Crystal structures and Hirshfeld surface analyses of methyl 4-{2,2-di-chloro-1-[(E)-phenyl-diazen-yl]eth-enyl}benzoate, methyl 4-{2,2-di-chloro-1-[(E)-(4-methyl-phen-yl)diazen-yl]ethen-yl}benzoate and methyl 4-{2,2-di-chloro-1-[(E)-(3,4-di-methyl-phen-yl)diazen-yl]ethen-yl}benzoate.

The crystal structures and Hirshfeld surface analyses of three similar azo compounds are reported. Methyl 4-{2,2-di-chloro-1-[(E)-phenyl-diazen-yl]ethen-yl}benzoate, C16H12Cl2N2O2, (I), and methyl 4-{2,2-di-chloro-1-[(E)-(4-methyl-phen-yl)diazen-yl]ethen-yl}benzoate, C17H14Cl2N2O2, (II), crystallize in the space group P21/c with Z = 4, and methyl 4-{2,2-di-chloro-1-[(E)-(3,4-di-methyl-phen-yl)diazen-yl]ethen-yl}benzoate, C18H16Cl2N2O2, (III), in the space group P with Z = 2. In the crystal of (I), mol-ecules are linked by C-H⋯N hydrogen bonds, forming chains with C(6) motifs parallel to the b axis. Short inter-molecular Cl⋯O contacts of 2.8421 (16) Šand weak van der Waals inter-actions between these chains stabilize the crystal structure. In (II), mol-ecules are linked by C-H⋯O hydrogen bonds and C-Cl⋯π inter-actions, forming layers parallel to (010). Weak van der Waals inter-actions between these layers consolidate the mol-ecular packing. In (III), mol-ecules are linked by C-H⋯π and C-Cl⋯π inter-actions forming chains parallel to [011]. Furthermore, these chains are connected by C-Cl⋯π inter-actions parallel to the a axis, forming (01) layers. The stability of the mol-ecular packing is ensured by van der Waals forces between these layers.

Crystal structure and Hirshfeld surface analysis of 1,3-bis-{2,2-di-chloro-1-[(E)-phenyl-diazen-yl]ethen-yl}benzene.

In the mol-ecule of the title compound, C22H14Cl4N4, the central benzene ring makes dihedral angles of 77.03 (9) and 81.42 (9)° with the two approximately planar 2,2-di-chloro-1-[(E)-phenyl-diazen-yl]vinyl groups. In the crystal, mol-ecules are linked by C-H⋯π, C-Cl⋯π, Cl⋯Cl and Cl⋯H inter-actions, forming a three-dimensional network. The Hirshfeld surface analysis indicates that the most important contributions to the crystal packing are from H⋯H (30.4%), C⋯H/H⋯C (20.4%), Cl⋯H/H⋯Cl (19.4%), Cl⋯Cl (7.8%) and Cl⋯C/C⋯Cl (7.3%) inter-actions.

Two patients with Ehlers-Danlos syndrome type VIII with unexpected hoarseness.

Ehlers-Danlos syndrome (EDS) encompasses a genetically and clinically heterogeneous group of connective tissue disorders, characterized by joint hypermobility, skin hyperextensibility and tissue fragility. It is a rare condition, and inheritance is either autosomal dominant or recessive. Previously grouped into 11 different subtypes, with increasing knowledge of the underlying molecular defects, it was reclassified in 1997 into 6 major groups, with type VIII excluded from this classification. Type VIII EDS is a very rare subtype, characterized by severe, early-onset periodontitis, skin fragility and abnormal scarring. Voice abnormalities have occasionally been described in other forms of the condition, and may be due to defects in the collagen of the vocal ligament. We report two cases of patients with EDS type VIII and hoarseness.

Multicentre evaluation of intraoperative molecular analysis of sentinel lymph nodes in breast carcinoma.

BACKGROUND: Ideally, intraoperative sentinel lymph node (SLN) analysis in breast cancer should be automated, have high concordance with extensive histopathology, and be applicable in any hospital setting. A prospective multicentre evaluation of the one-step nucleic acid amplification (OSNA) automated molecular diagnostic system of SLN analysis was undertaken. METHODS: Intraoperative examination of SLNs from 204 patients with breast cancer was performed by OSNA at four sites in the UK. Half of each SLN was assessed by OSNA (for cytokeratin 19 mRNA) and the remaining half was paraffin embedded for intensive histological examination at ten levels. Discordant cases were reanalysed by further molecular biological techniques and by additional histological examination of all remaining nodal material to ascertain whether the discordance was due to an uneven distribution of metastases, known as tissue allocation bias (TAB). RESULTS: After exclusion of samples affected by TAB, the overall concordance rate for OSNA versus histopathology was 96.0 per cent, with a sensitivity of 91.7 per cent and a specificity of 96·9 per cent. The median time to process a single SLN was 32 (range 22-97) min, and that for two nodes 42 (30-73) min. CONCLUSION: OSNA enables accurate automated intraoperative diagnosis and can be used successfully in different UK hospitals. When the SLN is shown to be positive, the patient can undergo immediate axillary clearance under the same anaesthetic rather than having a delayed second procedure.

Intra-operative imprint cytology for assessing the sentinel node in breast cancer: results of its routine use over 8 years.

INTRODUCTION: Intra-operative imprint cytology (IIC) for analysing sentinel lymph node/s (SLN) in breast cancer allows definitive axillary surgery as a one-step procedure. Most reported studies are research oriented. This study reports long-term results of IIC done as routine clinical practice. MATERIALS AND METHODS: Eight hundred ninety-six female, operable breast cancer patients underwent SLN biopsy over an 8-year period (January 1999-December 2006). Data were extracted retrospectively from medical records. SLNs were sent intra-operatively to the laboratory where they were bisected, touch imprinted and stained with Hematoxylin & Eosin. Patients with positive IIC had axillary clearance. Formal histological analyses of SLNs were compared with IIC findings. The impact of routine pre-operative axillary ultrasound (introduced in 2003) on IIC sensitivity and specificity was also assessed. RESULTS: Median age was 61 years (26-89) and median tumour size was 18 mm (2-100). A total of 244/896 patients had SLN metastases on final paraffin histology of which 177 were correctly detected by IIC (67 false negatives). 39/67 false negatives could be attributed to sampling error. The overall sensitivity and specificity of IIC for the identification of SLN metastases was 73% and 100%, respectively. The sensitivity of IIC after introduction of pre-operative axillary ultrasound decreased from 75% to 71%. DISCUSSION: Routine use of IIC for analysis of the SLN in breast cancer allows complete axillary surgery during a single anaesthetic for a majority of patients undergoing SLN biopsy. Almost two thirds of positive axillae were spared a second operation. False negative results are frequent and patients should be warned about the potential need for further axillary surgery.

An atypical case of Sjögren's syndrome causing unilateral severe lacrimal gland enlargement and hypoglobus.

We report the first case of Sjögren's syndrome causing gross lacrimal gland swelling and secondary hypoglobus and uncharacteristically absent sicca syndrome. Histopathological diagnosis of the excision biopsy of the orbital lobe of the gland confirmed a mixed T and B cell infiltrate of the gland with no lymphomatous transformation. The condition remains quiescent following complete excision.

The morphological variants of papillary carcinoma of the thyroid: a clinico-pathological study--AFIP experience. Armed Forces Institute of Pathology.

Many variants of papillary carcinoma of thyroid have been described. Identification of some of these may have prognostic implications. Eighty-two cases of papillary carcinoma of the thyroid diagnosed at Armed Forces Institute of Pathology, Rawalpindi over a six year period were reviewed with the aim of identifying these variants. Fifty-eight (70.7%) were classical papillary carcinoma. Thirteen (15.9%) had follicular variant, 6 (7.3%) columnar cell variant and 3 (3.7%) had tall cell variant. The mean age at diagnosis was 27 years for classical papillary carcinoma, 46 years for follicular variant, 61 years for columnar cell variant and 52 years for tall cell variant. The columnar cell variant had a more aggressive clinical presentation than others. Tall cell, columnar cell and diffuse sclerosing variant have a poor prognosis. An effort should be made to identify them on histopathology so that specific therapy can be planned.

Quantitative assessment of basement membranes in soft tissue tumours. Computerized image analysis of laminin and type IV collagen.

Basement membranes (BMs) in 201 soft tissue tumours were quantified using computerized image analysis of tissues immunostained for laminin and type IV collagen. The purpose of the study was to compare and quantify the extent of BM deposition in a large and varied group of benign and malignant tumours. Laminin and type IV collagen gave similar results. The difference between benign and malignant was statistically highly significant (P = 0.0001), with greater deposition in benign tumours. BM deposition was homogeneous in benign tumours and heterogeneous in sarcomas and appeared to correlate with the degree of differentiation. Some poorly differentiated sarcomas showed cytoplasmic laminin staining but little or no extracellular BM. Immunohistochemical evaluation of BM has some advantages over electron microscopy; specialized equipment is not needed and since large samples can be studied with little sampling error, heterogeneity can be studied more readily. Subjective visual assessment gives a good overall indication of the extent of BM deposition and in many situations is likely to be a suitable alternative to image analysis. Because of staining heterogeneity, BM immunohistochemistry is unlikely to be of significant value in the diagnosis of specific types of sarcoma.