Tumors of the adrenal gland and extra-adrenal paraganglia

S OF RECENT PuBLICATIONS BY AFIP STAFF Carcinoids of the jejunum and Ileum: an immunohistochemical and clinicopathologic study of 167 cases Allen P. Burke, M.D. Rebecca M. Thomas, M.D. AI M. Elsayed, M.D. Leslie H. Sobin, M.D. BACKGROUND. Carcinoid tumors of the gastrointestinal tract differ in their clinical and histopathologic features, depending on the site of origin. There are few clinicopathologic studies that specifically describe jejunoileal carcinoid tumors. METHODS. One hundred sixty-seven ileal and jejunal carcinoids were retrospectively studied with emphasis on clinical, pathologic, immunohistochemical, and prognostic features. RESULTS. The mean age of patients at the time of presentation was 62 + 12 years (range, 13-93 years). Eight patients had carcinoid syndrome (5%) and I had Zollinger-EIIison syndrome. Twenty-six percent of tumors were multiple, and 77% were transmurally invasive; 31% had regional lymph node metastases only, and 32% had liver or mesenteric metastases. Ninety-three percent of tumors had an insular growth pattern. Serotonin was expressed in 86% of tumors (86 of I 02), chromogranin in 92%, and neuron specific enolase in 95%. Twenty percent of tumors (1 0 of 5 1) expressed prostatic acid phosphatase; 96% were argyrophil , and 98% argentaffin. Of 80 cases with follow-up data (mean fo llow-up, 52 + 5 months), 21% were dead of disease, 16% were dead of other causes, 19% were alive with disease, and 44% had no evidence of disease at last fo llow-up. The 5-year KaplanMeier survival estimate for all cases was 58%. By univariate analysis, survival was negatively correlated with distant metastases at the time of surgery (P = 0.002), mitotic rate (P = 0.0 I), tumor multiplicity (P = 0.0 I), the presence of carcinoid syndrome (P = 0.02), depth of invasion (P = 0.03), and female gender (P = 0.05); by multivariate analysis, survival was negatively associated with distant metastasis (P = 0.002), carcinoid syndrome (P = 0.0 I), and female gender (P = 0.03). CONCLUSIONS. Jejunoileal carcinoid tumors have a relatively high rate of transmural invasion and aggressive clinical behavior. They are usually insular and largely argentaffin, with a high rate of chromogranin and serotonin positivity. These features differentiate jejunoileal carcinoids from other gastrointestinal carcinoids. Cancer. 1997;79: 1086-93. Detailed RT-ISPCR protocol for preserving morphology and confining PCR products in routinely processed paraffin sections Van-gao Man, Zhengping Zhuang, Gary L. Bratthauer, Omar Bagasra and Fattaneh A. Tavassoli A modified reverse transcription in situ polymerase chain reaction (RT-ISPCR) protocol has been developed for mRNA detection in routinely processed paraffin sections. Compared to previously published methods, this protocol applies several new strategies, including (I ) placing tissue sections on regular microscopic slides to reduce the size of the reaction chamber; (2) substituting enzymatic digestion with overnight incubation at 80°C to eliminate "cross-links " induced by formalin fixation; (3) adding anti-AEUAE3 antibodies to RT solution to create a spongelike tissue surface to trap and confine newly formed PCR products; (4) reducing the number of high-temperature treatment steps to avoid complete tissue desiccation; and (5) placing sections at 4°C after RT reaction and amplification to facilitate newly formed PCR products to settle down. With these strategies, we have been able to obtain reproducible results in which the morphology of tissue is well preserved, different cell types are readily distinguishable, and the ampli fied PCR products are easily identi fi able. This protocol can also be used for detection of DNA in paraffin sections with stronger signals and better preservation of morphology. The specificity of this method is confirmed by results from different controls and from other approaches, including immunohistochemistry with specific antibodies, in situ hybridization with specific mRNA probes, and tube PCR with the same primers and PCR conditions used for RT-ISPCR The basic rationale of our approach is discussed. Cell Vis. 1996;3:389-396. Inflammatory pseudotumor of lymph nodes: a study of 25 cases with emphasis on morphological heterogeneity Cesar A. Moran, MD, Saul Suster, MD, and Susan L. Abbondanzo, MD The clinicopathological and immunohistochemical findings in 25 cases of inflammatory pseudotumor of lymph nodes (115) ·are presented. The patients were 13 women and 12 men between 8 and 81 years of age. Clinically, symptoms of prior infection, fatigue, abdominal pain, weight loss, fever of unknown origin, pelvic inflammatory disease, or nausea and night sweats were obtained in 15 patients, whereas six patients presented with asymptomatic lymphadenopathy. In four additional patients, no clinical information was obtained. The involved nodes included cervical, supraclavicular, inguinal, mesenteric, and mediastinal lymph nodes. In two cases, there was synchronous involvement of separate lymph node groups (inguinal and cervical in one case and cervical and mediastinal in another case), whereas in a third patient there was synchronous involvement of the spleen and a paraaortic lymph node. Histologically, the lesions were characterized by a fibrosing/ inflammatory process that showed marked heterogeneity and striking variation from case to case. Based on their histological features, the lesions could be classified into three different groups: Stage I was characterized by the appearance of single or multiple small foci containing a spindle cell proliferation admixed with a prominent inflammatory background, with complete preservation of the remainder of the nodal architecture; stage II was characterized by more diffuse involvement of the lymph node with a marked inflammatory response itdmi xed with a prominent myofibroblastic proliferation leading to subtotal effacement of the nodal architecture, often with extension of the process beyond the capsule into perinodal fat; and stage III was characterized by almost complete replacement of the lymph node by diffuse sclerosis with scant residual inflammatory elements and total loss of the normal nodal architecture. Immunohistochemical studies in 20 cases showed a striking number of vimentinand actin-positive myofibroblastic cells with moderate increase in CD20/CD45+ small lymphocytes and polyclonal plasma cells in the stage I lesions, the emergence of numerous CD68+ histiocytes admixed with lymphocytes, plasma cells, and abundant fibromyofibroblastic cells in the stage II lesions , and only few remaining scattered CD68+ histiocytes and fibroblasts in the stage III lesions. Our findings suggest that inflammatory pseudotumor of the lymph node represents an evolving, dynamic process that may adopt different morphological appearances depending on its stage of evolution. Recognition of the various stages of this process may be of importance for differential diagnosis with other fibros ing/inflarnmatory conditions of lymph nodes. Hum Patlwl. 1997;28:332-338. Armed Forces Institute of Pathology Washington, D.C. 20306-6000