Recurrence of choroid plexus papilloma with malignant transformation--case report and lectin histochemistry study.

A very rare primary choroid plexus carcinoma occurred in a 44-year-old male presenting with occipitalgia, nausea, and blurred vision. The tumor had progressed from a choroid plexus papilloma in the fourth ventricle which was totally removed 6 years previously. Lectin histochemistry might be useful for the differential diagnosis of primary choroid plexus neoplasms and other brain tumors such as secondary carcinoma.

Rat hepatocarcinogenesis induced by N-nitrosodiethylamine and N-nitrosomorpholine continuously administered at low doses. From basophilic areas of hepatocytes to hepatocellular tumors.

The development of hepatocellular tumors was investigated with histological, histochemical, and morphometrical methods in male Sprague-Dawley rats continuously administered N-nitrosodiethylamine (DEN) or N-nitrosomorpholine (NNM) in the drinking water at low doses (0.5 mg DEN/100 ml; 1 mg NNM/100 ml). Groups of control, DEN-, and NNM-treated rats were investigated at 5-week intervals. Similar results were obtained in DEN- and NNM-treated rats. Two types of areas composed of basophilic or glycogenotic hepatocytes were observed preceding the appearance of hepatocellular adenomas and carcinomas. Besides their cytologic differences, the basophilic and glycogenotic areas induced displayed distinct histochemical features. Both types of areas were detected simultaneously and increased in parallel with time to a similar incidence, but basophilic areas reached larger sizes than the glycogenotic ones. Furthermore, each type of area, which clustered around and along efferent veins, was differently linked to tumorigenesis. Basophilic areas frequently developed into basophilic adenomas and trabecular carcinomas through a characteristic sequence. Early basophilic areas consisted of hepatocytes with lamellar cytoplasmic hyperbasophilia and exhibited the normal laminar liver structure. With time, an increasing number of basophilic areas also contained hepatocytes with powdered diffuse hyperbasophilia, which frequently were arranged in thick trabeculae, showed abundant mitotic figures, and invaded efferent veins. Neither such signs of malignancy nor conversion into basophilic areas or tumors could be established for areas of clear and acidophilic glycogenotic hepatocytes. However, a few small glycogenotic adenomas probably developed from glycogenotic areas. Our data thus underline the central role of basophilic areas for hepatocarcinogenesis. Moreover, taking into account the data from other experiments, it seems likely that although glycogenotic areas may be associated with the application of some carcinogens at high doses, they are not obligatory precursors of hepatocellular tumors.

Inverted squamous papilloma with neuro-ophthalmic features.

The schneiderian or inverted papilloma is an infrequent and usually benign tumor of the paranasal sinuses. It most commonly manifests as unilateral nasal obstruction. This is a case of an inverted papilloma in a 92-year-old woman who presented with severe proptosis, loss of vision in the left eye, and rhinorrhea. The mass was visible in her left nostril; neuroimaging studies showed that the lesion extended from the left paranasal sinus into the frontal sinuses. In addition, there was secondary spread into the cranial cavity and brain substance.

[Cutaneous manifestation of Hodgkin's disease associated with verrucosis plantaris of unusual appearance]. / Cutan manifesztációjú M. Hodgkin és szokatlan megjelenésü verrucosis plantaris.

The association of malignant lymphoma (M. Hodgkin) and verrucosis plantaris of abnormal extent was found in a young woman patient whose death was due to an underlying disease. In connection with this case the authors discuss the immunopathogenesis of malignant lymphomas (among them that of M. Hodgkin), the biology of human papilloma viruses as well as the common etiological aspects of the above immune deficient condition and the associated virus infection.

[Pulmonary cancerization in juvenile laryngeal papillomatosis]. / Zum Problem der pulmonalen Kanzerisierung der juvenilen Larynxpapillomatose.

A case of early onset type of juvenile laryngeal papillomatosis (JLP) is reported, where pulmonary involvement developed in typical aspiration site evidenced by tuberculosis of the right lung, and which stimulated after years a squamous epithelial carcinoma. After comparison of this case with similar cases reported in the literature, the clinical feature of cancerization in JLP is discussed in the context of recent virological, immunohistochemical and pathohistological findings. The infectious nature of this disease and the reparative character of the pathologically accelerated proliferation of the papilloma epithelium are stressed, which latter is thus particularly susceptible to additional noxae: irradiation, cigarette smoke, infection and necrosis. These noxae are considered to be the ultimate cause of cancerization in JLP, especially long-standing necrosis. These noxae are considered to be the ultimate cause of cancerization in JLP, especially long-standing necrotisation of lung structures in pulmonary involvement. Surgical treatment of JLP, eradication being unconceivable, should therefore be rather conservative, and any therapeutic attendance should take utmost care to avoid intrapulmonary seeding.

Malignant conversion and metastasis of mouse skin tumors: a comparison of SENCAR and CD-1 mice.

The progression of papillomas to squamous cell carcinomas (malignant conversion) was studied in the skin of SENCAR and Charles River CD-1 mice, using a three-stage treatment protocol. After initiation with 7,12-dimethylbenz(a)anthracene (DMBA) (stage 1) and limited promotion by 12-O-tetradecanoylphorbol-13-acetate (TPA) (stage II), papilloma-bearing mice were treated (stage III) with either tumor initiators, such as urethane, N-methyl-N'nitro-N-nitrosoguanidine (MNNG) or 4-nitroquinoline-n-oxide (R-NQO), the promoter TPA, or solvent (acetone). Similar final carcinoma yields were found in the mice treated in stage III with TPA or acetone, although carcinomas developed earlier in the TPA-treated mice. In contrast, treatment with tumor initiators in stage III increased both the rate of appearance and the final yield of carcinomas. Similar results were obtained in both SENCAR and CD-1 mice. A papilloma stage appears to be necessary for carcinoma development since elimination of TPA treatment in stage II greatly reduced the incidence of both papillomas and carcinomas in both stocks of mice. The heterogeneity of papillomas with regard to progression to carcinomas is demonstrated by the low rate of conversion of TPA-dependent papillomas and the high rate of conversion of persistent papillomas in CD-1 mice. The carcinomas that develop using the three-stage regimen vary in metastatic potential. In CD-1 mice, the frequency of metastases to lymph nodes were similar in groups treated in stage III with MNNG, urethane, 4-NQO, TPA, or acetone, but treatment with urethane substantially increased metastases to the lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Juvenile laryngeal papillomatosis with pulmonary spread. Regression following transfer factor therapy.

A 6-year-old girl with a history of juvenile laryngeal papillomatosis since 6 months of age and progressing pulmonary extension of the tumor for two years was treated with transfer factor prepared from her mother. Within one month of the onset of therapy, she exhibited marked clinical improvement. A computed tomographic scan performed after four months of therapy revealed almost complete resolution of her pulmonary lesions.

Tracheal involvement in laryngeal papillomatosis.

A review of 39 laryngeal papilloma patients at The Johns Hopkins Hospital revealed an incidence of subglottic and tracheal extension much higher than previously reported. Subglottic disease was present in 69% of patients and tracheal involvement in 26%. Factors associated with distal spread were the presence of subglottic papillomas, history of tracheostomy, total number of endoscopic resections, and the duration of disease. The relationship to the presence of viral antigen was cited. Detection and elimination of all papillomas is felt to be the key for the prevention of distal spread. The strategy of management is described.

Secondary foci of primary tumors of the bladder in the upper urinary tract.

In 10 years the authors have observed 16 cases of upper urinary tract tumors, appearing from 2 to 16 years after the initial diagnosis of bladder carcinoma. Such lesions are more frequent than has been suggested in the literature and represent 25% of all tumors of the renal pelvis and ureter seen in our service during this period. We have shown vesicoureteral reflux directly in 6 cases, indirectly in a further 6 with suggestive signs in 3 more. We believe that reflux causing the implantation of desquamated tumor cells from the bladder tumor is the most important pathogenetic mechanism for upper urinary tract "recurrences." The interval between the initial diagnosis of bladder tumor and the appearance of secondary foci may be longer than 20 years. Prolonged surveillance is therefore necessary, particularly if vesicoureteral reflux has been shown.

Tumours of the renal pelvis and ureter. Symptomatology, diagnosis, treatment and prognosis.

Forty-two cases of tumour of the renal pelvis and/or ureter are presented. The primary tumour was in the renal pelvis in 25 cases and in the ureter in nine. A co-existent tumour elsewhere in the uroepithelium was found in 16 of these 34 patients. In the remaining eight patients, tumour of the urinary bladder was the initial diagnosis, but tumours of the upper urinary tract subsequently appeared. The principal symptom (38 of 42 cases) was haematuria, but flank pain and a mass in the kidney region also occurred. In most cases the diagnosis was indicated by the urograms and was confirmed by retrograde pyelography. Nephro-ureterectomy was done in most of the patients. The possibility that local tumour resection may be sufficient is briefly discussed. The tumours were classified as papillary in 24 patients and as solid in nine. There was no histologic classification in nine cases. The mean observation time was 29 months. Since new growths tend to arise at other sites in the uro-epithelium, follow-up examination should always include cystoscopy and urography. The prognosis was particularly poor in solid tumours: two-thirds of these patients died in the first postoperative year. Survival was clearly dependent on the tumour differentiation. High-grade tumours carried a poor prognosis.