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AIM--To investigate overexpression of c-erbB2, expression of the p53 protein product and proliferation rates in benign breast lesions with specific reference to apocrine adenosis. METHODS--Twenty one cases of apocrine adenosis were stained with monoclonal antibodies to p185, the protein product of the c-erbB2 oncogene, the protein product of the p53 tumour suppressor gene and to the cell cycle related protein Ki67. Three cases were associated with concomitant ductal carcinoma in situ of large cell type and two were associated with invasive tubular or cribriform carcinoma. RESULTS--Twelve (57.1%) cases showed membrane staining for c-erbB2 oncoprotein of apocrine cells within sclerosing adenosis and six (28.6%) had occasional p53 protein positive cells. One case not associated with carcinoma showed extensive staining of apocrine metaplasia outside the area of apocrine adenosis. The proliferation rate, as measured by Ki67 staining, was increased in some of the lesions and all lesions showed at least some of the cells to be in the cell cycle. CONCLUSIONS--The expression of abnormal oncogene products and increased proliferation in some of these apocrine lesions questions the supposed degenerative nature of the atypia seen in such cases and suggests that there may be an association between these lesions and large cell ductal carcinoma in situ and hence invasive carcinoma.

Traditionally India ink has been used to mark surgical resection margins, more recently with acetone to aid drying. Alternative methods have been suggested in recent months, including solutions of alcian blue, and Tippex. These methods use one colour only and Tippex is radiodense. Artists' pigments have been used, but their radiodensity makes them unsuitable for the detailed mammograms of the sliced screened specimens. An alternative method was specifically designed for impalpable breast lesions. It is based on coloured gelatins that are painted on to the biopsy specimen before dissection. The markers are radiolucent, quick to set, and do not penetrate the connective tissue. They can be applied to both fresh and fixed tissues, and the cost is about 0.05 pounds a specimen. The system is also suitable for marking other large specimens.

A method called "backprocessing", for subgross examination of sections, ranging between 50 microns and 1 mm in thickness using a dissecting microscope was developed. It requires either archival or current diagnostic breast tissue. In this study tissue is assumed to have been already embedded in paraffin wax for immediate diagnostic purposes. The advantages of backprocessing include the ability to select valuable or rare diagnostic tissue from archival histopathological material, and the preservation of histological structure should further examination at 5 microns thickness be required at a later date.

Two cases of peritoneal granulomatous reactions to food starch are described. They followed bowel perforation and clinically mimicked tuberculous and glove-powder starch peritonitis. Their histological differences from corn-starch peritonitis warrant attention in the absence of previous documentation of starch as a component of peritoneal food granulomas. Food-starch granules tend to be larger than those of glove powder, are often oval, and may be extremely resistant to salivary diastase digestion.

A consecutive series of 1000 operative frozen section diagnoses was reviewed. Correct diagnosis was made at the time in 96.5% of the cases. Clinically relevant errors were found in 1.3% of the cases and unimportant errors in 0.9%. Diagnosis was deferred, to await subsequent paraffin sections, in a further 1.3%. All the errors and provisional diagnoses in the deferred cases were conservative false negative results; no false positive diagnosis of malignancy was made. The cases of incorrect or deferred diagnosis were analysed to ascertain the origin of the difficulties, which comprised: technical imperfection (three cases); the focal nature of the lesion (14); and pathological misinterpretation (28). More than one of these factors played a part in eight cases. Further retrospective assessment indicated that the factors leading to error or deferred diagnosis were avoidable in 57% and potentially avoidable in 43% of cases. Misinterpretation was the single factor responsible for all avoidable misdiagnoses or deferred diagnosis. None the less, unavoidable factors led to erroneous or deferred diagnosis in about 2% of operative frozen section requests. Using present methods this seems to be the irreducible minimum of failures to make the correct diagnosis when frozen sections are assessed.

The performance of carbon and metallic inks, silver nitrate solution, and artists' pigments mounted in acetone was compared for marking the surface of surgical biopsy specimens. Using India ink is an unsatisfactory procedure because of slow drying, messiness, and spreading of the ink. It is concluded that use of artists' pigments has many advantages over other reagents, because of their rapid drying, resistance to tissue processing, and the ability to mark simultaneously many different planes of excision. Furthermore, the pigments are readily visible, are distinguishable from each other on microscopical examination, and the method entails little extra cost.

An artefactual smooth muscle lesion was found in seven of 500 consecutive rectal biopsy specimens. The lesions had the deceptive appearance of a genuine tumour although none of the patients with the lesion had presented with a rectal mucosal swelling. The morphology of the lesion and its poor reproducibility under experimental conditions suggested that it was an artefact of the biopsy procedure: it was easily reproduced in resected specimens of large bowel using punch or basket forceps but not when using flat forceps. The presence of the lesion seems to depend on the type of forceps used rather than on differences in deployment and seems to be caused by avulsion of the superficial part of the muscularis propria and its incorporation into the tissues included in rectal biopsy specimens.

A patient is described with myeloma without paraproteinaemia or Bence Jones proteinuria in whom the tumour cells have been shown to contain monoclonal immunoglobulin. The use of immunoelectrophoresis and polyacrylamide gel electrophoresis has established, apparently for the first time, that the immunoglobulin components are present in the form of intact molecules and free light chains.

The first two cases of alpha chain disease from Central Africa are reported from Nigeria. Both patients show the classical features of the disease with diffuse involvement of the small bowel and malabsorption. The patients were lost to follow-up but died soon after diagnosis.