The studied series comprised a self-selected sample in which there was doubt about the grade of atrophy and such a sample will produce lower kappa values than a random sample of gastric biopsies. The results nevertheless confirm that better guidelines and firm criteria are needed to properly diagnose and grade gastric atrophy. It is suggested that the use of two grades, low- and high-grade atrophy, akin to that in use for grading inflammatory bowel disorder (IBD)- associated dysplasia, could improve agreement. Furthermore optimal biopsy quality with full thickness mucosa and proper orientation appears important for grading gastric atrophy.

SUMMARY Lymphocytic gastritis is a histopathological entity characterised by the accumulation of small lymphocytes in the surface and foveolar epithelium. In order to investigate the correlation between endoscopy and histology in this condition, 192 observations selected on the basis of a presumed diagnosis of erosive or varioliform gastritis were reviewed. Ninety two instances corresponded to lymphocytic gastritis, while 100 did not show any particular microscopic feature and were labelled non-specific gastritis. There was a good correlation (48 of 58) between the diagnosis of the so-called varioliform gastritis and the histological evidence of lymphocytic gastritis. The correlation was even better when nodules, erosions, and enlarged folds were considered. Lymphocytic gastritis has a typical endoscopical appearance consisting of nodules, erosions, and large folds predominating in the gastric body. This contrasts with non-specific gastritis, which affects the antrum and produces erosions on a flat mucosa.We have previously described a histopathological form of gastritis characterised by a dense epithelial lymphocytic infiltration. Using this criterion for further research, this entity has been labelled 'lymphocytic gastritis'.'Our preliminary investigations have suggested the presence of a correlation between lymphocytic gastritis and the endoscopical features of nodules, thickened rugal folds, and erosions. These features appeared unusual and different from those seen in chronic gastritis.23The aims of the present retrospective study are to evaluate the correlation between endoscopic erosive or nodular forms of gastritis and the histological picture of lymphocytic gastritis, and to define the basic endoscopical lesions indicating a diagnosis of lymphocytic gastritis. Methods MATERIALThis retrospective study is based on the cases of

BACKGROUND.The evidence of an infectious agent other than human immunode-

Pancreases from insulin-dependent diabetics (IDDM), noninsulin-dependent diabetics (NIDDM), and nondiabetic subjects were analyzed by stereological and morphometrical methods in order to determine the weight of the lobe rich in pancreatic polypeptide (PP) cells in relation to the total weight of the pancreas and the volume density of PP cells in both parts of the gland, those rich and poor in PP cells. In control subjects, neither the relative weight of the lobe rich in PP cells, nor the volume density of PP cells varied significantly with aging. In IDDM and NIDDM, the volume density of PP cells was similar to that observed in control subjects. The total weight of the pancreas was markedly decreased in IDD because of an almost selective atrophy of the lobe poor in PP cells; the relative weight of the lobe rich in PP cells was thus much higher than that in control subjects. A less marked atrophy, restricted to the lobe poor in PP cells, was also observed in NIDDM. It is suggested that PP may exert a local trophic role which protects the lobe of the pancreas rich in PP cells from atrophy in diabetic patients. The results further show that the elevated levels of PP in the plasma of elderly or diabetic subjects cannot be ascribed to a hyperplasia of PP cells.

Leukaemic and lymphomatous infiltration of the appendix is rare and even rarer is acute appendicitis as the initial manifestation. From our routine biopsy material we collected four cases of haematological malignancies presenting as acute appendicitis or acute abdomen, caused or accompanied by tumoral infiltration of the appendix. Appendicitis was the initial manifestation that allowed diagnosis of the underlying disease. The clinical histories and histological examinations of the appendices and of one autopsy are described. We report the first detailed description of acute myeloid leukaemia involving the appendix, and three cases of lymphomatous infiltration of the appendix presenting with appendicitis, and give an overview of the literature. In these days of budgetary cuts in national health services, where one may be tempted not to have seemingly commonplace cases of appendicitis histologically verified, our cases emphasize that careful histopathological examination of all appendectomy specimens should be mandatory. Despite the fact that leukaemia and lymphoma of the appendix are rare, our cases illustrate that these must be included in the differential diagnosis of acute appendicitis and that physicians and surgeons have to be aware of these conditions.