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A young male aged 20 years had resection of the upper lobe of right lung for plasma cell granuloma. Five years later he developed three lesions in the brain, one of which was resected. Brain lesion showed similar histopathological picture. A unique case of plasma cell granuloma involving more than one organ is reported.

The morphological features of ENL, occurring in histoid leprosy are described. Its infrequent occurrence has been emphasised. The possible immunopathogenesis of its occurrence in histoid leprosy is briefly outlined.

The role of histopathology in the diagnosis of donovanosis was assessed in 42 patients. There was heavy infiltration of the dermis with plasma and mononuclear cells but with few lymphocytes and neutrophils. The epidermis contained focal collections of polymorphoneuclear leucocytes. Endothelial proliferation and dilation of dermal blood vessels was striking. Intracellular and extracellular Donovan bodies were shown in Giemsa stained sections from 40 patients. Pseudoepitheliomatous hyperplasia was found in biopsy specimens from a few patients.

Autopsy study of 60 cases of rheumatic heart disease is presented, demonstrating an increased incidence of panvalvulitis in our series. The presence of Aschoff bodies is correlated with the clinical and laboratory parameters of activity and their significance is discussed.

Histo-morphological changes of the coronary vessels in cases of rheumatic heart disease (RHD) have been studied in 60 cases. Involvement of intramyocardial branches of coronary vessels in the form of active rheumatic vasculitis or inactive lesions characterized by medial hypertrophy and replacement fibrosis was seen in 15 of 60 cases. These lesions may affect myocardial function. Atherosclerosis of the pulmonary trunk and its branches was frequently seen in these hearts, indicating that this may be an important index of pulmonary hypertension. An unusual association of bicuspid aortic stenosis and RHD was seen in one case. Another case showed acute myocardial infarction due to coronary embolism from bacterial vegetation of bacterial endocarditis.

The histopathological features in type I (lepra) reaction comprised a loose and disorganised granuloma in the upper and mid-dermis, dermal edema and variable cellular contents, namely, epithelioid cells, lymphocytes, giant cells, and macrophages. While ENL reactions, were characterised by predominant involvement of subcutaneous vessels, vasculitis, and polymorphonuclear infiltration in and around the blood vessels.

Histological appearances of the tissue fragments obtained by cavitron ultrasonic surgical aspirator (CUSA) were studied in 25 cases to determine whether the aspirated tissue could be used for diagnosis. It was found that a definite diagnosis could be made on the tissue removed by this method.

Cutaneous hypersensitivity and antibody-producing capacity were assessed in patients with lepromatous leprosy with defective immunity, by immunizing them with monomeric flagellin from Salmonella adelaide. Results were compared with those of controls, matched for age and sex, derived from similar socioeconomic stratum, but without any defect of the immunological system. In contrast to the normal individuals, who showed Jones-Mote type of hypersensitivity, no lepromatous patient could mount any 'delayed-in-time' cutaneous hypersensivivity reaction against an intradermal challenge of monomeric flagellin. However, when immunized through the subcutaneous route, both groups could produce adequate amounts of specific serum antibody. In addition to this unique split tolerance found in all lepromatous patients, some patients showed low levels of 'natural' IgM antibody, reduced formation of specific antibody when immunized through the subcutaneous route, and incomplete maturation of IgG class of anti-flagellin antibody. When immunized by the intradermal route, however, production of both anti-flagellin antibody and maturation of IgG antibody was significantly inhibited in normal adults but not in lepromatous patients. Thus, contrary to the earlier concept of hyperactivity of the humoral immune apparatus in lepromatous leprosy, the present study detected B-cell hypofunction in some patients.

Thirty six untreated cases of early syphilis comprising 10 primary and 26 secondary syphilis were included in the study. Primary syphilis depicted classical istopathological features of ulceration, exocytosis, perivascular infiltrate of lympocytes and plasma cells along with endothelial cell proliferation. Secondary syphilis, however, depicted intriguing features. Lichenoid infiltrate along with basal layer dissolution was seen in 3 and psoriasiform appearance in 1 cases. Three cases showed granulomatous reaction. One case manifesting as pruritic follicular rash had classical features on histopathology. Vascular changes were absent or inconspicuous in as many as 22.2% and 8.3% respectively.

The authors emphasize the meticulous search for microangioma under magnification in cases of spontaneous haematoma. Two cases of low flow (cryptic) arteriovenous malformations are described. The CT scan and angiography are non-contributory in detecting such lesions. These small-sized angiomas are buried in the wall of the haematoma cavity. Histologically there is evidence of thrombosis in arteriovenous malformation.

Fifty untreated vitiligo patients were subjected to histo-chemical examination using dopa reaction technique. Dopa positive melanocytes were absent in a large majority (82%) of cases. Increase in the number of supra-basal clear cells was observed in 70 percent. Presence of inflammatory infiltrate at dermo- epidermal junction along with basal cell layer-dissolution was seen in 7 cases. Grayish-black, void cells considered to be inactive melanocytes, were seen in the basal layer.

Twenty three clinically diagnosed histoid leprosy patients were subjected to histopathological and histochemical investigations. The histopathological features were comprise of a well-formed lesion surrounded by a pseudocapsule. In addition, a free, midly eosinophilic, uninvolved sub-epidermal zone, and variously arranged spindle-shaped histiocytes were noted in the lesion. Polygonal and foamy histiocytes were also sited in a few sections. The lesion also had a large number of solid staining acid-fast lepra bacilli. The latter might have stimulated a peculiar histiocytic tissue response almost identical to that seen in histiocytoma(cutis) but for the absence of haemosidrin and lipids.

Cutaneous tuberculosis incidence was recorded as 0.15%. Of the 42 patients, 23 had scrofuloderma, 17 lupus vulgaris, and 2 tuberculosis verrucosa cutis. Both men and women were affected by the disease in the second and third decades. Its duration was variable. An affirmative family history was elicited in five scrofuloderma patients. The clinical expression largely conformed to the ritual text. Variation in Mantoux test positivity was unremarkable. The disparity in the demonstration of bacilli in the smear and tissue sections was, however, quite apparent in scrofuloderma. The correlation of different parameters indicates a continuous spectrum, formed at one end by lupus vulgaris, and at another by scrofuloderma. A moderate to strongly positive Mantoux text, enormous lymphocytes in the granuloma, absence of tubercle bacilli, negative culture, and an apparently normal immunoprofile were features of lupus vulgaris; whereas scrofuloderma had a moderately positive Mantoux test, lesser number of lymphocytes in the granuloma, large number of bacilli in tissue smear and/or tissue section, raised levels of immunoglobulins, and a grossly lowered C3 levels. The other variants probably occupy a position in between.