UNDIFFERENTIATED CARCINOMA OF THE THYROID GLAND WITH OSTEOCLAST-LIKE GIANT CELLS

Three cases of undifferentiated carcinoma of the thyroid gland with osteoclast-like giant cells resembling those of giant-cell tumor of bone are presented. The clinical and morphologic characteristics of these cases are described and the literature concerning these tumors is reviewed. The lesions occur in elderly people, grow rapidly and are fatal, as do the usual undifferentiated carcinomas of the thyroid gland. Nevertheless, the tumors differ histologically from the usual undifferentiated carcinoma of giant cell or spindle cell type in having the osteoclast-like giant cells with many, small, uniform, benign appearing nuclei. All three tumors contained partial areas of moderately to well differentiated carcinoma; papillary carcinoma in two, and follicular carcinoma in one. Although the histogenesis of the osteoclast-like multinucleated giant cells is not definitely established, it is proposed that the giant cells are reactive in nature and histiocytic in origin because of their benign appearance, phagocytic activity, high level of acid-phosphatase activity, and some ultrastructural features and that they are formed by fusion of mononucleated histiocytes.     

BREAST CANCER WITH OSTEOCLAST-LIKE MULTINUCLEATED GIANT CELLS

A case of breast cancer containing osteoclast-like multinucleated giant cells was examined cytologically, light and electron microscopically to find morphological evidences suggesting the origin of the giant cells. There were multiple evidences showing the same carcinomatous origin of each cell including osteoclast-like multinucleated giant cells. ACTA PATHOL. JPN. 34: 1475–1484. 1984.     

UNDIFFERENTIATED CARCINOMA OF THE PAROTID GLAND WITH BIZARRE GIANT CELLS

A rare autopsy case of undifferentiated carcinoma of the parotid gland with bizarre giant cells is reported. Grossly, the tumor was fist-sized, firm, solid, grayish-white in color, and was not encapsulated, with a bean-sized ulceration on the skin. Microscopical examination revealed undifferentiated carcinoma of the parotid gland composed of bizarre giant cells, large tumor cells, and spindle cells in part. Ultrastructural examination, recovered from formalin-fixed material, disclosed filamentous structure in some large tumor cells. It is strongly suggested that myoepithelial cells played an important role in the development of the undifferentiated carcinoma of the parotid gland. The clinical and histopathological characteristics of this case is described, and the literature concerning undifferentiated carcinoma of the parotid gland is reviewed.     

PAPILLARY CARCINOMA OF THE THYROID GLAND WITH ANAPLASTIC TRANSFORMATION IN THE METASTATIC FOCI An Immunohistochemical Study

An immunohistochemical study was made on an autopsy case of papillary carcinoma of the thyroid with anaplastic transformation in the metastatic foci occurring in a 72-year-old woman. The anaplastic carcinoma cells were sarcomatous in appearance, and they were vimentin-positive and cytokeratin-negative. Whereas, papillary tumor cells which were intermingled in the anaplastic carcinoma contained both cytokeratin and vimentin. The close correlation between tumor cell anaplasia and the expression of the different intermediate filament proteins in thyroid carcinoma was briefly discussed.     

ANAPLASTIC CARCINOMA OF THE THYROID GLAND An Ultrastructural Study on Four Cases

Four cases of anaplastic carcinoma of the thyroid, composed of one small cell carcinoma and three giant cell carcinomas, were studied with electron microscope. In the case of small cell carcinoma, fine cytoplasmic interdigitations and junctional complex between apposing cytoplasmic membranes of neighbouring tumor cells and a few microlumina within tumor cell clusters surrounded by well-defined basal lamina were seen. In the cases of giant cell carcinoma, occasional cytoplasmic interdigitations as well as desmosomal structures were detected even in tumor cells markedly pleomorphic and anaplastic. Abundant cytoplasmic organelles including profiles of Golgi apparatus, rough endoplasmic reticulum and a few mitochondria were seen in the cytoplasm of tumor cell of all four cases. Of interest to note was that all giant cell carcinomas demonstrated evidences of fairly well differentiated tumor within anaplastic carcinoma, indicating probable pre-existing either benign or malignant epithelial neoplasm more differentiated, with its subsequent anaplastic trasformation. Findings in the present study support an assumption that these anaplastic tumors are derived from the follicular epithelium of the thyroid gland. In addition, it can be said that tumor cells of the small cell carcinoma provide evidences suggesting functional differentiation of carcinoma cells to a certain extent, yet unable to produce thyroglobulin.     

ANAPLASTIC CARCINOMA OF THE ESOPHAGUS

The present report includes the histological, electron microscopical and immunohistochemical findings observed in two cases of anaplastic carcinoma of the esophagus. Anaplastic carcinoma of the eosphagus revealed histological features similar to oat-cell carcinoma and carcinoid. Positive argyrophil reaction, neurosecretory granules, and hormonal activity suggest that both cases come under the category of neuroendocrine cell tumors. Anaplastic carcinoma of the esophagus may be considered as a pluripotential tumor. The biological behavior of this tumor is quite different from that of carcinoid and is a highly malignant tumor.     

OSTEOCLAST-LIKE GIANT CELL TUMOR OF THE LIVER

A 66-year-old male with osteoclast-like giant cell tumor of the liver that arose in the non-cirrhotlc liver is presented. The liver tests were almost normal, and plasma levels of alpha-fetoprotein and carcinoembryonic antigen were within normal limits. The findings of liver scan by ^99mTc phytate, celiac angiography, and CT scans are described for the first time for this rare neoplasm, showing a large, unresectable liver tumor. Histologically, the tumor mainly consisted of osteoclast-like giant cells and mononuclear cells, which were focally arranged in a vaguely trabecular pattern and sarcomatous pattern. By an electromicroscopic study, however, no definitive evidence was obtained whether it arose from epithelial cells or nonepithellal cells. Various clinicopathological features were described and compared with previously reported cases including two cases arising in the liver.     

ULTRASTRUCTURE OF AN ANAPLASTIC GIANT-CELL CARCINOMA FOUND 8 YEARS AFTER OPERATION ON A PAPILLARY CARCINOMA OF THE THYROID

Light and electron microscopic studies have been made on an anaplastic giant-cell tumor that developed in a woman 8 years after an operation on the thyroid for papillary carcinoma. Many giant cells were observed in the anaplastic tumor tissue, but no follicles. Numerous tightly-packed mitochondria and abundant ribosomes were present, but there were no desmosomes. The basement membrane was not distinct.     

MEDULLARY CARCINOMA OF THE THYROID WITH ECTOPIC ACTH SYNDROME

An autopsied patient with medullary carcinoma of the thyroid and ectopic ACTH syndrome is reported. A microadenoma of pancreatic islet coexisted in this case, which is assumed to be of D cell origin. Immunohistochemical study revealed decreased number of pituitary ACTH cells. Some of them showed Crooke's degeneration. Hormone assay study of tumor tissue and plasma disclosed abnormal ACTH, β-MSH as well as calcitonin. Somatostatin and Substance P were also demonstrated in tissue. Histologically the tumor showed solid alveolar pattern with a minor part consisting of small cell variant and this histologic variation is discussed.     

LOSS OF INTRACELLULAR PEROXIDASE and ANAPLASTIC CHANGE OF DIFFERENTIATED CARCINOMA OF HUMAN THYROID GLAND

Ultrastructural localization of endogenous peroxidase (peroxidase) in differentiated thyroid carcinoma was studied in 2 cases of follicular carcinoma and 12 of papillary carcinoma. The reaction product for the enzyme was observed in cancer cells which had a round and smoothly-contoured nucleus and rather few number of microvilli (positive cells) and the product localized mainly in the rough-surfaced endoplasmic reticulum and perinuclear cisternae. The positive cells resembled normal follicular cells in localization sites of the reaction product and ultrastructural features. On the contrary, in cancer cells having an irregularly-outlined nucleus with or without intranuclear cytoplasmic inclusion and many microvilli, no reaction product was visualized (negative cells). The positive cells were frequently found in 2 follicular carcinomas and 2 papillary carcinomas. Only a few number of positive cells presented in 2 papillary carcinomas. The remaining 8 papillary carcinomas were composed only of negative cells. Histologically, follicles with colloid were frequently found in carcinomas with abundant positive cells, whereas they were few in number in carcinomas containing only negative cells.
These findings suggest that loss of peroxidase activity in cancer cells of follicular cell origin correlates with anaplastic change of the cancer cells.     

CARCINOMA WITH SIGNET RING CELLS OF THE ESOPHAGUS

A 55-year-old man with carcinoma with signet ring cells of the esophagus is described. The results of morphological examination are presented, and the classification and histogenesis of this rare tumor are discussed. Morphological examinations revealed this tumor to be composed of squamous, mucous-positive and signet ring cells. The signet ring cell had an intracyto-plastic microcyst and bundles of tonofllaments. These findings suggested that the signet ring cell was an intermediate form of squamous and adenocarcinoma cells. The findings for these three components indicated that the tumor was a kind of mucoepidermoid carcinoma. Histological findings suggested this tumor's development originated from the esophageal mucosal epithelium.     

PAPILLARY CARCINOMA OF THE THYROID

Twenty-one papillary thyroid carcinomas (PTCs), grouped into predominantly papillary (14 cases), predominantly follicular (5 cases), and extremely follicular, i.e., follicular variant (2 cases) types, were studied in comparison with three cases each of follicular lesions including follicular carcinoma, follicular adenoma, adenomatous goiter and Graves'disease. Histochemical, im-munoperoxidase, and electron microscopic analyses demonstrated no remarkable differences between the predominantly papillary and predominantly follicular PTCs, but the presence of common characteristics distinct from those of the follicular lesions. These two types of PTCs showed less glycogen, more mucoid material, more epidermal keratin, less thyroid hormone with relative predominance of T₃ over T₄, and more interdigitating reticulum cells (IDCs) than most of the follicular lesions. Ultrastructurally, the tumor cells of these PTCs had markedly irregular nuclei, a vesicular chromatin pattern, and small basally located lysosomes, in contrast with the cells in the follicular lesions which had smooth round nuclei, more heterochromatin, and apical or dispersed lysosomes of various sizes. The follicular variant PTCs showed some mixed features, such as glycogen in the follicular portion and mucoid material in metastatic papillary foci, positive keratin and IDCs but greater amounts of thyroid hormone, and a rather intermediate type of ultrastructure with only mildly irregular but vesicular nuclei and large apical as well as small basal lysosomes. These findings cytologically support the WHO definition of papillary carcinoma that includes tumors with variable mixtures of papillary and follicular patterns. However, separate consideration may be necessary with regard to the follicular variant. ACTA PATHOL. JPN. 37: 1563-1579, 1987.     

GIANT CELL CARCINOMA OF THE PANCREAS

A case of giant cell carcinom of the pancreas is reported herein. The patient is a 67-year-old Japanese woman complaining of ascites, general fatigue, loss of weight, abdominal distention, nausea, and vomiting. Cytological diagnosis of ascites revealed adenocarcinoma. At autopsy, a whitish tumor measuring around 5 cm in diameter was found at the head of the pancreas. Metastasis was seen only in the liver. Histological examination displayed bizarre multinucleated giant cells occasionally phagocytosing the tumor cells and neutrophils.     

C CELL CARCINOMA OF THE THYROID

Two cases of papillary type of C cell carcinoma of the thyroid were reported. They showed papillary arrangement with Abrovascular stalk in properly Axed tissues. Histochemically argyrophil reaction was positive in the cytoplasm and amyloid deposited in the stroma. Ultrastructurally secretory granules were found in their cytoplasm. The papillary type is not an artifact but one of the histologic variations of this carcinoma. ACTA PATH. SAP. 29: 653–659, 1979.     

THREE CASES OF GRANULOMATOUS MYOCARDITIS WITH GIANT CELLS

Three autopsy cases of granulomatous myocarditis were presented, which showed numerous multinucleated giant cells and diffuse proliferation of collagenous tissue. The first case revealed limited lesions only in the myocardium and classified as isolated myocarditis. The second and third cases disclosed classical generalized sarcoidosis with emphasis of myocardial involvement. The interrelationship between these two entities was discussed. Giant cell myocarditis, a disease entity, should be differentiated from the myocardial manifestation of sarcoidosis. ACTA PATH.JAP. 17: 503–515, 1967     

MORPHOLOGY OF THE WARTHIN-FINKELDEY GIANT CELLS IN MONKEYS WITH EXPERIMENTALLY INDUCED MEASLES

The lymphoid tissues of 9 monkeys infected experimentally with wild type measles virus were examined by light and electron microscopy. Multinucleated giant cells of the Warthin-Finkeldey type were found 7 to 11 days after virus inoculation. The giant cells occurred mostly in the germinal center of lymphatic follicles, where they underwent degeneration and disappeared rapidly. Lymphoid and reticular types of giant cells were recognized. The ultrastructural evidence suggested that some of the nuclei contained in giant cells were formed by an aberrant nuclear cleavage. The majority of giant cells, however, were postulated to arise from virus-mediated cell fusion, although direct evidence of cell fusion was not seen. Peculiar nuclear changes, in which some nuclei and fragments of the outer nuclear membrane were contained in a common outer membrane of the nuclear envelope, were observed in all lymphoid giant cells. Both cytoplasmic and intranuclear inclusions were seen to be composed of viral nucleoprotein strands. The former were detected in all giant cells of both types, and the latter in occasional nuclei, providing the direct evidence that giant cell formation resulted from replication of the virus.     

A HIGH-GRADE MALIGNANCY BRONCHIAL MUCOEPIDERMOID CARCINOMA WITH FEATURES OF GIANT CELL CARCINOMA

A high-grade mucoepidermoid carcinoma associated with giant cell carcinoma of the bronchus was found in a 41-year-old man. Light and electron microscopic examinations showed glandular and squamous elements. The histology of the giant cell carcinoma was similar to those of previously reported giant cell carcinomas. It was assumed that the giant cell carcinoma in the present case is the result of transformation of mucoepidermoid carcinoma originating in the bronchial gland.     

MINUTE CARCINOMA OF THE THYROID and ITS DEVELOPMENT TO ADVANCED CARCINOMA

The relationship between the size of carcinomas and their histological characteristics such as encapsulation and sclerosis was studied using 157 cases of thyroid minute carcinomas with diameters less than 10 mm. When the diameter of the tumor was less than 1 mm, encapsulated carcinomas were not found, but they were presented in a group with a larger diameter. Sclerosing carcinomas were more frequently distributed in the group with a diameter less than 5 mm. With increasing tumor size, the carcinomas were reduced markedly in number and only two cases of sclerosing carcinoma were observed with a diameter more than 8 mm. It was concluded that thyroid minute carcinomas arise as nonencapsulated carcinoma, either sclerosing or nonsclerosing, followed by encapsulation at a later time and that some of the nonsclerosing carcinomas become apparent clinically, whereas most of the sclerosing carcinomas remain clinically silent throughout the entire life of the host. ACTA PATHOL. JPN. 35 : 377–383, 1985.     

PRIMARY MUCIN-PRODUCING ADENOSQUAMOUS CARCINOMA OF THE THYROID GLAND

A rare case of mucin-producing adenosquamous carcinoma of the thyroid gland is reported in a 57-year-old woman. Light microscopically, much of the tumor showed a feature of mucin-producing adenosquamous carcinoma; squamous cells and mucous signet ring cells. In the lower portion of the tumor, a calcified area containing small foci of follicular carcinoma and its squamous cell metaplasia was accompanied. Histochemically, neutral, non-sulphated and sulphated acid mucins were found in the mucous cells, and no thyroglobulin or calcitonin was detected in the tumor cells. Electron microscopically, some tonofibrils and mucin production were observed concomitantly in the tumor cells. These findings suggested the possibility that this mucin-producing adenosquamous carcinoma originated from squamous cell metaplasia of pre-existing follicular carcinoma. ACTA PATHOL. JPN. 37: 1157 -1164, 1987.