Biomedical subjects
Publications and source records attributed to T F Warner.
Adult rhabdomyoma is a benign, highly differentiated tumor of skeletal muscle. We observed transverse tubules and triads beside myofilaments in a rhabdomyoma from the submandibular area of a 66-year-old woman. Several types of muscle cells were present. In one, mitochondria abounded; in another, muscle filaments predominated. Myoglobin was also detected in the tumor.
A large hepatic excised from a 62-year-old man resembled a carcinoid tumor. No endocrine syndrome was present and an alternative primary source of tumor was found, despite an intensive search. The tumor cells were classified according to the type of electron-dense granules present: ACTH, gastrin (G), bombesin (P), and pancreatic polypeptide (PP) type granules were identified. Immunofluorescent staining with antibodies to several polypeptide hormones detected PP-containing tumor cells only. This rare tumor is therefore a PP-apudoma; possibly of intrahepatic bile duct origin.
An unusual case is presented of adenocarcinoma developing at a ureterosigmoidostomy site 49 years after repair of a congenital exstrophic bladder. This is the longest latent period for tumor development in such a site reported to date.
A congenital nevus removed from a 20-year-old woman was found to contain a minimum deviation melanoma. Subsequently, there were multiple nodular recurrences in the region of the excision as well as in the grafted skin. Microscopically the recurrent lesions closely resembled the original nevus, including the junctional activity and even the grafted skin. Lymph node metastasis occurred 5 1/2 years after excision of the nevus. This is the first report of a minimal deviation melanoma arising in a congenital nevus with epidermotropic metastases.
Tumors that were identical in morphology to a previously excised atrial myxoma were found in the choroid plexus and the scapula of a 46-year-old woman 8 and 10.5 years, respectively, after cardiac surgery. Ultrastructurally the scapular lesion resembled previously reported atrial myxomas. This case demonstrates that atrial myxoma is a true neoplasm capable of metastatic spread despite its slow growth and innocuous histologic appearance.
Retroperitoneal leiomyosarcoma arising in a spermatic blood vessel is described. In addition to typical leiomyosarcoma, areas of atypical histiocyte-like cells and storiform pattern bearing a close resemblance to malignant fibrous histiocytoma, were seen. Ultrastructurally, cells with features of smooth muscle, partially differentiated cells with marginal densities and basal lamina and histiocyte-like giant cells were present. Phagocytosis of inflammatory cells by tumour cells with marginal densities and an investment of basal lamina was observed. It is suggested that the precursor cell in this lesion was a primitive mesenchymal cell showing varying degrees of smooth muscle differentiation and giant cell formation.
Multiple malignant melanocytic lesions developed in a 54-year-old man 4 years after a primary malignant melanoma (Clark level IV) had been excised and 2 months after taking L-Dopa for Parkinsonism. Several of the recurrent lesions that showed junctional melanocytic components were considered primary melanomas and it was suggested that L-Dopa was responsible for malignant transformation of nevi and for rapid progression of the disease. The case was re-examined and on recent evidence it is likely that these lesions were epidermotropic metastases and that L-Dopa played no part in the progress of this unusual tumor.
An unusual case of epidermolysis bullosa dystrophica with extensive stenosis, high perforation, and dissection of the oesophagus forming a "double-barrel" structure is described. Gastric epithelium found in the upper oesophagus is thought to be of metaplastic origin and caused by repeated minor trauma with repair.
Extensive junctional complex formation was observed between cells of an insulinoma with an acinar pattern. Cytolysosomes, multivesicular bodies, and small vesicles were present in the luminal aspect of acinar cells that were shedding cytoplasm. These and other ultrastructural features suggest a recapitulation of intestinal development by this tumor and this is consistent with an endodermal origin of pancreatic beta-cells or their precursors. Psammoma body formation, a rare occurrence in apudomas, was probably due to the accumulation of intraluminal cytoplasmic debris.
Carcinoid tumors of the breast are extremely rare. We studied what is to our knowledge the second case of an extramammary carcinoid presenting initially as a breast mass. Varying degrees of ribbon, trabecular, acinar, and insular patterns were present in the primary bronchial tumor and in several secondary deposits, including the initial breast lesion. The cells were argyrophilic and contained round and membrane-bound electron-dense granules. Estrogen and progesterone receptors were present in a cerebral metastasis. Polypeptide hormones and 5-hydroxytryptamine were not detected by immunocytochemistry.
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An unusually large number (108) of carcinoids was discovered in the ileum of a 63-year-old male. The clustering and size distribution of tumor nodules suggests that the phenomenon reflects mucosal metastasis from a dominant parent tumor rather than multicentric neoplastic foci. A predilection for the antimesenteric mucosa was also observed and may be related to mucosal lymphatic spread of the carcinoid tumor.
Occlusion of mesenteric vessels due to fibrosis and adventitial elastosis complicated ileal carcinoids and resulted in infarction of bowel in two patients. Synovial sarcoma antedated the carcinoid syndrome in one patient who died; carcinoma of the breast was discovered one year after hemicolectomy in the other. This rare mesenteric occlusive lesion is associated exclusively with ileal carcinoids; it is poorly recognized and the mortality is high.
We report on an 89-year-old female admitted with signs of intestinal obstruction in whom three independent adenocarcinomas of the proximal jejunum were found. Multiple foci of pyloric gland metaplasia, glandular hyperplasia and dysplasia, carcinoma-in-situ, and several varieties of adenocarcinoma were identified on microscopic examination of 14 cm of excised jejunum. Multifocal adenocarcinoma of the small intestine is extremely rare. We are not aware of any case harboring the complex changes described herein.
Light and electron microscopic examination of a goblet cell carcinoid revealed cells with pleomorphic neurosecretory-type granules, cells containing mucin some of which also contained these granules and less differentiated cells lacking the aforementioned features. Recent embryologic and anatomic studies of developing avian and mammalian gut, respectively, show that intestinal APUD cells are probably of endodermal origin. Therefore, mixed carcinoid tumors such as the goblet cell variant could arise in crypt base stem cells.
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Light microscopic examination of a basalioma (basal cell carcinoma) revealed unusual keratinizing cells resembling signet ring cells with pink cytoplasmic inclusions. Ultrastructurally the inclusions consisted of filamentous masses encircled by abundant tonofilaments giving a striking picture of abnormal individual tumor cell keratinization.
Proliferating pilar cysts are rare tumors which occur most commonly on the scalp of elderly women. The infiltrative areas of these tumors should be differentiated from epidermoid carcinoma because they are usually benign. The intimate association of this entity with a spindle cell component is described here, to our knowledge for the first time.