Unique cytological features and chromosome aberrations in chondroid lipoma: a case report based on fine-needle aspiration cytology, histopathology, electron microscopy, chromosome banding, and molecular cytogenetics.

Chondroid lipoma is a rare, benign tumor that may mimic soft-tissue sarcoma clinically. Its histopathologic features may resemble hibernoma, myxoid liposarcoma, myxoid chondrosarcoma, and other lipomatous or chondroid neoplasms. In this study, a chondroid lipoma was analyzed by fine-needle aspiration cytology, histopathology, electron microscopy, chromosome banding, and metaphase fluorescence in situ hybridization. The results demonstrate that chondroid lipoma exhibits a characteristic pattern by fine-needle aspiration cytology, including a mixture of benign adipose tissue with lipoblastlike cells, and chondroblastlike cells with a fibrochondroid matrix. Cytogenetically, a three-way rearrangement between chromosomes 1, 2, and 5 was found, together with an 11;16 translocation with a breakpoint in 11q13, approximately 1 Mb proximal to the MEN1 region shown to be rearranged frequently in hibernoma. The presence of a karyotype of low complexity, but without any of the genetic aberrations characteristic for other types of soft-tissue tumors, indicate that chondroid lipoma develops along a unique pathogenetic pathway.

Modes of adherence of Helicobacter pylori to gastric surface epithelium in gastroduodenal disease: a possible sequence of events leading to internalisation.

We have investigated various modes of adherence of Helicobacter pylori to the human gastric epithelium, using transmission electron microscopy, in biopsies from nine patients with peptic ulcer disease and from four patients with chronic active gastritis. H. pylori was demonstrated in abundance in all cases within the surface mucous layer. In all ulcer- and in one out of four gastritis patients H. pylori was shown in close proximity to the gastric epithelium, with concurrent alterations in the configuration of microvilli and the apical cytoplasmic region of gastric cells. Previously described modes of H. pylori adherence were confirmed, such as loose attachment with fibrillar-like strands, firm attachment with pedestal formation, invasion in the intercellular spaces, and invagination with "cup" formation. Moreover, in many cases a fusion between the bacterial outer layer and gastric cell membranes was evident. In four cases (31%; three with active and one with past ulcer disease) viable H. pylori was found in the cytoplasm of gastric mucous cells. Our results support the hypothesis that the different modes of adherence of H. pylori represent a stepwise, possibly sequential, process which in a significant number of cases leads to internalisation of the organism. The invariable occurrence of adhesion and more frequent internalisation of H. pylori in ulcer patients may suggest a link with the pathogenesis of peptic ulcer disease.

Sarcoma of the pulmonary artery: report of four cases with electron microscopic and immunohistochemical examinations, and review of the literature.

Herein we report the clinicopathological features of four cases of pulmonary artery sarcoma that appeared at our institution during a period of 30 years. The patients, 2 males and 2 females, were 50-62 years old. Tumour was found in the pulmonary trunk and right pulmonary artery in all cases, in the pulmonary valve and left pulmonary artery in three of the four cases, and in the right ventricular outflow tract in one case. There was direct extension or metastases to the lungs in two cases, the heart in one case, mediastinum or lymph nodes in two cases and the pleura in one case. Ultrastructural examination in one case revealed cells with features of smooth muscle cells and myofibroblasts. Immunohistochemical examination of three cases gave the following results: vimentin and smooth muscle specific actin was positive in all three cases, desmin in one case and cytokeratin in one case. No positivity was found for Factor VIII. This and other studies indicate that histologically most pulmonary artery sarcomas are leiomyosarcomas or "undifferentiated spindle cell sarcomas". Immunohistochemical and ultrastructural examinations favour an origin from myofibroblasts, probably derived from multipotent (undifferentiated) cells in the wall of the vessel. Most lesions show extensive intrathoracic growth although they rarely metastasize outside the thoracic cavity. They have a poor prognosis although some cases are currently being diagnosed during life.

Infection of BALB/c A mice by spiral and coccoid forms of Helicobacter pylori.

Helicobacter pylori exists in two different morphological forms, spiral and coccoid. This study demonstrated that both forms can infect BALB/c A mice. The animals were inoculated orally three times at 2-day intervals with 10(8) cfu of both spiral and coccoid forms of strain CCUG 17874 (NCTC 11637), strain 25 and strain 553/93. Infection was followed over a 30-week period by histological scoring of the grade of inflammation in gastric biopsies. At each time point sera were collected for analysis in ELISA and immunoblot analysis. Both spiral and coccoid forms of all H. pylori strains gave significantly higher inflammation scores than a control group of animals 1 week after inoculation. The histological evidence persisted throughout the entire 30 weeks. The inflammation was most severe in the pylorus and duodenum. Infection with strain 553/93 displayed the most severe gastritis. The spiral form of strain CCUG 17874 gave an immune response after only 4 weeks, whereas its coccoid form as well as strains 25 and 553/93 (spiral and coccoid forms) gave a significant increase in antibody response in ELISA and immunoblot after 16 weeks. It is concluded that both spiral and coccoid forms of H. pylori can cause acute gastritis in BALB/c A mice.

Near-haploid clones in a malignant fibrous histiocytoma.

Near-haploid solid tumors are very rare. In a storiform-pleomorphic malignant fibrous histiocytoma (MFH) of bone, we found three cell populations: one with a near-haploid, a second with a near-diploid, and a third with a near-tetraploid chromosome number. The near-haploid cells had few structural rearrangements: i(12p) and t(13q21q) in one clone, and these two and an additional t(19;?)(p11;?) in another clone. One structurally normal copy of all chromosomes was also present, except that the only chromosome 13 was involved in the t(13q21q). There were also two near-diploid clones, one without the t(19;?) and one with a single copy of this derivative chromosome. This is the first tumor with i(12p) among bone and soft tissue tumors.

Clonal chromosome aberrations in three sacral chordomas.

Cytogenetic analysis was successful in seven of eight sacral chordomas. Clonal chromosome aberrations were detected in three. One had a t(1;6)(q44;q11) as the sole aberration, one displayed three near-diploid clones that shared del(2)(p21), del(9)(p13), -10, structural rearrangements of 12q13, and add(19)(p13), and the third chordoma had two aberrant cell populations--one hypodiploid with several numerical and structural changes, the other hypertriploid-hypotetraploid with all marker chromosomes in duplicate. Including the present cases, seven cytogenetically aberrant chordomas have been reported. Five have had hypodiploid clones and the most frequent changes have been -3, -4, -10, and -13. No recurrent structural rearrangement has been identified; the only chromosome bands involved more than once are 1q21, 3q11, 5p15, 20q13, and 21q22.

The ultrastructure of fresh and cultured cells in fifteen soft tissue and bone tumors.

Cultured cells from 15 soft tissue and bone tumors and surgical specimens from 14 of these were studied by electron microscopy. The cells, cultured for one to five weeks, maintained ultrastructural features similar to those found in the fresh tumor tissue. The ultrastructural characteristics of the cultured cells were distinct enough for diagnostic purposes. Short-term cultures from all tumors were subjected to cytogenetic analysis. Clonal chromosome aberrations were found in 11 of the tumors and normal karyotypes in the remaining four. Ultrastructural analysis of cultured cells can be used for cell type identification and tumor classification.

Aspiration cytology of neuroendocrine (Merkel-cell) carcinoma of the skin. Report of a case.

An 89-year-old female with a two-year history of a growing tumor of the skin on her left thigh was subjected to fine needle aspiration. Cytologic examination of the aspirate revealed a small-cell carcinoma, and a Merkel-cell carcinoma was suggested. The diagnosis was confirmed by histopathologic and electron microscopic analysis of the removed tumor. The cytologic findings are presented and correlated with the light and electron microscopic pictures of the operative specimen.

Diagnostic value of electron microscopy in rare malignant musculoskeletal tumors. Experience from an orthopedic tumor center.

Rare musculoskeletal tumors can be difficult to diagnose by light microscopy or immunohistochemistry. Electron microscopy can be of diagnostic assistance especially if histotype specific ultrastructural features exist. In particular, electron microscopy for uncommon sarcomas such as alveolar soft part sarcoma, parachordoma, atypical Ewing's sarcoma and epithelioid sarcoma may be the diagnostic modality of choice.

Morphologic conversion of Helicobacter pylori from spiral to coccoid form. Scanning (SEM) and transmission electron microscopy (TEM) suggest viability.

Helicobacter pylori is a pathogen associated with type B gastritis, peptic ulcer disease, gastric atrophy, and stomach cancer. H. pylori exists in two morphological forms, spirals and coccoids. The latter has been described as viable but non-cultivable. The role of the coccoid form in the pathogenesis of gastric disease is disputed. Some authors consider the coccoid form to be a degenerative or dead form of H. pylori, while others consider it a resting but still metabolically active form. This study reports the conversion from spiral to coccoid form ultrastructurally. Dense material is accumulated in the periplasmic space, the spiral bacteria bend and the outer membrane is separated from the inner cell wall layer. Remodeling of inner structures takes place, ending in the coccoid form of the bacteria with preserved light polyphosphate areas. Reduction of surface takes place by production of surface membrane vesicles, which later are squeezed off. The finding of preserved subcellular structures and intact double membranes in combination with degenerative forms suggests that some of the coccoids are viable. Scanning electron microscopy (SEM) demonstrates coccoid form of bacteria with slightly ruffled surfaces but no spiral forms.

Ultrastructural diagnosis in the immotile cilia syndrome.

This article reports on the experience with 38 biopsies from nasal mucosa, submitted with the question of immotile cilia syndrome. Fixation in glutaraldehyde with MgSO4 is preferable. At least 50 cilia should be scrutinized in the electron microscope, and dynein arms, radial spokes, sheaths, nexin links and orientation should be tabulated. Six cases displayed virtual absence of inner and outer dynein arms. The orientation of these cilia was random. Two of the patients had situs inversus. In biopsies considered not to represent the immotile cilia syndrome, about four inner and seven outer dynein arms were found per cilium.

Inflammatory fibroid polyp of the ileum. Case report.

In a 55-year-old woman with intestinal obstruction and intussusception, an excised segment of distal ileum was shown by light and electron microscopy and immunohistologically to contain an inflammatory fibroid polyp. This rare, usually solid lesion of the gastrointestinal canal should be included in differential diagnosis of small-bowel obstruction and intussusception.

Diagnostic value of electron microscopy in a case of juvenile neuronal ceroid lipofuscinosis.

Neuronal ceroid lipofuscinoses (NCLs) represent a large group of inherited neurodegenerative disorders characterized by an abnormal accumulation of lipopigment in neuronal and extraneuronal cells. The authors present a case of juvenile neuronal ceroid lipofuscinosis in a 7-year-old boy. Ultrastructural examination of a skin biopsy disclosed deposits of curvilinear profiles and fingerprint-like structures in epithelial cells of sweat glands, endothelial cells, peripheral nerve endings, and fibroblasts. These findings allowed specific confirmation of the assumed diagnosis of juvenile neuronal ceroid lipofuscinosis. Due to the genotypic and phenotypic variability within the group of NCLs, the clinical investigation may be long and complicated. With the NCL disorders in mind, an accurate diagnosis based on ultrastructural examination of a skin biopsy may shorten this investigation, thus benefitting the patient.

Fine needle aspiration (FNA) in the diagnosis of soft tissue tumours; a review of 22 years experience.

FNA plays an important role in preoperative diagnosis of soft tissue tumours. A close clinical/morphologic cooperation is essential. FNA should be performed on the most accessible part of the tumour, avoiding penetration of the deep portions of the tumour. Needles 0.7 mm (22 G) are recommended. For deep lesions, needles with a stylet should be used. After the FNA, tattooing of the aspiration channel is recommended, and the channel is surgically removed together with the tumour, if a sarcoma. Material from the FNA can be used for additional examinations, i.e. electron microscopy, immunohistochemistry, DNA ploidy analysis and chromosomal analysis. Those techniques are of great importance in the differential diagnosis, particularly in the paediatric small/round cell tumours. The majority of sarcomas can be defined as low grade or high grade malignant in FNA. For malignancy grading the following parameters are used: cellularity, pleomorphism, chromatin pattern, nucleolar structure, mitotic figures and necroses. Cytodiagnostic details of the most common soft tissue tumours and their differential diagnoses are presented.

Mucosal ultrastructure of continent cecal reservoir for urine and its ileal nipple valve 2-9 years after construction.

Biopsy specimens from continent cecal reservoir for urine and from its ileal nipple valve were studied with electron microscopy after two to nine years of function in ten patients. In the colonic mucosa from the reservoir there was shortening of microvilli, in some cases with random orientation and numerical reduction-changes unrelated to the time from reservoir construction. Filamentous core rootlets were also randomly oriented and numerically diminished. Glycocalyceal bodies were present in most cases. Mucosal edema and reduced numbers of goblet cells were found in six cases and increased amount of collagen in two. In the ileal nipple valve mucosa there were no microvillous changes, but metaplastic formation of glycocalyceal bodies was interpreted as adaptation to physiologic conditions comparable with those in the reservoir's colonic mucosa. Collagen increase was found in two of the nipple valves. Neurogenic processes, enterochromaffin cells and Paneth cells were always well preserved in normal amounts in the cecal as well as the ileal mucosa.

Intestinal spirochaetosis of the colon diagnosed with colono-ileoscopy and multiple biopsies.

This paper deals with the clinical history, the histopathological and TEM features of a case of intestinal spirochaetosis associated with ulcerative colitis and tubular adenomas of the colon. It is the fifth described case of intestinal spirochaetosis in Sweden, and the first in the literature in which a complete colonoscopy with multiple biopsies has been performed. Intestinal spirochaetosis might lead to minor complaints as distension and vague abdominal discomfort, as in this case, but also to more prominent symptoms such as diarrhoea. Heavy infestation of the gut surface epithelium by spirochaetes was seen in the total colon, but was not found in the distal ileum.

Ultrastructural development of Kaposi's sarcoma in relation to the dermal microvasculature.

Ultrastructural subtypes of endothelial cells in Kaposi's sarcoma were compared with lymphatics and the normal dermal microcirculation in different stages of lesional development. In the earliest patch stage, lymphatic channels, recognised by their dissecting growth pattern and a lack of a basal lamina and pericytes, were prominent. Venous endothelium was recognised by virtue of its multilaminated basal lamina and often showed markedly irregular luminal and abluminal cytoplasmic projections. As the histological stage progressed toward spindle cells, venous endothelium showed a tetrad of changes: dissolution of the basal lamina; fragmentation and disappearance of the pericyte sheath, decreased and often rudimentary intercellular junctions and markedly reduced numbers of Weibel-Palade bodies. These were also features of spindle cells, which were rarely seen to emerge from narrow vascular channels of indeterminate type. Spindle cells showed sparse intercellular junctions and minimal basal lamina but no Weibel-Palade bodies. These progressive venous alterations thus resulted in a mixed intermediate subtype of endothelium with the morphological traits resembling lymphatics as well as venous blood vessels. The mixed subtype included endothelial tubes surrounded by a complete basal lamina but lacking pericytes, and much more commonly, tubes with pericytes but a scanty basal lamina. Both forms had remarkably few or no Weibel-Palade bodies. In the spindle cell stage, normal vessels were largely replaced by the mixed subtype and an indeterminate type of frequently disrupted endothelial tube which lacked a basal lamina as well as a pericytic investment. Dissecting lymphatic channels could not be confidently distinguished from the latter vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

S-100-immunoreactive nerves in the guinea-pig uterus with reference to ultrastructural correlations: effects of chemical sympathectomy and pregnancy.

In the guinea-pig uterus, by use of an indirect immunofluorescence method, S-100 immunoreactivity was found to be restricted to nerves that corresponded in number, distribution and type to adrenergic axons and pre-terminals. With advancing pregnancy S-100 immunoreactivity completely disappeared in uterine tissue adjacent to a fetus, in parallel with an ultrastructural degeneration of the adrenergic innervation. In the cervix and the uterine horn devoid of a fetus, however, the number and distribution of S-100-immunoreactive nerves was seemingly unchanged and no ultrastructural changes were found in adrenergic nerves. In contrast, chemical sympathectomy produced by 6-hydroxydopamine did not change S-100 immunoreactivity of uterine nerves. These findings suggest that there are differences in the denervation effected by chemical and by pregnancy-induced sympathectomy. The latter probably represents a special type of adrenergic denervation by inducing a degeneration of Schwann cells in addition to destruction of neuronal structures. This may explain the differences in the speed of regeneration of uterine adrenergic nerves following the two types of denervation.

Cloacogenic adenocarcinoma of the vulva.

Primary adenocarcinoma of the vulva is rare, and cloagocenic adenocarcinoma of the vulva is extremely rare. Here we report a vulvar tumor characterized by columnar cells with prominent brush border and the presence of goblet cells and endocrine cells, presenting the tubulovillous pattern and mucin histochemistry of enteric adenocarcinoma. Electron microscopy verified a colon-like pattern. We suggest that cloacogenic carcinoma of the vulva arises from embryonic tissue, normally present in the vulvar introital area. In our case, a wide local excision was sufficient for radical cure.