Prenatal diagnosis of trisomy 20 mosaicism indicating esophageal and rectal origin

Trisomy 20 mosaicism in cultured amniotic fluid cells has in only a few cases been confirmed in fetal tissue. This may lead to the assumption that the trisomic cells are of extra-fetal origin and interruption of the pregnancy is not advisable. Chromosome analysis of numerous fetal tissues indicated in two cases the presence of one or more trisomy 20 cell clones in rectum and esophagus, respectively. The clinical significance of trisomy 20 mosaicism in single organs remains to be elucidated. Besides the karyotype, genetic counselling should take into account all accessible information of the pregnancy, e.g. ultra-sound, serum alpha-fetoprotein values and obstetrical history.

Acrokeratosis paraneoplastica (Bazex' syndrome)

A 63-year-old man had acrokeratosis paraneoplastica (Bazex' syndrome) characterized by violaceous erythema and scaling of the fingers, toes, nose, and aural helices. Severe nail dystrophy was present. Extensive examination of the patient for malignant neoplasms a few months after the initial appearance of the skin changes disclosed no abnormalities, but one year after onset, an epidermoid carcinoma of the lung was found.

Malignant histiocytosis. The diagnosis based on chromosomal, immunologic and histiopathologic analysis

A 38-year-old female suffered for several months from persistent fever without signs of infectious or immunologic disease. 57Co-bleomycin scintigraphy revealed abnormal concentration in the liver. Following a diagnostic laparotomy, the patient died from abdominal haemorrhage. Malignant cell infiltration was demonstrated in a biopsy from the liver. Histiocytic cells were demonstrated in a bone marrow smear obtained shortly before death. Investigation of cultured lymphocytes obtained from the patient the day before she died showed deficiency of T-lymphocytes. Investigations of chromosomes delineated several clones with polyploidi. The diagnosis of malignant histiocytosis was based on erythrophagocytosis, and immunologic and chromosomal aberrations. If malignant histiocytosis is the primary disease, a terminal stage of different diseases or a sign of complication secondary to immuno incompetence (e.g. virus infection) is an open question.

Permanent cardiac pacemakers implanted in the pleural space

Intrapleural implantation is recommended for children, active adolescents and adults, psychiatric patients, and infection-prone patients because of the protection afforded by the pleural space. The implantation technique is briefly described. Complications include diaphragmatic muscle stimulation (with a unipolar unit) and continuous migration of the pulse generator. The advantages of this implantation site include the following (1) reduced risk of lead fracture, (2) protection from physical trauma, (3) reduced risk of infection and erosion. (4) improved cosmetic appearance, and (5) minimized child/generator size disproportion. In one groups of patients undergoing both standard and intrapleural implantation, the number of pacing months per surgical procedure was increased from 5.1 months (standard implant) to 26.2 months (intrapleural implant). Intrapleural implantation may be considered the generator position of choice for the small percentage of patients who require special pacing system protection.

The extent of carcinoma in situ in urinary bladders with primary carcinomas

The occurrence of carcinoma in situ was examined in a consequtive series of cystectomy specimens from 43 patients. All patients were suffering from or had been suffering from primary bladder cancer. Carcinoma in situ was defined as a definitive polymorphia of enlarged nuclei with abnormal chromatin structure in non-tumour bearing areas. It was found in 26 bladders. By means of a systematic technique of cutting the specimens, the extent of the alterations was quantitied, relating the number of blocks containing the alteration to the total number of blocks in which the changes possibly might be present. The extent of carcinoma in situ ranged from 2 to 81% with an average of 20%. The distribution of the alterations was unpredictable, often strongly focal, most often in continuation of the tumour. In one specimen, the margins of resection were involved. The extent was largest in bladders with poorly differentiated tumours. A temporal relationship between in situ carcinoma and invasive carcinoma could not be shown, as regards tumour size and duration of clinical symptoms. The morphology of the changes is discussed seen in the light of variations in the normal epithelium lining the lower urinary tract. Minor degrees of atypia of the epithelium showed rather bad reproduction. The dominating occurrence of carcinoma in situ in bladders with poorly differentiated tumours may either be a manifestation of a biological difference between tumours of different grades of differentiation or that the morphological criteria used correspond to the in situ type of poorly differentiated tumours.

Types of metaplasia in forty urothelial bladder carcinomas. A systematic histological investigation

In a systematic study of bladders from consecutively cystectomized patients, 40 primary urinary bladder carcinomas were examined with regard to the type of differentiation. Metaplastic areas were found in 24 of the tumours. A positive reaction of keratin to Kreybergs stain was required for the definition squamous metaplasia. Squamous areas were found in 16 of the tumours. In 4 tumours there was, in addition to squamos metaplasia, glandular metaplasia which was defined as definite glandular tissue with dysplasia of the epithelium. In 4 tumours, glandular metaplasia was also present in addition to the urothelial carcinoma. In 18 cases, metaplastic changes were present in the luminal portion of the tumour from which the biopsy material and desquaminated material originated. The occurrence of metaplasia was related to the degree of differentiation of the urothelial part of the tumour. Metaplastic changes were most frequent in the poorly differentiated tumours. The biopsies obtained pre-operatively permitted of the diagnosis metaplasia being made in 15 cases, while the cytological material suggested metaplastic changes in 4 cases only. The biological function of metaplasia is unknow. The possibility that these areas will react differently to radiation and chemotherapy is present and the frequency of such changes would suggest that their importance should be studied by their registration as mixed forms as stated by WHO.