Horner's Syndrome: An Uncommon Complication of Thyroidectomy and Selective Lateral Neck Dissection.

BACKGROUND: Horner's Syndrome is defined by myosis, enophthalmos, lack of sweating and eyelid ptosis, as well as vascular dilatation of one half of the face, caused by damage of the ipsilateral cervical sympathetic chain. It is known that Horner's syndrome is an unusual complication of thyroidectomy and selective lateral neck dissection. Its exact pathophysiology is not totally explained and its treatment remains conservative. CASE PRESENTATION: A 27-year-old man developed one-sided partial eyelid ptosis, enophthalmos and myosis two hours after a total thyroid gland excision and a selective lateral neck dissection for papillary carcinoma. A clinical diagnosis of Horner's syndrome was formed. He was treated conservatively and presented with an incomplete recovery at a 2-month follow up. CONCLUSIONS: The present case report underlines the adjacent anatomical correlation between the thyroid gland, the celluloadipose tissue and the cervical sympathetic trunk throughout thyroidectomy and selective lateral neck dissection. Every surgeon should be familiar with the potential complications in order to preoperatively counsel patients, as well as avoid them during the surgical procedure.

Capitellar erosion after radial head arthroplasty: A comparative biomechanical study of operated radial head fractures on cadaveric specimens.

BACKGROUND: We asked whether open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA), common techniques used for the confrontation of displaced or comminuted radial head fractures, are correlated with cartilage wear of the capitulum. HYPOTHESIS: We hypothesized that neither ORIF nor RHA are correlated with capitellar cartilage wear. MATERIAL AND METHODS: On 5 cadaveric elbow specimens, osteotomies were employed to simulate radial head comminuted fractures followed with ORIF by Herbert screws. Radial heads were also excised from other 5 cadaveric elbow specimens and were replaced by metallic monopolar implants. Finally, 2 elbows were not operated and used as a control group. Custom-made rotary machines, working unstoppably, generated 700,000 pronation and supination forearm movements at a 110° arc of motion. The elbow joints were examined with pre- and postoperative magnetic resonance imaging (MRI) scans and the articular surfaces of the capitula were resected and sent for histopathology study. RESULTS: In the 2 cadaveric elbows of the control group and the 4 elbows treated with ORIF, no cartilage damage was found. The fifth one displayed cartilage fissures, which were, classified according to International Cartilage Repair Society (ICRS) grading system as grade I cartilage damage. On the contrary, all 5 elbows treated with RHA sustained complete cartilage loss, exposure of the subchondral bone and were classified as ICRS grade IV cartilage damage. DISCUSSION: Our study suggests that metallic monopolar RHA after a displaced or comminuted radial head fracture carries a high risk of rapidly evolving cartilage loss of the capitulum.

Intratumoral gene therapy versus intravenous gene therapy for distant metastasis control with 2-diethylaminoethyl-dextran methyl methacrylate copolymer non-viral vector-p53.

Lung cancer still remains to be challenged by novel treatment modalities. Novel locally targeted routes of administration are a methodology to enhance treatment and reduce side effects. Intratumoral gene therapy is a method for local treatment and could be used either in early-stage lung cancer before surgery or at advanced stages as palliative care. Novel non-viral vectors are also in demand for efficient gene transfection to target local cancer tissue and at the same time protect the normal tissue. In the current study, C57BL/6 mice were divided into three groups: (a) control, (b) intravenous and (c) intatumoral gene therapy. The novel 2-Diethylaminoethyl-Dextran Methyl Methacrylate Copolymer Non-Viral Vector (Ryujyu Science Corporation) was conjugated with plasmid pSicop53 from the company Addgene for the first time. The aim of the study was to evaluate the safety and efficacy of targeted gene therapy in a Lewis lung cancer model. Indeed, although the pharmacokinetics of the different administration modalities differs, the intratumoral administration presented increased survival and decreased distant metastasis. Intratumoral gene therapy could be considered as an efficient local therapy for lung cancer.

Neuroendocrine tumor of the cystic duct.

Neuroendocrine tumours of the extrahepatic bile ducts are extremely rare with less than 70 cases having been reported in the literature. Neuroendocrine tumours are neoplasms of variable malignant potential that arise from the embryonic neural crest cells. They most commonly occur in young females and usually present with painless jaundice. Preoperative diagnosis is seldom made and neuroendocrine tumours are usually incidentally found during abdominal surgical intervention for other indication. Due to their indolent biological behaviour aggressive surgical treatment is recommended. We present a case of an incidentally discovered neuroendocrine tumour of the cystic duct in a 41 year old woman following laparoscopic cholecystectomy for symptomatic gallbladder microlithiasis. The present case is the 8th case of cystic duct NET and the 63rd of extrahepatic bile duct NET. While a rare location for a NET, it is important to report cases of biliary tract neuroendocrine tumours in order for their pathogenesis and physical history to be clarified.

Imaging of an unusually located aggressive osteoblastoma of the pelvis: a case report.

INTRODUCTION: We present a case of an aggressive osteoblastoma involving the posterior acetabular column and the ischium, which is very rare location for the tumor. CASE PRESENTATION: A 21-year-old man presented with a persistent pain on the left buttock which extended on the rear surface of the thigh and the front surface of the left hip. A plain radiograph, a CT and MRI examinations were performed. The tumor was radically excised and histologically it proved to be an aggressive osteoblastoma. CONCLUSIONS: Although aggressive osteoblastoma is a rare entity it should be considered in the differential diagnosis of bone tumors. Our purpose is to reveal the radiographic presentation of this rare tumor.

Mesothelial mesenteric cyst in patient with ascending colon cancer. Case report.

Mesenteric cysts are rare cystic malformations of the mesentery. They are usually located at the iliac mesentery. Clinically most mesenteric cysts are asymptomatic, but sometimes they present with non-specific abdominal symptoms. Diagnosis can be aided using US, CT and MRI but careful interpretation of the images and high index of suspicion of this rare condition is essential for the correct diagnosis, which cannot always be preoperatively established. The therapeutic method of choice is complete surgical excision of the cyst which minimizes the possibility of recurrence. Histopathologically they are classified in six group. We present a case of a mesothelial mesenteric cyst in patient with colon cancer. The cyst was misdiagnosed as urinary bladder diverticulum in the preoperative CT scan.

Sister Mary Joseph's nodule as the sole presenting sign of gastric signet ring cell adenocarcinoma.

The Sister Mary Joseph's nodule is a periumbilical metastatic tumor originating from advanced metastatic intra-abdominal and intrapelvic malignancies. It is an inconspicuous and uncommon clinical sign, which not only shows the presence of visceral malignancy but also reveals the poor prognosis of these malignancies. The majority of cases originate from gastrointestinal or ovarian cancer. We present a case of an 80-year-old woman with an umbilical nodule, which was the sole presenting symptom of advanced signet ring cell carcinoma of the stomach with generalized peritoneal carcinomatosis. There are very few cases of gastric signet ring cell adenocarcinoma presenting as a SMJN, a fact rather striking as signet ring cell gastric carcinoma has an increased frequency of peritoneal dissemination and carcinomatosis of the peritoneum.

Pilomatricoma of the arm with extensive ossification.

Pilomatricoma is a benign skin tumor derived from the hair follicle, usually located in the head and neck and presenting in the first two decades of life. Clinically it most commonly presents as a hard, mobile, well circumscribed nodule. Microscopically it is characterized by the presence of shadow cells and may show calcification, while extensive ossification is rare. Surgical removal is the treatment of choice, as the recurrence rate is very low. We present a rare case of late regressive pilomatricoma of the arm in a 33 year old female which presented with extensive ossification.

Primary myeloid sarcoma of the jejunum and greater omentum causing small intestine obstruction.

Myeloid sarcoma, which is highly associated with acute myeloid leukemia, is defined as an extramedullary discrete tumor mass, consisted by immature myeloid cells or myeloblasts. Myeloid sarcoma usually involves the skin, lymph node, bone, soft tissue and testis, while involvement of the gastrointestinal tract is rather uncommon. The diagnosis depends on histological features and immunohistochemical results. We present a rare case of myeloid sarcoma, with synchronous involvement of the jejunum and the greater omentum, manifesting with small bowel obstruction.

Induction of hepatic hematopoiesis with tenascin-C expression during the second trimester of development.

OBJECTIVE: To determine the role of tenascin-C in fetal hepatic hematopoietic proliferation and differentiation in different stages of development. STUDY DESIGN: We examined and compared the immunohistochemical expression of tenascin-C in the hepatic stromal portal fields in the first, second, and third trimester of gestation respectively, in relation to the appearance of CD34 progenitor hematopoietic, stromal progenitor and vascular endothelial positive cells. RESULTS: Our results demonstrated a quantitative difference in the second trimester of gestation concerning the expression of tenascin-C in the connective tissue stroma of the hepatic portal fields over the equivalent expression of the protein in the first (P<0.0001, t-test) and third trimester (P<0.0001, t-test). Similar changes in the above period were found concerning the expression of CD34 over the first (P<0.0001, t-test) and third trimesters (P<0.0001, t-test), suggesting a direct involvement of tenascin-C in the sustaining of hematopoietic activity. CONCLUSIONS: Our data provide evidence that an ECM glycoprotein component, tenascin-C, plays a relevant role in hematopoiesis through interaction between stromal cells and hematopoietic progenitor cells.

Presence of a bone marrow stromal cell line with myoid differentiation in reactive plasmacytosis and plasma cell myeloma.

The presence of myoid cells (MCs) - stromal cells with myogenic differentiation - in human bone marrow (BM) has been observed during hematopoiesis in embryonic life, whereas during adult life, it is strictly related to various pathologic conditions. The aim of this study was to examine the presence, distribution and quantitation of cells in the stroma of the BM expressing alpha-smooth muscle actin (alpha-SMA) in reactive BM plasmacytosis and plasma cell myeloma. For this reason, a series of 10 trephine BM biopsies from patients with plasma cell myeloma and 10 specimens from healthy controls with reactive plasmacytosis were examined for the presence of stromal cells with myoid differentiation, using a monoclonal antibody recognizing alpha-SMA. Our results suggest that the incidence of MCs and subsequent fibrosis rises in plasma cell myeloma and in a lesser degree in the BM stroma of individuals with reactive plasmacytosis.

Immunohistochemical expression of vimentin and secretory component antigens in endometrial hyperplasia and neoplasia.

Vimentin is an intermediate filament protein normally expressed in mesenchymal cells, but evidence is accumulating in the literature which suggests that the aberrant expression of vimentin in epithelial cancer cells might be related to local invasiveness and metastatic potential. Previous studies strongly support the implication of vimentin in the metastatic progression of breast and cervical lesions. The secretory component is isolated from human colostrum and is of help in more precise grading of endometrial carcinoma. In this study we examined vimentin and secretory component (SC) expression in adenomatous hyperplasia, atypical adenomatous hyperplasia and well-differentiated adenocarcinoma (cribriform pattern). The results showed decreased expression of vimentin and increased expression of the secretory component as the lesion progressed to malignancy.

Immunophenotypic profile of tumor infiltrating lymphocytes in medullary carcinoma of the breast.

Medullary carcinoma (MC) of the breast is considered to carry a more favorable prognosis than other subtypes of infiltrating ductal carcinoma. This is a biological paradox because its clinical behavior contrasts with its anaplastic morphology. MC is characterized by a dense lymphocytic infiltrate. In this study, we determined the immunological profile of tumor infiltrating lymphocytes (TILs) in MC by CD20 (L26), CD8, and CD45RO (UCHL 1) immunostaining on paraffin-embedded sections. We examined 14 cases of typical MC (TMC), 15 cases of atypical MC (AMC) classified according to Ridolfi criteria (1977) and 19 cases of poorly differentiated infiltrating ductal carcinoma (PDC-NOS). TILs were quantified separately into cells infiltrating tumor nests (intraepithelial) and cells infiltrating tumor stroma (stromal). The number of CD8 positive and CD20 positive cells infiltrating tumor nests and tumor stroma were significantly increased in TMC and AMC as opposed to the PDC-NOS group. There was a loss in the number of CD45RO positive cells, both intraepithelial and stromal, in TMC and AMC as opposed to the PDC-NOS group. We conclude that MC tumor lymphocytic infiltrate demonstrates a mixed-T cytotoxic (CD8+) and B cell (CD20+)-immunophenotypic profile. This might in part explain the improved clinical outcome of the disease.

Gains and losses of glycoprotein CD44 and secretory component expression in endometrial hyperplasia and neoplasia.

CD44 is an adhesion molecule, which binds hyaluronic acid and participates in a number of cell-cell interactions, including lymphocyte homing. The CD44 antigen is expressed on approximately 90% of lymphocytes, monocytes, granulocytes, and, in lower amounts on thymocytes, fibroblasts, and erythrocytes. Platelets lack CD44. In non-haematopoietic tissues, CD44 is widely distributed. The secretory component is isolated from human colostrum and is of help in more precise grading of endometrial carcinoma. In this study we examined CD44 and secretory component expression in adenomatous hyperplasia, atypical adenomatous hyperplasia and well-differentiated adenocarcinoma (cribriform pattern). The results showed decreased expression of CD44 and increased expression of secretory component as the lesion progressed to malignancy.

Immunohistochemical expression of alpha-smooth muscle actin in infiltrating ductal carcinoma of the breast with productive fibrosis.

Myoepithelial cells are normally located between the epithelial cells and the basal lamina of secretory elements of exocrine glands. Their role in the histogenesis of breast tumours has been studied extensively, and a definite differentiation towards myoepithelial cells has been demonstrated in adenoid cystic carcinoma, adenomyoepithelioma, low-grade adenosquamous (syringomatous) carcinoma, pure malignant myoepithelioma and poorly differentiated myoepithelial-rich breast carcinoma. All these tumours are of low malignancy, with the exception of malignant myoepithelioma and poorly differentiated myoepithelial-rich carcinoma. We examined the possibility that invasive ductal carcinoma of the breast might show differentiation towards both epithelial and myoepithelial cells because there is no reason to assume that one type of differentiation necessarily excludes the other. We performed the avidin-biotin immunohistochemical analysis of 20 cases of infiltrating ductal carcinomas (IDCs) with diffuse fibrosis, 20 cases of IDCs without fibrosis and five cases of metaplastic carcinomas, to detect myoepithelial differentiation of the tumour cells. Myoepithelial differentiation was determined by the expression of alpha-smooth muscle actin (alpha-SMA). We concluded that IDCs with diffuse fibrosis are associated with a myoepithelial immunophenotype of carcinoma cells.

Gains and losses of CD8, CD20 and CD56 expression in tumor stroma-infiltrating lymphocytes compared with tumor-associated lymphocytes from ascitic fluid and lymphocytes from tumor draining lymph nodes in serous papillary ovarian carcinoma patients.

Serous papillary ovarian cancer (SPC) is a highly aggressive tumor. About two-thirds of women have advanced disease at the time of diagnosis. Although many women with disseminated disease respond at first to combinations of surgery and chemotherapy, nearly 90% of tumors recur and women die of disease. Update progress in our knowledge of tumor-associated antigens and insight into mechanisms involved in immune-mediated recognition of these antigens, have provided a strong starting point for using the immune system as a model for novel therapy. In this study we determined the immunological profile of tumor-infiltrating lymphocytes (TILs), tumor-associated lymphocytes (TALs) in ascitic fluids, and lymphocytes from tumor draining regional lymph nodes (LNs) in SPC patients by CD20 (L26), CD8, and CD56 immunostaining. We examined 14 cases of TILs, 15 cases of TALs and 19 cases of LNs. TILs were infiltrating tumor stroma. No significant difference was detected in TILs, TALs and LNs in the expression of the B-cell marker CD20. In contrast, CD8 (T-cytotoxic) and CD56 (natural killer cell, NK) markers were dominant in LNs and TALs, but not in TILs. We conclude that SPC tumor lymphocytic infiltrate demonstrates a deplete T cytotoxic (CD8+) and NK cell (CD56+) immunophenotypic profile. This might in part explain the poor clinical outcome of the disease.

Immunocytochemical profile of malignant pleural effusions of small-cell lung cancer.

BACKGROUND: Small-cell lung carcinoma (SCLC) is a highly malignant tumour of a somewhat distinctive cell type. The aim of this study was to determine the immunocytochemical profile of tumor cells and lymphoid cell in SCLC pleural fluids. METHODS: Nine cases of malignant pleural fluids of SCLC were studied using cell block preparation. In pleural effusions cytologically proven to be malignant in 9 patients with SCLC, the immunocytological features of tumor cells, together with the determination of lymphocytic subsets were documented. RESULTS: In all 9 cases, tumor cells reacted with neuron-specific enolase (NSE) (100%), whereas in 6 of 9 cases (66,66%) tumor cell expressed synaptophysin, thyroid transciption factor-1 (TTF-1) and chromogranin A antigens. Phenotyping of the lymphocytes revealed in the majority of cases an expression of CD3 and CD4 antigens (8 and 7 cases, respectively) in contrast to CD8 and CD20 expression (1 and 1 case, respectively). CONCLUSIONS: The reactivity pattern of the tumor cells with the markers used in our study is a specific for SCLC. No significant difference in the distribution of lymphocytic subpopulations is observed in correlation with other malignant and no malignant processes involving the pleural cavity.

[Clinico-genetic features of epilepsy in isolates and a panmictic population with intra-pair, intra-isolate and inter-isolate analysis]. / Kliniko-geneticheskie osobennosti épilepsii v izoliatakh i panmiksnoi populiatsii s vnutriparnym mezhizoliatnym i vnutriizoliatnym analizom

Clinico-genealogical investigation revealed certain specific clinico-genetic characteristics of epilepsy under the conditions of isolation (62 cases) as compared to a panmictic population (76 cases). Itra-pair inter-isolate (31 pairs) and intra-isolate (29pairs) comparison has shown a higher frequency of complete phenotypic similarity in cases of intraisolate (24,1%), than in cases of inter-isolate (9,7%) epilepsy. A more conspicuous interisolate (than intra-isolate) clinical polymorphism of epilepsy combined with an equal frequency of intra-pair inter- and intra-isolate similarity with respect to exogonia and with a distinct (two-fold) increase of the average inbreeding coefficient between the parents of the patients (F = 0,0285) as compared to the general population of the isolates affords the evidence of the genetic heterogeneity of the disease. One of the mechanisms of the hereditary heterogeneity is assumed to be the polylocularity (genocopying).