Benign cystic teratoma of the fallopian tube.
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Biomedical subjects
Publications and source records attributed to W Jao.
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A metastasizing fibrous histiocytoma arising in the lung of a patient who received radiation therapy and long-term chemotherapy for malignant lymphoma is presented. Ultrastructural studies revealed fibroblast-like and histiocyte-like cells, cells of intermediate type showing ultrastructural features of both fibroblast-like and histiocyte-like cells, primitive mesenchymal cells, multinucleate tumor cells, and xanthomatous cells. The neoplastic cells showed dilated rough endoplasmic reticula with intracisternal accumulation of electron-dense material forming lattice-like structures. Direct immunofluorescence staining of the neoplastic cells using antihuman alpha 1-antitrypsin showed specific activity, with fluorescent deposits exhibiting interlacing globular formations. These findings and their implications are discussed.
This case report illustrates the value of ultrastructural examination of an undifferentiated carcinoma mestastatic to skin. In this patient, ultrastructural study of a cutaneous nodule demonstrated cytoplasmic neurosecretory granules characteristic of an amino precursor-uptake and decarboxylation cells (APUD) tumor and supported the diagnosis of metastatic bronchial carcinoid. Additional nine cases of bronchial carcinoids metastatic to skin are also briefly reviewed.
Severe hypokalemia (2.6 mEq/l), hypomagnesemia (0.6 mg/dl), mild hypercalcemia (10.9 mg/dl), and secondary hyperaldosteronism developed in a patient receiving viomycin for pulmonary tuberculosis. Reversible renal wasting of both potassium (K+) and magnesium (Mg++) was documented. Viomycin administered to 40 rats resulted in severe damage to the proximal tubule and mild damage to the distal tubule. THe case report and experimental data suggest viomycin induces proximal tubule dysfunction that results in renal wasting of sodium, K+ and Mg++ and secondary hyperaldosteronism. Hypercalcemia, not previously associated with viomycin therapy, may be secondary to hypomagnesemia-induced hyperparathyroidism.
Seven cases of mucinous (colloid) breast carcinoma were studied by electron microscopy. In addition to the predictably abundant mucosubstance production, the following observations merit elaboration: 1) absence of myoepithelial differentiation and basal lamina deposition, 2) notably developed cytoplasmic filamentous systems and relatively scarce lysosomes, 3) frequent and apparently well-developed intercellular junctions, and 4) a distinct paucity of vessels in the tumors' stroma. The rather favorable clinical prognosis of mucinous breast carcinoma despite the absence of myoepithelial differentiation and basal lamina deposition parallel observations made on medullary and tubular breast carcinomas, thus confirming that those parameters, however important, are not the sole determinants of an aggresive behavior. The conspicuous cytoplasmic filaments appear to be neither true myoepithelial filaments or tonfilaments. The peculiar arrangement of these contractile proteins and the suspected sarcity of lysosomal collagenases may be reflected in the rather low invasiveness of these carcinomas. Another factor that may impact favorably on the cohesiveness of these neoplastic cell clusters is the presence of abundant and well-developed intercellular junctions. We further speculate that the paucity of stromal vessels in these neoplasms may be the result of as yet unidentified factors that might inhibit angiogenesis.
This study was undertaken to determine the incidence and significance of enlarged mitochondria ("swollen" or "giant") in individuals with various forms of liver disease and in patients with idiopathic nephrotic syndrome. Enlarged mitochondria were observed in 20/30 liver biopsies and in 24/45 renal biopsies. They were present in hepatocytes but not in the bile duct epithelial cells and in the epithelial cells of both proximal and distal convoluted tubules of the nephron. The available experimental data indicate that enlargement of this organelle is associated with inhibition of mitochondrial respiration and uncoupling of oxidative phosphorylation. Mitochondrial swelling follows almost universally every type of cell injury but megamitochondria with intramatrical crystals appear only under certain conditions. No explanation is available for their common presence in various forms of human disease.
In 1967, Mehregan et al described a new and distinct clinicopathologic entity that they called reactive perforating collagenosis (RPC). This rare disease is classified with a group of disorders that involve the transepithelial elimination of histochemically altered dermal tissue. In RPC, minor trauma such as an insect bite, scratch, or pilosebaceous infection alters the collagen fibers in the papillary dermis. The histochemically altered but ultrastructurally intact collagen elicits both a dermal and epithelial response. For the case presented, it is our purpose to demonstrate transepithelial elimination of collagen fibers by ultrastructural study, thereby supporting the recognized histochemical observations.
Four chronic heroin addicts had renal amyloidosis and the nephrotic syndrome. Amyloidosis had the secondary type of tissue distribution and developed after many years of addiction. That chronic immunologic stimulation by one or more exogenous antigens or multiple acute inflammatory episodes were important factors in the pathogenesis of amyloidosis in these patients is postulated. Amyloidosis, although uncommon, must be considered among the different types of renal involvement that are known to occur in drug addicts, especially those with the nephrotic syndrome, and amyloid should be specifically searched for in their renal biopsies.
Two hibernomas, 16 myxoid, and eight pleomorphic liposarcomas were studied by transmission electron microscopy. Neoplastic cells in hibernomas and the type I cells--adipocytes--in myxoid liposarcomas consistently display abundant lipid droplet populations and prominent basal lamina deposition. Despite some variability in their distribution, these features clearly pertain to the mature and/or maturing characteristics of brown and white adipose cells. On the other hand, the more primitive type II cells of myxoid liposarcomas display highly variable, and occasionally absent, lipid droplet populations and basal lamina deposition. Moreover, the type II cells may also display other features such as prominent cytoplasmic filaments and rough endoplasmic reticulum that, while not characteristic of typical adipose cells, are still consistent with the more primitive mesenchymal cells from which they are assumed to derive. The cells of pleomorphic liposarcomas exhibit a variable lipid droplet population and apparently total absence of basal lamina deposition. Moreover, they often display atypical cell junctions that are neither characteristic for adipose cells nor for the "primitive reticular cells" from which adipocytes presumably derive. These observations would suggest that some "high grade" sarcomas may no be truly "undifferentiated"; rather, they may often display structural characteristics indicative of multiple as well as variable lines of differentiation. Therefore, classifications of such tumors based on quantitatively limited observations may not truly reflect their evident complexities.
Sixteen cases of breast fibroadenomas and 11 of adenosis were studied ultrastructurally; emphasis was placed on the patterns of myoepithelial differentiation and the number and appearance of the basal laminae. Ducts of both fibroadenomas and adenosis showed well differentiated, peripherally arranged myoepithelial elements with conspicuous cytoplasmic filaments and numerous hemidesmosomes; focal myoepithelial multilayering occurred. Myoepithelial cells exhibited complex, convoluted cytoplasmic processes extending into the stroma and resulting in the formation of pseudocysts containing stromal material. Basal lamina deposition was invariably found; basal lamina reduplication was extremely frequent. Basal lamina discontinuities with cytoplasmic processes extending directly into the stroma were seen in adenosis. Myoepithelial features and conspicuous basal lamina deposition indicate advanced differentiation and correlate well with the benign prognosis of these lesions. The focal basal lamina gaps in adenosis may be significant in the long-term evolution of this and similar dysplastic processes.
This ultrastructural description of human thyroid cancers is based on the available literature and on our own studies of about 150 cases. Electron microscopy is an invaluable diagnostic adjunct to light microscopy, as it may eliminate inaccurate designations such as "small cell malignant tumors of the thyroid," which include tumors of different histogenetic origin with a different prognosis and treatment that share only a similarity in appearance under the light microscope. Ultrastructure is also of diagnostic importance in cases of medullary carcinoma that imitate papillary or follicular patterns or lack amyloid stroma. Its importance in separating follicular adenomas from carcinomas, however, has not been proven. In conjunction with other methods ultrastructural study might throw new light on the controversial classification of papillary and follicular carcinomas and improve our understanding of their different biologic behavior. Immunoelectron microscopy may help in solving the problem of amyloid pathogenesis in endocrine tumors and in charting the subcellular mechanisms involved in the production of multiple polypeptide hormones in a single tumor.
Heavy proteinuria and/or the nephrotic syndrome rarely occur late in pregnancy. We report the clinical and renal biopsy findings on 11 patients with the nephrotic syndrome occurring during pregnancy in whom light and electron microscopic findings were characteristic of pre-eclampsia. Immunofluorescent microscopy revealed deposits of IgG, IgM, IgA, beta 1C globulin, and fibrinogen, predominantly in the subendothelial position. Only two patients were primigravid; three were in their second or third pregnancy; in six, pre-eclampsia first occurred in the fourth to eighth pregnancy. Clinical abnormalities appeared first between the 23rd and 39th week of gestation. All patients had marked elevation of blood pressure and of serum uric acid levels. Of the 12 infants, eight were alive and well, including one set of twins; four were stillborn. Following delivery, clinical resolution was similar to that in less severe pre-eclampsia. The findings suggest the possible importance of the role of intravascular coagulation in the genesis of pre-eclampsia.
Large forms of Candida are characteristically present in invasive lesions and are often cleared by host defenses. Therefore, an in vitro system was developed to study interactions between leukocytes and pseudohyphae. By light, phase contrast, and electron microscopic observations, in the absence of serum, neutrophils attached to and spread over the surfaces of partially ingested pseudohyphae, which then appeared damaged. Using a new assay which measured neutrophil-induced inhibition of uptake of [(14)C]cytosine by Candida, damage to Candida in the absence of serum was 53.04+/-2.96% by neutrophils from 27 normal subjects. With serum, damage to Candida increased because of opsonization by low levels of anti-Candida immunoglobulin G in normal sera. Damage to Candida was inhibited by colchicine, cytochalasin B, and 2-deoxyglucose, which interfered with spreading of neutrophils over the surfaces of Candida. Dibutyryl cyclic AMP, theophylline, and isoproterenol also inhibited damage to Candida. Hydrocortisone was inhibitory in levels (10 muM) achievable with pharmacologic doses in man. Light, fluorescence, and electron microscopy indicated that neutrophils degranulated after contact with Candida. Quantitative studies revealed only a minimal increase in specific release of lysosomal enzymes from azurophil granules, but much greater release of lysozyme from specific granules. Candida activated neutrophil oxidative microbicidal mechanisms, as shown by iodination of Candida by neutrophils, and chemiluminescence from neutrophils interacting with Candida. Unlike live Candida, killed Candida did not induce chemiluminescence, were not iodinated, and did not attach to neutrophils by microscopy. Like Candida pseudohyphae, contact between neutrophils and hyphal forms of Aspergillus and Rhizopus occurred in the absence of serum. This did not occur with Cryptococcus neoformans, an encapsulated yeast, and was low with Candida yeasts. These findings indicate that neutrophils can recognize and attach to Candida pseudohyphae, then damage the Candida. This may represent a general reaction between neutrophils and large forms of fungi. Though the size of the organisms precludes complete ingestion, neutrophil oxidative microbicidal mechanisms are activated, and preferential release of contents of specific granules appears to occur.
Evidence suggests that neutrophils are important in host defenses against invasive aspergillosis and mucormycosis, although hyphae in these lesions are too large to be phagocytized. Interactions of neutrophils with hyphae of Aspergillus fumigatus and Rhizopus oryzae were studed in vitro. Light and electron microscopic observations indicated that neutrophils attached to and spread over the surfaces of hyphae, even in the absence of serum. This was followed by dramatic morphologic changes which suggested severe damage and probably death of hyphae. An assay of neutrophil-induced reduction of uptake of radioisotopes was used to quantitate damage to the fungi by neutrophils from normal subjects. Damage to hyphae was inhibited by a variety of compounds which are known to affect neutrophil surface functions, motility, and metabolism. Use of inhibitors of oxidative microbicidal mechanisms of neutrophils indicated the central importance of these mechanisms in damage to hyphae. Inhibitors of neutrophil cationic proteins altered damage only to Rhizopus. Damage to hyphae by lysozyme suggested that it may play a secondary role in the neutrophil, primarily against Aspergillus. This new nonphagocytic mechanism may play an important role in host defenses against these and other hyphal forms of fungi.
A patient with multiple myeloma had severe cutaneous and gastrointestinal xanthomatization and symptoms characteristic of systemic sclerosis. Clinical findings included thickened sclerotic skin, dysphagia associated with an akinetic esophagus, and abnormal findings on roentgenograms of the upper and lower gastrointestinal tract. Biopsy specimens obtained from the skin and the gastrointestinal tract studied by light and electron microscopy showed thickening, hyalinization, and xanthomatization of the subepithelial connective tissue. Macrophages containing lipid vacuoles were shown to assume a perivascular orientation on ultrastructural study. Our case appears to be unique since this combination of findings has not been reported previuosly. In addition, our electron micrographs may help to define better the pathogenetic process involved in the association between myeloma and plane xanthomata.
A strumal carcinoid arose in a benign cystic teratoma of the ovary. Ultrastructural studies demonstrated that both the solid acinotubular areas as well as the "follicular" components were comprised of light and dark cells that contained numerous secretory granules. These findings indicate that this neoplasm is a pure carcinoid tumor with a follicular pattern. The present study raises the question of whether all strumal carcinoids are indeed pure carcinoid neoplasms.