Biomedical subjects
Publications and source records attributed to R Mir.
This is the first reported case of a Merkel cell carcinoma arising in the oral mucosa. The tumor occurred in a 53-year-old white man, and it originated in the right mucobuccal fold. The Merkel cell origin was confirmed by electron microscopic and immunohistochemical studies.
A metastatic neuroblastoma arose in a posterior mediastinal tumor that had been present for at least 52 years. The diagnosis of neuroblastoma was first made when the patient was 81 years of age from biopsy of a metastatic lesion to the femur and later from biopsy of the mediastinal mass.
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The estrogen receptor (ER) status of breast cancer is important as an indicator of prognosis and in the selection of patients for endocrine therapy. Biochemical techniques (estrogen receptor analysis [ERA]) are conventionally used to determine ER; however, they have limitations and disadvantages. In this study a monoclonal antibody to ER (estrogen receptor-immunochemical assay [ERICA]) was used to detect the presence of ER on cytologic and frozen tissue specimens of breast cancers and was compared with the dextran-coated charcoal assay. One hundred two breast cancers were studied. Ninety-four specimens were studied by ERA and ERICA; in eight patients in whom tissue was insufficient for ERA, ERICA alone was performed. ERICA correlated remarkably well with ERA: 94% sensitivity, 89% specificity, and 93% accuracy. In the eight patients in whom ERA could not be performed, ERICA was successfully applied to obtain information regarding receptor status. There was uniform agreement between frozen-sectioned tissues and cytologic smears. The results suggest that immunocytochemical determination of ER is a valuable adjunct and/or alternative to the biochemical method for determination of the ER status of breast cancers.
A retrospective study of 76 primary gastrointestinal lymphomas utilizing an avidin: biotinylated horseradish peroxidase complex (ABC) technique demonstrated 22 B-cell lymphomas, including two associated with alpha-heavy chain disease. Seven cases were classified as true histiocytic lymphomas based on a positive reaction for one or more of three histiocytic enzyme markers utilized, predominantly alpha-1-antitrypsin and alpha-1-antichymotrypsin. However, in 20 cases, an intense admixture of reactive histiocytes was noted and these cells stained preferentially for the enzyme, lysozyme. Twenty cases, which stained for both kappa and lambda light chains and positively or negatively for albumin, could not be classified and 27 cases failed to stain with any of the antisera utilized.
Review of the literature reveals that postradiation chondrosarcoma is a rare secondary malignant bone tumor. This case report demonstrates a Grade 1 chondrosarcoma of the proximal right clavicle in a 17-year-old boy, eight years after extensive chemotherapy and radiation therapy for a Stage IIB Hodgkin's disease.
Trichomatricial carcinoma has been recently recognized as a rare malignant variant of pilomatricoma with a potential for local recurrence and, rarely, for distant metastases. We describe such a tumor in a 52-year-old man who developed local recurrence and axillary lymph node metastases within six months of local excision, followed by bilateral pulmonary metastases and 2 1/2 years later by death due to disseminated tumor. This, to our knowledge, is the second reported case of metastasizing trichomatricial carcinoma.
This report describes an unusual case of bilateral metachronous granulocytic sarcoma of the breast. The patient initially did not have evidence of leukemia and her marrow cell culture in soft agar (CFU-C array) showed normal in vitro growth pattern. The patient was treated with systemic chemotherapy at a time when there was no evidence for systemic disease but she nevertheless developed meningeal leukemia and bone marrow disease 11 and 18 months, respectively, following the initial chemotherapy.
This is the third in a series of articles dealing with oral presentations in non-Hodgkin's lymphoma. In this section the authors discuss the clinical and microscopic features of six cases occurring in children, four of which qualified as Burkitt's lymphoma.
We describe a predominant extranodal involvement of unusual sites by sinus histiocytosis with massive lymphadenopathy (SHML). The patient first presented at 13 years of age with bilateral parotid gland enlargement and was discovered to have a large asymptomatic left renal mass and adjacent hilar adenopathy, histologically diagnostic of SHML. Following a left nephrectomy, he remained well with persistent parotid and lacrimal gland disease and, 20 years later, plaquelike meningeal involvement mimicking meningioma en plaque developed that was associated with reactive meningeal nests within the body of the lesion. At no time during the last 20 years has there been a recurrence of significant external nodal enlargement, and biopsy specimens of neck and intrathoracic lymph nodes have been nondiagnostic of SHML.
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Primary gastrointestinal lymphomas (PGLs) are the most frequent extranodal non-Hodgkin's lymphomas and involve stomach more commonly than small bowel in Western countries. PGLs need to be differentiated from a variety of tumor-like hyperplastic lymphoid lesions; this may be facilitated by immunotyping of lymphoid cells. In PGLs, large-cell types predominate. Our study of 76 PGLs utilizing the ABC immunoperoxidase technique has led us to conclude that the majority are of B cell origin and that, while true histiocytic PGLs do indeed exist, their incidence is not greater than in nodal lymphomas. An important observation was that 26% of the cases showed an intense admixture of muramidase-positive reactive histiocytes, a feature that could result in an erroneous impression of a histiocytic derivation of the neoplasm. The prognostic significance of immunologic subtypes is currently not known. However, survival in PGL is determined by the clinical stage of the disease and to a lesser extent by the histologic type. Current optimal therapy includes resection of tumor-bearing bowel followed by radiotherapy and/or chemotherapy.
An osteogenic sarcoma occurring in a 22-year-old woman was found to be associated with production of a large amount of beta human chorionic gonadotrophin (B-hCG). Pregnancy was excluded on the basis of a normal ultrasonogram and a proliferative type endometrium obtained by curettage. A homogenate of the tumor was strongly positive for B-hCG while immunohistochemical staining of the tumor cells was strongly positive for B-hCG and negative for pregnancy associated glycoprotein. These results indicate ectopic production of hCG by the osteosarcoma.
In a series of 31 patients with NHL presenting in the oral region, nine lesions were in the maxilla and 5 were in the mandible, for a total of 14 (45%) lesions that arose in bone. The most common locations were the posterior regions of the maxilla (7 cases) and mandible (4 cases). Diffuse subtypes clearly predominated, 13 out of 14 cases demonstrating this pattern. Six of the cases were in children, and 4 of these qualified as Burkitt's lymphoma. In general, it was found that the statistics relating to survival of patients with jawbone lymphoma correspond closely to the findings reported for skeletal lymphomas. Despite the high incidence of diffuse patterns, 6 of these 14 patients with NHL in bone were alive with no evidence of disease 3 years or longer.
An immunoperoxidase study of 20 cases of Hodgkin's disease demonstrated universal staining of Reed Sternberg cells and their mononuclear variants for both kappa and lambda light chains and, in all but one case, for IgG. Staining for IgA and albumin was variable and for IgD and IgM uniformly negative. A double staining procedure using two different chromogens produced the paradoxical finding of both light chain types within the same cell, but these could only be demonstrated sequentially and not simultaneously, suggesting a blocking phenomenon. The above findings coupled with the demonstration of muramidase and/or alpha-1-antitrypsin in Reed-Sternberg cells and their mononuclear variants in all but two cases studied favor a histiocytic origin for these cells. This characteristic profile of results is also very helpful in distinguishing Hodgkin's disease from other neoplasms which mimic Hodgkin's disease because of the presence of Reed-Sternberg-like cells.
Thirty-one patients with oral manifestations of non-Hodgkin's lymphoma have been studied with reference to age, sex, race, location of lesion in oral cavity, stage of disease on presentation, duration of disease at time of presentation, histologic type, modes of treatment, and survival. There were 6 children and 25 adults, ranging in age from 3 to 89 years. Only 2 of the 31 patients were black. Sex incidence was almost equal, with 17 females and 14 males. In 12 cases the oral findings alone represented the initial presentation of lymphoma. The maxilla, mandible, and palate accounted for 24 of the 31 cases. The preponderance of diffuse histologic patterns was striking (77.4 percent). Eighteen cases (58.0 percent) presented in Stage I or Stage II, indicating relatively limited extent of disease. More generalized involvement was found in the remaining thirteen cases (41.9 percent). Thus, although NHL may appear in the oral region as the first detected evidence of disease, in many patients a work-up will show that the process is widespread in distribution. In this brief series survival data coincide with the established principles that a poorer prognosis is associated with the diffuse histologic pattern, as well as certain identified histiocytic and poorly differentiated lymphocytic subtypes.