bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathogen derived elicitors: searching for receptors in plants
Authors: Montesano Marcos , Brader Günter , Palva E. Tapio
Published: March 2003

Recognition of potential pathogens is central to plants’ ability to defend themselves against harmful microbes. Plants are able to recognize pathogen‐derived molecules; elicitors that trigger a number of induced defences in plants. Microbial elicitors constitute a bewildering array of compounds including different oligosaccharides, lipids, peptides and proteins. Identifying the receptors for this vast array of elicitors is a major research challenge. Only in a very few cases has the cognate receptor for a particular elicitor been identified. Biochemical studies have resulted in the characterization of some elicitor binding proteins that may be part of the recognition complex. Transmembrane receptor‐like protein kinases (RLKs) constitute one of the most likely categories of receptors involved in pathogen perception. Some of these serine/threonine kinases have been identified as resistance or R genes, others as induced by pathogens or elicitors. One of the RLKs belonging to a leucine rich repeat (LRR) class of putative receptor kinases was recently identified as a receptor for bacterial flagellin, and the underlying signal pathway leading to activation of defence genes was elucidated. These and other recent studies have revealed intriguing similarities in elicitor recognition and defence signalling processes in plant and animal hosts suggesting a common evolutionary origin of eukaryotic defence mechanisms.
Review article: Consumer health information services*
Authors: KEMPSON ELAINE
Published: March 2003

There has been a growing interest, in Britain and other countries, in the provision of cousumer health information services. Developments have taken place within a number of different disciplines, including health education, community work, advice work, nursing and librarianship.

Services like the Lister Hospital Health Information Service, Wessex Region's Help for Health and the Royal Marsden patient education programme have shown what can be achieved when separate short‐term funds are made available. The evidence shows that, at the very least, the National Health Service should provide funds for a specialist consumer health information resource unit within each Regional Health Authority. This would support local health information initiatives through community groups, public libraries, community health councils, local hospitals and general hospitals, as well as acting as a specialist information centre to which these agencies could refer enquirers.
The Chartered Librarian as Information Officer: experiences in Huntingdon Health Authority*
Authors: SCARLETT SUSAN
Published: March 2003

The experience of the author as Information Officer to an NHS District Health Authority and the benefits drawn from her professional training are outlined. Attention is drawn to the inadequate provision of library resources for NHS managers at District level and the suggestion made that the Institute of Health Service Administrators look at this area, especially in view of the recent expansion of examinations and the opportunityfor qualifications which it offers to young administrators. The emphasis which Huntingdon Health Authority places on developing good information provision for managers is stressed and a call is made to all Districts to follow this example.
The impact of health information delivery on the quality of patient care: whither medical information science?*
Authors: GARFIELD EUGENE
Published: March 2003

The various ways in which the modern hospital library can support clinical decision making by providing current information to users in a quick and cost‐effective manner are discussed. The role of the library in continuing education and the importance of demonstrating the value of its activities through quantitative evaluation are stressed.
Library services for management trainees in the NHS: report of an investigation
Authors: GILBERT SUSAN
Published: March 2003

A questionnaire survey was carried out in one NHS region on the use of literature and libraries by administrators studying for IHSM qualifications. The results showed that these students relied almost totally on course reading lists toguide their studies. They obtained the required texts by borrowing them from colleagues or buying them. Students seem unaware of NHS libraries and the help they could obtain from librarians. Suggestions for improving library services to these students and for improving the students' use of libraries are made.
Copyright: where are we now?
Authors: STEWART PAMELA C.
Published: March 2003

The Copyright Act of 1956 is outlined indicating those areas which are particularly relevant to librarians. Current problems and the moves at present being made to amend the Act are discussed.
Disaster librarianship: the Bradford City Fire Disaster Information Service
Authors: KING IAN P. G.
Published: March 2003

The establishment of a city‐wide Information and Document Supply Service after the Bradford City Football Club's fire disaster is described, together with an overview of how the needs of the different user groups involved were met and coordinated.
Evidence‐based practice: the role of the NHS Centre for Reviews and Dissemination
Authors: GLANVILLE JULIE
Published: March 2003

The increasing need to adopt evidence‐based practice places large information demands on health professionals. This paper draws on the experience of the information team of the NHS Centre for Reviews and Dissemination to examine opportunities for information workers to assist researchers and health professionals in the move to more evidence‐based care. The importance of research reviews for the development of evidence‐based practice and the process of conducting overviews are discussed. The Centre for Reviews and Dissemination is disseminating the results of reviews and developing information services for information professionals, health practitioners and health service managers. The services include databases of structured abstracts of quality reviews and economic evaluations and an enquiry service.
The value of structured abstracts in information retrieval from MEDLINE
Authors: BOOTH ANDREW , O'ROURKE ALAN J.
Published: March 2003

Objective: To determine whether information retrieval might be enhanced by making each component of a structured abstract a separately searchable field.

Design: Parallel searches on records arranged so that each abstract could either be searched in its entirety or as a collection of structured fields.

Subjects: Records about cardiovascular disease downloaded from MEDLINE and tested against clinical questions derived from a concurrent survey of CD‐ROM use in three health science libraries.

Intervention: The investigators identified terms used to structure abstracts on MEDLINE and imported the abstracts into an Idealist database prior to searching using keywords from clinical questions.

Measurements and main results: recall and precision rates are given for each question in the ‘structured’ and the ‘unstructured’ set of records.

Conclusions: Use of structured, rather than unstructured, abstracts improves precision at the expense of recall and places heavier demands upon the searcher's skill in choosing the correct fields within the abstract to search. Further investigation requires more accurate simulation of MEDLINE software that utilizes features such as MeSH terms, explode, facilities and delimiters.
The Wisdom Project: virtual education in primary care
Authors: O’Rourke AlaN. , Dolman Elaine , Fox NicK. , Lane PaT. , Roberts Chris
Published: March 2003

This article examines the development of the Wisdom Project, a pilot for the teaching of informatics to primary health care professionals, using an original educational model based on e‐mail and Web pages. The article begins by placing the development of the Wisdom Project in the context of changes in medical education and training. The aims and objectives of Wisdom are outlined, and the methodologies for setting up and evaluating the project are described. The article then presents the results of the evaluation, including the identification of significant improvements in knowledge of CD ROMs (P = 0.01), e‐mail (P = 0.03), Medline (P = 0.02), operating systems (P = 0.02), Web browsers (P = 0.003) and word processing (P = 0.03). Improvements in evidence‐based practice (EBP) did not reach significance. Finally, a number of conclusions are presented, considering the lessons learnt for the future development of such projects.
Evidence into Practice: an information service for primary care professionals
Authors: Monaghan Valerie , Misso KatE.
Published: March 2003

This paper describes the development of the Primary Care Information Service (PCIS) in South Humber Health Authority—a practical example of an information service which aims to make it easier for primary care practitioners to have access to information services and resources, both by electronic and more traditional means. Also, issues to consider when establishing a service for primary care professionals, including barriers to be overcome, are outlined, and an examination is made of how the service has been developed around principles of evidence‐based medicine. Finally, the achievements to‐date are considered.
Efficient literature searching in diffuse topics: lessons from a systematic review of research on communicating risk to patients in primary care
Authors: Matthews Elaine J. , Edwards Adrian G. K. , Barker Jackie , Bloor Michael , Covey Judith , Hood Kerenza , Pill Roisin , Russell IaN. , Stott Nigel , Wilkinson Clare
Published: March 2003

Using the example of communication about risk in a primary care setting, this paper puts forward a method of developing and evaluating a detailed search strategy for locating the literature for a systematic review of a ‘diffuse’ subject. The aim of this paper is to show how to develop a search strategy that maximizes both recall and precision while keeping search outputs manageable. Six different databases were used, namely Medline, Embase, PsychLIT, CancerLIT, Cinahl and Social Science Citation Index (SSCI). The searches were augmented by hand‐searching, contacting authors, citation searching and reference lists from included papers. Other databases were searched but yielded no extra references for this subject matter. Of the 99 papers included, 80 were indexed on Medline. The Medline search strategy identified 54 of them and the remaining 26 were located on other databases. The 19 further unique references were found using the other databases and methods of retrieval. A combination of several databases must be used to maximize recall and to increase the precision of searches on individual databases, thus improving the overall efficiency of the search.
Multiple polypoid lesions of primary mucosa‐associated lymphoid‐tissue lymphoma of colon
Authors: Yatabe  , Nakamura  , Nakamura  , Seto  , Ogura  , Kimura  , Kuhara  , Kobayashi  , Taniwaki  , Morishima  , Koshikawa  , Suchi
Published: March 2003

Aims:

This study was focused on unusual cases of mucosa‐associated lymphoid tissue (MALT) lymphoma presenting with multiple polypoid lesions of the colon and rectum with a special reference to the differential diagnosis of mantle cell lymphoma.

Methods and results:

The lesions of these five cases grossly showed a segmental distribution of nodular protrusions in three patients and of innumerable small polyps in two. These patterns of involvement simulated those of multiple lymphomatous polyposis, known as the gastrointestinal presentation of mantle cell lymphoma (MCL), and caused a differential diagnostic problem between MALT lymphoma and MCL, which have different prognostic and therapeutic implications. Their histological features are almost indistinguishable from each other, especially in the small biopsy specimens via endoscope. The most important procedure for their differentiation is cyclin D1 immunohistochemistry and its negative reaction provides strong indication of MALT lymphoma. Of interest, one case showed a rare karyotypic abnormality of t(11;18)(q21;q21), which has been reported specifically in MALT lymphoma.

Conclusions:

This study has indicated that the multiple polypoid lesions of the colon occur not only in MCL, but also in MALT lymphoma, making differential diagnosis between the two entities necessary, and cyclin D1 immunohistochemistry is indispensable for distinguishing between them.
Immunoperoxidase staining for cytokeratins 8 and 18 is very sensitive for detection of occult node metastasis of colorectal cancer: a comparison with genetic analysis of K‐ras
Authors: Sasaki  , Watanabe  , Jass  , Ajioka  , Kobayashi  , Hatakeyama
Published: March 2003

Aims:

Recent reports suggest that genetic examination of K‐ras or p53 mutation is more sensitive for the detection of occult lymph node metastasis in colorectal carcinomas than conventional examination by haematoxylin and eosin (H & E) staining or immunohistochemistry for gene products. The aim of this study was, first, to define the microscopic characteristics of metastatic cancer cells in lymph nodes stained by the anti‐cytokeratin antibody CAM5.2 for cytokeratins 8 and 18, and, second, to compare the detection rate of occult lymph node metastasis for immunohistochemical vs genetic methods.

Methods and results:

K‐ras mutations were first examined in primary tumours of seven cases which showed distant metastasis or local recurrence within 5 years of the initial surgery in spite of the original reporting of no lymph node metastasis by routine H & E staining. K‐ras mutations were positive in three cases in primary tumours and lymph nodes, and the remaining four primary tumours were negative for p53 mutation as well as K‐ras mutation. Therefore, genetic analysis of occult lymph node metastasis was uninformative, but occult metastasis was detected by cytokeratin staining in two of these four cases. Comparative study of cytokeratin‐positive cells was performed on each of the 43 lymph nodes from three cases with K‐ras mutations. Cancer cells were detected in 28 of the 43 lymph nodes (65.1%) by cytokeratin staining and in 10 of the 43 corresponding lymph nodes (23.3%) by genetic analysis. Artefactual contamination by cancer cells was present in eight of the 28 cytokeratin positive lymph nodes, and three of the eight nodes were genetically positive.

Conclusions:

This study suggests that cytokeratin immunohistochemistry is more sensitive and specific for the detection of occult lymph node metastasis than genetic diagnosis by K‐ras mutation in cases with genetic alterations as well as in cases without them.
Value of histochemical stains for copper in the diagnosis of Wilson's disease
Authors: Pilloni L , Lecca S , Van Eyken P , Flore C , Demelia L , Pilleri G , Nurchi A M , Farci A M G , Ambu R , Callea F , Faa G
Published: March 2003

Aims: The histochemical demonstration of hepatic copper is important in the diagnosis of Wilson's disease (WD). Conflicting results have been published with regard to the ability of different histochemical methods to demonstrate copper storage in the liver. Therefore, we evaluated the diagnostic value of three available histochemical methods in a large series of patients affected by WD.

Methods and results

Seventy‐nine consecutive liver needle biopsies, from 74 patients, 39 males and 35 females, aged 4–60 years (mean age 28.5 years) were stained with orcein, rhodanine and using Timm's method. On the basis of the histological picture, liver biopsies were subdivided into three groups: group A, steatosis; group B, interface hepatitis; group C, chronic hepatitis with bridging fibrosis and/or cirrhosis. In group A, 30.4% of the cases were positive using Timm's method, vs 13.2% using the rhodanine and 17.5% using the orcein method. In group B, Timm's method was positive in 40.1% while rhodanine and orcein showed positivity in 26.7%. In group C, the Timm's method stained 58.6%, rhodanine 36.6% and orcein 29.3% positively.

Conclusions

Our data show that: (1) Timm's silver stain is the most sensitive method for the demonstration of copper in all cases of WD; (2) rhodanine and orcein have minor value in the diagnosis of WD, especially in the early stages of the disease; (3) to increase the diagnostic value of histochemistry for copper multiple histochemical stains in serial sections are required; and (4) although hepatic copper concentration is highest in the early stages of WD, the histochemical demonstration fails in a large number of cases.
Xanthogranulomatous cystitis associated with malignant neoplasms of the bladder
Authors: Bates A W , Fegan A W , Baithun S I
Published: March 2003

Aims: Two cases of xanthogranulomatous cystitis in conjunction with malignant neoplasms of the bladder are described.

Methods and results

A partial gastrectomy specimen from a 55‐year‐old man showed a urachal adenocarcinoma partly surrounded by a large xanthogranulomatous inflammatory mass. Multiple resections of the locally recurring tumour over the subsequent 10 years did not show further xanthogranulomatous changes. In the second case, a 76‐year‐old woman, a focus of xanthogranulomatous cystitis was present near a moderately differentiated transitional‐cell carcinoma of the vesico‐ureteric junction.

Conclusions

Xanthogranulomatous inflammation is associated with malignant neoplasms in the bladder, as it is in the kidney and extra‐urinary sites, as well as with benign neoplasms and non‐neoplastic conditions such as urachal diverticula. The presence of a concomitant neoplasm should therefore be considered when the diagnosis of xanthogranulomatous cystitis is made.
Granulomatous inflammation in sigmoid diverticulitis: two diseases or one?
Authors: Burroughs S H , Bowrey D J , Morris‐Stiff G J , Williams G T
Published: March 2003

Aims

Histological appearances indistinguishable from Crohn's disease have been described in patients undergoing sigmoid colectomy for complicated diverticular disease. To investigate whether this finding represents coincidental dual pathology or merely a granulomatous colitis confined to the diverticular segment, we undertook clinical follow‐up of affected patients.

Methods and results

Eight patients (median age 64 years, four males) whose sigmoid colectomy specimens showed acute diverticulitis and granulomatous inflammation were identified. All had a pre‐operative diagnosis of diverticular disease and no previous evidence of Crohn's disease. Non‐caseating epithelioid granulomas, unrelated to foreign material and usually unrelated to inflamed diverticula were present in the bowel wall of seven cases and in the regional lymph nodes of five. Three had granulomatous vasculitis and two had granulomas in ‘background’ mucosa. Mural lymphoid aggregates were identified in all cases. However, fissuring ulcers distinct from inflamed diverticula were not identified. On median follow‐up of 51 months (range 18–112 months) none of the patients developed evidence of chronic inflammatory bowel disease. Three had died from unrelated causes.

Conclusions

Granulomatous inflammation appears to be part of a spectrum of sigmoid diverticulitis. In this setting, caution should be exercised to avoid an inappropriate diagnosis of Crohn's disease.
Sclerosing epithelioid fibrosarcoma: a study of five cases emphasizing diagnostic criteria
Authors: Eyden B P , Manson C , Banerjee S S , Roberts I S D , Harris M
Published: March 2003

Aims

To study the clinical and histopathological features of sclerosing epithelioid fibrosarcoma, and to define diagnostic criteria for this uncommon soft‐tissue tumour.

Methods and results

Standard histological, immunohistochemical and ultrastructural techniques were applied to five tumours from head and neck, chest wall and groin. Tumours consisted of groups of monomorphic rounded/epithelioid cells surrounded by a prominent collagenous stroma. Tumour cells showed positive vimentin staining but were negative for other markers. They contained prominent rough endoplasmic reticulum and a large Golgi apparatus which in one case was producing collagen secretion granules, an ultrastructural marker for collagen production. Three patients had medium to long‐term survival (3–7 years). Of these, one was disease‐free for 3 years, and two experienced multiple recurrences: one of the latter died of metastatic disease.

Conclusion

Criteria for diagnosing this uncommon tumour include: small to medium cell size, clear or pale cytoplasm, cellular arrangement in cords and strands, dense collagenous stroma; vimentin staining; rough endoplasmic reticulum and a Golgi apparatus producing, in well preserved examples, collagen secretion granules. The paper emphasizes the value of electron microscopy, supporting an appropriate histological picture and immunophenotype, in identifying these relatively low‐grade sarcomas.
Diagnostic markers in paediatric medulloblastoma: a Paediatric Oncology Group Study
Authors: McLendon  , Friedman  , Fuchs  , Kun  , Bigner
Published: March 2003

Aims

We have reviewed immunohistochemically 17 paediatric medulloblastomas in order to determine if correlations exist that might be useful in subclassifying these tumours.

Methods and results

The patient group included 11 children who had died (mean survival 13 months) and six still alive (followed for up to 10 years). Ten tumours were diffuse and six were nodular (one biopsy had only perivascular tumour). Of the 10 diffuse tumours, three were desmoplastic; of the six nodular tumours, all six were desmoplastic. All 17 tumours were synaptophysin‐reactive; three nodular tumours were glial fibrillary acidic protein (GFAP)‐reactive in the nodules (two of three S100‐reactive tumours were also GFAP‐reactive). MIB‐1 labelling indices (LI) ranged from 5 to 80%. Six tumours exhibited at least 1% LI against Tp53 (Mab D07 and/or Mab 1801). Eight cases were 100% bcl2‐reactive with nine cases having an LI <80% (‘low labelling’). All nine ‘low labelling’ bcl2 cases were TP53 non‐reactive; all six Tp53‐reactive cases were bcl2 100% reactive. Six of 10 patients with diffuse medulloblastomas survived 18 months or less while four of 10 are alive up to 10 years. In contrast, five of six patients with nodular neoplasms died within 48 months of diagnosis with one patient followed up for less than 1 year.

Conclusions

Immunohistochemistry is a useful adjunct in characterizing subsets of paediatric medulloblastomas and confirms that larger co‐operative studies may be fruitful in identifying a prognostic utility of a combined histochemical/immunohistochemical analysis on these tumours.
Molecular genetic analysis of non‐astrocytic gliomas
Authors: Tong  , Ng H‐K , Pang  , Hui  , Ko  , Lee
Published: March 2003

Aims

Oligodendroglial tumours follow genetic pathways different from but overlapping with those of astrocytic tumours. The aim of this study was to examine whether major genetic events such as loss of chromosome 10 and p53 mutation found in astrocytic gliomas are also involved in the development and anaplastic transformation of non‐astrocytic gliomas and to correlate the findings with histopathological subtypes of these tumours.

Methods and results

Sixty‐one formalin‐fixed, paraffin‐embedded oligodendroglial and ependymal tumours (16 oligodendrogliomas, 12 anaplastic oligodendrogliomas, seven oligoastrocytomas, 24 ependymomas and two anaplastic ependymomas) were examined for allelic deletions on chromosome 10q23 and 10q25–26 regions, mutations of PTEN/MMAC1 and p53, MDM2 gene amplification and apoptosis. The frequencies of allelic deletions at marker D10S2491 (which mapped within PTEN/MMAC1) and between markers D10S209 and D10S587 (where DMBT1 was located) were found to be < 30% in both types of non‐astrocytic gliomas. High frequency of allelic deletions was detected at marker D10S215 (80%) at the proximal 10q23 region in both oligodendroglial and ependymal tumours and between markers D10S216 (42%) and D10S169 (67%) at distal 10q25–26 region in oligodendroglial tumours. No mutations of PTEN/MMAC1 were found. p53 mutations were detected in three oligoastrocytomas and one ependymoma; three out of five mutations were found in exon 4. MDM2 gene amplification was found in one ependymoma harbouring wild‐type p53. The apoptotic index was lower in p53‐mutated tumours than in tumours with wild‐type p53.

Conclusion

The telomeric end of chromosome 10q could be involved in the development and anaplastic transformation of oligodendroglial tumours. Mutations of PTEN/MMAC1 and p53, amplification of the MDM2 gene and allelic loss on chromosome 10q do not play a major part in the pathogenesis or anaplastic transformation of oligodendrogliomas and ependymal tumours.
Gastric cryptosporidiosis: correlation between intensity of infection and histological alterations
Authors: Rivasi  , Rossi  , Righi  , Pozio
Published: March 2003

Aims

A retrospective study was carried out to determine the histopathological alterations of the gastric mucosa associated with the presence of Cryptosporidium parasites in the stomach.

Methods and results

Gastric biopsies from eight patients with AIDS and cryptosporidiosis were reviewed. Most individuals were males (7/8, mean age 34.7 years) intravenous drug users (6/8), with very low peripheral blood CD4 lymphocyte counts (< 150/mm3; mean 56/mm3). Endoscopic examination showed no significant mucosal abnormalities in half of the individuals; inflammation was observed in the other four individuals and was associated with erosions in two cases. The lesions observed (reactive changes, oedema, erosions, etc.) are not pathognomonic, since they are seen in most common acute and chronic gastrititis of various aetiologies (toxic, infectious, mechanical). The histological examination showed Cryptosporidium parasites in the antrum–pylorus of all examined persons, whereas only two of them had parasites in the corpus. Modifications of histological features consisted mostly of hyperplastic reactive changes of the gland epithelial and inflammation in the connective tissue of the lamina propria. No clear correlation was found between endoscopy and histological findings, whereas a close correlation between intensity of the infection and degree of histological alterations was observed.

Conclusion

These findings suggest that, in individuals with AIDS, cryptosporidiosis and severe immunodepression, upper endoscopy with random gastric biopsies should be performed, even in the absence of endoscopically appreciable lesions. The diagnosis of gastric cryptosporidiosis has to rely on histological findings, and pathologists must be aware of the fact that Cryptosporidium parasites are mainly found in areas showing reactive hyperplasia.
Adult respiratory distress syndrome — an update
Authors: Hasleton  , Roberts
Published: March 2003

In adults, acute lung injury or adult respiratory distress syndrome (ARDS) may complicate a wide range of serious medical and surgical conditions, only some of which involve direct pulmonary insult. The characteristic histological feature of ARDS is an intense inflammatory process in the lungs, which may progress to fibrosis. The earliest physiological characteristic is an increase in the protein permeability across the endothelial and epithelial barriers of the lungs. This clinical syndrome is characterized by arterial hypoxaemia and bilateral radiographic infiltrates, which represent protein‐rich oedema fluid. In addition there is a neutrophilic and macrophage infiltrate.  Pulmonary endothelium is actively involved in the development of ARDS. It alters cell–cell adhesion as the initial step in leucocyte migration which, in turn, changes the permeability that allows protein‐rich fluid to move into the interstitium. The quantity of this interstitial oedema may be sufficient to cause bulk flow through the epithelial barrier. There is probably independent epithelial injury. Finally, the endothelium can release and metabolize vasoactive and inflammatory substances, such as endothelins, nitric oxide and cytokines, etc. No single substance is responsible for acute lung injury, but rather a complex interplay exists between diverse pro‐ and anti‐inflammatory mediators.
DCIS grading schemes and clinical implications
Authors: Shoker  , Sloane
Published: March 2003

The frequency with which ductal carcinoma in situ (DCIS) is detected has increased greatly since the introduction of mammographic screening. The number of treatment options has also increased and mastectomy has been extensively replaced by local excision with or without radiotherapy. DCIS is generally unicentric, as evidenced by the rarity with which it is bilateral and the location of recurrences at the site of previous surgery. Complete excision is thus curative but assessing adequacy of excision is beset with significant technical problems and consequently margin involvement does not correlate very well with the presence of residual disease in the breast or the development of clinical recurrence. Lesion size is related to recurrence but is also often difficult to measure. At the histological level, DCIS is a heterogeneous group of proliferations varying in cytological and architectural features, some of which are related to clinical outcome. The traditional method of classification was by growth pattern but was found to lack reproducibility and prognostic power. As a consequence, several new classifications have been proposed in recent years. Some have been assessed more rigorously than others in terms of the consistency with which they can be applied and their ability to predict clinical outcome. There is strong evidence, however, that nuclear grade is the best predictor of recurrence and the time scale over which it is likely to occur although presently it can be determined with only fair to moderate consistency. Necrosis is also a useful feature when used in combination with nuclear grade, but specifically recognizing a comedo pattern appears to have little clinical value and is associated with significant diagnostic inconsistency. No histological features to date have been found to predict the development of invasive disease. Histological assessment alone is insufficient to determine how patients with DCIS should be managed, which should also take account pathological assessment of excision margins and lesion size as well as radiological and clinical features.
Basaloid squamous carcinoma of the oesophagus: a distinct neoplasm with multipotential differentiation
Authors: Cho  , Jang  , Lee  , Zo
Published: March 2003

Aims

Basaloid squamous carcinoma (BSC) is an uncommon variant of squamous cell carcinoma, with its prevalent sites being the hypopharynx, tongue base and larynx. In the oesophagus, BSC is rarer than in the head and neck region. This study was aimed to document the clinicopathological features of BSCs of the oesophagus, and to present their relative incidence and immunohistochemical findings.

Methods and results

Eighteen cases of BSC of the oesophagus, comprising 3.6% of 502 oesophageal carcinomas, were reviewed for their pathological and clinical features, and examined for the immunohistochemical expression of neuroendocrine markers, cytokeratins, p53, pRb and bcl‐2. Oesophageal basaloid squamous carcinomas tended to be biphasic or multiphasic carcinomas, most commonly with basaloid and squamous components (eight cases), or with additional adenocarcinoma (three cases) or with small cell carcinoma (two cases). Each component was microscopically clearly distinguishable from the others, and metastasized separately, chiefly the basaloid component. The remaining five cases were apparently pure basaloid carcinomas, being characterized by lobules and nests of monotonous round undifferentiated cells with frequent comedo necrosis. They resembled, but were differentiated from, the small cell carcinoma on the basis of neuroendocrine markers and cytokeratin expression. p53, pRb and bcl‐2 oncoprotein, which are known to normally present in the basal/parabasal cells of the oesophageal epithelium, were detected in 40–50% of cases, with a heterogeneous expression pattern. The patients were all male, with the age ranging 47–74 years (median 57) and presented at variable stages. The plotted 3 years survival rate was 51%, and the immunohistochemical expression of p53, pRb and bcl‐2 was not related to the survival of the patients.

Conclusion

Basaloid squamous carcinoma of the oesophagus is a peculiar neoplasm with a capacity of multidirectional differentiation, often with heterogeneous oncogene expression, probably reflecting the pluripotential stem cell origin.
Warthin‐like tumour of the thyroid gland: RET/PTC expression indicates it is a variant of papillary carcinoma
Authors: D'antonio A , De Chiara A , Santoro M , Chiappetta G , Losito N S
Published: March 2003

Aims

Three cases with features of so‐called ‘Warthin‐like tumour’ of the thyroid (WaLTT) are described, in order to evaluate its relationship with papillary carcinoma (PC).

Methods and results

We performed an histological and immunohistochemical study with emphasis on RET/PTC expression. The most striking features are represented by marked lymphocytic infiltration in the stalks of papillae and by oxyphilic metaplasia of epithelium, resembling Warthin tumour of the salivary gland. In all cases, we found nuclear features reminiscent of PC. The neoplastic cells were strongly positive for Leu M1 and epithelial membrane antigen (EMA), less for thyroglobulin and negative for calcitonin. The lymphocytic infiltrate was composed of a mixed population of B and T‐cells with sparse S100‐positive Langerhans cells. An interesting finding was the strong positivity with the antibody against RET/PTC.

Conclusion

All clinicopathological data along with the presence of the extensive lymphocytic infiltrate could imply a more favourable prognosis. The expression of RET/PTC fusion gene adds support to the hypothesis that this tumour is a variant of PC, probably related to the oncocytic variant of PC.
Laboratory diagnosis of variant Creutzfeldt–Jakob disease
Authors: Ironside J W , Head M W , Bell J E , McCardle L , Will R G
Published: March 2003

The neuropathological and biochemical features of 33 cases of variant Creutzfeldt–Jakob disease (vCJD) diagnosed up to the end of 1998 are analysed in relation to the 646 cases of suspected CJD referred to the CJD Surveillance Unit laboratory from 1990 to 1998. Morphological studies of the central nervous system, lymphoid tissues and other organs were accompanied by immunocytochemistry; Western blot analysis of PrPRES was performed on frozen brain tissue. The findings were analysed in relation to clinical and genetic data. The pathology of vCJD showed morphological and immunocytochemical characteristics distinct from other cases of CJD. PrP accumulation was widespread in lymphoid tissues in vCJD, but was not identified in other non‐neural tissues. PrPRES accumulation in vCJD brain tissue showed a uniform glycotype pattern distinct from sporadic CJD. All analysed cases of vCJD were methionine homozygotes at codon 129 of the PrP gene.  No evidence currently exists to suggest that cases of CJD diagnosed in individuals who are MV or VV at codon 129 of the PrP gene represent ‘human bovine spongiform encaphalopathy (BSE)’. Continued surveillance is required to further investigate this possibility, with the need to investigate autopsy tissues from suspected cases by histological and biochemical techniques.
Secondary neoplasms of the male genital tract with different patterns of involvement in adults and children
Authors: Dutt N , Bates A W , Baithun S I
Published: March 2003

Aims

The incidence, presentation and macroscopic and histological features of secondary neoplasms of the male genital tract are described with reference to their differential diagnosis.

Methods and results

A retrospective study of cases from the Royal London Hospital yielded a total of 31 secondary neoplasms involving the testis: 14 at postmortem examination and 17 surgical specimens. Nine cases were leukaemias: six acute lymphoblastic and two acute myeloid leukaemias in children, and one chronic lymphocytic leukaemia in an adult. The commonest primary sites of metastases to the testis were prostate (six cases), stomach (five cases) and lung (three cases). There were two malignant melanomas and isolated examples of metastases from the adrenal gland (neuroblastoma), cerebellum (medulloblastoma), soft tissue (alveolar rhabdomyosarcoma), pancreas and rectum. Of the metastases from solid tumours, 12 involved the right testis only, three involved the left and four were bilateral. In seven of these cases there were multiple testicular nodules, in seven there was a single mass, and in the rest there was diffuse involvement. Secondary neoplasms represented 4.6% of all testicular neoplasms at autopsy, and 1.6% in surgical specimens. There were five secondary penile neoplasms: two each from the pancreas and prostate and one from the bladder. Two neoplasms metastatic to the spermatic cord, both from a gastric primary, were included in the series.

Conclusions

Secondary neoplasms of the testis occur with a frequency comparable to other sites in the genitourinary tract, and metastases to the spermatic cord, epididymis, and penis, are rare in comparison. Disseminated neoplasms rarely present initially at this site and are histologically distinctive in adults, but in children they must be distinguished from primary small round blue cell tumours.
High sensitivity and specificity of immunohistochemistry for the detection of hormone receptors in breast carcinoma: comparison with biochemical determination in a prospective study of 793 cases
Authors: Zafrani B , Aubriot M‐H , Mouret E , De Crémoux P , De Rycke Y , Nicolas A , Boudou E , Vincent‐Salomon A , Magdelénat H , Sastre‐Garau X
Published: March 2003

The hormone receptor (HR) status of breast cancer is an important prognostic factor and predictive parameter of the response to hormone therapy. Enzyme immunoassay (EIA) is currently the standard for determination of HR, but immunohistochemistry (IHC) represents a potentially useful alternative. We used IHC to determine HR status in a large prospective study and compared the results to those obtained by EIA. This study was designed to determine which technique should be used in daily practice in our institution which manages a large number of patients.

Oestrogen (ER) and progesterone (PgR) receptor status was evaluated in a prospective series of 793 infiltrating breast cancers by IHC in paraffin‐embedded tissue sections, using antibodies 6F11 and 1A6, with a rigorous quality control of the methodology. ER were found to be significantly expressed in 81% of cases after IHC analysis and in 78% of cases by EIA. For PgR, the respective rates of positivity were 65% and 69%. The tumour HR level detected by either technique was significantly correlated with the value of tumour size, histological grade and S‐phase fraction. A significant link was observed between the percentage of labelled cells after IHC analysis and the amount of protein detected by EIA. Critical analysis of discordance found that, in the group of invasive lobular carcinomas, the rate of HR positivity was higher with IHC (84%) than with EIA (45%) and that, in the overall population, IHC was more specific than EIA, since cases with nonrelevant positivity related to intraductal normal or neoplastic cells expressing HR could be discarded. The cost of IHC analysis was found to be about one‐third of that of EIA.

IHC is more sensitive, specific and economical than EIA. It should constitute the new standard technique provided that good quality assurance procedures are respected.
Caspase‐3/CPP32 immunoreactivity and its correlation with frequency of apoptotic bodies in human prostatic carcinomas and benign nodular hyperplasias
Authors: Sohn J H , Kim D H , Choi N G , Park Y E , Ro J Y
Published: March 2003

Apoptosis is mediated by apoptosis‐specific genes, certain oncogenes and tumour suppressor genes. Caspase‐3, a group of cystein proteases, is involved in the induction of apoptosis and has been considered to correlate with apoptosis. The aim of this study was to determine whether caspase‐3 is expressed in prostatic carcinoma and benign prostatic hyperplasia, and correlated with the apoptosis.

We studied the apoptotic index and caspase‐3 immunoreactivity in 40 cases of benign nodular hyperplasia (BPH) and 40 cases of prostate carcinoma (PCA) by in‐situ labelling and immunohistochemistry. The mean number of apoptotic bodies in cases with BPH was not significantly different from cases with PCA I (Gleason score 2–4), but samples from patients with PCA II (Gleason score 5–7) and PCA III (Gleason score 8–10) showed a significantly higher apoptotic number than cases with BPH. Positive staining for caspase‐3 was seen in 42.5% (17/40) of the BPH, and 27.5% (11/40) of the PCA: PCA I was 41.7% (5/12), PCA II 14.3% (2/14) and PCA III was 28.6% (4/14).

Based on our results, the number of apoptotic bodies was not correlated with the caspase‐3 expression and there was no relationship between caspase‐3 expression and Gleason score. However, the number of apoptotic bodies was significantly higher in cases with intermediate (Gleason score 5–7) and high‐grade (Gleason score 8–10) PCAs than cases with BPH and low‐grade PCAs (Gleason score 2–4).
Precursor lesions of ovarian epithelial malignancy
Authors: Feeley K M , Wells M
Published: March 2003

Most ovarian carcinomas arise from the mesothelial surface lining of the ovaries, or from invaginations of this lining into the superficial ovarian cortex to form cortical inclusion cysts. The native ovarian surface mesothelium is of an ‘uncommitted’ phenotype, and has potential to modulate to epithelial or mesenchymal phenotypes in response to signals such as those associated with ovulation. The exposure of the mesothelial lining of an inclusion cyst to the ovarian stromal microenvironment may be responsible for the phenotypic change to Müllerian epithelium so commonly seen in these cysts. Müllerian metaplasia is usually to a serous phenotype, and it is possible that undefined molecular events occurring in an inclusion cyst that has undergone Müllerian metaplasia may initiate neoplastic change in these cysts. This may be the developmental pathway of most invasive serous carcinomas. Occasional rare cases of ovarian intraepithelial neoplasia, manifested by epithelial atypia in an inclusion cyst or on the surface epithelium without invasive carcinoma, are identified histologically. Serous borderline tumours represent a separate category and in most cases probably do not progress to frank carcinoma. Mucinous carcinomas may in some cases have arisen from pre‐existing benign and borderline mucinous tumours. Endometriosis of the ovary is associated with genetic abnormalities and is frequently found in association with clear cell and endometrioid carcinomas, suggesting that in many cases these latter two types of carcinoma may have arisen directly from endometriotic deposits. Ovaries removed prophylactically from women with a family history of ovarian carcinoma or with a mutation in one of the genes predisposing to ovarian carcinoma should be processed in their entirety, and examined closely not just for obviously neoplastic lesions, but also for more subtle morphological abnormalities of the surface epithelium or the epithelium lining cortical inclusion cysts.
S100 expression in cutaneous scars: a potential diagnostic pitfall in the diagnosis of desmoplastic melanoma
Authors: Robson A , Allen P , Hollowood K
Published: March 2003

Aims:

The histological distinction of desmoplastic melanoma from cutaneous scar tissue, particularly in the context of re‐excision specimens or possible recurrence, may be very difficult. Immunostaining for S100 protein is often used to discriminate although there are little data on S100 expression in scar tissue. The aim of this study was to assess whether S100‐positive cells are present in dermal scars and, if so, their extent, distribution and nature.

Methods and results:

Twenty‐two re‐excision specimens of previously biopsied nonmelanocytic skin lesions were reviewed. Formalin‐fixed paraffin‐embedded sections containing dermal scars were stained by a standard ABC immunoperoxidase technique for S100 protein, CD1a and neurofilaments. The distribution and morphology of positive cells within the dermal scar tissue were documented. Cells expressing S100 protein were identified within the scars of 21 of the 22 cases. The number of S100‐positive cells varied between cases but in four specimens was substantial. They displayed a variety of morphological appearances but the majority were spindle‐shaped. A few showed mild cytological atypia. It is suggested that the majority represent Schwann cells with a minority of Langerhans cells and cells of uncertain lineage.

Conclusion:

S100‐positive cells, including spindle cells showing mild atypia, are found in cutaneous scars. S100 staining of re‐excision specimens or putative recurrences of desmoplastic melanoma should be interpreted with caution.
Different roles of arteriosclerosis in the rupture of intracranial dissecting aneurysms
Authors: Sakata N , Takebayashi S , Kojima M , Masawa N , Suzuki K , Takatama M , Kusumi Y , Mitsumata M
Published: March 2003

Aims: Although intracranial dissecting aneurysm (IDA) is a newly described variant of the brain aneurysms that affects mainly the vertebrobasilar arterial system, its pathogenesis remains obscure. We aimed to clarify the role of arteriosclerosis in the pathogenesis of IDA based on histopathological findings in seven autopsy cases of IDA.

Methods and results: All cases exhibited systemic hypertension or left ventricular hypertrophy. Macroscopically, all cases exhibited subarachnoid haemorrhage. Two types of dissection were recognized in the vertebral artery. Six of seven IDA cases showed a widespread disruption of the entire thickness of the arterial wall with the formation of a dilated pseudoaneurysm, which consisted of thin adventitia (arterial wall disruption type). Medial disruption of the arterial wall and subadventitial dissecting haemorrhage were also found, resulting in the formation of a false lumen and stenosis of the ‘true’ lumen of the artery. However, these lesions were connected to the site of rupture of the entire arterial wall. Within 1 day after onset of IDA, the autopsy cases showed formation of fibrin thrombus, marked leucocyte infiltration and necrosis of the arterial wall at the site of the lesion. Cases that survived more than 1 week showed smooth muscle cell proliferation, macrophage accumulation and lymphocytic infiltration in the lesions. These cases showed no atherosclerotic plaque, but non‐atherosclerotic fibrocellular intima. The thickness of intima and media was significantly less in the vertebral artery of IDA patients than that of non‐IDA patients with systemic hypertension. On the other hand, the remaining case showed severe atherosclerosis with haemorrhage into the lipid core without connection to the arterial lumen (intra‐atheromatous plaque haemorrhage type). However, unusual arterioles and neovascularization of the intra‐and peri‐arterial walls were observed.

Conclusions: Our results suggest that disruption of the entire arterial wall may be a critical event in the development of IDA and result in the medial disruption and subadventitial haemorrhage. Non‐atheromatous intima might function as a protective factor in arterial wall disruption. On the other hand, atherosclerosis may predispose to intra‐atheromatous plaque haemorrhage type of IDA through intramural haemorrhage originating from the newly formed vessels.