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All the malignant soft tissue tumours in the extremities and limb girdles reported to the Finnish Cancer Registry between 1960–1969 were reviewed. From a total of 246 sarcomas, 38 were diagnosed as malignant fibrous histiocytoma. There was an equal number of male and female patients with the median age of 67 years. The thigh was the most frequent site, and the majority of the tumours originated in the deep soft tissues. The predominant treatment was excision followed by radiation therapy. In 17 patients there were one or more recurrences and in 21 patients there was a metastatic spread ascertained by biopsy, autopsy or clinical or radiographic evidence. There were 11 survivors with a minimum of 5 years' follow-up; seven patients died of an intercurrent disease and the remaining 20 patients were considered victims of their tumour. The findings that seemed to favour a poor prognosis were higher age and female sex of the patient as well as deep location, large size, necrotic areas, and high mitotic activity of the tumour.

We report a case of a glomus tumor in the trachea which was an incidental finding in a 66-year-old man. The histological picture and immunohistochemical profile were typical for this tumor. The glomus tumor is an exceedingly rare mass lesion in the trachea, but it is useful to keep it among differential diagnostic alternatives when a tracheal tumor is seen on radiographs or endoscopy.

To study the prognostic value of DNA image cytometry in primary skin melanomas.DNA image cytometry was performed on 62 stage I, Clark level II-V, primary skin melanomas. The DNA histograms were classified into three categories (diploid, nondiploid and aneuploid) according to the percentages of cells with higher-than-diploid and higher-than-twice-the-diploid DNA content (the P90 and 2P90 exceeding rates [ERs]). The prognostic value of P90ER, 2P90ER, type of DNA histogram, melanoma thickness, Clark level, and patient age and sex were analyzed for disease-specific survival with Cox's stepwise proportional hazards model.Aneuploid DNA histograms were as common in thin as in thick melanomas. Melanoma thickness and P90ER had prognostic value in univariate analysis, but in the multivariate analysis only P90ER had independent and significant prognostic value.Aneuploidy is a common feature of malignant melanoma, and it is as common in thin as in thick melanomas. P90ER has more prognostic value than the type of DNA histogram. The prognostic value of P90ER as compared with melanoma thickness should be studied further.

To investigate how nuclear morphometric variables, tumor thickness (measured according to Breslow), invasion depth (classified according to Clark), nuclear DNA content and type of DNA histogram are associated with each other in primary malignant melanomas of the skin.Image analysis DNA cytometry and nuclear morphometry were performed on 85 primary skin melanomas. The relationships of size, sphericity and DNA content of melanoma cell nuclei; melanoma thickness; and Clark level were analyzed in detail. The effect of melanin bleaching on DNA cytometry results was studied.Melanoma thickness correlated with nuclear size in aneuploid, but not diploid, melanomas. The prevalence of aneuploidy did not increase with tumor thickness. In aneuploid melanomas the proportion of cells with higher-than-diploid and higher-than-tetraploid DNA content increased with tumor size.Aneuploidy is as common in thin as in thick melanomas. Genetic instability in aneuploid melanomas correlates with melanoma thickness. This correlation in aneuploid melanomas partially explains the correlation between nuclear size and melanoma thickness. In diploid melanomas no correlation was observed between nuclear size and melanoma thickness. DNA cytometry is a valuable tool for studies on the background of phenotypic changes in skin melanomas.

The original histomorphological diagnoses in a series of 34 mycotic lesions from 23 patients with haematological malignancies were re-evaluated by immunohistochemistry. A panel of antibodies was used to identify the agents of aspergillosis, candidosis, fusariosis, scedosporiosis (pseudallescheriosis), and zygomycosis. Apart from improving the diagnosis of aspergillosis, candidosis, and zygomycosis, the application of immunohistochemistry also disclosed three lesions of aspergillosis which had been overlooked during the original screening. It is concluded that the use of immunohistochemistry for the diagnosis of common opportunistic mycoses will not only increase diagnostic specificity, but will also reveal more tissue infections than the conventional histomorphological examination of traditionally stained sections.

Pancreatic acinar cell carcinoma is a rare neoplasm (comprising about 1% of pancreatic tumours). We studied three cases (61-year-old female; 42-year-old male; 57-year-old male), whose survival after diagnosis ranged from 1 year 2 months to 6 years 8 months. There were widespread metastases in each case. The tumours had acinar, trabecular and solid growth patterns. By immunohistochemistry, pancreatic acinar cell markers including carboxyl ester lipase, pancreatic secretory trypsin inhibitor and pancreatic phospholipase A2 (group I PLA2) gave a strong positive reaction in all three cases. By electron microscopy, zymogen granules were seen in the cytoplasm of the tumour cells. Immunostaining for prostate-specific antigen was positive in all three cases. Above-normal concentrations of pancreatic PLA2 were measured in the serum of one patient and the values decreased during chemotherapy concomitantly with the reduction in the size of the tumour mass. In conclusion, immunohistochemical demonstration of the secretory products of acinar cells including the new marker pancreatic PLA2 is useful in the differential diagnosis of pancreatic acinar cell carcinoma. Determination of the concentration of pancreatic group I PLA2 in serum may be helpful in the evaluation of therapy.

Immunohistochemical characteristics of a mucinous islet-cell carcinoma of the pancreas are described. The tumour presented with jaundice in a 59-year-old male. It consisted of polygonal atypical cells forming a reticular pattern, and invaded the common bile duct. In DNA flow cytometry, the tumour cells showed a clear-cut aneuploid peak. Intercellular mucin was abundant. A panel of antisera and monoclonal markers was applied in the immunohistochemical analysis. In addition to general epithelial and endocrine markers, the tumour cells showed a focal positive immunoreaction with anti-glucagon, anti-insulin, anti-vasoactive intestinal polypeptide, anti-pancreatic secretory trypsin inhibitor and anti-phospholipase A2 antigen. At the ultrastructural level, mucous and neuroendocrine granules were demonstrated in the same tumour cells.

In a survey of all malignant soft tissue tumors in the extremities and limb girdles in Finland between 1960 and 1969, only one alveolar soft part sarcoma was found among 246 tumors (0.4%). Another alveolar soft part sarcoma, diagnosed in 1976, was more thoroughly studied. There was evidence that the characteristic crystals of alveolar soft part sarcoma are formed from the dense granules. Both were PASM-positive at ultrastructural level. No monoamines were detected in the cells by formaldehyde-induced fluorescence. This is a further fact to nullify the theory of the paraganglionic origin of alveolar soft part sarcoma, but the question of the histogenesis of the tumor still remains open.

To study the morphological alterations and clinical outcome after gastric resection 53 patients operated on for peptic ulcer disease 5 to 7 years earlier were analyzed. The type of reconstruction was either Billroth I (n = 16), Billroth II (n = 19) or Roux-en-Y (n = 18). Vagotomy was combined with Billroth II in 7 (31%) cases and with Roux-en-Y in 8 (44%) cases. According to a modified Visick classification the late functional results were similar after Billroth reconstructions, whereas failures were most often after Roux-en-Y reconstruction (28%). No ulcer recurrences were found. The histological findings were similar in the operative specimens, but biopsies from the gastric stump mucosa 5 to 7 years after surgery showed significantly (P less than 0.05) more atrophic gastritis after Billroth operations than after Roux-en-Y reconstruction. No dysplastic changes were found. It is concluded that Roux-en-Y reconstruction causes least changes in the gastric stump mucosa after gastric resection. The delayed gastric emptying associated with this procedure may, however, cause late functional disturbances.

We describe here a 65-year-old woman with a right-sided ureteral tumour that was treated by nephroureterectomy. The tumour appeared to be a signet-ring cell carcinoma obstructing the lumen and infiltrating the whole thickness of the ureteral wall. No other primary site could be found, and the tumour is believed to represent the first reported case of primary signet-ring cell carcinoma of the ureter.

Patients who had undergone resection for gastric or duodenal ulcer 10-13, 21-22 or 31-32 years previously were offered endoscopic follow-up examination. Of the 272 surviving patients, 145 (53%) attended. No gastric stump carcinoma was found. Histologic studies showed atrophic gastritis in 79% and intestinal metaplasia in the gastric mucosa in 72% of the patients, but no definite dysplastic changes. The changes appeared soon after gastric resection and increased equally with patient age. Atrophic gastritis was more prominent after resection for gastric than for duodenal ulcer 10-13 years previously, but 20 years after the operation this difference was no longer significant. Hyperplastic polyps in the stomal region were found in 20% of cases 21-22 and 31-32 years postoperatively, but in only 4% after 10-13 years. Enterogastric reflux was endoscopically seen in most cases, but showed no clear correlation with the atrophic changes or polyps found in the gastric remnant mucosa. Endoscopic screening of all patients following gastric resection does not seem to be an effective method in selecting patients for further follow-up.

Second follow-up 36-37, 26-27 and 15-18 years after gastric resection for peptic ulcer disease was performed for 72 patients who in the first screening five years earlier had severe atrophic gastritis and/or intestinal metaplasia in the gastric remnant mucosa. Of the 72 patients 60 were still alive. The death certificates revealed no gastric stump carcinomas among the 12 deceased patients. Neither were any cases of gastric stump carcinoma found among the 38 endoscopically screened patients. Severe atrophic gastritis, which was present in 37 patients in 1982-83, had regressed in 14 cases (p less than 0.01) and proceeded in one case. The extent of intestinal metaplasia had increased in 11 cases and decreased in five cases (p = 0.149, NS). Dysplasia, which was not seen five years ago, was now detected in four cases (10.5%). There was an association between dysplasia and incomplete intestinal metaplasia in three cases. Although these mucosal changes may be premalignant it is not possible to be categorical about the prognosis. Thus, endoscopic screening of all patients whose stomach has been resected for peptic ulcer disease cannot be recommended. Endoscopy, however, is always indicated when gastric symptoms appear in a patient with history of gastric resection.

Synovitic symptoms and radiologically documented cystic lesions in several carpal bones and distal radius developed two years after the implantation of silicone rubber scaphoid prosthesis for pseudoarthrosis. Open biopsy revealed granulomatous synovitis and osteitis and foreign material in carpal tissues. Ultrastructurally dense material was found in the cytoplasm of histiocytic, often multinucleated cells. Electron-probe analysis of the material showed a definite peak for silicon, proving the causal relationship of symptoms and signs to the silicone rubber prosthesis.

Osteonecrosis of the femoral head developed in two patients with malignant lymphoma treated with combined chemotherapy. Pain was the main symptom. It was not possible to radiographically distinguish the necrotic lesions from metastatic tumour growth, and in both cases only histological examination revealed the true nature of bone destruction. The large doses of corticosteroids included in the treatment regimens were most likely of more importance in the etiology of the necrosis than the cytostatic drugs proper.

In a survey of all malignant soft tissue tumors in the extremities and limb girdles in Finland between 1960 and 1969, only one alveolar soft part sarcoma was found among 246 tumors (0.4%). Another alveolar soft part sarcoma, diagnosed in 1976, was more thoroughly studied. There was evidence that the characteristic crystals of alveolar soft part sarcoma are formed from the dense granules. Both were PASM-positive at ultrastructural level. No monoamines were detected in the cells by formaldehyde-induced fluorescence. This is a further fact to nullify the theory of the paraganglionic origin of alveolar soft part sarcoma, but the question of the histogenesis of the tumor still remains open.