Morphodynamic interpretation of acute coronary thrombosis, with special reference to volcano-like eruption of atheromatous plaque caused by coronary artery spasm.

Routine autopsy studies of hearts with coronary thrombosis, collected over a period of eleven years, showed unique morphologic features of rupture of soft atheromatous plaques. These features include: (1) irregular luminar outline: angulation, invagination, upheaval, and/or wrinkles, (2) wavy outline of atheromatous cavity, (3) volcano-like rupture with seepage or gushing of semiliquid atheromatous contents into lumen, (4) cholesterol crystals arranged in rheologic vector direction, (5) rupture of deeper intimal fibrous tissue, (6) one or multiple intimal upheavals, (7) focal thickening of contracted media, (8) vestige of volcano-like eruption with organized thrombus, and (9) old thrombotic occlusion with wavy appearance of thick intimal fibrous tissue. The authors present a dynamic model of vasoconstriction or artery spasm that accounts for these features and the rupture of soft atheromatous plaques.

Carcinoidal tumor of the kidney.

Two cases of primary renal carcinoidal tumor are reported. One was discovered in a 32-year-old pregnant woman. The other tumor was retrospectively diagnosed 3 years after nephrectomy in a 65-year-old woman who was hospitalized with a metastatic lesion in her lumbar spine. Both tumors are compared with 5 other cases previously reported in the literature, and hypotheses about the cause of renal localization of this tumor are reviewed.

Studies on melanocytes. VI. Melanocytes in the middle ear.

Melanocytes are present in the lamina propria of the middle ear mucosa of young children to elderly adults in both whites and blacks. Melanin pigment melanin pigment also is seen in the epithelial cells, so-called melanogenic metaplasia. The melanocytes in the middle ear mucosa are of neural crest origin and their presence explains melanocytic tumors at this anatomic site.

Clinical-pathological determinants in prognosis of fibrous histiocytomas of head and neck.

Review of the literature reveals 76 cases of fibrous histiocytoma of the deep structures of the head and neck. To this we have added 11 of our own cases, and analyzed the total group to determine clinical and histological features of a high risk population. Age, sex, presence of pain, location of tumor, size of tumor, and local invasion appear to be important clinical criteria. Bizarre giant cells, numerous and atypical mitoses, necrosis, and inflammation appear to be important histologic features. The treatment of choice is wide local excision. Chemotherapy appears to produce tumor regression.

Cytomegalic inclusion disease of the skin.

Acute cytomegalovirus infection was associated with two episodes of morbilliform eruption in a patient receiving ampicillin therapy. Shortly after the eruption cleared, the patient died. Histologic examination of the skin indicated a cytomegalovirus infection of the vascular endothelium with luminal obliteration, stasis, vasculitis, and thrombus formation.

Studies on melanocytes. V. The presence of melanocytes in the human dental primordium: an explanation for pigmented lesions of the jaws.

Melanocytes were observed within the dental lamina or tooth bud in three of eleven Caucasian and in all six Negro fetuses, 12 to 18 weeks of gestation, studied. The presence of these cells in the dental primordium points to a contribution by the neural crest to the formation of the tooth in mammals. The occurrence of melanocytes in the dental anlage may also explain the histogenesis of such pigmented lesions as the melanotic "progonoma," calcigying odontogenic cyst, and the pigmented odontogenic tumor of Richardson.

Paragangliomatosis associated with multiple endocrine adenomas.

A 19-year-old woman had multiple functioning extra-adrenal paragangliomas, a pituitary adenoma associated with acromegaly, parathyroid hyperplasia, and pigmentary abnormalities. This case differs from previously described instances of multiple endocrine adenomatosis (MEA) and has features that bridge the classic MEA type 1 and 2 syndromes and possibly Von Recklinghausen disease. The coexistence of pheochromocytoma with acromegaly is extremely rare, and the association with extra-adrenal paragangiliomas appears to be unique. Thyroid parafollicular cell proliferation could not be proved by immunohistochemical or electron microscopical studies. The large number and extensive distribution of paragangliomas, ranging from neck to pelvis, is another unique feature of this case. The concept of neurocrestopathy or of an endocrine polypeptide (APUD) cell system may offer an explanation for the interrelation of these diverse growths.

Sebaceous glands in the esophagus. First case observed grossly.

Minute, pale tan macules of the esophageal mucosa observed at autopsy proved, on microscopical study, to be sebaceous glands unaccompanied by hair follicles. Metaplasia of pluripotent cells is postulated as their origin in this purely endodermal tissue, rather than derivation from islands of misplaced epidermis.