The pattern of cell injury at the perfusion boundary of experimental myocardial infarcts

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RCPA & NZ SOCIETY OF PATHOLOGISTS

PROGNOSTIC SIGNIFICANCE OF VASCULAR CHANNEL INFILTRATION BY CARCINOMA OF BREAST

RADKA BETTELHE~M & H. G. PENMANRoyal Marsden Hospital, Sutton, Surrey and Crawley Hospital, W . Sussex, U.K. As part of a study of breast carcinoma (under the auspices of the S.W. Thames Regional Cancer Organisation and the Ludwig Institute for Cancer Research at the Royal Marsden Hospital, Sutton, England), observations have been made on vascular channel infiltration in the region of the primary tumour, and on axillary lymph node status, in 23 I U.I.C.C. stage 1-111 patients. The patients were entered into the study between September 1976 and March 1980. Of the 231 patients, I10 (47.6",) were found to have unequivocal evidence of vascular channel infiltration by tumourcells. Asat September 1981,disease was known to have recurred in 71 patients (distant metastatic disease in nearly all these). Of these patients with recurrences 53 belonged to the group of 1 I0 with known vascular channel infiltration (480,:: I7 fatal), but only 18 amongst the 121 without apparent vascular channel infiltration had manifested recurrence (14.8"',: 9 fatal). The incidence of recurrences in vascular channel positive and negative groups closely matched the incidence of recurrences in lymph node positive and negative groups (46.6";,and 13.5'1;), but there was by no means an exact correspondence in individual cases, there being many lymph node +ve but vascular channel -ve patients and many with apparently tumour-free lymph nodes but infiltrated vascular channels. In both lymph node - ve and lymph node +ve cases (1 11 and 120 respectively), but particularly in the former, detected vascular channel infiltration worsened prognosis. Since September 1981, the number of recurrences in the vascular channel - ve group has gained a little on those in the other group, but a wide disparity remains. Most of the vascular channels involved were originally thought to be lymphatics; in only 9 cases was there thought to be blood vessel infiltration (in each of these lymphatics were also thought to be involved). N o special staining methods were used. Partly because of the association of supposed lymphatic infiltration with distant rather than local recurrence we are now doubtful about our interpretation and prefer to talk of'vascular channel' involvement. This does not affect our conclusion that 'vascular channel' infiltration may well be of similar prognostic and therapeutic significance to the finding of lymph node involvement and that this could be important particularly in those patients whose lymph nodes appear clear of tumour and in those increasingly frequent patients whose lymph nodes are not available for histopathological examination. Reference Bettelheim

R. Munro Neville A. Lancet 1981,11.631

IMMUNOFLUORESCENCE OF RENAL DISEASE

A. R. MCGIVEN Department of' Pathology, Christchurch Clinical School of' Medicine Immunofluorescence has made an important contribution to our understanding of the immunopathology of renal disease and to the classification and diagnosis of glomerulonephritis. The range of antisera used in routine examinations should detect IgG, IgA, IgM, C3, Clq and fibrin, and reagents which detect light chains and other components may be added. The basic patterns of glomerular staining comprise the linear capillary basement membrane staining seen in Goodpasture's syndrome. the mesangial aggregates seen in IgA nephropathy and the granular capillary loop pattern found in a variety of immune complex nephropathies including acute post-streptococcal glomerulonephritis, membranous nephropathy and SLE. Tubules in addition to containing casts may show protein absorption droplets. Tubular basement membranes may show linear immunoglobulin and complement deposition in some patients with interstitial nephritis and transplant rejection, or granular staining in patients with SLE. Vessel walls may also stain for plasma proteins, C3 being found most commonly. Conditions such as IgA nephropathy depend o n immunofluorescence for their diagnosis. In other cases

Pathology (1983), 15, July immunofluorescence can confirm a diagnosis suggested by histopathological features o r indicate a diagnosis, such as early membranous nephropathy or SLE, which was not suspected from histological appearances. THE PATTERN OF CELL INJURY AT THE PERFUSION BOUNDARY OF EXPERIMENTAL MYOCARDIAL INFARCTS

M. D. SAGE,J. B. GAVIN & P. B. HERDSONDepartment of Pathology, School if Medicine, University of Auckland, New Zealand The precise relationship of myocardial cell injury to vascular supply at the margin of developing myocardial infarcts is controversial. Regional ischemia of 4 h duration was produced in isolated rabbit hearts by controlled separate perfusion of the left anterior descending coronary artery (LAD). After perfusion fixation (2.5% glutaraldehyde), the LAD bed was injected with acrylic resin (viscosity 8 cps) containing brown lead dioxide particles (109/ml).Simultaneously, and at the same pressure (90 torr) the remainder of the vascular tree was injected with similar resin coloured red (Fat Red 7B dye). After complete polymerization, transmural blocks were dissected, transversely cryofractured, freeze dried and examined by scanning electron microscopy in the back scattered electron image mode. Most of the LAD region contained swollen, rounded myocytes with widely separated myofibrils and mitochondria. Intercellular spaces were narrow and contained few (14%) dilated capillaries, and brown resin filled only 3% of all the capillaries. This pattern showed an abrupt boundary with areas of smooth compact myocyte profiles with indented outlines and prominent intercellular spaces, typical of the remainder of the heart. Close to the infarct 84% of capillaries were dilated and 14% contained red-coloured resin. The remainder of the heart showed 77% of capillaries dilated and 63% filled with red-coloured resin. The low proportion of perfusable capillaries in the infarct is consistent with the no reflow phenomenon. The surprisingly low proportion of perfusable capillaries close to the infarct indicates a narrow border zone of reduced vascular supply outside the abrupt morphological boundary. There was little evidence (1%) of collateral flow between capillary beds across this boundary. (Supported by the Medical Research Council of New Zealand.) RAPID DIAGNOSIS OF MICROBIAL INFECTIONS WITH SPECIAL REFERENCE TO METHODS OF BACTERIAL ANTIGEN DETECTION

DAVIDHANSMAN & S. DUNCAN Microbiology Department, Adelaide Children's Hospital Microscopy of body fluids remains a rapid, valuable and inexpensive test in clinical microbiology. This applies especially to examination of samples of cerebrospinal fluid (CSF)in meningitis where a Gram's stain may reveal numerous pleomorphic Gram-negative rods and polymorphs, leading to a tentative diagnosis of hemophilus meningitis, which can be confirmed rapidly in appropriate cases by demonstrating a capsular reaction with type-specific Hemophilus influenrue type B serum. In early and pre-treated cases of bacterial meningitis where bacteria are not detectable in CSF, tests for bacterial antigen are especially useful. Counter-current immuno-electrophoresis (CCIE), which depends upon the migration of the negatively-charged capsular polysaccharide in an electrical field to the anode, can detect 5 nanograms polyribosephosphate per ml in CSF. (Polyribosephosphate is the capsular polysaccharide of H. influenzae type B.) In Adelaide, for the 5 yr period 1976 through 1980, CSF from 66 (79%) of 84 cases of hemophilus meningitis yielded a positive CCIE result. Four (5%) cases were diagnosed by CCIE, bacterial culture being negative (probably because of pre-treatment). Results with CCIE were less satisfactory in meningococcal and pneumococcal meningitis. In hemophilus meningitis CCIE has been superseded in part by the latex test using commercially-prepared latex particles 0.8 p in diameter coated with H . influenzae type B serum: in the presence of polyribosephosphate the latex particles are aggregated. Latex can detect as little as 0.2 ng polyribosephosphate per ml and so is some 25 times more sensitive than is CCIE. In 46 cases of hemophilus meninptis in