Polypoid squamous carcinoma of the esophagus. A case report with immunostaining for keratin.

Polypoid carcinoma of the esophagus is a rare variant of squamous carcinoma, which occurs typically in elderly patients who present with symptoms of dysphagia. This tumor has been given a variety of names, including spindle cell carcinoma, carcinosarcoma, and pseudosarcoma. These designations reflect the controversy surrounding the nature of the spindle cell component of this lesion. We have studied a case of polypoid carcinoma of the esophagus with immunoperoxidase staining for keratin which has been shown to be specific for epithelial cells. Positive staining for keratin was demonstrated in both the carcinomatous and spindle cell "sarcomatous" appearing components of the tumor, supporting the contention that this tumor is of entirely epithelial origin.

"Placental polyp": light microscopic and immunohistochemical observations.

A case of the chronic type of placental polyp, occurring in a 37-year-old woman approximately 9 years after abortion of her last known pregnancy, is reported. The placental polyp was predominantly composed of necrotic and hyalinized chorionic villi without identifiable lining trophoblast; however, some villi showed a thin rim of apparently viable syncytiotrophoblast that exhibited focal strong positivity for human chorionic gonadotropin by immunohistochemical studies. Intermediate trophoblast, especially abundant within the intervillous fibrin, appeared most viable and showed strong positivity for human placental lactogen (hPL); syncytiotrophoblast also showed focal positivity for hPL. The basal aspect of the polyp was composed of abundant decidua that contained dilated and ectatic blood vessels. This study demonstrates the presence of cytoplasmic markers for pregnancy in a chronic type of placental polyp, apparently of 9 years' duration, and draws attention to an entity that may be encountered more frequently due to the current prevalence of induced abortions.

Immunohistochemical and electron microscopic findings in benign fibroepithelial vaginal polyps.

Eleven classic benign "fibroepithelial polyps" of the vagina were examined using a panel of immunocytochemical agents. Two were also examined electron microscopically. In all cases the stellate and multinucleate stromal cells characteristic of these lesions stained strongly for desmin, indicating muscle intermediate filament production. In common with uterine fibroleiomyomata, numerous mast cells were also often seen. Myoglobin staining was negative. Electron microscopical examination confirmed that the stromal cells contained abundant thin filaments with focal densities and also showed the ultrastructural features usually associated with myofibroblasts. It is concluded that these tumours would be better designated polypoid myofibroblastomas in view of the above findings.

Vocal cord polyps: biochemical and histologic evaluation.

The stratified squamous epithelium covering vocal cord polyps can vary from normal to hyperplastic and keratinized. We have analyzed the histology and cytokeratins of 11 of these polyps. Cytokeratins were separated on one-dimensional SDS-acrylamide gels to determine molecular weights. There was significant heterogeneity in the cytokeratins present in the different polyps. Comparison of histologic findings and cytokeratin content showed a correlation between extent of keratinization and presence of high molecular weight cytokeratins. We conclude that the epithelium of vocal cord polyps exhibit patterns of cytokeratins characteristic of both hyperproliferation and abnormal states of differentiation, which are mirrored by histologic variations, and that vocal cord polyps are a heterogeneous group of benign lesions.

Solitary polypoid hamartoma of the oxyntic mucosa of the stomach.

A solitary pedunculated polyp of the oxyntic mucosa removed from a 66-year-old patient with atrophic gastritis and achlorhydria exhibited distinctive histological features consisting of submucosal, mostly oxyntic-type glands with a smooth muscular framework. Histochemical and immunohistochemical studies demonstrated that the glands were composed of well differentiated chief, parietal, and endocrine cells. Moreover, less frequent glands of the antro-pyloric type were also seen. The lesion was regarded as a previously unrecognized variety of gastric hamartoma.

Myogenic expression in esophageal polypoid tumors.

Four cases of esophageal polypoid tumors composed of squamous cell carcinoma and spindle cell sarcomatous components were investigated. Squamous cell carcinoma was consistently present in the base of the polypoid lesions in all four cases and was also intermingled with spindle-shaped sarcomatous cells in two cases. Metastases in the lymph nodes were observed in two cases: one was squamous cell carcinoma with a sarcomatous component and the other consisted of a pure sarcomatous component. All tumors involved at least the muscularis mucosae. In the sarcomatous region, the tumor was composed of highly anaplastic cells with or without forming interlacing fascicles. Pleomorphism was marked and bizarre giant cell forms were frequent. Mitoses were frequently present. Immunohistochemical study revealed that the anaplastic cells in the sarcomatous component in all cases were immunoreactive to desmin, muscle actin, vimentin, and alpha 1-antichymotrypsin, but were negative for cytokeratin, even in the metastatic tumors of the lymph nodes. The immunohistochemical results favor myogenic differentiation of the anaplastic cells, and these tumors were considered to be true carcinosarcomas composed of squamous cell carcinoma and leiomyosarcoma.

[Is vesicular cholesterolosis a particular anatomo-clinical form of cholesterol lithiasis? Apropos of a case of cholesterol polyp manifested by an acute complication]. / La cholestérolose vésiculaire est-elle une forme anatomo-clinique particulière de la lithiase cholestérolique? A propos d'une observation de polype cholestérolique révélé par une complication aiguë.

A case of cholesterolic polyp, revealed by the formation of an infundibulo-cystic enclave, is reported, the polyp having the appearance of a cholesterolic calculus, but a pediculated one, and one acting as a calculus. The extreme rarity of this complication is emphasized. Despite the frequency of associated lithiasis, the cholesterolosis are included in a different framework from lithiasis, that of the cholecystoses that on histology show typical pure parietal lesions without inflammation. Findings in this atypical case suggest possible common pathogenic factors for the two affections, and raise a proposal for inclusion of cholesterolosis within the nosologic framework of lithiasis.

[DNA content of gastric mucosal epithelium in various diseases]. / Soderzhanie DNK v épitelii slizistoi obolochki zheludka pri razlichnykh ego zabolevaniiakh.

Evaluation of DNA content in superficial epithelial cells of gastric mucosa by gastrobiopsy using the flow-through cytophotometric method revealed some differences in the distribution of DNA values in benign and carcinoma cases. The polymorphism of epithelial cells in benign gastric disorders is accompanied, as a rule, by an increase in the amount of cells in S and G2 + M phases of the cell cycle. In the cases with epithelial cell atypia, a small peak in the hypertetraploid range is often seen and DNA-histograms are identical with those in carcinoma of the stomach. Malignant specimens usually have an increased 3n and 4n DNA level and an obvious third peak at the hypertetraploid level. Different forms of carcinoma (adenocarcinoma and undifferentiated form) have their own distinguishing features in DNA content distribution.

[Comparative study of the DNA content and cross-sectional area of the interphase nuclei of epithelial cells in stomach polyps and cancer (based on gastric biopsy data)]. / Sravnitel'noe izuchenie soderzhaniia DNK i ploshchadi secheniia interfaznykh iader épitelial'nykh kletok polipov i raka zheludka (po dannym gastrobiopsii).

Cytospectrophotometric measurement of DNA level of interphase nuclei versus their cross-reaction area was carried out in mucosal cells of the stomach. The material included gastric bioptates from healthy subjects and patients with single and multiple adenomatous polyps of the stomach as well as gastric cancer. Tumor cells, and to a lesser degree, those of multiple polyps exhibited certain changes in DNA content: histograms showed several peaks and variations in DNA level increased, the latter being unmatched by a rise in DNA content per nucleus. A correlation was established between DNA content and cross-reaction area of interphase nuclei. Therefore, both parameters may serve for diagnosis.

Lipid-chemical features of human gastric cancerous, polypous and ulcerative tissues.

Fourteen cases of gastric cancer, 9 cases of gastric polyp and 4 cases of gastric ulcer were studied on their tissues lipid-chemically with the aim to clarify the biochemical differences between malignant and benign growth of the human gastric tissue. Tissues were collected by surgical operation or a biopsy together with the normal tissues surrounding the lesions. One part of each tissue was subjected to histologic examination and the other part to lipid analyses by means of TLC and GLC. The total lipid content was dcreased in 71% of gastric cancerous cases and in 75% of both cases of gastric polyp and gastric ulcer as compared with the respective control tissues. The phospholipid fatty acid content of the lesions was decreased in 83% of cancerous cases but in 50% of polypous cases as compared with the respective control tissues. As for the phospholipid fatty acid composition, the percentage value of C20:4 was increased and the percentage value of C18:2 was decreased in gastric cancerous tissues when compared with those of gastric polypous tissues. Such a change of the phospholipid fatty acid composition may produce the change of the fluidity of the cell membrane and may provoke a malignant growth of human gastric cancer cells.

The occurrence of multiple steroid hormone receptors in disease-free and neoplastic human ovary.

The cytoplasmic receptors for 17 beta-estradiol (ER), 5 alpha-dihydrotestosterone (AR), progesterone (PR), and cortisol (GR) have been quantified in 36 specimens from the human ovary (13 disease-free, 5 benign, and 18 malignant) by a dextran-coated charcoal (DCC) technique. The occurrence of receptor-positive biopsies were: ER 46%, AR 85%, PR 54%, GR 92%, in normal tissue; ER 40%, AR 100%, PR 20%, GR 50%, in benign tumors; and ER 67%, AR 72%, PR 50%, GR 88%, in malignant lesions. Furthermore, the simultaneous occurrence of ER and PR in malignant tumors was 50% yet all four receptors were found to be present only in 44% of the cases. The findings reported here on the strong correlation existing between ER and PR presence or amount agree with previous observations on normal and neoplastic specimens from human breast and endometrial tissues.

Polyps of the colon in juvenile and young patients: histological type and C.E.A. content in relation to follow-up.

31 colonic polyps in 21 patients between 2 and 30 years of age removed by endoscopy were studied. The site, size, cytohistological characteristic and tissue CEA content of these polyps were evaluated. 58% of the polyps were located in the rectum and sigmoid, the remaining 42% were in the descending colon. At histological examination 13 polyps proved to be neoplastic, 3 of which had severe dysplasia. In 3 cases of juvenile hyperplastic hamartomatous polyps and in 5 cases of inflammatory polyps the tissue C.E.A. was low; in 13 neoplastic polyps it was in direct correlation with the degree of dysplasia. Moreover in 10 patients with neoplastic polyps, 5 presented further adenomas at follow-up, and in 3 of them the C.E.A. tissue content of the first polyps obtained was medium to high. The occurrence in young patients of polyps of the colon with C.E.A. content medium to high must be followed by endoscopic examination at close intervals.

Gastrin concentrations in serum and gastric mucosa in patients with pernicious anaemia.

Sessile polyps in the antrum were found in 12 of 51 patients with pernicious anaemia. During gastroscopy, mucosal biopsies for gastrin determination were taken from the antrum and fundus and from the polyps. Patients with high gastrin concentration in the antral mucosa showed high serum gastrin concentrations, while most patients with low antral gastrin concentrations also had low serum gastrin values. On an average, the gastrin concentrations in the antrum were approximately 10 times, and those in the fundus approximately 100 times, higher than the corresponding values obtained in a reference group. The gastrin content in the polyps was not different from that in the surrounding antral mucosa. This study suggests that the polyps are not due to a functional hypertrophy of the antral mucosa caused by locally increased production of gastrin.

Healthy and diseased epithelium of the oral and maxillary sinus mucosa studied by X-ray microanalysis.

Concentrations of Na, Mg, P, S, Cl, K, and Ca in healthy and pathologically transformed epithelial cells of oral cavity and maxillary sinus mucosa in man were measured by X-ray microanalysis. Biopsies from normal mucosa, irradiated and clinically cured squamous cell carcinoma, mucoepidermoid carcinoma from the oral cavity, and polyposis in the maxillary sinus were prepared by rapid freezing and cryosectioning. In normal mucosa, nuclei and cytoplasm of basal, intermediate and apical epithelial cells were analyzed. A slight decrease in the concentration of Na, Mg, P and Cl was found towards the apical cells. The concentration of Na in the nuclei of the different cell layers parallelled that of P. The elemental composition of the pathologically transformed cells differed markedly from that of the cells of healthy oral mucosa (higher Na and Cl). In the irradiated squamous cell carcinoma the concentrations of Mg and K were extremely low.

A clinical and histopathological study of gastric polyps in familial polyposis coli.

Fundic gland area gastric polyps in familial polyposis coli (FPC) were compared with those in non-familial polyposis coli clinicopathologically to elucidate their histogenetic and biological characteristics. Some differences were observed in age, sex, and radiological and endoscopical features. Although the polyps were similar histologically, they showed an apparent histochemical difference between the two groups in periodic borohydride technique/potassium hydroxide/periodic acid-Schiff stain which demonstrates O-acylated sialic acid. The superficial and foveolar epithelium of the polyps was positive in 10 of 12 familial polyposis coli cases, while the epithelium was positive in only one of 13 non-familial polyposis coli cases with the same staining. These results suggest differences between the two groups in the degree of epithelial intestinal metaplasia. The presence of gastric polyps with O-acylated sialic acid therefore indicates the necessity of examination of the colorectum.

Flow cytometric DNA studies in human gastric cancer and polyps.

Flow cytometric DNA studies were performed on cell suspensions of biopsy specimens from gastric tumors and neutral gastric mucosa in 18 patients with gastric cancer and 9 patients with gastric polyps. In cancer, aneuploidy was found in two tumors in the antral and five in the body part of the stomach (39%). The mean DNA index for aneuploid cancers was 1.57. In patients with aneuploid carcinomas three biopsy specimens from uninvolved mucosa also showed aneuploidy. In diploid carcinomas in the antral part of the stomach, the proliferative index (PI) was increased when compared with that of antral mucosa in controls (p less than 0.05). Increased PI was found in uninvolved mucosa in aneuploid carcinomas of the body part of the stomach when compared with that in diploid carcinomas (p less than 0.001). In uninvolved body mucosa in aneuploid carcinomas of the body part significantly reduced levels of acid-beta-glucuronidase (p less than 0.0001) were found when compared with diploid carcinomas. No polyps showed aneuploidy, and the PI in biopsy specimens from patients with gastric polyps did not differ from that in controls.

[X-ray fluorescent determination of iron, copper, zinc, bromine and rubidium in biopsies of the gastric mucosa]. / Rentgenofliuorestsentnoe opredelenie zheleza, medi, tsinka, broma i rubidiia v bioptatakh slizistoi obolochki zheludka.

A method of a combined use of fiber gastroscopy and x-ray fluorescent analysis was elaborated for a study of the chemical composition of the gastric mucosa. Fr, Cu, Zn, Br, and Rb concentrations were determined in gastric mucosa biopsy specimens obtained during fiber gastroscopy, using x-ray fluorescent analysis. The concentrations of trace elements in the gastric mucosa were determined in 13 healthy persons, in 23 patients with chronic mucosal atrophy, in 15--with gastric ulcer, and in 16--with polyps. Besides, the content of trace elements was determined in the tumorous tissue of 66 gastric cancer patients. The results of the investigation revealed a statistically significant rise of mean Fr concentrations on the ulcer edge, in polyps and tumorous tissue as compared to the unchanged mucosa. Polypous tissue differed from the normal gastric mucosa by a low level of Cu, the difference being statistically significant. A tendency to a decrease in Zn content as compared to the unchanged mucosa was noted in the edge of ulcerative defects. The method can be effectively used for intravital studies on Fr, Cu, Zn, Br, and Rb levels in the G. I. tract mucosa.

Sulfatide cholecystosis.

Polypoid masses metachromatic sulfatides have been found at autopsy in the gallbladder of patients with metachromatic leucodystrophy. In a 10-year-old girl with this disease oral cholecystrography demonstrated a filling defect, which was felt to represent a polyp. In the proper clinical setting, sulfatide cholecystosis should be considered in the differential diagnosis of polypoid lesions of the gallbladder.

Vulvovaginal polyps. Histologic appearance, ultrastructure, immunocytochemical characteristics, and clinicopathologic correlations.

A clinicopathologic study of 18 vulvovaginal fibroepithelial polyps with a comparison to normal stroma is presented. Twelve cases were analyzed by immunohistochemical methods for the presence of vimentin, desmin, muscle-specific actin, myoglobin, S-100 protein, alpha 1-antitrypsin (AAT), alpha 1-antichymotrypsin (ACHT), cytokeratin (AE1/AE3), and epithelial membrane antigen. Stromal cells reacted with vimentin antiserum in eight cases. Desmin reactivity was detected in five of 12 cases, four of which coexpressed vimentin. Two cases exhibited muscle-specific actin reactivity, and a single case weak AAT reactivity. The stromal cells were unreactive with S-100 protein, epithelial membrane antigen, cytokeratin, ACHT, and myoglobin. Ultrastructurally, the stromal cells of four fibroepithelial polyps resembled fibroblasts and myofibroblasts. Our immunohistochemical and ultrastructural data suggest that the stromal cells of fibroepithelial polyps are a collection of functional fibroblasts that may be capable of differentiating along two or more cell lines. Dramatically elongated cytoplasmic processes extend from both normal vulvovaginal stromal cells and the cells of the polyps. The cell attachments to each other and to bundles of collagen suggest a potential for a physiologic role in tissue contractility, especially in the immediate postpartum state. The common association with pregnancy may represent a local exuberant response to some presently unidentified trophic or stimulating factor.

[The estrogen receptors of the endometrial plasma membranes in proliferative processes in the postmenopause]. / Retseptory éstrogenov plazmaticheskikh membran éndometriia pri proliferativnykh protsessakh v postmenopauze.

Estradiol receptors of plasma membranes (PM), PM lipids, the activity of membrane-bound enzymes and plasma levels of hormones have been tested in patients of postmenopausal ages with various endometrial diseases (glandular fibrous and glandular cystic polyps, highly, moderately and poorly differentiated adenocarcinomas). Test findings were similar in patients with the glandular cystic polyps and poorly and moderately differentiated adenocarcinomas. Therefore, the patients with the glandular cystic endometrial polyps are at high risk of endometrial cancer. Since the risk increases with higher estrogen plasma levels, the patients with proliferative endometrial conditions may benefit from intake of antiestrogens.