Glutathione S-transferase genotype and p53 mutations in adenocarcinoma of the small intestine.

Adenocarcinoma of the small intestine (ASI) is a rare disease of unknown aetiology. The glutathione S-transferase M1 (GSTM1) enzyme catalyses the detoxification of compounds involved in carcinogenesis of adenocarcinoma of the stomach, colon and lung, including constituents of tobacco smoke. We investigated a possible interaction between the lack of GSTM1 enzyme activity and the carcinogenic compounds of tobacco smoke. Based on the theory that certain carcinogens cause specific point mutations in the p53 gene we analysed by single strand conformation polymorphism (SSCP) and sequencing, p53 exon 5-8 of 52 samples of ASI collected in Sweden, Germany, France, Italy and Denmark between 1995 and 1997. The GSTM1 gene status was investigated by multiplex PCR. The prevalence of GSTM1 negative genotype among cases with ASI was 69% and higher than previous reports of 50% suggesting a higher risk of ASI among GSTM1 negative compared with GSTM1 positive subjects. A 'case-only' approach was used to address the combined association between the GSTM1 negative genotype and lifestyle exposures in patients with ASI. Using this method, heavy smokers (> 20 pack-years) with the GSTM1 negative genotype had an odds ratio of 4.8; 95% confidence interval (CI) (0.6-38.7) for ASI as compared to smokers who expressed GSTM1. No similar association between alcohol consumption and ASI was found. No p53 mutations in exon 5-8 were found in these samples, but the method may not be sensitive enough to identify smaller differences. Thus p53 does not seem to be the target of carcinogens acting in the small intestine.

Cerebral gumma.

A patient presented with symptoms from a tumour in the frontal region. Syphilis had been treated 15 years earlier but the serological tests were inconclusive on this admission. The CT-scan showed oedema surrounding a contrast enhancing tumour. Angiography showed displaced but otherwise normal vessels. Histologically the lesion proved to be a gumma.

Diverticula of the vermiform appendix. Alternatives of clinical presentation and significance.

The vermiform appendix can be the site of development of diverticula which may suffer either inflammatory complications with or without appendicitis or may only be an incidental finding in an uninflamed appendix. This is a retrospective study of 10 of 575 cases of consecutive appendices removed and examined within a year, with single or multiple appendiceal diverticula with diverticulitis and peridiverticulitis. In six of the 10, the lumen of the appendix did not show any inflammatory changes. In conclusion, one could assume that inflammatory complications of the appendiceal diverticula, although they may mimic acute appendicitis, are quite distinct clinical entities. Acute appendicitis in the presence of appendiceal diverticula may carry an earlier and higher rate of perforation and appendiceal diverticula, as an incidental finding, may justify appendectomy on occasion.

Lymphangiomyoma of the thoracic duct with previously undescribed epithelial tubules.

A case of mediastinal lymphangiomyoma with tubules covered with epithelium is reported. The epithelium of these tubules is morphologically identical to that of the bronchi. It is the first time that epithelial, presumably pulmonary, elements have been described in an extrapulmonary lymphangiomyoma. It is concluded that the present case of mediastinal lymphangiomyoma suggests a hamartomatous malformation. Whether this applies in general to lymphangiomyomatosis still remains a matter of discussion.

Gastric carcinoma I. The reproducibility of a histogenetic classification proposed by Masson, Rember and Mulligan.

The purpose of the present paper has been to examine the reproducibility of the classification of gastric carcinomas, as proposed by Mulligan and Rember. Two microscopic slides from each of one hundred randomly selected specimens of gastric carcinoma, obtained by gastrectomy or gastric resection, were classified independently by both authors. Neither of the authors knew which slides originated from the same specimen. The inter-examiner reproducibility rate was 79 per cent. The reproducibility rates of the diagnoses with two independent slides from the same tumour was 74 per cent with examiner I and 80 per cent with examiner II.

Gastric carcinoma 2. An analysis of morphological and prognostic parameters correlated to the classification proposed by Masson, Rember and Mulligan.

One-hundred and fifteen gastric adenocarcinomas were classified according to Mulligan and Rember into one of the following types: Intestinal cell carcinoma (IC), pyloro-cardiac gland carcinoma (PC), mucous cell carcinoma (MC) and unclassified. The tumour type was correlated to the growth pattern and inflammatory reaction at the margin of the tumour, invasion of the veins and nerve sheaths, Dukes' stage, intra- and extracellular mucous production, and occurrence of intestinal metaplasia in the non-tumour bearing parts of the gastric mucosa. MC was the only type of tumour producing the macroscopic picture "linitis plastica". PC was the type of tumour that dominated in the cardiac region. The following parameters showed no relation to tumour type: Sex and age, size of tumour, invasion of lymphatic vessels. This study suggests that the three types of tumour are different entities, MC being the most aggressive and IC the least aggressive of the types of tumour.