Biomedical subjects
Publications and source records attributed to H Fox.
The clinical and pathological features of a case of malakoplakia of the adrenal gland occurring in a woman with Escherichia coli infection are described. This lesion mimicked a neoplasm, the true diagnosis only being revealed by histological examination. The light and electron microscopic features are described and it is suggested that malakoplakia is due to an abnormal macrophage response to E coli infection.
A brief description is given of the significance of gross and histological abnormalities of the placenta. The question of placental ageing is discussed and the possible ill-effects of inflammation and immune-mediated damage to the placenta considered. Finally, the pathology of the utero-placental vasculature is outlined, and the view is expressed that most cases of apparent 'placental insufficiency' are, in reality, due to maternal vascular insufficiency.
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Histological and ultrastructural studies of four placentae heavily infectd with Plasmodium falciparum revealed large intervillous accumulations of erythrocytes containing parasites together with monocytes which had ingested pigment. These appearances were associated with focal syncytial necrosis, loss of syncytial microvilli and proliferation of cytotrophoblastic cells. In addition, marked irregular thickening of trophoblastic basement membranes and protrusion of tongue-like projections of syncytiotrophoblast into the basement membrane were observed. In six other placentae which contained scanty amounts of pigment but no parasites, representing past or inactive infection, no large collections of monocytes or abnormalities of trophoblast were apparent but basement membrane thickening was evident. Immunohistological studies revealed no significant differences between placentae positive for parasites and those containing pigment only, although the amount of certain immunoproteins and clotting factors was clearly increased above normal. These findings establish that P. falciparum infection in the placenta may result in substantial damage although lesions within the villus are rare. Furthermore, previous infection, although adequately controlled, may leave a heritage of pigment deposition, basement membrane thickening and immunopathological lesions. These results may thus account for both the high frequency of intra-uterine growth retardation and the rarity of congenital malaria in the presence of P. falciparum malaria.
Two cases of histiocytic endometritis are described, both characterized by total replacement of the endometrium with sheets of lipid-containing histiocytic cells. This condition appears to be a rare complication of cervical occlusion and it is suggested that the histiocytic reaction occurs as a response to a haematometra.
Twenty-two patients were carefully defined as having progressive dementia without other known cause and not complicated by clinical or laboratory evidence of multiinfarct dementia. Their degree of dementia measured by the ESD correlated highly with EEG disturbance (r=-0.79). The LPRS correlated 0.73 with ventricular enlargement. Although the EEG and CT scan only correlated significantly with each other in advanced cases, a combined index of EEG and CT Scan change, (Physical Measures Index) achieved a correlation of 0.93 with a combined index of psychological change (Psychological Measures Index). The results indicate the possiblity of using physical and psychological measures to monitor quantitative change in Alzheimer's Disease, the EEG contributing more initially and the CT scan more in the most advanced cases.
Syncytiotrophoblast microvillous plasma membrane (StMPM) preparations were obtained from human full-term placentae by previously published methods of cold saline extraction and phase centrifugation. Purity of these preparations was assessed by electron microscopy, enzyme analysis and hydroxyproline content. IgG, albumin, alkaline phosphatase, transferrin, ferritin and alpha 2-macroglobulin were consistently detected in the aqueous soluble fraction from sodium deoxycholate-solubilised StMPM preparations by antigenic or electrophoretic analysis, beta 2-Microglobulin was not detected in these preparations. Up to 21 discrete protein bands could be demonstrated by SDS--PAGE, and their molecular weights determined. Many of these components need to be further identified, including a glycoprotein of molecular weight 36 500 which was particularly prominent. The soluble fraction from StMPM preparations gave a single strong precipitin reaction in immunodiffusion against wheat germ agglutinin, but not against other lectins studied.
Nine cases of Mullerian adenosarcoma of the uterine body, first defined in 1974 by Clement & Scully, are described. The tumour usually occurs in elderly women and appears macroscopically as a polypoid mass filling the uterine cavity. Histologically these neoplasms are characterized by having a benign epithelial component set in a sarcomatous stroma. The epithelial element consists of tubular glands, cystically dilated glands and a surface epithelium. The glandular and surface epithelium usually resembles that of proliferative endometrium but may be of mucinous type and can undergo squamous metaplasia. Occasional mitotic figures, multilayering and intraluminal tufting are seen in the actively growing but benign glands which are considered to be an integral component of the tumour. The sarcomatous stroma contains spindle cells, round cells and, less frequently, multinucleated giant cells and rhabdomyoblasts. The Mullerian adenosarcoma represents a relatively benign variant of the mixed mesenchymal sarcoma of the uterus and is probably more common than is generally realized. Myometrial invasion is rarely deep and the majority of patients with this neoplasm survive. Vaginal recurrence occurs only in a minority of patients and distant metastasis is exceptional.
In a patient who had a hysterectomy and bilateral salpingo-oophorectomy for endometrial adenocarcinoma, a giant cell arteritis was found in many of the myometrial and tubal vessels and in a few of the small arteries of the cervix and ovaries. On subsequent questioning, a history of treatment for polymyalgia rheumatica during the preceding 12 months was elicited. Of the three previously reported patients with giant cell arteritis of the uterus, two were suffering from polymyalgia rheumatica whilst one possibly had disseminated visceral giant cell arteritis.
A series of five benign and 60 malignant colonorectal neoplasms has been examined immunohistochemically for the presence of HCG. This hormone was not demonstrated in any of the benign tumours but was present in 43% of the malignant neoplasms. The incidence of HCG secretion was unrelated to the sex of the patient but tended to be decreased in patients of advanced age. The HCG-containing tumours, which were predominantly from the left side of the large intestine, had all penetrated the full thickness of the bowel wall while a significant proportion of those tumours lacking HCG were still confined to the bowel wall. Despite the greater degree of local aggressiveness shown by the HCG-secreting tumours there was no correlation between HCG production and the presence of local metastases but, as the presence of HCG is associated with local invasion, it is suggested that preoperative immunohistochemical studies of HCG in biopsies of large bowel neoplasms may be of value in the planning of surgical procedures.
An immunohistochemical study of the tissue CEA content of 82 epithelial neoplasms of the ovary has shown that mucinous tumours contain more of this substance than do their serous counterparts; otherwise a knowledge of tissue CEA content appears to be of little value in the differential histological diagnosis of this group of neoplasms. Among mucinous tumours there is only a partial correspondence between their degree of malignancy, as assessed histologically, and their content of CEA. It is postulated that immunohistological study of tissue CEA may add a degree of finesse to morphological analysis of these neoplasms and thus allow for a more precise grading of their degree of malignancy.
An electronoptical study has been made of eleven placentae from cases of materno-fetal rhesus incompatibility. The characteristic findings are focal, but sometimes quite extensive, syncytial necrosis, retention of normal pinocytotic and secretory activity in the non-necrotic syncytiotrophoblast, cytotrophoblastic hyperplasia, thickening of the trophoblastic basement membrane, immature-type endothelial cells in the fetal villous vessels and thickening or lamination of the capillary basement membranes. The pathogenesis of many of these chantes is not clear but there is no evidence that they are immunologically mediated. It is suggested that the syncytial necrosis may be due to narrowing of the intervillous space as a result of increased villous size, that the cytotrophoblastic hyperplasia is a response to the syncytial damage and is responsible for the changes in the trophoblastic basement membrane and that the fetal capillary changes are indicative of endothelial cell damage due, possibly, to fetal anaemia. Despite the damage suffered by the placenta in materno-fetal rhesus incompatibility there is little evidence of impaired functional efficiency.
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A pseudomesotheliomatous carcinoma of the lung which appeared to be ectopically secreting large quantities of salivary (S) type amylase is described. This unusual variant of adenocarcinoma may mimic a mesothelioma, but is distinguished from mesothelioma by its histiological and histochemical features.
An electron-microscopic study has shown that in placentae from prolonged pregnancies there is hyperplasia of the villous cytotrophoblastic cells, degeneration of occasional isolated cytotrophoblastic cells, a paucity of syncytial microvilli in some areas and microvillous proliferation in others, abnormalities of microvillous form, focal syncytial necrosis, dilatation of syncytial endoplasmic reticulum, decreased synctial pinocytic activity, a reduced size and number of syncytial mitochondira, thickening of the trophoblastic basement membrane and contraction, blebbing and vacuolation of endothelial cells of the stromal foetal villous capillaries. Many of these morphological changes indicate that there is, in prolonged pregnancy, a decline in trophoblastic functional activity but it is suggested that this is due, not to placental senescence, but to a relatively mild, sustained uteroplacental ischaemia. Although there is morphological evidence to suggest that compensatory mechanisms come into play to limit the effects on the placenta of uteroplacental ischaemia the changes in the foetal capillaries, which are of unknown pathogenesis, will result in decreased foetal perfusion of the placenta and thus restrict still further adequate materno-foetal transfer.
Seventeen placentae from second trimester abortions induced by the injection of extra-amniotic prostaglandin have been examined. The extraplacental membranes, the chorionic plate of the placenta, the placental intervillous space and the placental villi were normal in all cases. In all but one specimen lesions were, however, noted in the decidua, these including focal decidual necrosis, intradecidual haemorrhage, thrombosis of maternal vessels and dilatation and congestion of the maternal vasculature. Similar decidual lesions were also seen in placentae from spontaneous and surgical second trimester abortions and it is concluded that prostaglandins do not produce any specific lesions in the placenta or decidua. It is suggested that the negative findings of this study indicate that prostaglandins do not induce abortion by either direct injury to the placenta or by provoking utero-placental ischaemia.
An example is described of the syndrome of refractory anaemia in association with the plasma cell variant of giant lymph node hyperplasia of the mediastinum; the anaemia responded to removal of the lymphoid mass. The entity of giant lymph node hyperplasia is discussed and its relationship to the haematological syndrome is considered.