Plasmacytoma arising in giant lymph node hyperplasia.

Giant lymph node hyperplasia (GLNH) is generally thought to represent a benign process. A patient with GLNH of the chest wall had part of the lymph node replaced by large nodules of infiltrating plasma cells, and a serum paraprotein of the IgG lambda type. A peroxidase-antiperoxidase immunocytochemical technic showed that the plasma cells within areas of typical appearing GLNH were polyclonal, whereas those making up the nodular infiltrates were monoclonal. The observation of a plasmacytoma arising in this lesion demonstrates the neoplastic potential of GLNH.

Immunologic abnormalities in two patients with pulmonary hyalinizing granuloma.

Pulmonary hyalinizing granuloma (PHG) is a disease of slowly enlarging pulmonary nodules made up of dense bundles of collagen accompanied by an infiltrate of chronic inflammatory cells. The etiology is unknown. Although it has been suggested that the lesions represent an exaggerated immune response to unidentified agents, results of a detailed immunologic work-up of these patients have not been published. This report presents the laboratory findings of two patients with biopsy-proven PHG who have been followed four and eighteen years. Autoantibodies were detected (antinuclear antibody, rheumatoid factor, and positive antiglobulin tests), although clinically there was no evidence of a specific collagen-vascular disorder. Both patients had elevated levels of circulating immune complexes. These data suggest that immune complex mechanisms may be important in the pathogenesis of PHG.

Intraoral multifocal adult rhabdomyoma. Report of a case and review of the literature.

Adult rhabdomyomas are uncommon, benign neoplasms of the head and neck region. They are usually solitary, but may rarely be multifocal. We report the clinical and morphologic features of a multifocal adult rhabdomyoma apparently present in the floor of the mouth of an elderly woman for 20 years. At the time of exploratory surgery, the surgeon believed there was diffuse multinodular enlargement of both sublingual glands. The differential diagnosis of a biopsy specimen that was taken for frozen section included salivary gland oncocytosis, a reactive process. On examination of permanent sections, however, the lesion was found to be a multifocal rhabdomyoma. No evidence of salivary gland tissue was found. Ultrastructural study demonstrated the characteristic attempts by this tumor to recapitulate its origin from skeletal muscle by the formation of abnormal contractile elements.

Squamous morules in gastric mucosa.

An elderly white man undergoing evaluation for pyrosis was found to have multiple polyps in the fundus and body of the stomach by endoscopic examination. Histologic examination of the tissue removed for biopsy over a 2-year period showed fundic gland hyperplasia and hyperplastic polyps, the latter containing nests of immature squamous cells. These nests arose within superficial gastric glands and resembled squamous morules seen in benign endometrium. Previous reports of this type of squamous epithelium in gastric mucosa were not encountered in our literature review. This most probably represents a benign process since there is no evidence to support its relationship to the occurrence of either primary squamous cell carcinoma or adenosquamous carcinoma of the stomach.

The papillary and solid neoplasm of the pancreas: a report of two cases with electron microscopy, one containing neurosecretory granules.

Two pancreatic tumors occurred in young women without detected functional symptoms. They had similar gross and histologic features and appeared to be of low grade malignancy. Case 1 was a typical example of the recently described entity referred to as papillary and solid neoplasm of the pancreas. Electron microscopic findings in this case indicated a duct cell origin, similar to previously reported cases. Case 2, also ultrastructurally similar, is unique in that it contained neurosecretory granules. Since considerable evidence indicated that cells of small pancreatic ducts give rise to islet cells, case 2 suggests that some tumors of ductal origin recapitulate the embryogenesis of the pancreatic islets and, therefore, may contain neurosecretory granules without showing the classic morphology of the more common pancreatic endocrine tumors.

The ultrastructure of the adenomatoid odontogenic tumor.

An adenomatoid odontogenic tumor (AOT) which occurred in the maxilla of an 8-year-old boy was studied by the light and electron microscopy. The tumor was found to contain cells resembling preameloblasts, the stratum intermedium, and the stellate reticulum, suggesting its origin from the enamel organ, in agreement with previous reports. Characteristic ductlike structures are thought to be formed as a result of secretory activity of the tumor cells, rather than degeneration. Duct-lining cells ultrastructurally similar to preameloblasts were found to contain electron-dense granules. These granules are believed to play a role in secretion by tumor cells, a concept not previously considered. The results of previous ultrastructural studies of the AOT are reviewed and summarized.

Estrogen receptor status in malignant melanoma.

Estrogen receptor (ER) positivity demonstrated in malignant melanomas by histochemical and biochemical assays suggested the possibility of hormonal management and improved prognosis as for breast carcinoma patients. We studied the ER status of 5 primary and 28 metastatic malignant melanomas with a commercial immunohistochemical kit (ER-ICA monoclonal), that utilizes monoclonal anti-ER and a peroxidase-antiperoxidase technique, and by a histochemical method using fluorescein-conjugated estradiol (Fluoro-Cep Estrogen assay), on frozen sections. In addition, we conducted a biochemical assay [dextran-coated charcoal cytosolic assay (DCC)] in 16 cases. All 33 cases were ER negative by ER-ICA and Fluoro-Cep: 11 biochemical assays were negative (less than 3 fmol ER/mg protein), four were in the borderline range (3 to 10 fmol ER/mg protein), and one was positive (greater than 10 fmol ER/mg protein) at 11 fmol. The melanomas in 97% of the cases we studied were ER negative by two or three different assays. Low-level estrogen binding of MM tissues may be the result of interactions other than with Type I true ER. The low frequency of ER positivity of malignant melanomas appears to preclude the clinical use of ER status as an indicator for response to hormonal manipulation in patients with malignant melanoma.

Requirement of an essential thiol group and ferric iron for the activity of the progesterone-induced porcine uterine purple phosphatase.

The progesterone-induced purple phosphatase isolated from the uterine flushings of pigs is activated by a variety of reagents that cleave disulfide bonds, including 2-mercaptoethanol, dithiothreitol, L-ascorbate, L-cysteine, sulfite, and cyanide. It is inhibited by various mercurials, iodoacetamide, O-iodosobenzoate, and hydrogen peroxide. Thiols increase the specific phosphatase activity from 25 to about 300 units per mg of enzyme. This activation is accompanied by a shift in the extinction maximum to higher energy to yield a protein with a pink coloration. Following maximum activation there is a gradual decrease in enzyme activity and protein color which is accompanied by loss of ferrous iron from the protein. Sodium dithionite at 10 mM or higher causes an immediate inhibition of phosphatase activity and bleaching of color, and can be used to prepare the iron-free apoprotein. The latter can be partially reactivated by Fe3+ salts but not by Fe2+. The Fe3+ restores the pink form of the enzyme with a specific activity of about 200 units/mg of protein. Cu2+ also causes some reactivation, but other metal ions were ineffective. ESR studies showed that the pink form of phosphatase contains approximately 1 atom of high spin ferric iron per molecule. It is concluded that the phosphatase requires a free thiol and Fe3+ for activity. Reduction of the iron leads to complete loss of both color and enzyme activity. The color change from purple to pink represents disulfide reduction and is not due to reduction of iron.