Periarticular tumoral calcinosis and hypercalcemia in a hemodialysis patient without hyperparathyroidism: a case report.

We present a case of a 58-yr-old male to illustrate the scintigraphic, roentgenographic, clinical, and pathologic features of periarticular tumoral calcinosis that occurred in a hemodialysis patient. Soft-tissue calcifications developed 3 yr after onset of hemodialysis, became progressively larger during the ensuing five years, and culminated in voluntary withdrawal from dialysis because of the extreme discomfort and lack of mobility that resulted from the calcinosis. Histologically, an aplastic disorder was present with very low bone formation. On bone scintigraphy, intense calcium uptake in soft tissues implied that it was metabolically active. We hypothesize that this high metabolic activity contributed to the persistent hypercalcemia observed during the patient's last year of life.

Cytologic detection of penile malignant melanoma of soft parts in pleural effusion using monoclonal antibody HMB-45.

A case of penile malignant melanoma of soft parts ("clear cell sarcoma") with pulmonary metastases and malignant effusions is reported. The tumor cells in the pleural effusion were scattered singly and admixed with reactive mesothelial cells. They had abundant granular cytoplasm and round nuclei with prominent nucleoli. Although staining for S-100 protein was positive in sections from the penile lesion, it was negative in sections of a cell block prepared from the effusion; however, the effusion tumor cells demonstrated immunoreactivity with HMB-45, an antimelanoma monoclonal antibody.

Nephrotic syndrome and rapid renal failure in autosomal dominant polycystic kidney disease.

A 44-year-old man, with autosomal dominant polycystic kidney disease and hypertension under satisfactory control, developed nephrotic syndrome with negative serology. Open renal biopsy revealed focal glomerular sclerosis. Prior to the appearance of heavy proteinuria, serum creatinine was 1.7 mg/dl. After the nephrotic syndrome had been established, renal function deteriorated rapidly and hemodialysis was started within 2.6 years. In patients with autosomal dominant polycystic kidney disease, the appearance of nephrotic range proteinuria along with a rapid decline in renal function indicates the presence of a glomerular lesion, which needs to be investigated by renal biopsy.

Aggressive jejunal lymphoma of large granular lymphocytes. Immunohistochemical, ultrastructural, molecular, and DNA content analysis.

An unusual large cell lymphoma of the proximal jejunum with large granular lymphocyte (LGL) morphologic characteristics and T-helper/inducer cell phenotype is described. Although the cells strongly expressed Leu-7 (HNK-1), studies with antibodies directed against the more specific natural killer (NK) antigens, CD16 (Leu-11) and Leu-19, were negative. Ultrastructural analysis of the neoplastic cells demonstrated substantial numbers of electron-dense granules and rare parallel tubular arrays. Clonal rearrangement of the T-cell receptor beta chain gene and germline configuration of the immunoglobulin heavy chain gene confirmed the T-cell origin of the neoplastic cells. This lymphoma pursued an aggressive clinical course, with rapid dissemination to the lungs and central nervous system. DNA content analysis indicated that a similar DNA aneuploid population was present in the jejunal primary and lung tissue at recurrence. There was no evidence of nodal, peripheral blood, splenic, or bone marrow involvement. Morphologic and functional similarities between the lymphoid tissues of the gastrointestinal tract and lung have previously prompted a classification of the immune system into distinct peripheral somatic and mucosal components. Based on the distribution and migratory properties of the tumor cells in this case, the authors propose that this lymphoma arose from a minor mucosa-associated LGL subset that may be unrelated to circulating LGLs. In addition, these observations emphasize that prominent granulated cytomorphologic features may be seen in neoplastic disorders with the T-helper/inducer phenotype, as well as in the more widely recognized lymphoproliferative disorders of NK and cytotoxic/suppressor cell types.

Immunoreactivity of tumor-associated glycoprotein (TAG-72) in normal, hyperplastic, and neoplastic colon.

Monoclonal antibody B72.3 recognizes tumor-associated glycoprotein (TAG-72) and has been widely used to identify malignant epithelial cells in cytologic and histologic preparations. We investigated TAG-72 expression in normal, hyperplastic, and neoplastic adult colon tissues. Formalin-fixed, paraffin-embedded samples of normal (43), hyperplastic (20), and neoplastic (70) colonic tissue were studied with B72.3 using the avidin-biotin complex immunoperoxidase method. TAG-72 expression was detected in 100% of the invasive carcinomas, in 84% of the normal colon samples, in 100% of the hyperplastic polyps, and in 93% of the adenomatous or mixed hyperplastic-adenomatous lesions. Among cases expressing TAG-72 immunoreactivity, the extent of staining varied from 100% of cells in normal and hyperplastic lesions to 10% to 100% in neoplastic lesions. A consistent supranuclear (presumably Golgi) staining pattern was observed in all tissues with the exception of carcinoma and some adenomas; in these cases, staining localized to the luminal surface and intraluminal mucin and/or was diffusely cytoplasmic. From these data, it is clear that TAG-72 is expressed in both benign and neoplastic cells of the human adult colon, although different patterns of expression may distinguish malignant transformation. Furthermore, carcinoma cells less consistently express TAG-72, so that small biopsies or cytologic specimens may be falsely negative due to sampling errors.

Metastatic breast carcinoma mimicking granular cell tumor.

Metastatic breast carcinoma may assume many patterns. We describe a case in which cutaneous, pulmonary and lymph node metastases of an adenocarcinoma of the breast all resembled granular cell tumor. In all sites, the lesion stained positive with antibodies against EMA and cytokeratins, but failed to stain with anti-S100.

The CD4 Leu 8- T helper cell in colonic mucosa: a quantitative and functional analysis.

CD4 T cells in the colonic lamina propria are primarily B cell helper as identified by their surface phenotype CD4 Leu 8- (CD4 Leu 8+:CD4 Leu 8- ratio = 1:3.5). This is in contrast to autologous peripheral blood where CD4 Leu 8+ cells predominate (CD4 Leu 8+:CD4 Leu 8- ratio = 2.4:1). Functionally CD4 Leu 8- T cells isolated from the colon are able to provide autologous peripheral blood B cell help comparable to that of peripheral blood CD4 Leu 8- T cells. Immunoperoxidase staining of colonic tissue sections confirmed the relative lack of Leu 8 staining cells in the lamina propria and that when present these cells are located in the outer margins of lymphoid follicles.

Management of stage A prostate cancer with a high probability of progression.

For the patient with incidentally discovered prostatic cancer that has a high probability of progression further treatment may be indicated. Several studies have shown that survival free of disease is increased by additional therapy but the choice of treatment remains unclear. The lack of matched controls has prevented rigid statistical analysis of the efficacy of prostatectomy and radiotherapy or expectant management in the treatment of these tumors. A prior review of 251 patients with stage A prostate cancer provided a population base from which to perform a matched pair analysis between 30 control patients receiving no additional treatment and 30 patients treated by either prostatectomy or radiotherapy. A second and unpaired analysis was performed among patients undergoing radical prostatectomy (17), radiotherapy (31) and expectant management alone (33). The treated group achieved a significantly superior survival free of disease over the matched control group managed expectantly. The unpaired analysis again demonstrated the advantages of treatment over no treatment but failed to define a clear statistical difference between the 2 treated groups. Radical prostatectomy appeared to provide a recognizable advantage over radiotherapy in survival free of disease but was not statistically significant owing to the small size of the sample population.

Incidental carcinoma of the prostate: an analysis of the predictors of progression.

Incidentally discovered prostatic cancer can pursue a benign clinical course or it can rapidly progress. Differentiating those tumors with low biological potential from more aggressive lesions has been the focus of many reports. To define more completely the variables that can be used to predict those patients with low biological potential requiring limited treatment from those needing more extensive therapy, a retrospective study of 232 patients with incidentally discovered cancer was undertaken. Progressive disease was used as an endpoint for statistical analysis with the Kaplan-Meier technique and Cox's multiple hazard regression mode. This extensive analysis of multiple parameters demonstrated a significant advantage of survival free of disease for patients presenting with tumors manifesting a lower Gleason score and volume extent. Probability tables were constructed to allow for prediction of the probability of progression for a given patient with incidentally discovered prostate cancer directly related to patient age at diagnosis, Gleason score, and initial volume extent of the tumor. With these tables a logical therapeutic approach can be derived for each patient in an attempt to maximize survival free of disease with minimal intervention.

Multiple gastric adenomas.

Gastric adenomas are uncommon, and multiple gastric adenomas are rare. We report an instance of three gastric adenomas found in an elderly man. Of the two polyps that contained histologic changes of malignancy, one measured 8 cm in length. The radiographic and pathologic findings are presented with a pertinent review of the literature.

Intussusception secondary to squamous carcinoma of the lung.

This report describes unusual radiologic and pathologic findings in a patient with multiple small bowel metastases from squamous cell carcinoma of the lung. The diagnostic work-up revealed a large, pleural-based, right lung mass, a large left adrenal mass, two ulcerated small bowel masses, and a unique giant peduncular mass that caused intermittent intussusception. A pertinent review of the literature is presented.

Blast cells transfer experimental hypersensitivity pneumonitis in guinea pigs.

We previously demonstrated that experimental hypersensitivity pneumonitis (HP) can be transferred by lymph node cells (LNC) cultured in vitro with antigen. The purpose of this study was to identify the cells responsible for transfer and to determine if pulmonary cells can transfer HP. We cultured LNC from sensitized Strain 2 guinea pigs with a soluble extract of Micropolyspora faeni for 72 h, separated lymphoblasts from small lymphocytes, and transferred both subpopulations intravenously to syngeneic recipients. We also transferred irradiated lymphoblasts (1,500 rads), macrophage-depleted, lymphoblast-enriched populations, and pulmonary cells either without culture or after culture with M. faeni. Control animals received an equal volume of medium. All recipient animals were challenged intratracheally (i.t.) with M. faeni 48 h after the cell transfer, and they were killed 4 days after i.t. challenge. Randomly selected microscopic fields of the lung (250/animal) were judged to be normal or abnormal without knowledge of treatment. This measurement was reproducible (r = 0.95 for duplicate measurements, n = 55). All guinea pigs were maintained in HEPA-filtered air. There was a low level of pulmonary response to an i.t. challenge of M. faeni in animals that received medium. Animals that received pulmonary cells, either cultured or noncultured, did not differ from those in the control group. There was a substantial increase (p less than 0.01) in the extent of pulmonary abnormalities in the recipients of the lymphoblast population, with significant correlation (r = 0.87, p less than 0.01) between the number of lymphoblasts transferred and the extent of pulmonary abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Three-phase radionuclide bone scanning in evaluation of local radiation injury. A case report.

The management of local radiation injuries is influenced by the degree of vascular compromise within the skin and underlying tissues. Other authors have used thermography and angiography in assessing the blood flow to radiation damaged tissues. This report describes the use of radionuclide imaging in the evaluation of a patient who developed necrosis of his distal digits following a radiation accident. In addition to determining the vascular status of the hands, imaging helped indicate an appropriate level for amputation.

Comparison of keratin monoclonal antibodies MAK-6, AE1:AE3, and CAM-5.2.

Two routinely used antikeratin monoclonal antibodies, AE1:AE3 (Hybritech Inc., La Jolla, CA) and CAM-5.2 (Becton-Dickinson, Mountain View, CA), were compared with a new antikeratin monoclonal antibody mixture, MAK-6 (Triton Biosciences, Inc., Alameda, CA). Various poorly differentiated epithelial neoplasms, lymphomas, melanomas, and sarcomas were studied with the use of the avidin-biotin-peroxidase technic. All three antibodies had similar staining profiles, however, some differences were noted. The MAK-6 and CAM-5.2 antibodies illustrated stronger staining for some grade III transitional cell carcinomas, whereas the AE1:AE3 was variably positive to negative in all cases. Three renal cell carcinomas were positive with all three antibodies, two were negative with all three, and one had scattered positive cells with MAK-6 only. All lymphomas and plasmacytomas were negative with MAK-6 and CAM-5.2, however, AE1:AE3 faintly stained two of three plasmacytomas and two of the seven large cell lymphomas. Two out of three hepatomas evaluated were strongly positive with CAM-5.2 and MAK-6 and variably positive with AE1:AE3. The third case had both positive and negative cells with all three antibodies. In conclusion, MAK-6 antikeratin antibody is as useful as AE1:AE3 and CAM-5.2 for identification of poorly differentiated epithelial neoplasms.

Lymphatic distribution of the stomach in normal, inflammatory, hyperplastic, and neoplastic tissue.

Prompted by the lack of knowledge of the distribution of gastric lymphatics and the discrepancy between the incidence of lymph node metastases from intramucosal gastric carcinoma versus intramucosal colonic carcinoma, we undertook a study of the distribution of lymphatics in normal, abnormal non-neoplastic, and neoplastic gastric mucosas. The study involved the histologic, immunocytochemical, and electron microscopic evaluation of a total of 47 gastric biopsy, polypectomy, and resection specimens and showed that the gastric lymphatics normally begin as a plexus of vessels immediately superficial to, within, and below the muscularis mucosae. The upper two-thirds of the gastric lamina propria is normally devoid of lymphatics. This distribution is maintained throughout the cardia, fundus, and antrum and is also maintained in hyperplastic and neoplastic tissues. However, in patients with severe atrophic gastritis in which the overall height of the gastric mucosa is markedly decreased, lymphatic capillaries may be found near the surface epithelium. The relevance of these findings to the behavior of early gastric cancer is discussed.

Distribution of histopathology and Ia positive cells in actively induced and passively transferred experimental autoimmune orchitis.

Histopathology in testes from mice with actively induced experimental orchitis (EAO) (active EAO) and those from recipients of testis-sensitized lymphocytes (passive EAO) had different distributions. In passive EAO, maximum orchitis existed in the straight tubules, rete testis, and ductus efferentes, obstruction of which led to extreme dilatation of seminiferous tubules. Unusual intralymphatic granulomata also resulted in dilated testicular lymphatics. In active EAO, maximum orchitis affected seminiferous tubules under the testicular capsule, away from the rete testes. Vasitis was common and occurred in both active and passive EAO. In normal testes, IA+ F4/80+ cells were sparse but formed a cuff around the straight tubules. After immunization with testis in adjuvant or with adjuvant alone, the number, size, and staining intensity of IA+ cells increased dramatically beginning on day 5, 7 days before disease onset. Simultaneously, epithelial cells confined to the ductus efferentes became Ia+. Although recipients of sensitized lymphocytes also developed epithelial Ia in the ductus efferentes, they did not show changes in testicular interstitial Ia+ cells. Our findings indicate that testicular autoantigens are not completely sequestered, but are accessible to and can react with passively transferred immune lymphocytes in well-defined regions of the germ cell compartment. These regions coincided to a large extent with maximum expression of periductal or epithelial Ia. Changes in Ia+ cells in the testis, which are inducible by adjuvants and precede orchitis, may account in part for the different distribution of histopathology of active EAO.