized nodules. None recurred after local excision. Fibromatosis, a locally aggressive tumor, does not metastasize, but may cause considerable morbidity or even death due to local infiltration which may be difficult to control surgically. Fibrosarcoma may cause death either by local infiltration or by metastasis, but has a better prognosis than most other sarcomas of this region. We recommend that a large en bloc resection be performed initially for fibromatosis and fibrosarcoma growing in this area, after the diagnosis has been made by biopsy. In this series, including patients who had more than one operation, recurrent tumor was seen following 10 of 12 limited local excisions performed for fibromatosis and fibrosarcoma, but in only one of 13 patients after a large bloc resection. The problems involved in histologically differentiating fibrous tissue tumors from other lesions are discussed. A patient with the rare syndrome of multicentric fibromatosis with spontaneous regression of lesions is presented.