An unusual myofibroblastic proliferation of the pinna.

INTRODUCTION: Myofibrosis of the ear is rare. Myofibromas are mesenchymal tumours which usually present in infancy but have been reported sporadically in adults. OBJECTIVE: To present a rare case of trauma as a cause of pinnal myofibrosis. DESIGN AND METHOD: Case report. A 29-year-old soldier suffered repeated trauma from helmet wear and sports, and presented to our clinic with an exquisitely painful lump in the anti-helix of the pinna. RESULTS: The lump was excised uneventfully. Pathology revealed a reactive myofibroblastic proliferation which, given the history of trauma, raised the possibility of a florid cellular repair process. The main differential diagnosis was myofibroma. Immunohistochemistry was used to exclude other possible causes. CONCLUSION: No similar case has previously been reported. The aetiology of myofibroma is unclear, but repeated trauma may be a trigger. Histological and immunohistochemical analysis are recommended when the diagnosis is ambivalent.

Granuloma annulare presenting as multiple nodules on the pinna.

Granuloma annulare is a benign, idiopathic, inflammatory dermatosis characterized clinically by dermal papules and annular plaques. We describe the case of a 40-year-old man who presented with a long history of multiple nodules on the left pinna. Histological examination revealed the typical necrobiotic granulomas of granuloma annulare. The condition predominantly affects the extremities of children and young adults; cases involving the pinna are extremely rare. Nodular lesions are common in otolaryngological practice, and this case illustrates the need for careful clinical assessment and appropriate biopsy in diagnosing lesions of the outer ear

Concordance of FIGO grade of endometrial adenocarcinomas in biopsy and hysterectomy specimens.

AIMS: We compared the FIGO grade of endometrial adenocarcinomas in endometrial samples and subsequent hysterectomy specimens, between 1997 and 2000 in a general pathology department. Our aims were to assess concordance, and the influence of the sampling technique, patient age, reporting pathologist and interval between the biopsy and definitive surgery. In order that the study reflected working practice, the tumour grade given by the reporting pathologist was used whenever possible. METHODS AND RESULTS: Endometrial samples and the subsequent hysterectomy specimens from 125 patients were studied. The comparative FIGO grades were analysed with reference to biopsy type, patient age, reporting pathologist and interval between biopsy and hysterectomy. Concordance was 45% for grade 1, 63.3% for grade 2 and 75.6% for grade 3 carcinomas, the overall concordance being 64.5%. The concordance for grade 3 tumours was significantly higher than for grade 1. The predictive accuracy was independent of biopsy type, patient age, the interval between biopsy and hysterectomy, and whether the same pathologist reported both specimens. CONCLUSIONS: Irrespective of the sampling device used, patient age, time-lapse between biopsy and hysterectomy, or whether the same pathologist reported both specimens, the grade of endometrial adenocarcinoma often differs in the initial biopsy sample from that in the final hysterectomy specimen. This may have important implications for patient management, especially for tumours that yield low-grade biopsies.

Severe hyponatraemia secondary to beer potomania complicated by central pontine myelinolysis.

A case of severe hyponatraemia in a 56-year-old male alcohol misuser secondary to beer potomania is presented. In view of severe volume depletion and the patient's inability to drink, normal saline was cautiously infused. Despite initial improvement, he subsequently deteriorated neurologically. Magnetic resonance imaging demonstrated the classical lesion of central pontine myelinolysis (CPM). The rate of correction of plasma sodium was within limits normally considered safe. Beer potomania should be considered as a cause of hyponatraemia in alcohol misusers. Recognition is important as the electrolyte imbalance repairs simply with cessation of alcohol intake and institution of normal diet. Correction of chronic hyponatraemia by infusion of normal or hypertonic saline should not be attempted unless life-threatening neurological complications supervene. When the balance of risks favours correction, caution should be exercised, as CPM may occur. Although a rate of correction of plasma sodium of up to 10 mM per 24-hour period has been associated with a low risk of precipitating CPM, this case illustrates that a completely safe rate of correction probably cannot be defined.

Displaying the long-term progression of patients with coronary artery disease.

Cardiac clinicians are often faced with the problem of trying to assimilate details of a patient's long-term history. Case notes are often lengthy, making this process difficult if not impossible in the time available during an outpatient examination. A computer system has been developed to assist with this task. This generates a graphical summary of the principal features of a patient's long-term progression. It gives an overview of how the patient's anginal status has changed, his or her drug treatment and any surgical interventions. The system also allows the clinican to display summaries of diagnostic tests carried out. The system can be used to assist clinical management and speed up outpatient examination. It can also be used to facilitate case conference sessions and has potential for being used in medical education.