Periodic acid-Schiff Diastase Research Articles

Young Nepalese Male With Jaundice

Introduction: Pancreatic acinar cell carcinoma is a rare malignancy accounting for less than 1% of all pancreatic tumors. Given its rarity, diagnosis is often difficult and delayed. There are no current standard treatment protocols and surgical resection is the only curative measure. This cancer is primarily seen in older males. However, we report a case of acinar cell carcinoma in a young male from Nepal who presented with jaundice. Case Report: A 30-year-old Nepalese male with no significant past medical history who presented with jaundice, generalized pruritus, dark urine, and a 34-pound weight loss in 1.5 months. He presented with elevated serum liver enzymes. An abdominal ultrasound was performed, which showed fatty liver, distended gallbladder containing large amounts of sludge, and dilated common bile duct with sludge. A subsequent MRCP confirmed a dilated distal common bile duct along with a filling defect, 2.0 cm from ampulla of Vater with no other significant abnormalities. His initial ERCP showed a stricture in the common bile duct, a sphincterotomy was performed, and a stent was placed. Cytology was nondiagnostic and only showed atypical glandular cells. A CT did not show any other lesions or gross abnormalities. Subsequent endoscopic ultrasound (EUS) showed a well-demarcated mass in the lower third of the common bile duct with no significant pathology in the pancreas. Another ERCP was performed, which showed a dilated common bile duct with distal stricture that was restented and nondiagnostic biopsies. The patient’s laboratory values showed a slightly elevated CA 19-9, normal CEA, negative ANA, and normal IgG4, making autoimmune pancreatitis unlikely. The patient underwent a pylorus-sparing pancreaticoduodenectomy (partial Whipple resection), abdominal lymphadenectomy, and cholecystectomy. Pathology showed a 3-cm high-grade acinar cell carcinoma in the pancreatic head. The final staging of the tumor was T3N1M0 with 2 out of 5 resected abdominal lymph nodes being positive for metastasis. All resection margins were negative. Tumor cells were positive for Cam 5.2, AE1/AE3 and anti-chymotrypsin, making it consistent with acinar cell carcinoma in addition to positive PAS (periodic acid-Schiff-diastase) staining of cytoplasmic granules. The patient was started on a course of radiation with 5 fluorouracil, 3 months after surgery, followed by chemotherapy with Gemzar. After 1 month post-adjuvant radiation and chemotherapy, the patient’s CA 19-9 decreased. At 12 months’ follow-up, the patient is doing well and is on oral medications for brittle diabetes. The patient’s follow-up PET scan was negative.

Comparison between Malassezia Folliculitis and Non-Malassezia Folliculitis.

BackgroundAmong the various types of folliculitis, differentiation of Malassezia folliculitis (MF) from other forms of folliculitis is important because it is usually treated with antifungal agents.ObjectiveWe attempted to find a method to enhance the detection rate of MF, and examined the differences in the clinical manifestation between MF and non-MF (NMF).MethodsWe performed a retrospective study involving patients with folliculitis who were previously diagnosed with MF or NMF on the basis of serial tissue sectioning and diastase-Periodic acid-Schiff (d-PAS) staining findings. The clinical features of MF and NMF were compared.ResultsAmong a total of 100 folliculitis patients, 20 were diagnosed with MF and 80 with NMF. Tissues from the 80 patients with NMF were sectioned serially into 10 slices and stained with hematoxylin and eosin stain; among these, 10 had many round-to-oval yeast organisms in the hair follicles that confirmed MF. Finally, d-PAS staining was used to detect the presence of yeast in the NMF slides. Notably, among the 70 d-PAS-stained samples, yeast organisms were found in 6 samples, confirming MF. As a result, the diagnosis of 16 patients changed from NMF to MF. Compared with NMF, MF showed major involvement of the trunk and low involvement of the face and legs as well as male predilection.ConclusionPhysicians should consider serial sectioning and/or d-PAS staining of folliculitis lesions, particularly of those on the trunk of male patients, even if no yeast organisms are detected initially.

A Left Preauricular Mass

A teenage boy presented with a 3-month history of a left preauricular mass. His medical history was notable for an atypical teratoid rhabdoid tumor of the left temporoparietal lobe diagnosed at age 3 years, which had been resected and treated with chemoradiation. Physical examination demonstrated a 2-cm firm, nontender, mobile mass without overlying skin invlvement. There was no palpable lymphadenopathy, butweakness of the frontal branch of the left facial nervewasnoted.Magnetic resonance imaging (MRI) of the neck revealed a 1.0 × 1.7 × 1.9-cmmildly enhancingmass lateral to the left subcondylar mandible, which was inseparable from the anterior parotid gland (Figure, A). A superficial parotidectomy was performed. The superior division of the facial nerve was intimately associated with the parotid mass, and sacrifice of the upper division of the facial nerve branches with a cable nerve graft was required. The cut surface of the surgical resection specimen of the superior parotid revealed a 1.7-cm reddish tan variegated mass. Microscopic sections showed a circumscribed tumor with microcystic architecture (Figure, B). The tumor was composed of monotonous amphophilic cells with granular cytoplasm and round to ovoid nuclei (Figure, B and C). An immunohistochemical panel showed notably positive tumoral staining for the proteins S-100 and vimentin and negative staining for DOG1 and p63 antibodies. Special stains for mucicarmine and periodic acid–Schiff diastase (PASD) were performed. Mucicarmine highlighted abundant extracellular (luminal) mucin, but intracellular mucin was absent. PASD confirmed the absence of zymogen granule formation. Fluorescence in situ hybridization (FISH) was positive for translocation of the ETV6 gene. What is your diagnosis? A B

Clear cell carcinoma of salivary gland type presenting as an endotracheal polypoid tumor

A 66-year-old woman presented with a 2-year history of asthma has progression of dyspnea within a week, and a computed tomography (CT) revealed an endotracheal tumor at level of aortic arch. The resected tumor, measured by 18 × 12 × 10 mm, has histologically malignant features including frank invasion with desmoplastic stroma and foci of necrosis. Presence of glycogen and mucin was confirmed by periodic acid-Schiff (PAS) and diastase PAS staining. Immunohistochemically, the tumor cells were diffusely positive for cytokeratin (CK) 7 and AE1/3, focally positive for CK5/6 and CK14, but negative for CK20. Thyroid transcription factor-1 (TTF-1), Napsin A, and SP-A, indicating lung parenchymal origin were all negative. Other muscular markers, neuroendocrine markers, renal cell carcinoma markers, and markers related to perivascular epithelioid cell tumors were all negative. Postoperative systemic examination suggests no primary tumor outside the lung. The follow up was excellent being recurrence free for 14 months in spite of the positive surgical margin by the tumor cells. This is a first report of rare neoplasm, clear cell carcinoma of salivary gland type, presenting as an endotracheal mass.

The cytological features of mammary analogue secretory carcinoma

Mammary analogue secretory carcinoma (MASC) of the salivary glands is a newly described tumor entity associated with the t(12;15)(p13;q25) ETV6-NTRK3 translocation. Early studies have shown this tumor to be a distinct entity with histologic, biologic, and clinical differences from acinic cell carcinoma and adenocarcinoma, not otherwise specified. Because this tumor was described only recently, it remains relatively unknown outside of head and neck specialty pathology centers. In the current study, 6 cases of fine-needle aspiration cytology from histologically and/or molecularly confirmed cases of MASC are presented. Using cytomorphology, MASC primarily raises the differential diagnosis of an oncocytic salivary gland tumor but there are some features that can suggest the specific diagnosis of MASC. The 6 cases presented in the current study all demonstrated at least focal cytoplasmic vacuolization and papillary formations on smears. MASC can be differentiated from acinic cell carcinoma by a lack of periodic acid-Schiff diastase-positive zymogen granules and S-100 protein positivity. The results of the current study the ability of ETV6 break-apart fluorescence in situ hybridization to detect gene rearrangement on cell block material. This is the first report of a case of MASC prospectively diagnosed on a cytology specimen.

Primary Peritoneal Serous Papillary Carcinoma: A Clinical and Pathological Study

Primary peritoneal serous papillary carcinoma (PPSPC) is a rare primary tumor of the peritoneum that found predominantly in elderly and post-menopausal women. The aim of our study is to review the clinical and pathologic information of 22 patients, and then try to summarize clinical behavior and pathological characteristics of PPSPC, in order to be better recognized of this entity in future. We retrospectively reviewed the data from 22 patients with PPSPC treated at our hospital from 1992 to 2008. All paraffin blocks were recut for periodic acid-Schiff diastase and immunohistochemical staining for CD15, cytokeratin7(CK7), cytokeratin20(CK20), S-100 protein, carcinoembryonic antigen (CEA), CA125, estrogen receptor(ER) and progesterone receptor(PR). The median age of the patients at the time of surgical staging was 56years (range, 32-77years). The most common presenting symptoms were abdominal distension (59.1%) and ascites (63.6%). Pretreatment CA125 levels were significant elevated in 90.5% patients. Optimal debulking was performed in 18 patients. All patients were consequently treated with platinum-based chemotherapy. Response to treatment is promising, and the median overall survival of all patients was 21.0months (95% CI 16.9, 25.1months). The positive rate of immunohistochemical staining was CD15 95.5%, CK7 90.9%, S-100 protein 68.2%, CA125 59.1%, CK20 31.8%, ER 31.8%, CEA 27.3% and PR 9.1%, respectively. Gynecologist should be aware of PPSPC when abdominal distension, gross ascites and a raised level of CA125 in women without ovarian enlargement. Immunohistochemical staining might be helpful as accessory criteria for the differential diagnosis among the PPSPC, peritoneal malignant mesothelioma (PMM), primary epithelial ovarian carcinoma (PEOC) and peritoneal carcinomatosis from the gastrointestinal tumors (SPCGT). Cytoreductive surgery combined with pre/postoperative platinum-based chemotherapy may be effective for PPSPC patients.

Diagnosis of alpha-1-antitrypsin deficiency in bleeding disorder-related neonatal death

Alpha-1-antitrypsin (AAT) deficiency is a rare genetic disorder characterized by hepatitis in neonates, childhood and adulthood (protease inhibitor (PI)*ZZ) and emphysema with or without hepatitis (PI*ZZ)/(PI*SS,SZ or null) in adulthood. We report the case of a female neonate born at 40 weeks of gestation who presented with vitamin K deficiency-related intracranial bleeding and cholestasis of which she died at 28 days of age. At autopsy, the infant was found to have intracranial bleeding, hepatomegaly, and cholestasis with paucity of bile ducts in the liver. Small periodic acid-Schiff diastase positive intrahepatic granules and positive staining with antibodies against AAT protein suggested an AAT deficiency. AAT is a glycoprotein that has a protease inhibitor function. Its deficiency can be the result of various point mutations in Serpin 1 located on chromosome 14. The diagnosis AAT deficiency was confirmed by mutation analysis showing the PI*ZZ genotype in the neonate. In conclusion, AAT deficiency is a rare genetic disorder that can lead to a serious bleeding disorder in the neonatal period if not recognised on time. Pathological diagnosis together with verifying molecular analysis can be used to identify index patients.

Hepatobiliary and Pancreatic: Glycogenic hepatopathy: A reversible condition

Glycogenic hepatopathy is an under recognised condition, described as a pathological overloading of hepatocytes with glycogen in patients with poorly controlled type 1 diabetes mellitus. Clinical presentations can include abdominal pain, tender hepatomegaly, nausea and elevated transaminases. We report a case of a 33 year old woman, with poorly controlled type 1 diabetes mellitus (HbA1c 13.7%) who was referred for evaluation of diarrhoea and abnormal liver enzymes, to highlight the diagnostic challenges of glycogenic hepatopathy. Physical examination revealed a diffusely tender abdomen. Liver enzymes were significantly elevated at ALP 205 U/L, GGT 88 U/L, AST 428 U/L and ALT 404 U/L. Bilirubin and liver synthetic function were normal, and screening for other causes of liver disease was negative. Ultrasound examination suggested fatty infiltration of the liver. The degree of liver enzyme elevation led to a liver biopsy. The biopsy showed enlarged, swollen hepatocytes with no evidence of steatosis, inflammation, fibrosis or necrosis (Figure 1). Mallory hyaline bodies were not seen. The enlarged hepatocytes showed intense cytoplasmic staining with Periodic Acid-Schiff stain, and negative staining with Periodic Acid-Schiff Diastase. This is suggestive of glycogen accumulation (Figure 2), and consistent with glycogenic hepatopathy. At 12 month follow-up, the patient had achieved significant improvement in glycaemic control (HbA1c 9.3%), with normalisation of liver enzymes. Fibroscan (non-invasive method of measuring liver elastography), was performed on our patient. A mean reading of 5.3 Kpa was found, suggesting early fibrosis. The literature suggests that glycogenic hepatopathy is reversible with improved glycaemic control. This is certainly demonstrated in our patient with normalisation of liver enzymes, though the early fibrosis evident on Fibroscan does not correlate with this picture. Repeat liver biopsy would be needed for confirmation. Cases similar to ours have been described amongst the paediatric and adult population. However there are no reports of Fibroscans on these patients. The hallmark of this condition is its reversibility with improved glycaemic control, unlike hepatic steatosis. Glycogen overload is not known to progress to fibrosis, distinct from fatty liver disease. However, Fibroscan findings propose this may not be the case. More studies of similar cases with both liver biopsies and Fibroscan readings would be needed to clarify this further. The condition remains under recognised by clinicians, pathologists and radiologists. Diabetic patients are frequently diagnosed with fatty liver disease as it is indistinguishable unless biopsy is performed. Awareness of the condition is important, particularly as imaging is not diagnostic, and is likely a reversible condition.

Z and Mmalton‐1‐antitrypsin deficiency‐associated hepatocellular carcinoma: a genetic study

The histological hallmark of alpha-1-antitrypsin deficiency (AATD) is the presence of periodic acid-Schiff diastase (PASD)-resistant positive globules in hepatocytes, with a heterogeneous distribution. It is noteworthy that hepatocellular carcinoma (HCC) arises specifically from the AAT-negative areas but the reason for this remains unclear. To determine whether the different distribution of AAT globules within neoplastic and non-neoplastic hepatocytes is the result of a self-induced correction of the genetic defect. Two HCV-positive patients with AATD-associated HCC were studied. One patient harboured a compound heterozygous PiSZ genotype whereas the other showed the rarer PiMMmalton in heterozygosity. In both cases, neoplastic hepatocytes appeared globule devoid, while non-neoplastic hepatocytes showed intracytoplasmic accumulation of PASD-positive globules. Laser-assisted microdissection was used to assess a genotype/phenotype correlation in single liver cells from HCC and from non-neoplastic hepatocytes. Direct sequencing of DNA purified from globule-devoid and globule-filled hepatocytes demonstrated that all liver cells carried the same mutant genetic background. Our findings indicate that (i) both variants of HCC arising in AAT deficiency (Z and Mmalton) do not accumulate the mutant protein and (ii) the different phenotypic appearance of hepatocytes is not the result of a retromutation during neoplastic transformation, but other mechanisms should be investigated.

Lafora-Like Ground-Glass Inclusions in Hepatocytes of Pediatric Patients: A Report of Two Cases

We report 2 cases of ground-glass hepatocyte inclusions occurring in pediatric patients. Case 1 had alpha-thalassaemia major and was receiving iron chelation therapy, whereas case 2 had trisomy 21 with a history of bone marrow transplantation for acute myeloid leukemia. The liver sections in both cases showed eosinophilic, periodic acid-Schiff diastase-positive intracytoplasmic inclusions that were negative for hepatitis B surface antigen. Immunohistochemically the inclusions showed positive staining with KM279, a monoclonal antibody against polyglucosan derived from Lafora inclusions. On electron microscopy, in case 1, intracytoplasmic inclusions were composed of degenerate organelles, glycogen, and irregular fibrillar structures; in case 2, they were composed of vesicular structures containing granular material. Ultrastructural changes in both cases differed from classical Lafora inclusions and ruled out hepatitis B surface antigen, glycogenosis type IV, and fibrinogen storage disease. Genetic analysis of the Lafora's disease genes performed in case 2 revealed no mutations. The development of hepatocyte cytoplasmic inclusions in both our cases could be related to medication effects, because similar inclusions were reported in patients using cyanamide. Drug-induced inclusions, mimicking Lafora's disease, should be included in the differential diagnosis of hepatocyte ground-glass inclusions.

A Comparative Morphologic Analysis of Adult Onset Leukodystrophy With Neuroaxonal Spheroids and Pigmented Glia-A Role for Oxidative Damage

We performed a blinded study on 5 cases of hereditary diffuse leukoencephalopathy with spheroids and 10 cases of the pigmentary type of orthochromatic leukodystrophy, 6 of the latter having a family history of neurologic illness. Patients presented in the third to sixth decade with behavioral, cognitive, and motor symptoms. All cases displayed widespread myelin loss, predominantly frontotemporal with relative sparing of subcortical U-fibers, and variable numbers of both neuroaxonal spheroids and pigmented glia. Immunohistochemically, spheroids contained amyloid precursor/neurofilament proteins, several neurotransmitters or neuropeptides, and ubiquitin. Cytoplasmic inclusions in glia and numerous pigmented macrophages were autofluorescent and stained consistently with diastase-periodic acid-Schiff, prolonged Ziehl-Nielsen, and Sudan black, but the same cells labeled inconsistently for iron or ferritin. Ultrastructurally, the most characteristic autofluorescent glial lipopigments consisted of bosselated masses of granular, electron-dense material. These morphologic features are those of ceroid, an end-product of oxidative damage. Glial immunoreactivity for markers of oxidative stress (hemeoxygenase-1 and superoxide dismutase 2) and damage (4-hydroxynonenal, malondialdehyde, and nitrotyrosine) was noted, particularly in cases with increased iron and ferritin. These data support the hypothesis that the similar clinicopathologic features of hereditary diffuse leukoencephalopathy with spheroids and the pigmentary type of orthochromatic leukodystrophy reflect a common disease due, at least in part, to an oxidative insult.

Expression of Ki-67 and p53 in cutaneous free flaps used to reconstruct soft tissue defects following resection of oral squamous cell carcinoma

Radial forearm free flaps are used routinely to reconstruct oro-facial tissues following resection of oral squamous cell carcinoma. Surprisingly, there is little information regarding their behaviour following engraftment. The present report is a clinico-pathological study of 10 patients who had incisional biopsies of cutaneous free flaps after the presence of a white patch or erythema raised clinical suspicion. Tissues were stained with haematoxylin and eosin, diastase-periodic acid-Schiff reagent and labelled immunohistochemically for Ki-67 and p53. Four of 10 specimens showed severe epithelial dysplasia within the graft, which was contiguous with dysplasia in the adjacent oral mucosa; the remaining grafts had features typical of candidosis (n=4) or hyperkeratosis (n=2). Grafts with dysplasia had a significantly higher Ki-67 labelling index than lesions in the 'non-dysplastic' group. There were no significant differences in the Ki-67 labelling index between areas of dysplasia in the graft and areas of dysplasia in the adjacent oral epithelium. p53 staining was present in all strata of the epithelium in the dysplastic grafts and adjacent dysplastic mucosa, but was absent or weakly expressed in the stratum basale of grafts showing reactive changes only. None of the dysplastic lesions progressed to carcinoma despite a mean follow-up period of 32 months; one patient developed a recurrent mucosal tumour at the resection margin. These observations indicate that cutaneous free flaps grafted to a site of field cancerisation can develop severe epithelial dysplasia with concomitant deregulation of proliferation and increased p53 expression. Such changes raise the possibility that these lesions have the potential for malignant transformation.

Histological Assessment of the Effect of Laser Irradiation on Skin Wound Healing in Rats

The purpose of this study was to evaluate, from the histological point of view, the effect of diode laser irradiation on skin wound healing in Sprague-Dawley rats. Various biological effects have been described in different studies after low-level laser therapy (LLLT). Two parallel full-thickness skin incisions were performed on the back of each rat (n = 49) and immediately sutured. After surgery, one wound of each rat was exposed to laser irradiation (continuous mode, 670 nm, daily dose 30 J/cm2), whereas the parallel wound was not irradiated and served as control. Both wounds were removed 24, 48, 72, 96, 120, 144, and 168 h after surgery and routinely fixed and embedded in paraffin sections, stained with hematoxylin and eosin, van Gieson, periodic acid Schiff + periodic acid Schiff diastase, Mallory's phosphotungstic hematoxylin, and azur and eosin, and histopathologically evaluated. As compared to nonirradiated control wounds, laser stimulation shortened the inflammatory phase as well as accelerated the proliferative and maturation phase, and positively stimulated the regeneration of injured epidermis and the reparation of injured striated muscle. LLLT at 670 nm positively influences all phases of rat skin wound healing.

Possible role of the bulge region in the pathogenesis of inflammatory scarring alopecia: lichen planopilaris as the prototype

Lichen planopilaris (LPP) is the prototype of scarring alopecias that mainly target the infundibuloisthmic (bulge) region of hair follicle. Hair follicle stem cells have been shown to reside in the bulge. We carried out this study to better define the possible pathogenetic role of the bulge in LPP. Thirty-five cases of LPP were studied. Multiple serial sections of biopsy specimens stained with hematoxylin and eosin, periodic acid Schiff-diastase, and Elastic van Gieson. The following immunostains were applied: CD3, CD4, CD8, CD1a, and Ki-67. Uninvolved follicles and normal scalp biopsy specimens served as normal controls. All cases showed a lichenoid lymphocytic infiltrate at the bulge region. The bulb area was spared. CD8(+) T cells were increased compared with CD4(+) T-cell population. Langerhans' cells were decreased. Proliferating stem cells, highlighted by Ki-67, showed a marked decrease in the bulge compared with uninvolved follicles. Our study supports the finding that in LPP, the inflammatory infiltrate mainly involves the bulge region, where the stem cells reside. Once this area is damaged, the hair loses its potential of regrowth with resulting scarring alopecia. This is in contrast with inflammatory non-scarring alopecias such as alopecia areata, where the bulb region is targeted, sparing the stem cells.

Subcutaneous alternariosis

A case of subcutaneous alternariosis caused by Alternaria alternata is reported in a 52-year-old male who underwent kidney transplantation 1 year earlier. The infection manifested as a vegetating mass about 7 cm in diameter on the right forearm. Histological examination with Grocott staining and periodic acid-Schiff diastase revealed fungal spores and hyphae with chronic granulomatous inflammation. Biopsy fragments inoculated on Sabouraud-glucose agar with chloramphenicol produced colonies which were identified as Alternaria alternata on the basis of macroscopic and microscopic characters.

Basal cell carcinomas with unusual histologic patterns

Uncommon histologic variants of basal cell carcinoma (BCC) can present a diagnostic challenge. In this case series, we describe 3 patients with unusual BCCs encountered in a dermatologic surgical unit over a 1-year period from September 2003 to September 2004. The formalin-fixed, paraffin-embedded histologic specimens were initially examined microscopically after staining with hematoxylin and eosin. Additional stains, including diastase periodic acid-Schiff, colloidal iron, carcinoembryonic antigen, and cytokeratin-20, were subsequently performed as appropriate. Of the 3 lesions, one exhibited apocrine differentiation and two demonstrated a trabecular growth pattern. Although BCCs demonstrating apocrine differentiation have previously been described, a trabecular growth pattern, to our knowledge, has not been previously reported for BCC.

A rare case of multiple congenital epulis

We report a case in a female newborn infant of multiple congenital epulis, i.e. granular cell tumor, that was undetected during regular pregnancy ultrasound monitoring. At birth the neoplasms appeared as two voluminous lesions protruding from the newborn's mouth. The greater of them (5.5 cm x4 cm x3 cm) was pedunculated and attached to the external superior gingiva, shifting the alae nasi and making it difficult to enter the coanae. The second mass was somewhat smaller (3 cm x4 cm x2.5 cm), pedunculated and attached to the external inferior gum. A third smaller mass was less evident, unpedunculated and attached to the rim of the lower gingiva. Histologically the lesions were characterized by large cells, which had abundant pale acidophilic granular cytoplasm. A round-oval nucleus was located centrally. The cell membranes were distinct. Neither mitosis nor necrosis was found. Staining for cytoplasmic granules was intensely periodic acid-Schiff (PAS) positive and diastase resistant. Immunohistochemical negativity for S100 protein, positivity for lysozyme and numerous phagolysosomes in the cytoplasm of neoplastic elements, observed on ultrastructural examination, supported the hypothesis that the congenital type of granular cell tumor cannot have a Schwannian origin like that of the adult type, but is probably a mesenchymal lesion which, for unknown cause, regresses by a degenerative process.

A rare case of multiple congenital epulis

We report a case in a female newborn infant of multiple congenital epulis, i.e. granular cell tumor, that was undetected during regular pregnancy ultrasound monitoring. At birth the neoplasms appeared as two voluminous lesions protruding from the newborn's mouth. The greater of them (5.5 cm × 4 cm × 3 cm) was pedunculated and attached to the external superior gingiva, shifting the alae nasi and making it difficult to enter the coanae. The second mass was somewhat smaller (3 cm × 4 cm × 2.5 cm), pedunculated and attached to the external inferior gum. A third smaller mass was less evident, unpedunculated and attached to the rim of the lower gingiva. Histologically the lesions were characterized by large cells, which had abundant pale acidophilic granular cytoplasm. A round-oval nucleus was located centrally. The cell membranes were distinct. Neither mitosis nor necrosis was found. Staining for cytoplasmic granules was intensely periodic acid-Schiff (PAS) positive and diastase resistant. Immunohistochemical negativity for S100 protein, positivity for lysozyme and numerous phagolysosomes in the cytoplasm of neoplastic elements, observed on ultrastructural examination, supported the hypothesis that the congenital type of granular cell tumor cannot have a Schwannian origin like that of the adult type, but is probably a mesenchymal lesion which, for unknown cause, regresses by a degenerative process.

Mucinous metaplasia of the penis.

To determine the incidence of mucinous metaplasia occurring in the foreskin or glans penis and any associated clinical or histopathological features. Following the recognition of two index cases, 100 other foreskin specimens were retrieved from the histopathology archives at Southampton General Hospital. The haematoxylin and eosin-stained slides were examined by a single observer to detect the presence of mucin-producing cells in the surface epithelium. The absence of mucinous metaplasia in negative cases was confirmed with mucin histochemistry. In total, four cases of mucinous metaplasia were identified, three involving the foreskin and one involving the glans penis. The age range was 51-80 years. Three cases were associated with Zoon's balanitis and the fourth showed mild non-specific balanitis. All four cases showed positive staining with both diastase periodic acid-Schiff and alcian blue. No mucin-producing cells were identified in non-inflamed or minimally inflamed specimens. Mucinous metaplasia of the penis is an uncommon but under-recognized condition. It is seen in the elderly and appears to be a metaplastic change associated with severe chronic inflammation, and possibly more specifically with Zoon's balanitis. Our study identified a case affecting the glans penis, a site not previously recorded.

Hyperlipasemia in 6 dogs with pancreatic or hepatic neoplasia: evidence for tumor lipase production.

Amarked increase in serum pancreatic lipase (PL) activity with minimal concurrent increase in serum alpha-amylase activity was observed in 6 dogs with pancreatic or hepatic neoplasia. Serum PL activity ranged from 5410 U/L to 42,900 U/L, 11 to 93 times the upper reference limit for our laboratory. Neoplasms included pancreatic adenocarcinoma (n=3), endocrine carcinoma (n=2), and hepatic carcinoma of unknown origin (n=1). Tumor tissue and normal canine pancreatic tissue were stained histochemically with diastase periodic acid-Schiff to demonstrate zymogen granule content, and immunohistochemically with human monoclonal antibody for PL. Normal canine pancreatic tissue stained positive for both zymogen granule content and PL. Five of the 6 tumors stained positive for zymogen granule content, and 2 of the 6 tumors stained positive for PL. Together, the histochemical and immunohistochemical staining patterns suggested tumor PL production in 5 of the 6 dogs. Marked, unexplained hyperlipasemia may be a noninvasive indicator and biochemical marker for neoplasia of the pancreas and liver in dogs.