Fibromuscular dysplasia in the extremities

Four patients had fibromuscular dysplasia of the extremities involving the brachial, deep femoral, popliteal, anterior and posterior tibial and peroneal arteries. One of them demonstrated a string-of-beads appearance in the superficial veins of the arm and this was pathologically confirmed as fibromuscular dysplasia. We believe this is the first report of this disease affecting the peripheral arteries and the superficial veins of the extremities. The sympathetic system seems to be related to the development of fibromuscular dysplasia.

[A case of coexistent multiple malignant lymphomas and early carcinoma of the stomach]

A 68-year-old man with multiple malignant lymphomas and early gastric carcinoma in the stomach is described. In the resected stomach, six lesions of malignant lymphoma, large cell type (LSG classification) or histiocytic type (Rappaport classification) were observed at the posterior wall of the gastric body. Well differentiated tubular adenocarcinoma as an early carcinoma of type IIc was also found on the lesser curvature of the gastric body. In addition, multiple early follicular proliferation of malignant lymphoma was microscopically revealed centering around the gastric body. This rare case of coexistent multiple malignant lymphomas and early carcinoma of the stomach is reported and discussed.

[Ganglioneuromatosis with carcinoid foci in the large bowel]

A rare case of a 27-year-old man who suffered from ganglioneuromatosis with five carcinoid foci arising from the colon and underwent subtotal colectomy is reported. There was no malignancy. The tumors extended to the mucosa and/or submucosa, and in most parts, tumors created polypoid lesions protruding into the intestinal lumen. In the rectum the tumors showed circumscribed extension around the wall. In the sigmoid and descending colon, polypoid lesions were seen on the side opposite from the attachment line of the mesocolon. In one of five carcinoid foci, a transitional pattern between carcinoid and neuroma was investigated.

Primary chondroid chordoma arising from the base of the temporal bone. A 10-year post-operative follow-up

A 36-year-old male with a primary chondroid chordoma is presented. This tumour arose from the base of the temporal bone and extended to the mastoid cavity. It involved the facial nerve and was adherent to the internal jugular vein and internal carotid artery. The tumour was excised and the patient has been carefully followed up for 10 years. He has shown no evidence of local recurrence, intracranial extension of the residual tumour and distant metastasis.

Solitary neurofibroma of the esophagus

A rare case of solitary neurofibroma located in the esophagus is reported. A large (4.2 X 4.0 X 3.0 cm) submucosal tumor was surgically removed from the midportion of the esophagus of a 64-year-old woman. Light and electron microscopic examination, and immunohistochemistry of S-100 protein in the tumor tissue confirmed neurofibroma. The patient had no evidence of von Recklinghausen's neurofibromatosis. A review of literature failed to find other reports of solitary neurofibroma of the esophagus with reliable histological diagnosis.

Desmoid tumor in the maxillary sinus: a case report

Desmoid tumor in the maxillary sinus is a rare condition. The present case occurred in a 37-year-old male complaining of left nasal obstruction and dull pain in the nape of the neck. The clinical picture, pathology, diagnosis and prognosis are discussed and the literature is reviewed.

[HCG-positive cells in seminoma of the testis]

In a retrospective study of 38 patients with pure seminoma, serum and urine levels of human chorionic gonadotropin (HCG) were measured and the cellular origin of HCG-like substance was searched using the technique of indirect immunoperoxidase on step sections of the tumors. Eight of the patients had elevated HCG in serum or urine, and 5 had HCG-positive cells in the sections of tumor specimens. With this technique, two types of HCG-positive cells were identified, syncytiotrophoblastic giant cells (STGC) and mononuclear cells otherwise indistinguishable from seminoma cells. Patients in the present series responded well to conventional radiation therapy or cytotoxic chemotherapy and had a favorable outcome regardless of the presence of STGC or slightly elevated HCG levels.

Gastric plasmacytoma and multisystem autoimmune disease

A 54-year-old women with solitary gastric plasmacytoma, Ig M and kappa-light chain type, associated with multisystem autoimmune disease is described. The gastric plasmacytoma developed seven years after the diagnosis of Hashimoto's thyroiditis, primary biliary cirrhosis and Sjögren's syndrome. We speculate that this plasmacytoma developed in association with an immunodeficient and/or immunosuppressed state resulting from multisystem autoimmune disease and therapy.

[Autopsy case of atypical medulloblastoma in an adult]

A 24-year-old female complained of headache and vomiting. The brain-CT scan demonstrated a tumor shadow in the right cerebellar hemisphere. The tumor was partially resected, and irradiation therapy was started. She died of intraventricular hemorrhage about 6 months after the onset of symptoms. Autopsy revealed a recurrent tumor mass in the cerebellum extending to the brain stem. It showed systemic metastases to the leptomeninx, liver, bones and ovaries. Histological examination showed a tumor which was a primarily composed of typical medulloblastoma cells with occasional Homer-Wright type rosettes. It partly showed glioblastoma-like configuration. Some tumor cells were positive for GFAP by the PAP method, suggesting glial differentiation.

[Liver cell carcinoma with extensive proliferation of sarcoma-like neoplastic cells--an autopsy case]

A 73-year-old male was admitted with suspected Grawitz tumor. Aspiration cytology from the tumor was diagnosed as Class V with suspected sarcoma. He died 17 days after admission. Autopsy revealed this to be a massive hepatic tumor occupying over half of the right lobe. It showed protrusion into the right retroperitoneum. Histology of the tumor evidenced widespread proliferation of sarcoma-like neoplastic cells besides a minute area of definite liver cell carcinoma in the center of the tumor mass. Definite transitional features between liver cell carcinoma and a sarcomatous pattern, the latter involving a major part of this tumor, were noted. Thus, we diagnosed this tumor to be liver cell carcinoma with a sarcoma-like histological pattern. The possibility of collision tumor or carcinosarcoma could be ruled out.

[Histopathological evaluation of minute stomach cancer]

We histologically examined 17 lesions from minute gastric cancer (less than 5 mm in diameter). Flat or IIb type was frequently seen in minute cancer (47%); the depressed type was predominant in ordinary early gastric cancer (72%). Differentiated adenocarcinoma was noted more often in minute cancer (88%) than in ordinary early gastric cancer (61%) or advanced cancer (45%). Differentiated type minute cancer was frequently associated with severe atrophic gastritis (93%) and intestinal metaplasia (73%). There was no evidence for the preexistence of chronic peptic ulcer, because no fibrosis was present in the gastric wall beneath the minute cancerous lesions.

Emperipolesis and annulate lamellae in erythroleukaemia

The bone marrow in the erythraemic phase of 2 erythroleukaemia patients was studied electron microscopically. Emperipolesis of erythrocytes as well as annulate lamellae were revealed in the cytoplasm of the erythroblasts of these cases. It is assumed that these findings show a high rate of erythroblastic proliferation. This is the first report of emperipolesis within the erythroblast by erythroleukaemia. In addition, other various abnormalities, namely, nuclear-cytoplasmic asynchrony, nuclear bleb or cleft formation, abundant glycogen particles and ferruginous micelles in mitochondria such as described in some previous reports, were also recognized.

Fibrous long spacing-like fibers in the bone marrow of myloproliferative disorder

Bone marrow obtained at autopsy from four cases of primary myelofibrosis and four cases of chronic myelogenous leukemia, was studied electron microscopically. In all the cases of primary myelofibrosis, the excess of collagen fibers in the bone marrow showed mostly about 2,000 A diameter and 1,000 A periodicity, i.e. fibrous long spacing (FLS)-like fibers. These FLS-like fibers were also seen in secondary myelofibrosis in three of the four cases of chronic myelogenous leukemia. These fibers were abundant around fibroblasts and small blood vessels. An apparent continuity between the dark bands of FLS-like fibers and the basement membrane material around small blood vessels was also revealed. Moreover, it was observed that these dark bands of FLS-like fibers contained acid mucopolysaccharides.

Mucoepidermoid carcinoma of the thymic region

A case of mucoepidermoid carcinoma in thymus in a 59-year-old Japanese female is presented. She died of cardiac tamponade due to tumor invasion ater a 5 years' clinical course. At autopsy the main tumor was found in the thymic region with metastases to the sternum, regional lymph nodes, pericardial, and left pleural cavity. The mucoepidermoid carcinoma might be probably originated from a hen's egg-sized cyst which was located in the upper posterior aspect of the tumor-involved thymus. No teratomatous components were present. The cyst was most likely to be of thymic or bronchogenic cyst origin, though it was not determined, in view of the lining with pseudostratified ciliated columnar epithelium of the cystic wall and the surrounding with the thymic tissue outside. Moreover, there was thymic hyperplasia with germinal center that was compatible with SLE-like symptoms in her past history and autoimmune nature of the autopsy findings of pulmonary fibrosis.

A scanning electron microscopic study of the boundary zone of the human spleen

The structural characteristics and cellular elements of the boundary zone between the white and red pulp of the human spleen were studied by SEM and TEM. The boundary zone consisted of both the perifollicular region and the region surrounding the periarterial lymphoid sheath. The perifollicular region was further subdivided into two, equally thick layers. The inner half layer of the perifollicular region outside the mantle zone of the lymph follicle was composed of tightly packed medium-sized lymphocytes, interspersed by a small number of reticular cells. The outer half layer was composed of a reticular cell meshwork containing blood cells in vessels, which communicated with the splenic cords of the red pulp. Intermittent rows of reticular cells distinguished the outer from the inner half layer. The region surrounding the periarterial lymphoid sheath revealed the same type of reticular cell meshwork as the outer half layer of the perifollicular region. Capillary ends opened into the reticular cell meshwork, which suggested the presence of an open circulation in the human spleen. A deep lymphatic vessel which communicated with the periarterial lymphoid sheath was noted.

Extranodal non-Hodgkin's lymphoma in the head and neck. Irradiation and clinical course

A retrospective analysis was performed of localized extranodal non-Hodgkin's lymphomas in the head and neck region treated with irradiation. Histopathologic reevaluation revealed 94 per cent with a diffuse type. The lesions were as a rule locally cured with doses ranging from 30 to 50 Gy. Relapses in localized stage I and II patients were, however, not seldom observed in distant extranodal sites. Gastrointestinal relapse in cases with lesions originally located in Waldeyer's ring was thus frequently observed, and the probability of multiple or systemic involvement should be considered also when the disease is located in the oral cavity or sinus region. The value of systemic examination for staging purposes is discussed.

Carcinomas of the esophagus with synchronous or metachronous primary carcinoma in other organs

Twenty-eight patients with esophageal carcinoma and one or more separate primary carcinomas in other organs were treated from 1960 to 1980, representing 8.3 per cent of the 339 cases of esophageal carcinoma observed during this period. The most frequent sites of the additional tumors were the oral cavity and pharynx (11 patients) and the stomach (12 patients). Awareness of the frequent combination of esophageal carcinoma with other primary neoplasms in the sites mentioned may lead to the detection of small curable malignant tumors.

Malignant pheochromocytoma arising in the organ of Zuckerkandl--a clinicopathological study

An autopsy case of malignant pheochromocytoma arising in the organ of Zuckerkandl is reported, of which distant metastases were found in the liver and lymph nodes. The biochemical and electron microscopic findings from the tumor tissue showed noradrenaline-secreting type. It was revealed that sex ratio in malignant pheochromocytoma was more prominent in the female, and the frequency of extra-adrenal origin was higher in malignant pheochromocytoma than in benign one from comparative study of reported cases of malignant pheochromocytoma.

Oral manifestations of acute promyelocytic leukemia

A study was conducted of 16 patients with acute promyelocytic leukemia. The most common oral manifestations were hemorrhagic diathesis and leukemic involvement. There was gingival bleeding, petechiae, and ecchymosis of the oral mucosa, massive infiltration-induced gingival swelling, ulcerative glossitis, swelling of the tonsils, and facial palsy. Inflammatory stomatitis also occurred. Patients with acute promyelocytic leukemia had a higher incidence and severity of oral bleeding than those with other types of acute leukemia. However, the oral findings in our series were not necessarily specific for acute promyelocytic leukemia because the same oral symptoms occur in other forms of acute leukemia.

An electron microscopic and enzyme histochemical study of the boundary zone between the white and red pulp of the human spleen

Three parts were distinguished by electron microscopy and by enzyme histochemistry at the boundary zone between the white and red pulp of the human spleen. The first was the inner layer of the perifollicular region, composed of medium-sized lymphocytes with abundant free ribosomes in their cytoplasm. A small number of reticulum cells intervened among these lymphocytes. This inner layer was considered to correspond to the "Follikelaussenzone" (Strasser). The second was the outer layer of the perifollicular region, composed of a meshwork of reticulum cells with reticular fibers, and sheathed and non-sheathed arteries. Small and medium-sized lymphocytes, granulocytes, erythrocytes, platelets, and a small number of plasma cells were observed in the mesh spaces. This outer layer was considered to correspond to the "marginal zone" (Snook). At the outermost part of this layer, the venous sinus appeared. There was no distinct border between this layer and the red pulp. The third was the neighboring region of the periarterial lymphoid sheath, showeing similar structure and cellular components to the outer layer of the perifollicular region. It was characteristic feature for the lymphocytes and some of the reticulum cells of this region to have a strong activity for alkaline phosphatase reaction, while the lymphocytes of the outer layer showed only a weak activity. Adenosine triphosphatase and 5'-nucleotidase activities were demonstrated on the lymphocytes of these three parts of the boundary zone as well as the lymph follicle. Different activities for these enzyme reactions may indicate the functional properties of the B-cell system.

An enzyme histochemical study of non-Hodgkin's lymphoma and allied disease

The enzyme activity for alpha-naphthyl-acetate esterase, naphthol-AS-acetate esterase, naphthol-AS-D-chloroacetate esterase, acid phosphatase, L(+)-tartrate-resistant acid phosphatase, adenosine triphosphatase, and 5'-nucleotidase was examined on the neoplastic cells of giant follicular lymphoblastoma, the so-called reticulum cell sarcoma and Sézary syndrome. The neoplastic cells of giant follicular lymphoblastoma showed distinct activity for adenosine triphosphatase and 5'-nucleotidase, and those of the so-called reticulum cell sarcoma had no characteristic nature of the reticulum cells or histiocytes enzyme histochemically. These findings suggest that these neoplastic cells may be derived from the B-cell system. In Sézary syndrome, acid phosphatase activity was localized in a small paranuclear area in Sézary cells, which were considered to have a T-cell nature. It is thought that these enzyme histochemical methods are easy and useful in differentiating the B- or T-cell nature and the classification of non-Hodgkin's lymphomas.