2007 Winter Meeting - London - The Pathological Society of Great ...

P49P50T-Regulatory Cells are Increased in the Cellular Infiltrates ofHypersensitivity Pneumonitis{P} DA Oble, RL KradinMassachusetts General Hospital, Boston, MA, United StatesHypersensitivity pneumonitis (HP) represents a pulmonary immune response toinhaled antigens characterized by peribronchiolar and interstitial T-lymphoidinfiltration and microgranulomas. T regulatory cells (Treg) play a role indown-regulating cellular immunity and can be identified by their expression ofFOXP3. We identified Treg and other lymphoid subsets in situ in five cases ofbiopsy-proven HP, non-specific interstitial pneumonitis (NSIP) and normallung. While an increased number of CD3 cells were present in HP relative toNSIP (p=0.03), the CD4/CD8 ratios for HP and NSIP were comparable (1.5 and1.4, respectively). Interestingly, HP showed increased FoxP3 positive Tregcompared to NSIP (p=0.02). We conclude that HP is specifically characterizedby an increase in Treg in situ. Further studies to elucidate the role of thislymphoid subset are in progress.This abstract is not availablefor publicationuntil after presentationat the MeetingP51Malignant Clear Cell Hidradenoma of the Vulva: A CaseReport and Review of the Literature{P} OJ Biedrzycki 1 , B Rufford 2 , DPJ Barton 2 , C Jameson 11 Department of Histopathology, The Royal Marsden Hospital, London,2 Department of Gynaecology, The Royal Mardsen Hospital, LondonClear cell hidradenoma (CCH) is a rare tumour derived from eccrine sweatglands with a predilection for the head, face and upper extremities. Itsbiological behaviour is unpredictable, although frank malignant transformationis reportedly rare (6.7% in one review). Malignant clear cell hidradenoma(MCCH) exists only as case reports or very small series in the literature.We present a 39yr old female who underwent marsupialisation of a presumedleft vulval Bartholin’s gland cyst. She had no significant past medical historyand her smear history was normal. Microscopy revealed a tumour with thefeatures of CCH; no atypia, necrosis or mitoses were seen. Ten months later,she developed enlarging left groin nodes, one of which contained a metastaticclear cell tumour. Radiology did not reveal any other primary source and thediagnosis of MCCH was confirmed by expert review. A re-excision of thevulval primary site was performed which contained residual tumour. She iscurrently free of any further recurrence nine months after excision of the lymphnode metastasis.The case highlights the difficulty in predicting the behaviour of CCH fromhistology alone and the importance of considering MCCH in the differentialdiagnosis of a lymph node containing a metastatic clear cell tumour.P52Pathological findings associated with the presence of a Mirenacoil at hysterectomy{P} H Rizkalla, M Higgins, P Kelehan, C O'HerlihyDepartments of Pathology, Obstetrics and Gynaecology, NationalMaternity Hospital, Dublin, IrelandThe Mirena intra-uterine system (IUS) has changed the management of womenwith menorrhagia. Sometimes IUS treatment fails and patients undergohysterectomy. We have reviewed the histopathological findings of the uteri offifty women undergoing hysterectomy, 48 of which had a clinical history ofabnormal uterine bleeding following unsuccessful IUS treatment. The meanpatient age was 42.7 years. The majority of women (60%) had the expectedappearance of atrophic endometrial glands and pseudodecidual stromal reaction.Thirty hysterectomy specimens contained benign leiomyomata with reducedreactivity in the enlarged uterine cavity and incomplete suppression of theendometrium. Fourteen specimens had adenomyosis, of which eight also hadfibroids. One specimen had, an atypical polypoid adenomyoma of theendometrium and fibroids. Four cases had invasive cervical squamous cellcarcinoma. Two specimens had endometrial hyperplasia where the IUS wasunsuccessful. Two specimens showed intrauterine misplacement of the IUS.Seven specimens showed no histological abnormalities.In conclusion, Although IUS can be used successfully in the treatment ofmenorrhagia due to uterine fibroids; in our series the majority of hysterectomiesfollowing failed IUS suppression of menorrhagia contained uterine fibroids.Specimens with cervical carcinoma highlighted the need to consider cervicalcauses in the investigation of abnormal uterine bleeding.40 Winter Meeting (191 st ) 3–5 January 2007 Scientific Programme