Haemolytic uraemic syndrome after bone marrow transplantation: an adverse effect of total body irradiation?

Eight cases of haemolytic uraemic syndrome occurring after bone marrow transplantation are presented and the other 15 reported cases are reviewed. Two patients were recipients of autologous marrow whereas all cases previously reported occurred after allogeneic transplantation. Six patients had not received cyclosporin and two had no evidence of cytomegalovirus infection. The roles of cyclosporin, cytomegalovirus infection, graft-versus-host disease, total body irradiation (TBI) and chemotherapeutic drugs as aetiological agents are discussed. It is postulated that TBI, perhaps potentiated by cyclophosphamide, is likely to be the most important factor but that other agents may act additively with TBI and influence the time course and severity of the disease.

Non-Hodgkin's lymphoma presenting as an isolated temporal soft tissue swelling.

Non-Hodgkin's lymphoma (NHL) of the head and neck has been described in several sites including the larynx, the pharynx, Waldeyer's ring, the nose and paranasal sinuses. NHL of the temporal region has not been previously described. We describe a 65-year-old woman with a diffuse swelling of the right temporal region. A histological diagnosis of NHL was made following complete excision of the lesion. No further treatment was given and there was no evidence of recurrence at six months.

Endometrioid carcinoma of the prostate: a misnomer?

The origin of this unusual variant of carcinoma of the prostate has provoked discussion ever since its first description in 1967. This is of both embryological interest and therapeutic importance. Four cases have been reviewed, and all have demonstrated immunohistochemical features consistent with an origin from prostatic tissue. In addition, three had evidence of disseminated disease which responded well to androgen ablation. It is concluded that the term endometrioid carcinoma is of descriptive value only, and these tumours are a variant of primary duct prostatic carcinoma. Patients should be treated by androgen ablation when metastases are present.

How do we teach pathology? The Royal Free Hospital School of Medicine.

The teaching of pathology at the Royal Free Hospital has evolved over the past few decades in a stepwise manner, moving away from a didactic lecture- and classroom-based approach to one in which staff time is mainly spent in small-group teaching. We present an outline of our current teaching programme in the belief that it differs substantially from that in many other medical schools.

Choriocarcinoma of the colon: report of a case and review of the literature.

Primary choriocarcinoma of the colon is a very rare tumor, with only six reported cases in the world literature, all but one of which was associated with an adjacent adenocarcinoma. This has led to the suggestion that colonic choriocarcinomas may arise from the more typical adenocarcinoma a process of further dedifferentiation. This article reviews the above cases and adds a further case from a 73-year-old male in whom no associated adenocarcinoma could be found despite careful postmortem examination. This finding gives support to the hypothesis that, rather than arising as a result of further dedifferentiation of an existing tumor, primary choriocarcinomas may also develop in the large intestine.

Neuroendocrine islet cell tumour producing gastrin and ACTH in a patient with calcifying chronic pancreatitis.

A patient with a calcifying chronic pancreatitis was found to have a neuroendocrine islet cell tumour (a previously unreported association). The tumour secreted both gastrin and ACTH leading to clinical manifestations of both the Zollinger-Ellison syndrome and Cushing's syndrome.

Effects of dietary fatty acids in an animal model of focal glomerulosclerosis.

The obese Zucker rat develops hyperlipidemia, proteinuria and focal glomerulosclerosis without prior changes in renal hemodynamics. To study the effects of oral fatty acid intake on the development of renal injury in this model, rats were fed standard chow or chow supplemented with either 14% fish oil or 14% beef tallow after unilateral nephrectomy at the age of 10 weeks. At 32 weeks post-nephrectomy animals were sacrificed and renal tissue saved to assess histology and glomerular eicosanoid production. Fish-oil treated rats had lower mean plasma cholesterol levels and developed less proteinuria than control or tallow-fed animals although there was no difference in plasma creatinine or blood pressure. Histological analysis showed significantly fewer sclerosed glomeruli in the fish oil group (4.0 +/- 0.8% vs. control 19.4 +/- 4.1%, P less than 0.0005 and vs. beef tallow 10.8 +/- 1.9%, P less than 0.005). Glomeruli derived from rats on fish oil supplements produced smaller amounts of prostaglandin (PG)E2 and of the stable metabolites of PGI2 (6-oxo-PGF1 alpha), PGF2 (PGF2 alpha) and thromboxane (TX)A2 (TXB2) than those from tallow-fed animals. This study demonstrates that oral fatty acid intake may influence the development of glomerulosclerosis. The apparent beneficial effects of fish oil have not been fully defined, but may relate to favorable changes in plasma lipid concentration and renal eicosanoid production.