Mucoepidermoid carcinoma of salivary glands: a clinicopathologic study of 46 cases

Forty-six cases of mucoepidermoid carcinoma (MEC) of the salivary glands were reviewed with an emphasis on the clinicopathologic aspects and prognosis of the tumors. MEC occurred in a wide age range, with few cases being diagnosed in childhood. Its peak of incidence was in the fifth decade and it involved major and minor salivary glands with equal frequency; the parotid gland was the gland most commonly affected. Presence of a mass was the most common complaint of all 46 patients. About 64% of the patients presented with stages 3 and 4 disease. Three distinct histologic grades were found after analyzing cellular pleomorphism, mitotic activity, and presence of necrosis. This study showed that clinical staging and histologic grading are the most important factors influencing survival and they seem to be independent of each other. Other variables found to be important in prognosis were age, sex, and the development of recurrent disease after surgery. Surgery with total resection of the tumor was the most effective treatment in our cases and adjuvant radiotherapy proved to be of little value in improving survival of MEC in our series of cases, considering that the patients in whom this type of treatment was used had unfavorable clinicopathologic factors.     

Lipomatous meningioma: a clinicopathologic study of 18 cases with special reference to the issue of metaplasia

We report 18 cases of lipomatous meningioma occurring in patients aged 14 to 79, most being females (72%). Sixteen were supratentorial and 2 involved the spinal meninges. Follow-up ranged from 1 to 120 months. Fifteen patients were cured with surgery alone and 3 (17%) experienced a recurrence at 7, 8 and 24 months. Of these, one died with disease 4 years after resection of the primary lesion. Histologically, 12 tumors were meningothelial, 3 transitional, 2 showed myxoid stromal changes and 1 was microcystic. The 2 spinal tumors were atypical. The proportion of fatty cells ranged from 10 to 90%. These resembled mature adipocytes or less commonly lipoblasts. Xanthomatous meningothelial cells were also noted in 6 tumors (30%). Both conventional meningothelial as well as lipid-laden cells exhibited epithelial membrane antigen immunoreactivity. In addition, occasional cells resembling mature adipocytes showed reactivity for S-100 protein. Ultrastructurally, lipidization of neoplastic cells varied from intracytoplasmic lipid droplets to a single massive globule. Moreover, lipid-laden meningothelial cells featured interdigitating cell membranes and well-formed desmosomes. Lipid droplets were not membrane-bound. In that metaplasia denotes differentiation of one mature cell type to another, lipid accumulation in meningiomas cannot be considered true metaplasia since their lipid-laden cells retain the immunophenotype and ultrastructural features of meningothelium. We suggest that this distinctive subset of meningiomas be termed "lipidized meningiomas" rather than being included in the metaplastic category.     

Serological and histological study of lupus nephritis with special reference to anti-SSA antibody

Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which many organs are damaged by deposition of pathogenic autoantibodies and immune complexes Clinically lupus nephritis occurs about 50% in SLE Many studies revealed the association between autoantibodies and lupus nephritis However, the pathogenetic role of autoantibodies in lupus nephritis remains obscure. To elucidate the pathogenetic role of anti-SSA antibody in lupus nephritis, 32 patients with SLE were evaluated by serological and histological methods. Enzyme-linked immunosorbent assay for anti-SSA antibody was developed for this study. It was confirmed that this assay was specific, did not detect autoantibodies other than anti-SSA antibody. The levels of anti-SSA antibody determined by this assay significantly correlated with the levels determined by double immunodiffusion (p less than 0.01). The level of anti-SSA antibody greater than or equal to 200 units was regarded as positive. The serum levels of antinuclear antibody, anti-DNA antibody, anti-RNP antibody, anti-SSA antibody, anti-SSB antibody, C3, and C4 were also determined. Renal biopsy materials were evaluated according to the WHO criteria, and activity index (AI), chronicity index (CI), and pathologic score (PS) were calculated according to Austin et al. The patients were divided into group A (AI greater than or equal to 4, n = 17) and group B (AI less than or equal to 3, n = 15) The levels of anti-DNA antibody were significantly higher in group A than in group B (p less than 0.05). The frequency of positive anti-SSA antibody in group A (70.6%) was greater than in group B (23.3%) significantly (p less than 0.05). However, there were no differences in the levels of anti-nuclear antibody, anti-DNA antibody, anti-RNP anti-body, anti-SSA antibody, anti-SSB antibody, C3, and C4 between group A and group B. Then these patients were divided into group I (anti-SSA greater than or equal to 200 units, n = 17) and group II (anti-SSA less than 200 units, n = 15). AI and CI were greater than in group I than in group II significantly (p less than 0.05). The frequency of pericarditis in group I (35.3%) was greater than group II (6.7%) (p = 0.061), but the frequencies of the other clinical manifestations were not different. AI was correlated with anti-DNA antibody significantly (p less than 0.01), but there were no correlations between other serological data and parameters.(ABSTRACT TRUNCATED AT 400 WORDS)     

Thymic neuroendocrine carcinoma: a clinicopathologic study in four patients.

BACKGROUND: Thymic neuroendocrine carcinoma (carcinoid) is rare. Here we present four cases of this unusual neoplasm to provide more clinical, radiologic, and prognostic data. MATERIALS AND METHODS: Four male patients with an average age of 44 years (range 27-63) were identified as having thymic neuroendocrine carcinoma and were reviewed retrospectively. RESULTS: One patient had Cushing's syndrome with elevated serum ACTH. Three others were asymptomatic with normal laboratory findings, one case was associated with MEN type 1. All underwent complete resection along with invaded adjacent structures. Local recurrence developed in two patients at 45 and 98 months after the initial excision. Both patients died at 90 and 105 months, respectively. The other two patients are alive and have been disease-free for 27 and 120 months, respectively. CONCLUSIONS: Thymic neuroendocrine carcinomas have a rather poor prognosis based on their tendency to recur and metastasize many years after the initial operation. Therefore, prolonged follow-up is essential for these tumors.     

Current problems in staging and grading prostatic carcinoma with special reference to T3 carcinoma of the prostate

Summary The staging and grading results of 107 patients considered to be potential candidates for radical prostatectomy are described. In all patients lymph node status was proven histologically. Understaging of the local tumor was found in 51.4% of the patients. Local overstaging in clinical T3 patients was noted in 23%. Undergrading of the pre-operative biopsy specimen was noted in 42% of the patients, while overgrading occurred in 6% of the patients. False negative frozen sections of pelvic lymph nodes occurred in 7%. The percentage of false negative frozen sections was higher in higher T-categories and higher tumor grades. The presence of lymph node metastases is a function of T-category and tumor grade. In T3G3 patients positive nodes were found in 90% of the cases. Bipedal lymphangiography and CT-scanning were of no value in detecting lymph node metastases in patients not being T3 or G3. In clinical T3 patients total tumor removal, as defined by negative pelvic lymph nodes and negative margins of resection, could be achieved in 30% of the cases.     

Prevalence of carcinoma of the penis with special reference to India.

The frequency of carcinoma of the penis throughout the world is tabulated and compared with similar data from 32 hospitals in India. There is a wide variation in the frequency of penile carcinoma in India despite the fact that circumcision is not practiced by Hindus and is by Muslims. There must be some other etiologic factors such as poor sexual hygiene and lack of cleanliness to account for this variability in frequency. There was no association between the frequency of cervical and penile carcinomas.     

Long-term survival in prostatic carcinoma, with special reference to age as a prognostic factor. A nation-wide study

A total of 44,300 cases of prostatic cancer, comprising 90% of all newly diagnosed cases reported to the Swedish Cancer Registry in 1960 through 1978, constituted a cohort followed up for 1-19 years. Survival rates were adjusted for expected mortality in the general population, and were expressed as relative survival (RS). RS for the total cohort after 5, 10 and 15 years was 51, 34 and 24%, respectively, with an annual excess death rate of about 8% which persisted also after long-term observation. RS was similar in the age groups between 45 and 74 years, whereas among patients older than 74 at diagnosis, approximately 10% lower RS appeared early and was persistent. These data demonstrated that the highly varying natural course of prostatic cancer is only slightly related to patient age at diagnosis. The low long-term relative survival rate definitely contradicted the concept that biologically inactive (latent) tumours constitute a significant proportion of the prostatic cancers diagnosed in clinical practice.     

Urinary antiseptics with special reference to a clinical study of benzochrome

In the present series there were twenty-five patients, twenty-one females and four males. The ages ranged from 19 to 62 years, with an average of 36. The urinary symptoms included frequency, dysuria, malaise, fever, suprapubic, right lower quadrant, right loin and lower back pain. The diagnoses included cystitis, pyelitis, pyelocystitis, pyelonephritis, kidney abscess and nephrolithiasis. Benzochrome was used consistently and in three instances following argyrol instillation, an alkaline régime and methenamine respectively. Benzochrome uniformly gave symptomatic relief and in most cases urinary abnormalities vanished. In a few cases relief was noted despite persistence of pus cells in the urine. Patients were noted to remark about the freedom from burning on urination after benzochrome medication. In the above cases no attempt was made to influence the diet or reaction of the urine. The urines examined were all acid to litmus paper.     

Clinical and histological correlations in prolactinomas,with special reference to bromocriptine resistance

Summary Background. Prolactinomas usually exhibit a benign course and can be safely and effectively managed by dopamine agonists (DA). However, some are locally invasive and may show resistance to DA therapy, and the management of such cases remains controversial. The aim of the present study was to determine whether histological features and markers of cell proliferation correlated to the clinical behaviour of prolactinomas and with DA resistance.Method. This retrospective study included 74 cases (36 men and 38 women) who had monohormonal prolactinomas removed by transsphenoidal surgery. The prolactinomas were categorized on the basis of tumour size (48 macroadenomas), invasion of the cavernous sinus (n = 31), and resistance to bromocriptine (BRC) therapy (n = 14). Group 1 consisted of non-invasive microprolactinomas (n = 24), group 2 of non-invasive macroprolactinomas (n = 19), group 3 of invasive non-BRC-resistant tumours (n = 19), and group 4 of invasive BRC-resistant tumours (n = 12). The later group included one case of carcinoma with bone and lung metastases. Seven additional parameters were studied, these being age, sex, basal prolactin (PRL) levels, the Ki-67 and PCNA labelling indices (LI), mitotic count, and cellular atypia.Findings. Age and preoperative PRL levels did not correlate to the histological parameters studied. Tumour size and invasion were related to cellular atypia and the Ki-67 LI. BRC-resistant tumours were more frequently invasive (12/14) than BRC-responsive tumours (11/30; p = 0.002) and were more frequent in men than in women (33 versus 5%; p = 0.003). BRC-resistant tumours had a higher Ki-67 LI and mitotic count (4.2±2.0% and 4±1, respectively) than other tumours (0.7±0.2% and 1±0, respectively; p<0.05). The strongest correlations with tumoural staging were seen with male sex and high mitotic activity. Six out of the 12 invasive BRC-resistant macroprolactinomas, including the PRL secreting carcinoma, exhibited histological features of aggressiveness (a mitotic count ≥3 [i.e. in the fourth quartile] and/or a high Ki-67 LI and cellular atypia).Conclusions. In this surgical retrospective series, histological signs of aggressiveness are present in 50% of invasive and BRC-resistant prolactinomas, which are more frequent in men than in women. This fits with the behaviour of BRC-resistant prolactinomas, which can continue to grow despite DA treatment. These findings justify the long-term follow up of these tumours, and the use of surgery and/or radiotherapy if there is concern about the control of tumour growth.     

Postpubertal cryptorchism. Morphofunctional study with special reference to Leydig's cells

In a group of 17 patients of postpubertal age with unilateral (n = 15) or bilateral (n = 2) cryptorchism, a significant decrease in the tubular diameter was observed, in addition to Leydig cell hyperplasia (many with cytoplasm vacuolization and/or atrophy) in both the cryptorchid testes and in the contralateral scrotal testes. The number of testosterone-positive Leydig cells in testicular tissue sections, studied with peroxidase-antiperoxidase, was diminished in the cryptorchid testes, whereas in the contralateral scrotal testes it was similar to the control group. Together with normal testosterone levels and elevated luteinizing hormone and follicle-stimulating hormone levels in peripheral blood, this leads us to think of a compensated dysfunction of the Leydig cells. This possible lower testosterone production by the Leydig cells in the cryptorchid testis is not borne out morphologically, where the volume of the organelles is similar to the contralateral scrotal testes.     

Myoepithelial carcinoma of the salivary glands: a clinicopathologic study of 25 patients

Salivary gland carcinomas displaying exclusively myoepithelial differentiation (myoepithelial carcinoma) are considered rare. Their histopathologic features, immunohistochemical profile, and clinical behavior are not well characterized. The authors reviewed the clinicopathologic features of 25 salivary gland tumors fulfilling two fundamental histologic criteria: unequivocally malignant and exclusively myoepithelial. For most of these, the original diagnosis was malignant mixed tumor. Thirteen men and 12 women aged 24 to 77 years (mean age, 55 yrs) participated in the study, and most presented with a painless mass. The parotid gland was the most common site (n = 15). Tumors ranged from 2.1 to 5.5 cm, arising either in association with a benign mixed tumor (n = 15) or de novo (n = 10). Histologically, all the tumors displayed infiltrative growth and most had a characteristic multinodular architecture with a cellular periphery and central necrotic/myxoid zones. Epithelioid, hyaline, spindle, clear, or mixed cell types were noted with accompanying myxoid and/or hyalinized extracellular matrix. Ten tumors were high grade cytologically and 15 were low grade. The mitotic rate ranged from three to 51 mitoses per 10 high-power fields. Necrosis was present in 15 tumors and perineural and vascular invasion were identified in 11 and four neoplasms respectively. Immunoreactivities included CAM5.2 (89%), AE1:AE3 (100%), 34betaE12 (92%), cytokeratin 7 (21%), cytokeratin 14 (53%), vimentin (100%), S-100 protein (100%), smooth muscle actin (50%), calponin (75%), muscle-specific actin (31%), glial fibrillary acidic protein (31%), carcinoembryonic antigen (0%), and epithelial membrane antigen (21%). Ultrastructural examination of three tumors showed myoepithelial features. Ten patients developed recurrences, mostly multiple. Follow up of 17 patients showed that eight patients (47%) developed metastases (six high grade, two low grade) and five patients (29%) died of disease (four high grade, one low grade) after a mean of 32 months. Two patients were alive with disease (19 and 49 mos). Ten patients (59%) were without any evidence of disease after a mean of 42.2 months. Myoepithelial carcinomas exhibit a wide spectrum of cytomorphologic features and diverse clinical outcomes. As a result of their morphologic heterogeneity, they can be confused easily with many tumors. Myoepithelial carcinomas have been underrecognized in the past, primarily by being lumped under a broader category of "malignant mixed tumor." Awareness of their unique cytoarchitectural patterns and immunohistochemical profile is crucial for accurate identification.