[Primary breast lymphoma: case report and review of literature]. / Linfoma primitivo della mammella: descrizione di un caso clinico e revisione della letteratura.

Primary non-Hodgkin's lymphoma of the breast is a rare entity representing 0.04-0.5% of all malignant female breast tumors, less than 1% of all patients with non-Hodgkin lymphoma and approximately 1.7-2.2% of all patients with extranodal non-Hodgkin lymphomas. A 75 years old patient presented with masses in the lateral part of the left breast for 6 weeks. Ultrasound detected 3 masses suggesting fibroadenomas while mammography set the suspicion of breast multicentric carcinoma. Fine needle aspiration cytology of one mass showed low grade lymphoma subsequently confirmed with histopathology which diagnosed extranodal non-Hodgkin lymphoma MALT type CD 20+/CD 79a+/CD 3-/Bcl 2- and index of proliferation Ki 67=30% (stage IE). Primary non-Hodgkin lymphomas of the breast, though rare, should be considered in the differential diagnosis of breast malignancies. At present, a standard treatment doesn't exist yet; low grade lymphomas should be managed with excision biopsy and/or local radiation therapy, while high grade lymphomas should be managed with chemotherapy in association with radiation therapy.

Age-related changes in the proliferative kinetics of phytohemagglutinin-stimulated lymphocytes. Analysis by uptake of tritiated precursors of DNA, RNA and proteins, and by flow cytometry.

We have examined the age-related changes in the kinetics of lymphocyte proliferative responses to phytohemagglutinin by flow cytometry and by the uptake of tritiated thymidine, uridine and leucine. The lymphocyte suspensions used in these experiments were obtained by umbilical cord blood samples of full-term normal newborns and from the peripheral blood of young (under 30-year-old) or aged (more than 70-year-old) healthy donors. The results indicate that the cord blood lymphocytes were activated by phytohemagglutinin to incorporate tritiated precursors of proteins, RNA and DNA at a more rapid rate than the lymphocytes from young or old donors in the first 3 days of in vitro culture. Flow cytometry confirmed higher percentages of activated cycling cells in umbilical cord blood after 24 h of culture. The lymphocytes from old donors incorporated significantly lower amounts of tritiated precursors of DNA and RNA than lymphocytes from young donors at the third day of culture. The uptake of tritiated leucine by lymphocytes from old donors was significantly reduced up to the sixth day of culture. On the contrary, at the eight day of culture, lymphocytes from old donors incorporated significantly higher amounts of labeled DNA, RNA and protein precursors. In agreement with these findings, flow cytometry demonstrated a trend towards higher percentages of cycling cells in the lymphocyte cultures from old donors after 6 and 8 days. These results indicate an age-related decline in the rate of lymphocyte blastogenesis after in vitro PHA stimulation and suggest that after a delayed PHA-induced activation, the lymphocytes from aged donors have a near-normal ability to proliferate.

In search of predictive markers of remission from insulin dependence in type 1 diabetes: a preliminary report.

We studied 18 newly diagnosed diabetic patients (8 males and 10 females, aged 18-26 years, within 10-120 days from the onset of symptoms) who were submitted for 15 days to intensive insulin therapy performed via subcutaneous insulin infusion (CSII). We investigated some metabolic and immunological parameters in order to identify a possible marker to predict the selection of patients potentially more responsive to CSII treatment for the remission of type 1 diabetes. In accordance with the International Diabetes Immunology Group we considered clinical remission as being the withdrawal of insulin therapy for at least 3 months. In order to assess beta-cell function a fasting and post-prandial serum C-peptide, blood glucose and HbA1c were performed on all patients before, and 3 days after, the discontinuation of CSII. Islet cell antibodies were determined in all sera by indirect immunofluorescence. Analysis of T-lymphocyte subpopulations was carried out before starting the therapy. The following monoclonal antibodies were used: CD4, CD8, CD57, CD25, HLA-DR. The levels of C3 and C4 and serum IgG, IgA and IgM were also evaluated. After CSII, 11 of 18 patients showed remission. At the beginning of the study we observed no major difference in metabolic parameters between the two groups. Interestingly, the patients who exhibited remission presented a statistically higher percentage of positive cells for CD57, HLA-DR and CD25 surface antigens, significantly lower C4 levels and CD4/CD8 ratio and significantly higher IgG levels compared with patients who did not show any remission.(ABSTRACT TRUNCATED AT 250 WORDS)

Ascitic fluid-associated lymphocytes in patients with metastatic ovarian cancer. Analysis of lymphocyte subsets and of phenotypical changes induced by "in vitro".

Ascitic fluid and peripheral blood samples, from seven patients affected by peritoneal carcinomatosis secondary to ovarian tumors, were analyzed to examine the phenotypic properties of ascitic fluid-associated lymphocytes (AFAL) and then asses T-cell activities in the presence of different interleukins. The AFALs showed a relative enrichment of CD2+, CD3+, CD5+, CD4+ T cells compared to the peripheral blood samples, while the contrary was true for CD56+ and CD57+ cells. The same phenomenon was observed in both CD3+, CD56+ and CD2+, CD56+ cell populations. Fewer CD71+ and CD25+ cells were found in the ascitic fluid suspensions whilst the opposite was true for HLA-DR+ lymphocytes. The data obtained from the in vitro incubation of AFALs in the presence of IL-1 (or), IL-2, IL-4, IL-6 or IFN showed that IL-1, IL-2 and IFN- can induce a two-fold increase in the percentages of HLA-DR+ T lymphocytes. IL-6, IL-2 and IL-1 seemed to have a fairly modest effect on CD25. A better survival of CD56+ cells was found only in the presence of IL-4 and IL-6. Even though preliminary and based on a limited number of patients, our results would seem to invite caution in instituting intraperitoneal administration of one or more cytokines for the treatment of such lesions in humans.

[Duodenal diverticula]. / I diverticoli duodenali.

After an examination of the anatomopathological and clinical features of duodenal diverticula, the various ancillary pathologies are analysed as are the complications linked to the diverticulum itself. A meticulous review of the literature and several personal surgical cases confirms the view that only those diverticula causing evident symptoms or complications should be treated. The various surgical techniques selected as appropriate for the different cases are also described.

[Elastofibroma of the back. Considerations on 2 cases]. / Elastofibroma del dorso. Considerazioni su due casi.

Two cases of fibroelastoma of the back are reported. It is pointed out that probability diagnosis in mainly entrusted to the objective examination and to the typical site of tumefaction, backed by echotomography, xeroradiography and computerised tomography and demonstrated by histological examination of the operative piece. Differential diagnosis has to be established versus fibrosarcoma, liposarcoma, desmoid tumour and malignant tumour of the synovia. The need for surgical removal is reiterated.

[Towards the standardization of sentinel lymph node analysis in women with breast cancer]. / Verso una standardizzazione dell'analisi del linfonodo sentinella in donne con cancro della mammella.

Sentinel lymph node biopsy allows enhanced pathology through serial sections and immunohistochemical analysis of the retrieved node, with detection of micrometastases and isolated tumor cells not otherwise recognized. We present our experience with a simple, effective, pathology protocol requiring six couples of sections at three different sentinel lymph node levels. Additional micrometastases or ITC were diagnosed in 51/416 patients (14.6%).

[Does incidence of sentinel lymph node metastasis increase after diagnostic manipulation in women with breast cancer?]. / Aumenta l'incidenza di metastasi nel linfonodo sentinella dopo manipolazione diagnostica in donne con cancro della mammella?

503 patients were retrospectively evaluated to assess whether a previous needle or core biopsy, or surgical surgical excision of the primary tumor are associated with passive dislodgment of tumor cells in the sentinel lymph node, as reported in recent publications. We could not identify any increased incidence of sentinel lymph node micrometastases or isolated tumor cells after diagnostic manipulation of the primary tumor.

B cell chronic lymphocytic leukemia and lung carcinoma with T-lymphocyte-rich pleural effusion in a single patient.

The case of a patient with B cell chronic lymphocytic leukemia (CLL) and T-lymphocyte-rich pleural effusion secondary to carcinoma of the lung is presented. Monoclonal B cells were the main cell population in the peripheral blood and the helper/suppressor cell ratio of the residual T lymphocytes was lower than 1. On the contrary, T lymphocytes with helper phenotype were prevalent in the pleural fluid. The results indicate that local factors influence strongly the distribution of the lymphocyte subpopulations in different districts of the body and suggest that an etiopathogenesis unrelated to the B cell lymphoproliferative disease must be searched for, when a T-cell-rich pleural effusion is present.

Double (IgA kappa + IgG kappa) paraproteinaemia in a single patient: immunofluorescence evidence for a common plasma cell clone 'frozen' at the switch phase.

We present a patient with multiple myeloma and double (IgA kappa + IgG kappa) paraproteinaemia in the serum. Immunofluorescence analysis of bone marrow plasma cell with fluorochrome-conjugated goat antibodies specific for mu, delta, gamma or alpha immunoglobulin heavy chain and kappa or lambda light chains revealed the presence of a plasma cell clone synthesizing simultaneously gamma, alpha and kappa chains. A minority of plasma cells synthesized gamma or alpha chains separately. Moreover, in the patient's peripheral blood, a few cells with the morphology of lymphoplasmoblasts and simultaneously positive for gamma, alpha and kappa chains were also detected. These results indicate that in this patient, the neoplastic plasma cell clone was 'frozen' at the differentiative step of the switch from IgG to IgA synthesis.

Ontogeny of human lymphocytes. Two-color fluorescence analysis of circulating lymphocyte subsets in fetuses in the second trimester of pregnancy.

By using monoclonal antibodies, two-color immunofluorescence techniques and flow cytometry, we evaluated the surface marker phenotypes of lymphocyte subsets in cord blood samples from fetuses in the second trimester of pregnancy. The results indicate that cells of the T-, B- and NK-cell lineages as well as precursor cells can be detected in fetal blood at 18-20 weeks of gestation. At this stage of development, variable proportions of T and B lymphocytes express surface molecules, such as the CD1, CD10, CD38, CD45RA, indicative of a precursor or 'naive' state; on the other hand, the CD57 molecule is not detectable on the membrane of NK and T cells, and the RO isoform of the CD45 leukocyte antigen is synthesized by a low percentage of T cells. We suggest that the observed phenotypic peculiarities of the lymphoid cells might be related to the easy induction of tolerance that occurs in the early ontogenetic stages of the immune system.