A case of mixed hepatoblastoma in a woman is described. A survey of the English literature reveals 13 cases acceptable as mixed hepatoblastoma; these have been described and published under a variety of names. Difficulties in nomenclature and the histology of these cases are discussed. Diagnosis depends on the identification of both malignant mesenchymal and malignant epithelial elements. The former include myxoid connective tissue resembling primitive mesenchyme and areas resembling adult fibrosarcoma. Mature fibrous tissue with calcification and bone formation may be seen. Epithelial areas show tissue resembling fetal liver, poorly differentiated epithelial cells, and/or areas of adenocarcinoma. The current view on histogenesis is also given. 'mixed tumour' represent hepatoblastoma. This is made clear when surveying Milman's cases,5 collected from a review of the earlier literature. True hepatic teratoma, for example, may occur. Other names under which mixed hepatoblastoma of the adult has masqueraded include hepatic embryonic

Death during prostatectomyIn a recent report from this hospital,' three cases, one fatal, were described, of cardiovascular collapse due to absorption of irrigation fluid, occurring during transurethral resection of the prostate. However, the implications for pathologists conducting necropsies in such cases were not emphasised. Since then a further possible fatal case has occurred, as well as several "near misses" that were successfully treated. We now report the necropsy findings in these two fatal cases and stress the role of the pathologist in identifying the cause of death in such cases.The first case, as described in the original paper, was a man aged 76 who collapsed and died 30 minutes after the start of a routine transurethral resection of prostate (TUR). The anaesthetist, who had diagnosed and successfully treated other cases, suspected the diagnosis and took a blood sample for estimation of the serum NA+, during attempted resuscitation. This revealed a concentration of 86 mmol/l. At necropsy, there was evidence of pulmonary oedema and congestion and small effusions in all the body cavities. There was no evidence of significant cardiac disease, and the remainder of the necropsy was essentially negative. Further confirmation of absorption of irrigating fluid was obtained by estimation of the glycine concentration in the same blood sample as was used for the Na+ estimation. A level of 80 mmol/l (600 mg/100 ml) was reported. The concentration of glycine in the irrigating fluid is 1 5 g/100 ml of water. Glycine, a low molecular weight amino acid, is presumably distributed throughout the extracellular fluid, given time. However since death can occur rapidly, the degree of equilibration at the time of collapse or death is difficult to assess. Despite these limitations, one can calculate that at least three litres and probably more, was absorbed.The second patient was a man aged 77 who was admitted to a medical ward for investigation of drop attacks. Two days after admission he developed acute retention. Cardiological studies revealed evidence of ischaemic heart disease, and a systolic murmur was also apparent. A prostatectomy three years earlier had been uneventful. Two The interpretation of the results in this second case is much more difficult due to two factors. The necropsy was performed 65 hours after death, and there is evidence that Na+ concentrations fall after death, although there is considerable individual variation in the rate of fall.2 In addition, the patient was given 200 ml of 8-4% bicarbonate during resuscitation. In retrospect, we should have estimated the Na+ level in vitreous humour, since the concentrations at this site are much more stable post mortem,3 and estimated the blood glycine. Only then would we have been able to assess the degree of absorption. The amount of fluid absorbed and the degree of hyponatraemia was undoubtedly much less than in the first case, but with significant cardiac disease, it seems reasonable that lesser degrees may be fatal.In conclusion, the message seems ...

A case of pneumatosis intestinalis studied by light and electron microscopy is presented. The cysts are dilated lymphatic vessels. Abundant fine fatty globules are found in the cysts and in the histiocytes and multinucleated giant cells which line the lymphatics and which are present in the interstitium. The giant cell formation and florid histiocytic reaction are most probably due to leakage of fatty material from the dilated lymphatics.

It has been stated that carcinoma must never be diagnosed in the presence of granular cell myoblastoma,' in view of the associated pseudoepitheliomatous hyperplasia. We submit a case with collision tumours of squamous cell carcinoma and granular cell myoblastoma in the oesophagus as a rare example. Case reportA 68 year old woman presented with a history of two months' dysphagia and two years' intermittent indigestion and retrosternal discomfort. She had lost 9.5 kg in weight in four months. The patient had smoked up to 20 cigarettes a day for many years. Her past medical history was unremarkable. Barium swallow showed an irregular filling defect at the junction of the middle and lower third of the oesophagus. Oesophagoscopy confirmed a ragged lesion at 31 cm. After biopsy, which showed a well differentiated squamous cell carcinoma, oesophagogastrectomy was performed. Three months after operation the patient had recurrent dysphagia and a subsequent biopsy showed recurrent squamous cell carcinoma but no granular cell myoblastoma.The operation specimen comprised an 11 cm segment of distal oesophagus with a cuff of stomach 4 cm long. In the oesophagus there were two collision tumours (fig 1). One was an annular, grey, centrally ulcerated tumour (2.8 cm long and 1.5 cm deep) and the other a yellowish grey, umbilicated, submucosal tumour 2 cm in length and 1 cm in depth. The latter was situated on the gastric side of the ulcerated tumour, directly abutting on to it.The larger tumour was a moderately well differentiated squamous carcinoma (flg 2), in some areas arising from dysplastic surface epithelium, going through to the serosa; it affected two lymph nodes and showed venous invasion. The smaller submucosal tumour blended with the muscularis mucosae in places. It was separated from the muscularis propria by a narrow margin of unaffected submucosa. It was unencapsulated and consisted of syncytial cords and islands of large cells with finely granular eosinophilic cytoplasm and faint PAS positivity separated by a scanty fibrous stroma (fig 2). No mitoses were seen. The appearance of the tumour were typical of a benign granular cell myoblastoma. In all the sections a thin fibrous septa separated the lateral border of the granular cell myoblastoma from the carcinoma. In most areas there was a distinct gap between the myoblastoma and the surface squamous epithelium. Occasional islands of dysplastic epithelium were present overlying the myoblastoma. DiscussionThe present case illustrates collision tumours with a granular cell myoblastoma occurring contiguously with an invasive squamous cell carcinoma. It has been stated2 that a review of the world literature fails to demonstrate a case of true squamous carcinoma, as evidenced by metastasis, intimately associated with or caused by a granular cell myoblastoma." In the present case, however, there is unequivocal evidence of squamous carcinoma as shown by invasion through the serosa, lymph node metastases, venous invasion, and postoperative recurrence. In the 551 on 12 May 201...

Analysis of 86 patients who underwent salvage cystectomy following a radical course of radiotherapy for bladder cancer and 37 patients who underwent primary cystectomy has shown a greater survival for women than men. The following factors were associated with a significant deterioration in survival: 1. Age at time of cystectomy: post-operative mortality and tumour recurrence are greater over the age of 70. 2. Non-function of one kidney on IVU. 3. Grade 3 tumour on cystectomy specimen. 4. pT3 or pT4 tumour on cystectomy specimen.