[Problems in the classification of thyroid tumors. Their significance for prognosis and therapy].

Standardized nomenclatures of tumors are mandatory for epidemiological investigations as well as for the correct interpretation of pathological diagnoses by the clinician. Not least thanks to the activity of the World Health Organization (WHO), uniform tumor nomenclatures in worldwide use have been adopted for most organs. This applies also for the thyroid, even in Switzerland, where many pathologists had formerly been convinced that only the special and rather complicated nomenclature of Langhans, adapted by Wegelin, was consistent with the special tumor situation in Switzerland, a former endemic goiter area.

Hyperplasia and hypertrophy of Leydig cells associated with testicular germ cell tumours containing syncytiotrophoblastic giant cells.

In patients with seminomas and non-seminomatous germ cell tumours of the testis syncytiotrophoblastic giant cells (STGC) are largely responsible for elevated levels of chorionic gonadotropin. In searching for these cells, the question arises whether hyperplasia and/or hypertrophy of Leydig cells in the adjacent testicular tissue is a relevant finding. To elucidate this problem we analysed the tumour-free testicular tissue of 20 seminomas and 20 combined seminomatous and non-seminomatous germ cell tumours with or without immunohistochemically demonstrable STGC morphometrically.

Malignant haemangioendothelioma of the thyroid, immunohistochemical evidence of heterogeneity.

26 cases of malignant haemangioendothelioma (MHE) of the thyroid gland were investigated immunohistochemically with the endothelial marker UEA-1 lectin and the panepithelial marker Lu-5. The results were compared with the results of staining for factor VIII-related antigen in the same cases observed in a previous study of Pfaltz et al. The 26 cases were classified on light microscopic grounds without reference to the immunohistochemical results as classical MHE (15 cases) and borderline cases intermediate between MHE and undifferentiated carcinoma (11 cases).

The WHO histological classification of thyroid tumors: a commentary on the second edition.

This article introduces the revised WHO classification of thyroid tumors, giving an account of the major changes made and the reasons behind the changes, as well as listing the actual classification now recommended. It is intended to draw general attention to the revision, the full version of which will be published separately.

Differences between subcutaneous and intraperitoneal forms of three human testicular teratocarcinomas in nude mice.

Three human testicular teratocarcinomas were serially passaged following subcutaneous transplantation into nude mice. Tumor cell suspensions from selected passages were injected intraperitoneally. The subcutaneous transplants of each tumor conserved the morphological characteristics of one component of the primary tumor, namely an embryonal carcinoma in one case and a yolk sac tumor in two.

[Bilateral germ cell tumors of the testis].

Before the introduction of effective chemotherapy for testicular germ cell tumours, the relative frequency of bilateral germ cell tumours was about 1.6%. Now, as more patients with unilateral tumours survive, an increase in this percentage is to be expected.

Haemangioblastoma. An immunohistochemical study of ten cases.

Ten cases of cerebellar haemangioblastoma were studied using the immunoperoxidase technique for glial fibrillary acidic protein (GFAP), Factor VIII-related antigen (F8RA), Ulex europeus agglutinin 1 (UEA-1), S-100 protein, neurone-specific enolase (NSE), leucocyte common antigen, synaptophysin, chromogranin and eight polypeptide hormones (bombesin, pancreatic polypeptide, somatostatin, thyroglobulin, calcitonin, glucagon, insulin and gastrin). GFAP and S-100 were demonstrated at the periphery of all tumours and in small groups of cells in the centre of four cases. Most of these cells had the morphology of reactive astrocytes but some had the appearance of stromal cells.

Solid cell nests (SCN) in Hashimoto's thyroiditis.

In Hashimoto's thyroiditis squamous metaplasia has been described by several authors. Such foci resemble the so-called solid cell nests (SCN) of the thyroid, epidermoid structures thought to be remnants of the fourth endodermal pouch. These cell nests can be identified by their particular histological appearances and by their positive reaction with polyclonal anti-CEA.

Structure and motility of primary cilia in the follicular epithelium of the human thyroid.

In order to clarify contradictory reports concerning ciliary structure and function, follicular epithelium from macroscopically normal portions of 37 surgical specimens of human thyroid were processed for video-microscopy and/or transmission electron microscopy. The cilia of living cells were immotile. In transverse sections the cilia revealed a 9 + 0 pattern at the base of the shaft, whereas towards the distal end the number of microtubular doublets diminished.

Intracranial mixed germ cell tumor with syncytiotrophoblastic giant cells and precocious puberty.

A 9-year-old male patient developed a germ cell tumor in the right basal ganglia which secreted beta-human chorionic gonadotropin (beta-HCG) and caused precocious puberty. Histology and immunohistochemical staining for placental alkaline phosphatase (PLAP), alpha-fetoprotein (alpha-FP), and beta-HCG showed a mixed population of neoplastic germinocytes, embryonal carcinoma, and syncytiotrophoblastic giant cells (STGC). Immunohistochemical double-staining for alpha-FP and beta-HCG revealed that these two markers were produced by different subsets of cells.

[Cryptococcoma of the adrenal gland].

The case is described of a 49-year-old man who developed cryptococcal meningo-encephalitis ten months before his death. Six months later complicating hydrocephalus occurred which required the implantation of a ventriculo-peritoneal shunt. A further four months later the patient, who was receiving anticoagulation therapy due to deep vein thrombosis, died from intraventricular cerebral haemorrhage.

[Combination of heart myxoma with primary nodular adrenal cortex dysplasia. Case report of a further kinship of this rare familial syndrome].

Another case of the rare syndrome of combined papillary cardiac myxoma and primary adrenocortical nodular dysplasia is reported. The lesions were discovered incidentally at autopsy in a 64-year-old woman who had died of cerebrovascular stroke. Further investigation of the family by echocardiography revealed a small left atrial tumor in the 33-year-old son of the patient.

[Hippel-Lindau syndrome: morphology and immunohistochemistry of tumors related to this syndrome].

Hippel Lindau syndrome (HLS), inherited as a simple dominant trait, is characterized by angiomatosis in the brain and retina, and also by cysts and tumours in various abdominal organs. Microscopically there is a striking morphological similarity between some of these tumours and especially between those in the brain (hemangioblastomas) and in the kidneys (renal cell carcinomas). Biopsy and autopsy material from two patients with HLS was examined chiefly by immunohistochemical methods, to investigate further the origin of these tumours.

Abnormal basement membrane structures in autoimmune thyroid disease.

Thyroidectomy specimens of 8 patients with focal thyroiditis, 7 with diffuse thyroiditis, 13 with Graves' disease and 5 with nodular goiter were investigated by electron microscopy for changes in the follicular basement membrane. Five different types of abnormal basement membrane structures (ABMS), analogous to the ones described in the glomerular basement membrane, were found. Type 1 ABMS were present in all diagnostic groups and seemed to be nonspecific.

[Occurrence of fibrosis in subacute de Quervain thyroiditis].

Subacute thyroiditis of de Quervain is histologically characterized by an inflammatory reaction with histiocytes and giant cells around residues of colloid, producing a tubercle-like granulomatous picture. A variable degree of fibrosis occurs, but recovery is generally almost complete. Investigation of a series of thyroid glands with de Quervain's thyroiditis gave the impression of rather extensive and increasing fibrosis in most of these glands.

A human testicular germ cell tumor with borderline histology between seminoma and embryonal carcinoma secreted beta-human chorionic gonadotropin and alpha-fetoprotein only as a xenograft.

Two macroscopically distinguishable components (designated soft and firm) of a human testicular germ cell tumor with borderline histology between seminoma, embryonal carcinoma and yolk sac tumor, were maintained as xenografts in nude mice for over 20 passages. Levels of beta-human chorionic gonadotropin (beta-HCG) and of alpha-fetoprotein (AFP) were normal in the patient's serum and were undetectable by immunohistochemical studies of the surgical specimen. The xenografted soft part, however, with morphologic characteristics of an embryonal carcinoma, secreted beta-HCG and AFP during early passages.

Evidence of vascular differentiation in anaplastic tumours of the thyroid--an immunohistological study.

Sixteen cases of anaplastic carcinoma (ACA) and 4 cases of malignant haemangioendothelioma (HAE) of the thyroid were studied by light microscopy and immunohistochemistry. Seven cases of ACA and 3 cases of HAE were characterized by coexpression of immunohistological features of epithelial and vascular endothelial cells. Expression of vimentin was common to all tumours investigated.

Duodenal and ampullary carcinoid tumors. A report of 12 cases with pathological characteristics, polypeptide content and relation to the MEN I syndrome and von Recklinghausen's disease (neurofibromatosis).

Twelve duodenal carcinoid tumours are presented, 4 of them located in the ampulla. Symptoms included the Zollinger-Ellison syndrome (4 patients), the carcinoid syndrome (1 patient), mechanical obstruction (3 patients), bleeding (1 patient) and abdominal pain (1 patient). Two further tumours were detected by chance.

Cat scratch disease: evidence for a bacterial etiology. A retrospective analysis using the Warthin-Starry stain.

97 cases of acute necrotizing granulomatous lymphadenitis (so called "reticulozytärabszedierende Lymphadenitis") were examined retrospectively with the Warthin-Starry stain, in order to detect bacteria in patients with cat-scratch disease (CSD). 27 patients with CSD were found and among those, bacteria were demonstrated in 4. The organisms were pleomorphic rods of about 3 micron length and occurred in clumps within foci of fresh necrosis.

Histopathology and ultrastructure of primary adrenocortical nodular dysplasia with Cushing's syndrome.

The characteristic adrenal lesions of five patients with bilateral primary adrenocortical nodular dysplasia and Cushing's syndrome developing in adolescence are presented histopathologically, and in two cases ultrastructurally. Two of the patients were siblings with additional extra-adrenal lesions such as pigmented spots on the face, myxoid cutaneous tumours and in one case familial cardiac myxoma. The adrenals were small with an uneven surface due to numerous small brown to black pigmented nodules in the inner cortex.