Extraskeletal myxoid chondrosarcoma in young children

Two extraskeletal myxoid chondrosarcomas with a solid soft tissue mass occurred on the right upper arm of a 4-year-old boy and on the chest wall of a 1-year-old boy. Microscopically, both tumors were characterized by lobular configuration and were sparsely cellular with a background of myxoid matrix. The cells were small and round, and appeared undifferentiated, sometimes with a narrow eosinophilic cytoplasm. They grew in nests or strands and sometimes in a single file. They were strongly positive for S-100 protein and vimentin. Ultrastructural features suggested that the cells had a poorly differentiated mesenchymal nature with chondrocytic differentiation. These are the sixth and seventh reported cases of extraskeletal myxoid chondrosarcoma occurring in children. There are definite differences between this tumor with immature features and the extraskeletal myxoid chondrosarcoma in adults. Problems of differential diagnoses from other small round cell sarcomas also are discussed.

Adenomatoid tumor of the ovary: an immunohistochemical and ultrastructural study

A rare case of adenomatoid tumor arising in the ovary is presented. At autopsy on a 61-year-old woman, a soft, solid and cystic tumor, measuring 0.8 X 0.7 cm, was detected in the hilus of the left ovary. Light microscopic study showed characteristic features of adenomatoid tumor. Alcian blue stain, with and without hyaluronidase pretreatment, revealed the presence of hyaluronic acid on the luminal surface and in the vacuoles of the tumor cells. Immunohistochemical stains of tumor cells were positive for low-molecular-weight cytokeratin (PKKL), vimentin, and carbohydrate antigen (CA) 125, whereas they were focally positive for high-molecular-weight cytokeratin (34 beta E12). They were negative for factor VIII-related antigen (FVIII-RAG), Ulex europaeus I lectin (UEA I), carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA). Ultrastructural studies disclosed surface microvilli and bundles of tonofilaments. These observations strongly support the idea of this tumor being of mesothelial origin.

Hemangiopericytoma of the meninges: a clinicopathologic and immunohistochemical study

This clinicopathologic study concerns 15 cases of hemangiopericytoma of the meninges (so-called hemangiopericytic meningioma) among approximately 300 examined cases. Ages of the patients at the first surgery ranged from 25 to 67 years, with a median of 44 years. According to follow-up information, 9 of the 15 died between 1 year and 15 years after the initial treatment. Histologically, the tumor was indistinguishable from the hemangiopericytomas in other tissues and was characterized by a homogeneous vascular pattern, a uniform cell population and a wide range of cellular anaplasia. The presence of prominent mitotic activity suggested a highly active biological behavior. Immunohistochemical analyses for epithelial membrane antigen (EMA) were done in 35 various meningiomas, 12 meningeal hemangiopericytomas, and three extracranial hemangiopericytomas. Most of the meningiomas of meningotheliomatous, transitional, fibroblastic, papillary, angiomatous, and anaplastic types showed a positive immunoreactivity for EMA, while all of the meningeal hemangiopericytomas and extracranial hemangiopericytomas examined were negative for EMA. Our immunohistochemical study may support the concept that the meningeal hemangiopericytoma is composed of poorly differentiated cells which may originate from a perivascular mesenchymal cell of the meninges but not from the arachnoidal cap cell.

Malignant fibrous histiocytoma of soft parts: an ultrastructural quantitative study

Thirty-two cases of soft tissue malignant fibrous histiocytoma (MFH), including 24 of common storiform-pleomorphic type, 7 of myxoid type, and 1 of inflammatory type, were analyzed in an ultrastructural quantitative study, the objective being to clarify the cellular composition and distribution of the tumor. Approximately 100 unselected cells in each tumor were classified into seven types as follows: undifferentiated (10%-62%, m: 29%), histiocytelike (8%-69%, m: 37%), fibroblastlike (0.9%-26%, m: 11%), myofibroblasts (0%-22%, m: 3%), intermediate between histiocytelike and fibroblastlike cells (1%-41%, m: 15%), multinucleated giant (0%-1%), and xanthomatous cells (0%-1%). The undifferentiated, histiocytelike, fibroblastlike, and intermediate cells constituted the principal types, invariably present, although in varying proportions in each tumor. No statistical difference in ultrastructural cellular composition was evident in different portions of the same tumor, and such was also the case between the two main subtypes of MFH, common and myxoid. Naphthyl thiol acetate (NTA) esterase was demonstrated in fibroblastlike cells, using the ultrastructural cytochemical technique, in both cases examined. The possibility that MFH may be of alternative undifferentiated mesenchymal cell origin has to be considered.

Epithelioid hemangioma versus Kimura's disease. A comparative clinicopathologic study

A clinicopathologic and immunohistochemical study of eight cases of epithelioid hemangioma and 11 cases of Kimura's disease was performed. Patients with epithelioid hemangioma (EH) ranged in age from 15 to 56 years (mean, 37 years) and had small papular or nodular lesions occurring most often on the face and scalp. The lesions were less than 2.0 cm in diameter. There were irregularly hypertrophic vascular structures with swollen endothelial cells and of a variable lymphoid infiltrate with eosinophils. The clustering of small vessels around the arteries or veins was another distinctive feature. Arteriovenous shunts were evident in three lesions. Patients with Kimura's disease, however, presented large solitary or multiple nodules occurring most commonly in the periauricular region. Six patients had a history of regional lymphadenopathy; three patients had eosinophilia of the peripheral blood. Microscopically, the distinctive features were of numerous lymphoid follicles and a salient eosinophilic infiltrate. These lymphoid follicles possessed distinct germinal centers and contained an increased number of dendritic cells. Although some small-vessel proliferation was noted, it was not as distinctive as for patients with epithelioid hemangioma. We conclude from this study that the two conditions should be considered different entities.

Epiphyseal osteosarcoma: distinguishing features from clear cell chondrosarcoma, chondroblastoma, and epiphyseal enchondroma

In a retrospective radiologic and histologic study of 286 osteosarcomas in files of a metropolitan hospital, four patients (three men and one woman) with osteosarcomas confined to the epiphysis were identified. In this series, there were also 16 metaphyseal osteosarcomas that extended to the epiphysis with penetration through the cartilaginous growth plate, a structure that ordinarily resists tumor growth. All tumors occurred in the femoral condyle. Characteristically, all four patients had histories of knee joint pain, and three reported antecedent trauma. Radiologically, the tumors showed predominantly lytic features. Histologically, three of the tumors were osteoblastic in type, and one was mostly chondroblastic. Purely epiphyseal osteosarcoma has overlapping radiologic features with clear cell chondrosarcoma, epiphyseal chondroblastoma, and epiphyseal enchondroma. The epiphyseal osteosarcomas of the distal femur reported here were characterized by a history of symptoms localized to the knee joint itself as a consequence of their epiphyseal location and joint involvement. This is in contrast to the usual metaphyseal osteosarcomas, which present with lower thigh pain and swelling. Because osteosarcomas may present as lytic tumors confined to the epiphysis, they should be included in the differential diagnosis of such lesions.

[An ultrastructural analysis of malignant soft tissue tumors]

The differential diagnosis of malignant soft tissue tumors constitutes a major problem in surgical pathology. A distinction among sarcomas is sometimes difficult, but this is a situation in which histologic examination of representative tissue will give a diagnosis in the majority of cases. Electron microscopy sometimes contributes to the proper diagnosis of sarcomas. For electron microscopy, fresh samples from 110 cases of sarcoma filed at the Department of Pathology, Faculty of Medicine, Kyushu University, were examined. The distinguishing ultrastructural appearance of the following tumors are discussed: Spindle cell sarcomas (leiomyosarcoma 10 cases, malignant Schwannoma 5, fibrosarcoma 5, monophasic synovial sarcoma 7). Round cell sarcomas (rhabdomyosarcoma 10 cases, extraskeletal Ewing's sarcoma 1, malignant neuroepithelioma 1, malignant rhabdoid tumor of soft parts 3, monophasic synovial sarcoma 9). Pleomorphic sarcomas (malignant fibrous histiocytoma 24 cases, pleomorphic liposarcoma 1). Myxoid sarcomas (myxoid malignant fibrous histiocytoma 8 cases, myxoid liposarcoma 8, extraskeletal myxoid chondrosarcoma 4). Sarcomas with a specific pattern. Using electron microscopy, general analysis of cellular morphology and detection of specific structures are helpful for evaluating these sarcomas. Nevertheless, poorly differentiated sarcomas may still pose a diagnostic dilemma, since their specific features are poorly represented.

Undifferentiated carcinoma of the lung with osteoclast-like giant cells

We treated a patient with undifferentiated carcinoma of the lung, with osteoclast-like giant cells resembling those of the giant cell tumor of bone. The clinical and morphologic characteristics of this case are documented, and the literature concerning this type of tumor is reviewed. The tumor differed histologically from the pleomorphic carcinoma, which occurs most commonly in the lung, and showed diverse pleomorphic manifestation with benign looking osteoclast-like multinucleated cells and bizarre giant cells. In addition, and undifferentiated carcinoma with a sarcoma-like appearance containing small areas of papillary adenocarcinoma was evident in the tumor.

Epithelial profile of epithelioid sarcoma. An immunohistochemical analysis of eight cases

Eight cases of epithelioid sarcoma were examined immunohistochemically, in order to clarify the adjunct epithelial profile of the tumor and to ascertain the intermediate filaments contained in the tumor cells. All tissues showed a strongly positive immunoreactivity for epithelial membrane antigen (EMA) and tissue polypeptide antigen (TPA). In the case of carcinoembryonic antigen (CEA), one showed a strong reaction, whereas the others were variably less stained. Cytokeratins (45 kd and 54 kd) specific for simple epithelia, including coelomic epithelium, were regularly found in all cases; a small number of cells were positive for high molecular weight cytokeratin (57 kd) and none for 66 kd cytokeratin. Coexpression of both cytokeratin and vimentin was confirmed using fresh-frozen materials. Therefore, both microscopic and immunohistochemical evidence supports the hypothesis that epithelioid sarcoma masquerades as a carcinoma.

The existence of rhabdoid cells in specified soft tissue sarcomas. Histopathological, ultrastructural and immunohistochemical evidence

We report the occurrence of rhabdoid cells in several specified soft tissue sarcomas of round cell variety. The rhabdoid cells had an acidophilic cytoplasm containing a globular perinuclear inclusion and were characterised ultrastructurally by the presence of aggregates of 10 nm intermediate filaments. These filaments contained both cytokeratin and vimentin, as demonstrated immunohistochemically. Extensive sampling of soft tissue sarcomas revealed the presence of such cells in different types of soft tissue round cell sarcomas as follows: 12 of 13 cases of epithelioid sarcomas, 8 of 13 synovial sarcomas (composed predominantly of round cells), 6 of 20 extraskeletal myxoid chondrosarcomas and 4 of 4 round celled malignant mesotheliomas. We wish to stress that the appearance of rhabdoid cells is not a monopoly of one particular type of tumour.

Renal cell carcinoma in Japanese children

Renal cell carcinoma in children is extremely rare compared to Wilms tumor. We report on a 7-year-old Japanese boy with left renal cell carcinoma. Since the disease was clinical stage I, nephrectomy with tumor extirpation was performed after a short course of initial chemotherapy had been administered. The patient is free of disease 3 years postoperatively. In a review of the Japanese literature we found 71 reports of renal cell carcinoma in children less than 15 years old. Mean patient age at occurrence was 8.1 years, there were no differences in regard to the sex or the affected side, and the most frequent symptom was the presence of a mass. We stress the early establishment of diagnosis in children with a persistent abdominal mass, hematuria and flank pain, since surgical treatment leads to a favorable prognosis only in the early stage of renal cell carcinoma.

Epithelioid hemangioendothelioma of bone. A clinicopathologic, ultrastructural, and immunohistochemical study

In a review of 29 cases of solitary and multicentric hemangioendothelial sarcomas of bone, 14 were found to have histologic features of epithelioid hemangioendotheliomas. These were characterized by the presence of epithelioid or "histiocytoid" endothelial cells that were either round or spindle-shaped. Intracytoplasmic vacuolization was noted, and some showed nesting of cells, mimicking metastatic adenocarcinoma. The presence of a myxoid matrix suggested the diagnosis of chondrosarcoma in some cases. Some of the tumors strongly resembled the lesions formerly designated as intravascular bronchioloalveolar tumor, angioglomoid tumor of bone, or malignant myxoid angioblastoma of bone. Factor VIII-related antigen was detected in five of the six cases examined, and ultrastructural study in five cases confirmed the endothelial nature of the tumor cells; Weibel-Palade bodies were present in three cases. There were 11 men and three women, and the tumors were seen predominantly in patients who were under 30 years of age (10 cases). Four cases involved solitary tumors, and nine were multicentric in bone. The multicentric tumors had a predilection for the bones of one lower extremity (five cases). The total series had a protracted clinical course, and the multicentric tumors appeared to follow a less aggressive course.

Intramuscular myxoma. A clinicopathologic, immunohistochemical, and electron microscopic study

This clinicopathologic study concerns 17 cases of intramuscular myxoma, including an immunohistochemical survey of 10 cases and an electron microscopic examination of 4. There was a female preponderance in a ratio of 14:3. The most common sites of tumors were the large muscles of the thigh (seven cases), followed by those of the buttock (three) and the lower leg (three). The size of the tumor ranged from 1.5 to 20 cm (median, 6 cm) in the greatest diameter. Neither recurrence nor metastasis was seen in any of 15 patients for whom information was available. In addition to the conventional microscopic features, such as hypocellularity, absence of a plexiform capillary network, and no detection of typical glycogen-rich lipoblasts, the following findings were regarded as helpful to differentiate an intramuscular myxoma from myxoid liposarcoma: hypovascularity of the tumor, demonstrated by angiography; a homogeneous computed tomography appearance with low density, absence of S-100 protein immunoreactive cells such as lipoblasts; and electron microscopically, the constituent cells were predominantly fibroblast-like cells with a prominent secretory activity, together with a small number of primitive mesenchymal cells and histiocyte-like cells, but with no lipoblasts. After simple excision, the 15 patients who could be followed are well with no recurrence during various periods of follow-up.

Leiomyosarcoma of the external soft tissues. A clinicopathologic, immunohistochemical, and electron microscopic study

This clinicopathologic study concerns 25 cases of leiomyosarcoma of the external soft tissues, including an immunohistochemical survey of 19 cases and an electron microscopic examination of six. There was a female preponderance in a ratio of 16:9. The most common site of tumors was the thigh (nine cases), followed by the knee (five cases). Three tumors were located in the dermis, 9 were confined down to the subcutis, 2 involved the deep fascia, and 11 involved the skeletal muscle. Superficially located tumors were smaller than deeply located ones. According to the predominant histologic features, the tumors were classified into well (6), moderately (14), and poorly (5) differentiated. In addition to the classical microscopic features, dedifferentiated areas resembling malignant fibrous histiocytoma were noted in three primary tumors and one recurrent tumor. In six tumors, the anatomical location and histologic features were highly suggestive of leiomyosarcoma arising in the venous wall. Many tumor cells immunoreactive for actin were seen in 13 and for desmin in 9 of the 19 cases. Four tumors contained a few tumor giant cells positive for alpha-1-antichymotrypsin. Ultrastructurally, the tumors were characterized by smooth muscle tumor cells showing a spectrum of differentiation of varying degrees. In two cases, histiocyte-like tumor cells were detected. The most reliable prognostic parameter was the depth of the initial tumors; all patients with a leiomyosarcoma confined down to the subcutis are living, most of them more than 5 years after excision, whereas seven of the nine patients with a tumor involving the muscle have died within 5 years after excision.

Giant-cell reparative granuloma of the thoracic vertebra

Giant-cell reparative granuloma occurring in the thoracic vertebra of a 16-year-old girl is presented, and the literature concerning the subject is reviewed. This report is of the second documented case with this essentially rare lesion arising in the vertebra. Microscopically, the lesion was characterized by a reactive granulation tissue with formation of reactive osteoid, collagenization and vascularization, and focal accumulations of giant cells, particularly around hemorrhagic portions. The patient is doing well without further recurrence 38 months after the second therapeutic curettage. The authors describe the clinicopathologic features of this particular case because of its rarity in location, and briefly discuss the difference from other giant-cell lesions of bone mainly in view of differential diagnosis.

Giant cell tumor of the tendon sheath (nodular tenosynovitis). A study of 207 cases to compare the large joint group with the common digit group

Clinicopathologic, enzyme histochemical, and electron microscopic findings in 207 cases (208 lesions) of giant cell tumor of tendon sheath (GCTTS) are presented. The GCTTS could be divided into two groups according to the anatomic location, the first occurring in the digits (digit group, 182 cases) and the second, in the larger joints (large joint group, 25 cases). In the majority of cases of the digit group, the tumor occurred in one of the fingers (158 cases), whereas in the large joint group, the tumor was common in the ankle (10 cases) and knee joints (8 cases). The lesion was more common in women (67%) than in men (33%). Microscopically, the GCTTS in both groups consisted of a mixture of abundant histiocyte-like, foam, and multinucleated giant cells of the osteoclast type. However, worthy of special mention were the large clefts or wide pseudoglandular spaces lined by synovial cells and that were more striking in the large joint group than in the conventional digit group. The component cells had functional properties of macrophages, as determined in the enzyme histochemical study. Electron microscopically, the tumors consisted essentially of histiocyte-like, fibroblast-like, and intermediate cells, together with myofibroblasts.

Pigmented villonodular synovitis. A clinicopathologic study of 52 cases

Clinicopathologic, enzyme histochemical and electron microscopic findings in 52 patients with pigmented villonodular synovitis (PVS) are reported. The lesion was by far the most common in the knee joint (48%), followed by the ankle joint (25%). As to sex incidence, there seemed to be no predilection (46% in men, 54% in women). Microscopically, the PVS showed thin or thick villous projections of the involved synovial membrane, associated with or without nodular formation. The nodule of PVS consisted essentially of a proliferation of histiocyte-like cells with phagocytic activities. Another characteristic feature was large clefts and pseudoglandular or alveolar spaces lined by synovial cells. Enzyme histochemical studies revealed that the lesional cells had functional properties of macrophages. Electron microscopically, the lesion consisted essentially of histiocyte-like and fibroblast-like cells, together with intermediate cells and myofibroblasts.

Giant cell tumor of the tendon sheath (nodular tenosynovitis). A study of 207 cases to compare the large joint group with the common digit group

Clinicopathologic, enzyme histochemical, and electron microscopic findings in 207 cases (208 lesions) of giant cell tumor of tendon sheath (GCTTS) are presented. The GCTTS could be divided into two groups according to the anatomic location, the first occurring in the digits (digit group, 182 cases) and the second, in the larger joints (large joint group, 25 cases). In the majority of cases of the digit group, the tumor occurred in one of the fingers (158 cases), whereas in the large joint group, the tumor was common in the ankle (10 cases) and knee joints (8 cases). The lesion was more common in women (67%) than in men (33%). Microscopically, the GCTTS in both groups consisted of a mixture of abundant histiocyte-like, foam, and multinucleated giant cells of the osteoclast type. However, worthy of special mention were the large clefts or wide pseudoglandular spaces lined by synovial cells and that were more striking in the large joint group than in the conventional digit group. The component cells had functional properties of macrophages, as determined in the enzyme histochemical study. Electron microscopically, the tumors consisted essentially of histiocyte-like, fibroblast-like, and intermediate cells, together with myofibroblasts.

Primary ciliary dyskinesia with transverse colon carcinoma

Primary ciliary dyskinesia, characterized by chronic airway infection, impaired fertility, and situs inversus in half the number of cases, was detected in a 58-year-old Japanese woman, along with carcinoma of the transverse colon. She was of complete situs inversus and subfertile and had chronic bronchitis and nasal polyposis. Ultrastructurally, the cilia of the nasal mucosa lacked dynein arms. This is the first documentation of this disease coupled with cancer.

Intratumorous distribution of catecholaminergic clone cells of human neuroblastoma. A catecholamine fluorescence study

The intratumorous distribution of catecholaminergic clone cells in 23 human neuroblastomas was studied using Falck-Hillarp's method, and the findings compared with the catecholamine (CA) content within the tumour. All the specimens contained elements with CA fluorescence, and the pattern of fluorescence was classified from the distribution of CA-positive cells and neurofibrils, as diffuse cellular (DC), diffuse fibrillary (DF), sporadic (S), clustered (C), island-shaped (I), and bundled (B). The strength of CA fluorescence of both cellular and fibrillary elements correlated well with the CA content within the tumour. In addition, all tumours of urinary VMA-negative cases also contained significantly larger amounts of CA than other, non-functioning, tumours in the paediatric age group. The results of this study suggest that firstly, the ratio of CA-positive cells to CA-positive neuronal processes is proportionately higher in the poorly-differentiated neuroblastomas and that secondly, even tumours negative for urinary VMA or HVA might be polyclonal and contain catecholaminergic elements.

Malignant soft tissue neoplasms with the histologic features of renal rhabdoid tumors: an ultrastructural and immunohistochemical study

Five round cell neoplasms of the soft parts that histologically resembled malignant rhabdoid tumors of the kidney were studied. The tumors were composed mainly of poorly differentiated round or, sometimes, polygonal cells, with a minority of elongated cells; the cytoplasm of many of the cells contained filament-laden acidophilic inclusions. Ultrastructurally, the intracytoplasmic structures were seen to consist of aggregates of 10-nm intermediate filaments, and immunohistochemical staining revealed the presence of cytokeratin and vimentin. All five patients with this tumor had an aggressive clinical course; three of the patients died shortly after the initial diagnosis. As this tumor does not seem to be linked to any known entity, it is referred to as malignant rhabdoid tumor of the soft parts and could be a heterogeneous entity.

Hepatoblastoma producing both alpha-fetoprotein and human chorionic gonadotropin. Clinicopathologic analysis of four cases and a review of the literature

A clinicopathologic study was done of four cases of hepatoblastoma with precocious puberty, together with an analysis of 21 such cases reported in the literature. All four patients were males, the age ranging from 11 to 35 months. Three of the four patients died within 12 months after operation, but the fourth is living. Histologically, all patients had a hepatoblastoma with the coexistence of both fetal and embryonal type cells, although predominantly fetal in two and predominantly embryonal in the other two. Tumor giant cells were rarely encountered in all these cases. Both alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) in the serum or urine increased in our four cases and in five other cases reported in the literature. Though the serum AFP level paralleled the severity of clinical symptoms, the serum or urine hCG did not necessarily correspond to the clinical course. It is likely that these poorly prognostic virilizing hepatoblastomas secrete two different tumor markers, AFP and hCG, from different cells, and that these functioning tumor cells may not always exist concurrently in the recurrent or metastatic tumor.

Fibroma of tendon sheath: a tumor of myofibroblasts. A clinicopathologic study of 18 cases

A clinicopathologic study of 18 cases of fibroma of tendon sheath included an immunohistochemical survey of 7 cases and an electron-microscopic examination of one. The age of the patients ranged from 1 to 77 years, with a median of 34 years. The most common site of the tumors was the finger (7 cases), followed by the knee (3), the hand (2), and the foot (2). The median greatest diameter of the tumor was 2 cm. The tumors were attached or closely related to the tendon or tendon sheath, and usually well circumscribed, and multinodular or lobulated. Microscopically, spindle or stellate tumor cells with fuchsinophilic cytoplasm were embedded in a dense fibrous stroma with scattered small blood vessels. Most tumor cells have immunoreaction products for actin in the cytoplasm with accentuation along the cell membrane. Ultrastructurally, many of the tumor cells proved to be myofibroblasts.

Myositis ossificans. A clinicopathologic study of 21 cases

This clinicopathologic study concerns 21 patients with myositis ossificans, whose ages ranged from 7 to 81 years (average, 40.3 years). The lesions were located in the thigh (10 cases), upper arm (6 cases), and other sites (5 cases). In all patients the lesion was solitary, and in all but one, it was seen within the muscle. Histologically, the lesions exhibited a wide range of histologic features with different amounts of immature fibroblastic cells, osteoid, cartilage, and young or mature bone accompanied by fibrous connective tissue. They could be classified into three types according to the predominant or most striking histologic features. Type I (6 cases) was characterized by highly cellular areas with islands of osteoid, having occasionally been confused with extraskeletal osteogenic sarcoma. Type II lesions (8 cases) consisted mainly of osteoid and young bone rimmed by osteoblasts, in the occasional presence of cellular areas. Type III lesions (7 cases) were made up almost wholly of mature bone and cartilage surrounded invariably by dense fibrous connective tissue. Prognosis was excellent in 17 patients for whom follow-up information was available. Difference between Type I myositis ossificans and extraskeletal osteogenic sarcoma was briefly described, following an additional review of three cases of the latter.

Extraskeletal Ewing's sarcoma. A clinicopathologic and electron microscopic. Analysis of 8 cases

This clinicopathologic study concerns 8 cases of extraskeletal Ewing's sarcoma, including electron-microscopic examination of one case. In three patients, autopsy was done. The age of the patients ranged from 12 to 31 years with a median of 16 years. The tumors mainly arose in the soft tissues of the trunk (4 cases) and the lower extremity (3 cases). Histologically, they were made up of closely packed uniform, small cells, arranged in sheets separated by strands of fibrovascular stroma. The tumor cells had round to oval nuclei with finely dispersed chromatin and scanty ill-defined cytoplasm almost invariably containing a fair amount of diastase-digested PAS-positive material. Ultrastructurally, the tumor cells were composed principally of undifferentiated mesenchymal cells, and contained prominent pools of glycogen in the cytoplasm. Aggregates of intermediate filaments were seen in a perinuclear location. These light- and electron-microscopic findings are indistinguishable from those of Ewing's sarcoma of the bone. Differential points from other soft-tissue small round cell sarcomas such as malignant neuroepithelioma (peripheral neuroblastoma), embryonal or alveolar rhabdomyosarcoma were briefly discussed.

Malignant pheochromocytoma with ganglioneuroblastoma elements in a patient with von Recklinghausen's disease

A 14-year-old girl with numerous café-au-lait spots in her skin was hospitalized because of fever, weight loss, and a mass of the right upper quadrant of the abdomen. Despite intensive chemotherapy, she died 6 months after admission. The autopsy revealed a right adrenal tumor with metastases to liver, lungs, vertebrae, and lymph nodes. Histologically the tumor was a pheochromocytoma with small foci of ganglioneuroblastoma. The catecholamine contents of the tumor were markedly elevated, as confirmed by the catecholamine fluorescence technique. Electron microscopically, the tumor cells contained intracytoplasmic membrane-bound chromaffin granules of varying sizes and shapes. This may be the first report of the concomitant occurrence of malignant catecholamine-secreting pheochromocytoma with ganglioneuroblastoma elements in a patient with von Recklinghausen's disease.

Myofibroblasts in fibromatoses. An electron microscopic study

Fifteen cases of fibromatoses were analyzed by electron microscopy, the objective being to compare the incidence and frequency of myofibroblasts in each category. Myofibroblasts were identified in all 15 cases and a considerably large number of these cells appeared in palmar fibromatosis, plantar fibromatosis, and nodular fasciitis. In keloid and cicatricial fibromatosis, however, only a small number of these cells were evident. In seven cases of extra-abdominal desmoid fibromatosis, the frequency of myofibroblasts in the component cells ranged from 10% to 64%, with a mean of 30%. The frequency was high in hypercellular lesions and low in hypocellular lesions, assuming that it would be roughly in parallel to the cellularity of the lesion in extra-abdominal desmoid fibromatosis and in other fibromatoses as well. There appeared to be no particular correlation between the number of myofibroblasts and recurrence of the lesion.

Malignant giant cell tumor of tendon sheath. Report of a case

In a patient with pigmented villonodular synovitis of the right knee joint, there occurred a malignant giant cell tumor of tendon sheath. There was clinical evidence of metastasis after the second local recurrence and the recurrent tumors were studied enzyme cytochemically and electron microscopically. Ultrastructurally, the malignant tumor consisted of three principal cell types; histiocyte-like cells, fibroblast-like cells, and intermediate cells, with unique attendance of myofibroblasts. This may be the first report of the presence of myofibroblasts in malignant giant cell tumor of tendon sheath. Enzyme cytochemistry revealed various functional properties of histiocytes.

Malignant smooth muscle tumors of the retroperitoneum and mesentery: a clinicopathologic analysis of 44 cases

Forty-four cases of leiomyosarcoma arising in the retroperitoneum (33 cases) and mesentery (11 cases) were analyzed clinicopathologically, and four were examined ultrastructurally. These tumors were more common in women (61%) than in men (39%), and the median age of the patients was 59 years. Except for three tumors, most were large and over 10 cm in the greatest diameter. Twenty-seven tumors were classical leiomyosarcomas, while seven were composed predominantly of epithelioid cells and classified as malignant leiomyoblastoma (epithelioid leiomyosarcoma). In addition to the classical microscopic features, dedifferentiated areas resembling malignant fibrous histiocytoma were noted in three cases. Ultrastructurally, the tumors were characterized by smooth muscle tumor cells showing a spectrum of differentiation of varying degrees. Of the 42 patients for whom follow-up information could be obtained, 33 (79%) died within a period of five years after the initial treatment. Mitotic activity showed no significant correlation with biological behavior; ten of the 15 patients in whom the mitotic counts were less than five per 10 high-power fields (HPF), expired of the tumor.

Dupuytren type fibromatoses. A clinicopathologic study of 62 cases

This clinicopathologic study concerns 62 patients with one of the Dupuytren type fibromatoses. Of the 62 patients, 42 had the lesion in the palm (palmar fibromatosis), 12 in the sole (plantar fibromatosis), 2 in the penis (penile fibromatosis), and 6 in the ectopic locations, the dorsal aspect of the hand in 3 patients, the dorsum of the fingers in 2, and the forearm in 1. The clinically palpable nodules were histologically classified into those of the following three phases, according to LUCK'S classification: proliferative phase (27), involutional phase (23), and residual phase (12). In addition to fibroblastic proliferation, the lesion of the proliferative phase exhibited vascular features consisting of one or more layers of cells with oval nuclei around the vessels within the nodule. In the lesions of the late proliferative and involutional phase, the intracytoplasmic fine filaments were visible in cells compatible with myofibroblasts by Masson's trichrome stain. The nuclei of the elemental fibroblasts in the same phases were often crossed transversely by one or more fine basophilic lines.

Malignant hemangiopericytoma and other sarcomas with hemangiopericytoma-like pattern

This clinicopathologic study concerns 19 cases of malignant hemangiopericytoma among 755 cases of soft tissue sarcomas. The age of the patients ranged from 18 to 76 years, with a median of 43 years. Tumors occurred on the trunk in 8, lower extremities in 5, the head in 3, and the retroperitoneum in 3. According to follow-up information, nine of the 19 patients had died. Histologically the tumor was characterized by its homogeneous vascular pattern, its uniform cell population and a wide range of cellular anaplasia. After extensive sampling of the tumors, a comparative light microscopy revealed differences in diagnostic histology between malignant hemangiopericytoma and other soft tissue sarcomas with a hemangiopericytoma-like vascular pattern. The frequency of appearance of such pericytoma pattern in different soft tissue sarcomas was as follows: 4/4 cases (100%) in extraskeletal mesenchymal chondrosarcoma, 11/14 (79%) in infantile fibrosarcoma, 27/45 (60%) in synovial sarcoma, 62/201 (30%) in malignant fibrous histiocytoma, 9/37 (25%) in malignant schwannoma and 6/72 (8%) in liposarcoma.

Myxoid malignant fibrous histiocytoma versus myxoid liposarcoma. A comparative ultrastructural study

An ultrastructural comparison of 7 examples of myxoid malignant fibrous histiocytoma (myxoid MFH) with 6 of myxoid liposarcoma is described. Despite certain histological differences between the two, electron microscopy was more valuable in differentiating MFH from liposarcoma. Electron microscopically, MFH contained a variety of cell types including histiocyte-like, fibroblast-like, intermediate-type, xanthomatous, multinucleated tumor giant cells and undifferentiated cells. Liposarcoma was composed mainly of lipoblasts at various stages of differentiation with a minority of undifferentiated cells and fibroblast-like cells. In contrast to the component cells of the MFH, these lipoblasts were characterized by abundant cytoplasmic glycogen, numerous pinocytotic vesicles and a discontinuous basal lamina in addition to large lipid droplets.

Synovial sarcoma. A clinicopathologic and ultrastructural study of 42 cases

This clinicopathologic study concerns 42 cases of synovial sarcoma (13 biphasic and 29 monophasic), including electron-microscopic examination of five cases, among 753 cases of soft tissue sarcomas. The age of the patients ranged from 9 to 70 years, with a median of 35 years. Tumors occurred most commonly on the extremities with 31 on the lower extremities. Histologically the monophasic type on this occasion included tumors with focal or minimal biphasic differentiation (9 cases) in addition to totally monophasic tumor (20 cases). A comparative light microscopy revealed otherwise inappreciable differences in histologic characteristics between the monophasic synovial sarcoma and certain other spindle cell sarcomas. Ultrastructurally, the cells composing the spindle-cell area of the synovial sarcoma contained basically the same elements as did the cells forming epithelioid or gland-like structures, and as the cells in the areas of gradual transitions of the two. One exception was that the cells lining the gland-like lumina had microvillar projections. Characteristic secretory-like granules, similar to those seen in the synovial type B cell of the normal human synovium, were evident in all five cases studied electron microscopically. In contrast to the findings of others, patients with monophasic tumors had a better prognosis, 58% surviving 5 years compared to 36% for those with biphasic tumors.

Glomus tumor: a clinicopathologic and electron microscopic study

This clinicopathologic study concerns 63 instances of glomus tumor of the soft tissues. The tumors occurred at different ages but were more common in earlier adult life and most commonly occurred on the fingers (35 cases), frequently as subungual nodules (26 cases). Other sites of occurrence were the forearm in seven, the knee in seven, and the leg in six. All patients but one complained of pain. Histologically, the tumors, showing endothelium-lined vascular spaces surrounded by masses of epithelioid cells, could be divided into three varieties: vascular (29 cases), myxoid (23 cases), and solid (11 cases). Under electron microscope the tumor cells in four cases proved to be smooth-muscle cells. The clinicopathologic evidence presented supports the hypothesis that the glomus tumor is a tumor-like lesion of mesodermal disorder rather than a true neoplasm.

Glomus tumor: a clinicopathologic and electron microscopic study

This clinicopathologic study concerns 63 instances of glomus tumor of the soft tissues. The tumors occurred at different ages but were more common in earlier adult life and most commonly occurred on the fingers (35 cases), frequently as subungual nodules (26 cases). Other sites of occurrence were the forearm in seven, the knee in seven, and the leg in six. All patients but one complained of pain. Histologically, the tumors, showing endothelium-lined vascular spaces surrounded by masses of epithelioid cells, could be divided into three varieties: vascular (29 cases), myxoid (23 cases), and solid (11 cases). Under electron microscope the tumor cells in four cases proved to be smooth-muscle cells. The clinicopathologic evidence presented supports the hypothesis that the glomus tumor is a tumor-like lesion of mesodermal disorder rather than a true neoplasm.

Membranous lipodystrophy. A case report

The case is described of a 35-year-old housewife diagnosed as having membranous lipodystrophy (as described by Nasu et al. in 1970 and called lipomembranous polycystic osteodysplasia by Hakola in 1972). The main symptom of this patient was a slowly progressive dementia. Skeletal symptoms were not seen. The computerized tomogram of the brain showed calcification of bilateral basal ganglia and the plain roentgenograms of the bones revealed cystic radiolucent areas at the distal end of the bones of the patient's extremities. Histological examination of the curretted material from the right talus revealed fa 'membranocystic' pattern. The fatty tissue curetted from the cyst of the talus and the lysosomal enzymes of the white blood cells were biochemically normal. A possible relationship between this disease entity and connective disorders is considered.

Immunocytochemical identification of human chorionic gonadotropin- and alpha-fetoprotein-producing cells of hepatoblastoma associated with precocious puberty

A one-year-five-month-old boy with hepatoblastoma producing both human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) is presented. Histologically, the primary tumor was mainly composed of well differentiated hepatoblastoma cells, with minor areas of poorly differentiated cells. Immunoperoxidase staining of the tumor for hCG and AFP showed that a few well differentiated, fetal type cells and multinucleated giant cells were positive for hCG, and AFP was never stained in the same cells. In areas where cells were poorly differentiated, positive reactions for either hCG or AFP were not observed. Electron microscopic studies revealed focal aggregates of cytoplasmic cored vesicles in some tumor cells, similar to secretory granules.

Malignant fibrous histiocytoma. An electron microscopic study of 17 cases

The ultrastructural findings in 17 cases of malignant fibrous histiocytoma (MFH) are described. The tumors consisted of fibroblast-like cells and histiocyte-like cells in different proportions in different cases. Intermediate, undifferentiated, xanthomatous and multinucleated giant cells were also identified. In 12 of 17 cases myofibroblasts were evident. Acid phosphatase activity was detected cytochemically in the Golgi zone, endoplasmic reticulum and lysosomes (GERL) mainly within histiocyte-like cells, in three cases. These observations indicate that the GERL of the tumor cells are engaged in th formation of lysosomes. The polymorphic cellular composition, including undifferentiated cells, lends support to the concept that the MFH originates from a primitive multipotent undifferentiated mesenchymal cell.

Extraskeletal myxoid chondrosarcoma--a clinicopathologic and electron microscopic study

This clinicopathologic study concerns 14 cases of extraskeletal myxoid chondrosarcoma from among 603 cases of soft tissue sarcomas. The ages of the patients at the time of initial biopsy ranged from 16 to 69 years. The tumors mainly arose in the lower extremities including buttocks (10 cases), and consisted histologically in cords and strands of small acidophilic cells with occasional vacuolated cells in an abundant myxoid matrix composed of chondroitin sulfate. Electron microscopy in four revealed a continuum of cell differentiation of the tumor cells from chondroblastic cell to undifferentiated mesenchymal cell. Morphological studies indicated that the extraskeletal myxoid chondrosarcoma included so-called chordoid sarcoma, as a variant.

Malignant fibrous histiocytoma. A clinicopathologic study of 130 cases

A clinicopathologic study of 130 cases of malignant fibrous histiocytoma (MFH) of the soft tissues is reported. This malignant neoplasm principally of middle and late adults occurred most often in the proximal portions of the extremities (48%) including the thigh and buttocks (35%). MFH may be subclassified into common (storiform and pleomorphic), myxoid, xanthogranulomatous, and giant cell types, the common type being accounted for 100 cases (77%) of the series. The prognosis was more favorable in patients with storiform and myxoid tumors than in patients with pleomorphic or other type tumors, the overall relative five-year survival rate being 48%. The depth of the tumor also affected prognosis with a significantly lower survival rate in deeply situated tumors. The rate of local recurrence of the tumor was 48%. Because of incomplete informations, metastasis was confirmed in only 26 patients and was most frequently to the lung (73%). In addition, electron microscopic, histochemical and tissue culture findings in limited cases are presented, concerning the histogenesis of the MFH.

Epithelioid sarcoma. A clinicopathologic and electron microscopic study

This clinicopathologic study concerns four cases of epithelioid sarcoma, which were seen among a group of 603 cases of soft tissue sarcomas in our file. The patients were of young age between 8 and 21 years at the time of initial treatment. The tumors arose in the upper (2 cases) or lower extremities (2 cases), and consisted histologically of irregular nodular masses of Polygonal epithelioid cells merging with spindle cells. Electron microscopy in two cases revealed that the tumor cells were an admixture of synovioblast-like cells and fibroblast-like cells, the former cells being characterized by pseudoacini and filopodia. In three of the four patients, the tumors recurred one to three times, and one patient with primary tumor had metastases to the skin of the more proximal portions of the same extremity and to the regional lymph nodes. Follow-up ranging from two to four years, however, revealed that all patients were living and well after single or multiple operations.

Postirradiation sarcoma (malignant fibrous histiocytoma) following breast carcinoma: an ultrastructural study of a case

Sarcoma of the chest wall following postoperative radiation therapy (2500 rads) for breast carcinoma is presented; it appeared 16 years after the initial radiation, and had light and electron microscopic features of malignant fibrous histiocytoma (MFH). Unique ultrastructural finding was the presence of Langerham cell granules in some of the tumor cells. This appears to be the first documented instance of a soft tissue MFH containing such granules in the tumor cells.

Primary malignant peripheral nerve tumors (malignant schwannomas). A clinicopathologic and electron microscopic study

A clinicopath-logic and electron microscopic study was performed on 35 cases of primary malignant peripheral nerve tumors, among which 12 developed in association with neurofibromatosis (von Recklinghausen's disease) and further 11 in keeping with anatomically discernible nerves in patients without neurofibromatosis. Depending upon the histologically predominant pattern, these tumors were subdivided into three groups: 23 compact spindle cell, 6 myxoid, and 6 epithelioid varieties of the tumor. The common ultrastructures in three of the 35 tumors were as follows: 1) The cell membranes manifested characteristic infoldings and lamellar configuation. 2) The tumor cell surfaces were coated by occasional basal lamina or homogeneously electron-dense membranous material. 3) The cytoplasms contained well-developed organelles and a few neurosecretory-type granules. Differential points from other soft-tissue sarcomas were briefly discussed on the histologic basis.

Clear cell sarcoma of tendons and aponeuroses: a comparative study of 13 cases with a provisional subgrouping into the melanotic and synovial types

Electron microscopy of two cases of clear cell sarcoma of tendons and aponeuroses showed different fine structures. On the basis of these differences a proposed division is made of melanotic and synovial types of the tumor. A subsequent comparative histological study carried out on these tumors showed that there were histological criteria to separate the melanotic and synovial types of sarcoma. Using these histological criteria eleven further cases of clear cell sarcoma in the files of the Tumor Registry were subdivided. Review of the Tumor Registry material showed that eight were melanotic type tumors and one was a further synovial type tumor. Using these histological criteria there are two further cases in the Tumor Registry which are not clearly classifiable into either group. The present observations indicate that the majority of the so-called clear cell sarcomas are in reality "melanomas of soft parts" with a minority of this type of tumor being of "synovial type".

Postirradiation fibrosarcoma following radical mastectomy

A case of fibrosarcoma arising in the scar of the radical mastectomy with postoperative irradiation of breast carcinoma is reported. The tumors arose five times in spite of the extirpations including surrounding tissue since 11 years after radical mastectomy and postoperative irradiation. All of arisen tumors were diagnosed fibrosarcoma histologically and with every recurrence the aggravation of malignancy of tumors was shown. In this case, the primary tumor of the breast was infiltrating carcinoma and no sign of fibrosarcoma was noted histologically. The mastectomy scar was indicated the irradiation therapy postoperatively and fibrosarcoma developed 11 years after postoperative irradiation. Namely, this case agreed to the strict criteria of the postirradiation sarcoma proposed by Cahan et al. In this paper, a case of postirradiation fibrosarcoma arising in the scar of radical mastectomy for carcinoma is presented.

Noradrenaline-secreting glomus jugulare tumor with cyclic change of blood pressure

A glomus jugulare tumor secreted a large quantity of noradrenaline (NA) and produced symptoms of tinnitus, palpitation, sweating, and labile hypertension. The NA content of the tumor was 0.75 mg/gm of tissue. Electron microscopical study of the tumor demonstrated many membrane-limited osmiophilic granules. This indicates the capacity of the tumor not only to synthesize but also to store NA in the tumor. Continuous blood pressure recording showed a cyclic change of blood pressure with a cycle length of 10 to 17 minutes that terminated after intravenous doses of phentolamine (0.1 mg/kg) or diazoxide (4.5 mg/kg) and surgical removal of the tumor.