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Synovial sarcoma most commonly occurs in the peri-articular regions of the extremities. The present report describes a rare case of primary biphasic synovial sarcoma of the pleura in an 18-year-old female. The diagnosis was made on the basis of light microscopy, immunohistochemistry, electron microscopy and the characteristic translocation found on cytogenetic analysis. Synovial sarcoma should be included in the differential diagnoses of pleural tumors. more...

Background: Neuroendocrine tumors, usually small cell (oat cell) carcinomas, are almost always primary in the lungs and are highly malignant. Similar tumors have recently been described to occur in various extrapulmonary sites, such as the uterine cervix and prostate. We report a primary neuroendocrine carcinoma of the breast in a female first diagnosed by fine needle aspiration biopsy (FNAB). Search of the literature revealed only three other reports of small cell carcinoma of the breast, one in a male and two in a female, thus making this the third documented case of neuroendocrine carcinoma of the breast in a female., Case: A 45-year-old, black female presented with a firm, nontender mass at the tail of her left breast. FNAB showed atypical epithelial cells with pale nuclei and inconspicuous nucleoli. An excisional biopsy performed one week later showed microscopically a predominantly solid and syncytial pattern of small cells that appeared spindly in places. It had a high mitotic count, and the stroma was rich in lymphocytes and plasma cells. Immunohistochemical and ultrastructural studies confirmed the diagnosis., Conclusion: Small cell (neuroendocrine) mammary carcinoma is a rare entity but does occur and can be diagnosed by FNAB. It does not differ essentially from other mammary neoplasms with regard to prognosis. more...

Extrapulmonary small cell carcinoma has been reported from multiple sites, including the gallbladder. Small cell carcinoma of the gallbladder is a very rare tumor, found usually in elderly women and associated with cholelithiasis. It carries a grave prognosis, metastasizing early and causing death shortly after diagnosis. Treatment of metastatic disease with two different chemotherapeutic regimens has been shown to improve survival. To the best of our knowledge, this tumor has not been previously reported in a black individual, or in any subject less than 49 yr or more than 79 yr old. We report two cases: one is the first black and youngest reported case. The second is the oldest person reported with this rare malignancy. Radiological studies such as ultrasound and CT scan were useful in evaluating tumor spread and follow-up. more...

We describe the clinical and pathologic findings of the first reported case of pulmonary botryomycosis in a patient with AIDS. Botryomycosis is an uncommon, chronic, suppurative disease that is often mistaken clinically and histologically for a fungal infection. The patient responded to systemic antibiotic therapy. more...

In early secondary syphilis, predominant features of spirochetal infection may include hepatitis and glomerulonephritis. We report a 27-year-old woman with characteristic physical, laboratory, and microscopic findings of syphilitic hepatitis and glomerulonephritis; she responded to penicillin therapy and recovered completely. The importance of clinically and pathologically recognizing this treatable disease is emphasized. more...

A poorly differentiated primary retroperitoneal angiosarcoma with abundant intracytoplasmic and extracytoplasmic eosinophilic globules containing alpha 1-antitrypsin and alpha 1-antichymotrypsin is presented. Recognition of these globules may facilitate future diagnoses of the neoplasm in this or other locations. To the best of our knowledge, this is the first article on a primary angiosarcoma of the retroperitoneum. more...

The fine structures of three fibrous hamartomas of infancy were studied. All three components of these lesions were examined. The principal cells in the fibrous and myxoid areas were fibroblasts. Cells with stellate cytoplasmic projections were more prominent in myxoid areas. Myofibroblasts were abundant in two cases and not in the other. The adipose tissue component was formed by lipocytes and occasional preadipose fibroblasts. Blood vessels were more numerous in myxoid areas. Larger vessels were accompanied by smaller vessels and by clusters of cells with primitive junctions, suggesting early blood vessel formation. Some small vessels were surrounded by concentric layers of mesenchymal cells, as if attempting to form media. Electron microscopy seems to confirm the hamartomatous nature of fibrous hamartomas of infancy. The lesion appears to recapitulate the formation of blood vessels and fat, as seen in fetal tissues. Cellular myxoid areas showed prominent vasoformative proliferation, which decreased in the adipose tissue and was least prominent in the dense fibrous component. The latter may represent the end stage of the fibrous proliferation. more...

A prostatic leiomyoma with nuclear atypia, similar in appearance to atypia sometimes seen in uterine leiomyomas, was an incidental finding in a fifty-three-year-old man who underwent prostatectomy for hyperplasia. The smooth muscle nature of the lesion was confirmed by electron microscopic examination. This is the third lesion of this type to be reported. more...

Staphylococcus aureus antigen was identified within the glomeruli of a patient with acute bacterial endocarditis and diffuse glomerulonephritis. Routine immunofluorescence had revealed only granular deposits of complement (C3). C3 activator and C4 were not present. Direct immunofluorescence studies with a specific anti-Staphylococcus aureus conjugate were positive. Electron microscopy showed subepithelial and intramembranous electron-dense deposits. Eluates of the kidney did not contain anti-S. aureus antibody. The absence of immunoglobin suggests that the toxic action of S. aureus antigens may activate complement and cause glomerular injury and that immune complexes are not essential for the production of glomerulonephritis in this entity. more...

A case of diencephalic-midbrain hemorrhage presenting with excessive thirst, coma, and death is discussed. Some diencephalic dysfunction syndromes are reviewed, as well as their physiological basis. Thirst and drinking behavior can provide a valuable localizing symptom and sign in clinical-pathological correlations. more...

The cases of 14 patients seen 6 weeks to 7 years after gunshot wounds with painful, restrictive joint disease and retained intra-articular bullets were reviewed. Twelve patients had radiographic findings characteristic of lead synovitis. The earliest finding was a fine, punctate deposition of radiopaque lead on the articular cartilage that resembled chondrocalcinosis but was of greater density. This was followed by more discrete lead speckling of hypertrophied synovium. The opacities became larger, coarser, and more confluent over time, ultimately outlining the synovium, articular cartilage, and joint capsule. Synovial hypertrophy and diffuse chronic inflammation and fibrosis were seen in seven patients on gross pathologic examination. The lead was deposited extracellularly in the subsynovial layer and within the marrow spaces of subarticular and periarticular bone. Electron-microscopic study suggests that lead is initially incorporated within cells and secondarily deposited extracellularly after cell death. Bullets in joints are not physiologically inert and should be removed when encountered. more...

This report of desmoplastic fibroma of bone (DFB) in the left ulna represents the 56th published case of the neoplasm. To the best of the authors' knowledge, the present case is the first instance of this type of excision of the distal ulna performed for DFB with a metallic prosthesis and successful restoration of distal radial ulnar anatomy and function. more...

Squamous cell carcinoma of the stomach is a rare, unusual lesion which tends to occur at a somewhat earlier age than adenocarcinoma. Grossly and radiologically the tumor is indistinguishable from adenocarcinoma and may involve any portion of the stomach. Although the pathogenesis of this lesion remains unclear, most authors favor the "metaplastic theory" for the development of the tumor. In this case it is felt that the tumor probably arose from gastric squamous mucosa present congenitally in the lesser curvature. more...

A case of low-grade ovarian stromal sarcoma in a postmenopausal woman is described. Although pelvic recurrences of the tumor followed 5 and 7 years after the original surgery, the patient has remained well and without evidence of tumor 3 years since the last operation. Histopathologic, electronmicroscopic, and hormonal studies are described. There was evidence of estrogenic stimulation by the theca elements of the tumor in this patient. Cases previously reported in the world literature as malignant thecoma were analyzed, and most of them were considered inadequately documented; indeed most of them were probably either sarcomatoid granulosa cell tumors, stromal sarcomas, or fibrosarcomas. If a thecoma ever becomes malignant, the tumor cells dedifferentiate so that they cannot be recognized any longer as theca cells; instead, they proliferate as a stromal sarcoma or fibrosarcoma. It is proposed, therefore, that the term "malignant thecoma" not be used. On the other hand, very rare malignant ovarian stromal tumors do exist, consisting of undifferentiated stromal cells, fibroblasts, and theca cells, which can show evidence of hormonal activity. more...

A 40-year-old man had disseminated toxoplasmosis preceded by miliary tuberculosis and associated with skin anergy. In previously reported cases of disseminated toxoplasmosis, the three organs most commonly involved were brain, heart, and lungs. The histopathologic picture of toxoplasmal lymphadenopathy was not present in our case or in previously reported cases. Therefore, we believe that the diagnosis of disseminated toxoplasmosis should not be rejected simply because of the likely absence of toxoplasmal lymphadenopathy in biopsy material. The thymus in our case was morphologically abnormal and showed features suggestive of an autoimmune process. more...

An immunopathologic analysis of the testes of 20 homosexual acquired immune deficiency syndrome (AIDS) patients was performed to investigate the hypothesis that the testicular atrophy of these patients represents an immune-mediated process. The findings were compared to those in a control group of heterosexual men without AIDS. The testes of the homosexual AIDS patients showed an overall lower degree of spermatogenesis with more prominent interstitial inflammation and thickening of the tubular basement membrane. However, direct immunofluorescence and immunoperoxidase studies failed to demonstrate significant differences in the prevalence of immune complex deposits along the tubular basement membrane in the two study groups. No electron-dense deposits were demonstrated in cases examined ultrastructurally. Therefore, this study does not support the hypothesis that the testicular atrophy of homosexual AIDS patients is a manifestation of autoimmune orchitis. Further studies are needed to elucidate the pathogenesis of the testicular atrophy in AIDS, as this appears to be a specific manifestation of the disease. more...

Disseminated histiocytic proliferation and intestinal malakoplakia due to Mycobacterium intracellulare occurred in a 2-year-old white boy. Light and electron microscopic examination of autopsy material disclosed disseminated histiocytosis and malakoplakia of the intestine with numerous intracellular acid-fast bacilli. The isolated organism produced a similar disseminated histiocytosis and finally death when injected into experimental animals. A review of the literature showed only 12 previously reported cases of disseminated histiocytosis due to M intracellulare infection. We were unable to find a previous report of malakoplakia due to nontuberculous mycobacterial infection. more...

Diffuse melanosis of the epithelial lining of an unusually large median raphe cyst of the penis is reported. Its light microscopic and ultrastructural features are described. The findings are discussed in the context of the published literature of genitourinary melanosis. more...

An adenocarcinoma which arose in a dermoid cyst of the ovary displayed areas of melanocyte colonization and pigmentation. Ultrastructural study revealed the presence of epithelial tumour cells and melanocytes; many tumour cells contained compound melanosomes, but not premelanosomes, suggesting transfer of melanin from melanocytes to tumour cells. Melanocyte colonization of malignant tumours is a curious phenomenon the significance of which remains to be elucidated. more...

Serum angiotensin-converting enzyme in a patient with type 2 acute neuronopathic Gaucher's disease (242 nmol/min/ml) was 10.8 times higher than values for eight patients with other hereditary neurologic abnormalities (22.5 +/- 2.0) and 9.4 times higher than those for 12 patients with other diseases (25.7 +/- 2.6) (P less than 0.001). Serum lysozyme was not elevated in the patient with type 2 Gaucher's disease. These results indicate that elevated serum angiotensin-converting enzyme in an infant with neurologic involvement and hepatosplenomegaly is suggestive of the possibility of type 2 Gaucher's disease. Typical Gaucher's cells and fibrosis were observed by light and electron microscopy of the liver. An aspect hitherto unreported in Gaucher's disease or in the liver was that approximately 20% of the collagen fibrils were of the long-spacing type, with periodicity of 1,000 to 1,100 A and diameters of 900 to 1,500 A. more...

A tumor mass removed from the subcutaneous tissue of the shoulder of a dog had the light and electron microscopic features of extraneuraxial meningioma. The neoplasm probably arose from arachnoid cap cells displaced during embryogenesis. more...

A case of centronuclear or myotubular myopathy in a 13-year-old boy who was admitted with hypotonia and congenital ptosis is reported. Clinical, electromyographic and pathologic studies are discussed. A review of the electron microscopic features and comparison with out findings is included. Review of the literature disclosed near 50 cases of centronuclear myopathy. The diferential diagnosis is discussed. more...

Immunoglobulin deposits and DNA were identified by use of immunofluorescence microscopy within the ciliary process and choroid of a majority of (NZB X W)F1 mice with murine lupus. The number of animals with such deposits increased from 57% at 36 weeks of age to 90% at one year of age. Ultrastructural examination showed electron-dense deposits between the basement laminae of the endothelium and pigmented epithelium of the ciliary process, accompanied by alterations in the epithelial basement membranes. Similar electron-dense deposits were also identified in the vicinity of the lamina choroidocapillaris. The titer of antibody to DNA did not correlate with the presence of ocular deposits, suggesting that time is an important factor in the development of ocular immunopathology in these animals. more...

We describe a benign diffuse neurofibroma of the pylorus, unassociated with von Recklinghausen's neurofibromatosis, which was a cause of pyloric stenosis; epigastric discomfort, vomiting, and weight loss of 60 lb were the most prominent symptoms. Partial gastrectomy resulted in a cure. The literature on nerve-sheath tumors of the stomach is reviewed. more...

This is the eighth case report of an endodermal sinus tumor of the mediastinum (first case studied by electron microscopy). The ultrastructure of the tumor was found to mimic that of the normal yolk sac and was also similar to that of three previously reported cases of endodermal sinus tumor of the ovary, thus confirming the correctness of Teilum's original interpretation of the tumor as arising in germ cells and differentiating towards extraembryonic structures. more...

A previously unreported calcifying epithelial odontogenic tumor (CEOT; Pindborg tumor) occurring in a Negro patient is presented. Only 12 per cent of these neoplasms have been found in nonwhite patients. Ultrastructural and histochemical studies indicated that the amorphous, acellular, eosinophilic substance present within the tumor was not amyloid. The presence of only sparse calcifications is an unusual histologic variant. No relationship between neoplasm and reduced enamel epithelium could be demonstrated. more...

Argentaffin cells were searched for in the epithelial nests of 30 Brenner's tumors, with the Fontana-Masson stain for the screening. Although these cells were found in five tumors, ultrastructural examination of one case, in which the argentaffin cells were multiple, identified the cytoplasmic granules as lysosomes and not as amine precursor uptake and decarboxylation (APUD)-type granules. We conclude that the epithelial component of Brenner's tumors consists of urothelium only and does not include the cells containing argentaffin APUD-type granules. more...

Malignant lymphoma developed in the dorsum of the hand in a patient with a long-standing postmastectomy lymphedema. The tumor subsequently spread to involve skin of the forearm and arm. Growth and spread of malignant cells within the stagnant dilated lymphatics are the likely cause of the characteristic nodular dissemination of the tumor in a lymphedematous extremity, regardless of the type of neoplasm. more...

Ultrastructural study of a case of benign lipoblastomatosis revealed a cellular spectrum which included undifferentiated mesenchymal cells, stellate myxoid cells, fibroblasts, lipoblasts, lipocytes and many intermediate forms. The uni- and multivacuolated fat cells contained membrane and non-membrane bound cytoplasmic vacuoles, predominatly of saturated lipid. Their cytoplasm also contained simple-structured mitochondria devoid of intramatrical or crystalloid bodies. The fine structure of the cellular components of lipoblastomatosis supports the concept that this is a neoplasm related to fetal white fat rather than to brown fat. more...

Jejunal mucosa from 7 patients with amyotrophic lateral sclerosis (A.L.S.), 20 newly reported patients with multiple sclerosis (M.S.), and 35 control patients without either disease was studied by immunofluorescence. An immune reaction was present in all A.L.S. specimens and consisted of altered ratios of immunoglobulin-labelled cells in the lamina propria, complement-labelled cells in the same location, and, in some, immunoglobulin and complement deposits in the epithelial basement membrane. Poliovirus antigen was detected in 4 cases, and in 1 of the these cases measles antigen was also present. A fifth specimen showed large amounts of herpesvirus antigen. In 2 cases studied at necropsy, both viral infection and immunological change was confined to the proximal jejunum. Measles antigen was identified in every case of M.S., and in biopsy specimens from 16 of the 20 M.S. patients immunological reactions similar to those seen in A.L.S. were present. With 2 exceptions, the controls did not show these changes in the jejunal mucosa. The exceptions were a patient with Friedreich's ataxia, who had an increase of IgG-labelled cells and some complement-bearing cells in the lamina propria, and a patient diagnosed as having non-tropical sprue, in whom large quantities of herpes antigen were seen. more...

Folic acid antagonists have been demonstrated to cause gross changes in the morphology of chlamydial inclusions in cell culture. The ultrastructural changes were examined by electron microscopy in cultures of Chlamydia trachomatis treated with trimethoprim and sulphamethoxazole. Examination of these cultures demonstrated a failure of the reticulate bodies to develop into normal elementary bodies. These changes were seen in cultures treated with either compound, although sulphamethoxazole was more active by weight, and suggest that both drugs ultimately interfere with nucleic acid synthesis. more...