Aspirates (n = 163) from 157 patients with enlarged superficial lymph nodes were obtained over a 5-year period in a combined surgical/FNAC clinic. A definitive diagnosis was achieved in over 77% of the cases: benign 52.7%, malignant 25.1%. The diagnostic accuracy was 94.4%, sensitivity 85.4%, and specificity 100%. The false-negative rate was 12.5% but decreased to 3.5% when lymphoma cases were excluded. There were 36 cases of metastatic disease, the majority of which were from a primary breast carcinoma. The main diagnostic difficulty was in distinguishing low-grade lymphoma from reactive hyperplasia. An added advantage was that aspirated material could be used in ancillary tests to help with the differential diagnosis. FNAC has a well-defined role in the investigation of superficial lymphadenopathy. Used in the proper setting it will provide a definitive diagnosis in the majority of cases, especially relating to recurrent malignancy or metastatic disease. Patients with a reactive cytological picture and no clinically suspicious symptoms could be spared unnecessary surgery and reviewed through follow up. This technique is cost-effective, of high diagnostic accuracy, and results in considerable resource savings.

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A case ofa 60 year old man with malignant eccrine spiradenoma involving the perineum is described. Areas of typical eccrine spiradenoma were admixed with carcinomatous and sarcomatous elements. Immunohistochemical and ultrastructural analysis revealed no evidence of epithelial differentiation in the sarcomatous areas. The tumour qualified for the designation carcinosarcoma arising in eccrine spiradenoma. The clinical course was aggressive with rapid development of nodal and pulmonary metastases. Histology showed an intact epidermis with no evidence of dysplasia. A tumour was present within the dermis and subcutaneous fat. This had a variegated appearance and included areas of typical eccrine spiradenoma ( fig 1A). On high power examination two cell types were identified. Cells with round to ovoid nuclei containing evenly dispersed pale chromatin were admixed with smaller cells that had round hyperchromatic nuclei. Ductular structures were also present. In these areas, there was little nuclear pleomorphism and only an occasional mitotic figure was identified. Adjacent to the typical eccrine spiradenoma, carcinomatous areas were present ( fig 1B). Here, groups and cords of epithelioid cells were surrounded by a fibrovascular stroma. Again two cell types and glandular structures were present. However, tumour cell nuclei were pleomorphic with prominent nucleoli and mitotic figures were easily identified (mitotic count in the region of 10 in 10 high power fields).At the deep aspect of the neoplasm, sarcomatous areas were present (fig 1 C). Tumour cells were spindle shaped with no glandular formation or other discernible arrangement. There was marked nuclear pleomorphism with many multinucleate tumour giant cells. Tumour cells contained moderate to abundant eosinophilic cytoplasm, but cross striations were not identified. Numerous mitotic figures were present (mitotic count in the region of 20 in 10 high power fields), and there were large areas of necrosis. No chondroid areas or areas of osteoid formation were identified.Histology of several of the satellite lesions showed them to be composed of typical eccrine spiradenoma, located in the dermis.Sectioning of the left inguinal lymph node dissection specimen revealed several nodes, one of which was enlarged and necrotic. Histology of this node showed it to be almost totally replaced by metastatic tumour that was extensively necrotic. In areas, the tumour had a carcinomatous appearance, similar to the carcinomatous areas within the skin neoplasm. However, elsewhere the tumour had a sarcomatous appearance, identical to the corresponding areas within the cutaneous neoplasm.The other nodes showed no evidence of metastatic tumour.

antisocial, and had intellectual difficulties. A psychotherapist she saw regularly diagnosed a narcissistic personality disorder. After four years of self bleeding she stopped for one year, and her haemoglobin concentration became 120-130 g/l.

Bronchiolitis obliterans organizing pneumonia (BOOP) presents with fever, dyspnoea, pleuritic chest pain and hypoxia. The diagnosis can be made from radiological appearances on chest radiograph and CT scan correlated with histological findings following biopsy. We present a 52-year-old gentleman undergoing treatment for high grade non-Hodgkin's lymphoma who developed respiratory symptoms during chemotherapy. BOOP was diagnosed and he responded well to oral prednisolone. The cause of BOOP is often not certain. However, in this case we suspect pegylated filgrastim or rituximab as possible agents.

Semi-automatic image analysis was used to make a morphometrical assessment of 15 nuclear and cellular variables in normal (n = 20) and malignant (n = 30) colorectal epithelium. Principal components analysis on the matrix of correlations between variables identified four main sources of variation within the dataset. These were, in decreasing order of importance: (1) nuclear size, nuclear cytoplasmic ratio and nuclear position within the cell; (2) the variability of nuclear size; (3) nuclear elongation and polarity; (4) nuclear shape and its variation. Discriminant analysis was conducted between histologically normal mucosa (n = 10) and adenocarcinoma in ulcerative colitis (n = 20). Using stepwise variable selection, the mean nuclear cytoplasmic ratio (normal, mean 20.4 (s.d. +/- 2.0); tumour, mean 39.7 (s.d. +/- 7.0)) and the coefficient of variation of nucleus to cell apex distance (normal, mean 19.2 (s.d. +/- 7.5); tumour, mean 47.8 (s.d. +/- 9.1)) were chosen as discriminating features. They were used to derive a discriminant function which gave perfect discrimination between the two groups. Scatter plots of these two variables confirmed complete separation of normal mucosa from adenocarcinoma and provided a simple method of applying the discriminant function. Discriminatory performance did not deteriorate when the function was applied to further normals (n = 10) and adenocarcinoma (n = 10). This study highlights the descriptive differences between normal and malignant colorectal epithelium and shows that case allocation may be made to these two lesion categories using a morphometrically-derived classification rule.

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