Isolated pseudogout diagnosed on hip arthroscopy.

Idiopathic calcium pyrophosphate deposition disease (pseudogout) has a variable presentation. Many joints are usually affected; single joint disease is uncommon. We present a case report of primary monoarticular pseudogout affecting the hip. The diagnosis was made on the appearance and analysis of specimens obtained at arthroscopy. Monoarticular pseudogout is rare, but should be considered in the differential diagnosis of any presentation of joint pain.

Rectal polyposis in tuberous sclerosis.

Microhamartomatous rectal polyps are described in 11 out of 15 patients with tuberous sclerosis (TS). These readily identifiable polyps are of no clinical significance but their prevalence and unique nature rank them as of equal importance to other better known markers of TS such as the facial angiofibromata (adenoma sebaceum).

Breast sarcoma. A clinicopathologic review of 25 cases.

Sarcoma of the breast represents less than 1% of primary mammary malignancies; this study reports 25 such cases. The largest group had malignant fibrous histiocytoma (44%), followed by liposarcoma (24%) and fibrosarcoma (16%). Also represented were clear cell sarcoma, neurogenic sarcoma, leiomyosarcoma, and alveolar soft part sarcoma (4% each). Of 19 patients treated by wide local excision or simple mastectomy with or without adjuvant radiotherapy, 11 had local recurrence develop, of which one patient died and nine of the remaining ten had metastases develop. Of the remaining eight patients in this group with no local recurrence, only two had metastases develop. Of the six patients treated by radical or Patey mastectomy, none had local recurrence develop, but two died of metastases. No patient had metastases develop more than 5 years after diagnosis. Regional lymph node involvement with tumor was observed in only one patient (with malignant fibrous histiocytoma) despite regional lymphadenopathy in seven. The overall mortality at 5 years is 64% but does not increase thereafter. The authors' findings suggest that failure to establish local control is associated with a poor prognosis and that wide local excision or simple mastectomy does not provide sufficient clearance to be used as first-line treatment. Excision of the axillary lymphatics and adjuvant radiotherapy are unlikely to be beneficial.

The endosonic appearances of normal colon and rectum.

With the increasing use of transrectal sonography, accurate preoperative staging of rectal cancer requires correct identification of the normal ultrasonographic appearances of the colon and rectum. Fifteen rectal and colonic specimens have been studied in vitro to define the normal anatomy. Five distinct ultrasonic layers have been identified; a first echogenic layer that corresponds to the mucosa, a second echopoor layer made up of mucosa and muscularis mucosae, a third echogenic layer that is submucosa, a fourth echopoor layer that is muscularis propria, and a fifth echogenic layer made up of serosa and perirectal fat.

Endoluminal ultrasound in the assessment of local invasion in rectal cancer.

A new method for staging local invasion in rectal cancer has been assessed. Thirty-eight patients with primary rectal cancers have been examined pre-operatively with endoluminal rectal ultrasound and results compared with histological analysis of resected specimens in 33 cases. Three patients who also underwent laparotomy but not resection had good evidence of both stage T3 (1) and T4 (2) disease. The coefficient of correlation between ultrasonic and histological staging was 0.93 (P less than 0.001). Invasion beyond the muscularis propria was predicted with a sensitivity of 96 per cent, specificity of 92 per cent and a predictive value of 96 per cent.

Richter's syndrome--an indication for lymph node biopsy in chronic lymphocytic leukaemia. A case report.

A patient suffering from typical chronic lymphocytic leukaemia (CLL) developed a rapidly fatal high-grade lymphoma (Richter's syndrome). In cases of CLL Richter's syndrome must be distinguished from coexistent Hodgkin's disease and prolymphocytic transformation. The prognosis is dismal but not hopeless if the condition is treated early. Lymph node biopsy is essential for diagnosis and treatment.

Spontaneous rupture of the spleen in rheumatoid arthritis.

Two patients with rheumatoid arthritis without splenomegaly or Felty's syndrome developed spontaneous rupture of the spleen. The histological appearance was consistent with involvement of the splenic capsule by the rheumatoid process, and this may have predisposed to splenic rupture.