Metaplastic carcinoma of the thymus is a distinct clinicopathological entity that should be distinguished from the usually benign medullary thymomas and from the clinically aggressive carcinosarcomas and sarcomatoid carcinomas.
We report on three resected cases of intrapulmonary plasma cell granuloma. All of them were asymptomatic. One of them showed bilateral multiple lesions and in this case bilateral partial resections of lung in one stage were performed. Under light and electron microscopy the lesions were composed of plasma cells and other kinds of inflammatory cell. The plasma cells were mature and had rich endoplasmic reticulum but no kind of intracytoplasmic inclusion. Steroid therapy was effective for the recurrent lesion after the operation.
Histologically normal thymus (type A) in patients with myasthenia gravis (MG) was immunohistochemically compared with hyperplastic MG thymus (type B) and normal non-MG thymus. In formalin-fixed, paraffin-embedded sections of ten type A, ten type B, and eight non-MG cases, the thymic epithelium and other cellular components were stained in conjunction with the basement membrane by a double immunoenzymatic method. This technique demonstrated a moderate architectural disturbance in type A thymus, with distended perivascular space (PVS), elongated medullary epithelium, and disrupted basement membrane. These changes were more prominent in type B thymus but were minimal to lacking in non-MG thymus. Compared with those in non-MG thymus, the myoid cells in MG thymuses of both types tended to cluster around the Hassall's corpuscles, with a slight decrease in number in type B but not in type A. B-lymphocytes were present in type B, type A, and non-MG thymuses in that order of abundance; the cells were confined to the medullary parenchyma in the non-MG group but were numerous both in the PVS and medulla in the MG groups. T-lymphocytes were increased in the expanded PVS of type A and B MG thymuses. The number of interdigitating reticulum cells was similar in the three groups, but the cellular distribution was more dispersed in MG thymuses of both types. These findings, although previously described in type B thymus, have not been well recognized in type A thymus. They support the view that a common abnormality (presumably chronic thymitis), differing in degree only, underlies MG thymuses regardless of the presence of follicular hyperplasia.
Fourteen thymomas were studied by electron microscopy and immunohistochemistry. Based on the ultrastructure of the neoplastic epithelial cells in comparison with normal thymic epithelium, four cortical-, three mixed-, five medullary-, and two corpuscular-type tumors were categorized. Histologically the tumors of cortical type showed prominent lymphocytic infiltration, but scant interdigitating reticulum cells (IDCs) were demonstrated by immunoperoxidase method on paraffin sections with anti-S-100 protein antiserum. Fewer lymphocytes but more IDCs were present in the tumors of medullary and corpuscular types, although variable in those of mixed type. This corticomedullary difference among thymomas was confirmed in some of them by the immunoperoxidase method on frozen sections with monoclonal antibodies. The cortical-type tumors were HLA-DR positive in tumor cells and infiltrated predominantly with cortical thymocytes (OKT-6+, OKT-3-, both Leu 3a/3b+ and OKT-8+), whereas the medullary- and corpuscular-type tumors were HLA-DR positive primarily in IDCs but not in tumor cells and were infiltrated more with medullary thymocytes (OKT-6-, OKT-3+, either Leu 3a/3b+ or OKT-8+). The classification of thymomas based on neoplastic epithelial cells will serve to refine the traditional classification based on reactive lymphocytes.
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