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A Leydig cell tumor of testis was discovered during evaluation of infertility in a 36-year-old white man with azoospermia and high plasma estrogen level. Histological examination revealed multiple foci of calcification and massive adipose metaplasia. This is the first time that adipous metaplasia is observed in association with Leydig cell tumor of testis.
The histogenesis of gastric cancer is still hypothetical. A major difficulty in attempting to define the different steps of gastric carcinogenesis is the great confusion of terminology concerning the epithelial abnormalities, such as metaplasia and dysplasia. The author proposes the following definitions. Metaplasia is the transformation of a normal tissue into another normal tissue with different structure and functions. Hyperplasia is characterized by an increased number of cells but without modification of tissue organization. Neoplasia is a tissue neoformation linked to an excessive cell proliferation. Dysplasia, in gastric pathology, is an acquired abnormality of cell multiplication implicating evolution toward malignity but with phenotype expression confined only to the epithelium. Based on strict morphological criteria, the diagnosis of dysplasia leads to the diagnosis of intra-epithelial carcinoma, which is important for the preventive treatment of gastric cancer.
Discussed is a 33-year-old premenopausal woman who noted a mass in her right breast. On palpation, the tumor was determined as being 3.5 x 2.5 cm in size, well circumscribed, of a firm consistency, and freely movable. Mammography showed a well-defined oval lesion which contained a coarse calcification in the upper external quadrant. An ultrasound study revealed a well-defined oval low echoic lesion with a high echoic portion in the internal echo. The tumor was extirpated and a gross inspection found it to be an ordinary fibroadenoma, 3.2 x 2.5 x 1.5 cm in size. Histologically the lesion was a hyalinized fibroadenoma showing osseous metaplasia. A review of the literature has not revealed cases of a benign breast tumors showing an osseous and/or cartilagenous metaplasia. Notable however is that many reports show mammary osteosarcomas as originating from a fibroadenoma. Thus, this tumor also might have possibly developed into a osteosarcoma.
260 ulcers and 128 cancers were found by means of stomach biopsies. Analyzing the coincidence of ulcer resp. cancer with intestinal metaplasia or fungus contamination about double the frequency of linkage to intestinal metaplasia (26% versus 15%) and likewise to fungus contamination (13% versus 7%) could be ascertained.--The figures in the combinations of cancer resp. ulcer with fungus infection and IM (4% cancer; 2% ulcers) were strikingly low. This is to be explained by an increased immunologic defense function of the intestinalised stomach mucosa.--Following demands of practice any neoplastic process with ulcerated fungi-contaminated lesion of stomach mucosa has to be safely excluded.
The authors report a case of necrotic metaplasia of the salivary glands and review the principal clinical, histological, and evolutional characteristics of this rare affection of unknown etiology. The lesion occurs in adults, is located exclusively in the palate and appears as a small usually greatly ulcerated swelling which is sometimes preceded by pain. Histological examination, which requires a relatively deep and fairly large sample, demonstrates a group of modifications essential for diagnosis: ulceration on a inflammatory base with hyperplasic epithelial borders, plus deeper accessory salivary lobules with necrotic plaques and a great deal of malpighian metaplasia, and conservation of normal gland structure. This affection, which is sometimes wrongly diagnosted as a tumor, heals spontaneously within several weeks, which contra-indicates any strong therapeutic measures.
Nephrogenic metaplasia of the bladder is rare; less than one hundred cases have been reported. Four personal cases and 16 cases reported in the literature concerning renal transplant patients demonstrate that the frequency of this disease is much higher in this group than in the general population. The symptoms and signs, age of onset, macroscopic and microscopic appearance of the lesions correspond to the description in non-transplant patients, apart from the preferential site adjacent to the reimplanted ureter and the presence, in two cases, of cells with virus-like inclusions, one of which corresponded to CMV infection. The traumatic factor in these patients is not sufficient on its own to explain the relative frequency of this lesion in renal transplant patients. The role of immunosuppression, resulting in a reduction of "immunological surveillance", is possible; this metaplasia usually has a benign course, but this high risk population must be carefully monitored for the development of this lesion.
Blood enzymatic activities in gastric carcinoma depend on the release from carcinomatous tissues, surrounding non-neoplastic tissues, increased permeability and necrosis of carcinomatous tissues. However, those enzymatic activities did not parallel the extent and macroscopic appearance of the tumor. Various enzyme proteins and gastrointestinal hormones concerning gastric carcinoma and intestinal metaplasia including pepsin, LDH, AFP, beta-glucuronidase, rGTP, lysozyme, ferritin, sialic acid, polyamine, CEA, Ca 19-9, collage, gastrin, immunoglobulin are discussed in this paper. The variation of enzymes and proteins occurring in gastric carcinoma and intestinal metaplasia are well documented. Some of them would be a useful indicator of diagnosis and treatment as a tumor marker.
Histological and histochemical evaluation of 33 biopsies and 8 distal esophagectomy specimens revealed specialized columnar epithelium with intestinal features [intestinal metaplasia (IM)] to be the most common type (91%) of metaplasia in Barrett's esophagus (BE). Junctional epithelium was found in only 3 of the 33 biopsies. The type III subvariety of IM (TIII-M), characterized by the presence of sulfomucins in the non-goblet columnar cells, was found in 58% of all our biopsies and 62% of operative specimens. Six of the 7 cases of epithelial dysplasia were associated with TIII-M; one of them subsequently developed an adenocarcinoma. The transitional epithelium adjacent to adenocarcinomas in the operative specimens also showed TIII-M in five of six cases. Our findings indicate that TIII-M is almost as common in Barrett's-associated carcinoma as in nonneoplastic cases of BE, thereby limiting the usefulness of this histological marker as an indicator of neoplastic change (P = 0.5). On the other hand, TIII-M seems to be significantly associated with mild dysplasia in BE. The value of TIII-M as a prognostic indicator regarding the subsequent development of esophageal carcinoma remains in doubt and could be more precisely assessed by a prospective study.
In recent years scanning electron microscopy has been used in gastric biopsy studies, contributing to better recognition of intestinal metaplasia and carcinoma, as a complement to light and transmission electron microscopy. During the second half of 1983, 53 cases of gastric carcinoma were diagnosed at the Department of Pathology of Hospital Mexico, of which six were studied ultrastructurally. A pattern similar to that of intestinal epithelium was found in cases of intestinal metaplasia. Well differentiated adenocarcinomas showed marked tumor cell proliferation with irregular "projections". In poorly differentiated carcinomas, changes were limited to areas where tumor cells invaded the epithelial surface. In summary, scanning electron microscopy is of great help in research and diagnosis of pathologic changes occurring in mucosal surfaces.
Monoclonal antibody B72.3 recognizing a pan-associated carcinoma antigen expressed also in metastatic human breast cancer cells has been tested using the avidin-biotin peroxidase method applied to paraffin-embedded sections in 50 samples of mammary tissue showing apocrine metaplasia and in 58 cases of other mild or severe focal epithelial proliferative changes of the breast, including mostly in situ lobular or ductal carcinomas collateral to clinical cancer removed after radical mastectomy. The antigen detected by this antibody was present in the apocrine cells of 48 cases (96%). In the majority of these cases the reactivity was localized on the luminal border of the apocrine cells and in the luminal secretion. But ten cases showed positive staining also in the cell cytoplasm either focal or diffuse. The normal structures and mild focal hyperplastic changes collateral to clinical cancer were, in the majority of the cases (43 of 55), negative, and, when positive, displayed positivity only at the luminal border. By contrast, the independent foci of in situ carcinoma (17 of 31 examined), the intraduct papillomas (seven cases of 14), and the intraductal component of breast carcinoma (seven cases of 17) were positive, displaying a cytoplasmic focal or diffuse staining. In conclusion, mammary apocrine metaplasia, a metaplastic change of the normal epithelium that has been associated with increased breast cancer risk, shares antigens in common with breast cancer cells and/or with cells showing severe atypia. The possible clinical significance of the site of antigenic expression (cytoplasm or luminal border) needs further investigation.
A 41-year-old woman underwent a fractional dilatation and curettage for menorrhagia and a diagnosis of adeno-acanthoma was made from the curettings. However, the subsequent hysterectomy and bilateral salpingo-oophorectomy specimen revealed the presence of a clinically undiagnosed tubal pregnancy and extensive immature squamous metaplasia (morules) of the endometrium. No malignancy was present. A review of the original curettings lead to the recognition of the benign lesion already present at that stage. Difficulties in the differential diagnosis are discussed. The presence of endometrial polyps is considered as a possible factor responsible for the morular metaplasia rather than the tubal pregnancy, which seems to be a previously undescribed and interesting coincidence.
The diagnosis of chronic gastritis can be made from the macroscopic lesions seen on endoscopy, and the severity of the changes noted in the mucosa after biopsy under direct vision. Gastric intubation can also be used to confirm the pathological results. If the atrophied mucosa shows highly differentiated diffuse intestinal metaplasia, the examinations should be repeated at regular intervals, as they could herald the onset of malignant changes. The authors discovered 312 cases of intestinal metaplasia in 4 920 patients who had been gastroscoped in the Digestive Endoscopy Center of François-Moutier. A total of 157 of them, were noted to have very highly differentiated diffuse lesions, and 54 of these cases had at least yearly repeat gastroscopies. A diagnosis of intrinsic cancer was made in four patients, and this was confirmed by taking serial sections of the specimens removed.
Metaplasia of bile duct epithelium was studied clinicopathologically in 36 autopsy cases (Group-A), 18 surgical cases of obstructive jaundice without bile duct carcinoma (Group-B) and 56 surgical cases of bile duct carcinoma (Group-C). The results were as follows: In Group-A there were 24 cases with metaplastic pyrolic glands, and no metaplastic goblet cells. In group-B, there were 16 cases with metaplastic pyrolic glands, 2 cases with metaplastic goblet cells and 1 case with enterochromaffin cells. The mucosa of non-tumorous region of Group-C had metaplastic pyrolic glands in 46 cases, metaplastic goblet cells in 14 cases, enterochromaffin cells in 2 cases and intestinal absorbtive epithelia in 5 cases. In the tumorous region, however, tumor cells with goblet vesicles (malignant goblet cells) were seen in 31 cases, malignant intestinal absorptive villi were in 18 cases, malignant enterochromaffin cells were in 8 cases. Thirty one cases with malignant goblet cells were classified as intestinal type of the bile duct carcinoma (I-type). And 25 cases without malignant goblet cells were classified as non-intestinal type of the bile duct carcinoma (non-I-type). Conclusively, these clinicopathological findings suggest that I-type and non-I-type in the carcinoma of the bile duct are identifiable and I-type in the carcinoma of the bile duct are identifiable and I-type may arise from the lesion with intestinal metaplasia of the benign epithelia of the duct.
The results of recent histopathologic studies of the nasal mucosa in nickel workers show that, in addition to metaplastic changes, there are frequently dysplastic alterations which are probably preneoplastic lesions. Seen by scanning electron microscopy metaplasia appears monomorphic and no major qualitative differences exist between nickel workers and controls of the same age although it tends to be more pronounced in the former group. Dysplasia and carcinoma, on the other hand, are characterized by considerable polymorphism in surface features which make distinction from metaplasia simple. In both dysplasia and carcinoma four defined types of surface can be distinguished: globule- and tongue-like structures, pleomorphic microvilli and microridges. In addition, parts of individual cells and adjacent cells often show a considerable variation in surface pattern. The surface structures are dynamic features and changes in these are related to the degree of maturation, genetic and metabolic properties of epithelial cells.
A follow-up study including endoscopic examinations was performed on patients previously (23--27 years earlier) treated with partial gastrectomies for benign ulcer disease. From 106 patients satisfactory biopsy specimens were obtained. Intestinal metaplasia was diagnosed on pure morphologic findings and on histochemical findings (alcian blue at pH 2,5). The histochemical method was shown to be more sensitive. The significance of intestinal metaplasia in the carcinogenesis is briefly discussed.
Mucinous tumors of the ovary are generally considered to have a dual origin in histogenesis. Teratomatous elements, however, have recently been reported as appearing in a process of intestinal metaplasia. Malignant transformation has also been felt to occur through intestinalization. To clarify the matter, the relationships among morphological changes in intestinalization, carcinoembryonic antigen and mucus antigens named IMA and M1, which were isolated from intestinal mucosa and ovarian mucinous cyst fluid respectively, were studied in 4 benign, 8 borderline and 6 malignant mucinous tumors of the ovary. Intestinal type and goblet- like cells were sparse, if any, in benign tumors, but conspicuous in borderline and malignant ones. Carcinoembryonic antigen was located in the glycocalyx of intestinal type cells in the benign tumors, but distributed over the entire cytoplasm increasingly with malignancy. These findings lend support to the theory that malignant transformation may occur through intestinal metaplasia in mucous tumors. M1 was positive in many cells of all mucinous tumors, but IMA was shown in some goblet-like cells of a few tumors, regardless of malignancy or the presence of argyrophil cells. These phenomena could be best understood by postulating that IMA was located in the teratomatous intestinal goblet cells of the tumors.
Mice were repeatedly infected with consecutive doses of mouse-adapted strains of influenza virus A HON1, H1N1, H2N2, and H3N2. Homo- and heterologous antibody levels as well as the incidence of metaplasia were followed. Statistically significant correlation was found between the metaplasia incidence and higher level of antibodies homologous to virus used for a given challenge dose.
Mice preimmunized with influenza virus A Scotland 840/74 H3N2 were given cyclophosphamide or hydrocortisone, then challenged with the same active virus. Serum antibody levels and metaplasia of the respiratory epithelium were followed for the next two weeks. Administration of the immunosuppressors was found to decrease antibody levels, and to delay the appearance of metaplasia by 7 days as compared with controls.