SUMMARY Sixty-three patients, who had had a partial gastrectomy 15-27 years previously, were examined by endoscopy and multiple mucosal biopsies. No patient had a completely normal gastric mucosa; they showed varying degrees of gastritis, intestinal metaplasia, and dysplasia; 21 % had significant dysplasia, and these are regarded as an 'at-risk' group requiring frequent follow-up examinations. One patient had severe dysplasia (carcinoma-in-situ), but no case of infiltrating carcinoma was found.
Sixty-three partial gastrectomy patients an average 20 years after surgery were reviewed by endoscopy and biopsy in 1977. No cases of invasive carcinoma were found. The patients were then divided into two groups. Those with moderate epithelial dysplasia (13 patients) were reviewed at 6-12 monthly intervals. One patient developed severe dysplasia but none developed an invasive carcinoma. The remaining patients with either no or mild dysplasia were offered endoscopy after 5 years and 24 agreed. Of the 12 patients with no dysplasia at the outset: 5 still had no dysplasia 5 years later, 3 had mild dysplasia and 4 now had moderate dysplasia. There were 12 with mild dysplasia at the first endoscopy, 9 remained unchanged at the review and 3 had moderate dysplasia. If dysplastic changes in gastric mucosa are pre-malignant, progression to invasive carcinoma would appear to be slow. Even 25 years after gastrectomy only a modest deterioration in the grade of dysplasia was found and no invasive cancer.
Among 38 male patients undergoing cystectomy for bladder carcinoma, invasion of the prostate, or coincident dysplasia or carcinoma of the prostatic ducts was found in 2 1 . It is suggested that these changes confer a poor prognosis with regard both t o response t o non-operative treatment and t o survival following cystectomy.A previous communication on transitional cell carcinoma involving the prostate diagnosed by transurethral surgery noted that in some patients with apparent primary prostatic transitional cell tumour there was evidence of carcinoma in situ elsewhere in the urothelium (Kirk et al., 1979). The present paper explores further the relationship between transitional cell tumours of bladder and prostate and discusses its prognostic significance.
Summary
A woman presented with painful enlargement of her parotid and submandibular glands. She was shown to have the previously unreported combination of idiopathic thrombocytopenic purpura, Sjögren’s syndrome, Hashimoto’s disease, and myasthenia gravis. Parotid gland biopsy and bone marrow examination showed the presence of a rare lymphoplasmacytoid lymphoma. There was amyloid deposition in the parotid glands, gums and on muscle biopsy. Immunohistochemical staining of the parotid lymphoma and amyloid was monotypic for lambda light chains, and there was also a lambda chain paraprotein. It is felt that the lymphoplasmacytic lymphoma was responsible for the light chain amyloidosis.
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