Biomedical subjects
Publications and source records attributed to F A Tavassoli.
A case of malignant mixed mesodermal tumor (MMT) of the uterus in a 4-year-old girl is reported. The patient had a polypoid lesion protruding from the vagina which was initially thought to be a sarcoma botryoides. This is one of the youngest cases of MMT on record. A review of MMT in premenopausal women and children is presented.
Seven carcinomas of the breast with osteoclastlike giant cells were studied. Recurrences and lymph node metastases also contained osteoclastlike giant cells. Judging from ultrastructural and histochemical studies, the osteoclastlike giant cells are not epithelial, but are of mesenchymal origin. They may appear in a variety of different types of carcinoma.
Nine examples of mammary adenoid cystic carcinoma with sebaceous differentiation were studied. Each one of the nine tumors contained basaloid, eosinophilic, and sebaceous cells. Two of these tumors were examined by electron microscopy and compared with four mammary adenoid cystic carcinomas without sebaceous differentiation. The sebaceous cells were similar to normal adnexal sebaceous cells. The eosinophilic cells reflected adenosquamous differentiation and were identical to superficial cells of eccrine sweat ducts. The basaloid cells showed no distinctive cytoplasmic differentiation. Cells with features between the basaloid, sebaceous, and adenosquamous cells were present, indicating that basaloid cells have the potential to differentiate toward skin adnexal structures giving rise to both sebaceous and adenosquamous cells. Myoepithelial cells were not identified in any of the six tumors evaluated by electron microscopy.
A review of 13 ovarian strumal carcinoids in the files of the Armed Forces Institute of Pathology has established further evidence that these tumors have both endocrine and neuroendocrine differentiation. The two functional routes of differentiation occur even within individual tumor cells. Immunohistochemical reaction for thyroglobulin was positive in the strumal regions of all 12 cases tested. This positivity was also present in transitional zones where the thyroid follicles merged with nests of carcinoid cells. Electron microscopy performed in six cases showed cells with neuroendocrine granules in the thyroid follicles; these cells resemble the C-cells of the normal thyroid gland. An immunoperoxidase reaction for calcitonin, however, revealed no positivity in any of the cells corresponding to the neuroendocrine cells within the follicles or those in the carcinoid component. Variable positivity for serotonin was observed, however. It is proposed that cells within the struma that have morphologic similarities to the C-cells of the thyroid give rise to the carcinoid component. These cells appear capable of producing thyroglobulin as well as neuroendocrine granules.
The morphologic features of 15 uterine plexiform tumorlets are described. Four of the 15 were examined ultrastructurally; all of these showed features of smooth muscle differentiation. Thus, origin from smooth muscle cells is most likely.
This report describes a previously unreported type of ovarian tumor containing three distinct components: germ cells, gonadal stromal cells, and epithelial cells. The germ cells were mainly of the types seen in various stages of oogenesis. The gonadal stromal component had two lines of differentiation. Cells containing Charcot-Böttcher filaments were identified as Sertoli cells and granulosa cells were characterized by a microfollicular arrangement. The epithelial component resembled the cells present on the ovarian surface and lacked specific differentiation toward any of the common ovarian (müllerian) epithelial cell lines. The tumor was discovered as an abdominal mass in a newborn girl with a 46XX karyotype. Subsequently, the child has developed normally and is well 7 years after surgery.
The clinical and pathologic features of 11 examples of microglandular adenosis of the breast are presented. Microglandular adenosis is a rare, benign lesion that is easily confused with carcinoma. It is characterized by a concentrated proliferation of round glands with open lumens in a densely homogeneous stroma that clearly delineates microglandular adenosis from the adjacent uninvolved breast. The glands are lined by a single layer of cells with distinctly vacuolated or granular cytoplasm. Ultrastructurally, the single layer of epithelial cells lacks cytoplasmic protrusions and is surrounded by a thick multilayered basement membrane. Light- and electron-microscopic features that help distinguish microglandular adenosis from well-differentiated (tubular) carcinoma and sclerosing adenosis, entities with which it is easily confused, are discussed.
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Peritoneal leiomyomatosis (PL) occurs in women of reproductive age. Of 20 women with PL in this study, 10 were pregnant or immediately postpartum, and 7 were taking oral contraceptive steroids. Only three of the 20 women were not pregnant or taking exogenous hormones. All PL nodules were composed mainly of spindle cells, but decidual cells were admixed with the spindle cells in some of the nodules in six of the 10 pregnant and postpartum women. Electron microscopy was applied to the nodules from six women representing the three different hormonal backgrounds. All contained smooth muscle cells. One was composed exclusively of smooth muscle cells, while four of the six contained smooth muscle cells predominantly but were admixed with myofibroblasts or altered smooth muscle cells and fibroblasts. Decidual cells were conspicuous in the nodules examined ultrastructurally from a pregnant woman. Despite incomplete excisions, none of the 14 women with follow-up had progressive disease. Complete or partial regression of PL was verified by "second-look" laparotomy in four women, but a repeat cesarian section in a fifth woman revealed persistence (or recurrence) of PL 1.5 years after the initial diagnosis. PL probably results from an unusual predisposition, or selective sensitivity, of subperitoneal mesenchymal stem cells in some women to undergo metaplasia and differentiation to smooth muscle, fibroblasts, myofibroblasts, and decidual cells. In the majority of women, hormonal stimulation is an initiator or promoter of the process.
The clinical and pathological features of six dysgerminomas containing syncytiotrophoblastic giant cells were studied; these represented 3% of the dysgerminomas in the AFIP files. Syncytiotrophoblastic giant cells, the distinguishing histological feature, were present either in clusters or were distributed diffusely. Human chorionic gonadotropin was demonstrated immunocytochemically within the cytoplasm of the syncytiotrophoblastic giant cells in both of the two tumors tested for it. Serum or urine gonadotropin titers, measured in four patients, were elevated in three, and two of these were thought to have ectopic pregnancies. All of the dysgerminomas were Stage Ia, and the six patients were well 1-14 years after treatment.
The clinical and pathologic features of three hemangiopericytomas of the breast in women are described. The three tumors presented as painless, nontender nodules. The morphologic variation typical of hemangiopericytomas was present in each tumor. One case was studied by electron microscopy and was found to be composed of two types of pericytes. Both cell types were closely associated with vessels, partially or completely surrounded by basal lamina, and contained pinocytotic vesicles. There were only minor differences between the two forms of pericytes. Smooth muscle cells, fibroblasts, or transitional cell forms were not observed. The two patients on whom follow-up information was available have remained free of tumor 2.8 and 4 years after their surgery, indicating that not all vascular tumors of the breast are highly aggressive neoplasms.
Endometrial stromal nodules are well-circumscribed neoplasms composed of cells identical to those in low-grade endometrial stromal sarcoma and proliferative endometrium. The clinical and pathologic features of 60 endometrial stromal nodules were studied to determine their characteristics and behaviour. A follow-up of up to 16 years revealed that none of the 60 patients developed recurrences or died of her disease, indicating that circumscribed endometrial stromal tumours are benign. A number os specific features such as irregularities in the margin, high mitotic counts, and a glandular trend did not seem to alter the benign course of this lesion.
The clinical and pathologic features of 28 Sertoli tumors of the ovary are presented. Seventeen of the 18 neoplasms had a functional effect. The effects were hyperestrinism (eight women), isosexual precocious puberty (three girls), virilization (four women), a progestational decidual reaction on the peritoneum (one woman), and a combination of virilizing and estrinizing signs (one woman). There were three histologic patterns: simple tubular, complex tubular, and folliculome lipidique. Two neoplasms recurred, both of which had the distinctive feature of invasion of the supporting stroma by individual and columns of tumor cells in the original tumors. Electron microscopic evaluation of three neoplasms disclosed. Charcot-Böttcher filaments unequivocally identifying the Sertoli differentiation of the predominant cells in the neoplasm. The identification by electron microscopy of a smaller population of cells within the three tumors similar to typical ovarian stromal cells suggests that Sertoli tumors arise from ovarian stromal cells.
Nineteen examples of a very rare type of carcinoma of the breast have been studied. The carcinoma is unusual in that it has exaggerated secretory features previously reported only (with one exception) in juveniles. But not all the patients in our series were juveniles; they ranged in age from 9 to 69 years (median age, 25 years). Six were 30 years of age or older. Eighteen patients were female and 1 was a 9-year-old boy. Treatment varied from local excision of the tumor to radical mastectomy. Four of the 11 patients who had axillary node dissection had metastatic deposits showing the same secretory features as the primary neoplasm. One of these 4 patients, a 25-year-old woman, died within ten months with disseminated tumor. Because this distinctive pattern of carcinoma is not limited to children and adolescents, we propose that it be called "secretory carcinoma." Since, of the 19 patients, 4 (21%) had axillary node metastases and 1 (5%) died with disseminated tumor, an extended simple mastectomy is recommended as the initial treatment for patients more than 20 years of age.
The clinical and pathologic features of 32 smooth muscle tumors of the vulva were studied to determine the pathologic characteristics that best relate to the clinical behavior and to define criteria for separating leiomyomas from leiomyosarcomas. The length of follow-up ranged from 16 months to 20 years, with a median of 9 years. None of the tumors metastasized. Of the 4 neoplasms that recurred, the 2 with infiltrating margins recurred within 1 year and of these 2, the one with more than 5 mitotic figures in 10 high-power fields (HPF) recurred 5 times within a 2-year period. Neoplasms were discovered during pregnancy in 7 patients; these were characterized by extensive myxoid change, but none of the tumors that occurred during pregnancy showed significant cellular atypism or mitotic activity. Local excision is recommended as initial therapy and also for recurrences.
The clinical and pathologic features of 60 smooth muscle tumors of the vagina were studied to determine the pathologic characteristics which best relate to clinical behavior and to define criteria for the diagnosis of leiomyosarcoma. Cellular atypism, mitotic activity, and tumor size and contour were examined, and their relationship to recurrence was evaluated. Only 5 neoplasms recurred, and these were all greater than or equal to 3 cm, with greater than or equal to 5 mitotic figures per 10 high-power fields (HPF) and various degrees of atypia. The only patient whose tumor had an infiltrating margin died with metastatic tumor in the lungs. With the exception of this 1 neoplasm, all other smooth muscle tumors of the vagina were either benign or only locally aggressive. Local excision is the treatment of choice when the tumor is well circumscribed. A neoplasm with moderate to marked atypism and greater than or equal to 5 mitotic figures per 10 HPF merits the designation of leiomyosarcoma.
An unusual case of solitary extraskeletal plasmacytoma (SEP) arising from the meninges of the anterior fossa in a 58-year-old woman is presented. Despite an apparently complete surgical excision and 5000 rads to the tumor area given postoperatively, a recurrence ensued 5 years later. During the 5 years of clinical observation, repeated serum electrophoresis and immunoelectrophoresis, bone surveys, and bone marrow aspirations have ruled out the presence of underlying multiple myeloma. Immunofluorescence studies of the recurrent tumor showed the neoplastic cells to be producing a monoclonal immunoglobulin (IgA, kappa). Ultrastructural examination showed neoplastic plasma cells with marked nucleocytoplasmic asynchrony, frequent cytoplasmic electron-dense bodies, and rough endoplasmic reticulum dilated and filled with with electron-dense material. A critical evaluation of the eight cases of intracranial SEP published in the literature revealed that only three are well-documented examples of this tumor.
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