Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain.

Seven patients who had pain in the anterior aspect of the ankle were found to have a thickened distal fascicle of the anteroinferior tibiofibular ligament. Each patient had a history of an inversion sprain of the ankle followed by chronic pain in the anterior aspect of the ankle. The thickened distal fascicle was resected without loss of stability of the ankle. Five patients needed débridement of an area of abraded hyaline cartilage on the anterolateral aspect of the talus. Six patients were followed for a mean of thirty-nine months (range, twenty-four to fifty-nine months). Four of them had no pain in the ankle or limitation in activities, and two reported marked improvement, with only occasional pain in the ankle related to overuse. A separate distal fascicle of the anteroinferior tibiofibular ligament is present in most human ankles and can be a cause of talar impingement, abrasion of the articular cartilage, and pain in the anterior aspect of the ankle. Resection of this ligament usually will alleviate the pain caused by the impingement.

Phakomatous choristoma of the lower eyelid. A light and ultrastructural study.

This article documents the eighth reported case (to our knowledge) of a phakomatous choristoma, a rare congenital tumor of the lower eyelid of infants. Among the eight cases, there was no instance of tumor recurrence recorded nor was there any detectable postoperative eye defect, despite incomplete resection of the tumor in two patients. While usually clinically diagnosed as a dermoid cyst, the highly characteristic histologic features of this entity should allow more frequent recognition. Ultrastructural examination in our case provided additional evidence of its lenticular origin.

Correlation of colposcopy and histology findings in pre-clinical neoplasia of the cervix.

The histology findings of pre-clinical neoplasia of the cervix at cone biopsy were compared with the previous colposcopic assessment in fifty-eight patients. In 84.5% of cases colposcopy prediction was within one grade of the histology findings. This close correlation is important where suitability for local ablative therapy depends on accurate colposcopic assessment prior to tissue destruction.

Langerhans' cells and lymphocyte subsets in the female genital tract.

Cryostat sections of healthy cervical, vaginal and vulval epithelium were examined using immunohistological labelling techniques and a panel of monoclonal antibodies recognizing Langerhans' cells, T- and B-lymphocytes and HLA-DR antigen. The distribution of Langerhans' cells in squamous epithelium of the cervix, vagina and vulva showed a marked variation with the highest median values in the vulva (18.7 per 100 basal squamous cells) and the lowest in the vagina (5.5 per 100 basal squamous cells). There was also a substantial variation in number and distribution of lymphocytes of each of these three areas with a distinct preponderance in the transformation zone of the cervix. In addition, intraepithelial lymphocytes, predominantly of the T-cytotoxic suppressor sub-type were present at all sites with the greatest number in the transformation zone. We conclude from this study that lymphoid tissue of the cervical transformation zone has several unique characteristics which are not observed at other sites in the lower genital tract. We suggest that this tissue be designated 'cervical lymphoid tissue' and that it forms a part of the 'mucosal associated lymphoid tissue' (MALT) as noted at other mucosal sites exposed to the external environment.

Malignant epithelial tumors of the ovary in childhood: a clinicopathological study of 13 cases in Great Britain 1962-1978.

The clinicopathological features of 13 childhood epithelial malignancies of the ovary occurring in Great Britain in the 17-year period 1962-1978 are presented. The majority (10 cases or 77%) were mucinous neoplasms; tumors of borderline malignancy constituted 45% of the total number. These results differ substantially from incidence rates encountered in ovarian neoplasia in adults and suggest that some childhood mucinous neoplasms may be monophyletic teratomas.

Langerhans' cells and T cells in human skin tumours: an immunohistological study.

In this study normal skin and a range of skin tumours, both benign and malignant, have been examined using monoclonal antibodies to identify the distribution and morphology of Langerhans' cells and T cells, the distribution of T lymphocytes and their subsets have been analysed using monoclonal anti-T cell antibodies. The results indicated that Langerhans' cells can be reliably identified in both normal and malignant skin biopsies using monoclonal antibodies. A striking finding to emerge was that in benign skin lesions Langerhans' cells were increased, whereas in malignant tumours they were not only markedly depleted or absent but also grossly stunted and deformed in outline. The majority of lymphocytes surrounding these skin tumours were shown to be T cells with helper cells outnumbering suppressor cells by a ratio from 2 to 5:1. This study shows the usefulness of immunohistological techniques using monoclonal antibodies for examining the morphology and distribution of Langerhans' cells in skin pathology. In addition they are particularly appropriate for identifying their topographical relationships with other immunologically important cells such as T cells.

An immunohistological study of reactive lymphoid tissue.

The aim of this study was to document the patterns of cytoplasmic Ig heavy and light chain expression in reactive lymphoid tissue, using single and double immunoenzymatic labelling techniques. This investigation was undertaken, firstly, to provide information on whether the normal counterparts of high grade lymphoma cells (e.g. centroblasts, immunoblasts) ever express more than one light or heavy chain (as has been noted in the past for lymphomas) and also, secondly, to seek evidence of intraclonal 'switching' from cytoplasmic IgM to cytoplasmic IgG expression. Paraffin embedded sections, all showing substantial reactive changes, were analysed by means of immunoperoxidase stains for the three major immunoglobulin classes (IgG, IgM and IgA), both light chain classes and J chain. In addition, double immunoenzymatic labelling techniques were used to search for cells showing simultaneous expression of kappa and lambda light chains and cells expressing mu and gamma heavy chain. Large transformed lymphocytes showing cytoplasmic Ig-staining in the pulp and interfollicular areas often have nuclear morphology indistinguishable from germinal centre centroblasts. There was no evidence of primitive appearing IgM-positive cells and IgG-positive cells of more mature morphology. In addition, immunoenzymatic staining showed that cells simultaneously expressing both IgG and IgM are only rarely encountered. When such cells were detected, the morphology was not that of a blast cell, but rather of a plasma cell containing Russel bodies. Hence it is suggested that cytoplasmic IgM switching to IgG is rarely detected by immunohistological methods in reactive tissue. Double staining for kappa and lambda revealed that cells simultaneously expressing both light chain types were not detected even among cells showing the most primitive morphology.

Cervical wart virus infection, intraepithelial neoplasia and carcinoma; an immunohistological study using a panel of monoclonal antibodies.

The pattern of epithelial antigen expression has been examined in normal and disordered cervical squamous epithelium using immunohistological methods and a range of monoclonal antibodies. It was demonstrated that wart virus infection (WVI) is associated with disordered staining for a keratin-associated component and for HLA-DR antigen. Furthermore, wart-infected epithelium shows strong labelling for carcinoembryonic antigen (CEA) and for human milk fat globule antigens 1 and 2 (HMFG1 and 2). In addition these antigens (CEA, HMFG1 and 2) are also expressed in mixed WVI and cervical intraepithelial neoplasia (CIN), CIN III and in carcinoma. While these findings do not allow immunohistological discrimination between non-neoplastic and neoplastic cervical epithelia, they do provide support for the view that cellular proliferation of the type induced by papilloma virus may represent an initiator stage in the process of neoplastic transformation.

Malignant ovarian tumours in childhood in Britain, 1962-78.

The files of the Childhood Cancer Research Group and of the Oxford Survey of Childhood Cancers were scrutinized for all the ovarian neoplasms registered in England, Scotland and Wales in children under age 15 years throughout the period 1962-78. Among 172 cases confirmed as malignant ovarian tumours, 145 (84%) were tumours of germ cell origin (54 dysgerminomas, 36 malignant teratomas, 26 endodermal sinus tumours, 4 embryonal carcinomas, 2 pure choriocarcinomas, 20 mixed germ cell neoplasms, 3 gonadoblastomas), 13 (8%) were epithelial carcinomas (3 serous or undifferentiated, 10 mucinous), 9 (5%) were sex-cord stromal tumours (3 granulosa cell, 3 Sertoli-Leydig, 3 unclassified) and 5 (3%) were other miscellaneous tumour types. Less than 10% of the neoplasms occurred at age less than 5 years, approximately 20% from 5-9, and greater than 70% from 10-14 years. Germ cell neoplasms of greater malignancy (immature teratomas, endodermal sinus tumours) occurred in a significantly higher proportion at younger age (less than 10 years) than dysgerminomas (P = 0.01). The overall incidence (approximately 1.7 cases per 10(6) per annum) did not show any noticeable trend over the 17-year period considered. The clustering of two confined cases and, possibly, a third case, of germ cell neoplasms in three generations of the same family pointed to a genetic component in the aetiology of some of these neoplasms. A large number of sex related and mental or neurological abnormalities was also reported in case children. The 10-year survival rates, determined by the life-table method were: epithelial carcinomas 73%, sex-cord stromal tumours 44%, dysgerminomas 73%, malignant teratomas 33%, endodermal sinus tumours 39%, embryonal carcinomas 25%, other germ cell neoplasms 30% and gonadoblastomas 100%. Apart from cell-type, factors associated with prognosis were clinical stage (in all types), size and degree of histological differentiation (in malignant teratomas, but only when stage was not allowed for). The adoption of efficacious polychemotherapy regimens completely changed the prognosis of germ cell tumours other than dysgerminomas (from 29% to greater than 85% disease-free survivors in the present series).