Castleman's disease of the neck: a description of four cases on contrast-enhanced CT

Castleman's disease of the neck is an uncommon benign lymphoproliferative disease that usually presents as homogeneously enhancing enlarged lymph nodes on contrast-enhanced CT scan. We described the appearance of four confirmed cases of Castleman's disease of the neck on contrast-enhanced CT scan. Three of these presented as a solitary enhancing lymph node and the fourth case presented with multiple bilateral enhancing lymph nodes. A central non-enhancing area was present in two of the three cases that presented as a solitary node. Pathological correlation of one of these cases showed that this was due to a central fibrotic scar. One of the enhancing nodes in the fourth case with multiple and bilateral lymphadenopathy also contained a central non-enhancing area. We would like to propose that if a central non-enhancing scar is observed in an enhancing lymph node in the neck on CT scan, Castleman's disease should be considered as a possible diagnosis.

Foetal intralobar lung sequestration: antenatal diagnosis and management

OBJECTIVES

The objectives of this study are to discuss the use of ultrasonography for the diagnosis of foetal intralobar sequestration (FILS) antenatally and the management options available for these pregnancies.

METHODS

This is a retrospective review of six cases of FILS diagnosed antenatally by two dimensional (2D) and colour Doppler ultrasonography out of a total of 31,508 deliveries over a two-year period at the KK Women's and Children's Hospital.

RESULTS

The incidence of FILS in this hospital was 1 in 5,251 deliveries. 2D ultrasonography showed an echogenic lung in all cases. FILS was confirmed by the demonstration of a systemic vessel leading to the affected lung on colour Doppler examination. After counselling, four terminated their pregnancies during mid-trimester, while two continued their pregnancies to term. Confirmation of the terminated cases was by post-mortem. In the two pregnancies that continued, regular growth scans were done to monitor the progression of the condition. Computed tomography confirmed the diagnosis post-delivery. Both were well but one had a resection of the sequestrated lung although he was asymptomatic. Histology also confirmed the diagnosis.

CONCLUSION

FILS is a rare anomaly. 2D and colour Doppler ultrasonography are used to diagnose the condition antenatally. Termination of the pregnancy is not always indicated, as there are favourable outcomes from FILS.

Primary histiocytic lymphoma of the central nervous system: a neoplasm frequently overshadowed by a prominent inflammatory component

True histiocytic lymphoma, as defined by strict criteria, is a very rare neoplasm. We describe three cases occurring as primary tumors in the central nervous system. The patients, two females and one male, ranged in age from 11 to 69 years. The tumors involved the brain in two cases and spinal cord in one, with a size ranging from 7 to 17 mm. Two patients died at 4 months and 8 months, respectively, and one was alive with disease at 5 months. Pathologically, the tumors comprised groups and sheets of noncohesive large cells with pleomorphic vesicular nuclei, distinct nucleoli, and abundant eosinophilic cytoplasm. A dense inflammatory infiltrate consisting of neutrophils, lymphocytes, plasma cells, and histiocytes was present, with multiple foci of necrosis and abscess formation. All three cases demonstrated an identical immunophenotype: positive for CD68 and lysozyme; focally positive for S-100 protein, CD45RB, and CD4; and negative for CD3, CD20, CD21/CD35, CD1a, CD30, ALK1, myeloperoxidase, glial fibrillary acidic protein, and cytokeratin. The proliferative index ranged from 20% to 35%. Ultrastructural examination further confirmed the histiocytic nature of the tumor cells, characterized by irregularly folded or multisegmented nuclei and abundant cytoplasm containing lysosomes; Birbeck granules, interdigitating cell processes, and cell junctions were not found. Although the presence of abundant inflammatory cells could obscure the neoplastic histiocytes, making the distinction from inflammatory conditions difficult, awareness of this unusual histologic feature and the invariable finding of pleomorphic cells in some areas of the lesion permit the correct diagnosis to be made.

Telecommunications and disabled people: a rural perspective

In the context of the National Health Service and Community Care Act 1990 this paper focuses on the role of home- and community-based telecommunication services in sustaining the life-style and independence of elderly and disabled people in rural Britain. It draws on findings from a recent survey in the North Cotswolds to evaluate four models of telecommunication support: telephone trees; community alarm systems; community teleservice centres (CTCs); and on-line computer systems. The arguments in favour of a "low-cost-voluntary-care-support-model", a variant of the CTC, are discussed with respect to client need and community setting.

Cancer in the Gizan province of Saudi Arabia: An eleven year study

The occurrence of histologically diagnosed primary malignant tumors in Saudi and Yemeni patients in Gizan Province over the 11 years from 1982 to 1992 was analyzed. During the study period, 1398 malignancies of known primary site were seen in males and 972 in females. In common with other parts of Saudi Arabia, the overall incidence of malignant disease was low by Western standards with lymphoreticular malignancies relatively common and tumors of lung, bowel, breast and the female genital system relatively uncommon. Some malignancies are more common in Gizan Province as compared to elsewhere in Saudi Arabia. Oral cancer was the most common malignancy in females and the most common overall, probably due to widespread use of oral tobacco preparations. Liver cancer was the most common malignancy in males, reflecting the endemic nature of hepatitis B in the area. The incidence of bladder cancer, and particularly of squamous carcinoma of the bladder, was also more, probably due to the high incidence of schistosomiasis in the area. No significant trends in incidence of specific malignancies were noted over the 11-year study period, even though the period has been marked by dramatic and unprecedented changes in lifestyle and public health.

Wilms' tumour associated with deep cystic nephroma-like changes: three cases of a putative Wilms' tumour precursor

We describe three cases of Wilms' tumour accompanied by central pericalyceal multicystic lesions closely resembling those seen in cystic nephroma. In continuity with these lesions or elsewhere in the kidney were areas of dysplastic renal tissue of the type sometimes referred to as intralobar nephroblastomatosis. A close homology of tissue differentiation was observed between the dysplastic lesions and the interstitial components of the cystic lesions. These findings support the hypothesis that, in some cases at least, cystic nephroma has more in common with the group of dysplastic lesions referred to as the nephroblastomatosis complex than with the true renal tumours of childhood.

The case for samples of anonymized records from the 1991 census

"The census of population represents a rich source of social data. Other countries have released samples of anonymized records from their censuses to the research community for secondary analysis. So far this has not been done in Britain. The areas of research which might be expected to benefit from such microdata are outlined, and support is drawn from considering experience overseas. However, it is essential to protect the confidentiality of the data. The paper therefore considers the risks, both real and perceived, of identification of individuals from census microdata. The conclusion of the paper is that the potential benefits from census microdata are large and that the risks in terms of disclosure are very small. The authors therefore argue that the Office of Population Censuses and Surveys and the General Register Office of Scotland should release samples of anonymized records from the 1991 census for secondary analysis."

Panlobar nephroblastomatosis: a distinctive form of renal dysplasia associated with Wilms' tumour

An increasing variety of dysplastic lesions of metanephric origin ('the nephroblastomatosis complex') have been recognized as precursors of Wilms' tumour. We describe here four cases of a hitherto unrecognized renal dysplasia associated with Wilms' tumour and having a panlobar distribution. It has many features in common with the intralobar form of nephroblastomatosis, but differs in extending through the full thickness of the renal substance from calyx to capsule. These cases are also characterized by an increased proportion of well-differentiated tissue elements and by the presence, in some cases, of anomalous metanephric differentiation in the pericalyceal tissues or renal capsule. The presence of Wilms' tissue arising deep in the renal substance should alert the pathologist to make a thorough search for associated dysplastic elements in the kidney.

[Prenatal diagnosis of triploidy]

In two pregnant women the diagnosis fetal triploidy was made by transabdominal villous biopsy at 20 and 21 weeks. Chromosomal analysis revealed a 69, XXX respectively 69, XXY karyotype. The diagnosis was suspected because of fetal growth retardation and a large vesicular placenta on sonographic examination. One patient had bilateral multilocular ovarian cysts. She had an eclamptic seizure at 22 weeks. In both patients labour was induced by intravenous prostaglandins. One fetus had a small spina bifida, the other fetus had no congenital malformations. Microscopy of both placentas showed a partial mole. A short description is given of the abnormalities associated with triploidy.

Epithelioid angiomatosis in the acquired immunodeficiency syndrome: morphology and differential diagnosis

A rare vascular proliferation found as a skin lesion in patients suffering from the acquired immunodeficiency syndrome and sometimes referred to as epithelioid angiomatosis is believed to be a manifestation of infection by the cat scratch bacillus or a related organism. We describe the histological findings from eight lesions seen in two cases. In all cases the diagnosis could be confirmed by demonstration within the lesions of groups of gram-negative rod-shaped organisms staining positively with the Warthin-Starry stain. This condition needs to be distinguished from a variety of reactive and neoplastic vascular proliferations.

Disseminated cat-scratch disease in a patient with AIDS

A patient with AIDS developed subcutaneous nodules and associated osteolytic lesions with negative stains and cultures for bacteria, fungi and parasites. Flucloxacillin was not effective but treatment with vancomycin was associated with improvement. Six months later the patient became severely ill, with fever, malaise and multiple skin and laryngeal papules. Cat-scratch disease was diagnosed from the typical epithelioid angiomatosis seen in skin biopsies with bacterium-like structures in the Warthin-Starry stain. Retrospectively these typical structures were also seen in earlier biopsies. All lesions improved after therapy with erythromycin had been instituted.

Histiocytoid breast carcinoma: an apocrine variant of lobular carcinoma

Two cases of in situ and invasive histiocytoid breast carcinoma are described. The invasive components of both tumours showed architectural and cytological similarities to lobular carcinoma. The in situ components showed areas of classical lobular carcinoma in situ, areas of lobular carcinoma with apocrine features and areas with transitional features. It is concluded that histiocytoid carcinoma represents an apocrine variant of lobular carcinoma. Differentiation of this tumour from chronic sclerosing inflammation may be difficult in both primary and secondary lesions.

Sulindac hepatotoxicity

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