bromochloroacetic-acid and Neurofibromatosis-1

In this report, we describe a highly unusual case of glandular malignant peripheral nerve sheath tumor presenting as a neck mass in a previously healthy 29-year-old man. Grossly, the tumor was found to arise from a swollen peripheral nerve trunk. The tumor was largely composed of spindle cells that demonstrated marked nuclear pleomorphism and numerous abnormal mitotic figures. In addition, histologically malignant glandular structures lined by simple nonciliated columnar cells with goblet cells were found clustered in the center of the tumor. Examination of the swollen peripheral nerve trunk revealed the presence of a plexiform neurofibroma. The spindle cells were positive for S100. The glands were negative for S100 but positive for keratin, epithelial membrane antigen, and neuroendocrine markers (somatostatin, chromogranin, Leu-7, and calcitonin). This patient was subsequently diagnosed as having von Recklinghausen disease and died of tumor metastasis to the lungs 34 months after the presentation. To our knowledge, only 3 similar cases have been previously described in the literature.

Topics: Adult; Biomarkers; Carcinoembryonic Antigen; Cell Nucleus; Epithelial Cells; Fatal Outcome; Head and Neck Neoplasms; Humans; Immunohistochemistry; Keratins; Lung Neoplasms; Male; Mitosis; Mucin-1; Nerve Sheath Neoplasms; Neurofibromatosis 1; S100 Proteins; Skin Neoplasms

Topics: Acrodermatitis; Amino Acid Metabolism, Inborn Errors; Basal Cell Nevus Syndrome; Epidermolysis Bullosa; Hair Diseases; Humans; Ichthyosis; Keratins; Keratosis; Neurofibromatosis 1; Psoriasis; Refsum Disease; Skin; Skin Diseases; Skin Neoplasms; Tuberous Sclerosis; Tyrosine; Warts; Xeroderma Pigmentosum

Topics: Antibodies, Monoclonal; Antibody Specificity; Biomarkers; Gastrointestinal Stromal Tumors; Humans; Keratin-18; Keratin-8; Keratins; Neurofibromatosis 1; Reagent Kits, Diagnostic; Ultrasonography, Doppler, Color

A case of multiple small intestinal stromal tumors (SIST) with skeinoid fibers of the jejunum arising in a 50 year old male with neurofibromatosis 1 (NF-1) is reported. Seven small tumors of the jejunal wall were incidentally found and excised during an operation for abdominal and retroperitoneal neurofibromas. Histologically, the tumors were composed of uniform spindle-shaped cells with fascicular pattern, almost indistinguishable from the histology in leiomyoma. Periodic acid Schiff stain-positive hyaline globules were observed among the tumor cells. Ultrastructurally, these globules were stromal tangles of curvilinear, fluffy fibrils, consistent with skeinoid fibers. The electron-dense granules, possibly neuro-secretory granules, were found in the cytoplasm of the tumor cells. Immunohistochemically, the tumor cells were positive for vimentin, neuron specific enolase and CD34, but negative for muscle markers and S100 protein. The association of NF-1 and multiple SIST with skeinoid fibers may have clinical implications. The multiple occurrence of SIST with skeinoid fibers seems to be often cited as one of the gastrointestinal manifestations of NF-1. The possible site of origin of SIST with skeinoid fibers in NF-1 may be the enteric autonomic nerve plexus in the small intestinal wall.

Topics: Humans; Immunohistochemistry; Intestinal Neoplasms; Intestine, Small; Keratins; Male; Middle Aged; Neurofibromatosis 1; Phosphopyruvate Hydratase; Vimentin

The cellular heterogeneity of cutaneous tumors from nine patients with type 1 (von Recklinghausen's) neurofibromatosis was studied using several antigenic markers with special reference to focal heterotopic differentiation and interindividual variation. Furthermore, cells which actively express the genes for type I and III collagens and fibronectin, the major components of the abundant extracellular matrix of neurofibromas, were localized using in situ hybridizations. In eight of nine cases, the S-100 protein positive cells, i.e. Schwann-like cells, composed 60 to 80% of the total cell population. However, in one case, only about 40% of the cells were S-100 protein positive. The latter tumor was studied with respect to perineurial cell differentiation and stained with a mixture of two antibodies, directed against the S-100 protein and type IV collagen. In Schwann cells, the staining reaction for S-100 protein was observed in the nuclear region, whereas the staining reaction for type IV collagen was located peripherally, corresponding to the basement membrane zone covering the cells. The stromal cells which showed only the peripheral staining profile were considered to be neoplastic perineurial cells. Distinct structures with epithelial, endothelial, or smooth muscle cell differentiation were present within the benign tumors, as detected by immunostaining for cytokeratin, epithelial membrane antigen, factor VIII-related antigen and desmin, respectively. In situ hybridizations revealed a clearly detectable expression of type I procollagen genes in less than 10% and type III procollagen gene in less than 5% of the total cell population. Active synthesis of fibronectin was limited to the vascular walls, when examined by in situ hybridization, and antibodies to cellular fibronectin localized to the same areas. However, antibodies to plasma fibronectin produced a uniform staining reaction throughout the tumors suggesting that most of the fibronectin in neurofibromas is plasma-derived. The latter observation suggests that neurofibroma cells are freely accessible to various plasma proteins, including growth factors, which may influence the growth characteristics of these lesions.

Topics: Antibodies, Monoclonal; Antigens; Antigens, Neoplasm; Cell Transformation, Neoplastic; Collagen; Desmin; DNA Probes; Endothelium; Epithelium; Epitopes; Extracellular Matrix; Factor VIII; Fibronectins; Gene Expression Regulation; Humans; Immunoenzyme Techniques; Immunohistochemistry; Keratins; Mast Cells; Membrane Glycoproteins; Mucin-1; Muscles; Mutation; Neurofibromatosis 1; Nucleic Acid Hybridization; Phagocytes; Procollagen; RNA, Messenger; S100 Proteins; Schwann Cells; Skin Neoplasms; von Willebrand Factor

The numerical keratinocyte to melanocyte relation was studied in café au lait spots and adjacent normally pigmented skin of 9 patients with classical neurofibromatosis. Compared to normal skin of healthy individuals, the keratinocyte:melanocyte ratio distributions obtained in neurofibromatosis indicated a shift to lower values in the biopsies of café au lait spots and normally pigmented skin. These results are evidence in favor of an impaired tissue organization of the epidermis in neurofibromatosis with regard to the keratinocyte-melanocyte interrelation.

Topics: Adult; Aged; Biopsy; Cell Count; Epidermis; Humans; Keratins; Melanocytes; Middle Aged; Neurofibromatosis 1