Ewing's sarcoma arising primarily in the spinal epidural space: fifth case report.

Ewing's sarcoma is found exceptionally as a primary epidural tumor of the spine. Four cases have been described in the literature. We describe the fifth case: a 10-year-old boy who underwent operation followed by radiotherapy and chemotherapy. For 1 year he then had a complete remission with no local recurrence and his neurological condition was satisfactory, although metastases developed later. Comparison with the cases described previously shows all five to possess interesting features in common.

An unusual case of primary hormone-secreting germ cell tumor of the retroperitoneum.

An unusual case of primary retroperitoneal germ cell tumor is presented. Criteria for considering such a diagnosis in patients with apparent poorly differentiated carcinomas are discussed. An interesting hypothesis is presented to explain the hormonal abnormalities observed.

Fibromatosis of the larynx in the adult.

We describe the fourth case of aggressive fibromatosis of the larynx arising in an adult. Most cases of laryngeal fibromatosis have been described in children. In the larynx it may behave the same as in other sites, with local aggressiveness but without metastasis. The possible differential diagnoses are discussed.

[Clinico-diagnostic considerations on lymphocytic thyroiditis. Presentation of clinical cases]. / Considerazioni clinico-diagnostiche sulle tiroiditi linfocitarie. Presentazione di casi clinici.

Personal experience with autoimmune lymphocyte thyroiditis, represented by 11 cases observed between 1972 and today, is reported. After some brief aetiopathogenetic notes on the lesions in question, the problems of diagnosing the nature of the thyropathy are stressed. After reviewing the examinations that have been proposed in the literature, it is noted that the preoperative recognition of a thyroiditis with autoimmune genesis is still problematical. The institution of a diagnostic protocol based on the systematic search for antibodies, the perchlorate test, the thyrostimulation test, ESR study, the search for alpha2 and gamma-globulins, scintigraphy with positive indicators and needle biopsy as well as on scintigraphy and thyrometabolic tests (T3-T4-TSH-TRH test) is proposed. Even when such a protocol is adopted, however, it should be mentioned that only in 18% of the personal cases was it possible to diagnose thyroiditis, in the other subjects this being merely an occasional post-operative finding. In confirming the personal therapeutic approach, which at least initially is medical, for recognized forms, it is pointed out that surgical treatment is to be preferred in certain cases because of the presence of compressive phenomena, and in others it appears capable of relieving, in follow-up, the thyroiditic process, probably as a result of the removal of the antigenic tissue.

[Mesothelial cyst of the diaphragm. Presentation of an unusual case]. / Cisti mesoteliale del diaframma. Presentazione di un inusuale caso.

The authors report a case of mesothelial cyst of the diaphragm in a boy 11 years old who was examined for pain in the right hypochondrium with exacerbation during respiratory movements. Ultrasonography and CT suggested the diagnosis. However the final diagnosis of mesothelial cyst of the diaphragm was possible only after laparotomy and histological examination. The topographical, clinical, radiological, therapeutic and histological aspects of primary cysts of the diaphragm are presented and a survey of the literature is made.

[Soft-tissue malignant melanoma (clear-cell sarcoma). Description of 2 cases with unusual histological features]. / Melanoma maligno delle parti molli (sarcoma a cellule chiare). Descrizione di due casi con inusuali aspetti istologici.

Malignant melanoma of soft part. Report of two cases with unusual histological features. Two examples of malignant melanoma of soft parts (clear cell sarcoma) are reported. In the first case the tumor cells showed predominantly eosinophilic cytoplasms; positive staining for S-100 protein has been observed immunohistochemically in the majority of the tumor cells. The second case, in recurrent lesion, showed a prominent "balloon cell" transformation of tumor cells. The clinico-pathologic picture, differential diagnosis and histogenetic problems are also discussed.

Xanthogranulomatous pyelonephritis in childhood: report on an unusual case.

A case of localised xanthogranulomatous pyelonephritis (XPN) in a 4-year-old female with an unusual radiological picture is reported. The young girl was suspected to have a liver tumour because of a hypervascularised area found by arteriography in the hepato-diaphragmatic region. Laparotomy disclosed a large mass in the upper pole of the right kidney which was adherent to the liver and to the diaphragm. Excision of the large mass including upper pole of the kidney was carried out. Recovery was uneventful. Pathological examination revealed the XPN disease pattern.

Verruciform xanthoma of the vulva: case report.

A rare case of verruciform xanthoma of the vulva is reported. Diagnosis was made possible by histopathological examination and immunohistochemical staining. Verruciform xanthomas generally occur in the oral cavity. To the best of our knowledge, this is the third reported case of the tumour located on the genital mucosa. Immunohistochemical study supported the histiocytic origin of the lesion. Clinically, verruciform xanthomas may mimic other verrucous lesions of the vulva, such as seborrhoeic keratosis, verruca simplex, condyloma acuminatum, verrucous carcinoma, or erythropasia of Queyrat, or conditions such as histiocytosis, cutaneous lipidosis, or granular cell myoblastoma. The characteristics that differentiate those conditions from verruciform xanthoma, which can be seen only on histology, are given.

Carcinoma of the breast with osteoclast-like giant cells. Fine-needle aspiration cytology, histology and electron microscopy of 5 cases.

Five cases of a rare peculiar type of mammary carcinoma with osteoclast-like stromal giant cells are reported. The tumors are characterized by a large number of multinucleated giant cells in intimate association with the epithelial neoplastic cells. The light and electron microscopic observations confirm the earlier reports about the origin of the giant cells from mononuclear histiocytes as a local response to some tumoral products. In 3 patients a preoperative fine-needle aspiration biopsy was carried out and the cytomorphology of these tumors is described to alert cytopathologists who encounter this entity in the routine breast mass aspiration biopsy.

Hyperthyroidism due to a thyroid-stimulating hormone (TSH)-secreting pituitary adenoma associated with functional hyperprolactinaemia. A case report.

This paper reports the case of a 31-year-old woman with hyperthyroidism, increased TSH and thyroid hormone levels, evidence of a pituitary adenoma, hyperprolactinaemia, amenorrhoea, and galactorrhoea. Following trans-sphenoidal pituitary adenomectomy, mild hyperthyroidism and increased TSH and alpha subunit levels persisted, whereas hyperprolactinaemia, amenorrhoea, and galactorrhoea disappeared. Serum TSH levels were not affected by administration of TRH, metochlopramide, domperidone, l-dopa or somatostatin. Serum TSH chromatography showed a normal pattern. Following a second trans-sphenoidal pituitary adenomectomy and radiotherapy, hyperthyroidism disappeared, and the TSH and alpha subunit levels returned to normal. Light microscopy showed no specific TSH immunostaining although electron microscopy revealed numerous secretory granules alined along the plasma membrane. The post-operative follow-up confirmed the presence of a TSH-secreting pituitary adenoma associated to functional hyperprolactinaemia.