Chronic lymphocytic leukemia with 6q- shows distinct hematological features and intermediate prognosis.

Cytogenetic and fluorescence in situ hybridization studies were successfully performed in 217 chronic lymphocytic leukemia (CLL). In all, 13 patients with 6q21 deletion were identified and characterized in comparison with 92 patients with 'favourable' karyotype (normal or 13q-), 69 cases with 'intermediate risk' (1-2 anomalies) and 43 cases with 'unfavourable' karyotype (complex, 11q- or 17p-). Six out of 13 cases with 6q- showed an excess of atypical lymphocytes, a finding confirmed at the histologic level; >20% CD38+ cells were seen in 5/6 cases. IGVH mutational status revealed >98% homology to the germline sequence in 4/10 cases. When compared with the 'favourable' group, patients with 6q- showed a higher white blood cell (WBC) count, frequent splenomegaly, atypical morphology, CD38+ and short time from diagnosis to first treatment and short survival. A higher median WBC count was found in the 6q- group vs the intermediate-risk group; survival was shorter in the unfavourable group. To ascertain if the 6q- anomaly was an independent factor predicting for an inferior outcome among those patients with 'favourable' cytogenetics, we performed an analysis of prognostic factors in 105 patients (92 'favourable' plus 13 with 6q-), showing that the 6q- chromosome maintained its prognostic significance at multivariate analysis (P=0.02) along with stage (P=0.01). We conclude that CLL with 6q- is characterized by a high incidence of atypical morphology, classical immunophenotype with CD38 positivity and intermediate incidence of IGVH somatic hypermutation. Clinicobiological features and outcome show that this cytogenetic subset of CLL should be allocated in an intermediate-risk category.

Solitary fibrous tumor of the orbit: a case report.

Solitary fibrous tumor is a very rare neoplasm affecting the head and neck. We present a case located in the orbit in which clinical, pathological and surgical features are reviewed.

Ectopic thymoma simulating a pericardial cyst.

We present a case of a 53 year old man with a thymoma near the pericardium, a rare ectopic localisation of thymoma. A round radiodensity found at the right cardiophrenic angle was initially suspected at the echocardiography to be a pericardial cyst. The diagnosis of thymoma was made only after histopathological examination of the surgically re-sected lesion.

Evidence for androgen receptor gene expression in human thyroid cells and tumours.

Androgen-binding activity has been identified in normal and pathological thyroids, but evidence for the expression of the canonic androgen receptor (AR) in the thyroid has not been provided so far. In this study we have used reverse transcription (RT)-PCR to examine RNA expression of the canonic AR gene in human thyroid tissues, in primary cultures of human thyrocytes and in a variety of neoplastic thyroid cell lines (NPA, TPC and WRO). An AR cDNA fragment with the expected size of 262 bp was detected in normal tissues and cultured thyrocytes as well as in neoplastic cell lines, demonstrating that the gene for AR is indeed expressed in thyroid follicular cells. Immunocytochemical analysis revealed the presence of the AR protein in cancer cell lines and androgen treatment increased nuclear positivity to AR. In a survey of 35 thyroid tissues AR cDNA was detected in all the non-neoplastic samples (6 normal and 3 goitrous) and in 19 of 26 neoplastic samples. AR cDNA was not detected in 4 of the 9 follicular adenomas and in 3 of the 12 papillary carcinomas. AR was revealed by immunohistochemistry in 1 of 2 normal thyroids, in 1 goiter and in 1 of 2 neoplastic thyroids. These findings show the presence of the canonic AR in the human thyroid.

p53 expression in colorectal cancer: relation to tumor type, DNA ploidy pattern and short-term survival.

p53 protein expression was evaluated in a series of 204 primary colorectal adenocarcinomas by immunohistochemistry using frozen tissue sections and monoclonal antibody DO-7. Nuclear staining of more than 5% of neoplastic cells was observed in 124 (60.8%) adenocarcinomas, which were classified as p53 positive. p53 immunoreactivity was found to he unrelated to several clinical and pathologic variables, including age and sex of patient, tumor site, tumor stage, grade of differentiation, pattern of growth, degree of peritumoral lymphocytic infiltration, and venous invasion. A strong association was demonstrated between p53 immunostaining and tumor type. Only 4 of 21 mucinous carcinomas examined (19%) were p53 positive. Conversely, 120 of 183 (65.6%) nonmucinous adenocarcinomas showed positive p53 immunostaining (P <.0001). p53 expression also was related to the flow cytometric DNA ploidy pattern, aneuploid carcinomas with DI >1.20 showing higher frequency of p53 overexpression than DNA diploid, and aneuploid tumors with DI < or = 1.20 (P = .0003). No relationship was found between p53 expression and the Ki-67 proliferation index. With respect to the total study population (mean follow-up 33.4 months; range 19-47 months) the duration of overall survival was independent of p53 expression. In the group of 141 patients with stage I, stage II, and stage III disease who had undergone curative resection, positive p53 immunostaining was associated with poorer overall survival (P = .029). Subgroup analysis showed that the reduced survival conferred by p53 overexpression was confined to patients with stage III tumors (P = .027). However, in multivariate analysis, p53 expression failed to demonstrate independent prognostic significance. Our results indicate that immunohistochemical analysis of p53 expression provides valuable information for the understanding of colorectal cancer biology and clinical behavior.

Lymphoepithelial cyst of the pancreas.

A rare case of lymphoepithelial cyst of the pancreas is reported. Microscopically the cyst content consisted of keratinous material and the walls were lined by mature squamous epithelium surrounded by dense lymphoid tissue. Immunohistochemistry showed diffuse reactivity for CD20 and CD3 in the lymphoid tissue and uniform positivity for cytokeratins in the squamous epithelium. Although the histogenesis of lymphoepithelial cysts of the pancreas is not understood, awareness of this lesion is helpful in differentiating it from other pancreatic cystic lesions.

Kaposi's sarcoma in renal transplant recipients: pathogenetic relation between the reduced density of Langerhans cells and cyclosporin-A therapy.

Patients treated with immunosuppressive drugs can develop cancers. The authors present two cases of Kaposi's sarcoma in kidney transplant patients who had been treated with azathioprine, steroids and cyclosporin-A; during this treatment the Langerhans cells decreased and Kaposi's sarcoma appeared. Discontinuation or reduction of the dosage of cyclosporin-A led to complete regression of the illness, and the Langerhans cells reappeared. We suggest that cyclosporin-A damages the immunological function of the epidermal Langerhans cells, and that this is the primary factor in the development of Kaposi's sarcoma.

Immunohistochemical assessment of growth fractions in colorectal adenocarcinomas with monoclonal antibody Ki-67. Relation to clinical and pathological variables.

Immunostaining with monoclonal antibody Ki-67 (MAb Ki-67) has been employed to determine the growth fractions in a series of 139 primary adenocarcinomas of the large bowel. A wide range (18.9-71.4%; mean 39.4%; median 37.2%) in the percentage of Ki-67 reacting cells (Ki-67 index) was observed. The Ki-67 index was found to be unrelated to tumour stage, lymph node involvement, and presence of synchronous distant metastases. Mucinous carcinomas showed higher levels of Ki-67 reactivity than non-mucinous adenocarcinomas (P = 0.0003). Among non-mucinous adenocarcinomas a significant inverse correlation was demonstrated between the percentage of Ki-67 stained cells and the degree of differentiation (P = 0.002), and preservation of nuclear polarity (P less than 0.001). Moreover, tumours of patients younger than 45 years were generally characterized by high numbers of proliferating cells. There was no correlation between Ki-67 index and the other clinical and pathological variables examined. In most cases small differences in Ki-67 reactivity were observed in different samples from the same tumour. These results demonstrate that immunohistochemical assay with MAb Ki-67 represents a simple and reliable method for the assessment of proliferative activity in colorectal adenocarcinomas and suggest that Ki-67 labeling may provide information of clinical relevance in the management of patients with large bowel cancer.

Metastatic carcinoma to artero-venous haemangioma. Case report.

A case of metastasis of primary lung-carcinoma to a cerebral artero-venous haemangioma is presented. Although the phenomenon of metastasis to primary brain neoplasm is being recognised with increasing frequency, we've found only two cases into vascular tumours reported. The authors emphasize the rarity of this occurrence and discuss the possible pathogenetic mechanisms, which are at present incompletely understood.

Analogs of cord red blood cell membrane components displayed on placenta, amnion and amniotic cells in culture.

Placenta and amnion were analyzed to ascertain the presence of antigens in common with red blood cells (RBC) from cord or fetuses. The expression of distinct antigens displayed on a subpopulation of cord RBC and detected by anticord RBC membrane antibodies was particularly investigated, concomitantly with the presence of transferrin receptors (TR) by employing immunohistochemistry. The placenta showed both cord antigen and TR; on the contrary, amnion--which was labelled by anti-cord RBC membrane antibodies--was not stained by the anti-TR antibody. The results of inhibition and double labelling assays further excluded TR as the relevant antigen in the labelling of both placenta and amnion. The staining of fetal membranes disappeared after absorption of antibodies with cord RBC membranes. These results suggest that the antigens externally expressed on a subpopulation of cord RBC are shared by amnion and placenta.

Morphologic changes, mucin secretion, carcinoembryonic antigen (CEA) and peanut lectin reactivity in colonic mucosa of patients at high risk for colorectal cancer.

We studied 393 endoscopic colonic biopsies from 72 patients, classified in different groups after assessment of their risk factors, using: histologic, histochemical and immunohistochemical techniques (CEA-PAP and PNA-Px). In high risk patients (Groups A and B) the most relevant modifications were dysplasia with hyposecretion and hyperplasia with sialomucin secretion (TR-type change); in Group A 31 adenomas and 19 hyperplastic polyps also were found. A premalignant nature of dysplasia and predysplastic significance of TR change were suggested: 1) by finding the same alterations in mucosa of Group E (colectomized patients for carcinoma at after 1 year); 2) by increasing expression of CEA and PNA-Px ligands; 3) by their absence in Group D (normal controls). Hyperplastic polyps were confirmed not to be premalignant lesions, but since they had peculiar characteristics (increased CEA and PNA-Px positivity, association with adenomas) it does not seem justified to regard them as lesions unrelated to colorectal cancer, especially when associated with other risk factors. CEA and PNA-Px reactivity correlated well with the risk evaluation and with morphohistochemical changes in the mucosa; the reactivity significantly increased from normal mucosa to dysplasia.

Mortality for tracheal, bronchial and lung cancer: possibilities and limits in data quality-control.

Linkage of various archives (municipal, hospital, autopsy) has enabled the authors to reconstruct the flow of information regarding death due to tracheal, bronchial or lung cancer (TBL ca) for the population residing within the Municipality of Ferrara during the period 1983-1985. The authors subsequently attempted to verify the cause of death by performing quality controls on clinical charts, radiologic findings, cytohistologic examinations and autopsy findings. Analysis of the data obtained in this manner suggests that municipal records are more "accurate" than are hospital records. The authors likewise indicate the usefulness and importance of the autopsy for a correct diagnosis of cause of death.

Primary carcinoma of the Bartholin gland.

The authors report a case of primary carcinoma of the Bartholin gland treated with a radical vulvectomy and bilateral inguinal lymphadenectomy.

One case of immunotactoid glomerulopathy: morphological-ultrastructural aspects.

Starting from a group of 736 renal biopsy patients, evaluated by ultrastructural studies over a period of 22 years, the authors present a rare case of immunotactoid glomerulopathy, suggesting that these forms, until a few years ago considered in the same group as fibrillary glomerulonephritis, are in fact a separate entity; moreover, they may represent a very early manifestation of plasmacellular dyscrasia still at the initial stage.

[Non-secretory plasmacytoma. Bibliographic review and immunohistochemical study of a case]. / Plasmocitoma non secernente. Revisione bibliografica e studio immunoistochimico di un caso.

After a brief examination of the recent literature on non-secretory multiple myeloma, the Authors describe the immunohistologic study (peroxidase-antiperoxidase method) of a case of truly non producing plasmacytoma, interesting because of the presence of a small polyclonal plasma cell population within the neoplastic clone. Several possible explanations are considered.

H reflex excitability following voluntary muscle contraction of different duration.

The importance of the duration of contraction on the excitability of the motoneuronal pool was evaluated by measuring the H reflex from soleus muscle after short and long contractions at constant effort equal to 60% maximal voluntary contraction (MVC); the difference between the amplitude of H reflex at rest and after contraction of different duration was evaluated in 10 normal subjects and in one hemiparetic patient. The authors found a significant inhibition of H reflex after contraction of 10 seconds and after 40 seconds and a longer duration of the inhibition after 40 seconds. In the hemiparetic patient the H reflex did not show inhibition which suggests a possible reduction of the presynaptic inhibition, and a lack of modulation of the motoneuronal pool after contraction.

[Staphylococcal scalded-skin syndrome in AIDS]. / Staphylococcal scalded-skin syndrome in corso di AIDS.

The Authors report a case of SSSS in a patient with AIDS. SSSS in adults is rare. Immunosuppression for several causes could predispose towards SSSS. The principal diagnostic differential to be made is from toxic drug induced epidermal necrolysis. Exfoliative cytology and histology can be useful in the diagnosis.

West Nile Virus encephalitis in intensive care: a small mosquito, a tremendous danger.

The authors describe two of three cases of West Nile virus (WNV) meningoencephalitis admitted to ICU in Ferrara (south of Po River) underlying the main common features. They focus on the difficulties in diagnosis, with key-points including seasonality (late summer in Italy), unspecific flu-like symptoms at the beginning, as hyperpyrexia, myalgia and asthenia, followed by neurological impairment, and use of steroids in the patient clinical history. Special attention is deserved to the poor outcome at both short and long term.