Leonard R. Matz

The Causes of Malignant Melanoma: Results from the West Australian Lions Melanoma Research Project

In Australia malignant melanoma ranks forth among cancers as a cause of morbidity and premature death (Armstrong 1985). For this reason, and because the State of Western Australia has one of the highest incidence rates of melanoma in the world (Holman et al. 1980), we undertook a multidisciplinary research program embracing the epidemiology, histopathology, and clinical management of melanoma. A major component of our research was a population-based case-control study in which constitutional traits, sunlight exposure, hormones, diet and other possible causal factors were evaluated. We have already published several reports of the results relating to particular subject areas (Holman and Armstrong 1983, 1984 a, b; Holman et al. 1984 b, 1985; English et al. 1985). In this report we aim to bring together in summary form the key results of the project to date and to present new data on diet and other factors.

Inverted Urothelial Papilloma

Summary Summary Two examples of inverted urothelial papilloma are reported. One was from the renal pelvis, a site of origin not previously described. A study of serial sections showed that these lesions are not neoplasms, but an exaggerated form of the common urothelial crypt lesion.

High prevalence of osteoporosis in cardiac transplant recipients and discordance between biochemical turnover markers and bone histomorphometry

All patients attending the cardiac trans‐plantation clinic at the Royal Perth Hospital were investigated to determine the prevalence of osteoporosis and to assess changes in bone metabolism and histomorphometry in a cohort of cardiac transplant recipients.

Intravenous aminobisphosphonate in Paget's disease: clinical, biochemical, histomorphometric and radiological responses

Intravenous 3‐amino‐l‐hydroxypropylidene‐1, 1‐blsphosphonic acid (APD) was used to treat 26 patients with Pagets disease. Three daily dosages were studied; 20–30 mg/day in 20 patients, 45 mg/day in three patients and 60 mg/day in three patients, by daily 4‐hour Infusions for 2–10 days. The fasting urinary hydroxyprollne excretion (Hype) declined exponentially, reaching 50% of pretreatment values at 1·92±0·16 (mean±SEM) days. This initial rapid decline was complete by 4 days following treatment to a mean of 28·0±3·4% of pretreatment values. Thereafter, there was no significant decline in Hype. The Initial rate of decline of Hype was unchanged by Increasing the daily dose of APD. Transient non‐symptomatic hypocalcaemia with secondary hyperparathyroidism occurred In all patients. No adverse changes In the renal handling of calcium or phosphate, as seen with high‐dose 1‐hydroxyethylldene‐1,1‐bisphosphonate (EHDP), were seen in any patient on any daily dose. Fever occurred In 73% of patients in the first 2 days of treatment. Overall, there was a significant fall In the lymphocyte count (P> 0·005 febrile group, n=19; P> 0·02 non‐febrile group, n=7) and a fever‐dependent rise in the neutrophil count (P> 0·005 febrile group only). The occurrence of fever was associated with a more rapid decline in Hype, compared to the non‐febrile group, so that Hype was significantly lower in the febrile group by day 5 (P > 0·025). Seventy‐two per cent of patients with bone and/or joint pain reported a reduction in pain. APD therapy resulted in repair or arrest of progression of Pagetic lytlc bone lesions in those seven patients with measurable lesions. Quantitative histomorphometry was performed in eight patients. Significant Improvement was seen in all Indices. In the six patients for whom a post‐treatment calcification rate could be deter‐mined, there was no evidence of a mineralization defect. All patients with mild‐moderate disease (Hype > 10 μmol/IGF) achieved normal Hype and alkaline phosphatase values following a single course of APD. Provided that pretreatment Hype was · 10 μmol/IGF, an upper limit for the total dose of APD required to achieve normalization of Hype could be estimated. For those patients with ‘severe’ disease (defined as Hype > 10 μmot/1 GF), a reduction of > 50% In Hype could be achieved readily, but biochemical normalization was not possible with a single course of up to 315 mg of APD.

An improved method of analysis of observer variation between pathologists

An improved method of analysing interobserver variation in histopathological studies is described and illustrated, by use of data from a congruence survey of malignant melanoma. The method provides, between any number of pathologists, an assessment of overall agreement and of agreement on each individual category of a classification system. Adjustment for differences in chance agreement due to varying numbers of categories or an altered composition of cases is included in the analysis. A generalization of the procedure designed to measure the strength of associations between different categories is formulated and explained with the use of an example.

Collecting duct carcinoma of the kidney: a report of three cases and review of the literature

Summary Collecting duct carcinoma (CDC) of the kidney is a rare neoplasm arising from the medullary collecting ducts. The clinicopathological features of three cases are here presented to add to the 42 cases reported so far in the English language literature. Hematuria is the most common presenting symptom, although 10% of patients present with metastatic disease, often in neck lymph nodes. The tumor mass is typically centred on the medulla of the kidney and extends into the cortex. Radiological diagnosis may be difficult because the radiological features of CDC are poorly described. The histological appearances have been described as tubulo‐papillary, tubular, solid and sarcomatoid. Intracytoplasmic mucin may be present. The typical immunohistochemical profile is positive staining with antibodies for low and high molecular weight keratin and epithelial membrane antigen (EMA) and positive staining with the lectin Ulex europaeus agglutinin. Literature reports of cytogenetic characterisation show loss of chromosomes resulting in monosomies. Prognosis is poor as more than half of the reported cases have developed metastases or died within two years of presentation.Abbreviations: CDC, collecting duct carcinoma; EMA, epithelial membrane antigen; FNA, fine needle aspiration; RCC, renal cell carcinoma.

Collagenous colitis: A case report and review of the literature

Summary A case of collagenous colitis is reported and the literature reviewed. the disease presents with watery diarrhea and abdominal pain in middle‐aged subjects. Women predorninate in the small number of reported cases. Colonic and rectal biopsies show excessive collagenization of the so‐called collagen table in the superficial lamina propria. There is an associated degeneration and desquamation of the interglandular epithelial lining cells. the cause is not known but the clinical course with symptomatic treatment can wax and wane with corresponding deterioration or improvement in the biopsy features.

Ross River virus arthritis in Papua New Guinea

In 1975 it was reported that antibodies to Ross River virus (RRV) were present in the sera of many population groups in Papua New Guinea. We describe here 3 cases of polyarthritis that occurred in Port Moresby, the capital of Papua New Guinea, during 1980-81 and in which the diagnosis of RRV infection was confirmed by serological tests, and 3 other cases in which serological tests suggested RRV infection but were not diagnostic. A possible case of fatal RRV encephalitis is also reported.

THE COMPLEX OF MYXOMAS, SPOTTY PIGMENTATION AND ENDOCRINE OVERACTIVITY

We describe a 40‐year‐old male with acromegaly, multiple and recurrent cutaneous myxomas, spotty cutaneous pigmentation, a mammary myxoma, a large‐cell calcifying Sertoli cell tumour of the testis, and an unusual calcifying pigmented neuroectodermal tumour. He presented a combination of clinical and histological features not previously documented within the complex of myxomas, spotty pigmentation and endocrine overactivity, and therefore the findings broaden the spectrum of the syndrome.

The rye classification of a population based series of hodgkin’s disease patients in Western Australia

&NA; Data are presented on the incidence in Western Australia of subtypes of Hodgkins disease which were obtained by review of all cases of the disease notified between 1960 and 1974. Observations were also made on within‐ and between‐observer agreement on the use of the Rye classification by a group of 9 surgical pathologists, all in the day‐to‐day practice of pathology. Although many consensus diagnoses were made only after spirited discussion by the Group, the results suggested that general surgical pathologists can perform nearly as well as lymphoma experts. A comparison of the incidence of Hodgkins disease and distribution of Rye subtypes in Western Australia with 4 other populations showed a similar overall incidence but appreciable variation in the relative frequency of the subtypes—mainly in the proportions of nodular sclerosing and mixed cellularity.