Disseminated peritoneal leiomyomatosis: a case report.

Disseminated peritoneal leiomyomatosis (DPL) is an exceedingly rare condition that simulates metastatic tumour and mostly occurs in women of reproductive age group subjected to an altered hormonal milieu, usually pregnancy. Here we report a case of a pregnant 28 year female with DPL, spontaneously regressing after pregnancy.

Giardia lamblia trophozoites in gastric biopsies.

To assess the prevalence of gastric giardiasis in gastric biopsies of patients with carcinoma stomach and in patients taking treatment for duodenal ulcer. Gastric biopsy specimens from 54 patients of carcinoma stomach and 100 antral biopsies from patients taking treatment for duodenal ulcer were included in the study. Sections were stained with haematoxylin and eosin, methylene blue and May Grunwald-Giemsa stains and examined for presence of Giardia lamblia trophozoites. Eight out of 54 (14.9%) biopsies of gastric carcinoma patients harboured trophozoites of Giardia lamblia. Associated H. pylori infection was present in all biopsies (8/8; 100%). Atrophy and intestinal metaplasia was present in 62.5% (5/8) and 25% (2/8) cases respectively. Sections from seven out of 35 patients (20%) taking treatment for duodenal ulcer showed presence of G. lamblia. H. pylori infection, gastritis and atrophy were found in 85.7% (6/7), 71.4% (5/7) and 28.6% (2/7) cases respectively. First gastric biopsy in these patients was negative for G. lamblia but 2nd and 3rd biopsies were positive. A careful search for G. lamblia trophozoites should be made while examining the gastric biopsies, especially in patients with carcinoma stomach, intestinal metaplasia, atrophic gastritis and those taking treatment for duodenal ulcer. This may help in indirect diagnosis of clinically unsuspected cases of intestinal giardiasis and may explain persistence of vague upper gastrointestinal tract (UGIT) symptoms despite clearance of H. pylori in patients on anti-ulcer therapy.

Extramedullary blast crisis in chronic myeloid leukemia--a case report.

Presence of focal poliferation of myeloblasts at an extramedullary site even when peripheral blood/bone marrow blast count is less than 20% in a case of chronic myeloid leukaemia leads to a diagnosis of blast crisis. A case of focal extramedullary blast crisis with chronic myeloid leukaemia is reported here.

Pleomorphic lipoma of the tonsillar fossa--a case report.

Pleomorphic lipoma is a benign adipocytic tumor, commonly located in the shoulder and posterior neck region. The presence of bizarre, hyperchromatic stromal cells along with multinucleated giant cells often poses difficulty in diagnosis, especially when it arises at an unusual site like tonsillar fossa.

Inflammatory fibroid polyp of small intestine in a child.

Inflammatory fibroid polyps are rare lesions that are usually solitary and affect adults. We report an inflammatory fibroid polyp in a 7-year-old boy who presented with intestinal obstruction. He recovered after excision of the affected segment of ileum.

Gall stones and carcinoma gall bladder.

One hundred and fifty surgically resected gall bladder specimens were included in the study to evaluate the relationship between the prevalence of gall stones and histochemical alteration in sequential changes of metaplasia, dysplasia and neoplasia in gall bladder epithelium. Multiple sections were processed and stained with haematoxylin and eosin, Periodic acid Schiff's stain, Alcian blue (pH 2.5)/Periodic acid, Orcein/Alcian blue (pH 2.5) and Alcian Blue/Periodic acid/Potassium borohydride saponifications stains. Details of gall stones present were also noted. Prevalence of gall stones in gall bladders with metaplastic, dysplastic and neoplastic mucosal changes was significantly higher (P < 0.001) than those gall bladders which had no epithelial changes. Increase in sialomucin with a corresponding decrease in sulphomucin was observed from metaplasia to malignancy. Neutral mucin increased in metaplastic cells but was significantly reduced in neoplastic cells. Loss of O-acylation in sialmucin was also present in neoplastic cells. The histochemical changes suggest that chronic injury due to cholelithiasis induces appearance of neutral mucin positive metaplastic cells, which may further dedifferentiate to sialomucin containing dysplastic or neoplastic cells if the stimulation persists.

Testicular biopsy in infertility.

Eighty-eight infertile couples attended the infertility clinic. Semen analysis was abnormal in 64 cases. The cases were divided into 3 groups according to sperm count:Group I (count zero), group II (count < 20 million/ml) and group III (20-50 million/ml). The morphology of testicular biopsy categorised into 5 groups were normal--10(15.63%), hypospermatogenesis--42(65.63%), the Sertoli cell only syndrome--2(3.13%), maturation arrest--2(3.13%) and tubular hyalinization--8(12.50%). Quantitative analysis of biopsies was done using mean Johnson score(MJS) and Silber score(SS). The morphology in any single section was not uniform but of mixed type. Normal spermatogenesis in azoospermics indicated bilateral ductal obstruction. As compared to MJS, SS showed a more direct correlation between number of mature spermatids per tubular cross section and sperm count in unobstructed cases.

Effect of helium-neon laser on wound healing.

To estimate the biostimulatory effects of low intensity laser radiation on healing of skin wounds, two linear skin wounds were produced on either side of dorsal midline in rats and immediately sutured. Wounds on the left side were irradiated daily with helium neon laser at 4 Joules/sq.cm for 5 min., while those on right side were not exposed and served as controls. The mean time required for complete closure in control group was 7 days while irradiated test wounds took only 5 days to heal (P < 0.01). The mean breaking strength, as measured by the ability of the wound to resist rupture against force, was found to be significantly increased in the test group. Early epithelization, increased fibroblastic reaction, leucocytic infiltration and neovascularization were seen in the laser irradiated wounds. The results establish the biostimulatory effects of low intensity laser radiation on healing of skin wounds.

Re-classification of carcinoma cervix uteri by mucin histochemistry.

Biopsies of cervix uteri from 166 patients with benign and malignant lesions (12 normal, 48 inflammatory lesion, 6 adenocarcinoma, 2 adenosquamous carcinoma and 98 from squamous cell carcinomas) were studied histochemically. The stains used were PAS with/without diastase, AB/PAS (pH 2.5) and OR/AB. In inflammatory lesions neutral mucin was predominent which was replaced by sialomucin and sulphomucin in endocervical polyps. In malignant lesions sulphomucin was predominent. Seventeen percent cases of squamous cell carcinomas needed reclassification after mucin staining. Of the fourteen large cell non-keratinizing squamous cell carcinomas, 12 were reclassified as squamous cell carcinoma with mucin secretion and 2 as adenosquamous carcinoma. One case of small cell non-keratinizing squamous cell carcinoma was reclassified as moderately differentiated adenocarcinoma. None of the keratinizing carcinomas had evidence of mucin secretion. Mucin histochemistry should be done routinely on non-keratinizing squamous cell carcinomas to pick up more cases of carcinoma with evidence of mucin secretion which can be missed on routine haematoxylin and eosin stains. Such carcinomas are known to pursue a more aggressive clinical course and have a poorer prognosis than non-mucin secreting type of squamous cell carcinoma.

Mucin histochemistry--a simple and effective method for diagnosing premalignant and early malignant lesions of lower gastrointestinal tract.

Mucin histochemistry of colo-rectal mucosa was studied in 124 biopsies which included 28 specimens from normal mucosa, 35 inflammatory lesions, 20 polyps, 26 malignant lesions and 15 specimens from transitional mucosa. The stains used were Haematoxylin and Eosin, Periodic acid schiffs, Alcian blue--Periodic acid schiffs (pH 2.5), Orcein--Alcian blue and Periodic acid sodium borohydride saponification. Normal mucosa, mucosa from inflammatory lesions, juvenile and hyperplastic polyps had neutral mucin in traces along with O-acylated sialomucins and sulphomucins. Predominant changes in adenomatous polyps and malignancy were a significant loss of sulphomucins and O-acylation at position C7, C8 or C9 in sialomucins. The changes in transitional mucosa were more on the pattern of malignant lesions. The alterations in the amount and/or pattern of mucin in colorectal mucosa has been found to predate frank morphological changes of malignancy. A routine use of mucin histochemistry in suspicious colorectal biopsies might be helpful in diagnosing premalignant and early malignant lesions in otherwise apparently normal colorectal mucosa or mucosa with chronic inflammatory changes and thereby reduce mortality.

A correlative study of histology and imprint cytology in the diagnosis of gastrointestinal tract malignancies.

Endoscopic mucosal biopsies from 323 patients (201 from upper gastrointestinal tract and 122 from lower gastrointestinal tract) were studied to correlate the diagnostic efficacy of histology and imprint cytology in the diagnosis of malignant lesions of gastrointestinal tract. Of these 71 were from normal controls, 113 from benign lesions and 131 from malignant lesions. Histology showed no false positive reports but it was false negative in 6 cases (3 in oesophagus, 1 in stomach and 2 from colon). Imprint was false positive in 3 cases (2 oesophagus, 1 colon) and false negative in 2 cases (both oesophagus). The overall diagnostic accuracy of histology and imprint cytology in oesophagus, stomach and lower gastrointestinal tract was 95%, 98%, 98% and 95%, 100%, 98% respectively. When combined, the diagnostic accuracy increased to 98%, 100% and 100% in oesophagus, stomach and lower gastrointestinal tract respectively. The sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy for histology and cytology irrespective of the site was 96%, 100%, 100%, 94%, 97% and 98.5%, 97%, 98%, 98%, 98% respectively. Thus imprint cytology can act as an adjunct to bioptic histology to increase the diagnostic efficacy and save the time but definitely it cannot replace it as chances of false positives are high.

A sequential study of humoral factors in ovarian neoplasms.

A sequential study of serum immunoglobulins, circulating immune-complexes (CIC) and blocking effect of patients' sera on normal T lymphocytes was conducted in 15 patients with benign ovarian tumour, 32 with carcinoma ovary and 20 agematched healthy women. In patients with benign ovarian tumour there was a significant increase in IgG and IgM, while IgA was not altered. In carcinoma, there was no significant change in IgG and IgM but IgA was found to be increased significantly as compared to benign ovarian tumour. Post-operatively, IgM showed a significant increase on the 10th day, probably due to the effect of surgery. There was no significant difference in CIC levels and percentage T cell depression between patients with benign ovarian tumours and healthy controls. In carcinoma ovary both these parameters were increased significantly as compared to benign ovarian tumours. After tumour ablation, they were decreased significantly, until there was recurrence. The alterations in these parameters was not related to any specific histologic type of neoplasm. The study of serum immunoglobulins indicates tumour load, while the estimation of CIC and blocking effect of cancer sera on normal lymphocytes is of a definite diagnostic and prognostic significance.

A study of humoral factors in carcinoma cervix.

Serum immunoglobulins, circulating immune-complexes and blocking effect of patients' sera on normal T lymphocytes were studied in 10 patients with chronic cervicitis, 25 with carcinoma cervix and 20 age matched healthy women. No significant difference was observed between the healthy controls and chronic cervicitis. In carcinoma, there was a significant increase in IgG and IgA in stage I, IgG and IgM in stage II and in all the three immunoglobulins in stage III as compared to chronic cervicitis. Circulating immune-complexes and T cell depression were also found to be increased and stage related. After radiotherapy, both these parameters and IgG were found to be significantly reduced. The study of these immune parameters seems to be a promising aid in the diagnosis and prognosis of patients with carcinoma cervix.

Proximal versus distal carcinoma of the stomach. A clinicoendoscopic study.

During the period 1978 to 1988, 4619 upper gastrointestinal fibreoptic panendoscopies were carried out. There were 106 (2.2%) histologically confirmed cases of carcinoma of the stomach. The annual incidence was 9.6. The peak incidence was in the fifth decade. The mean age of these patients was 49.4 years and the male: female ratio was 3.6:1. The most frequent symptoms were weight loss (81%) and anorexia (72.9%). Dysphagia was present in 30% of patients. Thirty two percent of patients had proximal carcinoma, 63.2% had distal carcinoma and in 4.7% the whole stomach was involved. Patients with distal carcinoma had a longer history (P less than 0.01) and were more likely to present with weight loss (P less than 0.001), anorexia (P less than 0.005), abdominal pain (P less than 0.05) and abdominal lump (P less than 0.05), compared to proximal carcinomas. Dysphagia was, however, more likely to be present in patients with proximal carcinomas (P less than 0.001).

Antispermatozoal antibodies in leprosy with special reference to their morphological patterns.

Sixty two male patients with polar leprosy--38 lepromatous and 24 tuberculoid types were investigated for the presence of antispermatozoal antibodies with special reference to their morphological patterns. Antibodies were detected by three different immunological techniques. Sperm agglutination was found to be the most sensitive. The incidence of antibodies was higher in patients with lepromatous leprosy and was directly proportional to the duration of the disease in both types of leprosy. Morphologically, head-to-head type of agglutination was observed in 50 percent of the patients, mixed in 41.7 percent and tail-to-tail type in 8.3 percent. There was no correlation between the number of ENL attacks and the incidence of anti-bodies. In polar tuberculoid leprosy patients the histological findings of testicular biopsy indicated cell mediated tissue damage occurring in a non-infective form.