5alpha-dihydrotestosterone stimulation of human prostate in organ culture.

Explants of human benign hypertrophied prostate were cultured for 8 days. The effect of 5alpha-dihydrotestosterone on the morphology, DNA and glucose utilization of 14 cases was investigated. In four cases proliferation was clearly more extensive in the dihydrotestosterone-treated explants than in the controls. In six explants, there were no morphological differences between those cultured with or without dihydrotestosterone and in half of these, proliferation was present. Four explants were either necrotic or did not contain epithelial cells. The mean DNA content of the treated explants was higher than that of the controls (P smaller than 0.01). There was no significant difference in the rate of glucose utilization by the explants treated with dihydrotestosterone, and by the controls.

Malakoplakia in a cadaver renal allograft: a case study.

Malakoplakia is an uncommon chronic inflammatory disease characterized by histocytes with intracellular Michaelis-Gutmann bodies. The etiology is uncertain, but it is thought that depressed macrophage phagocytosis of bacteria is important. This presentation describes a case of malakoplakia arising in a cadaver renal transplant. The association of long term immunosuppression and repeated E. coli urinary tract infections is discussed.

Food-starch granulomatous peritonitis.

Two cases of peritoneal granulomatous reactions to food starch are described. They followed bowel perforation and clinically mimicked tuberculous and glove-powder starch peritonitis. Their histological differences from corn-starch peritonitis warrant attention in the absence of previous documentation of starch as a component of peritoneal food granulomas. Food-starch granules tend to be larger than those of glove powder, are often oval, and may be extremely resistant to salivary diastase digestion.

Spicular arrangement of amyloid in renal biopsy.

A spicular arrangement of amyloid on the epithelial aspect of the glomerular basement membrane has been seen to a variable degree in silver-stained sections of renal biopsies in eight of 38 patients with amyloidosis. Electron microscopical examination revealed a spectrum of appearances of the amyloid fibrils which would account for this finding. Only two of these eight patients had amyloidosis secondary to chronic infection, a much lower proportion than in the group as a whole. The possibility of confusion with membranous nephropathy is discussed with relevance to possible modes of treatment.

Isolated arteritis of the epididymis.

The clinical, histological, and immunohistochemical features of two cases of apparently isolated arteritis of the epididymis are presented. The aetiology and pathogenesis of the condition are discussed. Immunoglobulin and complement were shown in the acute arterial lesions, but this is not conclusive evidence that isolated arteritis is either an immune complex disease or a forme fruste of polyarteritis nodosa.

Asymptomatic arteritis of the uterine cervix.

A necrotizing arteritis in the uterine cervix is described as an incidental finding in surgical material from 10 patients. The histological features are compared with those seen in polyarteritis nodosa. Subintimal hyaline deposition and a relative paucity of neutrophil and eosinophil polymorphs characterized the lesion but the histological appearance was never sufficiently specific to exclude confidently the possibility of polyarteritis nodosa. None of the patients had evidence of multisystem disease either at the time of operation or at subsequent follow-up assessment.

Clinical findings and testicular histology in three hyperprolactinemic infertile men.

Three azoospermic infertile men with marked hyperprolactinemia are described. All three men had clinical evidence of distal genital tract obstruction, and one man had evidence of severe spermatogenic arrest. The histology of testicular biopsies taken from each of these men is described and the role of hyperprolactinemia in male infertility is discussed.

Congenital absence of the vasa deferentia presenting with infertility.

Congenital absence of both vasa deferentia is not an infrequent cause of sterility. Between April 1975 and December 1981, 11 men out of a total of 749 presenting with infertility were diagnosed as having congenital absence of both vasa deferentia. Subsequent clinical investigations showed that FSH levels were within the normal range (2-10 mIU/ml), blood karyotype (XY) was normal, and testicular histology demonstrated normal spermatogenesis. Seminal volume was markedly reduced in nine patients (range 0.25-1.0 ml). In three out of four patients tested, seminal fructose was found to be completely absent. Of the 11 patients, eight subsequently had exploratory surgery. In four men, the whole epididymis was present on both sides, while the other four had varying parts of one or both epididymides absent. In six of the eight patients explored surgically, no trace of the vasa deferentia could be found, while one other patient had thin fibrous cords in the anatomical site of the vasa deferentia. A possible cause for the abnormality and the importance of seminal fructose estimation are discussed.

Small bowel biopsy for disaccharidase levels: evidence that endoscopic forceps biopsy can replace the Crosby capsule.

Lactase, sucrase and maltase activities in endoscopic biopsies from the second part of the duodenum were compared to those in Crosby capsule biopsies from the proximal jejunum. In patients with villous atrophy disaccharidase activities were reduced compared with histologically normal mucosa in the duodenum and jejunum. Disaccharidase activities were significantly lower in the duodenum than in the proximal jejunum of patients with histologically normal mucosa and in those with partial villous atrophy but not significantly different for total villous atrophy patients. Primary and secondary disaccharidase deficiencies can be identified in biopsies from the duodenum. Duodenal biopsy is a valid alternative to jejunal biopsy for the diagnosis of disaccharidase deficiency.

Colonic polyps complicating ureterosigmoidostomy.

Polypoid tumours of the small and large intestine have been recognized as a complication of the implantation of ureters into the bowel for many years. Some cases could be recurrences of the urothelial tumour which necessitated the original operation or alternatively others may be tumours arising from the bowel epithelium itself. Malignant and benign varieties of such bowel tumours have been reported, although the description of some of the latter have suggested that they were not true tumours but some variety of 'polyp'. We describe here two polyps arising in the colon some 22 years after ureterosigmoidostomy and discuss the probably mixed nature with elements of both juvenile polyp and tubular adenoma.

Carcinoma of the bladder complicating cyclophosphamide therapy.

Two patients with cyclophosphamide induced cystitis and co-existent bladder tumour are described. Possible mechanisms for these associated diseases are discussed and the difficulty of diagnosing bladder tumour in patients with haemorrhagic cystitis is stressed.

Mucinous biliary papillomatosis: a tumour in need of wider recognition.

We report three cases of mucinous biliary papillomatosis occurring high in the extrahepatic bile ducts. Histological assessment of malignancy is difficult and subjective because there is no unequivocal evidence of stromal invasion. Using anti-laminin antibodies to assess the basement membranes of these tumours we have found a large number of discontinuities in the epithelial basement membrane. On this basis we consider that mucinous biliary papillomatosis should be considered a low-grade malignancy. This would correlate with the natural history of these tumours, namely recurrence but with no widespread metastasis, death resulting from liver failure usually with 5-6 years of presentation.

Multicentric, pigmented carcinoma in situ of the vulva in association with vulval condyloma acuminata.

A case report is presented of a 22-year-old woman with carcinoma in situ of the vulva in a multicentric pigmented form in association with vulval condyloma acuminata. The aetiology of the disease, varied appearances, malignant potential, and mode of treatment are discussed.

Germinal aplasia: how it may mimic obstructive azoospermia.

Six patients with azoospermia due to germinal aplasia are described. It is demonstrated that germinal aplasia may be mistakenly diagnosed as azoospermia due to ductal obstruction.

Intestinal trehalase activity in a UK population: establishing a normal range and the effect of disease.

Trehalose is a disaccharide, the main dietary source being mushrooms. It has been approved as an additive in the preparation of dried food. Isolated intestinal trehalase deficiency is found in 8% of Greenlanders, but is rare elsewhere. The normal range of trehalase activity and the incidence of isolated trehalase deficiency in the UK have not been reported. Patients (n 400) were investigated for suspected malabsorption. Endoscopic distal duodenal biopsies were taken for histological assessment and maltase, sucrase, lactase and trehalase estimation. Disaccharidase activities were determined by Dahlqvist's technique (Dahlqvist, 1968). Most patients (n 369) had normal duodenal histology. In these, square root transformation of trehalase activity produced a normal distribution. The normal range (mean +/- 2 SD) was 4.79-37.12 U/g protein. One patient had an isolated borderline trehalase deficiency. The thirty-one patients with villous atrophy had significantly reduced disaccharidase activities. With ingestion of a gluten-free diet, maltase, sucrase and trehalase activities recovered to normal in most patients, whereas lactase activity did not. The normal range and very low incidence of isolated enzyme deficiency is comparable with that described in populations from the USA and mainland Europe. Activity is significantly reduced in untreated coeliac disease and recovers with treatment with a gluten-free diet. There is no place for routine determination of trehalase activity in the UK population and there should be no concern over the introduction of trehalose-containing dried foods.

Renal cell carcinoma presenting as nephrotic syndrome.

A 64-year-old woman presenting with a history of increasing oedema was found to have nephrotic syndrome with a 24-hour urinary protein excretion of 20.7 g and renal impairment with an initial serum creatinine level of 197 mumol/l (2.16 mg/dl). A renal tumour was demonstrated by ultrasound scanning and subsequent nephrectomy revealed a renal carcinoma extending as far as the resected end of the renal vein. Histology of the kidney not involved by the tumour showed normal light microscopic appearances, with electron microscopy demonstrating foot process fusion, suggesting a diagnosis of minimal-change nephropathy. Nephrotic syndrome is a rare complication of renal cell carcinomas, and it is particularly uncommon for minimal change nephropathy to be associated with solid tumours.

Metal deposition in post-surgical granulomas of the urinary tract.

Fourteen cases of post-surgical granulomatous inflammation of the urinary tract were studied to investigate the possible deposition in the tissues of metals derived from the diathermy instruments used. The granulomas showed central necrosis, palisaded histiocytes and giant cells. On electronmicroscopy both amorphous material and electrondense particles were seen in the granulomas. The former appeared to be necrotic tissue. The particles were metallic in nature. Energy dispersive analysis of X-rays showed the presence of tungsten, iron, copper, nickel, chromium, zinc and vanadium. Tungsten particles were always pure. Other single particles contained two or more of the remaining elements, indicating the presence of alloy metals. Analysis of the diathermy instruments showed the cutting loops to be pure tungsten and the 'rollerballs' to be nickel silver containing copper, zinc, nickel, manganese and iron. Both the loops and balls are supported on stainless steel wires containing iron, chromium, nickel, manganese, molybdenum, copper and vanadium. It is proposed that metallic fragments from the instruments were deposited in the tissues during the surgical procedures and elicited an immunological reaction with granuloma formation. Tungsten is probably inert but nickel, chromium, copper and zinc are immunogenic. Under certain circumstances both nickel and chromium may also be carcinogenic.

Carcinoma of the prostate of ductal origin.

Thirty-nine patients with ductal prostatic carcinoma have been reviewed. Their mode of presentation, initial stage, plasma phosphatase levels and response to hormone therapy were found to be similar to those in a group of 124 patients with the common acinar prostatic cancer. Histochemical examination demonstrated prostate-specific antigen in all ductal carcinomas.