Fat necrosis in surveillance biopsies of heart transplants.

Fat necrosis was observed in surveillance biopsies of five patients following heart transplant. This reaction is poorly documented in the literature, but in personal communication, some pathologists working in the field have had experience with it. Four of the cases developed two to six days after transplantation, but in the fifth case, fat necrosis developed ten months after transplantation. Autopsy study of one case showed extensive severe fat necrosis involving both donor and recipient tissues. The cause is not known, and the changes are independent of rejection. However, the fat necrosis can be found within the interstitial tissues of the myocardium and subendocardium and may be mistaken for rejection if lymphocytes and polymorphs are part of the inflammatory response. The only clinical finding thought to be related to the fat necrosis was the development of transient complete heart block in a patient in whom the International Society for Heart and Lung Transplantation (ISHLT) standardised rejection grading was never greater than IA.

Collecting duct carcinoma of the kidney: a report of three cases and review of the literature.

Collecting duct carcinoma (CDC) of the kidney is a rare neoplasm arising from the medullary collecting ducts. The clinicopathological features of three cases are here presented to add to the 42 cases reported so far in the English language literature. Hematuria is the most common presenting symptom, although 10% of patients present with metastatic disease, often in neck lymph nodes. The tumor mass is typically centred on the medulla of the kidney and extends into the cortex. Radiological diagnosis may be difficult because the radiological features of CDC are poorly described. The histological appearances have been described as tubulo-papillary, tubular, solid and sarcomatoid. Intracytoplasmic mucin may be present. The typical immunohistochemical profile is positive staining with antibodies for low and high molecular weight keratin and epithelial membrane antigen (EMA) and positive staining with the lectin Ulex europaeus agglutinin. Literature reports of cytogenetic characterisation show loss of chromosomes resulting in monosomies. Prognosis is poor as more than half of the reported cases have developed metastases or died within two years of presentation.

Abdominal aortic dissection due to idiopathic medial aortopathy in a 32-year-old Caucasian man.

A case of dissection of the abdominal aorta in a 32-year-old Caucasian man associated with a histological diagnosis of granulomatous aortitis and a clinical diagnosis of idiopathic medial aortopathy is described. The relationship between giant cell "temporal" arteritis, Takayasu's disease and idiopathic medial aortopathy is discussed.

Esophageal malignancies: is preoperative radiotherapy the way to go?

During the period 1969 to 1988, 68 patients with esophageal malignancy were subjected to preoperative radiotherapy consisting of 30 Gy over 3 weeks followed by esophagectomy after a wait of 2 weeks. Sixty-two of 68 patients (91%) were followed up retrospectively (5-year survival rate, 17.2%; 10-year survival rate, 4.8%). Radiosensitivity of the tumor was graded by a radiation effect scoring method devised by us, and this was found to correlate with long-term prognosis (p = 0.05). Radiotherapy "sterilized" malignant involvement of adventitia and draining lymph nodes in 8 patients and thereby converted "palliative" into potentially "curative" resections with a mean survival of 57.2 months in this group of patients. Preoperative radiotherapy was found to increase the survival, decrease the incidence of residual tumor at the resected stump, reduce the incidence of local recurrence, and increase the resectability rate.

Herpes simplex virus interstitial nephritis in a renal allograft.

We report a 35-year-old woman who developed herpes simplex virus (HSV) type 1 interstitial nephritis following a cadaveric renal transplant. Transplant function was poor and a transplant nephrectomy was performed 23 days post-transplant. Histological changes characteristic of herpes virus infection were seen on the renal biopsy with positive immunoperoxidase staining for HSV. HSV 1 was cultured from the transplant nephrectomy specimen.

Caecal diverticulitis.

Ten cases of caecal diverticulitis are reviewed. Caecal diverticulitis is frequently diagnosed as appendicitis pre-operatively and is difficult to distinguish from carcinoma or inflammatory bowel disease intra-operatively. The average age of presentation is younger than that of left-sided colonic diverticulitis. Most of the diverticula are narrow-neck false diverticula. When diagnosed intra-operatively hemicolectomy can often be avoided.

Endocrine dysfunction in lymphomatoid granulomatosis.

Endocrine abnormalities in lymphomatoid granulomatosis are rare and have never been a major determinant of the clinical course. We describe three patients who illustrate that a wide range of endocrine dysfunction (hypoadrenalism, hypercalcemia, hypothyroidism, diabetes insipidus and hypogonadism) may be encountered in this disorder. Moreover, such endocrine manifestations may be the major feature at presentation, the treatment of which may significantly influence the subsequent clinical outcome.

Melanoma in Western Australia in 1980-81: incidence and characteristics of histological types.

All cutaneous malignant melanomas diagnosed in Western Australia in 1980-81 were reviewed and classified according to histological type (i.e., superficial spreading melanoma, Hutchinson's melanotic freckle melanoma (lentigo maligna melanoma), nodular melanoma and melanoma of unclassifiable type). The most common invasive melanoma was superficial spreading melanoma with an incidence rate of 14.3 per 100,000 person-years in females and 9.0 in males. It most commonly affected the trunk in males and the lower limbs in females and showed a peak incidence in middle life. Invasive Hutchinson's melanotic freckle melanoma was much less common than invasive superficial spreading melanoma (1.8 per 100,000 person-years in both sexes), occurred most commonly on the head and neck and increased progressively in incidence with age. Nodular melanomas were more frequent in men (4.5 per 100,000 person-years) than women (2.0). They were thicker than other types of invasive melanomas, showed more mitotic activity and had less evidence of regression. Their site distribution was similar to that of superficial spreading melanoma. In women the pattern of incidence with age was also similar to that of superficial spreading melanoma. In men it was more like that of Hutchinson's melanotic freckle melanoma. Melanomas of unclassifiable type did not have distinctive epidemiological features common to both sexes, although the trunk was the site most commonly affected in both men and women. With some exceptions the patterns of occurrence of in-situ lesions were similar to those of the corresponding invasive lesions. Benign melanocytic naevi were found less often in association with Hutchinson's melanotic freckle (melanoma) (6%) and nodular melanoma (9%) than with superficial spreading melanoma (22%) or melanoma of unclassifiable type (34%).

Plasma-cell granuloma of the trachea.

A case of intratracheal plasma-cell granuloma is presented together with a review of the literature. The discussion includes the presentations of tracheal tumours, the pathology of this lesion and its variants, the clinical course and the treatment modalities that are available, and emphasizes a more conservative approach.

A study of arthritis in Papua New Guinea.

A study was undertaken of 182 Melanesian patients with arthritis who were admitted to three major hospitals in Papua New Guinea between 1977 and 1982. There were 118 male and 64 female subjects, whose mean ages were 29 years and 25 years respectively. A diagnosis was made in 101 cases (55.5%) but in 81 cases, because assessment and management had been inadequate, a diagnosis could not be made. The commonest cause was infectious arthritis (44%), followed by rheumatoid arthritis (14%), gout (8%), and reactive arthritis (8%). In the 44 subjects with infectious arthritis, gonorrhea was the cause in 25 cases (57%) and in a further six cases (14%) it was attributed to Ross River virus infection. In five cases, arthritis was believed to be caused by Wuchereria bancrofti infection. In several cases, chronic arthritis was present in association with ankylosing spondylitis, psoriasis, systemic lupus erythematosus, dermatomyositis, or systemic sclerosis.

Ross River virus arthritis in Papua New Guinea.

In 1975 it was reported that antibodies to Ross River virus (RRV) were present in the sera of many population groups in Papua New Guinea. We describe here 3 cases of polyarthritis that occurred in Port Moresby, the capital of Papua New Guinea, during 1980-81 and in which the diagnosis of RRV infection was confirmed by serological tests, and 3 other cases in which serological tests suggested RRV infection but were not diagnostic. A possible case of fatal RRV encephalitis is also reported.

The complex of myxomas, spotty pigmentation and endocrine overactivity.

We describe a 40-year-old male with acromegaly, multiple and recurrent cutaneous myxomas, spotty cutaneous pigmentation, a mammary myxoma, a large-cell calcifying Sertoli cell tumour of the testis, and an unusual calcifying pigmented neuroectodermal tumour. He presented a combination of clinical and histological features not previously documented within the complex of myxomas, spotty pigmentation and endocrine overactivity, and therefore the findings broaden the spectrum of the syndrome.

Sister Mary Joseph's nodule.

A case of ovarian carcinoma that spread to the umbilicus and resulted in Sister Mary Joseph's nodule is described in which the mode of metastasis can be demonstrated. To our knowledge, this is the first report of confirmed contiguous extension from the peritoneal surface.

Asbestos related interstitial pneumonitis associated with glomerulonephritis and lymphomatoid granulomatosis.

We report a case of pulmonary asbestosis in a patient who also developed glomerulonephritis and lymphomatoid granulomatosis. The pulmonary reaction was unusual, characterized clinically by an acute onset of symptoms after a prolonged latent period and morphologically by an interstitial pneumonitis with prominent desquamative features and a paucity of fibrosis. The association of pulmonary asbestosis with glomerulonephritis and lymphomatoid granulomatosis has been hitherto unreported.