The risk of rupture of an abdominal aortic aneurysm increases with aortic diameter. To obtain insight into the pathological processes associated with the vascular remodeling that accompanies aortic dilatation, we compared the histological features and the activity of matrix metalloproteinases (MMPs) in biopsies from 21 small (4.0 to 5.5 cm in diameter) and 45 larger abdominal aortic aneurysms. The histological feature most clearly associated with enlarging aneurysm diameter was a higher density of inflammatory cells in the adventitia, P = .018. This inflammation was nonspecific, principally macrophages and B lymphocytes. Fibrosis of the adventitia provided compensatory thickening of the aortic wall as the aneurysm diameter increased. A combination of zymography and immunoblotting identified gelatinase A (MMP-2) as the principal metallogelatinase in small aneurysms, whereas zymography indicated an increasing activity of gelatinase B (MMP-9) in large aneurysms. Homogenates prepared from both small and large aneurysms had similar total activity against gelatin or type IV collagen. However, the concentration of gelatinase A, determined by immunoassay, was highest for small aneurysms: median concentrations, 385, 244, and 166 ng/mg protein for small aneurysms, large aneurysms, and atherosclerotic aorta, respectively. Immunolocalization studies indicated that gelatinase A was concentrated along fibrous tissue of both the acellular media and the atherosclerotic plaque. The recruitment of inflammatory cells into the adventitia, with subsequent elaboration of metalloproteinases, including gelatinase B, may contribute to the rapid growth and rupture of larger aneurysms.

Nineteen cases of mucinous carcinoma of the breast were studied. Twelve tumours were of the pure type, and seven were mixed. All had abundant neutral and acidic mucin, and stained strongly with CAM 5.2. Of the 12 pure mucinous tumours, six were devoid of argyrophilic granules and were S-100 negative, and only one was CEA positive. All six patients are alive with no evidence of recurrence (mean follow-up 42 months). The other six pure mucinous tumours were rich in argyrophilic granules. Five of these showed S-100 positivity and all were CEA positive. One patient developed local recurrence and one died of myocardial infarction with no evidence of tumour recurrence (mean follow-up 80 months). Of the seven mixed tumours, only one contained an occasional cell with argyrophilic granules and four had variable degrees of CEA positivity. Two patients died and one developed bony metastasis (mean follow-up 40 months). Our findings emphasise the microscopic and prognostic differences between the three subtypes of mucinous carcinoma of the breast, and support the concept of dividing pure mucinous tumours into two distinct subtypes. We suggest that the latter subtyping can be qualitatively made on the basis of the presence or absence of argyrophilic granules in the tumour cells.

SUMMARY An immunohistological method (Shintaku-Said method) for the demonstration of oestrogen receptors in routinely processed paraffin wax embedded tissue was applied to 19 cases of mucinous carcinoma of the breast. Seventeen (89%) tumours showed variable degrees of positivity and two were negative. In eight cases the receptors were also assayed biochemically using a dextrancoated charcoal method, and the results of the two methods showed good correlation. No difference in the distribution of positive and negative cases was noted between pure and mixed mucinous tumours, and in the latter group the pattern of staining of the mucinous elements was similar to that seen in the solid elements.It is concluded that the major advantage of this method is its ability to offer for study the distribution of the receptors in individual cells and specific histological structures. The results also indicate that most mucinous carcinomas of the breast are oestrogen receptor positive, irrespective of whether they are pure or mixed type.

A 56-year-old lady presented with striking peau d'orange-like, woody, diffuse infiltration of the skin of the upper, inner aspects of both arms and thighs. Initial biopsy specimens showed a granulomatous panniculitis with non-specific lymphohistiocytic infiltration. Clinical deterioration occurred with development of ascites and peripheral oedema; a single axillary node became palpable. Cytology of ascitic fluid, and histology and immunopathology of the axillary node, and of a further skin biopsy, now revealed diagnostic changes of a diffuse large cell lymphocytic lymphoma of T suppressor/cytotoxic type. Granulomatous panniculitis resulting in diffuse cutaneous infiltration may rarely be a presenting sign of malignant lymphoma.

Cervical endometriosis is usually a retrospective finding on histology. We describe the diverse symptomatology of the disease, wherein a suspicion of diagnosis may be raised. A series of five patients with cervical endometriosis confirmed on histology was identified. One patient was asymptomatic but examination revealed a mass arising from the cervix. Two patients presented with persistent postcoital bleeding, one patient with intermenstrual bleeding and one patient with both intermenstrual and postcoital bleeding. All patients were followed up with colposcopy and cervical biopsy. Persistence of symptoms determined the mode of treatment which included surgical management in the form of large loop excision of the transformation zone (LLETZ) biopsy in four patients. Cervical endometriosis is a benign condition which may present with symptoms such as persistent post-coital bleeding or intermenstrual bleeding. Colposcopy and cervical biopsy are pivotal to the diagnosis. This condition can be managed expectantly in asymptomatic patients and persistent symptoms may warrant surgery.

Orbital pseudotumour is a non-specific inflammation of the orbit which forms a tumour-like mass composed of increased connective tissue and ground substance with vascular proliferation and an infiltrate of chronic inflammatory cells. No demonstrable aetiological agents are found locally, and there is no evidence of specific disease entities such as Hodgkins, SLE or temporal arteritis.The condition may present in many different ways to the otolaryngologist, and is therefore a rare but important differential diagnosis to be born in mind. We report a rare case of orbital pseudotumour presenting initially with involvement of the maxillary antrum and in association with Riedel's thyroiditis.

Complications of Gastrooesophageaalreflux disease (GORD) are associated with supine or combined reflux. Upright reflux has been reported to be of less severity, but some reports have suggested a correlation between oesophagitis and post-prandial reflux (PPR).200 patients with reflux symptoms were analysed to establish the relative frequencies of uptight, supine and combined rellux, Further analysis was then carried out to establish the contribution of PPR. PPR was defined as % pH < 4 during periods of 60 minutes after eating, Results: 144 patients had abnormal pH profile, significant upright reflux being detected in 111 (77. I%), This was combined with significant supine reflux in 74 (66.6%) of the above. 37 (25.7%) of the total abnormal population had upright reflux alone and 33 (22.9%) had supine reflux only. In the pure upright refluxers (group A) PPR was < pH 4.0 for a mean of 17.1% of the total post-prandial time, and accounted for 30.2% of the total reflux time. In combined retluxers (group B) the mean duration of PPR was 27.6% of the post prandial time and accounted for 23.4% of total reflux. Supine refluxers (group C) PPR duration was 5.2% which represented 13% of total reflux in this group.Total % PPR % Restored to Normal Group A (n=37) 9.5 (7.5) 17,1(16.3) 51.0"** Group B (n = 74) 22.5 (16.6) 27.6 (21,1) 8.1% Group C (n = 33) 10.9 (8.3) 5.2 (4.2) 0%Mean % (+SD) *** p < 0.00I, Chi-square test.Elimination of PPR by subtracting PPR time from total reflux time restored 19 (51%) of group A and 6 (8.1%) of group B patients to within normal range, It is concluded that PPR is a significant factor in upright reflux which has implications for treatment. 2HOW GOOD IS OPEN COMMON BILE DUCT EXPLORATION?

A case of inferior vena caval (IVC) tumor penetration and obstruction, twenty years after treatment of uterine stromal endometriosis (low-grade stro mal sarcoma) is presented.