Thyroid neoplasms: surgical and cyto-histopathological connections on a six year cases study.

OBJECTIVE: This study aims to evaluate the percentage of cyto-histologic correlation in patients with a thyroid disease documented through clinical-instrumental, cytological (FNAB), histological and surgical examinations. The purpose of this study is also to determine the percentage of disease incidence and evaluating any surgical indication in relation to biological behavior (benign, malignant or indeterminate lesions, occult carcinomas), sex, and age. BACKGROUND: Almost all of thyroid neoplasms is manifested through thyroid nodule. Therefore, clinical evidence of the thyroid nodule analysis is primarily related to the need to exclude malignant pathology or carcinoma of the thyroid, present in 4-6.5% of cases. PATIENTS AND METHODS: The trial was conducted analyzing the data including cytological and histology thyroid reports recorded from 1 March 2010 to 1 March 2016, for a total of 5,956 reports. To determine the cyto-histological correlations, have been considered eligible all patients of both sexes, that have performed at least one cytologic exam followed by an histologic exam. Thus, the total number of the cases studied is 554 cases. RESULTS: Cyto-histologic compliance was 93% with a diagnostic accuracy of 4% higher than the literature examined. CONCLUSIONS: The results thus obtained show, furthermore, that there is a non-negligible percentage of thyroid disease with malignant biological behavior and involvement of male individuals. Therefore, the execution of the FNAB is of utmost importance for the purpose of a correct surgical indication.

Reliability of the bright liver echo pattern in diagnosing steatosis in patients with cryptogenic and HCV-related hypertransaminasaemia.

AIM: To evaluate the reliability of the bright liver (BL) echo pattern on ultrasound to detect histological steatosis in chronic cryptogenic hypertransaminasaemia (CCH) and hepatitis C virus (HCV)-related forms of hypertransaminasaemia. MATERIALS AND METHODS: One hundred and fifty patients, 54 with CCH and 96 with HCV hypertransaminasaemia (76 genotype 1/2 and 20 genotype 3), were enrolled. Histological steatosis was measured as the percentage of hepatocytes involved. The reliability of the BL sign was estimated using the sensitivity, specificity, positive and negative predictive values. RESULTS: Histological steatosis was present in 102/150 patients (68%) divided into 59/96 (62%) in the HCV group and 43/54 (79.6%) in the CCH group (chi(2)=4.4; p=0.035). In a multivariate analysis, the variable associated with the BL echo pattern was steatosis percentage (p=0.0018). Steatosis percentage was higher in CCH group than in the HCV genotype 1/2 and 3 groups (p=0.02). The sensitivity of the BL echo pattern was 88% in the CCH group [confidence interval (CI) 95% 74-95] versus 61% (CI 95% 44-73) in the HCV genotype 1/2 group. The CI indicates that ultrasound can provide evidence for steatosis in a statistically significant way in the CCH versus HCV genotype 1/2 patients. In the genotype 3 group, the sensitivity was high (90%), but the limited number of cases limited the statistical significance due to the high CI. CONCLUSION: In CCH the BL echo pattern has excellent reliability in diagnosing steatosis, better than in HCV hypertransaminasaemia because of the higher prevalence and extent of steatosis.

Primary malignant fibrous histiocytoma of the mesocolon transversum.

Primary malignant fibrous histiocytoma (MFH) is a rare and biologically aggressive tumor. Differential diagnosis must include cystic neoplasms of the pancreas (mucinous and serous cystoadenoma or cystocarcinoma), cystic lymphangioma or mesothelioma and retroperitoneal haematoma. Making the right diagnosis preoperatively may be often difficult, but MFH may be suspected when a huge retroperitoneal mass is found at imaging in elderly patients. We report a case of a primary abdominal MFH originating from the mesocolon transversum.

Carbamazepine transbuccal delivery: the histo-morphological features of reconstituted human oral epithelium and buccal porcine mucosae in the transmucosal permeation.

Transbuccal drug delivery is an attractive way of administration since several well-known advantages are provided, especially with respect to peroral management. Carbamazepine (CBZ) is an anticonvulsant which is useful in controlling neuropathic pain, and it is currently administered by peroral route, although its absorption and bioavailability is limited due to various factors. The oral cavity could be an interesting site for transbuccal CBZ delivery due to two properties: slow administration of constant low drug doses and less dose-related side effects. However, in transbuccal absorption a major limitation could be the low permeability of the mucosa which results in low drug bioavailability; thus the aptitude of the drug to penetrate the buccal mucosa has to be assessed by using tissue models resembling human normal mucosa. In our experience, CBZ well permeates mucosal membranes. In order to assess the efficacy of CBZ transbuccal delivery and to verify the reliability of these tissues in permeability testing before and after the passage of CBZ, the histo-morphological features of reconstituted human oral (RHO) epithelium (E) and buccal porcine mucosae were investigated. Significant histological changes due to CBZ passage were observed both in RHO-E and porcine mucosa. The main findings detected in RHO samples were cellular swellings with a signet ring-like appearance, nuclear swelling, prominent nucleoli lined against the nuclear membrane and the presence of keratohyalin granules. The most striking finding regarding porcine buccal mucosa was a cytoplasmic vacuolization, mainly involving the basal layer.

Immunophenotypic profile and role of adhesion molecules in splenic marginal zone lymphoma with bone marrow involvement.

Splenic Marginal Zone Lymphoma (SMZL), with or without villous lymphocytes (VL+/-), is a low-grade lymphoproliferative disorder with constant involvement of the bone marrow (BM). Different BM infiltration patterns, mainly intra-sinusoidal, interstitial and nodular, have been described. Adhesion molecules (AMs) constitute a heterogeneous group of antigenic receptors playing a major role in leukocyte recruitment, in lymphocyte homing and in cellular-mediated immune response. Evolution and pattern of the BM infiltrate could be influenced by a variable expression of AM on SMZL lymphocytes. The degree and pattern of BM infiltration and the immunohistochemical expression of AM (H-CAM, BL-CAM, L-selectin, PSGL-1, E-selectin, ICAM-1, VCAM-1 and Beta-1 integrin) among the different infiltration patterns were evaluated in BM biopsies of 38 patients with SMZL and graded according to a semi-quantitative score ranging from 0-4 and based on the percentage of positive cells. An intra-sinusoidal infiltration was constantly observed, alone or in conjunction with other patterns. H-CAM and BL-CAM showed a moderate-to-high degree of positivity in the intra-sinusoidal infiltrate (median expression grade-3) and were expressed in the neoplastic lymphocytes independently from the pattern. PSGL-1 was mostly expressed in the perisinusoidal region and in case of interstitial infiltration (grade-2). ICAM-1 and VCAM-1 were selectively expressed in the nodules as a reticular meshwork located in the core region (grade-2); VCAM-1 was also expressed in the perinodular endothelia. E-selectin, L-selectin and beta-1 integrin proved constantly negative. These data suggest that different expression of AM can influence the modality of BM infiltration in SMZL.

Response to low-dose oral methotrexate and prednisone in two patients with angio-immunoblastic lymphadenopathy-type T-cell lymphoma.

INTRODUCTION: AILD-type T-cell lymphoma is characterized by very poor prognosis in most patients and the response rate to conventional chemotherapy is unsatisfactory. MATERIALS AND METHODS: Two patients (a 65 year old female and a 67 year old male) with AILD-type lymphoma who did not respond to conventional treatment with steroids or aggressive chemotherapy were treated with Methotrexate and Prednisone. Both patients received a weekly dose of MTX (10 mg/m(2)) that was administered orally in combination with PDN at an initial dose (15 mg/day), given on a daily basis. RESULTS: Both patients responded rapidly showing marked improvement with no major side effects. Complete clinical remission was recorded in the two patients who were treated with this combination after conventional chemotherapy had failed to produce any improvement. CONCLUSION: Our observations in two patients with refractory/relapsed AILD-type lymphoma who were given low-dose oral MTX as salvage treatment, suggest that this agent has immunosuppressive effects that can be beneficial for treating patients with AILD-type T-cell lymphoma. Pilot clinical trials are needed to verify its efficacy in this setting.

Giant cell tumor of the ovary. Immunohistochemical evidence of origin from stromal ovarian cells.

Giant cell tumor (GCT) of the ovary is a rare condition, found almost invariably in the context of a mucinous tumor and presenting a microscopic picture indistinguishable from GCT of bone. We describe a case of GCT in the wall of a serous cyst of the ovary. An immunohistochemical study was performed using a panel of antibodies to epithelial, mesenchymal and leukocyte antigens. Mononuclear and giant tumor cells were positive for vimentin; CD 68 and LCA were found only in giant cells whereas actin was only found in mononuclear tumor cells. The immunophenotypic profile of the stromal cells of the residual ovary was identical to that of mononuclear tumor cells. The presented data suggest that GCT of the ovary is probably a non-neoplastic lesion of the mesenchymal stromal cells that react against substances of the associated tumor or cyst.

Mental nerve invasion by basal cell carcinoma of the chin: a case report.

A case of perineural infiltration from recurrent cutaneous basal cell carcinoma of the chin is reported. Clinical presentation, surgical treatment, and pathological evidence are discussed. This report stresses the importance of a correct follow-up and an accurate clinical staging in order to identifying clinical signs highly suspicious for neoplastic perineural infiltration.

Perineural infiltration by cutaneous squamous cell carcinomas of the head and neck.

In this paper six cases of cutaneous squamous cell carcinoma of the head and neck region with histologically-documented perineural tumoral infiltration are presented. Most patients showed recurrent disease during follow-up and have been treated with surgery and radiotherapy with or without systemic chemotherapy. The prognostic implications of perineural neoplastic infiltration as well as of therapeutic options are discussed.

Pleomorphic adenoma and adenoid-cystic carcinoma of the salivary glands: comparative immunohistochemical patterns.

A series of 20 cases of pleomorphic adenoma and 19 cases of adenoid-cystic carcinoma of the salivary glands, and one case in the mammary location, were investigated regarding immunohistochemical reactivity for Tissue Polypeptide Antigen (TPA), Pre-Keratins, Vimentin, S-100 Protein, and their arrangement pattern of fibronectin. As a whole, the results support the hypothesis of morpho-structural and mainly, onto-histogenetic similarities between these tumours, but they also underline the need for great care in outlining their morpho-functional features, in relation to their different prognoses.

Correlation of an estrogen receptor-related phosphoprotein with histopathological features in breast cancer.

A series of 65 cases of different histological types of breast carcinoma was investigated for the immunohistochemical location of the estrogen receptor-related, 29 kD phosphoprotein using the ER-D5 monoclonal antibody. The ER-D5 response is heterogeneous in relation to some therapeutic limitations and is correlated with histopathological features of the tumors and survival. The main parameters for evaluation of breast cancers are reviewed, both those that are statistically correlated and those that are not apparently always correlated but are known to have considerable biological meaning, such as the ER-status of tumors.

Morphometric study of the bone marrow in polycythemia vera following interferon-alpha therapy.

Bone marrow cellularity and extent of fibrotic change were determined in nineteen patients with polycythemia vera, treated with interferon-alpha (IFN) for 1 year. The cellularity was evaluated with an interactive semiautomatic method using Leitz TAS plus microscope: in particular, number and size of megakaryocytes were evaluated after immunostaining with Y2/51 (CD 61); reticulin content was studied by light microscope with a semiquantitative method. Before IFN therapy mean cellularity was 80.5% (+/- 13.7). After 6 and 12 months mean cellularity was 75.4% and 68.4% respectively. Six months after cessation of IFN therapy the cellularity was 69.1%. A decrease of the number, density and morphometrical parameters of megakaryocytes was also remarked. Reticulin fibrosis was mild in 13 cases and moderate in 6 cases before IFN therapy. Reticulin content was unmodified during therapy in all cases but two, in which fibrosis changed from mild to moderate. In conclusion IFN therapy is to be considered a good method in polycythemia vera for the control of proliferative activity of bone marrow but with IFN therapy one cannot determine regression of marrow fibrosis.

Xanthogranulomatous cholecystitis. Histopathological study and classification.

Xanthogranulomatous cholecystitis (XC) is a chronic inflammatory lesion of the gallbladder histologically characterized by the presence of varying amounts of foamy histiocytes in the inflammatory infiltrate. In this study a review of 63 cases selected from 1207 surgically removed gallbladder is presented; the percentage found (5.2%) is slightly higher than that of previous reports showing that XC is less uncommon than generally believed. A detailed microscopic study is performed: the authors observed according to the histological features particularly the different patterns of distribution of the inflammatory infiltrate and postulate the existence of three subtypes of XC: multinodular, focal and diffuse XC. Finally, the main etiopathogenetic hypotheses are briefly discussed.

Bilateral hairy polyp of the oropharynx.

Hairy polyp of the nasopharynx is an unusual but well-recognized entity, generally presenting as a single mass at birth or in the first year of life. We describe the clinico-pathological features of a previously unreported bilateral hairy polyp in an adult and briefly discuss the pathogenesis of this condition.

[Correlations between morphometric characteristics and the presence of lymph node metastasis in stage T1 and T2 breast carcinoma]. / Correlazione tra caratteristiche morfometriche e presenza di metastasi linfonodali nei carcinomi mammari in stadio T1 e T2.

In this study the relationship between cyto-morphometric characteristics of breast cancer and lymph node status was investigated. The study was conducted on 20 cases of T1-T2 breast cancer with node metastasis and 20 cases of T1-T2 breast cancer without node metastasis. About 100 nuclei for each patient were analyzed by means of a computerized image analyzer, and mean nuclear diameter, mean nuclear area, mean form factor and number of cells in 8 classes of diameter were studied. Mean mitotic index was also calculated. No statistic difference was found for all these variables, between the two groups. In conclusion, cyto-morphometric parameters although often represent an index of aggressiveness, they are not related to lymph node status. This one is, in fact, only an indicator of tumor's ability to spread, and tumor's diffusion can occur through different ways from the lymphatic one.

[Intestinal carcinoid. A propos of a case]. / Il carcinoide intestinale. A proposito di un caso.

In this paper the authors report a case of carcinoid neoplasm in a rare localization like sigmoid colon. They describe the clinical and biological aspects of this kind of tumors, with particular regard to the tumor site and its biochemical products. A rational and prompt clinical approach to this neoplasm is considered important for the good chance of long survivals, achievable in the case of early diagnosis.

Double endocrine neoplasia in a renal transplant recipient: case report and review of the literature.

INTRODUCTION: The incidence of cancer compared for age groups is 3-4 times higher in transplant recipients than the general population. The increased risk is related to immunosuppressive therapy as well as the use of increasingly older donors and recipients. Although cardiovascular disease with a functioning transplant is the leading cause of death (47%), cancer mortality is significant especially among older patients. However, the most frequent posttransplantation cancers relate to hemolymphopoietic organs and skin, whereas the occurrence of solid tumors elsewhere is rare. Herein we have described a rare case of synchronous double malignancy of endocrine organs (thyroid-adrenal) in a young woman who underwent renal transplantation. CASE REPORT: A 37-year-old woman with end-stage renal disease for 18 years underwent transplantation when she was 30 years old with a 17-year-old standard cadaveric donor receiving immunosuppressive therapy with mycophenolate mofetil, cyclosporine, and steroids. Follow-up demonstrated good indices of renal function with negative tumor pathology at 79 months when, at an annual ultrasound monitoring, we found a lesion in the right lobe of the thyroid and left adrenal neoplasm of dubious interpretation. The cytology for the thyroid was highly suspicious of papillary carcinoma, whereas the histological examination after surgery diagnosed a thyroid multifocal papillary microcarcinoma (mpT1NxMx) and an oxyphil cell adrenocortical carcinoma (pT2, N0). RESULTS: Six months after total thyroidectomy with central lymphadenectomy and left kidney and adrenal gland removal the patient showed no evidence of recurrent lesions and stable graft function. CONCLUSIONS: The rare occurrence of solid tumors after transplantation has no known etiopathogenetic relation. Despite the young age of the patient and the double neoplasm that could have produced an unfavorable outcome for the patient and the graft, careful follow-up for tumor pathologies and multidisciplinary management achieved an early diagnosis of both tumors with a surgical eradication without adjuvant therapy, preserving the life of the patient and the function of the graft.

New prospectives in the delivery of galantamine for elderly patients using the IntelliDrug intraoral device: in vivo animal studies.

The transbuccal delivery of drugs could assist several categories of chronic, especially elderly, patients in adhering to a correct dosage regimen. In particular, patients suffering from dementia have several difficulties in following the prescribed dosage, in addition to problems associated with swallowing tablets. Galantamine is currently used for treating patients with mild to moderate Alzheimer's-type dementia. The transbuccal delivery of this drug could be an interesting non- invasive and safe administration route. Several studies have been performed in vitro and ex vivo within the framework of a European Commission funded Project (IntelliDrug-FP6), aimed at developing a device which would be fitted for controlled delivery of drugs by an electronic and software-driven system. The primary objective of this study was to evaluate the efficacy of a prototype of the IntelliDrug device in vivo on 6 pigs, following a single Galantamine dose to be delivered through the buccal mucosae, as compared to intravenous drug injection. The secondary objectives were: a) to verify Galantamine bioavailability through buccal delivery; b) to evaluate the permeation enhancement effect of iontophoresis; and, finally, c) to assess any histomorphological changes in the buccal mucosae after transbuccal delivery. The results suggested that transbuccal delivery has the potential to cause long-lasting and controlled blood levels of Galantamine. The latter crosses the entire buccal mucosae, reaching systemic circulation after about 30 minutes and its plasmatic peak approximately 120 minutes after administration. The histological analysis of the buccal mucosae did not reveal any evidence of flogosis or tissue injury. Our results have clearly confirmed that the buccal delivery of Galantamine is a reliable tool with which to overcome the drawbacks associated with the conventional administration route. In general, transbuccal drug delivery has been shown to be an interesting, non-invasive and safe administration route for delivering systemically-acting drugs.