Myelofibrosis presenting as chronic cholecystitis.

A 61 year old man presented with abdominal pain typical of chronic cholecystitis of one month's duration. Pallor was noted on examination and investigation uncovered myelofibrosis and a small gallstone. Cholecystectomy relieved the pain and pathological examination of the gall bladder showed widespread myeloid metaplasia. This is the first reported case of myelofibrosis presenting as chronic cholecystitis.

Selective sampling of yellow prostate chips: a specific method for detecting prostatic adenocarcinoma.

Yellow chips were sought in 206 transurethral resection specimens of prostate. 18 (9%) contained yellow chips, and 46 (22%) prostatic adenocarcinomas were present. Yellow chips showed a specificity of 100% (95% confidence interval, CI 98-100%), a sensitivity of 39% (95% CI 25-55%), and a positive predictive value of 100% (95% CI 82-100%) for prostatic adenocarcinoma. Yellow chips were more easily recognized in poorly fixed specimens. On comparing prostatic adenocarcinomas with or without yellow chips, there was no significant difference in Gleason score or percentage of chips infiltrated by tumour. Complete sampling of prostate chips may be unnecessary, if yellow chips are present and selectively sampled. Naked-eye detection of prostatic adenocarcinoma may be increased by examining the tissue before fixation.

Elastofibroma of the forefoot.

Elastofibroma is an uncommon soft tissue lesion that most often presents as a mass in the lower scapular region of elderly female subjects. The authors report an elastofibroma arising in the right forefoot of a 63-year-old woman. Pain over the plantar aspect of the head of the third metatarsal preceded the formation of a tender mass. Although rare, elastofibroma should be considered in the differential diagnosis of painful conditions and tumors of the forefoot.

Lack of detection of human papillomavirus DNA in male urine samples.

OBJECTIVES: To evaluate polymerase chain reaction (PCR) methodology for the detection of urethral human papillomavirus (HPV) infection by examining urinary sediment from males. SETTING: Department of Genitourinary Medicine, Leeds General Infirmary. SUBJECTS: 73 male patients attending for treatment of sexually transmitted diseases, including 14 patients with genital warts which did not involve the urethral meatus. METHODS: Urinary sediment was tested for HPV DNA and human beta globin gene DNA by PCR methodology. A consensus primer set capable of detecting a wide range of HPV types was used. PCR product was analysed by gel electrophoresis and ethidium bromide staining. RESULTS: HPV DNA was not detected in any of the specimens. Human beta globin gene DNA was identified in 40 of the 73 specimens (55%). CONCLUSIONS: Screening urinary sediment for HPV DNA by PCR methodology with analysis of PCR product by gel electrophoresis and ethidium bromide staining is probably unhelpful for studying the prevalence of urethral HPV infection in men.

Mast cell density and PGP 9.5-immunostained nerves in angioleiomyoma: their relationship to painful symptoms.

Angioleiomyoma is frequently painful and the cause of the pain is unknown. The purpose of this study was to compare the mast cell population and innervation of painful and painless angioleiomyomas. Twenty-four cases of angioleiomyoma were examined; 16 painful and 8 painless cases. Pinacyanol erythrosinate and antibodies to protein gene product (PGP) 9.5 were used to demonstrate mast cells and nerves respectively. PGP 9.5-immunoreactive nerve fibres were found in most of the painful (13/16 cases) and painless lesions (5/8). Mast cells were not seen in half of the painful lesions but were seen in most of the painless lesions (7/8). The median mast cell density was 1.1 cells/mm2 for the painful lesions and 21.9 cells/mm2 for the painless lesions (P = 0.048, Mann-Whitney test). The lower mast cell density in the painful lesions may reflect increased mast cell degranulation. It is proposed that neural and vascular events, similar to those occurring in the triple response to mild cutaneous injury, may produce pain in angioleiomyoma and other painful skin tumours.

Traumatic neuroma at the tail of the pancreas following splenectomy.

A 50 year old man presented with abdominal pain and weight loss after a splenectomy performed 26 years ago for abdominal trauma. At laparotomy, a mass was found at the tail of the pancreas. Pathological examination showed this was a traumatic neuroma and revealed evidence of chronic pancreatitis. Traumatic neuroma may be a rare cause of a pancreatic mass, especially after previous surgery or trauma.

Renin-secreting retroperitoneal leiomyosarcoma: an unusual cause of hypertension.

A 41 year old man with severe hypertension due to a renin-secreting retroperitoneal leiomyosarcoma is described. Clinical, immunohistochemical, electron microsopic and autopsy findings are presented. The origin of juxtaglomerular cells from vascular smooth muscle is briefly discussed.