Stereotactic brain biopsy: An audit of sampling reliability in a clinical case series.

Stereotactic brain biopsy is the current gold standard procedure to obtain a neuropathological diagnosis. An audit of 207 stereotactic cases, between January 1997 and December 2000 was carried out. The aim was to determine the optimum number of target sites required to make the final diagnosis and thereby set up recommendations for future practice. The overall diagnostic success rate was 89.3%. A significant positive correlation between the number of targets taken and the probability of achieving the final diagnosis was seen. In a subset of glioblastoma cases 96.1% of the tumours could have been confidently diagnosed on the basis of any two of the targets chosen, although often more targets were taken than this. The recommendations made by the audit were: (i) in cases where it is suspected the lesion does not require grading, one target site should be taken and further sites should only be taken if the first proves to be non diagnostic; (ii) in suspected glial series tumours, two targets should be routinely taken, with further sites taken only if these prove inconclusive on intraoperative smear.

Tubular aggregate myopathy presenting with acute type II respiratory failure and severe orthopnoea.

Acute hypercapnic respiratory failure (AHRF) is a common reason for hospital admission. Most patients have an underlying chronic lung disease such as chronic obstructive pulmonary disease. We report the case of a man who presented with AHRF secondary to tubular aggregate myopathy.

Distribution of cell adhesion molecules in skeletal muscle from patients with systemic lupus erythematosus.

OBJECTIVE: To investigate the pathophysiology of perivascular mononuclear cell infiltrates observed in skeletal muscle from patients with systemic lupus erythematosus (SLE). METHODS: Immunocytochemical techniques were used to examine frozen 5 microns sections from the quadriceps needle muscle biopsy specimens of 14 patients with SLE (including seven with infiltrates) for the expression of the cytokine inducible adhesion molecules intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin. RESULTS: Vessels in 6/7 SLE biopsy specimens with perivascular infiltrates expressed VCAM-1 at a density of > 2 vessels/mm2 in contrast with 0/7 SLE biopsy specimens without infiltrates and 1/6 control specimens. In contrast, E-selectin expression was increased ( > 0.3 positive vessels/mm2) in SLE biopsy specimens compared with control tissue regardless of the presence of perivascular infiltration. VCAM-1 and ICAM-1 were also noted on extravascular cells in the infiltrates, being particularly prominent on the intermuscle fibre dendritic processes of CD68+ HLA-DR+ cells. CONCLUSION: Expression of these cytokine inducible adhesion molecules may be important in the migration of mononuclear cells into skeletal muscle and may be involved in intercellular interactions within the tissue.

Expression of epidermal growth factor receptor in human glioblastoma multiforme.

The expression of epidermal growth factor receptor was determined in a series of 88 patients with glioblastoma multiforme using a monoclonal antibody to the receptor. Positive staining was seen in 17 patients but this did not have prognostic significance when compared with known clinical prognostic factors using a computer model. The significance of receptor expression in these tumours is discussed.

Orbital lymphomas and Castleman's disease.

A series of 100 consecutive orbitotomies for tumour was assessed. Lymphoid infiltrations contributed 27% and malignant non-Hodgkin lymphoma was the commonest primary malignant orbital tumour in this series. The clinical and histological features of the first histologically proven case of primary orbital Castleman's disease are reported, as are the results of a study of 27 patients with pure orbital lymphoid infiltrations. The natural history of conjunctival lymphomas differs significantly from that of pure orbital lymphomas and for this reason no conjunctival lymphomas were considered in this series (which therefore contrasts with some previous reports). Histological examination with fresh unfixed tissue available for immunohistochemical staining enhances the diagnostic accuracy of these varied underlying diseases. More than one biopsy may be required before the diagnosis is established. These are significant factors given the differing lines of management for each disorder.

Whipple's disease with cerebral involvement.

A case of Whipple's disease, initially presenting with abdominal symptoms and later with neurological manifestations, is reported. The diagnosis was not made in life, but on post-mortem examination of the brain. This case emphasizes the importance of early diagnosis and treatment of this uncommon disorder.

Immunolocalization of cathepsin D in the human central nervous system and central nervous system neoplasms.

The cellular distribution of the lysosomal proteinase cathepsin D was studied in a series of 76 neoplasms and 18 non-neoplastic tissues from the human central nervous system, using a well-characterized polyclonal antibody in a peroxidase-antiperoxidase technique. In the normal and developing brain, cathepsin D is confined to neurons and choroid plexus epithelium. Strong granular cytoplasmic staining was present in neuronal and choroid plexus neoplasms, and in reactive macrophages. A large variety of other neoplasms also exhibited positive cytoplasmic staining, albeit usually of a weaker diffuse type. Cathepsin D cannot be considered a specific marker for neuronal or choroid plexus neoplasms, but the antiserum used in this study may be of value in antibody panels for the investigation of these tumours. Its localization may also be of value in embryological studies, particularly in the cerebellum, and in investigations of steroid hormone receptor-associated proteins in meningiomas and Schwannomas.