Four cases of distinctive meningiomas with Zellballen growth pattern

Dong Y, Zhou X, Wu B, Wang J, Ma H, Zhou H, Jiang S, Lu G, Hu Q. Four cases of distinctive meningiomas with Zellballen growth pattern. APMIS 2009; 117: 936–40. Meningiomas are attributed to those tumours with slow‐growing pattern occurring predominantly in middle‐aged or elderly patients. Fifteen histological variants have been described based on the variable histomorphological features. Herein we report four cases with specific Zellballen growth pattern, giving the tumours a ‘paraganglioma‐like’ general aspect. The diagnosis of meningiomas was confirmed by immunohistochemical and ultrastructural findings. Histopathologists should be aware of this specific morphology which can lead to misdiagnosis.     

Lymphoid follicular hyperplasia--a distinctive feature of diversion colitis

Diversion colitis refers to the inflammatory changes that occur in the defunctioned segment of the large intestine following diversion of the faecal stream. We report the histological features in the defunctioned rectums from seven patients: one each with severe constipation and Beh?et's disease, two with Crohn's disease with rectal sparing and three with ulcerative colitis. The appearances of diversion colitis in a previously normal rectum are compared with diversion colitis with superimposed inflammatory bowel disease. Lymphoid follicular hyperplasia was found in all cases. This was marked in patients with inflammatory bowel disease, with or without initial rectal involvement. Other changes comprised surface epithelial degeneration and ulceration, mucosal inflammation including crypt abscesses, and crypt branching. Inflammatory and crypt changes were mild, except in ulcerative colitis where changes were marked and resembled those of the proximal colon. Lymphoid hyperplasia is a distinctive feature in diversion colitis. The term follicular proctitis, previously used to indicate chronic ulcerative colitis exclusively, should be re-examined.     

Placental site nodule and characterization of distinctive types of intermediate trophoblast.

Both placental site nodule and exaggerated placental site are described as being composed of intermediate trophoblast (IT), yet their morphological features and clinical presentation differ significantly. This study was undertaken to evaluate the morphological and immunohistochemical features of trophoblastic cells in placental site nodules and compare them with the trophoblastic cells in exaggerated placental sites as well as in different anatomic locations in the developing placenta to evaluate these differences. Forty-two placental site nodules, 20 abortus specimens ranging from 3 to 13 weeks, 8 second- and 10 third-trimester placentas, and 12 exaggerated placental sites were studied by conventional light microscopy and immunohistochemistry. This analysis showed that the trophoblastic cells in the placental site nodule closely resemble those in the chorion laeve. We have designated these cells "chorionic-type IT cells." They are composed of two populations of cells, one with eosinophilic and the other with clear (glycogen-rich) cytoplasm. The eosinophilic cells tended to be larger with more pleomorphic nuclei, whereas the clear cells were smaller with more uniform nuclei. Chorionic-type IT cells in the chorion laeve and placental site nodule were diffusely positive for placental alkaline phosphatase but were only focally positive or negative for human placental lactogen (hPL), Mel-CAM (CD146), and oncofetal fibronectin. In contrast, hPL, Mel-CAM, and oncofetal fibronectin were diffusely expressed in IT cells in the placental site, both normal and exaggerated. The chorionic-type IT cells in placental site nodule and chorion laeve showed mild proliferative activity as indicated by an increased Ki-67 labeling index (3% to 10%). In contrast, the Ki-67 labeling index in normal and exaggerated implantation sites was zero. The morphological and immunohistochemical features of chorionic-type IT cells contrast with the IT cells in the implantation site that we have designated "implantation site IT cells." Both types of IT cells develop from a population of trophoblastic cells in the trophoblastic columns that we have tentatively termed "villous IT cells." Four of 42 placental site nodules were larger (>5 mm) than the remainder and showed transitional features between a typical placental site nodule and an epithelioid trophoblastic tumor, a recently described distinctive gestational trophoblastic tumor. There were no recurrences among the placental site nodules regardless of size. All placental site nodules were immunoreactive for inhibin-alpha and cytokeratin 18, whereas 33 squamous cell carcinomas of the cervix, which can at times be confused with placental site nodules, were negative. In conclusion, there appear to be three subpopulations of IT cells with distinctive morphological and immunohistochemical features. Different subpopulations can be related to different trophoblastic lesions: implantation site IT cells to an exaggerated placental site and its neoplastic counterpart, placental site trophoblastic tumor and chorionic-type IT cells to a placental site nodule and its neoplastic counterpart, epithelioid trophoblastic tumor.     

Expression of cytokeratin by malignant meningiomas: diagnostic pitfall of cytokeratin to separate malignant meningiomas from metastatic carcinoma.

Based on clinical and histologic features, differentiating metastatic carcinomas from benign or malignant meningiomas usually is not difficult. Occasionally, however, in some patients without a clinical history of carcinoma, malignant meningiomas can morphologically simulate metastatic carcinoma, necessitating an immunohistochemical study for cytokeratin to make a correct diagnosis. However, the utility of immunohistochemical markers to separate malignant meningioma from metastatic carcinoma has not been investigated. The immunoperoxidase method with antigen retrieval was used to characterize the expression of three cytokeratins (AE1/AE3, CAM 5.2, and Pan cytokeratin), EMA, CEA, Ber-EP4, CD 15, and B72.3 in 12 previously diagnosed malignant meningiomas, 20 benign meningiomas, and 20 metastatic carcinomas. Cytokeratin expression was detected in 75% of malignant meningiomas, 0% of benign meningiomas, and 100% of metastatic carcinomas. While epithelial markers of Ber-EP4, CEA, B72.3 and CD-15 were positive in 90, 80, 70 and 65% of the metastatic carcinoma, respectively, they were negative in all 12 malignant meningioma examined. Vimentin immunoreactivity was seen in all benign and malignant meningiomas, and in 20% of metastatic carcinomas. Our results indicated that cytokeratin is not a reliable immunohistochemical marker to separate a malignant meningioma from metastatic carcinoma. A panel of epithelial markers including Ber-EP4, CEA, B72.3 and CD-15, and vimentin may be needed to separate malignant meningioma from metastatic carcinoma. Cytokeratin expression can be a potential pitfall for confusing a malignant meningioma with a metastatic carcinoma.     

Lymphoid follicular hyperplasia–a distinctive feature of diversion colitis

Diversion colitis refers to the inflammatory changes that occur in the defunctioned segment of the large intesting following diversion of the faecal stream. We report the histological features in the defunctioned rectums from seven patients: one each with severe constipation and Behcet's disease, two with Crohn's disease with rectal sparing and three with ulcerative colitis. The appearances of diversion colitis in a previously normal rectum are compared with diversion colitis with superimposed inflammatory bowel disease. Lymphoid follicular hyperplasia was found in all cases. This was marked in patients with inflammatory bowel disease. with or without initial rectal involvement. Other changes comprised surface epithelial degeneration and ulceration, mucosal inflammation including crypt abscesses, and crypt branching. Inflammatory and crypt changes were mild, except in ulcerative colitis where changes were marked and resembled those of the proximal colon. Lymphoid hyperplasia is a distinctive feature in diversion colitis. The term follicular proctitis, previously used to indicate chronic ulcerative colitis exclusively, should be re-examined.     

A population of lymphocytes in human blood distinctive in morphology and other characteristics.

Evidence is presented that lymphocytes characterised by being large and having abundant feebly staining, and usually profusely granulated cytoplasm ('pale' cells) are a group which is distinct from the other small basophilic ('dark') cells. In patients with genetic storage disorders characterised by abnormalities of lymphocyte structure, the structural peculiarites were confined to the basophilic cells, and cytochemical differences were found between the 'pale' and 'dark' cells in normal subjects.     

The hyaline cell: a distinctive feature of ''mixed'' salivary tumours

We have identified and described a distinctive type of cell which is characteristic of the "mixed" salivary tumour. This "hyaline cell" or plasmacytoid cell is particularly common and conspicuous in "mixed" tumours of the palate and other sites in the mouth. It occurs also in tumours of the major glands, but with much lesser frequency. The hyaline cell is found in "mixed" salivary-type tumours in other sites, e.g. the skin. It is not present in the other types of salivary tumour, notably adenoid cystic carcinoma, adenolymphoma, mucoepidermoid and acinic tumour. Ultrastructural study suggests that the hyaline cell is an indicator of myoepithelial differentiation. Current concepts of the acceptable pathways of myoepithelial differentiation in "mixed" tumours are discussed briefly. The specificity of the hyaline cell will probably prove valuable in separating "mixed" tumours from monomorphic adenomas, thus retaining the identity of the latter. The hyaline cell is almost as distinctive a feature of "mixed" tumours as is myxochondroid tissue and its specificity is of practical value in the diagnosis and classification of salivary tumours.     

Widespread occurrence of diverse human pathogenic types of the fungus Fusarium detected in plumbing drains

It has been proposed that plumbing systems might serve as a significant environmental reservoir of human-pathogenic isolates of Fusarium. We tested this hypothesis by performing the first extensive multilocus sequence typing (MLST) survey of plumbing drain-associated Fusarium isolates and comparing the diversity observed to the known diversity of clinical Fusarium isolates. We sampled 471 drains, mostly in bathroom sinks, from 131 buildings in the United States using a swabbing method. We found that 66% of sinks and 80% of buildings surveyed yielded at least one Fusarium culture. A total of 297 isolates of Fusarium collected were subjected to MLST to identify the phylogenetic species and sequence types (STs) of these isolates. Our survey revealed that the six most common STs in sinks were identical to the six most frequently associated with human infections. We speculate that the most prevalent STs, by virtue of their ability to form and grow in biofilms, are well adapted to plumbing systems. Six major Fusarium STs were frequently isolated from plumbing drains within a broad geographic area and were identical to STs frequently associated with human infections.     

Ruminative thinking. A distinctive sign of melancholia

We propose that ruminative thinking, the tendency to dwell on the same thought or theme, is useful for distinguishing melancholic from nonmelancholic major depression. We demonstrate that the symptom can be rated reliably and that interview ratings are concordant with ward observation of the symptom. The frequency of ruminative thinking, rated retrospectively in a prior study, was 60% in 75 patients having autonomous depression while only 18% of 48 nonautonomous patients were so affected. In this study, we found that ruminative thinking, prospectively rated in 71 patients with unipolar major depression, was present in 53% of patients with DSM-III melancholia but only 11% of the nonmelancholic patients. The presence of ruminative thinking appears to be useful for making the diagnosis of melancholia and its definition may facilitate study of the psychobiology of this disorder.     

The histopathological spectrum of human meningiomas

Histopathological examination and grading of meningiomas gives valuable prognostic information, although the method is subject for interobserver variability. The aim of this study was to review a large series of human meningiomas in order to examine the frequency of benign (grade I), atypical (grade II), and anaplastic (grade III) forms depending on various WHO classification schemes. In addition, we wanted to describe the frequency of various histopathological features and their mutual correlations. Sections from 196 consecutively treated primary human meningioma patients were revised retrospectively. The established criteria to grade meningiomas, which are also known to be associated with tumorigenesis, were shown to correlate significantly. The number of grade II meningiomas increased when using the WHO 2007 classification (30%) compared with previous editions, mainly due to the definition of brain infiltrating meningiomas as atypical (grade II). bimodal frequency distribution among age groups of females was observed. Continuous revision of histopathological classification systems is required to improve the diagnostic accuracy.     

Myogenic hyperuricemia. A common pathophysiologic feature of glycogenosis types III, V, and VII

To identify the mechanism of hyperuricemia in glycogen storage diseases (glycogenoses) that affect muscle, we studied the effects of exercise and prolonged rest on purine metabolism in two patients with glycogenosis type III (debrancher deficiency), one patient with type V (muscle phosphorylase deficiency), and one patient with type VII (muscle phosphofructokinase deficiency). All had hyperuricemia except for one patient with glycogenosis type III. Plasma concentrations of ammonia, inosine, and hypoxanthine increased markedly in all the patients after mild leg exercise on a bicycle ergometer. The plasma urate concentrations also increased, but with a delayed response. Urinary excretion of inosine, hypoxanthine, and urate increased greatly after exercise, consistently with the increases in plasma levels. Hypoxanthine and urate concentrations were extremely high in the plasma and urine of the patient with glycogenosis type VII. With bed rest, the plasma hypoxanthine level returned to normal within a few hours, and the plasma urate concentration decreased from 18.6 to 10.6 mg per deciliter (1106 to 630 mumol per liter) within 48 hours. Similarly, the urinary excretion of these purine metabolites was reduced by bed rest. These findings indicate that muscular exertion in patients with glycogenosis types III, V, and VII causes excessive increases in blood ammonia, inosine, and hypoxanthine due to accelerated degradation of muscle purine nucleotides. These purine metabolites subsequently serve as substrates for the synthesis of uric acid, leading to hyperuricemia.     

Salivary gland adenocarcinomas: a clinicopathologic analysis of three distinctive types

Myoepithelial cells play an important role in the histogenesis of adenocarcinomas arising from the salivary duct unit nearest the acini. Prototype adenocarcinomas arising from the intercalated duct are the terminal duct carcinoma and the epimyoepithelial carcinoma, both typically low-grade malignancies. Those salivary adenocarcinomas arising from the larger nonintercalated excretory ducts do not manifest myoepithelial cells in their composition. A prime example is the salivary duct carcinoma, which is a high-grade malignancy. These adenocarcinomas have distinctive clinical and pathologic features and they should be recognized by the examining pathologist. Because of the potential clinical confusion between terminal duct carcinoma and salivary duct carcinoma when rendered as a diagnosis, each should be further qualified, eg, by adding high or low grade.     

Intracytoplasmic lumina--a useful diagnostic feature of adenocarcinomas

The monoclonal antibody NCRC-11, which has epithelial membrane antigen (EMA)-like immunoreactivity, was used to identify intracytoplasmic lumina in a series of 105 adenocarcinomas from various sites and in 283 breast carcinomas; 55% of the non-breast carcinomas and all breast carcinomas except one of spindle cell type contained intracytoplasmic lumina. The highest frequency (16.4% of tumour cells) was found in invasive lobular carcinoma of the breast. The use of antibodies with EMA reactivity is advocated in the routine investigation of metastatic and undifferentiated tumours.     

Enhanced expression of the c-myc protooncogene in human intracranial meningiomas.

We examined the alteration and expression of c-myc protooncogene in 11 human intracranial meningiomas using Southern blot, Northern blot and immunohistochemical techniques. Southern blot showed neither amplification nor rearrangement but Northern blot and immunohistochemical study revealed enhanced expression of the c-myc gene. Immunohistochemically, c-myc product was found in all of the 11 cases and seven of these cases showed an above moderate degree of immunoreaction in semiquantitative analysis. Loss of heterozygosity at IGLC2 locus on chromosome 22 was detected in four of the 8 informative cases. But extent and intensity of immunoreactivity did not correlated with loss of heterozygosity on chromosome 22. These genetic changes may play important roles in the pathogenesis of human intracranial meningioma.