2 78
Brief reports
growth which would not be expected of a true hamartoma. Aneuploid cells, which are features of a neoplasm rather than a hamartoma, have been identified in those parts of a ganglioglioma that showed increased cellularity, atypical ganglion cells and numerous mitoses. The less atypical parts of the same tumour contained only diploid cells. It was suggested that the development of aneuploidy may have been associated with the sudden rapid growth of the tum0ur5.The lack of aneuploid cells in the case we report here may be reflected in its extremely indolent growth. The small growth fraction of gangliogliomas, estimated immunohistochemically as correlates with their lack of aggressive behaviour. The mitotic cells, and possibly the neuroblast-likecells, it is suggested, produce daughter cells most of which differentiate and do not divide further. Gangliogliomas are perhaps best regarded as neoplasms largely composed of post-mitotic cells. Their clinical behaviour may, as in the case reported here, somewhat resemble that of a hamartoma when their rate of proliferation approximatesto that of cell loss. The development of more aggressive behaviour may be associated with genetic changes including the develop-
1x6,
ment of aneuploid foci. Such aneuploid foci were not detected in the indolent hunour reported here.
References 1. Hedley DW. Friedlander ML,Taylor IW,R u g g CA, Musgrove EA. Method for analysis of cellular DNA content of paraih-embedded pathologicalmaterial using flow cytometry.1.Histochern. Qtochern. 1983;31;1333-1335. 2. Smbrh R, RobertsonDM. Ganghoneuroma arising in the pituitary fossa: a twenty year follow up. 1. Neurof. Neurosurg. Psnchlatry 1984;47; 97-98. 3. Demierre B, Stichnoth FA, Hori A. Spoerri 0. Intracerebral ganglioglioma. J. Neurosurg. 1986;65; 177-182. 4. Fletcher WA. Hoyt WF, Narahara MH. Congenital quadrantanopia with occipital lobe ganglioglioma. Neurofogg 1988; 38: 18921894. 5. Bowles AP Jr., Pantazis CG. Allen MB Jr..Martinez J, Allsbrook WC Jr. Ganglloglioma. a malignant tumour? Correlation with flow deoxyribonucleic acid cytometric analysis. Neurosurg. 1988;23; 376-381. 6. Giangaspero F. Doglioni C,Rivano MT, Pileri S, Gerdes J, Stein H. Growth fraction in human brain tumours debed by the monoclonal antibody Ki-67. Actn Neuropathof. (Berl) 1987: 74; 179182.
Hkt0path0100~1992. 21, 278-280
BRIEF REPORT
Sebaceous glands and hair follicles in the cervix uteri M.C.ROBLED0,
i.J.VAZQUE2,
F.CONTRERAS-MEJUTO & G.LOPE2-GARCIA
Department of PuthoZogy, Clintca Universituriu Nuvarru, Pumplonu, Spain Date of submlssion 20 November 1991 Accepted for publication 24 February 1992
We report a case of ectopic ectodermal structures in the ectocervix of a 51-year-old female. Sebaceous glands and numerous abnormal hair follicles were present in the stroma of an othevwise normal cervix.
Introduction
These correspond to sebaceous glands, hair follicles, hair, sweat glands and They may occur from the lower third of the vagina up to the endocervical canal2.The presence of these structures may be due to a metaplastic response to a long-standing chronic Mammation’.’ or they may simply derive from misplaced embryonic tissue, being then a true heterotopia5. We report a case in which sebaceousglands and hair follicles were observed in the ectocervtx.
Ectopic ectodermal and mesodermal structures have occasionally been described in the cervix and vagina.
Case report
Address for correspondence: Dr I.J.Vazquez.Department de Anatom’a Patol6gica. Clinlca Univemitaria de Navama, Apdo 192, 31080 Pamplona. Spain.
A 51-year-old woman, para I1 (last pregnancy 18 years ago), underwent a routine gynaecological examination which showed normal external genitalia, uterus and
Keywords: sebaceous glands, hair follicles,cervix
Brief reports
2 79
Figure 1. Cervical biopsy: abnormal hair follicles and a sebaceous gland (arrow) are present. H & E. x 140. Figure 2. Hair follicle: three distinctly separated layers are observed:
adnexal structures. Colposcopy revealed a white patch which was biopsied. A PAP smear performed simultaneously was diagnosed as cervico-vaginitissecondary to Gardnerella. PATHOLOGICAL FINDINGS
The biopsy consisted of a small wedge of 5 x 4 x 2 mm. Histologically,the ectocervical mucosa was covered by a slightly keratinized acanthotic stratified squamous epithelium. The stroma showed epidermal appendages. These comprised three sebaceous glands and numerous abnormal hair follicles closely apposed to each other (Figure 1). The sebaceous glands were composed of sebaceous cells ringed by a layer of basal epithelial cells. The hair follicles showed a keratin-filled centre (hair shaft) surrounded by the cuticle (hair shaft cuticle) (Figure 2). The outer sheath consisted of epithelial cells. A focus of chronic inflammation with foreign body giant cells within the connective tissue near these structures probably corresponded to extrusion of sebaceous material or keratin from ruptured hair follicles.
cortex, cuticule and cellular layer made up by inner and outer root sheaths. Trichrome stain. x 370.
Discussion On rare occasions ectodermal and mesodermal structures have been reported in the cervix. Ectodermal derivatives such as hair follicles, hair, sweat glands and sebaceous glands have occasionally been described in cervix and Willis collected eight cases from the literature and added one case of his own involving the cervix and vagina, all in adults aged between 34 and 742.All but one had evidence of chronic inflammation. Few cases have been described since then, most of them case reports. The presence of these structures in the cervix has been ~ that explained in two ways. Some a ~ t h o r s l -believe under an appropriate stimulus, such as long-standing chronic inflammation, adult mesodermal epithelium forms epidermis and epidermalappendages analogous to skin. To others5, these structures are most likely derived from misplaced ectodermal embryonal precursors following an abnormal cephalic migration. Having
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-
Brief reports
growth which would not be expected of a true hamartoma. Aneuploid cells, which are features of a neoplasm rather than a hamartoma, have been identified in those parts of a ganglioglioma that showed increased cellularity, atypical ganglion cells and numerous mitoses. The less atypical parts of the same tumour contained only diploid cells. It was suggested that the development of aneuploidy may have been associated with the sudden rapid growth of the tum0ur5.The lack of aneuploid cells in the case we report here may be reflected in its extremely indolent growth. The small growth fraction of gangliogliomas, estimated immunohistochemically as correlates with their lack of aggressive behaviour. The mitotic cells, and possibly the neuroblast-likecells, it is suggested, produce daughter cells most of which differentiate and do not divide further. Gangliogliomas are perhaps best regarded as neoplasms largely composed of post-mitotic cells. Their clinical behaviour may, as in the case reported here, somewhat resemble that of a hamartoma when their rate of proliferation approximatesto that of cell loss. The development of more aggressive behaviour may be associated with genetic changes including the develop-
1x6,
ment of aneuploid foci. Such aneuploid foci were not detected in the indolent hunour reported here.
References 1. Hedley DW. Friedlander ML,Taylor IW,R u g g CA, Musgrove EA. Method for analysis of cellular DNA content of paraih-embedded pathologicalmaterial using flow cytometry.1.Histochern. Qtochern. 1983;31;1333-1335. 2. Smbrh R, RobertsonDM. Ganghoneuroma arising in the pituitary fossa: a twenty year follow up. 1. Neurof. Neurosurg. Psnchlatry 1984;47; 97-98. 3. Demierre B, Stichnoth FA, Hori A. Spoerri 0. Intracerebral ganglioglioma. J. Neurosurg. 1986;65; 177-182. 4. Fletcher WA. Hoyt WF, Narahara MH. Congenital quadrantanopia with occipital lobe ganglioglioma. Neurofogg 1988; 38: 18921894. 5. Bowles AP Jr., Pantazis CG. Allen MB Jr..Martinez J, Allsbrook WC Jr. Ganglloglioma. a malignant tumour? Correlation with flow deoxyribonucleic acid cytometric analysis. Neurosurg. 1988;23; 376-381. 6. Giangaspero F. Doglioni C,Rivano MT, Pileri S, Gerdes J, Stein H. Growth fraction in human brain tumours debed by the monoclonal antibody Ki-67. Actn Neuropathof. (Berl) 1987: 74; 179182.
Hkt0path0100~1992. 21, 278-280
BRIEF REPORT
Sebaceous glands and hair follicles in the cervix uteri M.C.ROBLED0,
i.J.VAZQUE2,
F.CONTRERAS-MEJUTO & G.LOPE2-GARCIA
Department of PuthoZogy, Clintca Universituriu Nuvarru, Pumplonu, Spain Date of submlssion 20 November 1991 Accepted for publication 24 February 1992
We report a case of ectopic ectodermal structures in the ectocervix of a 51-year-old female. Sebaceous glands and numerous abnormal hair follicles were present in the stroma of an othevwise normal cervix.
Introduction
These correspond to sebaceous glands, hair follicles, hair, sweat glands and They may occur from the lower third of the vagina up to the endocervical canal2.The presence of these structures may be due to a metaplastic response to a long-standing chronic Mammation’.’ or they may simply derive from misplaced embryonic tissue, being then a true heterotopia5. We report a case in which sebaceousglands and hair follicles were observed in the ectocervtx.
Ectopic ectodermal and mesodermal structures have occasionally been described in the cervix and vagina.
Case report
Address for correspondence: Dr I.J.Vazquez.Department de Anatom’a Patol6gica. Clinlca Univemitaria de Navama, Apdo 192, 31080 Pamplona. Spain.
A 51-year-old woman, para I1 (last pregnancy 18 years ago), underwent a routine gynaecological examination which showed normal external genitalia, uterus and
Keywords: sebaceous glands, hair follicles,cervix
Brief reports
2 79
Figure 1. Cervical biopsy: abnormal hair follicles and a sebaceous gland (arrow) are present. H & E. x 140. Figure 2. Hair follicle: three distinctly separated layers are observed:
adnexal structures. Colposcopy revealed a white patch which was biopsied. A PAP smear performed simultaneously was diagnosed as cervico-vaginitissecondary to Gardnerella. PATHOLOGICAL FINDINGS
The biopsy consisted of a small wedge of 5 x 4 x 2 mm. Histologically,the ectocervical mucosa was covered by a slightly keratinized acanthotic stratified squamous epithelium. The stroma showed epidermal appendages. These comprised three sebaceous glands and numerous abnormal hair follicles closely apposed to each other (Figure 1). The sebaceous glands were composed of sebaceous cells ringed by a layer of basal epithelial cells. The hair follicles showed a keratin-filled centre (hair shaft) surrounded by the cuticle (hair shaft cuticle) (Figure 2). The outer sheath consisted of epithelial cells. A focus of chronic inflammation with foreign body giant cells within the connective tissue near these structures probably corresponded to extrusion of sebaceous material or keratin from ruptured hair follicles.
cortex, cuticule and cellular layer made up by inner and outer root sheaths. Trichrome stain. x 370.
Discussion On rare occasions ectodermal and mesodermal structures have been reported in the cervix. Ectodermal derivatives such as hair follicles, hair, sweat glands and sebaceous glands have occasionally been described in cervix and Willis collected eight cases from the literature and added one case of his own involving the cervix and vagina, all in adults aged between 34 and 742.All but one had evidence of chronic inflammation. Few cases have been described since then, most of them case reports. The presence of these structures in the cervix has been ~ that explained in two ways. Some a ~ t h o r s l -believe under an appropriate stimulus, such as long-standing chronic inflammation, adult mesodermal epithelium forms epidermis and epidermalappendages analogous to skin. To others5, these structures are most likely derived from misplaced ectodermal embryonal precursors following an abnormal cephalic migration. Having
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-
