Journal of Clinical Pathology

A patient with the apparently unique combination of pernicious anaemia and acute erythraemic myelosis is described. The implications of some of the unusual features together with the difficulties encountered in diagnosis and treatment are discussed.

Different doses of aspirin, indomethacin, paracetamol, benorylate, and sodium salicylate were taken by four volunteers. The minimal dose that altered a platelet function test and the persistence of this alteration at different dose levels were studied. Minute doses of indomethacin (0·035 mg/kg) were effective but the effect of even a large single dose did not persist. A tenth of the therapeutic dose of aspirin (1 mg/kg) was effective, and higher doses altered the platelets' function for several days. Benorylate in a high therapeutic dose gave aspirin-like results. Paracetamol and sodium salicylate were relatively inactive. The persistence of the aspirin effect may be related to the acetyl group. These findings are surveyed in relation to a general theory of the action of anti-inflammatory drugs.

Background:The antiapoptotic and epithelial–mesenchymal transition activities of Twist have been implicated in the neoplastic transformation and the development of metastasis, respectively. Upregulation of Twist, described in several types of human cancer, also acts as a prognostic marker of poor outcome.

Aim:To investigate Twist expression in oesophageal squamous cell carcinoma (SCC) and its prognostic value in a Chinese cohort of patients with oesophageal SCC.

Methods:Twist expression in primary oesophageal SCC of 87 Chinese patients was investigated by immunohistochemical staining. Twist protein level in one immortalised normal oesophageal epithelial cell line and six oesophageal SCC cell lines was measured by western blot analysis.TwistmRNA level in 30 pairs of frozen specimens of primary oesophageal SCC and non-neoplastic oesophageal epithelium from the upper resection margin of corresponding oesophagectomy specimen was also determined by semiquantitative reverse transcription-PCR.

Results:It was found that Twist was upregulated in oesophageal SCC cell lines, and its mRNA and protein levels were both increased in oesophageal SCC and the non-neoplastic oesophageal epithelium (p<0.001). In addition, a high level of Twist expression in oesophageal SCC was significantly associated with a greater risk for the patient of developing distant metastasis within 1 year of oesophagectomy (OR 3.462, 95% CI 1.201 to 9.978; p = 0.022).

Conclusions:Our results suggest that upregulation of Twist plays a role in the neoplastic transformation to oesophageal SCC and subsequent development of distant metastasis. Twist may serve as a useful prognostic marker for predicting the development of distant metastasis in oesophageal SCC.

In a survey of laboratories where members of the Association of Clinical Pathologists worked, hepatitis was reported from 5 percent of 244 in 1970, 7 percent of 215 in 1971, and 2 percent of 337 in 1972. Of the 36 laboratories reporting hepatitis, a modest excess tested specimens from haemodialysis, transplant, and haemophilia units and performed tests for HB Ag. The average annual attack rate for staff of all types was 111 per 100,000 with higher rates for biochemists (268 in science graduates and 204 in technicians) and medical haematologists (258). Tests for HB Ag were positive in 17 cases ans negative in 15; nine were untested. No case was fatal and only 10 of the 41 required admission to hospital. Fourteen had a history of contract with 'high-risk (haemodialysis) specimens' but the most frequently suspected source of infection was personal contact with jaundiced or HB Ag-positive individuals and only in three cases were laboratory accidents suggested as the suspected source of infection. The findings indicate a need for caution and sensible safety precautions but not for exaggerated alarm.

Aim:To report the description of a rare benign osseous lesion affecting the ribs entitled post-traumatic fibro-osseous lesion (PTFOL).

Methods:Seven cases of PTFOLs were retrieved from the archives of the University Hospital of Lille. Histological slides were reviewed and lesions were classified according to the histological patterns described by McDermottet al. Clinical and follow-up data were obtained from the patients’ charts.

Results:PTFOLs occurred principally in men (mean age 31.8 years) with a known or suspected previous chest injury for four of them. No previous cancer was noted. Radiologically, PTFOLs readily presented as an isolated expansive lucency with a sclerotic rim located on the last five ribs. A constant increased uptake of radionucleotide was noted on bone scan. Microscopically, two fibro-osseous, four xanthomatous and one mixed pattern were individualised. Lesions were characterised by a network of anastomosing bone trabeculae without osteoblast lining within a fibrous stroma. A zonal maturation from woven to peripheral lamellar bone was characterised. Central sheets of lipid-laden histiocytes were conspicuous in the xanthomatous type. For each patient, clinical follow-up was excellent, without any recurrence.

Conclusions:This is the second largest series of PTFOLs, which is considered to be a dysplastic healing process after trauma. It may be symptomatic or shown by imaging studies realised for unrelated reason. PTFOL is regularly misdiagnosed with other more common lesions of the ribs, such as fibro-osseous dysplasia, osteoma osteoid and benign fibrous histiocytoma. Its recognition is of importance because no follow-up is needed after resection.

AIMS: To examine neuroendocrine differentiation, as shown by chromogranin A (CGA) expression, in cervical carcinomas. METHODS: Sixty seven cervical carcinomas were studied and were classified as adenocarcinomas, adenosquamous carcinomas or squamous cell carcinomas based on the assessment of haematoxylin and eosin staining and stains for mucin. Where features of glandular differentiation were identified, sections were also stained for evidence of intestinal type mucin. CGA immunostaining was done and the results were graded on a three point scale: 0, + (1-5% of cells positive) and ++ (> 5% of cells positive). These findings were then analysed with respect to lymph node status, tumour differentiation and clinical outcome. RESULTS: There were 32 adenocarcinomas, 18 adenosquamous carcinomas and 17 squamous cell carcinomas. Positive staining was seen in 14 (20.9%) cases, of which four were strongly positive. All but one case were either adenocarcinomas or adenosquamous carcinomas. There was a trend for CGA positivity to be related to intestinal differentiation but this failed to reach statistical significance. No correlation could be demonstrated between CGA staining and lymph node status, tumour differentiation and clinical outcome. CONCLUSIONS: Neuroendocrine differentiation is common in cervical carcinomas where there is evidence of glandular differentiation. Whilst the numbers in this study are relatively small, the presence of neuroendocrine cells in otherwise typical carcinomas does not seem to have any association with clinical behaviour.