Granulocytic sarcoma presenting as an epidural mass with cord compression.

Granulocytic sarcoma (GS) usually occurs during the course of, or as a presenting sign of myelogenous leukemia. Rarely it is found before peripheral blood or bone marrow evidence of leukemia is present. We describe a man who presented with low back pain and lower extremity weakness. He had spinal cord compression due to GS without evidence of leukemia. Only four such instances have been previously reported. Such aleukemic presentations of GS are frequently misdiagnosed. The chloroacetate esterase stain and electron microscopy are useful in demonstrating the myeloid origin of GS cells. GS lesions are probably best treated by localized radiation therapy and systemic chemotherapy.

Spurious elevation of automated leukocyte counts induced by Fluosol DA 20%.

During studies with Fluosol DA 20% (FDA) in rats, an artifactual leukocytosis was observed when an impedance type electronic cell counter was used. The effect was found to be directly related to the duration of the interval between addition of an erythrocyte lysing fluid and counting, observed up to 11 d after transfusion with FDA, blood cell associated, reproducible in vitro, FDA concentration dependent, temperature dependent, and present when human blood was used instead of rat blood. Microscopically, the effect appears to be the result of agglutination of lysed erythrocyte membranes due to the interaction of erythrocytes, the emulsion component of FDA, and the quaternary ammonium salt component of the lysing fluid. These data suggest that FDA causes subtle changes in erythrocytes and raises the possibility that other cells may be similarly affected.

Functioning oxyphil adenoma of parathyroid gland. An ultrastructural and biochemical study.

Oxyphil cells and oxyphil cell adenomas of parathyroid glands are, in most instances, regarded to be nonfunctioning. Although 21 cases of hyperparathyroidism associated with parathyroid oxyphil cell adenoma have been reported, secretion of hormone by these tumors has not been conclusively demonstrated. A parathyroid adenoma, diagnosed by light microscopy as oxyphil type, together with the results from ultrastructural and biochemical studies of the patient's adenomatous tissue, are reported here. The patient, a 64-year-old male, was found to have elevated serum calcium, low serum phosphorus, and elevated serum immunoreactive parathormone: findings consistent with hyperparathyroidism. After excision of two small normal-appearing glands and one greatly enlarged (1.9 g) parathyroid gland, those laboratory values returned to normal. Light microscopy of the enlarged parathyroid indicated that it consisted almost entirely of an oxyphil adenoma. Electron microscopy revealed that the adenoma was composed mainly of mitochondria-rich oxyphil cells but also of interspersed transitional oxyphil cells and rare scattered chief cells. Golgi zones, rough endoplasmic reticulum, and prosecretory and secretory-like granules were observed in some oxyphil cells, in most transitional oxyphil cells, and in the infrequent chief cells. Thus, many of these cells appear to contribute to the production and secretion of parathormone. Biochemical studies performed directly on the adenomatous tissue demonstrated that it was able to synthesize proparathormone and parathormone, although the proportion of hormonal peptide synthesis relative to that of the total protein synthesis in this tissue was much smaller (0.9%) than that found in normal parathyroid tissue (5.7%). There was a small increase in immunoreactive parathormone when the adenoma tissue was incubated in a low-calcium medium. These findings indicate that this oxyphil adenoma of the parathyroid gland synthesized and secreted parathormone, apparently to some extent autonomously, but suggest that its capacity to do so was largely dependent on its component of cells other than fully developed oxyphil cells, such as transitional oxyphil cells.

Multiple granular-cell tumors of the ascending colon: microscopic study.

Light and electron microscopic study of a case of multiple granular-cell tumor of the ascending colon is presented, and the relevant medical literature is reviewed. It seems that the biologic behavior of this tumor in the colon does not differ from that in other locations. Histologically, a few granular cells are seen in neural tissue in the vicinity of the tumor, suggesting a close relation of the tumor to the neural tissue. Electron-microscopically, the granular cells resemble Schwann cells more closely than neural cells and axons. Histochemically, the granules of the tumor cells show autofluorescence and high activity of acid phosphatase, which was located electron-microscopically in the limiting membranes and matrices of the granules. It is suggested that the granular-cell tumor is a neoplasm of Schwann-cell origin with a unique metabolism that causes acceleration of autophagocytosis and accumulation of ceroidlipofuscin.

Carcinosarcoma of the adult kidney.

Carcinosarcoma of the adult kidney is a very rare tumour and there are only a few well documented cases in the literature. In this report such a tumour is described from a 50-year-old white male, which progressed very rapidly with widespread metastases. Histologically, the tumour consisted of renal cell carcinoma and fibrosarcomatous components. The interesting features in this case were that both the carcinomatous and sarcomatous elements of the tumour exhibited metastases separately to various organs.

Mucoepidermoid carcinoma of the subglottis. An ultrastructural study.

A well-differentiated mucoepidermoid carcinoma of the subglottis of a 77-year-old man was studied by light and electron microscopy. The tumor consisted of mucous cells, epidermoid cells, and intermediate cells of both differentiation. Mucous cells formed glands and cystic spaces filled with mucin. Abundant tonofibrils in aggregates were observed in tumor cell cytoplasms when they were differentiated into epidermoid cells. Epidermoid cells varied in differentiation.