Low grade marginal zone B-cell lymphoma presenting as local amyloidosis in a submandibular salivary gland.

An unusual case of a low grade marginal zone B-cell lymphoma is reported and the literature reviewed. This case demonstrates that a diagnosis of lymphoma must be considered when there is amyloidosis in an otherwise asymptomatic submandibular salivary gland mass.

Characterization of the insulin-like growth factor axis and Wilms' tumour suppressor gene in hyperparathyroidism.

BACKGROUND: Genetic mutations and upregulation of growth factors are implicated in the pathogenesis of hyperparathyroidism. The aim of this study was to evaluate the role of Wilms' tumour suppressor gene (WT-1) and the insulin-like growth factor (IGF) axis in hyperparathyroidism. METHODS: The expression of WT-1 and IGF components was examined by immunohistochemistry, reverse transcriptase-polymerase chain reaction and western immunoblotting in a panel of parathyroid specimens from both primary and secondary hyperparathyroidism. A human parathyroid cell culture model was established to examine the parathyroid response to IGF stimulation. RESULTS: There was a significantly lower level of WT-1 expression in parathyroid tumours than in normal parathyroid glands. Most tumours expressed IGF-I and IGF-II receptors and responded to IGF stimulation. Only IGF-I was present in normal parathyroid glands, whereas IGF-II was expressed exclusively in parathyroid tumours. CONCLUSION: Abnormal expression of WT-1 and the IGF axis may play a role in the pathogenesis of hyperparathyroidism.

Anaplastic thyroid carcinoma implantation after fine needle aspiration cytology.

We report the case of a 59-year-old man with a two-month history of a fast-growing, left-sided neck mass and a 5 mm nodule over a thyroid mass at the site of fine needle aspiration cytology performed four weeks earlier. Histopathological studies confirmed anaplastic carcinoma of the thyroid and cutaneous needle track seeding of the primary tumour. The patient succumbed to extensive disease 10 weeks after initial diagnosis. To our knowledge, this is a rare report of implantation of anaplastic thyroid carcinoma along the track of fine needle aspiration. Some factors involved in needle track seeding are: needle size; number of passes; withdrawing the needle without releasing suction; injecting the tumour at time of biopsy; and inherent characteristics of the lesion (e.g. number of cells dislodged, adhesiveness of cells, amount of stroma present, enzymes released and immunologic characteristics).

Best practice no 183. Examination of parathyroid gland specimens.

The pathological examination of parathyroid glands is an essential component of the evaluation of hyperparathyroidism. Traditionally, this has involved intraoperative frozen sections during bilateral surgical exploration of the neck, to confirm removal of parathyroid tissue. With recent developments in imaging, some diseased glands can be localised preoperatively, enabling removal by minimally invasive, targetted surgery, with or without additional non-histological intraoperative procedures to confirm the removal of all hyperfunctioning parathyroid tissue. This article reviews these developments and describes the ideal approach to reporting parathyroid specimens.

Histopathological changes in the human larynx following expanded polytetrafluroethylene (Gore-Tex(R)) implantation.

BACKGROUND: Expanded polytetrafluroethelyne (e PTFE, Gore-Tex(R)) has been advocated as an implant material for medialization of the vocal fold. Animal studies involving rabbits and a porcine model have demonstrated host tolerance of the implant. There have been no reports describing the histological changes in a human laryngectomy specimen with a Gore-Tex implant. CASE PRESENTATION: The histological findings in a laryngectomy specimen of a patient previously implanted with e PTFE for medialization of a paralyzed vocal fold following excision of a vagal neurofibroma were studied.Histopathology revealed a mild foreign-body giant cell granulomatous reaction with some associated fibrosis. The granulomatous response was limited to the periphery of the Gore-Tex and although it closely followed the profile of the material it did not encroach into or significantly break up the material. There was no significant neutrophilic or lymphocytic inflammation. CONCLUSIONS: Our findings are consistent with the animal models confirming that Gore-Tex implantation does not result in a significant granulomatous reaction in the human larynx over a 13-month period. Moreover, there is no evidence of resorption or infection. Further, the lack of lymphocytes in association with the granulomas indicates that there is no significant immunological hypersensitivity. Histologically, the slight permeation by connective tissue is similar to that seen in Gore-Tex vascular and cardiac implants. The degree of the slight giant cell response appears to be dependent on the profile of the material; a sharp edge incited more of a response than a flat surface.

Exposure to Asulox inhibits the growth of mosses.

Asulox is a herbicide used to control bracken. Its effects on mosses were investigated to ascertain whether exposure proved as detrimental as found in parallel studies on pteridophytes. Mature gametophytes of 18 mosses were exposed to a range of concentrations of Asulox under standard conditions and the effects on growth monitored. Plants were cut to a standard length, exposed to Asulox solution for 24 h, grown for 3 weeks and total elongation (main stem and branches) measured. EC50 values were calculated and species ranked according to sensitivity. The effects of exposure on total elongation were compared with those on main stem elongation alone. Under the conditions tested, the total elongation of all species was inhibited after exposure to Asulox. The amount of elongation observed after exposure was different for different species and inhibition of elongation occurred at different exposure concentrations. A single regression equation was not adequate to describe the dose response curves of all species tested. An ability to produce secondary branches may confer increased tolerance to Asulox exposure. It is concluded that mosses suffer detrimental effects after exposure to Asulox at concentrations similar to those that affect fern gametophytes such as bracken.

Contrasting strategies for UV-B screening in sub-Arctic dwarf shrubs.

The content and distribution of UV-absorbing phenolic compounds was investigated in leaves of three species of Vaccinium co-existing at a site in north Sweden. Vaccinium myrtillus L., Vaccinium vitis-idaea L., and Vaccinium uliginosum L. exhibit markedly different strategies, in terms of localization and content of leaf phenolics and in their responses to UV-B enhancement. Plants were exposed to either ambient radiation or to enhancement of UV-B corresponding to 15% (clear sky) depletion of stratospheric ozone for approximately 10 years prior to commencement of this study. Vaccinium myrtillus contained the highest concentration of methanol-extractable UV-B-absorbing compounds, which was elevated in plants exposed to enhanced UV-B. Fluorescence and confocal laser scanning microscopy showed that these compounds were distributed throughout the leaf, and were particularly concentrated in chlorophyll-containing cells. In V. vitis-idaea, most phenolic compounds were cell wall-bound and concentrated in the walls of the epidermis; this pool increased in response to UV-B enhancement. It is suggested that these two plants represent extreme forms of two divergent strategies for UV-B screening, the different responses possibly being related to leaf longevity in the two species. The response of V. uliginosum was intermediate between the other two, with high concentrations of cell wall-bound phenolics in the epidermis but with this pool decreasing, and the methanol-soluble pool tending to increase, after exposure to enhanced UV-B. One explanation for this response is that this plant is deciduous, like V. myrtillus, but has leaves that are structurally similar to those of V. vitis-idaea.

Evaluation of a Tay-Sachs disease screening program.

Tay-Sachs Disease (TSD) is an autosomal recessive neurodegenerative disorder. TSD is prevalent in the Ashkenazi Jewish population, and carrier screening programs have been implemented worldwide in these communities. A screening program initiated in 1997 involving the Melbourne Jewish community (Australia) incorporated education, counselling and carrier testing of high-school students aged 15 to 18 years. This study aimed to assess the participation rates, level of knowledge obtained and predicted feelings and attitudes of the students involved. Seven hundred and ten students participated, there was a 67% uptake for testing with a carrier rate of 1 in 28 determined. The level of knowledge of the students following education was high and of relative importance in regard to decision making, as were their feelings and attitudes about genetic testing for carrier status. A significant impediment to test uptake was the need for blood sampling, resulting in a recommendation for the introduction of DNA analysis on cheek brush samples. The evaluation of this program has given a wider scope for further development as well as providing valuable information for the implementation of community screening programs.

Nicotinic acetylcholine receptor subunit mRNA expression and channel function in medial habenula neurons.

Relationships between nicotinic acetylcholine receptor (nAChR) channel function and nAChR subunit mRNA expression were explored in acutely isolated rat medial habenula (MHb) neurons using a combination of whole-cell recording and single cell RT-PCR techniques. Following amplification using subunit-specific primers, subunits could be categorized in one of three ways: (i) present in 95-100% cells: alpha3, alpha4, alpha5, beta2 and beta4; (ii) never present: alpha2; and (iii) sometimes present ( approximately 40% cells): alpha6, alpha7 and beta3. These data imply that alpha2 subunits do not participate in nAChRs on MHb cells, that alpha6, alpha7 and beta3 subunits are not necessary for functional channels but may contribute in some cells, and that nAChRs may require combinations of all or subsets of alpha3, alpha4, alpha5, beta2 and beta4 subunits. Little difference in the patterns of subunit expression between nicotine-sensitive and insensitive cells were revealed based on this qualitative analysis, implying that gene transcription per se may be an insufficient determinant of nAChR channel function. Normalization of nAChR subunit levels to the amount of actin mRNA, however, revealed that cells with functional channels were associated with high levels (>0.78 relative to actin; 11/12 cells) of all of the category (i) subunits: alpha3, alpha4, alpha5, beta2 and beta4. Conversely, one or more of these subunits was always low (<0.40 relative to actin) in all cells with no detectable response to nicotine. Thus the formation of functional nAChR channels on MHb cells may require critical levels of several subunit mRNAs.

Fern spore extracts can damage DNA.

The carcinogenicity of the vegetative tissues of bracken fern (Pteridium) has long been established. More recently, the carcinogenic effects of the spores of bracken have also been recognized. Both vegetative tissues and spores of bracken can induce adducts in DNA in animal tissues, but the possible genotoxic or carcinogenic effects of spores from fern species other than bracken are unknown. The single-cell gel electrophoresis ('comet') assay was used to investigate whether fern spores can cause DNA damage in vitro. Extracts of spores from six fern species were administered to cultured human premyeloid leukaemia (K562) cells. Spore extracts of five fern species: Anemia phyllitidis, Dicksonia antarctica, Pteridium aquilinum, Pteris vittata and Sadleria pallida, induced significantly more DNA strand breaks than those in the control groups. Only in one species, Osmunda regalis, was the effect no different from that in the control groups. Using extracts from A. phyllitidis and P. vittata, the extent of DNA damage was increased by increasing the original dose 10 times, whereas an experiment in which exposure times were varied suggested that the highest levels of strand breaks appear after 2 h exposure. Simultaneous incubation with human S9 liver enzyme mix ablated the damaging effect of the extracts. Our data show that fern spore extracts can cause DNA damage in human cells in vitro. Considering the strong correlation between DNA damage and carcinogenic events, the observations made in this report may well have some implications for human health.

Imprint cytology of parathyroid tissue in relation to other tissues of the neck and mediastinum.

OBJECTIVE: To retest the hypothesis that imprint cytology may be used to reliably diagnose parathyroid tissue and, if so, to ascertain whether accuracy in this technique may be easily attained. STUDY DESIGN: Imprint preparations from 15 parathyroid, 10 thyroid, 8 lymphoreticular and 2 adipose tissue specimens were assessed blindly by two pathologists, one of whom (pathologist B) had only limited experience with endocrine tissue imprint cytology. RESULTS: Both assessors consistently distinguished parathyroid and thyroid preparations from lymphoreticular and adipose tissue preparations. While there was occasional difficulty in distinguishing between parathyroid and thyroid preparations, this was usually attributable to the scanty nature of the preparations. No single cytologic feature allowed a distinction between parathyroid and thyroid tissue. However, by considering several relatively diagnostic features collectively, pathologist B showed an increase in specificity and sensitivity rates for distinguishing parathyroid from thyroid imprints from 82% to 100% and 57% to 83%, respectively. CONCLUSION: The high accuracy rates and rapid [table: see text] learning curve shown by imprint cytology in distinguishing between different neck or mediastinal tissue types, together with its time- and cost-cutting potential, support a role for the technique in the intraoperative diagnosis of parathyroid tissue.

The association of platelet-derived growth factor receptor expression, plaque morphology and histological features with symptoms in carotid atherosclerosis.

Platelet-derived growth factor may influence smooth muscle cell migration and proliferation and, therefore, carotid plaque composition and stenosis. Platelet-derived growth factor receptor expression and histological features were compared in carotid plaques from symptomatic and asymptomatic patients. Immunocytochemistry and histology determined platelet-derived growth factor-alpha and -beta receptor expression, white blood cell infiltration, smooth muscle cell, elastin, cholesterol, collagen and intraplaque haemorrhage in carotid artery plaques removed at surgery or the post-mortem. Plaques with > 70% stenosis from asymptomatic (n = 10) and symptomatic patients (n = 27) had higher expression of platelet-derived growth factor and beta receptors and higher scores for macrophages and intraplaque haemorrhage than plaques with < 70% stenosis from asymptomatic patients (n = 33). Plaques with > 70% stenosis from symptomatic patients had significantly lower alpha receptor expression than plaques with > 70% stenosis from asymptomatic patients. The reduction of alpha receptor expression, which may inhibit smooth muscle cell migration, suggests that differential expression of platelet-derived growth factor receptor subunits in plaques may be related to symptoms.

Adaptations to extreme low light in the fern Trichomanes speciosum.

Trichomanes speciosum is a threatened species restricted to sheltered, very humid sites. Uniquely amongst European ferns, differing ecological tolerances of the gametophyte and sporophyte generations are manifested as widely differing distributions. The perennial, vegetatively propagating gametophyte persists in drier, colder, darker habitats than the sporophyte. In sites where the gametophyte grows, light availability was found to be < 1 µmol m2 s1 for approx. 85% of daylight hours, rarely or (in some sites) never rising above 10 µmol m2 s1 . Much of the time, light was < 0.01% of full sunlight. Measurements of gas exchange and chlorophyll fluorescence yield show that these plants have optimal photosynthesis at light intensities c. 5-10 µmol m2 s1 , the highest light to which they are normally exposed to in their natural environment. The absence of any capacity for reversible nonphotochemical fluorescence quenching means that there is little or no protection of the photosynthetic apparatus from light-induced damage. We conclude that these plants are able to create what are essentially monocultures in their extreme environments only because of a combination of low metabolic rate (at low temperatures) and an ability to make efficient use of what little light is available to them by morphological and physiological means.

Upregulation of surface alpha4beta2 nicotinic receptors is initiated by receptor desensitization after chronic exposure to nicotine.

It is hypothesized that desensitization of neuronal nicotinic acetylcholine receptors (nAChRs) induced by chronic exposure to nicotine initiates upregulation of nAChR number. To test this hypothesis directly, oocytes expressing alpha4beta2 receptors were chronically incubated (24-48 hr) in nicotine, and the resulting changes in specific [3H]nicotine binding to surface receptors on intact oocytes were compared with functional receptor desensitization. Four lines of evidence strongly support the hypothesis. (1) The half-maximal nicotine concentration necessary to produce desensitization (9.7 nM) was the same as that needed to induce upregulation (9.9 nM). (2) The concentration of [3H]nicotine for half-maximal binding to surface nAChRs on intact oocytes was also similar (11.1 nM), as predicted from cyclical desensitization models. (3) Functional desensitization of alpha3beta4 receptors required 10-fold higher nicotine concentrations, and this was mirrored by a 10-fold shift in concentrations necessary for upregulation. (4) Mutant alpha4beta2 receptors that do not recover fully from desensitization, but not wild-type channels, were upregulated after acute (1 hr) applications of nicotine. Interestingly, the nicotine concentration required for half-maximal binding of alpha4beta2 receptors in total cell membrane homogenates was 20-fold lower than that measured for surface nAChRs in intact oocytes. These data suggest that cell homogenate binding assays may not accurately reflect the in vivo desensitization affinity of surface nAChRs and may account for some of the previously reported differences in the efficacy of nicotine for inducing nAChR desensitization and upregulation.

Regulation of alpha4beta2 nicotinic receptor desensitization by calcium and protein kinase C.

Neuronal nicotinic acetylcholine receptor (nAChR) desensitization is hypothesized to be a trigger for long-term changes in receptor number and function observed after chronic administration of nicotine at levels similar to those found in persons who use tobacco. Factors that regulate desensitization could potentially influence the outcome of long-lasting exposure to nicotine. The roles of Ca2+ and protein kinase C (PKC) on desensitization of alpha4beta2 nAChRs expressed in Xenopus laevis oocytes were investigated. Nicotine-induced (300 nM; 30 min) desensitization of alpha4beta2 receptors in the presence of Ca2+ developed in a biphasic manner with fast and slow exponential time constants of tauf = 1.4 min (65% relative amplitude) and taus = 17 min, respectively. Recovery from desensitization was reasonably well described by a single exponential with taurec = 43 min. Recovery was largely eliminated after replacement of external Ca2+ with Ba2+ and slowed by calphostin C (taurec = 48 min), an inhibitor of PKC. Conversely, the rate of recovery was enhanced by phorbol-12-myristate-13-acetate (taurec = 14 min), a PKC activator, or by cyclosporin A (with taurec = 8 min), a phosphatase inhibitor. alpha4beta2 receptors containing a mutant alpha4 subunit that lacks a consensus PKC phosphorylation site exhibited little recovery from desensitization. Based on a two-desensitized-state cyclical model, it is proposed that after prolonged nicotine treatment, alpha4beta2 nAChRs accumulate in a "deep" desensitized state, from which recovery is very slow. We suggest that PKC-dependent phosphorylation of alpha4 subunits changes the rates governing the transitions from "deep" to "shallow" desensitized conformations and effectively increases the overall rate of recovery from desensitization. Long-lasting dephosphorylation may underlie the "permanent" inactivation of alpha4beta2 receptors observed after chronic nicotine treatment.

Measurement of vascularity as a diagnostic and prognostic tool for well differentiated thyroid tumours: comparison of different methods of assessing vascularity.

AIMS: To determine whether the measurement of vascularity can be used to differentiate follicular adenomas from follicular carcinomas or to reflect the prognosis of follicular carcinomas and papillary carcinomas of the thyroid gland, and to compare four methods of assessing vascularity. METHODS: Tissue sections from 26 papillary carcinomas, 15 follicular adenomas, and 15 follicular carcinomas were stained with an antibody to CD34. A computerised image analysis system was used to calculate, for each tumour, mean endothelial areas and the mean endothelium to tumour epithelial nucleus area ratio from 10 systematically selected fields across one dimension of the tumour ("systematic field" analysis) or from the three most vascularised fields of the tumour ("hot spot" analysis). A European Organisation for Research on Treatment of Cancer (EORTC) prognostic index was calculated for each papillary carcinoma and follicular carcinoma. RESULTS: Significant differences in vascularity between the three tumour groups could only be shown by comparing mean endothelial area values measured from hot spots. While the hot spot median mean endothelial area of follicular carcinomas was significantly greater than that of follicular adenomas, there was a large overlap between the two groups. For follicular carcinomas, higher hot spot mean endothelial area values were related to worse prognosis as indicated by the EORTC prognostic indices. No association between vascularity and prognosis was found for the papillary carcinomas, regardless of the method of assessing vascularity. CONCLUSIONS: Measuring endothelial area from hot spots using a computerised image analysis system is a sensitive method of assessing the vascularity of thyroid tumours. While vascularity measurement cannot be recommended as a practical tool for differentiating between malignant and benign follicular tumours, the suggestion that vascularity may reflect prognosis for follicular carcinomas deserves further study.