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We report a case in which initially the wrong diagnosis of renal cell carcinoma with bone metastases was made. Nephrectomy and bone biopsy led to the right diagnosis of oncocytoma with transient osteoporosis. This report stresses the importance of pathological investigation and points to oncocytoma in the differential diagnosis of solid renal masses. In addition, the possible relationship between this tumour and migratory osteoporosis, which disappeared after surgery, is described.

In the past 30 years, staging and treatment of Hodgkin's disease have changed dramatically, and prolonged remission can now be induced in the majority of patients. Our purpose was to assess improvement in long-term survival, previously reported for specific patient groups, among unselected patients diagnosed and treated between 1972 and 1993 in general hospitals in South-East Netherlands. Data on all 345 Hodgkin's patients were derived from the population-based Eindhoven Cancer Registry; histopathology and clinical records were reviewed. Follow-up was attained up to 1994. Relative survival rates, i.e. the ratio of observed to expected rates, were 80% after 5, 70% after 10 and 67% after 15 years. Independent prognostic factors for lower overall survival were (in decreasing order of significance): advanced age, histology (lymphocyte depletion), advanced stage and earlier period of diagnosis. Distribution of age and stage did not change over the study period, but there was a modest increase in the incidence of the nodular sclerosis histological subtype. Crude 5-year survival rates improved from 60% in the period 1972-1976 to 81% in the period of 1987-1992 (P < 0.005). The largest improvement occurred in the 1970s and was most prominent among those aged over 50 years. As previously reported, cured Hodgkin's patients exhibit a higher mortality rate, which can be explained by treatment-related long-term complications such as second malignancies and cardiovascular diseases. The relatively high survival rates compared to other population-based studies may be attributable to the existence of a regional network within the framework of a comprehensive cancer centre. Better staging, new combinations of chemotherapy, improved radiation technology, advances in supportive care as well as more frequent intensive treatment of the elderly could explain the improvement in prognosis.

A 56-year-old woman is reported with severe ulcerative colitis who developed a corticosteroid-resistant haemolytic anaemia. The pathogenesis and treatment options in ulcerative-colitis-related haemolytic anaemia are discussed.

To assess the reliability of DNA estimation using image cytometry, deparaffinized lymph nodes from 70 patients with Hodgkin's disease were examined and the results obtained were compared with those from flow cytometry. Image analysis without discriminating between the various cell types, as found in Hodgkin's disease, revealed no separate aneuploid peak. Selecting on morphologically defined nuclear types DNA aneuploidy was detected in 20% of the cases (14/70). The aneuploid populations were limited to the population of nuclei defined as Reed-Sternberg (RS)-like or medium-sized lymphocytes. Benign lymph nodes DNA aneuploidy was not found in any of the controls. Comparison of DNA histograms obtained by image and flow cytometry showed aneuploid peaks using image cytometry in 4 of 30 diploid and 10 of 40 aneuploid flow histograms. In conclusion, image analysis using the CAS 200 system as compared to flow cytometry is more time-consuming and less sensitive to assess ploidy status, although it may provide extra information in some selected cases. Evidence is obtained that DNA aneuploidy in Hodgkin's disease is preferentially expressed by cells with the RS/H-like and medium-sized lymphocyte morphology.

Background: The p53 gene has a tumor-suppressor function. The mutated gene encodes for a protein which has a longer half-life than the normal p53 protein. This enables the detection of the mutated p53 protein by immunohistochemistry., Materials and Methods: In this study we examined 53 lymph nodes of patients with Hodgkin's disease for the presence of p53. The lymph nodes were stained with DO-1 and CM-1, two antibodies directed against the p53 protein., Results: DO-1 weakly stained 2/14 samples positively, and CM-1 10/25. When preincubated with Target Unmasking Fluid, CM-1 stained 51/53 samples positively. Although, only Hodgkin and Reed-Sternberg cells stained positively, p53-negative Hodgkin and Reed-Sternberg cells were also seen in the same sample., Conclusion: Based on these results, we conclude that the p53 mutated protein is present in a high number of cases with Hodgkin's disease, which is suggestive for an important event in the pathophysiology of the disease. In addition, because of the absence of positive staining in the surrounding lymphocytes, these cells are unlikely to be part of the malignant clone.

Paraffin-embedded lymph nodes from patients with Hodgkin's disease were examined for flow cytometric DNA content. In order to increase the sensitivity of the assay we tried to enrich for the neoplastic cells by bivariate analysis using a polyclonal anti-nucleolar antibody (AN-AB) and the forward scatter (FSC). DNA aneuploidy was found to be present in 67 of all 137 cases (49%), in 24 cases only demonstrable by dual-parameter analysis. The DNA index varied from 0.69 to 1.89 with a total of 22 hypo-diploid cases. The number of aneuploid nuclei exceeded the expected frequency of Reed-Sternberg (RS) and Hodgkin (H) cells in most of the analysed specimens. In conclusion, flow cytometry in Hodgkin's disease appears to give useful information regarding the ploidy status and evidence has been provided that the malignant cell population in Hodgkin's disease is not limited to the classical RS/H cells.

Background: Aneuploidy and S-phase fraction are well recognized prognostic features of solid tumors and non-Hodgkin's lymphoma. However, only limited data on Hodgkin's disease are available., Patients and Methods: In this study flow cytometric data on ploidy status and S-phase fraction are analyzed in relation to clinical characteristics and prognosis in 137 patients with Hodgkin's disease., Results: The presence of DNA aneuploidy was not associated with other clinical characteristics. When the histologic subtypes were clustered according to a higher number of Reed-Sternberg/Hodgkin cells into two classes (LP + NSI and the histologic NSII + MC + LD), it appeared that cases with an SPF > or = 7.5% had the histologic subtypes NSII + MC + LD significantly more frequently than those with an SPF < 7.5% (P = 0.001). There was no significant difference in complete remission rates, relapse-free or overall survivals between the patients with diploid and those with aneuploid lymph nodes. The complete remission rate for patients with and SPF < 7.5% was higher than for those with an SPF > or = 7.5%, 95% (56/59) and 76% (50/66), respectively (P = 0.006). The 10-year survival rate was 78% for patients with an SPF < 7.5% and 48% for those with an SPF > or = 7.5% (P = 0.04). However, by multivariate analysis only the ESR, age and clinical stage proved to be of independent prognostic importance., Conclusion: DNA aneuploidy did not correlate with known prognostic factors or survival, but the SPF might turn out to be an indicator of patients who will have less favourable outcomes.

Sulphasalazine is an active agent in the treatment of chronic inflammatory bowel disease, but there are a number of well-known side effects, including pancreatitis. The newer 5-ASA agents are thought to be equally effective but less toxic. Here we describe a patient who developed a pancreatitis due to mesalamine; this was confirmed at rechallenge.

We describe a patient with panhypopituitarism and adrenal insufficiency associated with systemic AA-amyloidosis caused by tuberculosis. This case demonstrates the ongoing process of amyloidosis, despite a presumed cure for the tuberculosis more than 30 years previously. Difficulties in recognizing clinical symptoms and interpreting laboratory data in a patient on regular haemodialysis are discussed.