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Biomedical subjects

R A Sinclair

Publications and source records attributed to R A Sinclair.

At least 19 recordsLinked to original sources

Pelvic lipomatosis with cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder: first reported case.

Pelvic lipomatosis is a rare disease which may cause obstructive uropathy. It has been reported with cystitis cystica and cystitis glandularis. Cystitis cystica and cystitis glandularis have been reported previously as progressing to adenocarcinoma of the bladder. The first reported case of pelvic lipomatosis, cystitis cystica, cystitis glandularis and adenocarcinoma of the bladder is presented and the literature reviewed.

Adenocarcinoma

Central nervous system lymphoma: primary lumbar nerve root infiltration.

Primary malignant lymphoma of the central nervous system (CNS) is rare and only infrequently involves the spinal cord, usually in association with multifocal CNS spread. We report a case of primary lymphoma infiltrating lumbar nerve roots without evidence of systemic lymphoma. There has been an excellent response to combined modality therapy, comprising radiotherapy with intrathecal and intravenous cytotoxics. The patient remains well and active 22 months after diagnosis. The literature regarding these rare tumors is reviewed.

Ganglia, Spinal

Cerebral deposits of carcinoid tumour.

This report details a most unusual case of cystic cerebral metastasis. The patient developed symptoms due to carcinoid deposits in the brain. The clinical course has been protracted and the primary source of the carcinoid tumour remains unknown.

Brain

The breast: tissue changes and cancer risk.

Long-standing confusion about the premalignant significance of benign changes in breast tissue is being resolved. The majority of patients whose breast biopsy sample does not show invasive carcinoma is not at a significantly-increased risk of developing a breast malignancy. Tissue markers that indicate a risk for invasive carcinoma include atypical hyperplasia and carcinoma-in-situ but only a minority of patients with these changes ever develops invasive carcinoma. The implications for patient management are discussed.

Breast Neoplasms

Glomerulonephritis in the acute phase of Ross River virus disease (epidemic polyarthritis).

Hematuria and proteinuria were detected at the peak of symptoms in a case of Ross River virus (RRV) disease. No other infective cause was identified. A renal biopsy 28 days after the onset of nephritis showed mild mesangial proliferative changes and one segmental sclerotic lesion. Immunofluorescence showed widespread linear deposition of IgG in glomerular capillary walls with similar but weak staining for IgM, complement (C3) and fibrinogen; granular deposits of IgM and C3 in several arterioles; and IgM in a few mesangial cells. No electron-dense deposits were detected, nor was RRV antigen found in the renal tissue. Anti-glomerular basement membrane antibodies were not detected in the serum. Recovery from the renal disturbance was complete within three months although rheumatic symptoms persisted for 30 months.

Acute Disease

Composite lymphoma.

A case of composite lymphoma in a young female is described. The patient was found to have lymphocyte-predominant Hodgkin's disease at presentation, but subsequent staging laparotomy revealed coexistent but distinct Hodgkin's disease and diffuse large cell lymphoma in the spleen. Possible explanations for this rare occurrence are discussed, and the literature is reviewed.

Adult

Lymphoma immunotyping by paraffin immunoperoxidase and cell suspension methods--a comparative study.

Immunoperoxidase staining incorporating an enzyme digestion step was performed on paraffin sections of 84 biopsy cases of lymphoproliferative disorders. Monoclonality was demonstrated in 100% of plasmacytomas and related tumours, and in 66% of non-Hodgkin's lymphomas. In 83% of lymphomas the immunoglobulin class was IgM and the light chain distribution was kappa 64% and lambda 36%. Polyclonality was found in 89% of cases of reactive lymphoid hyperplasia and within Reed-Sternberg cells in 55% of cases of Hodgkin's disease. Similar results were obtained by dispersed cell studies in 56 overlapping cases. The concordance rate between the two methods in 40 cases of non-Hodgkin's lymphoma was 67.5%. Reasons for the inconsistencies are discussed. Immunoperoxidase staining of enzyme digested paraffin sections is useful in the diagnosis of B cell lymphoproliferative disorders with a particular role in centres where cell suspension studies are not available or when there is no access to fresh tissue.

Cytological Techniques

Recurrent dysgerminoma after 33 years.

Surgery with or without radiotherapy produces a high cure rate in localized pure dysgerminoma of the ovary. Recurrence rates are low, and usually occur within 2 years. We report the case of a 58-year-old para 1 who developed recurrent pure dysgerminoma 33 years after initial surgery. The need for long-term follow-up of these patients is emphasized.

Dysgerminoma

Post partum nephrotic syndrome in mixed essential cryoglobulinemia.

The clinical and histological findings of a patient with mixed essential cryoglobulinemia (MECG) who developed post partum renal failure and the nephrotic syndrome are described. The renal insufficiency responded dramatically to intensive plasma exchange and longer term immunosuppression with associated resolution of the renal histological changes. To our knowledge deterioration of renal function in the post partum period has not been previously described in the syndrome of MECG.

Adult

Endothelial morphology in long-term keratoconus corneal transplants.

Endothelial morphology was studied in 55 long-term keratoconus grafts. Photographs were taken with a Zeiss non-contact endothelial lens and analyzed with a Zeiss MOP-3 digital analyzer. Donor ages were known in 39 cases. Statistical analysis was carried out correlating endothelial cell count with several parameters, including recipient age and cell form as expressed by the coefficient of variation. Cell counts varied from 502 to 1708 cells/mm2. No correlation between cell counts and donor age was found. Recipient age had an unexpected significance as a predictor of endothelial cell survival in that cell counts decreased as recipient age increased despite donor age. As the grafts aged, more cell pleomorphism was found as expressed by the coefficient of variation.

Adolescent

Immunoperoxidase staining of formalin-fixed, paraffin-embedded, human renal biopsies with a comparison of the peroxidase-antiperoxidase (PAP) and indirect methods.

The results of immunoperoxidase staining of 33 routinely processed renal biopsies correlated with the results of direct immunofluorescence in 79% of tests performed. Most of the discrepant results were due to positive immunoperoxidase staining, possibly reflecting greater sensitivity of the method. A comparison of two immunoperoxidase methods showed that the indirect method produced less intense staining than the peroxidase-antiperoxidase (PAP) method when equivalent primary antibody titres were used. Lowering the primary antibody titres for the indirect technique resulted in equivalent staining by the two methods. Predigestion by protease VII effectively revealed the antigens under study without causing tissue damage or section loss.

Biopsy

Small cell carcinoma of the lung. Prognosis in relation to histologic subtype.

Forty-six of 59 patients with small cell carcinoma of the lung who were treated with multiple drug chemotherapy and radiotherapy were subclassified according to the World Health Organization classification. Subtyping was not possible in the 13 other patients who were diagnosed on sputum cytology findings alone. There was no significant difference in extent of disease, response, duration of response to treatment, or median survival between the different subtypes. Two main difficulties arise in applying the subtyping classification. First, many tumors showed features of several histologic subtypes, implying the existence of a morphologic continuum within the general group of small cell anaplastic carcinomas. Second, tissue crushing artefact was common. Our results do not reveal any advantage in knowing the tumor subtype. It remains essential to differentiate small cell anaplastic carcinoma from other forms of lung carcinoma not responsive to chemotherapy.

Antineoplastic Agents

Primary lymphoma of lung.

Five cases of primary lymphocytic lymphoma of the lung are described. One patient died 14 years after diagnosis, with spread of the tumour to the opposite lung. The remaining four patients were alive and well 18 months to 25 years after diagnosis. The pathological features of these five cases are described and the nature, diagnosis, therapy, and prognosis are considered in relation to experience in the literature. The tumor is rare. It is important because of its good prognosis and diagnostic difficulty.

Adult

Rapidly progressive fatal silicosis in a young man.

A case is reported of rapidly progressive silicosis in a 30-year-old male who developed symptoms two years after first exposure and died 30 months later. The causative agent was silica powder. This case serves to highlight the fact that this potentially dangerous material is currently being used in industry and that adequate precautions are not always taken.

Acute Disease

Renal proliferative arteriopathies and associated glomerular changes: a light and electron microscopic study.

This presentation reports the light and electron microscopic findings relating to the vascular and glomerular changes in the kidney in a series of 25 patients having malignant hypertension, the hemolytic-uremic syndrome, scleroderma, or toxemia of pregnancy. The pathologic changes were generally similar in each of the diseases studied, the changes being related more to the severity and duration of injury than to the specific disease. Vascular narrowing was due mainly to intimal thickening, and by light microscopy the lesions were categorized as onionskin, mucinous, or fibrous with or without associated elastosis. Intimal erythrocyte extravasation, fibrinoid necrosis, and luminal thrombosis were also seen. Electron microscopy provided additional morphologic information: Myointimal cells were found to be the cellular component in each type of intimal thickening; it was possible to distinguish collagen from large intimal accumulations of basement membrane material; mucinous intimal material was characterized ultrastructurally; and fibrinoid necrosis was identified as a lesion inconstantly associated with cellular necrosis and consisting mainly of fibrinoid material and small deposits of fibrin. It seems likely that there is a common pathogenesis for intimal thickening in a variety of diseases and that this involves endothelial cell damage and increased permeability, leakage of serum and erythrocytes into the intima, and a healing reaction of the vessel wall was developing from migration of smooth muscle cells into the intima with subsequent myointimal cell proliferation and fibrogenesis. A common glomerular change in all diseases studied was a striking accumulation of electron lucent material between the endothelium and the lamina densa of the basement membrane. This lesion was interpreted as a manifestation of acute ischemia.

Adolescent