Malignant chondroid syringoma. Report of a case with widespread metastasis and review of pertinent literature

The authors report the autopsy case of a 73-year-old man with widespread, metastatic, malignant chondroid syringoma, with a long clinical history. Three years after resection of the primary tumor on the back, the tumor recurred at the same site, metastasized to the cervical lymph nodes 7 years later, and finally, after 13 years exhibited widespread metastases. Histologically, the tumor showed cords and nests of cuboidal or polygonal tumor cells with little cellular pleomorphism and few mitoses surrounded by a mucoid matrix. Histochemically, the matrix contained hyaluronic acid and sulfated acid mucopolysaccharides, such as chondroitin sulfate A and/or C. To the knowledge of the authors there have been nine reported cases of malignant chondroid syringoma in the English literature, four of which had distant metastasis. A review of the literature reveals that malignant chondroid syringoma is more common in women and occurs most often in trunk and extremities, which is in contrast to its benign counterpart, its histologic appearances vary greatly, and it may even have benign appearances.

An unusual case of metaphyseal chondrodysplasia with an abnormal perilacunar matrix associated with agranulocytosis and hypoplasia of the thymus

We report herein an unusual skeletal dysplasia in a 6-month-old boy characterized by metaphyseal dysplasia associated with agranulocytosis and hypoplasia of the thymus. A radiological survey revealed generalized metaphyseal abnormalities showing widening and increased density. Pathological changes in the chondro-osseous tissues were unusual and distinctive. There was widespread evidence of abnormal chondrocytes with an abnormal perilacunar matrix containing a PAS-positive, diastase resistant substance. Chondrocyte maturation and regular columnar arrangement were absent in most growth plates with only scattered ball-like nests of chrondrocytes showing incomplete maturation. This case is a newly described form of osteochondrodysplasia.

[A case of intracranial germinoma with multiple remote metastases (author's transl)]

A case of suprasellar germinoma with multiple remote metastases was reported including its autopsy findings. Several series of radiation therapy and prolonged steroid administration were considered to be causes of immunosuppression bringing about such metastases. A 29-year-old man had undergone a suprasellar germinoma removal and 5,200 rad of postoperative local irradiation at a university hospital 5 months prior to the admission to our clinic. A walnut-sized left cerebellopontine angle mass was subtotally extirpated by us, which proved to be germinoma. Total dosis of 5,5550 rad with lineac was applied locally to the operated site. Since the second surgery, several nodules had been seen in the lumbosacral region, scalp and left cervical region, which were individually treated with lineac and beta-tron by 5,000, 6,000 and 4,750 rad. The patient had been on steroid substitution therapy for hypopituitarism since the first operation. Eventually the patient expired 9 months after the second operation. Autopsy findings included multiple metastases to the spinal arachnoid, dura, extradural space, spines, scalp, thoracic cage, lymph nodes, heart, lungs, liver, kidney, adrenal and pancreas. Nine cases including ours were reviewed as remote metastases of the tumors in the pineal region and of so-called ectopic pinealomas. The cases of only subarachnoid seeding of these were excluded in this study.

Peliosis hepatis. An unusual case involving multiple organs

The case is that of a 70-year-old Japanese male who had peliosis hepatis with disseminated peliotic lesions in various organs. The initial sign was spontaneous pneumothorax followed by pulmonary hemorrhage. There was no history of anabolic steroid ingestion and his history of pulmonary tuberculosis revealed no pathological changes. Autopsy findings suggested that dilatation of sinusoids with slow progressive injury of sinusoidal endothelium and hepatocytes due to unknown local and general etiologic factors may be an initial mechanism in the development of peliosis hepatis.