A W Bates

Secondary neoplasms of the bladder are histological mimics of nontransitional cell primary tumours: clinicopathological and histological features of 282 cases

The incidence, anatomical localization and histological appearances of secondary neoplasms of the urinary bladder are described, with emphasis on the points of distinction from primary tumours.

Secondary neoplasms of the male genital tract with different patterns of involvement in adults and children

Aims

Malignant lymphoma of the urinary bladder: a clinicopathological study of 11 cases

Aim—To report the clinical and histological features and outcome of primary and secondary malignant lymphomas of the urinary bladder. Methods—Eleven cases of malignant lymphoma of the urinary bladder were obtained from the registry of cases at St Bartholomews and the Royal London Hospitals. The lymphomas were classified on the basis of their morphology and immunophenotype, and the clinical records were reviewed. Results—There were six primary lymphomas: three extranodal marginal zone lymphomas of mucosa associated lymphoid tissue (MALT) type and three diffuse large B cell lymphomas. Of the five secondary cases, four were diffuse large B cell lymphomas, one secondary to a systemic follicular follicle centre lymphoma, and one nodular sclerosis Hodgkins disease. Four patients with secondary lymphoma for whom follow up was available had died of disease within 13 months of diagnosis. Primary lymphomas followed a more indolent course. In one case, there was evidence of transformation from low grade MALT-type to diffuse large B cell lymphoma. The most common presenting symptom was haematuria. Cystoscopic appearances were of solid, sometimes necrotic tumours resembling transitional cell carcinoma, and in one case the tumours were multiple. These cases represented 0.2% of all bladder neoplasms. Conclusions—Diffuse large B cell lymphoma and MALT-type lymphoma are the most common primary malignant lymphomas of the bladder. Lymphoepithelial lesions in MALT-type lymphoma involve transitional epithelium, and their presence in high grade lymphoma suggests a primary origin owing to transformation of low grade MALT-type lymphoma. Primary and secondary diffuse large B cell lymphomas of the bladder are histologically similar, but the prognosis of the former is favourable.

Atypical mixed tumor of the skin - Histologic, immunohistochemical, and ultrastructural features in three cases and a review of the criteria for malignancy

Three cases of cutaneous mixed tumor with atypical features are described. These biphasic tumors comprise cords and nests of often plasmacytoid cells with areas of tubule formation, set in a chondroid stroma. The tumor cells show immunohistochemical positivity for both CAM 5.2 and S-100 and ultrastructural features of myoepithelium. The atypical histological features of an infiltrative margin, satellite tumor nodules, and tumor necrosis, which were present in these cases, have been described in malignant chondroid syringoma; however, a review of the small number of previous case reports demonstrates that histological appearances did not always correspond with apparent malignant potential in this tumor. The term atypical mixed tumor is recommended for tumors in which there are histological features of malignancy, especially local invasion, without proven metastases. Complete excision of the tumor and careful follow-up are advised, as at present the malignant potential of these tumors cannot be reliably predicted from their histological appearance.

Secondary solid neoplasms of the prostate: a clinico-pathological series of 51 cases

Abstract The incidence, presentation, and macroscopic and histological features of secondary solid neoplasms of the prostate gland are described with reference to their differential diagnoses. A continuous series of autopsy and surgical cases from the Royal London Hospital from 1907 to the present yielded a total of 51 secondary neoplasms involving the prostate: 24 at post-mortem examination and 27 surgical specimens. The histology of these specimens was re-examined. In 34 cases, tumour reached the prostate by direct spread: 29 from the bladder and 5 from the rectum. The most common primary sites of metastases to the prostate were lung (eight cases) and pancreas (two cases). There were isolated examples of metastases from the bladder, rectum, skin (malignant melanoma), breast, eye (malignant melanoma), adrenal cortex and gallbladder. Secondary neoplasms represented 2.1% of all neoplasms in surgical specimens, a similar proportion of the total number of malignant solid neoplasms as secondary tumours at other sites in the genitourinary tract. The patients were usually symptomatic, presenting with prostatism, haematuria or pelvic pain, almost always in those with widely disseminated disease.

The significance of secondary neoplasms of the urinary and male genital tract

Abstract. Secondary neoplasms account for some 1.6–3.0% of solid malignancies encountered in surgical specimens from the genitourinary tract. At autopsy the proportion is higher, largely due to sampling bias. The peak incidence occurs around the seventh decade, and male and female incidences are approximately equal at all sites except the kidney, which shows a male preponderance owing to an excess of metastatic lung cancer. Adenocarcinomas are the most common histological type of secondary neoplasm and may be histologically and immunohistochemically indistinguishable from primary neoplasms arising from colonic-type epithelial metaplasia. Seeding of tumour along the urinary passages does not appear to be a significant mechanism of metastasis, and spread from one part of the genitourinary tract to another is uncommon. Clinical information and ancillary investigations are more helpful than special histological techniques in differential diagnosis.

Defining eosinophilic colitis in children: insights from a retrospective case series.

Objectives: Although it is a well-described syndrome in infants, eosinophilic colitis is a loosely defined and poorly understood diagnosis in older children. The aims of this case series were to characterise colonic eosinophilia in children and to determine whether it represents a distinct clinicopathological condition. Methods: We retrospectively reviewed symptomatic children older than 12 months with the principal diagnosis of colonic eosinophilia who presented between January 2000 and February 2007 (n = 38) and a further 10 children whose colonic biopsies were reported as histologically normal. The eosinophil density in all available gastrointestinal biopsies (n = 620) of these children was determined using a validated quantitative morphometric method. Patients were subdivided according to mean colonic eosinophil levels into 3 groups (marked, moderate, or minimal colonic eosinophilia). The following patient information was obtained and compared among patient groups: symptoms prompting endoscopy, atopic history, outcome, serum C-reactive protein and total immunoglobulin E (IgE) levels, erythrocyte sedimentation rate, blood eosinophil count, and endoscopic findings. Results: In all 3 patient groups, there was a colonic gradient of decreasing eosinophil density from caecum to rectum. Upper gastrointestinal tract biopsies did not exhibit eosinophilia. Although a significant association (P = 0.03) between abnormal total IgE levels and moderate or severe colonic eosinophilia was found, there was no significant difference (P > 0.05) in other patient characteristics. Furthermore, follow-up data did not show a consistent relation between eosinophil density and progression of symptoms. Conclusions: We find no association between “eosinophilic colitis,” defined as a histologically demonstrated marked colonic eosinophilia, and symptoms, history of atopy, inflammatory markers, or clinical outcome.

Congenital gastrointestinal stromal tumour is morphologically indistinguishable from the adult form, but does not express CD117 and carries a favourable prognosis

Aims: The histological and immunohistochemical features of a congenital stromal tumour of the jejunum are compared with those of adult gastrointestinal stromal tumours (GIST). The literature concerning the diagnosis and prognosis of congenital small intestinal stromal tumours is reviewed.

“Indecent and Demoralising Representations”: Public Anatomy Museums in mid-Victorian England

On 18 December 1873, at Marlborough Street magistrates’ court in London, Messrs Roumanielle, Davidson, and Dennison pleaded guilty to offences under the Obscene Publications Act 1857, and the magistrate Mr Knox ordered that their property, which had been held by the court since February, be destroyed. The prosecuting solicitor, Mr Collette, asked for the “privilege” of beginning the destruction himself, which was immediately granted, and, accompanied by Police Inspector Harnett and Sergeant Butcher, he proceeded to smash with a hammer a collection of wax anatomical models, the fragments of which were then handed back to the defendants. The destroyed models “which were of the most elaborate character, and said to cost a considerable sum of money” had formed part of Kahns Anatomical Museum, which for more than twenty years had been the best-known popular medical exhibition in Britain.1 Jonathan Reinarz recently suggested that the museum was to nineteenth-century medical education what the clinic was to its practice: “museum medicine” focused students’ attention on particular anatomical sites of disease, dissected out from the rest of the body.2 Museums were particularly important to anatomy teaching, as they allowed more prolonged and careful study than the dissecting room, and availability of specimens could be guaranteed. In 1836, the anatomist Frederick Knox wrote that “[w]ithout museums the profession [of anatomy] would be in the state of man without a language”.3 Unlike the dissecting room, museums were open to the non-medical public. Only the well connected had an entree to the Royal College of Surgeons’ Museum, but there were smaller anatomy exhibitions in London and the provinces, open to anyone with the price of admission, in which models produced in Italy and France as aids to medical teaching were displayed to the public. The popularity of these museums suggests that, despite the concerns aired around the time of the 1832 Anatomy Act over the provision of cadavers for anatomists, the public regarded anatomy as an interesting and acceptable activity. Public anatomy museums were tolerated, or even recommended, by medical men, until the mid-1850s, when museums at which treatments for venereal disease were sold became targets for anti-quackery campaigns, in the course of which the medical profession made much of the “obscene” content of anatomy shows. The Obscene Publications Act was first employed against an anatomy museum in 1860 in Leeds, but London police and magistrates remained indifferent until the medical profession funded private prosecutions in the 1870s, when the last of the public anatomy museums was closed down. At the same time, anatomy assumed increasing prominence in medical training and by 1875 the General Medical Council required all medical students to undertake dissection. In the twentieth century, public anatomy museums received little attention from historians, and those who did discuss them tended to accept the medical professions characterization of them as disreputable places, catering for those seeking eroticism and coarse humour. In 1924, a description of Antonio Sartis exhibition, whose proprietor had been “so gentle, so quiet and patient in his explanations” of models that contemporary journalists and medical men had found unobjectionable, was included in an account of the Judge and Jury show, poses plastiques, and other “questionable” West End entertainments of the mid-nineteenth century.4 Later accounts of nineteenth-century public anatomy museums considered them primarily as popular entertainments or quack medicine shows.5 Rene Burmeister, however, re-evaluated them, accepting some of the educational claims made by their proprietors and noting that medical opposition arose after they had become linked with unorthodox medical practitioners.6 In this essay, I shall examine the content and purpose of popular anatomy museums and the medical professions response to them. Though advertised after the Anatomy Act as a means of learning something of anatomy without the unpleasantness of dissection, by the 1850s anatomy museums were also dispensing medical advice and treatments for venereal disease: the museum setting gave the vendor an air of medical authority, and horrifying models of diseases alarmed patients and entertained casual visitors. The medical professions labelling of public anatomy museums as obscene can be seen as a strategy for creating a medical monopoly of anatomy by categorizing it as knowledge from which laypeople could be excluded on moral grounds. Under English obscenity laws, professionals, by virtue of their education, social background and character, were deemed impervious to influences that could corrupt the weaker-minded public. By the 1870s, the practice of anatomy was the hurdle that initiated, and sometimes deterred, entrants to the medical profession. Though it enhanced the reputation of medical men as professional and dispassionate observers, anatomy was also seen as a potentially demoralizing science.

Xanthogranulomatous cystitis associated with malignant neoplasms of the bladder

Aims: Two cases of xanthogranulomatous cystitis in conjunction with malignant neoplasms of the bladder are described.