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Localization of hepatitis B surface antigen in neoplastic cells of primary hepatocellular carcinoma
196
ROYAL COLLEGE OF PATHOLOGISTS OF AUSTRALIA
Pathology (1978), 10, April
lobular carcinoma in situ. 143 cases of atypical lobular hyperplasia and 226 cases of very early lobular atypia. Concurrent invasive carcinoma was present in 43 of the cases ofcarcinoma in situ,48 of atypical hyperplasia and 49 of very early atypia. Follow-up ranging from 1 to 22 yr is available for 42 cases of carcinoma in situ, 128 cases of atypical hyperplasia and 201 cases of very early atypia. These groups have subsequently developed 2, 5 and 5 invasive breast cancers respectively. These results suggest that lobular carcinoma in situ and atypical hyperplasia have a different pattern of occurrence and behaviour in our community from that reported in the United States of America. A PATHOLOGICAL STUDY OF THE RELATIONSHIP BETWEEN LICHEN SCLEROSUS ET ATROPHICUS AND SQUAMOUS CARCINOMA OF THE VULVA
BAIRD.PHILLIPJ., RUSSELL.PETER& LAVERTY, COLINR. Departments of Pathology, King George V Memorial Hospital, Sydney, and The University of Sydney When examined histologically, clinical leukoplakia of the vulva in the postmenopausal female exhibits features of lichen sclerosus et atrophicus (LSA) in most cases. Leukoplakia of the vulva has long been regarded as premalignant and in a number of previous series of invasive squamous carcinoma of the vulva, LSA was reported to be seen in association with the carcinoma in only l&500; of cases. During the 12-yr period 1966-77, we have examined 924 tissue specimens of the vulva. Of these, 157 were malignant lesions, 106 being invasive squamous carcinoma and 36 being carcinoma in situ. A review of the pathological material taken from vulvectomy specimens of all the invasive squamous carcinoma in postmenopausal females disclosed that when 5-10 tissue blocks of the tumour and the vulval skin were examined, the association with LSA was 20-30";. However, when 15-30 blocks were examined, the association was 60-7PA, many showing multifwal microinvasive carcinoma arising in areas of LSA while others showed adjacent LSA with dysplastic epithelium. Therefore, to assess reliably the distribution, incidence and premalignant potential of vulval LSA with squamous carcinoma, adequate tissue sampling of the primary tumour and the adjacent skin has to be done. CERVICAL WART VIRUS INFECTION: CYTOLOGICAL, HISTOLOGICAL AND ULTRASTRUCTURAL STUDIES
LAVERTY. COLINR., BOOTH,NANCY& RUSSELL, PETER Department oj'Pathology, King George V Menlorial Hospital, Sydney Genital warts are due to an increasingly prevalent venereally spread virus infection. Typical condylomas affect vulval. vaginal and both original and metaplastic cervical squamous epithelia. The cervix is involved more commonly than formerly realized. A significant number of cervical lesions are not typical condylomas, but have a rather flat contour and such cases have been under-diagnosed in the past. Cellular atypia is common, confusion with dysplasia has occurred and wart virus infection is thought to be the basis ofmany reported so-called mild dysplasias which regressed spontaneously. There has been speculation about the possible premalignant significance of cervical warts. This suggestion is supported to some extent by the known but rare occurrence of malignant change in condylomas, and by the fact that flat cervical warty lesions resemble histologically epidermodysplasia verruciformis, a non-genital wart virus infection which is frequently followed by squamous carcinoma. The cytological, histological and ultrastructural features of two illustrative non-condylomatous cervical wart virus lesions will be shown. LOCALIZATION OF HEPATITIS B SURFACE ANTIGEN IN NEOPLASTIC CELLS OF PRIMARY HEPATOCELLULAR CARCINOMA
MURUGASC',R. Royal Neucastle Hospital, Nencastle In 2 cases of primary hepatocellular carcinoma (PHC), hepatitis B surface antigen (HB,Ag) was localized in the cytoplasm of neoplastic cells and some of the nuclei had nuclear inclusions. In both cases, the non-neoplastic liver tissue showed post-hepatitic cirrhosis and HB,Ag was present in the non-neoplastic hepatocytes. There is no previous report localizing HB,Ag within neoplastic cells of PHC. These 2 cases of PHC were from a series of 23 in which both neoplastic and non-neoplastic tissues were studied with histochemical (Shikata's orcein stain) and immunological methods. HB,Ag was localized in the cytoplasm of non-neoplastic hepatocytes in 19 cases (83%). Post-hepatitic cirrhosis
ABSTRACTS OF ANNUAL MEETING 1977
197
was present in 20 cases (87%) and the 3 remaining cases showed evidence of chronic persistent hepatitis. There is a high proportion of HB,Ag positivity and post-hepatitic cirrhosis in these cases of PHC. These findings support the view that post-hepatitic cirrhosis is a premalignant condition and hepatitis B virus may play an important role in the aetiology of PHC. A CASE OF CHOLERA
RAO,AHALYAMedical Microbiologist, Princess Alexandra Hospital, Brisbane This paper reports the first microbiologically proven clinical case of cholera in an indigenous patient in Australia. COMPUTED RENAL BIOPSY DATA
OJEDA,V. J. & HERDSON, P. B. Pathology Department, University of Auckland School of Medicine, Auckland, New Zealand Data obtained from 1121 renal biopsies pertaining to 826 patients have been computed. There were 676 needle biopsies (60.3%), 76 necropsies (6.77%), 36 nephrectomies (3.21%), and 133 transplant nephrectomies/biopsies (1 1.86%). 8.7% of the needle biopsies failed to produce renal tissue adequate for histological assessment. Immunofluorescence was done in 40.3%of these patients, being positive in 20.46% of them. Electron microscopy was done in 61.38% of the patients. Among the principal clinical presentations (one per patient) there were: 130 nephrotic syndrome (15.73%), 98 nephritic syndrome (1 1.86%), 88 chronic renal failure (10.65%), 79 proteinuria (9.56%),61 systemic lupus (7.38%), 51 hypertension (6.17%),36 acute renal failure (4.35%),31haematuria (3.7573, and 25 Goodpasture’s syndrome (3.02%). The principal pathological diagnoses were: Glomerulonephritis in 473 patients (57.26%);Vascular disease in 78 (9.44%); Interstitial nephritis in 52 (6.29%); Diabetic nephropathy in 17 (2.05%); Tubular degeneration in 55 (6.65%);Neoplasia in 6 (0.72%); Amyloid in 10 (1.21%); Transplantation nephropathy in 55 (6.65%); Congenital renal disease in 6 (0.72%); End stage renal disease in 25 (3.02%); Normal renal tissue in 24 (2.90%); and Failed biopsies in 25 patients (3.02%). There were 322 patients presenting Diffuse glomerular disease and 135 patients with Focal glomerulonephritides. The commonest conditions were: Acute diffuse proliferative and exudative glomerulonephritis (100 cases), Minimal change or lipoid nephrosis (68 cases), Diffuse mesangiocapillary glomerulonephritis (47 cases), Nonspecific focal glomerular disease and membranous glomerulonephritis (36 cases of each), and Goodpasture’s syndrome (27 patients). THIAMPHENICOL IN LUPUS NEPHRITIS
SIMPSON, L. O., AARONS, I. & HOWIE,J. B. Department of Pathology, University of Otago Medical School The (NZB x NZW)F, hybrid mouse is an excellent experimental model of lupus nephritis. To groups of such mice, thiamphenicol glycinate was administered at dosage rates of 25, 50 and 250 mglkgjday for the greater part of their life span. The effects of the drug were monitored by regular checks including estimation of proteinuria, blood urea, haematocrit and antinuclear antibodies. Renal histopathology of moribund animals revealed that the features and actual sequence ofdevelopment of the renal lesions were not altered by the drug. Nevertheless, the usual progress of severe glomerulonephritis was slowed down and in high doses actually halted at a glomerulitis-often quite mild. However, it did not appear to be possible to relate the increased survival rate to the degree of amelioration of the renal lesions which were induced by different dosage levels of the drug. ULTRASTRUCTURE OF THE VASCULAR LESIONS IN MALIGNANT HYPERTENSION
SINCLAIR, R. A. Department of Anatomical Pathology, Royal Melbourne Hospital Renal biopsy material from 15 cases of malignant essential hypertension were studied by light and electron microscopy with the aims of elucidating the nature and pathogenesis of the lesions well known from light microscopic studies. The term fibrinoid necrosis is often a misnomer since cell necrosis was inconstant. The ‘necrotic’lesions consisted mainly of granular electron-dense material (fibrinoid), small angular fibrillary fragments of fibrin and whole or fragmented red cells. Onion-skin intimal thickening was made up of smooth muscle-like cells (myointimal cells), multiple layers of basement-membrane material, fibrin and fibrinoid and finely granular electron-lucent material
ROYAL COLLEGE OF PATHOLOGISTS OF AUSTRALIA
Pathology (1978), 10, April
lobular carcinoma in situ. 143 cases of atypical lobular hyperplasia and 226 cases of very early lobular atypia. Concurrent invasive carcinoma was present in 43 of the cases ofcarcinoma in situ,48 of atypical hyperplasia and 49 of very early atypia. Follow-up ranging from 1 to 22 yr is available for 42 cases of carcinoma in situ, 128 cases of atypical hyperplasia and 201 cases of very early atypia. These groups have subsequently developed 2, 5 and 5 invasive breast cancers respectively. These results suggest that lobular carcinoma in situ and atypical hyperplasia have a different pattern of occurrence and behaviour in our community from that reported in the United States of America. A PATHOLOGICAL STUDY OF THE RELATIONSHIP BETWEEN LICHEN SCLEROSUS ET ATROPHICUS AND SQUAMOUS CARCINOMA OF THE VULVA
BAIRD.PHILLIPJ., RUSSELL.PETER& LAVERTY, COLINR. Departments of Pathology, King George V Memorial Hospital, Sydney, and The University of Sydney When examined histologically, clinical leukoplakia of the vulva in the postmenopausal female exhibits features of lichen sclerosus et atrophicus (LSA) in most cases. Leukoplakia of the vulva has long been regarded as premalignant and in a number of previous series of invasive squamous carcinoma of the vulva, LSA was reported to be seen in association with the carcinoma in only l&500; of cases. During the 12-yr period 1966-77, we have examined 924 tissue specimens of the vulva. Of these, 157 were malignant lesions, 106 being invasive squamous carcinoma and 36 being carcinoma in situ. A review of the pathological material taken from vulvectomy specimens of all the invasive squamous carcinoma in postmenopausal females disclosed that when 5-10 tissue blocks of the tumour and the vulval skin were examined, the association with LSA was 20-30";. However, when 15-30 blocks were examined, the association was 60-7PA, many showing multifwal microinvasive carcinoma arising in areas of LSA while others showed adjacent LSA with dysplastic epithelium. Therefore, to assess reliably the distribution, incidence and premalignant potential of vulval LSA with squamous carcinoma, adequate tissue sampling of the primary tumour and the adjacent skin has to be done. CERVICAL WART VIRUS INFECTION: CYTOLOGICAL, HISTOLOGICAL AND ULTRASTRUCTURAL STUDIES
LAVERTY. COLINR., BOOTH,NANCY& RUSSELL, PETER Department oj'Pathology, King George V Menlorial Hospital, Sydney Genital warts are due to an increasingly prevalent venereally spread virus infection. Typical condylomas affect vulval. vaginal and both original and metaplastic cervical squamous epithelia. The cervix is involved more commonly than formerly realized. A significant number of cervical lesions are not typical condylomas, but have a rather flat contour and such cases have been under-diagnosed in the past. Cellular atypia is common, confusion with dysplasia has occurred and wart virus infection is thought to be the basis ofmany reported so-called mild dysplasias which regressed spontaneously. There has been speculation about the possible premalignant significance of cervical warts. This suggestion is supported to some extent by the known but rare occurrence of malignant change in condylomas, and by the fact that flat cervical warty lesions resemble histologically epidermodysplasia verruciformis, a non-genital wart virus infection which is frequently followed by squamous carcinoma. The cytological, histological and ultrastructural features of two illustrative non-condylomatous cervical wart virus lesions will be shown. LOCALIZATION OF HEPATITIS B SURFACE ANTIGEN IN NEOPLASTIC CELLS OF PRIMARY HEPATOCELLULAR CARCINOMA
MURUGASC',R. Royal Neucastle Hospital, Nencastle In 2 cases of primary hepatocellular carcinoma (PHC), hepatitis B surface antigen (HB,Ag) was localized in the cytoplasm of neoplastic cells and some of the nuclei had nuclear inclusions. In both cases, the non-neoplastic liver tissue showed post-hepatitic cirrhosis and HB,Ag was present in the non-neoplastic hepatocytes. There is no previous report localizing HB,Ag within neoplastic cells of PHC. These 2 cases of PHC were from a series of 23 in which both neoplastic and non-neoplastic tissues were studied with histochemical (Shikata's orcein stain) and immunological methods. HB,Ag was localized in the cytoplasm of non-neoplastic hepatocytes in 19 cases (83%). Post-hepatitic cirrhosis
ABSTRACTS OF ANNUAL MEETING 1977
197
was present in 20 cases (87%) and the 3 remaining cases showed evidence of chronic persistent hepatitis. There is a high proportion of HB,Ag positivity and post-hepatitic cirrhosis in these cases of PHC. These findings support the view that post-hepatitic cirrhosis is a premalignant condition and hepatitis B virus may play an important role in the aetiology of PHC. A CASE OF CHOLERA
RAO,AHALYAMedical Microbiologist, Princess Alexandra Hospital, Brisbane This paper reports the first microbiologically proven clinical case of cholera in an indigenous patient in Australia. COMPUTED RENAL BIOPSY DATA
OJEDA,V. J. & HERDSON, P. B. Pathology Department, University of Auckland School of Medicine, Auckland, New Zealand Data obtained from 1121 renal biopsies pertaining to 826 patients have been computed. There were 676 needle biopsies (60.3%), 76 necropsies (6.77%), 36 nephrectomies (3.21%), and 133 transplant nephrectomies/biopsies (1 1.86%). 8.7% of the needle biopsies failed to produce renal tissue adequate for histological assessment. Immunofluorescence was done in 40.3%of these patients, being positive in 20.46% of them. Electron microscopy was done in 61.38% of the patients. Among the principal clinical presentations (one per patient) there were: 130 nephrotic syndrome (15.73%), 98 nephritic syndrome (1 1.86%), 88 chronic renal failure (10.65%), 79 proteinuria (9.56%),61 systemic lupus (7.38%), 51 hypertension (6.17%),36 acute renal failure (4.35%),31haematuria (3.7573, and 25 Goodpasture’s syndrome (3.02%). The principal pathological diagnoses were: Glomerulonephritis in 473 patients (57.26%);Vascular disease in 78 (9.44%); Interstitial nephritis in 52 (6.29%); Diabetic nephropathy in 17 (2.05%); Tubular degeneration in 55 (6.65%);Neoplasia in 6 (0.72%); Amyloid in 10 (1.21%); Transplantation nephropathy in 55 (6.65%); Congenital renal disease in 6 (0.72%); End stage renal disease in 25 (3.02%); Normal renal tissue in 24 (2.90%); and Failed biopsies in 25 patients (3.02%). There were 322 patients presenting Diffuse glomerular disease and 135 patients with Focal glomerulonephritides. The commonest conditions were: Acute diffuse proliferative and exudative glomerulonephritis (100 cases), Minimal change or lipoid nephrosis (68 cases), Diffuse mesangiocapillary glomerulonephritis (47 cases), Nonspecific focal glomerular disease and membranous glomerulonephritis (36 cases of each), and Goodpasture’s syndrome (27 patients). THIAMPHENICOL IN LUPUS NEPHRITIS
SIMPSON, L. O., AARONS, I. & HOWIE,J. B. Department of Pathology, University of Otago Medical School The (NZB x NZW)F, hybrid mouse is an excellent experimental model of lupus nephritis. To groups of such mice, thiamphenicol glycinate was administered at dosage rates of 25, 50 and 250 mglkgjday for the greater part of their life span. The effects of the drug were monitored by regular checks including estimation of proteinuria, blood urea, haematocrit and antinuclear antibodies. Renal histopathology of moribund animals revealed that the features and actual sequence ofdevelopment of the renal lesions were not altered by the drug. Nevertheless, the usual progress of severe glomerulonephritis was slowed down and in high doses actually halted at a glomerulitis-often quite mild. However, it did not appear to be possible to relate the increased survival rate to the degree of amelioration of the renal lesions which were induced by different dosage levels of the drug. ULTRASTRUCTURE OF THE VASCULAR LESIONS IN MALIGNANT HYPERTENSION
SINCLAIR, R. A. Department of Anatomical Pathology, Royal Melbourne Hospital Renal biopsy material from 15 cases of malignant essential hypertension were studied by light and electron microscopy with the aims of elucidating the nature and pathogenesis of the lesions well known from light microscopic studies. The term fibrinoid necrosis is often a misnomer since cell necrosis was inconstant. The ‘necrotic’lesions consisted mainly of granular electron-dense material (fibrinoid), small angular fibrillary fragments of fibrin and whole or fragmented red cells. Onion-skin intimal thickening was made up of smooth muscle-like cells (myointimal cells), multiple layers of basement-membrane material, fibrin and fibrinoid and finely granular electron-lucent material