Showing papers in "Československá patologie in 1993"

Diffuse sclerosing variant of papillary thyroid carcinoma.

Abstract: Five cases of the diffuse sclerosing variant of papillary thyroid carcinoma (DSPC) were presented. The fifth case was discovered in a statistically not defined series of carcinomas of the thyroid gland. DSPC were found in 5.7% of 70 cases of thyroid papillary carcinoma. All the cases described showed a similar histological picture. In the first case a "dominant nodule" was found. Immunohistologically B-cell markers were mostly proved on lymphocytes of the focal lymphocytic infiltration. Accumulation of Langerhans cells was present in the tumour foci. The finding of these cells is regarded as a sign of an enhanced immunological defense mechanism. The clinical follow-up interval of patients was 3 to 9 years. Less favourable prognosis of DSPC as compared with classical papillary carcinomas could not be confirmed in this series.

Cytologic diagnosis of medullary carcinoma of the thyroid gland

Abstract: Over a five year period 50 malignant tumours (3.8% of investigations) has been histologically proved in a group of 1378 patients who underwent fine needle aspiration biopsy of thyroid. Five of these were medullary carcinomas (0.38% of investigation, 10% of malignancies). During revision and cytohistological correlation the most important cytologic diagnostic features for the sequential diagnosis of medullary carcinoma especially in cases without indicative clinical symptomatology have been checked. The following proved to be indicative especially if coinciding: a) background formed by blood with minimum or no colloid; b) clusters of epithelial cells with poor cohesion, sometimes multilayered, microfollicular, or stroma-like fusiform cells; c) striking anisocytosis, polygonal, plasmacytoid, fusiform, polyploid, and binucleated cells and naked nuclei in the background; d) striking anisokaryosis, at least part of the nuclei ovoid or elongated, chromatin rough, giant nuclei; e) amyloid identifiable in some tissue micro-fragments. If additional smears or cyto-block material are available it may be possible to establish the diagnosis at the cytology level using amyloid staining, argyrophilia test or immunohistochemistry. However if there is any cytological suspicion of medullary carcinoma, serum calcitonin should be investigated to confirm the preoperative diagnosis of medullary carcinoma enabling the patient to undergo one-step radical surgery.

[Nonbacterial thrombotic endocarditis--a study of 171 case reports].

Abstract: A descriptive term nonbacterial thrombotic endocarditis (NBTE) is used currently instead of the former name marantic endocarditis. The study describes 171 cases of NBTE encountered in autopsies over a period of 22 years (an incidence of 0.93% in adults). Malignancy was present in 59% of cases. Tumors relatively most frequently associated with NBTE were carcinomas of the ovaries, biliary system, pancreas, lung, and stomach. The vegetations were located mostly on the left-sided valves (mitral 64%, aortic 24%, both 9%). The involved valves were otherwise normal in 82%, and they were previously damaged in 18%. Systemic emboli from valvular vegetations occurred in 41% of patients, with splenic, cerebral, and renal circulations being most frequently affected. Pulmonary embolism was noted in 43%. The state of nutrition at autopsy was within normal limits in 35%; there was undernourishment or cachexia in 40%, and overweight or obesity in 22% of patients. The main pathogenetic factor in NBTE seems to be a state of hypercoagulation.

Glomus tumour with intravascular spread.

Abstract: We present here a case of 48 year-old man with a glomus tumour on the dorsal side of the right foot which displayed intravascular spread of the tumour cells. Four years after excision the patient was without recurrences and metastases. Intravascular spread of tumour in our case can be compared with the same phenomenon in intravascular leiomyomatosis. We do not consider such spread in glomus tumour as a sign of malignancy.

Heterotopic ossification in endobronchial metastases of rectal adenocarcinoma

Abstract: An endobronchial metastasis of rectal carcinoma was found in a 62-year-old man three years after removal of the primary tumour. It imitated an aspirated foreign body and produced stromal foci of heterotopic ossification. Focal ossification was noticed in the revised primary tumour as well.

Collagenous crystalloids and collagenous spherules in salivary gland tumors. A light microscopy and immunohistochemistry study

Abstract: In a series of 354 salivary gland tumors, the morphological and immunohistochemical study of two distinctive types of extracellular matrix deposits was carried out. First, collagenous crystalloids, distinct spherical crystalloids composed of radially arranged needle-shaped collagen fibres, were found in twelve cases of benign salivary gland tumors. Second, collagenous spherules, globoid structures often showing concentric lamellar or radial pattern, were found in 46 cases of both benign and malignant salivary gland tumors. Immunohistochemically, collagenous crystalloids and collagenous spherules contain varying amounts of type I and III collagens, proteoglycans and elastic fibres but not collagen types II and VI. Strong linear deposition of basement membrane proteins, collagen type IV and laminin, surrounded collagenous spherules. Discontinuous patchy deposits of both proteins were, however, found near collagenous crystalloids. The cells surrounding these collagenous crystalloids and collagenous spherules showed immunohistochemical and morphological features of modified myoepithelial cells. Our observations may improve a terminology of the structures in question. Proposed active role of modified myoepithelial cells in the origin of these extracellular deposits still remains open for discussion.

Pathogenesis of micropolygyria

Abstract: Neonatal micropolygyria (MG) was studied concerning a possible proportion of neuroblastic migration in its formal pathogenesis. Section of three selected groups of neonatal brains yielded complete series of frontal histotopograms. Findings were compared with experimental MG induced in the period of neuroblastic migration. Group A: Registration of residual neuroblastic migration in cerebral cortex. There was found that the residual migration could participate on production of MG as late as in the 27th week of gravidity (weight of 1000g). Group B: Evaluation of neuroblastic migration in partial necrosis. Migrating neuroblasts were found in neonatal cerebral cortex with hypoxic encephalopathy. A correlation existed with experimental data proving that MG neonatal cerebral cortex could be produced by neuroblastic migration through fields of partial necrosis. Group C: Detailed investigation concerned 4 neonates with MG due to hypoxic necroses- 2 cases with probable lesion of big vessels perfusion after thromboembolia and 2 cases with cortical vessels perfusion lesion in toxoplasmosis and rubella meningoencephalitis. Findings were compared with experimental MG and correlated with the data from group A and B. Results showed that the production of MG formations in neonatal brain (atypical irregular MG cortex, 4-layer-MG cortex, intracortical nodules, MG intracortical microsulci, neuronal protrusion into molecular layer and pia mater, intracortical and subcortical neuronal heterotopias) can be participated by neuroblastic migration in the transformation of injured immature cerebral cortex. Probable timing of various MG formations and of a relation of MG to ulegyria were presented.

Histological structure of the peniform clitoris in congenital adrenogenital syndrome

Abstract: Peniform clitoris in 50 girls suffering from congenital adrenogenital syndrome were subtotally removed at the age of 4-6 years and studied by biopsy. A corpus spongiosum more or less developed was found in all cases beneath the corpora cavernosa in the bottom part of corpus clitoridis, epithelial urethral rudiments represented by single or multiple short tubules with transitional epithelium and mucinous glands were found in 46 cases; they were localized in corpus spongiosum or close to it in loose connective tissue. Other urethral rudiments occurring in glans clitoridis were represented by long slight pegs of squamous epithelium extending into corpus spongiosum glandis. Control samples from 20 4-6-year-old girls who had deceased from tumours showed but once heterotopic epithelial urethral rudiments-tubules with transitional epithelium and mucinous glands.

Spindle cell hemangioendothelioma

Abstract: Subcutaneous spindle cell hemangioendothelioma was observed in lower limb of a woman and forearm of a man. Cavernous and slit-like sinusoid vascular spaces were combined with solid spindle cell areas in both tumours. Spindle cells showed local immunohistochemical positivity of Factor XIII. Cavernous spaces comprised numerous thrombi in different phase of organization and sinusoids were full of lingering erythrocytes and lots of siderophages. Recurrence of the tumour occurred in the woman. Biologic nature of the lesion is not evident for the time being because its reactive proliferative character cannot be excluded.

Mycoses of the heart

Abstract: There is an increasing frequency of heart mycoses. Authors identified 19 such cases between 1972 and 1991, 63% in the last 6 years (frequency was 0.1% in 17.661 autopsies of patients over 7 days of life). Males prevailed (17:2). Yeasts of genus Candida dominated, unusual etiology represented Candida parapsilosis, Torulopsis candida and Aspergillus restrictus. Sampling from vegetations or abscesses was a prerequisite for positive autoptic cultivation. Probable source of infection was found in 12 patients and 5 of them had an infected thrombosis of venous catheter. Mycosepsis comprised nearly equal number of endocarditides (mostly left sided) and myocarditides. Spread of endocardial infection into myocardium was rare, most myocarditides resulted from disseminated infection in immunocompromised patients. Endocarditides mainly complicated surgical interventions.

Neurilemmoma of the esophagus imitating carcinoma of the thyroid isthmus

Abstract: Fine needle aspiration cytology of a "stone hard" nodule in isthmic thyroid region of a 56-year old woman yielded unusual spindle and polyploid cells in a relatively monomorphic inflammatory background. Finding was suspicious of malignancy. Differential diagnosis of reparative inflammatory changes, anaplastic or medullary carcinoma was considered. During the operation a tight connection of the tumour with oesophageal wall as well as with thyroid was discovered. Biopsy proved the tumour to be a neurilemmoma originating in the oesophageal wall. Most of the tumour cells were S-100 protein positive. Comparison of the cytologic smears and biopsy slides proved the unusual cells to be of tumour origin.