Malignant mixed tumor (carcinosarcoma) of parotid gland diagnosed by fine-needle aspiration biopsy.

True malignant mixed tumor (carcinosarcoma) of salivary gland is a very rare neoplasm. Only one brief account of the Fine-Needle Aspiration Biopsy (FNAB) cytologic findings of this tumor was found in the literature. The authors report a case of malignant mixed tumor (chondrosarcoma and epidermoid carcinoma) arising from the left parotid gland in an 84-yr-old man, which was definitely diagnosed by FNAB. The cytologic findings and differential diagnosis are discussed.     

AN AUTOPSY CASE OF MALIGNANT RHABDOID TUMOR ARISING FROM SOFT PARTS IN THE LEFT INGUINAL REGION

An autopsy case of malignant rhabdoid tumor arising from soft parts in the left inguinal region of a 31-year-old Japanese male is reported. The tumor grew rapidly and appeared as a large mass measuring 21.5 × 16.5 cm located in the subcutaneous tissues of the lower abdominal wall. Histologically the tumor was composed of small round cells resembling rhabdomyoblasts, which showed a diffuse or alveolar arrangement. The cytoplasm of the tumor cells was eosinophilic and frequently contained round inclusion bodies, each consisting of an aggregation of globular filaments by electron microscopy. Immunohistochemistry showed the tumor cells to be positive for vimentin and keratin in the cytoplasm, but negative for actin, myoglobin and myosin. At autopsy, extensive metastatic or invasive tumors were observed mainly in the retroperitoneum and pelvic organs. The patient showed hypercalcemia which disappeared for only short periods just after surgery. ACTA PATHOL JPN 38: 1087∼1096, 1988.     

MALIGNANT GIANT CELL TUMOR OF TENDON SHEATH Report of a Case

In a patient with pigmented villonodular synovitis of the right knee joint, there occurred a malignant giant cell tumor of tendon sheath. There was clinical evidence of metastasis after the second local recurrence and the recurrent tumors were studied enzyme cytochemically and electron microscopically. Ultrastructurally, the malignant tumor consisted of three principal cell types; histiocyte-like cells, fibroblast-like cells, and intermediate cells, with unique attendance of myofibroblasts. This may be the first report of the presence of myofibroblasts in malignant giant cell tumor of tendon sheath. Enzyme cytochemistry revealed various functional properties of histiocytes. ACTA PATHOL. JPN. 35 : 699–709, 1985.     

CHONDROID SYRINGOMA (MIXED TUMOR OF THE SKIN)

The clinicopathology of 13 cases of chondroid syringoma were examined. The ages of the patients ranged from 26 to 86 years, with an average of 48 years. There were eight males and five females. Ten tumors out of the thirteen appeared on the face. Only one patient out of ten was suspected of recurrence in follow-up information. Histologically, all tumors consisted of epithelial cells, chondroid or myxoid matrix, and other strumal elements. The tumors were histologically classified into two types; twelve tumors had tubular and cystic lumina lined by two layers of epithelial cells, and only one case had small lumina lined by only a single layer. By an immunohistochemical study with a PAP method, positive stainings of keratin were observed in all cases, and S-100 protein in all but one. Ultrastructurally, the tumor cells showed features of an epithelial cell. Some ultrastructural differences were noted between two types of chondroid syringoma. Type I tumor cells had many tonofilaments in cytoplasm, but cytoplasmic filaments in type II were of the intermediate-type.     

EMBRYONAL CARCINOMA (MIXED GERM CELL TUMOR) OF THE OVARY

The purpose of this paper Is to report a case of embryonal carcinoma (mixed germ, cell tumor) of the ovary. Clinical data indicated significant levels of both alpha-fetoprotein and HCG with good correlation to the clinical course. Histologically the tumor showed teratoma, embryonal carcinoma with embryoid bodies and syncytiotrophoblasts, endodermal sinus tumor and dysgerminoma in the order of predominance. Emphasis was focused upon the close relationship of these histologic types to one another. The transitions from one histologic pattern to the other seemed to have occurred by means of duct system which was composed of ducts and their dilated forms commonly seen in teratoma, embryonal carcinoma and endodermal sinus tumor. These facts support, though indirectly, totlpotential cells as a source of germ cell tumor. Subtle questions were given to the notion of endodermal sinus tumor or yolk sac tumor.     

GRANULAR CELL TUMOR OF THE GALLBLADDER: Report of a Case

A rare case of granular cell tumor of the gallbladder in a 58-year-old Japanese man is presented. This is the third report of such a tumor arising in the gallbladder. The immunohistochemical study demonstrated the localization of the nervous-system-specific protein (S-100 protein) in the granular component cells, thereby supporting the Schwann cell origin of this tumor. ACTA PATHOL. JPN. 35: 687–691, 1985.     

Carcinoma ex-pleomorphic adenoma of the breast. Report of three cases suggesting a relationship to metaplastic carcinoma of matrix-producing type

Three cases of carcinoma ex-pleomorphic adenoma of the breast are reported. Patients were 82, 60 and 56 years old and presented with a breast lump. All tumours showed areas of pleomorphic adenoma adjacent to typical areas of malignant transformation. These cases add to the spectrum of tumours shared by breast and salivary gland. The relationship between these neoplasms and metaplastic carcinoma of matrix-producing type is discussed.     

A CASE OF OVARIAN GRANULOSA CELL TUMOR WITH INVASIVE ADENOCARCINOMA OF THE ENDOMETRIUM. A Case Report and Review of the Japanese Literature

A 47-year-old woman was admitted complaining of irregular uterine bleeding. On surgery, an ovarian tumor was found together with a broad-based polypoid endometrial mass. These lesions were histologically diagnosed as granulosa cell tumor with invasive adenocarcinoma of the endometrium. To our knowledge, only four other cases of granulosa cell tumor with adenocarcinoma of the endometrium have been reported in Japan, although our case was unique in showing invasion to the uterine myometrium. ACTA PATHOL JPN 38: 947∼951, 1988.     

恶性蝾螈瘤MR影像分析（附1例报道）

目的：探讨恶性蝾螈瘤（MTT）的MRI表现和临床病理特点,提高临床对MTT的认识.方法：手术切除辅以放疗治疗右前臂MTT 1例.结合文献复习,分析MTT的MRI表现及病理特征.结果：MTT的MRI表现为T1WI稍低信号、T2WI高信号的软组织肿块,肿瘤信号不均、T2WI上高信号肿块影内环形或线样低信号分隔影或许是MTT的特征性MRI表现之一.MTT的恶性度高,其治疗以手术切除为主,疗效及预后不佳,易在短期内复发及转移.结论：深入了解MTT的MRI表现,对MTT的早期诊断、早期治疗具有重要价值.     

Synchronous Benign Epithelial Tumors Arising in the Palatal Minor Salivary Gland: First Report of an Unusual Minor Salivary Gland Lesion

A review of the literature shows that unilateral benign salivary gland tumors of different histologic types in a single gland are so rare as to be curiosities, and all of such reported tumors have arisen in the parotid gland. The present paper reports a case of synchronous benign epithelial tumors of different histologic type arising in the palatal minor salivary gland of a 57 year old woman who had first noted palatal swelling about 20 years previously. Pathologically, the lesion was composed of two distinct tumors, pleomorphic adenoma and lumenless trabecular adenoma, which were sharply demarcated from each other by a thin layer of fibrous connective tissue. Foci of tumor cells with cellular atypia were seen in some areas of the pleomorphic adenoma. The present case is thought to represent a previously undescribed component within the spectrum of minor salivary gland tumors. Acta Pathol Jpn 40: 143–148, 1990.     

MALIGNANT CHEMODECTOMA (PARAGANGLIOMA) OF THE LARYNX A Case Report with Electron Microscopy and Biochemical Assay

This report presents a case of malignant chemodectoma In the epiglottic region of a 47-year-old man. His initial complaint was laryngeal discomfort and he expired from generalized metastases of the tumor about one year after operation. The tumor was detected by laryngoscopy and laryngogram. The yellow parenchymatous tumor, 2.8×2.5×1.5 cm in size, was resected together with two enlarged regional lymph nodes. The mass was subjected to a histopathological study and biochemical assay. Microscopically, the tumor was located in the submucosa of the epiglottis and showed an alveolar growth pattern of comparatively uniform tumor cells. Neurosecretory granules were clearly demonstrated by Grimelius'method and by electron microscopy. The biochemical assay revealed that the tumor contained small amounts of serotonine, epinephrine, norepinephrine, and dopamine. The distribution of paraganglia as the source of these tumors, the clinicopathological review of the previous reports and significance of neurosecretory granules are discussed.     

PANCREATOBLASTOMA IN JAPAN, WITH DIFFERENTIAL DIAGNOSIS FROM PAPILLARY CYSTIC TUMOR (DUCTULOACINAR ADENOMA) OF THE PANCREAS

Twelve cases of pancreatoblastoma, 7 males and 5 females, were 5 years of age in average and showed an organoid structure consisting of acinar differentiation with squamoid corpuscles. Seven cases died, but 5 lived after surgery. On the contrary, 17 cases of papillary cystic tumor, ductuloacinar adenoma of the pancreas, one male and 16 females, were 21 years of age in average and disclosed a monomorphous pseudopapillary pattern of ductuloacinar type of tumor cells with some degenerative and granulomatous changes. All of the cases had suffered no recurrence after resection. Immunohistochemically, strong positivity for α₁-antitrypsin may be associated with the autodigestive process and limited growth of this tumor. Electron microscopically, both tumors showed centroacinar and acinar types of tumor cells. Both tumor cells frequently contained well-developed RER, zymogen-like granules, and annulate lamellae. The ductular or acinar lumina were clear in pancreatoblastoma, but not in ductuloacinar adenoma due to degeneration. Though both tumors disclosed contiguous histogenesis, pancreatoblastoma should be differentiated from ductuloacinar adenoma, based upon the young age, almost equal sex ratio, unfavorable prognosis, high serum AFP level in three measured cases, an organoid structure containing frequent mitotic figures, and the invasive growing margin.     

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.     

Monomorphic (Basal Cell) Salivary Adenoma of Ovary: Report of a Case

A pregnant 26-year-old woman presented with an asymptomatic 10-cm left ovarian mass diagnosed at 19 weeks gestation. On removal, the tumor was shown to be a cribriform variant of basal cell salivary adenoma with no other teratomatous or germ cell tumor elements present. The pregnancy continued uneventfully to term and the patient remains symptom-free 10 months after diagnosis. Tissues of salivary type are occasionally observed within mature cystic teratomas of the ovaries and are presumed to have given rise to the present lesion, which is thought to be the first reported case of a neoplasm of salivary type arising in the ovaries.     

Monomorphic (Basal Cell) Salivary Adenoma of Ovary: Report of a Case

A pregnant 26-year-old woman presented with an asymptomatic 10-cm left ovarian mass diagnosed at 19 weeks gestation. On removal, the tumor was shown to be a cribriform variant of basal cell salivary adenoma with no other teratomatous or germ cell tumor elements present. The pregnancy continued uneventfully to term and the patient remains symptom-free 10 months after diagnosis. Tissues of salivary type are occasionally observed within mature cystic teratomas of the ovaries and are presumed to have given rise to the present lesion, which is thought to be the first reported case of a neoplasm of salivary type arising in the ovaries.     

PHYLLODES TUMOR (CYSTOSARCOMA PHYLLODES) OF THE BREAST: A Clinicopathologic Study of 45 Cases

The correlation between the histology and biologic behavior of phyllodes tumor was studied in order to establish the histologic criteria of this tumor, particularly its malignant counterpart. A preliminary analysis of five tumors with metastases revealed that a single essential indicator of malignant potential was the presence of a disproportionate overgrowth of the stromal elements at the expense of the ductal element. The presence or absence of such stromal overgrowth in the tumor showed a positive correlation with the degree of stromal atypism and the rate of mitoses. Seventeen out of 45 tumors were determined to be malignant, on the basis of our criteria. The arrangement of the stromal component in malignant phyllodes tumors was usually one of the particular sarcomatous types, with or without the focal areas of one of the specified types of sarcoma. On the other hand, 24 tumors recurred locally but never metastasized, and were preferentially interpreted to be benign phyllodes tumor. Histologically, these tumors had a general architecture resembling that of fibroadenoma but were characterized by high cellularity expressed by the distinct formation of bundles or fascicles of stromal tumor cells. The remaining four tumors seemed to form a borderline phyllodes tumor subset. A follow-up study revealed that, irrespective of the mode of therapy, the outcome of patients with phyllodes tumor was well correlated with the histologic criteria we proposed. ACTA PATHOL JPN 38: 21–33, 1988.     

CARCINOID TUMOR OF THE MIDDLE EAR: An Immunohistochemical and Electron Microscopic Study Report of a Case

A primary tumor of the middle ear was examined histologically, histochemi-cally, immunohistochemically and ultrastructurally. Neuroendocrine cell differentiation, a carcinoid feature, was demonstrated by the presence of numerous argyrophil granules, as well as positive serotonin, glicentin, glucagon, and human pancreatic polypeptide (hPP) granules in some of the Grimelium-positive cells. Chromogranin A was also detected in the cells, but much less frequently than Grimelius-positive staining. Neither neuron-specific enolase (NSE) nor epithelial membrane antigen (EMA) was demonstrated in the tumor. Mucin was demonstrated only intraluminally. Electron microscopy revealed many typical neurosecretory granules in tumor cells, but no apical mucin granules. The tumor appeared to be benign, and there has been no sign of recurrence during a postoperative period of one year. ACTA PATHOL JPN38: 1453–1460, 1988.     

PRIMARY ADRENAL LYMPHOMA. Report of an Autopsy Case

A rare case of malignant lymphoma of the adrenal gland In a 68-year-old male is reported. Autopsy revealed bilateral and symmetrical adrenal tumors (lt: 54 g, rt: 39 g) and almost complete effacement of both adrenal glands, while no tumors were present in other organs or systemic lymph nodes. Both adrenal tumors histologically presented a picture of diffuse malignant lymphoma of mixed cell type. Microscopic involvement in both lungs, spleen, liver, lymph node, bone marrow and both kidneys was found. Immunohistochemically, the positive reactions shown by the lymphoma cells were of B cell type, i.e., observed using antibodies to the leukocyte common antigens, MB-1, LN-1, LN-2 and LN-3, but not by anti-factor VIH-related antigen or MT-1. Examination of peripheral blood obtained just before the patient died showed the presence of 18% atypical cells. This lymphoma was considered to have transformed to a leukemic phase, at least at the end stage. To the authors'knowledge, this is the second case of primary adrenal lymphoma to be reported in Japan, and the first case showing formation of bilateral and symmetrical tumors. ACTA PATHOL JPN 38: 929∼939, 1988.     

Aorticopulmonary Paraganglioma (Aortic Body Tumor): Report of a Case

A case of aorticopulmonary paraganglioma in a 57-year-old man is described. The tumor comprised nests of uniform cells in a fibrovascular stroma. Electron microscopy revealed abundant neurosecretory granules, and S-100 protein staining demonstrated scattered sustentacular cells at the periphery of typical zellballen. The findings in this case correlated with those of studies on the prognosis for extraadrenal paragangliomas.