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

P65IMMUNOPHENOTYPIC VARIATION WITHIN CASES OFMULTIPLE MYELOMA{P} C Brodie 1 , D Horncastle 1 , C Giles 2 , A Rahemtulla 2 , K Naresh 11 Department of Histopathology, Hammersmith Hospital,, London, UnitedKingdom, 2 Department of Haematology, Hammersmith Hospital, London,United KingdomIntroduction: The immunophenotype of multiple myeloma cells resemblesnormal plasma cells, with frequent expression of CD38, CD138, CD79a andepithelial membrane antigen (EMA) but with aberrant expression of CD56 andcyclin D1. Variation in immunophenotypic profile within cases has not beencharacterised.Methods: Multiple myeloma cases with sequential bone marrow biopsies,accessioned by the histopathology department between October 2002 andDecember 2005, were retrieved. Expression of CD138, kappa, lambda, CD20,CD79a, CD56, cyclin D1 and EMA was recorded for each biopsy. Expressionin serial biopsies was compared and analysed with respect to prospectivelyrecorded clinical data including date of relapse, date of progression and status atlast follow-up.Results: 51 cases of multiple myeloma were assessed. All biopsies expressedCD138. Expression of kappa (38) and lambda (13) remained constant insuccessive biopsies. 21 cases (41%) showed a change in expression of one ormore antigen. CD20 expression changed in 4 cases, CD79a changed in 8,CD56 in 3, cyclin D1 in 3 and EMA in 6. There were potentially significantassociations between changes in the immunophenotype and disease outcome.Conclusions: Variability in immunophenotype within cases of multiplemyeloma is not an uncommon phenomenon and could have bearing on diseaseoutcome.P66T-cell Receptor Gene Rearrangements in Hodgkin’sLymphoma{P} L Venkatraman 1 , MA Catherwood 2 , P Kettle 11 Royal Victoria Hospital, Belfast Northern Ireland, United Kingdom,2 Belfast City Hospital, Belfast Northern Ireland, United KingdomIntroduction: B or T-cell clonality in Classic Hodgkin’s lymphoma (CHL) isdetected by polymerase chain reaction (PCR) of the microdissected Hodgkin-Reed Sternberg cells (H-RS) but seldom demonstrable by whole tissue DNAPCR. This aids the distinction between CHL, peripheral T-cell lymphoma(PTCL) and T-cell rich B-cell lymphoma.Patients and methods: We report 3 cases that were morphologically CHL buthad clonal TCR gene rearrangements, resulting in diagnostic uncertainty.Case 1 (58yrs, male) stage IIA nodular sclerosing CHL. Case 2 (29 yrs, female)stage IV CHL diagnosed on a lymph node needle aspirate and a bone marrowbiopsy. Case 3 (39yrs, female) stage III(2) mixed cellularity CHL noted onpreoperative investigations for rectal adenocarcinoma. Cases had predominantlymononuclear LCA-, CD15-CD30+, EBV-, Alk-1- Hodgkin cells. T-cellantigens were not expressed in cases 1 and 2; a proportion of Hodgkin cells incase 3 were CD3+ and CD4+. Whole tissue PCR revealed clonal TCR gamma(case 2) and TCR beta (cases 1 and 3) rearrangements. All receivedchemotherapy for CHL. Two patients are disease free after a short follow-up.Case 3 transformed to a high grade CD30+ T cell lymphoma 6 months afterdiagnosis and died 4 months later.Conclusion: The presence of clonal TCR on whole tissue DNA in H-RS cellssuggests a Hodgkin like PTCL rather than CHLP67Sudden Unexpected Death in the First Week of Life: AutopsySeries from a Single Specialist Centre{P} MA Weber, DJ Fowler, N Baxter, MT Ashworth, M Malone,NJ SebireUCL Institute of Child Health and Great Ormond Street Hospital forChildren, London, United KingdomIntroduction: Sudden unexpected death in the first week of life (suddenunexpected neonatal death or SUND) shares many features with SUDI but isusually not formally included in the SUDI group, which is limited to postperinataldeaths. The aim of this study was to review all SUND autopsiesperformed in a single specialist centre over a 10-year period, from 1996-2005.Methods: Retrospective analysis of >1,500 consecutively performed postmortemexaminations, all of which were carried out by specialist paediatricpathologists. The autopsies were performed according to a local protocol thatincluded the use of detailed ancillary investigations.Results: Of 1,516 post-mortem examinations overall, 180 were neonatal deathsin the first week of life, of which 55 (31%) presented as SUND. Almost half(49%) of these were explained following post-mortem examination; theremainder were unexplained, and a third of these were associated with cosleeping.Of the explained deaths, over 40% were associated with previouslyundiagnosed congenital abnormalities, with almost all of these due to clinicallyundetected congenital heart disease. In addition, there were three deaths fromunsuspected metabolic disease, including two medium chain acyl-CoAdeficiencies. There were no accidental or non-accidental deaths in this agegroup.Discussion: There are distinct differences between SUND and SUDI, withsignificantly more explained deaths in the former. Compared to SUDI, a muchhigher proportion of SUND are due to congenital abnormalities, whilst themajority of explained SUDI are reported to be infection related.P68Causes of Paediatric Death: Results of >1,500 Autopsies froma Single Specialist Centre{P} MA Weber, I Brooke, MT Ashworth, RA Risdon, M Malone,NJ SebireUCL Institute of Child Health and Great Ormond Street Hospital forChildren, London, United KingdomIntroduction: It is now recommended that perinatal and paediatric post-mortemexaminations are performed by specialist paediatric pathologists. This is anaudit of all paediatric autopsies from a single specialist institution over a 10-year period.Methods: Retrospective analysis of >1,500 consecutively performed autopsiesin a single centre from 1996 to 2005, all of which were carried out by specialistpaediatric pathologists to a common protocol.Results: There were 1,516 post-mortem examinations; excluding stillbirths andabortions, more than 70% were of infants 1 year of age. Whilstautopsy numbers have risen steadily during the study period, from 129 casesper annum in 1996 to 285 cases in 2005, the percentage of consented hospitalpost-mortems has decreased to 26% in 2005. Overall, 52% of all non-perinatalcoronial deaths were explained by the autopsy findings, whereas thecommonest indication for hospital autopsies was congenital abnormalities.Discussion: The increase in autopsy numbers in this centre is likely to be areflection of the current national trend to ensure that all paediatric autopsies areperformed in a specialist unit. The high proportion of sudden and unexpecteddeaths, and of congenital abnormalities, highlights the need of a specialistpathology service for the investigation of paediatric deaths.44 Winter Meeting (191 st ) 3–5 January 2007 Scientific Programme