- Email: [email protected]
The histological diagnosis of liposarcomas
ABSTRACTS OF ANNUAL MEETING 1978
309
of recent literature up to the end of 1977 reveals that there have been no cases of focal nodular hyperplasia associated with oral contraceptive therapy reported from this part of the world. 3.
PRIMARY NASAL LYMPHOMA WITH LONG SURVIVAL-POSSIBLE CHANGE TO IMMUNOBLASTIC SARCOMA. AFTER 25 YEARS
1. WARIlILL Patho!oKY Departmenl, Hamilton Medica! Lahoralory. and C. A. BAILEY Waikalo Hospital. Hamilton. Ne,,' Zealand
C.
M.
DAvm,
FAIRBROTHER
G. E. Waikato Hospilal. Dcpartmcnr IJj'Nuclear Medicine.
lTK had a nasal polyp removed in 1953 at the age of 28 yr, reported as a lymphosarcoma composed oflarge, oval, pale-staining cells with prominent nucleoli and surface necrosis containing inflammatory cells and plasma cells. He was treated with radiotherapy and had a clinical recurrence in 1954, but refused treatment. [n 196 I and 63 further biopsies were taken of which no record now exists. He remained free of disease till September 1977 when a large polyp was removed from the same site as the previous lesions. A further small 'granuloma' in the nose was removed a few months later; the histological picture had now completely altered to a very pleomorphic type of tumour with huge cells with huge nuclei and nucleoli and many giant cells. [n March 197R he developed a single lymph node enlargement in the left submandibular region with identical histology. Apart from the nasal lesions the patient is and always has been in excellent health. This man is therefore a case of primary lymphoma of the nose diagnosed 25 years ago with a recurrence 25 years later of the tumour with a remarkable change to a very pleomorphic type. The diagnosis is proffered that this was originally a mid-line maliKnant reticulosis which is a unique type of primary lymphoma of the nose to be differentiated from malignant mid-line granuloma, lymphosarcoma and plasmacytoma. An alternative diagnosis is that of primary immunocyloma of the nose. The lesion has now developed we believe into an immunoblastic sarcoma 25 years later- -there are minor elevations in the immunoglobulin levels, there is pyroninophilia, and immunoperoxidase stains for [gG are positive. This case is considered to be unique. REASSESSMENT OF THE SIGNIFICANCE OF SENILE PLAQUES IN AGEING HUMAN BRAINS J. KARIKS, A. PRYCE, S. NICOLLS & R. LEVICK
Oliver Latham Lahoratory. Sydney
Some uncertainty and confusion is still prevalent in medical publications about the significance of senile plaques when present in ageing human brains. After re-examination of 332 hrains which included 26 cases of Alzheimer presenile dementia, 129 cases of Alzheimer senile dementia, 149 cases of aged (age 70 yr and over) mentally disturbed patients, 9 mongols, and 19 cases of aged people (age 70 yr and over) without known mental disturbances, a conclusion is made that the presence of senile plaques and neurofibrillary degeneration in ageing human brains indicates either an overt or an incipient Alzheimer dementia. EXTENSIVE DAMAGE TO SUBSTANTIA NIGRA IN CHRONIC ALCOHOLICS
1.
KARIKS
Oliver Latham Lahoratory. Svdney
Neuronal depigmentation, necrosis, and increased pigment- melanin and iron--deposition in the perivascular spaces have been observed in the substantia nigra in 40 chronic alcoholic brains. Eosinophilic nuclear inclusions, the significance of which remains unclear, were noted with an increased frequency within the nuclei of the substantia nigra neurons. The observed frequency and severity of the damage to the substantia nigra in chronic alcoholics leaves little doubt that alcohol is able to cause yet another damage to the human brain. THE HISTOLOGICAL DIAGNOSIS OF LIPOSARCOMAS
P. W. ALLEN Institute of Medical and Veterinary Science, Branch Lahoratol'Y, Mount Gamhier. South Australia Liposarcomas arc tumours which differentiate as adult or embryonic adipose tissue, are likely to recur locally, and metastasize in at least a small proportion of cases. A tumour can be regarded as differentiating as adult or embryonic adipose tissue if it produces numbers of unequivocal lipid containing lipoblasts or, if lipoblasts are absent, it manifests a histological picture which is otherwise typical of either well differentiated myxoid liposarcoma or well differentiated sclerosing liposarcoma. Histological criteria for the diagnosis of lipoblasts and liposarcoma will be illustrated. Based on these diagnostic criteria, the incidence of liposarcoma in South Australia is approximately 2.4 cases per
310
ROYAL COLLEGE OF PATHOLOGISTS OF AUSTRALIA
Pathology (1979), It, April
million population per annum. This is comparable to the incidence of 2.5 per million per annum reported by Kindblom and colleagues in Sweden, suggesting that the histological criteria used in South Australia for the diagnosis of liposarcoma are the same as those operating in Sweden. If similar diagnostic criteria are employed throughout Australia, the Swedish follow-up figures and methods of treatment should be directly applicable in this country. Reference: KINDBLOM, L. G., ANGERVAl.l., L. & SVENSDEN, P. (1975): Liposarcoma. A clinical, radiographic and prognostic study. Acta. Path. Microbiol. Scand. Sect. A. Suppl. 253. WERNICKE-KORSAKOV LESIONS IN CORONER'S NECROPSIES
R. RODDA & R. CuMMINGS Department of Pathology, University of" Tasmania and Department of Forensic Pathology, Royal Hobart Hospital, Hobart Twelve cases are described in which the lesions of the Wernicke-Korsakov syndrome were found at postmortem examination although the diagnosis had not been made before death. In a one-year period there were 9 cases (5.3Y,') among 169 necropsies ordered by the coroner in unexpected or unexplained, non-violent deaths. The characteristic brain lesions were grossly apparent in 5 cases and identified only histologically in 7 cases. The findings suggest that in cases of coma or in cases found dead who might have been alcoholics, adequate postmortem examination of the brain is likely to demonstrate the lesions of the Wernicke-Korsakov syndrome in a significant number of them. NEUROPATHOLOGICAL FINDINGS IN 31 UNSELECTED PAPUA-NEW GUINEA BRAINS 1. KARIKS
Oliver Latham Lahoratory, Sydney
The mean adult male brain weight was l275g, with a range from I075g to 1550g. The mean adult female brain weight was 1165g, with a range from IOIOg to 1330g. On external macroscopic examination, 16 brains showed brachycephalic appearance and 7 brains showed prominent parietooccipital fissure. On microscopic examination, 8 brains showed media calcification in the arteries of globus pallidus, mild to moderate atherosclerotic changes and hyaline wall thickening was present in the subcortical and the basal ganglia arteries in 8 brains. Granular ependymitis was present in one case. Fragments of a sheathed filaria were seen in the brain of a 26-yr-old male. In 6 cases, a peculiar calcification surrounded the ventral surface of the medulla oblongata. 4.
FATAL INFLUENZA IN OTAGO DURING 1976
A. G. DEMPSTER Zealand
Pathology Department, University of Orago Medical School, Dunedin, New
An extensive outbreak of influenza caused by an H3N2 A 75 Victoria like strain of influenza occurred in Otago from May to August 1976. Despite the generally mild nature of the illness several confirmed fatalities occurred. Postmortem findings together with aspects of the clinical course are discussed in 7 fatal cases presumptively diagnosed as demonstrating the consequences of influenza. Virus was isolated in 5 instances. Four fatalities occurred in children aged 8 mth or younger. Two developed features of congestive cardiac failure weeks after an influenzal episode, one of which was confirmed virologically. Evidence of extensive healed myocarditis was found in each case. A third child aged 8 mth developed progressive respiratory failure over 48 h and demonstrated an extensive viral pneumonitis with alveolar exudate and hyaline membranes. Histological evidence of a viral pneumonitis with isolation of the virus was demonstrated in a IO-wk-old infant in whom there was no history of illness prior to death. Of two middle-aged adults both yielding virus on culture one developed progressive influenzal pneumonitis complicated by early straphylococcal bronchopneumonia, while the other developed an extensive necrotizing pneumonia and cerebral abscesses caused by an aspergillus species. A third, previously fit young woman, developed klebsiella pneumonia complicating an influenzal-like illness with development of thrombotic thrombocytopenic purpura and renal cortical necrosis. AN AUSTRALIAN CASE OF LEGIONNAIRES' DISEASE
J. HARKNESS, R. WRIGHT, D. BRYANT & B. O'CONNEl.l. Hospital, Sydney
Department of Microbiology, St Vincent's
A case of Legionnaires' disease in an Australian male will be described. This is believed to be the first such case diagnosed in the country.
309
of recent literature up to the end of 1977 reveals that there have been no cases of focal nodular hyperplasia associated with oral contraceptive therapy reported from this part of the world. 3.
PRIMARY NASAL LYMPHOMA WITH LONG SURVIVAL-POSSIBLE CHANGE TO IMMUNOBLASTIC SARCOMA. AFTER 25 YEARS
1. WARIlILL Patho!oKY Departmenl, Hamilton Medica! Lahoralory. and C. A. BAILEY Waikalo Hospital. Hamilton. Ne,,' Zealand
C.
M.
DAvm,
FAIRBROTHER
G. E. Waikato Hospilal. Dcpartmcnr IJj'Nuclear Medicine.
lTK had a nasal polyp removed in 1953 at the age of 28 yr, reported as a lymphosarcoma composed oflarge, oval, pale-staining cells with prominent nucleoli and surface necrosis containing inflammatory cells and plasma cells. He was treated with radiotherapy and had a clinical recurrence in 1954, but refused treatment. [n 196 I and 63 further biopsies were taken of which no record now exists. He remained free of disease till September 1977 when a large polyp was removed from the same site as the previous lesions. A further small 'granuloma' in the nose was removed a few months later; the histological picture had now completely altered to a very pleomorphic type of tumour with huge cells with huge nuclei and nucleoli and many giant cells. [n March 197R he developed a single lymph node enlargement in the left submandibular region with identical histology. Apart from the nasal lesions the patient is and always has been in excellent health. This man is therefore a case of primary lymphoma of the nose diagnosed 25 years ago with a recurrence 25 years later of the tumour with a remarkable change to a very pleomorphic type. The diagnosis is proffered that this was originally a mid-line maliKnant reticulosis which is a unique type of primary lymphoma of the nose to be differentiated from malignant mid-line granuloma, lymphosarcoma and plasmacytoma. An alternative diagnosis is that of primary immunocyloma of the nose. The lesion has now developed we believe into an immunoblastic sarcoma 25 years later- -there are minor elevations in the immunoglobulin levels, there is pyroninophilia, and immunoperoxidase stains for [gG are positive. This case is considered to be unique. REASSESSMENT OF THE SIGNIFICANCE OF SENILE PLAQUES IN AGEING HUMAN BRAINS J. KARIKS, A. PRYCE, S. NICOLLS & R. LEVICK
Oliver Latham Lahoratory. Sydney
Some uncertainty and confusion is still prevalent in medical publications about the significance of senile plaques when present in ageing human brains. After re-examination of 332 hrains which included 26 cases of Alzheimer presenile dementia, 129 cases of Alzheimer senile dementia, 149 cases of aged (age 70 yr and over) mentally disturbed patients, 9 mongols, and 19 cases of aged people (age 70 yr and over) without known mental disturbances, a conclusion is made that the presence of senile plaques and neurofibrillary degeneration in ageing human brains indicates either an overt or an incipient Alzheimer dementia. EXTENSIVE DAMAGE TO SUBSTANTIA NIGRA IN CHRONIC ALCOHOLICS
1.
KARIKS
Oliver Latham Lahoratory. Svdney
Neuronal depigmentation, necrosis, and increased pigment- melanin and iron--deposition in the perivascular spaces have been observed in the substantia nigra in 40 chronic alcoholic brains. Eosinophilic nuclear inclusions, the significance of which remains unclear, were noted with an increased frequency within the nuclei of the substantia nigra neurons. The observed frequency and severity of the damage to the substantia nigra in chronic alcoholics leaves little doubt that alcohol is able to cause yet another damage to the human brain. THE HISTOLOGICAL DIAGNOSIS OF LIPOSARCOMAS
P. W. ALLEN Institute of Medical and Veterinary Science, Branch Lahoratol'Y, Mount Gamhier. South Australia Liposarcomas arc tumours which differentiate as adult or embryonic adipose tissue, are likely to recur locally, and metastasize in at least a small proportion of cases. A tumour can be regarded as differentiating as adult or embryonic adipose tissue if it produces numbers of unequivocal lipid containing lipoblasts or, if lipoblasts are absent, it manifests a histological picture which is otherwise typical of either well differentiated myxoid liposarcoma or well differentiated sclerosing liposarcoma. Histological criteria for the diagnosis of lipoblasts and liposarcoma will be illustrated. Based on these diagnostic criteria, the incidence of liposarcoma in South Australia is approximately 2.4 cases per
310
ROYAL COLLEGE OF PATHOLOGISTS OF AUSTRALIA
Pathology (1979), It, April
million population per annum. This is comparable to the incidence of 2.5 per million per annum reported by Kindblom and colleagues in Sweden, suggesting that the histological criteria used in South Australia for the diagnosis of liposarcoma are the same as those operating in Sweden. If similar diagnostic criteria are employed throughout Australia, the Swedish follow-up figures and methods of treatment should be directly applicable in this country. Reference: KINDBLOM, L. G., ANGERVAl.l., L. & SVENSDEN, P. (1975): Liposarcoma. A clinical, radiographic and prognostic study. Acta. Path. Microbiol. Scand. Sect. A. Suppl. 253. WERNICKE-KORSAKOV LESIONS IN CORONER'S NECROPSIES
R. RODDA & R. CuMMINGS Department of Pathology, University of" Tasmania and Department of Forensic Pathology, Royal Hobart Hospital, Hobart Twelve cases are described in which the lesions of the Wernicke-Korsakov syndrome were found at postmortem examination although the diagnosis had not been made before death. In a one-year period there were 9 cases (5.3Y,') among 169 necropsies ordered by the coroner in unexpected or unexplained, non-violent deaths. The characteristic brain lesions were grossly apparent in 5 cases and identified only histologically in 7 cases. The findings suggest that in cases of coma or in cases found dead who might have been alcoholics, adequate postmortem examination of the brain is likely to demonstrate the lesions of the Wernicke-Korsakov syndrome in a significant number of them. NEUROPATHOLOGICAL FINDINGS IN 31 UNSELECTED PAPUA-NEW GUINEA BRAINS 1. KARIKS
Oliver Latham Lahoratory, Sydney
The mean adult male brain weight was l275g, with a range from I075g to 1550g. The mean adult female brain weight was 1165g, with a range from IOIOg to 1330g. On external macroscopic examination, 16 brains showed brachycephalic appearance and 7 brains showed prominent parietooccipital fissure. On microscopic examination, 8 brains showed media calcification in the arteries of globus pallidus, mild to moderate atherosclerotic changes and hyaline wall thickening was present in the subcortical and the basal ganglia arteries in 8 brains. Granular ependymitis was present in one case. Fragments of a sheathed filaria were seen in the brain of a 26-yr-old male. In 6 cases, a peculiar calcification surrounded the ventral surface of the medulla oblongata. 4.
FATAL INFLUENZA IN OTAGO DURING 1976
A. G. DEMPSTER Zealand
Pathology Department, University of Orago Medical School, Dunedin, New
An extensive outbreak of influenza caused by an H3N2 A 75 Victoria like strain of influenza occurred in Otago from May to August 1976. Despite the generally mild nature of the illness several confirmed fatalities occurred. Postmortem findings together with aspects of the clinical course are discussed in 7 fatal cases presumptively diagnosed as demonstrating the consequences of influenza. Virus was isolated in 5 instances. Four fatalities occurred in children aged 8 mth or younger. Two developed features of congestive cardiac failure weeks after an influenzal episode, one of which was confirmed virologically. Evidence of extensive healed myocarditis was found in each case. A third child aged 8 mth developed progressive respiratory failure over 48 h and demonstrated an extensive viral pneumonitis with alveolar exudate and hyaline membranes. Histological evidence of a viral pneumonitis with isolation of the virus was demonstrated in a IO-wk-old infant in whom there was no history of illness prior to death. Of two middle-aged adults both yielding virus on culture one developed progressive influenzal pneumonitis complicated by early straphylococcal bronchopneumonia, while the other developed an extensive necrotizing pneumonia and cerebral abscesses caused by an aspergillus species. A third, previously fit young woman, developed klebsiella pneumonia complicating an influenzal-like illness with development of thrombotic thrombocytopenic purpura and renal cortical necrosis. AN AUSTRALIAN CASE OF LEGIONNAIRES' DISEASE
J. HARKNESS, R. WRIGHT, D. BRYANT & B. O'CONNEl.l. Hospital, Sydney
Department of Microbiology, St Vincent's
A case of Legionnaires' disease in an Australian male will be described. This is believed to be the first such case diagnosed in the country.