Aspirates were obtained by introducing a 9 cm 22 gauge spinal needle connected to a 20 ml syringe into the area of the stricture, after accurate localisation, and applying suction while oscillating the needle for a few millimetres in its long axis within the lesion. At least two passes were made on each patient. Specimens were handled immediately by a cytology technician. Fine needle aspiration specimens were expressed onto glass slides and bile and cytology brushings were smeared directly on to slides. The slides were either fixed immediately in 95% alcohol solution and later stained by the Papanicolaou method or air dried and stained with the MayGrunwald-Giemsa stain. The syringe was then rinsed with Eagle's medium, centrifuged, and cytospin preparations made. Some smears were stained with the periodic acid-Schiff reagent with and without diastase digestion to identify mucin production. The slides were examined by two trained pathologists and coded as unsatisfactory (acellular), negative, highly suspicious for malignancy, or definitely positive.
Leiomyoma of the nose and paranasal sinuses is rare. It constitutes about 1 per cent of all benign tumours. This is due to the paucity of smooth muscle in the nose. In this paper, the authors present one case of vascular leiomyoma which arose in the inferior turbinate in a 64-year-old lady. It was treated by partial turbinectomy with the relief of her symptoms of nasal obstruction, epistaxis and facial pain. The English literature on the topic is reviewed.
Sweat gland abnormalities occur much more frequently than hitherto described in cutaneous graft versus host disease (GVHD). Two patterns of abnormalities were identified in 80 per cent of cases of acute GVHD: a cytopathic pattern consisting of a combination of basal vacuolopathy with or without lymphocytic infiltration and basal cell degeneration, and a proliferative pattern consisting of basal cell hyperplasia. In chronic GVHD, complete sweat gland destruction with fibrosis was commonly observed. Squamous metaplasia and dilation of the sweat glands were less frequently identified. Ki67 immunostaining confirmed proliferative activity in the basal cells of the distal duct. HLA-DR antigens were expressed on the basal cells of the duct and secretory glands in acute GVHD but not in normal skin. Langerhans cells were absent in both normal and abnormal sweat glands. The role of HLA-DR or Langerhans cells in the initiation of GVHD is questioned in the light of the new data and the primary involvement of proliferating cells is confirmed.
Three cases of angiolymphoid hyperplasia with eosinophilia are reported at the site of tetanus toxoid vaccination. All presented as nodules on the upper arm, a known adverse effect of the vaccine following superficial inoculation. Histologically the nodules showed numerous small and medium sized vessels, some lined by hyperplastic endothelial cells with perivascular lymphocytic cuffing and an inflammatory infiltrate of plasma cells, eosinophils and scattered mast cells. Lymphoid follicles replete with germinal centres were identified in the dermis and subcutaneous tissue. Immunostaining revealed a polytypic lymphoplasmacytic infiltrate and a curious IgE reticulated pattern within the germinal centres, a feature described in both Kimura's disease and angiolymphoid hyperplasia. The present study suggests that atopic reaction to tetanus toxoid may be an aetiological factor in some cases of angiolymphoid hyperplasia.
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