Does pTis exist in HPV-driven tonsillar carcinomas? An ultrastructural review and examination of two cases.

Many tonsillar tumors present clinically as cervical nodal metastases and the primary tumor is often difficult to find. HPV-driven tonsillar carcinoma begins in the reticulated crypt epithelium, possibly through viral integration. The basement membrane is not complete in the reticulated crypt epithelium, which may enhance the immune function. We examined the reticulated crypt epithelium in a normal case and five neoplastic tonsils with cervical metastasis as the presenting symptom to further investigate whether tonsil carcinoma in-situ exists. Our results suggest that in-situ carcinoma may need to be excluded from the future staging for human papilloma virus associated tonsillar tumors.

[Malignant fibrohistiocytoma in otorhinolaryngology. Review of two cases]. / Fibrohistiocitoma maligno en ORL. Una revisión a propósito de dos casos.

Fibrohistiocytomas are soft-tissue tumors of histiocytic origin that have a variety of histological patterns. Although cases of malignant fibrohisticytoma (MFH) of the head and neck have been reported with increasing frequency in recent years, they can be considered rare. However, they probably are more frequent than thought because of the different designations that the disease has received and confusion among clinicians and pathologists regarding these tumors. We report two cases of MFH of the tonsil and larynx, respectively. The histopathological diagnostic criteria, therapeutic indications, and prognosis evaluation are described.

Mean nuclear area and chromosomal DNA content of squamous cell carcinomas of the oral cavity using computerized image analysis.

Morphometric measurements of nuclei may be of prognostic value in some cancers. In this present study we have evaluated the mean nuclear area (MNA) of 50 squamous cell carcinomas of the oral cavity (SCCOC) using computerized image analysis. Since chromosomal DNA content is a reflection of the DNA content in the nucleus, we have evaluated the relationship between MNA and chromosomal DNA. Thirteen tumours had a MNA greater than 49.9 microns2 and 37 had a MNA less than this. Six tumours were classified as hypodiploid, 29 as diploid and 15 as aneuploid. There were 44 node-negative patients and six node-positive. When comparing MNA in these groups, 50 per cent of node-positive patients had a larger MNA whilst only 20 per cent of the node-negative group had a large MNA. The correlation coefficient between MNA and DNA indices was r = 0.75. The greater nuclear size is possibly a reflection of a more aggressive tumour biology in the node-positive patients. We conclude that a large MNA may be a marker of aggressive tumour biology in this group. In the future, we aim to evaluate the prognostic significance of MNA in patients with SCCOC.

A case of non-Hodgkin's lymphoma with macroglobulinemia.

A case of non-Hodgkin's lymphoma with macroglobulinemia is reported. A 48-year-old man consulted our hospital with complaints of dysphagia and sleep apnea. On the first examination, degree III hypertrophy of tonsils, Bence-Jones protein of K-type on urinalysis, and an M-peak in the gamma-glb. Beta-glb areas on fractionation of protein were found. Of serum immunoglobulins, IgM was increased markedly with 3,946 mg/dl and about 30% atypical lymphocytes were noted in the bone marrow. Bilateral tonsillectomy was carried out. The diagnosis of malignant lymphoma, non-Hodgkin, follicular, medium-sized cell type, B cell (sm IgM, K) was made by immunostaining of tissues. Chemotherapy was made after operation, and IgM levels decreased gradually. At present, the patient is following a satisfactory postoperative course, showing no swelling of tonsil.

Apoptosis in normal epithelium, premalignant and malignant lesions of the oropharynx and oral cavity: a preliminary study.

To explore the involvement of apoptosis in the development of oral and oropharyngeal squamous cell carcinoma (SCC) in vivo, biopsies were taken from patients with macroscopically normal (n = 6), leukoplakic (n = 12) or malignant (n = 8) mucosa. Leukoplakic lesions were divided histologically into dysplasia (n = 5) or carcinoma in situ (CIS: n = 7). Material was prepared for light and electron microscopy. The apoptotic index (AI), vertical cell position of apoptoses (cp), mitotic index (MI) and AI:MI ratio were calculated for each patient. AI increased from 0.12% +/- 0.07 S.E.M. (normal) to 0.58 +/- 0.13 (CIS) but fell to 0.14 +/- 0.14 in SCC. Apoptoses were suprabasal in normals, but generalised in CIS. MI increased from normal (0.20 +/- 0.06) to SCC (0.32 +/- 0.09), and AI:MI was at its maximum in CIS (1.57; SCC: 0.44). The results suggest that a change in apoptosis accompanies the onset of invasion in a premalignant lesion of the human oral cavity and oropharynx.

Follicular dendritic cell tumors of the oral cavity.

Follicular dendritic cell tumors are uncommon, and all the reported cases have occurred as primary lymph node tumors. We report two cases in the oral cavity, one in the soft palate and one in the tonsil. The tumors were characterized by sheets, whorls, and storiform arrays of spindly and syncytial-appearing cells with oval nuclei, fine chromatin, distinct nucleoli, and occasional nuclear pseudoinclusions. Multinucleated forms were present and were prominent in one case. An unusual feature was the presence of irregular pseudovascular spaces, which could raise a concern for vascular neoplasm. Because the tumors showed cohesive growth and a sharp interface with the fibrous stroma, they could also be mistaken for carcinoma, sarcoma, or melanoma. After radiation therapy, the palatal tumor showed a greater degree of nuclear pleomorphism, numerous nuclear pseudoinclusions, and striking nuclear grooving and foldings, mimicking interdigitating reticulum cell tumors. The diagnosis in both cases was confirmed by immunoreactivity with CD21 and CD35 and by ultrastructural demonstration of interdigitating cell processes with desmosomes. Both tumors also showed unexpected immunoreactivity with muscle-specific actin. Follicular dendritic cell tumor merits wider recognition of its possible extranodal occurrence as well as its full morphological spectrum in order to better define its behavior.

Prevalence and expression of human papillomavirus in tonsillar carcinomas, indicating a possible viral etiology.

The presence of human papillomavirus (HPV) DNA was assessed in biopsies of tonsillar carcinomas (n = 10) and cases of tonsillitis (n = 7), serving as controls, by general-primer-mediated PCR (GP-PCR). All carcinomas appeared HPV-positive, whereas all cases of tonsillitis were HPV-negative. Additional type-specific PCR for HPV 6, 11, 16, 18, 31 and 33 revealed that 4 carcinomas contained HPV 16 DNA, 4 contained HPV 33 DNA and 1 contained an HPV 16/33 double infection. False positivity was excluded by additional Southern blot analysis of type-specific PCR-positive samples (n = 4). Further characterization of GP-PCR products by sequence analysis revealed that 2 carcinomas contained still uncharacterized HPV genotypes; one of these also contained HPV 33 DNA and one was negative by type-specific PCR. Application of RNA PCR revealed expression of HPV 16 or HPV 33 E7 encoding spliced E6*1 transcripts in all tonsillar carcinomas (n = 4) examined. Additional non-radioactive RNA in situ hybridization performed on 3 biopsies revealed the presence of HPV 16 or HPV 33 E7 transcripts exclusively localized within the carcinoma cells, whereas stroma stained negative. These findings strongly support a role for certain HPV types in the pathogenesis of tonsillar carcinomas.

Non-Hodgkin's lymphoma involving the tonsil: an immunohistochemical study.

Twenty-one patients with non-Hodgkin's lymphoma involving the palatine tonsil were studied in an attempt to relate pathological data to clinical outcome. Eleven tumours were classified as low-grade and ten as high-grade on morphological criteria. The results of immunohistochemical investigations are presented; all tumours but one were of B-cell origin. None of the pathological factors studied were found to be useful prognostic indicators.

B-cell lymphoma with vimentin-positive cytoplasmic inclusions.

A 60-year-old woman complaining of cervical lymphadenopathy was admitted to Keiyu General Hospital, Yokohama. Malignant lymphoma involving systemic lymph nodes and the bilateral tonsils was suspected by computed tomography. The biopsy diagnosis of the cervical lymph nodes was B-cell lymphoma, diffuse medium-sized cell type. The cleaved centrocytic lymphoma cells were immunoreactive for CD20 and CD22 but negative for immunoglobulins. Characteristically, a considerable number of neoplastic lymphocytes possessed eosinophilic round inclusions in the cytoplasm. The inclusions were green in color by Papanicolaou staining, whereas they appeared vacuole-like in Giemsa-stained preparations. Ultrastructural study confirmed the presence of aggregates of intermediate-sized filamentous structures mainly in the perinuclear area. The rough endoplasmic reticulum and Golgi apparatus were poorly developed. Immunocytochemical staining using cytologic specimens and fresh-frozen sections disclosed that the inclusions were composed of vimentin filaments. Morphologic similarities to signet ring cell lymphoma are discussed.

Burkitt's lymphoma of the tonsil.

A case of Burkitt's lymphoma involving the tonsil in a 10-year-old Bedouin boy, is presented. The biological behaviour and the clinical presentation of this unusual neoplasm are discussed and the English language literature is reviewed. The diagnosis was made by histological examination, electron microscopy and confirmed by immunohistochemistry. The patient showed an excellent symptomatic response to surgery and chemotherapy.

Anaplastic small cell (oat cell) carcinoma of the tonsils: report of two cases.

Two cases of anaplastic small cell (oat cell) carcinoma of the tonsils are presented. In the first, cervical metastases preceded the manifestation of the primary tumour by 2 years. In case 2 the tonsillar carcinoma was accompanied by a bronchial tumour of the same histological type and by cervical and axillary metastases. Positive Grimelius stain, positive immunohistochemical staining for chromogranin A and neurone-specific enolase and the presence, in case 1, of membrane-bound granules indicate that these tumours display many similarities with neuroendocrine carcinomas even if they originate from pluripotential ductal cells of tonsillar minor salivary glands and not from Kulchitsky-like cells.

[Melanoma of the palatal tonsil. SEM examination]. / Melanoma na migdalku podniebiennym. Badania w sem.

In scanning microscopy the right tonsil melanoma was examined. The authors stressed the usefulness of this examinations in precise diagnose of above mentioned tumor along with the routine histopathologic examination.

Improved nuclear contour indices for lymphoid morphometry.

The morphometric analysis of benign and neoplastic lymphoid proliferations relies heavily on nuclear shape factors to identify clefted, cerebriform or convoluted nuclei. Most studies employ the size-independent nuclear contour index (NCI = perimeter/square root area) or the closely related (nuclear) form factor to evaluate the degree of nuclear irregularity. These indices, however, cannot distinguish a truly irregular shape from a perfectly smooth elliptical one. A variation of the standard NCI is therefore proposed in which the NCI of the ellipse (NCIe) that best approximates the nuclear shape is determined to indicate the degree of nuclear elongation or ellipticity and the separate NCI of the nuclear irregularity (NCIni) is determined to indicate the true irregularity of the nuclear perimeter, independent of nuclear elongation. These two new shape factors were tested on a series of shapes and on mantle and follicular-center cells present in 3-micron plastic-embedded sections from three tonsils with reactive lymphoid hyperplasia. Whereas the standard NCI increased with increasing ellipticity or nuclear irregularity, the NCIe increased only with increasing ellipticity and NCIni with increasing nuclear irregularity. Mantle cell and, to a greater extent, follicular-center-cell nuclei showed mean NCIe and NCIni greater than what would be expected from a perfectly round nucleus. These nuclei, therefore, were both more elliptical and more irregular in outline than a perfect circle. The NCIe and NCIni were shown to vary independently in both mantle and follicular-center cells. These new and relatively simple indices should lead to a more accurate morphometric description of lymphoid cells.

Ovarian androblastoma metastatic to tonsil.

Structural pattern of a tonsillar tumor found in a 67-year-old female was similar to a small ovarian androblastoma diagnosed histologically 6 1/2 years earlier. Electron microscopic study of the tonsillar mass revealed crystalloid structures suggestive of the Leydig cell origin of the tumor. After tonsillectomy, there was no local recurrence of the tumor, but the patient died a year later of multiple metastases. There appeared to be no previous reports of ovarian tumors metastatic to tonsil, and malignant androblastomas of the Leydig cell type are extremely rare.

Signet-ring cell variant of large cell lymphoma.

A diffuse, large cell lymphoma of palatine tonsil was found to contain a considerable number of enlarged tumor cells with prominent, hyaline, Russell body-type cytoplasmic inclusions displacing the nucleus peripherally and, thus, the morphologic features of signet-ring cell lymphoma. Immunoperoxidase staining revealed that the contents of the signet-ring cells were strongly positive for mu heavy chains and kappa light chains. Ultrastructurally, Russell body-type inclusions consisted of multiple, angulated, electron-dense crystalloids enclosed within expanded segments of rough endoplasmic reticulum.

A case of adult rhabdomyoma in the tonsillar region. A light and electron microscope study.

A case of rhabdomyoma in a 71-year-old woman is reported. The lobulated, soft tumour was situated in the left tonsillar region. It was encapsulated, easily removable and of a uniformly greyish-red colour on the cut surface. Both light and electron microscopy showed the classical features of a benign rhabdomyoma of adult type, with large "spider" cells and typical myofilaments, as well as Z-band fragments. To achieve the correct diagnosis in such cases the most important thing is probably to bear the possibility of this rare, but benign tumour in mind.