Diseases of the pericardium: morphologic study of surgical specimens from 35 patients.

The gross and microscopic features of 35 pericardial surgical specimens are described. Nineteen specimens were associated with pericardial effusion, and microscopic study showed nonspecific fibrous changes in eight, tuberculous granulomatous inflammation in four, purulent inflammation in four, neoplastic involvement in four, and siderosis of the pericardium in one. Twelve of these were clinically associated with constriction. Calcification of the pericardium was the predominant feature in eight of the specimens. None of these eight specimens showed features of tuberculous infection. Of the remaining four, two showed chronic fibrinous changes and the other two showed granulomatous inflammation of presumed tuberculous origin. Four pericardial cysts were seen. Pericardial disease was an incidental finding in 13 instances (37 per cent), suggesting the frequent underdiagnosis and asymptomatic nature of disease of the pericardium. The associations of infections, trauma, hemopericardium, and collagen diseases and pericardial diseases are discussed.

The histopathologic features of lithium-associated thyroiditis.

The case of a 62-year-old woman with lithium-associated thyroiditis is presented. Lithium can produce goiters associated with hypothyroidism and, less commonly, hyperthyroidism and euthyroidism. The characteristic histopathologic features of the affected thyroid gland included fibrosis, lymphoid follicles with atrophy, and hyperplasia of thyroid follicles. The pathogenetic mechanism appears to be immunologic, with lithium acting as a haptene with a thyroid antigen to induce an "autoimmune" type of thyroiditis.

Anaplastic small cell neoplasms of the thyroid: an immunoperoxidase study.

The cell origins of ten anaplastic small cell neoplasms of the thyroid gland were investigated using the immunoperoxidase technique. Sections of the neoplasms were examined for immunostaining for the tissue markers of B lymphocytes, thyroid follicular cells, and C cells by incubation with antisera to the lambda and kappa light chains, human thyroxine and human calcitonin, respectively. Six neoplasms were identified as malignant lymphomas, and two were identified as anaplastic small cell follicular carcinomas. The cell origins of the remaining two neoplasms could not be determined. The prognosis for patients with malignant lymphoma was favorable compared with the prognoses for patients in the other two groups. The prognosis for patients with anaplastic small cell follicular carcinomas was better than for those with small cell malignancies of undetermined cell origins. These findings suggest an important role for the immunoperoxidase technique in the precise classification of anaplastic small cell neoplasms of the thyroid.

Malignant hyperthermia susceptibility. A light and electron microscopic study of endomyocardial biopsy specimens from nine patients.

Cardiomyopathy develops in some individuals who have a susceptibility to malignant hyperthermia. We studied right ventricular endomyocardial biopsy specimens from nine patients defined as having this disorder because of positive caffeine contracture tests on skeletal muscle biopsy specimens. Three patients had clinical evidence of cardiomyopathy and six did not. Light microscopy showed cytoplasmic contraction bands, perinuclear clearing, and a mild to moderate variation in myocyte and nuclear size. Ultrastructurally cytoplasmic contraction bands were associated with cardiac villi, myofiberlysis, and myofibrillolysis. These changes and occasional breaks in the sarcolemma were regarded as artefacts of the biopsy procedure. Megamitochondriosis with accompanying degenerative changes in the mitochondria were also seen and probably indicate increased cell metabolism; vacuolation of the cytoplasm was regarded as an "aging" phenomenon. Thus, the biopsy specimens were abnormal, but the changes were artefactual or nonspecific and were not unique to this group of patients. Biopsy did not provide a morphological explanation for abnormal cardiac function.

Isoantigen status in condyloma acuminata of the uterine cervix: an immunoperoxidase study.

The immunoperoxidase technic was used to investigate the blood isoantigen status in condyloma acuminata, which is regarded as being caused by the human papillomavirus (HPV). Since HPV is associated with epithelial atypias and intra-epithelial neoplasia, and since epithelial malignant transformation is associated with isoantigen loss, the purpose of the study was to determine if koilocytotic atypias are associated with isoantigen loss. Complete isoantigen loss was seen in 33% of cases, partial loss in 47%, and retention in 20%. The significance of this study lies in being able to recognize those lesions that may be associated with malignant transformation (80%) as indicated by isoantigen loss. Isoantigen retention may identify those epithelial atypias that undergo spontaneous regression. Long range follow-up of such patients will help further elucidate the role of HPV in neoplastic transformation of condylomatous lesions. The immunoperoxidase technic can be used in retrospective studies of condylomata of the cervix.

Temporal (granulomatous) arteritis: a histopathological study of 32 cases.

Thirty-two cases of temporal arteritis were reviewed. All patients were adults with a mean age of 69.6 years, and no sex predominance. The erythrocyte sedimentation rate was raised and there was a good response to steroid therapy in the 29 patients who were adequately documented and followed up. Detailed histopathological study of the temporal artery biopsies showed three main histopathological variants; 12 cases (37.5%) had predominantly intimal proliferative changes, four cases (12.5%) had granulomatous inflammation without giant cells and 16 (50%) had granulomatous inflammation with giant cells. The predominantly intimal change variant, consisting of a cellular proliferation of fibroblasts and myointimal cells with little or no changes in the media represent an active pathological process and not a healed disease as has been previously suggested. The internal elastic lamina showed abnormal features in all three morphological variants. The need to recognize this variant, the temporal relationship between these variants and the need to study multiple sections are discussed. Biopsy of clinically normal temporal arteries in patients suspected of having temporal arteritis is recommended as some of these vessels may show disease. No correlation was observed between the clinical picture and the histopathological findings.

Eccrine spiradenoma: clinical and pathologic study of 49 tumors.

A clinical and pathologic study of 49 eccrine spiradenomas occurring in 46 patients is presented. The study showed that pain and/or tenderness are not such characteristic clinical features of this tumor as has previously been suggested; either or both were present in only 23% of the 35 patients with well-documented clinical histories. Some pathologic features, not previously documented in this tumor, were seen and included: cylindromatous foci, aggregates of stromal clear cells, clear cells lining ducts and ulceration of the overlying epidermis. Two tumors had undergone malignant transformation, but there were no recurrences in the 35 patients with adequate follow-up.

Hyaline cells in a benign chondroid syringoma. Report of a case and findings by conventional and electron microscopy.

This report describes the features of a benign chondroid syringoma removed from a foot of a 34-year-old woman. Histologic examination showed that an acidophilic hyaline cell was the predominant cell type; keratinocytes and cells with clear to foamy cytoplasms were less abundant. The hyaline cells and keratinocytes were within a chondroid and myxoid stroma. Ultrastructural study revealed large numbers of pale epithelial cells whose cytoplasms were loaded with intermediate filaments and dark cells with many tonofilaments. Intermediate transition forms between the pale and dark cells were also identified, as were myoepithelial cells with intermediate filaments, and secretory cells. These cells were also lodged in a chondroid and myxoid matrix. This study showed that acidophilic hyaline cells are of both epithelial and myoepithelial origin and that both may be responsible for laying down the matrix.

The significance of atypical nuclear changes in benign eccrine acrospiromas: a clinical and pathological study of 18 cases.

A clinicopathologic study of 18 eccrine acrospiromas with atypical nuclear changes is presented. The changes included nuclear pleomorphism, prominent nucleoli, chromatin condensation, multinucleate giant cells and increased mitotic activity. Of the 5 neoplasms that occurred, 2 recurred once and were histologically and clinically benign, and the other 2 recurrences were histologically malignant. One neoplasm recurred twice, the first recurrences being histologically benign and the second histologically malignant. It is suggested that such nuclear atypias in otherwise clinically and histologically benign eccrine acrospiromas may be associated with local benign recurrences some of which may undergo malignant change. Search for these nuclear changes and long follow-up of patients in whom they occur are, therefore, recommended.

Fatal retropleural hematoma complicating internal jugular vein catheterization. A case report.

This report describes a case of fatal retropleural hematoma complicating percutaneous insertion of a central vein catheter. The patient was a 55-year-old female undergoing surgery for severe rheumatic mitral valve disease. Factors responsible for this catastrophic incident are the anticoagulation of the patient, the edematous state of the soft tissues, and the multiple punctures of the wall of the jugular vein.

Carcinoma of the breast: the prognostic significance of extranodal extension of axillary disease.

A retrospective study to determine the effect of extranodal axillary disease on prognosis in invasive carcinoma of the breast was undertaken in a series of 152 cases. It was found that extranodal disease has an unfavorable effect on prognosis in those patients with three or less involved axillary nodes and no effect on prognosis in those patients with four or more involved axillary nodes. Extranodal axillary disease was found to have no influence on the interval between surgery and initial recurrence nor on the anatomic distribution of the recurrence, local or remote.

Primary malignant lymphomas of the breast.

Fourteen cases of primary malignant lymphomas of the breast were found in the pathology files of the M. D. Anderson Hospital and Tumor Institute from 1944 to 1975. The lymphomas represented only 0.12% of 11,277 primary malignant breast tumors seen during the same period. There were no definite clinical features to distinguish the patients with lymphoma from those with breast carcinoma. All of the lymphomas had a diffuse pattern. Eight cases were classified as undifferentiated lymphoma, five as histiocytic, and one as poorly differentiated lymphocytic, convoluted cell type. Four patients had mastectomies and the remainder biopsies as their sole surgical procedure. Eight patients received post-surgical radiotherapy and all eventually had chemotherapy. The five-year survival rate for the 13 patients with follow-up was 49%. Patients with histiocytic lymphoma appeared to have a more favorable prognosis than those with the undifferentiated type. Six of the latter patients are dead with a median survival of seven months, comparable to the reported survival of patients with American Burkitt's lymphoma. The patient with the convoluted cell type has developed acute blastic leukemia and is currently under therapy.

Bacterial endocarditis of the mitral valve associated with annual calcification.

Bacterial endocarditis, caused mainly by Staphylococcus aureus, was found at autopsy in five patients who had a calcified posterior mitral valve annulus. Clincopathologic correlation indicates that the infection should be suspected in elderly patients with a calcified mitral annulus, the murmur of mitral insufficiency, fever, anemia, polymorphonuclear leukocytosis and a positive blood culture, regardless of evidence of peripheral embolism or of another disease that could cause the last four features. Pertinent pathologic findings are a calcified mitral valve annulus, vegetations of bacterial endocarditis towards the base of the posterior leaflet associated with leaflet perforation and an annulus abscess, and no other valvular disease. The infection may develop on the atrial aspect of a leaflet ulcerated by the calcium mass or may begin on its ventricular aspect, subsequently perforating the leaflet and infecting its atrial surface.

Kaposi's sarcoma of the penis.

The 11th case of Kaposi's sarcoma of the glans penis is reported. Aetiology and treatment are discussed and evidence adduced to support a conservative surgical approach by local excision, supplemented if necessary by low dosage irradiation and possibly methotrexate infusion.