2004 Summer Meeting - Amsterdam - The Pathological Society of ...

177
Spectrum Of Tonsillar Pathology In A Paediatric Referral
Centre: Correlation Of Histopathological Findings With
Clinical Asymmetry
B Vadgama , N J Sebire , M Malone , A D Ramsay
Great Ormond Street Hospital, London, United Kingdom
Tonsils are commonly encountered surgical specimens in general
histopathology departments. Tonsillectomy is advocated less frequently now
and clinical indications are more restrictive. In adults, a unilaterally enlarged
tonsil is an indication for surgery. Physiological hypertrophy is maximal
between the ages of 2 and 5, making clinical assessment difficult in a child. We
examined the spectrum of tonsillar and adenoidal histopathology in a specialist
paediatric unit and assessed the correlation with the clinical details provided.
We searched the histopathology computer database (1990–2003)
for all archived reports coded as tonsils and/or adenoids. Over 13.3 years, 120
surgical episodes were identified involving 119 patients. 111 were locally
resected (age range 1-17 years). The most common clinical details given were:
tonsillar asymmetry (17), obstructive sleep apnoea (12), tonsillar hypertrophy
(12), recurrent tonsillitis (11) and lymphadenopathy (7). 15 patients had known
haematological disorders including 10 with previously diagnosed lymphomas.
Bilateral tonsils alone (55) were by far the most common type of specimen,
followed by unilateral tonsils (16) and combined bilateral tonsils with adenoids
(13). 9 were referred slides sent for second opinion. Non-specific follicular
hyperplasia was seen in 74 cases and chronic tonsillitis confirmed in 8 cases.
Other diagnoses included: lymphangioma (4), storage disease (3) and viral
adenopathy (2). 7 malignant diagnoses comprised lymphomas (5),
rhabdomyosarcoma and alveolar soft part sarcoma. In 17 cases of clinical
asymmetry, 1 showed lymphoma, 4 acute or chronic tonsillitis and 12 follicular
hyperplasia.
This study highlights the poor correlation of childhood tonsillar
asymmetry with unfavourable histopathological findings.
178
Identification of Two Types of Ductal Types Malformations in
Meckel Syndrome By Computer-based Image-Analysis System
S. Adam 2 , Ph. Kahl 2 , H.F. Otto 2 , C. Sergi 1
1 University of Innsbruck, Innsbruck, Austria, 2 University of Heidelberg,
Heidelberg, Germany
Aims: The ductal plate malformation in Meckel syndrome might occur through
two histologic types: the first one (I) with cystic dilatation of the primitive
biliary structures and little intraportal fibrosis and the second one (II) with
pronounced intraportal fibrosis and no or little dilatation of the primitive biliary
structures. To support this hypothesis, we studied the liver in fetuses with
Meckel syndrome (14 type I, 7 type II).
Methods: Anti-pan-cytokeratins (AE 1+3) Mo-Abs and the avidin-biotinperoxidase
technique (Vectastain Elite ABC kit, Vector, Burlingame, CA) were
used. A computer-based image-analysis system was used consisting of the
following components: a light microscope (Zeiss, Jena, Germany), CCD
greyscale video camera (Sony CCD-IRIS, Sony Corp., Cologne, Germany),
BNC cable hook-up, an Intel-based personal computer equipped with video
frame grabber card, a Windows 3.11 operating system, Bioscan Optimas
version 5.2 software (Bioscan, Edmonds, WA) running in interlaced mode, a
20’’ colour monitor (GDM, 2063 MS, Stimmler, München, Germany), and a
drawing pad (Wacom digitizer II) equipped with an induction mouse.
Results: The amount of connective tissue obtained by subtracting the surface
values of the portal vein, portal artery and biliary structures to the portal tract
surface was greater in type II than type I (ratio connective tissue area / portal
tract area: 0.54 [type I] vs. 0.88 [type II]). The ratio between the area of all
biliary structures and the area of portal tracts was lower in type II than type I
lesions (0.37 [I] vs. 0.07 [II]).
Conclusions: Two types of ductal plate malformation may probably be
identified in Meckel syndrome.
179
Malaria in Kenya: Elective Report from Clinico-Pathological
Experiences in the Delivery Room and Paediatric Ward.
S. Kassam 1 , S. Nesbitt 2 , E. Sequeira 3 , S. Sayed 4 , C. Gontier
4 , A. Wasunna 5 , J. Odondi 6 , T. Mboya Okeyo 7 , N. Oster 8 , P.
Soothill 9 , C. Sergi 1 0
1 Dept. Paed. Pathology, Bristol, United Kingdom, 2 Dept. of Paediatrics,
Gertrude's Garden Children's Hosp., Nairobi, Kenya, 3 Dept. of Obs. &
Gyn., Aga Khan Hosp., Nairobi, Kenya, 4 Dept. of Pathology, Aga Khan
Hosp., Nairobi, Kenya, 5 Dept. of Paediatrics & Child Health, Univ. of
Nairobi, Nairobi, Kenya, 6 Trust HQ, Nyanza Provincial Hosp., Kisumu,
Kenya, 7 Dept. DSRS, Ministry of Health, Nairobi, Kenya, 8 Dept. of
Parasitology, Inst. of Hygiene, Univ. of Heidelberg, Heidelberg, Germany,
9 Dept. of Obs. & Gyn., Univ. of Bristol, Bristol, United Kingdom, 1 0 Inst.
of Pathology, Univ. of Innsbruck, Innsbruck, Austria
Aims: Malaria represents the fifth most important cause of illness among the
world's poorest population. It has been estimated that an average of 300 million
clinical cases of malaria occur every year at any one time, 90% of this burden
being in Africa. The first author (SNK) conducted an elective research rotation
in a malaria-endemic region in the West of Kenya. The aim was to study
materno-fetal complications of malaria infection during pregnancy.
Methods: Ninety malaria-infected and non-infected pregnancies were
studied using statistical and clinical methods. Ethical approval was obtained
from the Ministry of Health, Kenya and regional Hospitals. Patients provided
written, informed consent.
Results: 43% of patients under the age of 20 years had fever in the last four
weeks of pregnancy. 24% of low birth-weight babies (