bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined silver Perls's stain for differential staining of ringed sideroblasts and marrow iron.
Authors: Tham K T , Cousar J B
Published: June 2007

During a study of nucleolar organiser regions, a modified silver stain was found to be a sensitive marker for the iron in ringed sideroblasts, more so than Perls's stain when the marrow iron stores were low. To enhance the usefulness of the silver stain, a combined silver Perls method was developed. This stains the ringed sideroblast iron black and haemosiderin blue, thus rendering the detection of ringed sideroblasts easier even when marrow iron stores are excessive. AT the same time, it allows marrow iron content to be evaluated. The silver reagent in this combined method probably shows phosphate rather than the iron present in the abnormal mitochondria in ringed sideroblasts. This facilitates the differential staining of ringed sideroblast "iron" and haemosiderin.
Frozen section simulation of trabecular adenoma and medullary cancer by papillary thyroid carcinoma
Authors: Andrew A C , Williamson J M S
Published: June 2007

Two patients are reported in whom initial misdiagnoses of medullary cancer or trabecular hyaline adenoma for papillary carcinoma were made.
Rearrangements of c-myc and c-abl genes in tumour cells in Burkitt's lymphoma.
Authors: Casares S , Rodríguez J M , Martin A , Parrado A
Published: June 2007

Rearrangements of oncogenes c-myc and c-abl were detected by non-radioactive hybridisation in a case of Burkitt's lymphoma/leukaemia. The surface phenotype of Burkitt's cells were positive for CD19, CD20, HLA-DR, CD14, CD33 and surface immunoglobulin markers. Although cytogenetic analysis was not performed, the c-myc and heavy immunoglobulin genes had the same 14.2 kilobase EcoRI molecular size fragment, suggesting a possible t(8;14) translocation which is a common marker of this malignancy. The c-abl oncogene was also rearranged in DNA digested BamHI and EcoRI. The physiopathological implications of the rearranged c-abl gene are unknown, this being the first case, as for as is known, of Burkitt's lymphoma/leukaemia with a rearranged c-abl gene.
Fatal case of echovirus type 9 encephalitis.
Authors: Zuckerman M A , Sheaff M , Martin J E , Gabriel C M
Published: June 2007

Enteroviruses are rare causes of acute focal encephalitis. A fatal case of echovirus type 9 infection is reported in a 9 month old boy who presented with a fever and a macular rash followed by two focal seizures. Echovirus type 9 was isolated from lung tissue after seven days.
Benign cystic peritoneal mesothelioma.
Authors: Bhandarkar D S , Smith V J , Evans D A , Taylor T V
Published: June 2007

The well defined but rare entity of benign cystic mesothelioma is reported. The aetiology of this neoplasm remains obscure. The presenting features make a precise preoperative diagnosis difficult; information provided by computed tomography and cytology may help. A firm diagnosis can only come from electron microscopic or immunohistochemical examination of the tumour. Diagnostic accuracy and diligent follow up are essential because, although the tumour is considered benign, it does tend towards local recurrence.
Cytokeratin expression and acetowhite change in cervical epithelium.
Authors: Maddox P , Szarewski A , Dyson J , Cuzick J
Published: June 2007

AIM--To investigate the distribution of cytokeratins 10, 13, 14 and 19 in biopsy specimens taken from acetowhite and non-acetowhite areas of the cervix. METHOD--Cervical biopsy specimens were taken from both acetowhite and non-acetowhite areas from 44 patients who presented with abnormal cervical cytology. The specimens were snap frozen in liquid nitrogen and multiple sections taken from each specimen. Staining was performed for cytokeratins 10, 13, 14, 19 and NADPH diaphorase enzyme. The areas of each section positive for the various markers were measured. RESULTS--Cytokeratin 10 positive cells were greatly increased in number in acetowhite biopsy specimens compared with non-acetowhite samples (45.1% v 2.8%; p < 0.0001). Cytokeratin 19 was also increased, but to a lesser extent (17.8% v 5.5%; p < 0.0001). In contrast, the almost universal expression of cytokeratin 13 was reduced in acetowhite biopsy specimens (86.2% v 96.9%; p < 0.0001). Cytokeratin 14 was found diffusely in the basal region of the stratified squamous epithelium and was marginally more apparent in the acetowhite biopsy specimens (p = 0.04). CONCLUSION--It is suggested that the presence of cytokeratin 10 may be an essential requirement for the formation of acetowhite change in association with the cellular swelling caused by acetic acid.
Expression of c-erbB-2 oncogene product in Barrett's adenocarcinoma: pathological and prognostic correlations.
Authors: Fléjou J F , Paraf F , Muzeau F , Fékété F , Hénin D , Jothy S , Potet F
Published: June 2007

AIMS--To establish the prevalence of c-erbB-2 protein expression in a surgical series of Barrett's adenocarcinomas; and to correlate this expression with clinicopathological data and prognosis. METHODS--Sixty six surgical specimens of Barrett's adenocarcinomas were included in this retrospective study. Blocks of the tumour and of non-dysplastic Barrett's mucosa were stained with a polyclonal antibody specific for the intracytoplasmic domain of the c-erbB-2 protein. RESULTS--Seven of 66 tumours showed membrane staining for the c-erbB-2 protein. The non-dysplastic Barrett's mucosa was negative in all cases. There was no difference between c-erbB-2 positive and negative tumours with regard to mean age, sex ratio, percentage of alcohol misusers, percentage of smokers, tumour differentiation, depth of invasion, lymph node response, and proliferative activity, assessed by the percentage of tumour cells positive with the MIB-1 antibody directed against the Ki-67 antigen. All c-erb B2 positive tumours were of Lauren's intestinal type compared with negative c-erbB-2 tumours. Patients with c-erbB-2 positive tumours had a significantly poorer prognosis than patients with negative tumours. CONCLUSIONS--The prevalence of Barrett's adenocarcinomas expressing c-erbB-2 found in this study (11%) was similar to that observed in published series of gastric adenocarcinomas. c-erbB-2 protein expression could be an important prognostic indicator in Barrett's adenocarcinoma.
Audit of deaths from cervical cancer: proposal for an essential component of the National Screening Programme.
Authors: Slater D N , Milner P C , Radley H
Published: June 2007

AIMS--To ascertain the type and relative frequency of major factors associated with deaths from cervical cancer. METHODS--Deaths from cervical cancer in Rotherham district for the period 1989-1991 were subjected to multifactorial audit by reviewing laboratory, hospital, and general practitioner records; together with, when appropriate, re-screening of cytology smears. This period represented the three to five years after a computerised National Screening Programme (NSP) had been implemented with a five year recall interval. RESULTS--Thirty six deaths were identified. The average age of death was 59 years with 39% occurring in those over 65. Only 6% of cases presented as a result of a cervical smear, comprising 3% derived from the NSP and 3% by chance. Forty seven per cent of cases in which the patient had died had no record of a previous smear invitation; 22% of patients were under 65 years and 25% 65 or over. Those under 65 had presented before the appropriate age band had been called. A non-response to a cervical smear invitation was identified in 22%. In 25% of cases a true negative smear had been reported one to eight years previously (average 4.8 years). An inappropriate laboratory diagnosis was identified in 17% of cases. Fourteen per cent represented false negative smears and 8% comprised inadequate smears that had been reported as negative. Inappropriate clinical diagnosis or management was identified in 19% of cases. In 22% two or more contributory factors were identified in the same patient. CONCLUSIONS--Areas highlighted by the audit warranting further attention included the targeting of women over 65 with no cytology record; those not responding to smear invitations; laboratory performance; clinical acumen; and the reasons for true negative cervical smears. Multifactorial audit of all deaths from cervical cancer should be advocated nationally to assess and improve the effectiveness of the NSP.
Relation of CD30 expression to survival and morphology in large cell B cell lymphomas.
Authors: Noorduyn L A , de Bruin P C , van Heerde P , van de Sandt M M , Ossenkoppele G J , Meijer C J
Published: June 2007

AIMS--To investigate whether CD30 expression is correlated with anaplastic morphology, and whether this correlated with a better survival in large cell B cell lymphomas, as has been described for T cell lymphomas. METHODS--CD30 expression was investigated using frozen sections in a series of 146 large cell B cell lymphomas. Clinical data and follow up information were collected from 25 lymphomas with strong CD30 expression, 30 lymphomas with partial CD30 expression, and a control group of 25 lymphomas which did not express CD30. RESULTS--Morphological distinction between anaplastic and non-anaplastic tumours was difficult. Of the cases with an anaplastic morphology, 50% were CD30 positive, as were 24% of the polymorphic centroblastic B cell lymphomas. Only 65% of the morphologically non-anaplastic tumours were completely CD30 negative. There was no difference in survival among patients with lymphomas expressing CD30 and those that did not. Patients with morphologically anaplastic B cell lymphomas did not differ in their survivals from those with other high grade B cell lymphomas. Clinical stage at presentation was the only variable that was significantly associated with survival. CONCLUSIONS--CD30 expression occurs frequently in large cell B cell lymphomas and is poorly related to anaplastic morphology. Morphological distinction between anaplastic and non-anaplastic tumours is difficult. In contrast to T cell lymphomas, CD30 positive B cell lymphomas do not show a relatively favourable clinical course. The results presented here raise serious doubts as to whether large cell B cell lymphoma, based on the expression of CD30 or anaplastic morphology, can really be termed a separate entity.
Colorectal tumours and pit pattern.
Authors: Kudo S , Hirota S , Nakajima T , Hosobe S , Kusaka H , Kobayashi T , Himori M , Yagyuu A
Published: June 2007

AIMS--To investigate the morphological and histopathological associations between an individual pit seen on stereomicroscopy or magnifying colonoscopy and an individual crypt seen in histological sections; and to examine these associations in colorectal tumours. METHODS--Fourteen thousand and twenty three cases were examined by colonoscope at Akita Red Cross Hospital. The surface mucosal pits of the lesions were observed using a magnifying endoscope in vivo and the pits of the extracted specimens were observed in vitro using a stereo microscope. Histological diagnoses were determined by light microscopy: the pit patterns in 100 glands were analysed. RESULTS--Pit pattern was classified into seven principal types: (1) normal round pit; (2) small round pit; (3) small asteroid pit; (4) large asteroid pit; (5) oval pit; (6) gyrus-like pit; and (7) non-pit. There was a correlation between pit pattern and the structure of the underlying crypt or gland. Furthermore, there was an association between pit pattern and the histology of the cells in the gland. Macroscopically, types 3, 4, 5, and 6 were common in protruding lesions. Type 2 was common in depressed lesions. The non-pit pattern was recognised in both. The depressed lesions had invaded the deeper layers more rapidly than protruding lesions. CONCLUSIONS--There were associations between individual pits and crypts. The branching carcinoma gland is thought to be the result of malignant transformation of the adenoma gland. The straight carcinoma gland is thought to result from the normal gland becoming malignant. The gland of the small round pit is thought to change from normal to the straight carcinoma gland via malignant transformation.
Effects of combination endocrine treatment on normal prostate, prostatic intraepithelial neoplasia, and prostatic adenocarcinoma.
Authors: Montironi R , Magi-Galluzzi C , Muzzonigro G , Prete E , Polito M , Fabris G
Published: June 2007

AIMS--To investigate the effect of combination endocrine treatment (CET) or luteinising hormone releasing hormone agonist and flutamide on non-neoplastic prostate, prostatic intraepithelial neoplasia, and prostatic adenocarcinoma. METHODS--The morphology, including the mitotic activity, of 12 radical prostatectomies from patients with prostatic adenocarcinoma pretreated for three months with CET was evaluated in haematoxylin and eosin stained sections and compared with an untreated age and stage matched control group. RESULTS--A differential effect on the non-neoplastic prostate was observed. In fact, the transition zone of the treated prostate showed simplification of the glandular lobules: the ducts and acini were small without undulations of the epithelial border and with a prominent basal cell layer. Within the peripheral zone there was inconspicuous branching of the ducts and acini which looked dilatated and lined by flattened atrophic epithelium. Prostatic intraepithelial neoplasia occurred in scattered ducts and acini in the peripheral zone of 10 of the 12 patients. The epithelial cell lining showed a prominent basal cell layer. A certain degree of secretory cell type stratification was always present. However, crowding was less evident than in the untreated prostate because of cytoplasmic clearing and enlargement as a result of coalescence of vacuoles. The treated adenocarcinomas had neoplastic acini which looked small and shrunken, and areas of individual infiltrating tumour cells separated by abundant interglandular connective tissue. The secretory cells of the nonneoplastic, prostatic intraepithelial neoplasia, and prostatic adenocarcinoma lesions had inconspicuous nucleoli, nuclear shrinkage, chromatin condensation, and cytoplasmic clearing. Apoptotic bodies were easily identifiable in all the cell layers. The lumina were rich in macrophages, sloughed secretory cells with degenerative features, and apoptotic bodies. Mitoses were not observed in any of the treated non-neoplastic prostate, prostatic intraepithelial neoplasia, or prostatic adenocarcinomas, whereas the mitotic frequency increased from non-neoplastic prostate through prostatic intraepithelial neoplasia up to prostatic adenocarcinomas in the untreated specimens. CONCLUSIONS--CET before radical prostatectomy causes regressive epithelial changes together with enhanced apoptosis and blocked mitotic activity.
Expression of c-erbB-2, c-myc, and c-ras oncoproteins, insulin-like growth factor receptor I, and epidermal growth factor receptor in ovarian carcinoma.
Authors: van Dam P A , Vergote I B , Lowe D G , Watson J V , van Damme P , van der Auwera J C , Shepherd J H
Published: June 2007

AIMS--To assess whether the overexpression of five dominant oncogene encoded proteins is crucial to the pathogenesis of ovarian carcinoma and whether this provides any useful prognostic information. METHODS--The expression of the insulin-like growth factor 1 receptor (ILGFR 1), epidermal growth factor receptor (EGFR), and the c-erbB-2, c-ras, and c-myc products was studied by multiparameter flow cytometry in 80 patients with epithelial ovarian cancer for whom long term follow up was available. RESULTS--Overexpression of ILGFR 1, EGFR, c-erbB-2, c-ras and c-myc was found in, respectively, nine of 80 (11%), 10 of 80 (12%), 19 of 80 (24%), 16 of 80 (20%) and 28 of 80 (35%) ovarian carcinomas. The levels of expression of ILGFR 1, EGFR, c-erbB-2 and c-ras were significantly higher in the tumours of patients with recurrent or persistent disease after chemotherapy than in the tumours of patients at initial presentation (p < 0.02). Multivariate analysis showed that residual tumour (p < 0.001), FIGO stage (p = 0.002), EGFR overexpression (p = 0.030) and previous chemotherapy (p = 0.034) were independent variables for predicting survival. CONCLUSIONS--Overexpression of these oncoproteins only occurs in a small proportion of ovarian carcinomas but may have an important role in the progression of the disease.
Endocrine and cytokine changes during elective surgery.
Authors: Wellby M L , Kennedy J A , Barreau P B , Roediger W E
Published: June 2007

Elective surgery was used as a model of severe non-thyroidal illness (SNTI) to study the inter-relation between changes in serum thyroid hormones, thyroid stimulating hormone (TSH), cortisol, and interleukin 6 concentrations. The study was designed to determine whether the expected interleukin 6 increases after surgery are the cause of decreased serum tri-iodothyronine (T3) concentration normally observed following severe trauma. Blood was sampled for 24 hours before, during, and for 48 hours after abdominal surgery under general anaesthesia in 11 patients. Total T3 decreased 30 minutes after induction and continued to decrease at 24 hours. After a transient increase at 30 minutes, free T3 also decreased, and free thyroxine (T4) concentrations, other than a similar transient increase, did not change. TSH concentrations were increased at four hours and the nocturnal surge was suppressed. The increase in the serum interleukin 6 concentration was not observed until four hours. Cortisol concentrations were increased at 30 minutes and peaked at four hours. Therefore, the early changes in thyroid hormones and TSH accompanying surgery do not seem to be caused by changes in interleukin 6 concentrations.
Effects of changes in acid base and calcium concentration on fasting serum insulin, proinsulin, and glucose concentrations.
Authors: Smellie W S , O'Donnell J , Davidson H , Couper J , Logue F C
Published: June 2007

AIMS--To test the hypothesis that alterations in acid base or calcium concentration may affect proinsulin processing or the insulin secretion mechanism. METHODS--Changes in proinsulin secretion or cleavage were assessed by measuring serum intact proinsulin and immunoreactive insulin concentrations in three models of acid base and calcium disturbance: (1) subacute changes in acid base status in six volunteers who received oral placebo, ammonium chloride, or sodium bicarbonate for three five day periods; (2) acute changes in calcium concentration in eight subjects who received 25 mmol oral calcium; (3) chronic changes in calcium concentration in seven patients with primary hyperparathyroidism and five with pseudohypoparathyroidism. RESULTS--Acid base changes were confirmed by rises in serum bicarbonate concentrations (p < 0.01). No changes in serum insulin, intact proinsulin, or the proinsulin:insulin molar ratio were found. Serum calcium concentrations increased (2.49 v 2.38 mmol/l; p < 0.05) and parathyroid hormone concentrations decreased (1.1 v 1.9 pmol/l; p < 0.01) two hours after acute calcium loading. There were no significant differences in serum glucose, insulin, or intact proinsulin concentrations. Fasting proinsulin concentrations were significantly lower in the hyperparathyroid group (1.1 v 2.1 pmol/l; p < 0.05) and increased significantly after parathyroidectomy (2.1 v 1.1 pmol/l; p < 0.05). CONCLUSIONS--The results indicate that subacute acid base changes do not affect proinsulin cleavage. Although acute calcium loading has no demonstrable effect, chronic hypercalcaemia may influence the mechanism of insulin secretion.
Chronic liver disease and active hepatitis C virus infection in patients with antibodies to this virus.
Authors: Petrelli E , Manzin A , Paolucci S , Cioppi A , Brugia M , Muretto P , Clementi M
Published: June 2007

AIMS--To assess the association between active hepatitis C virus (HCV) infection and liver damage in randomly selected patients with antibodies to the virus. METHODS--Thirty three consecutive subjects with serologically confirmed positivity for antibodies to HCV were studied for the presence of liver and circulating viral sequences by using the reverse transcription polymerase chain reaction (RT-PCR) and specific primers for the 5'-untranslated region (5'-UTR) of the HCV genome. Parallel clinical, biochemical, and histological investigations were carried out in all cases. RESULTS--A comparative virological and histological investigation showed the presence of molecular signs of active viral replication and different degrees of liver damage in all cases. Baseline values of liver and plasma samples from all the patients showed (with one exception) the presence of detectable HCV RNA sequences, despite alanine amino transferase activities being within normal values or within 1.5 times the upper limit of normal in 13 of them. Examination of percutaneous liver biopsy specimens showed the presence of confirmed liver damage (ranging from chronic persistent hepatitis to cirrhosis) in all 33 patients. CONCLUSIONS--Circulating HCV RNA sequences (a direct sign of active HCV infection) are associated with liver damage, even in the absence of clinical or biochemical signs of overt liver disease. Parallel molecular, histological, and clinical follow up of these patients is needed to understand precisely the natural history of HCV infection and for correct clinical management.
Stability of infectious HIV in clinical samples and isolation from small volumes of whole blood.
Authors: O'Shea S , Rostron T , Mullen J E , Banatvala J E
Published: June 2007

AIMS--To evaluate the stability of infectious HIV in clinical samples and the efficiency of isolating it from small volumes of whole blood. METHODS--Titres of infectious HIV were measured in peripheral blood mononuclear cells and plasma 2, 24, and 48 hours after peripheral blood had been collected from 10 HIV positive adult volunteers. Volumes of whole blood (1 ml to 5 microliters), collected from a further five volunteers, were used to determine the minimum volume from which HIV could be isolated. Infectious HIV was isolated by co-culture with phytohaemagglutinin stimulated umbilical cord mononuclear cells. RESULTS--Geometric mean titres of infectious HIV seemed to be more stable in peripheral blood mononuclear cells than in plasma. HIV was recovered from all 10 peripheral blood mononuclear cell samples during the 48 hours after sample collection, but from only four plasma samples. HIV could occasionally be isolated from 5 microliters of whole blood and reliably from 200 microliters. CONCLUSIONS--HIV can be isolated from peripheral blood mononuclear cells and plasma for up to 48 hours after sample collection. Isolation of HIV from small volumes of whole blood has applications for the diagnosis and management, of HIV positive children.
Morphological transformation of Helicobacter pylori during prolonged incubation: association with decreased acid resistance.
Authors: Moshkowitz M , Gorea A , Arber N , Konikoff F , Berger S , Gilat T
Published: June 2007

The survival of clinical isolates of H pylori at two cultural ages (two and four days) at pH 2, in the presence of different buffers, with and without urea, was investigated. It was found that the morphological changes which occur with longer incubation of H pylori have an inverse correlation with its resistance to an acidic environment. The finding that the addition of urea almost reversed this phenomenon and prolonged survival of the cultures emphasises the role of urea in the survival of H pylori in acidic environments.
Rapid techniques for DNA extraction from routinely processed archival tissue for use in PCR.
Authors: Sepp R , Szabó I , Uda H , Sakamoto H
Published: June 2007

AIMS--To evaluate the ability of four rapid DNA extraction methods to provide DNA for the polymerase chain reaction (PCR) from routinely fixed, paraffin wax embedded archival tissues. METHODS--Eighteen blocks of various tissues, 18 blocks of cervical cancer specimens, and nine blocks of B cell lymphomas were investigated. Both normal and biopsy specimen sized tissues were studied. DNA was extracted using four methods: boiling for 20 minutes in distilled water; boiling for 20 minutes in 5% Chelex-100 resin solution; 3-hour proteinase K digestion; and 3-hour proteinase K digestion, followed by boiling in 5% Chelex-100. Different exons of the p53 gene, human papillomavirus type 16 (HPV 16) sequence, and immunoglobulin heavy chain (IgH) gene rearrangement were amplified from the extracts. RESULTS--The Chelex boiling, proteinase K digestion, and proteinase K digestion-Chelex boiling methods produced DNA suitable for amplification in all of the 45 samples. Boiling in water yielded insufficient template for the PCR in three of the 45 cases (7%), and in six of 42 positive cases (14%) much fainter bands were observed, mostly when the processed material was either biopsy specimen sized or a B cell lymphoma sample. Fragments of the p53 gene were successfully amplified up to 408 base pairs in water boiled extracts, up to 647 in Chelex boiled preparates, and up to 984 in proteinase K digested and proteinase K digested-Chelex boiled samples, although with decreased sensitivity in the last case. All of the templates were reusable after 3 months of storage at -20 degrees C. CONCLUSIONS--Chelex boiling, proteinase K digestion, and proteinase K digestion followed by Chelex boiling produce suitable templates for the PCR from a large variety of paraffin wax embedded tissues. As the simple 20 minute boiling method in 5% Chelex-100 solution requires minimal manipulation and time, it could be useful, especially in the routine processing of large amounts of material.
p53 expression in anaplastic carcinomas arising from thyroid papillary carcinomas.
Authors: Matias-Guiu X , Cuatrecasas M , Musulen E , Prat J
Published: June 2007

AIM--To study the expression of p53 tumour suppressor gene in anaplastic carcinomas arising from thyroid papillary carcinomas. METHODS--Formalin fixed, paraffin wax embedded tissues from four cases of anaplastic carcinomas associated with thyroid papillary carcinomas were studied by immunohistochemistry with two different p53 monoclonal antibodies. RESULTS--The anaplastic component showed nuclear immunostaining in two cases, but not in the other two. In all cases the papillary carcinoma component was negative. CONCLUSION--The results support the hypothesis that p53 stimulates tumour progression in thyroid tumours.
Non-transferrin bound iron and neutropenia after cytotoxic chemotherapy.
Authors: Harrison P , Marwah S S , Hughes R T , Bareford D
Published: June 2007

AIMS--To investigate and characterise the appearance of non-transferrin bound iron (NTBI) in the serum of patients after cytotoxic chemotherapy and to compare this with the onset and duration of neutropenia. METHOD--Non-transferrin bound iron was measured by a bleomycin assay in patients undergoing intensive chemotherapy for treatment of acute leukaemia or lymphoma. RESULTS--NTBI was detected after 26 of 27 courses of chemotherapy and lasted for a mean of 14.5 days. The presence of NTBI correlated with the serum iron binding saturation, but not with serum ferritin. Neutropenia occurred after all courses of chemotherapy and lasted for a mean of 20.0 days. NTBI and neutropenia occurred concurrently after 23 courses of chemotherapy, and had a mean joint duration of 9.5 days. CONCLUSIONS--NTBI is consistently present in the serum of patients after cytotoxic chemotherapy, often at the same time as the patient is neutropenic. This may be an additional risk factor for the development of infective episodes after chemotherapy.
Simultaneous bilateral pleomorphic adenomas of the parotid glands with unilateral tyrosine rich crystalloids.
Authors: Warfield A T , Smallman L A
Published: June 2007

A case of simultaneous, bilateral pleomorphic adenoma of the parotid glands following irradiation to the head and neck for childhood Hodgkin's disease is presented. The tumour on the side given the highest radiation exposure contained so-called tyrosine rich crystalloids (TRCs). Simultaneous salivary gland neoplasms are rare; TRCs are also an unusual finding. Simultaneous pleomorphic adenomas with TRCs confined to one tumour have never been described, and any association between TRCs and irradiation has never been commented on. The precise nature of the TRCs remains obscure. Their unilateral distribution in this case supports the hypothesis that local factors are more important in their formation than systemic factors. In conjunction with other published work, this provides circumstantial evidence that irradiation may predispose to TRC deposition.
CD4+ lymphocytopenia due to common variable immunodeficiency mimicking AIDS.
Authors: Kaczmarski R S , Webster A D , Moxham J , Davison F , Sutherland S , Mufti G J
Published: June 2007

There are an increasing number of published reports of patients with acquired immunodeficiency without evidence of HIV infection, who have been labelled as having "idiopathic CD4+ lymphocytopenia". The case is reported here of a young man who presented with Pneumocystis carinii pneumonia (PCP), CD4+ lymphopenia, and hypogammaglobulinaemia attributable to common variable immunodeficiency (CVID). The presentation of this condition, with many of the clinical and laboratory features of AIDS, highlights CVID as a diagnosis to be considered in the differential diagnosis of CD4+ lymphocytopenia.
Intracapillary glomerular metastases in a nephrectomy specimen removed for ipsilateral renal cell carcinoma.
Authors: Carr R A , Yoong A K , Newman J
Published: June 2007

A case of intraglomerular metastases observed in a nephrectomy specimen removed for primary renal cell carcinoma is reported. The intraglomerular metastases arose by dissemination of malignant cells into the systemic circulation via invasion of the renal veins. Intraglomerular metastases are therefore an indicator of malignant dissemination which in turn should be associated with a poor prognosis. It is recommended that in nephrectomies undertaken for primary renal cell carcinoma at least one random block of renal cortex should be examined to confirm or exclude intraglomerular metastases.
Rapid and specific diagnosis of t(11;22) translocation in paediatric Ewing's sarcoma and primitive neuroectodermal tumours using RNA-PCR.
Authors: Diffin F , Porter H , Mott M G , Berry P J , Brown K W
Published: June 2007

One case of paediatric Ewing's sarcoma and two peripheral primitive neuroectodermal tumours/extra-osseous Ewing's sarcoma were studied for the characteristic t(11;22) translocation, using a recently described RNA-polymerase chain reaction method (RNA-PCR). PCR products of the expected sizes were obtained from RNA derived from the Ewing's sarcoma and the peripheral primitive neuroectodermal tumours, but not from other paediatric malignancies. Direct sequencing of the RNA-PCR products confirmed the presence of the EWS-FLI-1 fusion transcript. In one case the presence of the translocation was confirmed by cytogenetic analysis. These results highlight the potential use of PCR for the rapid demonstration of diagnostically important tumour specific chromosome rearrangements.
Granulomatous Pneumocystis carinii pneumonia: DNA amplification studies on bronchoscopic alveolar lavage samples.
Authors: Wakefield A E , Miller R F , Guiver L A , Hopkin J M
Published: June 2007

Three HIV positive subjects presented with symptoms and radiographic changes suggestive of Pneumocystis carinii pneumonia. Methenamine silver staining of bronchoscopic alveolar lavage (BAL) fluid was negative (from one sample in one patient and two samples in the other two patients). Open lung biopsy was performed because of uncertain clinical progress and diagnosis; all three patients were found to have multiple pulmonary granulomata encasing numerous P carinii organisms. DNA amplification, using P carinii specific oligonucleotides, was performed on stored bronchoscopic BAL samples. P carinii specific amplification product was detected by ethidium bromide staining after electrophoretic separation on agarose gel in one case, and by the more sensitive technique of oligohybridisation in all three cases. In granulomatous P carinii pneumonia organisms are rarely identified in bronchoscopic alveolar lavage samples using histochemical staining, but are detectable by DNA amplification, although not at levels which can be readily distinguished from low, subclinical infection.
IgD multiple myeloma with thoracic spine compression due to epidural extra-osseous tumour spread.
Authors: Lolin Y I , Lam C W , Lo W H , Au K L , Masarei J R
Published: June 2007

On initial presentation of a patient with IgD multiple myeloma there were no features to suggest an unusual variant. Two months later she developed spinal cord compression due to an IgD plasmacytoma. This complication of IgD myeloma has rarely been reported. During the course of the disease and using the routine laboratory protocol for investigating and identifying paraproteins, including IgD, the patient's results became indistinguishable from those in Bence-Jones proteinuria myeloma.
Pure red cell aplasia associated with malignant thymoma, myasthenia gravis, polyclonal large granular lymphocytosis and clonal thymic T cell expansion.
Authors: Handa S I , Schofield K P , Sivakumaran M , Short M , Pumphrey R S
Published: June 2007

A case with the triad of pure red cell aplasia (PRCA), myasthenia gravis, and malignant thymoma is reported. There was a clonal proliferation of T cells within the thymoma, as demonstrated by a T cell antigen receptor (TCR) delta chain gene rearrangement. However, despite a large granular lymphocytosis, clonality could not be shown in the peripheral blood either before or after thymectomy. There was no evidence of human T cell lymphotrophic virus type 7 (HTLV1) infection. It is postulated that the clonal thymic T cell population secreted cytokine(s), which stimulated the polyclonal proliferation of large granular lymphocytes, which in turn suppressed erythropoiesis. Thymectomy removed the stimulus to the large granular lymphocytes and hence there was a resurgence of erythropoiesis.
Prevalence of human papillomavirus types 16 and 18 in penile carcinoma: a study of 41 cases using PCR.
Authors: Chan K W , Lam K Y , Chan A C , Lau P , Srivastava G
Published: June 2007

AIMS--To determine retrospectively the prevalence of human papillomavirus (HPV) types 16 and 18 in penile carcinomas. METHODS--Forty one surgically resected penile carcinomas from the archives at Queen Mary Hospital, Hong Kong, were reviewed and classified into verrucous carcinoma, and well, moderately, and poorly differentiated squamous cell carcinomas. Paraffin wax embedded tumour tissue was sectioned and analysed for HPV 16 and HPV 18 using the polymerase chain reaction with type specific internal probes. RESULTS--There were seven verrucous carcinomas, and 11 well, 17 moderately, and six poorly differentiated squamous cell carcinomas. Six of the 41 (15%) patients had penile carcinoma containing HPV 16 or HPV 18 DNA, or both, with HPV 16 found in four (10%) and HPV 18 in four (10%). The mean ages of HPV positive and HPV negative groups of patients were 68.5 and 57.6 years, respectively (p < 0.05). None of the seven verrucous and 11 well differentiated squamous cell carcinomas was positive for HPV. The mean age of patients who had these carcinomas was 52.4 years. As a group, these low grade carcinomas occurred in patients younger by more than a decade than those who had carcinomas of the higher grades (mean age 64.4 years; p < 0.01). CONCLUSIONS--Penile carcinomas had much lower rates of infection by HPV 16 or HPV 18 than cervical carcinomas in this Hong Kong population. Based on our findings and on data collated from published findings, it is concluded that penile verrucous carcinomas are not associated with HPV 16 and HPV 18. The overall low prevalence of HPV 16 and HPV 18 in penile carcinomas suggests that other HPV types might be important in the pathogenesis of these tumours.
Influence of nifedipine on interstitial fibrosis in renal transplant allografts treated with cyclosporin A.
Authors: McCulloch T A , Harper S J , Donnelly P K , Moorhouse J , Bell P R , Walls J , Feehally J , Furness P N
Published: June 2007

AIMS--To compare the degree of interstitial fibrosis in renal transplant biopsy specimens from immunosuppressed patients using conventional doses of cyclosporin with and without calcium channel blockade with a combination of low dose cyclosporin and azathioprine; to correlate the degree of interstitial fibrosis with the glomerular filtration rate. METHODS--A single blind histomorphometric assessment was done of cortical interstitial volume fraction from biopsy specimens taken intraoperatively and at one, six, and 12 months after transplantation from three prospectively randomised groups of patients: (A) conventional dose cyclosporin; (B) conventional dose cyclosporin plus nifedipine; (C) low dose cyclosporin plus azathioprine. RESULTS--Interstitial volume increased with time in all groups. No differences in interstitial volume were present at operation or at one month, but at six months interstitial volume was significantly less in group B than group A (p < 0.001) or group C (p < 0.05). More grafts failed in group A than group B leaving only small numbers for comparison at 12 months. At 12 months the differences persisted but did not reach significance. These results strongly reflected the clinical findings, where glomerular filtration rate was significantly lower in group A than groups B or C at six and 12 months; no differences in glomerular filtration rate were found at one month. In a direct comparison glomerular filtration rate showed a significant negative correlation with interstitial volume fraction. CONCLUSIONS--These findings suggest that calcium channel blockade with nifedipine slows the development of interstitial fibrosis in renal transplant recipients treated with cyclosporin. When clinical data are considered, it is suggested that calcium channel blockade may have a mitigating effect on the long term nephrotoxic effects of cyclosporin and should be considered as adjunctive treatment in patients requiring this immunosuppressant following renal transplantation.
Demonstration of cytoplasmic and nuclear antigens in acute leukaemia using flow cytometry.
Authors: Farahat N , van der Plas D , Praxedes M , Morilla R , Matutes E , Catovsky D
Published: June 2007

AIMS--To detect cytoplasmic and nuclear antigens using flow cytometry in acute leukaemia and to use this technique for double marker combinations. METHODS--Cytoplasmic staining was carried out in samples from 40 cases of acute leukaemia with monoclonal antibodies against the myeloid antigen CD13, the lymphoid antigens CD3, CD22, mu chain and the enzymes terminal deoxynucleotidyl transferase (TdT) and myeloperoxidase (MPO). The cells were fixed with paraformaldehyde and permeabilised with Tween 20 and Becton Dickinson's FACS lysing solution. Flow cytometry results were compared in the same cases with immunocytochemistry results using the alkaline phosphatase anti-alkaline phosphatase method. RESULTS--The gentle permeabilisation induced by this method permitted preservation of the membrane antigens and the size and morphology of the cells. The results using flow cytometry were comparable with those obtained using immunocytochemistry, with nearly complete concordance in most cases. CONCLUSIONS--This technique is simple, rapid, sensitive and reproducible and it is suitable for double staining procedures, such as nuclear and cytoplasmic, nuclear and membrane, or cytoplasmic and membrane. It therefore provides a powerful tool for extending the use of immunophenotyping for the diagnosis and follow up of acute leukaemia. It could also be used for the investigation of minimal residual disease.
Recurrent thrombotic occlusions of arteries and veins caused by intravascular metastatic adenocarcinoma.
Authors: Levi M , Bronkhorst C , Noorduyn L A , Vreeken J
Published: June 2007

The occurrence of unexplained, rapidly recurring occlusions of arteries and veins in a previously healthy young woman is described. Post mortem examination showed no macroscopic abnormalities but revealed microscopic metastatic adenocarcinoma with remarkable intravascular localisation of the malignant cells. Whereas highly sensitive markers for the existence of systemic activation of blood coagulation remained within the normal range, it is suggested that specific characteristics of the tumour cells may have been responsible for this particular clinical presentation.
Pancreatic islet cell tumour in a patient with familial adenomatous polyposis.
Authors: Stewart C J , Imrie C W , Foulis A K
Published: June 2007

A case of familial adenomatous polyposis is reported in a 39 year old patient who underwent a Whipple's resection for adenoma of the duodenum. He subsequently developed a pancreatic glucagonoma. Endocrine neoplasia other than papillary carcinoma of thyroid has seldom been reported in association with FAP. The true incidence of islet cell tumours in FAP may be underestimated.
Corynebacterium aquaticum septicaemia in a neutropenic patient.
Authors: Moore C , Norton R
Published: June 2007

Corynebacteria are a well recognised cause of sepsis in the immunocompromised patient. Corynebacterium aquaticum, however, is rarely seen in the clinical setting, being an environmental organism associated with fresh water. A septicaemic episode caused by this organism in a 74 year old neutropenic woman with an indwelling central venous catheter is reported. It is postulated that the source of the organism was untreated stored rainwater which she used for showering.
Transient abnormal myelopoiesis accompanied by hepatic fibrosis in two infants with Down syndrome.
Authors: Yagihashi N , Watanabe K , Yagihashi S
Published: June 2007

Two necropsy cases of Down syndrome are reported. These showed transient abnormal myelopoiesis accompanying characteristic hepatic sinusoidal fibrosis. Numerous megakaryocytes were found in the liver of one case, but not in the other. Only eight cases of Down syndrome with simultaneous occurrence of hepatic fibrosis and transient abnormal myelopoiesis have been reported. The cases described here showed slight fibrotic changes in the hyperplastic bone marrow, which were not found in the previously reported cases of transient abnormal myelopoiesis.
Acute hepatic and renal failure caused by Pneumocystis carinii in patients with AIDS.
Authors: Boldorini R , Guzzetti S , Meroni L , Quirino T , Cristina S , Monga G
Published: June 2007

Clinical and pathological findings are described in two AIDS patients with Pneumocystis carinii infection who received prophylactic treatment with nebulised pentamidine and developed unusual hepatic and renal failure. Histological examination showed clumps of P carinii massively obstructing hepatic sinuses and portal vessels in the first patient, and merular and intertubular capillaries in the second. These findings could explain the unusual clinical features, characterised by acute hepatic and renal failure.
Role of re-screening of cervical smears in internal quality control.
Authors: Baker A , Melcher D , Smith R
Published: June 2007

AIMS--To investigate the use of rapid re-screening as a quality control method for previously screened cervical slides; to compare this method with 10% random re-screening and clinically indicated double screening. METHODS--Between June 1990 and December 1994, 117,890 negative smears were subjected to rapid re-screening. RESULTS--This study shows that rapid re-screening detects far greater numbers of false negative cases when compared with both 10% random re-screening and clinically indicated double screening, with no additional demand on human resources. The technique also identifies variation in the performance of screening personnel as an additional benefit. CONCLUSION--Rapid re-screening is an effective method of quality control. Although less sensitive, rapid re-screening should replace 10% random re-screening and selected re-screening as greater numbers of false negative results are detected while consuming less resources.
Flow cytometry in diagnosis and management of large fetomaternal haemorrhage.
Authors: Johnson P R , Tait R C , Austin E B , Shwe K H , Lee D
Published: June 2007

AIMS--To evaluate an indirect immunofluorescence flow cytometry technique in a series of patients with large fetomaternal haemorrhage (FMH). METHODS--Patient samples identified by Kleihauer testing in local laboratories as having FMH > 4 ml were sent for flow cytometric analysis. In a proportion of cases the mothers received anti-D immunoglobulin prophylaxis according to the flow cytometer estimate of FMH volume. RESULTS--Forty three cases of FMH were studied prospectively. The correlation between Kleihauer and flow cytometry results was poor. In 38 (88%) cases the size of FMH quantitated by flow cytometry was lower than that estimated using the Kleihauer technique. In 13 (30%) cases no Rh D immunoglobulin positive cells were detected by flow cytometry. Centralised review of the original Kleihauer films using a calibrated microscope resulted in improved, but still suboptimal correlation with flow cytometry results. In 15 cases anti-D immunoglobulin was given according to the flow cytometer estimation of FMH size, resulting in a 58% reduction in the amount of anti-D immunoglobulin given. None of the patients were immunised when tested six months later. CONCLUSIONS--Flow cytometry is helpful for the accurate quantitation and management of patients with large FMH and in cases where the presence of maternal haemoglobin F containing cells renders the Kleihauer technique inaccurate. Worthwhile reductions in the use of anti-D immunoglobulin can be achieved.
Vimentin and cytokeratin expression in nodular hyperplasia and carcinoma of the prostate.
Authors: Heatley M , Maxwell P , Whiteside C , Toner P
Published: June 2007

AIM--To assess the value of vimentin and cytokeratin (CK) intermediate filament proteins (IFPs) in distinguishing between nodular hyperplasia and carcinoma of the prostate and in predicting prognosis in prostatic cancer. METHODS--Fifteen carcinomas and 49 cases of nodular hyperplasia were studied using frozen sections and monoclonal antibodies to CK and vimentin IFPs. RESULTS--There was no statistically significant difference in vimentin expression between nodular hyperplasia and carcinoma. The luminal epithelium in both also reacted with antibodies which detect CK8, 18 and 19. CK 7 expression was found in 57% of cases of nodular hyperplasia and was not identified in any carcinoma. There was a reaction with antibodies to CK1, 2, 3, 4, 10, 11, and 13 in only a minority of cases. There was no statistically significant difference in vimentin and CK reactivity in high and low grade carcinomas. CONCLUSION--Neither vimentin nor CK expression assists in establishing whether a prostatic lesion is benign or malignant or in predicting the biological behaviour of a prostatic carcinoma.