IgA multiple myeloma presenting as non-obstructive jaundice

Multiple myeloma can occasionally present with jaundice. The underlying process may be pancreatic head myeloma infiltration causing obstructive jaundice or hepatic amyloid deposition resulting in cholestatic jaundice. A rare case of myeloma presenting as jaundice due to hepatic myeloma infiltration is reported.

Fat necrosis of the breast: a cytological and clinical study

Fat necrosis of the breast is a sterile condition that usually results from trauma to the breast. It may present with a breast lump that, on clinical and mammographic examination, can mimic malignancy. The literature suggests that fat necrosis of the breast can only be diagnosed accurately by histological examinations of breast biopsies. In this paper, we review the findings of a series of 35 patients in whom fat necrosis was diagnosed on fine needle aspiration cytology. Repeated fine needle aspiration cytology with close follow-up have proven to be a reliable method of establishing the diagnosis of fat necrosis of the breast, thereby reducing the necessity for open biopsy.

Multiple oncocytic cysts of the larynx

Oncocytic metaplasia in laryngeal epithelium is uncommon. Oncocytes have been described in the lining of laryngeal cysts and such cysts have been reported in the literature under a variety of names. There is an ongoing debate about the exact nature of 'oncocytic cysts', which tend to be solitary. An unusual case of multiple oncocytic cysts of the larynx is described. The pathology and treatment are discussed.

Cavitation of mesenteric lymph nodes: a rare complication of coeliac disease, associated with a poor outcome

Five cases are presented, all of which showed peculiar cavitation of mesenteric lymph nodes. Clinically, three presented with abdominal symptoms, a mass or obstruction, warranting laparotomy. Two patients showed cavitating mesenteric lymph nodes at autopsy. Lymph nodes were enlarged with central, partly cystic degeneration; milky fluid exuded from the cut surface. In each case, investigation showed intestinal villous atrophy and splenic atrophy; coeliac disease was confirmed by response to gluten withdrawal. Three patients died, two from cachexia and the other from pneumonia; the other two are alive and well one year and six years after presentation. Review of the literature shows 12 previously reported cases, with a mortality of about 50%. The diagnosis is made by the histopathologist, alerting appropriate treatment. The pathogenesis is unknown.

Necrobiotic granulomas of the urogenital system

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Cytomegalovirus gastritis with perforation and gastrocolic fistula formation

A 76-year-old man with lymphoma involving cervical and mediastinal lymph nodes and abdomen was treated by radiotherapy and chemotherapy. He subsequently developed cytomegalovirus gastritis and gastric ulcers with a gastrocolic fistula and a jejuno-jejunal fistula, necessitating a partial gastrectomy. The pathogenesis of cytomegalovirus gastritis and its complications are discussed.

Cellular heterogeneity in giant cell tumour of bone (osteoclastoma): an immunohistological study of 16 cases

Sixteen cases of giant cell tumour of bone (osteoclastoma) were analysed by immunohistochemical techniques using various monoclonal antibodies specific for macrophages, monocytic and granulocytic cells, T- and B-lymphocytes and other cell types. The multinucleate osteoclastic giant cells failed to react with the majority of antibodies specific for myeloid cells and HLA-DR. In contrast to previous findings, giant cells in some tumours reacted with a rat, but not mouse, antibody to leucocyte common (CD45) antigen. Macrophages were detected in all tumours, though their numbers varied considerably; small numbers of T- and B-lymphocytes were identified in four of 16 cases. The neoplastic, spindle-shaped, stromal cells were largely unreactive with the monoclonal antibodies used in this study, further supporting the view that they are not the precursors of the characteristic giant cells, nor are they of haemopoietic origin.

Identification of cells of the human mononuclear phagocyte system with rat monoclonal antibodies

Five rat monoclonal antibodies (McAbs) to human macrophages are described: YTH 8.18, YTH 25.7, YTH 51.1, YTH 85.12.1, and YHB 65.5. These McAbs are divided into three groups, since YTH 8.18, YTH 51.1, and YHB 65.5 are thought to identify the same antigen. These McAbs react with some bone marrow blast cells, granulocytes, and different percentages of peripheral blood monocytes. When studied on different body tissues, they were found to identify all members of the mononuclear phagocyte system (MPS), except Langerhans cells of skin and epithelium and in the case of one group (YTH 8.18/YTH 51.1/YHB 65.5) osteoclasts. In nine reactive lymph nodes the anti macrophage McAbs identified germinal centre macrophages, sinus macrophages, and interdigitating cells, but not dendritic reticulum cells. They also identified epithelioid macrophages and Langhans-type multi-nucleated giant cells in lymph nodes involved in granulomatous lesions (sarcoidosis and toxoplasmosis). In 24 cases of non-Hodgkin's lymphoma, the antimacrophage McAbs identified reactive macrophages in cases of B- or T-lymphocyte origin, whereas in three selected cases of true histiocytic lymphoma all the McAbs were found to be reactive with the vast majority of neoplastic macrophages as they were with the cells of a neoplastic macrophage line (U937). The possible use of these McAbs in the identification of benign and malignant macrophages in different systems is discussed.

Histochemistry of dipeptidyl aminopeptidase (DAP) II and IV in reactive lymphoid tissues and malignant lymphoma

A modified histochemical method was used to show the presence of dipeptidyl aminopeptidase (DAP) II and IV in fixed, freeze dried, cryostat sections of tonsils, lymph nodes, and skin. In 14 reactive tonsils and lymph nodes both enzyme reactions were largely confined to T dependent areas where scattered positive lymphocytes were shown in the paracortical zones, while lymphocytes of germinal centres (B dependent areas) were negative. In either site some macrophages showed strong positivity for both enzymes. In 23 lymph node and two skin biopsy specimens of non-Hodgkin's lymphoma the neoplastic lymphocytes of 12 B cell lymphomas were completely unstained, whereas in the 13 cases of T cell lymphoma the neoplastic lymphocytes showed variable reactions with positivity for DAP II in eight and for DAP IV in seven, both reactions being positive in four and negative in two. Touch imprints of a lymph node from a case of Hodgkin's disease showed that the Reed-Sternberg cells were unreactive for both enzymes. The histochemistry of DAP II and IV may supplement other histochemical and immunological markers in the cytological classification of lymphomas.

Identification of macrophages and smooth muscle cells in human atherosclerosis using monoclonal antibodies

Sections of human atherosclerotic plaques were stained by the indirect immunoperoxidase technique using three rat anti-human monoclonal antibodies: YAML 501.4 (anti-'leukocyte-common' (T200) antigen; YTH 8.18 (antimacrophage cytoplasm); and YPC 1/3 . 12 (anti-smooth muscle cell). The cells of diffuse intimal thickening were almost all smooth muscle cells but there were rare subendothelial macrophages. Focal lesions, in contrast, contained numerous macrophages as well as smooth muscle cells. Macrophage 'foam cells' were particularly numerous in fatty streaks and in advanced fibro-fatty plaques, but were less conspicuous in focal fibro-elastic lesions. The results confirm that macrophages are an important component of atherosclerotic plaques and suggest that they may have a significant role in atherogenesis in man.

Monocytic origin of foam cells in human atherosclerotic plaques

Foam cells in 4 human atherosclerotic plaques reacted with 3 rat monoclonal antibodies directed against T.200 ('anti-leucocyte common' antibody), HLA-Class II molecules and macrophage cytoplasm, respectively. Smooth muscle cells did not react. The results support the view that foam cells are monocyte-derived macrophages.

Immunohistological screening in the selection of monoclonal antibodies: the use of isotype-specific antiglobulins

This paper describes the use of the immunoperoxidase technique for the screening of rat hybridoma culture supernatants on tissue sections. By combining the avidin-biotin system with mouse monoclonal antibodies specific to different rat immunoglobulin isotypes, it is possible to resolve the specificity patterns of complex mixtures of monoclonal antibodies from uncloned culture wells. This strategy is particularly useful in the derivation of monoclonal antibodies to cell surface antigens.