Mucinous tubular and spindle cell carcinoma with Fuhrman nuclear grade 3: a histological, immunohistochemical, ultrastructural and FISH study

Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney generally shows low nuclear grade. MTSCC with high nuclear grade is relatively rare. In this article, we report two cases of MTSCC with Fuhrman grade 3. One case occurred in a 57-year-old Japanese female and the second case in a 49-year-old Caucasian female. Histologically, the tumors were composed of neoplastic cells with cuboidal or columnar and spindle morphology, and Fuhrman nuclear grade 3. The myxoid stroma was also observed. This stroma was positive for Alcian blue stain. Immunohistochemically, neoplastic cells of both cases were positive for AMACR, but negative for CD10 and RCC Ma. Ultrastructurally, tumorous cells of one case contained numerous mitochondria. In FISH analysis, many neoplastic cells of both cases demonstrated monosomy of chromosomes 15 and 22 and disomy of chromosomes 7 and 17. One of the two patients died of respiratory failure due to pleuritis carcinomatosa 48 months postoperatively. Finally, the pathologist should recognize that high grade MTSCC exists despite its rare frequency. FISH analysis may be helpful in establishing the diagnosis of this entity. Furthermore, we present the first report of a patient with MTSCC dying of distant metastasis.     

Logistic regression analysis of high grade spindle cell neoplasms. A fine needle aspiration cytologic study.

OBJECTIVE: To identify primary diagnostic cytologic criteria for various high grade spindle cell neoplasms. STUDY DESIGN: We reviewed 30 osteosarcomas, 29 malignant fibrous histiocytomas (MFH), 26 malignant melanomas, 13 chondrosarcomas, 12 leiomyosarcomas, 7 angiosarcomas and 5 liposarcomas. All specimens were coded as to the presence or absence of the following variables: high or low cellularity, tissuelike fragments, glandlike fragments, single cells, binucleated cells, multinucleated cells, lipoblastlike cells, histiocytelike cells, fibroblastlike cells, signet-ring cells, short spindle cells, long filamentous cells, stellate cells, osteoclastic giant cells, malignant giant cells, background cells, pointed nuclei, cigar-shaped nuclei, fishhook-shaped nuclei, round or ovoid nuclei, intranuclear vacuoles, macronucleoli, small nucleoli, mitotic figures, abnormal mitotic figures, pleomorphism, nuclear/cytoplasmic ratio (mild, moderate, marked increase), amount of cytoplasm (scant, moderate, abundant), fine or coarse granular cytoplasm, intracytoplasmic hemosiderin deposits, melanin, cytoplasmic vacuoles, fat, capillary vessel fragments, storiform pattern, necrosis, large or small amount of myxoid material, filamentous stroma, dense collagenous stroma, osteoid, chondroid and cells in lacunae. A logistic regression analysis was performed to identify the variables predictive of each diagnostic category. RESULTS: The statistical analysis selected positive expression of osteoid, osteoclastic giant cells and low cellularity as the primary criteria associated with osteosarcomas. Positive expression of fibroblastlike cells, large amount of myxoid material and multinucleated cells were identified to be the key criteria for MFH. The analysis selected the presence of melanin as the major criterion for malignant melanomas, cells lying in lacunae for chondrosarcomas, fishhook nuclei for leiomyosarcomas, intracytoplasmic iron deposits for angiosarcomas and lipoblastlike cells for liposarcomas. CONCLUSION: From the previously described cytologic criteria, statistical analysis helped identify several key features that are significant in the evaluation of pleomorphic spindle cell neoplasms.     

Logistic regression analysis of low grade spindle cell lesions. A cytologic study

OBJECTIVE: To identify key diagnostic cytologic criteria for various low grade spindle cell lesions. STUDY DESIGN: We reviewed 20 synovial sarcomas, 18 benign neural tumors, 10 reparative lesions, 24 other benign and 27 additional malignant low grade spindle cell lesions. All specimens were coded as to the presence or absence of the following variables: high cellularity, tissue fragments, tissue culture appearance, epithelial fragments, vessel fragments, vascular arcades, fibrillar ground substance, myxoid background, microcystic areas, parallel arrangement of nuclei, naked nuclei, single cells, binucleate cells, multinucleate cells, long filamentous cells, short spindle cells, stellate cells, lipoblasts, nuclear pleomorphism, nuclei with pointed ends, comma/fishhook nuclei, cigar-shaped nuclei, ovoid/round nuclei, small nucleoli, large nucleoli, mitotic figures, intranuclear vacuoles and background histiocytes. A logistic regression analysis was performed to identify the variables predictive of malignant lesions, specifically synovial sarcomas, benign neural tumors and reparative lesions. RESULTS: Statistical analysis selected high cellularity, short spindle cells, small nucleoli and absence of tissue culture appearance as the main criteria for malignant neoplasms. Tissue fragments and high cellularity were selected as the primary criteria and absence of long filamentous cells and of myxoid background as the secondary criteria for synovial sarcomas. It selected fibrillar ground substance and absence of ovoid/round nuclei as the key criteria for benign neural tumors. The presence of a tissue culture appearance was the major criterion for reparative lesions. CONCLUSION: There are many previously described cytologic criteria, but we found that when subjected to statistical analysis, only a few features were significant in the evaluation of low grade spindle cell lesions.     

Primary histiocytic sarcoma arising in the head and neck with predominant spindle cell component

Background

Spindle cell tumors of the larynx are rare. In some cases, the dignity is difficult to determine. We report two cases of laryngeal spindle cell tumors.

Case presentation

Case 1 is a spindle cell carcinoma (SPC) in a 55 year-old male patient and case 2 an inflammatory myofibroblastic tumor (IMT) in a 34 year-old female patient. A comprehensive morphological and immunohistochemical analysis was done. Both tumors arose at the vocal folds. Magnified laryngoscopy showed polypoid tumors. After resection, conventional histological investigation revealed spindle cell lesions with similar morphology. We found ulceration, mild atypia, and myxoid stroma. Before immunohistochemistry, the dignity was uncertain. Immunohistochemical investigations led to diagnosis of two distinct tumors with different biological behaviour. Both expressed vimentin. Furthermore, the SPC was positive for pan-cytokeratin AE1/3, CK5/6, and smooth-muscle actin, whereas the IMT reacted with antibodies against ALK-1, and EMA. The proliferation (Ki67) was up to 80% in SPC and 10% in IMT. Other stainings with antibodies against p53, p21, Cyclin D1, or Rb did not result in additional information. After resection, the patient with SPC is free of disease for seven months. The IMT recurred three months after first surgery, but no relapses were found eight months after resurgery.

Conclusion

Differential diagnosis can be difficult without immunohistochemistry. Therefore, a comprehensive morphological and immunohistochemical analysis is necessary, but markers of cell cycle (apart from the assessment of proliferation) do not help.     

Histochemical and ultrastructural study on the innervation of the byssus glands of Mytilus galloprovincialis

The aluminium-formaldehyde (ALFA) histofluorescence method reveals an extensive plexus of brilliant greenish monoaminergic elements in the glandular zones of the Mytilus foot, while only scanty nerve fibres are acetylcholinesterase-positive. By electron microscopy, bundles of nerve fibres can be seen i) in close connection with the intrinsic musculature located in the connective septa among the glands, and ii) near the cell bodies and necks of all the byssus glands. The nerve fibres show varicosities containing three types of vesicles: small clear (50-60 nm), small granular (80-90 nm), and large granular (160-200 nm). The regions of close apposition between nerve terminals and muscle or gland cells generally do not show typical pre- or postsynaptic specializations. Along the pedal groove, mainly in the proximal two thirds of the foot, peripheral bipolar neurons can be detected, both by fluorescence and electron microscopy.     

Fine needle aspiration cytology of clear cell sarcoma. Report of a case with immunocytochemical, immunohistochemical and ultrastructural studies.

Cytologic findings of clear cell sarcoma obtained by fine needle aspiration (FNA) of a tumor are described. The tumor probably originated in the retroperitoneal tissue, and the diagnosis was confirmed histologically by open biopsy. Percutaneous needle aspirates of the intraabdominal tumor and touch preparations obtained from the open biopsy specimen revealed numerous atypical cells with an extremely hyperchromatic nucleus, prominent nucleoli and clear cytoplasm. The cytoplasm was rich in glycogen. The immunocytochemical technique demonstrated S-100 protein and neuron-specific enolase in the cytoplasm, both of which were exhibited also in the histologic specimen. Clear cell sarcoma is a rare tumor of soft tissue, and to our knowledge, detailed cytologic appearances of this tumor obtained by FNA have not been reported. In addition, the present tumor was unique in location. It is possible to diagnose clear cell sarcoma accurately on an FNA cytologic specimen if the periodic acid-Schiff stain and immunocytochemical technique are utilized in addition to the routine Papanicolaou method.     

Histochemical localization of adenosine triphosphatase activity in thymus: A light microscopical and ultrastructural study

Summary Ultrastructural localization of ATPase at high pH in the presence of Ca²⁺ showed that activity in thymocyte precursors was stronger than in mature thymocytes. The activity was localized in the nuclear envelope, rough endoplasmic reticulum, Golgi apparatus and mitochondria. The difference in activity was attributed to a marked decrease in ATPase-containing organelles, mainly the endoplasmic reticulum in the mature thymocytes. This appears to be related to the proliferative activity of the cells rather than to the immunological maturity of the thymocytes. A very strong activity, also localized in the same organelles, was present in the macrophages and interdigitating cells which might have a secretory function and possibly contribute to thymocyte maturation. The Ca²⁺—ATPase activity in the nuclear envelope—endoplasmic reticulum system suggests that these may be the sites for storage and regulation of cytoplasmic calcium.     

Early contacts between normal fibroblasts and mouse sarcoma cells : An ultrastructural study

When chick heart fibroblasts and mouse sarcoma (S180) cells make contact with each other, an ultrastructural study shows no formation of cortical specialisations at the area of contact, as are seen in the case of fibroblast-fibroblast contacts.     

Membranocystic lesion in the brain in cerebrotendinous xanthomatosis. Histochemical and ultrastructural study with evidence of its ceroid nature

A case is described of cerebrotendinous xanthomatosis with purely neurological manifestations. Cholestanol deposition in both affected and unaffected brain regions was markedly increased, reaching 18.5-20.8% of the sterol fraction. The unilateral lesions localized in the basal ganglia and cerebellar white matter featured perivascular accumulation of foam cells containing apolar lipid and ceroid. Necrosis with lipid-rich debris was a frequent finding often accompanied by prominent collagen deposition. Within these lesions there were numerous refractile thick membranes which, according to lipid histochemical techniques, could be qualified as ceroid-type lipopigment. It is suggested that the ceroid membranes arise extracellularly directly from the lipid-rich debris. Ultrastructurally, they were composed of convolutes of highly organized trilaminar membranes about 15 nm thick similar to those seen in intracellular ceroid granules. The membranes were embedded in an amorphous substance of low or medium density and were identical in their general appearance, stainability and fine structure to the membranocystic lesion in Nasu-Hakola disease and to the extracellular ceroid in atherosclerotic plaques.