Squamous cell carcinoma in situ arising in inflammatory cloacogenic polyps: report of two cases with PCR analysis for HPV DNA.

Inflammatory cloacogenic polyp (ICP) is regarded as part of the spectrum of pathological changes encountered in mucosal prolapse syndrome (MPS)/solitary rectal ulcer. We present the clinicopathological features of two females with squamous cell carcinoma in situ arising in their ICPs. Human papillomavirus (HPV) type 16 was demonstrated in the areas of squamous carcinoma in situ in both polyps by polymerase chain reaction. These cases highlight the need for close scrutiny of the squamous components of these lesions.

Use of the same archival papanicolanou smears for detection of human papillomavirus by cytology and polymerase chain reaction.

An optimal method for the processing of archival cervical Papanicolaou (pap)-stained smears for the amplification of human papillomavirus (HPV) DNA by polymerase chain reaction (PCR) was developed. This methodology was then applied to a series of 44 pap smears designated as HPV positive or negative (on the basis of both major and minor cytological criteria) or cervical intraepithelial neoplasia (CIN)-cancer. For the detection of HPV DNA, each sample was tested with the consensus GP5/6 primers, and when negative, with CPI-IIG primers. The HPV DNA was detected in 100% (8 of 8) of CIN-cancer smears using the GP5/6 primers. In smears with cytological evidence of HPV without CIN. the use of both sets of primers yielded positive results in 100% (19 of 19) of the samples. Direct sequence analysis of PCR products showed that 16 of the 27 HPV-positive samples contained more recently described HPV types. When tested with both primer combinations, all 17 cytologically negative smears were positive for beta-globin but negative for HPV DNA. The findings show the value of using archival pap smears for further investigations to address issues such as latency, but they indicate that cytological criteria and DNA technology will be critical factors in the reliability of the results.

Filiform viral squamous papillomas on sheep.

Filiform squamous papillomas occur rarely on young sheep and correspond closely to those on cattle and other species; they lack the fibromatous component of papillomas reported previously. This paper describes microscopical, immunological and molecular evidence for the presence of a putative ovine papillomavirus in these lesions.

Skin reactions to diltiazem.

A survey of Australian dermatologists was conducted into skin reactions observed to diltiazem. These have included: erythema multiforme, subcorneal pustular dermatosis, photosensitive erythroderma, macular exanthem, allergic vasculitis and urticarial vasculitis. The range of clinical and histopathological features are described. A review of the literature is presented. Photosensitive erythroderma and urticarial vasculitis have not, to our knowledge, been reported in the literature previously.

Recurrent cutaneous erythralgia and arthralgia.

Two cases are reported of Vietnamese men who presented in young adult life with recurrent, painful, erythematous patches (which we have termed "erythralgia") over and adjacent to joints and accompanied by marked constitutional symptoms of malaise and lethargy, arthralgia and in one patient, fever. In the other, from the onset of the disease there were nodules over the bony prominences and in the interphalangeal regions of the fingers. The duration of the disease was over 12 years, the duration of each episode without therapy was one week and the interval between episodes was one to two weeks. In addition the patients showed a raised ESR and peripheral neutrophil leucocytosis of over 70%. There was a rapid response, within hours, to non-steroidal anti-inflammatory agents. Skin biopsies taken at varying stages of the disease episode failed to demonstrate neutrophils thereby failing to satisfy one major criterion of Sweet's Syndrome. Direct immunofluorescence studies were negative. Biopsy of the nodules did not show rheumatoid pathology. The serum rheumatoid factor was negative. Investigations failed to demonstrate any recognised pattern of cutaneous or rheumatologic disease; infections such as borreliosis were excluded. Both patients showed evidence of past hepatitis B infection. As recurrent painful cutaneous erythema is an uncommon phenomenon in dermatology except where the patient is suffering from recurrent cellulitis of the lower limbs, the patients reported here exhibit a pattern of disease not previously described.

Papillomavirus infection of the female genital tract before and after treatment: a cytological, colposcopic and histological study.

Papillomavirus infection (HPV) of the female genital tract is now recognized as a major risk factor for the development of neoplasia. With the combined investigative modalities of cytology, colposcopy and histopathology, it is clear that precancerous changes and HPV are closely associated. The differentiation of innocent HPV infection from progressive premalignant disease is not clear-cut in all situations. Despite various treatment modalities, close follow-up of these patients by cytology, colposcopy and histology reveals the presence of persistent genital tract infection by HPV.

Unilateral facial actinic elastotic plaque--a new clinical variant of actinic elastosis.

The case is reported of an 82-year old woman with a four month history of an erythematous indurated plaque on the left cheek. Light and electron microscopy demonstrated the presence of solar elastosis alone. We believe that this is a new clinical variant of solar elastosis. The spectrum of cutaneous actinic damage is reviewed.

Chorioamnionitis: how useful is the determination of C-reactive protein?

This study was designed to derive the predictive value of C-reactive protein (CRP) in peripheral venous serum of patients admitted to hospital with suspected premature rupture of the membranes (PROM). CRP was assayed by each of 4 separate methods and the results have been compared for accuracy and practical value with respect to clinical outcome and the histopathology of the placenta. Of the 4 techniques used only the latex test had characteristics suitable for a diagnostic screen. While the results were only semiquantitative, when comparisons were made to other techniques no significant change in clinical diagnosis would have been made. The results have confirmed that chorioamnionitis and preterm labour are often associated, but in some instances the extent of inflammatory infiltration was greater than might have been expected from the short time interval between documented membrane rupture and delivery. Thus it may be speculated that some cases of PROM are secondary to, rather than causative of, infection. Finally it is suggested that a controlled therapeutic trial of active intervention in those cases of PROM with elevated CRP in the absence of other clinical parameters suggestive of intrauterine infection should be undertaken.

Moving to micro-based cost accounting.

Cost accounting information is needed for flexible budgeting, productivity management, contracting with third party payors, physician evaluation, and investment and divestment decisions. This article discusses why an increasing number of hospital managers are turning to microcomputer-based accounting systems as solutions to these growing needs.

Brenner tumours of the ovary: a study of the histology, immunohistochemistry and cellular DNA content in benign, borderline and malignant ovarian tumours.

Brenner tumours are now generally regarded as being of ovarian epithelial origin. Most have a limited growth potential and are benign. For this reason they are usually found incidentally at hysterectomy. In common with other epithelial ovarian tumours there is a histopathological spectrum of appearances ranging from benign through borderline to invasive malignancy. In this series all 54 tumours were graded according to the degree of cytological atypia, presence of mitoses and tumour necrosis. Heterogeneity of DNA content was observed in the higher grade tumours, two of the four being diploid and two being aneuploid (all benign tumours being diploid). The presence of aneuploidy correlated with the histological features and a poor clinical prognosis. Immunohistochemical staining for keratoprotein was found to be of limited value in the diagnosis of Brenner tumours and their metastases.

Steroid receptors in human ovarian malignancy. A review of four years tissue collection.

The oestrogen and progestogen receptor status in ovarian cancers from 72 patients was correlated with histological type, primary or secondary origin and peripheral hormone concentrations. Changes occurred in receptor status during malignant transformations of ovarian tissues, with those for oestrogen being found more often, and those for progestogen less often than in non-diseased ovarian fragments. It is suggested that the similarity in sex steroid receptor content between ovarian and breast cancers warrants prospective study of ovarian sex steroid receptor status as a predictive index of survival and response to hormonal therapy in multi-centre clinical trials. Additional data on androgen receptors are also presented.

The value of the monoclonal antibody (cancer antigen 125) in serial monitoring of ovarian cancer: a comparison with circulating immune complexes.

The use of circulating immune complexes and a commercial monoclonal antibody to ovarian cancer (CA 125 kit) in monitoring progress in patients with ovarian cancer has been assessed. While changes in immune complexes were apparent in some patients with active progression of disease, the marked change in values and linear trend make the use of CA 125 a useful clinical marker.

Atypical polypoid adenomyoma: a case report with ultrastructural examination.

A case of atypical polypoid adenomyoma occurring in a 40 yr-old female is reported. The lesion was composed of irregular glands lined by atypical epithelium lying in a spindle cell stroma containing smooth muscle cells. The mitotic count of the stroma was less than 1 per 10 high power fields. Squamous metaplasia was present in the glandular elements. Ultrastructural examination of the stroma confirmed the presence of smooth muscle cells. The lesion is compared with similar cases previously reported. The differential diagnosis is considered, including endometrial adenocarcinoma, adenomyosis, endometrial polyps and mixed Mullerian tumours. Atypical polypoid adenomyoma is a benign lesion, and conservative management is recommended.