Calcium oxalate crystals in breast biopsies. An overlooked form of microcalcification associated with benign breast disease.

Two distinct forms of microcalcification are found in breast disease. The more commonly recognized type is basophilic and nonbirefringent and consists predominantly of calcium phosphates (type II). The other type is a birefringent, colorless crystal that is composed of calcium oxalate (type I). It has not been emphasized in the literature that calcium oxalate can produce radiopacities and yet is easily overlooked in tissue sections. In this study, histologic sections taken from 127 randomly selected, mammographically directed biopsies were reviewed and the presence or absence of microcalcifications, the type of microcalcification, and the associated disease process were noted in each case. Seventy-eight of the 127 specimens were obtained because of suspicious calcifications detected by mammography and 9 (11.5%) contained only type I microcalifications, 9 (11.5%) contained both types I and II microcalcifications, and 48 (61.5%) contained only type II microcalcifications; in 12 specimens (15.4%), microcalcifications were not identified. The overall incidence of type I calcifications was 17.3% (22/127), but the incidence in those specimens obtained because of calcifications detected by mammography was 23.1% (18/78). Type I microcalcifications were found only in benign cysts and were not associated with carcinoma or epithelial hyperplasia, whereas type II microcalcifications were associated with benign or malignant lesions. These findings are in keeping with the hypothesis that type I microcalcifications are a product of secretion whereas type II microcalcifications are a result of cellular degeneration or necrosis. In biopsies in which type II microcalcifications are not identified, examination of sections under polarized light may reveal the presence of calcium oxalate crystals.

Malignant lymphoma arising in a large congenital neurofibroma of the head and neck. Report of a case.

A lymphoma developed in a large neurofibroma in a young woman who had no other stigmata of neurofibromatosis. The neurofibroma was congenital and extensively involved the soft tissue and bone of the face and neck. Despite multiple attempts to excise the neurofibroma, it persistently recurred. At the age of 30 the patient underwent another resection of the lesion, and a follicular, mixed, small and large cell lymphoma was present within the neurofibroma. Over 3 years the lymphoma transformed into a diffuse large cell type despite the fact that it remained localized to the neurofibroma. After the lymphoma had transformed, the patient received multiagent chemotherapy. She responded well, and a repeat biopsy showed no residual lymphoma. She is alive and well 25 months after completion of chemotherapy. To the best of our knowledge, this is the first report of a lymphoma arising in a soft tissue neoplasm.

Gastric carcinoma in the young: a clinicopathological and immunohistochemical study.

Seventeen patients 40 yr of age and less with gastric carcinoma were studied retrospectively. Clinicopathological findings and survival data were collected on all patients. Immunohistochemistry for serotonin, gastrin, somatostatin, carcinoembryonic antigen, beta-human chorionic gonadotropin, and alpha-fetoprotein was performed and the results correlated with pathological and survival data. Patients were divided into two groups according to the presence or absence of endocrine markers in their tumors. The group with endocrine immunoreactivity tended to present with less advanced disease and had longer survival than the group without endocrine immunoreactivity (p less than 0.05). Although the number of patients in the study is too small to reach definite conclusions, our results are interesting in light of current knowledge of the pathobiology of gastric carcinoma and have important implications for future investigations.

Functioning oncocytic islet-cell carcinoma. Report of a case with electron-microscopic and immunohistochemical confirmation.

A case of a 58-year-old woman with an unusual variant of malignant islet-cell tumor showing oncocytic features is described. Using the light microscopy technique, the tumor appeared comprised of solid nests of uniform cells with abundant, eosinophilic cytoplasm and round nuclei with granular chromatin. Ultrastructurally, the cells contained numerous abnormal mitochondria, dilated rough endoplasmic reticulum, and scattered dense-core neurosecretory granules, often associated with cytoplasmic filaments. Tumor cells were focally immunoreactive for insulin, glucagon, and somatostatin and diffusely immunoreactive for alpha 1-antitrypsin as assayed by the avidin--biotin technique. The tumor was immunonegative for human chorionic gonadotropin, gastrin, adrenocorticotropic hormone, and serotonin. The patient exhibited some of the clinical features associated with glucagonoma syndrome, including diabetes mellitus and chronic diarrhea. The tumor behaved in a malignant fashion, with widespread lymphatic involvement and bony metastases at the time of presentation. This report of an oncocytic islet-cell carcinoma supports the concept of oncocytic differentiation in islet-cell tumors in a fashion analagous to oncocytic carcinoids.