Pneumococcal endoprosthetic pulmonary valve endocarditis with crescentic glomerulonephritis and acute renal failure.

We describe a case of acute renal failure with crescentic glomerulonephritis, due to pneumococcal infective endocarditis on an endoprosthetic pulmonary valve. The patient's renal insufficiency subsequently improved following eradication of the microbe with antibiotics alone. Moreover, this is the first description of pneumococcal PVE leading to a crescentic glomerulonephritis.

Prediction of the presence of invasive disease from the measurement of extent of malignant microcalcification on mammography and ductal carcinoma in situ grade at core biopsy.

AIM: To determine whether the extent of microcalcification and ductal carcinoma in situ (DCIS) grade can be used to accurately predict the presence and size of invasive cancer in cases of malignant microcalcification. MATERIALS AND METHODS: Over a 10-year period, 402 cases of malignant microcalcification from an NHS screening programme were analysed. For each case, measurement of mammographic microcalcification extent, DCIS grade, and the presence and size of invasive carcinoma from the excised surgical specimen were recorded. RESULTS: The final histological diagnosis was DCIS only in 71% (284/402) and DCIS with a focus of invasive disease in 29% (118/402). The risk of invasive disease increased with increasing size of microcalcification from 20% (27/136) for cluster size less than 11mm, to 45% (18/40) for cluster size more than 60mm. The risk of invasive disease also increased with increasing histological grade of DCIS from 13% (4/31) with low-grade DCIS to 36% (86/239) with high-grade DCIS. There were significant associations with the presence of invasive disease for cluster size (p=0.0001) and DCIS grade (p=0.003), and when using univariate analysis with simple [cluster size (p=0.01) and grade (p=0.01)] and multiple [cluster size (p=0.02) and grade (p=0.02)] logistic regression, respectively. The Hosmer-Lemeshow goodness-of-fit test suggests that the multiple logistic regression model has a good fit (p=0.99). CONCLUSION: The multidisciplinary team can use these data in individual cases to estimate the risk of invasive cancer and decide whether to carry out an axillary staging procedure.

Acute intermittent porphyria and chronic renal failure.

Despite the little known association between renal damage and the acute porphyrias, limited information is available on the characteristics and pathogenesis of renal disease in this patient group. Previous reports have focused on hypertension as the principal etiological factor. We have studied a series of 9 patients with acute intermittent porphyria (AIP) attending the Porphyria Clinic at King's College Hospital, London, UK, who were referred to the Renal Unit for investigation and treatment of their renal disease. No evidence of a glomerular lesion was found in any of the patients. In contrast, renal histology showed features of a tubulointerstitial disease, and there was evidence of impaired erythropoietin production. Hypertension and nonsteroidal antiinflammatory drug use were present in about a half of the patients. It is postulated that the nephrotoxic effects of porphyrin precursors may contribute to the etiology of this clinical syndrome.

A hat trick of ulcerating pathogens in a single genital lesion.

We report on a patient from a London clinic, (a Jamaican heterosexual man known to have herpes) who has donovanosis and syphilis in a single genital ulcer. The case highlights the importance of careful clinical examination of genital ulcers.

Biodiversity and recombination of cassava-infecting begomoviruses from southern India.

Cassava mosaic disease (CMD) is caused by various begomoviruses of the family Geminiviridae leading to considerable crop losses in Africa and Asia. Recombination between their genomic components has generated new pathotypes with enhanced virulence in Africa. Here, we report about a survey on the biodiversity of begomoviruses in cassava from southern India (Tamil Nadu and Kerala states) performed in 2001 and 2002. Viral DNA A components from stem cuttings were analysed using polymerase chain reaction and restriction fragment length polymorphism. Eight representative examples were completely sequenced. The majority of DNA sequences (7 of 8) obtained were more closely related to that of Sri Lankan cassava mosaic virus (SLCMV) than of Indian cassava mosaic virus (ICMV). Only one sequence collected in Kerala was related to ICMV. The diversity of the SLCMV-like sequences was rather low compared to the variability of African viruses associated with cassava mosaic disease. Based on DNA A sequence data, all of these isolates should be classified as variants of SLCMV or ICMV. Phylogenetic analysis revealed mosaic structures within the DNA sequences which may indicate footprints of recombination events between ancestors of SLCMV and ICMV.

Identification of a second begomovirus, Sri Lankan cassava mosaic virus, causing cassava mosaic disease in India.

The DNA A and DNA B components of a begomovirus associated with cassava mosaic disease (CMD) originating from Kerala, India, were cloned. Biolistically inoculated clones induced symptoms typical of CMD in cassava. Sequence comparisons showed the virus to be an isolate of Sri Lankan cassava mosaic virus (SLCMV). This is the first time this begomovirus species has been identified in India and only the second species shown to cause CMD in the country. The implication of these findings on our understanding of the diversity and geographic distribution of CMD-associated begomoviruses in the region and on efforts to obtain resistance to CMD are discussed.

Is radiotherapy needed after breast conservation for small invasive breast cancers?

AIMS: The purpose of this study was to determine the rate of local recurrence in patients with small invasive breast cancers (<1 cm) who had been treated with breast-conserving surgery either with (group 1) or without (group 2) adjuvant radiotherapy. METHODS: This is a retrospective study of 110 patients with an invasive breast cancer less than 1 cm in size, treated in our centre by breast-conserving surgery. Parameters examined included age at and mode of presentation, histopathological features, adjuvant therapy, length of follow-up and outcome in terms of local recurrence rate and death. RESULTS: In group 1 there were 59 women of median age 57 (38-80) years. The median tumour size was 9 (1-10) mm and median follow-up was 74 (15-110) months. There were no local recurrences. In group 2 the median age at presentation was 59 (48-81) years. The median tumour size was 7 (2-10) mm and median follow-up was 47 (14-93) months. There were three non-breast-cancer related deaths and three local recurrences (6%). CONCLUSIONS: A local recurrence rate of 6% at almost 4 years median follow-up suggests that it may be possible to avoid adjuvant radiotherapy in a subgroup of largely screen-detected, node-negative patients with invasive tumours less than 1 cm, in whom adequate local excision is performed. Further follow-up is required to substantiate this.

Periampullary gangliocytic paraganglioma.

A33-year-old man presented with features of obstructive jaundice. Enterohepatic retrograde cholangiopancreatography examination revealed a periampullary growth. After pancreatoduodenectomy, histologic examination of the growth revealed three elements: a spindle cell element, large ganglion cells, and smaller paraganglioma-like cells arranged in small nests and groups. A diagnosis of gangliocytic paraganglioma was given. Gangliocytic paraganglioma is a rare benign duodenal tumor, with uncertain histogenesis. It is possible to identify the three components that are essential for its diagnosis on routine hematoxylin and eosin sections without the use of immunohistochemical markers. Because this lesion may present clinically as a periampullary carcinoma, it is important to recognize and diagnose this rare, but benign, entity.

Intraabdominal desmoplastic small cell tumor mimicking adenocarcinoma. A case report.

BACKGROUND: Fine needle aspirates and washings from intraabdominal desmoplastic small cell tumors (IADSCTs) are rarely encountered by pathologists. Immunocytochemical examination of histologic material is usually necessary for a definitive diagnosis. CASE: A 23-year-old man presented with abdominal pain, ascites and bilateral pleural effusion. Examination of ascitic fluid suggested adenocarcinoma, but histologic and immunocytochemical examination of surgically resected tissue showed features of an IADSCT. CONCLUSION: This case is a reminder that IADSCT should be included in the differential diagnosis of intraabdominal neoplasms and that its diagnosis in cytologic preparations requires a high index of suspicion. In particular, this case appears to be the first reported example of IADSCT mimicking adenocarcinoma.

Secondary neoplasms of the male genital tract with different patterns of involvement in adults and children.

AIMS: The incidence, presentation and macroscopic and histological features of secondary neoplasms of the male genital tract are described with reference to their differential diagnosis. METHODS AND RESULTS: A retrospective study of cases from the Royal London Hospital yielded a total of 31 secondary neoplasms involving the testis: 14 at postmortem examination and 17 surgical specimens. Nine cases were leukaemias: six acute lymphoblastic and two acute myeloid leukaemias in children, and one chronic lymphocytic leukaemia in an adult. The commonest primary sites of metastases to the testis were prostate (six cases), stomach (five cases) and lung (three cases). There were two malignant melanomas and isolated examples of metastases from the adrenal gland (neuroblastoma), cerebellum (medulloblastoma), soft tissue (alveolar rhabdomyosarcoma), pancreas and rectum. Of the metastases from solid tumours, 12 involved the right testis only, three involved the left and four were bilateral. In seven of these cases there were multiple testicular nodules, in seven there was a single mass, and in the rest there was diffuse involvement. Secondary neoplasms represented 4.6% of all testicular neoplasms at autopsy, and 1.6% in surgical specimens. There were five secondary penile neoplasms: two each from the pancreas and prostate and one from the bladder. Two neoplasms metastatic to the spermatic cord, both from a gastric primary, were included in the series. CONCLUSIONS: Secondary neoplasms of the testis occur with a frequency comparable to other sites in the genitourinary tract, and metastases to the spermatic cord, epididymis, and penis, are rare in comparison. Disseminated neoplasms rarely present initially at this site and are histologically distinctive in adults, but in children they must be distinguished from primary small round blue cell tumours.

Histological comparison of chronic hepatitis B and C in an Indian population.

Many studies have shown that steatosis, lymphoid aggregates or follicles and bile duct injury on histology are more consistently associated with chronic hepatitis C than chronic hepatitis B. We compared liver biopsies of 30 patients of chronic hepatitis B with an equal number of age matched patients with chronic hepatitis C. Steatosis, lymphoid aggregates or follicles and bile duct injury were noted in 66.6%, 36.6% and 26.6% cases respectively of chronic hepatitis B as compared to 70%, 33.3% and 30% cases respectively of chronic hepatitis C. Thus none of the features were considered distinctive of HCV infection.

Clear cell carcinoma of the ovary arising in a mucinous cystadenoma.

A 57 year old woman presented complaining of increasing abdominal swelling of six months duration. A mixed solid cystic left ovarian tumour measuring 24 cm in diameter was excised. Histology showed numerous cysts lined by benign mucinous epithelium blending imperceptibly into borderline clear cell and mucinous areas that in turn merged with an invasive clear cell carcinoma. To the best of our knowledge, this is the first reported case of clear cell carcinoma arising in a mucinous cystadenoma. The implications for the previously postulated pathogenesis of these tumours are discussed.

Cyclical changes in the pituitary gonadotrophs (GTH cells) in relation to the testicular cycle in Puntius sarana (Hamilton).

The pituitary gland of Puntius sarana is of the leptobasic type and has three subdivisions--a proximal pars distalis (PPD), a rostral pars distalis (RPD) and a pars intermedia (PI) arranged vertically one below the other. The gonadotrophs (GTH cells) of the PPD were identified by their PAS, ATh, AF, aniline blue and alcian blue positivity and by their immunoreactivity to ovine anti-LH beta-subunit, anti-salmon GTH and anti-silver carp GTH. The testes of Puntius sarana have been classified as the "unrestricted type". The morphological, histological and histometric findings indicate that the testing passes through four distinct stages--preparatory, fully mature, spawning and spent. Spermatogenesis begins in January and continues up to July. The spawning season lasts from late July until October. Cyclical changes in the gonadotrophs correlate well with changes in the testes. The histometric data show that the GTH cells attain maximum values (size and number) during the breeding season. The peak values for testicular weight, lobule diameter, the gonadosomatic index (GSI) and the sperm concentration in the testes, and the number, size and amount of secretory material in the cytoplasm of the gonadotrophs, coincide with the time of maximum environmental temperature and the longest days.

Photoperiodic control on the ovary and pituitary gonadotrophs in Puntius sarana (Hamilton).

Exposure of the fish to a long photoperiod (16L/8D) during the prespawning period accentuates the development of the ovary and increases the secretory activity of the pituitary gonadotrophs (GtH cells). A short photoperiod (8L/16D) or total darkness brings about follicular atresia of the vitellogenic oocytes and inhibits secretory activity of the GtH cells. Both the vitellogenesis and the GtH cell activity are restored in the fish exposed to short photoperiod if it is followed by a long photoperiod. Results indicate that the photoperiod plays a major role in controlling the reproductive activity in the teleost, Puntius sarana.

Effect of hypophysectomy and starvation on the fine structure of vitellogenic oocytes in the newt, Triturus pyrrhogaster (Laur).

Hypophysectomy and starvation in Triturus pyrrhogaster result in a similar ultrastructural pattern of follicular atresia. The first detectable change in the oocytes is decrease in the size and number of microvilli. Subsequently the yolk precursor bodies (YPB) disappear from the micropinocytotic vesicles and the mitochondria degenerate. Finally the yolk platelets undergo decomposition. The smaller yolk platelets disintegrate by granulation, vacuolation and lobule formation. The larger platelets, after losing their superficial layer and the inner crystalline lattice, are surrounded by a laminated membrane complex. The pattern of yolk breakdown is comparable to that during development. A rather delayed effect is observed on the nucleolus of the oocytes. Pigment granules seem to play an important role in the proteolysis of the yolk.