Drug-induced lung disease

A EST R ACTS

4

COLOFECTAL CARCIN=MA IN MAORI AND FOLYNESIAN mPLJIATI0F:c 1 : m zE?LAhD.

T Sutton, T Eide, J R Jass, kpartn-ent of Pathology, University of Auckland, S c b l of Medicine, P a r k Road, Auclrland 3.

20,031 cases of c o l o r e c t a l carcinm were i d e n t i f i e d from the records of the New Zealand National Cancer Registiy fcr tk period Gf 1970 t o 1904. The mcidence of c c l o r e c t a l ca-cincm i n t h e total New 7 ~ a l a n d ,Maori and Polynesian resident pzpulations w a s studied. C a s e s =re analysed III terms of h ~ S C, X , site, stage and h i s t o l o g i c type a d p-adde. f l . e ~ e&& a ikirkedly low% incidcnce of both colcnic and rectal c a r c i n m i n Maori 6.~5P ~ l ~ ~ s W i pc Ani t i c n s Lq ccnF;-ison with t l l c t o t a l p p h t i o n . This L.ZS p i i r t i c u l m l y evident in t h e o l d e r 6% ~ G U ~ SAii. IXASU; firdirq bzs tf-2 large p r o p a t i o n G f high gmde rnJcezsL i p r i g i-koris. Maori and POlynesiarl p p l a t i c n s ha3 a veiy similes rate of incidence of a l l types cf cda-ectal carcincrm. Maoris h2d a higher i n c i d e n a cf rmi-e &+xilied disease (Ixrkes C x,d mtastatic disease) fit tjirsei,i.iticn than e i r h e r Polyncsims mi- t : e i ~ t t a l~ p i k ' c i m . There was also a rise? i n canccr incidsnce, t k t i g h with d i f f e r e n c e s L--; a; , 2 s mc? cite. ?he increase LT incidence with tirrr wz m;r7) cvidmt in t k o i i s and P o l ~ s i a n s .Tl;e% d i i f s c n c c s are not c a s i l y explaiqed in t e r n s of the u s u d e t i o l o g i c a l speculations -lipat ions e t c h e r genetic or unknown environmental f a c t o r s .

.,,

KEYhORDS:

Colorectal, C a z i n m , Maori, Polynesian.

THE HlSTOPATHOLOGY OF PANKICULITIS

Le e , I n s t i t u t e of P a t h o l o g y , P r i n c e s s Margaret H o s p i t a l , Kowloon, Hong Kong.

K.C.

The c l i n i c a l a p p e a r a n c e of l e s i o n s of p a n n i c u l i t i s i s o f t e n n o n - s p e c i f i c and t h e i r h i s t o p a t h o l o g i c a l d i a g n o s i s d i f f i c u l t b e c a u s e of t h e s t e r e o - t y p e d r e s p o n s e of t h e s u b c u t a n e o u s f a t t o a wide v a r i e t y of i n s u l t s . The d i a g n o s t i c proble ms a r e f u r t h e r c o m p l i c a t e d by t h e m o r p h o l o g i c a l v a r i a t i o n s w i t h t h e e v o l u t i o n of t h e l e s i o n s and t h e l a c k of g e n e r a l l y a c c e p t e d d e f i n i t i o n s f o r many forms of panniculitides. The h i s t o p a t h o l o g i c a l d i a g n o s t i c a p p r o a c h t o p a n n i c u l i t i s i n c l u d e s t h e a n a l y s i s of t h e f o l l o w i n g p a r a m e t e r s : (1) t h e p r i n c i p a l s e a t of inflammation, whether i t i s predominately s e p t a 1 o r l o b u l a r ; ( 2 ) the p r e s e n c e and a p p e a r a n c e o f f a t n e c r o s i s and d e g e n e r a t i v e c h a n g e s , which f r e q u e n t l y a r e t h e most i m p o r t a n t c l u e s p o i n t i n g t o a s p e c i f i c d i a g n o s i s ; ( 3 ) t h e n a t u r e of c e l l u l a r i n f i l t r a t e s ; ( 4 ) t h e p r e s e n c e of v a s c u l a r c h a n g e s , s u c h a s v a s c u l i t i s , t h r o m b o s i s , and c a p i l l a r y p r o l i f e r a t i o n ; and (5) t h e p r e s e n c e of s p e c i a l f e a t u r e s including c a l c i f i c a t i o n , foreign bodies, m i c r o o r g a n i s m s , and p h a g o c y t o s i s . Often it i s impossible to classify a lesion without clinicopathologicai correlation. To i l l u s t r a t e t h e s e p o i n t s , t h e p a t h o l o g y of a number of comaon a nd r a r e l e s i o n s a r e p r e s e n t e d . Keywords

:

Panniculitis,

diagnosis,

DRUG-INDUCED LUNG DISEBSI-

MALACOPLAKIA OF THE LUNG : A REVIEW.

B G o r r i n , Depart ment o f Lung P a t h o l o g y , N a t i o n a l H e a r t a n d Lung I n s t i t u t e , Brompton H o s p i t a l , London SW3 6LY, UK

R.W. Byard',

.

I t i s e s t i m a t e d t h a t 5% o f a l l h o s p i t a l a d m i s s i o n s a r e d u e t o d r u g s , t h a t 10-18% o f i n p a t i e n t s e x p e r i e n c e a d r u g r e a c t i o n and t h a t 3% of h o s p i t a l d e a t h s may be d r u g related. The l u n g s are o f t e n i n v o l v e d i n t h e s e a d v e r s e reactions. A u s e f u l scheme for a s s e s s i n g u h e t h e r a p a r t i c u l a r c l i n i c a l manifestation represents an adverse drug reaction considers previous experience v i t h t h e drug, a l t e r n a t i v e e t i o l o g i c a l agents, the timing of e v e n t s , d r u g l e v e l s , t h e e f f e c t of w i t h d r a v i n g t h e d r u g a n d r e c h a l l e n g e v i t h t h e d r u g (JAMA 1979, 242, 633-8). Drug r e a c t i o n s may be c l a a s i f i e d a c c o r d i n g t o t h e mechanism of t h e r e a c t i o n ( o v e r d o s e , i n t o l e r a n c e , s i d e e f f e c t , secondary e f f e c t , h y p e r s e n s i t i v i t y , i d i o q n c r a s y ) , t h e t y p e of d r u g ( a n a l g e s i c , a n t i b i o t i c , c y t o t o x i c e t c ) or t h e p a t t e r n o f d i s e a s e . T h i s l a s t method w i l l be a d o p t e d h e r e , u s i n g examples i l l u s t r a t i n g t h e f o l l o w i n g : A l l e r g i c bronchopul monary d i s e a s e ; Alveolar i n j u r y , b o t h a c u t e ( d i f f u s e a l v e o l a r damage) a n d c h r o n i c ( i n t e r s t i t i a l pneumonia and f i b r o s i s ) ; A l v e o l a r histiocytosiS/lipoprDteinOSiS; A s p i r a t i o n l e s i o n s ; Pulmonary v a s c u l a r d i s e a s e . O t h e r r e s p i r a t o r y drug e f f e c t s include: Central depression o f r e s p i r a t i o n ; Broncho-constriction; P l e u r a l disease; Opportunistic i n f e c t i o n s ; Metastatic c a l c i f i c a t i o n ; Carcinoma. A c o mp r e h e n siv e r e v i e w is p r o v i d e d by Cooper e t a 1 (Am Rev R e e p i r D i s 1 986, 1 3 3 , 321-340 a n d 488-505).

pathology.

A.J. Bourne, P.S. Thorner. Department of Histopathology, Adelaide Children's Hospital (ACH). North Adelaide, Australia; Department of Pathology, Hospital for Sick Children (HSC), Toronto, Canada. Malacoplakia of the lung is a very rare condition that occurs in immunocompromised patients who present with non-specific pulmonary infiltrates. A 6-year-old girl who presented to HSC infiltrate, subsequently diagnosed as with a pulmonary malacoplakia, prompted us to review the literature to delineate more clearly the clinicopathological features of this entity. Five further patients were found ranging in age from 42-61 years. The bulk were debilitated with presenting features of fever, cough, haernoptysis. anorexia, weight loss, and dysphagia. Only I patient was asymptomatic. Two patients had received organ transplants, 2 had haematopoietic malignancies, I was an alcoholic and I had widely disseminated malacoplakia involving other organs. The clinical diagnosis was malignancy (2), infection (2), and possible infection or malignancy in 1 case. The diagnosis of pulmonary involvement was made on aspirate or biopsy (4) and at autopsy (2). All cases showed infiltrates characterised by aggregates of granular, inclusion-containing histiocytes with characteristic Michaelis-Gutmann bodies. Pathogenic bacteria were grown in cultures from the lungs in 5 patients. Successful treatment in 2 patients who were alive and free of disease within 3 months of diagnosis resulted either from broad spectrum antibiotic administration or from reduction in immunosuppressive medication dosage. The clinicopathologic features of these patients are reviewed in detail to draw attention to this highly unusual lesion which has different prognostic implications and therapeutic requirements from the more common pulmonary infiltrates and space occupying lesions that are being encountered more frequently by pathologists in immuno- compromised patients.