bluuebunny/crossref_metadata_2025 huggingface dataset:
A survey of current United Kingdom practice for antenatal screening for inherited disorders of globin chain synthesis. UK Forum for Haemoglobin Disorders.
Authors: Bain B J , Chapman C
Published: January 2009

AIMS: To document current United Kingdom practice for antenatal screening for inherited disorders of globin chain synthesis and to compare such practice with guidelines published by the British Committee for Standards in Haematology and the Standing Committee on Sickle Cell, Thalassaemia and other Haemoglobinopathies (SMAC). METHODS: The members of the UK Forum on Haemoglobin Disorders were surveyed about their current practice for antenatal haemoglobinopathy screening. The UK Forum is a national group of haematologists, paediatricians, laboratory scientists, and counsellors working in the field of diagnosis and management of disorders of haemoglobin synthesis; such disorders including the alpha and beta thalassaemias, sickle cell disease, and other haemoglobinopathies. RESULTS: Completed questionnaires from 38 hospitals (or cooperating groups of hospitals) were analysed. The great majority of hospitals were applying appropriate laboratory methods, but problems were commonly encountered in ensuring that appropriate testing of antenatal patients and, when necessary, of their partners, was carried out early in pregnancy. When screening was selective there was quite often a failure to identify all women in whom testing was indicated, and cut off points used as an indication for further testing were sometimes inappropriate. CONCLUSIONS: Many practical problems are still encountered in following guidelines for the antenatal diagnosis of haemoglobinopathies. A need for improved administrative procedures and increased funding was identified. In addition there is a need for agreed guidelines giving more specific advice on technical aspects of laboratory practice.
A novel technique for assessment of adherence of Candida albicans to solid surfaces.
Authors: Williams D W , Waters M G , Potts A J , Lewis M A
Published: January 2009

A novel approach for the assessment of adherence of Candida albicans to translucent acrylic material is described. The method uses the inverted microscope to visualise yeast adhering to acrylic surfaces while the test material remains immersed in buffer. Adherent cells were not subjected to surface tension forces that can occur during drying processes, so that an even distribution of yeast with no aggregation occurred. The process of counting attached yeast was subsequently performed without difficulty. From the 11 C albicans isolates examined, two groups were evident with respect to acrylic adherence: one group of four isolates with an adherence level of 400 yeast/mm2 acrylic, and one group of seven isolates with adherence levels of 1000 yeast/mm2 acrylic.
Detection of Helicobacter pylori associated antigen and heat shock protein 60 on follicular dendritic cells in the germinal centres of low grade B cell lymphoma of gastric mucosa associated lymphoid tissue (MALT).
Authors: Kobayashi K , Yokota K , Yoshino T , Kawahara Y , Dey A , Hirai Y , Oguma K , Akagi T
Published: January 2009

AIMS: To investigate the localisation of Helicobacter pylori antigens and the expression of human heat shock proteins (HSP) in stomachs affected by MALT lymphoma. METHODS: Surgically resected stomachs from 24 patients with MALT lymphoma were immunostained with anti-H pylori rabbit antibodies (ORP-1 and ORP-2) and anti-human HSP60 mouse monoclonal antibodies (mAb) (LK-1 and LK-2). RESULTS: Follicular dendritic cells of germinal centres in the stomachs affected by MALT lymphoma were immunostained with anti-H pylori polyclonal antibodies and with anti-human HSP60 mAb, as were the epithelial cells. None of the lymph node samples reacted. CONCLUSIONS: Human HSP60, which cross reacts with anti-H pylori polyclonal antibodies, is often expressed on follicular dendritic cells in gastric MALT lymphoma tissues and may be aetiologically relevant to lymphomagenesis of MALT lymphoma.
The Splendore-Hoeppli phenomenon in hepatic botryomycosis.
Authors: Schlossberg D , Pandey M , Reddy R
Published: January 2009

A 68 year old diabetic man developed septicaemia and multiple liver abscesses due to Streptococcus intermedius. Liver biopsy revealed streptococcal botryomycosis which showed the Splendore-Hoeppli phenomenon. Diabetes mellitus is an example of the immunosuppressed states that have been associated with botryomycosis.
The travels of a lone star tick.
Authors: Alderdice J M , Burgess I F
Published: January 2009

A lone-star tick, Amblyomma americanum, was found as a pedunculated lesion on the back of the arm of an 84 year old man in Northern Ireland. This was acquired on a visit to the USA. The tick is found mainly in Texas and the Ozark mountains of Missouri, with scattered foci in other parts of southern USA. It is the vector of Rocky Mountain spotted fever. As worldwide travel becomes increasingly common, exotic parasites make occasional appearances in northern Europe.
Lymphoma associated bone marrow necrosis with raised anticardiolipin antibody.
Authors: Murphy P T , Sivakumaran M , Casey M C , Liddicoat A , Wood J K
Published: January 2009

A case of high grade B cell lymphoma presented with bone marrow necrosis, followed by development of extensive marrow fibrosis, the evolution of which was documented by serial magnetic resonance imaging and bone marrow trephine histology. A markedly raised anticardiolipin antibody titre at diagnosis suggests that lymphoma associated antiphospholipid syndrome may have contributed to the aetiology of the bone marrow necrosis.
Raised serum hCG in a male patient caused by primary jejunal choriocarcinoma.
Authors: Chan G S , Ng W K , Chua D T , Wu P C
Published: January 2009

A rare case of primary choriocarcinoma of the jejunum occurred in a 45 year old Chinese man. This tumour was associated with massive melaena and a markedly raised serum human chorionic gonadotrophin (beta-hCG) concentration. Necropsy examination showed no primary lesion in other possible sites including testes, mediastinum, and pineal gland. Histologically, the tumour showed morphology typical of choriocarcinoma with no adenocarcinomatous element identified. The presence of choriocarcinoma in non-gonadal sites may be explained by retrodifferentiation or metaplasia of a conventional carcinomatous component to primitive trophoblasts. Serum beta-hCG level may represent a useful marker in earlier diagnosis and monitoring of this potentially treatable disease.
Endothelial nitric oxide synthase immunoreactivity in early gestation and in trophoblastic disease.
Authors: Ariel I , Hochberg A , Shochina M
Published: January 2009

AIMS: To study the localisation of the endothelial nitric oxide synthase (eNOS) in the normal placenta, with special emphasis on the implantation site in the first trimester of pregnancy, and in the different subtypes of trophoblastic cells in gestational trophoblastic disease. METHODS: The immunoperoxidase technique with an antibody directed against eNOS was applied to paraffin sections from first and second trimester placentas, placenta accreta, partial and complete hydatidiform moles, and choriocarcinoma. Immunoperoxidase staining for human placental lactogen (hPL) was performed on parallel sections. RESULTS: Prominent immunoreactivity for eNOS was found to be present in the intermediate trophoblastic cells of the cell columns of the anchoring villi and in trophoblastic cells at the implantation site. Staining was also present in the syncytiotrophoblast, most conspicuous at the apical cell border. In trophoblastic disease, proliferating large mononuclear cells, which were strongly positive for hPL, were found to be immunoreactive for eNOS. CONCLUSIONS: eNOS immunoreactivity is strongly positive in the extravillous trophoblastic cells and to a lesser extent in the syncytiotrophoblast. In the former it may play a role in implantation and vascular invasion. Cells with differentiation to intermediate trophoblast in complete hydatidiform mole and choriocarcinoma also show high levels of eNOS, which may be associated with the haematogenous mode of spread of trophoblastic disease.
Immunophenotypic and genotypic characterisation of multiple myelomas with adverse prognosis characterised by immunohistological expression of the T cell related antigen CD45RO (UCHL-1).
Authors: Menke D M , Horny H P , Griesser H , Atkinson E J , Kaiserling E , Kyle R A
Published: January 2009

AIMS: To investigate whether plasma cell expression of early B cell, late B cell/preplasma cell, T cell, and myelomonocytic antigens or myeloma associated lymphocytic infiltrates correlated with prognosis in bone marrow biopsy specimens of patients with multiple myeloma. METHODS: Bone marrow biopsy specimens of 23 patients with multiple myeloma were investigated for plasma cell expression and interstitial lymphocyte expression of T cell related antigen CD45RO (UCHL-1). RESULTS: Eight patients showed plasma cell expression of CD45RO and 16 showed increased tumour infiltrating CD45RO positive lymphocytes, which were correlated with poor survival by multivariate analyses (p = 0.005 and p = 0.04, respectively). B cell antigens (MB2, CD20) but no T cell specific antigens (CD3) or T cell receptor gene rearrangements were expressed by plasma cells in CD45RO positive myelomas. Of 16 patients with myeloma who had increased tumour infiltrating CD45RO positive lymphocytes, four had interstitial lymphocyte expression of B cell antigens and two had interstitial lymphocyte expression of the T cell specific antigen CD3. CONCLUSIONS: The recognition of plasma cell expression of CD45RO and increased interstitial CD45RO lymphocytes in bone marrow biopsy specimens of patients with multiple myeloma is an adverse prognostic finding not indicative of an aberrant T cell phenotype or genotype; it is consistent with B cell/pre-plasma cell antigen expression by myeloma cells and their lymphocytic precursors.
In situ localisation of Yersinia enterocolitica by catalysed reported deposition signal amplification.
Authors: Odinot P T , Meis J F , Hoogkamp-Korstanje J A , Melchers W J
Published: January 2009

AIM: The sensitive detection of pathogenic Yersinia enterocolitica in paraffin embedded tissue sections by in situ hybridisation (ISH). METHODS: Y enterocolitica infected cell lines, rat spleens, and patient biopsy specimens were used to compare conventional ISH, immune fluorescence assay (IFA) detection, and catalysed reporter deposition (CARD) signal amplification ISH. RESULTS: CARD-ISH was shown to be more sensitive then conventional ISH and had a comparable sensitivity to IFA. In contrast to IFA, CARD-ISH preserved good tissue morphology. CONCLUSIONS: CARD-ISH appeared to be a fast and sensitive ISH method for detecting Y enterocolitica in routinely processed tissue sections. Application of this method allows the combination of routine detection and cellular localisation of the pathogen within the infected tissue.
Multivariate analyses of DNA index, p62c-myc, and clinicopathological status of patients with ovarian cancer.
Authors: Curling M , Stenning S , Hudson C N , Watson J V
Published: January 2009

AIM: To determine if either DNA index or p62c-myc is an independent prognostic variable in ovarian cancer. METHODS: Multivariate and univariate analyses of the relation between DNA index, p62c-myc, FIGO stage, histological type, tumour grade, completeness of surgery, and patient survival in ovarian cancer were examined. RESULTS: Multivariate analysis showed significant association of survival only with stage and grade. There was no relation between survival and DNA index. CONCLUSIONS: DNA index is not an independent prognostic variable in ovarian cancer.
Prothrombin time derived fibrinogen determination on Sysmex CA-6000.
Authors: Lawrie A S , McDonald S J , Purdy G , Mackie I J , Machin S J
Published: January 2009

AIM: To evaluate PT derived fibrinogen determinations with reference to the Clauss fibrinogen assay using a Sysmex CA-6000 random access coagulation analyser. METHODS: Samples were analysed from normal subjects (n = 20), patients with renal or liver dysfunction (n = 25), critically ill patients (n = 25), patients receiving oral anticoagulant treatment (n = 50), and patients with a haemoglobinopathy (n = 127). Prothrombin times were performed using two thromboplastins: one derived from rabbit brain (Dade: Thromboplastin IS) and the other from recombinant human tissue factor (Dade: Innovin). Fibrinogen was assayed by the Clauss method using a commercial kit (Dade: Fibrinogen). RESULTS: The relation between Clauss fibrinogen and PT derived fibrinogen was found to be dependent on the patient's clinical group and source of the thromboplastin used. When the data from the above sample groups were pooled there was still a significant difference (p < 0.001) between Clauss fibrinogen and PT derived fibrinogen, irrespective of thromboplastin used. CONCLUSIONS: It is unsafe to use the PT derived fibrinogen for patient monitoring owing to non-uniform variability in response to clinical status and reagent employed; however, it may prove to be a useful screening test in a research environment for estimating fibrinogen levels among defined patient groups.
Haemoglobin Le Lamentin (alpha 20 (B1) His-->Gln) in a British family: identification by electrospray mass spectrometry.
Authors: Reynolds T M , McMillan F , Smith A , Hutchinson A , Green B
Published: January 2009

The first identification of haemoglobin Le Lamentin (alpha 20 (B1) His-->Gln) in a British patient is described. The patient was a 69 year old asymptomatic white male being screened for diabetes, whose blood was undergoing its first ever analysis for glycated haemoglobin using a Glycomat II analyser. Identification of the haemoglobin variant was by electrospray mass spectrometry.
A prospective controlled study of the association of Streptococcus bovis with colorectal carcinoma.
Authors: Potter M A , Cunliffe N A , Smith M , Miles R S , Flapan A D , Dunlop M G
Published: January 2009

AIM: To investigate the ability of Streptococcus bovis to colonise colorectal cancers. PATIENTS: 19 patients with colorectal cancer and 23 controls without malignancy. SETTING: University teaching hospital. METHODS: Prospective study comparing unselected patients with known colorectal cancer with age and sex matched controls. Carcinoma tissue from patients with colorectal cancer and normal colonic mucosa, stool, and blood from both patients and control subjects were cultured. RESULTS: In contrast to published data, the faecal carriage rate was similar in cancer (11%) and control groups (13%). CONCLUSIONS: Faecal colonisation by Str bovis in colorectal cancer patients is lower than previously reported and does not differ significantly from controls.
Cytomegalovirus colitis in immunocompetent individual.
Authors: al Mahdy H
Published: January 2009

A woman with peripheral vascular disease developed cytomegalovirus colitis following repair of abdominal aortic aneurysm. Cytomegalovirus colitis developing in an immunocompetent individual may be caused by a breach in the integrity of the mucosal lining of the colon from various causes and should alert the clinician to explore these causes in order to provide effective care.
Adult hypertrophic pyloric stenosis: case report and review.
Authors: Graadt van Roggen J F , van Krieken J H
Published: January 2009

A case of adult hypertrophic pyloric stenosis presented in an older female with no apparent predisposing factors which might be likely to precipitate the condition. There was a history of chronic dyspepsia and occasional episodes of vomiting. No contributory medical history was identified. Barium swallow and follow through showed a markedly reduced emptying time of the stomach. A partial gastrectomy was eventually done and on histopathological examination a diagnosis of adult hypertrophic pyloric stenosis was made.
The effect of four interventions on the informational content of histopathology reports of resected colorectal carcinomas.
Authors: Cross S S , Feeley K M , Angel C A
Published: January 2009

AIM: To investigate the effect of different interventions on the inclusion of data items in the histopathology reports of resected colorectal carcinomas. STUDY POPULATION: 272 routine histopathology reports on colorectal carcinomas from the department of histopathology, Royal Hallamshire Hospital, Sheffield. METHODS: The presence or absence of 10 specific data items was recorded for each report. The reports were divided into five audit periods. In the initial period reports were generated using free text with no agreed guidelines. In period 2, text guidelines had been issued; in period 3, flow diagram guidelines had been issued; and in periods 4 and 5, template proformas were attached to each specimen request form. RESULTS: All interventions produced some increase in inclusion rate for some features, but only with the introduction of template proformas did these rates approach 100% for all data items. Inclusion rates were 100% for all items in all cases reported using a proforma. In the final audit period 96% of specimens were reported using proformas. CONCLUSIONS: Template proformas produce a high rate of inclusion of data items in reports of colorectal carcinoma resection specimens.
Stage 0 mucinous adenocarcinoma in situ of the urachus.
Authors: Paul A B , Hunt C R , Harney J M , Jenkins J P , McMahon R F
Published: January 2009

Adenocarcinomas of the urinary bladder are rare (1-5% of bladder tumours) and of notoriously poor prognosis. About one third of such tumours arise in urachal remnants related to the bladder. This is believed to be the first report of in situ change in the urachal remnant. The patient presented with mucusuria and computed tomography showed a typical urachal cyst. After excision the cyst was found to contain mucinous adenomatous epithelium but without invasion of the basal lamina. Pathological stage is the best prognostic indicator in urachal tumours. Prompt investigation and management of mucusuria may allow the diagnosis of urachal tumours in this preinvasive stage.
The identification of salicylates as normal constituents of serum: a link between diet and health?
Authors: Paterson J R , Blacklock C , Campbell G , Wiles D , Lawrence J R
Published: January 2009

AIM: To examine sera for the presence of salicylic acid and 2,3- and 2,5-dihydroxybenzoic acids (2,3- and 2,5-DHBA), in individuals not taking salicylate drugs. METHODS: Extracts of acidified serum samples were analysed by high performance liquid chromatography with electro-chemical detection. The chromatographic conditions were altered, and the retention times of the unknown compounds compared against authentic salicylic acid, 2,3-DHBA, and 2,5-DHBA. Serum samples (some spiked with salicylic acid) were incubated with salicylate hydroxylase and analyses undertaken. An extract of acidified serum was derivatised using N-methyl-N-trimethylsilyltrifluoroacetamide and the salicylic acid derivative identified by gas chromatography-mass spectrometry. RESULTS: Salicylic acid, 2,3-DHBA, and 2,5-DHBA were identified as being normal constituents of serum. CONCLUSIONS: Salicylic acid, 2,3-DHBA, and 2,5-DHBA possess anti-inflammatory properties. The finding that these compounds are present as normal constituents of serum, possibly arising from diet, raises important questions as to their role in the promotion of health.
The EnVision++ system: a new immunohistochemical method for diagnostics and research. Critical comparison with the APAAP, ChemMate, CSA, LABC, and SABC techniques.
Authors: Sabattini E , Bisgaard K , Ascani S , Poggi S , Piccioli M , Ceccarelli C , Pieri F , Fraternali-Orcioni G , Pileri S A
Published: January 2009

AIM: To assess a newly developed immunohistochemical detection system, the EnVision++. METHODS: A large series of differently processed normal and pathological samples and 53 relevant monoclonal antibodies were chosen. A chessboard titration assay was used to compare the results provided by the EnVision++ system with those of the APAAP, CSA, LSAB, SABC, and ChemMate methods, when applied either manually or in a TechMate 500 immunostainer. RESULTS: With the vast majority of the antibodies, EnVision++ allowed two- to fivefold higher dilutions than the APAAP, LSAB, SABC, and ChemMate techniques, the staining intensity and percentage of expected positive cells being the same. With some critical antibodies (such as the anti-CD5), it turned out to be superior in that it achieved consistently reproducible results with differently fixed or overfixed samples. Only the CSA method, which includes tyramide based enhancement, allowed the same dilutions as the EnVision++ system, and in one instance (with the anti-cyclin D1 antibody) represented the gold standard. CONCLUSIONS: The EnVision++ is an easy to use system, which avoids the possibility of disturbing endogenous biotin and lowers the cost per test by increasing the dilutions of the primary antibodies. Being a two step procedure, it reduces both the assay time and the workload.
Immunohistochemical localisation of advanced glycation end products in pulmonary fibrosis.
Authors: Matsuse T , Ohga E , Teramoto S , Fukayama M , Nagai R , Horiuchi S , Ouchi Y
Published: January 2009

AIM: To investigate the presence and distribution of advanced glycation end products (AGE) in pulmonary fibrosis. METHODS: Lung tissue samples obtained from seven necropsy cases with idiopathic pulmonary fibrosis and seven with normal pulmonary parenchyma were examined immunohistochemically with a monoclonal antibody specific for AGE: 6D12. We also tested three cases with diffuse alveolar damage. RESULTS: All the specimens from cases with pulmonary fibrosis and diffuse alveolar damage showed strong AGE expression on macrophages. Lung specimens from normal parenchyma showed positive AGE immunoreactivity on macrophages from only two of seven cases. CONCLUSIONS: These findings suggest that AGE modified proteins accumulate in alveolar macrophages in patients with diffuse alveolar damage and idiopathic pulmonary fibrosis.
Chromosome 3p loss of heterozygosity and mutation analysis of the FHIT and beta-cat genes in squamous cell carcinoma of the head and neck.
Authors: González M V , Pello M F , Ablanedo P , Suárez C , Alvarez V , Coto E
Published: January 2009

AIMS: To study the loss of heterozygosity at the short arm of chromosome 3 in primary tumours from patients with squamous cell carcinoma of the head and neck; to determine whether the FHIT gene, mapped to 3p14.2 and the CTNNB1 (beta-cat) gene, mapped to 3p21, are deleted or mutated in these tumours. METHODS: DNA was extracted from fresh tumours. Loss of heterozygosity was assessed by microsatellite analysis of the following markers: D3S1283 and D3S1286 (3p24), D3S966 (3p21), and D3S1300 (3P14.2). Homozygous deletion was determined by radioactive multiplex polymerase chain reaction of exons 5 and 6 of the FHIT gene. The presence of mutations in FHIT exon 5 and beta-cat exon 3 was studied by single strand conformation polymorphism. RESULTS: 50% of informative cases (25/50) showed loss of heterozygosity for at least one of the 3p markers. 3p21 was the region with the highest rate of allelic deletion (63%). No point mutation was found in FHIT exon 5 or beta-cat exon 3. No case showed homozygous deletion for the FHIT (exons 5 and 6) or the beta-cat exon 3. CONCLUSIONS: The short arm of chromosome 3 is often deleted in the head and neck squamous cell carcinomas. In the remaining alleles of the FHIT or beta-cat genes, no evidence was found for point mutations or deletions, documented in other common carcinomas. Inactivation could occur by different mechanisms such as methylation, or other genes (not studied here) could be target of allelic losses in squamous cell carcinoma of the head and neck.
KU activity: a method for calculating histopathologists' workloads.
Authors: Suvarna S K , Kay M S
Published: January 2009

An attempt to model activity of individual histopathologists or departments is illustrated, in which specimen numbers and types are weighted to produce an overall Kim unit (KU) activity. By cross referencing this numerical score against individual pathologists and clinicians, it is not only possible to interrogate departmental activity retrospectively, but also to predict and cost the impact of any change in service. The advantages over Welcans and Korner Units are illustrated.
Not everything acid fast is Mycobacterium tuberculosis--a case report.
Authors: Olson E S , Simpson A J , Norton A J , Das S S
Published: January 2009

The Ziehl-Neelsen (ZN) stain is important in identifying organisms that are acid fast, principally Mycobacterium tuberculosis. However, decolorisation with a weaker acid concentration (for example 1% hydrochloric acid), often used in ZN staining in histology, can result in a wider variety of organisms appearing acid fast and can be a cause of misidentification. To illustrate this point, a patient is described with pulmonary nocardiosis who was misdiagnosed as having tuberculous empyema on pleural biopsy.
Treated bacterial endocarditis as a histological mimic of fungal infection.
Authors: Roskell D E , Bowler I C , Barnes P
Published: January 2009

Histological assessment of cardiac valve tissue contributes to the diagnosis of infective endocarditis and is of particular importance in cases in which no organism is cultured. Antibiotic treatment of bacterial endocarditis may lead to abnormal bacterial morphology and staining characteristics. Although in many cases the presence of some residual bacteria of normal appearance makes the diagnosis straightforward, in some only abnormal bacteria may be seen. Unless the appearances of these are interpreted with caution, the presence of larger spherical organisms with the staining properties of a yeast may lead to an erroneous diagnosis of fungal infection.
Improved FNA cytology results with a near patient diagnosis service for non-breast lesions.
Authors: Mayall F , Denford A , Chang B , Darlington A
Published: January 2009

AIM: To review fine needle aspiration (FNA) cytology from sites other than the breast a year before and a year after the introduction of a near patient FNA diagnosis (NPFD) service in which the FNA were performed by a pathologist and reported within a few minutes. METHODS: The setting was a large hospital in rural New Zealand. The year before the introduction of the NPFD service was examined retrospectively, and the year after prospectively. The pattern of use and the quality of the results before and after starting the NPFD service were compared. RESULTS: Time taken to report the specimens decreased from a few days to a few minutes. There were statistically significant changes in the following: an increase from 237 to 304 in the number of non-breast FNA performed, and in particular an increase from 65 to 113 in the number for general surgery; an increase in the use of immunolabelled flow cytometry from 0 to 19 and cell blocks from 3 to 41; an increase in specificity from 53% to 80%; a decrease in the overall inadequacy rate from 29% to 9%; and a decrease in the inadequacy rate for cancers from 9% to 2%. The cost of the non-breast FNA service increased by about 9200 Pounds a year. CONCLUSIONS: Starting an NPFD service for sites other than the breast greatly reduced the reporting time and produced statistically significant increases in the use of FNA cytology and in the quality of the results.
Secretory breast carcinoma in a 66 year old man.
Authors: Kuwabara H , Yamane M , Okada S
Published: January 2009

A secretory carcinoma of the breast, associated with axillary node metastasis, unilateral gynaecomastia, and chronic active hepatitis, occurred in a 66 year old man. Although secretory carcinoma of the breast usually occurs in children and adult women, our case shows that it can rarely occur in the elderly male.
High prevalence of acute myocardial damage in a hospital necropsy series, shown by C9 immunohistology.
Authors: Ferreira M A , Owen H E , Howie A J
Published: January 2009

AIMS: To use a sensitive test of acute myocardial damage--immunohistological detection of complement component C9--to assess the prevalence of damage in an unselected series of hearts taken at necropsy in adults. METHODS: Sections of formalin fixed and paraffin wax embedded myocardium were cut from 128 consecutive necropsy cases on which a block of heart had been taken. These were stained with an immunohistological method for C9. Necropsy findings were reviewed and clinical risk factors for myocardial damage noted. The extent of C9 immunostaining was correlated with clinical and pathological findings. RESULTS: There was immunostaining for C9 in 109 heart sections (85%). Most had conventional evidence of coronary artery disease or acute or chronic myocardial abnormality, but necrosis was identified by orthodox microscopy in only 12 (11% of C9 positive cases). In 29 cases, orthodox examination showed no abnormality, but C9 was detected. These cases had clinical risk factors for damage such as hypoxia and hypotension. Increasing age, heart weight, and total number of risk factors and pathological findings were associated with increasing extent of C9 immunostaining. CONCLUSIONS: Acute myocardial damage was common in a hospital necropsy series and its prevalence was underestimated by conventional pathological techniques. Immunostaining for C9 was a simple and useful way of detecting such damage.
Myoepithelial carcinoma (malignant myoepithelioma) of the parotid gland arising in a pleomorphic adenoma.
Authors: McCluggage W G , Primrose W J , Toner P G
Published: January 2009

A myoepithelial carcinoma, a rare malignant salivary gland neoplasm, arose in a pleomorphic adenoma of the parotid gland. The initial tumour was a pleomorphic adenoma with epithelial and myoepithelial elements. Subsequently the tumour recurred twice and was characterised by invasion of the mandible. Histological examination of the second recurrence showed a malignant spindle cell neoplasm with an infiltrative growth pattern and a high mitotic rate. There was involvement of local lymph nodes. The immunophenotype was characteristic of myoepithelial differentiation: tumour cells stained positively with anticytokeratin antibodies, S-100 protein, alpha smooth muscle actin, and vimentin. Electron microscopy confirmed myoepithelial differentiation, with small foci of keratinocytic phenotype. Large numbers of tumour cell nuclei were reactive with the anti-p53 antibody, DO-7, in contrast to the two previous resections. Thus malignant transformation of a pleomorphic adenoma may involve myoepithelial as well as epithelial elements. Accumulation of p53 protein, perhaps through mutational events, may have played a role in this malignant transformation.
Isolation of Burkholderia cepacia by enrichment.
Authors: Flanagan P G , Paull A
Published: January 2009

Burkholderia cepacia is a recognised cause of respiratory failure in patients with cystic fibrosis. The value of routine use of selective enrichment broth to increase the yield of B cepacia from cystic fibrosis sputa was investigated. Two hundred sputa from 86 adult and paediatric patients were cultured onto B cepacia selective agar and also in enrichment broth. The enrichment broths were subcultured after incubation onto B cepacia selective agar. Fourteen sputa from eight patients yielded B cepacia. In all cases the isolate was recovered from the primary selective agar as well as the enrichment broth subcultures. The routine use of enrichment for cystic fibrosis sputa is of unproven benefit and increases laboratory costs.
The contribution of MIB 1 in the accurate grading of vulvar intraepithelial neoplasia.
Authors: van Beurden M , de Craen A J , de Vet H C , Blaauwgeers J L , Drillenburg P , Gallee M P , de Kraker N W , Lammes F B , ten Kate F J
Published: January 2009

AIM: To determine the interobserver variation in scoring presence and grade of vulvar intraepithelial neoplasia (VIN) in haematoxylin/eosin (H/E) slides, MIB 1 slides, and the combined use of H/E and MIB 1 slides. METHODS: 10 slides were stained with H/E and MIB 1 with each of the following diagnoses: normal vulvar skin, VIN 1, VIN 2, and VIN 3. Six observers first scored the H/E slides separately from the MIB 1 slides and second the combined H/E and MIB 1 slides. RESULTS: Unweighted group kappa for MIB 1 was 0.62 and the weighted group kappa was 0.91. This was significantly better than the unweighted group kappa for H/E slides (0.47, p = 0.023) as well as the weighted group kappa for H/E slides (0.82, p = 0.014). There was no improvement by the combined use of H/E and MIB 1 slides. VIN 2 is far less confused with VIN 3 in the combined use of H/E and MIB 1 slides (9%) than in H/E slides (38%) (p = 0.007). There is a tendency to grade VIN in a two tailed grading system rather than a three tailed grading system, which became more apparent with the combined use of H/E and MIB 1 slides. CONCLUSIONS: The interobserver variation with sole use of MIB 1 is better than with the use of H/E stain in VIN. The use of MIB 1 in grading VIN diminishes confusion between VIN 2 and VIN 3 fourfold. A two tailed grading system for VIN seems already to work in daily practice.
Effect of using templates on the information included in histopathology reports on specimens of uterine cervix taken by loop excision of the transformation zone.
Authors: Reid W A , al-Nafussi A I , Rebello G , Williams A R
Published: January 2009

AIM: To determine the change in information relayed from histopathologists to clinicians by using templates for reporting specimens of uterine cervix sampled by loop excision of the transformation zone (LETZ). METHODS: Minimum datasets for the information required from LETZ specimens received from the colposcopy clinic, Royal Infirmary, Edinburgh, were incorporated into templates on the clinical service computer (Pinnacle) of the pathology department, University of Edinburgh. Pathologists completed hard copy versions, which were transcribed into the computer templates for report generation. The effect of the changes on the quality of the pathology reports was studied. The number of cases in which each item in the dataset received comment in template generated reports was compared with that in traditional prose reports compiled before the use of the templates and in prose reports issued after the introduction of the templates. Questionnaire studies were undertaken of clinicians' and pathologists' opinions of the template reports. RESULTS: In the template reports nearly all items received comment in almost 100% of cases. In the prose reports issued both before and after the templates were in use, most items were mentioned in a significantly lower proportion of cases. Clinicians thought the template reports were clearer and the information could be more readily assimilated than from the prose versions. CONCLUSIONS: The use of template reports in these types of specimen allowed more consistent and detailed information transfer. The change appeared to result from the use of the templates rather than from increased awareness of the items to be reported.
Papillary hidradenoma: immunohistochemical analysis of steroid receptor profile with a focus on apocrine differentiation.
Authors: Offidani A , Campanati A
Published: January 2009

AIM: To make a quantitative evaluation by image analysis of oestrogen receptors, progesterone receptors, and androgen receptors in papillary hidradenomas and anogenital sweat glands. METHODS: 20 papillary hidradenomas and the anogenital sweat glands detected in surgical specimens selected from 10 vulvectomies for squamous carcinoma, eight haemorrhoidectomies, and one anal polypectomy, all from female patients, were investigated by the avidinstreptavidin peroxidase testing system. RESULTS: 90% of papillary hidradenomas and almost all the anogenital sweat glands showed immunoreactivity for oestrogen receptor and, more weakly, for progesterone receptor, with immunolabelled nuclear area ranging from 10% to 90%. Conversely conventional sweat glands did not show any nuclear staining. Overexpression of androgen receptors occurred in 20% of papillary hidradenomas, with nuclear staining strictly bordering papillary epithelium with apocrine differentiation. There was no immunoreactivity for androgen receptors in anogenital sweat glands. CONCLUSIONS: Oestrogen and progesterone receptors seem to represent reliable markers for differentiating between anogenital sweat glands and conventional sweat glands, and a further link to explain why papillary hidradenomas occur almost exclusively in the female anogenital region. Positivity for oestrogen/progesterone receptors suggests that epithelia either of anogenital sweat glands or of papillary hidradenomas are controlled by ovarian steroid hormones. Androgen receptor nuclear staining of the epithelium with apocrine differentiation in vulvar papillary hidradenoma strengthens its homology with breast duct papilloma.
Possible involvement of IL-12 expression by Epstein-Barr virus in Sjögren syndrome.
Authors: Horiuchi M , Yamano S , Inoue H , Ishii J , Nagata Y , Adachi H , Ono M , Renard J N , Mizuno F , Hayashi Y , Saito I
Published: January 2009

AIM: To determine the correlation between interleukin 12 (IL-12) expression and Epstein-Barr virus (EBV) in Sjögren syndrome. METHODS: Indirect immunohistochemical technique, enzyme linked immunosorbent assay (ELISA), and immunoblot analysis were used to investigate IL-12 expression by EBV activation, using 13 surgical specimens and four B cell lines. RESULTS: Marked expression of IL-12 was found in the epithelial cells and the infiltrating B cells of salivary gland tissues from patients with Sjögren syndrome (six of 10 cases), but not in those from normal individuals (none of three cases). A striking topographic correlation between IL-12 and EBV was found. In addition, levels of IL-12 production by B cell lines were clearly enhanced by EBV activation in vitro. CONCLUSIONS: IL-12 expression closely reflects the intracellular event of EBV activation in Sjögren syndrome, and may contribute to the T helper cell type 1 (Th1) cytokine overexpression seen in this disease.
Immunohistochemical localisation of androgen receptor in apocrine metaplasia and apocrine adenosis of the breast: relation to oestrogen and progesterone receptors.
Authors: Selim A G , Wells C A
Published: January 2009

AIM: To investigate the receptor status of the sex steroid hormones in apocrine metaplasia of the breast. METHODS: 82 cases of apocrine metaplasia, including 18 of the rare lesion apocrine adenosis, were studied immunohistochemically for the expression of androgen receptor, oestrogen receptor, and progesterone receptor proteins on formalin fixed, paraffin embedded tissue sections. The standard avidin biotin complex (ABC) technique was followed and appropriate positive and negative controls were used. RESULTS: All the studied cases (82/82) were positive for androgen receptor, but were negative for oestrogen receptor and progesterone receptor. CONCLUSIONS: Apocrine metaplastic epithelium, unlike the normal breast epithelium, is responsive to androgens, through androgen receptors, rather than to the female sex hormones. This may have clinical implications.
CD10 positive thyroid marginal zone non-Hodgkin lymphoma.
Authors: Millar E K , Waldron S , Spencer A , Braye S
Published: January 2009

A 72 year old woman presented with swelling of the right lobe of her thyroid gland. Fine needle aspiration and flow cytometry showed a clonal population of B cells expressing CD10 and a diagnosis of follicle centre cell lymphoma was made. Subsequent excision of the thyroid showed the typical histological features of a marginal zone non-Hodgkin lymphoma. Polymerase chain reaction showed no evidence of t (14;18). Immunohistochemistry confirmed CD10 positivity and LN1 (CDw75) expression. This is only the second report of aberrant expression of CD 10 by a marginal zone lymphoma.
Post-test probability that men in the community with raised plasma ferritin concentrations are hazardous drinkers.
Authors: Peach H G , Bath N E
Published: January 2009

BACKGROUND: Raised plasma ferritin concentrations occur unexpectedly during iron studies done by primary care physicians. Plasma ferritin concentration has been positively associated with alcohol use among men. AIM: To determine the post-test probability that men in the community with raised plasma ferritin concentrations are hazardous drinkers. METHODS: The subjects were 152 men, randomly selected from a city's electoral roll. Nineteen (12.5 (2.7)%, mean (SEM)) admitted to drinking hazardously. The pretest probability of a man being a hazardous drinker was 0.125. This was converted to pretest odds of 0.14. The likelihood ratio (the ratio of the probability of obtaining a raised plasma ferritin concentration in a hazardous drinker (sensitivity) to the probability of obtaining a raised plasma ferritin concentration in a non-hazardous drinker (1-specificity)) was calculated for different plasma ferritin cut off points. RESULTS: A plasma ferritin level of > 652 micrograms/l gave the largest likelihood ratio, 4.16. Post-test odds were obtained by multiplying the pretest odds (0.14) by the likelihood ratio (4.16). A plasma ferritin level of > 652 micrograms/l had a post-test odds for a man being a hazardous drinker of 0.58. This was converted to a post-test probability of 0.37. CONCLUSIONS: Inquiries could usefully be made into the alcohol consumption of men with a plasma ferritin concentration > 652 micrograms/l, as approximately one in three would admit to drinking hazardously.
CD44s as a surrogate marker for distinguishing intraductal papilloma from papillary carcinoma of the breast.
Authors: Saddik M , Lai R
Published: January 2009

BACKGROUND: It has been shown that CD44 variants are differentially expressed in normal and neoplastic breast tissues. The diagnostic value of these markers in distinguishing benign from malignant breast lesions has not been well examined. AIMS: To evaluate the diagnostic value of CD44s in distinguishing between intraductal papillomas and papillary carcinomas of the breast, which may be difficult morphologically. METHODS: Expression of CD44s detected by immunohistochemistry was studied in a series of intraductal papillomas (11) and papillary carcinomas (10). The normal breast tissues surrounding the lesions of these cases served as a control. The number of CD44s positive epithelial cells was scored and categorised as < 10%, 10-70%, or > 70%. RESULTS: Normal breast epithelial cells and all intraductal papillomas (11 of 11) expressed CD44s in a high proportion of cells (> 70%). In contrast, the majority of papillary carcinoma cases (eight of 10) expressed this marker in < 10% of the cells. In the remaining two papillary carcinoma cases, positivity was seen in more than 10% but still less than 70% of the cells. CONCLUSIONS: CD44s detection by immunohistochemistry is useful in distinguishing intraductal papillomas from papillary carcinomas of the breast.
Reporting basal cell carcinoma: a survey of the attitudes of histopathologists.
Authors: Milroy C J , Richman P I , Wilson G D , Sanders R
Published: January 2009

AIMS: To investigate the histopathological reporting of basal cell carcinoma. METHODS: Methods of classification and attitudes to excision margins were ascertained from histopathologists in 130 centres; 82 replies were obtained (63% response rate). RESULTS: 24% of those replying did not use any classification system for basal cell carcinoma. The remainder (76%) used a wide variety of different classification systems. A small number (9%) of those questioned felt reporting on completeness of excision was not important. The majority of histopathologists considered the excision margin was worth reporting but there were differences in methods of processing and reporting biopsies. CONCLUSIONS: There is considerable variation in histopathological reporting of basal cell carcinoma. There is a need for uniformity of histopathological reporting to allow both improved management decisions and comparative audit of this extremely common skin cancer.
Prognostic evaluation of metallothionein expression in human colorectal neoplasms.
Authors: Ioachim E E , Goussia A C , Agnantis N J , Machera M , Tsianos E V , Kappas A M
Published: January 2009

AIM: To investigate the role of metallothionein in colorectal tumours and the possible relation with other factors associated with tumour progression: expression of cathepsin D (CD), CD44, p53, Rb, bcl-2, c-erbB-2, epidermal growth factor receptor (EGFR), proliferation indices (Ki-67, proliferating cell nuclear antigen (PCNA)), and conventional clinicopathological variables. METHODS: The immunohistochemical expression of metallothionein was investigated in 23 cases of colorectal adenoma and 94 adenocarcinomas. Metallothionein expression was examined by the avidinbiotin peroxidase immunoperoxidase (ABC) using the monoclonal mouse antibody E9, on formalin fixed, paraffin embedded tissue. RESULTS: Positive metallothionein expression (> 5% of neoplastic cells) was observed in 30.4% of adenomas and 25.5% of adenocarcinomas, while 8.7% of adenomas and 14.9% carcinomas showed focal metallothionein positivity. In contrast, 60.9% of adenomas and 59.6% of carcinomas almost completely lacked metallothionein expression. In the series of adenocarcinomas, metallothionein expression was inversely correlated with CD44 in neoplastic cells (p = 0.01). There was no statistically significant difference of metallothionein expression, or the other variables examined, between adenocarcinomas and adenomas. CONCLUSIONS: Metallothionein expression does not seem to indicate aggressive biological behaviour in colorectal adenocarcinomas, in comparison with the other types of carcinoma. The inverse correlation with CD44 could suggest that the decreased metallothionein expression may contribute to the metastatic spread of the lymph node involvement in colorectal cancer. Metallothionein expression does not seem to represent an independent prognostic marker in colorectal cancer.
Immunohistochemical study of thrombospondin and its receptors alpha root of beta 3 and CD36 in normal thyroid and in thyroid tumours.
Authors: Patey M , Delemer B , Bellon G , Martiny L , Pluot M , Haye B
Published: January 2009

AIM: To describe the pattern of distribution of thrombospondin (TSP1) and its receptors, alpha root of beta 3 integrin and CD36, in normal human thyroid tissue and to compare their expression in different benign and malignant thyroid conditions. METHODS: Immunohistochemistry was used to study TSP1 and its receptors in 40 surgical thyroidectomy specimens (normal parenchyma, 7; follicular adenoma, 4; multinodular goitre, 13; papillary carcinoma, 6; follicular carcinoma, 8; anaplastic carcinoma, 2). RESULTS: In the normal thyroid parenchyma, there was weak expression of TSP1 limited to the vessels with no staining of the extracellular matrix. In goitres, the expression of TSP1 was more pronounced in areas of fibrosis, with staining of alpha root of beta 3 on thyrocytes located in the vicinity. In thyroid adenomas, expression of TSP1 was slightly enhanced compared with normal tissue, located in the basement membrane of vessels. In papillary carcinomas, TSP1 was abundant in the desmoplastic stroma with a cytoplasmic distribution of alpha root of beta 3 integrin in thyrocytes. In follicular carcinomas, TSP1 was less abundant in the extracellular matrix, limited to the vessels of the stroma with a weaker expression of alpha root of beta 3 on thyrocytes than in papillary carcinomas. In anaplastic carcinomas, TSP1 was only present in the numerous capillaries of the stroma, with a marked positivity for alpha root of beta 3 in one case. No immunostaining of thyrocytes is observed with CD36. CONCLUSIONS: These results suggest the importance of the interaction between alpha root of beta 3 integrin and TSP1 during remodelling of the matrix in fibrous goitres with areas of early sclerosis comparable with wound healing. In papillary carcinomas, the overexpression of TSP1 restricted to the stroma suggests protective effects against tumour progression.