Primary amyloidosis of the breast associated with invasive breast cancer

Amyloidosis is usually a systemic disorder. A localised form can involve the breast and may mimic breast cancer. We report a case of primary amyloid deposit confirmed by immunohistochemistry, occurring in a patient with early breast cancer and review other cases of breast involvement with various types of amyloid.

Angiotropic B-cell lymphoma (malignant angioendotheliomatosis): failure of systemic chemotherapy

A 65-year-old female with angiotropic B-cell lymphoma is reported. Despite the absence of systemic involvement on formal staging and the favourable response of the cutaneous lesions to triple systemic chemotherapy with prednisolone, vincristine and cyclophosphamide, postmortem findings showed that death was due to widespread disease dissemination.

An assessment of the value of Ag NOR staining in the identification of dysplastic and other borderline melanocytic naevi

One hundred and six melanocytic lesions were studied to determine the value of the so called Ag NOR technique in differentiating dysplastic naevi, Spitz naevi and spindle cell naevi of Reed from malignant melanoma and from 'banal' compound or intradermal naevi. In 79 cases Ag NOR counts were possible. The banal naevi (36) had a mean count of 1.54, (SD 0.3), and the unequivocally malignant superficial spreading melanomas (13), lentigo maligna melanomas (4) and secondary melanomas (4) had a mean count overall of 3.9 (SD 1.59). For dysplastic naevi (16) the mean Ag NOR count was 1.63 (SD 0.36) and for Spitz and spindle cell naevi (in toto 6) the figure was 1.72 (SD 0.55). The difference in Ag NOR counts between all types of naevi and all types of melanoma was highly statistically significant, but there was no difference between banal naevi and dysplastic, Spitz, and spindle cell naevi. Correlation of Ag NOR counts between three independent observers was good. This technique may, therefore, be a useful adjunct in separating true melanoma from borderline melanocytic naevi.

Diffuse villous adenoma of the pancreatic duct

A case of diffuse villous adenoma affecting the pancreatic duct in a 31-year-old woman is described. The diagnosis was made by endoscopic retrograde cholangiopancreatography and the patient treated by proximal pancreatectomy. One year later the patient is alive and well. Papillary tumors affecting the pancreatic duct have rarely been described. All previous cases have occurred in middle-aged or elderly patients. None of the previously described benign tumors was as extensive as the one reported here. The possible pre-malignant potential of such tumors is discussed.

Mixed apocrine-medullary carcinoma of the breast. Report of a case with fine needle aspiration cytology

The case of an unusual variant of breast carcinoma arising in an 80-year-old woman is presented. Fine needle aspiration (FNA) cytology of this carcinoma revealed sheets of cells showing apocrine differentiation and significant cellular atypia mixed with lymphocytes and plasma cells. At mastectomy, the neoplasm was found to have features of both apocrine carcinoma and medullary carcinoma, with a prominent lymphocytic infiltrate. This case underlines the difficulty in distinguishing between malignant apocrine cells and apocrine metaplastic cells by FNA cytology. The presence of an inflammatory component, as seen in this case, may compound such difficulties.

Proposed alternative terminology and subclassification of so called "dysplastic naevi"

The term "dysplastic" melanocytic naevus has recently been used to describe pigmented naevi with unusual histological and clinical features. There is currently no clear clinical or pathological definition of the term, and this has led to a lack of comparability of material described in reports on these lesions. As a result of careful histological study and a clinicopathological correlation of 100 naevi, we suggest that three distinct groups of histopathological features distinguish so called dysplastic naevi from banal melanocytic naevi. These are architectural atypia, cytological atypia, and a host response. Description of each of these features in routine reports and in published series in place of the loose use of the term "dysplastic" would enable comparisons to be made between series of melanocytic lesions reported from different centres. In the course of this study we observed a considerably increased incidence of naevus type giant cells in the dermal portion of the atypical naevi. These giant cells should not be confused with possibly premalignant cytological atypia.