Biphasic large cell neuroendocrine carcinoma--pure mucinous carcinoma of the gallbladder (MANEC): a unique combination.

INTRODUCTION: We report a case of primary combined large cell neuroendocrine carcinoma (LCNEC)--pure mucinous carcinoma of the gallbladder (MANEC)--which represents the first description of this entity. METHODS: The patient is a 59-year-old Italian male who underwent cholecystectomy under a preoperative diagnosis of cholecystitis with gallstones and gallbladder tumour. During laparotomy, cholecystectomy, liver wedge resection and regional lymph node dissection were performed. The resected gallbladder showed a thickened wall, gallstones and a 4 cm gelatinous, cauliflower-like soft tissue mass. RESULTS: Following surgery, the gallbladder tumour was diagnosed as a mixed endocrine-exocrine carcinoma. There was evidence of lymph node metastasis or direct liver invasion. The mucin-producing carcinoma was composed of poorly differentiated glandular cells with mucin lakes. The LCNEC was characterized by large cells with prominent nucleoli, coarse chromatin and a high mitotic rate. The cells showed an "organoid" growth pattern with rosette formation and frequent areas of necrosis. Chromogranin A, synaptophysin and CD56 were diffusely and strongly expressed. DISCUSSION: This case may provide helpful insights regarding the histogenesis of this unusual combination of tumors: the concept of a collision tumor between two neoplasms that have arisen in adjacent areas may be the best explanation for its pathogenesis.

[A useful panel in proliferative urothelial lesions: an analysis of cytokeratin 20, p53, CD44 and Ki-67 antigens]. / Panel di ausilio diagnostico nella patologia proliferativa uroteliale: studio degli antigeni citocheratina 20, p53, CD44 e Ki-67.

Urothelium can show several pseudoneoplastic lesions. Mimic lesions diagnosis is therapeutically and prognostically critical but it is often difficult on the basis of morphology alone in bladder biopsy specimen. We studied in a retrospective way an immunohistochemical panel that helps in this differential diagnosis. The panel includes antibodies against cytokeratin 20 (CK20), CD44, Ki67 (MIB-1) e p53 and we applied it to 31 cases of non-neoplastic urothelium (26 urothelial biopsies with reactive atypia and 5 normal urothelium) and 50 cases of urothelial neoplasia where we analized the distribution of the markers over the urothelium. We obtained two different "standard" results, for neoplastic and non-neoplastic urothelium. We were able to prove that this panel is useful, non expensive tool in the differential diagnosis of urothelial proliferative lesions.

Effect of a propolis extract and caffeic acid phenethyl ester on formation of aberrant crypt foci and tumors in the rat colon.

We have studied the effect of propolis and its main active ingredient caffeic acid phenetyl ester (CAPE) on formation of aberrant crypt foci (ACF) and tumors in the rat colon in vivo. CAPE (50 mg/kg i.p.) reduced the formation of ACF and tumor induced by azoxymethane, while propolis ethanolic extract was without effect. These results suggest a potential anti-carcinogenesis of CAPE but not propolis.

Role of nuclear factor-kappaB in a rat model of vascular injury.

In this study we have investigated the relationship between neointima formation and NF-kappaB activation in a model of endothelial denudation of rat carotid artery (balloon angioplasty) using the antioxidant pyrrolidine dithiocarbamate as inhibitor of NF-kappaB activation. Furthermore, we have correlated NF-kappaB activation to the expression of inducible isoforms of both nitric oxide synthase (iNOS) and cyclooxygenase (COX-2) in injured carotids. In control group a significant proliferation of neointima was observed 14 days after balloon angioplasty, which was correlated to an increase of NF-kappaB/DNA binding activity as well as p50/p65 nuclear levels compared to those observed in the carotids from naive or sham-operated rats. Furthermore, NF-kappaB activation was correlated to increased iNOS and COX-2, but not beta-actin, protein expression. Treatment of rats for 14 days with the antioxidant agent pyrrolidine dithiocarbamate (50, 100, 200 mg/kg per os and day) caused a significant inhibition of all the parameters assayed, except beta-actin protein expression. These results indicate that prevention of NF-kappaB activation may lead to the inhibition of neointima formation and suggest that antioxidant agents may have therapeutic relevance for the prevention of human restenosis.

Non neoplastic diseases of the prostate from transrectal biopsy.

Two hundred-seventy-six were screened with one or all diagnostic deviated parameters: neoplastic lesions were 115 (41.7%), non neoplastic were 144 (52.1%), unfit or suspicious were 17 (6.2%). These results are agreed with recent literature and confirm the effectiveness of methodology.

[Leiomyosarcoma of the small intestine and the colorectum. A case contribution]. / Il leiomiosarcoma del tenue e del colon-retto. Contributo casistico.

Smooth muscle tumors of the alimentary tract are uncommon. A retrospective study was made of 7 patients treated for leiomyosarcoma of the small and large bowel to identify prognostic factors that influence results. The symptoms associated with these tumors varied according to the anatomic sites of the lesions and the position of the growth in relation to the intestinal lumen but the most common presenting clinical signs are bleeding or obstruction. The differential diagnosis between benign and malignant smooth muscle tumors is sometimes quite difficult. Clinical behavior of the myosarcomas of the gastrointestinal tract can be predicted to a large extent by the site of the tumor, the presence or absence of invasion of adjacent vital organs, and the histopathologic grade of malignancy. Although the mitotic activity of a gastrointestinal stromal tumor remains the most critical prognostic factor, tumors have been seen to recur locally and to metastasize even with rare or absent mitotic figures. Further studies are needed to pinpoint the factors that may be correlated to the prognosis.

Acetic acid-induced colitis in normal and essential fatty acid deficient rats.

Eicosanoids and platelet-activating factor (PAF) production increases in experimental colitis. Both eicosanoids and PAF seem to arise from similar membrane phospholipids. To support both these suggestions we have investigated whether a fat-free diet, which should alter production of eicosanoids and PAF, affects experimental colitis. Essential fatty acid deficient (EFAD) rats were obtained by putting 4-week-old animals on a fat-free diet for 3 months. Experimental colitis was induced by a single intracolonic administration of 2 ml of 4% acetic acid. One to seven days later the animals were sacrificed and the colon removed to assess macroscopically and histologically intestinal damage. Eicosanoids and PAF levels were also measured in the mucosa scrapings by specific radioimmunoassay. The injury to the colon was more evident in control rats compared with EFAD rats. Besides colonic tissue of control rats showed a highly significant increase of PGE2, LTB4 and PAF, compared with levels in EFAD rats. Our results indicate that fat-free diet reduces tissue damage, and at the same time PGE2, LTB4 and PAF colonic content.

[Signet ring cell carcinoma of the rectum in a 15-year-old youngster]. / Carcinoma a signet ring cell del retto in un giovane di 15 anni.

Primary colonic signet ring cell carcinoma is a rare neoplasia. The prognosis is particularly poor with only very few patients surviving more than one year following diagnosis. We report a case of primary signet ring cells carcinoma of the rectum, detected in a 15 year old young male, particularly interesting for the patient young age and for good prognosis.

Recombinant secreted nonpancreatic phospholipase A2 induces a synovitis-like inflammation in the rat air pouch.

OBJECTIVE: The aim of this study was to test the proinflammatory action of human secreted phospholipase A2 (sPLA2) in an animal model of synovitis-like inflammation and to compare it with a Group 1 (porcine pancreatic) and a Group 2 (Naja mocambique mocambique) PLA2. METHODS: The subcutaneous injection of air in the rat pouch induced the formation of a connective tissue cavity lined with cells closely resembling a synovium. sPLA2 (0.01-10 micrograms/pouch) porcine pancreatic (10 micrograms/pouch), PLA2 or Naja mocambique mocambique PLA2 (10 micrograms/pouch) were injected in a 6-day rat air pouch. RESULTS: Our data show that recombinant human enzyme PLA2 (0.01-10 micrograms/pouch), but not Naja mocambique mocambique (Group 2 PLA2) and porcine pancreatic PLA2 (Group 1 PLA2), was able to exacerbate the inflammatory response without increasing eicosanoid release. CONCLUSION: Only sPLA2 was able to exacerbate rat air pouch and its effect was unrelated to eicosanoid release.

Essential fatty acid-deficient diet modifies PAF levels in stomach and duodenum of endotoxin-treated rats.

Platelet-activating factor (PAF) is thought to play an important role in pathogenesis of endotoxin shock. Here, using essential fatty acid deficient (EFAD) rats, we have evaluated changes in mean arterial blood pressure, PAF levels and damage in both stomach and duodenum following intravenous administration of endotoxin (LPS). In EFAD rats the second phase of LPS-induced hypotension was strongly reduced. Similarly, PAF levels in stomach and duodenum of EFAD rats were also reduced and correlated to the diminished damage. Our study confirms a direct involvement of PAF in LPS-induced gastrointestinal damage.

[Periapical lesions treated with CaO. Histological controls]. / Lesioni periapicali trattate con CaO. Controlli istologici.

The results of histological examinations conducted on 2 granulomas found in teeth and treated with calcium oxide are reported. It is concluded that the treatment produces significant changes in the histological picture with the formation of scar tissue that precedes the growth of newborn in a relatively short time.

Fine needle aspiration cytology of the breast: a statistical evaluation of accuracy based on 1,080 cases.

Fine needle aspiration cytology (FNAC) of the breast is a minimally invasive and low-cost method. In this study we reviewed our experience on a total of 1,080 cases. Sensitivity, specificity and predictive value were calculated. The causes of error were examined and we concluded that accuracy improves when aspirations are done by the cytopathologist himself and fixing and staining procedures are immediately performed in a specialized laboratory.

A case of fistulizated pelvic malacoplakia: cytohistologic, immunohistochemical and electron-microscopic study.

A case of malacoplakia with a tumor-like involvement of the pelvis is presented. It was characterized by a urine-trickling fistula from the bladder to the gluteal surface and by acute urinary retention. Examinations both cytologic of urine collected from urethra and from fistula, and histological of tissues from bladder and rectum were performed. Histiocytes with Michaelis Gutmann bodies were found in all specimens. The specimens were also studied from an immunohistochemical and electron-microscopic point of view. The case was found interesting because of the unusual fistulization and for the absence of other important associated diseases usually reported in the literature.

The value of endometrial cytology by scraping in 1,798 cases: screening in asymptomatic women and diagnosis in symptomatic ones.

A study of 1,798 endometrial cytological samples, obtained with an "endocyte" (a disposable scraping device) and controlled in histology is presented. The method was tested for its usefulness in screening of precancerous lesions and preclinical cancer in 1,248 asymptomatic women and in the diagnosis of endometrial pathology in 550 symptomatic ones. The classification of hyperplasia into benign simplex and complex hyperplasia and atypical hyperplasia was followed; atypical hyperplasia, considered real intraepithelial neoplasia, was included in the positive cases. Histological verification was made chiefly on cell block in asymptomatic cytologically negative cases and either on curettage or hysterectomies in the others. The main endometrial cytological patterns are described. On the basis of findings, considering also endocyte's low cost, effectiveness, and ease of use, we think the method could be usefully employed in screening of endometrial cancer for an asymptomatic population. In symptomatic women, the use of histologic procedures is still preferable, and cytology cannot be considered a "first option" method.

The cytology of the normal cyclic endometrium.

Endometrial cytologic samples obtained with Cohen's endocyte from 501 normally menstruating women were studied and correlated with histologic sections from cell blocks. In this article, the cytologic diagnostic criteria for normal cyclic endometrium are pointed out. The diagnostic accuracy of normal cyclic endometrium has been 92%. A possibility of a cytologic dating is discussed. The diagnostic accuracy was 71.8% for early proliferative endometria, 82% for late proliferative, 93% for early secretory, 81% for midsecretory, and 60% for late secretory endometria.

Cytodiagnosis of oral pemphigus vulgaris.

A study was undertaken to verify the reliability of the Tzanck test, performed both by traditional cytomorphology and by a direct immunofluorescence technique, for the diagnosis of oral pemphigus vulgaris. Cytologic smears were obtained from oral erosions of 129 patients with various bullous diseases of the oral mucosa, clinically suspected of being oral pemphigus, as well as from 30 healthy subjects. The 40 cases with subsequent histologic proof of oral pemphigus were cytologically diagnosed as such, based on the significant cytomorphologic findings of acantholytic cells or on the pericellular deposition of IgG (which persisted after cytocentrifugation) in epithelial cells, as studied by direct immunofluorescence. Cytomorphology gave positive results in 37 patients with pemphigus and in one patient with a final diagnosis of herpetic stomatitis and gave negative results in all other cases. Immunocytology gave positive results in all patients with pemphigus and negative results in all other cases. The findings indicate that cytomorphologic studies may be useful in screening suspected cases of oral pemphigus vulgaris while the immunocytologic test may provide a reliable definitive diagnosis.