Collagenous colitis: jejunal and colorectal pathology.

AIMS: To determine: (1) whether there is an association between collagenous colitis and coeliac disease or lymphocytic colitis; (2) the distribution of lymphocyte subsets and macrophages in the lamina propria and surface epithelial layer in collagenous colitis; and (3) the colorectal distribution of the disease and whether a mucosal biopsy specimen, using a flexible sigmoidoscope, is sufficient to diagnose it. METHODS: The clinical data and colorectal biopsy specimens from 38 patients with collagenous colitis were studied. In 10, small bowel biopsy specimens were also available for review. Immunostaining of the mucosal lymphoid infiltrate with a panel of relevant antibodies was carried out on formalin fixed tissue in seven cases; in three the phenotyping was performed on fresh biopsy specimens separately frozen or fixed in B5 solution. RESULTS: Coeliac disease was found in four out of the 10 patients with collagenous colitis who had had a small bowel biopsy, in contrast to the prevalence of the disease in Australia of 1 in 3000. Collagenous colitis did not respond to gluten withdrawal. Five of 29 (17%) of the patients had a mixed pattern of lymphocytic and collagenous colitis. Immunostaining of the lymphoid infiltrate showed that the striking increase in intraepithelial lymphocytes in collagenous colitis was due to an influx of CD8 positive cells. The occurrence and severity of collagenous colitis along the large bowel were independent of the anatomical site, and in more than 90% of cases biopsy specimens from the sigmoid colon or rectum were diagnostic. CONCLUSIONS: There is a very high incidence of coeliac disease among patients with collagenous colitis so that jejunal biopsy should be an essential part of their investigations, especially if symptoms persist. However, only a minority showed a mixed pattern of lymphocytic and collagenous colitis. The intraepithelial lymphocytes in collagenous colitis are CD8 positive cells. Collagenous colitis can be diagnosed from rectal or sigmoid colon biopsy specimens in more than 90% of cases.

Benign vaginal rhabdomyoma.

A case of benign polypoid vaginal rhabdomyoma occurring in a 52-year-old female is described. The characteristic histological features were interlacing bands of striated muscle cells with prominent cross and longitudinal striations, with surrounding loose collagenous stroma, within which were many dilated vascular spaces. Electron microscopy confirmed the striated muscle origin of these cells. The pathogenesis is possibly a localized area of abnormal mesenchymal differentiation.

The pathological assessment of ovarian neoplasms. IV: The sex cord-stromal tumours.

All neoplasms of the ovary encountered in a 25-yr study period at the King George V Memorial Hospital were classified according to the World Health Organisation (WHO) Histological Classification of Ovarian Tumours. Of just less than 1700 tumours, 168 fell into the category designated as sex cord-stromal tumours, this report analysing their major clinical and pathological correlates. A detailed histological assessment is then presented, including 4 cases of the recently separated subcategory of sclerosing stromal tumour of the ovary.

Monoclonal antibody analysis of glomerular hypercellularity in human glomerulonephritis.

To determine the contribution of infiltrating circulating leucocytes to glomerular hypercellularity, and to further investigate the immune and inflammatory mechanisms involved in human glomerulonephritis, a series of renal biopsies were evaluated using cell-specific monoclonal antibodies. In ninety-three renal biopsies from patients with glomerulonephritis, intraglomerular leucocytes were identified by immunoperoxidase localization of monoclonal antibodies to the leucocyte-common antigen, and antigens characteristic of T-cell and T-cell subsets, B-cells, monocytes and granulocytes. Normal glomeruli contained a mean of 2 leucocytes, predominantly monocytes, per glomerular cross-section. No significant increase in leucocytes was found in 41 biopsies with non-proliferative types of glomerulonephritis. However, in renal biopsies from 22 of the 46 patients with proliferative forms of glomerulonephritis, there was a significant increase in glomerular leucocytes. These biopsies were from 5 patients with post-infectious glomerulonephritis (mean of 30 leucocytes per glomerulus), 11 patients with crescentic glomerulonephritis (mean of 16 leucocytes per glomerulus) and 6 patients with mesangial proliferative glomerulonephritis due to systemic lupus erythematosus (mean of 5 leucocytes per glomerulus). The increased intraglomerular leucocytes consisted of macrophages and granulocytes. T and B-cells were generally not found within glomeruli. Thus, glomerular hypercellularity in proliferative glomerulonephritis is in part due to infiltration by inflammatory cells. No evidence was found to directly incriminate cellular immune mechanisms in the pathogenesis of the glomerular lesions of glomerulonephritis since T-cells were not identified within glomeruli.

Sclerosing stromal tumours of the ovary.

Sclerosing stromal tumours of the ovary have recently been described as a histologically and clinically distinct subgroup within the thecoma-fibroma spectrum of benign ovarian sex cord stromal tumours. Reported cases occurred predominantly in young women and only occasional tumours showed evidence of hormonal activity. The present series of five cases expands the spectra of both histological patterns and clinical presentations and suggests that the entity of sclerosing stromal tumours may not be as clearly circumscribed as has been previously reported.

Leukocyte analysis using monoclonal antibodies in human glomerulonephritis.

The leukocyte subpopulations were analyzed within both the glomeruli and the interstitium in renal biopsies from 145 patients with various forms of glomerulonephritis. Cells were identified by monoclonal antibodies to leukocyte cell-surface antigens and immunoperoxidase labelling. Leukocytes, as defined by a monoclonal antibody to the leukocyte common antigen (PHM1), were present in normal, human renal tissue in both glomeruli (2.8 +/- 0.6 cells/glom. cross section) and interstitium (102 +/- 18 cells/mm2). Monocytes constituted the predominant infiltrating cell type in normal glomeruli (1.3 +/- 0.2) and T cells were rarely found (0.3: range 0 to 0.8), whereas both monocytes (34 +/- 10/mm2) and T lymphocytes (33 +/- 14/mm2) were found in the normal interstitium. In the non-proliferative forms of glomerulonephritis there was no significant increase in the number of glomerular inflammatory cells when compared with normal glomeruli. However, significantly increased numbers of T lymphocytes were seen in the interstitium of biopsies with minor non-specific changes (67 +/- 15/mm2), membranous nephropathy (134 +/- 30/mm2), focal glomerulosclerosis (207 +/- 53/mm2), and diabetic nephropathy (198 +/- 81/mm2). In the proliferative forms of glomerulonephritis only crescentic GN and post-infectious GN demonstrated significantly-increased glomerular monocytes and granulocytes. There was no significant increase in the number of glomerular T cells when compared with normal glomeruli. However, there was a significant increase in the number of interstitial T lymphocytes in all forms of proliferative glomerulonephritis when compared with the normal interstitial cell population.(ABSTRACT TRUNCATED AT 250 WORDS)

The carcinoid tumour.

Carcinoid tumours are by no means rare. The wide range of sites in which they occur is explained by their origin from APUD cells of the neural crest. These cells migrate to all parts of the alimentary tract during embryonic life, and ultimately are found as well in various gut derivatives such as the respiratory, pancreatic and biliary systems. On the basis of a series of 31 carcinoid tumours seen at the Royal Prince Alfred Hospital in a five-year period, the distinctive clinical and histological features of carcinoids of foregut, midgut and hindgut origin are reviewed. Diagnosis, treatment and results are discussed, and recommendations regarding management of the patient with a carcinoid tumour are given.

Thymic seminoma and myasthenia gravis.

Computed tomography detected an enlarged thymus in a 27-year-old man with myasthenia gravis of recent onset. Pathological examination of the thymus revealed lymphoid hyperplasia and a thymic seminoma (or germinoma), which was arising as an intramural nodule in a thymic cyst. This is the first reported association of thymic seminoma, lymphoid hyperplasia, and myasthenia gravis.