Chronic urticaria associated with thyroid carcinoma: report of 4 cases.

Chronic urticaria is a common condition that can be very disabling when severe. A variety of causes has been reported to induce urticaria, including food, infections, drugs and other factors. In more than 50% of cases of chronic urticaria, however, the cause remains unknown and cannot be ascribed to allergic, physical, environmental or other factors. Although an association between chronic idiopathic urticaria and malignancy has been occasionally reported, such an association remains controversial because it is difficult to demonstrate it is not just coincidental. Here we report the cases of four female patients with occult papillary carcinoma of the thyroid who developed chronic urticaria. In all of these cases, removal of the tumor led to prompt resolution of the urticarial lesions, thus suggesting a pathogenetic relationship between the two. This is the first report of papillary thyroid carcinomas associated with chronic urticaria and highlights how chronic urticaria may be an important cutaneous marker for patients with thyroid carcinoma.

[Mesenteric fibromatosis: a case report]. / Fibromatosi mesenterica: a proposito di un caso.

Authors report a case of mesenteric fibromatosis, not associated to familial adenomatous polyposis or Gardner's syndrome. It is generally considered benign lesion without metastases, though local recurrences are very frequent. No symptoms are usually referred until compression of the surrounding organs, due to the mass growing, takes place. Surgical therapy is considered treatment of choice.

[Distal pancreatic resection with splenic preservation for metastasis of renal carcinoma diagnosed 24 years later from the nephrectomy]. / Pancreasectomia distale con preservazione della milza per metastasi di carcinoma renale diagnosticato a 24 anni di distanza dalla nefrectomia.

Renal cell carcinoma is a malignant tumor with a singular biological behaviour, presenting in some reported cases very late metastases. This report describes a case of solitary pancreatic metastasis from kidney carcinoma, operated on 24 years before, that appears exceptional because of the long disease-free period after nephrectomy and the unusual metastatic site. The 73-year-old woman concluded the follow-up several years before; she presented aspecific abdominal pain and ultrasonographic examination and CT-scan revealed the presence of a mass in the pancreatic istmus. The mass was excised with splenic preservation and was diagnosed to be a pancreatic metastasis from clear cell renal carcinoma. We discuss the diagnostic and therapeutic features of this tumors. It appears important to obtain the diagnosis preoperatively, because good results may be obtained with surgery, justifying an aggressive surgical approach.

Prognostic value of Goseki histological classification in adenocarcinoma of the cardia.

Various histologic classification systems have been proposed as prognostic factors for gastric cancer. We assessed the prognostic value of Goseki classification as well as the TNM staging system, histological tumour grading, Lauren, WHO, Goseki and Siewert classifications in 100 patients with cardia carcinoma undergoing curative surgery. Two patients were lost at follow-up. The median time of follow-up in the remaining patients was 32.9 months after surgery (range: 0.1-142.1 months). No differences in survival rates were observed according to tumour grading, Lauren or WHO histologic or Siewert topographical classification. No differences were found according to Goseki classes, when considering either the mucin content of the carcinoma (types I and III vs II and IV) or the differentiation grade (types I and II vs III and IV). Multivariate analysis showed that the only lymph node positivity was a significant predictor of survival: 7.2% of patients with, but 41.5% of those without nodal involvement were alive after five years (P=0.0001). In conclusion, we found no prognostic role for Goseki or the traditional histological indexes, while the TNM staging system and particularly lymph node positivity were the main predictors of survival in patients with cardia adenocarcinoma.

Hemorrhagic cholecystitis as a likely cause of nontraumatic hemobilia in metachromatic leukodystrophy: report of a case.

A 17-years-old man with the juvenile form of MLD developed massive hemobilia. CT and US scans showed blood and clots filling the gallbladder and the biliary ways, with no bleeding source seen at selective angiography. Explorative laparotomy evidenced bleeding from a papillomatous gallbladder mucosa, resolved with cholecystectomy. Histologic examination with specific colorations diagnosed hemorrhagic cholecystitis from metachromatic leukodystrophy of the gallbladder. This is, to our knowing, the third case reported in Literature, and thus hemorrhagic cholecystitis may be considered a life-threatening complication of MLD to be prevented with cholecystectomy as soon as signs of gallbladder pathology (papillomatosis/polyposis, jaundice, abdominal pain) are suspected.

Association of multiple granular cell tumors and squamous carcinoma of the esophagus: case report and review of the literature.

This report describes the case of a man who underwent subtotal esophagectomy for the concomitant presence of a multifocal esophageal squamous carcinoma and a granular cell tumor (GCT); he had been previously affected by another metachronous esophageal GCT excised endoscopically. This is the sixth case described in the literature detailing other cases of a combination of malignancies involving additional organs. We emphasize the need for a prolonged surveillance of patients with multiple GCTs in order to promptly recognize the possibility of associated neoplasms.

Histopathology of chronic viral hepatitis: guidelines for a revised classification.

Over the last few years a need for reassessment of the classification of chronic hepatitis has emerged in both clinicians who diagnose and treat liver patients and histopathologists who evaluate liver biopsies. The introduction of an aetiologic terminology, the evaluation of inflammatory activity and necrosis (grading) as well as of fibrosis as the equivalents of a stage in the disease appear to be major requirements. Due to the present satisfactory knowledge of the natural history of hepatitis B, there is also a discussion on the advisability of a personalized classification of chronic hepatitis B, i.e. a classification based upon consideration of profiles (or phases) rather than rigid morphological categories. This paper is intended as a guideline with a view to a revised classification of chronic hepatitis.

[Cystic adenoid carcinoma of the esophagus. Description of a case and review of the literature]. / Il carcinoma adenoido cistico dell'esofago. Descrizione di un caso e revisione della letteratura.

The clinical and histopathologic characteristics of a case of adenoid cystic carcinoma of the esophagus are reported. The authors reviewed the literature on the matter and stressed the more aggressive behaviour of the tumor that differs from the same tumor of the salivary glands and other anatomical sites. Surgical resection is the treatment of choice, however the aggressiveness of the tumor requires, also, a chemo and radiotherapeutic approach.

Endodermal sinus (yolk sac) tumor of the parotid gland: a case report.

Malignant salivary gland neoplasms in children are rare, most common being mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma and adenocarcinoma. Most germ-cell neoplasms of head and neck in children are teratomas. The authors report a case of endodermal sinus tumor (EST) of the parotid gland in a 2-year-old girl, which recurred after chemotherapy. The role of alpha-fetoprotein (AFP) serum level as a helpful marker in differential diagnosis and in evaluating tumor progression is underlined.

[Bone marrow biopsy in HIV-positive patients with thrombocytopenia. Light and electron microscopy]. / La biopsia osteo midollare nei pazienti piastrinopenici HIV positivi. Microscopia ottica ed elettronica.

Isolated thrombocytopenia (platelets less than 100,000 mmc) may be the first clinical symptom in HIV positive patients or occur in all the evolutive phases up to overt AIDS. In this paper bone marrow lesions are evaluated at light and electron microscopy in 32 HIV positive patients with isolated thrombocytopenia (group II and III CDC 1986). At light microscopy an increase in megakaryocytes with small dysplastic changes, plasmacytosis and hypereosinophilia were the bone marrow lesions detected. Electron microscoy revealed megakaryocytes with focal nuclear alterations (hypolobation and dilatation of the perinuclear cisternae) and abnormalities in the maturation of platelets associated with cytoplasmic micro-macrovacuolation, absence of viral particles or of virus correlated structures. About 9% of HIV positive patients presented with isolated thrombocytopenia as a first clinical symptom: thrombocytopenia is not believed to have unfavourable prognostic significance in the evolution to overt AIDS.