Biomedical subjects
Publications and source records attributed to L Angervall.
An intraluminal reactive hyperplastic lesion from the lower labial mucosa of an adult male patient is described. It has been termed intravascular papillary endothelial hyperplasia and may have arisen in an organizing thrombosed vein. The importance of distinguishing it from a malignant vascular neoplasm is stressed, and the differential diagnosis is discussed.
A relationship between analgesic abuse and urothelial renal pelvic tumors was first observed in 1965. Since then more than 100 cases of such tumors have been reported in abusers of phenacetin-containing drugs; most of these cases have been from Sweden. Many patients had a preexisting nephropathy with renal papillary necrosis. The total consumption of the drugs could be estimated to several kilograms, and the average period of consumption was 17 yr in the Göteborg study. The manifest development of the tumor often came a few years after the cessation of the drug abuse. The clinical picture and the pathologic findings are described and the five-year survival rate is given. Multiple tumors in the urinary tract were common. Carcinogenic factors are discussed. Phenacetin is an aromatic amide with N-hydroxylated metabolites, closely related to known carcinogenic amines like the naphthylamines which earlier caused occupational bladder cancer. Furthermore, the data on exposition (consumption) time and tumor induction time were very similar in occupational bladder cancer and in renal pelvic cancer related to analgesic abuse. Animal experiments of long-term phenacetin feeding have produced a high degree of papillary epithelial hyperplasia. Further investigations are under way.
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The case report of a 72-year-old man with the characteristic clinical and pathologic-anatomic picture of the Cronkhite-Canada syndrome is presented. The clinical features and the radiographic appearance of the gastrointestinal tract suggested Ménétrier's disease. Subtotal gastrectomy was performed and at the subsequent pathologic-anatomic examination, the diagnosis of Cronkhite-Canada syndrome was made. The patient slowly recovered over the following five months while being treated with the so-called astronaut diet (Vivasorb) supplemented with vitamins, iron and electrolytes. He died five months after surgery from intercurrent disease. The differential diagnosis of gastrointestinal polyposis with or without mucocutaneous pigmentation is briefly discussed. The histochemical characteristics of the epithelium in the gastric and colonic polyps was studied in some detail. The authors believe that the gastrointestinal polyps in the Cronkhite-Canada syndrome are regenerative and non-neoplastic in nature.
The growth of the prostatic lobes and the seminal vesicles was studied morphologically in alloxan-diabetic and non-diabetic castrated adrenalectomized rats. In non-diabetic but not in alloxan-diabetic rats cortisone in daily doses of 3 or 6 mg induced growth and secretory activity in the epithelium of the dorsolateral prostate, the coagulating glands and the seminal vesicles. Insulin administration to alloxan-diabetic rats could restore the effect of cortisone on these glands. This indicates that insulin deficiency per se was the main reason for the failure of cortisone to induce secretory activity of the prostatic lobes and the seminal vesicles of alloxan-diabetic rats.
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A report of 2 cases of solitary fibromatosis in a 10-day-old boy and a girl 3 years and 10 months old is presented. Both lesions were deep-seated and showed a nodular and infiltrating growth, predominantly buil-up by immature fibroblast-like cells and including hemangiopericytoma-like areas. One of the lesions also showed leiomyoma-like areas. An ultrastructural study however, revealed no intra-cytoplasmatic myofilaments. At follow-up examinations after 21 years and 1 year, respectively, there were no signs of recurrences or metastases. These 2 cases are considered to represent a solitary form of congenital generalized fibromatosis. The differential diagnosis from infantile hemangiopericytoma and fibrous lesions seen in infancy and early childhood, such as infantile fibrosarcoma, diffuse infantile fibromatosis, extra-abdominal desmoid, fibrous hamartoma of infancy and juvenile aponeurotic fibroma, is discussed.
Pseudosarcomatous lesion of the soft tissues is a term used in the present study for various soft tissue lesions and tumours easily clinically or histologically, or both, misinterpreted as sarcoma. Eighty-one cases, that is to say 10 per cent of all tumours classified and reported to the Swedish Cancer Registry as malignant soft tissue tumours during the 6-year period studied (1958-1963), were reclassified as pseudosarcomatous lesions of the soft tissues. Forty-seven cases were classified as pseudoarcomatous proliferative lesions of the soft tissue with or without bone formation; 38 cases of nodular fasciitis, 1 of proliferative fasciitis and 8 of proliferative myositis. In 3 of these cases there were mixed forms of proliferative fasciitis and proliferative myositis with areas compatible with the diagnosis of nodular fasciitis evident in all cases. Twenty-two cases of atypical fibroxanthomas of the skin were next in frequency, followed by 7 ancient neurilemmomas, 2 spindle cell lipomas, 1 pseudomalignant osseous tumour of the soft tissues, 1 pigmented villonodular synovitis and 1 juvenile xanthogranuloma. An attempt is made to explain the reasons for these erroneous diagnoses of sarcoma and it is stressed that for these lesions the conventional histological criteria for malignancy are not valid. The awareness and knowledge of the existence of these particular entities are therefore considered mandatory for an accurate diagnosis.
A series of 30 myxofibrosarcomas is described. These malignant soft tissue tumours are characterized by a mucoid and nodular appearance, a coarse plexiform capillary pattern, and they are mostly seen subcutaneously (26 out of 30) in the extremities (24 out of 30) and trunk (4 out of 30) elderly people. Histochemical studies, comprising staining with Alcian blue and toluidine blue at different pH's with and without preceding digestion with testicular hyaluronidase and with the Scott technique, indicated the presence of hyaluronic acid but not sulphated glycosaminoglycans as chondroitinsulphates. Myxofibrosarcoma is believed to belong to the general category of fibroblastic and histiocytic malignant soft tissue tumours. The median diameter of the tumours was 7 cm. They were divided into 4 grades according to cellularity, cell atypia and mitotic activity. The grade III and IV tumours showed pronounced atypia, often with the bi- and multinucleated giant tumour cells and occasionally with giant cells of Touton's type, suggesting a relationship to malignant fibroxanthoma. All of the patients were treated surgically and one received also pre- and post-operative irradiation. None of the 2 grade I myxofibrosarcomas recurred, while 2 out of 7 grade II tumours, 6 out of 10 grade III tumours, and 7 out of 11 grade IV tumours recurred once and up to 9 times. Metastasis appeared in 7 out of 30 patients; grade I tumours were not seen in any of these cases. By the time of follow-up after intervals ranging from 1 month up to 27 years, 14 patients had died; 6 of these had died post-operatively or of intercurrent disease. The differential diagnosis between myxofibrosarcoma and other myxoid soft tissue tumours is discussed.
Forty-five patients with achlorhydria due to severe atrophic corpus gastritis or gastric atrophy were studied by determination of serum gastrin, histological examination of multiple biopsy from the antrum, and quantitation of gastrin cells revealed by an indirect immunofluorescence technique. In a reference group of 12 persons with normal gastric secretion and without atrophic antral gastritis the mean number of gastrin cells per field of vision was 52 +/- 6.5 (S.E.M.). In a group of achlorhydric patients having normal antral mucosa (n = 24), the serum gastrin levels was 324 +/- 56 pmol/l and the number of gastrin cells was 79.6 +/- 7.5 cells/field of vision. The corresponding values for a group of achlorhydric patients with chronic superficial antral gastritis (n = 11) were 361 +/- 186 pmol/l and 88.0 +/- 14.4 cells/field of vision. In a group of achlorhydric patients with atrophic antral gastritis (n = 10) serum gastrin was 15.0 +/- 3.3 pmol/l, and the number of gastrin cells was 6.2 +/- 3.3 cells/field of vision. Compared to the subjects in the reference group, the number of gastrin cells was significantly higher in the groups of achlorhydric patients with normal or superficially inflamed antral mucosa and significantly lower in achlorhydric patients with atrophic antral gastritis. It is concluded that serum gastrin in general is a good indicator for the presence or absence of antral atrophic gastritis in achlorhydria.
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The growth of the ventral and dorsolateral prostate, the coagulating glands and the seminal vesicles was studied morphologically in castrated rats following 21 daily injections of oestradiol benzoate or protamine zinc insulin alone or in combination. Oestradiol benzoate was given in daily doses of 0.010 mg, protamine zinc insulin in daily doses of 10 IU. In the ventral and dorsolateral prostate oestradiol had an androgen-like action inducing epithelial growth and secretory activity in the epithelium. In the seminal vesicles and coagulating glands oestradiol induced an increased fibromuscular growth. Protamine zinc insulin induced growth and secretory activity in the dorsolateral prostate, while no such effect was observed in the other accessory reproductive glands. Protamine zinc insulin accentuated the androgen-like action of oestradiol benzoate on the epithelium of the dorsolateral prostate but did not influence on the increased fibromuscular growth seen after oestradiol in the coagulating glands and the seminal vesicles.
The aim of the present investigation was to assess the prognosis of epithelial pelvic tumors and evaluate from multivariate analysis the influence of different morphologic and clinical factors on the prognosis. The basic data are derived from the Swedish national series of patients with epithelial renal pelvic tumors diagnosed by histologic examination during 1962-63. Ninety-four of the 102 patients studied had a urothelial pelvic tumor and eight had an epidermoid carcinoma. The corrected 5-year survival rate was 51% in the curatively operated series, 60% among the males and 33% among the females. Infiltration depth was found to be of significant importance for the 5-year survival and thus a strong predictor for prognosis. Furthermore, each tumor grade and tumor structure exerts some influence on the prognosis independent of the infiltration depth. Nine patients had verified, and 16 patients had suspected phenacetin abuse and/or renal papillary necrosis. The survival rate was low and the relative frequency of females was high in this group of patients. These data may indicate a poorer prognosis in patients with phenacetin abuse, and may explain the sex difference in 5-year survival. Thirty-eight per cent of the patients with urothelial tumors of the renal pelvis had a synchronous or asynchronous tumor elsewhere in the urinary tract. The high frequency of local recurrence as well as the high frequency of infiltrating tumors and multiple tumors indicate the necessity for a more extensive operation such as perifascial nephrectomy with total ureterectomy including a cuff of the bladder.
Twenty-one of 40 rats fed phenacetin in the diet for up to 86 weeks developed urothelial hyperplasia of the renal papillae. Two of 30 rats in the control group had similar changes associated with chronic pyelitis. The difference is statistically significant (p less than 0.01).
Thirty female Sprague-Dawley rats were fed 0.535 per cent phenacetin in the diet for up to 110 weeks. Twenty-six of these rats developed urothelial hyperplasia, partly papillary, of the renal papillae. Twenty-eight rats showed dilatation of the vasa recta frequently associated with thrombus formation and calcification. One phenacetin fed rat had epithelial hyperplasia associated with chronic pyelitis. In 2 of the 30 control rats urothelial hyperplasia was found to be associated with chronic pyelitis. The hyperplastic urothelial changes and vascular changes were often, but not always, present simultaneously. One control rat developed a mammary carcinoma, as compared with 5 rats in the phenacetin group. Four phenacetin fed rats developed carcinoma of the ear duct. The results of the present investigation provide evidence that phenacetin can induce proliferative lesions of the urothelium of the rat renal pelvis with weak carcinogenic activity in the ear duct and mammary glands.
A clinical, light- and electronmicroscopic study of 14 patients with spindle cell lipoma is presented. Spindle cell lipoma is considered to be a distinctive lipomatous tumour histologically characterized by a mixture of fat cells and fibroblast-like spindle cells, ultrastructurally similar to fibroblasts, in a matrix with varying amounts of collagen and mucosubstances. The tumours showed a predominance for elderly men and all but one were situated in the posterior neck, shoulder region or upper back. The tumours varied between 1 and 9 cm, with a median value of 5 cm, in the widest diameter and were entirely or almost entirely situated in the subcutaneous tissue. A follow-up study of 11 patients, observed for 1-25 years, confirmed that the clinical course is benign. The differential diagnosis is discussed and it is emphasized that spindle cell lipoma is easily misinterpreted as sarcoma. Three tumours showed a pronounced nuclear polymorphism without mitotic activity, thought to be regressive in nature. The cellular change in these three tumours are presumed to be analogous with those in so called ancient neurilemmoma and therefore the name ancient spindle cell lipoma is proposed for the polymorphic spindle cell lipomas.
A case report of a girl with two foetal rhabdomyomas is presented. One tumour was a small cutaneous lesion present at birth in the left thigh and the other was located in the chest wall deeply in the subcutaneous tissue and attached to the adjacent intercostal muscle. The patient also had the naevoid basal cell carcinoma syndrome which lends credence to the opinion that foetal rhabdomyoma is a malformation rather than a true neoplasm.
Forty-two patients with pernicious anemia (PA) and 35 patients with achlorhydria but without PA were investigated by means of serum gastrin determination and estimation of circulating parietal cell and thyroidal autoantibodies. In 38 of the 77 patients, gastroscopic and histopathological examinations of the antral and corpus mucosa were performed. The patient groups were similar with regard to distribution of high and normal serum gastrin levels, the frequencey of autoantibodies and antrum-sparing atrophic gastritis. In the present selection of patients, therefore, the achlorhydria group was supposed to represent a precursor state of the group with PA. A minor proportion of patients with severe atrophic gastritis of the antrum as well as of the corpus mucosa was found in the two groups.