280
Brief reports
taken into account that all cases had evidence of chronic idammation and that, in two cases, these structures were found in polyps2, the former theory seems more probable. We are of the opinion therefore that these structures represent a metaplastic lesion.
References CM,Moore WR. Cotten N. Histologic dlagnosis and clinical signiRcance of benign lesions of the nonpregnant cervix. Ann. NY. Acad. Sci. 1967: 97; 683-702.
1. Dougherty
2. WUIis RA. Metaplasia in epithelia. In The Borderland oJ Embriology and Puthologu. 2nd edn. London: Butteworths. 1962: 533-535. 3. Watson AA, Cochran AJ. Sebaceous glands of the cervix uteri and buccal mucosa. 1. Pathol. 1969: 98; 87-89. 4. Bonilla-Musoles P. Monmeneu RM, Simon C. Sema V. Can the uterine cervix grow a moustache?Eur. I. Gynuecol. Oncol. 1989: 1 0 14 5- 146. 5. Fichera G, Santanocito A. Pilosebaceouscystic ectopy of the uterine cervix. Clin. Erp. Obstet. Gynecol. 1989: 16; 21-25. 6. Chiarelli SM, Onnis GL. PUc-sebaceous structures in the uterine cervix: case report. Clin. Erp. Obstet. Gynecol. 1981: 8; 15-17.
Histopalhologll 1992, 21, 280-282
BRIEF REPORT
Necrotizing sialometaplasia (adenometaplasia) of the trachea V.ROMAGOSA, M.R.BELLA, C.TRUCHERO* & J.MOYAt Departments of Pathology, *Intensive Care Unit and tThoracic Surgery, Hospital 'Princeps d'Espanya', Ciutat Sanitaria de Bellvitge, Barcelona, Spain Date of submission 30 December 1991 Accepted for publication 3 March 1992
Necrotizing sialometaplasia is a benign condition first described in minor salivary glands of the soft palate with morphological changes which can be misinterpreted as squamous-cell carcinoma. Similar lesions have been subsequently reported in other locations including major salivary glands, lip, breast and skin (the term syringometaplasia has been applied for the latter). We report three cases of such a process involving submucosal glands in the trachea following prolonged translaryngeal intubation. Keywords: trachea, necrotizing sialometaplasia
Introduction Necrotizing sialometaplasia was 6rst described by Abramsl as a benign, self-healing condition of palatal minor salivary glands that can mimic squamous-cell carcinoma and thus be misinterpreted as such. Similar changes have been described subsequently in other anatomical locations, including nasal cavity and paranasal sinuses2, major salivary glands3, lip4 and even female breast5. The aetiology of the disease remains Address for correspondence: J k V.Romegosa. Department of Pathology, Hospital 'prfnceps d'llspanya', c/Feixa Llarga. s/n 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
unknown but most authors seem to favour an ischaemic ca~se~.~.~. We present three cases of this lesion in the trachea of patients who underwent translaryngeal intubation for periods ranging from 7 to 50 days. The three cases were detected after review of tracheal biopsies from 47 patients admitted to the intensive care unit of our hospital because of cranio-encephalic trauma or after complicated surgery, that required mechanical respiratory assistance. The patients subsequently had a tracheostomy performedin order to avoid complications due to prolonged translaryngeal intubation. Tracheal biopsies were performed routinely at tracheostomy in order to assess the extent of inflammatory changes after prolonged intubation.
Case reports Case 1 was a 57-year-old male patient admitted following an automobile accident. Translaryngeal intubation was maintained during 12 days, after which a tracheostomy was done and a tracheal biopsy taken. He developed severe acute tracheitis with positive cultures for Pseudornona aeruginosu. Case 2 was a 29-year-old male who required admission due to meningococcal meningitis and acute renal fail-
Brier reports
281
Figure 1. Squamous metaplasia of mucous glands near tracheal cadage with a moderate inflammatory reaction: a ‘pseudo-invasive’pattern is produced by some of the nests (right).
ure. Tracheostomy and tracheal biopsy were done after 26 days of translaryngeal intubation. Case 3 was a 33-year-old male admitted after cranio-encephalic trauma. At day 2 3 he underwent tracheostomy and tracheal biopsy. Gram-negative sepsis developed soon after and led to a fatal outcome.
Figure 2. In this case note again the squamous metaplasia with some adjacent normal mucous glands.
PATHOLOGICAL FINDINGS
The material obtained was routinely processed after neutral formalin fixation and paran-embedded. Serial H & E sections were prepared and, in selected cases, Benn and Brent’s stain for bacteria and periodic acid-schiff
282
Brief reports
stain and methenamine silver for fungi were performed. The histological examination in all three cases showed variable degrees of mucosal ulceration with superficial acute idammation and granulation tissue extending into the submucosa. Focal squamous metaplasia of the non-ulcerated mucosa was present in case 2. The excretory ducts and acini of submucosal mucous glands were replaced in all three cases by squamous nests with focal squamous pearl formation featuring a pseudoinvasive pattern .(Figure 1). The general glandular architecture, however, was preserved and the squamous maturation was orderly and even, with no evidence of atypical features, nuclear pleomorphism or mitoses. A mild to moderate lymphocytic infiltration was present that extended to the perichondrium of the involved tracheal ring. Focal necrotic changes were seen in some mucosal glands in all three cases, but normal glands were also immediately present to these (Figure 2).
Discussion The pattern of histological change seen was similar to what has been described as necrotizing sialometaplasia in other settings. The term adenometaplasia is probably appropriate in view of the' non-salivary nature of the glands involved and in the same way as the term syringometaplasia has been used for similar lesions in the skin6. It seem that ischaemia may play a role in the development of the process in our cases, in that translaryngeal intubation requires the intratracheal
placement of an inflated balloon. Other pathogenetic mechanisms, such as acute bacterial infection, present at some point in all three reported cases, cannot, however, be ruled out. We are not aware of any case with similar pathological changes in radical laryngectomy for squamous cancer of the larynx in patients who underwent previous tracheostomy. Such an event might well mimic involvement of the tracheal margin of resection by tumour cells. It is, therefore, worthwhile to be aware of the possibility of the entity of adenometaplasia in such a location to avoid misinterpretation of the superficially malignantlookhg pattern. Conversely, the recognition of this entity should not make us overlook an underlying malignancy.
References 1. Abrams AM, Melrose RJ.Howell PV. NecroWng sialometaplasia.A disease simulating malignancy. Cancer 1973; 32; 130-135. 2. Johnston WH. Necrotizing sialometaplasia involving the mucous glands of the nasal cavity. Hum. Pathol. 1977: 8; 589-592. 3. Batsakis JG, Manning JT.Newtizing sialometaplasla of major salivary glands. I. Larungol. otol. 1987; 101; 962-966. 4. Granick MS. Solomon MP, Benedetto AV, Hannegan MW, Sohn M. Necrotlatng sialometaplasiamasquerading as residual cancer of the Up. Ann. Plast. Surg. 1988; 21; 152-154. 5. Hurt MA, Diaz-Arias AA. Rosenholtz MJ. Havey AD, Stephenson HE. Post-traumatic lobular squamous metaplasia of breast. An unusual pseudocarcinomatow metaplasia resembling squamous (necrotidng) sialometaplasia of the salivary gland. Mod. Pathol. 1988; 1; 385-390. 6. Metcalf JS, Maize JC. Squamous syringometaplasta in lobular paniculitis and pyoderma gangrenosum. Am. I. Dermatopathol. 1990; 12; 141-149.
HiStoptholOfiM 1992,21,282-284
BRIEF REPORT
Ceroid granuloma of the uterine cervix A.I.AL-NAFUSSI, D.HUGHES & G.REBBLL0 Department of Pathology, University of Edinburgh, Edinburgh. Scotland, UK Date of submission 6 February 1992 Accepted for publication 20 March 1992
An excision biopsy was taken from a 59-year-old woman with a small dark-brown lesion on the anterior lip of the cervix. The histology revealed an ulcerated Address for correspondence: Dr A.Al-Nafuussi. Department of Pathology, University of &burgh Teviot Place, Edinburgh EH8 9AG. Scotland. UK.
surface epithelium with a band-like infiltrate of pigment containing macrophages in the subepithelial zone. Histochemical examination of the specimen revealed that the pigknept was ceroid. This is, to the best of OUT knowledge, the flrst case report of ceroid granuloma of the uterine cervix. Keywords: cervix, ceroid, granuloma
Brief reports
taken into account that all cases had evidence of chronic idammation and that, in two cases, these structures were found in polyps2, the former theory seems more probable. We are of the opinion therefore that these structures represent a metaplastic lesion.
References CM,Moore WR. Cotten N. Histologic dlagnosis and clinical signiRcance of benign lesions of the nonpregnant cervix. Ann. NY. Acad. Sci. 1967: 97; 683-702.
1. Dougherty
2. WUIis RA. Metaplasia in epithelia. In The Borderland oJ Embriology and Puthologu. 2nd edn. London: Butteworths. 1962: 533-535. 3. Watson AA, Cochran AJ. Sebaceous glands of the cervix uteri and buccal mucosa. 1. Pathol. 1969: 98; 87-89. 4. Bonilla-Musoles P. Monmeneu RM, Simon C. Sema V. Can the uterine cervix grow a moustache?Eur. I. Gynuecol. Oncol. 1989: 1 0 14 5- 146. 5. Fichera G, Santanocito A. Pilosebaceouscystic ectopy of the uterine cervix. Clin. Erp. Obstet. Gynecol. 1989: 16; 21-25. 6. Chiarelli SM, Onnis GL. PUc-sebaceous structures in the uterine cervix: case report. Clin. Erp. Obstet. Gynecol. 1981: 8; 15-17.
Histopalhologll 1992, 21, 280-282
BRIEF REPORT
Necrotizing sialometaplasia (adenometaplasia) of the trachea V.ROMAGOSA, M.R.BELLA, C.TRUCHERO* & J.MOYAt Departments of Pathology, *Intensive Care Unit and tThoracic Surgery, Hospital 'Princeps d'Espanya', Ciutat Sanitaria de Bellvitge, Barcelona, Spain Date of submission 30 December 1991 Accepted for publication 3 March 1992
Necrotizing sialometaplasia is a benign condition first described in minor salivary glands of the soft palate with morphological changes which can be misinterpreted as squamous-cell carcinoma. Similar lesions have been subsequently reported in other locations including major salivary glands, lip, breast and skin (the term syringometaplasia has been applied for the latter). We report three cases of such a process involving submucosal glands in the trachea following prolonged translaryngeal intubation. Keywords: trachea, necrotizing sialometaplasia
Introduction Necrotizing sialometaplasia was 6rst described by Abramsl as a benign, self-healing condition of palatal minor salivary glands that can mimic squamous-cell carcinoma and thus be misinterpreted as such. Similar changes have been described subsequently in other anatomical locations, including nasal cavity and paranasal sinuses2, major salivary glands3, lip4 and even female breast5. The aetiology of the disease remains Address for correspondence: J k V.Romegosa. Department of Pathology, Hospital 'prfnceps d'llspanya', c/Feixa Llarga. s/n 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
unknown but most authors seem to favour an ischaemic ca~se~.~.~. We present three cases of this lesion in the trachea of patients who underwent translaryngeal intubation for periods ranging from 7 to 50 days. The three cases were detected after review of tracheal biopsies from 47 patients admitted to the intensive care unit of our hospital because of cranio-encephalic trauma or after complicated surgery, that required mechanical respiratory assistance. The patients subsequently had a tracheostomy performedin order to avoid complications due to prolonged translaryngeal intubation. Tracheal biopsies were performed routinely at tracheostomy in order to assess the extent of inflammatory changes after prolonged intubation.
Case reports Case 1 was a 57-year-old male patient admitted following an automobile accident. Translaryngeal intubation was maintained during 12 days, after which a tracheostomy was done and a tracheal biopsy taken. He developed severe acute tracheitis with positive cultures for Pseudornona aeruginosu. Case 2 was a 29-year-old male who required admission due to meningococcal meningitis and acute renal fail-
Brier reports
281
Figure 1. Squamous metaplasia of mucous glands near tracheal cadage with a moderate inflammatory reaction: a ‘pseudo-invasive’pattern is produced by some of the nests (right).
ure. Tracheostomy and tracheal biopsy were done after 26 days of translaryngeal intubation. Case 3 was a 33-year-old male admitted after cranio-encephalic trauma. At day 2 3 he underwent tracheostomy and tracheal biopsy. Gram-negative sepsis developed soon after and led to a fatal outcome.
Figure 2. In this case note again the squamous metaplasia with some adjacent normal mucous glands.
PATHOLOGICAL FINDINGS
The material obtained was routinely processed after neutral formalin fixation and paran-embedded. Serial H & E sections were prepared and, in selected cases, Benn and Brent’s stain for bacteria and periodic acid-schiff
282
Brief reports
stain and methenamine silver for fungi were performed. The histological examination in all three cases showed variable degrees of mucosal ulceration with superficial acute idammation and granulation tissue extending into the submucosa. Focal squamous metaplasia of the non-ulcerated mucosa was present in case 2. The excretory ducts and acini of submucosal mucous glands were replaced in all three cases by squamous nests with focal squamous pearl formation featuring a pseudoinvasive pattern .(Figure 1). The general glandular architecture, however, was preserved and the squamous maturation was orderly and even, with no evidence of atypical features, nuclear pleomorphism or mitoses. A mild to moderate lymphocytic infiltration was present that extended to the perichondrium of the involved tracheal ring. Focal necrotic changes were seen in some mucosal glands in all three cases, but normal glands were also immediately present to these (Figure 2).
Discussion The pattern of histological change seen was similar to what has been described as necrotizing sialometaplasia in other settings. The term adenometaplasia is probably appropriate in view of the' non-salivary nature of the glands involved and in the same way as the term syringometaplasia has been used for similar lesions in the skin6. It seem that ischaemia may play a role in the development of the process in our cases, in that translaryngeal intubation requires the intratracheal
placement of an inflated balloon. Other pathogenetic mechanisms, such as acute bacterial infection, present at some point in all three reported cases, cannot, however, be ruled out. We are not aware of any case with similar pathological changes in radical laryngectomy for squamous cancer of the larynx in patients who underwent previous tracheostomy. Such an event might well mimic involvement of the tracheal margin of resection by tumour cells. It is, therefore, worthwhile to be aware of the possibility of the entity of adenometaplasia in such a location to avoid misinterpretation of the superficially malignantlookhg pattern. Conversely, the recognition of this entity should not make us overlook an underlying malignancy.
References 1. Abrams AM, Melrose RJ.Howell PV. NecroWng sialometaplasia.A disease simulating malignancy. Cancer 1973; 32; 130-135. 2. Johnston WH. Necrotizing sialometaplasia involving the mucous glands of the nasal cavity. Hum. Pathol. 1977: 8; 589-592. 3. Batsakis JG, Manning JT.Newtizing sialometaplasla of major salivary glands. I. Larungol. otol. 1987; 101; 962-966. 4. Granick MS. Solomon MP, Benedetto AV, Hannegan MW, Sohn M. Necrotlatng sialometaplasiamasquerading as residual cancer of the Up. Ann. Plast. Surg. 1988; 21; 152-154. 5. Hurt MA, Diaz-Arias AA. Rosenholtz MJ. Havey AD, Stephenson HE. Post-traumatic lobular squamous metaplasia of breast. An unusual pseudocarcinomatow metaplasia resembling squamous (necrotidng) sialometaplasia of the salivary gland. Mod. Pathol. 1988; 1; 385-390. 6. Metcalf JS, Maize JC. Squamous syringometaplasta in lobular paniculitis and pyoderma gangrenosum. Am. I. Dermatopathol. 1990; 12; 141-149.
HiStoptholOfiM 1992,21,282-284
BRIEF REPORT
Ceroid granuloma of the uterine cervix A.I.AL-NAFUSSI, D.HUGHES & G.REBBLL0 Department of Pathology, University of Edinburgh, Edinburgh. Scotland, UK Date of submission 6 February 1992 Accepted for publication 20 March 1992
An excision biopsy was taken from a 59-year-old woman with a small dark-brown lesion on the anterior lip of the cervix. The histology revealed an ulcerated Address for correspondence: Dr A.Al-Nafuussi. Department of Pathology, University of &burgh Teviot Place, Edinburgh EH8 9AG. Scotland. UK.
surface epithelium with a band-like infiltrate of pigment containing macrophages in the subepithelial zone. Histochemical examination of the specimen revealed that the pigknept was ceroid. This is, to the best of OUT knowledge, the flrst case report of ceroid granuloma of the uterine cervix. Keywords: cervix, ceroid, granuloma
