Dilated Minute Chambers in Laryngeal Vocal Fold Polyps: Histopathological and Ultrastructural Features

In Reinke's space of human vocal fold, type III collagen forms a three dimensional network and this contains numerous minute chambers in between these fibers. These compartments are occupied by glycosaminoglycans and glycoproteins. In laryngeal fold lesions, such as Reinke's edema and vocal fold polyps, proteoglycan (PG)/hyaluronic acid (HA) components of extracellular matrix increased. We investigated the size and quantity of the minute chambers within Reinke's space, filled with PG/HA with the aid of transmission electron microscopy. Eight vocal fold polyps and 10 mucosal biopsies (as control group) were all evaluated by light microscopy and electron microscopy. We detected that PG/HA in extracellular matrix had been increased in vocal fold lesions when compared with control group, by Alcian Blue-pH 2.5 stain. The mean volume of the chambers in Reinke's space of normal larynx was measured as 0.040233 µm² whereas the mean volume of these chambers in vocal fold polyps was measured as 6.420221 µm². The difference between the volumes of these chambers in vocal fold polyps and in control group was statistically significant (P = 0.001). Within these chambers PG/HA were found and PG/HA filling these chambers were increased in vocal fold polyps. We think proteoglycan and glycosaminoglycans, especially HA, play an important role in determining biochemical properties of vocal fold lesions.

[Electron microscopic observation of vocal fold polyps]

OBJECTIVE

The purpose of this study was to observe the ultrastructure of the fibroblasts, collagen and elastic fibers in vocal fold polyps.

METHODS

Ten vocal fold polyps and 3 normal vocal fold specimens obtained from total laryngectomy were studied by means of transmission electron microscope and scanning electron microscope.

RESULTS

The result showed that in vocal fold polyps, the quantity of fibroblasts increased and there were abundant organelles, suggesting that the fibroblast were in the status of activation. As the main cell to produce lamina propria extracellular matrix, the representation suggested that the extracellular matrix metabolism was active. Leucocytes soakage was observed, suggesting that the inflammation may play a role in the lesion. It was found by scanning electron microscopy that in case of lesions, collagen fibers and elastic fibers arrayed irregularly.

CONCLUSIONS

Under pathologic circumstance, fibroblasts, collagen and elastic fibers altered in morphology, which possibly induced the functional alteration.

Symptomatic gastric leiomyoma mimicking giant gastric polyp: endoscopic diagnosis and removal

Gastric leiomyoma is an uncommonly found benign submucosal neoplasm which may cause hemorrhage in rare cases. A 67-years-old patient was admitted to our attention due to two episodes of hematemesis and melena occurred in the previous two days. Esophagogastroduodenoscopy showed a giant semi-pedunculated gastric polyp (diameter of 4 centimeters) located at the distal body. A large ulcer with a clot was seen on the polyp. We treated endoscopically the giant polyp using the new two-steps-technique recently described by us for the treatment of the large pedunculated gastric and colorectal polyps, and the polypectomy was successfully performed without immediate or delayed complications. Histological evaluation of the transected polyp revealed morphology according to a gastric submucosal leiomyoma. Endoscopic control, performed one and four weeks and 12 months later, showed complete reepithelization of the gastric mucosa, without any sign of endoscopic, endosonographic and histological recurrence of the disease. This case report shows that our endoscopic approach may be successfully used also for giant semi-pedunculated gastric polyps.

Clinicopathological correlation of polypoidal choroidal vasculopathy revealed by ultrastructural study

AIMS

To describe the clinical and histopathological findings in a patient with polypoidal choroidal vasculopathy.

METHODS

A 76 year old Japanese man had a discrete, orange-red lesion of 1 disc diameter in the macula, with the fluorescein and indocyanine green angiographic and optical coherence tomographic findings compatible with polypoidal choroidal vasculopathy. He underwent a surgical removal of the macular lesion, followed by light and electron microscopic examinations.

RESULTS

The histopathological examination revealed that the specimen consisted of degenerated retinal pigment epithelium-Bruch's membrane-choriocapillaris complex and inner choroid. A tortuous, unusually dilated venule was present adjacent to an arteriole with marked sclerotic changes, appearing to form arteriovenous crossing. These vessels seemed to represent native inner choroidal vessels, and had haemorrhage per diapedesis. Blood cells and fibrin filled the lumina of the vessels and accumulated in the extravascular spaces, indicating vascular stasis.

CONCLUSION

Hyperpermeability and haemorrhage due to stasis of a dilated venule and an arteriole involved by sclerosis at the site where they cross in the inner choroid might cause oedema and degeneration of the tissue. Voluminous accumulation of blood cells and fibrin might generate elevation of tissue pressure sufficient to displace the weakened lesion anteriorly. The result suggests that the polypoidal vessels in this case represent abnormality in the inner choroidal vasculature.

Surface structures of aural polyps: a scanning electron microscopic study

Surfaces of aural polyps collected from 30 patients were examined by scanning electron microscopy. In the polyps not associated with cholesteatoma, the epithelial lining showed individually variable metaplasia towards cuboidal 'cobblestone'-type and squamous epithelium covered with microvilli of various shapes and sizes. Squamous epithelium was present on the surface of all polyps with underlying cholesteatoma, with superficial cells possessing elongated microvilli, microplicae of different sizes, grooves and pits. Such surface structures reflect different stages of the keratinization process that seems to be characteristic for the epithelial lining of polyps with underlying cholesteatoma. Incomplete epithelium accompanied by granulation tissue was found in several polyps; in two cholesteatoma-associated polyps plate-like cholesterol crystals were observed.

Ultrastructural changes in malignant transformation of oral mucosa

Transmission electron microscopy (EM) has been used to identify the ultrastructural details of normal and cancerous human oral mucosa. However, inconsistent reports of structural descriptions have rendered transmission EM valueless in the diagnosis of oral squamous cell carcinoma (SCC) or as a prognostic indicator. To identify features of dysplasia for diagnostic purposes, normal mucosa, severe dysplasia, oral SCC and normal margin adjacent to oral SCC were used to compare the ultrastructural features of normal and premalignant oral mucosa and oral SCC. The preparatory stages of dehydration, embedding, cutting and positive staining for transmission EM were modified and tested to improve ultrastructural definition. Thin and discontinuous basal laminas were found in mucosa with severe dysplasia and normal margin adjacent to oral SCC. No basal lamina was identified in oral SCC. This study has shown that there are some ultrastructural changes during malignant transformation of oral mucosa. Together with other laboratory investigative techniques, transmission EM may be helpful in detecting malignant changes in oral mucosa.

Imaging of fibrosis of the oral mucosa by 20 MHz sonography

OBJECTIVES

To compare the ultrasonographic (US) appearances of the oral mucosa in health with patients with systemic sclerosis (SSc).

METHODS

An innovative 20 MHz US scanner was used to examine the lips, cheeks and oral vestibule of ten healthy persons and ten patients with SSc. The clinical, US and histopathological features of one patient with a fibro-epithelial polyp of the buccal mucosa are reported in detail.

RESULTS

Two patients with SSc displayed increased echogenicity due to fibrotic deposits. A similar echo pattern was seen in the case of the histopathologically verified fibro-epithelial polyp of the buccal mucosa.

CONCLUSION

20 MHz sonography may be suitable as a non-invasive tool for evaluation of fibrosis of the oral mucosa.

Motilin-producing liver and bone metastases evidenced 14 years after resection of a rectal polyp

A 62-year-old man with a history of a resected rectal polyp was diagnosed 14 years later with right liver and multiple bone metastases. The liver biopsy showed a malignant epithelial tumor that was positive for neuron-specific enolase immunostaining and negative for chromogranin. Electron microscopy was characteristic of that for an endocrine tumor. Most circulating hormonal peptide levels were within normal ranges and only motilin level was elevated. On the right hepatectomy, the three large metastases had a histologic picture suggestive of an endocrine tumor. Immunohistochemistry revealed in some areas numerous tumor cells expressing motilin, and a few cells were strongly positive for pancreatic polypeptide and somatostatin. The retrospective analysis of the rectal polyp showed a similar histology and immunohistochemical profile, indicating that this lesion was the primary tumor. Motilin-positive cells from one of the hepatic lesions were identified on semithin sections and further processed for electron microscopy. Neurosecretory granules were numerous in all cells. Immunoelectron localization enabled us to characterize the motilin-containing neurosecretory granules, which had a mean diameter of 168.3x38.1 nm. Although not all tumor cells were motilin-positive, a diagnosis of motilinoma for the rectal polyp and its hepatic and bone metastases was proposed.

[Rating of transvaginal sonography in the evaluation of postmenopausal bleeding]

OBJECTIVE

The purpose of this study was to evaluate transvaginal ultrasonography (TVS) in differential diagnosis of vaginal bleedings in postmenopausal patients.

MATERIAL AND METHODS

Between January 1990 and December 1996, 1198 postmenopausal patients with vaginal bleedings were sent to our clinic for a histological evaluation. Eight hundred and seventy-nine patients (73.4%) were preoperatively scanned by transvaginal probe, and endometrial thickness (< 5, 5-7, 8-10, > 10 mm) was measured.

RESULTS

Atrophy was found in 46.3%, endometrial polyps in 19.8%, endometrial cancer in 17.5%, and hyperplasia in 6.7%. An endometrial thickness of lower than 5 mm (p < 0.0001) was shown in TVS patients with atrophy in 71%, with endometrial polyps in 10.9%, with endometrial cancer in 3.9% and hyperplasia in 6.8%. In 55.2% of these eases with endometrial cancer the preoperatively estimated thickness was 10 mm or more. The additionally morphologic examination in cases with an endometrium smaller than 5 mm was false positive in 75% (9/12). Thus an endometrial thickness of > 5 mm had a sensitivity of 92.5%, specificity of 71.0%, positive and negative predictive value of 75.6, respectively 90.9% for the detection of endometrial pathology.

CONCLUSIONS

TVS allows the detection of an endometrial pathology in the vast majority of patients with postmenopausal bleedings. In cases with a single postmenopausal bleeding and an endometrium smaller than 5 mm we recommend expectative procedures with repeated ultrasound examination of the endometrium.

Atypical cervical polyp with intracytoplasmic inclusions

Benign polyps containing atypical stromal cells are described at many anatomical sites and some such lesions have been shown to contain intracytoplasmic actin-rich inclusions, believed to represent deranged filament metabolism in proliferating myofibroblastic cells. We present a case of an atypical cervical polyp with intracytoplasmic inclusions, occurring in a 23 year old female, and provide support for the proposal that these inclusions are composed of actin filaments, identical to those initially reported in infantile digital fibromatosis. This report emphasises the need to recognise the benign nature of such stromal proliferations and expands the range of myofibroblastic lesions in which actin inclusions may occur. Characterisation of the inclusions will provide further insight into the complexities of actin metabolism.

Fibroepithelial polyps of the anus: a histologic, immunohistochemical, and ultrastructural study, including comparison with the normal anal subepithelial layer

Fibroepithelial polyps of the anus (FEPA) are relatively common lesions that have attracted little attention. A series of 40 FEPA, together with sections from normal anal mucosa, were studied histologically, histochemically, immunohistochemically, and ultrastructurally. The polyps consisted of myxoid or collagenous stroma covered by squamous epithelium. Stromal cells with two or more nuclei were found in 30 polyps (80%). In five cases (12%) these cells showed atypical nuclear features. All the polyps harboring atypical cells were of large size. Mast cells were frequently present and sometimes intimately related to the stromal cells. Stromal cells stained positive for vimentin and negative for actin. Desmin was expressed in 30% of the cases. Electron microscopic examination confirmed the fibroblastic and myofibroblastic nature of the stromal cells. Examination of the subepithelial connective tissue from the normal anal mucosa showed bizarre multinucleated cells and mast cell infiltration. It is concluded that FEPA are benign lesions characterized by the presence of mononucleated and multinucleated, sometimes atypical stromal cells showing fibroblastic and myofibroblastic differentiation. The morphologic similarity between FEPA and normal anal mucosa supports the hypothesis that FEPA may represent a reactive hyperplasia of the subepithelial connective tissue of the anal mucosa. Mast cells, by means of their fibrogenic, fibrolytic, and angiogenic activities may play an important role in the pathogenesis of FEPA.

Estrogen and progesterone receptor expression in postmenopausal tamoxifen-exposed endometrial pathologies

Assessment of receptor levels in tamoxifen-exposed endometrial pathologies may indicate endometrial cells potential for interaction with tamoxifen. To assess this assumption, we analyzed estrogen receptor (ER) and progesterone receptor (PR) expression by an immunohistochemical technique in endometrial specimens with benign hyperplasia, benign polyps, and carcinoma obtained from postmenopausal breast cancer patients treated with tamoxifen (study group) and from age-matched healthy postmenopausal women treated with estrogen replacement therapy (control group I) and not treated with estrogen replacement therapy (control group II). Overall gland and stromal ER expression of benign endometrial hyperplasia and of benign endometrial polyps was significantly higher in control groups I and II than that obtained from the study group (endometrial hyperplasia: P = 0.0274 and 0.00093, respectively, and P = 0.00003 and 0.00001, respectively; benign endometrial polyps: P = 0.02889 and 0.00596, respectively; and P = 0.00228 and 0.00005, respectively), while there were no differences between the two control groups. Overall gland and stromal PR expression was nearly similar in all the three groups (P = NS). There was no correlation between the length of tamoxifen treatment and the presence of ER and PR in various endometrial pathologies in the tamoxifen-treated patients. The significantly lower ER expression in most benign endometrial pathologies obtained from postmenopausal tamoxifen treated patients may further support the weak estrogen-like effect of tamoxifen on the endometrium in the menopause.

Immunohistochemical characterization of benign laryngeal lesions

It has been proposed that laryngeal nodules and polyps represent injury to the basement membrane zone of the vocal fold. Repeated trauma from shearing forces produced by excessive or abusive phonation leads to basement membrane zone disruption and thickening. This thickening, along with poorly understood vascular changes, creates the characteristic clinical appearance of the vocal nodule or polyp. As such, to better understand vocal fold nodules it is imperative to characterize the extracellular matrix in this area of injury. Secondary to the small size and relatively acellular nature of these lesions, hematoxylin and eosin (H & E) preparations of histologic material are unsatisfying. A previous study examined this area with immunohistochemical techniques to better characterize its contents. The report, however, contained little information with regard to the clinical appearance of the lesions prior to excision. Therefore, we were prompted to review histologic material from 31 patients who underwent microsurgical excision of 41 benign lesions, vocal nodules (4), polyps (19), polypoid corditis (4), and cysts (14) with immunohistochemical techniques to characterize the patterns of fibronectin and collagen type IV within these lesions. Normal human vocal folds were stained for control. All material was correlated with the H & E preparations and the clinical diagnosis. Collagen type IV and fibronectin appeared present in relatively abnormal patterns in the areas adjacent to the lesion. This study validates earlier results. In addition, correlation with clinical data allows association of immunohistochemical staining patterns with clinical diagnosis.

Developmental lesions of the head and neck: terminology and biologic behavior

As much confusion has been generated in the literature by the inaccurate or improper use of terms describing developmental lesions such as hamartoma, choristoma, and teratoma, a number of different benign and malignant developmental lesions are described and distinguished in the hope that these lesions can be more reliably identified and consequently also more adequately managed.

Histologic structure of antrochoanal polyps

The antrochonanal polyp (ACP) is defined as a maxillary sinus polyp that originates in the maxillary sinus, passes through the sinus ostia, and extends into the choana. The aim of this study was to compare the histologic findings of 40 cases of ACP with those of allergic and non-allergic nasal polyps, and so possibly to elucidate the pathogenesis of ACP. No allergy could be verified in any of the ACP patients. Inflammatory cell infiltration was significantly more severe in the ACP group than in the allergic polyp group. Eosinophilic infiltration was significantly less severe in the ACP group than in the allergic polyp group. Edema was not significantly different between the ACP, allergic, and non-allergic groups. In the ACP group, the presence of submucous glands was significantly less pronounced than in the ordinary nasal polyp groups. The fibrous type was present significantly more often than the infiltrative or granulating type in the ACP group. The histologic findings and clinical features of the ACP indicate that it has little causal relationship with nasal allergy but is all the more intimately associated with inflammatory processes. The paucity of submucous glands suggests that the ACP results from edematous hypertrophy of the respiratory epithelium rather than from distension of the glandular structures.

Persistent episiotomy granulation polyps; a polysymptomatic clinical entity

We describe a number of patients with persistent symptoms of vaginal discharge and discomfort, dyspareunia and postcoital bleeding. They presented 2-4 months following delivery with episiotomy. In these patients, the symptoms were associated with localised granulation tissue polyps, on the episiotomy site. Simple ablation resulted in rapid and effective relief of the symptoms. These lesions may be more common in clinical practice than is suggested by the lack of published reports. They should be looked for in women who may suffer from symptoms for several months after delivery.

Polyp pathogenesis--a histopathological study in experimental otitis media

We examined the mucosa of 50 rat middle ears in an experimental model of acute otitis media, in order to obtain information on the mechanisms of polyp formation. The right middle ear of 25 rats was inoculated with type 3 pneumococci, and the left ear served as a control. The animals were killed, the middle ear bulla removed, and the mucosa was dissected from the bone, stained PAS-alcian blue and embedded as a whole-mount. The whole-mounts were examined in a light microscope for polypous mucosal prominences. Serial sections were made of all polyps, and of relevant parts of the mucosa. 15 polyps were found in 11 (44%) of 25 infected ears; none were found in normal control ears. Goblet cell density was increased in polyps and the surrounding epithelium. Epithelial microruptures were seen in areas with widespread intra-epithelial liquid vacuoles and subepithelial accumulation of liquids, luminally migrating inflammatory cells, increased vascularization and edema. Connective tissue of the lamina propria was prolapsed through most ruptures. Some prolapses showed signs of re-epithelialization, while others had a full epithelial lining that resembled a fully developed polyp. Our findings support our earlier theory on nasal polyp pathogenesis, based on the following stages: i) Localized rupture of the epithelial lining. ii) Luminal protrusion of the lamina propria through the epithelial defect. iii) Re-epithelialization of protruded tissue, and formation of a polyp.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cytologic findings on chronic inflammatory disease of the vocal folds]

The usefulness of cytologic diagnosis in laryngeal pathology is still controversial, also in the cytopathologist's opinion. A sampling procedure such as routine cytodiagnosis can be considered useful for both diagnosis and treatment of non-surgically related laryngeal diseases. This study was designed in order to demonstrate how cytodiagnosis can be useful in etiologic and pathogenetic diagnosis of chronic non-specific inflammatory diseases of the vocal folds. Cytologic sampling was carried out on brushing material of simple and hyperplastic laryngeal inflammations and on normal vocarfolds which were used as control. Through cytologic examination it was possible to evidence specific morphological findings which allowed differentiation of not only healthy from diseased vocal cords, but also hyperplastic from simple inflammatory processes. Moreover, the high incidence of goblet cells and cylindric squamous metaplasia in hyperplastic corditis, as well as the frequent presence of fungal involvement in the simple forms, prompted the Authors to hypothesize pathogenetic mechanisms as well as progression inducing factors of the pathologies in question.

[Morphological analysis of 40 polypoid lesions of the gallbladder and their clinical significance]

For the purpose of studying the histological types of gallbladder polyps and their relations to the clinical features, 40 specimens of postoperative polypoid lesions of the gallbladder collected from Changhai Hospital were observed by means of light and electron microscopy. The results demonstrated that the histological types of gallbladder polyps might be divided into: cholesterol polyp, inflammatory polyp, mixed-type polyp and adenomatoid polyp. Cholesterol polyp was the most frequently encountered and the next was inflammatory polyp. A mixed-type polyp is proposed. The adenomatoid polyp might have atypical hyperplasia and potential malignancy. The cholesterol polyp had no relationship with cholesterolosis of the gallbladder.

A method to quantitate the relative nuclear area of colorectal polyps by image analysis

Image analysis of the nuclear area was performed on Feulgen-stained sections from 94 colorectal polyps: 57 colorectal adenomas with or without invasive growth, 28 hyperplastic polyps and 9 Peutz-Jeghers hamartomas (without dysplasia or carcinoma). The lowest mean values of nuclear area were recorded in control cases: in hyperplastic polyps (27.3%), followed by hamartomatous polyps (34.7%). The nuclear area was significantly increased in tubular adenomas with low-grade dysplasia (37.9%), in villous adenomas with low-grade dysplasia (41.16%) and in tubular and villous adenomas with high-grade dysplasia (47.0% and 46.0%, respectively). The nuclear area in villous adenomas with invasive growth was significantly higher than in all other adenomas without invasive growth (56.0%). The present data suggest that the nuclear area in colorectal polyps (as deduced by image analysis studies) correlates well with the degree of nuclear atypia. Thus, measurements of nuclear area appear to be an important parameter in studies aiming to elucidate the malignant potential of these lesions.

A method for quantitating the nuclear area of gastric polyps using image analysis

With the aid of an image quantifier, the nuclear area in Feulgen-stained sections from 29 gastric adenomas and 8 hyperplastic gastric polyps were recorded. In each specimen, the nuclear area and the total mucosal area were measured in three consecutive fields of (1) the lesion and (2) its adjacent normal gastric mucosa. The results, expressed as the percentage of the nuclear area to the total mucosal area, showed significantly higher (P less than .001) values in gastric adenomas than in hyperplastic gastric polyps. The highest mean of the difference between the nuclear values was found in gastric adenomas with invasive growth. The method reported herein appears to be useful for making the differential diagnosis between neoplastic and nonneoplastic polyps arising in the gastric mucosa.

Immunohistochemical and electron microscopic findings in benign fibroepithelial vaginal polyps

Eleven classic benign "fibroepithelial polyps" of the vagina were examined using a panel of immunocytochemical agents. Two were also examined electron microscopically. In all cases the stellate and multinucleate stromal cells characteristic of these lesions stained strongly for desmin, indicating muscle intermediate filament production. In common with uterine fibroleiomyomata, numerous mast cells were also often seen. Myoglobin staining was negative. Electron microscopical examination confirmed that the stromal cells contained abundant thin filaments with focal densities and also showed the ultrastructural features usually associated with myofibroblasts. It is concluded that these tumours would be better designated polypoid myofibroblastomas in view of the above findings.

Ultrastructural study of two subtypes of gastric adenoma

An ultrastructural study was performed to identify any differences in fine detail between type III and IV gastric polyps, which seem to differ from each other because they have different histological features and malignant potential. Clear ultrastructural differences were found, implicating microvilli, mucous granules, interdigitations, ribosomes, mitochondria and nuclei. Although these two subtypes have often been grouped together as borderline lesions or adenomas, the findings imply that they should be treated as essentially different.

Ultrastructural features of vocal fold nodules and polyps

Earlier investigation did not show any clear distinctive pathological features that differentiate vocal polyps from vocal nodules. The light microscopic distinctive features between the two lesions point in the direction of a more pronounced epithelial reaction and a more fibrous stromal change in vocal nodules. In the present study, 19 vocal polyps and 11 vocal nodules were subjected to ultrastructural examination aiming at finding distinctive features that may be pathognomic for each of these clinically distinct entities. The study was carried out by EM Philips 400 T. The results demonstrate that nodules showed epithelial changes in the form of gaping of the intercellular junctions and absence of the basal lamina in parts. These changes are less apparent in polyps, whereas the stromal changes are more pronounced and varied. The significance of these results and their interpretation are discussed.

[Localization of endometrial hyperplasias and their nuclear morphology]

The success of a prevention program on a cytological basis depends above all on the localization and extent of the nuclear changes, both of which can be determined using simple morphological methods. Using histologic specimens taken from the cases of hyperplasias at the Erlangen University Gynecological Hospital between 1963 and 1981, location of the endometrial hyperplasias and nuclear pattern were determined. It was established that 8.6% of precancerous endometrial hyperplasias are situated exclusively in deeper regions of mucous membrane and thus, as a rule, escape detection by cytologic instruments. No nuclear enlargement was shown in 22.9% of precancerous cells. 14.2% showed no changes in chromatin patterns, and 8.6% of precancerous cells revealed neither nuclear enlargement nor changes in chromatin. Since a number of precancerous cells are situated in deeper sections of mucous membrane and fail to show nuclear enlargement, cytologic screening cannot provide a basis for successful recognition of the precancerous stage of endometrial carcinoma.

Endocervical polyp with pseudosarcomatous pattern and cytoplasmic inclusions: an electron microscopic study

A case of endocervical polyp with atypical stromal cells in a 32-year-old woman is reported. Light microscopy showed atypical stromal cells with eosinophilic cytoplasmic inclusions which, by electron microscopy, were nonmembrane-bound, compact fibrillary structures in close relationship with the cytoplasmic microfibrils. The ultrastructural features demonstrated a fibroblastic nature of bizarre cells. These inclusions are similar to those of infantile digital fibromatosis. These findings have not been reported previously.

Unusual endocervical polypoid tumor with endocrine cells: an immunohistochemical and ultrastructural analysis

Light microscopic, immunohistochemical, and ultrastructural features of an unusual polypoid tumor of endocervix are reported. Numerous polypeptide hormone and amine-producing endocrine cells were disclosed. Main conventional characteristics were the architectural growth pattern, with infolding glands giving rise to small secondary glands, the hypermucinous benign-appearing epithelium of endocervical type, and, possibly, the stromal smooth muscle. Ultrastructural analysis showed a highly differentiated tumor. Glandular elements were surrounded by a basal lamina. Mucinous cells, several endocrine cell types, amphicrine cells, nonsecretory ciliated cells, ciliated mucinous cells, and possible reserve cells were observed. This tumor departs appreciably from normal mucosa and common varieties of endocervical polyp, particularly its distinctive endocrine profile. The present case does not correspond to a well-defined type of endocervical neoplasia. It shares morphologic analogies with mucinous tumor of ovary. The malignant potential of this lesion as well as its relationship with minimal deviation adenocarcinoma remain questionable.

Cytology and histopathology of metastatic malignant melanoma involving a polyp on the uterine cervix. A case report

A case of unusual localization of metastatic malignant melanoma on the cervix uteri, which was diagnosed by cytologic examination of a Papanicolaou smear is reported. The cells contained no pigment, but they had the characteristic appearance that suggested the possibility of a metastatic malignant melanoma, which was confirmed by histopathologic examination of an excised polyp.

An immunohistochemical and electron-microscopic study of vascular endothelial cells in vocal fold polyps

Gelatinous and telangiectatic types can be differentiated among the human vocal fold polyps. Telangiectatic polyps are characterized by eosinophilic deposits consisting of fibrin and cellular blood constituents. Labyrinthine vascular channels are characteristic of these polyps, and are partially or completely lined by a single layer of flat cells. Using electron microscopy and immunohistochemical stainings (antibodies against factor VIII-related antigen, Ulex europaeus I lectin, and antibodies against lysozyme), we found that the lining cells are true vascular endothelial cells and are not organizing histiocytic cells that are arranged in an endothelial-like pattern.

The Cronkhite-Canada syndrome: an ultrastructural study of pathogenesis

Electron microscopical and cytochemical studies of intestinal biopsies from a patient with typical features of the Cronkhite-Canada syndrome show that the primary process affects the crypts. This results in cystic dilatation associated with expansion and focal degeneration of the crypt compartment of the intestinal epithelium. The villous epithelium compartment is reduced but ultrastructurally normal. Inflammation and oedema of the lamina propria follows from leakage of mucin through breaks in the abnormal crypts.

Pseudomalignant erosion in hyperplastic gastric polyps

Six cases of hyperplastic gastric polyps are described that, in the region of the eroded head, revealed strikingly atypical mesenchymal cells. These disseminated cells with marked nuclear pleomorphism and also atypical mitotic figures, undergoing direct transition to typical granulation tissue, are considered to be particularly activated mesenchymal cells. In a single case in which only excisional biopsy was performed, these cells were found to persist over a lengthy period, while in endoscopic-biopsy follow-ups of the polypectomized cases, these cells were subsequently no longer detectable. In four of the cases, the polyp was located in the region of the cardia, so that a traumatic factor may possibly be considered as having some causal relevance. In particular when biopsy excisions are performed, the differential diagnosis of this polyp with its endoscopic and histologic appearance of a tumor-like lesion, from epithelial and mesenchymal malignancies, as also from neural tumors, can be difficult.

Peritoneal endometriosis: scanning electron microscopy and histology of minimal pelvic endometriotic lesions

In 36 patients with laparoscopically diagnosed endometriosis, biopsies were taken from different areas of the pelvic peritoneum bearing foci of endometriosis. The biopsies were studied by scanning electron microscopy and by light microscopy. Combined use of these techniques resulted in the differentiation of three topographically and morphologically different types of endometriotic lesions: intraperitoneal endometriotic polyps with no glandular openings but associated with deeper endometriotic glands and stroma; intraperitoneal endometriotic foci with surface epithelium, glands, and stroma; and retroperitoneal small lesions with few glands and scant stroma. The morphologic features of endometriotic foci indicate that they do not follow the typical cyclic changes described for the uterine endometrium. Our microanatomic characterization of endometriosis is discussed in relation to the conflicting data concerning peritoneal fluid constituents and infertility in patients with minimal endometriotic lesions.

Scanning electron microscopy of upper urinary tract tumors

Scanning electron microscopy (SEM) was performed on specimens from 16 patients with low-grade tumors, and 4 patients with benign lesions of the upper urinary tract. Pleomorphic microvilli could be seen at a low frequency on the majority of the tumor specimens as well as on surface cells of specimens from patients with inverted papilloma, fibroepithelial polyp, and hydronephrosis. The SEM appearance of the lining cells was similar whether the specimen was obtained from a patient with a tumor, or an inflammatory or proliferative lesion. Furthermore, pleomorphic microvilli were observed in five histologically normal bladders in which the covering cells had been rubbed off with a cold loop of a resectoscope. Pleomorphic microvilli are thus not morphologic markers of preneoplastic hyperplasia or tumor. It is likely that their presence merely reflects an increased rate of detachment of superficial epithelial cells which are replaced by cells from the deeper part of the epithelium. The demonstration of pleomorphic microvilli is therefore of questionable value in the preoperative diagnosis of tumors of the upper urinary tract and, consequently, their significance must be re-evaluated.

Spindle cell carcinoma of the larynx

Histology, histogenesis, biology and treatment of the rare spindle cell carcinoma of the larynx are presented. The histogenesis of spindle cell tumours has been much debated, but electron microscopic investigations have shown that most of the laryngeal lesions are squamous epithelial carcinomas that have undergone transformation to a spindle cell pattern. As confusion with supporting tissue neoplasms may occur in the light microscope, the use of the electron microscope in differential diagnostics is recommended.

Dysplastic collagen fibrils in the human vocal fold. An electron microscope study

Electron microscope studies made on biopsy samples of the human vocal cord from patients suffering from chronic hoarseness revealed pathological changes in both the collagen fibrils and the elastic fibres. There was splitting and fracturing of the collagen fibrils and lacuna or cyst formation in the elastic fibres, or even the complete fibre degeneration. Further investigations must be undertaken in order to establish whether the changes observed are of a primary or secondary nature.

[Comparative study of the DNA content and cross-sectional area of the interphase nuclei of epithelial cells in stomach polyps and cancer (based on gastric biopsy data)]

Cytospectrophotometric measurement of DNA level of interphase nuclei versus their cross-reaction area was carried out in mucosal cells of the stomach. The material included gastric bioptates from healthy subjects and patients with single and multiple adenomatous polyps of the stomach as well as gastric cancer. Tumor cells, and to a lesser degree, those of multiple polyps exhibited certain changes in DNA content: histograms showed several peaks and variations in DNA level increased, the latter being unmatched by a rise in DNA content per nucleus. A correlation was established between DNA content and cross-reaction area of interphase nuclei. Therefore, both parameters may serve for diagnosis.

Fetal rhabdomyoma of the larynx

A patient had fetal cellular rhabdomyoma of the larynx confirmed histologically and by electron microscopy. The literature on laryngeal rhabdomyomas is reviewed. Adult and fetal rhabdomyomas demonstrate no clinical differences in the larynx, unlike rhabdomyomas described elsewhere in the body. Most patients are middle-aged men with less than three years' history of hoarseness. The diagnosis is established pathologically by using routine histologic criteria, special stains, and electron microscopy. Treatment consists of local surgical excision. The tumors rarely recur.

Xanthogranulomatous pseudotumor of the vagina: evidence of a local response to an unusual bacterium (mucoid Escherichia coli)

Utilization of nonconventional bacterial strains and electron microscopy occasionally may aid in the recognition of unusual microorganisms which fail to be demonstrated by more conventional bacterial stains. We report an unusual case of recurrent vaginal polyps, initially thought by physical examination to represent a malignant neoplasm and histologically to represent a granular cell tumor. The lesions were comprised microscopically of sheets of large, polygonal, histiocytic-like cells with abundant eosinophilic granular cytoplasm. With the Dieterle silver stain, the cytoplasm of these cells contained large numbers of intracellular rod-shaped bacilliform bodies thought to be microorganisms. These organisms stained not at all or very poorly with more conventional bacterial stains, such as Gram and Giemsa stains. Electron microscopy was employed to confirm the presence of intra- and extracellular bacilliform bodies and the absence of large numbers of cytosegresomes, the latter characteristically seen in typical granular cell tumors. Cultures of tissue from the biopsy documented a pure strain of a mucoid form of Escherichia coli. We were unable to identify any prior report describing a similar recurrent inflammatory vaginal lesion in which mucoid E. coli was demonstrated. We discuss possible pathogenesis of this case, and relate it to morphologically similar diseases, such as Whipple's disease and malakoplakia, in which there appears to be defective clearance of bacteria from a variety of tissues.

Encapsulated sensory corpuscle in the mucosa of human vocal cord: an electron microscope study

Encapsulated sensory corpuscles of the Krause type were found in the mucosa of surgically removed human vocal cords. The corpuscles were ellipsoidal structures of about 30 to 50 micrometers and were located beneath the free edge in the mid-region along the intermembranous part. They contained a number of varicose nerve endings and lamellar cells. The lamellar cells had thin cytoplasmic lamellae which contained numerous cytoplasmic filaments and were interposed between the nerve endings. Attachment devices were frequently noted between the cytoplasmic lamellae and between the lamellae and nerve endings. Half-desmosomes were also noted along the plasma membrane of the lamellar cells. The intercellular space was filled with amorphous electron lucent material and contained a few collagen fibrils. Ladder-like filamentous structures were frequently encountered in the intercellular space. The location of the corpuscles at the free edge of the vocal cords suggests that the endings may receive the bilateral touch of the vibrating part of the cords in order to give sensory information for the control of the movement of the cords in phonation.

Glucagon-, glicentin-, and pancreatic polypeptide-like immunoreativities in rectal carcinoids and related colorectal cells

Three nonargentaffin rectal carcinoids have been investigated immunohistochemically. In one case most tumor cells reacted with antiglucagon sera as well as with antiglicentin, antibovine pancreatic polypeptide (BPP), and antihuman pancreatic polypeptide (HPP) sera; they were identified ultrastructurally as L cells. Another case showed glucagon-, glicentin-, and BPP-immunoreactive cells but lacked HPP immunoreactivity. In the third case glucagon- and glicentin-immunoreactive cells were well represented, while PP immunoreactivities were scarce. Parallel investigations of human rectal and sigmoid mucosa showed numerous cells reacting with glucagon, glicentin, and BPP antisera, most of which lacked HPP immunoreactivity. Cells reacting with glucagon and glicentin antisera, while lacking PP immunoreactivities, were also found. Thus, both tumor and nontumor cells produce glucagonlike immunoreactive (GLI) peptides--one of which may be glicentin or a related molecule--as well as PP-related sequences, although differing histochemically and ultrastructurally from glucagon or PP cells of the human pancreas. It is concluded that nonargentaffin rectal carcinoids are histogenetically linked to nonargentaffin endocrine cells of the human rectum.

Pathogenesis of diethylnitrosamine-induced tumors in the trachea of the Syrian golden hamster

The pathogenesis of tracheal tumors induced in Syrian hamsters by subcutaneous treatment of N-nitrosodiethylamine (DEN) was examined in a serial sacrifice study using light and electron microscopy. Initial ultrastructural changes were noted in ciliated and mucous cells, and basal cells were identified as source of the later developing papillary polyps and squamous carcinomas.

Polypoid and papillary epithelial hyperplasia: a potential cause of ductal obstruction in adult polycystic disease

In experimental models of cystic renal disease, functional studies define conditions that suggest increased resistance to outflow from dilated or cystic nephrons. Morphologically, models exhibit foci of cellular hyperplasia and micropolyp formation along outer medullary collecting tubules. Temporally, cellular proliferation precedes cyst formation. These findings in models have led to a hypothesis that polypoid hyperplasia participates in cyst formation in susceptible kidneys by increasing resistance to the outflow of tubular urine. The present study was undertaken to establish the presence, extent, and distribution of cellular hyperplasia in human adult polycystic kidney disease. Kidneys from four unrelated individuals were studied by light and by transmission and scanning electron microscopy. Foci of hocation of hyperplasia along the nephron were similar to those seen in the models. These findings delineate a heretofore unappreciated morphologic similarity between the models and human disease and add further support to the hypothesis that partial rubular obstruction participates in the pathogenesis of renal cystic disease, whether it be heritable or acquired, in animals and in man.

An unusual multifocal leiomyosarcoma of the stomach: a light and electron microscopic study

A multifocal leiomyosarcoma of the stomach originating from the muscularis mucosae with lymph node and distant metastases is described in a 66 year old man. The electron microscopic features of a representative tumor mass and a metastasis confirmed the smooth muscle histogenesis. The light microscopic appearance consistently suggested malignant fibrous histocytoma. The pathological features of gasttric leiomyosarcomas are reviewed with special emphasis on the problem of practical diagnosis. This case also indicates that not all sarcomas with storiform features are necessarily histiocytic in origin.

[In-vitro formation of plasma polyps in the human placenta and their isolation by means of "inverted centrifugation" (author's transl)]

1. Histological observations on sliced human placenta shaked in Krebs-Ringer-solution showed an high plasma polyp formation by the syncytiotrophoblast without any monoidoacetate or sodiumfluoride poisoning [1]. 2. The high plasma polyp formation of placenta slices incubated with gased (96% O2, 4% CO2) Krebs-Ringer-solution and shaked at 37 degrees C decreased rapidly and lasted up to 40 min. 3. Perfusion of the placenta intervillosum with fetal serum added Krebs-Ringer-Solution gave results in plasma polyp production up to six times higher than serum free Krebs-Ringer-solution perfusions. 4. Plasma polyp isolation and concentration by one step is discribed applying the inverted centrifugation technique: Plasma polyps migrate centripetally in Krebs-Ringer-solution containing 6% Ficoll (Pharmacia) and were concentrated in the tip of a tube invertedly placed into a swing-out-rotor.