Aspiration cytodiagnosis of metastatic Merkel-cell carcinoma.

A case of metastatic Merkel-cell carcinoma to lymph nodes on the left side of the neck and left parotid is described. The primary was at the left side of the cheek and bridge of the nose. The cytologic features in needle aspirates of metastases included increased cellularity, discohesive or loose groups of small-to-medium size malignant cells with uniform, round-to-oval nuclei, delicate nuclear membranes, fine chromatin, multiple micronucleoli, and scanty cytoplasm. Additionally, rare intermediate filament "buttons" and frequent mitotic figures were found. The primary tumour showed similar features. On immunostaining, although a positivity for chromogranin was noted in the primary tumour, it was found to be negative in the cytologic material. All other histochemical and immunostains were found to be negative in both the primary and metastatic neoplasm. The problems in differential diagnosis from other small cell tumours and the features of this unique tumour that may be helpful in the diagnosis are discussed.

Late rupture of knitted velour Dacron arterial prostheses.

Rupture of a Dacron arterial prosthesis is a most unusual complication, although it has been reported previously. Three further such cases are reported with a brief review of the relevant literature.

Non-Hodgkin's lymphoma and farming: an expanded case-control study.

A previously published case-control study of agricultural risk factors involved male cases of non-Hodgkin's lymphoma registered under code 202 of the International Classification of Diseases (ICD). This study has been expanded with the inclusion of cases registered under ICD code 200, and additional controls. The expanded study comprises 100 ICD 200 cases and 83 ICD 202 cases registered during the period 1977-81, together with 338 controls selected from other cancer registrations during the same period. The largest relative risk for specific farming types was for orchard workers (odds ratio = 3.7, 90% confidence limits 1.1-12.1). No elevated risks were observed for exposure to farm animals, nor for potential exposure to phenoxy herbicides (odds ratio = 1.0, 90% confidence limits 0.7-1.5), or chlorophenols (odds ratio = 1.4, 90% confidence limits 0.8-2.3). The previous finding of an excess risk associated with fencing work was weakly supported by the expanded study (odds ratio = 1.4, 90% confidence limits 1.0-2.0). However, the previous finding of an excess risk associated with meat works employment was more strongly supported (odds ratio = 1.8, 90% confidence limits 1.2-2.6). One relevant risk factor is 2,4,6-TCP which is used in the treatment of pelts, but the excess risks do not appear to be confined to pelt department workers. An alternative hypothesis is that meat workers may be exposed to oncogenic viruses.

Resolution of acromegaly after removal of a bronchial carcinoid shown to secrete growth hormone releasing factor.

A 29 year old woman with an enlarged pituitary fossa and classical acromegaly, possibly present for ten years, had biochemical and partial somatic resolution of the disorder after removal of a bronchial carcinoid tumour. In addition, galactorrhea stopped, menstruation returned after two years, and amenorrhea and elevated prolactin levels fell towards normal. Immunocytochemistry showed numerous growth hormone releasing factor (GRF) staining cells in the tumour. The tumour cells, when cultured, produced a supernatant selectivity stimulating human pituitary somatotrophic cell cultures to produce growth hormone (GH). The bronchial carcinoid did not secrete detectable GH, but extracts of it, and preoperative serum contained GRF immunoreactivity which coeluted with synthetic human pancreatic GRF.

Case-control study of multiple myeloma and farming.

A previous case-control study which utilised the occupational information available on the New Zealand Cancer Registry found an increased risk of multiple myeloma in agricultural workers consistent with previous findings in the United States. The findings are now presented for the second phase of the study which involved interviewing 76 cases of multiple myeloma (who had been included in the previous study) together with 315 controls with other types of cancer. The previous finding on an excess of farmers in the case group was confirmed by the interview data (odds ratio = 1.7, 95% confidence limits 1.0-2.9, P = 0.04). There were no significant differences between cases and controls regarding potential exposure to phenoxy herbicides or chlorophenols. There were also no significant differences regarding activities involving potential exposure to other agricultural chemicals, although the odds ratio for fencing work, which may involve exposure to arsenic and sodium pentachlorophenate, was 1.6 (95% confidence limits 0.9-2.7, P = 0.11). The odds ratios were significantly elevated for sheep farming (odds ratio = 1.9, 95% confidence limits 1.0-3.6, P = 0.04) and exposure to beef cattle (odds ratio = 1.7, 95% confidence limits 1.0-2.9, P = 0.05). The odds ratio was also elevated for persons reporting a history of hay fever (odds ratio = 1.9, 95% confidence limits 1.0-3.5, P = 0.05). Overall, these findings suggest that the search for the causes of elevated mortality in farmers from multiple myeloma should be directed to potential causes other than pesticide exposure.

Perianal mucinous adenocarcinoma: a clue to its pathogenesis.

The case of a 49 year old male patient who presented with perianal mucinous adenocarcinoma is presented. This is a rare anal tumour with a low grade, well-differentiated histological pattern. Its pathogenesis remains obscure, although a long antecedent history of fistula in ano and associated perianal sepsis is characteristic. The exact etiological relationship with anal fistula is not clearly established. The upper rectum is usually spared. Perianal Paget's disease is often seen in association with the tumour. Metastases occur late and spread is usually to the inguinal group of lymph nodes. Clinical diagnosis is often delayed and difficult. Treatment is abdominoperineal resection with block dissection of the inguinal lymph nodes if the glands are involved.

Non-Hodgkin's lymphoma and exposure to phenoxyherbicides, chlorophenols, fencing work, and meat works employment: a case-control study.

A previous case-control study which used the occupational information available on the New Zealand Cancer Registry found that agricultural workers were at increased risk of developing non-Hodgkin's lymphoma. The findings are now presented for the second phase of the study which entailed interviewing 83 cases of non-Hodgkin's lymphoma registered under code 202 of the International Classification of Diseases together with 168 controls with other types of cancer and 228 general population controls. The findings for the two control groups were similar, and there were no significant differences between cases and controls regarding potential exposure to phenoxy-herbicides (odds ratio = 1.4, 90% confidence limits 0.7-2.5, p = 0.26) or chlorophenols (odds ratio = 1.3, 90% confidence limits 0.6-2.7, p = 0.39). The odds ratio for fencing work, necessitating exposure to several potential risk factors including arsenic and sodium pentachlorophenate was 2.0 (90% confidence limits 1.3-3.0, p = 0.01). The odds ratio for employment in a meat works, necessitating potential exposure to 2, 4, 6-trichlorophenol and zoonotic viruses, was 1.8 (90% confidence limits 1.1-3.1, p = 0.04). There was a significant statistical interaction between the risks associated with these two activities, the odds ratio for involvement in both activities compared with involvement in neither being 5.7 (90% confidence limits 2.3-14.3, p = 0.03).

Soft tissue sarcoma and exposure to phenoxyherbicides and chlorophenols in New Zealand.

Phenoxyherbicides, including (2,4,5-trichlorophenoxy)acetic acid (CAS: 93-76-5), have been widely used in New Zealand for over 30 years. In the light of Swedish studies reporting an association between exposure to phenoxyherbicides or chlorophenols and soft tissue sarcoma, a case-control study was undertaken that involved interviewing 82 subjects (cases) with soft tissue sarcoma and 92 controls with other types of cancer. For those potentially exposed to phenoxyherbicides for more than 1 day not in the 5 years before cancer registration, the estimate of relative risk was 1.3, with 90% confidence limits of 0.6-2.5. The comparable relative risk estimate for chlorophenol exposure was 1.5, with 90% confidence limits of 0.5-4.5. The discovery of cases in trichlorophenol manufacturing plants in the United States lended support to the Swedish findings, but further studies are needed to conclude whether human exposure to these chemicals truly increases the risk of soft tissue sarcoma.

Squamous cell carcinoma of the eyelid masquerading as 'malignant' ophthalmopathy of Graves's disease.

A patient with Graves's disease is described in whom the periorbital changes of severe ophthalmopathy and iatrogenic Cushing's syndrome delayed the diagnosis of a squamous cell carcinoma of the eyelid. It is suggested that the immunosuppressive therapy which the patient received may have enhanced the growth of a pre-existing malignancy.

Plasma exchange in Goodpasture's syndrome.

The clinical course and levels of anti-glomerular basement membrane (GBM) antibody were compared in 20 patients with Goodpasture's syndrome treated with plasma exchange and immunosuppression (8 patients), immunosuppression alone (4 patients) or no specific therapy (8 patients). There was a more rapid fall in the level of anti-GBM antibody and pulmonary hemorrhage was less protracted in the 8 patients treated with plasma exchange and immunosuppression. In this group, 1 patient who presented with severe renal failure showed a marked improvement of renal function and there was no progression of disease in the 4 with milder renal involvement. 2 of the 4 patients treated with immunosuppression alone, and only 2 of the 8 patients who received no specific therapy, maintained normal renal function. In the group which received no specific therapy, 1 of the 6 patients who progressed to renal failure had mild renal involvement initially. There was a significant correlation between the level of anti-GBM antibody and the severity of the morphological changes seen at renal biopsy but not between the level of anti-GBM antibody and the severity of lung hemorrhage. The course and outcome of the disease in those patients not treated, or treated with immunosuppression alone, was better than that described in early reports of this disease, while those patients with plasma exchange and immunosuppression fared even better. An adequately stratified controlled trial of immunosuppression and plasma exchange versus immunosuppression alone is in order.

The response of three inbred strains of rat to the carcinogen 1,2-dimethylhydrazine.

Rats of 3 inbred strains (DA, HS and AS2) were dosed with 1,2-dimethylhydrazine 2HCl (DMH) or saline by gavage weekly for 10 wk. DA and HS rats showed little overt toxic reaction but all AS2 rats died following DMH doses of 30 mg/kg. However, at 10 mg/kg 60% of AS2 rats survived the 30 wk experiment. All DA rats developed a high yield of adenocarcinoma of the bowel (means: males 6.8 tumours/large bowel and 0.8/small bowel; females 2.8/large and 0.08/small bowel) and one-third of the males developed tumours of the ear canal. A smaller proportion (52%) of HS rats developed tumours, specifically bowel tumours (means: male 1.4/large and 0.2/small bowel; females 0.4/large and 0.1/small bowel). Even on the lower dose of DMH AS2 rats showed extensive liver changes including cystic cholangioma (58%), angiosarcoma (25%) and hepatocellular carcinoma (8%) and 83% developed bowel tumours (means: males 2.3/large and 1.5/small bowel; females 3.5/large and 1.0/small bowel). The rapid induction and high yield of bowel tumours, the different toxicity of DMH in AS2 rats, and the differences in relative tumour density both between sexes and in the various segments of the bowel indicate the potential of these strains for studies of carcinogenesis in the bowel.

gamma-Glutamyltransferase, a common marker of human epithelial tumors?

Having previously established gamma-glutamyltransferase (GGT) as a marker of experimental carcinogenesis in rat liver, we investigated whether human tumors differ from their tissue or origin by showing a higher activity or different localization of this enzyme histochemically. We found such differences in each of the human carcinomas we examined. The presence of GGT activity in carcinomas arising in organs normally containing little (tongue) or no GGT activity (larynx, urinary bladder, and esophagus) clearly distinguished cancerous from normal epithelium. In the breast, colon and prostate, GGT activity was normally present in a defined anatomical distribution bordering luminal surfaces. Carcinomas arising from these tissues showed a loss of the normal pattern of activity and contained cells with almost homogenous GGT activity in the cytoplasm. Such differences clearly distinguished carcinomatous from normal epithelium in these organs. The increased GGT activity observed in all nine carcinomas arising from seven different organs suggests that GGT may be a common marker of human epithelial tumors and staining for GGT may become a useful tool in the detection of human epithelial neoplasms.

Goodpasture's syndrome: an analysis of 29 cases.

The pathologic features of 29 cases of Goodpasture's syndrome occurring during a 13-yr period in Auckland have been reviewed and correlated with clinical findings. There were 20 males and nine females in the series; two of the males and three of the females were Maoris. Age at the time of onset of symptoms ranged from 17 to 75 yr, with about 76% of the patients being from 17 to 27 yr of age. Sixteen (55%) of the patients died from less than a week up to about two years following the onset of symptoms, and the remaining 13 are live from 30 weeks to 14 yr after initial presentation. Underlying renal disease varied from mild focal glomerulitis to end-stage glomerulonephritis by light microscopy, but characteristic glomerular changes were seen in all specimens examined by electron and immunofluorescent microscopy. The lungs of 13 of the patients examined at autopsy showed typical abnormalities. The syndrome pursues a notably variable clinical course, affects a considerable proportion of females, occurs over a wide age range, and appears to be disporportionately common among Maoris.

Classification of glomerulonephritis.

A classification of glomerulonephritis which is being used as a basis for the New Zealand National Study of Glomerulonephritis is presented, together with comments about the salient pathological features of each type of glomerular disease.

Renal biopsy pathology in Auckland, 1969-1976.

The pathology of 1058 samples of kidney tissue studied during the past seven years as part of the renal biopsy service in Auckland is reviewed. About half of the samples were examples of glomerulonephritis, with diffuse proliferative and exudative glomerulonephritis being the most common finding. In the group of focal glomerular disease, lupus nephropathy and Goodpasture's Syndrome were frequently diagnosed.