THE COLLEGE OF PATHOLOGISTS OF AUSTRALIA
4. It is apparent, therefore, that similar end products of disturbed development in embryos can be reached by different pathways, a situation with its parallels in postnatal pathology. MONOCYTOSIS AND PRELEUKAEMIA
DEMPSTER, A. G. Department of Pathology, Medical School, Dunedin, New Zealand The association of monocytosis with a leukaemoid bone marrow picture and other haematological abnormalities may present a diagnostic dilemma. Review of Dunedin Hospital records covering the last 15 yr. revealed 7 cases showing these features where these initial findings were subsequently regarded as preleukaemic. A further 3 cases were also presented where similar changes suggested an early preleukaemic state. Morphological studies of bone marrow aspirates and correlation with clinical and post-mortem details indicated that these cases formed a unique group in the spectrum of chronic leukaemia. This group appeared to be a distinct entity differing from the few reported cases of chronic monocytic leukaemia. Cells resembling transition forms between primitive cells of the myeloid series and rnonocytes were consistently seen in the bone marrow. Features of chronic granulocytic leukaemia were lacking. I t was suggested that these cases should be regarded as a separate category of chronic leukaemia. EPIDERMAL ANTIGENS I N CUTANEOUS DYSPLASIA AND NEOPLASIA IN HAIRLESS MICE
MULLER,H. K. & SUTHERLAND, R. C. Department of Pathology, Momsh University, Melbourne, Victoria Tissue-specific antigen deletion is a feature of experimental and human tumours, including squamous cell carcinomas in man and mouse. Th e patterns of epidermal antigens were correlated with the histology of proliferative skin lesions induced in hairless mice, with U.V. light (wavelength 2800-3200 8)and as a comparison, Zmethylcholanthrene. Epidermal hyperplasia occurred in 3-8 wk., dysplastic changes in 2-4 mth. and squamous cell carcinomas from 4 mth. onwards. Antigenic changes in the treated skins were assessed by the indirect immunofluorescent method, using sera from patients with (a) pemphigus vulgaris, which stains the intercellular areas and cell membranes of normal epidermal cells, and (b) bullous pemphigoid, which stains the basement membrane zone of normal epidermis. Antigen deletion was not detected in hyperplastic lesions. Early dysplastic lesions showed focal loss of epidermal cell membrane staining in the 2 or 3 layers of cells immediately above the basement membrane zone; the staining of the associated basement membrane zone remained normal. With malignant change and invasion of the dermis, loss of epidermal cell membrane antigenicity was almost complete, except in isolated areas where the neoplastic cells had differentiated towards more typical squames. With invasion, the basement membrane zone staining became irregular, granular, or completely lost, particularly in regions where tumour cells were deep in the dermis. It was suggested that loss of epidermal cell membrane antigens in dysplastic lesions is an index of dedifferentiation towards malignancy. Loss of basement membrane zone antigenicity is associated with tumour invasion into the dermis. ADENOID CYSTIC CARCINOMA OF CERVIX
BELL, J. R. Department of Pathology, Mater Misericordiae Hospital, Brisbane, Queensland Adenoid cystic carcinoma may occur in the cervix and its histology is identical with that noted in other sites. The lesion is to be distinguished from adenosquamous neoplasms and basaloid variants of squamous cell carcinoma. The turnow should not provide a diagnostic problem for the pathologist, assuming an awareness of its existence in this site. It may occur in pure form or be associated with squamous carcinoma either in situ or invasive. Only a small number of reports have appeared in recent literature and this paper added a further case. Presentation in a 72-yr.-old woman was characteristic, with vaginal bleeding and back pain. Diagnosis was made on biopsy of a gross lesion and treatment instituted.
ABSTRACTS OF ANNUAL SCIENTIFIC MEETING
Biological behaviour of cervical adenoid cystic carcinoma cannot yet be ascertained owing to small numbers of cases and inadequate follow-up. The neoplasm seems to occur exclusively in postmenopausal patients with a range of 56-71 yr. There is no relation to gravidity or race. Patterns of metastatic spread are, as yet, undetermined but surgery probably is the most effective therapy. A conservative approach to treatment is not justified on the basis of present knowledge. MALIGNANT TUMOURS INDUCED BY IRRADIATION
MOTITRAM, R. Cancer Institute, Melbourne, Victoria Therapeutic irradiation given for a variety of conditions has produced malignant tumours locally in the area which received irradiation. I n 7 cases, the therapy was given to lesions in bone and bone sarcomata followed. Four of these were produced in jaw bones, the pre-existing lesions being respectively fibrous dysplasia, a hyperparathyroid ‘brown’ tumour and 2 examples of reparative granuloma. The other primary bone lesions were an aneurysmal bone cyst of the ilium, a giant cell tumour of the humerus and a plasma cell myeloma of a vertebra. All 7 patients had a silent interval of some years between receiving the irradiation and the appearance of the sarcoma, and histology which differed from that of the original condition. In 4 other cases, sarcomata were induced in either bone or soft tissue about the shoulder joint. Here the irradiation was given to the axillary and supraclavicular regions as a routine procedure following upon radical mastectomy for presumed carcinoma of the breast. In these 4 examples, it could be assumed that the tissues affected were normal previous to the irradiation. The treatment of a baby with a lymphangiomatous maaoglossia was followed by an anaplastic carcinoma of the maxillary antrum. Irradiation of haemangiomas during childhood was responsible for the subsequent development of carcinomas of the skin at the treatment site. Two examples of this were given, one a basal cell carcinoma, and the other a squamous cell carcinoma. Two patients who received irradiation for Hodgkin’s disease of the cervical lymph nodes had developed thyroid carcinomas. I n each case the thyroid gland had been included in the treatment field. PSEUDOSARCOMA OF THE SKIN
FINLAY-JONES, L. R.
Department of Pathology, Royal Perth Hospital, Perth, Western Australia The name given to this group of tumours implies a discrepancy between their structure and behaviour. Found mainly on the head and neck in the older age group, they usually develop within a matter of weeks or months and are often protuberant and ulcerated. Microscopically, there are abundant mitotic figures and bizarre cell forms which may result in a diagnosis of sarcoma or anaplastic carcinoma. A cure results after surgical excision which may have appeared to be conservative or even inadequate. THE HISTOPATHOLOGY OF TANGIER DISEASE
BALE,PATRICIA M., CLIFTON-BLIGH, P. & WHYTE, H. M. Royal Alexandra Hospital for Children, Sydney, New South Wales Tangier disease is a familial cholesterol storage disease, characterized by absence of high density plasma lipoproteins, and low plasma cholesterol. In childhood the patients are well except for very large tonsils with bright orange-yellow streaks. Adults may have slight splenomegaly, and may present with peripheral neuropathy or intermittent diarrhoea. Nine cases have been reported in the English literature, and the authors saw 2 others. The first was a girl aged 6 yr. who had large yellow plaques at the site of previous tonsillectomy. Microscopically, there were broad bands of very pale macrophages between the lymphoid follicles in tonsillar and adenoidal tissue. The second was a boy aged 5 yr., from a family unrelated to the other case. This boy died from the effects of cerebral birth trauma, and was found incidentally at necropsy to have bright yellow streaks in tonsils, thymus, lymph nodes, ileum and colon. These were due to collections of ‘foam’ cells which were shown on Sudan IV-Schultz staining to be laden with cholesterol in small intracellular acicular crystals as well as in droplets.