Ultrastructural analysis of asteroid bodies: evidence for membrane lipid bilayer nature of components

Phosphoglyceride crystal deposition disease involving adnexa uteri: a case report with histogenetic consideration

We present a rare case of phosphoglyceride crystal deposition disease (PCDD), as a gynecologic disease, with reference to histogenesis of crystal deposition. An 84-year-old woman, who had undergone simple hysterectomy for uterine leiomyoma 44 years previously, presented with multiple masses in the bilateral adnexa and the pelvic wall. The bilateral adnexal tumors were resected. The masses histologically revealed a foreign-body granuloma composed of numerous tiny, radially arranged needle-like crystal lumps surrounded by multinucleated giant cells and macrophages. The crystals showed birefringence under polarized light and were positive for gold hydroxamic acid stain, and the tumor was thus diagnosed as PCDD. The masses revealed central cystic changes due to old hemorrhage, which contained crystal lumps without foreign-body reaction or birefringence. The present case demonstrated for the first time that phosphoglyceride crystals developed in old hemorrhagic foci, although it was not confirmed whether the old hemorrhagic foci were formed after hysterectomy or due to endometriosis.

Changes in Dermal Thickness in Biopsy Study of Histologic Findings After a Single Injection of Polycaprolactone-Based Filler into the Dermis

BACKGROUND

During aging, facial skin thins, atrophies, and loses elasticity. Subdermal filler injections can volumize and treat wrinkles but cannot directly change dermal thickness. Polycaprolactone (PCL) fillers can improve skin texture and quality through dermal thickening and inducing neocollagenesis. Through biopsy study, evidence of neocollagenesis will be introduced.

OBJECTIVES

In this single-clinic prospective study, 13 patients received a single injection of diluted 0.5 cc of PCL filler in the facial dermis except the right temple area for intra-individual control study.

METHODS

A biopsy was performed from temple skin at 1 year for all patients. An additional biopsy was performed at 2 weeks and 4 years posttreatment for 3 patients. Dermal thickness was measured with sonography after 1 year.

RESULTS

On average, the mean rate of temporal skin thickness in biopsy specimens (n = 117 points in 13 patients) at 1 year posttreatment increased by 26.74% ± 9.26% from 1412.41 μm ± 69 μm to 1781.11 μm ± 110 μm (P < 0.001). On average, the mean thickness of facial skin (n = 39 points in 13 patients) measured by ultrasound at 1 year increased by 21.31% ± 4.34%. Around PCL particles, many fibroblasts, giant cells, new capillaries, new collagen, and elastic fibers were found in various stains.

CONCLUSIONS

Facial dermal thickness increased after intradermal injection of PCL filler by neocollagenesis to treat skin atrophy. PCL filler may last more than 4 years in the dermis.

LEVEL OF EVIDENCE: 4

Morphologic and Immunohistochemical Evidence of Continuity Between Different Components of Malignant Mesenchymoma of the Retroperitoneum

A malignant mesenchymoma with predominant leiomyosarcomatous component and significant chondrosarcomatous and focal osteosarcomatous elements is presented. Transitional areas with overlapping morphologic and immunohistochemical features were found between the smooth muscle and cartilaginous components. Stains for actin were strongly positive in leiomyosarcoma, and in scattered malignant chondrocytes. Malignant chondrocytes and scattered neoplastic smooth muscle cells were positive for S-100. Both components were strongly positive for p53. Ultrastructurally there were calcified particles in the matrix of both chondrosarcoma and leiomyosarcoma. These findings support the concept that malignant mesenchymoma results from divergent differentiation of primitive mesenchymal cell with pluripotential capability. A literature review of retroperitoneal malignant mesenchymomas with similar differentiation is presented.

Development of self-assembling peptide nanovesicle with bilayers for enhanced EGFR-targeted drug and gene delivery

Development of rational vectors for efficient drug and gene delivery is crucial for cancer treatment. In this study, epidermal growth factor receptor (EGFR)-binding peptide amphiphile (PA) were used as the primary bilayer skeleton material to construct ultra-stable self-assembling peptide nanovesicle (SPV). The resulted EGFR-targeted SPV (ESPV) could efficiently encapsulate therapeutic cargos (drugs or small interfering RNAs [siRNAs]) or labelled fluorescent cargo (quantum dots [QDs]) and exhibited excellent affinity for EGFR-positive cancer cells. Moreover, ESPV could deliver more drug or plasmid DNA to tumour sites and promote gene expression (a three-fold ratio of ESPVs vs cationic liposomes). Notably, the individual delivery or co-delivery of doxorubicin (DOX) and the acetylcholinesterase (AChE) gene via the ESPVs resulted in excellent drug/gene delivery both in vitro and in vivo and exerted a significant growth-suppressing effect on a liver cancer xenograft. This nanoscale, targeted cargo-packaging technology may provide a new strategy for the design of highly targeted cancer therapy vectors.

Silicone lymphadenopathy: presentation of a further case containing asteroid bodies on fine-needle cytology sample

Silicone lymphadenopathy is a recognized complication of breast augmentation. It is thought to occur when silicone droplets migrate from breast implants to lymph nodes. We report the cytologic findings in axillary and inguinal lymph node aspirate smears from a 35-year-old Italian woman, who came to our observation 10 years after bilateral cosmetic breast augmentation. A fine-needle cytology of the axillary lymph node showed extensive granulomatous inflammation, numerous histiocytes, and multinucleated giant cells containing star-shaped structures known as "asteroid bodies." The inguinal lymph node aspirate simply showed an aspecific reactive hyperplasia. No evidence of malignancy was present in any of the smears as well as in the excised axillary lymph node.

Urethral stromal tumor with pacemaker cell phenotype

Penile malignancies are rare in developed countries. The authors present a case of a penile urethral mesenchymal tumor occurring in a 51-year-old Caucasian male and displaying light microscopic, immunohistochemical, and ultrastructural features suggestive of a pacemaker cell type, combined with a lack of diagnostic features of any other established tumor category. The immunohistochemical profile was intensely positive for vimentin, PKC theta, and NSE and weakly positive to nonreactive for CD34 and smooth muscle actin, and entirely negative for CD117 (c-kit), S-100, and other markers. C-kit and PDGFRA gene analysis showed no mutations. Electron microscopy revealed tumor cells with plentiful cytoplasm and cytoplasmic processes/filopodia, both filled with intermediate filaments and occasional solitary focal densities. There were also prominent smooth endoplasmic reticulum cisternae, caveolae, neurosecretory granules, particularly concentrated in cytoplasmic processes, and synaptic-type structures. Poorly formed basal lamina, gap junctions, and intercellular collagen aggregates, consistent with skeinoid-type fibers, were also noted. Interstitial cells with potential pacemaker function have been recently described in the lower urinary tract, including the urethra, and this tumor may be related to this cellular phenotype.

Oral inflammatory myofibroblastic tumor demonstrating ALK, p53, MDM2, CDK4, pRb, and Ki-67 immunoreactivity in an elderly patient

Inflammatory myofibroblastic tumor (IMT) is a controversial lesion composed of myofibroblasts, accompanied by varying numbers of inflammatory cells. Various pathogenetic factors have been proposed (ie, reactive, infectious, autoimmune, and neoplastic) but the etiology of most IMTs remains unknown. Here we review the literature of oral IMTs, detailing the demographic profile of these rare lesions. Moreover, we present an unusual case of IMT arising from the mandibular alveolar mucosa of an 82-year-old female. Microscopic examination revealed plump spindle cells set in a myxoid vascular stroma admixed with inflammatory cells. Numerous large ganglion cell-like cells were seen, some exhibiting emperipolesis of neutrophils. Ultrastructurally, prominent myofibroblasts with abundant rough endoplasmic reticulum were noted. Tumor cells were immunoreactive for vimentin, smooth muscle actin, and KP1 (CD68), and negative for desmin, S-100, and EBV-LMP. The lesion was excised without margins and the patient has manifested no evidence of disease at an 18-month recall. In an attempt to further delineate the potential neoplastic nature of this lesion, we assessed the immunohistochemical expression of various markers that have been linked to neoplastic transformation. The recorded positivity for ALK, p53, MDM2, CDK4, pRb, and Ki-67, despite the absence of bcl-2 reactivity, strongly favors the neoplastic origin of the studied tumor.

Splenic hamartoma: immunohistochemical and ultrastructural profile of two cases

Splenic hamartoma (SH) is a rare, benign lesion. We present 2 cases, both in females (2 and 30 years, respectively) with multiple urinary tract infections, and left upper quadrant abdominal pain. Immunohistochemical staining with factor VIII displayed intense diffuse staining in the SH with corresponding weak staining in the adjacent spleen. CD31 showed a reverse pattern from that of factor VIII. CD34 staining pattern was identical in both the spleen and the SH. Ultrastructurally, the SH showed endothelial cells with relatively empty cytoplasm, scattered Weibel Palade bodies, and lining by basement membrane surrounded by fibrous long-spacing collagen. Our study highlights the unique immunohistochemical profile of SH. The ultrastructural features are interesting, although their diagnostic significance remains to be confirmed in future studies.

Malignant peripheral primitive neuroectodermal tumor-peripheral neuroepithelioma of the head and neck: a clinicopathologic study of five cases and review of the literature

BACKGROUND

The term primitive neuroectodermal tumor (PNET) encompasses a number of neoplasms of common neuroectodermal origin, but of variable clinical, histopathologic, ultrastructural, and molecular characteristics. Here, we focus on one particular member of the PNET family, the malignant peripheral PNET (pPNET) or peripheral neuroepithelioma of head and neck.

METHODS

Five patients diagnosed with malignant pPNET-peripheral neuroepithelioma of head and neck were included in the study. All existing literature was reviewed.

RESULTS

The diagnosis of malignant pPNET-peripheral neuroepithelioma of the head and neck was confirmed in all five cases. All patients are alive after treatment with a combination of therapeutic modalities; only one patient had metastatic disease develop. A literature review revealed another 38 reported cases.

CONCLUSIONS

Malignant pPNET-peripheral neuroepithelioma should be included in the differential diagnosis of small, round, blue cell tumors of head and neck. A combination of multiple diagnostic modalities is essential for correct diagnosis, and multimodality treatment offers the best outcome.

MDM2 and CDK4 expression in carcinosarcoma of the esophagus: comparison with squamous cell carcinoma and review of the literature

Certain tumors of the esophagus that display both sarcomatous and carcinomatous features have long been recognized. The nomenclature, classification, and histogenesis remain controversial and the microscopic differential diagnosis from other esophageal malignancies can be challenging, particularly in small biopsies. In this paper, we review the literature of carcinosarcoma and present two cases of esophageal carcinosarcoma, describing their salient histologic, immunohistochemical, and ultrastructural features. Also, we assess the expression of MDM2 and CDK4 in the carcinomatous and sarcomatous compartments of our cases and we compare them with the expression of these oncogenes in selected cases of esophageal squamous cell carcinoma with prominent stromal reaction. In both of our cases, identification of some epithelial ultrastructural and immunohistochemical features in cells of otherwise sarcomatous phenotype lends support to the common epithelial origin of these neoplasms. Moreover, positive staining for MDM2 and CDK4 in our cases with equally strong reactions in both carcinomatous and sarcomatous elements provides evidence of a role for these molecules in the pathogenesis of carcinosarcoma. In contrast, in cases of squamous cell carcinoma with prominent stromal reaction only the epithelial cells stained strongly for MDM2 and CDK4. These differences in the MDM2 and CDK4 immunohistochemical profile between carcinosarcomas and carcinomas of the esophagus may assist in their differential diagnosis.

Structural similarities between hematoidin crystals and asteroid bodies: evidence of lipid composition

Hematoidin crystals (HC) are found in tissues where extravasated erythrocytes undergo degradation. Previous studies have determined that hematoidin is composed, in part, of a bilirubin-like pigment. In a previous study (Papadimitriou and Drachenberg, Ultrastruct. Pathol. 16, 413-421, 1992), we demonstrated that giant cell asteroid bodies (AB) are formed by membrane lipid bilayers. We evaluated three cases in which HC developed within splenic infarcts. The crystals were analyzed by light microscopy (LM), electron microscopy (EM), and X-ray microanalysis. A case of sarcoidosis with multiple epithelioid granulomas containing AB was studied for comparison. By LM the HC demonstrated intense, golden-color, fine threads, both intracellularly and extracellularly, in small and large clusters, and in radiating, star-shape patterns ranging in size from 2 to 200 microm. By EM the HC were composed of a core of empty clefts, consistent with dissolved lipids, suggestive of cholesterol crystals, and were surrounded by myelinoid membrane aggregates. The AB showed by LM significant morphological similarities with the intracellular HC. By EM, the AB were composed of a core of dense phospholipid bilayer tubes surrounded by a halo of myelinoid membranes. No accumulation of specific elements was found in either HC or AB by X-ray microanalysis. HC and AB show a similar star-shape morphology by both LM and EM. We postulate that this shape is due to the physicochemical properties of the accumulated lipids which originate from superfluous cell membranes created during cell fusion in the case of AB and after cellular (predominantly red cell) breakdown in the case of HC. The golden color of the HC likely results from adsorption of hydrophobic bilirubin-like pigments left over from erythrocyte breakdown into the accumulated lipids. Thus, this study shows two different (patho)physiological processes that lead to a markedly similar morphological end-product and provides further support to our proposed mechanism for AB formation.

Islet cell damage associated with tacrolimus and cyclosporine: morphological features in pancreas allograft biopsies and clinical correlation

BACKGROUND

The introduction of the potent immunosuppressive drugs tacrolimus (FK) and cyclosporine (CSA) has markedly improved the outcome of solid organ transplantation. However, these drugs can cause posttransplantation diabetes mellitus. Abnormalities in the glucose metabolism are of particular significance in pancreas transplantation.

METHODS

We studied 26 pancreas allograft biopsies, performed 1-8 months posttransplantation, from 20 simultaneous kidney-pancreas transplant recipients, randomized to receive either FK or CSA. The biopsies were studied by light microscopy, immunoperoxidase stains for insulin and glucagon, in situ DNA-end labeling for detection of apoptosis, and electron microscopy. The islet morphology was correlated with the mean and peak levels of CSA and FK in serum, with corticosteroid administration and with glycemia.

RESULTS

On light microscopy cytoplasmic swelling, vacuolization, apoptosis, and abnormal immunostaining for insulin were seen in biopsies from patients receiving either FK or CSA. The islet cell damage was more frequent and severe in the group receiving FK than in the group receiving CSA (10/13 and 5/13, respectively) but the differences were not statistically significant. Significant correlation was seen between the presence of islet cell damage and serum levels of CSA or FK during the 15 days previous to the biopsy, as well as with the peak level of FK. Toxic levels of CSA or FK and administration of pulse steroids were associated with hyperglycemia when these occurred concurrently (P=0.005). Toxic levels of CSA or FK by themselves were associated with hyperglycemia in a minority of cases (8 and 26%, respectively). Electron microscopy showed cytoplasmic swelling and vacuolization, and marked decrease or absence of dense-core secretory granules in beta cells; the changes were more pronounced in patients on FK. Serial biopsies from two hyperglycemic patients receiving FK and evidence of islet cell damage demonstrated reversibility of the damage when FK was discontinued.

CONCLUSIONS

The structural damage to beta cells demonstrated in this study is similar to morphological and functional abnormalities previously described in experimental animal models and can at least partially account for the glucose metabolism abnormalities seen in patients receiving these drugs. Toxic levels of CSA or FK and higher steroid doses potentiate each others' diabetogenic effects.

Asteroid bodies and other cytoplasmic inclusions in necrobiotic xanthogranuloma with paraproteinemia

BACKGROUND

Necrobiotic xanthogranuloma (NXG) with paraproteinemia is a distinctive palisading granuloma of the skin. Extracutaneous lesions are rarely present.

OBJECTIVE

The purpose of this study was to confirm the presence and significance of giant cell asteroid bodies and other cytoplasmic inclusions in NXG with paraproteinemia.

METHODS

Skin biopsy specimens from 24 patients with NXG with paraproteinemia were reviewed; autopsy and lung biopsy specimens from two patients were stained for iron, calcium, and polysaccharide.

RESULTS

Giant cell asteroid bodies were observed in skin biopsy specimens of 8 (33%) of the 24 patients. In addition, large acidophilic polygonal cytoplasmic inclusions were observed in myocardial tissue of one of the autopsy cases. Iron and calcium were not found.

CONCLUSION

Asteroid bodies and other inclusions can be present in the giant cells of NXG with paraproteinemia. They are as frequent as, or more frequent than, in other granulomatous diseases and should be considered in the diagnosis of NXG with paraproteinemia.

The asteroid bodies of sporotrichosis

Some believe that asteroid bodies (AB) in sporotrichosis are nonspecific and are equivalent to the AB of sarcoidosis and other granulomatous diseases. We studied 25 skin biopsy specimens of sporotrichosis in which AB were demonstrated, ten of them with Sporothrix-positive culture. Immunohistochemistry was performed in paraffin-embedded biopsy specimens using an anti-Sporothrix antibody. The same procedures were done with seven biopsy specimens of lobomycosis, which contained AB within giant cells. These did not react with the anti-Sporothrix antibody, and by electron microscopy they displayed filamentous and myelin figures similar to the AB of sarcoidosis. In sporotrichosis, the AB are extracellular eosinophilic structures, 15-35 microm in diameter, and located within abscesses. One to three are found in a section. They consist of a central yeast, surrounded by eosinophilic spicules. The yeast stains with the anti-Sporothrix antibody, while the spicules do not. Therefore, AB in sporotrichosis are specific for disease. Visualization of the spicules alone can lead to the demonstration of the AB in adjacent sections, and thus is a useful clue in the diagnosis of sporotrichosis. Sporotrichotic AB must not be confused with the intracellular AB seen in giant cells of granulomatous reactions, which are filamentous and myelin figures that contain lipid.

Head and neck fibromyxoid sarcoma: clinicopathological correlation with emphasis on peculiar ultrastructural features related to collagen processing

A fibromyxoid sarcoma of the jaw of a young patient is described. The tumor recurred and was locally aggressive but displayed mostly a low-grade morphology with only a few areas showing undifferentiated (high-grade) appearance. An isolated lung metastasis was identified 15 years after the original presentation. Ultrastructurally, the tumor cells showed features of partial fibroblastic differentiation, with abundant and often markedly dilated rough endoplastic reticulum cisternae, but also interrupted segments of basal lamina. The cytoplasm contained numerous large, spindle-shaped, membrane-bound inclusions of collagen that showed a complex triple periodicity. A distinct cell polarity was seen, with the nucleus at one end of the cell and the collagenous inclusions at the other. All of these features indicate a tumor with significant cytodifferentiation, correlating with the relatively protracted clinical course. The intercellular space contained mature collagen fibers and scattered aggregates of delicate, slender fibers embedded in moderately electron-dense granular matrix (fibrillogranular aggregates). The results suggest that based on its morphology and clinical presentation this tumor represents an unusual variant in the spectrum of fibromyxoid sarcomas.

The asteroid body of lobomycosis

Lobomycosis is a dermal mycosis produced by Loboa loboi. It gives rise to dermal granulomas in which giant cells phagocytose an overwhelming number of fungi. Intracytoplasmatic asteroid bodies (AB) have been observed in some giant cells. Their nature is unknown and they have been confused with the sporotrichotic AB. We studied 84 skin biopsies from 53 patients with lobomycosis, 7 by electron microscopy (EM). Immunohistochemistry with a polyclonal anti-Sporothrix schenckii antibody was performed in five biopsies. We found AB in the giant cells in 22 of the 84 biopsies on HE staining. They appeared as single eosinophilic intracytoplasmic structures surrounded by a clear empty space. This clear space did not appear when the biopsy was fixed with OSO4, thus indicating that it is lipid in nature, and that the vacuole is an artefact produced by lipid extraction. Under the EM, the AB consist of bundles of dense, filamentous material, dense bodies and myelin structures resembling the image of AB in sarcoidosis. Some giant cells containing AB either phagocytosed only few fungi or did not contain any of them. The AB and the fungi did not react with the anti-sporotrichotic antibody, which stained the extracellular AB of sporotrichosis. These two asteroid structures are, therefore, different and unrelated phenomena.

Tubular inclusions in macrophages in the brain of a patient with acute hemorrhagic leukoencephalitis (Weston-Hurst syndrome)

A case history, biopsy findings, and autopsy findings of an unusually long-lasting case of acute hemorrhagic leukoencephalitis in a young woman are presented. Diagnosis by stereotactic biopsy of brain lesions seen on computed tomography and magnetic resonance imaging scans had been attempted previously. On histologic examination the biopsy showed sheets of macrophages, which were found to contain unusual tubular inclusions on electron microscopy. The nature of these inclusions is discussed.