Fibronectin expression in salivary gland pleomorphic adenoma.

The distribution of fibronectin in the normal and pleomorphic adenoma of the salivary gland was investigated in forty cases of surgically resected tumor specimens. The immunoreactivity of fibronectin using polyclonal antibody (anti-fibronectin A2 45, Dakopatts, Denmark) was detected in the cytoplasm of intercalated duct cells and certain striated duct cells in normal salivary glands. Pleomorphic adenoma showed few fibronectin positive cells with a scattered or isolated distribution within the epithelial tumor elements of tubulo-ductal or solid foci of tumor cells. Modified myoepithelial cells and luminal cells of tubulo-ductal structures reacted strongly to fibronectin. In hyalinous, myxoid and chondroid areas, fibrillary myoepithelial cells expressed strongly positive reactivity but with diffuse staining in the myxoid and chondroid areas suggesting that fibronectin plays an important role in tumor cell-extracellular matrix interactions to produce the complex histopathological features of pleomorphic adenoma.

Carcinoma in situ of the gallbladder with superficial extension into the Rokitansky-Aschoff sinuses and mucous glands.

Twenty-four cases of carcinoma in situ of the gallbladder encountered over the past 29 years were evaluated histopathologically. Macroscopic classification disclosed 12 protruding types and 12 superficial types (7 elevated types and 5 flat types). Histologically, 18 cases had papillary growth and 6 had tubular patterns. Epithelial dysplasia of varying degrees was observed around the carcinoma in situ in all except one case and was seen more extensively in superficial type cases, although it was often hard to distinguish dysplasia from carcinoma in situ in some cases. Metaplasia of the mucous glands was observed in 20/24 cases (83.3%). Superficial extension of carcinoma in situ into the Rokitansky-Aschoff sinuses (located below the muscle layer) was observed in 11 cases (45.8%), and extension into the mucous glands was seen in 8 cases (33.3%). These results indicate that it is very important to be able to differentiate invasive carcinoma from cases with superficial extension of dysplasia and/or carcinoma in situ deep into the mucous glands or Rokitansky-Aschoff sinuses. Histological assessment should also be conducted carefully while considering these factors.

A case of idiopathic retroperitoneal fibrosis with chronic pericarditis.

A 66-year-old male with chronic pericarditis accompanied by idiopathic retroperitoneal fibrosis was originally admitted for cardiac tamponade. A firm diagnosis was obtained only after the patient's sudden death when autopsy was performed. Chest X-rays showed cardiac enlargement and pleural effusion. Echocardiogram revealed bright echo density on the myocardium.

Immunohistochemical localization of glycosaminoglycans with the use of monoclonal antibodies in salivary pleomorphic adenomas.

Immunohistochemical identification of glycosaminoglycans (GG) in salivary pleomorphic adenomas (63 cases) was made to evaluate chondrogenesis in modified myoepithelial cell regions. Monoclonal antibodies (MoAbs) to GGs were used in conjunction with specific enzyme digestion, and chondroitin 4S proteoglycan (C4SPG), chondroitin 6S PG(C6SPG), dermatan sulfate PG(DSPG), heparan sulfate PG(HSPG) and keratan sulfate PG(KSPC) were identified. Modified myoepithelial cells showing fibrillar and plasmatoid shapes contained KSPG (68%), DSPG (32%) and CSPG(C6SPG:22%, C4SPG:33%). Foci of chondroidally changed cells stained intensely for KSPG (53%), and less so for CSPG(C6SPG:22%, C4SPG:33%), and DSPG (19%). Perinuclear matrix in chondroidal tissue reacted most strongly. Almost all types of modified myoepithelial cells, or outer layer tumor cells of tubulo-ductal structures, produced or synthesized CSPG, DSPG, and HSPG. Certain cells located in hyalinous and myxomatous tissues may undergo chondroidal metaplasia, and clusters of such cells may produce GGs and PGs in the perinuclear zone similar to those GGs in matrix synthesized in chondroidal tissue. GG-synthesizing cells might continuously produce KSPG until the cartilage matrix is completed.

Immunohistochemical expression of MAM-3 and MAM-6 antigens in salivary gland tumours.

MAM-3 and MAM-6 antigens of human milk fat globule membrane were detected immunohistochemically in 93 cases of salivary gland tumours as well as in normal glands. The antigens were visualized in 10% formalin-fixed paraffin sections. MAM-3 (MoAbs 115G3, 67D11) antigen was distributed in intercalated and striated duct cells of the normal salivary glands, and in luminal tumour cells and squamous metaplastic cells of pleomorphic adenomas. In pleomorphic adenomas the frequency of positive staining with MoAb 67D11 (54/67; 80.6%) was higher than that with MoAb 115G3 (36/67; 53.7%). MAM-6 (MoAbs 115D8, 115F5) antigen was expressed in luminal and lateral borders of serous acinar cells and ductal of the normal glands, and also in luminal borders of tubulo-ductal and glandular structures of salivary gland tumours. Ductal basal cells were characterized by existence of positive staining for MAM-6 antigen, in adenolymphomas MAM-6 antigen was restricted to the basal tumour cells. Some mucous cells of mucoepidermoid tumours were stained specifically with MoAb 115G3, and epidermoid cells of mucoepidermoid carcinomas manifested MAM-6 antigen staining. Immunohistochemical localization of MAM-6 antigen resembled that of epithelial membrane antigen (EMA) detected with MoAb.

[A case of intussusception due to intestinal metastasis of renal carcinoma].

Adult intussusceptions due to metastatic intestinal-tumor are very rare. A 71-year-old man with an intussusception due to intestinal metastasis of renal carcinoma is reported. To our knowledge, this is the third such patient in the Japanese literature. The patient was suffered from an intestinal obstruction six months after his renal carcinoma was detected. Laparotomy was performed, revealing that he had developed a jejunojejunal intussusception due to metastasis of renal carcinoma. The early diagnosis of metastatic intestinal tumor is difficult. It is important to bear in mind that patients with malignant tumor may already have metastasis.

Surgical treatment of skin depigmentation caused by burn injuries.

Thin split-skin autografts of normal color were performed on depigmented skin caused by second- and third-degree burns in 32 patients. Repigmentation appeared in almost all the recipient areas soon after grafting and no depigmentation occurred again in the treated area.

[A case of primary adenocarcinoma of the urinary bladder occurring in a patient with type 1 multiple endocrine adenomatosis (MEA)].

A case of primary adenocarcinoma of the urinary bladder occurring in a patient with type 1 multiple endocrine adenomatosis (MEA) is presented. The patient was a 36-year-old female who had a past history of type 1 multiple endocrine adenomatosis, namely, adenomatosis of the parathyroid gland, insulin and gastrin-producing adenomatosis of the pancreas, and prolactin-producing pituitary adenoma. She was admitted in January 1981 with the complaints of gross hematuria, pollakisuria and micturition pain lasting for about one year and a half. Cystoscopic examination revealed four solid tumors in the posterior and left lateral walls of the bladder with diffuse mucosal hyperemia. Biopsy of the tumors disclosed that they were adenocarcinoma. Clinical examinations revealed that there was no extravesical primary malignant neoplasm in this case. Radical cystectomy with urinary diversion by ileal conduit was performed on January 22, 1981. Histological examination revealed that the tumor was adenocarcinoma originating from the vesical mucosa. Follow-up for over three years since the time of surgery has not shown any sign of tumor recurrence or occurrence of extravesical malignant neoplasm. In addition, 28 cases of primary adenocarcinoma of urinary bladder in Japan reported during the last 25 years are reviewed and analyzed.

Significance of intestinal metaplasia for the evolution of cancer in the biliary tract.

Of 25 cases of cancer in the intrahepatic bile ducts, 44 cases of cancer in the extrahepatic bile ducts, 30 cases of adenoma in the gallbladder, and 100 cases of infiltrating carcinoma in the gallbladder, several to about 20% of the cases showed Paneth's cell metaplasia and/or enterochromaffin cell metaplasia within the tumor mass or in its surrounding mucosa. These metaplasia were not found in small adenomata of the gallbladder, but they were frequently seen in large adenomata. Goblet cell metaplasia and marked hyperplasia of mucous glands were seen more frequently in the mucosa surrounding cancer than in the mucosa of 500 non-neoplastic gallbladders. Although cancer in the gallbladder occasionally developed on the basis of intestinal metaplasia alone, intestinal metaplasia was not likely to be related to induction of most adenomata, but it was likely to be associated with growth and cancerous change of adenoma.

Heterotopic gastric mucosa in the small intestine.

A case of tumorous heterotopic gastric mucosa which acted as a leading point of jejunal double-barrelled intussusception in a 16-year-old girl is presented. The lesion, 5 x 3 x 2 cm, was polypoid in shape with sharp circumscription. Histologically, the tumor consisted of gastric fundic and pseudopyloric glands. The pertinent literature is also reviewed.

Evolution of carcinoma in the extrahepatic bile ducts.

The histopathology of 43 cases of carcinoma in the extrahepatic bile ducts was reported. All four cases of noninfiltrating carcinoma were papillary or polypoid in gross shape. Only one of the eight cases of papillary or polypoid cancers penetrated beyond the fibromuscular layer of the bile ducts, while most cases of nodular or flat cancers spread deeper than the fibromuscular layer. Adenomatous residue was found in 9 (21.4%) of the total 43 cases, and was particularly frequent in papillary or polypoid cancers (6 [75.0%] of 8 cases). It is likely that early cancers were usually polypoid or papillary in gross shape and that most carcinomas arose from a pre-existing adenoma. Carcinoma associated with a choledochal cyst was found in two cases. Multiple carcinomas were seen in one case. Three cases of carcinoma in the extrahepatic bile ducts were associated with carcinoma of the gallbladder.

Basal cell epithelioma occurring in an epidermal nevus.

An unusual case is presented of a thirty-year-old woman in whom basal cell epithelioma developed from a preexisting localized epidermal nevus in the scalp. The epidermal nevus was not associated with any abnormal pilosebaceous complexes.

DNA content of large intestinal adenoma.

In order to assess the developmental transition of large intestinal adenoma into carcinoma, the relationship between the DNA content of the epithelial nuclei and the histologic gradation of epithelial cells in such adenoma was studied. Histologic gradation was based on the extent of epithelial pseudostratification. As a control, the DNA contents of normal and cancerous epithelia were also measured. The DNA content of a nucleus in normal epithelium was 2.72 +/- 1.02N (N: arbitrary unit), and the value was 5.10 +/- 3.30N in cancerous epithelium. The mean DNA content of epithelial nuclei in adenoma was intermediate between normal and cancerous levels. In adenomas, the average DNA content steadily increased with the advance of histologic gradation.

DNA content of pancreatic duct hyperplasia and carcinoma.

The DNA content of epithelial nuclei of hyperplastic and carcinomatous ducts of the pancreas was examined cytophotometrically. The materials were obtained from 2 cases of nonpapillary hyperplasia, 3 of papillary hyperplasia, 2 of atypical hyperplasia and 2 of tubular adenocarcinoma, which were selected by reviewing the pancreata of about 1,600 human autopsy cases. A gradual shift was observed in the DNA content from the normal level to a carcinomatous level through various stages of hyperplasia. Based on these findings, the hypothesis that pancreatic duct hyperplasia is a potent precursor of pancreatic carcinoma is discussed.

Adenomatous residue in cancerous papilla of Vater.

Surgical specimens of carcinoma in the papilla of Vater were studied histologically. Adenomatous residue which suggested that the carcinoma was derived from a pre-existing adenoma was found in 18 cases (81.8%) out of 22. The histological transition of adenoma into carcinoma was also frequently seen.