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Paracoccidioidomycosis is a systemic disease endemic to South America, but rarely recognised in other parts of the world. The patient we describe represents the first case of paracoccidioidomycosis observed in Trinidad.

A nerve sheath myxoma involving the breast has been examined by light and electron microscopy, and by immunohistochemical and histochemical methods. Electron microscopically, cells with features indicative of Schwann cells, perineural cells and fibroblasts were identified in the tumour and S-100 protein and vimentin positivity was demonstrated in the tumour cells. The mucoid matrix stained positive for chondroitin-4 or 6-sulphate in keeping with a cartilaginous lesion. These findings are discussed in relation to the uncertain histogenesis and the differential diagnoses of the tumour in the breast.

Summary Pre-operative diagnosis of segmental infarction of the omentum is difficult because of its rarity and non-specific clinical features. We present a case of omental infarction and suggest that ultrasound scan may be helpful in the diagnosis of this entity.

The incidence of primary neoplasms of the central nervous system in Trinidad is less than 1 case per 100.000 population per year. There is no significant difference in the sex and age distribution of the cases, but a definite racial difference is seen in the frequency of different CNS neoplasms.

We present our first case of actinomycosis in Trinidad and we believe this is also the first reported case of hepatic actinomycosis in the West Indies.

Amylase activity was studied in 70 specimens of normal endometrium, 21 normal endocervices, 19 endometrial carcinomas, and 20 endocervical adenocarcinomas. Amylase was observed in the secretory (8.7 per cent) but not in the proliferative phase of the menstrual cycle. It is possible that the presence of amylase activity may serve a functional role in the degradation of glycogen to glucose in the secretory endometrium. The great majority (90.5 per cent) of uterine cervices showed strong and extensive staining of the endocervical glands for amylase. No glycogen was demonstrated and the role of amylase in endocervical glands remains obscure. Amylase was observed in one (5.3 per cent) out of 19 cases of endometrial carcinoma, and the presence of this enzyme may be considered a eutopic rather than an ectopic expression. Amylase was not detected in any of the endocervical adenocarcinomas examined. This study has shown a complete loss of amylase activity in malignant transformation of endocervical glands and this could be attributable to the immature nature of de-differentiated neoplastic cells.

Occurrence and expression of cytokeratins were studied by the immunoperoxidase-antiperoxidase (PAP) technique in formalin-fixed, paraffin embedded material from 18 cases of carcinoid tumours of the gastrointestinal tract. Polyclonal antikeratin for wide spectrum screening was detected in 12 cases; low molecular weight cytokeratins, C19 and CAM5.2 were positive in majority of the cases whereas antikeratins for high molecular weight were negative in all. Similar positive immuno-reactivity with antibodies to cytokeratins were detected in the surrounding epithelial cells. These results suggest that carcinoids of the gastrointestinal tract originate from the endodermal stem cell and differentiates along one or more directions, and the immunohistochemical findings depend upon the direction of their differentiation.

A case of mesenteric venous thrombosis in a young woman receiving oral contraceptives is reported. This is the first case encountered in the Caribbean region.

To detect the presence of Herpes Simplex Virus Type 2 (HSV-2) and Human Papilloma Virus (HPV), common structural antigens in penile cancers, 20 squamous cell carcinomas were studied by immunohistochemical methods. All specimens were from Singaporeans ranging in age from 44 to 69 years. None of the specimens contained HSV-2 and HPV common structural antigens. The reasons for the absence of HPV common antigen were discussed. The significance of the association of HPV with penile cancers is uncertain. The role of HPV in the carcinogenesis of penile cancer is far from clear. Further studies need to be done and other possible causes have to be explored.

In the period 1975-1983 40 cases of histologically proven penile cancers were observed. Although penile cancer is relatively common in the Indians of India and the negro population of our Caribbean neighbour Jamaica, this study shows that it is quite infrequent among both the Indians and negroes living in Trinidad. This is due probably to better socioeconomic conditions in our population.

The histological, histochemical and immunohistochemical features of twenty gastrointestinal carcinoid tumours are presented. Histologically, the foregut and hindgut carcinoids showed trabecular pattern and midgut carcinoid tumours usually showed insular type of growth. Histochemically, using the silver stains by the Grimelius and Masson-Fontana techniques, most (18 cases) were argyrophilic and 8 were argentaffin positive. Two appendiceal carcinoids were non-reactive. Mucin positivity was noted in a case of mucin producing carcinoid of the appendix. Immunohistochemistry for wide spectrum keratin, cytokeratin PKK1, carcinoembryonic antigen, neuron-specific enolase, neurofilament and S-100 protein revealed epithelial and neural characteristics of carcinoid tumour cells. Wide spectrum keratin was positive in 12 while cytokeratin PKKI was negative in all. Carcinoembryonic antigen positivity was noted in 8 cases. Neuron-specific enolase immunoreactivity was seen in 18 cases whereas neurofilament was negative. S-100 protein positive cells were observed in close contact with and/or intermingled with tumour cells but the tumour cells themselves were negative. Immunoreactivity for somatostatin was seen in 8 cases, glucagon in three, and corticotrophin, insulin and gastrin in one case each. More than one hormone expression was noted in three cases, one each of gastric, appendiceal and rectal carcinoid tumours. These findings suggest that carcinoid tumours may develop from an uncommitted cell native to the site of tumour and differentiates along one or more directions, and the immunohistochemical findings and secretory profile of these tumour cells depend upon the direction of their differentiation.

Summary Endometriosis associated with massive ascites is an unusual combination. Only 12 cases have been reported since its first description by Brews in 1954. The authors report the first case where radical surgery was avoided because of successful hormonal therapy.

Five cases of rhinosporidiosis are reported for the first time from Trinidad and Tobago. All patients were males. The conjunctiva was the site of the lesion in four cases, the nose in one case.

Increased levels of plasma prorenin, an inactive form of renin, and renin were demonstrated during normal menstrual cycles and the source of this enzyme was thought to be the ovary. To demonstrate that endometrium may produce renin, an immunohistochemistry for human renin was used in this study. Renin containing cells either in the glands or in the stroma were demonstrated in 5 of 20 sections of endometria. Since a product of renin, angiotensin II has been found to have angiogenic properties and may have a role in repair process, we postulate that renin containing cells present only in proliferative phase endometria may be involved in repair or regeneration of the endometrium.

Summary Although gastric strangulation in an inguinal hernia has been reported on three previous occasions, recurrent gastric outlet obstruction due to this hernia has not been previously documented. Prolonged traction on the distal stomach by omentum and transverse colon can draw the antrum and pylorus into the hernia and produce gastric outlet obstruction.

Summary Primary choriocarcinoma of the ovary arising, presumably, from a germ cell is extremely rare. The patient, a 16 year old girl who presented with dysuria and frequency of micturition developed fatal haemoperitoneum due to rupture of a pure primary nongestational ovarian choriocarcinoma.

A review of 1726 breast lesions in West Indian women from Trinidad showed that the pattern of disease is significantly different from that reported in whites but similar to reports from India and Africa. This difference is mainly due to the high frequency of fibro-adenoma in our adolescent women. Fibro-adenoma was the commonest lesion (39.3 per cent), followed by mammary dysplasia (32 per cent) and carcinoma (21 per cent). Although carcinoma comprised only 21 per cent of all breast lesions, nearly 40 per cent of true neoplasms were malignant. We believe all suspicious breast lumps in black women need biopsy and further analysis of morphological components of benign breast lesions is necessary to evaluate precursors to cancer of the breast.

Summary Thirty post-menopausal women with breast abscess were treated at Port of Spain General Hospital, Trinidad, between 1976 and 1980. In this age group, breast abscess can be confused with cancer due to a lack of inflammatory features. History and physical examination are often not helpful in differentiating an abscess from carcinoma. Although the usual treatment of an abscess is incision and drainage, in post-menopausal women, excision of the lesion is helpful for accurate histological diagnosis.

An experience with six cases of fractured penis is described. A ‘rolling sign’ accurately identifies clot at the fracture site and facilitates a direct and rapid approach to the torn corpus cavernosum. Early operation hastens recovery and limits deformity.