[Morphological characteristics of chordoma of the temporal bone: light amd electron microscopy]

For the first time chordoma of the temporal bone in a female aged 24 years is described. The tumor was studied histologically and ultrastructurally.

Sinonasal teratocarcinosarcoma: ultrastructural and immunohistochemical evidence of neuroectodermal origin

The authors report a case of sinonasal teratocarcinosarcoma in a 37-year-old man, which was located in the anterior skull base and extended to the right nasal cavity and paranasal sinuses. The tumor was surgically resected twice, but it could not be removed completely. Microscopically, it was mainly composed of primitive cell nests within a moderately cellular stroma. The components of squamous cell epithelia with focal teratoid appearance and adenocarcinomatous differentiation were observed. There were many rhabdomyoblasts scattered in the nests and stroma. Ultrastructurally, the primitive cells had many neural processes with parallel microtubules, resembling olfactory neuroblastoma. Rhabdomyoblasts showed various degrees of skeletal muscle differentiation. Some of the stromal spindle cells had actin filaments with dense patches and dense core granules. Immunohistochemically, the primitive cells were positive for epithelial markers, neuron-specific enolase, synaptophysin, and myogenic regulatory proteins. The rhabdomyoblasts showed immunoreactivity for myoid markers, cytokeratin, epithelial membrane antigen, and synaptophysin. Most of the stromal spindle cells were positive for smooth muscle actin, neuron-specific enolase and synaptophysin. The immunohistochemical and ultrastructural findings suggest that primitive cells had the most primitive phenotype of placodes, and support the possibility that sinonasal teratocarcinosarcoma is essentially a neuroectodermal tumor with divergent differentiation.

A chondromyxoid fibroma-like tumor of the cranial convexity: immunohistochemical and ultrastructural study

A rare chondromyxoid fibroma-like tumor arising from the temporal bone in a 49-year-old man is described. This case appears to be only the second reported of a cranial lesion of the tumor for which diagnosis could be confirmed by immunohistochemistry and electron microscopy.

Fine-needle aspiration of chondroblastic osteosarcoma of the skull: report of a case in an 11-year-old girl

We describe an unusual case of chondroblastic osteosarcoma of the skull in an 11-yr-old girl in whom a preoperative diagnosis was made by fine-needle aspiration (FNA) biopsy, followed by histologic confirmation of tissue biopsy and the surgically resected specimen. FNA cytology revealed pleomorphic oval cells with prominent nucleoli along with spindle cells, tumor giant cells, and a chondromyxoid background. The cell block of the aspirated material showed osteoid associated with the malignant cells. Immunocytochemical stains revealed S-100 and vimentin positivity; actin, myoglobin, and cytokeratin stains were negative. Electron microscopy revealed neoplastic cells with chondrocytic differentiation. This case demonstrates the value of FNA biopsy combined with immunocytochemical and ultrastructural studies performed on the aspirated material in diagnosing osteosarcoma from an unusual location such as the base of the skull.

Metastatic hypopharyngeal carcinoma to the temporal bone

Two cases of temporal bone metastasis by hypopharyngeal carcinomas are reported. One patient was a 43-year-old Japanese male who developed palsy of left oculomotor, trochlear, trigeminal, abducens and facial nerves. Carcinoma infiltrated the petrous portion of the left temporal bone. Tumor had destroyed a part of the facial canal and invading tumor cells were in contact with the perineurium. The other patient was a 59-year-old male who had no obvious facial nerve or otologic symptoms during the clinical course of his disease. Postmortem findings showed that carcinoma had invaded the right temporal bone and had produced extensive destruction of the facial canal. Degenerative findings were evident in the nerve. In the cases presented here, tumor resulted either from metastatic lymph nodes or had invaded through the suture of the temporal and sphenoid bones around the foramen lacerum to the middle cranial fossa and then infiltrated the temporal bone.

Hemangiopericytoma of the skull base and Collet-Sicard syndrome: a case report

Hemangiopericytoma (HP) is a mesenchymal tumor that originates from the pericytes of the capillary walls. This is a rare neoplasm, particularly in the head and neck; the skull base is involved exceptionally. We report a case of a large HP located in the jugular foramen. The last four cranial nerves were involved, causing a Collet-Sicard syndrome associated with facial palsy. Only one case of HP and Collet-Sicard syndrome is reported in the literature. The clinical course of the disease is described, emphasizing the long period of elapsed time between onset of the complaints and the final diagnosis. Diagnostic procedures and immunohistochemical evaluation are analyzed, along with the possible differential diagnosis with other pathological processes that more frequently involve the jugular foramen.

Base of skull chordoma. A correlative study of histologic and clinical features of 62 cases

BACKGROUND

Chordomas are uncommon primary malignant tumors of bone that typically occur in the axial skeleton including the sacrum, vertebrae, and skull base. The base of skull tumors usually are not amenable to complete surgical resection, and most require postoperative radiotherapy. The natural history of skull base chordoma is typified by slow locally invasive tumor progression and eventual death, although few parameters are known that allow stratification of patients into prognostic groups.

METHODS

Sixty-two patients with skull base chordomas treated at the Massachusetts General Hospital by proton beam irradiation therapy with at least 2 years of follow-up information were reviewed in an attempt to identify clinical and pathologic parameters that predicted outcome.

RESULTS

Female sex, tumor necrosis in preradiation treatment biopsy, and tumor volume in excess of 70 ml were each independent predictors of shortened overall survival after radiation therapy for skull base chordoma.

CONCLUSIONS

Stratification of patients with skull base chordoma into poor and good outcome groups can be performed using the three parameters identified in our study. In addition, the striking difference in survival between the sexes suggests that further investigations of these tumors should include determination of their hormonal receptors status and consideration of hormonal manipulation in their management.

Aggressive small cell tumor of the skull base

A 40-year-old Black man presenting with increasing nasal discharge of bloody, mucoid pus as well as nasal obstruction over a 2-month period is described. Magnetic resonance imaging of the skull showed a tumor eroding through the skull base into the clivus and extending into the sphenoid sinus. Endoscopy of the sphenoid sinus demonstrated a polypoid mass extending into the posterior choanae. The lesion was partially resected. Histologic evaluation showed a cellular small blue cell tumor punctuated by bland, epithelial-lined microcysts. Electron microscopy revealed epithelial cells with abundant rough endoplasmic reticulum and electron-dense membrane-bound endocrine granules, some undergoing misplaced exocytosis. Immunohistochemical evaluation demonstrated cytoplasmic reactivity for neuron-specific enolase, synaptophysin, and prolactin. Stains for leukocyte common antigen, HMB-45, desmin, cytokeratin, chromogranin, and the remaining spectrum of pituitary hormones including growth hormone, corticotropin, luteinizing hormone, follicle-stimulating hormone, and thyrotrophic hormone were negative. In contrast, the epithelium lining the cysts was cytokeratin positive and synaptophysin negative. This ostensibly small cell tumor therefore represented a remarkably extensive and aggressive prolactin cell adenoma with unusual light microscopic features. Characterization of the lesion required electron microscopy and further confirmation by immunocytology. The distinction of pituitary adenomas and particularly of prolactin cell tumors from other adenoma types and from other small cell lesions markedly affects therapy and patient prognosis.

Microtubule aggregates in a clival chordoma

We report a case of a clival chordoma in a 21-year-old man that ultrastructurally demonstrated large numbers of microtubule aggregates within the rough endoplasmic reticulum. Histologically, the tumor demonstrated classic chordoma architecture characterized by numerous physaliphorous cells and an abundant extracellular matrix. The tumor cells stained strongly for cytokeratin, S100 protein, and epithelial membrane antigen, indicative of the epithelial origin of this tumor. Ultrastructurally, the most conspicuous feature of this tumor consisted of parallel bundles of criss-crossing microtubules within the rough endoplasmic reticulum. These microtubules had a diameter of approximately 27 nm and did not demonstrate an internal structure. To our knowledge, this is the first report of microtubule aggregates in a spheno-occipital chordoma. We note that microtubule aggregates have been described in a number of different entities, and though proposed as a specific feature of "chondroid chordoma," they are a nonspecific finding.

[Cranial chordomas: their cytological and ultrastructural characteristics]

Three cases of cranial chordomas were investigated cytologically, histologically and electron microscopically. Heterogeneity of the tumor cells was established. Relevant morphofunctional characterization is given. Mechanisms of the cytoplasm vacuolization and the directions of differentiation are described.

Solitary infantile myofibromatosis of bone. An immunohistochemical and ultrastructural study

A rare case of solitary infantile myofibromatosis of bone in an 11-month-old boy is reported. Radiographically the lesion of parietal bone was round, well-circumscribed, and osteolytic with a sclerotic rim. Histologically the tumor was made up of nodules that were hyalinized or cellular and containing plump, spindle-shaped cells that were intermediate in appearance between fibroblasts and smooth-muscle cells, arranged in short bundles or whorls. Another typical feature was the presence of distended, cleft-shaped vascular spaces around the nodules. The microscopic features of this tumor were consistent with those of infantile myofibromatosis of other sites, such as the skin and deep soft tissue. The tumor cells showed immunoreactivities for vimentin and alpha-smooth muscle actin. Microfilaments with dense bodies were observed in the fibroblast-like tumor cells. In addition, many tumor cells stained for collagen type IV and were covered by incomplete external laminae, indicating infantile myofibromatosis has more advanced smooth-muscle differentiation than conventional fibromatosis.

[An immunohistochemical and ultrastructural study of 20 chordomas]

Altogether 20 chordomas were reported. The site distribution included 9 cases at the sacrococcygeal region, another 9 cases at the spheno-occipital region, 1 at the cervical vertebra, and another 1 at the lumbar vertebra. Histologic examination revealed that characteristic "physaliphorous cells" were easily identified in all the 19 cases. Tissue for immunohistochemistry study was available in 18 cases. Among them, tumor cells were found strongly positive to EMA, but negative for CEA. 16/18 cases also showed positive for keratin and S-100 protein. Totally, 2 cases were studied ultrastructurally and there were abundant RER and microfilaments seen in the cytoplasm of the tumor cells but only few surface microvilli detected. The epithelial nature of chordoma is strongly supported by the ultrastructural and immunohistochemical findings of these 20 cases.

Glomus tumors of the temporal bone: electron microscopic and immunohistochemical evaluation

Glomus tumors arising in the temporal bone are now recognized as being part of the diffuse neuroendocrine system. Material from 12 glomus tumors was studied by means of electron microscopic and immunohistochemical techniques to determine whether there was an association between tumor size, patient age, and the neuroendocrine functions of these tumors. Electronmicroscopic evaluation (seven tumors) revealed a highly variable concentration of neurosecretory granules. Immunohistochemical staining (nine tumors) demonstrated that glomus tumors do arise from neural ectoderm and that they all contain serotonin. The concentration of serotonin seems to correlate with the concentration of neurosecretory granules seen on electronmicroscopy. In addition, higher levels of serotonin were found in two patients who were in their late sixties. It is possible that some of the neuroendocrine activity associated with glomus tumors could be the result of the release of serotonin.

Fine needle aspiration cytology of recurrent ectopic meningioma

Fine needle aspiration was performed on a recurrent extracranial meningioma in the left pterygomaxillary and temporal fossas in a 39-year-old woman. Cytologic and electron microscopic study of the aspirate and comparison to the previously resected specimen proved the recurrent nature of the lesion. The cytologic and ultrastructural findings in meningiomas are discussed with special consideration of the differential diagnosis in extracranial sites.

Primary intraosseous malignant meningioma of the skull: case report

Primary intraosseous meningioma of the skull is rare. This report describes a 61-year-old man who was treated by craniectomy 3 times for a repeatedly recurrent primary intraosseous malignant meningioma. Transmission electron microscopy revealed interdigitation of cytoplasmic processes, microfilaments, and distinct desmosomal structures. Immunocytochemical studies of cultured cells showed strong expression of vimentin and weakly positive staining for S-100 protein. Primary intraosseous malignant meningioma should be considered in the differential diagnosis of massive solitary osteolytic lesions of the skull.

Chordomas in Fischer 344 rats

Tissue sections and records of 56 rats with chordoma, identified in the National Toxicology Program's (NTP) data base of approximately 115,000 rats, were examined to determine morphological characteristics, incidence, and aspects of biological behavior. Chordomas occurred in aged rats, originated predominantly in lumbosacral vertebrae, were highly malignant, occurred three times more often in male versus female rats, and commonly produced bilateral posterior paresis, paralysis, and/or distention of the colon and rectum.

Solid glomus tumor of the pterygoid fossa: a lesion mimicking an epithelial neoplasm of low-grade malignancy

An example of a solid glomus tumor occurring in the pterygoid fossa is described. Despite its epithelial appearance on light microscopy, the tumor was of connective tissue origin. The diagnosis of glomus tumor was based on characteristic cytologic, ultrastructural, and immunohistochemical features, but the unusual site of the tumor made the diagnosis difficult.

Multiple myeloma: a study of 10 cases

The clinical, radiographical, biochemical, microscopical and ultrastructural features of 10 cases of multiple myeloma were studied. The skull and jaw regions were frequently involved by the disease and although the diagnosis remains multidisciplinary, microscopical parameters differentiating a myelomatous bone marrow infiltrate from a reactive plasmacytosis are discussed. Biochemical and microscopical factors influencing the prognosis are highlighted and significant ultrastructural findings include erythrophagocytosis, cytoplasmic nuclear asynchrony of plasmablasts and intranuclear viral like inclusions.

Malignant fibrous histiocytoma of the clivus: case report

A case of malignant fibrous histiocytoma of the clivus in a 2 1/2-year-old boy is reported. There are no prior reports of this tumor in this location. The child was treated with operation, radiation therapy, and chemotherapy. The tumor recurred locally 21 months later. The recurrence was palliated by operation and chemotherapy, permitting an additional 20-month survival.

A simple method for processing cytologic samples obtained from body cavity fluids and by fine needle aspiration biopsy for ultrastructural studies

A simple method for processing routine cytologic samples for electron microscopy is described. The method has been successfully applied to body cavity fluids and fine needle aspiration biopsies. The technique neither requires additional time and personnel nor interferes with the normal activity of the laboratory.

Chondroid chordoma

We reject the notion that the concept of "chondroid chordoma" be abandoned in favor of an interpretation of the cartilaginous origin of these lesions. We have demonstrated by electron microscopic and immunohistochemical means that these neoplasms can exhibit distinctly epithelial characteristics in their chondroid as well as their epithelial areas. The presence of desmosomes, cytokeratin, carcinoembryonic, and epithelial membrane antigen in the cells of the chondroid as well as the epithelial areas; the presence of the microtubular inclusions, vimentin, and S-100 protein in the cells of the epithelial as well as chondroid areas; and the intermingling of the two and gradual transitions from one to the other all point to the conclusion that the chondroid and epithelial areas are only differing morphologic expressions of the same entity. The gradual evolution witnessed in the sequential biopsies of this case study, through which a predominantly chondromatous neoplasm became a chordoma of typical histologic appearance, provides further strong evidence to support the contention that chondroid chordoma is a variant of chordoma and not a primary chondrocytic neoplasm.

Infantile myofibromatosis. Report of two cases

Two cases of infantile myofibromatosis were presented. Case 1 was a 6-month-old girl with multiple nodular lesions in the left parietal bone, dermis of abdominal wall, chest wall, right upper arm, and bilateral femur. Case 2 was a 12-month-old girl with solitary nodular lesions in the left parietal bone having a tendency to enlarge. Histologically, these tumorous lesions consisted of broad bundles of well oriented spindle-shaped cells superficially resembling smooth muscle tissue. In electron microscopy, the constituent cells combined ultrastructural characteristics of both fibroblasts and smooth muscle cells., Immunoperoxidase method showed that anti-smooth muscle antibodies binded to the cytoplasm of the bundle forming cells. From these results, it may be concluded that the lesion consisted of pure proliferation of myofibroblasts, and its peculiar growth behavior was discussed, though the histogenesis still remains obscure.

Primary Ewing's sarcoma of the base of the skull

The authors report a case of primary Ewing's sarcoma of the petrous bone. The radiological features, including the computed tomographic scan and angiographic findings, are described in detail.

Tumorigenicity of cell lines (VMDk) derived from a spontaneous murine astrocytoma. Histology, fine structure and immunocytochemistry of tumours

Three cell lines (VMDk), derived from a spontaneous murine astrocytoma, which exhibit both morphological and antigenic characteristics of astrocytes in vitro (Pilkington et al. 1983), have been injected intracerebrally and subcutaneously into syngeneic mice at a range of concentrations in order to assess the number of cells required to produce the highest yield of tumours with the shortest possible latent period. Light- and electron-microscopical studies of the tumours confirmed their glial nature, however immunocytochemical staining for the astrocyte-specific markers glial fibrillary acidic protein (GFAP) and glutamine synthetase (GS) and for vimentin suggest that the tumours are composed mainly of poorly-differentiated neoplastic glial cells. Although the best-differentiated of the three cell lines failed to produce tumours, an invasive transplantable astrocytoma model has, nevertheless, been characterised fully and can now be used to study the effects of various therapeutic regimens.

Multicellular tumor spheroid interactions with bone cells and bone

In vitro coculture techniques were used to study HSDM1C1 murine fibrosarcoma multicellular tumor spheroid (HSDM1C1-MTS) interactions with mouse calvarial bone cells having osteoblastic characteristics and mouse bone explants. HSDM1C1-MTS attached to confluent bone cell monolayers and their attachment rate was quantified. HSDM1C1-MTS interaction with bone cells was further demonstrated by the release of 3H-deoxyuridine from prelabeled bone cells during coculture with multicellular tumor spheroids. HSDM1C1-MTS-induced cytotoxicity was mimicked by the addition of 10(-5) M prostaglandin E2 (PGE2) to 3H-deoxyuridine-labeled bone cells. The effects of low (10(-9) M) and high (10(-5) M) concentrations of PGE2 on bone cell proliferation were also studied. Higher concentrations of PGE2 inhibited bone cell proliferation. HSDM1C1-MTS resorbed living explants in the presence of indomethacin, suggesting that other tumor cell products may also participate in bone resorption. HSDM1C1-MTS caused direct bone resorption as measured by the significantly elevated release of 45Ca from prelabeled, devitalized calvaria. However, the growth of a confluent bone cell layer on devitalized, 45Ca-prelabeled calvaria resulted in a significant reduction in the amount of 45Ca released subsequent to the seeding of HSDM1C1-MTS onto the explants. Bone cells at the bone surface may act as a barrier against invasion and tumor cell-mediated bone resorption. Violation of this cellular barrier is achieved, in part, by tumor cell products.

Ecchordosis physaliphora and chordoma: a comparative ultrastructural study

A comparative study of the ultrastructure of two cases of ecchordosis physaliphora and of two chordomas demonstrated outstanding similarities in the cells composing these two entities. Chordoma cells possessed a more prominent Golgi apparatus, an endoplasmic reticulum-mitochondria complex, plasmalemmal infoldings, nuclear irregularities and a larger extracellular space with abundant matrix, reflecting their expanding neoplastic nature. Ecchordosis cells had nuclear inclusions, dense-core membrane-bound granules and subcytoplasmalemmal linear densities, not previously described. Both ecchordosis and chordoma cells have morphologic features of both epithelial and mesodermal character. This study supports the concept that chordomas arise from heterotopic notochordal remnants in the cranio-vertebral canal.

[Two cases of sellar chordomas. Ultrastructural and histochemical study (author's transl)]

Two cases of sellar chordomas are reported, with ultrastructural and histochemical study. The embryological origin and the histochemical data are discussed. The question of chondroid chordomas is evoked and the results of the ultrastructural study are interpreted on the basis of the cases hitherto reported. Special attention is called to the methods for the detection of polysaccharides by electron microscopy in such proliferations. Tissue culture seems to be able of providing a good information as to the secretory activity of the chordomas located at the skull base.

Hemangiopericytoma of the temporal bone

Hemangiopericytomas are uncommon soft tissue tumors. While their occurrence in sinuses and soft tissues around the ear is well documented, there are no reports of primary involvement of the temporal bone. This article discusses the case of a 21 year old patient who had a right temporal angioblastic meningioma resected and presented two years later with a hemangiopericytoma that extensively involved the right temporal bone and external auditory canal. In review, the "meningioma" had the same histological features as the auditory tumor and it was evident that both lesions resulted from the growth of a hemangiopericytoma arising from the intracranial aspect of the temporal bone. Electron microscopic examination of the tumor proved useful in making the diagnosis and in evaluating the cytological features that influence prognosis and treatment. Temporal bone involvement was a major problem and the opportunity is taken to document this rare occurrence and to discuss the biological behavior, pathological characteristics, and differential diagnosis of these neoplasms.

Biochemical studies of the matrix of craniovertebral chordoma and a metastasis

Glycosaminoglycans of human chordoma and a metastasis were studied. The glycosaminoglycans were derived from the extracellular matrix and consisted of chondroitin 4- and 6-sulphate, keratan sulphate and hyaluronate. The ratio of chondroitin sulphate to keratan sulphate was much lower in the metastasis than in the primary. Proteoglycan extracted with 4M guanidinium chloride and purified by associative density-gradient centrifugation was assessed on Sepharose 2B before and after reduction and alkylation. The result of this experiment suggested that only a small proportion of the proteoglycans were aggregated.

Intrasellar paraganglioma associated with hypopituitarism

A 37-year-old with a history of postpubertal arrest of sexual development and delayed growth was found to have an enlarged sella turcica. The clinical and biochemical features were consistent with hypopituitarism. A tumor was removed transsphenoidally that, through light microscopy, histochemistry, and electron microscopy, proved to be a paraganglioma. We report the possible origin of intrasellar paraganglioma, as well as the pathogenesis of hypopituitarism.