Rhinocerebral mucormycosis diabetes mellitus and adrenogenital syndrome.

A case of rhinocerebral mucormycosis in a diabetic is described. The case is unusual as the mucormycosis developed in the absence of ketoacidosis and because that patient had concomitant adrenogenital syndrome.

The pattern of paediatric malignancy in Zambia (1980-1989): a hospital-based histopathological study.

The pattern of malignancies among indigenous Zambian children is described. The study, based upon an analysis of histopathology, autopsy and haematology records for a 10-year period (1980-1989), reveals a total of 525 neoplasms with a peak prevalence in the 5-9 year age group. Non-Hodgkin's lymphoma (17.5%) was the most common disorder followed by Burkitt's lymphoma (13.9%), retinoblastoma (11.4%), Kaposi's sarcoma (8.8%), Hodgkin's disease (5.9%), Wilms' tumour (5.9%), acute lymphocytic leukaemia (4%), rhabdomyosarcoma (3.4%), nasopharyngeal carcinoma (2.7%) and osteogenic sarcoma (2.1%). Kaposi's sarcoma and Hodgkin's disease revealed a significant male dominance; the former presented mainly in nodal form. Compared to an earlier report from Zambia (1968-1972), a significant increase in the incidence of Kaposi's sarcoma and nasopharyngeal carcinoma was noted in the present series.

Malakoplakia of the small intestine as a cause of enterocutaneous fistula.

A case of malakoplakia of the small intestine presenting as an abscess of the anterior abdominal wall is described in a 28-year-old black Zimbabwean man. The patient developed an enterocutaneous fistula after incision and drainage of the abscess. Light and electronic microscopy revealed Michaelis-Gutmann bodies in some von Hansemann cells. He did well for eight months following laparotomy and resection of the fistula, but later died of a severe chest infection and septicaemia. It is suggested that malakoplakia in this case behaved like a locally aggressive lesion. Von Hansemann's histiocytes were sighted in the subcapsular sinus and germinal centres of nearby lymph nodes.

Azoospermic infertile men.

Of 1518 consecutive cases of men referred with infertility, 369 (24%) had complete absence of spermatozoa from their semen (azoospermia). This is a high incidence compared with the rates of 4 to 14% reported in other studies. Primary testicular failure, ductal obstruction, endocrine abnormalities, cryptorchidism and infection were common findings in these men; 247 (67%) gave a history of sexually transmitted infection. The duration of involuntary infertility on presentation ranged from 1 to 16 years. Very few couples accepted artificial insemination with donor semen (AID) as a method of achieving pregnancy and none would consider adoption.

Small bowel enterocyte abnormalities caused by methotrexate treatment in acute lymphoblastic leukaemia of childhood.

Jejunal biopsy specimens from 10 children with acute lymphoblastic leukaemia on methotrexate treatment were compared with 10 from children being investigated for diarrhoea or failure to thrive. In association with methotrexate treatment on both light and electron microscopy, there were marked morphological abnormalities in the villus enterocytes. These consisted of a striking distention of the lateral basal intercellular spaces, cell vacuolation and patchy necrosis and was most marked when methotrexate treatment was given between 24 and 72 h before biopsy. Two mechanisms may be involved: an early direct toxic effect on the mature enterocyte coupled with interference with crypt cell generation, possibly causing ageing and loss of cells proximal to the normal extrusion zone. These pathological changes may account for the malabsorption in association with methotrexate treatment.

A neurilemmoma of the cervix.

We present a case of neurilemmoma of the cervix which is the first to be reported in the English literature. The characteristic histological features are described and its differentiation from a leiomyoma is confirmed by electron microscopic studies.