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Background. In this study the MIB-1 immunostaining pattern as an index of cellular proliferation was analyzed in smears diagnosed as borderline dyskaryosis in order to establish whether the combination of human papillomavirus testing and MIB-1 staining could resolve equivocal cytology. Methods. Conventional Pap smears of 108 women diagnosed as borderline dyskaryosis were stained with MIB-1 and the proliferation index was assessed. These women were evaluated by colposcopy, histological sampling, and human papillomavirus, semi-quantitative evaluated by hybrid Capture II test. Results. All 64 human papillomavirus- and MIB-1-negative women had no underlying high-grade cervical intraepithelial neoplasia or cervical cancer. Forty of the 104 women with normal histology or cervical intraepithelial neoplasia I were positive for human papillomavirus, compared to only one positive MIB-1 test (i.e. proliferation index of more than 35%). Conclusions. Adding a MIB-1-test in human papillomavirus-positive women with equivocal cytology might reduce the number of colposcopies needed to predict ≥ cervical intraepithelial neoplasia II. With this approach only four instead of 43 human papillomavirus-positive women would have been referred for colposcopy.

The urinary bladder is lined by highly specialized epithelium, so-called urothelium or transitional cell epithelium. One specific characteristic of this urothelium is the ability to protect the human body against reabsorption of toxic elements excreted by the kidney. The constantly changing volume of urine in the bladder requires a high degree of stretching of the covering epithelium, while maintaining an intact barrier function. Unfortunately this highly specialized epithelium shows a strong tendency to develop neoplastic disease. In most industrialized parts of the world, bladder cancer constitutes an important issue in oncological health care (Rubben 1985).

Islet amyloid polypeptide is a recently discovered pancreatic polypeptide hormone which is produced by the B-cells of the islets of Langerhans and is co-secreted with insulin. IAPP is the formative protein in islet amyloid depositions in type-2 diabetes patients and in some non-diabetics.

The general aspects of sarcoidosis are presented, as well as some concepts derived from experimental work. Thereafter, a review of the literature on oral involvement in sarcoidosis is given, including the possible value of an oral biopsy in the case of suspected sarcoidosis. Finally, 3 patients — 2 with known sarcoidosis and 1 with unsuspected sarcoidosis — are presented as a brief illustration.

The case of a 64-year-old man with “ adenosquamous ” mesothelioma of the pleura is described. These two elements were intimately associated, which suggested that they formed an integral part of the tumor. To the authors, pluripotentiality of the mesothelium seems essential for the pathogenesis of this unusual neoplasm.

The introduction of a simple one-stage silver nitrate stain as a method of displaying nucleolar organizer regions (NOR's) in formalin-fixed tissue has made it possible to examine the significance of these structures in tumour pathology. In the current study argyrophilic proteins of the NOR's were studied in 39 consecutive patients with bladder tumours. The results indicate that the counting of silver staining particles is only of limited value in grading bladder tumours and that this method is not superior to other additional grading techniques such as histo-morphometry and flow cytometry.

The authors describe the results of the grading of bladder tumors using morphometry and then compare these with results of histologic grading of the same tumors by different pathologists. Nuclear sizes of cells obtained from superficial and deep cell layers of each carcinoma and from giant cells were measured in 27 cases in which histologic tumor grading by different pathologists was unequivocal. In cells from all three areas, nuclear area increased with higher tumor grade. However, tumors of grades I and II showed significant differences in the size only of the large cells. It is concluded that morphometry is a valuable tool in the objective grading of bladder tumors, with the exception of carcinoma in situ lining the bladder lumen.

The stromal characteristics in papillary and non-papillary tumours of the urinary bladder were investigated in an attempt to improve the accuracy of histopathological diagnosis. It appeared to be possible to differentiate true papillary tumours from pseudopapillary structures lined by carcinoma in situ. Stromal differences were not found in cases of carcinoma in situ accompanied by denuding cystitis and cystitis due to other aetiological factors. It is concluded that histopathological examination of the stroma of bladder tumours improves diagnostic accuracy.

In order to test the reproducibility of a histomorphometrical grading system of bladder tumours, 15 tumours were twice measured independently by three pathologists. The data obtained were then analysed and compared with that of histological grading only. The way in which these morphometrical results are presented to the clinician in a computerized report is described. The need for a satisfactory reliable reproducibility test of every histomorphometrical grading system before introduction in diagnostic pathology is discussed.

Thirty men and 7 women with malignant mesothelioma seen at the Free University Hospital from 1st January 1960 until 1st July 1981 were reviewed. The histological, histochemical and morphometrical findings are reported. These findings are compared with 25 cases of pleural metastatic carcinoma and 25 cases of reactive pleural lesions. Fourty-nine percent of malignant mesotheliomas produced hyaluronic acid, however all cases of pleural metastatic carcinomas failed to produce this substance. All cases of malignant mesothelioma were D-PAS negative while 15 cases of pleural metastatic carcinoma showed reactivity to D-PAS. All cases of malignant mesothelioma and 9 cases of metastases were CEA negative. To distinguish malignant mesothelioma from metastases it is advisable to perform the D-PAS staining first. If it is negative mesothelioma can be confirmed by showing hyaluronic acid activity. A positive CEA staining rules out mesothelioma. In our study it was shown that with these methods 18 of 37 mesotheliomas could be identified with certainty, and 22 of the 25 carcinoma metastases. Morphometrically the malignant mesotheliomas could not be distinguished from the metastases, however the reactive pleural lesions had smaller nuclei than the malignant cells with mean values below 30 mu2. In the malignant cases these values had a range from 36 to 101 mu2. In distinguishing between reactive pleural lesions and malignant mesothelioma the production of hyaluronic acid points to the malignant character of the lesion. Thus histochemistry and immunostaining are important in the distinction of malignant mesothelioma from metastases, while the value of morphometry lies mainly in the seperation of reactive lesions from malignant mesothelioma.

In three of 52 consecutive patients with a painful mass in the right lower quadrant, ultrasound (US) disclosed severe mural thickening of the terminal ileum and cecum and moderate mural thickening of the appendix. In all three, the tentative diagnosis of Crohn disease was subsequently confirmed. If these US features are found in a patient with a suspected appendiceal mass, the diagnosis of Crohn disease must be seriously considered, and further evaluation is imperative.

Summary The case of a 66 year-old women with a peritoneal mesothelioma is described, which manifested itself as a tumor in the umbilical region. The clinical, cytological, histological and electron microscopical features of the tumor are reported. The diagnostic problems of this tumor are discussed.

Levamisole (1.1–3.8 mg/kg daily) or a placebo was given in a randomized, double-blind study to 211 patients undergoing curative surgery for primary lung cancer. The treatment, in a fixed dose of one tablet (containing 50 mg or a placebo) t.i.d., was given for 3 days before the operation, and such 3-day courses were repeated every 2 weeks thereafter for 2 years. A significant reduction of the cancer mortality was observed at 18 and 21 months post surgery in the levamisole group. There was also a nonsignificant increase of the disease-free interval. In patients who had received more than 2 mg/kg (or more than 80 mg/m2) daily, the crude recurrence rates had been halved and the death rates reduced to one-third. No beneficial effect could be observed in the patients who had been given a lower dose. In the former, adequately dosed patients, the beneficial effect was more marked if the tumor had been more advanced at the time of surgery. In addition, the incidence of hematogenous secondaries was significantly reduced in the same group of patients.

In a detailed study of granulomas in lymph nodes of 19 patients with Sarcoidosis we assessed and correlated a number of features, with size, development and radiographic staging of the disease. Except with the epithelioid cells the number of constituent cells (lymphocytes, giant cells and polymorphs), size, confluency and degree of necrosis of the granulomas were found to be very variable within a single gland. This indicates that the granulomas are in different stages of activity at a given time. All the features studied showed little or no correlation with the radiographic staging, which suggests that the latter is not a good index of the extent of the disease.

Fifty-seven transurethrally resected bladder tumors were analyzed to determine whether different pathologists, using the World Health Organization grading system, graded the same bladder tumor differently (interindividual consistency) and whether the same pathologist graded a bladder tumor differently at different times (intraindividual consistency). Disturbingly high inter- and intraindividual inconsistency in the grading of bladder tumors was found. All pathologists showed essentially the same degree of intraindividual inconsistency: In almost 50 per cent of cases the tumor was graded differently at different times by the same pathologist. The inconsistencies might invalidate the usefulness of bladder tumor grading in clinical decision-making.

The histopathological diagnosis of squamous cell hyperplasia of the larynx is very subjective. Since morphometry is highly reproducible, this method was applied to routine processed slides of 45 such lesions to assess objectively the epithelial characteristics. In each case measurements of nuclei of 50 cells in the basal, intermediate, and superficial cell layers were carried out. The data were analysed statistically. The findings suggest that quantitative morphometry may be helpful for the histopathological classification of squamous cell hyperplasia of the laryngeal mucosa.

Several controlled studies in lung cancer have evaluated the adjuvant use of cytostatic chemotherapy. The results of these investigations, and particularly of the carefully randomized ones, have been disappointing as they range from a significant difference, to the disadvantage of chemotherapy [4], to some suggestion of benefit only [5]. In view of these data, two different attitudes can be taken in making further efforts to develop an effective adjuvant treatment modality for resectable lung cancer patients who are known to be seriously at risk of relapsing within the first few years after their operation. One research path is to continue using cytostatic chemotherapy but to more carefully select the drug(s) to be used, e.g., by relying on the known effects of these drugs in advanced cancer, and to scrutinize the intensity of the chemotherapeutic regimen to be given [7]. It seems obvious that this is a very delicate task as judged from the limited effectiveness of the wide range of available chemotherapeutic agents in advanced lung cancer, and, also, from the lack of well-established guidelines to choose a therapeutic scheme to be followed in the adjuvant setting. Moreover, if some amount of unexpected, divine intervention fails to occur, we will continuously have to deal with the sometimes very unpleasant side-effects of these drugs, even if such adverse effects may at first glance appear acceptable from the treating oncologist’s point of view: he is accustomed indeed to see more severe side-effects from more intensive treatment with the same drugs in patients with advanced malignancies.

Only 3% of patients with T1 bladder tumours die of bladder carcinoma within 5 years (Williams, Hammonds & Saunders 1977), therefore these patients are initially treated conservatively. There would however be benefits from being able to predict which patients should be treated more aggressively. Morphometry was applied to quantitate characteristic microscopical features of the removed T1 tumours in 16 patients who had survived for five years and in seven patients dead from the tumour, in order to evaluate the prognostic value of this method. The measurements of nuclear and cytoplasmic areas were made on routine H & E sections with a graphic tablet (ASM, Leitz). Statistical analysis of the obtained data revealed that there were significant differences between the two groups. It indicated that morphometric parameters of T1 bladder tumours can have prognostic as well as therapeutic significance which will be further tested in a prospective study.