Archives of pathology最新文献

The relationship between tumor "seed" and tissue "soil" in blood-borne metastasis is poorly understood. Therefore, an explanatory human model is proposed. It is based on the hypothesis that the spread of lung cancer cells to the adrenal vein provides in man not only a variable attribute, lung cancer seed, but also a constant attribute, adrenal venous soil, as in a scientific experiment. Out of 100 cases of lung cancer, four histologic types proved their invasive potentiality in 45 subjects by colonizing the adrenal parenchyma proper and yet differed appreciably in their ability to grow in the adrenal venous blood. Hence, in all probability, the systematic study of venous blood will help in the discovery of the potentialities and limitations of human blood in tumor metastasis.

The homozygous albino hairless mice at birth have hair bulbs and follicles the same as normal mice. Hairs develop and grow the same as in normal mice. However, about the sixth to eighth day hairs in the skin around the nose begin to disappear. This depletion of hairs continues over the head, neck, back, and abdomen of all mice in the same pattern. Essentially every hair over the entire body is absent macroscopically by the 30th to 40th day except for the vibrissae. A progressive atrophy of the hair bulbs and follicles is the basis for the absence of hairs after the first pelage. Only a rare follicle with a hair is present histologically in the adult mice. There are a few cysts in the dermis resulting from dilated residual hair follicles.

The organization of cellular and extracellular components appeared similar and was distinctive in three endocardial papillary elastofibromas studied. Each tumor papilla contained (1) a dense, central core of collagen and elastic tissue, (2) a peripheral, myxomatous layer with deposits of acid mucopolysaccharides, and (3) an overlying, hyperplastic layer of endothelial cells. Ultrastructural study of one tumor showed that the cells in all three zones had numerous cytoplasmic filaments, 100 Angstroms in diameter, and dilated cisterns of endoplasmic reticulum; endothelial cells also had intercellular junctions and numerous pinocytotic vesicles. The myxomatous stroma varied from amorphous to fibrillar, and the collagenous cores showed focal degeneration. The name "endocardial papillary elastofibroma" is suggested to emphasize those features which are most conspicuous and which serve to differentiate this tumor from myxoma.

Focal presence of the embryonic pattern of myoarchitecture and of a lacunary blood supply was found in the left ventricular wall of five infant hearts. Four of these hearts showed various malformations; one was a case of cardiac fibroma. The persisting intertrabecular spaces and sinusoids communicated with the ventricular lumen; there appeared to be some communication with the coronary branches. The intertrabecular spaces of the spongy myocardium were lined with a continuous layer of endothelial cells, thus resembling the microscopical appearance of myocardium of adult cold-blooded vertebrates rather than the embryonic phase of myocardial development of warm-blooded animals.

Histologic, histochemical, and ultrastructural studies of a tuberous xanthoma from a patient with homozygous type II hyperlipoproteinemia showed that all of the lipid was within histiocytic foam cells; no lipid was identified in interstitial regions or in blood vessels. Primitive mesenchymal cells, elongated perivascular and fibroblast-like cells, and lysosome-filled macrophages also were present within the xanthoma, indicating possible stages in the evolution of dermal mesenchymal cells into mature, cholesterol-rich foam cells. Morphologically, the lipid was in four different forms: large droplets, which were the dominant form, and membrane-bound crystals, concentric lamellar bodies, and ceroid. The paucity of membrane-bound lipid forms, relative to the abundant free lipid droplets, indicated that lysosomal digestion was a minor metabolic pathway for the intracellular metabolism of lipid in the xanthoma. Thus, nonlysosomal lipid storage in foam cells is a characteristic tissue response to the underlying metabolic defect in type II hyperlipoproteinemia.

A case of primary adenocarcinoma of the umbilicus is reported along with a review of the literature and discussion of possible origins of glandular tissue within this area. Multiple connections are present within the umbilicus (vascular, lymphatic, and embryologic) that may give this area access to metastatic lesions. The primary tumors may originate within the usual umbilical tissue (skin and soft tissue). Glands that are not normally present in the region of the umbilicus rarely develop malignant neoplasms. As postulated, glandular tissue may arise either as metaplasia from squamous epithelium or from glandular embryologic rests including omphalomesenteric duct remnants and urachal remnants.

A female infant with combined immune deficiency syndrome exhibited graft-versus-host reaction (GVHR) clinically during the nine weeks of her life. Pathologically, the first clue for GVHR was the lymphohistiocytic dermal and epidermal infiltrate with single cell necrobiosis seen on a skin biopsy specimen at 6 weeks of age. Two days before death, she received irradiated (3,500 rads) whole blood and plasma with specific antibodies against mother's lymphocytes, which was the first introduction of an allogenic hematopoietic substance. This suggests that the GVHR, which was confirmed at autopsy, occurred as the result of maternofetal cell transfer in utero or at time of delivery.

Lungs of 17 narcotic abusers from medical-legal autopsies were studied to determine the pathological basis for regional alterations of ventilation and perfusion. Postmortem pulmonary angiographic and histological techniques demonstrated acute alveolar wall inflammation with exudation of fluid and cells into the alveoli in all eight abusers dying of narcotism and in six of nine dying of other causes. All abusers had extensive focal chronic intersititial inflammatory infiltrates. Vascular obstruction due to foreign material occurred only with intravenous use of oral pharmaceuticals, and then only in the microcirculation. Lungs of ten young adults dying suddenly with no history or evidence of narcotics abuse showed no acute alveolitis or intravascular foreign material. Intravenous narcotics injection produces transient acute alveolar inflammation that may account for respiratory manifestations and death. Permanent injury to the lung parenchyma or larger vessels with the usual forms of narcotic abuse is not common.

An 84-year-old woman had Rytand-Lipsitch syndrome, ie, total atrioventricular block resulting from destruction of the central areas of the conducting system due to extension of calcification from the fibrous ring of the mitral valve. In a postmortem coronary arteriographic study of 500 hearts, degenerative calcification of the fibrous ring of the mitral valve was demonstrated in 4.4% (95% confidence limits--2.8% to 6.6%), rheumatic valvular changes not being included. There were significantly more women than men with calcification of the mitral valve apparatus (P less than .00005). Division of the material into two groups larger than or equal to 70 years and less than 70 years showed a statistically significant sex difference in the former group (P les than .005), whereas the sex difference was of borderline significance in the latter group (.1 greater than P greater than .05).