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Microfilm for tissue pathologists
14
R.C.P.A. AND A.A.C.B.
Pathology (1977). 9, January
supernatant in a simple tube precipitin test. During the early 1970s workers in Nigeria. the United States and Britain employed counter-current immunoelectrophoresis (C.C.I.E.)as a sensitive method of detecting small amounts of bacterial polysaccharide in body fluids. C.C.I.E. can detect a s little a s 0.05 pglml of H . ir7flitoizrtr type b antigen, and is about 50 times more sensitive than the precipitin technique (the sensitivity of the ring test is about 2.5 pg antigen ml). The theoretical advantages of C.C.I.E. are to facilitate the rapid diagnosis of haemophilus meningitis and to detect cases where previous chemotherapy has sterilized the c.s.f. before lumbar puncture. During the 10-month period October 1975 to July 1976 inclusive, we have used C.C.I.E. in children with suspected haemophilus epiglottitis or meningitis. Twelve of 14 cases of haemophilus meningitis yielded a positive result, including one case where bacteriological culture was negative. However, all of three cases of haemophilus epiglottitis gave negative results on C.C.I.E. MICROFILM FOR TISSUE PATHOLOGISTS . ALLEN,P. W , & ANGLE.B. V. Tlir Itislitzrte of Mediccil cititl I ‘ e t w k i r j ~Scirtice. 2 4 1 k c h i t k i ~ Soirth
A irstrdirr
Since 1968, varying amounts of data abstracted from surgical pathology reports of the Institute of Medical and Veterinary Science (I.M.V.S.) have been entered into a computer and subsequently stored on magnetic tape. Programmes have now been written which enable approximately 72.000 records, the number accessioned since 1971, to he arranged in alphabetical order of the patient’s name. Three separate programmes arrange the records in laboratory accession number order. in diagnostic order and in topographical order of the tissue examined. This immense amount of sorted data is printed directly on to microfilm fiche by a computer using a computer output microfilm (C.O.M.) process. Copies of the microfiche can he made cheaply. These microfiche records are then used as directories to the full pathology report. Every surgical pathology and autopsy report since 1973 has been photographed on 16 mm roll microfilm, with each report being separated by a counter ’blip’ which corresponds to the laboratory number. Once a laboratory number for a record ofinterest has been determined from the appropriate directory, the full report can be rapidly retrieved from the roll microfilm, viewed on a screen and ifrequired. printed by machines now available commercially. Relatively cheap minicomputers are now available. and C.O.M. record retrieval systems are becoming feasible for laboratories which do not have a large, expensive, centralized coniputcr. For satisfactory functioning of the system, concise English language diagnoses are included with the systematized Nomenclature of Pathology (S.N.O.P.) numerical diagnosis on computer tape and on the C.O.M. files. For example. a basal cell carcinoma might he coded, ‘T0100:M8093 possible recurrent pigmented basal cell carcinoma. skin, left lower eyelid’. Multiple S.N.O.P. numbers approximating to the diagnosis are used in conjunction with a precise English description to code diseases which d o not have a truly appropriate S.N.O.P. number. For example. a sarcoma with giant cells might he coded. ‘T0300:M8803; TI 900:M9253; T0381:M8803 malignant giant cell tumour in subcutaneous and deep soft tissues, left thigh’. This diagnosis would he retrieved with the giant cell tumours of bone (M9253) and with giant cell sarcomas (M8803) as well as with subcutaneous lesions (T0300). soft tissue diseases (T1900) and with subcutaneous lesions of the thigh (TO38I ). The English diagnosisprinted on the microfilm files enables a reviewer to comprehend a retrieved diagnosis without consulting the complete report or the S.N.O.P. number dictionary. JUVENILE SECRETORY CARCINOMA OF THE BREAST WITH AXILLARY METASTASES: REPORT OF A CASE IN A TWENTY-FIVE-YEAR-OLD WOMAN
SULLIVAN, J. J.* MAGEE.R. & DONALD,K . J.
*225 Widiltcrni Termce. Brishurir, Qtwrti.dmd
In reporting 7 cases of breast carcinoma occurring in children, McDivitt and Stewart in 1966 drew attention to a conspicuous and distinctive secretory change present in all the tumours studied. These neoplasms showed less aggressive behaviour than adult breast carcinoma. with only 1 recurrence and no observed regional o r distant metastases. Subsequently, McDivitt conducted a retrospective search for cases of this type in adults and found 6 such patients. Their clinical course seemed to be of similar indolence to the childhood tumours. The patient was a 25-yr-old woman who presented 7 mth after she had finished breast feeding her 2nd child. She had been taking various oral contraceptives for these 7 mth. for most of the time Serial C. She had an area of thickening in the left breast. just lateral to the areola, with a small fibroadenoma-like central nodule. Frozen section unexpectedly showed an infiltrating tumour with papillary and glandular areas and prominent secretory activity. Paraffin sections were considered by the Armed Forces Institute of Pathology. Washington, D.C., as characteristic of juvenile secretory carcinoma. The residual tumour was excised by segmental resection. Eight months later a recurrence was identified and radical mastectomy performed. Secondary deposits of typical secretory carcinoma
R.C.P.A. AND A.A.C.B.
Pathology (1977). 9, January
supernatant in a simple tube precipitin test. During the early 1970s workers in Nigeria. the United States and Britain employed counter-current immunoelectrophoresis (C.C.I.E.)as a sensitive method of detecting small amounts of bacterial polysaccharide in body fluids. C.C.I.E. can detect a s little a s 0.05 pglml of H . ir7flitoizrtr type b antigen, and is about 50 times more sensitive than the precipitin technique (the sensitivity of the ring test is about 2.5 pg antigen ml). The theoretical advantages of C.C.I.E. are to facilitate the rapid diagnosis of haemophilus meningitis and to detect cases where previous chemotherapy has sterilized the c.s.f. before lumbar puncture. During the 10-month period October 1975 to July 1976 inclusive, we have used C.C.I.E. in children with suspected haemophilus epiglottitis or meningitis. Twelve of 14 cases of haemophilus meningitis yielded a positive result, including one case where bacteriological culture was negative. However, all of three cases of haemophilus epiglottitis gave negative results on C.C.I.E. MICROFILM FOR TISSUE PATHOLOGISTS . ALLEN,P. W , & ANGLE.B. V. Tlir Itislitzrte of Mediccil cititl I ‘ e t w k i r j ~Scirtice. 2 4 1 k c h i t k i ~ Soirth
A irstrdirr
Since 1968, varying amounts of data abstracted from surgical pathology reports of the Institute of Medical and Veterinary Science (I.M.V.S.) have been entered into a computer and subsequently stored on magnetic tape. Programmes have now been written which enable approximately 72.000 records, the number accessioned since 1971, to he arranged in alphabetical order of the patient’s name. Three separate programmes arrange the records in laboratory accession number order. in diagnostic order and in topographical order of the tissue examined. This immense amount of sorted data is printed directly on to microfilm fiche by a computer using a computer output microfilm (C.O.M.) process. Copies of the microfiche can he made cheaply. These microfiche records are then used as directories to the full pathology report. Every surgical pathology and autopsy report since 1973 has been photographed on 16 mm roll microfilm, with each report being separated by a counter ’blip’ which corresponds to the laboratory number. Once a laboratory number for a record ofinterest has been determined from the appropriate directory, the full report can be rapidly retrieved from the roll microfilm, viewed on a screen and ifrequired. printed by machines now available commercially. Relatively cheap minicomputers are now available. and C.O.M. record retrieval systems are becoming feasible for laboratories which do not have a large, expensive, centralized coniputcr. For satisfactory functioning of the system, concise English language diagnoses are included with the systematized Nomenclature of Pathology (S.N.O.P.) numerical diagnosis on computer tape and on the C.O.M. files. For example. a basal cell carcinoma might he coded, ‘T0100:M8093 possible recurrent pigmented basal cell carcinoma. skin, left lower eyelid’. Multiple S.N.O.P. numbers approximating to the diagnosis are used in conjunction with a precise English description to code diseases which d o not have a truly appropriate S.N.O.P. number. For example. a sarcoma with giant cells might he coded. ‘T0300:M8803; TI 900:M9253; T0381:M8803 malignant giant cell tumour in subcutaneous and deep soft tissues, left thigh’. This diagnosis would he retrieved with the giant cell tumours of bone (M9253) and with giant cell sarcomas (M8803) as well as with subcutaneous lesions (T0300). soft tissue diseases (T1900) and with subcutaneous lesions of the thigh (TO38I ). The English diagnosisprinted on the microfilm files enables a reviewer to comprehend a retrieved diagnosis without consulting the complete report or the S.N.O.P. number dictionary. JUVENILE SECRETORY CARCINOMA OF THE BREAST WITH AXILLARY METASTASES: REPORT OF A CASE IN A TWENTY-FIVE-YEAR-OLD WOMAN
SULLIVAN, J. J.* MAGEE.R. & DONALD,K . J.
*225 Widiltcrni Termce. Brishurir, Qtwrti.dmd
In reporting 7 cases of breast carcinoma occurring in children, McDivitt and Stewart in 1966 drew attention to a conspicuous and distinctive secretory change present in all the tumours studied. These neoplasms showed less aggressive behaviour than adult breast carcinoma. with only 1 recurrence and no observed regional o r distant metastases. Subsequently, McDivitt conducted a retrospective search for cases of this type in adults and found 6 such patients. Their clinical course seemed to be of similar indolence to the childhood tumours. The patient was a 25-yr-old woman who presented 7 mth after she had finished breast feeding her 2nd child. She had been taking various oral contraceptives for these 7 mth. for most of the time Serial C. She had an area of thickening in the left breast. just lateral to the areola, with a small fibroadenoma-like central nodule. Frozen section unexpectedly showed an infiltrating tumour with papillary and glandular areas and prominent secretory activity. Paraffin sections were considered by the Armed Forces Institute of Pathology. Washington, D.C., as characteristic of juvenile secretory carcinoma. The residual tumour was excised by segmental resection. Eight months later a recurrence was identified and radical mastectomy performed. Secondary deposits of typical secretory carcinoma