Histologic spectrum of struma ovarii.

Six cases of struma ovarii, including two with associated carcinoid, with unusual microscopic features are described. The patients' age ranged from 22 to 50 years. The patients were clinically euthyroid. The largest tumour was 10 cms. in great dimension. All tumours were unilateral. Microscopically various changes observed in a non-neoplastic thyroid gland were observed in the struma including Hashimotos thyroiditis and goitrous change. Adenomatous foci with microfollicles were observed in one case. A trabecular carcinoid admixed with mucinous glands lined bygoblet cells which were argyrophilic was seen in two of the neoplasms. This finding is rare and has been reported only once before. In conclusion it is important for a pathologist to be aware of the changes that may be associated with struma ovarii, so as not to confuse it with other neoplasms. A careful search for typical thyroid follicles, or other components of a dermoid help to arrive at a diagnosis.

Can we diagnose early Barrett's oesophagus?

OBJECTIVES: The definition of Barrett's oesophagus, has been of late, is stressed on the presence of specialised columnar epithelium with goblet cells and not on other metaplastic epithelia, which however could be the early, immature, undifferentiated cell types such as junctional and gastric types. Hence this study was carried out to find out the ways of detecting the early metaplastic cell forms before the goblet cells appear. METHODS: Among 134 cases of reflux oesophagitis selected in the prospective study of 7 years from January 1992 to December 1998, 31 biopsies were diagnosed as Barrett's oesophagus (BO). These were compared with 20 age matched control biopsies from gastro-oesophageal junction. They were studied morphologically, morphometrically and histochemically for acid, neutral and sulphomucins using alcian blue (AB), alcian blue-periodic acid Schiff (AB-PAS) and high iron diamine-alcin blue (HID-AB) stains. RESULTS: Twelve of the cases were of junctional type, 16 of specialised columnar intestinal metaplastic (IM) type (Type I = 0, Type II = 5, Type III = 11) and three showed a combination of both junctional and Type I IM. Mucins were a mixture of neutral mucin, sialomucin and sulphomucin while the control biopsies showed chiefly neutral mucin. Morphometrically, the epithelial cells in BO were taller (mean 28u in junctional types and 32u in IM) in comparison to the control (mean 24.5 u). CONCLUSION: When the classical specialised columnar epithelium (with goblet cells) in oesophagus is absent, presence of metaplastic junctional type of mucosa, may, for all probabilities be considered as the initial step towards transformation to the classical Barrett's mucosa. In such situations, it is essential to differentiate it from the normal gastro-oesophageal junctional epithelium and is possible with histochemical analysis of the biopsy material aided by morphometry, especially so when the level of biopsy is not indicated.

Post-transplantation epididymitis associated with cytomegalovirus.

Cytomegalovirus (CMV) infection, though usually systemic, has been known to cause localised involvement of organs like lung, liver, testis and gastrointestinal tract. We report a case of cytomegaloviral infection involving the epididymis without systemic manifestations in an young male one month after renal transplantation. The diagnosis was made on histopathologic examination of the epididymo-orchidectomy specimen. Clinical improvement occurred after the emergency epididymo-orchidectomy. To the best of our knowledge, only three cases of CMV epididymitis have been described in the world literature--two in transplant patients and one in an AIDS patient.

Mast cells and macrophages in endometrial lesions.

One hundred and forty cases of endometrial lesions including 128 endometrial polyps, 7 cases of atypical hyperplasia and 5 cases of endometrial carcinoma were studied for mast cells and macrophages. Thirty six uteri with normal cyclic variations served as a control group. A cyclical variation in the mean mast cell value was observed in the control group with an increase in the secretory phase. Endometrial polyps showed a decrease in average mast cell count compared to the proliferative phase controls. Mast cells were significantly decreased in atypical hyperplasia and were absent in endometrial carcinoma. The observations indicate a hormonal basis for the significant variation in mast cell. Their presence probably suggests benign nature of the lesion. PAS positive macrophages were seen only in 4 endometrial polyps, too small for assessment of their significance.

Peanut agglutinin binding by gastric mucosal epithelial cells in Helicobacter pylori associated gastritis.

Gastric biopsies (42) from patients with peptic ulcer disease were classified into Helicobacter pylori positive (32) and negative (10) groups, based on the results of tissue urease test and microscopic demonstration of spiral bacteria. A statistically significant difference in peanut agglutinin (PNA) binding between the two groups was observed, attributable to exposure of sialic acid residues on gastric epithelium in the H. pylori positive group. That the negative binding was due to sialic acid, was further confirmed by application of sialidase digestion technique. These results support the existing biochemical evidence for exposure of sialic acid residues on H. pylori colonized epithelium.

Intestinal metaplasia in benign and malignant gastric lesions.

The purpose of this study has been to determine the prevalence of intestinal metaplasia (IM) and its subtypes in normal, benign and malignant states, with special reference to the significance of presence as well as location of sulphomucins in the metaplastic epithelium. Sixty-seven specimens of the normal, benign chronic gastric disease and gastric carcinoma have been studied. The overall prevalence of IM in gastric carcinoma has been found to be much higher (67 percent) than in the normal (nil) and benign lesions of stomach (11 percent). The sulphomucins producing IM also has a higher prevalence in gastric carcinoma (70 percent) but can occur in benign conditions also (40 percent). On the other hand Type III IM, characterized by sulphomucins in the columnar cells is seen only in gastric carcinoma, and not in the benign lesions.