The mucin and gland content of 26 rectal biopsy specimens-five normal specimens,

SUMMARY Plasma calcium and phosphate concentrations and alkaline phosphatase activities were examined retrospectively in 50 patients with histologically proven osteomalacia and 50 age-and sexmatched control subjects with normal bone histology. An abnormal plasma alkaline phosphatase activity was more useful than an abnormal plasma calcium or phosphate concentration in distinguishing between normal and osteomalacic subjects, producing a false-negative rate of 140% and a falsepositive rate of 8 %. False-negative and false-positive rates of 10 % and 8 % respectively were obtained when the presence of an abnormality in any one of the three biochemical measurements was used as a predictor of histological osteomalacia. When discriminant analysis was applied to plasma calcium, phosphate and alkaline phosphatase together a false-negative rate of 12 %/ and a false-positive rate of 0 % was obtained.Sixty-two patients in whom a diagnosis of osteomalacia was suspected were investigated prospectively, using both single biochemical abnormalities and the classification functions derived from the discriminant analysis of all three biochemical measurements to predict the presence or absence of histological osteomalacia. Plasma alkaline phosphatase activity gave false-negative and falsepositive rates of 10% and 32% respectively but was a more reliable predictor of abnormal bone histology than were plasma calcium or plasma phosphate concentrations or the presence of an abnormality in any one of the three measurements. Discriminant analysis using plasma calcium, phosphate and alkaline phosphatase together produced a false-negative rate of 160% and a falsepositive rate of 10 %.We conclude that plasma alkaline phosphatase activity is the best single routine biochemical screening test for osteomalacia, although a high false-positive rate may occur. Direct discriminant analysis of plasma calcium, phosphate and alkaline phosphatase together provides a more sensitive method of detecting histological osteomalacia which should be useful in determining the prevalence of osteomalacia within high-risk populations.Osteomalacia is characterised histologically by defective bone mineralisation producing an increase in osteoid volume and seam thickness with decreased calcification fronts and a reduced mineralisation rate.The most common clinical manifestations are bone pain and proximal muscle weakness. Biochemically, hypocalcaemia, hypophosphataemia and a raised plasma alkaline phosphatase activity may occur. However, the clinical symptoms and signs are

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The light microscopic appearances of Tru-cut needle biopsies from 50 consecutive soft tissue tumours were assessed by three pathologists and compared with the definitive histological diagnosis. Forty-four patients had soft tissue sarcomas and six had benign soft tissue lesions. A correct predictive diagnosis of sarcoma was made on 87-98 per cent of adequate Tru-cut specimens, the accuracy varying between pathologists. Three sources of diagnostic error were recognized: false positive cores (8 per cent), false negative cores (8 per cent), and cores inadequate for diagnosis (16 per cent). The major source of confusion related to difficulties in differentiating infiltrating fibromatosis from malignant fibrous histiocytoma. The high sensitivity of Tru-cut needle biopsy suggests that it could be a valuable aid in the diagnosis of clinically suspected soft tissue sarcomas.

Kikuchi's disease (necrotising lymphadenitis) is characterised by cervical lymphadenopathy in young patients and may be mistaken for malignant disease both clinically and histologically. Microscopically, there is a varying degree of effacement of the lymph node architecture and necrosis with an infiltrate of "histiocytic" cells and absence of polymorphs. The disease is of unknown aetiology. It was originally described in Japan, and only 27 cases have been reported elsewhere (none in the United Kingdom), although it has probably been seen but not recognised. The clinical, histopathological, electron microscopic, and immunohistological findings in four cases of the disease were evaluated. copyright.