International Journal of Surgical Pathology

The clinical and anatomopathologic features as well as DNA content of 83 renal cell carcinomas were analyzed. The possible interrelationship and prognostic value of these factors were also considered. The DNA study has been performed by flow cytometry using paraffin-embedded tissues. In each case an internal control with nonneoplastic renal tissue obtained in the same nefrectomy was also done in order to calculate the DNA index. Differences in patient age, nuclear grade, and mitotic activity were related with outcome; however, this relationship was not confirmed by the Cox test. Stage (P = .005), cell type (P = .002), and metastatic disease (P = .001) had independent prognostic values. Renal cell carcinomas with low stage and with low S-phase had better prognosis. Int J Surg Pathol 3(1):1-8, 1995

To determine the risk factors associated with development of acute cardiac allograft rejection during the first 3 months after transplant, data from 1,552 endomyocardial biopsies from 122 cardiac transplant recipients receiving their first graft were analyzed. An association (P< .0001) between the onset of a first rejection episode and the frequency of rejection episodes in the first 90 days was established. Our findings suggest that patients presenting with an early onset of first cardiac allograft rejection episode are at risk for multiple rejection episodes and should therefore be more closely monitored. Int J Surg Pathol 3(I):9-16, 1995

Phyllodes tumors of the breast are rare lesions that historically have been presumed to be related to fibroadenomata, largely by virtue of the entities' histologic similarities. We report four cases of malignant phyllodes tumors (cystosarcoma phyllodes) of the breast, three showing liposarcomatous differentiation and one showing chondrosarcomatous and osteosarcomatous differentiation, each of which had demonstrable histologic continuity with benign fibroadenomata; one patient had a prior and concurrent history of multiple bilateral fibroadenomata. We postulate that fibroadenomata and phyllodes tumors (benign, borderline, and malignant) may constitute a spectrum of one stromal disease analogous to mammary epithelial hyperplasia, atypical hyperplasia, in situ, and invasive carcinoma. Int J Surg Pathol 3(1):17-22, 1995

Seven patients with symptoms of chronic recurrent tonsillitis showed granulomatous reactions histologically in the resected specimens. There was nothing unusual about the preoperative clinical course or gross features of the tonsils. Given the usual clinical circumstances attending chronic tonsillitis, cultures were only sporadically done. No direct cultures of resected tissue were done. Special stain tests for acid-fast organisms and fungus, admittedly unreliable in the detection of their respective diseases, were negative. Five patients were followed 1-5 years and had no adverse sequelae. Granulomatous tonsillitis as a reflection of systemic disease (e.g., tuberculosis or sarcoid) has been recorded only in instances of concurrent clinical illness. The incidence of tonsillar involvement in other potential granuloma-producing conditions (e.g., Crohn's disease, Yersinia pseudotuberculosis infection or fungus) is unknown. Direct cultures of tonsils typically yield multiple aerobic and anaerobic organisms; however, granuloma eliciting organisms have not been sought. These cases are clinically typical but pathologically unusual because of the tissue reaction identified. Given the extent of the usual clinical and pathologic evaluations of patients with chronic recurrent tonsillitis, the most reliable means of assessing the significance of the granulomas is by clinical follow-up: benign, in the cases reported here. Int J Surg Pathol 3(1):23-28, 1995

Two cases of medullary carcinoma of the thyroid showing an angiosarcomatous pattern of growth are reported. Extensive hemorrhagic areas, strongly suggestive of a vascular tumor, characterized the gross appearance of case 1. Microscopically, pseudovascular spaces lined by elongated cells or containing nests of clear polygonal cells intermingled with red blood cells were a prominent feature in both cases. Calcitonin immunostaining was present in all neoplastic cells, both those in clear cell nests and the flat ones lining the pseudovascular spaces. A similar pattern was observed in cell block material obtained by fine-needle aspiration biopsy of case 2. Angiosarcoma-like medullary carcinoma of the thyroid patterns add to the long series of masquerades featuring medullary carcinoma of the thyroid and have to be considered in the differential diagnosis with hemangioendothelioma of the thyroid. Int J Surg Pathol 3(1):29-34, 1995

Mutations of the tumor suppressor gene p53 have been identified in a wide variety of human tumors, including soft tissue sarcomas. Most missense mutations of p53 increase the half-life of the protein resulting in its accumulation in the nucleus. Immunohistochemical staining with a monoclonal antibody PABI801 (Oncogene Science, Uniondale, NY) detects the intranuclear accumulation of p53 protein in formalin-fixed tissue, and, thus, indicates the presence of missense mutations within the p53 gene. We compared p53 immunoreactivity in paraffin sections of low-grade sarcomas that progressed to high-grade lesions with low-grade sarcomas that had not progressed to high-grade lesions to determine if (1) histologic progression is associated with increasing incidence of p53 missense mutations, and (2) p53 missense mutations within low-grade areas are predictive of which lesions undergo histologic progression. To examine these questions we studied well-differentiated liposarcoma with and without dedifferentiation and dermatofibrosarcoma protuberans with and without areas of fibrosarcoma. Nuclear p53 immunoreactivity was detected in 48% (12/25) of well-differentiated liposarcoma with dedifferentiation compared to only 6% (1/17) of well-differentiated liposarcoma alone. p53 nuclear immunoreactivity was also detected in 25% (4/16) of dermatofibrosarcoma protuberans with fibrosarcoma, and in 0% (0/24) of dermatofibrosarcoma protuberans lacking fibrosarcoma. In cases of well-differentiated liposarcoma with dedifferentiation and dermatofibrosarcoma protuberans with fibrosarcoma displaying immunoreactivity, the staining occurred almost exclusively in the high-grade areas and very infrequently in the low-grade regions as well. We conclude that histologic progression of well-differentiated liposarcoma and dermatofibrosarcoma protuberans is associated with increased nuclear p53 immunoreactivity. Since p53 immunoreactivity occurs infrequently in the low-grade areas of those sarcomas that had transformed to higher grade lesions, it does not appear to be a useful predictor of tumor progression in low-grade lesions. Int J Surg Pathol 3(1):35-42, 1995

A benign fibrohistiocytic neoplasm of bone containing unique epithelioid cells is described in a 54-year-old man who presented with a well-defined lytic lesion in the left calcaneus. Curetted specimens showed microscopic evidence of proliferation of large plump, protoplasmic epithelioid or histiocytic cells with spindled to rounded shape, arranged in a storiform pattern, and osteoclast-like giant cells. This tumor did not show any specific immunoreactivity except for vimentin and actins. In addition to the basic ultrastructural characteristics of fibro/myofibroblasts, the large cells with abundant eosinophilic cytoplasm by light microscopy were shown to be packed with intermediate filaments of the vimentin type. Tumor was treated by curettage and bone grafting and showed radiolucent changes 1 year after operation but had not progressed 3 years later. The term epithelioid fibrous histiocytoma of bone is suggested for this previously undescribed variant of osseous fibrous histiocytoma Int J Surg Pathol 3(1):43-48, 1995

We report the rare case of a rapidly growing inflammatory pseudotumor arising in the mediastinum of a 30-year-old man with myelodysplastic syndrome secondary to treatment for grade 3 astrocytoma. The tumor was discovered soon after discontinuation of 5-azacytidine therapy for myelodysplasia. Fine-needle aspiration was suggestive, and thoracoscopic biopsy was diagnostic. The tumor was excised because of rapid growth and encroachment on the left pulmonary artery and lung. Postoperatively, blastemia was discovered. Acute myeloid leukemia was confirmed by bone marrow biopsy. The patient died of aspiration pneumonia before commencement of leukemia chemotherapy. This case illustrates a rare occurrence of inflammatory pseudotumor in the mediastinum complicating or arising in the setting of multiple primary cancers and chemotherapy. A temporal association with azacytidine therapy is noted. Int J Surg Pathol 3(1):49-58, 1995

A case of an unusual pulmonary epithelioid hemangioendothelioma is described in which two distinctive types of histologic lesion were combined. The patient was a 54-year-old man with persistent hemoptysis. The main lesion was an endobronchial tumor that had classic features of epithelioid hemangioendothelioma of soft tissue. Multiple peripheral parenchymal nodules resembled features of intravascular bronchioloalveolar tumor of the lung. The endothelial origin of the tumor cells was evident on both ultrastructural and immunohistochemical findings, including the presence of Weibel-Palade bodies and positive immunostaining to Ulex lectin and factor VIII-related antigen. This case seems to be an example with mixture of endobronchial epitheloid hemangioendothelioma of soft tissue type and peripheral intravascular bronchioloalveolar tumor histology, an association that has not been reported as yet. Int J Surg Pathol 3(1):59-64, 1995