High molecular weight caldesmon positive stromal cells in the capsule of thyroid follicular tumours and tumour-like lesions.

AIMS: To investigate the smooth muscle nature of the spindle stromal cells in the capsule of thyroid tumours and tumour-like lesions. METHODS: Immunostaining for high molecular weight caldesmon (HCD), a highly specific marker for smooth muscle differentiation, was performed in 70 primary thyroid tumours and tumour-like lesions (21 hyperplastic nodules, 29 follicular adenomas, five minimally invasive follicular carcinomas, six widely invasive follicular carcinomas, and nine encapsulated papillary carcinomas). RESULTS: HCD positive stromal cells (HCD+ cells) were detected in the capsule of 20 of the 21 hyperplastic nodules, and all of the 29 follicular adenomas and five minimally invasive follicular carcinomas, whereas HCD+ cells were seen in the capsule of only four of the six widely invasive follicular carcinomas and no HCD+ cells were seen in the capsule of the nine encapsulated papillary carcinomas examined. CONCLUSIONS: The presence of HCD+ cells in the capsule is characteristic of thyroid follicular tumours and tumour-like lesions. The stromal cells in the capsule of thyroid follicular tumours and tumour-like lesions are different from those of encapsulated papillary carcinoma.

CD34 positive stromal cells in gastric adenocarcinomas.

AIMS: To investigate the role of CD34 positive stromal cells, namely dendritic interstitial cells, in gastric carcinomas, the distribution of CD34 positive stromal cells in gastric adenocarcinomas (GCs), with special reference to two histological types (diffuse (D-type) and intestinal (I-type)), was examined. METHODS: In total, 55 surgically resected GCs (15 D-type and 40 I-type) and their normal tissues were examined. To distinguish CD34 positive stromal cells from vascular endothelial cells and to recognise the tumour border, immunostaining for CD34, CD31, and low molecular weight cytokeratins was performed. RESULTS: In the 15 D-type GCs, eight of the nine D-type GCs invading the muscularis propria and subserosa had a large number of CD34 positive stromal cells in the tumour stroma, whereas all six D-type GCs confined to the submucosa had no CD34 positive stromal cells in the tumour stroma. All of the 40 I-type GCs had no CD34 positive stromal cells, regardless of tumour depth. CONCLUSIONS: These results suggest that CD34 expression in stromal cells is associated with progression of D-type GCs, and that absence of expression is also seen in I-type GCs that are progressing.

Immunohistochemical study with antibody to glycoprotein GCDFP-15 for metastatic lung cancer from breast cancer.

Even when gross pathologic specimens are available, evaluation is always complicated due to the difficulty in distinguishing the pathologic diagnosis of an adenocarcinoma as a pulmonary metastasis of the breast or lung. In this paper, we describe the usefulness of a preoperative immunohistochemical study using gross cystic disease fluid protein-15 (GCDFP-15). A 50-year-old woman, who had undergone a right radical mastectomy due to an infiltrating ductal carcinoma 4 years previously, was admitted because of an abnormal shadow on chest roentgenography. A chest CT scan showed a nodule 20 mm in diameter with an irregular margin and vascular involvement in the S3 region of the right lung. Though the specimen from a percutaneous CT guided needle biopsy revealed characteristic pathologic findings of a primary lung adenocarcinoma under H.E. stain, which was recommended for lobar resection, we re-examined that specimen immunohistochemically, which disclosed that the tumor cells were negative for the antibody to pulmonary surfactant apoprotein and were positive for GCDFP-15 antibody. Therefore, the diagnosis of a metastatic breast carcinoma in the lung was established. Upon her request, a wedge resection of the right upper lobe including the tumor was performed under video-assisted thoracoscopic surgery (VATS). Her postoperative course was uneventful.

Myofibroblasts at the tumor border of invasive gastric carcinomas: with special reference to histological type and tumor depth.

In order to elucidate the role of alpha-smooth muscle actin (ASMA)-positive stromal cells, namely myofibroblasts (MFs), in invasive growth of gastric carcinomas (GCs), we examined the number of MFs at the deep border (DB) of GCs. In total 78 invasive GCs (48 intestinal type GCs and 30 diffuse type GCs) were examined immunohistochemically, and analyzed from the view point of tumor depth and histological type. In the intestinal type GCs examined, both the GCs confined to the submucosa and muscularis propria had none or a small number of MFs at the tumor border facing the submucosa (smDB) and muscularis propria (mpDB), respectively; whereas the GCs invading the subserosa had a moderate or large number of MFs at the tumor border facing the subserosa (ssDB) (p<0. 05). Regardless of tumor depth, the diffuse type GCs examined generally had none or a small number of MFs at the smDB, mpDB and ssDB, respectively. There is a possibility that intestinal type GCs invading the subserosa showing tubular and papillary structure may induce myofibroblastic transformation of gastric subserosal stromal fibroblastic cells.

Adult-onset giant juxtaglomerular cell tumor of the kidney.

The juxtaglomerular cell tumor (JGCT) of the kidney is a rare neoplasm which commonly secretes renin. This tumor often occurs in teenagers. This paper documents the 14th adult-onset (over 30-years-old) case with a giant JGCT which measured 9.0 x 8.0 x 7.5 cm. Histologically, this tumor was composed of both vascular and tubular components. Immunohistochemically, the vascular component reacted with renin, cytokeratin 7, ulex europaeus agglutinin-1, vascular endothelial growth factor (VEGF) and Flk-1 (VEGF-R2), whereas the tubular component was positive for renin, epithelial membrane antigen (EMA), cytokeratin 7, alpha-1-antitrypsin, VEGF and Flk-1. This finding suggests that both vascular and tubular components of JGCT may promote neoplastic proliferation via an autocrine mechanism through the action of VEGF.

Adenoid basal carcinoma of the uterine cervix: a case report with ultrastructural findings.

Adenoid basal carcinoma of the uterine cervix is a rare tumor with a favorable prognosis. A case of adenoid basal carcinoma (ABC) of the uterine cervix was studied using light and electron microscopy. The patient was a 74-year-old Japanese woman who had undergone hysterectomy due to cervical intraepithelial neoplasia 3. Incidentally, ABC was found in the resected uterus. The tumor cells made small nests and infiltrated the cervical portion of the uterus. In the nests, glands, cribriform patterns with glandlike structures, and squamous differentiation were seen. Immunohistochemically, the glandlike structures were positive for laminin and type IV collagen. Ultrastructurally, the tumor cells had irregular nuclei, scanty cytoplasm, and cribriform patterns in which glandlike structures were covered with basal lamina. No myoepithelial differentiation of the tumor cells was seen. These findings suggest a similarity between adenoid basal carcinomas and adenoid cystic carcinomas. Furthermore, both tumors are considered to originate in the reserve cells of the uterine cervix. Because their outcomes are different, they should be distinguished from each other.

CD34 expression as a novel marker of transformed mesangial cells in biopsied glomerular diseases.

CD34 is a marker of haematopoietic progenitor cells, stromal precursors, vascular endothelial cells, and a variety of stromal tumour cells. This immunohistochemical study examined the CD34 expression of glomerular mesangial cells in normal and diseased glomeruli and compared it with the staining patterns of alpha-smooth muscle actin (ASMA), as a transformed mesangial cell marker, and CD31, as an endothelial cell marker. In addition, the CD34 and ASMA expression of mesangial cells in various glomerulonephritis and the relationship of the immunostaining intensity to the severity of IgA nephropathy were semiquantitatively evaluated. In normal glomeruli, all cell types were negative for CD34, but in glomeruli in mesangial proliferative glomerulonephritis, CD34 was expressed exclusively in mesangial cells, corresponding to ASMA expression. The dendritic and scattered staining pattern, the mesangial location of positive signals, and the enhanced expression were clearly different from CD31 expression in diseased glomeruli. In comparison with normal controls, the grade of immunostaining for CD34 (CD34 INDEX) in mesangial proliferative glomerular diseases was higher than that of ASMA (ASMA INDEX). With the severity of glomerulonephritis, the CD34 INDEX gradually increased. These studies indicate that CD34 is a useful marker of mesangial transformation and that immunohistochemical examination with the anti-CD34 antibody is useful for the diagnosis and stage determination of glomerular diseases.

Prostatic signet-ring cell carcinoma: case report and literature review.

Signet-ring cell carcinoma (SRCC) of the prostate is a very rare neoplasm and there have been only 38 cases reported to date. Here the 39th case of prostatic SRCC containing a small amount of neutral mucin, prostatic specific antigen (PSA) and prostatic specific acid phosphatase (PSAP) in the signet-ring cells is reported. It was also found that some intracytoplasmic lumina were derived from the shallow or deep invagination of luminal membranes of cancer cells that formed the neoplastic glands. Using immunohistochemistry, a combination of monoclonal antibodies against cytokeratins 7 and 20 as well as PSA and PSAP may be useful in differentiating prostatic primary SRCC from metastatic SRCC originating in the gastrointestinal tract.

The specific distribution of dendritic interstitial cells at the tumor border of major salivary gland pleomorphic adenomas.

To investigate the role of stromal cells at the tumor border of major salivary gland pleomorphic adenomas, we performed immunohistochemical analysis for detecting CD34-positive stromal cells (dendritic interstitial cells) and alpha smooth muscle actin (ASMA) -positive stromal cells (myofibroblasts) at the periphery of the tumor. We examined 21 pleomorphic adenomas of major salivary glands. All of the 21 pleomorphic adenomas examined had both dendritic interstitial cells and myofibroblasts at the tumor border. The ratio between the two cell types varied, and they exhibited a bilayered capsular structure; myofibroblasts were located in the inner layer of the tumor capsule, whereas dendritic interstitial cells derived from nearby vascular structures and nerves were located in the outer layer of the capsule. On the basis of the specific distribution of the dendritic interstitial cells in the present study, there is a possibility that dendritic interstitial cells are associated with the tumor growth regulation of major salivary gland pleomorphic adenomas.

The role of myofibroblasts at the tumor border of invasive colorectal adenocarcinomas.

BACKGROUND: In order to elucidate the significance of myofibroblasts in invasive growth of colorectal adenocarcinomas, we examined the number of myofibroblasts at the tumor border of colorectal adenocarcinomas. METHOD: A total of 91 invasive colorectal adenocarcinomas were examined immunohistochemically using anti-alpha-smooth muscle actin (ASMA) and high-molecular-weight caldesmon (h-CD) antibodies; 25 carcinomas confined to the submucosa (sm carcinomas), 40 carcinomas confined to the muscularis propria (mp carcinomas) and 26 carcinomas invading the subserosa or adventitia (ss carcinomas). We considered ASMA-positive and h-CD-negative stromal cells as myofibroblasts. RESULTS: Twenty-seven (67%) of the 40 mp carcinomas and 25 (96%) of the 26 ss carcinomas had a small number of myofibroblasts at the tumor border facing the muscularis propria. CONCLUSIONS: Although direct evidence is lacking, there is a possibility that the further immediately vertical and radial invasion of carcinoma cells into the subserosa or adventitia is associated with a smaller number of myofibroblasts at the tumor border facing the muscularis propria in mp carcinomas, resulting in a low incidence of mp and a high incidence of ss carcinomas in the colorectum.

Well differentiated adult-type fibrosarcoma arising from the occipital subcutaneous tissue in a 17-year-old man: case report with immunohistochemical study.

We report a case of a 17-year-old man with a spindle cell tumor in the occipital subcutaneous tissue. The enucleated tumor, measuring 2.5 x 2.0 x 1.0 cm, had a broad-bean shape and well circumscribed border and was localized to the subcutis without dermal involvement. Microscopically, the tumor was composed of uniform spindle cells showing interlacing bundle formation and a herringbone pattern. The neoplastic cells were separated by collagen fibers in parallel fashion, the amount of which varied with different areas in the tumor. Mitotic figures were eight mitoses per 50 high-power fields in number. The neoplastic cells were positive for vimentin, Factor-XIIIa, alpha-smooth muscle actin and CD34, but negative for desmin, calponin, high molecular weight caldesmon, smooth muscle myosin heavy chain, collagen type IV, laminin and S-100 protein. These immunohistochemical results indicated that the neoplastic cells showed differentiation toward fibroblasts/myofibroblasts/dendritic interstitial cells. Although more than 50% of the neoplastic cells were positive for CD34, the present tumor should be diagnosed as well differentiated fibrosarcoma, adult type, rather than extrapleural solitary fibrous tumor and fibrosarcomatous areas of dermatofibrosarcoma protuberans, on the basis of routine microscopic findings mentioned above.

Mesangial cell activation in the collagenofibrotic glomerulonephropathy. Case report and review of the literature.

Collagenofibrotic glomerulonephropathy is a new disease entity of unknown pathogenesis, which is characterized by the deposition of type III collagen within the mesangial matrix. We have investigated a case in which many mesangial cells in the type III collagen-deposited glomeruli were alpha-smooth muscle actin (ASMA) positive and showed an increase of subplasmalemmal filaments, indicating the activation and myofibroblastic transformation. It is suggested that the activated mesangial cells may synthesize the type III collagen deposited in the subendothelial space and mesangial matrix.

So-called neoplastic myoepithelial cells in chondroid syringomas/mixed tumors of the skin: their subtypes and immunohistochemical analysis.

An immunohistochemical study of nine cases of chondroid syringomas/mixed tumors of the skin was performed to elucidate the nature of the so-called neoplastic myoepithelial cells (NMEC) in tumor tissues. These nine tumors contained NMEC of considerable variability in number from one tumor to another. These NMEC were classified into three types: (i) hyaline cells (plasmacytoid cells); (ii) spindle NMEC; and (iii) polyhedral cells. They showed different immunostaining patterns, as the following describes. Cytokeratin 14 was positive in most of the spindle NMEC and a large number of the polyhedral cells, and in a small number of the hyaline cells. Concerning low molecular weight cytokeratins, most of the hyaline cells showed immunoreactivity, whereas they were negative in many of the spindle NMEC and were expressed only in a small number of the polyhedral cells. alpha-Smooth muscle actin and muscle-specific actin were positive in the spindle NMEC but negative in any of the hyaline cells and polyhedral cells. These findings strongly indicate that the hyaline cells and the spindle NMEC are of the simple epithelial and myoepithelial types, respectively. The findings also suggest that the polyhedral cells show differentiation toward basal cells of the sweat gland dermal ducts or myoepithelial cells.

Neuroepithelial and ependymal changes in HTX rats with congenital hydrocephalus: an ultrastructural and immunohistochemical study.

To investigate the pathogenesis of congenital hydrocephalus the brains of HTX rats aged between 16 days and 4 weeks and the brains of normal Wistar rats of the same ages were examined. In the fetal HTX rat brains, the lateral ventricles were symmetrically dilated from 20 days of gestation. The neuroepithelium bordering the ventricles showed thinning with cellular disarrangement and deformity. Similar neuroepithelial abnormalities were also found in the lateral ventricles of the HTX rat brain with no macroscopic signs of hydrocephalus at 20 days of gestation. The neuroepithelium showed flattening of the cells, widening of the intercellular spaces, formation of microvilli on the detached lateral cell surfaces, and frequent macrophage infiltration. On the other hand, the neuroepithelial cells of the third ventricle and the aqueduct were affected less severely or showed no significant abnormalities. Immunohistochemically, most of the neuroepithelium and ependyma of the lateral ventricles were positive for vimentin in both prenatal and postnatal hydrocephalic HTX rats, while a small number or none of those in normal control rats were positive. These morphological changes suggested that preferential involvement of the lateral ventricular neuroepithelium might be closely associated with the pathogenesis of congenital hydrocephalus in HTX rats.

Superficial angiomyxoma of the right inguinal region: report of a case.

We report one rare case of superficial angiomyxoma of the right inguinal region, in a 67-year-old man. The tumor, measuring 4.5 x 4.0 x 3.0 cm, had a finger-like shape, was composed of a well circumscribed conglomerate of multiple myxomatous nodules and was located partially in the dermis and partially in the subcutaneous tissue. Microscopically, in contrast to previously reported cases, the tumor was composed mainly of oval plump stromal cells with an amphophilic cytoplasm. Spindle-shaped stromal cells were scattered throughout the tumor. The tumor border was not infiltrative and was well defined by thick hyalized collagen bundles. Neither hyperchromasia nor pleomorphism was apparent. No mitotic figures were detected in the specimens prepared. Small to medium-sized blood vessels showed a scattered distribution, but large vessels, seen frequently in aggressive angiomyxoma, were absent. Moreover, no plexiform capillary pattern was evident. These findings were diagnostic of superficial angiomyxoma. Although this disease entity is considered as including cutaneous focal mucinosis, follicular fibroma, trichofolliculoma and trichogenic adnexal tumor, we propose that these tumors should be excluded.

Development of hepatic sinusoidal structure with special reference to the Ito cells.

To elucidate sinusoidal cell structure and function under normal conditions and their behavior in diseased settings, an understanding of their developmental aspects is needed. At day 10 of gestation in mice and rats or at 5 weeks of gestation in humans, the hepatic cords grow into the mesenchymal tissue of the septum transversum, and the primitive sinusoidlike structure is simultaneously observed between the liver cell cords. In the margin of the growing liver primordium, mesenchymal cells in the septum transversum are trapped in the subendothelial space. These subendothelial cells are at the early stages of organogenesis and become progenitors of the Ito cells. By days 12-14 of gestation in mice and rats or 8 weeks of gestation in humans, the basic structure of the sinusoids has developed. Embryonic hepatic sinusoids are usually lined by a continuous endothelium without basement membranes, and an incompletely fenestrated sinusoid appears at the middle gestational stage. In the late gestational stages, the Ito cells exhibit myofibroblastlike features in humans, mice, and rats. In association with this event, perisinusoidal reticular networks are gradually intensified. After birth until days 4-5 in mice and rats, the sinusoidal and perisinusoidal structures are almost completely formed, although slight morphological differences from those in adult livers still exist. What happens to sinusoidal endothelial cells and Ito cells in hepatic fibrosis-cirrhosis of the adult may be a deviated or uncontrolled occurrence of what goes on during the fetal period, i.e., a continuous nonfenestrated sinusoidal lining in the early embryonic stage and a myofibroblastlike transformation of Ito cells in late fetal life.

[A histologic study on prevention of surgical conduction disturbance, with special reference to the relationship between the central portion of the A-V bundle and adjacent structures].

UNLABELLED: The present study was aimed to examine the course of the proximal portion of the His bundle (HB). Twenty-six hearts was histologically investigated, 5 normal, 13 with isolated perimembranous ventricular septal defect (VSD) and with tetralogy of Fallot (TOF). Following items were analyzed by serial sectioning: 1. Distance from axis of the nonbranching bundle (NBB) to the lower irm of VSD. 2. Deviation of the penetrating bundle (PB) and the NBB to the right ventricular septal endocardium. 3. Distance from the HB to the attachment of the tricuspid septal leaflet (ALS). 4. Level of the HB under the provision that the ASL level is zero. 5. Length and distance of the HB. RESULTS: 1. In inlet type VDSs, the NBB-VSD distance was 0.40 +/- 0.27 mm, indicating that the conduction system maintained nearly the same level as the ASL. 2. In trabecular and infundibular type VDSs, the NBB-VSD distances were 1.57 +/- 0.80 mm and 1.75 +/- 0.35 mm, and the HB-ASL distances were 1.70 +/- 1.23 mm and 1.10 +/- 1.13 mm, respectively. 3. In membranous type TOF, the NBB lay more superficially than in muscular type. CONCLUSION: inlet type VSD and perimembranous type TOF have anatomic features in which the proximal His bundle tends to be jeopardized by suturing for VSD closure.

[Surgical landmarks of course of atrioventricular conduction system].

There is a certain tendency in the relationship between the distribution of the conduction system and the type of VSD as classified by Soto and coworkers. The course of the conduction system and its surgical landmarks were investigated histologically in various cardiac anomalies. In perimembranous inlet VSD, the His bundle ran superficially on the crest of the ventricular septum. It ran on the left ventricular aspect and somewhat deeply in trabecular VSD and far deeply in infundibular VSD. In perimembranous inlet or trabecular VSD, the RBB laid beneath or just anterior to a series of upper-uppermost accessory papillary muscle when these were present and descended posteroinferior to the MPM, basically as in the normal heart. The upper-uppermost AcPM are reliable landmarks for the RBB. The RBB descended just anterior to the so called MPM (embryologically the uppermost AcPM--Van Mierop) in infundibular VSD and TOF. These findings have provided us useful bases for suture placement to avoid conduction disturbance.