Short communication: determination of potential 5-hydroxymethyl-2-furaldehyde and 2-furaldehyde compounds in follow-on milks and infant formulas using the high-performance liquid chromatography method.

The aim of present study was to determine the levels of potential 5-hydroxymethyl-2-furaldehyde (HMF) and 2-furaldehyde (F) in 109 baby food samples (60 follow-on milks, 49 cereal- and milk-based infant formulas) obtained from different markets in Ankara (Turkey). Potential HMF and F compounds were determined by HPLC. Mean levels (± standard error) of HMF and F of follow-on milk samples were found to be 237.85±18.25 and 9.44±0.39 µg/100mL, respectively. Regarding the infant formulas, mean levels of HMF and F were found to be 905.41±91.94 and 13.22±1.21 µg/100g. As a result, potential HMF was determined in all of the samples; potential F was determined in all the samples except 1. The mean levels of potential HMF and F of infant formulas were higher than mean levels of potential HMF and F of follow-on milks. In addition, HMF and F values of some samples with an imminent expiration date were found to be higher than HMF and F values of the other samples. At present, no limits have been established in the Turkish Food Codex (TFC) for furfural compounds concentrations in infant formula and milks. Establishing limits related to these compounds would be important for protecting the quality of infant foods.

Short communication: investigation of aflatoxin M1 levels in infant follow-on milks and infant formulas sold in the markets of Ankara, Turkey.

Aflatoxins are fungal toxins known to be carcinogenic and are classified as food contaminants. This study was performed to investigate aflatoxin (AF) M1 levels in baby foods sold in Ankara (Turkey) and to evaluate the obtained results according to the Turkish Food Codex (TFC). For this purpose, a total of 84 baby food samples (50 follow-on milks and 34 infant formulas) were obtained from different markets in Ankara and the presence of AFM1 in the samples was analyzed by ELISA. In 32 (38.1%) of 84 infant food samples, the presence of AFM1 was detected in concentrations ranging between 0.0055 and 0.0201 µg/kg. The mean level (± standard error) of AFM1 was found to be 0.0089 ± 0.0006 µg/kg in positive infant follow-on milks. Aflatoxin M1 was detected in only 1 infant formula sample (2.94%) at a concentration of 0.0061 µg/kg. The extrapolated levels of AFB1 contamination in feedstuffs were calculated based on levels of AFM1 in baby food samples. The data estimating AFB1 contamination in dairy cattle feedstuff indicate that contamination may range from 0.3410 to 1.2580 µg/kg, with the mean level (± standard error) being 0.5499 ± 0.0385 µg/kg, which is lower than the level set by the TFC and European Union regulations (5 µg/kg). According to the obtained results, the levels of AFM1 in analyzed samples were within the allowed limit (0.025 µg/kg) set in the TFC. Low levels of AFM1 in infant follow-on milks and infant formula samples obtained during the study do not pose a health risk to infants.

Relevant histopathologic findings that distinguish acute cellular rejection from cholangitis in hepatic allograft biopsy specimens.

BACKGROUND AND AIM: Histopathologic differential diagnosis of acute cellular rejection (ACR) and cholangitis continue to pose important problems following liver transplantation. The purpose of the present study was to evaluate the histopathologic features of ACR versus cholangitis. METHODS: The following variables were evaluated among 36 hepatic allograft biopsy specimens, consisting of 21 with ACR (group 1) and 15 with cholangitis (group 2) for ductal neutrophilic infiltration, presence/density of portal eosinophilia, centrilobular necrosis, central/portal vein endothelialitis, pericentral inflammation, hepatocyte ballooning, hepatocanalicular/ductular cholestasis, hepatocyte apoptosis, lobular inflammation, ductular proliferation, periductal fibrosis/edema, ductular epithelial damage, and portal inflammation. Only the first biopsy samples of the ACR group were included in this study. RESULTS: The incidences of ductal neutrophilic infiltration (93.3% vs 19%), hepatocanalicular cholestasis (86.7% vs 47.6%), ductular cholestasis (60% vs 0%), ductular proliferation (93.3% vs 4.8%), and periductal fibrosis/edema (93.3% vs 19%) were significantly greater in group 2 than group 1 (P < .05). In contrasts the incidences of portal eosinophilia (mean +/- SD, 3.37 +/- 3.9 vs 0.73 +/- 0.8), dense portal eosinophilia (mean +/- SD, 0.33 +/- 0.31 vs 0.11 +/- 0.16), central vein endothelialitis (0% vs 57.1%), portal vein endothelialitis (20% vs 95.2%), apoptosis (40% vs 71.4%), and necroinflammation (0% vs 90.5%) were significantly higher in group 1 (P < .05). The other parenchymal histopathologic changes and features of portal inflammation were similar in the 2 groups. CONCLUSION: In the differential diagnosis, ductal changes (cholestasis, neutrophilic infiltration, proliferation, and periductal fibrosis/edema) favor cholangitis, whereas the presence and density of portal eosinophilia favor ACR. Portal inflammation is not a distinctive morphological finding.

Evaluation of posttransplantation malignancies compared with de novo tumors.

It is uncertain whether tumors arising in transplant patients resemble ones that develop de novo in pathogenesis, morphology, and behavior. This study sought to investigate some clinical, morphological, and immunohistochemical features of several posttransplantation malignancies compared with similar de novo tumors. The study group consisted of 40 malignant tumors encountered in 1350 transplant patients (1229 kidneys, 113 livers, 8 hearts) between 1986 and 2006. Tumors with 3 or more examples were compared with randomly selected controls. These included Kaposi's sarcoma (n=14); extranodal lymphoma (n=9); squamous cell carcinoma (n=6); and nodal lymphoma (n=3). The variables that were analyzed were the localization, predisposing lesions, degree of differentiation, and host response. For lymphomas, we also determined histological subtype, origin, and Ki-67 proliferation index. Most tumors (36/40, 90%) occurred in patients with renal transplants. However, the relative frequency was higher among liver transplant cases (3.53% vs 2.92% for kidney transplants). No malignancy was seen in heart transplant cases. Squamous cell carcinomas were better differentiated (P<.05) compared with controls and they were more frequently associated with precursor lesions (P<.05). Kaposi's sarcomas involved internal organs more frequently in posttransplant patients, and the Ki-67 proliferation index was higher in posttransplantation nodal lymphomas. However, these factors were not significantly different (P>.05). Our findings suggested that certain posttransplantation malignancies display unique characteristics compared with their de novo counterparts.

Active packaging of chicken meats with modified atmosphere including oxygen scavengers.

The effects of modified atmosphere packaging (MAP-70% CO2/30%N2) and iron-based oxygen scavengers (OS) with various absorption capacities (Ageless® ss100, ss300, and ss500) as an active packaging system on microbiological and oxidative changes in chicken thigh meats were evaluated during refrigerated storage (4°C) for 19 d at 3-day intervals. Total aerobic mesophilic bacteria counts exceeded the acceptability limit at d 7 in the control group without MAP (AIR), and at d 19 in MAP and OS containing samples. OS utilization resulted in around 1.5 and 1.0 log unit reductions in Pseudomonas spp. counts at d 7 and d 10 of storage, respectively, as compared with AIR and MAP groups (P < 0.05). MAP and OS groups had fewer (P < 0.05) coliform counts than did the AIR group, with an approximately 1.0 log reduction observed at d 10. Although in some cases OS utilization resulted in lower TBARS values and carbonyl and sulphydryl contents, particularly during later stages of refrigerated storage as compared to AIR and MAP groups, in general, these effects were not always apparent. The results of this study suggested that MAP suppressed microbiological growth and retarded lipid and protein oxidation in chicken thigh meats, with a 9-day shelf-life extention with insignificant effects of OS.

Microvessel density, VEGF expression, and tumor-associated macrophages in breast tumors: correlations with prognostic parameters.

Angiogenesis plays an important role in tumor growth, metastasis, and prognosis. Vascular endothelial growth factor (VEGF) is a potent endothelial mitogen and acts on the angiogenic stimulation of human neoplasias. In infiltrative ductal carcinoma (IDC), VEGF expression is correlated with high vascularity. Tumor-associated macrophages (TAMs) contribute to tumor proliferation, progression and angiogenesis and have a complex role in tumor biology. In this study, the correlations between microvessel density (MVD), VEGF expression, and TAMs and their relations to clinicopathological parameters such as tumor size, metastatic lymph node, mitotic activity index (MAI) and tumor grade were investigated in 48 cases of IDC and 30 infiltrative lobular carcinoma (ILC) cases. MVD showed a significant positive correlation with TAMs, VEGF, metastatic lymph nodes, tumor size and grade in IDC (P < 0.001). In ILC, MVD and tumor size were positively correlated (P = 0.003), while MVD was not correlated with VEGF, TAMs, MAI, metastatic lymph nodes, and grade. These findings are suggestive of angiogenesis stimulation in IDCs by VEGF, driving the macrophages into the tumor area. MVD and TAMs were found to be important prognostic factors in IDCs. On the other hand, however, VEGF did not contribute to angiogenesis in ILCs, and MVD and TAMs did not have any prognostic significance. These results suggest the involvement of factors not related to VEGF in the angiogenesis of lobular carcinoma.

Successful treatment of myelodysplastic syndrome-induced pyoderma gangrenosum.

We report successful treatment of a refractory myelodysplastic syndrome-associated pyoderma gangrenosum with the combination of thalidomide and interferon-alpha2a in a single patient. A non-healing wound developed on a 40-year-old woman's left thumb after minor trauma. Massive ulcerovegetative lesions developed after reconstruction surgery. Histopathological examination of the bone marrow and cytogenetic studies revealed an atypical myeloproliferative/myelodysplastic syndrome. The skin lesions resolved dramatically after two months of thalidomide and interferon-alpha2a combination therapy and the haematological status improved.

Hepatic stellate cells in biopsies from liver allografts with acute rejection.

BACKGROUND: [corrected] Hepatic stellate cells (HSCs) are nonparenchymal elements that play a major role in fibrogenesis due to various pathologies. HSCs are easily activated by certain injuries, which produce contraction and relaxation of HSCs, resulting in hepatic microcirculatory disturbances. The present study sought to analyze the expression of alpha-smooth muscle actin (alpha-SMA) positive HSCs in liver allografts during acute rejection episodes (ARE), determining whether it was related to the pathogenesis of this immune response. MATERIALS AND METHODS: Using immunohistochemistry and a semiquantitative scoring system, the expression of alpha-SMA in HSCs was analyzed in liver allografts with ARE (group 1, n = 64) or without ARE (group 2, n = 20). Normal liver tissue from transplant donors (group 3, n = 53) served as the control materials. RESULTS: Significantly more alpha-SMA positive HSCs were found in group 2 than in the other two groups (P < .05). The minimal difference observed between groups 1 and 3 was not statistically significant. As well, no statistical association was found between expression of alpha-SMA and the clinical parameters of age, gender, etiology of liver failure, donor type (partial or whole), posttransplantation period, and liver function tests. CONCLUSIONS: While these results represent preliminary findings, it may be possible that HSC expression is a protective mechanism during ARE in hepatic allograft patients. If this is true, enhanced expression of this protein may mitigate ARE in liver allograft patients.

Liver transplantation in children weighing less than 10 kilograms.

Orthotopic liver transplantation (OLT) remains a major medical and surgical challenge in small pediatric patients. From April 2003 through October 2005, 17 infants (each of whom weighed less than 10 kg) underwent the procedure. Four were girls and 13 were boys (mean age, 15.7 +/- 9.3 months [range, 2-36 months]; mean weight at the time of transplantation, 7.4 +/- 2.6 kg [range, 6-10 kg]). All transplants were obtained from living-related donors. Sixteen left lateral segments and 1 left lobe were transplanted. The median graft-to-recipient weight ratio was 3.5% +/- 1.2% (range, 1.5%-6.1%). During the early postoperative period, hepatic arterial thrombosis was identified in 2 infants, and a biliary leak in 1. Hepatic arterial thrombosis was treated by reanastomosis with polytetrafluoroethylene grafting in the first patient and by surgical embolectomy in the second. The biliary leak was treated with percutaneous drainage. In 1 infant, portal vein stenosis, which was identified during the late postoperative period, was treated by percutaneous balloon dilatation. At this time, 14 (82.3%) infants were alive, exhibiting good graft function at a median follow-up of 11 months (range, 2-36 months). Three infants died: 1 on postoperative day 47 from adult respiratory distress syndrome, 1 on postoperative day 12 from sepsis, and 1 on postoperative day 65 from sepsis associated with EBV infection. Episodes of acute rejection, which occurred in 5 patients, were treated with pulse steroid therapy. On follow-up, histologic examination revealed hepatocellular carcinoma in 2 infants and Burkitt's lymphoma in 1 infant. Our data confirm that extensive use of living-related donors in liver transplantation can result in an excellent outcome for small pediatric patients.

Posttransplant tubulointerstitial nephritis: clinicopathological correlation.

As a cause of graft dysfunction, tubulointerstitial nephritis (TIN) seems to be the third most common pathology after rejection and cyclosporine nephrotoxicity. Among 540 needle biopsies obtained from 280 renal transplant patients between 1996 and 1999, acute TIN was detected in 23 patients (8%). The cause of acute TIN was secondary to bacterial infection in 17 patients and secondary to cytomegalovirus (CMV) infection in three patients. The remaining three cases showed granulomatous pyelonephritis due to Mycobacterium tuberculosis (n = 2) and Candida albicans (n = 1). During follow-up, 13 of 23 patients (56.5%) showed at least one acute rejection episode. The average number of urinary tract infection (UTI) episodes in the 23 patients was 1.4 +/- 07. We observed that the number of UTI episodes showed a significant association with the development of chronic allograft nephropathy (P = .03) and graft loss (P < .01). Twelve patients (52.2%) lost their grafts during 5 years posttransplantation. Only 6 of 17 patients with bacterial TIN lost their graft at a mean time of 52.5 +/- 14 months. But all patients with CMV TIN or granulomatous TIN lost their grafts at a mean time of 31 +/- 3.1 months and 39 +/- 3 months, respectively (P < .05). In conclusion, these results support the pathological role of tubulointerstitial nephritis as a pathway of graft rejection or renal allograft deterioration among recipients after transplantation.

Frequency of recipient-derived chimerism and relationship with acute rejection and HLA tissue typing in transplanted livers.

BACKGROUND: We sought to determine the extent and time course of recipient-derived chimerism after transplantation and the relationship with acute rejection episodes (ARE) and HLA typing in hepatic allograft patients. PATIENTS AND METHODS: We studied 18 needle liver biopsy specimens from patients who had undergone orthotopic liver transplantation. Fluorescent in situ hybridization (FISH) analysis for X and Y chromosomes was performed in all cases with a sex mismatch. To evaluate the HLA matching, we used serological and polymerase chain reaction (PCR) methodology. RESULTS: There was a sex mismatch between the recipients and donors in all cases. X and Y chromosome chimerism was detected in 14 of 18 (83%; 31.14 +/- 27.4) patients. Also, no statistical association was found between the presence and the extent of chimerism and clinicopathological parameters (P < .05). CONCLUSIONS: Our results suggest that chimerism was frequently seen in liver allografts, but it did not influence the occurrence of ARE, tissue compatibility, or histopathological changes in the posttransplantation period. The clinical, immunological, and histopathological relevance of chimerism remain unclear. These results may relate to the small number of patients and disproportion of chimerism-positive versus-negative cases. Further prospective studies will be required to clarify these findings in a larger population of liver transplant patients.

Correlation between histological grade and MIB-1 and p53 immunoreactivity in meningiomas.

OBJECTIVE: Meningiomas for the most part are slow-growing benign tumors, but complete removal can be difficult and recurrence is an issue. The aim of this study was to re-evaluate tumors diagnosed as meningioma previously in our hospital, according to the latest World Health Organization classification. We also examined the relationships among parameters such as brain invasion, histological grade and Ki-67 and p53 expression in these tumors. MATERIALS AND METHODS: Meningioma biopsy specimens numbering 60 (48 grade I, 11 grade II, and 1 grade III tumors) were examined immunohistochemically using monoclonal antibodies for Ki-67 (MIB-1) and p53 protein. The MIB-1 labeling index (LI) for each tumor was calculated as a percentage based on the number of stained cells per total cells counted. The level of p53 expression in each sample was semiquantatively evaluated as < 1%, 1 - 10%, 10 - 70%, or > 70%. Any value > 1% was accepted as presence of p53 expression. RESULTS: Of the 60 meningiomas, 7 (11.7%) exhibited brain invasion. The mean MIB-1 LI values for the grade I and grade II tumors were 1.1% and 2.3%, respectively. The corresponding levels of p53 protein expression in these groups were 54.1% and 72.7%. The MIB-1 LI and the level of p53 expression in the one grade III meningioma were 6.7% and 10 - 70%, respectively. Histological grade was significantly correlated with MIB-1 LI and with p53 expression (p < 0.01 for both). Brain invasion was not correlated with histological grade, MIB-1 LI, or p53 expression. CONCLUSION: The results indicate that MIB-1 LI and p53 protein expression are good indicators of histological grade in meningioma and may be particularly valuable for distinguishing borderline atypical meningiomas. The number of cases was limited, but the findings also suggest that brain invasion is a prognostic parameter independent of grade, MIB-1 LI and p53 expression.

The significance of Tc-99m DTPA renal scintigraphy for the demonstration of progressive functional changes that accompany chronic allograft nephropathy.

OBJECTIVES: Chronic allograft nephropathy (CAN) is usually progressive; its natural course can only be modified in the initial stages. In this study, we graded Tc-99m diethylenetriaminepentaacetic acid (DTPA) renogram curves with respect to the perfusion/uptake pattern and correlated these findings with biopsy results in patients with CAN. METHODS: This study included 63 renal allograft recipients with biopsy-proven CAN. The agent used for renal scintigraphy was Tc-99m DTPA. Quantitative evaluation of perfusion included calculation of the ratio of peak perfusion counts divided by plateau counts (P:PL). Deterioration of renal function was accompanied with a gradual loss of a peak and plateau pattern. For the evaluation of uptake in relation to perfusion pattern, we graded the renogram curves into four based on the presence of a peak and plateau pattern and the presence of an uptake peak. RESULTS: In patients with CAN, the mean P:PL was significantly lower than that of the control group. The serial changes in successive grades of CAN in respect to uptake-perfusion pattern was a gradual loss of peak and plateau pattern followed by a decline in uptake. In recipients with high-grade CAN, an uptake peak was absent. CONCLUSIONS: Evaluation of Tc-99m DTPA time-activity curves revealed a progressive change in perfusion-uptake pattern in patients with CAN. According to our results, deterioration of perfusion preceded the decline in uptake. Serial renogram changes are thought to reflect initial hypoperfusion followed by increased intraglomerular pressure and finally glomerulosclerosis. These findings have implications for the pathophysiology and management of CAN.

Ki-67 proliferation index in Kaposi's sarcoma after renal transplantation: findings in skin-only cases versus cases with internal-organ involvement.

Kaposi's sarcoma (KS) is an angioproliferative condition that accounts for 6% of all malignancies in organ transplant patients. When we review the literature, the results of the studies comparing the different stages and the proliferative activity of the tumor are challenging. However, we found no previous study on Ki-67 protein expression in KS that correlates skin and organ lesions. In the current study, we investigated whether there is a correlation on the proliferative activity between skin and internal organ lesions in KS. Proliferative activity of 13 biopsy specimens of KS was assessed immunohistochemically using the monoclonal antibody MIB-1 (Ki-67). Mann-Whitney U test is used for statistical analysis and a P value < .05 was considered significant. Seven of 13 cases were skin and six were internal organ KS. For skin lesions, the mean MIB-1 proliferation index was 14.5%, and it was 13% for organ lesions. There was no significant association between skin and internal organ KS in regard to MIB-1 PI (P > .05). The findings suggested that the proliferative activity in KS does not differ in skin and organ lesions. On the other hand, it should be considered that the number of cases in our study was limited and further studies with a larger series are needed.

The role of early colonoscopy in CMV colitis of transplant recipients.

Cytomegalovirus (CMV)-associated diseases remain a major problem in transplant recipients. Early diagnosis is critical. Presentation of early CMV colitis can be mild and nonspecific in transplant recipients. Although serology is helpful in the diagnosis, sometimes it is inadequate. Because the endoscopic features of CMV colitis are specific, colonoscopy facilitates the histopathologic examination. We present the clinical properties and advantages of early colonoscopy in transplant recipients with CMV colitis. The study group included seven patients (six men, one woman of mean age, 36.7 years (range, 22 to 64 years) whose mean transplant duration was 12.3 months (range, 1 to 72 months). Six of the seven patients experienced an acute graft rejection treated with high doses of steroids; one patient had a herpes simplex virus infection. All patients were on steroid treatment with a various combinations of immunosuppressive agents, including cyclosporine, mycophenolate mofetil, and tacrolimus. All patients presented with mild diarrhea without any blood or mucous discharge. Four patients had fever exceeding 38 degrees C; two had abdominal pain. Stool examinations revealed normal findings in six patients, while one patient had white blood cells and amoebic cysts. Serum CMV IgM and CMV pp65 antigenemia were negative in five of seven patients and two had positive results. All patients showed typical colonoscopic and histopathologic findings compatible with CMV colitis. Standard ganciclovir treatment was successful in all patients. Early and rapid colonoscopy is beneficial for the early diagnosis and management of CMV colitis in transplant recipients.

Primary ovarian leiomyosarcoma: a case report.

Primary ovarian leiomyosarcomas are extremely rare tumors that comprise less than 0.1% of all ovarian malignancies. We present a case of 62-year-old postmenopausal woman with a slightly enlarged right ovary and a Color Doppler sonography resistance index (RI) measuring 0.54. The patient, after being managed with surgery alone, is alive after 14 months without any evidence of disease. This is an unusual case in that primary ovarian leiomyosarcoma was diagnosed in the setting of a slightly enlarged irregular postmenopausal ovary with a concomitant intermediate RI value on color flow Doppler evaluation. A high index of suspicion may help prevent delay in the diagnosis of this rare neoplasm.

Pelvic retroperitoneal paraganglioma mimicking an ovarian mass.

A 75-year-old hypertensive woman was referred with ultrasound findings of a 40 x 35 mm semi-solid right adnexal mass and right hydroureteronephrosis. She complained of headache and right-sided back pain. Computed tomography demonstrated a cystic adnexal mass that did not appear to originate from the right ovary and grade 2 hydroureteronephrosis. Magnetic resonance imaging indicated that the mass originated from the right ovary. Tumor markers were in the normal range. Exploratory laparotomy was performed to determine the origin of the lesion, and revealed a retroperitoneal mass obstructing the right ureter. The mass was completely removed and and the histopathologic diagnosis was paraganglioma.

A very unusual presentation of Niemann-Pick disease type B in an infant: similar findings to congenital lobar emphysema.

The main features of Niemann-Pick disease type B (NPD-B) are enlargement of the liver and spleen, and mild pulmonary involvement. Recurrent respiratory tract infection and progressive decline in pulmonary function are major contributors to morbidity and mortality in this patient group. Massive pulmonary involvement in early life is extremely rare. The most common finding on chest X-rays of NPD-B patients is reticular or nodular infiltration of the lungs. This article describes a very rare presentation of NPD-B in an infant who had suffered recurrent respiratory tract infections. Massive emphysema and marked infiltrative parenchymal changes (infiltration of the parenchyma) were initially attributed to congenital lobar emphysema and its compressive effects. However, NPD was suspected when a lung biopsy showed foamy cells and sea-blue histiocytes were detected in a bone marrow biopsy. The definitive diagnosis was established with an enzyme study for sphingomyelinase.

The analysis of gastrointestinal amyloidosis in 78 patients with chronic renal failure.

Systemic amyloidosis is not a single disease, but the product of a variety of diseases. Amyloid proteins are insoluble fibrils that are deposited extracellularly in many organ tissues. They stain with Congo red and appear apple green under polarized light. Definitive diagnosis and classification ofamyloidosis requires histologic examination of tissue samples. Gastrointestinal tract involvement is common, and all parts of the system can be affected Immunohistochemical studies have shown that amyloid deposited in the gastrointestinal system is most often of the AA, A kappa, or A lambda types. Another type of amyloidprotein, beta-2 microglobulin (beta2M), predominantly affects the musculoskeletal system, and is usually seen in patients who have been on long-term hemodialysis. Mixed systemic amyloidosis (beta2M and AA) is seen only rarely in these patients. In this study, we attempted to answer why this is so, and examined whether or not mixed amyloidosis is related to amyloidogenesis. We studied gastrointestinal tissues from 78 chronic renal failure patients who had systemic amyloidosis with gastrointestinal involvement. A total of 115 endoscopic samples and 1 jejunal resection specimen were analysed immunohistochemically. Immunohistochemical testing using a panel of antisera directed against two major amyloid fibril proteins (AA-Monoclonal, Dako-, and beta2M-Polyclonal, Dako-) showed that all samples contained AA amyloid, but not beta2M type protein. These findings can be explained by the patients' relatively short average duration of hemodialysis and the predominance of endoscopic biopsy samples in our study.

Primary extramedullary plasmacytoma of the liver.

Extramedullary plasmacytoma of the liver is a rare tumour, only two cases of which have been reported so far. A third case arising in a 22 year old woman, who presented with abdominal pain and enlargement of the liver, is described. Ultrasound and a computed tomography scan showed a solitary hepatic mass, 12 cm diameter, involving both lobes of the liver. Serum immunoelectrophoresis revealed an IgG kappa monoclonal gammopathy. Histologically, the tumour was composed of mature plasma cells with mild atypia. The plasma cells infiltrated the liver parenchyma and showed kappa light chain restriction. The monoclonal nature of the tumour was also demonstrated by PCR amplification of the immunoglobulin heavy chain genes. There was no evidence of bone involvement and repeated bone marrow aspirates and biopsy specimens were normal. The patient was treated with eight courses of chemotherapy. One year after diagnosis, the patient is well, the size of the tumour has decreased and the paraproteinaemia has disappeared.