CLEAR CELL ADENOCARCINOMA OF THE FEMALE URETHRA A Case Report

A case of urethral clear cell adenocarcinoma (mesonephric carcinoma) in a 62-year-old woman is reported. The patient consulted our hospital because of acute urinary retention. Fine needle aspiration cytology showed a few atypical cells; loose cluster cells with finely vacuolated cytoplasm, large nuclei and prominent nucleoli, and small cluster cells with finely vacuolated, delicate cytoplasm, small pale nuclei and small nucleoli. Cytologic diagnosis was adenocarcinoma and no diagnosis of clear cell adenocarcinoma was obtained. The neoplasia was localized at the posterior wall of the urethra and deep muscular layer of the vaginal wall. Histologically, the tumor revealed mainly small, elongated glands consisting of single-layered cuboidal or columnar cells with scanty cytoplasm and a focally hobnail appearance. In addition, a small cystic lesion resembling nephrogenic adenoma was observed. This finding raises the possibitily that clear cell adenocarcinoma may be a malignant counterpart of nephrogenic adenoma. ACTA PATHOL JPN 38: 217–223, 1988.     

CRYSTALLOID STRUCTURE IN ADRENOCORTICAL ADENOMA

The presence of crystalloid structures was demonstrated in the cytoplasm of a huge adrenocortical adenoma ultrastructurally. The crystalloids were classified into four types, and they differed from those of spironolactone bodies or intramitochondrial bodies in their size and shape. The structures of the crystalloids resembled the crystalloids of Reinke in the Leydig cells of the testis. Reports on intracytoplasmic crystalloids are rare in the tumors of the adrenal cortex. ACTA PATHOL. JPN. 35: 1501–1510, 1985.     

NON-FUNCTIONING ADRENOCORTICAL ADENOMA IN CULTURE

This report describes the morphological responses of unstimulated and stimulated non-functioning adrenocortical adenoma in culture. The removed adrenocortical adenoma was composed mainly of clear-type cells and partially had a small area of cholesterol granuloma. These adenoma cells had many lipid droplets and round to long rod-shaped mitochondria with tubular or tubulo-lamellar cristae which were similar to those in Cushing's adenoma. The non-functioning adrenocortical adenoma cells which were incubated in vitro under ACTH (10 mlU/ml) and angiotensin II (10–6 M/ml) stimulation, were examined by phase contrast microscopy, transmission and scanning electron microscopy, and the content of Cortisol and aldosterone in the culture medium was measured by radioimmunoassay. As a result of exposure of ACTH, the cultured cells revealed the retraction response and production of Cortisol and aldosterone. After administration of ACTH for many days, the cultured cells showed characteristic changes in sER and mitochondria. The sER were markedly developed and packed tightly into a network of dilated tubules. Mitochondria were larger and more numerous than in the unstimulated cells. The mitochondria appeared to be entwined by the tubules of the sER. Lipid droplets decreased in number. ACTA PATHOL. JPN. 35 : 871–884, 1985.     

MALIGNANT TRANSFORMATION OF ADENOMA IN LARGE INTESTINE—ESPECIALLY ON VILLOUS ADENOMA

The incidence of 454 resected adenomas was histologically 87.8% of tubular, 7.7% of tubulovillous and 4.5% of villous adenomas, respectively. Eighty-eight percent of villous and tubulovillous adenomas were located in the rectosigmoid region. Male to female ratio was 1 to 1.8, 1.5 to 1 and 1.8 to 1 for the villous, tubulovillous and tubular adenomas, respectively. Adenocarcinomas of large intestine consisted of 684 cases, 709 lesions and male to female ratio was 1 to 1.01. It should be considered that the adenomas in female may grow largely compared with those in male, with subsequent malignant transformation. Although the adenomas were found at the rate of 26.4% in the rectosigmoid region, 74.2% of the adenocarcinomas were found In this region, because the adenomas in this region grow largely compared with the other regions. Mucinous carcinomas were found in 33%, 23% and 9%, respectively, in the adenocarcinomas with remaining adenoma showing villous, tuvulovillous and tubular types.     

ADRENOCORTICAL ADENOMA WITH PRIMARY ALDOSTERONISM IN CULTURE

Four adrenocortical adenomata with primary aldosteronism (Conn's adenomata) were examined by light and electron microscopy employing cell culture methods. Unstimulated cells existed as a unit of the clusters, but Conn's ademona cells reacted to ACTH. The cultured cells produced mostly cortisol under ACTH-stimulation as time passed. Lipid droplets in their cytoplasm decreased in number and the smooth endoplasmic reticulum (sER) was well-developed with dilated, anastomosing tubule. Moreover, mitochondria sometimes had tubulovesicular cristae. It is assumed that Conn's adenoma cells are hybrid type cells, which are intrinsically capable of producing cortisol as well as aldosterone.     

ADRENOCORTICAL ADENOMA WITH CUSHING'S SYNDROME IN CULTURE

Two adrenocortical adenomata with Cushing's syndrome were examined employing cell culture methods. The results revealed that the clear-type cells changed into compact-type cells, and that the compact cells played a role in the production and secretion of steroid hormones. Furthermore, it is likely that they underwent fragmentation and produced collagen fibrils.     

PAPILLARY ADENOMA IN A LATERAL CERVICAL CYST

A lateral cervical cyst located in the left lower neck and had no connection with the thymus, thyroid or parotid gland has been described. Its origin might be the remnant of thymic duct, since Hassal's corpuscle-like structure was found in the cystic wall, although established thymic tissue could not be detected. The most interesting feature of the cyst was that the lining showed papillary adenoma approximately in one-fifth of the luminar surface, whereas the rest was lined by either cuboidal to columnar, nonciliated epithelial cells or metaplastic squamous epithelial cells. This is the first documented case of papillary adenoma in a lateral cervical cyst of possible thymic duct origin. ACTA PATHOL. JPN. 37: 1019–1024, 1987.     

CRYSTALLINE STRUCTURES IN HUMAN PANCREATIC BETA CELL ADENOMA

An electron microscopic observation on a pancreatic tumor removed from a 34-year-old woman revealed the fine structural morphology of a functional beta cell adenoma. Characteristic PAS positive crystalline structures were frequently observed in the cytoplasm of the tumor cells. They were not bounded by a membrane and had a rectangular or irregular hexagonal shape. Highly regular patterns were seen as such as lattice or honeycomb and parallel ripple structures. They are similar to the Reinke's crystal or crystalline structures reported in human hepatocytes suffering from several different diseases and considered as a protein-carbohydrate complex. Occasionally, small paracrystalline structures appeared to indicate an immature type of these structures in the opaque fine fibrillar mass. Crystalline or paracrystalline structures were not detected in the normal pancreatic tissue removed with the tumor from the patient.     

STRUCTURAL CHANGE OF ADRENOCORTICAL ADENOMA IN CUSHING'S SYNDROME

Eight adrenocortical adenomata from patients with Cushing's syndrome were examined by light and electron microscopy. Light microscopically, the reticulin fibers were markedly prominent in areas of the compact-type cells and ran tangentially to the adenoma cells or parenchyma! cells. Electron microscopically, adrenocortical adenoma was composed of parenchymal cells, interstitial cells, and endothelial cells. In areas of the clear-type cells, the parenchymal cells were arranged in long columns and covered by the sinusoidal wall. In areas of the compact-type cells, the sinusoid was well-developed and meandering. The dilated intercellular space was conspicuous and filled with filamentous substance and collagen fibrils. The parenchymal cells appeared to produce the filamentous substance and collagen fibrils, and underwent fragmentation. Interstitial cells and fragmented cytoplasm of the parenchymal cells were found in the intercellular and perisinusoidal space. It was likely that the fragmented cytoplasm flowed into the sinusoid. Experimental study using cell culture methods revealed these phenomena, especially a production of collagen fibrils. ACTA     

IMMUNOELECTRON MICROSCOPIC LOCALIZATION OF THYROGLOBULIN IN HUMAN FOLLICULAR ADENOMA

An electron microscopic immunohistochemical localization of thyroglobulin (TG) using PAP methods has been made in 15 cases of cold follicular adenoma. All cases of follicular adenoma showed organ specific functions such as synthesis, storage, reabsorption, and hydrolysis of thyroglobulin except for an area composed of follicular cells with trabecular arrangement. Immuno-reaction product for TG was precisely demonstrated in follicular lumina, subapical vesicles and reabsorbed colloid droplets. The reaction product observed in the follicular lumen was clearly demarcated from the cytoplasm of the follicular cells by the apical plasma membrane. The subapical vesicles ranging approximately from 50 mμ to 300 mμ in diameter were rarely observed in follicular adenoma and some of them fused with the reabsorbed colloid droplets. The reabsorbed colloid droplets usually had the intense reaction product and hydrolyzed colloid droplets had a vacuole containing floccular low electron dense materials. There is no reaction product in rough endoplasmic reticulum and Golgi complexes.     

COEXISTENCE OF STOMACH CANCER AND RENAL ADENOMA IN RENAL ALLOGRAFT

Autopsy findings of a 34-year-old Japanese male with stomach cancer in a renal allograft are presented. The renal graft was given by his 53-year-old mother, who had the same HLA type as the patient and showed negative response in the Mixed Leukocyte Culture Reaction test. Stomach cancer occurred 4 years and 5 months after the renal graft, and infiltrated widely into the abdominal cavity, causing rectal stricture. In his original left kidney, a small renal adenoma was found. The tumor cells of the adenoma were composed of clear cells. In the adenoma, infiltration of stomach cancer was found. The renal allograft functioned very well until his death in spite of several rejection episodes. This is the seventh reported case in Japan in which a renal allotransplant was accompanied by malignancies.     

FUNCTIONING OXYPHIL CELL ADENOMA IN A PATIENT WITH SECONDARY HYPERPARATHYROIDISM

A 45-year-old Japanese woman who has been receiving haemodialysis for 13 years suffered from an ectopic calcifying nodule and deformity of the thorax. She was diagnosed as hyperparathyroidism secondary to chronic renal failure. Total parathyroidectomy was performed, and the excised parathyroid glands showed hyperplasia in four and an adenoma in the left upper gland. On the electron microscopic study, the adenoma was composed of oxyphil cells and transitional oxyphil cells, the latter predominating in number. It was revealed from immunohistochemical study that the oxyphil cells in adenoma were strongly stained for parathyroid hormone (PTH). Continuous stimuli to secrete PTH seemed to generate the functioning oxyphil cell adenoma with an ability of PTH production, as well as hyperplasia of parathyroid chief cells. It seems to be the first case of tertiary hyperparathyroidism caused by an oxyphil cell adenoma. Functions of oxyphil cells and transitional oxyphil cells are briefly discussed.     

MALIGNANT PITUITARY CHROMOPHOBE ADENOMA IN AN INFANT ACCOMPANYING DIABETES INSIPIDUS

This report deals with a 1.5-year-old male infant terminating in viral pneumonia and "diabetes insipidus". The autopsy revealed malignant pituitary chromophobe adenoma, invading the wall of the third ventricle, extending to the periventricular-, dorsomedial- and ventromedial area, skipping to the lateral area adjacent to the optic nerve, and permeating into the subarachnoid space of the cerebrum. At the onset of disease polydypsia and polyuria were marked followed by interstitial pneumonia with high fever, and later generalized tonic convulsion terminated in death. This case is peculiar in at least two respects. Firstly, this is the youngest reported case of malignant chromophobe adenoma. Secondly, the manifestation of diabetes insipidus is rare in chromophobe adenoma. The malignant adenoma probably occurred from the primitive gland rest of chromophobe cells in the posterior lobe becoming malignant during the course of growth development and destroyed the cells of the posterior lobe, resulting in diabetes insipidus.     

PRODUCTION OF COLLAGEN FIBRILS IN ADRENOCORTICAL ADENOMA WITH CUSHING'S SYNDROME

The production of collagen fibrils, especially collagen type III, was studied with regard to eight adrenocortical adenomas with Cushing's syndrome. Anti-type III procollagen amino-terminal peptide serum (procollagen III) was employed for the PAP method. In areas of clear-type cells, the parenchymal cells were negative for procollagen III, but the stroma exhibited an intense reactivity and were arranged in an alveolar fashion. On the other hand, it was obvious that not only interstitial cells or spindle-shaped cells but also the parenchymal cells synthesized procollagen III in areas of compact-type cells, and the stroma showed a strongly positive reaction to it.     

BASAL CELL ADENOMA WITH PARALLEL TUBULES IN STROMAL CELLS OF THE PAROTID GLAND

A case of basal cell adenoma in the right parotid region of a 51 years old male was reported. The tumor measured 2.5 cm x 3 cm, was spherical and covered with a fibrous capsule. Histologically, it was a tubular monomorphic adenoma with scant edematous interstitial tissue. The stromal cells stained positively by the PAP method using anti-S-100 protein serum. Electron microscopically, the tumor cells forming tubules had many microvilli at the luminal surface, many filaments in the cytoplasm and well developed des-mosomes in the intercellular junctions. Ordinary intracellular organelles of the tumor cells were small in number, and their nuclei were oval with shallow indentation. In the dilated rough endoplasmic reticulum of the stromal cells, many straight parallel tubules were found. The tubules measured from 15 nm to 25 nm thick and 3.5 γm long in the longitudial sections and from 25 nm to 30 nm in diameter with electron lucent core and poor coat in the cross sections. Other cell organelles of the stromal cells were small in number, and filaments and dense attachments were found in the ectoplasm. Around the stromal cells there was a discontinous basement membrane. ACTA PATHOL. JPN. 34 : 1449–1458. 1984.     

ELECTRON MICROSCOPIC STUDY ON MITOCHONDRIA IN HÜRTHLE CELL ADENOMA OF THYROID

In this investigation Hürthle cell adenoma of the thyroid was observed by electron microscopy. The cytoplasm of the cells consisted chiefly of an accumulation of numerous irregularly shaped mitochondria. Very few other organellae were observed. In addition electron microscopy revealed various degrees of electron density in the matrix of the mitochondria. When 3 dimensional models of the mitochondria were constructed, they revealed the mitochondria to have 3 dimentional forms which sometimes looked as if they might be dividing into two or three parts. The authors felt that this indicated a process of vigorous division of mitochondria and an extension of their life span. However, it was not possible to identify the cause of this division of mitochondria.     

FUNCTIONAL PATHOLOGY OF ALDOSTERONE-PRODUCING ADENOMA

In addition to the morphological examination, the measurement of the content of corticosteroids was done in aldosterone-producing adenoma. Histologically, the adenoma consists of four types of cells. The major component of the adenoma was clear-type cells. In this type of cells, the activities of 3β-hydroxysteroid dehydrogenase and glucose-6-phosphate dehydrogenase showed weakly positive. The fine structure was characterized by numerous lipid vacuoles and poor organellae. On the contrary, intermediate- and compact-type cells revealed higher than moderate activities of these enzymes. Moreover, marked development of smooth endoplasmic reticulum and mitochondria was noted. Zona glomerulosa-type cells were observed only in a small part. The content of aldosterone and corticosterone in aldosterone-producing adenoma was significantly larger than those of the other type of adenoma. A tendency of positive correlation between the increase of compact-type cells and content of aldosterone was found. The cell origin of this aldosterone-producing adenoma and functional role of clear- and compact-type cells were also discussed.     

BASAL CELL ADENOMA WITH ACINIC DIFFERENTIATION

A case of basal cell adenoma in the left parotid region of a 45 years old male was reported. The tumor measured 1.1 cm × 0.9 cm, was spherical and covered with a fibrous capsule. Histologically, it was a monomorphic adenoma, forming solid, trabecular, tubular and acinic structure. The tumor cells secreted PAS-positive substance. Electron microscopically, the tumor consisted of three kinds of cells - secretory cells containing electron-dense secretory granules, non-secretory cells, and myoepithelial cells. The acinus was formed of single-layered secretory cells, in the base of which myoepithelial cells were observed. The tubulus was formed of both secretory and non-secretory cells, and myoepithelial cells were found in the base of the tubules. The interstitium was narrow, and was composed of a small amount of collagen fibers, myoepithelial cells, and basement membrane-like substance.     

雌性大鼠心内神经节中雌激素受体及其mRNA的表达

目的 在雌激素受体蛋白及ERmRNA水平提供雌激素对心内神经节中神经元作用的形态学依据。方法 采用免疫组织化学及原位杂交技术。结果 在心内神经节部分神经元中，雌激素受体免疫反应及其mRNA原位杂交反应阳性。雌激素受体免疫反应沉淀物呈棕黄色，定位于胞核，雌激素受体mRNA免疫反应沉淀物呈棕黄色，定位于胞浆。结论 大鼠心内神经节中，部分神经元能合成雌激素受体蛋白，说明ER阳性神经元可以为雌激素提供结合位点，因此，这些神经元可能受到雌激素的影响。