Thirty-six cases of breast carcinoma were classified according to their cells of origin using electron microscopy and ultrastructural histochemistry. The study showed that breast cancer can be classified into myoepithelial, ductal epithelial, and ductular epithelial carcinoma. In this study, all cases were easily classifiable except one mixed myoepithelial and ductular type which was classified as ductular carcinoma. Alkaline phosphatase, which is normally present in the myoepithelial cells of normal duct, becomes negative upon neoplastic transformation. Myoepithelial cancer cells retain their adinosine triphosphatase activity, and this behavior was helpful in identifying their cell of origin. Ductular epithelial cancer shows nuclear and free cytoplasmic acid phosphatase, and the significance of this finding was discussed. The study also revealed that carcinoma of ductular origin has a higher eventuality of metastases. Also, it was suggested that ductular carcinoma arises from hormonally sensitive cells, and the possibility of hormonal treatment for this cancer should be studied.
Light-microscopic and ultrastructural examinations of megalocytic interstitial nephritis, xanthogranulomatous pyelonephritis, and malakoplakia of the kidney were compared. The cases of megalocytic interstitial nephritis and xanthogranulomatous pyelonephritis represent the first reported electron-microscopic studies on human kidney of these diseases. The study confirmed the presence of a polymorphous cellular infiltrate with predominate histiocytes containing crystalloid material in the case of megalocytic interstitial nephritis; a polymorphous cellular infiltrate with histiocytes predominating in the case of xanthogranulomatous pyelonephritis; and macrophages containing Michaelis-Gutmann bodies in the case of malakoplakia. The characteristic sites of involvement within the kidney by each of the three lesions are discussed. It is believed that the lesions are distinct entities, but related to one another, and represent varied and unusual host responses to inflammation.
The clinical and pathologic features of a patient with Cushing's syndrome and a primary pulmonary tumor are presented. The Cushing's syndrome presented almost one year after removal of the lung tumor and chemotherapy for cerebral metastasis. The cause of the Cushing's syndrome was unclear, but failure to suppress with high-dose dexamethasone therapy indicated it was due to a primary adrenal tumor or ectopic ACTH production. Surgery revealed a large tumor in the right adrenal with a much smaller tumor in the left adrenal gland, and metastatic bronchial carcinoid with Cushing's syndrome due to ectopic ACTH production was diagnosed. The clinical significance of this is discussed with regard to routine light microscopy and patients who present with endocrine syndromes and tumors of questionable cause.
Paraffin-embedded surgical specimens from 69 patients who underwent resections of otherwise untreated Dukes stage C adenocarcinoma of the colon were examined for proliferative activity, DNA aneuploidy, DNA index, and proportion of aneuploid cells by flow cytometry. Results were correlated to clinical characteristics of the patients and to overall survival times. DNA aneuploid tumors were identified in 60 cases (87%), diploid tumors in 9 cases (13%). The mean S-phase fraction for all cases was 17.6%, with a standard deviation (SD) of 7.8. In univariate statistical analysis, younger patient age, lower tumor proliferative activity, DNA index less than or equal to 1.2, and presence of only 1-4 lymph nodes with tumor involvement were found to be significant predictors of improved patient survival. In multivariate Cox regression analysis, low tumor proliferative activity, younger patient age, and location of the tumor in the right or transverse colon were found to be significant independent predictors of increased patient survival. When tumor proliferative activity was stratified into statistically defined subgroups, patients with tumors of low proliferative activity (S-phase less than mean - 0.5 SD) had significantly longer survival than patients with tumors of moderate proliferative activity (S-phase value greater than mean - 0.5 SD and less than mean +0.5 SD) or high proliferative activity (S-phase greater than mean +0.5 SD). These results suggest that tumor proliferative activity in Dukes C colon carcinoma may be an important biological factor in determining patient prognosis.
