Adamantinoma of the tibia. An ultrastructural and immunohistochemical study

The light microscopic, ultrastructural, and immunohistochemical characteristics of two tibial adamantinomas are presented. The immunohistochemical studies utilized specific antibodies against Factor VIII-related antigen and keratin protein, considered as markers for endothelial and epithelial cells, respectively. These revealed positive staining for keratin in the tumor cells of both cases, whereas Factor VIII was not found in either. Ultrastructurally, both tumors had tonofilaments, desmosomes, gap junctions, microvillous-like projections, and basement membranes. Patient 1 had disease that was histologically of the classic spindle cell type; the disease of Patient 2 was atypical and closely resembled an epithelioid angiosarcoma. Immunohistochemical and ultrastructural findings in each case indicate an epithelial component in tibial adamantinoma.     

Glomangiosarcoma in a glomus tumor. An immunohistochemical and ultrastructural study

An extremely rare case of glomangiosarcoma (GS) occurring in a glomus tumor (GT) was evaluated ultrastructurally and histochemically. A man 65 years of age who was suffering from back pain underwent resection of a deep cutaneous nodule. Cells of a solid type GT showed numerous subplasmalemmal pinocytotic vesicles, thin filaments with scattered dense bodies, and thick external lamina, but negative desmin staining and a lack of glycogen. Similar findings also were observed in the GS, but were less obvious. The GS compressed the surrounding GT, exhibited many mitotic figures, prominent nucleoli, elongated nuclei and cytoplasm, and reacted more strongly to vimentin staining than the GT. The GT contained S-100 protein-positive Schwann cells, a few substance P-positive nerve fibers, and moderate numbers of infiltrating mast cells. None of these findings were observed in the GS. Results were consistent with the view that GS was transformed possibly from the GT, and that the good prognosis for GS may be due to its small size that may be related to the preexistence of a pain-causing GT.     

The histogenesis of small cell carcinoma of the prostate. An immunohistochemical study

Small cell carcinomas of the prostate are rare. A few reported cases have manifested morphologic and functional neuroendocrine characteristics, and it has been suggested that these tumors are derived from the argentaffinic/argyrophilic cells normally present in the prostate. The authors have recently studied three cases of primary prostatic small cell carcinoma in which the small cell component developed during the course of progression of "regular" prostatic adenocarcinoma, and reflected a terminal aggressive phase of the disease. Immunoperoxidase staining for prostate-specific acid phosphatase (PSAP) showed positivity in the adenocarcinoma but absence in the small cell component of each tumor. The association of small cell carcinoma with prostatic adenocarcinoma indicates that in considering the histogenesis of prostatic small cell carcinoma, a specific neuroendocrine cell of origin need not be implicated.     

An immunohistochemical and ultrastructural study of the sinusoids of hepatocellular carcinoma.

The sinusoids of 30 human hepatocellular carcinomas of various types were examined by electron microscopy and histochemically for binding to the Ulex europaeus lectin (UEA1). A population of sinusoidal macrophages was identified with an antibody to lysozyme (muramidase). The UEA1 binding was negative in normal sinusoids but positive in the tumor vessels. Macrophages resembling Kupffer cells were found within the tumor vessels but in smaller numbers than in either normal or cirrhotic liver tissue. Fibrolamellar and sclerosing carcinomas contained the smallest numbers. Ultrastructurally, endothelial cells of tumor vessels were thicker than normal, with fewer fenestrations. They contained bundles of microfilaments and showed basement membrane formation. Subendothelial myoid cells were found. These findings indicate that the sinusoidal vessels of hepatocellular carcinomas show features of true capillaries and precapillary blood vessels. The degree of this difference from normal hepatic sinusoids may reflect the relative immaturity of the cancer cells.     

食管小细胞癌的临床病理,免疫组化及电镜观察

目的：探计食管小细胞瘤的临床病理特征、抗原表达及超微结构特点。方法：收集食管小细胞癌２８例，分析统计临床病理资料，每例均采用ＳＬＡＢ方法做７项免疫学标记，分别为ＣＫ、ＬＣＡ、Ｓ－１００，ＣＤ５６（神经细胞粘连分子）、ＣＨＡ（铬粒素）、ＮＳＥ（神经特异性烯醇化酶）、ＨＨＦ３５，５例取新鲜组织做电镜观察。结果：患者年龄以中老年多见，部位在中下段，病情发展快、转移早，预后差。林体形态为溃疡型、隆起型，镜     

Hurthle cell thyroid tumors. An immunohistochemical study

Twenty-three Hurthle cell neoplasms of the thyroid were analyzed immunohistochemically for thyroglobulin, carcinoembryonic antigen (CEA), and for immunoreactivity with a monoclonal antibody to p21 ras oncogene product. Both benign and malignant tumors defined by the presence or absence of invasion and metastasis stained positively for thyroglobulin. Most tumors expressed both CEA and p21 ras oncogene product. Clinicopathologic analysis showed that malignant tumors were larger, occurred in slightly older patients (mean age, 52.8 years), and had an almost equal sex distribution, whereas benign tumors were more common in women and occurred in younger patients (mean age, 44.7 years). These results indicate that both benign and malignant Hurthle cell thyroid tumors produce thyroglobulin and express both CEA and p21 ras oncogene product, whereas adjacent normal thyroid tissues showed weak to absent immunoreactivity for p21 ras oncogene product. Because there are no specific immunohistochemical markers to distinguish between benign and malignant Hurthle cell tumors, one needs to rely on traditional histologic features such as invasion and metastasis to distinguish between benign and malignant Hurthle cell neoplasms.     

Pleomorphic adenoma of the external auditory canal. An immunohistochemical and ultrastructural study

Primary tumors arising from the glandular structures of the external auditory canal (EAC) are rare, with the majority arising from the ceruminous glands. The histochemical, immunohistochemical, and electron microscopic features of a pleomorphic adenoma of the EAC are presented; this is the seventh case reported. These studies confirm the key role of the myoepithelial cell in this tumor and include a correlation with pleomorphic adenomas in other sites.     

Small cell lung carcinoma: clinicopathological, immunohistochemical, and ultrastructural study.

Sixty-seven cases of small cell lung carcinoma (SCLA) in Tri-Service General Hospital (TSGH) during the past 16 years were studied. For patients with extensive stage of disease, the mean survival time and 2-year survival rate were 7.2 months and 3.1% versus 13.4 months and 16.7% for patients with limited stage. A better prognosis was obtained by treatment with a combination of intensive chemotherapy and radiotherapy. Immunohistochemical studies were performed by the peroxidase-antiperoxidase method. The positive rates in descending order were bombesin (80%), synaptophysin (74.3%), neurofilament (68.6%), neuron-specific enolase (60%), low molecular weight cytokeratin (54.3%), high molecular weight cytokeratin (25.7%), chromogranin-A (22.9%), adrenocorticotrophic hormone (0). Seven cases were examined and found to be ultrastructure; only 3 cases were found to contain neurosecretory granules. We emphasize that electron microscopy is not necessary as a routine diagnostic procedure, while light microscopy should be employed whenever possible; the immunohistochemical study should be considered within this context.     

Hairy cell leukemia. An immunologic and ultrastructural study.

A case of hairy cell leukemia in a 39-year-old man is reported. Hairy cells from the peripheral blood, spleen, and bone marrow had lambda-type immunoglobulin on their surfaces; those from the peripheral blood and bone marrow also had IgD on their cell membranes. Frozen sections of spleen reacted with IgGEA, but not IgMEA or IgMEAC markers. Transmission electron microscopy revealed ribosome-lamella complexes in cells from the spleen, but not the peripheral blood. Scanning electron microscopy demonstrated a spectrum of cell surface morphology with many cells characterized by ridges and ruffles. The significance of these findings is considered and it is suggested that the hairy cell is a B lymphocyte.     

Epithelio-reticular cell thymoma with lymphocytic "emperipolesis." An ultrastructural study.

The ultrastructure of an epithelio-reticular cell thymoma associated with myasthenia gravis is described. The neoplastic cells of an epithelio-reticular nature were dominant in the neoplasm, being closely associated with lymphocytes and scattered non-neoplastic macrophages. The thymic epithelio-reticular cell showed abundant glycogen and some lipid droplets inside the cytoplasm, which was vacuolated and had many elongated processes attached to desmosomes and a very prominent nucleolus. The appearance was similar to that of the immature embryonic epithelial cell of the thymus seen in mammals. Very close contacts existed between the thymic lymphocytes and the epithelio-reticular cells, the appearance being suggestive of the phenomenon of "emperipolesis." Cell death occurred secondarily through nuclear pyknosis and chromatolysis. Lymphocytic debris appeared inside the epithelio-reticular cells and, to some extent, in the cytoplasm of the mesenchymal marcrophages not directly involved in the phenomenon of "emperipolesis."     

Pseudomesotheliomatous carcinoma of the lung. An immunohistochemical and ultrastructural study of three cases

The authors report immunohistochemical and electron microscopic studies on three new cases of pseudomesotheliomatous carcinoma of the lung. Although the distinct clinical and histopathologic features of this peripheral lung cancer were described many years ago, its recognition as a distinct variety of lung carcinoma has not gained wide acceptance. Little is known of its incidence and only few cases have been reported until now. In the current study the authors demonstrate the epithelial nature of this tumor by its positive immunohistochemical reactions for epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), Leu-M1, B 72.3, and surfactant apoprotein. The ultrastructural features and staining of nuclear inclusions with surfactant apoprotein indicate differentiation into type II cells as found in other forms of peripheral lung adenocarcinoma. Despite these morphologic similarities, pseudomesotheliomatous carcinoma is characterized by extensive invasion of the pleura and rapidly fatal course. Because of this biologic behavior it deserves recognition as a distinct variant of peripheral lung carcinoma.     

Congenital self-healing histiocytosis (Hashimoto-Pritzker). An ultrastructural and immunohistochemical study

Congenital self-healing histiocytosis (CSHH) is a rare primary histiocytic skin disorder. Only a few cases have been studied by ultrastructure and immunohistochemistry. Here we report a new case that was investigated using an electron microscope and a panel of monoclonal (MCA) and polyclonal (PCA) antibodies. CSHH cells were found to bear the immunohistochemical phenotype of normal epidermal Langerhans cells (LC) and histiocytosis X (HX) cells (CD1a/c+, CD1b-, CD4+/-, human leukocyte antigen [HLA]-DR/DQ+, S-100+). However, an electron microscope showed a paucity of Birbeck granule (BG)-containing cells. This contrasted with their immunophenotype. This finding, along with other ultrastructural characteristics of CSHH cells, suggests that histologic differences exist between CSHH and HX. However, because no absolute histologic criterion is known that allows unequivocally the differential diagnosis between the two diseases, this distinction currently has to rely on clinical criteria, mainly the regressive course observed within a few months in CSHH. The precise nosologic position of CSHH among other histiocytic syndromes remains unsettled.     

Small cell carcinoma of the kidney. A clinicopathologic, immunohistochemical, and ultrastructural study

Three cases of primary small cell carcinoma of the kidney with light microscopic, immunohistochemical, and electron microscopic findings are reported. Two patients died of disseminated disease 8 months and 1 year, respectively, after the diagnosis and the third was free of tumor after 18 months. Immunohistochemical studies revealed keratin immunostaining of tumor cells in two cases and staining for neuron-specific enolase in the third. The third case also showed a few dense neurosecretory granules at the ultrastructural level. Although no strong conclusions regarding histogenesis can be drawn, this study indicates that small cell carcinoma of the kidney exists and does not necessarily exhibit a neuroendocrine differentiation. Small cell carcinoma of the kidney must be considered in the differential diagnosis of malignant renal tumor, especially in cases in which a large necrotic tumor is present. Based on the few cases presented in this study and on the one previously reported case, small cell carcinoma of the kidney appears to be an aggressive tumor.     

Effects of diethylstilbestrol and propylthiouracil on the rat pituitary. An immunohistochemical and ultrastructural study

The effects of diethylstilbestrol [(DES) CAS: 56-53-1] and propylthiouracil [(PTU) CAS: 51-52-5] on the pituitary glands of female weanling F344 rats were studied by immunohistochemistry and electron microscopy. Six weeks of PTU treatment resulted in a significant increase in pituitary gland weight and in the percentage of pituitary prolactin (PRL) cells. The percentage of thyroid-stimulating hormone (TSH) cells was slightly increased in PTU-treated rats. DES treatment produced a thirteenfold increase in pituitary gland weight and a significant increase in the percentage of PRL cells as well as in serum PRL levels. Combined PTU-DES treatment increased pituitary gland weight and serum PRL levels, but this increase was less than that observed with only DES treatment. A relative decrease in the percentage of TSH cells was seen after both DES and PTU-DES treatment. Ultrastructural immunohistochemical studies showed two types of PRL cells in the pituitary of all groups. Classical PRL cells with granule diameters of 150-800 nm were most abundant in DES-treated groups, whereas cells with smaller granules, 100-350 nm in diameter, were equally prominent in control groups and after PTU treatment. The results of this study show that while PTU causes a slight increase in pituitary gland weight and in PRL cell numbers, it inhibits estrogen-induced PRL cell hyperplasia. This model can be used to study the effects of PTU on pituitary PRL cell morphology and on the regulation of PRL cell hyperplasia.     

On the histogenesis of Ewing's sarcoma. An ultrastructural, immunohistochemical, and cytochemical study

Forty-two cases of Ewing's sarcoma (ES) have been studied with light microscopy during the 9-year period 1974 to 1982. Thirty-three patients had ES of bone, and in 9 patients the tumor was located in the extraskeletal soft tissues. Cases which fulfilled all the morphologic criteria were accepted as typical ES (31 cases), and those with some architectural or cytologic peculiarities were considered atypical forms of ES (11 cases). An immunohistochemical study (PAP method) to evaluate the presence in the tumor cells of the following markers: myoglobin, F-VIII-related antigen, lysozyme, alpha-1-antitrypsin, alpha-1-antichymotrypsin, and immunoglobulins (IgG, IgA, IgM, kappa and lambda light chains), was performed with negative results in all cases (paraffin blocks were available in 38 cases). The cytochemical study on fresh tissue imprints from five patients (PAS, Sudan Black, alpha-naphthyl acetate esterase, acid phosphatase, beta glucuronidase, myeloperoxidases, naphthol-AS-D chloroacetate esterase and alkaline phosphatase) gave no pattern of histogenetic significance, PAS being the best morphologic marker in tissue sections and touch preparations. A detailed ultrastructural study was performed on 34 cases; the main findings may be summarized as follows: medium sized cells, polygonal shape, oval nuclei, smooth nuclear envelope, abundant euchromatin, well-developed nucleolonema, scant membranous organelles, abundant hyaloplasmic glycogen, occasional lipid vacuoles, straight cell membranes, and primitive intercellular junctions. No differences were found between bone and extraskeletal ES; moreover, typical and atypical forms showed moderate quantitative differences with no qualitative change. The histogenesis is discussed; no functional or morphologic markers have been found to suggest the cell of origin; however, some cell lines may be excluded. It is the impression of the authors that they are dealing with a primitive noncommitted mesenchymal cell.     

Medullomyoblastoma. A histologic, immunohistochemical, and ultrastructural study

The light and electron microscopic features of a medullomyoblastoma arising in the cerebellar vermis of a 3-year-old boy are described. Differentiation along both glial and neuronal lines was present in the medulloblastoma component of the tumor. Astrocytic differentiation was confirmed by the observation of compact bundles of 8 to 10 nm glial filaments in cellular processes on ultrastructural examination, and by positive immunostaining for glial fibrillary acidic protein (GFAP). Neuroblastic differentiation was suggested by the demonstration of axon-like processes on silver impregnation, and ultrastructurally by the observation of microtubules, dense-core and clear vesicles, and rare synapse-like structures within cytoplasmic processes. The presence of both primitive and well-differentiated striated muscle fibers in the tumor was confirmed by the demonstration of thick and thin myofilaments and Z bands on electron microscopy, and by positive immunostaining for myoglobin. These findings clearly establish the presence of both neuroectodermal and rhabdomyoblastic components in this neoplasm, and thus set it apart from the pure rhabdomyosarcomas, which may also occur in the cerebellar vermis in children. This case also illustrates the usefulness of electron microscopy and immunohistochemistry in the diagnosis and histogenetic evaluation of primitive or poorly differentiated small cell tumors of the central nervous system.