Pleomorphic adenoma with nuclear palisading arrangement of modified myoepithelial cells: histopathologic and immunohistochemical study

Pleomorphic adenomas with a nuclear palisading arrangement of spindle-shaped modified myoepithelial cells (MMCs), suggesting the appearance of palisading leiomyoma or Antoni's A type of neurilemmoma, are quite rare, and its cytologic nature has been poorly understood. This paper reports histologic and immunohistochemical findings of palisading MMCs in two cases of pleomorphic adenoma. Histologically, foci of spindle-shaped MMCs with nuclei in a palisading arrangement were scattered in the myxoid areas. Near the large foci of spindle-shaped MMCs with nuclear palisading arrangements, tiny foci of spindle-shaped MMCs forming nuclear palisading or rosette-like arrangements were seen. Such nuclear palisading arrangements of MMCs were suggestive of differentiation or transformation of MMCs into cells that were more smooth muscle in nature, supported by occasional existence of palisading leiomyoma in the myometrium and gastrointestinal tract. However, immunohistochemical findings of palisading MMCs in pleomorphic adenoma were similar to those of non-palisading MMCs, and showed no evidence of smooth muscle differentiation; neither palisading nor non-palisading MMCs in pleomorphic adenoma expressed desmin, muscle specific actin (HHF-35), alpha smooth muscle actin, or myoglobin. The biologic significance and formative mechanism of nuclear palisading arrangement of MMCs in pleomorphic adenoma could not be determined in the present study. However, if the MMCs with nuclear palisading arrangements in pleomorphic adenoma, presented here, are aspirated for cytologic diagnosis or are included in a small biopsy specimen, the correct diagnosis of pleomorphic adenoma may be confused by a suspicion of myogenic or neurogenic tumor.

Allogeneic peripheral blood stem cell transplantation for the treatment of refractory follicular lymphoma

A 38-year-old male with follicular lymphoma at clinical stage IV failed to achieve complete remission (CR), and developed leukemic change. After the patient was further treated with intensive chemotherapy for acute lymphoblastic leukemia, lymphoma cells in the peripheral blood and bone marrow disappeared, but the bulky mass persisted. Then, the patient received allogeneic peripheral blood stem cell transplantation (allo-PBSCT) from his human lymphocyte antigen (HL A)-identical brother following high-dose cyclophosphamide and 12 Gy total body irradiation, and the patient achieved CR with the disappearance of Bcl-2 rearrangement. The patient is now alive in continuous CR for more than 19 months after allo-PBSCT.

Connexins in the developing salivary glands

Freeze-fracture and immunohistochemistry were used to elucidate the ultrastructure of gap junctions and the expression of connexins (gap junction structural proteins) Cx32 and Cx43 in the developing rat submandibular glands. Developing rat submandibular glands were examined from the 17th gestational day to the 14th day after birth. Gap junctions could be observed as clusters of particles 9-12 nm in diameter during the gestational days. The junctions were very small and consisted of about 20 particles in a relatively regular arrangement with a wide center-to-center spacing of 15-18 nm on the PF face. Fluorescence spots reacting positively to Cx43 were found between glandular cells from the 17th gestational day. Very few spots positive to Cx32 could be detected during gestation, their numbers increasing after birth. The possibility that Cx32 may have a role in the establishment of secretory regulation and that Cx43 is associated before birth with glandular growth and differentiation is discussed.

A study of the proliferative activity of the long junctional epithelium using argyrophilic nucleolar organizer region (AgNORs) staining

The proliferative activity of the long junctional epithelium (LJE) in rats was examined using stains for argyrophilic proteins of the nucleolar organizer region (AgNORs protein). The LJE was experimentally produced by insertion of a rubber piece between maxillary molars for 1 wk. After removal of the rubber, the length and AgNORs parameters of the LJE were measured and analyzed statistically. The LJE widely covered the apical side of the exposed root surface 4 wk after the removal. Its length was longest after 4 and 8 wk; it became shorter subsequently. The AgNORs were visible as black dots of various sizes and numbers on the sections. A high potential for proliferation was obvious in the LJE after 4 wk and was maintained until 12 wk after the removal. The AgNORs ratio on the connective tissue interface of the LJE was about twice of that of normal junctional epithelium after 4-12 wk. The proliferative activity on the root surface side was slightly increased after 4 wk. There was no significant difference in proliferative activity between the coronal and apical sides. These results suggest that the proliferative activity of the LJE is maintained continuously at a high level on the connective tissue interface supplying the epithelial cells. Basal cells proliferate at the connective tissue interface of the LJE, migrate directly to the root surface or via the apical portion and finally desquamate from the surface of the epithelium.

An immunoelectron microscopic localization of noncollagenous bone proteins (osteocalcin and osteopontin) at the bone-titanium interface of rat tibiae

This study was designed to investigate by postembedding immunogold method the localization and distribution of osteocalcin (Ocl) and osteopontin (Opn) at the bone-titanium interface in rat tibiae 14 and 28 days postimplantation to determine which bone proteins are present at this interface. Both proteins were widely distributed on the newly formed bone and accumulated predominantly in the region of bone close to the titanium, in electron-dense patches in the bone, and at the osteocytic lacunae. Collagenous osteoid showed little or no labeling for either Ocl or Opn. An amorphous zone (20-50 nm) was interposed between the titanium and interfacial slender cells, osteoid, or bone, and was labeled strongly for Ocl but only weakly for Opn. Furthermore, a second electron-dense layer, the lamina limitans, which faces the titanium, was labeled strongly for Opn but weakly for Ocl. Ocl as a marker protein of osteoblasts was sometimes found in the granules and vesicles of the interfacial cells and extracellularly in their intercellular spaces, close to the titanium. However, Opn was not detected in any granules. This is the first report to show that the amorphous zone contains large amounts of Ocl and small amounts of Opn, and that bone contacts titanium through this Ocl-rich amorphous zone. Furthermore, it is suggested that the interfacial cells seem to be osteoblasts, and that Ocl in the amorphous zone is produced and secreted by these cells and functions with Opn as a regulator of the mineralization front close to the titanium, and as a mediator of cell-matrix and matrix-matrix/mineral adhesion along the titanium.

Basaloid-squamous cell carcinoma of the oral mucosa: report of two cases and study of the proliferative activity

Two cases of basaloid-squamous cell carcinoma (BSC) of the oral mucosa are described. The first case occurred at the floor of the mouth in a 58-year-old man, and the second case occurred at the mandibular gingiva in a 79-year-old woman. The laboratory data of the first case showed a positive response to hepatitis C virus antibody. In the first case, the tumor mass measured 4 x 4 cm in size, and was located at the lingual side of the median mandible beside the sublingual gland. In the second case, the tumor mass measured 25 x 15 mm in size, and was located in the alveolar mucosa of the right mandible. Histologically, both tumors showed a neoplastic epithelium arranged in a solid pattern with evidence of peripheral palisading, central necrosis, and some squamous differentiation. The proliferative activities of the BSC were compared with conventional squamous cell carcinomas (SCC) in the oral floor and gingiva, respectively, by employing a sensitive argyrophilic nuclear organizer region (AgNOR) staining method. The number of AgNOR per nucleus of the BSC was higher than that of any other SCC cases. The results support the opinion that BSC of the oral mucosa has a worse prognosis than conventional SCC.

An immunocytochemical study for lysosomal cathepsins B and D related to the intracellular degradation of titanium at the bone-titanium interface

The morphological relationship between titanium and lysosomal proteinases, cathepsins B and D, at the bone-titanium interface using titanium-coated plastic implants placed for 28 days in the tibiae of 6-week-old rats was immunocytochemically investigated by the colloidal immunogold-silver method. Under light microscopy the titanium layer appeared to make direct contact with the bone and one or a few layers of slender cells were interposed between the bone and titanium. Ultrastructurally, the titanium came in contact with the bone or the slender cell layer through a 20 to 40 nm thin amorphous zone. The slender cells at the bone-titanium interface consisted of two types; one was an osteoblast type with glycogen granules which was found along the newly-formed bone facing titanium layer. The other was a fibroblast type which came in contact with the titanium layer and occasionally endocytosed the detached titanium fragments. In addition, some of the slender cells also showed degenerative changes. Immunocytochemically, cathepsins B and/or D were sometimes colocalized in some phagolysosomes with titanium fragments. These findings suggested that the fibroblast types at the bone-titanium interface may act as scavengers to remove both cell debris and titanium by means of some endocytotic ability, and lysosomal cathepsins also developed in response to the endocytosed titanium. The osteoblast type also appears to show a high degree of osteogenic activity around the titanium-coated plastic implants.

[A 10-year-old case with idiopathic oculomotor nerve palsy]

We reported a 10-year-old girl with acquired left oculomotor nerve palsy. Neurologic and radiological examinations failed to reveal the etiology. Following administration of corticosteroid and vitamin B6, diplopia improved within 6 weeks, and mydriasis has been improving over the past 9 months. Idiopathic acquired oculomotor nerve palsy is a very rare condition in childhood, and prognosis of the disease is sometimes good.

Role of sympathovagal balance in the initiation of idiopathic ventricular tachycardia originating from right ventricular outflow tract

VT originating from the right ventricular outflow tract (RVOT) is prone to occur when sympathetic nervous activity is increased. beta-Blockade is, therefore, effective in suppressing this VT. The purpose of this study was to determine the role of sympathovagal balance assessed by heart rate variability (HRV) in the spontaneous initiation of repetitive premature ventricular contractions (PVCs) and VT (five or more consecutive PVCs) arising from RVOT in seven patients without structural heart diseases. Frequency-domain measures of HRV were determined by analyzing 24-hour Holter electrocardiographic recording with the maximum entropy method over a 1,280-second period immediately before the onset of 35 single PVCs, 26 episodes of 2-4 consecutive PVCs, and 21 episodes of VT. High frequency component (HF: 0.15-0.40 Hz) was used as an index of parasympathetic activity, and the ratio of low frequency component (LF: 0.04-0.15 Hz) to HF (LF/HF ratio), as an index of sympathovagal balance. NN50(%), a time-domain variable of parasympathetic activity, was also determined. Mean RR interval and any measures of HRV did not change significantly before single PVCs. Mean RR interval shortened and HF decreased prior to repetitive PVCs and VT. The LF/HF ratio, however, increased only before the onset of VT. NN50(%) tended to decrease before repetitive PVCs and decreased significantly before VT. With propranolol (30-60 mg/day), frequency of repetitive PVCs was suppressed from 2,048 +/- 1,201 to 746 +/- 658/day and VT was totally abolished, but frequency of single PVCs did not change significantly. In conclusion, sympathetic predominance plays an important role in the initiation of repetitive PVCs and VT originating from RVOT in patients without structural heart diseases.

Single-trial analysis of P3 in patients with generalized epilepsy

The latencies and amplitudes of averaged P3, and the latencies, amplitudes and frequency components of single EEG responses to target tones were analyzed in 9 control subjects (CS group), 6 epileptics whose mean IQ was 100 (EP group) and 6 epileptics whose mean IQ was 52 (RE group), using an auditory oddball task. All of the subjects responded to the target tones correctly and there were no differences in the incidence of error in response to the target tones, or in the latencies and amplitudes of the averaged P3 among the three groups. However, the reaction times (RTs) in the RE group were significantly longer than those in the other groups (P < 0.05). Single EEG responses to target tone (single-trial ERPs) were classified into 2 types, those with and those without the P3 component. Type 1 had the P3 component and was observed in 42% of all of the responses in the RE group, significantly less than those in the CS (64%) and EP (61%) groups. The peak latencies of P3 in type 1 were similar among the three groups, but the amplitudes of P3 in type 1 in the RE group were significantly greater than those in the CS and EP groups. RTs in the RE group were significantly longer than those in the other groups, and had no correlation with the P3 latencies of type 1. There was little difference in the results of the frequency analysis among the three groups. These results suggest that all subjects in three groups recognized the target tones correctly, but they did not evaluate every target tone, since the incidence of P3 was almost 60% in the CS and EP groups, and 40% in the RE group. The characteristics of cognition and evaluation in three groups were the same, but the decrease in incidence of evaluation and the dissociation between the cognition and the response execution might be caused by impairment of the subject-environment contact mechanism, which resulted in the decrement of IQ in the RE group.

Immunolocalization of proliferating cell nuclear antigen in the peri-implant epithelium

The aim of the present study was to investigate the proliferating activity of peri-implant epithelium immunohistochemically using proliferating cell nuclear antigen (PCNA). Eight ITI (Internationale Team für Implantologie) implants were placed into simulated sockets in the mandibles of two beagle dogs two months following tooth extraction. As a control, junctional epithelium of the molar teeth in the same animals were used. The nature of staining and the distribution of PCNA immunoreactivity were determined by scoring a minimum of 100 cells on two sections from each of the implants. In the junctional epithelium, the immunoreactivity to PCNA was detected mainly in the basal cells, in some of the prickle cells, and in a few cells attached to the enamel. In peri-implant epithelium, only some of the basal cells were positive for PCNA. The PCNA score of the peri-implant epithelium was significantly lower than that of junctional epithelium. These results suggest that the peri-implant epithelium maintains a lower capacity to act as a proliferative defence mechanism than does the junctional epithelium.

Cell death during tooth eruption in the rat: surrounding tissues of the crown

We investigated the occurrence of apoptosis and other types of cell death around the crown during tooth eruption of the rat upper molar. The TdT-mediated-dUTP-biotin nick end labeling (TUNEL) method and transmission electron microscopy (TEM) were employed. Apoptosis was detected by both TUNEL and TEM in part of the reduced enamel epithelium and connective tissue in the resorbing bony crypt of the pre-erupted tooth. In TEM, a large number of cells showed condensed chromatin and membrane-bound small bodies (apoptotic bodies). Macrophages that phagocytosed apoptotic bodies could be detected. Based upon the distance between bone surface and these apoptotic cells, and the characteristics of their organelles, we suggested that the apoptotic cells might be osteocytes, bone-lining cells (osteoblasts), and macrophages. We surmised that the osteoclasts had also died. Cells which contained autophagic vacuoles and autophagosomes, and others whose cytoplasm had dissolved, were also frequently observed. No progressive cell death was found in the oral epithelium or the fibrous connective tissue over the crown. These results suggest that apoptosis gives rise to some cell death during tooth eruption, but that other types of cell death also occur in various cells.

Merkel cell carcinoma of palatal mucosa in a young adult: immunohistochemical and ultrastructural features

The first case report of a merkel cell carcinoma arising from the palatal mucosa in a young adult is presented. The histopathological similarities of this tumour in skin and oral mucosa are also discussed. The patient was a 14-year-old female with a non-symptomatic painful swelling in the left molar region of the maxilla. Under the diagnosis of a malignant tumour, a partial maxillary resection was performed, but there was a recurrence, and finally the patient died of cerebral metastasis. The tumor was composed mainly of uniform small cells. Immunohistologically, a large number of the cells were reactive to neuron specific enolase (NSE) and cytokeratin CK19, and some of the cells were positive to CK8, CK13, CK20, PGP9.5 and CEA focally and slightly. Pseudo-rosette formation and squamous differentiation were frequently detected. The ultrastructure of the tumour cells showed abundant Golgi bodies associated with neurosecretory granules. We conclude that it is the first case of a Merkel cell tumour arising from palatal mucosa and invading underlying bone with reactive hyperplasia. These findings closely resemble those of the same tumour occurring in the skin

Adenomatoid odontogenic tumor with extensive formation of tubular dentin

Although the adenomatoid odontogenic tumor (AOT) is categorized as an odontogenic epithelial tumor with odontogenic ectomesenchyme, AOT with induction of true tubular dentin with or without concomitant formation of enamel is exceedingly rare. This paper reports a case of AOT showing evidence of extensive induction of tubular dentin, but without concomitant formation of enamel. The patient was a 20-year-old female with a rather well-circumscribed intraosseous lesion of the maxillary incisor-premolar area without an embedded tooth. Histologically, extensive induction of a dysplastic form of tubular dentin with globular calcification was evident, in addition to the characteristic histological features of AOT. The present case lends support to the categorization of AOT as an odontogenic tumor consisting of a disorderly mixture of odontogenic epithelium and odontogenic ectomesenchyme with or without dental hard tissue formation.

Clear cell odontogenic carcinoma in the mandible: histochemical and immunohistochemical observations with a review of the literature

A rare case of clear cell odontogenic carcinoma was investigated using histochemical and immunohistochemical methods. The tumor occurred in the anterior mandible of a 69-year-old Japanese man. Histologically, the tumor was composed mostly of large clear cells and squamous cells. Columnar-shaped cells with basophilic nuclei polarized away from the basement membrane were observed at the periphery of the tumor foci. The tumor cells had aggressively invaded muscle and perineural tissues. The tumor cells were positive for PAS staining. Immunohistochemically, tumor cells reacted positively to keratin, cytokeratin19, epithelial membrane antigen, and S-100 protein. The tumor was diagnosed as a clear cell odontogenic carcinoma. Its characteristics are discussed in term of its histopathological, histochemical and immunohistochemical features.

Human gingival fibroblast migration promoted by platelet-derived growth factor on titanium is correlated with release of urokinase type plasminogen activator

The purpose of this study was to examine if the migration of human gingival fibroblasts on titanium was promoted by platelet-derived growth factor (PDGF) and whether the release of urokinase-type plasminogen activator (uPA) was correlated with it. The migration of the fibroblast on titanium was significantly promoted by PDGF in a wound healing assay (p < 0.001). The promotive effect was inhibited by aprotinin, a serine protease inhibitor used for the inhibition of uPA (p < 0.001). The conditioned medium when fibroblast migration was promoted contained a higher concentration of uPA than did that of the control. These results indicated that the promotive effect of PDGF on the migration of human gingival fibroblasts on titanium was correlated with the release of uPA from the fibroblasts.

Connexin expression in the salivary glands

To investigate the ultrastructure of gap junctions and functional differences between connexin (gap junction structural protein) 32 and 43 in the rat submandibular and sublingual glands, tracer and freeze-fracture methods were carried out, and the expression of both connexins was examined. In both glands, western blot analysis with anti-connexin 32 and 43 antibodies revealed bands of about 27kD and 43kD, respectively. Immunofluorescence showed the presence of connexin32-positive spots between acinar cells in both glands. In contrast, connexin43-positive spots were observed at the periphery of the acinar structures in either gland. Positive spots for both connexins could not be detected between ductal cells in both glands. By immunocytochemistry, connexin32 was found on the gap junctional membranes of acinar cells and connexin43 on the gap junctional membranes of myoepithelial cells. It is surmised that connexin32 of the gap junction is related to the secretory function of acinar cells and that connexin43 is associated with the contraction of the myoepithelial cells.

Differential expression of gap junction proteins connexin32 and 43 in rat submandibular and sublingual glands

We examined the expression and localization of the gap junction proteins connexin32 and 43 in rat submandibular and sublingual glands. Western blot analysis with anti-connexin32 and 43 antibodies showed bands of approximately 27 KD and 43 KD, respectively, in both glands. Immunofluorescence microscopy demonstrated the presence of reactive spots for connexin32 between acinar cells in both glands. The frequency of connexin32-positive spots in the submandibular glands was approximately equal to that in the sublingual glands. In contrast, reactive spots for connexin43 were observed at the periphery of the alveolar structures in both glands. The connexin43-positive spots in the sublingual glands were more frequent and larger than those in the submandibular glands. No positive spots for both connexins were detected between duct cells in either gland. Immunoelectron microscopy revealed that connexin32 was localized to the gap junctional membranes between acinar cells. Immunolabeling for connexin43 was located on the gap junctions between thin processes of myoepithelial cells. These results suggest that connexin32 of the gap junction is associated with regulation of the secretory function of acinar cells and that connexin43 is associated with that of contraction of the myoepithelial cells in rat salivary glands.

Left ventricular dimensions and autonomic balance during head-up tilt differ between patients with isoproterenol-dependent and isoproterenol-independent neurally mediated syncope

OBJECTIVES

This study sought to elucidate differences in mechanisms of neurally mediated syncope between patients with syncope induced by head-up tilt alone and those requiring isoproterenol infusion to induce syncope during head-up tilt.

BACKGROUND

Some patients with neurally mediated syncope require isoproterenol to induce syncope during head-up tilt (isoproterenol dependent), and others do not (isoproterenol independent). Differences in mechanisms between these two groups have not been well elucidated.

METHODS

A 60 degrees head-up tilt test was performed in 13 patients with isoproterenol-independent syncope (Group I, mean [+/- SD] age 28 +/- 12 years), 14 patients with isoproterenol-dependent syncope (Group II, mean age 34 +/- 14 years) and 20 control subjects without syncope (Group III, mean age 32 +/- 12 years). Left ventricular size and contractility were determined by echocardiography, and sympathovagal balance was determined with power spectral analysis of heart rate variability using a maximal entropy method.

RESULTS

Group I patients had smaller left ventricular dimensions than Group II and III during baseline tilt. During head-up tilt with isoproterenol infusion (0.01 to 0.04 microgram/kg body weight per min), left ventricular dimensions decreased to the same extent in Groups II and III, but fractional shortening was greater in Group II than in Group III at the end of the tilt. The ratio of low (0.05 to 0.15 Hz) to high frequency (0.15 to 1.0 Hz) component became greater in Group I than in Groups II and III during the last period of baseline tilt. However, the ratio was greater in Group II than in Group III during the last period of the tilt with isoproterenol.

CONCLUSIONS

Patients with isoproterenol-independent syncope had an exaggerated decrease in left ventricular size and sympathetic predominance preceding syncope during head-up tilt. In contrast, in patients with isoproterenol-dependent syncope, similar changes in autonomic nervous balance were evident only during isoproterenol infusion in addition to head-up tilt.

Laminin localization and gelatinolytic activity of epithelial rest of Malassez grown on titanium

The purpose of this study was to examine laminin localization in epithelial rests of Malassez grown on titanium and their gelatinase activity. Laminin localization was confirmed by immunocytochemistry in all epithelial cells grown on titanium. The conditioned medium from the epithelial cells grown on titanium exhibited 72kD- and 92 kD-gelatinase activities by gelatin zymography. Those results suggest that laminin contributes to the epithelial cell attachment to titanium and that gelatinases may be mobilized for epithelial cell movement on titanium.

Electrophysiologic effects of intravenous E-4031, a novel class III antiarrhythmic agent, in patients with supraventricular tachyarrhythmias

The electrophysiologic effects of intravenous (i.v.) E-4031, a new class III antiarrhythmic drug, were evaluated in 15 patients with supraventricular tachyarrhythmias [11 men, 4 women; mean age 41 +/- 19 (SD) years]. Eleven patients had accessory atrioventricular (AV) pathways, and 4 patients with no accessory pathway had paroxysmal atrial fibrillation. Electrophysiologic studies were performed before and after E-4031 administration (loading infusion 9 micrograms/kg for 5 min + maintenance infusion 0.15 microgram/kg/min). QT and QTc intervals were significantly prolonged by E-4031 from 0.40 +/- 0.03 (mean +/- SD) to 0.46 +/- 0.03 s (p < 0.0001) and from 0.43 +/- 0.03 to 0.49 +/- 0.04 s (p < 0.0001), respectively. No effect was observed on RR interval, PR interval, QRS duration, or AH and HV intervals. The effective refractory periods (ERPs) of the right atrium and ventricle were significantly prolonged from 219 +/- 27 to 236 +/- 26 ms (p < 0.001) and from 230 +/- 12 to 249 +/- 11 ms (p < 0.001), respectively. The ERP of the AV node did not change significantly after E-4031 administration. In patients with ventricular preexcitation, E-4031 significantly prolonged the ERP of the antegrade accessory pathway conduction from 340 +/- 101 to 362 +/- 106 ms (p < 0.001), but not retrograde accessory pathway conduction. AV reentrant tachycardia was induced in 3 of 11 patients with an accessory pathway, and repetitive atrial firing was induced in 3 of 4 patients with paroxysmal atrial fibrillation. E-4031 could prevent repetitive atrial firing in only 1 patient and could not prevent induction of AV reentrant tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

An experimental study of osteogenesis by autografted dental pulp, periodontal ligament, and bone marrow in vivo

Osteogenic activity of autografted dental pulp, periodontal ligament, and bone marrow of rat in vivo was investigated. Immunolocalization of ALPase in situ was also studied. One month after the transplantation, osteodentin was formed in all the dental pulp transplants (100%), bone or cementum like tissues were created in 20% of periodontal ligament transplants, and bone like tissues were in 20% of bone marrow transplants. After two months, osteodentin was produced in all the dental pulp transplants (100%) and bone like tissue were in 50% of both periodontal ligament and bone marrow transplants. Immunohistochemically, positive reactions to ALPase in situ were detected in cells just below the odontoblast layers in dental pulp, surface layers of alveolar bone in periodontal ligament, and endosteal membrane of bone marrow space. From these results, it was suggested that the cells of these three kinds of tissue can be termed osteogenic-fibroblasts in vivo.

Large cyst formation in pleomorphic adenoma

The aim of this study was to examine about the etiology of large cyst formation in pleomorphic adenoma from the histopathological standpoint by examining four cases of our own as well as previously reported ones. In the first of our cases, a large cyst wall lined with keratinized squamous epithelium was observed. In the second, a large cyst containing mucinous material was lined with a single cell layer of squamous epithelium-like cells. The third case was a carcinoma in pleomorphic adenoma with some large cysts lined with multiple layers of atypical epithelial cells. In the fourth case, a hemorrhagic portion were seen on a large cyst wall without a lining of epithelial cells. From these histopathological observations and the suggestions of previous authors, we surmised that the large cyst formation in pleomorphic adenoma might originate from the squamous metaplasia of tumor cells and the enlargement of duct-like structures by outstanding secretion from tumor cells or salivary gland tissues, hemorrhagic portions, or necrosis in the malignant tumor.