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Primary glomerular disease
Pathology (1970), 2, pp. 71-82
ABSTRACTS OF PAPERS PRESENTED AT THE SCIENTIFIC MEETING OF THE COLLEGE OF PATHOLOGISTS OF AUSTRALIA HELD I N SYDNEY, N E W SOUTH WALES 28, 29 and 30 August 1969 PATHOLOGICAL ASPECTS OF A CASE OF CARDIAC ALLOGRAFT TRANSPLANTATION AND A DISCUSSION OF CARDIAC REJECTION
RALSTON,MARYM.
S t . Vincent’s Hospital, Sydney, New South Wales
A cardiac transplant was carried out on a patient suffering from intractable heart failure due to extensive old antero-septa1 infarction, the result of severe atherosclerotic coronary artery disease. Death occurred 45 days later following haemorrhage from a perforation in the recipient aorta above the line of anastomosis. To the naked eye the anastomosis appeared healthy but microscopically each aorta was necrotic and contained colonies of cocco-bacilli. These organisms were present in the pericardial cavity and cultures yielded Serratia marcescens. Macroscopic appearances of rejection were not present in the transplanted heart. Microscopically, the myocardium contained foci of myocytolysis and collapse fibrosis; thrombi were present in small blood vessels. Areas of infarction were present in the atria. The left lung contained an abscess from which Pseudomonas pyocyanea and Aspergillus jlavus were cultured. There was severe ulceration of the tongue and, to a lesser degree, of the oesophagus around which squamous epithelial cells contained large intranuclear inclusions characteristic of herpes. Spleen and lymph nodes showed striking depletion of lymphoid tissue. It was concluded that there was evidence of minor cardiac rejection in this patient. Evidence of immune suppression was striking and this was accompanied by proliferation of various opportunistic microorganisms which was largely responsible for death. PRIMARY G LOM ER U LAR DISEASE
HERDSON, P. B.
University of Auckland Medical School, New Zealand
The increasing use of percutaneous renal biopsy techniques, together with the recent application of electron and immunofluorescent microscopy to these biopsies, has enabled the demarcation of primary glomerular diseases as one of the important large group of parenchymal renal diseases. In these primary glomerular diseases, the pathological changes appear to originate in, and predominantly to affect the glomeruli, although there may be concomitant changes in other parts of the kidney, and the renal changes may be part of a generalized process occurring elsewhere in the body. Included under primary glomerular diseases are the diffuse processes of acute proliferative and exudative glomerulonephritis, membranous glomerular disease, mixed membranous and proliferative glomerulonephritis, lipoid nephrosis and toxaemia of pregnancy, and the focal glomerular diseases. The salient morphological features of acute diffuse glomerulonephritis include intracapillary cell proliferation and exudation, in varying proportions, together with the presence of characteristic electron-
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dense subepithelial deposits (‘humps’). Membranous glomerular disease is characterized by diffuse thickening of the capillary walls due to widespread subepithelial deposits. It is of great clinical importance to distinguish membranous glomerular disease from lipoid nephrosis, in which widespread fusion of epithelial foot processes, in the absence of other significant changes, is the diagnostic feature. Mixed membranous and proliferative glomerulonephritis involves variable hypercellularity in different capillary loops, together with thickening of some but not all peripheral capillary walls. The renal changes seen in toxaemia of pregnancy include swelling of endothelial cells together with irregular thickening of the lamina rara interna of the capillary basement membrane. Focal glomerular disease is a relatively common finding in most large series of renal biopsies. A small proportion of these cases are associated with systemic lupus nephropathy, Henoch-Schonlein purpura, so-called Goodpasture’s syndrome, and subacute bacterial endocarditis, but in the vast majority we have no idea of the aetiology of the focal glomerular lesions. GLOMERULAR CHANGES I N FABRY’S DISEASE DUNCAN, C. State Health Department, Hobart, Tasmania
In this disease the important change in the glomeruli is the deposition of lipid in the epithelial cells. This material is intensely osmiophilic and takes the form of laminated circular bodies varying in size from about 1-12p. Ultimately, the epithelial cells with their foot processes are destroyed and renal failure results. The laminated bodies spill into the urinary space and are passed in the urine where they are readily identified by staining with osmium tetroxide. The presence of these bodies in the urine is considered to be a reliable indication of involvement of the glomeruli in this disease. PAPILLARY CYSTADENOMAS AND OXYPHIL CELL ADENOMAS OF THE LACHRYMAL CARUNCLE GREER,C. H. The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria
A recent case of papillary cystadenoma and two recent cases of oxyphil cell adenomas of the lachrymal caruncle were described in order to illustrate the histological features of these tumours in this situation. Evidence was presented from the author’s histological material and from published reports, that parotid adenolymphomas, papillary cystadenomas and oxyphil cell adenomas are closely related tumours, all of which originate from cells which have undergone oncocytic transformation. These cells may be ductal or acinic cells in serous and mucous glands or occasionally surface epithelial cells in certain locations of which the lachrymal sac is one. HISTOLOGICAL MODIFICATION OF FIBROADENOMA OF THE BREAST ASSOCIATED WITH ORAL CONTRACEPTIVES BROWN,JENNIFER M. Institute of Medical and Veterinary Science, Adelaide, South Australia
The normal breast is very sensitive to hormonal influences. For example, it is constantly changing under the influence of the ovarian hormones throughout each menstrual cycle. Deviations from these normal patterns give rise to the changes of mammary dysplasia (i.e. fibrocystic disease of the breast). It is thought that the fibroadenoma may represent a variant of this condition rather than a true neoplasm. A case was presented of a woman of 25 yr. who noticed a lump in one breast five months after restarting oral hormonal contraceptives. Clinically, this appeared to be a fibroadenoma, but, on histological examination, it presented the unusual features of exaggerated and bizarre epithelial proliferation and conspicuous secretory activity -quite different from the usual microscopical appearances of fibroadenoma. Reference was made to a report of four such cases by Goldenberg et al. (Amer. J. clin. Path., 1968). It was felt that caution should be exercised in the histological interpretation, especially on frozen section, of doubtful mammary lesions in women who are taking oral contraceptives. ENDO CAR DIAL TH RO M BOSIS-I NCI D ENCE AN D SI G N I FlCANC E BURRY,A. F. Royal Brisbane Hospital, Queensland A prospective study was made of the incidence of endocardia1 thrombosis in 1,000 consecutive adult autopsies. Macroscopic thrombi were found in 17% of cases. Approximately half of these were not related to myocardial infarction and had a characteristic distribution in the heart.
ABSTRACTS OF PAPERS PRESENTED AT THE SCIENTIFIC MEETING OF THE COLLEGE OF PATHOLOGISTS OF AUSTRALIA HELD I N SYDNEY, N E W SOUTH WALES 28, 29 and 30 August 1969 PATHOLOGICAL ASPECTS OF A CASE OF CARDIAC ALLOGRAFT TRANSPLANTATION AND A DISCUSSION OF CARDIAC REJECTION
RALSTON,MARYM.
S t . Vincent’s Hospital, Sydney, New South Wales
A cardiac transplant was carried out on a patient suffering from intractable heart failure due to extensive old antero-septa1 infarction, the result of severe atherosclerotic coronary artery disease. Death occurred 45 days later following haemorrhage from a perforation in the recipient aorta above the line of anastomosis. To the naked eye the anastomosis appeared healthy but microscopically each aorta was necrotic and contained colonies of cocco-bacilli. These organisms were present in the pericardial cavity and cultures yielded Serratia marcescens. Macroscopic appearances of rejection were not present in the transplanted heart. Microscopically, the myocardium contained foci of myocytolysis and collapse fibrosis; thrombi were present in small blood vessels. Areas of infarction were present in the atria. The left lung contained an abscess from which Pseudomonas pyocyanea and Aspergillus jlavus were cultured. There was severe ulceration of the tongue and, to a lesser degree, of the oesophagus around which squamous epithelial cells contained large intranuclear inclusions characteristic of herpes. Spleen and lymph nodes showed striking depletion of lymphoid tissue. It was concluded that there was evidence of minor cardiac rejection in this patient. Evidence of immune suppression was striking and this was accompanied by proliferation of various opportunistic microorganisms which was largely responsible for death. PRIMARY G LOM ER U LAR DISEASE
HERDSON, P. B.
University of Auckland Medical School, New Zealand
The increasing use of percutaneous renal biopsy techniques, together with the recent application of electron and immunofluorescent microscopy to these biopsies, has enabled the demarcation of primary glomerular diseases as one of the important large group of parenchymal renal diseases. In these primary glomerular diseases, the pathological changes appear to originate in, and predominantly to affect the glomeruli, although there may be concomitant changes in other parts of the kidney, and the renal changes may be part of a generalized process occurring elsewhere in the body. Included under primary glomerular diseases are the diffuse processes of acute proliferative and exudative glomerulonephritis, membranous glomerular disease, mixed membranous and proliferative glomerulonephritis, lipoid nephrosis and toxaemia of pregnancy, and the focal glomerular diseases. The salient morphological features of acute diffuse glomerulonephritis include intracapillary cell proliferation and exudation, in varying proportions, together with the presence of characteristic electron-
72
T H E COLLEGE O F P A T H O L O G I S T S O F AUSTRALIA
dense subepithelial deposits (‘humps’). Membranous glomerular disease is characterized by diffuse thickening of the capillary walls due to widespread subepithelial deposits. It is of great clinical importance to distinguish membranous glomerular disease from lipoid nephrosis, in which widespread fusion of epithelial foot processes, in the absence of other significant changes, is the diagnostic feature. Mixed membranous and proliferative glomerulonephritis involves variable hypercellularity in different capillary loops, together with thickening of some but not all peripheral capillary walls. The renal changes seen in toxaemia of pregnancy include swelling of endothelial cells together with irregular thickening of the lamina rara interna of the capillary basement membrane. Focal glomerular disease is a relatively common finding in most large series of renal biopsies. A small proportion of these cases are associated with systemic lupus nephropathy, Henoch-Schonlein purpura, so-called Goodpasture’s syndrome, and subacute bacterial endocarditis, but in the vast majority we have no idea of the aetiology of the focal glomerular lesions. GLOMERULAR CHANGES I N FABRY’S DISEASE DUNCAN, C. State Health Department, Hobart, Tasmania
In this disease the important change in the glomeruli is the deposition of lipid in the epithelial cells. This material is intensely osmiophilic and takes the form of laminated circular bodies varying in size from about 1-12p. Ultimately, the epithelial cells with their foot processes are destroyed and renal failure results. The laminated bodies spill into the urinary space and are passed in the urine where they are readily identified by staining with osmium tetroxide. The presence of these bodies in the urine is considered to be a reliable indication of involvement of the glomeruli in this disease. PAPILLARY CYSTADENOMAS AND OXYPHIL CELL ADENOMAS OF THE LACHRYMAL CARUNCLE GREER,C. H. The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria
A recent case of papillary cystadenoma and two recent cases of oxyphil cell adenomas of the lachrymal caruncle were described in order to illustrate the histological features of these tumours in this situation. Evidence was presented from the author’s histological material and from published reports, that parotid adenolymphomas, papillary cystadenomas and oxyphil cell adenomas are closely related tumours, all of which originate from cells which have undergone oncocytic transformation. These cells may be ductal or acinic cells in serous and mucous glands or occasionally surface epithelial cells in certain locations of which the lachrymal sac is one. HISTOLOGICAL MODIFICATION OF FIBROADENOMA OF THE BREAST ASSOCIATED WITH ORAL CONTRACEPTIVES BROWN,JENNIFER M. Institute of Medical and Veterinary Science, Adelaide, South Australia
The normal breast is very sensitive to hormonal influences. For example, it is constantly changing under the influence of the ovarian hormones throughout each menstrual cycle. Deviations from these normal patterns give rise to the changes of mammary dysplasia (i.e. fibrocystic disease of the breast). It is thought that the fibroadenoma may represent a variant of this condition rather than a true neoplasm. A case was presented of a woman of 25 yr. who noticed a lump in one breast five months after restarting oral hormonal contraceptives. Clinically, this appeared to be a fibroadenoma, but, on histological examination, it presented the unusual features of exaggerated and bizarre epithelial proliferation and conspicuous secretory activity -quite different from the usual microscopical appearances of fibroadenoma. Reference was made to a report of four such cases by Goldenberg et al. (Amer. J. clin. Path., 1968). It was felt that caution should be exercised in the histological interpretation, especially on frozen section, of doubtful mammary lesions in women who are taking oral contraceptives. ENDO CAR DIAL TH RO M BOSIS-I NCI D ENCE AN D SI G N I FlCANC E BURRY,A. F. Royal Brisbane Hospital, Queensland A prospective study was made of the incidence of endocardia1 thrombosis in 1,000 consecutive adult autopsies. Macroscopic thrombi were found in 17% of cases. Approximately half of these were not related to myocardial infarction and had a characteristic distribution in the heart.