Malignant angioendotheliomatosis--a true lymphoma: a case of intravascular malignant lymphomatosis studied by southern blot hybridization analysis

Malignant angioendotheliomatosis is a rare, systemic, usually fatal disease characterized by a massive proliferation of large, bizarre-looking mononuclear cells within small and medium-sized blood vessels. The histogenesis of the neoplastic cells has been the subject of long-standing controversy since the disease's initial description. Early investigators concluded that the entity represented a neoplasm of endothelial cells, but recently others have suggested that it is of lymphoid origin. We studied a case of malignant angioendotheliomatosis by Southern blot hybridization analysis which showed clonal rearrangements of the immunoglobulin heavy-chain gene strongly suggesting a B-lymphocyte origin. Our results provide additional evidence that malignant angioendotheliomatosis is an intravascular malignant lymphomatosis.

Entero-endocrine cell differentiation in carcinomas of the gallbladder and mucinous cystadenocarcinomas of the pancreas

Forty two carcinomas of the gallbladder and 25 mucinous cystadenocarcinomas of the pancreas were analyzed using silver stains and immunohistochemical techniques. Fourteen (33.3%) gallbladder carcinomas had argyrophil and argentaffin cells and 17 (40%) contained endocrine cells as shown by immunoperoxidase stains. The gallbladder tumors that had the largest number of endocrine cells were the well differentiated adenocarcinomas with colonic features. The most common endocrine cell in these tumors was the serotonin-containing (EC) cell followed by somatostatin-containing cells and cells that reacted to pancreatic polypeptide and gastrin. Intestinal metaplasia with pseudopyloric gland hyperplasia was present in the gallbladder mucosa adjacent to 11 carcinomas and had an endocrine cell population similar to that of the tumors. Endocrine cells were demonstrated in 18 (70%) of the 25 mucinous cystadenocarcinomas of the pancreas by the immunoperoxidase method although only 9 had argyrophil and argentaffin cells. The population of endocrine cells in these mucinous pancreatic tumors was similar to that found in gallbladder carcinomas. Endocrine cells were more numerous in areas with colonic-type glands, goblet cells and Paneth cells. The secretory products of the endocrine cells in these gallbladder and pancreatic tumors did not give rise to systemic endocrine manifestations. The presence of endocrine cells in these tumors can be explained on the basis of intestinal differentiation.

Quantitation of S100 protein-positive cells in inflamed and non-inflamed keratoacanthoma and squamous cell carcinoma

Langerhans cells (LC) were identified and quantitated in non-inflamed keratoacanthoma (KA), inflamed KA, non-inflamed squamous cell carcinoma (SCC), and inflamed SCC, by their content of S100 protein. The number of LCs per high-power field was markedly increased in inflamed KA when compared to the other groups. Using similar methods on frozen sections, the expression of HLA-DR was identified on keratinocytes in KA in areas of inflammation but not in other lesions under study. We hypothesize that increased numbers of LCs in inflamed KA are part of the process which results in tumor regression.

Monoclonal antibody ERY-1 identifies an antigen in erythroid cells, hepatocellular and renal cell carcinomas

We have identified a monoclonal antibody (ERY-1), which reacts with erythrocytes, erythroid precursor cells, and with embryonal yolk sac, and normal liver and kidney. The antibody also decorates the neoplastic cells of hepatocellular, renal, and yolk sac carcinomas. No reactivity was seen in a variety of other epithelial or mesenchymal neoplasms. It is possible that ERY-1 recognizes an erythropoiesis-associated antigen present in yolk sac, kidney, liver, and bone marrow, all of which are involved in erythropoiesis in various stages of human development. Furthermore, ERY-1 has proved to be extremely useful in the histopathologic diagnosis of hepatocellular and renal cell carcinomas.

Generation of multiple monoclonal antibodies for diagnostic use from a single hybridoma fusion

BALB/c mice were exposed simultaneously to three nonrelated immunogens, myelin basic protein, uridyl-galactosyl transferase, and tissue obtained from a formalin-fixed, paraffin-embedded block containing a pilomatrixoma. Standard hybridoma techniques were used and antibody generation assayed using an unlabelled antibody biotin-avidin method with sections of human cerebellum, liver, and pilomatrixoma as the substrates. Using the above assay, clones were selected that secreted antibodies with selective specificities for each of the immunogens. By ELISA assay, the monoclonal antibodies reacting with cerebellum also reacted to the myelin basic protein preparation used as immunogen and the monoclonal antibody reacting to hepatocytes bound to the preparation of uridyl-galactosyl transferase used as immunogen. Our data suggests that the generation of monoclonal antibodies with a variety of diagnostic applications can be obtained from a single fusion following immunization with multiple nonrelated antigens, requiring considerably less laboratory cost and effort than would be required to obtain similar monoclonal antibodies in separate fusions.

Mucinous cystadenocarcinoma of the pancreas. Morphologic and immunocytochemical observations

Twenty mucinous cystadenocarcinomas of the pancreas, most of which occurred in the tail of the pancreas in middle-aged women, were examined histologically and by immunohistochemical stains. Thirteen tumors displayed a marked histological heterogeneity and expressed intestinal differentiation as shown by the colonic appearance of the glands both at the light- and electron-microscopic levels. Other intestinal features included varying numbers of goblet cells, argyrophil and argentaffin cells, and even Paneth cells. By immunohistochemistry, endocrine cells were present in 13 of the 20 tumors (65%) and were more numerous in the poorly differentiated than in the well-differentiated epithelial component of the tumors. Serotonin-containing cells were the most common endocrine cells, followed by somatostatin-containing cells and cells that showed immunoreactivity for pancreatic polypeptide and gastrin. However, none of the patients had clinical manifestations of carcinoid, somatostatinoma, or the Zollinger-Ellison syndrome. The findings support the hypothesis that mucinous cystadenocarcinomas of the pancreas arise from an "endodermal stem cell" that differentiates into cells with intestinal phenotypes.

Intestinal metaplasia of the gallbladder: a morphologic and immunocytochemical study

The morphologic spectrum of intestinal metaplasia was studied in 49 gallbladders that had been excised because of cholelithiasis. Based on the absence or presence of endocrine cells, the cases of intestinal metaplasia were arbitrarily divided into two groups. The gallbladders from the first group (26 cases) contained isolated or small clusters of mature goblet cells, while those from the second group (23 cases), in addition to the goblet cells, contained argyrophil and argentaffin cells and, less frequently, Paneth cells and gland-like structures similar to colonic crypts. Pseudopyloric glands and superficial gastric-type epithelium were present in both groups. Argyrophil cells outnumbered argentaffin cells by a ratio of 4 to 1. By immunocytochemical methods serotonin-containing cells were found to be the most common endocrine cells. Other endocrine cells showed immunoreactivity for somatostatin, cholecystokinin, gastrin, and pancreatic polypeptide. The presence of gut endocrine cells and Paneth cells in the pseudopyloric glands suggests that these glands are also an integral component of intestinal metaplasia of the gallbladder. The findings support the hypothesis that cholelithiasis induces the appearance of a stem endodermal cell that, in turn, may differentiate into cells with mature intestinal or gastric phenotypes.

S100-protein-containing dendritic cells in fetal and newborn epidermis and thymus

Skin and thymus were obtained from abortuses of varying ages and from neonatal autopsies to determine if S100-protein-containing dendritic cells were present. Using an unlabeled antibody peroxidase-antiperoxidase method, we could not detect these dendritic cells in epidermis prior to live birth, but did detect them at all fetal ages in thymus. Within 24 hours of live, full-term delivery, dendritic cells containing S100 protein were identified in epidermis.

Immunohistologic identification of fungi in systemic and cutaneous mycoses

Using specific antibodies and the peroxidase-antiperoxidase technique, we were able to demonstrate a variety of fungal organisms in smears and sections of formaldehyde-fixed, paraffin-embedded tissue. The procedure is simple, fast, and accurate and may be used as an alternative to, or in conjunction with, cultural methods to identify fungi specifically.

Intestinal-type adenocarcinoma of the gallbladder. A clinicopathologic study of seven cases

Seven examples of a distinctive morphological variant of well-differentiated adenocarcinoma of the gallbladder with intestinal features are reported. Four tumors were composed predominantly of goblet cells and absorptive columnar cells, two of which had, in addition, a few Paneth cells and neuroendocrine cells. Three neoplasms closely resembled colonic carcinoma, and one of these also contained neuroendocrine cells. Serotonin-immunoreactive cells were demonstrated in three of the seven intestinal-type adenocarcinomas, two of which also had cells that stained for somatostatin pancreatic polypeptide and cholecystokinin. Four adenocarcinomas were associated with cholelithiasis, and three with intestinal metaplasia of the uninvolved mucosa. Despite the well-differentiated character of all neoplasms and the deceptively benign microscopic appearance of two of them, three patients died with extension to the liver and metastasis. Of the two survivors, one had carcinoma in situ and the other had a carcinoma that extended only to the muscle layer of the gallbladder. The various cell phenotypes found in these gallbladder adenocarcinomas can be explained on the basis of intestinal differentiation.

Renal cell carcinoma complicating long-term dialysis: computed tomography-guided aspiration cytology

The diagnosis of renal cell carcinoma was established by computed tomography-guided aspiration in two small solid lesions occurring in end-stage kidneys. This represents a safe means of providing more specific information about the various lesions that specific information about the various lesions that frequently develop in chronic hemodialysis patients: complex cysts, adenoma, and renal cell carcinoma. The proposed conservative approach of simple observation of these lesions may be altered if a precise diagnosis is obtained. Computed tomography is considered the most reliable imaging modality for evaluation and guided aspiration.

Delineation of nevus cell nests in inflammatory infiltrates by immunohistochemical staining for the presence of S100 protein

Fifteen halo nevi were stained for the presence of S100 protein by an unlabelled antibody peroxidase-antiperoxidase method. S100 protein was clearly identifiable within nevus cell nests in the inflammatory infiltrate. The presence of this substance helped to identify nevus cells in dense inflammatory infiltrates and confirm the histologic diagnosis of halo nevus.

Vaginal cancer after hysterectomy for benign disease: value of cytologic screening

Of 87 patients who were treated at the author's institution for primary cancer of the vagina, 31 had undergone total hysterectomy for benign disease. In this group of 31 patients, vaginal bleeding was the most common presenting symptom, although there were eight patients who were entirely asymptomatic and were diagnosed on routine examination. The stage of cancer was more advanced in the symptomatic patients than in the asymptomatic patients. There were seven patients with stage 0 disease, and four of these were asymptomatic and diagnosed by routine Papanicolaou smear. Overall, Papanicolaou smears were positive in 12 of 19 patients tested, a sensitivity rate of 63%. The authors recommend that patients who have a hysterectomy for benign disease continue to have Papanicolaou smears taken from the vaginal vault at regular intervals.

Papillomavirus common antigens. Papillomavirus antigen in verruca, benign papillomatous lesions, trichilemmoma, and bowenoid papulosis: an immunoperoxidase study

We surveyed a variety of papillomatous lesions, trichilemmoma, and bowenoid papulosis for the presence of papillomavirus common antigen using an unlabeled antibody peroxidase-antiperoxidase technique and an antibody against papillomavirus common antigen. Papillomavirus common antigen was detected in four of six verruca vulgaris lesions overlying the nuclei of koilocytotic cells. The antigen was observed much less often in the granular zone of verrucous lesions that did not contain koilocytotic cells. Thirteen of 18 lesions of bowenoid papulosis had positive immunostaining overlying occasional nuclei in the granular zone but the antigen was not detected in the granular zone of squamous cell carcinoma in situ or of trichilemmoma. These data support the hypothesis that some lesions of bowenoid papulosis represent a form of cutaneous infection by papillomavirus.

Prekeratin immunohistochemistry in the diagnosis of undifferentiated carcinoma of the nasopharyngeal type

We investigated the value of prekeratin immunostaining in establishing the diagnosis of undifferentiated carcinoma of the nasopharyngeal type (lymphoepithelioma). As in squamous cell carcinoma of the nasopharynx, all seven lymphoepithelial carcinomas stained for prekeratin whereas other look-alike but histogenetically different neoplasms (malignant lymphoma, esthesioneuroblastoma, and small round cell sarcomas) did not stain. In addition to confirming the squamous epithelial nature of lymphoepithelioma, our findings indicated that immunoperoxidase staining for prekeratin is a useful diagnostic tool in the differential diagnosis of nasopharyngeal carcinomas in general and lymphoepithelioma in particular.

Aspiration cytology of ovarian neoplasms. A review

Unlike other gynecologic tumors, which are accessible to inspection and biopsy, ovarian neoplasms are located within the pelvis or abdomen and are reachable only by laparoscopy or exploratory laparotomy. Because of its simplicity, fine needle aspiration cytology may be used as an alternative to surgical procedures. However, because of the great variety of tumor types in the ovary, cytologic interpretation of aspirates from that organ represents one of the most challenging fields in diagnostic cytology. Nevertheless, as clinicians become more experienced in using this technique and pathologists gain confidence in their ability to evaluate samples correctly, aspiration cytology may prove to be one of the most valuable and acceptable tools in the diagnosis of tumors of the female pelvis.

Immunoperoxidase staining of previously stained tissue

Using an unlabelled antibody peroxidase-antiperoxidase method, we have demonstrated that certain tissue antigens can be identified in tissue sections previously stained with hematoxylin and eosin. This technique is useful in identifying antigens in tissues where insufficient unstained material is available.