In a 47-year-old man left nephrectomy was performed in 1982 because of a solitary metastasis arising from a bronchial adenoid cystic carcinoma which had been extirpated 23 years previously, in 1959. Whole-body CT scanning one year after nephrectomy disclosed no local recurrence or further metastasis. The importance of long follow-up after surgery for adenoid cystic carcinoma is emphasized.
The influence of misinformation on the reliability of the histopathological classification of bladder tumours was analysed. Four consultant pathologists assessed 40 biopsy specimens of bladder tumours staging invasion and grading the specimens according to the Bergkvist classification. A random sample of 20 specimens was accompanied by systematically distorted information ("bias"-unknown to the pathologists) about previous histological grading of the patient (bias group); the other 20 specimens were used as control group (non bias group). After 6 months a second round with the same specimens was arranged to assess the influence of bias on the intraobserver variation. Using kappa (kappa) statistics the chance corrected interobserver agreement rate was poor both in staging of invasion and grading according to the Bergkvist classification (kappa < 0.50). The kappa values in the intraobserver study ranged from poor to excellent with a tendency towards lower kappa when the observer had been biased. The kappa values in the assessment of malignancy were acceptable to excellent. False information did not affect the pathologists' diagnosis significantly.
The clinical and histopathological features of 3 cases of colourless granulocytic sarcoma preceding acute myelogenous leukaemia by 3, 12, and 18 months are presented. One patient had involvement of the jejunum, another patient had involvement of the vulva and cervix, the third patient had a bone tumour. In 2 patients a misdiagnosis of non‐Hodgkin's lymphoma of the histiocytic type was made, in 1 patient the initial diagnosis was eosinophilic granuloma. The diagnosis of granulocytic sarcoma depends upon the demonstration of granulocytic differentiation in the tumour. This should imply the use of naphthol AS‐D chloroacetate stain;touch imprints and electron microscopy. The differential diagnosis of granulocytic sarcoma and histiocytic lymphoma is discussed. The pertinent literature is reviewed.
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