Detection of nodular pulmonary amyloid by PET positive scan--deception for lung cancer.

Amyloidosis results from proteins being deposited as insoluble ß-pleated sheets and disrupting organ function. Each precursor protein induces a separate spectrum of organ involvement, and different disease manifestations within the lung. Although autopsy findings often demonstrate amyloid deposits in various compartments of the lung, few are manifested pathologically. Amyloid lung nodules with positron emission tomography (PET) uptake are rare. We describe a rare case where PET uptake was detected in a pulmonary amyloid nodule. To our knowledge there are six previously reported cases in the English literature. This review also focuses on amyloid derived from immunoglobulin light-chain protein (AL disease), which most frequently involves the lung in both systemic and localized forms of the disease. Manifestations of AL-related lung disease range from nodules identified on incidental chest films to diffuse alveolar and septal deposition mimicking malignancy and or diffuse alveolar damage.

A rare case of primary lung adenocarcinoma detected by routine liquid-based cervical cytology.

Cervical cytology is mainly used for the screening and detection of early cervical cancers and its precursors. Rarely, detection of malignant cells in cervical cytology specimens is the first manifestation of an extrauterine (EU) malignancy. We report a case of a 49-year-old female in which adenocarcinoma initially diagnosed on routine, liquid-based cervical cytology led to the detection of a primary lung cancer.

Sinus histiocytosis with massive lymphadenopathy involving the orbit: reversal of compressive optic neuropathy after chemotherapy.

A 38-year-old woman from Antigua had compressive optic neuropathy of the right eye caused by orbital involvement with sinus histiocytosis. There was also nasal sinus involvement and massive cervical lymphadenopathy resulting in radiographic compression of the airway and carotid sheath. Because of the compressive optic neuropathy and threat to the airway and carotid perfusion, the patient underwent a 6-month chemotherapeutic regimen of cyclophosphamide, vincristine, and prednisone. After chemotherapy, the visual dysfunction resolved in correlation with diminution of the orbital mass, and marked regression of the cervical lymphadenopathy. This case demonstrates the potential efficacy of chemotherapy in the treatment of compressive optic neuropathy in cases of orbital sinus histiocytosis with massive lymphadenopathy.

Sinus histiocytosis with massive lymphadenopathy involving the orbit: reversal of compressive optic neuropathy after chemotherapy

A 38-year-old woman from Antigua had compressive optic neuropathy of the right eye caused by orbital involvement with sinus histiocytosis. There was also nasal sinus involvement and massive cervical lymphadenopathy resulting in radiographic compression of the airway and carotid sheath. Because of the compressive optic neuropathy and threat to the airway and carotid perfusion, the patient underwent a 6-month chemotherapeutic regimen of cyclophosphamide, vincristine, and prednisone. After chemotherapy, the visual dysfunction resolved in correlation with diminution of the orbital mass, and marked regression of the cervical lymphadenopathy. This case demonstrates the potential efficacy of chemotherapy in the treatment of compressive optic neuropathy in cases of orbital sinus histiocytosis with massive lymphadenopathy (Au)

Acinic cell carcinoma of the lacrimal gland.

An 18-year-old woman underwent exenteration of the right orbit for tumor recurrence 3 years subsequent to external-beam irradiation for a lacrimal gland tumor diagnosed as an "adenocarcinoma." Light microscopy of the exenteration specimen revealed an acinic cell carcinoma of the lacrimal gland, with a predominant microcystic (latticelike) pattern of growth. Cytoplasmic vacuoles and the secretion within the microcysts stained positive with periodic acid-Schiff with and without alpha-amylase, alcian blue (at a pH of 2.5), mucicarmine, and colloidal iron with and without hyaluronidase. This histochemical staining for epithelial mucins supports the theory that the lacrimal gland, although serous in type, may also function as a modified mucus gland. There was cytoplasmic immunopositivity for keratin (CAM 5.2, KAE 1-3); immunostaining for vasoactive intestinal polypeptide was negative. Electron microscopy disclosed undifferentiated features of intercalated duct cells. We speculate that the lack of immunoreactivity for vasoactive intestinal polypeptide may be correlated with the predominantly undifferentiated intercalated duct cell features observed ultrastructurally.

New barriers to ventricular invasion in paraglottic laryngeal cancer.

BACKGROUND: Anatomic barriers to the spread of laryngeal cancer include the conus elasticus, the quadrangular membrane, and the thyroid cartilage. It has been speculated that an elastic barrier surrounds and protects the ventricle. METHODS: The authors studied the microanatomic patterns of spread of 17 cases of patients who had laryngeal cancer with paraglottic disease and confirmed their findings by examining normal autopsy specimens. RESULTS: Five patients of the seventeen cases showed no ventricular mucosal involvement despite extensive paraglottic disease. Both an inner, central, subepithelial periventricular elastic membrane barrier were identified; the latter was in continuity with the conus elasticus and quadrangular membrane. CONCLUSIONS: Two weak fibroelastic barriers surround the ventricle. The outer, peripheral, fibroelastic membrane is contiguous with the conus elasticus and the quadrangular membrane. Therefore, ventricular involvement is not a sensitive indicator of paraglottic spread. Squamous cell cancer may grow around the periventricular barriers to involve both the true and false cords but may spare the ventricle. The prognostic significance of the violation or preservation of the periventricular elastic barriers is unknown.

Urethral involvement in female patients with bladder cancer. A study of 22 cystectomy specimens.

The cystectomy specimens of 22 female patients with various types of bladder cancer were studied for evidence of urethral involvement. The bladder showed high-grade invasive transitional cell carcinoma in 18 patients, in 14 cases in association with flat carcinoma in situ (multifocal in 11 cases and unifocal in three). Three patients had multifocal carcinoma in situ of the bladder without evidence of invasion, and one patient had multifocal high-grade noninvasive papillary carcinoma. Urethral carcinoma in situ was observed in four of 14 patients (29%) with multifocal carcinoma in situ of the bladder, in three cases extending into the periurethral glands. This frequent concurrence of carcinoma in situ of the bladder with urethral and periurethral gland involvement, analogous to the carcinomatous involvement of the prostatic urethra and ducts in male patients, warrants caution in the intravesical therapy of female patients with superficial bladder cancer. The urethra showed invasive carcinoma in three of 18 patients (17%) with invasive bladder cancer (stromal invasion in two cases and vascular invasion in one). This finding reconfirms the use of routine urethrectomy in conjunction with cystectomy in female patients with invasive bladder cancer. An incidental finding was the presence of condylomatous changes in the urethra in five cases (23%).

Intraoperative histologic evaluation in exploration of the parathyroid glands.

In this review, 123 explorations for primary hyperparathyroidism were performed, at which at least three glands were identified and specimens were taken for biopsy. Gross operative and histologic findings were evaluated and correlated with follow-up data. A new classification for disease of the parathyroid glands is devised in which microhyperplasia occurring in grossly normal glands is subclassified into two groups. One (Class II), consisting of hypercellularity only, is thought not to produce clinical hyperparathyroidism. The second group (Class III), which includes glands with nodular hyperplasia, abnormal cytologic findings or oxyphilic nodules, is considered clinically significant. Evaluation and follow-up study revealed three instances of clinical hyperparathyroidism attributed to Class III histologic changes, while there were no instances of recurrent or persistent hyperparathyroidism attributable to Class II disease. Involvement of multiple glands, both gross and microscopic, occurred frequently (26 per cent) and was often bilateral and nonuniform. We concluded that optimal surgical management of primary hyperparathyroidism is achieved by selective removal of parathyroid glands guided by the histologic findings in each gland.

Pseudosarcomatous stromal reaction in primary and metastatic urothelial carcinoma. A source of diagnostic difficulty.

We report five urothelial carcinomas (one primary and four metastatic) with pseudosarcomatous stromal reaction. The exuberant stromal reaction led to a histologic misdiagnosis in three of the original small biopsy specimens. The differential diagnoses of primary spindle cell lesions of urinary tract include spindle cell carcinoma, carcinosarcoma, sarcoma, and benign pseudosarcomatous lesions. The distinction between those conditions and urothelial carcinomas with pseudosarcomatous stromal reaction is obviously of great clinical significance. In an initial small biopsy specimen, it may be difficult to make such a distinction. Immunostaining for cytokeratin and examination of more material should be performed. In our study of metastatic urothelial carcinomas with pseudosarcomatous stromal reaction, clinicopathologic correlations along with immunostaining for keratin proved to be useful. The stromal inductive capability of transplanted urothelium, which has been established in animal experiments, has occasionally also been reported in humans. The malignant urothelium in humans similarly appears to be capable of inducing stromal reaction.

Prostatic carcinoma with endocrine features. A report of a neoplasm containing multiple immunoreactive hormonal substances.

A case of prostatic carcinoma with the cellular patterns of an adenocarcinoma and carcinoid tumor is reported. The tumor contained ultrastructural dense core neuroendocrine granules, and immunoperoxidase staining revealed prostatic acid phosphatase, prostatic-specific antigen, chromogranin, neuron-specific enolase, serotonin, adrenocorticotrophic hormone (ACTH), somatostatin, parathormone, calcitonin, bombesin, and glucagon but no insulin. The patient had exhibited hypercalcemia that may have been related to hormone production by the tumor. The literature on the endocrine aspect of the prostate and its tumor is reviewed.

Renal peripelvic multicystic lymphangiectasia.

Renal peripelvic multicystic lymphangiectasia is an unusual benign peripelvic fluid collection. The sonographic appearance, etiology, and differential diagnosis of peripelvic fluid collections are reviewed.

Hepatic disorders in the acquired immune deficiency syndrome: a clinical and pathological study.

We reviewed the clinical data, hepatic histology, and microbiological features of 21 patients with previously documented acquired immune deficiency syndrome who had liver biopsies. Diagnoses of specific infections were made on liver biopsy in 11/21 patients (57%). Granulomas were found in 10/21 patients (48%) and were most often a manifestation of infection with Mycobacterium avium-intracellulare. Elevated levels of serum alkaline phosphatase and longer duration of diagnosed illness were significantly associated with the presence of granulomatous disease.

Prostatic involvement in bladder cancer. Prostate mapping in 20 cystoprostatectomy specimens.

Twenty prostate glands from patients with either high-grade papillary tumors (19 patients, 15 of whom also had peripheral carcinoma in situ) or multifocal carcinoma in situ (1 patient) of the bladder who underwent cystoprostatectomy were studied histologically by mapping. Prostatic duct involvement by urothelial carcinoma was noted in nine patients, two with extensive involvement and seven with focal involvement confined to periurethral ducts. Carcinoma in situ of the bladder was observed in each of the nine patients and intraepithelial permeation appeared to be the predominant manner of spread of cancer cells into the prostate. The prostatic involvement was clinically silent and it may be a potential source of failure of conservative modalities of treatment of high-grade bladder cancer. A routine diagnostic transurethral prostatic biopsy may be recommended in the workup of patients with carcinoma in situ and high-grade carcinomas of the bladder. An incidental observation was the presence of 14 occult prostatic adenocarcinomas.

Heterotopic bone formation occurring near a ligated ureter.

A case of heterotopic bone formation found in juxtaposition to an accidently ligated ureter is reported. This case may represent a human equivalent of induction of bone formation by urothelium, which was documented previously in experimental animals.

Hypercalcemia in prostatic carcinoma. Report of eight cases.

Hypercalcemia is a rare complication of disseminated carcinoma of the prostate. To our knowledge, only three such patients have had their cases previously reported in the English language literature. Eight patients with prostatic cancer and hypercalcemia were seen at Montefiore Hospital and Medical Center, Bronx, NY, within the last six years. In six of the patients, the prostatic carcinoma exhibited unusual histologic patterns.

Mapping of urothelium in carcinomas of the renal pelvis and ureter. A report of nine cases.

Complete histologic mapping of the urothelium was performed in nine surgical nephroureterectomy specimens. In seven patients, the primary lesion was carcinoma of the renal pelvis; in two, carcinoma of the ureter. In all cases, in areas peripheral to obvious carcinomas, there were extensive epithelial abnormalities akin to those previously described in mapping studies of the urinary bladder. The epithelial changes ranged from hyperplasia to flat carcinoma in situ. The latter was observed in four patients and appears to be an unfavorable prognostic sign: one of the four patients died of disease three months after surgery, and two patients developed metachronous carcinomas of the urinary bladder. Only one of these four patients has been free of disease for 21 months. One additional patient with atypical urothelium in the renal pelvis also developed a metachronous bladder cancer. Significant neoplastic abnormalities of the epithelium of the collecting ducts were observed in six of the seven cases of carcinoma of the renal pelvis. The study emphasizes the essential unity of the urothelium as a target organ for neoplastic events.