Argyrophilic nucleolar organizer regions in breast carcinoma. Correlation with DNA flow cytometry, histopathology, and lymph node status.

Argyrophilic nucleolar organizer regions (AgNOR) have been correlated with proliferative activity of neoplasms. Increased AgNOR may reflect increased proliferative activity of cells or ploidy. To explore this hypothesis, 41 breast carcinomas were processed for AgNOR silver staining and DNA flow cytometry. AgNOR counts were expressed as mean AgNOR/nucleus and percentage of tumor cells with more than five AgNOR/nucleus. The first count was designated mean AgNOR or mAgNOR, and the second count was designated AgNOR proliferative index or pAgNOR. Using Mantel-Haensel statistical analysis, carcinomas that exhibited mAgNOR of 2.4 or more had a high likelihood of aneuploidy (P less than 0.0001), an S-phase fraction of more than 5.8% (P less than 0.003), or a diameter greater than 2 cm (P less than 0.007). In addition, tumors with pAgNOR of 8% or more showed a statistically significant correlation with aneuploidy (P less than 0.004), tumor grade (P less than 0.04), and a more significant one with high S-phase fraction (P less than 0.0001). No significant correlation was obtained between pAgNOR and tumor size or lymph node status. These data indicate that AgNOR quantitation reflects changes in DNA ploidy and cell proliferation. They also suggest that the mean AgNOR counts correlate best with the DNA mass or ploidy and that the frequency of cells with higher AgNOR count best reflects proliferative activity or S-phase fraction.

Late intracranial metastasis from esthesioneuroblastoma: case report and review of the literature.

Review of the literature reveals much disparity regarding the incidence, natural history, and survival rate in patients harboring esthesioneuroblastoma (olfactory neuroblastoma). The metastatic tendencies of this tumor have been highly variable in the literature, and reported intracranial involvement has been via local extension from the tumor's origin near the cribriform plate. Our present case describes a metastasis of esthesioneuroblastoma to the right parietal cortex and meninges in a patient without evidence of local recurrence after combined surgical and radiation therapy 5 years previously. The broad spectrum of biological behavior of this tumor, and its response to various therapies are discussed. The immunohistochemical and ultrastructural features of this unusual tumor are also presented. Recommendations are made for the management of these patients, including regular serial neurological examinations, serial computed axial tomography or magnetic resonance imaging of the head and neck, and, in the initial management, chemotherapy.

Lymphomatoid papulosis: a premalignant T cell disorder.

In an attempt to better define the process of lymphomatoid papulosis, two cases were studied by means of light and electron microscopy, immunohistochemistry studies, including the use of monoclonal antibodies, and cytogenetic technics. About 90% of the dermal lymphoid infiltrate, including the atypical cells, reacted with antibodies that define helper-inducer T cells. Only a few cells, about 5%, reacted with antibodies that define cytotoxic-suppressor T cells. Langerhans cells were increased mostly within the epidermis, and in the dermis they were in close proximity to lymphoid cells. Cytogenetic studies disclosed an abnormal hypertetraploid karyotype in dividing cells from the skin lesion, whereas skin fibroblast and phytohemagglutinin-stimulated cells from peripheral blood cultures had a diploid karyotype. The results support the concept that lymphomatoid papulosis is a disorder characterized by a predominance of helper-inducer T cells, including the atypical cells bearing an abnormal karyotype.

Mucoepidermoid carcinoma of the larynx.

Mucoepidermoid carcinoma of the larynx is an uncommon tumor that occurs almost exclusively in men. Primary vocal cord involvement is rare. We report a case of mucoepidermoid carcinoma of the vocal cord in a woman. Special histologic studies may be necessary to arrive at an accurate diagnosis of this neoplasm. Appropriate surgical intervention and close follow-up offer the patient the best chance for cure.

Postmenopausal virilization due to ovarian stromal hyperthecosis.

A 53-year-old woman presented with hirsutism of long duration and virilization of recent onset. She was gravida 12 para 9. The 17-ketosteroids were normal, gonadotropins were in the post-menopausal range, and the serum testosterone was in the male range. After bilateral oophorectomy, the testosterone became normal. Ovarian pathology revealed stromal hyperthecosis.