Cases reported "Lung Neoplasms"

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1/20. Pulmonary carcinosarcoma: immunohistochemical and ultrastructural studies.

    A case of pulmonary carcinosarcoma in a 68-year-old male patient is reported. The tumor in the resected left upper lobe extended mainly endobronchially, invading the normal bronchial lumina and mucosa. The carcinomatous component consisted of poorly differentiated squamous cell carcinoma and was mainly located in the periphery of the tumor nests. The sarcomatous component consisted of chondrosarcoma and was mainly located in the center of the tumor nests. Tumor cells in the sarcomatous component reacted with anti-S-100 protein antibody and were surrounded with abundant homogeneous extracellular matrix staining positively with alcian blue. The transition from the carcinomatous component to the sarcomatous component appeared to be very smooth. The tumor cells in both the carcinomatous and sarcomatous components reacted with anti-epithelial membrane antigen antibody. Ultrastructurally, the tumor cells with tonofibrils in the carcinomatous component were apposed and connected to each other by desmosomes. By contrast, in the sarcomatous component, the tumor cells had well-developed and dilated rough endoplasmic reticulum and were arranged loosely in a myxomatous matrix. Some tumor cells in the sarcomatous component had occasional tonofibrils, and were apposed and connected to each other by desmosome-like structures. It is shown for the first time, ultrastructurally and immunohistochemically, that the tumor cells in the sarcomatous component of pulmonary carcinosarcomas have features of both epithelial and mesenchymal cells. It is suggested that the sarcomatous component in the present case is derived from the carcinomatous component.
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2/20. Follicular dendritic cell tumor presenting in the lung: a case report.

    An example of extranodal follicular dendritic cell sarcoma (FDCS) presenting in the lung, a heretofore unreported site, is described. Macroscopically, a 9.5-cm, tan-white, dominant mass and multiple smaller parenchymal and pleural nodules were identified. Microscopically, the tumor was composed of spindled cells with uniform cytologic features arranged in short, intersecting fascicles and intermixed small lymphocytes and plasma cells. One of 4 peribronchial and hilar lymph nodes evaluated microscopically was focally involved by the process. Immunohistochemically, the neoplastic spindled cells expressed complement receptors CD21 and CD35 and low-affinity nerve growth factor receptor but did not express keratin (AE1/AE3 and CAM5.2), CD45 (leukocyte common antigen), CD20 (L26), S-100 protein, muscle-specific actin, or gp100 protein (HMB45). Ultrastructurally, the tumor cells have complex interdigitating cell surface processes and desmosomes. Epstein-Barr virus (EBV) was not detected in the tumor cells by in situ hybridization for EBV-encoded rna or by polymerase chain reaction for viral dna. FDCS should be considered in the differential diagnosis of any spindled-cell tumor with interspersed chronic inflammatory cells occurring in the lung. An immunohistochemical panel, including anti-CD21 and -CD35, can assist in its diagnosis, especially with small bronchial biopsy specimens. 2001 by W.B. Saunders Company.
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3/20. The fine structure of so-called minute pulmonary chemodectomas.

    Electron microscopy was performed on several minute tumors of the type called chemodectomas, all from the lung of a single patient. The cells had a whorling pattern with extensive interdigitating cytoplasmic processes joined by desmosomes. Except for tangles of cytoplasmic fibrils, the tumor cells had few distinctive organelles. They had no endocrine-like granules and were not associated with nerves or basement membranes. The tumors had little resemblance to paragangliomas, but displayed a puzzling similarity to meningiomas. Our observations permit no definite conclusions as to the histogenesis of these lung tumors. Viewed in the light of recent physiologic studies, they cast doubt on the presence of special chemoreceptive paraganglia in the lung.
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4/20. Poorly differentiated synovial sarcoma. A light and electron microscopic study.

    Few studies of the ultrastructural features of synovial sarcoma have appeared in the literature. The case under study represented a poorly differentiated synovial sarcoma with a predominant fibrosarcomatous component and a few areas with epithelioid and pseudoacinar patterns. Ultrastructurally, the cellular elements of the varied histologic patterns were similar. Basement membranes and desmosomes were absent, and the cell surfaces facing the acinar lumen exhibited multiple microvilli. It appears from a comparison of our studies with the previous reports that the fine structure of this tumor varies according to the degree of histologic differentiation.
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5/20. Ultrastructural, immunohistochemical and biochemical studies on amylase and ACTH producing lung cancer.

    Tumour tissue from a lung cancer patient who showed elevated serum amylase and adrenocorticotropin (ACTH) was studied ultrastructurally, immunohistochemically and biochemically. Histologically the tumour was a small cell carcinoma. On electron microscopic examination the tumour cells contained large zymogen-like granules within the cytoplasm. Furthermore, cells which possessed many small dense core granules of the endocrine type were also observed. It was of interest that the large zymogen-like granule-containing tumour cells had microvilli at the apical border, connected by desmosomes and forming lumina showing adenocarcinomatous differentiation. Electrophoretic analysis of the serum revealed that the major elevated amylase was of the salivary type with minor components. Immunostaining clearly demonstrated that most of the tumour cells possessed immunoreactive ACTH, whereas salivary amylase was only found in occasional clusters of the tumour cells. The results seem to indicate that the tumour showed both endocrine and exocrine characteristics--an amphicrine carcinoma, expressing amylase and ACTH simultaneously.
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6/20. Freeze-fracture study of the intercellular junctions in bronchiolo-alveolar carcinoma (Clara cell type).

    Two bronchiolo-alveolar carcinomas of Clara cell type have been studied by thin section and freeze-fracture techniques. Thin sections of the tumour cells showed junctional complexes (tight junctions and intermediate junctions) at the luminal aspect of the lateral cell membranes and desmosomes below them. Freeze-fracture replicas showed well-developed tight junctions with strands arranged in parallel or polygonal patterns. The junctions were continuous 'zonula occludens' type, usually three or more strands deep, with focal proliferation in some areas. The granules in the tumour cells tended to be larger than those of normal human Clara cells, although they were morphologically similar. There was no evidence of secretion of granules from the tumour cells. The relationships between tumour differentiation and growth pattern, and junctional development are discussed.
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7/20. Hematopoietic cell surface markers on metastatic small cell carcinoma detected with monoclonal antibodies.

    Using a panel of monoclonal antibodies, cells from lymph node biopsies have been examined in three patients with small cell carcinoma presenting with cervical lymphadenopathy. Two patients had small (oat) cell carcinoma of the lung; in the third patient, a primary tumor was not found. Two lymph node biopsies showed typical small (oat) cell carcinoma, and one was an intermediate cell variant; in the last, lung biopsy showed small (oat) cell carcinoma. Electron microscopy demonstrated desmosomes in all three tumors. In each case, lymph node cell suspensions were examined by indirect immunofluorescence with the use of a panel of monoclonal antibodies to antigens usually associated with lymphoid or myeloid cells. In two of the three cases malignant cells were positive with the lymphoid marker BA-2; in two cases malignant cells were positive with OK1a1, a marker for the Ia-like antigen (HLA-DR); and in one case malignant cells were positive with My-1. Caution is needed in the interpretation of cell surface marker studies in the differential diagnosis of small round cell tumors.
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8/20. Identification of desmosomes in the granular cell tumor. Implications in histologic diagnosis and histogenesis.

    Electron-microscopic examination of a malignant granular cell tumor revealed cells with abundant granular and glycogen-containing cytoplasm and eccentric nuclei. Numerous junctional structures including desmosomes were identified between tumor cells which, moreover, displayed a pattern of gland formation with the presence of short microvilli in one pole of the cell. The presence of junctional structures may provide a feature for positive identification of this tumor by electron microscopy. The findings may also have implications to further our understanding of the histogenesis of this tumor. This case further raises the question of familiar occurrence of this tumor.
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9/20. Metastasizing myxopapillary ependymoma of the sacrococcygeal region. A clinico-pathologic, light- and electronmicroscopic, immunohistochemical, tissue culture, and cytogenetic analysis of a case.

    A case of recurrent and metastasizing subcutaneous myxopapillary ependymoma of the sacrococcygeal region in a 44-year-old man is reported. The tumor was characterized light microscopically by numerous papillary projections, lined by epithelium-like cells, with a variable degree of polymorphism. Histochemical analysis relating to glucosaminoglycans indicated the presence of hyaluronic acid and chondroitin-4- and/or 6-sulfate. Using immunoperoxidase techniques, glial fibrillary acidic protein (GFAP) and S-100 protein were demonstrated within the tumor cells. Ultrastructurally, the tumor cells were characterized by an abundance of intermediate cytoplasmic filaments, prominent interdigitating cytoplasmic projections, the formation of desmosomes and external lamina-like material. The growth pattern in the tissue culture of this tumor is described, and the ultrastructural appearance of the cultured cells revealed features similar to the primary and recurrent tumor. Chromosome analyses by the G-banding technique of early generations of cultured tumor cells revealed a normal diploid stemline without gross chromosomal deviations. Among the different variant cells and clones recorded, those with x chromosome deviations were of special interest since gonosomal deviations have previously been observed in other types of glioma. The differential diagnosis against adenopapillary carcinoma, chordoma and malignant teratoma is briefly discussed.
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10/20. Osteogenic and sarcomatoid differentiation of a renal cell carcinoma.

    Sarcomatoid renal cell carcinoma is an uncommon renal tumor, and osteogenic differentiation has been reported in only a few of these tumors. The authors report such a case with radiographic, light microscopic, and electron microscopic findings, which demonstrate that the sarcomatoid areas of the tumor are derived from the malignant epithelial cells, retaining epithelial features such as desmosomes and lumina with microvilli. The use of electron microscopy is important in the establishment of this diagnosis.
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