Prevalence of thyroid abnormalities is not increased in Alzheimer's disease.

The aim of this study was to compare the prevalence of pathologically and clinically documented thyroid disorders in patients with Alzheimer's disease (AD) and nondemented individuals. We reviewed the records of 31 patients with a pathological diagnosis of AD and 31 age-matched nondemented patients selected from autopsy files. We examined the pathological findings in the thyroid gland in both groups. Twenty-four cases (77.4%) with AD and 21 patients (67.7%) in the control group showed pathological abnormalities in the thyroid gland. The prevalence of specific types of thyroid gland abnormalities on pathological examination did not differ significantly between the AD and nondemented cases. For the 19 AD and 18 control patients in whom clinical thyroid function had been documented adequately during life, the percentage of patients with abnormal thyroid function was similar in the AD (15.7%) and control (11.1%) groups. These results do not support a relationship between AD and thyroid abnormalities.

Immunocytochemical demonstration of cytochrome c oxidase with an immunoperoxidase method: a specific stain for mitochondria in formalin-fixed and paraffin-embedded human tissues.

Cytochrome c oxidase (CO) is the terminal electron carrier of the respiratory chain and is localized exclusively in the inner membrane of the mitochondria. Using a specific rabbit antiserum against bovine heart CO, mitochondria were specifically stained in sections of formalin-fixed paraffin-embedded human tissues by an immunoperoxidase method. The intensity of the immunostaining in different human tissues correlated mainly with the number of mitochondria and abundance of mitochondrial cristae, i.e., surface area of the inner mitochondrial membrane. Mitochondrion-rich cells, such as myocardial and gastric parietal cells, had very strong cytoplasmic staining. This technique was especially useful for the specific identification of oncocytes in normal tissues and in lesions composed of oncocytes. In addition, the immunoperoxidase method for CO makes possible retrospective investigations of lesions composed of oncocytes, since routine paraffin blocks of formalin-fixed tissue are quite suitable for such studies.

Ultrastructural localization of rat Clara cell 10 KD secretory protein by the immunogold technique using polyclonal and monoclonal antibodies.

Using a monoclonal antibody and affinity-purified polyclonal antiserum against a 10 KD protein isolated from rat pulmonary lavage, we have localized the protein within Clara cells by a post-embedment protein A-gold technique. The gold particles were localized over the secretory granules of rat Clara cells. Ultrastructural immunolocalization was abolished when the primary antibodies were previously absorbed with purified 10 KD protein. Other pulmonary cells, including type II pneumocytes and ciliated cells, were negative with this technique. These results demonstrate the presence of the 10 KD protein in the secretory granules of the Clara cell and support the concept that this protein constitutes a specific and unique secretory product of Clara cells.

Functioning oxyphil cell adenoma of the parathyroid gland: a clinicopathologic study of ten patients with hyperparathyroidism.

Adenomas of the parathyroid gland, the majority of which are of the solitary chief cell type, are the most frequent cause of primary hyperparathyroidism. Parathyroid adenomas composed predominantly or exclusively of oxyphil cells are rare and were previously considered nonfunctioning. Among 160 consecutive patients with primary hyperparathyroidism who were explored surgically, ten (6.25 per cent) had adenomas of the oxyphil cell variety. The eight women and two men in this series ranged in age from 28 to 82 years (average, 58 years). The tumors weighed from 0.2 to 4.0 g (average, 1.2 g). Nine of the adenomas were located in the left neck, while the remaining tumor was in the right neck. Histologically, the tumors were composed almost exclusively of transitional and typical oxyphil cells. A residual "capsular" parathyroid composed of chief cells was identified in each case. Electron microscopy, phosphotungstic acid-hematoxylin staining, and the immunoperoxidase technique for cytochrome c oxidase showed the presence of numerous mitochondria in oxyphil cells. All patients had normal serum calcium levels four months to four years (average, 23 months) after removal of the neoplasms.

Löffler's endocarditis. Occurrence with malignant lymphoma with a high content of epithelioid histiocytes ('Lennert's lymphoma').

In a patient who had malignant lymphoma with a high content of epithelioid histiocytes (so-called Lennert's lymphoma), Löffler's endocarditis developed 18 months after her diagnosis of lymphoreticular malignant neoplasm. She died of refractory congestive heart failure, and an autopsy showed the typical gross and microscopic findings of Löffler's endocarditis. To our knowledge, this is the first reported association of these two diseases. We noted nine autopsy cases in the literature of Löffler's endocarditis occurring in patients with lymphoreticular malignant neoplasms (acute lymphoblastic leukemia and lymphoma). Löffler's endocarditis with eosinophilia may be a relatively uncommon but significant complication in patients with malignant lymphoproliferative disorders. The peripheral blood eosinophilia probably represents a reactive response to tumor antigen.

Skeletal myxoid chondrosarcoma with microtubular aggregates within rough endoplasmic reticulum.

A skeletal myxoid chondrosarcoma of the femur was examined by light and electron microscopy. Light microscopic features were characteristic for myxoid chondrosarcoma or "chordoid sarcoma." Electron microscopy disclosed crystalline arrays of microtubules within dilated rough endoplasmic reticulum, a feature previously described in extraskeletal myxoid chondrosarcomas. Tumors with the histologic characteristics of extraskeletal myxoid chondrosarcoma ("chordoid sarcoma") occurring in bone have been rarely reported. We describe herein such a tumor and document the existence of distinct microtubules within the endoplasmic reticulum.

Primary adenocarcinoma arising at an ileostomy site. An unusual complication after colectomy for ulcerative colitis.

A case is reported of a 45-year-old man who developed a primary adenocarcinoma at the ileostomy site 23 years after proctocolectomy for ulcerative colitis. The patient underwent wide local excision of the tumor and died 13 months later with disseminated adenocarcinoma. Including the present case, a total of seven patients with ileostomy adenocarcinoma have been reported in the literature. Six patients were treated surgically for ulcerative colitis, and the other one for adenomatous polyposis coli. The diagnosis of stomal malignancy was made three to 23 years after the ileostomy (mean interval, 13 years). Of the four patients available for clinical follow-up, two died of disseminated adenocarcinoma ten and 13 months after diagnosis. Awareness of this unusual but important complication of ileostomy should lead to earlier diagnosis and treatment with improvement in prognosis.

Malignant lymphoma with a high content of epithelioid histiocytes (so-called Lennert's lymphoma). Immunocytochemical and ultrastructural observations.

The clinicopathological findings of four cases of an uncommon form of non-Hodgkin's lymphoma called malignant lymphoma with a high content of epithelioid histiocytes (MLHH) are described. In each case the peroxidase antiperoxidase technique was used for detecting cytoplasmic immunoglobulins (CIg) in the diagnostic lymphoid tissue. In one case (patient 1), IgG and IgM heavy chains and kappa light chain were detected in 30 to 40 percent of the atypical lymphoid cells. This result suggests that the proliferating B lymphocytes in this patient with MLHH are neoplastic rather than reactive in nature. We were unable to identify CIg in the proliferating lymphoid cells of the other three patients. Our case when coupled with others reported in the literature suggest that the morphologic features of MLHH (so-called Lennert's lymphoma) can be associated with a neoplastic proliferation of either T or B lymphocytes. The ultrastructural findings of one case are presented.

Teflon felt embolism of coronary arteries after cardiac surgery: a case report.

A case is presented of fatal coronary embolism of Teflon felt used to buttress sutures in the placement of a Björk-Shiley aortic valve prosthesis. The embolism occurred on the tenth postoperative day, lodging in the left anterior descending branch of the left coronary artery 5.5 cm. from the ostium, causing a large anterior myocardial infarct. The patient died in less than 24 hours following the infarct. A review of the literature indicates that this is the first reported case of clinically significant embolism of Teflon felt used in the placement of a Björk-Shiley aortic valve.

The development of non-Hodgkin's lymphoma following therapy for Hodgkin's disease.

Three patients developed non-Hodgkin's lymphoma (NHL) 3-6 years after treatment for Hodgkin's disease (HD). In no instance was there evidence of recurrence of HD following the initial chemotherapy or radiotherapy. None of these patients had received both radiation therapy and chemotherapy. The histologic classification of the developing of the developing NHL for the three patients was (1) diffuse, poorly differentiated lymphocytic, (2) nodular histocytic, and (3) nodular, poorly differentiated lymphocytic. In no instance was there any histologic similarity to the original HD. Perhaps most important with respect to histology was the easily demonstrable presence of Reed-Sternberg cells at the time of original diagnosis and their absence with onset of NHL. All patients responded well to conventional chemotherapy for NHL and are alive at 23+, 37+, and 65+ months after that secondary diagnosis. This report, when coupled with at least ten other such reported patients, suggests that NHL may be a relatively uncommon but significant complication of therapy for HD and must be distinguished for recurrence of HD.

Calcium transport and energy coupling in diabetic rat liver mitochondria.

Liver mitochondria from chronic diabetic rats took up Ca ions at a significantly slower rate than their normal counterparts. The same mitochondria, inhibited with ruthenium red, released Ca ions at a faster rate than normal mitochondria. In good agreement with the decrease of Ca ions uptake, measurement of the inner membrane potential by the safranine method yielded a significantly lower value with diabetic than with normal mitochondria. Respiratory control and P/O ratios were also decreased in diabetic mitochondria.

Effect of diabetes, adrenalectomy and hypophysectomy on D-3-hydroxybutyrate dehydrogenase activity and substrate oxidation by rat mitochondria.

In good agreement with previous observations, D-3-hydroxybutyrate dehydrogenase (OHBD) activity in disrupted liver mitochondria decreased significantly in chronic diabetic rats, whereas insulin treatment prevented this decrease. Similar effects were observed with kidney mitochondria. Adrenalectomy increased OHBD activity in liver and brain mitochondria from normal rats and in liver mitochondria from diabetic rats. Corticosterone depressed OHBD activity in liver mitochondria of normal rats and restored the normal level of OHBD in adrenalectomized rats. Hypophysectomy increased OHBD activity in normal rats, this effect being further increased by growth hormone administration. D-3-hydroxybutyrate (OHB) oxidation by liver mitochondria from diabetic, adrenalectomized or hypophysectomized rats varied as expected from OHBD activity in disrupted mitochondria, but to a relatively lesser degree. Submitochondrial particles from diabetic rats showed significant diminution in OHB-, succinate- and NADH-oxidase activities, whereas mitochondria from diabetic rats oxidized succinate and L-malate + L-glutamate at a slower rate than the corresponding controls.

Right splenorenal fusion with associated hypersplenism.

We report the second case of splenorenal fusion and the first occurrence of spleen fusion associated with a right retroperitoneal structure. Hypersplenism was cured by removal of the mass. A concomitant renal cell carcinoma and multiple adenomas within the mass were incidental clinical features. Aside from the rarity of the lesion, its documented occurrence on the right side is significant in that it provides evidence for the possible migration of spleen cells in embryogenesis as an explanation for some other splenic fusion anomalies.

Granular cell tumor arising in myelinated peripheral nerves. Light and electron microscopy and immunoperoxidase study.

The histologic, immunohistochemical and ultrastructural characteristics of two granular cell tumors arising from the right recurrent laryngeal and left facial nerves are described. S-100 protein was detected both in the nuclei and cytoplasm of the granular cells using the peroxidase-anti-peroxidase method. The ultrastructural findings in both cases support a Schwann cell derivation of the granular cells. It is suggested that the granularity of cells of granular cell tumor may represent a lysosomal disorder affecting most frequently neoplastic and nonneoplastic Schwann cells and occasionally other cells.

Malignant epithelioid hemangioendothelioma of the colon. Report of a case.

Angiosarcoma of the colon with epithelioid and histiocytoid features, a malignant counterpart of epithelioid hemangioendothelioma, was observed in a 72-year-old man. The disease first manifested as a right cervical mass, with the histologic appearance of malignant, undifferentiated, large-cell epithelioid neoplasm. Light microscopy of the colonic tumor disclosed angiosarcoma, with active erythrophagocytosis and positive immunoperoxidase reactions to lysozyme, alpha-1-antitrypsin, and alpha-1-antichymotrypsin. Ultrastructural features of the tumor cells were those of intermediate between endothelial and histiocytic cells. The disease took a rapid fatal course with recurrence, peritoneal dissemination, and massive peritoneal hemorrhage. The cause remains unknown.

Hypophysectomy and adrenalectomy decrease Ca2+-induced swelling of rat liver mitochondria.

Hypophysectomized rats showed significant modifications in Ca2+-induced swelling and MgATP-induced contraction of liver mitochondria. Two-three months after operation, maximal swelling (MS), rate of swelling (VS), maximal contraction (MC) and rate of contraction (VC) were decreased by 77 (MS), 83 (VS), 79 (MC) and 62 (VC) % (in all cases P less than 0.05 as compared with normal rat mitochondria). Treatment of hypophysectomized rats with bovine pituitary extract, for two weeks, counteracted the effect of hypophysectomy, whereas treatment with bovine growth hormone was ineffective. Adrenalectomy produced similar though less extensive modification of Ca2+-induced swelling but failed to affect the MgATP-dependent mitochondrial contraction. Substrate oxidation by hypophysectomized or adrenalectomized rat mitochondria showed no modification of the energy-yielding mechanisms, capable of explaining the observed changes in mitochondrial swelling.

Influence of the hypophysis on mitochondrial protein synthesis.

Hypophysectomy significantly decreased the capacity to synthesize protein by isolated liver and skeletal muscle mitochondria. Total hypophyseal extract, growth hormone or thyroxine administered to the whole animal in adequate doses prior to sacrifice enhanced protein synthesis to values similar or higher to those of the control, especially in the case of thyroxine.

Cervical lymph node metastases. Incidence and implications of extracapsular carcinoma.

The incidence and prognostic significance of extracapsular spread (ECS) of tumor in cervical lymphatics was investigated. The surgical specimens from 349 patients treated for squamous cell carcinoma by radical neck dissection between 1978 and 1982 have been examined retrospectively. Follow-up data were available relative to recurrence rate, site of recurrence, and disease-free intervals. Fifty-nine percent of the patients with N1 cervical metastases had ECS. Patients were classified according to the histopathologic findings in the radical neck dissection specimens. The three groups identified were patients with normal nodes, patients with no ECS, and patients with ECS. The histopathologic evidence of ECS was associated with a statistically significant reduction in survival when compared with patients without ECS. The disease-free interval between treatment and the development of recurrent disease was shorter for patients with ECS than for patients with no ECS.

Extracapsular spread of carcinoma in cervical lymph nodes. Impact upon survival in patients with carcinoma of the supraglottic larynx.

The treatment results and histologic findings in the cervical lymphatics of 96 patients with squamous cell carcinoma of the supraglottic larynx were studied retrospectively. The clinical assessment of the extent of disease in the cervical lymphatics correlated poorly with histologic findings. Forty-one percent of patients judged to have no evidence of cervical metastases were found to have carcinoma in the cervical lymphatics. Twenty percent of patients judged clinically NO were found to have extracapsular spread of tumor. Patients were subdivided according to the histologic findings in the cervical lymphatics. Three-year no-evidence-of-disease (NED) follow-up was available on all patients. Patients with no tumor in cervical lymphatics had a 71% 3-year NED. By comparison, patients with cervical metastases confined to the lymph node were 79% NED. Patients with histologic evidence of extracapsular spread of tumor were 45% NED (P less than 0.05). The use of histologic findings in predicting prognosis and treatment planning is discussed.