Infectious panniculitides: an update.

Very few areas in the realm of diagnostic dermatopathology may be so challenging both for the dermatologist and the histopathologist as are those related to panniculitis, because of their frequent overlapping microscopical patterns and uncertain etiology. Classically, a dicotomic taxonomy key has been proposed according the prevalent involvement of subcutaneous septa or lobules of the inflammation, presence or absence of vasculitis and type of vessel involved, but exceptions to this approach do occur and overlapping forms are sometimes encountered. Infectious panniculitides have also been traditionally approached according to this schema, and their microscopic diagnosis may be even more complex when the causative agent is unknown and underrepresented in the specimen. Many types of pathogens are capable to evoke protean clinical manifestations, which range from organism-specific to aspecific pictures. For this reason a tissue biopsy is always mandatory to ascertain the type of lesion and differentiate an infectious process from its many other mimickers essentially represented by reactive-based panniculitides. Recognition of morphologic changes which characterize distinct infections in the subcutis often needs a complete clinical history, physical examination and laboratory studies, especially when few microorganisms if any are found. This review will be focussed on the pathophysiology of the adipose tissue in relation to immunity and mechanisms of host reaction. The most frequent infectious panniculitides will then be discussed with special reference to their microscopic pictures, to provide clues to their specific diagnosis and the use of immunohistochemistry and molecular biology techniques as ancillary techniques.

Evaluation of HER-2/neu in serum and tissue of primary and metastatic breast cancer patients using an automated enzyme immunoassay.

Serum HER-2/neu concentrations were evaluated in 172 healthy subjects, 176 primary and 55 metastatic breast cancer patients, employing a new automated assay (Bayer Immuno 1 serum HER-2/neu). Using 13 ng/mL as the cutoff, abnormal HER-2/neu serum levels were found in 8% (14/176) of primary and 50.9% (28/55) of metastatic breast cancer patients. Both in primary and metastatic breast cancer a significant relationship was found with the stage of the disease when serum HER-2/neu was considered as a categorized variable (p=0.0003 and p=0.02, respectively), but not when it was taken as a continuous variable (p=0.247 and p=0.146, respectively). Moreover, we evaluated the correlation between Immuno 1 HER-2/neu and Oncogene Research Products ELISA assay in 53 normal subjects, 46 primary and 34 metastatic breast cancer patients. The correlation was relatively good (p<0.0001), although substantial differences could be found in single cases. The Immuno 1 assay was also evaluated for the first time in breast cancer tissue. The method, which showed good performance both in terms of imprecision and linearity, was used to measure HER-2/neu protein in 140 cytosol samples from primary breast cancer tissue and in homogenates from 40 matched cases. The correlation between the two matrixes was very close (p<0.0001). By contrast, no correlation was found between serum and matched cytosol (p=0.101) or homogenate samples (p=0.511).

Macrocystic serous cystadenoma of the pancreas: clinicopathologic features in seven cases.

BACKGROUND: Serous cystic neoplasms of the pancreas are uncommon tumors classified as microcystic adenomas. In this article, the authors report clinico-pathologic features of seven cases of macrocystic variant of the serous cystadenoma. METHODS: Seven patients (5 females and 2 males) with a diagnosis of cystic lesion of the pancreas were observed after 1995. Clinical, radiological, and pathologic features, including immunohistochemistry, were reported. Enzymes and tumor markers CEA, CA 19-9, CA 125, CA 15-3, CA 72-4, and mucin-like carcinoma-associated antigen (MCA) were investigated in the serum and cyst fluid of the patients. Cytology was also performed. RESULTS: Six patients were symptomatic complaining abdominal pain. All cases had radiologic evidence of unilocular cyst of the pancreas. The suspected diagnosis was consistent with mucinous cystic neoplasm. Serum tumor markers were all in the normal range. After surgery, pathology showed in all cases a cyst lined with cuboidal, periodic acid-Schiff (PAS)-positive epithelium, without mucin content or atypia. Minute microcysts were found surrounding the main cavity. Immunohistochemical stains were positive for cytokeratin, CA19-9, CA15-3, CA 72-4, and MCA. CEA was unexpressed. CA 125 in the cyst fluid were found elevated in three cases and CA 19-9 in three cases. Cytology was negative in all cases. CONCLUSION: When a unilocular pancreatic cyst is found, without history of pancreatitis and gallstones, having low serum tumor markers levels and negativity of CA 72-4 and MCA in the cyst fluid, the diagnosis of the macrocystic variant of the serous cystadenoma may be suggested. At present, the diagnosis is still based on pathological examination after cyst removal.

Solitary true cyst of the pancreas in adults. Report of three cases and review of the literature.

Solitary true cysts of the pancreas are extremely rare: to date, only eight cases have been reported in the English literature, four of which had clinical significance. An additional three cases of solitary true cysts of the pancreas are presented. One patient was incidentally found at operation, performed for other disease, to have a cystic lesion in the body of the pancreas; the other two patients experienced abdominal pain and nausea. Abdominal US, CT, and MR showed a unilocular cyst in the body and tail of the pancreas. In both cases, preoperative diagnosis of pancreatic cystic neoplasm was made. Two patients underwent excision of the mass and one distal pancreatectomy. Analysis of the cyst fluid revealed high CA 19-9 levels in two and CA 125 levels in one case. All cysts were lined by cuboidal epithelium, without morphological alterations. Preoperative differential diagnosis with the most common cystic pancreatic lesions (inflammatory or neoplastic) is difficult.

[Left cor triatriatum in a man over 60]. / Cuore triatriato sinistro in uomo ultrasessantenne.

A case of cor triatriatum in a 66-year-old man is reported. The patient died of pneumonia; ante mortem diagnosis was made with both transthoracic and transesophageal echocardiography. Autopsy finding showed a very good correlation between anatomical and echocardiographic abnormalities. Cor triatriatum is amenable to surgical correction and echocardiography is extremely helpful in the diagnosis.

Effect of cholecystokinin analogue caerulein and cholecystokinin antagonist lorglumide on pancreatic carcinogenesis in the rat.

The effects of the cholecystokinin (CCK)-analogue, caerulein, and CCK-receptor antagonist lorglumide (CR-1409) on pancreatic carcinogenesis induced by 7,12-dimethylbenz(a)anthracene (DMBA) were studied. One hundred thirty rats were divided into the following 10 treatment groups: group 1, DMBA (2-3 mg); group 2, DMBA + caerulein (5 micrograms/kg); group 3, DMBA + caerulein + CR-1409 (12 mg/kg); group 4, caerulein + DMBA; group 5, caerulein + CR-1409 + DMBA; group 6, DMBA + CR-1409; group 7, CR-1409 + DMBA; group 8, caerulein; group 9, CR-1409; and group 10, sham operation + saline. DMBA was surgically implanted into the pancreas. Caerulein and/or CR-1409 was administered twice daily for 15 days after (in groups 2, 3, and 6) or before (in groups 4, 5, and 7) DMBA implantation. Six months after carcinogen administration, all rats were sacrificed and autopsied. The incidence of pancreatic cancer appeared significantly (P < 0.001) increased when caerulein was administered following DMBA implantation. CR-1409 significantly inhibited (P < 0.02) caerulein effects and reduced tumor growth when injected after carcinogen exposure.

[A case of osteoma of the mandible]. / Considerazioni su di un caso di osteoma della mandibola.

Osteoma is a benign bone tumour with a very slow growth. In the maxillofacial district the paranasal sinuses and the mandible are more frequently involved. This type of tumour is clinically asymptomatic and the signs of its presence are due to the fact that its expansive and centrifugal growth changes the face features. The surgical operation has a double aim: to solve the aesthetic problem and to prevent complications. In fact, obstructions and compressions ab estrinseco may compromise the function of the nearest organs. The aim of our work has been to show a clinical case which is interesting from a clinical, diagnostic and therapeutic point of view.

Effect of castration and testosterone replacement on pancreatic carcinogenesis in Syrian hamsters.

Hormonal manipulation has been proposed as a possible new approach to the treatment of pancreatic cancer. We studied the effect of orchiectomy and testosterone replacement on early stage pancreatic carcinogenesis induced by diisopropanolnitrosamine (DIPIN) in Syrian golden hamsters. Eighty-five hamsters (mean body weight, 100 g) were divided into the following treatment groups: 1) DIPN (n = 20); 2) DIPN plus orchiectomy (n = 17); 3) DIPN plus orchiectomy plus testosterone (n = 18); 4) orchiectomy (n = 10); 5) sham operation (n = 10); 6) DIPN plus testosterone (n = 10). DIPN (125 mg/kg/body wt.) was administered s.c. every week and testosterone propionate (10 micrograms/g) was administered s.c. every 3 weeks. Bilateral orchiectomy was performed 1 week after the first injection of DIPN. All animals were killed 15 weeks after starting the treatment. The whole pancreas was removed, weighted and histologically examined. There was no difference in the incidence of preneoplastic lesions among groups 1, 2, 3 and 6 (respectively 87%, 83%, 77% and 80%); 3 animals in each group developed invasive carcinoma. In control groups (4 and 5), no precancerous lesions were recorded. In this experimental model, orchiectomy and testosterone replacement had no effect on nitrosamine-induced pancreatic carcinogenesis.

Aspiration cytology and immunocytochemistry of sacral chordoma with liver metastases: a case report.

We present the cytologic features and immunocytochemical profile of a case of sacrococcygeal chordoma metastatic to the liver. Cytologic diagnosis was suspected from the aspiration biopsy smears of the primary sacrococcygeal tumor and confirmed by histology. Further aspirates failed to reveal diagnostic physaliferous cells, and only undifferentiated spindle cells were obtained. Chordoma may lack physaliferous cells: in such cases, immunocytochemistry studies can greatly facilitate the diagnosis. This study confirms the utility of immunocytochemistry in the differential diagnosis of chordoma and tumors with similar cytologic characteristics.

Lymph node biopsy in the diagnostic and prognostic assessment of patients with HIV infection.

Thirty-three anti-HIV positive patients with persistent generalized lymphadenopathy (PGL) who underwent lymph-node biopsy were studied to assess the diagnostic and prognostic relations existing between clinical, histological and laboratory findings. Patients were also examined for known risk factors, laboratory and bacteriological tests, and mononuclear cell surface marker analysis. 4 histological types were identified according to Ràcz's classification. At biopsy, there were 21 cases of LAS (64%), 6 cases of ARC (18%) and 6 cases of AIDS (18%); a clear prevalence of type 1 was evidenced in LAS/ARC patients, while only type 4 was present in the AIDS group. An ARC type 3 patient developed manifest AIDS within 13 months from biopsy. These results suggest that anti-HIV positive asymptomatic patients with PGL apparently do not require lymph node biopsy, as none of them showed histologic findings suggestive of opportunistic infections, malignant lymphoma or Kaposi's sarcoma. On the contrary, lymph node biopsy can play a diagnostic and prognostic role in anti-HIV negative subjects with PGL, and in ARC and AIDS patients.