Primary gynaecological tumours mistaken for metastases: report of two cases with review of literature.

We describe two neoplasms of rare occurrence, one of ovarian and the other of uterine origin that were sent for consultation. Both lesions were diagnosed as metastatic carcinomas by pathologists with special interest in gynaecological pathology. The cases were referred for a second opinion because of subsequent failure to identify the primary source. We discuss the differential diagnoses, the need for generous sampling particularly in ovarian mucinous neoplasms and the value of including particular antibodies in the panel to aid the diagnostic process. Metastatic tumours mimicking primary tumours are always challenging. These two cases illustrate the need to be vigilant against the reverse scenario as well.

Kawasaki disease, Epstein-Barr virus and coronary artery aneurysms.

AIM: To establish whether infection with Epstein-Barr virus (EBV) contributed to the development of coronary artery lesions in a six year old child with an aneurysm and stenoses of the coronary arteries and suspected Kawasaki disease. METHODS: Postmortem paraffin wax sections of the coronary artery and myocardium were examined by in situ hybridisation for expression of EBER-1 (EBV-encoded RNA-1). Positive controls consisted of an EBV positive case of Hodgkin disease and a case of posttransplantation lymphoma. RESULTS: No EBER-1 positive cells were identified in either myocardium or walls of the coronary artery. CONCLUSIONS: Although EBV has been implicated in the aetiology of Kawasaki disease and development of coronary artery lesions, this process was not confirmed in this patient. It is likely that an unusual immunological reaction to a primary EBV infection with suspected deregulation of T helper cell activity leads to severe coronary artery damage in early childhood.

Aluminium and injection site reactions.

AIMS: To alert pathologists to the spectrum of histological appearances that may be seen in injection site reactions related to aluminium. METHODS: Four cases of injection site reaction were examined microscopically using routine staining with haematoxylin and eosin, electron microscopy and by electron probe microanalysis. RESULTS: As in previous reports, all four cases included collections of histiocytes which contained faint granular brownish refractile material within their cytoplasm; ultrastructural examination showed this to be aluminium. Two cases showed a prominent inflammatory reaction with numerous lymphoid follicles and a notable eosinophilic infiltrate. Two cases showed unusual features not described previously. In one, there was a sclerosing lipogranuloma-like reaction with unlined cystic spaces containing crystalline material. The other case presented as a large symptomatic subcutaneous swelling which microscopically showed diffuse and wide-spread involvement of the subcutis by a lymphoid infiltrate with prominent lymphoid follicles. CONCLUSIONS: This report highlights the changes encountered in aluminium injection site reactions and emphasises that the lesions have a wider range of histological appearances than described previously.

Simple method for necropsy dissection of the abdominal organs after abdominal surgery.

This paper illustrates a simple method of necropsy dissection of the abdominal organs after abdominal surgery. The organs are removed in one block as per the method described by Letulle. A retroperitoneal approach is then used. Structures are dissected away in a series of layers using the vasculature for guidance. This technique permits the examination of important structures in the postoperative abdomen which would otherwise be extremely difficult and time consuming using conventional methods. The anatomy is demonstrated without being obscured by the contents of the peritoneal cavity.

Artefacts in electron microscopy: ultrastructural features of chrysiasis.

Eleven cases of chrysiasis have been studied ultrastructurally and by electron probe microanalysis. Tissue samples were examined both with and without osmium and uranyl acetate staining. There was a significant morphological difference in the appearance of the gold deposits within aurosomes between the two groups. The untreated group showed finely granular deposits, often arranged in a linear fashion. Aurosomes from samples treated with osmium and uranyl acetate showed more electron-dense deposits and star-like formations. We propose that treatment of the tissue with osmium and uranyl acetate causes a change in the electron microscopic appearance of aurosomes, including the formation of the characteristic star-like aurosomes.