[Labial salivary gland biopsy in Gougerot-Sjögren's syndrome: a clinico-pathological, histoenzymological and ultrastructural study (author's transl)].
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Biomedical subjects
Publications and source records attributed to M Auriol.
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A scanning electron microscopic study of 40 oral mucosal smears from healthy controls or patients with cancer of the mouth has enabled a comparison of the "external" characteristics of normal, malignant and dysplastic (post-radiotherapeutic) cells. Normal cells, particularly the cells of the superficial epithelial layers, were characterized by well-defined polarized external protrusions with ridges on the upper surface and microvilli on the under surface. In cancer cells, both the shape and arrangement of these formations were profoundly altered. Dysplastic cells presented an intermediate appearance which was sufficiently characteristic to allow them to be distinguished from neoplastic cells.
A human His bundle was studied two hours after death by histoenzymological techniques and electron microscopy. The pathway had a much higher cholinesterase activity than the working myocardium, due to its richness in nerve endings: this was confirmed by electron microscopy which also distinguished "common" contractile cells (working cells) from P type and "intermediary" cells; those were by far the most common, presenting an ultrastructure identical to that of the Purkinje cells, classically described in the bundle branches alone. These findings and the unique longitudinal architectural organisation of the His bundle, confirm the studies of JAMES and may explain the rapidity of conduction in this structure.
Histo-enzymological and ultrastructural studies in 6 cases of cystadenolymphoma were able to confirm the marked metabolic activity of the oncocytic cells, which from the major part of these tumours. The oncocytes demonstrate greatly enhanced enzymatic activity, particularly of those enzymes concerned with oxydative metabolism and the diaphorases. Electron microscopy of the oncocytes shows that they are filled with mitochondria of very varied size and form, sometimes associated with the presence of several intracytoplasmic crystalloids. The second, lymphoplasmocytic component of these tumours present no particular morphological features.
Three cases of mandibular condyle metastasis of particular interest are reported: -- In two out of the three cases they were detected early enough for the primary tumour to be diagnosed; -- they all presented with articular symptoms; -- all three were treated surgically by excision of the condyles. Diagnosis was confirmed by histological examination, a rare event when mandibular metastasis are concerned, these usually being diagnosed after the primary tumour and then irradiated without histological proof. Primary tumours were respectively bronchial, pancreatic, and mammary.
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A case of post-traumatic desmoid tumor of the mandible is reported in a 4-year old girl. This tumor was considered typical clinically and by light microscopy. Four years later, the patient was symptomless, without evidence of recurrence. Histoenzymology showed a high level of leucine aminopeptidase activity. On electron microscopy, a part from a few primitive mesenchymal cells, abnormal fibroblasts represented the principal cellular component. These cells showed evidence of intracytoplasmic collagen fibers synthesis and of myoid differentiation (numerous filaments and endocytosis vacuoles). Myofibroblasts, with a microfibrillary network showing areas of dense osmiophilic condensation in the vicinity of cell membrane were also present. This atypical ultrastructural feature suggests, in this case, the non-neoplastic nature of this lesion. It seems to reflect an abnormal reaction to a traumatic aggression, characterized by proliferation of myofibroblasts (which normally disappear in the late stages of healing) and to have, thus, the signification of pathologic scar.
The ameloblastoma is usually thought to be devoid of any odontogenic capacity. However, the histological, ultrastructural and histoenzymological study of 5 cases demonstrates the fairly high level of differentiation of some ameloblastic cells in such neoplasms. Furthermore, it suggests very early stage of epithelio-conjunctive interaction. The tumours consist, in addition to stellate, squamous, clear and dark epithelial cells, of densely packed peripheral columnar cells similar to the differentiated ameloblasts of the inner epithelium of enamel organ (median nucleus, well-developed rough-surfaced endoplasmic reticulum, mitochondria and lysosomal-vacuolar system located in the distal end of the cells). Besides, the cytoplasmic membrane shows some pocket-like apical invaginations similar to early Tomes processes. On the other hand, similarly to physiological odontogenesis, an abundant amount of granulo-filamentous material is found along the lateral cellular membranes, and the basement membrane. This substance, sometimes, is intermingled with vertical collagenous fibers. In some areas, it is disrupted and cytoplasmic invaginations of epithelial cells, passing through these gaps, are connected with neighbouring mesenchymatous cells. In other respects, despite the lack of any odontoblastic differentiation, the high level of alkaline phosphatase activity found in these cells by means of histo and cytoenzymological technics, looks like that of odontogenic mesenchymal cells. These findings seem to demonstrate the histogenetic unicity of odontogenic tumours. These neoplasms, like the embryonary dental organ, are provided with two types of cells (epithelial and stromal cells). Thus, they are able to induce odontogenesis. But, in ameloblastoma, this power of induction is restricted to a very early stage of odontogenesis.
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Pathological examinations during autopsy of 1457 cases of cancer demonstrated the presence of metastatic pulmonary emboli in 10 p. cent (148 cases). The were divided, as a function of their site and histological type of the primary neoplasm, as follows: hepatoma 33 p. cent, chorioepithelioma 25 p. cent, endocrine glands 19 p. cent, biliary tract 17.6 p. cent, hypernephroma 15.6 p. cent, sarcoma 13 p. cent, and various other tumors such as cancer of the pancreas, and breast. Two anatomical types of these emboli can be distinguished: one mixed type associated with a pulmonary cancerous lymphangitis (90 cases), and observed at a later stage in the disease. This may be latent or cause a subacute cor pulmonale. The other type is not associated with lymphangitis (58 cases), results from hematogenic cancers (hepatoma, hypernephroma, etc...), is often seen at an early stage, and causes sudden death. Histological examination enabled the consequences of any infarct developing as a result of the emboli to be demonstrated, and the origin of the emboli from neoplasmatic thromboses in the primary cancer drainage routes or from metastases in the liver to be determined.
A comparative light microscopy, histoenzymological and ultrastructural study enabled the authors, in a case of invasive lobular carcinoma of the breast, to emphasise certain special morphological traits of this tumour type and to make a contribution to the understanding of its histogenesis. By light microscopy, the only special features of the case were the abundance of mucus secreting tumour cells in the perilobular infiltrating zones and in the stromal texture with marked perigalactophoric hyalinosis and active elastic neogenesis. From an ultrastructural standpoint, intralobular malignant zones contained epithelial type cells, rich in microfilaments and with numerous desmosomal junctions. Two other cell types were identified at the periphery of the lobules. On consisted of round cells with intracytoplasmic cavities filled with mucus (signet ring cells). This group, in common with the intralobular cells, contained abundant amounts of alkaline phosphatase. The other consisted of elongated "pseudo-fibroblastic" cells, rich in microfibrils and in granular ergastoplasm with secretion at points of contact of collagen and elastin. These cells showed marked ATPase activity. They no doubt represented "hybrid" cells, intermediate in terms of their morphology and enzyme activity between myoepithelial and epithelial cells. These findings would thus appear to offer arguments in favour of the double cell origin -- duct and myoepithelial -- of lobular carcinoma.
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Ear cartilage has been studied by histochemistry, histoenzymology, immunofluorescence and electron microscopy in three cases of relapsing polychondritis. The most significant lesions have been observed at the cellular level, both by enzymology and electron microscopy: chondrocytes of peripheral zones seem to be first hypertrophic and then necrotic; at the opposite, their is no correlation between histochemical and electron microscopic studies about the chondroid intercellular substance whom lesions are probably secondary to the cellular ones. A few chondrocytes are positive with antiimmunoglobulins sera (IgM and IgA); this fact could be a proof of the dysimmune nature of this disease.
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Using an experimental model of genetic diabetes (DBM mouse) a comparison was made of the results of quantitative data obtained by light and electron microscopy (measurement of glomerular and mesangial surface areas, assessment of the thickness of the basal membrane and its irregularities) and was used to demonstrate the actual presence of glomerulosclerosis in the renal parenchyma of 31 diabetic animals. In addition, immunofluorescent investigations in these same animals demonstrated the presence of serum proteins (in particular immunoglobulins and albumin) in the glomerulus and the tubular basal membrane. These substances transude through the vessels as a result of increased vascular permeability. In this area, membrane abnormalities are not a consequence of hyperglycaemia. In the group, one batch of animals in which hyperglycaemia was partially reduced by glycoregulatory therapy showed the same glomerular changes. Amongst other factors, the possible role of hyperinsulinaemia constantly present in these animals, regardless of their blood glucose level, is worthy of considération.
During the course of 6 000 autopsies, the number of cases of non-bacterial thrombotic endocarditis discovered was 130 (absolute frequency of 2.1 p. cent). Frequency was highest among patients with cancer, of which there were many in this series (4 p. cent of 2 287 autopsies). In 83 p. cent of cases, therefore, the endocarditis was of paraneoplasic origin, usually associated with adenocarcinomas, especially those of bronchopulmonary, pancreatic or gastric origin. Less frequently, they developed during the course of shock or debilitating affections. The endocarditis lesion consists of a coagulated fibrin and platelet mass without microbial germs, located electively on the mitral and aortal valves. Emboli are a frequent consequence (47 p. cent of cases) affecting primarily the central nervous system, the kidneys, spleen, and hart. Ischemic effects of these latter, observed in 75 p. cent of cases, are generally latent. In some cases they produce clinical manifestations, and they may be the cause of death from a cerebral or myocardial infarct. Pathological examination demonstrates the frequent association of these endocarditis lesions with often multiple vascular thromboses, and disseminated intravascular coagulation affecting the same regions as the emboli. This emphasizes the major role of coagulation disorders in their genesis.
Comparative ultrastructural and histoenzymological study of 10 osteogenic (4 osteosarcomas), osteolytic (3 benign giant cell tumours, 2 malignant osteoclastomas) and fibrosarcomatous osseous tumours of the jaw emphasised the analogies between osteoblasts and fibroblastic stromal cells of giant cell tumours. These two cell types, with their abundant granular ergastoplasm, secrete a collagen interstitial fibrillary substance which is capable of secondary calcification. Their enzyme activities, with regard to oxidative mechanisms and protein synthesis are identical. Osteogenic activity as assessed by ATPase and alkaline phosphatase, more marked than in osteosarcomas, is also found in the stroma of benign giant cell tumours. With regard to the plasmodes characteristic of giant cell tumours, they are certainly original from both a morphological and enzymological standpoint : richness in mitochondria and lysosomes, intensity of oxidative reactions (B.O.H.B.D. +++). Nevertheless, the morphological appearances seen would be more in favour of their stromal origin than in their arising from monocytes-macrophages coming from the blood.