Lymphomatoid granulomatosis mimicking bronchial carcinoma.

This report concerns a patient with lymphomatoid granulomatosis who presented with multiple ulcerated skin nodules, a solitary pulmonary mass and a cerebral mass. Biopsies taken from the skin and lung lesion showed necrotic tissue only. This combination of physical signs and the initial non-specific histological changes suggested a diagnosis of primary bronchial carcinoma with secondary spread. However, the subsequent temporary improvement and a further histological examination enabled a diagnosis of lymphomatoid granulomatosis to be made and this was confirmed at post-mortem. This report emphasizes the difficulty in obtaining diagnostic material in lymphomatoid granulomatosis and highlights the need to consider this diagnosis in a patient with suspected carcinoma when biopsy material shows necrotic tissue only.

beta 2-microglobulin in non-malignant and malignant human breast: a feature of differentiation.

An indirect immunofluorescent method has been used to study the distribution of the membrane protein beta 2-microglobulin in normal, benign and malignant human breast tissue. A uniform staining of epithelial cell membranes has been found in all normal and benign tissues, with only a minor variation in the intensity of reaction between samples. In contrast the carcinomas have shown a variety of reactions, with some behaving in a manner similar to the normal and benign breast tissue, others being heterogeneous with regard to intensity of staining and the remainder having a weak or a negative reaction. The immunohistochemical behaviour of the carcinomas has paralleled the degree of histological differentiation, with poorly differentiated carcinomas showing little reactivity. A comparable relationship with lymph node status has not been found. Although those carcinomas with a staining pattern akin to non-malignant tissue have a lower incidence of lymph node metastasis it has been the heterogeneous reacting group rather than the weak staining and negative tumours which has shown a higher rate of axillary lymph node metastasis. The prognostic significance of this finding is at present uncertain and can probably only be assessed from information about patient survival.

Broncho-oesophageal fistula: a late complication of endoscopic variceal sclerotherapy.

A case is reported of delayed broncho-oesophageal fistula presenting several weeks after fibreoptic injection sclerotherapy for oesophageal varices in a patient with chronic active hepatitis who eventually died from bronchopneumonia. Such serious complications of injection sclerotherapy should be kept in mind with the increasing popularity of this method of early treatment of bleeding oesophageal varices.