Coexistence of psoriasis and linear IgA disease in a patient with recent herpes zoster infection.

We report the case of a 29-year-old man with chronic plaque psoriasis who developed linear IgA disease following herpes zoster infection. There has only been one previous report describing the coexistence of psoriasis and linear IgA disease, which was confirmed by immunopathological studies. In our patient, immunoblotting studies identified IgA antibodies binding to BP180 and BP230 antigens, and IgG autoantibodies binding weakly to the BP180 antigen. This is an interesting case that we believe is an example of epitope spreading in the development of autoimmune subepidermal bullous diseases.

Polypoid uterine lesions mimicking endometrial stromal sarcoma.

Two polypoid submucosal uterine lesions were examined histologically and immunohistochemically with monoclonal antibodies to desmin and alpha smooth muscle actin. One case comprised a leiomyoma and the other a polypoid form of adenomyosis. Both polyps had prolapsed through the external cervical os. The lesions had an ulcerated surface with focal areas of marked increased cellularity and pronounced vascularity throughout, such that they mimicked a low grade endometrial stromal sarcoma infiltrating the myometrium. The cellular areas showed diffuse positivity for desmin and alpha smooth muscle actin, confirming them to be of smooth muscle origin. The changes of marked hypercellularity and pronounced vascularity within polypoid submucosal uterine lesions have not been emphasised in published reports up to now. Pathologists should be aware of these morphological features in order to avoid misdiagnosis of such cases as endometrial stromal sarcomas. The changes described here are likely to be secondary to trauma associated with a polypoid lesion prolapsing through the external cervical os.

Fine needle aspiration cytology (FNAC) of mammary granular cell tumour: a report of three cases.

This report describes the FNAC findings in three cases of granular cell tumour of the breast. The patients comprised two females aged 59 and 62 years and one male aged 28 years. All patients presented with a breast lump which was clinically and radiologically suspicious of malignancy. FNAs yielded moderately cellular specimens which on cytologic examipation consisted of groups of cells and single cells with small regular nuclei and abundant granular cytoplasm. Bare nuclei were also present but these did not have the characteristic bipolar appearance of myoepithelial cells. In two cases there was a granularity to the background. The aspirates were reported as equivocal or atypical, probably benign, and surgical biopsy was performed. Histological examination showed typical benign granular cell tumours with strong positive staining for S-100 protein. Pathologists should be aware that granular cell tumour may occur in or around the breast and should consider this diagnosis in aspirates containing a population of cells with regular nuclei and abundant granular cytoplasm. The main cytologic differential diagnoses are likely to be apocrine cells and histiocytes. The suspicion of a granular cell tumour should be heightened when these features are present in an aspirate from a clinically and radiologically suspicious mass. These cases highlight the role of the triple approach encompassing clinical, radiological and cytological features in the assessment of a breast lesion.

The travels of a lone star tick.

A lone-star tick, Amblyomma americanum, was found as a pedunculated lesion on the back of the arm of an 84 year old man in Northern Ireland. This was acquired on a visit to the USA. The tick is found mainly in Texas and the Ozark mountains of Missouri, with scattered foci in other parts of southern USA. It is the vector of Rocky Mountain spotted fever. As worldwide travel becomes increasingly common, exotic parasites make occasional appearances in northern Europe.

Subungal melanoma.

Subungal melanoma is a rare condition accounting for 1-3% of all melanomas. It has been associated with a poor prognosis, with a 10-30% 5 year survival usually attributed to the delay in diagnosis. Early biopsy of suspicious lesions followed by amputation of the digit in those proving positive is the treatment of choice.

Pathology of the heart and conduction system in lymphoma and leukaemia.

The clinical and pathological findings in two patients with non-Hodgkin's lymphoma and two patients with T helper cell prolymphocytic leukaemia affecting the heart are described. All four patients had extensive malignant disease, with infiltration of multiple organs. Cardiac infiltration varied from microscopic foci in one case, to grossly identifiable tumour deposits destroying and replacing normal heart structures in three cases. Two patients with infiltration of the conduction system had abnormal electrocardiograms and cardiac dysfunction: one died suddenly, and the other died in heart failure. A third patient with widespread cardiac lymphoma did not show any electrocardiographic abnormalities or dysfunction. Clinicians should be aware of the possibility of cardiac and conduction system disease, particularly in the light of the evolution of specific antitumour chemotherapeutic agents.

Embryonal carcinoma of testis simulating seminoma.

The clinical and pathological features of two patients with testicular germ cell tumour are described. The cases illustrate the area of gross and histological overlap between seminoma and solid embryonal carcinoma, for which there are useful distinguishing features which might aid diagnosis.

Diversity of autoantibodies in patients with antimitochondrial antibody and their diagnostic value.

A retrospective analysis of clinical and laboratory features of 102 patients, whose sera contained antibody to mitochondria, showed that primary biliary cirrhosis was diagnosed in 50% of them. Immunofluorescence showed that the sera of the patients with primary biliary cirrhosis all had the M2 antimitochondrial antibody staining pattern. A new staining pattern, designated M2(1), which could be mistaken for the M2 pattern, was not found in any patients with either primary biliary cirrhosis or chronic active hepatitis. Other serological variables such as antibody to mitochondria in IgM class, to multiple nuclear dots, and to the XR antigen, were associated with primary biliary cirrhosis, and taken in association with antimitochondrial antibody of M2 type, contribute to the diagnosis of the disease.

Factors influencing the survival of patients with testicular teratoma.

The histology of 51 cases of testicular teratoma, with or without seminoma, was reviewed and classified according to the World Health Organization criteria. Full pathological and clinical details were obtained, and patients were followed up for periods varying from one to 10 years from orchidectomy. Multiple factors were studied in order to discover which affected prognosis. The pathological stage of the tumour proved to be the most important indicator. The previously described poor prognosis associated with yolk sac tumour was not confirmed.

Gastrointestinal hormones in anorexia nervosa.

A study was undertaken of fasting and post-prandial blood levels of glucose and a number of gastrointestinal hormones in patients with anorexia nervosa. After an overnight fast their blood levels of glucose, insulin and pancreatic glucagon were significantly lower than those of age-sex matched healthy volunteers. There were no significant differences in the levels of gastrin, total glucagon-like immunoreactivity, vasoactive intestinal polypeptide, pancreatic polypeptide, secretin and gastric inhibitory polypeptide. Serial blood samples were taken for up to two hours after the ingestion of a standard mixed meal (450 kcal) and these showed a significant glucose intolerance, a reduced and delayed insulin response, and a reduced release of gastric inhibitory polypeptide, as compared with the controls. There was an increased release of pancreatic polypeptide but the difference in the post-prandial hormone profile between patients and controls for gastrin did not reach statistical significance.