Metastatic uterine leiomyosarcoma masquerading as a primary lesion of the masseter muscle.

Leiomyosarcomas are malignant tumours of smooth muscle origin. These tumours are very rare in the head and neck region. We report a case of metastatic uterine leiomyosarcoma masquerading as a primary sarcoma of the masseter muscle. We highlight the importance of considering the possibility of an unrecognised primary abdominal or uterine tumour.

Extreme hypervascularity and bruit in a treated hypothyroid goitre.

A child in early puberty, who presented with a modestly enlarged thyroid gland and confirmed hypothyroidism, was successfully treated with thyroxine. Subsequently a widespread bruit developed in the neck caused by bilaterally dilated superior thyroid arteries with increased blood flow to the goitre. At thyroidectomy, histopathology showed features of dyshormonogenesis with greatly increased vascularity and widespread diffuse staining for vascular endothelial growth factor (VEGF). It is likely that VEGF in association with other angiogenetic factors was associated with enlargement of the gland and its hypervascularity.

An alternate model of thyroid cytology: practical not perfect.

A sample of 384 thyroid cytology specimens prepared by cytospin over a 2.5-year period was classified by original report into inadequate, non-neoplastic and suspicious of neoplasia or worse. This was then compared with subsequent histology. The resulting data showed an inadequacy rate of 33%, a sensitivity of 55%, a specificity of 59%, a positive predictive value of 64% and a negative predictive value of 93%. On review of the cytology, in knowledge of the subsequent histology, the maximum achievable results were determined to have a positive predictive value of 79% and a negative predictive value of 97%. No clinically significant adverse event was detected.

New World leishmaniasis from Spain.

A 69 year old man living in Spain contracted mucocutaneous leishmaniasis involving the nose. The infecting organism was Leishmania infantum, which only rarely causes the New World form of the disease. The source of infection was probably a neighbour's dog. The patient began treatment with liposomal amphotericin B but died of pneumonia two months later.

In situ correlation of synthesis and storage of parathormone in parathyroid gland disease.

The distribution and expression of parathyroid hormone (PTH) were investigated in normal and abnormal parathyroid tissue. PTH was detected using a monoclonal antibody with specificity for the 44-68 region of the PTH molecule. Prominent reactivity for PTH was seen in normal parathyroid with a granular pattern of staining. Active parathyroid tissue (adenoma and hyperplasia) showed much less reactivity for PTH, although there was prominent reactivity in the normal tissue around adenomas. Comparison of expression of PTH with that of parathormone mRNA showed a reciprocal pattern in normal tissue and, to a less marked extent, in abnormal tissue. Parathyroid carcinoma in particular had coinciding areas of PTH and PTH mRNA expression. Oxyphil cells had little or no PTH expression, except in the associated 'colloid' in some cases. The findings indicate an inverse relationship between storage and cellular synthesis of PTH, this being more marked in physiological than in pathological conditions of the parathyroid.

Liver giant mitochondria revisited.

AIMS: To examine the correlation between the severity of alcohol induced liver damage and the presence of intracytoplasmic red bodies (defined as periodic acid-Schiff diastase negative, globular, hyaline cytoplasmic inclusions larger in size than the hepatocyte nucleolus). To investigate the incidence of intracytoplasmic red bodies (ICRBs) in non-alcoholic liver disease. METHODS: Liver biopsy specimens from 53 patients with alcoholic liver disease and 50 patients with a variety of nonalcohol related liver diseases were examined by light microscopy for the presence of ICRBs. For the 53 patients with alcoholic liver disease an assessment of recent alcohol consumption was made indirectly from measurements of red cell volume (MCV) and plasma gamma-glutamyl transferase (GGT). In addition, 10 liver biopsies with alcohol induced changes and ICRBs were examined by electron microscopy for the presence of mitochondrial aberrations including enlargement. RESULTS: ICRBs were detected in 18 of the 53 liver biopsy specimens showing alcohol induced changes, and were more abundant in those showing more advanced changes. Those patients whose liver specimens contained ICRBs were found to have a significantly higher mean plasma GGT activity and mean MCV than those individuals whose liver biopsy specimens did not contain ICRBs. Two of the 50 liver biopsy specimens showing non-alcohol induced changes contained ICRBs. Giant mitochondria were not detected by electron microscopy, but this may reflect sampling. CONCLUSIONS: The results of this study indicate that ICRBs are definitely associated with alcoholic liver disease and are more likely to be found in liver biopsy specimens showing more advanced alcohol induced damage, and when recent alcohol consumption has been high.

The expression of parathyroid hormone messenger RNA in normal and abnormal parathyroid tissue.

The distribution and expression of preproparathyroid hormone (PTH) mRNA were investigated in parathyroid tissue from 57 parathyroidectomy specimens. PTH mRNA was detected by in situ hybridization using digoxigenin-labelled oligonucleotide probes. Cell morphology was seen to correlate with PTH mRNA expression. Strong expression of PTH mRNA was confined to cells which on haematoxylin and eosin staining had large vesicular nuclei. These included both vacuolated and non-vacuolated cells. Chief cells with small dark nuclei and scanty cytoplasm had little or no expression. In both adenoma and chief cell hyperplasia, the striking difference from normal was the greatly increased proportion of cells expressing PTH mRNA. In adenomas, the rim of uninvolved parathyroid tissue showed PTH mRNA expression similar to that of normal parathyroid. In hyperplasia, there was frequently concordance of staining within individual nodules. The findings establish morphological criteria for activity of parathyroid tissue and support current concepts of the different pathogenesis of hyperplasia and adenoma. The expression of PTH mRNA in oxyphil change and parathyroid carcinoma was also investigated.

Developmental profile of chromogranin, hormonal peptides, and 5-hydroxytryptamine in gastrointestinal endocrine cells.

In this immunocytochemical study, we have analyzed the developmental profile and phenotypic expression of the endocrine cell antigens chromogranin, 5-hydroxytryptamine, gastrin/cholecystokinin, cholecystokinin (9-20), somatostatin, somatostatin 28 (1-14), somatostatin cryptic peptide, glucagon, glucagonlike peptides 1 and 2, glicentin, peptide YY, glucose-dependent insulinotropic peptide, secretin, neurotensin, and substance P in human fetal stomach and intestine. All currently identifiable endocrine cell types were detected by 10 wk of gestation. Immunostaining for the endocrine cell marker chromogranin revealed abundant endocrine cells in the earliest specimens (8 wk of gestation) with a relatively higher frequency in both proximal duodenum and distal colon/rectum compared with other areas. Quantification of endocrine cells showed an increase with age that was roughly parallel to the growth of the gut as a whole. These studies show that the diversity of the endocrine component of the gut appears to be established by 10 wk of gestation and that gut activity is preceded by the development of a fully differentiated endocrine component, which may subserve or even initiate the onset of functional maturity.

Fine needle aspiration of thyroid nodules: three years' experience.

To overcome the difficulties arising in the management of cold nodules of the thyroid--many are unnecessarily resected because of the risk of malignancy--fine needle aspiration cytology was used in the assessment of thyroid lesions in 113 patients. Aspirates were categorised into three groups as follows: group (i), consistent with simple goitre or cyst; group (ii), suspicious of underlying cellular lesion or tumour; group (iii), malignant. Resections for simple goitre were reduced from eight of 14 (40%) to two of 42 (3%) over three years, and the yield of neoplastic lesions coming to surgery as a result of aspiration increased from two of 12 (16%) to nine of 14 (69%) over the same period. It is concluded that fine needle aspiration cytology is an effective means of discriminating between simple and neoplastic thyroid lesions. This permits more appropriate patient management and a beneficial saving of resections for simple goitre. False negative diagnoses (two cases) in our series are of more concern than false positive results, but can be minimised by careful attention to sampling and cytological detail.

In situ hybridization: alkaline phosphatase visualization of biotinylated probes in cryostat and paraffin sections.

Alkaline phosphatase immunochemical systems were evaluated for use in the demonstration of in situ hybridized biotin-labelled probes in frozen and fixed sections of tonsil. Three probes were used: total genomic DNA, pHY2.1, a human repetitive sequence which hybridizes to a 2.12 KB sequence on the Y chromosome (2000 repeats) and a 2.0 KB sequence on the autosomes (100-200 repeats), and human papilloma virus type II. Indirect, three- and five-stage detection methods were compared on cryostat sections. The indirect method involved the application of a streptavidin, biotinylated alkaline phosphatase sequence. The three-stage procedure comprised a mouse monoclonal anti-biotin, rabbit anti-(mouse immunoglobulin), mouse APAAP system. In the five-stage method the indirect and three-stage reagents were sequentially applied. Alkaline phosphatase was demonstrated using a Fast Red naphthol-capture method. The total genomic DNA probe was used initially to investigate hybridization conditions including the optimum temperature of denaturation, which was found to be higher than previously reported. The five-stage detection method gave the most sensitive results for the Y sequence probe, with intense demonstration of the Y body in male nuclei and autosomal sequences in female nuclei. This method was then applied to fixed tissue sections and gave Y body signals on Bouin's and Carnoy's fixed tissue. On the other hand tissue fixed using formalin-based solutions required proteolytic digestion as a pretreatment to hybridization for a Y body signal. The application of this methodology to viral diagnosis in routine fixed anogenital tissue and cytological preparations was also demonstrated.

Oxyphil cells in thyroid disease: a uniform change?

Neoplastic and non-neoplastic oxyphil cells in thyroid disorders were investigated for enzyme and synthetic activity, ultrastructural features, and immune complex deposition. A reduced but definite content of thyroglobuliin and similar enzyme profiles and ultrastructural features in all types of oxyphill change were found. Immune complex deposition was seen in Graves' disease and Hashimoto's thyroiditis but not in oxyphil neoplasms or colloid goitre with focal oxyphil change. The findings suggest that oxyphil cells do represent a uniform change. Immunological damage with immune complex deposition might be the cause of oxyphil change in only some conditions.

Age-related peptide production by human thyroid C cells. An immunohistochemical study.

C cells of thyroid are known to express a variety of products beside calcitonin. These include the peptides PDN21 (katacalcin), calcitonin-gene related peptide (CGRP), bombesin and somatostatin. The expression of these products has been investigated by immunohistochemistry of thyroid tissue in six age ranges from fetal to late adult life. PDN 21 was found to have co-expression with calcitonin. CGRP and bombesin both demonstrated an age-related increase in numbers and intensity of cells stained. Somatostatin immunoreactivity was limited to small numbers of cells.

Etiological heterogeneity in sirenomelia.

Two babies with sirenomelia are described. Case 1, one of twins, showed the full sirenomelia sequence in conjunction with atelencephaly and cebocephaly. Case 2 had malformations consistent with a diagnosis of the VATER association. Review of the literature indicates that the basic defect in sirenomelia and the VATER association lies in the formation and differentiation of mesodermal tissue and that sirenomelia, the VATER association, and monozygotic twinning show a complex etiological interrelationship.

Follicular thyroid tumours: a study of laminin and type IV collagen in basement membrane and endothelium.

Immunocytochemical stains for laminin and type IV collagen can be used as markers for basement membrane and vascular endothelium. Thirty four follicular thyroid lesions were examined using these techniques to investigate two aspects: firstly, the relation between the extent of invasion and the integrity of basement membrane; secondly, whether the techniques could enhance the detection of tumour vascular invasion. The results showed that although basement membrane was lost in widely invasive tumours, preservation was seen in most but not all encapsulated tumours. The potential for improved recognition of vascular invasion was also found.

Amyloid P component in human thyroid.

The distribution of amyloid P component in the adult human thyroid was studied by direct immunofluorescence on frozen sections of surgically removed tissue. Amyloid P component shows a striking fibrillary and broken linear distribution in the interfollicular areas. This pattern corresponds to that of reticulin fibres. Amyloid P is also localised to the small amount of elastic tissue in blood vessels but is not demonstrable within cells or in acinar basement membranes.