Estrogen receptor assay in polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma of salivary gland origin. An immunohistochemical study.

An apparent relationship between breast cancer and salivary gland cancer has been observed, and there is one report in the literature that describes estrogen receptors in normal salivary gland and salivary gland cancers. With the use of a monoclonal antibody against estrogen receptor protein and the avidin-biotin immunoperoxidase procedure, we were unable to demonstrate estrogen receptors in formalin-fixed paraffin-embedded sections of either polymorphous low-grade adenocarcinoma or adenoid cystic carcinoma of salivary gland origin.

Helicobacter (Campylobacter) pylori in gastric brushing cytology.

Helicobacter (formerly Campylobacter) pylori is frequently associated with chronic gastritis and peptic ulcer and has been implicated as an etiologic agent. Identification of H. pylori is important for specific treatment with antibiotics and bismuth compounds. We studied 27 patients who presented with symptoms of gastritis or peptic ulcer on whom paired gastric biopsies and gastric brushings for cytology had been performed. Biopsies were stained with H & E and Warthin-Starry or Giemsa for H. pylori. Previously, Papanicolaou-stained brushings were restained with Giemsa and reviewed blindly by two cytologists. Cytologic examination revealed the characteristic 1-3 mu curved or spiral gram-negative bacilli embedded in mucus in 12 of 27 (44%) of cases. Biopsies showed H. pylori in 13 of 27 (48%) of cases. Cytology and histology were concordant in 22 of 27 (81%) of cases. Three cases were positive on biopsy, negative on cytology; two of these were unsatisfactory cytology specimens. Two cases were positive on cytology, negative on biopsy, apparently sampling artifacts. Papanicolaou-stained slides were scored for several morphologic parameters; numbers of acute and chronic inflammatory cells and degree of cytologic atypia. None of these were predictive of the presence of H. pylori. We conclude that Giemsa-stained gastric brushings are a useful complement to gastric biopsies in establishing the diagnosis of H. pylori.

Peritoneal cytology of uncommon ovarian tumors.

Peritoneal cytology has been well established as a diagnostic and staging tool in the management of the common epithelial tumors of ovary. Germ cell, mesenchymal, and sex-cord stromal tumors are much less frequently encountered in peritoneal specimens, often with cytologic features that may pose problems in differential diagnosis. This report presents the cytomorphology of the ascitic fluid in cases of endodermal sinus tumor, dysgerminoma, and Sertoli-Leydig-cell tumor, and peritoneal washings in a case of ovarian malignant mixed mullerian tumor. The cytologic features of Sertoli-Leydig-cell tumors have not been well described. Careful correlation of peritoneal cytologic findings, cell-block preparations, and immunocytochemistry with the cytohistologic features of these tumors is crucial for correct tumor classification.

Extrauterine mixed mesodermal tumors. An immunohistochemical study.

Mixed mesodermal tumors are uncommon outside the uterus. Nine extrauterine mixed mesodermal tumors (eight ovarian and one extragenital) were selected for histochemical and immunoperoxidase study. In eight cases, both epithelial and mesenchymal elements were malignant (chondroid in six, rhabdomyoid in four, and osteoid in two). One ovarian tumor was an adenosarcoma. All cases were stained with periodic acid-Schiff with and without diastase and for alpha 1-antitrypsin, myoglobin, keratin, vimentin, muscle-specific actin, and alpha 1-antichymotrypsin, by using the avidin-biotin-immunoperoxidase method. The periodic acid-Schiff-positive, diastase-resistant droplets in several of the tumors showed peripheral alpha 1-antitrypsin positivity. Keratin delineated epithelial areas well in seven cases, and rhabdomyoid differentiation was confirmed with myoglobin in four cases. However, squamous elements in one tumor were falsely positive for myoglobin. We concluded that despite occasional cross-reactivity, carefully interpreted immunoperoxidase stains can be useful in distinguishing epithelial and mesenchymal elements in these tumors.

Immunocytochemical localization of polyclonal carcinoembryonic antigen in hepatocellular carcinomas.

Hepatocellular carcinomas exhibit a unique canalicular immunocytochemical staining pattern with polyclonal antibodies directed against carcinoembryonic antigen (pCEA). The use of this method to facilitate a definitive diagnosis of hepatocellular carcinoma on fine needle aspirates of the liver was evaluated using aspirates and the corresponding core biopsy samples from nine cases. Immunoperoxidase staining with pCEA produced an identical canalicular staining pattern in 6 (66%) of 9 aspirates and 6 (75%) of 8 biopsy samples. The negative results in three aspirates may be due to their lack of the tissue fragments necessary to show this staining pattern. These findings indicate that the expression of this unique immunocytochemical staining pattern may aid in the diagnosis of primary hepatocellular carcinoma by fine needle aspiration cytology.

Hemodialysis-related amyloidomas of bone.

Lytic bone lesions secondary to amyloid deposition are a recently described complication of long-term hemodialysis. The authors refer to these tumorlike deposits as amyloidomas in a review of the subject and four proved cases. This entity typically appears as multiple well-defined, juxta-articular lytic lesions without matrix calcification. The duration of hemodialysis is probably the greatest risk factor for development of these intraosseous amyloidomas. Ultrastructurally, this new type of amyloid originates from beta 2-microglobulin, a low-molecular-weight serum protein that is not filtered by standard dialysis membranes.

Intravascular bronchioloalveolar tumor: CT and pathologic correlation.

Intravascular bronchioloalveolar tumor of the lung is an unusual neoplasm that usually presents as multiple pulmonary nodules in asymptomatic young women. The course of the disease is often indolent with some patients eventually dying of respiratory failure secondary to progressive tumor infiltration of the pulmonary interstitium. The cell of origin appears to be an endothelial cell, and epithelioid hemangioendothelioma of liver or other soft tissues is a pathologically identical neoplasm. Open lung biopsy is necessary for diagnosis. The radiologist should be aware of this tumor and suggest the diagnosis in the appropriate clinical setting.

Malignant struma ovarii.

Malignant struma ovarii is a very rare tumor, with considerable disagreement concerning the necessary histologic features for malignancy. The prognosis with patients with a malignant struma ovarii is difficult to make because of inadequate follow-up of the reported cases and long clinical courses. In most cases the patients responded well to surgical treatment but sometimes patients have died from malignant struma ovarii, in particular, if there is metastasis. There is evidence that radioactive iodine is effective in treating metastatic struma. The present case reports the use of intraperitoneal chronic phosphate for metastatic intraperitoneal disease, with thyroid suppression. Long-term follow-up will be necessary to properly evaluate this therapy. Prophylactic administration of thyroid hormone should be considered in cases of malignant struma ovarii.

Rare pancreatic malignancies.

The incidence of pancreatic malignancy in most countries is increasing, and the overall prognosis for nonendocrine pancreatic cancer is grim. The majority of nonendocrine pancreatic malignancies are duct cell adenocarcinomas with no special features. However, several morphologic subtypes have been fairly recently recognized and classified, some of which appear to have a different inherent biologic behavior and a chance for a longer survival after resection. This article describes the rare nonendocrine pancreatic malignancies, emphasizing those clinical, pathologic, and radiologic features that serve to differentiate these entities from the more common duct cell adenocarcinoma of the pancreas.

Lipomatous hypertrophy of the interatrial septum. Diagnosis by magnetic resonance imaging.

A surgically proved case of lipomatous hypertrophy of the interatrial septum is demonstrated on magnetic resonance imaging. The intensity on T1-weighted images and characteristic distribution of the lesion may make the diagnosis possible without surgical intervention.

Flow cytometric analysis of DNA content in Hürthle cell adenomas and carcinomas of the thyroid.

Paraffin-embedded surgical biopsy material from 17 Hürthle cell tumors of the thyroid was examined for DNA content by flow cytometry to assess the diagnostic and prognostic utility of ploidy determinations in these rare tumors. Both adenomas (11 cases) and carcinomas (6 cases) were studied. As a control for methods, ten randomly selected normal autopsy thyroids were analyzed, all of which demonstrated normal diploid DNA content. Among the Hürthle cell tumors, however, aneuploid peaks were present in six adenomas (55%) and in four carcinomas (67%). Similarly, polyploid DNA peaks in the absence of other aneuploid peaks were present in two adenomas and two carcinomas (18% and 33%, respectively). These findings demonstrate the limited value of aneuploidy or polyploidy as diagnostic features for malignancy in Hürthle cell tumors of the thyroid. As for prognosis, there does not appear to be any unfavorable prognostic significance for abnormal DNA content in histologically benign Hürthle cell tumors treated by surgical excision because no metastases or recurrences occurred in this group at a mean disease-free follow-up of 50 +/- 19 months for six aneuploid lesions and 19 +/- 7 months for two polyploid adenomas. Preliminary data suggest that aneuploidy may, however, have an important prognostic value for histologically defined Hürthle cell carcinomas, because the only patient to die from the tumor in this series had an aneuploid Hürthle carcinoma. Thus, the authors' data indicate that the diagnostic utility of DNA content in Hürthle cell tumors is extremely limited and that there does not appear to be any negative prognostic significance for aneuploidy in histologically defined Hürthle cell adenomas.