The reliability of staging and grading of bladder tumours. Impact of misinformation on the pathologist's diagnosis.

The influence of misinformation on the reliability of the histopathological classification of bladder tumours was analysed. Four consultant pathologists assessed 40 biopsy specimens of bladder tumours staging invasion and grading the specimens according to the Bergkvist classification. A random sample of 20 specimens was accompanied by systematically distorted information ("bias"-unknown to the pathologists) about previous histological grading of the patient (bias group); the other 20 specimens were used as control group (non bias group). After 6 months a second round with the same specimens was arranged to assess the influence of bias on the intraobserver variation. Using kappa (kappa) statistics the chance corrected interobserver agreement rate was poor both in staging of invasion and grading according to the Bergkvist classification (kappa < 0.50). The kappa values in the intraobserver study ranged from poor to excellent with a tendency towards lower kappa when the observer had been biased. The kappa values in the assessment of malignancy were acceptable to excellent. False information did not affect the pathologists' diagnosis significantly.

Anaemia of rheumatoid arthritis: serum erythropoietin concentrations and red cell distribution width in relation to iron status.

Immunoreactive serum erythropoietin concentrations were measured in 35 patients with anaemia associated with active rheumatoid arthritis. Based on an evaluation of stainable iron in the bone marrow (marrow iron grade 0-4) and serum ferritin concentrations (concentrations less than or equal to 60 micrograms/l compatible with iron deficiency) the anaemia was found to be complicated by iron deficiency in 19/35 (54%) of the patients. The mean serum erythropoietin level (57.6 (SD) 27.3) U/l) was sufficiently raised for the degree of anaemia irrespective of the size of the marrow iron stores. Thus the data do not support the contention that suppressed secretion of erythropoietin is involved in the pathogenesis of anaemia of chronic disorders. There was a significant inverse correlation between the haemoglobin concentration and log serum erythropoietin in the patients with rheumatoid arthritis. In the patients with adequate iron stores, but not in the iron depleted patients, there was a tendency for serum erythropoietin concentrations to correlate positively both with C reactive protein and erythrocyte sedimentation rate. Red cell distribution width (mean (SD) 16.3 (1.8)%) was above normal (11.5-14.5%) both in the iron replete and the iron depleted patients, and the mean red cell distribution width values did not differ significantly among the two subpopulations. The plasma lactoferrin concentration (mean (SD) 137.6 (109.9) micrograms/l) was normal and did not differ significantly between the iron deficient patients and those with adequate iron.

Lymphocytic adenohypophysitis. A review and a case.

An unconscious, 29-year-old woman was taken to hospital where, 28 hours after admission, she succumbed to an intractable shock. Autopsy disclosed a lymphocytic adenohypophysitis (LAH). Judged by experiments on animals and by antibody examinations in women during puerpera, LAH is probably an autoimmune disease belonging to a group of autoimmune endocrinopathies, from which one or more is seen with LAH. The description of the present case is accompanied by a description of the disease in eight cases, all women; in only one patient was the diagnosis not made by autopsy. The patients can be divided into two groups, one group consisting of postmenopausal women, another who all became ill approximately one year after giving birth. It is suggested that this histopathological diagnosis also has a clinical significance.

Bronchial carcinoid tumours. A clinicopathologic study of 82 cases.

A clinical and "blind" histologic review of 82 cases of bronchial carcinoid tumour is presented. The malignant potential of the tumours was only partly predictable from their histologic appearance. Histologically 65 of the tumours were typical benign carcinoids. Regional metastases were found at operation in two of these patients. Fatal carcinoid syndrome with regional and distant metastases appeared in two patients about 1 and 3 years postoperatively. One of the patients with regional metastases at operation is clinically free from carcinoid 12 years later. Malignancy was histologically suspected in 17 cases, in ten of which regional metastases were found at operation. Three of these ten patients are alive 6 to 16 years postoperatively, but two without regional metastases at operation died of local recurrence and distant metastases after 3 to 4 years. Carcinoid syndrome was not seen in these 17 patients. There was one peroperative death. Altogether ten patients (12%) died of recurrence. Among the cases judged at the "blind" histologic review to be suspectedly malignant, the corresponding figure was 50%. For typical carcinoids, conservative resection, including lymph-node metastases, is the treatment of choice. Wedge or sleeve resection with or without pulmonary resection were employed in ten cases. Suspectedly malignant carcinoid tumours may require more extensive surgery.

Influence of porosity on the viability of the neointima. A histological investigation on implanted synthetic vascular prostheses.

The influence of porosity on the viability of the neointima was evaluated in two types of Dacron vascular prostheses with quite different porosities. It could be concluded that the observed parietal thrombus formation in functioning prostheses, and the dislodgement of the neointima in several of these, might well be attributed to the low porosity of the investigated prostheses, as compared to the recommended value. At the same time it is remarkable that no pronounced difference in the histological picture was observed in the two types of prostheses, despite large differences in their mutual porosities.

Post-streptococcal glomerulonephritis. A quantitative glomerular investigation.

A light microscopical, quantitative glomerular examination was performed on renal biopsies from 14 patients with acute post-streptococcal glomerulonephritis. A significant increase of 58% (p less than 0.0025) in the total number of glomerular cells was found which was mainly due to an increase of endothelial cells (97%). Mesangial cells were, however, also increased (61%) and mesangial area was increased by 34% (p less than 0.05). Biopsies from patients with persisting proteinuria and/or hematuria revealed slight hypercellularity and an increase in mesangial area during the first six months of disease. The abnormalities in the acute phase of the disease could be so slight that they only would be disclosed by a quantitative investigation.

A quantitative study of glomeruli in idiopathic nephrosis with minimal or no glomerular lesions.

A quantitative investigation was performed of glomeruli in renal ibiopsies from patients with nephrotic syndrome or persisting proteinuria associated with normal light microscopic findings or slight changes not considered significant ("minimal change disease", lipoid nephrosis). The mesangial area was widened (+ 26 per cent, p less than 0.05) and there was an increase in the mean of the total number of cellular nuclei per glomerulus, the number of mesangial (+ 16 per cent) and edothelial nuclei (+ 23 per cent), but of these only endothelial hypercellularity was significant (p less than 0.025).

Endobronchial carcinosarcoma. A case with osteosarcoma of pulmonary invasive part, and a review with respect to prognosis.

A case of endobronchial carcinosarcoma is reported in which a small area of epidermoid carcinoma at the base of the partly necrotic, polypoid part of the tumor was found, and where the pulmonary invasive part consisted of osteosarcoma. To our knowledge such a case has not been published before. In the literature 23 cases of endobronchial carcinosarcoma were found. All but one of those alive at the time of diagnosis were considered operable. The first year survival rate of the reviewed and the reported cases was 36% of all or 42% of the resected cases. The figures for bronchial carcinoma are 33% or 62% of the resected cases. The pre- and post-operative mortality for endobronchial carcinosarcoma was 23%. Because follow-up was too short, the 5 year survival rate cannot be estimated. Features common to pulmonary sarcoma and pseudosarcoma of the upper respiratory tract are also discussed.