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Epidemiologic analyses of upper aerodigestive tract (UAT) carcinoma in situ (CIS) are nonexistent, hence only hospital records and surgical pathology resources are available for its descriptive characterization. The National Cancer Institute's Surveillance, Epidemiology and End Results investigation has, however, published valuable raw data pertaining to CIS of the UAT. This information is analyzed here and summarized for the first time, demonstrating the following: a male incidence rate which is four times greater than the female rate (0.8/100,000 males versus 0.2/100,000 females); similar ages at diagnosis for both sexes (62.7 and 60.0 years of age for males and females, respectively); no significant urban/rural incidence differences; that CIS represents 2.8% of all UAT malignancies; that 2.0% of all CIS lesions in humans are found at UAT sites; and that CIS of the uterine cervix is not a good model for CIS of the UAT.

Two cases of intramandibular neurofibromas unassociated with Von Recklinghausen's disease are presented and the literature is reviewed.

Kaposi's sarcoma is a cutaneous neoplasm commonly arising in the extremities, and rarely in the mucosa or skin of the head and neck. We discuss nine cases of Kaposi's sarcoma arising in the head and neck region, retrieved from the files of the Armed Forces Institute of Pathology, together with 74 cases from the literature. The commonest mucosal locations include the conjunctiva, palate, tongue, tonsils, and gums; common cutaneous sites are the eyelids, nose, ears, and face. Prognosis, sex distribution, and susceptible population groups for the head and neck tumor are similar to those for the commoner peripheral cutaneous form. Seventy percent of patients were 50 years or older; 15% of tumors occurred in children under 16 years. Children under 16 years were more likely to have initial head and neck involvement. In our series, 7 of 11 tumors in children initially involved the conjunctiva or skin of the eyelid. Recently the incidence of Kaposi's sarcoma has been increasing in patients with acquired immunodeficiency syndrome. The age of incidence for this group is lower; more tumors occur on the upper body, skin, and mucosal surfaces of the head and neck; and the prognosis is poorer than in traditional cases of Kaposi's sarcoma.

A patient with an intramuscular lipoma (infiltrating lipoma) located within the tongue is presented. There is only one previously reported case of an intramuscular lipoma located within the oral cavity. Because of its infiltrating nature, this tumor may be mistaken for a liposarcoma. Here, as in other sites, the important characteristics serving to distinguish an infiltrating lipoma from a liposarcoma are the absence of lipoblastic proliferation, myxoid differentiation, cellular pleomorphism, increased vascularity, and mitotic activity. Achievement of adequate surgical margins is essential, as the recurrence rate may be as high as 62.5% without complete excision.

The purpose of this review is to delineate the spectrum of neuroendocrine (NE) carcinomas of the larynx, thereby highlighting the histologic criteria differentiating these lesions. The importance of the histologic type impacts on and correlates with appropriate treatment modalities, and ultimately reflects on prognosis. A morphologically based classification scheme that incorporates both the histology and biology of each subtype is recommended. In this way, a more standardized nomenclature for these NE tumors is suggested, especially for NE carcinomas previously designed as atypical, pleomorphic, or malignant carcinoids. The distinction between laryngeal NE carcinomas (LNEC) and other malignant proliferations may be difficult when based solely on the morphologic appearance. An analysis incorporating clinical, histochemical, immunocytochemical, and ultrastructural parameters of the NE carcinomas as well as similar appearing lesions is detailed.

Polymorphous low-grade adenocarcinoma (PLGA) is a minor salivary gland carcinoma usually arising intraorally, primarily in the palate. It is characterized by cytologic uniformity, histologic blandness, and a variable, infiltrating growth pattern. To date, 117 tumors have been reported but the immunohistochemical features of this neoplasm have not been adequately described. This report describes the immunohistochemical distribution of epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), high-molecular-weight keratin, muscle-specific actin (MSA), and S-100 protein in four palatal polymorphous low-grade adenocarcinomas arising in two men and two women. Three patients were treated with a combination of radiation and surgery, and one was treated with just surgery; none of the tumors recurred or metastasized. More than 90% of tumor cells in all four tumors stained with S-100 and EMA, while 75 to 95% stained with keratin. MSA staining intensity was variable; it ranged from less than 10% to 67% of tumor cells staining positively. CEA staining also was markedly variable; it ranged from very focal luminal positivity to 75% of tumor cells staining positive. The diffuse staining pattern of EMA and S-100 and the difference in staining patterns of EMA and CEA in PLGA is distinct from that found in adenoid cystic carcinoma. In the latter neoplasm, EMA and CEA staining patterns are similar and they are localized to ductal lumina; S-100 stains much less diffusely. These differences are useful in the differential diagnosis between these two tumors.

A controversy presently exists about the structure of lymphatic valves, the bicuspid structure vs. the funnel-like architechture. This present study, along with a review of the literature was undertaken in an attempt to clarify this controversy. Twenty lymphatic valves from the collecting lymphatic channels draining the back paw region in four dogs were examined and several were photographed. The bicuspid nature and the three dimensional anatomy of these valves is clearly demonstrated.

Three hundred and one salivary gland lesions (162 benign, 72 malignant, and 67 benign non-neoplastic) of 677 cases were evaluated by use of intraoperative frozen sections by 66 pathologists. In seven patients, the diagnosis was deferred for permanent sections. In four cases (1.3%), the diagnosis at permanent section changed from one category of benign tumor to another, and in five cases (1.7%), from one category of malignant tumor to another. In four tumors, a frozen section diagnosis of benign was changed to malignant on permanent sectioning; all four involved acinic cell carcinomas. Only two tumors were incorrectly diagnosed as malignant. We conclude that diagnoses of most salivary gland lesions based on frozen section examination are reliable and accurate. However, the literature does indicate that caution should be exercised when malignant tumors are dealt with.

The morphology of canine thoracic duct and peripheral collecting lymphatics was determined using light microscopy together with scanning and transmission electron microscopy (SEM and TEM). The thoracic duct was compared to the thoracic aorta and to the vena cava. Luminal surface detail was determined using the secondary imaging mode of the SEM. Subsurface nuclear and connective tissue detail was determined using back-scattered electron imagining combined with Willard's modification of Gomori's Methenamine Silver Stain. Central and peripheral lymphatic vessels have surface morphology distinct from either arteries or veins. The endothelial cell density in lymphatic vessels is less than in arteries or veins. The nuclear chromatin of lymphatic endothelial cells is coarsely granular and evenly distributed. This contrasts with nuclei from arteries or veins in which the chromatin is segmented. The distribution and orientation of lymphatic subsurface connective tissue fibers also differs from that seen in arteries and veins. It is concluded that canine lymphatic vessels have a unique surface and subsurface morphology and can be unequivocally identified by SEM.

Endothelial cells from the canine or human thoracic duct were harvested using 0.2% collagenase digestion and grown in Media 199 supplemented with fetal bovine serum. The canine endothelial cells grew to confluence (4.4 to 12 X 10(4) cells/cm2) in 6 to 10 d; doubling times ranged from 1.5 to 2.8 d. There was a minimum critical density for cell growth between 5000 and 10 000 cells/cm2. The canine endothelial cells have been maintained in culture for periods up to 11 mo. The human thoracic duct endothelial cells are more difficult to grow and maintain. Endothelial cells were isolated from 5 out of 35 human thoracic ducts and grew for periods of up to 2 wk before degenerating. Both human and canine endothelial cells were Factor VIII positive. It has thus been demonstrated that it is possible to grow canine and, less easily, human thoracic duct endothelium in tissue culture.

Salivary gland myoepitheliomas are rare tumors accounting for less than 1% of neoplasms of the salivary glands. We report a myoepithelioma arising in the palate of an 8-year-old female, the youngest case in the literature. Electron microscopic and immunohistochemical studies support the myoepithelial origin of this tumor.

This case report describes an unusual benign neural tumor involving the lip. It appeared clinically as a gradually enlarging, painless growth arising on the lower lip. Microscopically, it was characterized by whorls of spindle-shaped cells with abundant myxoid cytoplasm and stroma.

Thyroid lesions containing adipose tissue are rare; only scattered case reports are recorded. This study of 17 lipomatous thyroid lesions on file at the Armed Forces Institute of Pathology was undertaken to better document the full range of these abnormalities. Patient ages ranged from 11 to 75 years; nine patients were female and eight were male. Fat-containing thyroid neoplasms included seven papillary carcinomas, four adenomatoid nodules, one follicular adenoma, and one minimally invasive follicular carcinoma. Nonneoplastic conditions associated with adipose tissue included four cases of amyloid goiter, two cases of lymphocytic thyroiditis, one case of dyshormonogenetic goiter, and one case of thyroid atrophy. This study documents the presence of adipose tissue in a wider range of benign and malignant thyroid lesions than has previously been reported.

Only twenty-seven cases of primary mucinous carcinoma of the skin have been reported. Three additional cases are included in this paper. The clinical presentation is distinctive; they are found most commonly in middle-aged, black males in the head and neck region as painless nodules, usually less than 3 cm in diameter. Previous reports have indicated the probable sweat gland origin of these tumours; one of our cases demonstrates a transition from a solid hidradenoma-like pattern to nests of tumour cells floating in mucin lakes, adding support for the sweat gland hypothesis. The clinical behaviour is relatively benign; late recurrences are common but metastases are rare. Only one case had widespread metastases. Although the histological appearance is distinctive, other primary sites first must be excluded. Local excision is the treatment of choice.

Factor VIII-related antigen (F8) and Ulex europaeus lectin (UEL) are accepted markers for human blood vessel endothelium. However, disagreement exists as to whether lymphatic vessels stain for F8, and accordingly this study was undertaken to address this issue. Moreover, another vascular endothelial marker, angiotensin converting enzyme (ACE) was also examined in lymphatics. Segments of human thoracic duct and portions of small bowel containing lacteals with post-mortem intervals of less than 15 hours, were removed at autopsy and fixed in B5 or formalin. The specimens were processed routinely and sections examined by indirect immunohistochemical techniques for F8 (Dako Corp.), ACE and for UEL (EY Lab). F8, UEL, and ACE positivity was uniformly found in thoracic ducts and lacteals; however, the staining intensity was less in lymphatic vessels with F8 and UEL than with comparable arteries or veins. ACE staining intensity, on the other hand, was similar in blood vessels and lymphatics. Both formalin and B5 fixation preserved antigenicity; however, background staining was greater with B5 fixation whereas tissue staining was slightly more intense with formalin fixation.

A nodule of the liver was incidentally noted during left colectomy for a large villous adenoma in a 74-year-old man. Microscopic examination disclosed a granuloma of the liver containing numerous Enterobius vermicularis ova and a cross-section of the nematode. This is the fourth reported case of hepatic oxyuriasis and the second case reported in North America.

The pathologic and echocardiographic findings of a massive right coronary arterial aneurysm in a 62 year old man are presented. The thrombosed aneurysm simulated a cardiac tumor, destroying one pulmonary valve cusp. It also caused marked pulmonary stenosis with elongation and narrowing of the outflow tract of the right ventricle and fixation of half of one cusp of the tricuspid valve.

Primary sebaceous tumors of salivary glands are extremely rare, although sebaceous glands are commonly present in parotid and submandibular glands. A review of the files of the Armed Forces Institute of Pathology yielded 21 cases of primary salivary gland sebaceous tumors. Five were sebaceous adenomas, 9 sebaceous lymphadenomas, 5 sebaceous carcinomas and 2 sebaceous lymphadenocarcinomas. Seventeen tumors were located in the parotid gland and one each in the submandibular gland, the minor salivary glands of buccal mucosa and in ectopic salivary gland tissue in a periparotid lymph node. Thirteen tumors occurred in males and six in females. The peak incidence for all the sebaceous tumors, occurred in the sixth and seventh decades. The influence of age, sex, race, clinical symptoms, and pathology on survival is reviewed for each tumor group. Our histopathologic observations strongly suggest that sebaceous lymphadenoma and sebaceous lymphadenocarcinoma arise from sebaceous glandular rests in a lymph node in a fashion similar to that of a Warthin tumor.

A splenic lymphangioma removed from the abdominal cavity during an exploratory laparotomy in a 16 year old girl was studied by light microscopy and scanning electron microscopy (SEM). The tumor was composed of numerous vascular channels some of which were filled with clotted lymph. SEM revealed these channels to be lined with an uniform endothelial lining composed of two morphologic cell types: one with a smooth surface; the other with numerous microvilli. The literature on the SEM of lymphatic vessels and lymphangiomas is reviewed and compared to the splenic lymphangioma.

Small cell carcinoma is primarily a pulmonary neoplasm that rarely arises in extrapulmonic sites including salivary glands of the head and neck. Twelve cases of small cell carcinoma of salivary gland origin were retrieved from the Armed Forces Institute of Pathology files. Six tumors occurred in the parotid gland and six in the submandibular gland. Tumors were classified into two categories: those with areas of histologically typical small cell carcinoma (7 cases) and those with areas of typical small cell carcinoma with foci of ductal differentiation (5 cases). Follow-up information was available in all 12 cases. Electron microscopy was done on eight tumors; only one demonstrated round electron dense intracytoplasmic neurosecretory granules. These observations further support evidence in the literature suggesting most of the small cell carcinomas of salivary gland origin are not true neuroendocrine ("oat cell") carcinomas, but actually are small cell ductal carcinomas. These tumors appear to have a better prognosis than small cell carcinoma of the lung or nonsalivary gland sites in the head and neck region, with an estimated 2- and 5-year survival of 70 and 46%, respectively.

One hundred seven sinonasal tract adenomatous neoplasms on file at the Armed Forces Institute of Pathology were reviewed in order to determine what percentage of and what type of nonsquamous epithelial neoplasms arise from surface mucosa. Seventy-seven percent of tumors were localized to the nose or maxillary sinus. Fifty-nine of the 107 tumors (55%) including 32 (50%) of the 64 adenocarcinomas and 19 (59%) of the 31 adenoid cystic carcinomas arose from the surface mucosa. Five of the six mucoepidermoid carcinomas also appeared to arise from the surface in a diffuse fashion, as did both mixed tumors, one of the oncocytic adenomas and the papillary cystadenoma. One can conclude that the majority of sinonasal tract adenomatous neoplasms arise from the mucosal lining of the sinonasal tract.

Anaplastic small cell (oat cell) carcinoma is a neoplasm commonly arising in the lungs. However, it may also occur, though rarely, in the larynx. A series of 43 cases is presented (ten cases from the Armed Forces Institute of Pathology, eight from the Department of Otolaryngology of the Padua University, and 25 from the literature). The tumor often presents in the sixth and seventh decades of life and appears to be highly aggressive, and metastases develop early. The most common presenting symptom is hoarseness. As in pulmonary small cell carcinoma, prognosis is poor and does not seem to depend upon therapeutic modalities, tumor location or the extent of initial local disease. The tumor seems to derive from the Kulchitsky cell present not only in the bronchial mucosa but also in the laryngeal lining. Like pulmonary anaplastic small cell carcinoma, small cell carcinoma of the larynx should be treated with systemic chemotherapy and radiotherapy. The association of small cell carcinoma with squamous carcinoma of the larynx is also reported and problems connected with the histogenesis of this mixed tumor are discussed.

The morphology of canine thoracic duct, peripheral collecting lymphatics and their valves was determined using scanning and transmission electron microscopy (SEM and TEM). Information from surface and subsurface structures was derived simultaneously in the SEM by using a heavy metal stain combined with backscattered electron imaging. The peripheral lymphatics and thoracic duct were covered by a continuous sheet of endotheial cells, the nuclei of which were slighly raised, avoid in shape with coarsely granular chromatin and long axes oriented parallel to the direction of flow. The immediate subendothelial connective tissue in the thoracic duct was primarily smooth muscle, whereas in the peripheral lymphatics reticular and elastic fibres predominated. Valves were seen in both peripheral and central lymphatics. These were covered with endothelium similar to the collecting lymphatic vessels, were usually bicuspid and had cusps that inserted either at a single point or overlapped prior to a wide based insertion. A complex network of connective tissue and elastic fibres was seen in valves and in the vessel walls adjacent to the valves. The similarities and dissimilarities of the SEM appearances of lymphatics arteries and veins are discussed.

In a demographic and histologic study of 426 oral minor salivary gland tumors, 57.5% were classified as benign and 42.5% were classified as malignant or potentially malignant. There was an overall female preponderance (1.59/1). The mean age for females was 53.1 years and for males was 50.6 years. The mean age for patients with malignant tumors was 5.4 years greater than for patients with benign tumors and was statistically significant. The palate was the most common site for oral minor salivary gland tumors followed by the upper lip and the buccal mucosa. These three sites accounted for 76.1% of all cases. Pleomorphic adenoma was the most common benign tumor (41% of all cases and 71% of benign tumors) followed by monomorphic adenoma of the canalicular and basal cell subtypes (10% of all tumors and 18.9% of benign lesions). Mucoepidermoid carcinoma was the most commonly encountered malignant tumor, accounting for 15.2% of all tumors and 35.9% of malignant lesions. Low-grade (terminal duct, lobular, polymorphous) adenocarcinoma was the most second most common type, making up 11% of all tumors and 26.4% of all malignant tumors. The results of this study are compared with other recent studies.

Adenoid cystic carcinoma is a specific variant of adenocarcinoma with a characteristic cribriform appearance. The tumor may arise from salivary glands and various other sites, but the origin and cellular composition of this unique neoplasm have been controversial. A potential use of immunohistochemistry is to provide additional information on the origin of various cellular components of tumors by comparing them with corresponding normal tissues. Immunohistochemical distributions of carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), keratin, low molecular weight keratin (54 kd), S100 protein, muscle-specific actin, laminin, and type IV collagen were evaluated in 20 adenoid cystic carcinomas arising in major and minor salivary glands. Anti-CEA, anti-EMA, anti-keratin, and anti-S100 antibodies strongly stained cells lining true lumina. Muscle-specific actin, a marker for myoepithelial cells, was found in lining cells of pseudocysts, in tumor cells proper, and in nonluminal cells with a tubular growth pattern. A monoclonal antibody against 54 kd keratin stained almost all cells in the neoplasms. In pseudocysts, replicated basal lamina reacted with antisera to laminin and to type IV collagen. The present study demonstrates that there are at least two populations of tumor cells in adenoid cystic carcinoma: luminal cells that express CEA and EMA, thus indicating their ductal character, and nonluminal cells that express muscle-specific actin characteristic of myoepithelium.

Eighty patients with clinically early stage adenocarcinoma of the prostate were treated with pelvic lymphadenectomy and interstitial implantation of 125iodine seeds. A new applicator that permits greater accuracy in spacing the seeds has been developed. Postoperative complications were minimal, with urinary irritability being the most common. Multiple transrectal needle biopsies were performed 12 and 18 months after treatment in 46 patients. The prostatic biopsies were negative for carcinoma in 61 per cent and positive in 39 per cent of the patients. Long-term followup is needed to correlate post-treatment biopsies with survival and to determine if patients with positive biopsies should receive further treatment.

Although adenoid cystic carcinomas are occasionally manifested in atypical ways, metastatic disease preceding detection of the primary tumor has not been previously reported. We have described a patient in whom multiple pulmonary metastatic nodules were found one year before identification of primary adenoid cystic carcinoma of the maxilla. This case illustrates the need to include adenoid cystic carcinoma in the differential diagnosis of patients with metastatic disease and an unknown primary lesion. The use of special stains and electron microscopy can be helpful in confirming a diagnosis of adenoid cystic carcinoma.

Multiple separate tumors arising in the major salivary glands are distinctly unusual. The records on 25 patients with synchronous unilateral salivary gland tumors on file at St Louis University and at the Armed literature. Bilateral tumors arose more frequently than multiple unilateral ones. The most common tumors with bilateral synchronous or metachronous development are the Warthin tumors, with more than 100 reported cases; the mixed tumor with at least 34 cases; and the acinic cell carcinoma, with 12 reported cases. The Warthin tumor also was the most likely to present with multifocal unilateral involvement with 29 tumors having three or more separate foci of tumor. The next most common tumor combinations are a Warthin tumor and a mixed tumor (20 cases), the multifocal membranous basal cell adenoma (12 cases), and multiple oncocytomas (nine cases). Numerous other tumor combinations were found covering the range of salivary gland neoplasia, however one of the tumors usually was a mixed tumor or a Warthin tumor.

We report 22 examples of an unusual and distinctive benign mesenchymal tumor arising exclusively from lymph nodes of the groin. The tumor, which presents clinically as a swelling, is composed of spindled cells arranged in solid sheets or short, vaguely palisaded fascicles similar to a neurilemoma. The spindled cells blend gradually with large mats of eosinophilic material that appear as thick bands, ellipses, or circular profiles, depending on the plane of section. These eosinophilic structures, which represent a highly characteristic feature of the tumor, contain deeply eosinophilic, collagen-rich cores surrounded by a weakly eosinophilic, actin-rich cuff. The actin within these eosinophilic structures is derived by coalescence of intracellular actin globules extruded from neighboring cells. In all cases, a thin, compressed rim of normal lymph node was identified. Immunohistochemical analysis indicates that the cells express actin but lack S-100 protein, synaptophysin, desmin, keratin, and epithelial membrane antigen. Delicate, linear striations were identified in only two cases by conventional histochemical techniques. The foregoing features suggest that the tumor is related to a myofibroblast or a specialized smooth-muscle cell. These tumors, therefore, probably arise from smooth-muscle-like cells, which are normally present in some lymph node capsules or stroma. Follow-up information on 17 patients indicated that all are alive and well without any evidence of recurrence or metastasis.