bluuebunny/crossref_metadata_2025 huggingface dataset:
Carcinoma in situ involving sclerosing adenosis: a mimic of invasive breast carcinoma
Authors: RASBRIDGE S.A. , MILLIS R.R.
Published: April 2007

The distinction between invasive and in situ carcinoma of the breast is important with regard to the treatment and prognosis of the patient. When carcinoma in situ involves breast tissue in which the normal architecture is altered by pre‐existing sclerosing adenosis, the resulting histological picture may closely mimic an invasive carcinoma. We record the histopathological features in 13 cases where there was difficulty in identifying the presence or extent of invasive carcinoma. The most useful clue was attention to the low power appearances of distorted lobular units in the areas of malignancy and comparison with surrounding breast tissue which usually showed recognizable sclerosing adenosis. The use of immunohistochemical stains for myoepithelium (α‐actin and S‐100 protein) and for basement membrane (collagen type IV and laminin) proved to be of considerable value in identifying the preservation of these features around glandular structures in areas of sclerosing adenosis containing in situ carcinoma.
Atrophic variants of dermatofibroma and dermatofibrosarcoma protuberans
Authors: ZELGER B.W. , ÖFNER D. , ZELGER B.G.
Published: April 2007

Dermal atrophy of more than 50% of the locoregional dermis may be the predominant histopathological feature in dermatofibroma and dermatofibrosarcoma protuberans. This may cause diagnostic difficulties. In the present study 26 cases of atrophic dermatofibroma were compared with three cases of atrophic dermatofibrosarcoma protuberans. Clinically, both conditions mostly occurred on the (upper) trunk of females. While atrophic dermatofibroma usually presented as a reddish, umbilicated lesion (0.5–1‐cm), often suspected to be a basal cell carcinoma, atrophic dermatofibrosarcoma protuberans showed irregularly arranged tan‐brown plaques (3–6 cm). Histologically, atrophic dermatofibroma showed a regular silhouette with a smooth nodular (9/26) or scalloped lower margin with an intervening lace‐like pattern of superficial fatty tissue infiltration (17/26) and variable sclerosis; atrophic dermatofibrosarcoma protuberans showed a deep, irregular infiltration of fatty tissue in a lacelike/honeycomb and/ or multilayered pattern, but no sclerosis. Immunohistochemically, atrophic dermatofibroma was mostly negative with QBEnd 10 (CD34; 24/26), variably positive for factor XIIIa (20/26) and metallothionein (11/26). Labelling for factor XIIIa and metallothionein was usually seen in ‘early’ (metabolically active) lesions, while ‘late’ sclerotic ones were negative. In contrast to atrophic dermatofibroma all three atrophic dermatofibrosarcoma protuberans showed a consistently uniform profile: CD34 positive, factor XIIIa and metallothionein negative. Our study delineates atrophic dermatofibroma and atrophic dermatofibrosarcoma protuberans as distinct entities clearly distinguishable from each other by clinicopathologic criteria.
Primary pulmonary non‐Hodgkin's lymphomas
Authors: FICHE M. , CAPRON F. , BERGER F. , GALATEAU F. , CORDIER J‐F. , LOIRE R. , DIEBOLD J.
Published: April 2007

We report a retrospective study of the pathological features in 69 primary pulmonary non‐Hodgkin's lymphomas which have previously been clinically reviewed. The tumours consisted of 61 (88%) low‐grade and eight (12%) high‐grade malignant lymphomas. Fifty‐four of the low‐grade malignant lymphomas were MALT lymphomas. Lymphoepithelial lesions were observed in bronchial, bronchiolar and alveolar lining. All tumours were composed of nodules, forming a lymphangitic pattern at the periphery and a confluent central mass. Invasion of pleura and vessels was often seen but this without any consequence on survival. Granulomas were found in 20% of cases. Six of the eight high‐grade tumours were centroblastic and another two were B‐cell lymphomas of undetermined type. In four cases, associated areas of low‐grade malignant lymphoma with lympho‐epithelial lesions indicated a preexisting MALT lymphoma. Clinical data suggest that limited surgery or non‐aggressive chemotherapy can provide long‐term survival in patients with such slowly developing neoplasms. However, non‐invasive diagnostic methods need to be developed.
Transitional cell carcinoma of the bladder: low incidence of human papillomavirus DNA detected by the polymerase chain reaction and in situ hybridization
Authors: LOPEZ‐BELTRAN A. , MUÑOZ E.
Published: April 2007

Viral studies on mammalian urothelium have shown an association between the bovine papillomavirus and cancer of the bladder in cattle. However, the evidence for human papillomavirus (HPV) involvement in urinary bladder in man is less clear. The aim of this study was to investigate the association between HPV DNA and transitional cell carcinoma of the bladder, using the highly sensitive polymerase chain reaction (PCR) and non‐isotopic DNA in situ hybridization on formalin‐fixed paraffin‐embedded tissues from 76 patients. An HPV type specific set of primers was localized on the E6‐gene for HPV 16/18 DNA. The second and third set of primers were specific for HPV 6/11 DNA. A biotinylated DNA probe which recognizes HPV 6/11, 16/18, and 31/33/35 was used for in situ hybridization. Of the 76 cases investigated, PCR analysis showed positive signals in seven (9.2%) of cases–six for HPV 16 DNA, and one for HPV 16 DNA and HPV 6 DNA. Four (5.2%) were also reactive for HPV 16/18 DNA using in situ hybridization. Most transitional cell carcinomas (71.4%) associated with HPV DNA were of high pathological grade/stage. One case had koilocytosis. Our results suggest that HPV DNA in transitional cell carcinoma is probably a rare occurrence, although the finding of the high risk HPV 16 DNA may indicate a role for it in this tumour's aetiology.
Solitary and generalized variants of spindle cell xanthogranuloma (progressive nodular histiocytosis)
Authors: ZELGER B.W.H. , STAUDACHER CH. , ORCHARD G. , WILSON‐JONES E. , BURGDORF W.H.C.
Published: April 2007

Twelve cases of solitary spindle cell xanthogranuloma, seven of which had originally been misdiagnosed as dermatofibroma/benign fibrous histiocytoma, were clinicopathologically compared with four cases of progressive nodular histiocytosis, a rare generalized non‐X histiocytic disorder. Clinically, a single brown‐yellowish papule or nodule is characteristic of solitary spindle cell xanthogranuloma, multiple generalized lesions of progressive nodular histiocytosis. Solitary spindle cell xanthogranuloma occurs with decreasing frequency on the head, neck, upper trunk, or occasionally the extremities of young adults (aged 20–40 years), progressive nodular histiocytosis mostly on the trunk of older patients (aged 40–60 years), both without sex predilection. Histologically, both entities are characterized by predominance (> 90%) of spindle‐shaped histiocytes arranged in a storiform pattern. Other mononuclear (vacuolated, xanthomatized, scalloped, oncocytic) and multinucleate (Touton) histiocytes are also regularly seen. Immunohistochemically, both entities exhibit a macrophage/dendritic cell lineage positive for KP1/Ki‐M1p (CD68), HAM 56 and factor XIIIa as well as for smooth muscle specific actin and HHF35. Ultrastructurally, dense, regularly laminated, myeloid or pleomorphic cytoplasmic inclusions may be found, but no Birbeck granules are present. This study documents that both solitary spindle cell xanthogranuloma and progressive nodular histiocytosis are distinct entities within the spectrum of a xanthogranulomatous reaction characterized by predominance of spindle‐shaped histiocytes.
Evaluation of clonal immunoglobulin heavy chain rearrangements in Hodgkin's disease using the polymerase chain reaction (PCR)
Authors: MANZANAL A. , SANTON A. , OLIVA H. , BELLAS C.
Published: April 2007

We have correlated histologic type of Hodgkin's disease, degree of Hodgkin and Reed‐Sternberg cell infiltration, percentage of Hodgkin and Reed‐Sternberg cell positivity for latent membrane protein, immunophenotype of Hodgkin and Reed‐Sternberg cells, and immunoglobulin heavy chain (IgH) gene rearrangements detected by polymerase chain reaction (PCR) in 56 unselected Hodgkin's disease cases. Two protocols were used for amplification of IgH gene using Fr2 or Fr3 V‐region primers, in conjunction with nested primers directed to the JH region. PCR products were run on polyacrylamide gels. Immunohistochemical studies were performed on paraffin sections using monoclonal antibodies for CD20 and latent membrane protein, and polyclonal antibody to CD3. Using both primer combinations we detected a definitive clonal band in 23.2% of the Hodgkin's disease cases. Clonal IgH rearrangements were detected in 23.6% of nodular sclerosis type and in 28.5% of mixed cellularity type. Using a highly sensitive method such as PCR, more than 20% of unselected cases of Hodgkin's disease were found to contain B‐cell clonal proliferations, but there was no correlation between histological and immunological parameters and molecular analysis results.
Hepatocellular prolapse of hepatic portal tracts and subendothelial space of central veins in idiopathic portal hypertension
Authors: SASAKI M. , NAKANUMA Y. , WATANABE K.
Published: April 2007

We report a case of idiopathic portal hypertension (IPH) with unusual liver pathology. The liver showed changes similar to these previously reported in IPH and, in addition, we observed the unusual features of prolapse of hepatocytes into portal tracts and also into the subendothelial space of hepatic veins. Hepatocyte prolapse into hepatic veins has previously been reported only in patients with a history of androgenic steroid therapy and immunosuppressive therapy. We speculate that, in our case, prolapse of hepatocytes could be related to the abnormal intrahepatic blood flow or to intrahepatic vasculopathy.
Botryomycosis of the liver
Authors: OMAR T. , COOPER K.
Published: April 2007

A case of visceral botryomycosis of the liver in a 50‐year‐old man is reported. The clinical diagnosis was hepatocellular carcinoma. Pathological examination of the surgically resected specimen demonstrated microabscesses containing gram‐ positive microorganisms with surrounding fibrosis replacing liver parenchyma. An immune deficiency state was not demonstrated. Recognition of this condition is important because of its clinical confusion with malignancy and its histological similarity to actinomycosis, nocardia, and eumycotic infections.
Comparison of ploidy analysis by flow cytometry and image analysis in hydatidiform mole and non‐molar abortion
Authors: JEFFERS M.D. , MICHIE B.A. , OAKES S.J. , GILLAN J.E.
Published: April 2007

Determination of DNA ploidy is useful in the diagnosis and classification of hydatidiform mole. Most reports of ploidy analysis in molar tissue have used DNA flow cytometry. Although image analysis cytometry offers theoretical advantages over flow cytometry, there have been few reports of ploidy analysis by image analysis in hydatidiform mole. We selected 47 cases and measured DNA ploidy by flow cytometry and image analysis cytometry in complete hydatidiform mole, partial hydatidiform mole and non‐molar abortion. The two cytometry modalities were compared using kappa statistics. There was reasonable overall agreement between the two modalities (κ= 0.69) and when ploidy was stratified into diploid/polyploid and triploid categories there was near perfect agreement (κ= 0.93). Aneuploid cell populations, which were not evident on flow cytometry, were identified by image analysis in a significant proportion of complete and partial hydatidiform moles and in a small number of non‐molar abortions. Flow cytometry and image analysis cytometry yield comparable ploidy information, useful in the diagnosis and classification of hydatidiform mole. Image analysis cytometry offers greater sensitivity in the detection of small non‐diploid cell populations but the significance of this latter finding is uncertain.
Calcium oxalate crystal deposition in epithelioid histiocytes of granulomatous lymphadenitis: analysis by light and electronmicroscopy
Authors: SYMMANS P.J. , BRADY K. , KEEN C.E.
Published: April 2007

In this study of 55 cases of granulomatous lymphadenitis of various aetiologies, both haematoxylin and eosin stained and unstained sections were examined by light and polarizing light microscopy for crystals within epithelioid histiocytes. This investigation was prompted by a case of granulomatous lymphadenitis in which the identification of ovoid birefringent structures within epithelioid histiocytes led to an initial false suggestion of foreign body reaction. Identical single, small, ovoid or biconvex, intensely birefringent crystals, invisible by ordinary light microscopy, were found within the cytoplasm of mononuclear epithelioid histiocytes in 37 cases. There was only minor crystal loss with routine H & E staining. The sections were also examined by scanning electronmicroscopy in secondary and backscattered electron imaging modes and 27 cases were found to contain biconvex crystals which were shown on X‐ray energy dispersive spectroscopic microanalysis to be consistent with calcium oxalate. There was a good quantitative correlation between light and scanning electron microscopy. Tissue from the index case was also examined by transmission electronmicroscopy, and electron dense crystals were identified. We confirm the previous findings of ovoid oxalate crystals in a variety of granulomatous conditions including Mycobacterial infection, sarcoidosis and Crohn's disease. Ovoid crystals of calcium oxalate, a common finding in granulomatous lymphadenitis, appear to be endogenously derived, and should be more widely recognized in order to avoid misdiagnosis of foreign body reaction.
DNA flow cytometric and immunohistochemical analysis of proliferative activity in spindle cell haemangioendothelioma
Authors: HISAOKA M. , KOUHO H. , AOKI T. , HASHIMOTO H.
Published: April 2007

Although spindle cell haemangioendothelioma was initially described as a low‐grade angiosarcoma, recent reports have suggested that it is a reactive or benign vascular proliferation. In order to assess the proliferative activity in spindle cell haemangioendothelioma, 12 cases, one of which was associated with Maffucci's syndrome, were immunohistochemically analysed with antibodies against proliferating cell nuclear antigen (PCNA), Ki‐67 and p53. DNA flow cytometry was performed on six of the 12 cases. Seven of the 12 patients had multiple nodules or papules. Although two cases recurred once and twice, respectively, after surgery, there was no evidence of metastasis. Immunohistochemically, the percentages of PCNA, Ki‐67 and p53 positive tumour cells ranged from 0.1% to 6.4% (mean 3.3%), 0.1% to 14.9% (3.5%) and 0.1% to 2.8% (1.1%), respectively, indicating a low proliferative activity and a low p53 expression in this tumour. All seven lesions from the six cases examined flow cytometrically were DNA diploid with proliferative indices (S + G2/M‐phase fractions) ranging from 4.9% to 19.5% (mean, 10.9%). These findings are compatible with a bland‐looking histological picture and an indolent clinical course of spindle cell haemangioendothelioma.
A comparative study of the value of immunohistochemistry and the polymerase chain reaction in the diagnosis of follicular lymphoma
Authors: ASHTON‐KEY M. , DISS T.C. , ISAACSON P.G. , SMITH M.E.F.
Published: April 2007

We have compared the value of immunohistochemical and polymerase chain reaction (PCR) techniques in distinguishing follicular hymphoma from follicular hyperplasia in formalin‐fixed paraffin‐embedded tissues of 41 follicular lymphomas, 15 reactive lymph nodes and 5 reactive tonsils. Immunohistochemistry demonstrated bcl‐2 protein in the follicle centre cells of 97% of follicular lymphomas whereas monoclonal immunoglobulin light chain was detected in 83% of cases. Assessing the lowest proliferating follicle of each case by MIB‐1 immunostaining, proliferation fractions in the lymphomas varied from 0.5% to 59% (mean 15.6%). Over 80% of lymphomas had proliferation fractions of less than 25%. PCR detected gene rearrangement either at the bcl‐2 locus, or at the IgH locus, or at both loci in 32%, 44% and 61% of lymphomas, respectively. The follicle centre cells of the reactive lymph nodes and tonsils were all bcl‐2 protein negative and polytypic for kappa and lambda light chains. Proliferation fractions of the lowest proliferating follicle in each reactive case ranged from 30.5% to 86.8% (mean 64.9%). Rearrangements of the bcl‐2 or IgH loci were not detected in any reactive case. This study demonstrates that bcl‐2 and light chain immunostaining are the most consistently helpful aids to diagnosing follicular lymphoma. A low proliferation fraction also indicates lymphoma but a high proliferation fraction does not exclude the diagnosis. Immunostaining with a combination of anti bcl‐2 and MIB 1 antibodies is a sensitive and specific method for identifying follicular lymphoma, is technically simple to perform and easy to interpret. In occasional cases, where immunostaining gives equivocal results, PCR analysis can confirm lymphoma, but a negative result does not exclude the diagnosis.
Pancreatic metaplasia of the human gastric mucosa is associated with high expression of transforming growth factor α but not of epidermal growth factor
Authors: STACHURA J. , KONTUREK J. , URBAŇZYK K. , BOGDAL J. , DOMSCHKE W.
Published: April 2007

Pancreatic acinar metaplasia of the gastric mucosa is a newly recognized entity. Its physiological relevance and association with other pathological conditions in the stomach remain to be elucidated. We studied by immunohistochemistry the expression of growth markers in the gastric mucosa in biopsies from 15 patients with recognized pancreatic metaplasia. Pancreatic metaplasia (both acinar and dispersed forms) was found in routine paraffin sections and confirmed by strong lipase immunoreactivity. In parallel paraffin sections we performed immunostaining for epidermal growth factor (EGF), transforming growth factor‐α (TGFα) and epidermal growth factor receptor (EGFr) using a biotin streptavidin method. Strong expression of TGFα but only weak expression of EGF was noted within metaplastic mucosa. EGFr was strongly expressed, not only in areas of pancreatic metaplasia but also in the surrounding gastric mucosa.
Melanin production in medullary thyroid carcinoma
Authors: ROMDHANE K. BEN , KHATTECH R. , OTHMAN M. BEN , GAMOUDI A. , AMMAR A. , CAMMOUN M.
Published: April 2007

A case of melanin‐producing medullary thyroid carcinoma is reported in a 51‐year‐old man. Histologically, the tumour had a typical pattern of medullary thyroid carcinoma with numerous scattered pigmented cells which contained large amounts of melanin pigment as confirmed by bleached Fontana‐Masson stain. Immunohistochemical staining revealed positivity of almost all tumour cells for calcitonin and chromogranin, whereas S‐100 protein and HMB‐45 staining was positive only in the pigmented tumour cells. This finding confirms the ability of medullary thyroid carcinoma cells to have multidirectional differentiation, although melanocytic differenciation remains an exceptional phenomenon.
Histopathology of gastroduodenal inflammation: the impact of Helicobacter pylori
Authors: WYATT J.I.
Published: April 2007

In this article the histological features of acute and chronic gastritis are reviewed. The histopathological gastric biopsy report can now encompass an aetiological, topographical (when antrum and corpus are sampled) and morphological comment on the gastric mucosa. The degree of detail included in the report (e.g. grading of the severity of inflammation, atrophy, density of Helicobacter pylori) will vary according to local requirement. However, the distinct recognisable patterns of inflammation categorised in the Sydney system provide a common terminology for a succinct diagnosis. The overall condition of the patient's gastric mucosa assigns him/her to one of the H. pylori‐positive or negative categories of chronic gastritis. This may not only have relevance to current clinical management, but may be a valuable record if the patient returns with dyspeptic symptoms in the future. For example, duodenal ulcers are unlikely to develop except in patients with antrum predominant H. pylori‐associated gastritis. Knowledge of the natural history of different types of gastritis is rapidly evolving, and the biopsy provides a permanent ‘snapshot’ of the state of the gastric mucosa at the time of the endoscopy.
Immunohistochemical staining patterns of keratins in normal oesophageal epithelium and carcinoma of the oesophagus
Authors: TAKAHASHI H. , SHIKATA N. , SENZAKI H. , SHINTAKU M. , TSUBURA A.
Published: April 2007

To clarify the keratin staining patterns of invasive carcinoma of the oesophagus, 22 cases of formalin‐fixed paraffin‐embedded surgical specimens were examined immunohistochemically with the labelled streptavidin biotin method using a panel of six different monoclonal anti‐keratin antibodies. The antibody reacted adequately when antigen was retrieved in a microwave oven, and the relationship between morphological characteristics and keratin reaction patterns was analyzed in carcinomas and compared with adjacent histologically normal epithelium. In the normal oesophageal epithelium, AE3 and CK8.12 labelled all layer of cells, KS‐1A3, E3 and KL1 labelled suprabasal cells, and LL002 selectively labelled the basal cells. In squamous cell carcinomas, AE3, CK8.12, KL1 and LL002 labelled almost all the tumour cells regardless of their differentiation, E3 only labelled keratinized cells, while marked decrease or loss of KS‐1A3 staining was seen in all cases examined. Therefore, the characteristic profile of squamous cell carcinoma was a strong and diffuse expression of keratin 14 and 16, strong but localized expression of keratin 17, and loss of keratin 13 expression. Undifferentiated carcinoma totally lacked all keratin reactivity. The findings suggested that the neoplastic epithelial cells showed different keratin reactivity and distribution compared to normal oesophageal epithelium. In addition, histologically normal epithelium, dysplasia and carcinoma‐in‐situ adjacent to or overlying carcinoma expressed keratin 14.
Distribution of extracellular matrix components and their receptors in human lymphoid tissue and B‐cell non‐Hodgkin lymphomas
Authors: JASPARS L.H. , BLOEMENA E. , BONNET P. , VALK P. VAN DER , MEIJER C.J.L.M.
Published: April 2007

In this study the distribution patterns of various extracellular matrix components and their receptors (i.e. β1 integrins) in B‐cell non‐Hodgkin lymphomas were examined and compared to those in reactive lymphoid tissue. Neoplastic follicles within follicular lymphomas showed similar patterns to that observed in reactive follicles, which appeared to be strongly associated with the presence of follicular dendritic cells. Diffuse lymphomas of low and intermediate malignancy grade revealed features comparable to those of interfollicular areas of reactive lymphoid tissue, irrespective to which compartment the tumour cells were related. Highly malignant lymphomas, however, displayed unique extracellular matrix configurations, resulting from active matrix degradation by macrophages; this may support rapid tumour growth. Extranodal lymphomas showed virtually the same matrix patterns as their nodal counterparts, suggesting that (malignant) lymphoid cells generate (at least partly) their own specific microenvironment. In reactive lymphoid tissue β1 integrins were mainly found on resident cells and except for α4, α5 (and β1) the lymphoid cells expressed very little, if any, β1 integrins. In comparison, expression of these integrins on lymphoma cells was reduced (follicular lymphomas) or could not be detected at all (diffusely growing lymphomas); this might contribute to the growth pattern and metastatic properties of the tumours.
Expression of proliferating cell nuclear antigen (PCNA) and Ki‐67 in unicystic ameloblastoma
Authors: LI T‐J. , BROWNE R.M. , MATTHEWS J.B.
Published: April 2007

The expression of proliferating cell nuclear antigen (PCNA) and Ki‐67 was studied in unicystic and solid ameloblastoma (follicular and plexiform types) using a biotin‐streptavidin method on routinely processed paraffin sections. To determine percentage PCNA and Ki‐67 labelling indices, positive tumour cells and total tumour cells were counted in areas of each unicystic ameloblastoma corresponding to cystic linings, intraluminal nodules and invading tumour islands, and in solid ameloblastomas. Positive cells in basal and suprabasal layers of cystic tumour lining were also counted with respect to the length of basement membrane determined by image analysis. In unicystic ameloblastoma the invading islands exhibited a significantly higher PCNA labelling index (29.2 ± 16.4%) than intraluminal nodules (13.6 ± 5.4%; P < 0.05). Cystic tumour lining had relatively few PCNA positive cells and a labelling index (5.5 ± 3.3%) significantly lower than invading islands (P < 0.001) or intraluminal nodules (P < 0.003). The labelling indices of solid ameloblastomas of follicular type (48.1 ± 12.9%) were significantly higher than those of cystic tumour lining (P < 0.0001), intraluminal nodules (P < 0.001) and invading islands (P < 0.04) in unicystic ameloblastoma. Similar relationships were found for Ki‐67 expression except that comparisons involving invading islands and intraluminal nodules were not significant, a finding probably due to the smaller number of specimens available for quantitative analysis. These results indicate differences in proliferative potential between different areas of unicystic ameloblastoma and between unicystic and solid lesions. The fact that invading tumour islands within the fibrous tissue wall showed high labelling indices is in agreement with the clinical observation that their presence may be related to recurrence after conservative surgery. This provides a biological basis for indicating more radical surgical excision as the treatment of choice for this subgroup of lesions.
Large cell calcifying Sertoli cell tumour of the testis
Authors: PLATA C. , ALGABA F. , ANDÚJAR M. , NISTAL M. , STOCKS P. , MARTÍNEZ J.L. , NOGALES F.F.
Published: April 2007

Five cases of large cell calcifying Sertoli cell tumour of the testis not associated with complex dysplastic syndromes are reported. The age of the patients ranged from 13 to 34 years and all the tumours were histologically similar, having large, isomorphic, non‐mitotic, eosinophilic Sertoli cells with foci of calcification. Flow cytometry demonstrated the cells to be diploid or hypodiploid. All cases were positive for vimentin and focally positive for low molecular weight keratin. The present cases, together with a review of the 22 previously reported tumours, demonstrate that there are two clear cut types of large cell calcifying Sertoli cell tumour; those which are associated with complex dysplastic syndromes and which are bilateral and multifocal, and those which are not associated and are unilateral and focal. Prognosis in all of our cases was uniformly good despite invasion of the rete testis in two cases. It is considered that conservative resection of the tumour is the treatment of choice in cases not associated with complex dysplastic syndromes, since the malignancy rate is low.
Salivary duct carcinoma
Authors: GRENKO R.T. , GEMRYD P. , TYTOR M. , LUNDQVIST P‐G. , BOERYD B.
Published: April 2007

Twelve cases of salivary duct carcinoma were examined clinically, pathologically and by flow cytometry to quantify their histological features as well as attempt to identify factors predictive of patient outcome. All of the tumours arose in the parotid gland. Eight of the twelve patients were male. Four patients died of disease (median survival 12.5 months); three are alive with disease; and five are alive with no evidence of disease (mean follow‐up of 50 months). Two tumours arose in a pre‐existing pleomorphic adenoma. Positive lymph nodes were present in eight of ten patients sampled; patients with two or more positive lymph nodes tended to die of their disease or be alive with metastases. Comedo necrosis, perineural invasion and vascular invasion were common findings by light microscopy. Ten of the twelve tumours were aneuploid. Neither clinical stage, tumour size, aneuploidy nor histological features correlated with patient outcome. This study confirms the aggressive nature of salivary duct carcinoma.
Melanotic oncocytic metaplasia of the nasopharynx
Authors: SHEK T.W.H. , LUK I.S.C. , NICHOLLS J.M. , FOK K.O.
Published: April 2007

Two cases of melanotic oncocytic metaplasia occurring in the nasopharynx are reported. One presented with serous otitis media and the other with tinnitus. Nasoscopic examination revealed a small brown nodule obstructing the Eustachian tube in both cases. While oncocytic metaplasia of the nasopharynx is not too uncommon, melanin pigmentation of the nasal or nasopharyngeal mucosa is very rare. To our knowledge, their combination has not been described.
Recent trends in haemodialysis: Australia 1994
Authors: KERR Peter G
Published: April 2007

Summary: Haemodialysis in Australia is mostly practiced without many of the innovations seen in the USA and Europe. Home haemodialysis is common, high‐flux dialysis is uncommon and 4 h dialysis is the norm.

This review examines the practice of haemodialysis in Australia, reflected in an annual mortality for dialysis patients of 11%. Issues of dialysis adequacy and biocompatibility are only just beginning to influence dialysis techniques in Australia and to this end the author's personal recommendations are put forward as suggestions regarding a sensible approach to Kt/v, biocompatibility, water quality and dialyser reuse.
Enhanced renal perfusion improves function in severe nephrosis with focal segmental glomerulosclerosis
Authors: FUTRAKUL Prasit , FUTRAKUL Narisa , SITPRIJA Visith
Published: April 2007

Summary: Fourteen cases of severe steroid‐resistant nephrosis with focal segmental glomerulosclerosis were identified by the moderate to severe impairment of glomerular function. Symptoms included low glomerular filtration rate, ultrafiltration coefficient and increased intraglomerular hydrostatic pressure, tubular dysfunction including a defect in transporting solute, which was reflected by increasing fractional excretion of filtered solutes, in concentrating and acidifying the urine, and vascular dysfunction including marked elevation of renal arteriolar resistances and inversely severe reduction of renal plasma flow and peritubular capillary blood flow.

Of these 14 nephrotics, eight patients were randomly treated with prednisolone, cyclophosphamide and antihypertensive agents, namely reserpine, hydralazine or prazosin, and the other six patients who had previously been resistant to prednisolone and cyclophosphamide were treated with an enhanced‐renal‐perfusion formula that consisted of a combination of antiplatelet agents, calcium channel blockers, angiotensin‐converting‐enzyme inhibitors, anticoagulant and prednisolone.

After follow‐up of 62 months, all eight patients were refractory to the conventional treatment, showing persistent proteinuria with a progressive deterioration of renal function entering end‐stage renal disease. In contrast, five of the six patients under the enhanced‐renal‐perfusion formula gradually improved their renal functions and survived after 82 months of follow‐up. the remaining patient, who did not improve, died of sepsis.
Lipoprotein (a): Relationship to vascular disease in dialysis and renal transplantion
Authors: POLLOCK Carol A , IBELS Lloyd S , ONG Colin S , CATERSON Robyn J , WAUGH David A , MAHONY John F
Published: April 2007

Summary: Serum lipids and lipoprotein (a) concentrations were measured in 91 renal transplant and 60 dialysis patients and correlations sought with clinically evident vascular disease. Serum lipoprotein (a) concentrations were greater than 300 mg/L in 24% of the renal transplant recipients and 40% of the dialysis patients. In the renal transplant recipients, low high density lipoprotein (HDL) cholesterol (P<0.05) and high total cholesterol to HDL cholesterol ratio (P<0.01) were more strongly associated with the presence of vascular disease than was elevated lipoprotein (a). In the dialysis patients, a low serum albumin (P<0.05) and low serum creatinine (P<0.001), indicative of a poor nutritional state, were associated with the presence of vascular disease. A high total serum cholesterol to HDL cholesterol ratio (P<0.05) was indicative of ischaemic heart disease, and high total serum cholesterol (P<0.01) and low density lipoprotein (LDL) cholesterol (P<0.01) of cerebrovascular disease. In the subpopulation on CAPD, elevated lipoprotein (a) levels were associated with cerebrovascular disease (P<0.01). the present study demonstrates that an elevation in serum lipoprotein (a) concentration is not as strongly associated with the presence of vascular disease in patients with end‐stage renal failure as are the total serum cholesterol, HDL and LDL cholesterol and the ratio of total cholesterol to HDL cholesterol.
Azathioprine induced myelosuppression in renal transplant recipients: A study of 30 patients
Authors: SAKHUJA V , JHA V , KALRA OP , VARMA S , VARMA N , MARWAHA N , CHUGH KS
Published: April 2007

Summary: Administration of azathioprine (Aza) to renal transplant recipients is not infrequently complicated by myelosuppression, but most studies have evaluated only the effects of short‐term administration of the drug. There is a lack of data on the frequency and outcome of myelosuppression after long‐term administration of Aza. In a retrospective analysis of 210 live related renal transplant recipients on azathioprine, a total of 33 episodes of myelosuppression were encountered in 30 (14.3%) patients. Myelosuppression occurred 2 weeks to 67 months (mean 16.8 ± 16.7 months) after starting Aza therapy. Whereas 30.3% of the episodes were noted within 2 months of starting Ma, 69.7% developed after this period. Leucopenia (n= 31) was the most frequent finding, followed by anaemia (n= 18) and thrombocytopenia (n= 16). There were 12 episodes of pancytopenia and one patient developed pure red cell aplasia. Bone marrow examination (n= 12) revealed hypocellularity and moderate megaloblastosis. A higher cumulative dose of Aza was associated with more prolonged myelosuppression. Following discontinuation of Aza, 20 patients recovered after periods varying from 2 weeks to 9 months (mean 2.6 ± 2.4 months). In three patients, myelosuppression persisted for over 12 months and was presumably irreversible. Seven patients died within 2 months of development of myelosuppression. Presence of pancytopenia, a total leucocyte count less than 2000/mm3 and graft dysfunction predicted a fatal outcome. Reinstitution of Aza in a lower dose was followed by a second episode of myelosuppression in three out of 12 (25%) patients.

We conclude that a high cumulative Aza dose increases the risk of development of prolonged myelo suppression. Development of irreversible myelosuppression, as noted in three patients, has not been reported previously. Reinstitution of Aza should preferably be avoided in patients who have recovered from an episode. of prolonged myelosuppression.
Endothelin‐1 affects AVP‐stimulated cAMP but not ANP‐induced cGMP productions in cultured rat IMCD cells
Authors: ONO Shuichi , KUSANO Eiji , AMEMIYA Morimasa , AKAI Yoichi , TAKEDA Shigeyuki , ANDO Yasuhiro , HOMMA Sumiko , ASANO Yasushi
Published: April 2007

Summary: The present study was undertaken to explore a potential interaction of endothelin‐1 (ET‐1) on vasopressin (AVP)‐dependent cyclic 3′,5′‐adenosine monophosphate (cAMP) and atrial natriuretic peptide (ANP)‐dependent cyclic 3′,5′‐guanosine monophosphate (cGMP) metabolisms in primary cultured rat inner medullary collecting duct (IMCD) cells. Endothelin‐1 did not affect ANP‐stimulated cGMP accumulation in the presence or absence of 3‐isobutyl‐1‐methylxanthine (IBMX). Levels of 10−10 to 10−7 mol/LET‐1 showed a dose‐dependent inhibition of the AVP‐dependent cAMP accumulation in the presence of IBMX and 10−7 mol/LET‐1 inhibited the cAMP generation by 34 ± 5.3% (n= 5, n= 20, P<0.01). Endothelin‐1 did not affect the cAMP generation either by 100 ng/mL cholera toxin or by 10−4 mol/L forskolin. Endothelin‐1 failed to inhibit the cAMP generation in the presence of 100 ng/mL pertussis toxin (PTX). the inhibitory effect of ET‐1 was reversed by 10−8 mol/L staurosporin (SSP), a protein kinase C (PKC) inhibitor. Furthermore, this inhibitory effect of ET‐1 was mimicked by 10−8 mol/L phorbol 12‐myristate 13‐acetate (PMA), an activator of PKC. A dose of 5 × 10−6 mol/L indomethacin did not affect this inhibitory effect of ET‐1. From these results, we suggest that the effect of ET‐1 on cyclic nucleotides metabolism seem to be selective. Endothelin‐1 did not affect the cGMP generation by ANP, whereas it inhibited cAMP production by AVP via PTX and SSP sensitive pathway in cultured rat IMCD cells.
Studies of glomerular protein content in the diabetic hypertensive rat: the effect of antihypertensive therapy
Authors: MAKARIOUS Malak M , DUGGAN Karen A , ZIMMERMAN Shantay E , MACDONALD Graham J , CHARLESWORTH Jraham A
Published: April 2007

Summary: The effects of enalapril and verapamil on glomerular protein content, fractional mesangial area and glomerular basement membrane (GBM) thickness were examined in spontaneously hypertensive rats with streptozotocin‐induced diabetes. Two groups of 16 animals received enalapril maleate or verapamil to achieve normal blood pressure while a third untreated group remained hypertensive throughout the 3 month experimental period. Blood glucose levels were maintained at 6–10 mmol/L in each group. Creatinine clearance and 24 h urine protein were measured at second weekly intervals. Glomerular protein and other structural parameters were measured at the end of the experiment. Plasma angiotensin II (AII) and glomerular All receptors were also quantitated at the end of the experiment. At 3 months, proteinuria was lowest in the enalapril‐treated animals while creatinine clearance was lower in the treated groups than controls. Glomerular protein content (μg/glomerulus) was lower in the enalapril‐treated group than verapamil‐treated (P<0.01) or untreated rats (P<0.05). Kidney weight, GBM thickness and fractional mesangial area were also lowest in this group (P<0.001 compared to other groups). Glomerular All receptor number was comparable among groups when expressed as sites/glomerulus. the data suggest that enalapril reduces glomerular protein content independently of blood pressure control and that this effect corresponds with changes in mesangial area and GBM thickness.
Infrafamilial infection with hepatitis C virus
Authors: CHEN Wan‐Yu
Published: April 2007

Summary: A review of the epidemiology of hepatitis C infection, as well as our experience, shows that intrafamilial infection is common. Screening of the family of infected individuals will be important in preventing further spread.
The endothelin system in the kidney
Authors: KARET Fiona E , PDAVENPORT Anthony
Published: April 2007

Summary: The most potent endogenous vasoconstrictors described, the endothelins, exert a variety of effects in the kidney, but their true pathophysiological role remains elusive. This review describes the renal endothelin system with special reference to man, discusses some pharmacological tools for its investigation, and outlines its potential pathophysiological involvement.
Evaluation of erythrocyte morphology in the urinary sediment for the differential diagnosis of haematurias using standard light microscopy
Authors: COSTA Roberto S , SOUZA Rosely M BESSA e , FRANCO Paulo B , DANTAS Márcio , GOMES Uilho A , DOS REIS Marlene A
Published: April 2007

Summary: The glomerular or non‐glomerular origin of haematuria can be identified by the morphologic study of red blood cells in the urine. In the present study, we report the results obtained by the morphologic study of red blood cells in the urine of 39 patients: 22 with glomerular diseases and 17 with extra‐glomerular diseases. In a blind study, we used conventional light microscopy, lowering the condenser lens to obtain a picture similar to that provided by phase contrast microscopy, an original strategy not previously reported in the literature. the highest specificity (100%) while maintaining good sensitivity (90%) was obtained when 70% or more dysmorphic erythrocytes were adopted as a criterion of dysmorphism.
Evaluation of an in‐line dialysate urea monitor including assessment of ‘V’
Authors: KERR Peter G , XIONG Ding Wei , HOWARD Jayne , McGEE Orla , STRAUSS Boyd JG , ATKINS Robert C
Published: April 2007

Summary: Dialysate based assessment of the delivered dose of dialysis offers several advantages over blood sampling methods as it remains accurate in the face of fistula recirculation, urea rebound, variable blood flow and incorrect treatment time. Kr/V is calculated from the slope of the decline in urea concentration in the dialysate over the course of the treatment. By equilibrating dialysate with blood at the initiation of the treatment an estimate of pre‐dialysis blood urea and the volume of distribution for urea (V) can be obtained. We performed Kt/V assessments on 20 in‐centre haemodialysis patients using the Baxter Biostat 1000® dialysate urea monitor and compared the results with urea reduction ratios and Kt/V calculated by the formula of Basile. In addition, in 11 of these patients, V and pre‐dialysis urea was derived and compared to total body water estimates using D2O. the mean Kt/V by Biostat was 1.11 ± 0.23 and by formula was 1.23 ± 0.16 (P < 0.005, Student's paired t‐test). the lab pre‐dialysis urea was 24.4 ± 6.2 mmol/L compared to the Biostat result of 23.9 ± 5.9 (when corrected for plasma water), with the mean difference of the techniques being −0.53 mmol/L. (95% CI −0.36–1.42). For V, the D2O result was 36.7 ± 9.7 litres, compared to the Biostat result of 37.9 ± 9.6. the mean difference of the techniques by Bland and Altman analysis (or bias of the Biostat) was 1.2 L (95% CI −0.9–3.3) and the limits of agreement were −5.2–7.6L. Thus the Biostat provides easy access to dialysis adequacy data and gives a reasonable assessment of V, tending to overestimate this value.
Myofibroblast involvement in renal interstitial fibrosis
Authors: HEWITSON Tim , BECKER Gavin
Published: April 2007

Summary: Interstitial fibrosis is a final common pathway for many, if not all forms of end‐stage renal disease. Although the kidney contains several cell types that are capable of collagen biosynthesis, most in vitro and in vivo studies suggest that fibroblasts generate the principal interstitial matrix collagens. Recent studies have defined a role for myofibroblasts (cells with features of both fibroblasts and smooth muscle cells) in progressive renal interstitial fibrosis. Renal myofibroblasts are hyperproliferative and up‐regulated matrix producers, consistent with them being ‘activated’ fibroblasts. Interstitial myofibroblasts also share a number of anatomical, phenotypic and biosynthetic features with the glomerular mesangial cell. the interstitium consists of a complex mixture of inflammatory and fibrogenic mediators. the fibroblast response to this microenvironment includes chemotaxis, proliferation and increased synthetic activity. However, the derivation and fate of the fibroblast/myofibroblast during scarring remains unclear, with migration, proliferation, differentiation and cell death all likely to determine cell number.
Glomerular expression of lipocortin‐1 in human glomerulonephritis
Authors: KIM Soon Bae , LEE Jong Soo , YANG Won Seok , YU Eunsil , NA Doe Sun , PARK Jung Sik
Published: April 2007

Summary: Lipocortin‐1 (LC‐1), a Ca++‐dependent phospholipid binding protein, is believed to be involved in anti‐inflammatory actions of glucocorticoids. to prove the hypothesis that steroid‐resistant glomerulonephritis would show increased expression of LC‐1, we evaluated the expression of LC‐1 in various types of glomerulonephritis. Frozen samples of seven normal kidneys and 30 kidney biopsy tissues were stained with indirect immunofluorescent method. In the normal tissues, minimal change disease (n=9), lupus nephritis (n=5) and IgA nephropathy (n=6), glomeruli did not stain for LC‐1. Positive reactions for LC‐1 were observed along the peripheral capillary walls in all five patients with membranous nephropathy with out hepatitis B surface antigen (HBsAg). In the patients with membranous nephropathy (MN) who also had chronic liver disease and HBsAg (n=3), only weak reactions for LC‐1 were found along the capillary walls and mesangial area in 1 patient. Patients with membranoproliferative glomerulonephritis (n=2) showed positive reactions for LC‐1 along the capillary walls. Fourteen patients with minimal change disease or lupus nephritis were treated with prednisolone. Ten patients showed substantial reduction of proteinuria, but four patients did not; however, staining for LC‐1 was not negative in the kidney tissues of both steroid‐responsive and steroid‐resistant patients. These findings suggest that LC‐1 does not mediate the action of glucocorticoids in human glomerulonephritis.
Treatment of small vessel vasculitis affecting the kidneys
Authors: CHAN TM , CAMERON JS
Published: April 2007

Summary: Treatment of vasculitis can be divided into two phases: (i) an induction phase to achieve remission, abate destructive inflammation and minimize scarring; and (ii) the maintenance phase to sustain patients in remission with minimal treatment‐related side‐effects. A combination of corticosteroids and cytotoxic agents is commonly used as induction therapy. the dose and route of administration of corticosteroids have not been studied adequately, but intravenous (i.v.) bolus doses of methyiprednisolone are often administered to patients with severe disease. It has the advantage of fewer side‐effects compared to prolonged high dose oral corticosteroids, and the immediate immuno‐modulatory effects of the steroid boluses may confer additional therapeutic benefits. It is the general impression that cyclophosphamide is more effective than azathioprine in the acute phase of patients with severe disease. the use of cyclophosphamide by i.v. pulse rather than orally is contentious, and some recent studies have demonstrated its failure to induce sustained remission. Azathioprine with low dose corticosteroids is often employed as long‐term maintenance immunosuppression, although low dose cyclophosphamide has also been used for such purpose, which should be withdrawn after 1 year of remission because of its potential side‐effects. Clinical and serologic parameters are useful monitors during maintenance therapy. Although serial levels of anti neutrophil cytoplasm antibodies (ANCA) correlate with disease activity, some patients remain well despite positive or increasing levels of ANCA. Consequently, whether immunosuppressive therapy should be esclated based on increasing ANCA Levels along remains controversal.
Critical review of treatment trials in hypertension
Authors: ROBERTSON JIS
Published: April 2007

Summary: Despite numerous deficiencies in some antihypertensive drug treatment trials, and some questionable selections of studies for inclusion in several meta‐analyses, undoubtedly such trials have shown treatment benefits from reducing hypertension. Complications that can be corrected or prevented include malignant hypertension, hypertensive heart failure, stroke and coronary artery morbidity. the all‐cause mortality has been lowered in several trials. the benefits have been seen in subjects aged over 60 years, in women and men, and in patients with isolated systolic hypertension. the benefits have been achieved using a wide range of drugs, not only with beta‐blockers or diuretics. Non‐pharmacological means of lowering blood pressure have not been evaluated in relation to morbidity.