[Pathogenesis and clinical observations of papillomatous diseases of the skin and of the mucous membranes (author's transl)]

Electron microscopy of juvenile nasopharyngeal angiofibroma: clinical and histopathological correlates

BACKGROUND

The histological and electron-microscopic (EM) characteristics of juvenile nasopharyngeal angiofibroma (JNA) have been described but no study has compared them with one another or with clinical features. The objective is to compare ultrastructural characteristics of JNA with clinical parameters.

METHODS

This prospective study included histology of 21 samples of which only 13 underwent transmission-EM. Four clinical parameters (age, duration, epistaxis, recurrence), three radiological-staging, 13 histological and 15 EM characteristics were considered. A descriptive analysis for association of these characteristics and also with clinical parameters was attempted. Furthermore statistical analysis of clinical and radiological categories with respect to frequencies of ultrastructural characteristics was also undertaken.

RESULTS

Dense-intranuclear-inclusions (DNI) and peripheral-nuclear-irregularities were universally encountered while other very prominent features were nuclear-blebs-and-pockets, myoid-features, thin-vessel-wall (TnVW), irregular-vascular-contour (IVC) and fibrous-stroma (FS). Statistical significance was obtained between recurrence with histology (p = 0.04) and Fisch staging with EM (p = 0.001). While muscle-in-vessel-wall, thick-vessel-wall, mast-cells, stellate-stromal-cells and cellular-stroma predominated in recurrent cases, the upfront disease showed predominance of scar-like-stroma, fusiform-stromal-cells, IVC, TnVW, FS, organised-collagen-bundles and less-cellular-stroma. A very unique Rod-like-structures were appreciated in the cytoplasm of the fibroblast for the first time.

CONCLUSIONS

While histological parameters of recurrence need further validation, a larger sample may better define histopathological surrogate for predicting intracellular dynamics that may further correlate with underlying cellular stresses. Hence an 'ultrastructural staging' may better customise treatment protocol and prognosis. Furthermore 'characteristic' unique rods need to be further investigated along with validation of viral aetiology for DNI.

Tubular forms of papova viruses in human laryngeal papilloma

In two cases of recurrent laryngeal papillomatosis tubular forms of papova viruses could be observed. The same material revealed the close relation between nuclear chromatine and the release of particles, as well as a capsomere like substructure of the virions.

Electron microscopic findings in four cases of nasopharyngeal fibroma

Light and electron microscopic investigations of four cases of juvenile nasopharyngeal fibroma revealed characteristic structures; a fibrous stroma, an inclination to hyalinisation and formation of scar like tissue, a lacunar thin walled vascular component, large numbers of mast cells and of fibroblasts. The tumor fibroblasts contained different nuclear bodies and particles. There existed five different types of more or less complex spherical bodies. The previously described nuclear electron dense particles with an electron lucent halo could be divided into four groups measuring 60, 90, 150, and 300 nm in diameter. In addition to the previously described ultrastructural properties of the tumors, the nuclei of the tumor fibroblasts were found to contain virus like particles. These particles were less electron dense, measuring 40 to 55 nm in diameter and arranged in groups throughout the nucleoplasm; they were different from chromatin condensations and from perichromatin granules. The structure and the size of the smallest particles was not comparable with the other nuclear inclusions.