Angiomyolipomas are tumours of uncertain histogenesis which occur only in the kidney. They may represent hamartomas or true benign tumours. Renal angiomyolipomas are uncommon, except in patients with tuberous sclerosis, where 40 to 80% have small bilateral tumours discovered incidentally at autopsy (Lynne et al., 1979). About 200 cases in the general population had been described by 1976 (Busch et al., 1976), but with newer techniques of investigation more asymptomatic tumours are being picked up incidentally. Histologically, the tumours from patients with tuberous sclerosis are indistinguishable from those found in patients without this condition. In patients with tuberous sclerosis the tumours tend to be small, multiple, bilateral and asymptomatic, while in other patients they are large and unilateral. The patients may present with recurrent renal symptoms or as an acute abdomen following haemorrhage. Despite microscopic features which might suggest aggressive behaviour, the tumours are usually benign and only endanger life from the effects of haemorrhage and renal failure (Farrow et al., 1968). On rare occasions they may recur following surgical treatment and invade adjacent soft tissue (Kragel and Toker, 1985).

Case reportThe cervical smear of a 28 year old nulliparous woman showed inflammation together with ova of Schistosoma haematobium (Fig. 1). Eighteen months earlier she had returned from a two year backpacking trip in Africa. She had visited Kenya, Uganda and Malawi. Four days had been spent on Lake Malawi swimming three times a day. She was asymptomatic. In particular, there had been no vaginal discharge, intermenstrual bleeding, postcoital bleeding, dyspareunia, urinary frequency or haematuria. She could not recollect having had pruritis or a fever during the five weeks following her African adventures.Abdominal and pelvic examinations were normal. Colposcopy showed numerous, cream-coloured, 2 4 mm diameter nodules within the squamous and metaplastic epithelium of the ectocervix. All the visible columnar epithelium was normal. Following the application of acetic acid, the nodules became relatively dark centrally with a surrounding pale halo (Fig. 2). The uptake of Schiller's iodine was reduced at these sites. There was also a small area of acetowhite epithelium showing mosaicism suggestive of high grade intraepithelial neoplasia. This area was well demarcated with iodine. No abnormalities were seen within vaginal or vulva1 skin.A punch biopsy taken from a cervical nodule contained many Schistosoma ova in the subepithelial stroma surrounded by a granulomatous reaction with multinucleate giant cells and eosinophils (Fig. 3). A worm pair was identified. A second biopsy confirmed the presence of grade 2 cervical intraepithelial neoplasia. No ova were found in two late morning urine specimens or in a sample of faeces. Her blood count was normal and her eosinophil count was not raised at 0 . 2 1~1 0~. A Schistosoma ELISA was positive at level 3. The Schistosoma infection was treated with a single 2 g dose of praziquantel. The intraepithelial neoplasia was managed by loop diathermy excision. No colposcopic abnormality was found at a six month follow up examination, but the Schistosoma ELISA was unchanged.

The technique of immunocytochemistry was used to identify myoglobin in kidney, confirming a diagnosis of neuroleptic malignant syndrome following an otherwise obscure autopsy in a decomposed body. The features of neuroleptic malignant syndrome are reviewed with a differential diagnosis of myoglobin renal casts. The report emphasizes a thorough and detailed assessment of deaths which occur during treatment with neuroleptic drugs.