Incidence of cancer among anthophyllite asbestos miners in Finland.

A cohort of 736 male and 167 female workers of two anthophyllite mines in Finland was followed up through the Finnish Cancer Registry for cancer in 1953-91. Compared with the total cancer incidence of the east Finnish population, the men had a raised risk of total cancer (standardised incidence ratio (SIR) 1.7; 95% confidence interval (95% CI) 1.4-1.9), mainly attributable to an excess in lung cancer (SIR 2.8; 95% CI 2.2-3.6). The risk of lung cancer was somewhat higher among workers classified as heavily exposed (SIR 3.2; 95% CI 2.4-4.1) than among those moderately exposed (SIR 2.3; 95% CI 1.5-3.6) and the risk increased with increasing smoking and with increasing time of work with exposure. There were four cases of mesothelioma v 0.1 expected, all in men who smoked and had had a long and heavy asbestos exposure. Among women, a non-significant excess in total cancer (SIR 1.5; 95% CI 0.9-2.4) was found in the subgroup with heavy exposure to asbestos. Anthophyllite asbestos seems to have high potency in the carcinogenesis of lung cancer and low potency in carcinogenesis of mesothelioma in comparison with the other types of asbestos.

Four cases of mesothelioma among Finnish anthophyllite miners.

Four cases of mesothelioma in a cohort of 999 Finnish anthophyllite miners and millers are described. Three deaths were due to pleural mesothelioma and one to peritoneal mesothelioma among the total of 503 male deaths up to 1991. All four patients with mesothelioma had had long term (13 to 31 years) exposure in anthophyllite mining and milling. The latency time from the onset of employment until diagnosis was 39 to 58 years. All four patients were smokers or ex-smokers and had asbestosis. In three of the cases the pulmonary fibre concentration and fibre type were analysed by transmission electron microscopy. High concentrations (270 to 1100 million fibres/g dry tissue) of anthophyllite fibres were detected. The anthophyllite fibres were thicker and had lower aspect ratios than the values reported for crocidolite fibres retained in the lungs of patients with mesothelioma.

Post-molar trophoblastic disease following coexisting molar pregnancy and living fetus subsequent to clomiphene citrate therapy.

A case of the combination of a complete hydatidiform mole and a coexisting, living fetus arising from a twin pregnancy, subsequent to clomiphene citrate therapy for ovulation induction, is presented. The diagnostic problems of this combination as well as the incidence of molar pregnancy following the use of ovulation inducers are discussed.

Long-term efficacy of PUVA treatment in lichen planus: comparison of oral and external methoxsalen regimens.

Forty-three patients with lichen planus (LP) were treated with either oral methoxsalen PUVA (10 cases), bath methoxsalen PUVA (13 cases) or no PUVA (20 cases). In the bath treatment series, a good or excellent clearing of the lesions was registered in 10 out of 13 cases after courses of 8-46 irradiations, while in the orally medicated group only 5 out of 10 had a similar response after 8-30 irradiations. In addition, 11 of the 23 PUVA-treated patients showed progressive improvement of their condition during the first few months after PUVA therapy. A clinical follow-up study was made 15 and 10 months later in the oral and bath PUVA groups, respectively, and at 10 months in the no-PUVA group. Six of the 23 PUVA-treated patients (23%) were found to be totally clear, but the remaining 17 patients (74%) had clinical signs of LP. Eleven of the 20 no-PUVA-treated patients (55%) showed total clearing. It is concluded that while both oral and bath methoxsalen PUVA regimens have a distinct immediate (1-2 months) clearing effect on LP, the late outcome of the rash is not better than with no UV treatment; PUVA treatment may possibly even prolong the ultimate course of LP.

Graft-versus-host reaction in 3 adult leukaemia patients after transfusion of blood cell products.

We describe 3 cases of acute graft-versus-host (GVH) disease in patients with acute myeloid leukaemia following transfusions taken from non-HLA-identical healthy donors. The leucocyte transfusions were given because of severe bone marrow aplasia and granulocytopenia following leukaemia induction treatment. The first patient had an acute GVH reaction with an erythrodermia-like skin reaction all over and associated with severe abdominal cramping, enlarged liver and pathological liver function tests. The second patient had a relatively mild skin reaction and enlarged liver. Both died of severe pulmonary infection. The third patient also had a mild skin reaction and enlarged liver. He died of pulmonary embolism. The diagnosis of GVH of the latter 2 cases was made on skin biopsy. The autopsy samples revealed in all cases a heavy lymphocytic infiltration of the kidneys and liver portal area. Until more precise guidelines can be established, irradiation of blood cell products given to patients with neutropenia due to leukaemia induction treatment should be considered.

Proliferating glia and other heterotopic tissues in the uterus: fetal homografts?

The authors describe clinically and histologically the cases of 5 patients with glial tissue in the uterus and discuss the explanation for this rare phenomenon. The glial tissue was generally manifested as an endocervical polyp, and in one case as a large polypoid tumor on the ectocervix. Histologically, apart from glial tissue, one patient had islands of cartilage, bone, and keratinizing squamous epithelium both in the cervix and in the endomyometrial layers. Only a few investigators have found cartilage and bone in addition to glial tissue, and the authors know of no other case in which epidermal tissue has been found. The authors believe that the theory postulating the fetal origin for these foreign tissues in the uterus is the most plausible one. The specific immunologic as well as cytologic and cytogenetic factors remain to be defined.

Female genital tuberculosis and consequent infertility.

During the years 1971-1980, genital tuberculosis was found in seven patients examined for infertility at the Department of Obstetrics and Gynaecology, Turku University Central Hospital. None of these patients had a previous history of tuberculosis manifestations. Chest X-ray examinations were normal for all patients. Six of the patients had tuberculous endometritis. Infertility was the only one had tuberculous endometritis. Infertility was the only symptom for these patients. The findings for the hysterosalpingogram were varied and generally not typical of genital tuberculosis described in the literature. All diagnoses were confirmed histologically. Two cases of full-term pregnancy after treatment of genital tuberculosis are described. In one case there was a purulent tuberculous salpingo-oophoritis and in the other case there were tuberculous implants at the surfaces of the uterus and ligamentum latum. In addition two cases of extrauterine pregnancy are described.

Tuberculous peritonitis simulating peritoneal carcinosis.

Two cases are reported exemplifying the difficulties faced in the clinical diagnosis of peritoneal tuberculosis. Two fertile-aged nulliparous females were admitted with symptoms and signs of an acute abdomen. Both showed a relative intestinal obstruction, abdominal mass and ascitic fluid. A malignant disease was suspected and laparotomy was performed. Tuberculous peritonitis was demonstrated histologically in biopsy and later confirmed by positive culture for tubercle bacilli. In the first case the correct diagnosis was disclosed during operation by frozen section, although the histological picture also indicated possible carcinosis because of a heavy mesothelial hyperplasia. A 9-month chemotherapy with isoniazide and rifampicin, supplemented during the first 2 months by streptomycin or ethambutol, was successful in both cases.

Clear cell (mesonephroid) tumors of the ovary with characteristics resembling endodermal sinus tumor.

Twenty-five ovarian clear cell tumors and six endodermal sinus tumors were studied by histochemical, immunohistochemical, and ultrastructural methods. The results of the study indicate that some clear cell tumors contain periodic acid Schiff (PAS) positive and diastase resistant hyaline globules, and also basement membrane-like material, which have been previously considered as being observed only in endodermal sinus tumor. In view of this, we would like to emphasize the importance of the presence of the various histological patterns observed in endodermal sinus tumor, in addition to the classical perivascular formations (Schiller-Duval bodies) and the presence of alpha-fetoprotein (AFP), as diagnostic features of endodermal sinus tumor. On the other hand, the presence of glycogen, abundant rough endoplasmic reticulum stacked in parallel rows, and a more uniform histological pattern are indicative of clear cell (mesonephroid) tumor of the ovary.

Diagnosis and treatment of primary vaginal carcinoma in situ and dysplasia.

Fifteen cases of primary carcinoma in situ or severe or moderate dysplasia of the vagina have been diagnosed and treated during the period 1966-75 at the Department of Obstetrics and Gynecology, Turku University Central Hospital. Because of abnormal vaginal cytology the lesion was localized by means of colposcopy and iodine staining. For 6 patients local estrogen treatment was applied to increase the thickness of the epidermal layer. For 6 patients, treatment consisted of simple excision. Nine patients, including both those with carcinoma in situ, were treated with intravaginal radiation therapy. The radiation dosage was 2 000 to 2 600 rad at a distance of 1 cm from the surface of the epithelium. None of the patients showed any complications, and all are now symptom-free.