Biomedical subjects
Publications and source records attributed to J G Azzopardi.
A case of autoimmune haemolytic anaemia is described in which recovery, with disappearance of antibody, followed splenectomy and removal of an ovarian ;dermoid' cyst. A causal relationship between removal of the ovarian tumour and recovery is strongly suggested and the possible pathogenesis discussed. Fourteen previously recorded cases of this association are reviewed.
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Continuous therapy with synthetic progestogen-oestrogen produces marked atrophy of endometrial glands and massive pseudodecidual stromal transformation. Cyclical therapy produces initially a ;frustrated secretory response' with precocious attempts at secretion in poorly developed glands. Pseudodecidua appears about the 20th day. With later cycles there is progressively greater gland atrophy while pseudodecidua is less marked. A possible inductive role of the glands on the stromal response to progestogens is postulated. The effect of different drugs and dosages is discussed. Decidual necrosis may occur with heavy doses. The Arias-Stella reaction, previously regarded as diagnostic of pregnancy, can be produced with ordinary doses of these drugs. Suppression of spiral arterioles is usual. Ballooning of venules is a frequent finding, possibly accounting for breakthrough bleeding. Red degeneration of myomata was present in three of seven hysterectomy specimens containing myomata.
Mucoprotein-containing macrophages (muciphages) are a common finding in routine rectal biopsies, occurring in about 50% of cases. No correlation was found between their presence and the sex, age, and disease of the patient. They must be distinguished from the cells of Whipple's disease and from lipofuscin-containing macrophages. The origin of the mucoprotein is discussed and rectal epithelial mucin is considered a possible source.
Among 8,758 necropsies there are 93 cases of systemic amyloidosis. Of these, 14 are associated with malignancy: seven with myelomatosis or malignant lymphoma, and seven with carcinoma. The incidence of amyloidosis in myelomatosis is at least 10%. Attention is drawn to the presence of amyloid in the tubular casts of ;myeloma kidney'. In Hodgkin's disease the incidence is about 4% but it may be higher in patients receiving chemotherapy. In lymphosarcoma it is of the order of a fraction of 1% but in macroglobulinaemia, essential or associated with malignant lymphoma, the incidence is considerably higher. Systemic amyloid is found in one in 375 of patients with carcinoma and in only a single patient among 1,500 ;control cases'. Renal carcinoma accounts for one-quarter of all carcinomas associated with systemic amyloid. The other carcinomas originate in a variety of organs. In myelomatosis, amyloid may be found in the tumour deposits. In Hodgkin's disease and in lymphosarcoma there appears to be greater amyloid deposition in neoplastic tissue than hitherto realized. The carcinomas provide a striking example of topographical association of amyloid and tumour, the two being closely related in six of seven cases.
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Tenosynovial fibroma or angiofibroma of tendon sheath is a distinctive clinicopathological entity occurring mainly in young and middle-aged men and affecting dominantly the distal extremities. Fingers, hands and wrists are the site of 80 per cent of cases. Palmar aspects of hands and plantar aspects of foot are preferentially involved. The trunk and neck are seldom affected. They are generally small, firm, sometimes painful lesions attached to tendon sheath and/or tendon. The lesion must be distinguished from a variety of benign lesions including nodular fasciitis, angiomyoma and giant-cell tumour of tendon sheath. It can also be confused with sarcoma, including synovial sarcoma, because of the presence in it of characteristic slit-like spaces which have been identified as vascular rather than synovial spaces by virtue of the Factor VIII content of their lining cells.
A series of pilar tumours is presented. Although they are predominantly tumours of the elderly female, they occur also in men and in middle age. Some 90 per cent occur on the scalp or nape of neck; about 10 per cent affect other areas. Most tumours outside the scalp involve the trunk; they are rare on the extremities. Evidence is presented that most arise from pre-existing pilar cysts. Two tumours recurred, but were cured by re-excision. Four tumours exhibited histological and/or cytological criteria of malignancy. Two of these were interpreted as in situ carcinomas, and two as combined invasive and in situ carcinomas. None is known to have metastasized or to have behaved aggressively. The prognosis of pilar tumours in excellent whatever the histological appearance. The nature of the lesion and the problems of nomenclature associated with it are discussed.