Mixed germ cell sex cord-stromal tumors of the testis and ovary. Morphological, immunohistochemical, and molecular genetic study of seven cases.

We present the morphological, immunohistochemical, and molecular genetic features of three cases of testicular and four cases of ovarian mixed germ cell sex cord-stromal tumors (MGSCT). The germ cells in the testicular MGSCTs morphologically differed from those in classical seminomas by lacking the typical "square off" quality of the nuclei. In contrast to the nuclei in classical seminomas, their size in testicular MGSCTs was smaller and nucleoli were inconspicuous and the cytoplasm was Periodic Acid-Schiff (PAS) negative. Quite on the contrary, the variability in the size of the nuclei of the germ cells in the testicular MGSCTs was more similar to that seen in the germ cells of spermatocytic seminomas. Immunohistochemically, the germ cells of MGSCTs in one case reacted positively with antibody to AE1-AE3 by paranuclear dot-like or rodlike positivity. All three testicular MGSCTs had a negative reaction with the rest of antibodies, including placental alkaline phosphatase (PLAP), OCT4, and c-kit protein. Ovarian MGSCT in our series differed from the testicular lesions in both the germ cell component and the sex cord component. The germ cells in all four ovarian cases had cytomorphological and immunohistochemical features identical to those in classical seminomas/dysgerminomas. They possessed the typical "square off" quality of the nuclei, which were much more blastic, with more mitoses compared with the testicular tumors in our series, and they were PLAP (4/4), OCT4 (4/4) and c-kit protein (3/4) positive immunohistochemically. The cytoplasm of the germ cells in ovarian neoplasms contained PAS positive glycogen. Germ cells in one ovarian MGSCTs showed amplification of 12p. All other germ cells were negative for amplification of 12p. All five successfully analyzed cases showed no mutation in all studied exons and exon-intron junctions in c-kit and PDFGRA genes.

Normal pregnancy in a patient with multiple myeloma and sickle cell anaemia

A 39-year-old negro woman with sickle cell anemia, 32 weeks pregnant, was found to have multiple myeloma. The patient proceeded to full term normal delivery, and there was little deterioration in the following three years. The patient died 3 years and 8 months after delivery. The haematological and biochemical data are presented and problems of therapy in this case are discussed (AU)

Immunoglobulins in Jamaicans and Nigerians with immunogenetic typing of myeloma and lymphoma in Jamaicans

Serum IgG concentration was lower in Jamaicans than in Nigerians. The maternal foetal IgG ratio was lower in Jamaican sera than in Nigerian sera. It is suggested that endemic malaria in Nigeria may be responsible for these differences. The higher IgG concentration in the Nigerian cord sera may be further evidence of this. Eighteen new cases of myeloma were detected in Jamaicans between August 1966 and May 1967. Based on Gm typing, only two of these showed evidence of mixed white ancestry. All others had the typical Gm groups of Negroes. Similarly, only two patients out of a total of 17 with malignant lymphoma showed evidence of mixed white ancestry. Twelve of the patients with myeloma showed serum proteins of the IgG type, five were IgA, and one had only light chains in the serum. The majority of the patients had myeloma protein of the kappa type. The Gm typing suggested that six patients had myeloma protein of the y1 heavy chain subclass, and one patient had a y3 subclass heavy chain, the remainder belonging most likely to the y2 heavy chain subclass since y2 occurs about four times as frequently as y4.

Clinico-pathological study of malignant lymphoma in Jamaica

A clinico-pathological study of malignant lymphoma in Jamaica was undertaken to examine the disease pattern in a predominantly Negro population of West African origin. During a 9-year period (1958-66) 260 histologically verified cases of malignant lymphoma were encountered. The distribution of the different histological types was as follows: Hodgkin's disease 50.9 percent, lymphoma 1.9 percent. No cases of Burkitt's tumour were encountered. This study indicates that malignant lymphoma is not uncommon in Jamaica, and that its distribution pattern is similar to that observed in Europe and North America, except for the apucity of giant follicular lymphoma, and is different from the pattern observed in parts of Africa populated by Negroes, where Burkitt's tumour is the most common type, and where Hodgkin's disease is relatively uncommon. The age and sex incidence was in general similar to other reported series, but the duration of symptoms was short. The majority of patients presented with generalised periperal lymphadenopathy. Hepatosplenomegaly and anaemia were common on admission. The prognosis was generally poor in comparison with European and North American series due to advanced stage of disease on presentation.(Summary)

Clinico-pathological study of multiple myeloma in Jamaica

A clinico-pathological study of multiple myeloma in Jamaica was undertaken in order to examine the disease pattern in a predominantly negro population of West African origin. During a 10-year period (1957-66) 101 cases of multiple myeloma and 3 cases of solitry plasmocytoma were encountered. This indicates that multiple myeloma is more common in Jamaica than in parts of Africa populated by negroes. The sex incidence was nearly equal, and there was no evidence that the disease occurs earlier in the negro than in white populations. The haematological, biochemical, and radiological findings were similar to those reported from Europe and North America. The majority of patients presented with advanced disease, and the prognosis was very poor. Post mortem findings showed a high incidence of extra-medullary involvement and amyloidosis. (AU)

Radiological and pathological observations in a series of seventeen cases of hypertrophic pyloric stenosis of adults

A study of the radiological appearances and pathological features of a series of 17 cases of hypertrophic pyloric stenosis of the adult revealed several interesting features. It was shown that the generally accepted radiological description of smooth, severe and regular narrowing and elongation of the pyloric canal is only present in a proportion of cases. The radiological picture is very variable and many cases presented with an irregular pyloric canal and antrum with only moderate degree of narrowing or as pyloric stenosis. The classical pathological changes are said to be those of hypertrophy and hyperplasia of the circular muscle of the pyloric canal and adjacent part of the antrum. The use of special staining techniques revealed varying amounts of fibrous tissue in the hypertrophied smooth muscle in every case, a feature only briefly referred to in one or two previous communications. The presence of fibrous tissue is compatible with the theory that hypertrophic pyloric stenosis of the adult is secondary to pyloric channel ulcer and further evidence is presented to support this. In a significant proportion of cases, the pyloric muscle hypertrophy is complicated by the presence of a benign ulcer on the lesser curvature of the stomach. The significance of this is also discussed. (AU)

Pure adenoma of the breast

Pure adenoma of the breast was seen in a 21-year-old Negro woman. The fibroadenoma shows a predominantly glandular component differentiating it from the lactating adenoma with which it has often been confused. A review of 300 cases of "adenomatous" breast tumors are presented and a classification is suggested. A world literature review revealed only two cases which fulfilled the criteria of pure ademona of the breast, emphasizing its extreme rarity. (AU)

Congenital mitral atresia

The clinical and pathological features of 9 cases of congenital mitral atresia are described. Six cases were associated with aortic atresia or hypoplasia and one with transposition of the great vessels. The usual clinical presentation was sudden onset of dyspnoea and cyanosis in the neonatal period followed by rapid deterioration, a picture producing diagnostic difficulties that are often increased because of coexisting cardiac anomalies. A correct anatomical diagnosis can be made at necrops by careful inspection of the heart and great vessel, aided in some cases by microscopical examination.(AU)

Aortic aneurysms in Jamaica

The pathological findings in 91 cases of aortic aneurysm seen at the Pathology Department of the University of the West Indies in the years 1953-1966 have been reviewed. They were divided into aetiological groups based on histological features. Dissecting aneurysm was unexpectedly common with an incidence of 0.85 percent in the post-mortem cases, and there was almost equal male and female incidence, as opposed to the male preponderance reported in most other series. Atherosclerosis was much more common than syphillis as an aetiological factor. This finding resembles those from North America and Europe and differs from the findings in Africa where the main cause is reported as syphilitic. The clinical findings were in keeping with the pathological changes. The resemblance of these findings in Jamaican Negroes to those in the North America white and Negro populations, and their differences from the findings in Africa, suggest that environmental factors are more important than racial factors.(Summary)

Hemangiomas of the ovary and the uterine cervix

Cavernous hemangiomas of the uterine cervix and of the left ovary, a combination of lesions never before reported, were found as incidental findings at autopsy in a 41-year-old woman. There were no hemangiomas in other organs. The world literature is reviewed, indicating the rarity of cervical and ovarian hemangiomas.(AU)

Clinico-pathological study of malignant lymphoma in Jamaica

Malignant Lymphoma is a group of diseases of neoplastic aetiology affecting the lymphatic system. Since the description of the Burkitt's tumour (African lymphoma) as a separate entity, and the possibility of virus causation and transmission by insect vectors, there has been a great resurgence of interest in this group of diseases. As the population of Jamaica is of predominantly African origin, even though the environment is different, the study of this group of diseases here may be of considerable interest. The classification of this group has for long been very complex and confused. Even since it has been agreed that histological criteria are the only ones which can be acceptable for accurate diagnosis, there has been no classification, which would satisfy all the workers in the field. But it has long been agreed that simplicity and acceptability are most important criteria regarding classification. Thus a simple classification, which is acceptable to most workers in the field has been used here. Thus malignant lymphoma has been classified as follows: reticulum cell sarcoma, lymphosarcoma, hodgkin's disease, giant follicular lymphoma, Burkitt's tumour (African lymphoma). Between 1958-1965 221 cases of malignant lymphoma were seen. These were divided as follows: reticulum cell sarcoma - 30(14 percent), lymphosarcoma - 73(33 percent), Hodgkin's Disease - 114(51.5 percent), giant follicular lymphoma - 3(1.5 percent), Burkitt's tumour (African lymphoma) - 0. It was found that patients affected by these diseases came to seek medical advice relatively late and that the follow-up is inadequate due to default by patients. There is similarity to the disease pattern of North America and European lymphoma and not to the African lymphoma (AU)

The picture of multiple myeloma in Jamaica

During the period 1954-1966, a total of sixty-seven cases of multiple myeloma were seen at the University College Hospital of the West Indies. The majority of these cases were of African or predominantly African origin. The clinical, laboratory and pathological findings in these cases are reviewed and compared with reports from other parts of the world. It is suggested that the condition is a relatively common one in Jamaica, and despite the relative inadequacy of present day method of treatment, emphasis is placed on the early recognition of the disease (AU)