Showing papers in "Annales De Pathologie in 1988"

Osseous metaplasia within tumours. A review of 11 cases.

Abstract: Although numerous mechanisms that involve characteristic histological changes have been suggested to explain the development of heterotopic ossification within tumours the precise morphogenesis remains obscure. The histological features of 11 tumors that contain heterotopic bone are described with a particular emphasis on those features that are thought to predispose to ossification.

Focal myositis and its differential diagnosis. A case report and review of the literature.

Abstract: A 55 year-old woman underwent a wide surgical excision because a left thigh mass. The histopathological study showed a focal myositis of the vastus lateralis muscle. The patient remains asymptomatic after four years follow-up. The differential diagnosis with soft tissue sarcomas and other inflammatory myopathies is discussed.

Silver staining of nucleolus organizer regions (NORs). Application to the study of nucleolar structure and value in pathology

Abstract: Nucleolus is the morphologic expression of synthesis and maturation of ribosomal RNA (rRNA) from amplified ribosomal DNA (rDNA). Nucleolar Organizer Regions (NORs) are functional subunits of the nucleolus in which actively transcribed rDNA is surrounded with numerous regulatory proteins. Some of them are argyrophilic non-histone proteins (Ag-NOR proteins). By using a cytochemical reaction based on this argyrophilia, active NORs may be stained by the precipitation, at their level, of metallic silver granules whose quantity is directly related to the nucleolar activity. In the present paper, we described various applications of a silver-staining method we developed in our laboratory. The Ag-NOR proteins were ultrastructurally localized within precise nucleolar components. Moreover by viewing thick-sections of silver-stained cells with high-voltage microscopes we were able to describe the three-dimensional structure of nucleoli. Finally, this silver-staining method may be applied at the optical level, to sections of routinely fixed and paraffin-embedded human tissues. With this simple staining method, it is now possible to study the relationships of the number of nucleolar argyrophilic structures with the diagnostic of neoplasms.

Pathology of the cytoskeleton

Abstract: In the last years, considerable advances have been made in the study of the proteins and polypeptides of the cytoskeleton, and its three main components: microfilaments (MF), intermediate filaments (IMF) and microtubules (MT). The principal properties of these elements and those of many associated proteins are recalled. The actin MF are mainly involved in cell contractility, the IMF in cell shape, while the MT and their associated proteins are involved in intracellular transport. Some pathological modifications of the cytoskeleton will be considered. In the liver, accumulations of keratin result in the formation of Mallory's hyalin, found in several types of cirrhosis and hepatomas. In muscle, accumulations of desmin are observed in various myopathies. An accumulation of alpha-actinin at the Z bands characterizes nemalin myopathy. In several forms of hemolytic anemias, alterations of the membranous cytoskeletal components of the red blood cells--spectrin, ankyrin, actin--may explain their abnormal shape and excessive fragility. In the nervous system, many pathological conditions are related to abnormal cytoskeletal components. In Parkinson's disease, Lewy bodies are an accumulation of neurofilaments (IMF). In Alzheimer's disease, and some related conditions, the intraneuronal tangles are associated with modifications of MT and neurofilaments. The role of MT and in particular of the MT-associated protein tau, as demonstrated recently, confirms the involvement of the MT. The observed disturbances of MT-related axonal flow may explain some of the known functional changes in these forms of dementia.

Breast carcinomas and the extracellular matrix

Abstract: This paper underlines the interrelations between tumoral cells and the extra-cellular matrix in breast cancers with possible applications for the diagnosis and the prognosis. In mammary carcinomas, the first step of tumoral invasion is characterized by the loss of basement membrane components, particularly type IV collagen and laminin. Immunohistochemical detection of these disruptions of basement membrane is easy and useful for the diagnosis of "in situ" or microinvasive carcinomas. Laminin seems also to facilitate the adhesion of cancer cells to type IV collagen, and the dosage of its fragment P1 in the blood serum may be a good marker for the follow up of the patients. Stromal reaction involves many intricate macromolecules of the extra-cellular matrix. Types I and III collagens are often present in non colloid carcinomas. Rate, turn over of elastin and its prognostic value are still debated. Elastosis is related to well differentiated carcinomas and the presence of estrogen receptors. The stroma of the colloid form of breast cancer is rich in proteoglycans. Malignant and stromal cells, through the intermediary of cytokines, can synthesize these macromolecules. Hyaluronic acid and chondroitin sulfate are abundant in mammary carcinomas and form a favorable substrate for the growth and the migration of malignant cells. However, proteases decrease and limit their action. The presence of fibronectin, principally in the stroma, is difficult to interpret but fibronectin seems to play a role in tumoral retraction.

Melanotic adenocarcinoma of the uterus. Neuroendocrine tumor of the uterus

Abstract: The case reported concerns a 76-year-old woman under treatment for a previously diagnosed "poorly differentiated endocervical adenocarcinoma". New biopsies revealed an adenocarcinomatous tumor with unexpected melanotic pigmentation. The patient underwent cesium therapy followed by colpohysterectomy with lymphadenectomy. As there were no metastases, external complementary radiotherapy was not used. Four months after surgery, a large recurrence was detected; surgical excision proved impossible but revealed a grossly pigmented tumor from which several samples were taken. The patient died 11 months after the first consultation. No autopsy was performed. Morphological study was done on the initial biopsy, on the uterine tumor and on the recurrent tumor, using histological, cytological, ultrastructural and immunohistochemical techniques. Flow cytometry and biochemical study were also carried out on the recurrent tumor. All the samples studied histologically revealed uniform tumor morphology showing a poorly differentiated adenocarcinoma with an irregular distribution of melanin pigmentation (Fontana +). Electron microscopy confirmed the epithelial nature of the tumor, showing differentiated apical poles with villosities, linked by desmosomes. Basement membranes were irregularly present. Electron microscopy also demonstrated the melanotic nature of the pigmentation with melanosomes and premelanosomes. A few membrane-bound neurosecretory granules were seen. Immunohistochemistry showed that the tumor contains no S 100 protein and that no staining was obtained with monoclonal antibodies against malignant melanoma. Hormonal secretion and chromogranin were not detected. Tumor cells contained neither GFAP nor neurofilaments. Positive staining was obtained for neuron specific enolase and synaptophysin. Tumor cells contained three types of intermediate filament proteins = Vimentin, cytokeratins and peripherin (peripherin is an intermediate filament protein identified in 1984 by Portier, of the college of France, who very kindly supplied the antiserum and was good enough to do most of the biochemical study. Peripherin is considered to be characteristic of the peripheral nervous system. This case is the first example of demonstration of peripherin in a tumor). The biochemical study gave the following results: Cytosol assays for estrogen and progesterone receptors were negative. Vimentin, cytokeratins and peripherin were demonstrated by a study carried out in the College de France. No GFAP was found. A study of the metabolism of melanin derivatives showed high levels of urinary dopamine, serum and cytosol L. dopa.(ABSTRACT TRUNCATED AT 400 WORDS)

The lymphoid system of the digestive tract in man

Abstract: Description des cellules immunitaires et de leur fonction dans la muqueuse digestive. Origine et circulation de ces cellules: cycle entero-enterique. Regulation de la reponse immunitaire apres immunisation orale chez l'homme

Amniotic band syndrome associated with an acardiac malformation in a twin pregnancy. Apropos of a case

Abstract: We report herein a case of a twin pregnancy with one fetus showing an amniotic band syndrome, the other being an acardiac monster. This is, to our knowledge, the first case of this unusual combination. Both fetuses showed multiple severe malformations. According to the classification of Napolitani, one fetus had to be classified as "acardius anceps". The malformations of both bodies and the anomalies of both umbilical cords suggest a similar defect of the germinal disc, possibly occurring very early during the pregnancy.

Primitive malignant lymphomas of bone. Study of 14 cases.

Abstract: Between 1953 and 1956, 54 cases of bone tumors initially diagnosed as reticulum cell sarcoma, lymphosarcoma and malignant lymphoma were found in the file of Department of Pathology at A.C. Camargo Hospital. After review of patients' charts, slides and immunohistochemical study only 14 were admitted in the study as primary lymphoma of bone. 11 were of high grade malignancy (8 centroblastic, 1 multilobated cell type, 1 immunoblastic and 1 lymphoblastic) and 3 were of low grade malignancy according to the Kiel classification. No case of true histiocytic sarcoma was found.

Fetal rhabdomyomatous nephroblastoma. Report of a case with unusual clinical behavior.

Abstract: The authors report a case of fetal rhabdomyomatous nephroblastoma that presented pulmonary metastases at diagnosis, a feature infrequently observed in this type of tumor.

Spontaneous dactylolysis or ainhum. Histopathologic study

Abstract: Ainhum or dactylolysis spontanea is characterized by the occurrence of a circular constriction located at the root of the 5th toe, rarely of a finger. It deepens, the toe becomes disabled and finally amputation occurs, spontaneously or by surgery. It is a tropical disease of the adult, the origin of which remains obscure. It seems frequent in Niger. 7 cases have been histologically studied. Classical features have been found, including hyperkeratosis, chronic dermatitis, osteoporosis with cortical bone resorption. This study has also revealed in all cases complete ligamental destruction. Moreover, vegetal foreign body granulomas have been found in 4 cases, lying deep in the dermis and in one case in a synovial membrane. Ainhum is compared with pseudo-ainhum seen in genodermatosis, in yaws and in congenital strictures. Among the usually considered etiopathogenetic hypotheses, our findings are in favor of a mechanical and inflammatory origin.

[Papillary carcinoma of the thyroid: development of the histological criteria for diagnosis. Study of 29 cases and review of the literature].

Abstract: Papillary carcinoma (PAP) is the most frequent malignant tumour of the thyroid. PAP and follicular carcinoma of the thyroid are two biologically different tumours, without any intermediate or mixed form. Therefore the differentiation between PAP and follicular carcinoma is essential. The histological diagnosis of PAP is based upon several criteria, the most important being the papillae, the "ground glass" nuclei, and the psammoma bodies. The value of the "ground glass" nuclei in the diagnosis of PAP has been particularly emphasized in the last 10 years. The need to take into account all the diagnostic histological criteria of PAP is necessary in the definition of the different variants of PAP, particularly its follicular variant. We report 28 cases of PAP and one case of insular carcinoma, the latter probably originating from a PAP. "Ground glass" nuclei often associated with "grooved nuclei", were identified in the paraffin sections of 7 PAP. One case was classified as a follicular variant of PAP. Psammoma-bodies were seen in 6 PAP. Eleven PAP were less than 1 cm in diameter (microPAP). One microPAP presented with important lymph node metastases and blood vessels' involvement; 2 others microPAP arose in a vesicular adenoma. Six PAP were entirely encapsulated, without any lymph node metastasis or vessel invasion. Six PAP presented with lymph node metastases associated with lymphatic and/or blood vessels invasion. Lymphatic and blood vessel invasion was seen more often in association with PAP extending to the thyroid capsule. The histological classification and prognostic criteria are discussed and compared with those previously described in the literature.

[Adeno-myoepithelial proliferation in the breast].

Abstract: The authors report 13 cases of myoepithelial cell proliferation in the breast. One of them is a neoplasm with a predominant myoepithelial component. These proliferations in mastopathies or neoplasms raise important questions concerning differential diagnosis with invasive adenocarcinoma and prognosis.

Tumor syndromes with inappropriate renin secretion. Diagnostic criteria and review of published cases

Abstract: Besides the juxtaglomerular cell tumors, tumors may be responsible for a primary hyperreninism syndrome. Strict criteria allow to assert that the tumor cells themselves are involved in ectopic renin secretion. They are as follows:--measurement of the renin in the blood and in tumoral tissue extracts with assessment of active anf inactive renin,--absence of any other cause of hyperreninism,--regression of the hyperreninism when the tumor is removed, and possibly recurrence when metastases appear,--demonstration of renin antigen in tumor cells by immuno-histochemistry and more recently detection of renin messenger RNA using in situ hybridization with human renin probe. About 40 cases of these tumors have been described. They are mainly renal tumors: nephroblastomas (29 cases), adenocarcinomas (7 cases) and other rare tumors. Among extrarenal tumors, it has been observed epithelial tumors (broncho-pulmonary cancers, ovarian, fallopian and pituitary tumors), soft tissue tumors (alveolar sarcomas. epithelioid sarcoma, hemangiopericytoma, leiomyosarcoma). It has not been demonstrated that tumor cells from pheochromocytoma could be themselves involved in renin production.

[Carney's complex (myxomas, pigmented spots and endocrine hyperactivity). Apropos of a partial form in monozygotic twins].

Abstract: The authors describe monozygotic twins with right ventricular myxoma, one of whom had cutaneous myxomas, large cell calcifying Sertoli cell tumor of the testis (a lesion which was certainly latent in his brother) and recurrent cardiac myxoma. These elements are manifestations of "Carney's complex". This recently reported inherited syndrome should be recognized by pathologists because of major risk of cardiac myxoma. Cutaneous lesions, specially cutaneous myxomas, are heralds of this syndrome.

Neuropathologic study of 15 cases of multinucleated giant cell encephalitis in acquired immunodeficiency syndrome (AIDS)

Abstract: The central nervous system (CNS) of 40 patients who died of acquired immune deficiency syndrome (AIDS) between August 1982 and August 1987 was examined. In 15 cases, multinucleated giant cells (MGC) characteristic of Human Immunodeficiency Virus (HIV) infection were observed. In 3 cases ultrastructural examination disclosed HIV-like viral particles in the cytoplasm of some MGC. All cases with MGC showed, in addition, predominant white matter lesion: diffuse myelin pallor, multiple small, usually subcortical, necrotic foci, vacuolar myelopathy, proliferation of rod-shade microglia and microglial nodules, reactive astrocytosis, mineralization of the vessel walls. These changes, typical of HIV encephalitis, were isolated in 3 cases. In the other cases, they were associated with other AIDS-related CNS lesions, i.e., cerebral toxoplasmosis (9 cases), cytomegalovirus infection (5 cases), progressive multifocal leukoencephalitis (1 case), cryptococcosis (1 case) and cerebral lymphoma (1 case). The involvement of MGC with these lesions was remarkable.

Chorionic gonadotrophic hormone and transitional cell carcinoma of the bladder. Immunohistochemical characterization of HCG and its alpha and beta subunits

Abstract: Investigation of cellular localization of hCG and alpha- and beta- subunits in 17 transitional cell carcinomas of urinary bladder was performed using immunohistochemical techniques. Serial sections were tested with monoclonal antibodies to hCG, free beta hCG and free alpha hCG. Transitional cell carcinomas producing hCG and/or beta hCG are easily found (6/17 cases). None of these tumors correspond morphologically to a choriocarcinoma. However, it must be mentioned that neoplastic areas exhibit some features reminiscent of a choriocarcinomatous structure. Notably, positive cells can be disposed at the periphery of neoplastic nests, mimicking the arrangement of syncytiotrophoblast. Positive neoplastic cells express hCG and/or beta hCG; alpha hCG immuno-reactivity is quite rare. The relative distribution of hCG/beta hCG is excessively variable from case to case. In contrast, normal transitional epithelium contains endocrine cells which only express the alpha-subunit of hCG.

Role of the pathologist in the treatment of osteosarcoma

Abstract: Nous presentons l'etude anatomo-pathologiques des pieces chirurgicales d'osteosarcomes traites par chimiotherapie selon Rosen et Huvos. Elle a pour buts l'evaluation histologique de la reponse tumorale a la chimiotherapie preoperatoire et l'appreciation per et postoperatoire de l'extension tumorale. La frontiere entre bonne et mauvaise reponse est aux environs de 5% de cellules viables. Cette reponse histologique guide la chimiotherapie postoperatoire

Buccal histoplasmosis. Apropos of a case with a difficult histopathologic diagnosis

Abstract: A 65-year-old man who had lived in several tropical countries, particularly in Brazil, is observed for an ulcerative lesion of the mouth that appeared two months ago. The biopsy reveals polymorphic granuloma with numerous giant cells. PAS and Gomori-Grocott stains show very numerous roundish structures of variable size (3 microns to 15 microns). There are multiple buds like in paracoccidioidomycosis but culture reveals Histoplasma capsulatum. These abnormal forms have been described in large necrotic zones and especially in endocarditis (intravascular proliferations). To our knowledge, it is the first description of these forms in primary infestation. This case shows the necessity to control histological diagnosis of mycosis. Culture and biological identification are absolutely necessary for specific diagnosis.

Histological study of a case of chondrocostal aspergillosis

Abstract: Histological study of biopsy specimens successively taken from the 7th, 5th and 6th right chondrocostal regions in a 33 year-old man; the patient was under chemotherapy for a diffuse lymphoma and has been operated for an aspergilloma of the right lung superior lobe. Non-specific chronic osteomyelitis was observed as well as Aspergillus fumigatus perichondritis (acute and chronic) which had lead to cartilage fragmentation. Cartilage fragmentation could be attributed to an enzymatic chondrolysis induced by polymorphonuclears inflammation. Such matrix degradation seems to favour the penetration of aspergillus into the cartilage surface. This case report recalls that fungi (including Aspergillus despite it appears exceptional) must be considered as a possible cause of osteomyelitis, particularly in immunosuppressed patients.

Nephroblastoma with symptomatic neuronal differentiation

Abstract: We report the anatomoclinical analysis of a child with a renal tumor: the preoperative diagnosis was neuroblastoma, because of elevated dopamine urinary excretion and positive MIBG scintigraphy. The histopathological and immunohistochemical analysis revealed a prominent neural differentiation in a multicystic nephroblastoma. This observation recalls the Masson's proposed neuroectodermal histogenesis of Wilms tumor; however the currently accepted metanephrogenic blastematous origin is not reconsidered. This is the first case of nephroblastoma with a neural differentiation detectable otherwise from by pathological analysis.

Immunohistochemical detection of estrogen receptors and image analysis (SAMBA 200) in breast carcinomas

Abstract: Estrogen receptor (ER) immunocytochemical assay (ER-ICA) was assessed human breast carcinomas. The patient's age, the tumor size, the histological type and SBR grade, the presence or the absence of axillary lymph node metastases and of vessel invasion in tumor borders were recorded in all the cases included in the series (n = 469) estrogen and progesterone receptors were concomitantly evaluated (DCC method) and or immunoenzymatic assays. Monoclonal H222 sp gamma and PAP procedure (Abbott kit) were applied in frozen sections, tumor imprints and fine needle aspirates. A computerized system of image analysis referred to as SAMBA (TITN), permitted to achieve a multiparametric quantitative analysis of ER positive surfaces. With this system, in each tumor, the cellularity, the percentage ER surface versus the total cell surface and versus the epithelial (keratin positive) surface, integrated optical density (IOD), mean optical density, index of the concentration of labelled objects, and IOD histograms, were obtained and correlated to histological and biochemical data. It was shown that: 1) ER antigenic sites were heterogeneously distributed in ER positive tumors, with a specific nuclear localization in epithelial cells; 2) the SAMBA 200 multiparametric analysis of the ER sites distribution in tissue was appropriate, accurate, reproductible and therefore more reliable than the semi-quantitative analysis; 3) the standardization and the complete automation of this method of immunoprecipitates evaluation on tissue section permit to daily and to routinely analyse a large number of preparation; 4) there was a correlation between ER binding sites evaluation (DCC) and ER antigenic sites immunodetection (ER-ICA and ER-EIA); 5) there was a correlation between the SAMBA evaluation of ER-ICA and other histological prognostic factors such as small tumor size, low SBR grade, the absence of axillary lymph node metastasis and vessel invasion; 6) the preliminary SAMBA analysis of ER-ICA in tissue sections, imprints and fine needle aspirates suggest that fine needle aspirates may not reflect accurately the tumor cell heterogeneity.

Plasmacytoma and gastric amyloidosis associated with nodular pulmonary amyloidosis.

Abstract: The authors report an association of gastric and pulmonary amyloidosis in a 74 year old woman. The patient had had a gastric plasmacytoma for the last 11 years. On autopsy, the stomach was found to contain intramural deposits of amyloid, and was infiltrated by plasma cells secreting monoclonal IgG lambda light chain. In the lungs, the plasma cells in the vicinity of the amyloid deposits proved to be polytypic, suggesting that these deposits originated from circulating precursor proteins.

Lipoblastic liposarcoma of the lung. Ultrastructural study of a case

Abstract: A case of fatal lipoblastic pulmonary liposarcoma in a 20 year-old female is reported. A thoracotomy was performed but failed to yield the pathological diagnosis. This diagnosis was obtained by ultrastructural study of a cerebral metastasis. To our knowledge, only seven cases of pulmonary liposarcoma have been previously described in the literature and the lipoblastic aspect was never mentioned.

[Dapaong "tumor". Helminthiasis caused by Oesophagostomum].

Abstract: Etude de 28 cas de pseudo-tumeurs coliques, ileales et appendiculaires dues a une infestation par Oesophagostomum bifurcum, nematode ne parasitant l'homme que rarement

Hémangiome histiocytoïde cardiaque: étude histologique et immunohistochimique d'un cas

Abstract: We present the fourth case report of an histiocytoid hemangioma of the heart, which was found incidentally, as in the other three reported cases, in a 50 year old man during surgery for congenital heart disease. A polypoid sessile reddish tumor with a smooth surface, which measured 2 cm in diameter, was found in the right atrium. No necrosis nor cystic areas were seen. Histologic evaluation revealed a proliferation of histiocytoid or epithelioid cells, whose arrangement varied a great deal within the infiltrate. Sometimes, the cells were isolated but in most places they were arranged in sheets or nests surrounded by connective tissue. Some of these nests were compact whereas in others a lumen formation, frequently occupied by erythrocytes, could be appreciated. A striking feature was the presence of vacuolated tumor cells sometimes assuming a signet-ring configuration. Some large vascular spaces were lined by histiocytoid or epithelioid endothelial cells, many of which protruded into the lumen. Multinucleated tumor cells were occasionally observed. Mitoses were rare (up to 1/10 HPF) and scattered inflammatory cells such as lymphocytes, macrophages, neutrophils and eosinophils were seen. Histologic appearance of our patient's tumor is identical to the histiocytoid hemangioma of Rosai et al., which is an ubiquitous endothelial benign neoplasm.

Carcinosarcomas of the bladder. Immunohistochemical study in 3 cases

Abstract: We present 3 cases of carcinosarcoma of the bladder. We discuss the value of histochemistry on their diagnosis. We compare them to similar tumors reported in the medical literature. Like fusocellular carcinoma, carcinosarcoma finally appear as a morphological variant of high grade urothelial carcinoma, often difficult to diagnose. With our present knowledge, it is not possible to propose for these tumors other therapeutic measures than those already in use for high grade urothelial malignancies, based on the level of infiltration in the bladder wall. The classic pejorative prognosis of these tumors is contradicted by the favorable evolution in some cases reported in medical literature.

Oncocytoma of the kidney and oncocytic adenocarcinoma. 10 cases of oncocytoma

Abstract: Having studied 484 previously reported and 10 personal cases of oncocytomas we believe that the main controversies surrounding this tumor are related to the fact that the term oncocytoma is wrongly applied to all tumors with oncocytic cells. The term oncocytoma must be restricted to well encapsulated tumors, sometimes very large ones, made up solely from regular oncocytic cells. The benign clinical behavior of oncocytomas thus defined, is supported by numerous well documented observations in medical literature. Thanks to the progress made in radiology investigations and to better defined histological criteria, it is possible, by means of diagnosis with frozen sections, to practice partial surgery.