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OBJECTIVE: To analyze-cellular proliferation in non-Hodgkin's lymphoma (NHL) of T-cell origin using three variables available on histologic paraffin, dewaxed sections. STUDY DESIGN: The study group consisted of 35 T NHLs (22 low and 13 high grade). Two immunohistochemical methods established the percentage of cells expressing proliferating cellular nuclear antigen (PCNA), or PCNA index, and the Ki-67 antigen, or MIB-1 index. The third method quantified nucleolar organizer regions (NORs) with an image analyzer, giving the NOR area and number of NORs; an internal reference on lymphocytes was used. RESULTS: For the PCNA index, each subtype of low grade NHL demonstrated a difference as compared with high grade NHL except for angioimmunoblastic type NHL (AILD). The difference between the two grades became significant after including AILD-type NHL within high grade NHL (P = .02). The MIB-1 index gave similar results. The PCNA index and MIB-1 correlated (r = .55, P = .008). The relative NOR area and number of NORs differed significantly between the two grades (P < 10(-4) and P < 10(-2); the absolute NOR area differed to a lesser degree (P = .02), and no difference was observed for the absolute number of NORs (P = .07), stressing the importance of an internal reference. NOR areas and numbers correlated highly (r = .90 for relative and .78 for absolute variables, P < 10(-4)). No relation was found between PCNA and MIB-1 indexes. CONCLUSION: Correlations between these variables and grades of malignancy, between the two indices with each other and between the AgNOR variables with each other, including referring to internal lymphocytes, were reported for these T NHL-like tumors in studies on B NHL. The proliferative character of the AILD-type T NHL was in accordance with their worse prognosis. The absence of a correlation between PCNA or MIB-1 indices and NOR variables may reflect a biologic difference between B and T NHLs in a shorter cell cycle or more important functional activity in T NHL.

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Systemic mastocytosis is a chronic disease with proliferation of mastocytes in organs separate from skin. We report the case of a systemic mastocytosis revealed by a lymphocytic ascites in the absence of cutaneous involvement. The diagnosis was established by the ultrastructural examination of the bone marrow. Identification of few mastocytes in ascites suggested a mast cell infiltration of the peritoneum. A treatment by alpha-2b interferon was unsuccessful, and death rapidly occurred.

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Bronchial carcinoma in situ is an intra-epithelial proliferation of tumour which does not cross the basement membrane and is asymptomatic. The evidence for this cancer often rests on a biopsy carried out on a bronchus which may show simple inflammation or may even be normal. We report a new observation on a bronchial carcinoma in situ which was completely ablated after a bronchial biopsy. However surgery remains the first form of treatment for bronchial cancer. If the patient is inoperable, endobroncho-cryotherapy, radiotherapy or phototherapy may be tried but tumour recurrence remains a possibility.

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A case of fatal cytomegalovirus pneumonia in a non-immunocompromised 65-year old man is reported. The patient presented with symptoms of a lower respiratory tract infection. The diagnosis of cytomegalovirus pneumonia was made after histopathological examination of the open lung biopsy. Confirmation of cytomegalovirus infection was made with in situ DNA Hybridization. The outcome was rapidly fatal. This case demonstrates the value of DNA probe analysis for diagnosis. This case is also unusual in that a non-immunocompromised adult had severe evolution of cytomegalovirus infection.

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This report describes three cases of acute malignant myelofibrosis characterized by pancytopenia, absence of splenomegaly, bone marrow fibrosis with an immature cell proliferation and rapidly fatal outcome. The authors investigated the origin of blast cells with the use of immunohistochemical markers on paraffin embedded material with anti-factor VIII, BNH9 and anti-lysozyme. They studied the expression of megakaryoblastic, erythroblastic and myeloblastic differentiation in these cells. They demonstrated the heterogeneity of blast cells which are capable of differentiating along the three hematologic cell lines. The morphometric study showed the mutilating or systematized character of myelofibrosis. The increase in reticulin fiber density compared with normal bone marrow was not significantly different from two other types of myelofibrosis. It would be interesting to correlate a quantitative parameter with the course of this disease in order to evaluate the prognosis and the treatment.

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The authors report a case of malignant fibrous histiocytoma of the left atrium which was excised but rapidly recurred in a 47-year-old woman. Clinical examination, echocardiography and the absence of biochemical abnormalities were in favour of the diagnosis of left atrial myxoma. This report illustrates the clinical similarity between myxoma and sarcoma of the left atrium. Very careful anatomopathological examination of multiple sections of the tumour are necessary to distinguish it from benign tumours, especially myxomas.

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The authors report a case of cardiac metastasis revealing a malignant tumor of the biliopancreatic junction. This observation raises the problem of the diagnosis of revealing metastases. Immunohistochemical and ultrastructural studies may help to diagnose and identify primary tumors. This identification plays a major role predicting the prognosis and determining an optimal treatment.

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The authors report an unusual case of oesophageal pseudo-diverticulosis. A 63-year-old male patient presented with dysphagia. A preoperative diagnosis of oesophageal intramural tumour was made on radiological and endoscopic abnormalities. The histopathological study of the involved oesophagus showed a pseudocystic dilatation of glandular ducts in the submucosa with a lymphocytic infiltrate. The authors review the relevant literature on oesophageal intramural pseudodiverticulosis and suggest a possible pathogenesis for this rare and benign entity.

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Using scanning electron microscopy (SEM), then light microscopy, the authors have studied 25 colonic adenomas, 5 specimens of peri-adenomatous mucosa and 9 specimens of normal colonic mucosa. Comparison between SEM features and histological characteristics has shown that each of the three histological entities had an specific surface architecture. Comparative analysis of the different aspects observed at SEM has shown a close architectural relationship between the adenomas and the adjacent mucosa, and suggests the hypothesis that adenomatous polyps are formed by invagination of the surface epithelium which has a well-known capacity of proliferation.

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Metastatic carcinoma of the thyroid is uncommon in surgical pathology and may masquerade as primary thyroid cancer. We studied 6 cases of biopsied and/or surgically resected metastatic carcinoma of the thyroid and their corresponding primary carcinoma, with emphasis on the differential diagnosis. There were 4 men and 2 women patients aged 44 to 77. The primary carcinoma was a breast infiltrating duct carcinoma (3 cases), a colorectal adenocarcinoma (2 cases) and a bronchial oat-cell carcinoma (1 case). The interval between primary carcinoma and secondary thyroid carcinoma was 2 to 9 years in 4 cases; 2 other cases showed simultaneous occurrence. Five patients died with widespread metastases 1 to 14 months following the diagnosis of secondary carcinoma of the thyroid; 1 patient was alive after 24 months. The histological differentiation of secondary from primary thyroid cancer may be difficult in the following situations: clear-cell, Hürthle-cell and signet ring cell changes; positivity of mucins stains; production of melanin; epidermoid differentiation; very rare miscellaneous tumours ("columnar cell carcinoma" and primary thymoma of the thyroid). Immunoperoxidase methods and mucin histochemistry may help.

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A case of malignant histiocytosis was studied by cytology, cytochemistry, electron microscopy, and cytogenetics. It was shown that the malignant cells expressed a fully differentiated histiocytic pattern with high macrophagic activity. This correlated with the presence of polyploid metaphases. The significance of polyploid cells in the definition of malignant histiocytosis is discussed.

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A case of Carrington's chronic eosinophilic pneumonia associated with bronchocentric granulomatosis in a young asthmatic woman is reported. Among the numerous forms of "eosinophilic lung", the characteristic features of these two diseases in asthmatic patients are briefly described. Concerning the association, the authors have found that some authors suggest a common nosological framework with many transitional forms.

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A comparison was made between the biochemical and histological properties of collagens contained in samples of normal tracheas obtained at autopsy or of stenosed tracheas obtained during surgery. The amounts of total collagen solubilized by pepsin was increased seven times in the pathological samples, and the proportion of cartilage type II collagen decreased by about one half, being replaced by type I collagen, whose ratio was increased five times. Microscopic studies confirmed that cartilage underwent a degenerative process and was progressively infiltrated by fibrils of interstitial collagen.

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A 58-year-old man showed bone marrow crystalline structures associated with a lambda light chain producing multiple myeloma. Analysis and processing of electron images clearly displayed the periodic structure of the crystals. Immunochemistry suggested that they contained the whole or a fragmented constant portion of immunoglobulin.

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The distribution of type I, III, IV and V collagen in 35 gliomas and 20 meningiomas was studied by indirect immunofluorescence staining. In addition, the presence of fibronectin (FN) and laminin (LN) is also reported. In gliomas expression of type IV collagen and LN was found in the vessel walls and associated with the endothelial glomerulus-like proliferations. FN and type V collagens were located in proliferating vessel walls in a pattern corresponding both to the basement membrane and the perivascular matrix around the vessels. In the extracellular matrix of grade III and IV gliomas occasional faint intercellular fluorescence was also observed with both FN and type V collagen. Type I and III collagens were localised in the vessel walls and in the perivascular connective sheet. Glioma cells did not express any of the antigens investigated. In meningiomas, type IV and V collagens, LN and FN were found in vessel walls, whorls formations and psammoma bodies. These stainings support the hypothesis of a vascular origin of these psammoma bodies which were only found in syncytial and transitional meningiomas. Both type I and III collagens were detected in the perivascular connective tissue. In general, meningioma cells and extracellular matrix did not express any of these molecules, except in transitional meningiomas where occasional fluorescence was observed in extracellular matrix with type V collagen and FN.

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Forty laryngeal carcinomas were studied by immunofluorescence with specific antisera against components of the basement membrane (type IV collagen and laminin) as well as antisera against connective tissue antigens (type V collagen and fibronectin). The basement membrane surrounding well-differentiated squamous cell carcinomas showed an appearance similar to that seen beneath normal epithelium. In contrast, marked alterations of the basement membrane were constantly observed around infiltrating and poorly-differentiated carcinomas. The staining of connective tissue components in most cases was as intense in carcinomas as in normal laryngeal mucosa. The use of antibodies to basement membrane components may help to elucidate the mechanism of invasion of connective tissues by malignant cells.

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In Hashimoto's thyroiditis, there is a diffuse interfollicular infiltration of lymphocytes and plasmocytes and lymphoid collections with germinal centers. Eleven cases of Hashimoto's disease were studied with immunocytochemical methods for characterization of intracytoplasmic immunoglobulins (IgA, IgG, IgM, Kappa and lambda light chains). Most of the cells are plasmocytes stained positively for intracytoplasmic IgG; IgA positive cells were less frequent and IgM positive cells are rare. Kappa positive plasma cells are more numerous than lambda positive cells in the germinal centers and the interfollicular infiltration. By an indirect immunofluorescence technique in frozen tissue, we have studied with four monoclonal antibodies (OKT3, OKT4, OKT8, B1) the T cells subsets populations in two cases.

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The authors report the case of a female bird breeder who presented with severe pneumopathy from which she died within two weeks. An autopsy was performed. The case is compared with others taken from the literature and the danger of a severe outcome under certain circumstances is emphasized. The authors advocate recourse to immunohistochemical detection of specific markers.

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