title: Ultrastructural morphometry distinguishes Burkitt's-like lymphomas from neuroendocrine neoplasms: useful criteria applied to the evaluation of a poorly differentiated neuroendocrine neoplasm of the nasal cavity masquerading as Burkitt's-like lymphoma.
abstract: The present study describes the potential usefulness of ultrastructural morphometry in diagnosis. Ultrastructural morphometric criteria were applied to the evaluation of a poorly differentiated neuroendocrine neoplasm of the nasal cavity that was initially thought to be a Burkitt's-like lymphoma (BLL). Although the nasal lesion in question failed to stain with over 50 cell lineage-relevant antibodies, it did stain for vimentin (an intermediate filament protein) and Ki-67 (a nuclear antigen associated with cell proliferation). Routine electron microscopy revealed a primitive neoplasm with abundant cytoplasmic lipid droplets and sparse dense granules with no intercellular junctions. Treatment options, which included extensive facial surgery, prompted more study. Tissue processed for the uranaffin reaction revealed sparse uranaffin-positive granules indicating the presence of true neurosecretory granules. An ultrastructural morphometric analysis of the neoplastic nuclei of this patient placed the tumor outside the morphometric domains for BLLs (18 cases) and neuroblastomas (11 cases) and within the morphometric domain of neuroendocrine carcinomas (9 cases). A greater mean standard deviation (P less than 0.05) and mean coefficient of variation (P less than 0.02) of nuclear perimeter in the neuroendocrine (NE) group related to the BLL group indicated greater nuclear pleomorphism within the NE group as illustrated in bivariate graphic displays. The possible origin of the neoplasm within the nasal mucosa is discussed.
authors.affiliation: Department of Pathology, College of Medicine, University of Arizona, Tucson.
authors.forename: C M
authors.initials: CM
authors.lastname: Payne
authors.forename: W L
authors.initials: WL
authors.lastname: Smith
authors.forename: T M
authors.initials: TM
authors.lastname: Grogan
authors.forename: R B
authors.initials: RB
authors.lastname: Nagle
authors.forename: S H
authors.initials: SH
authors.lastname: Paplanus
authors.forename: T
authors.initials: T
authors.lastname: Palmer
mesh_terms: D002051:Burkitt Lymphoma / Q000175:diagnosis / Q000473:pathology / Q000648:ultrastructure*; D003937:Diagnosis, Differential; D006801:Humans; D007150:Immunohistochemistry; D008854:Microscopy, Electron; D009296:Nasal Cavity / Q000648:ultrastructure*; D009369:Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000648:ultrastructure; D009447:Neuroblastoma / Q000175:diagnosis / Q000473:pathology / Q000648:ultrastructure; D018241:Neuroectodermal Tumors, Primitive, Peripheral / Q000175:diagnosis / Q000473:pathology / Q000648:ultrastructure; D009490:Neurosecretory Systems; D009669:Nose Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000648:ultrastructure*