RESUMEN
Some cases of successful pregnancy after conservative endometrial cancer management have been reported. This paper presents such a case, an infertile patient with conservatively treated endometrial cancer (stage 1a grade 1) who conceived and carried a successful pregnancy after IVF treatment. The conservative treatment consisted of hysteroscopic biopsies and oral megestrol acetate 600 mg daily for 3 months. At the end of the treatment the endometrial cancer remitted to simple endometrial hyperplasia. IVF was performed immediately and 32 days after embryo transfer an intrauterine single gestational sac with fetal pole and heartbeat was detected by transvaginal ultrasound. The woman received routine obstetric care and a caesarean section was performed at 38 weeks of gestation. The histological evaluation after delivery showed no evidence of recurrent disease. Twenty-six months after the delivery, the woman is healthy and free of the disease. It is concluded that conservative treatment of stage 1a and grade 1 endometrial adenocarcinoma is an available option in young women who wish to preserve their fertility.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Transferencia de Embrión/métodos , Neoplasias Endometriales/tratamiento farmacológico , Fertilización In Vitro/métodos , Acetato de Megestrol/uso terapéutico , Adulto , Neoplasias Endometriales/patología , Femenino , Humanos , Embarazo , Resultado del Embarazo , Resultado del TratamientoRESUMEN
BACKGROUND: Diagnosis of pancreatic masses is often difficult. Endoscopic ultrasound-fine needle aspiration has been proposed as the best single-step strategy. AIMS: To prospectively evaluate feasibility, effectiveness and safety of endoscopic ultrasound-fine needle aspiration of pancreatic masses in a consecutive study of unselected patients. METHODS: Two hundred ninety-three patients were enrolled in two referral Hospitals in Northern Italy. All patients were referred either due to the presence of imaging test abnormalities (suspected or evident masses, or features indirectly suggesting the presence of a mass) or due to clinical or biochemical findings suggesting pancreatic cancer in the absence of positive imaging. All patients underwent linear array endoscopic ultrasound and, when indicated, fine needle aspiration. All procedures were recorded prospectively. The final diagnosis was established at the end of follow-up or when the patients underwent surgery or died. RESULTS: Fine needle aspiration was indicated in 246 of 293 cases (84%), considered technically feasible in 232 of 246 cases (94%) and gave adequate samples for histopathological diagnosis in 204 of 232 cases (88%). Endoscopic ultrasound sensitivity, specificity and accuracy were 79, 60 and 72%, respectively; the corresponding figures for endoscopic ultrasound-fine needle aspiration were 80, 86 and 82%. There was good agreement with final diagnosis for endoscopic ultrasound-fine needle aspiration (kappa 0.673, 95%CI 0.592-0.753), greater than that for endoscopic ultrasound alone (kappa 0.515, 95%CI 0.425-0.605). There was one case of intracystic haemorrhage and one case of transient hyperthermia (0.3%). CONCLUSIONS: Endoscopic ultrasound-fine needle aspiration of pancreatic masses seems to be feasible, effective and safe in this consecutive study of patients.
Asunto(s)
Biopsia con Aguja Fina/métodos , Endosonografía/instrumentación , Enfermedades Pancreáticas/patología , Anciano , Diagnóstico Diferencial , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/diagnóstico por imagen , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Herpesviridae infection or spread may be a hazard in immunodepressed patients. In the field of inflammatory bowel disease, refractory severe ulcerative colitis is a challenging condition, closely associated to immunosuppression both for inanition due to the disease activity and for immunosuppressive treatments. Cytomegalovirus (CMV) has been proposed as a major cause of refractoriness, while other Herpesviridae may be a risk factor in the long-term follow-up. AIM OF THE STUDY: To evaluate the positivity rates of CMV, Epstein-Barr (EBV) and Human herpes virus-8 (HHV8) in a consecutive group of ulcerative colitis patients who underwent colectomy for refractoriness to medical treatment compared to a control group, using state of the art methods. PATIENTS AND METHODS: Colonic specimens from 24 consecutive patients with ulcerative colitis submitted to colectomy for refractoriness and from 20 controls (submitted to colectomy for colorectal cancer) were studied. Standard histology and immunohistochemistry (IHC) for CMV and specific polymerase chain-reaction (PCR) for CMV, EBV and HHV8 were carried out. RESULTS: Regarding CMV, 1 case (4%) was positive at histology and IHC, whereas 3 cases (13%) were positive at PCR, compared to none in the control group (p=0.239). For EBV 2 cases (8%) and 2 controls (10%) were positive at PCR. None of the cases or of controls was positive for HHV8. The only clinical characteristic independently associated to CMV positivity was the white blood cell count at admission, higher among CMV positive patients (p<0.001). At the end of the post-surgery follow-up (median 7.3 years) none of the CMV positive cases experienced pouchitis, compared to 3/21 (14%) of the CMV negative cases (p=1.000). DISCUSSION: Our data suggest that CMV is uncommon (13%), even though PCR techniques, considered to be the most sensitive tools, were used for virus detection and the study population is made by highly selected patients with definite refractoriness. EBV and HHV8 may represent a theoretical risk of immunosuppressive therapy because of their potential role as cancer triggers; however in our study, results seem to be reassuring that UC patients undergoing immunosuppressive therapy are not exposed to an excessive risk of viral infection.
Asunto(s)
Colitis Ulcerosa/virología , Infecciones por Herpesviridae/complicaciones , Infecciones por Herpesviridae/epidemiología , Esteroides , Adolescente , Adulto , Anciano , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/inmunología , Citomegalovirus/aislamiento & purificación , Resistencia a Medicamentos , Femenino , Infecciones por Herpesviridae/diagnóstico , Herpesvirus Humano 4/aislamiento & purificación , Herpesvirus Humano 8/aislamiento & purificación , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Esteroides/uso terapéuticoRESUMEN
A series of 60 cases of oxyphilic (Hurthle cell) carcinomas (HCC) of the thyroid were reviewed to determine whether it is possible to correlate morphologic and clinical features as a means of assessing prognosis. Twenty cases showing predominant solid or trabecular patterns (as described in poorly differentiated carcinomas with a follicular pattern) were selected and the clinicopathological features were investigated. Based on cell size, two groups of solid or trabecular HCCs were identified: The first group (17 cases) was made up of typical large granular oxyphilic cells, and the second (three cases) had small oxyphilic cells. All tumors were reactive for thyroglobulin and for a mitochondrial antigen, selectively marking oxyphilic, mitochondrial-rich cells. Nuclear pleomorphism in individual cells was a common feature, but foci of anaplastic carcinoma were never found. Four cases overexpressed p53 protein and 10 expressed bcl-2 gene product. At follow-up, among the high-stage (pT3-pT4) tumors, seven patients had recurrences or metastases, six of whom were alive with disease or died of disease. In the control group of HCC with predominant follicular patterns, only one of 40 cases had a fatal outcome. The difference was statistically significant. Small-cell patterns and a p53 protein-positive/bcl-2 gene product negative phenotype were features of clinically aggressive HCC cases. We suggest that within the spectrum of oxyphilic (Hurthle cell) tumors, poorly differentiated HCC showing solid or trabecular patterns are a distinct group, based on both morphological and clinical features.
Asunto(s)
Adenocarcinoma/patología , Neoplasias de la Tiroides/patología , Adenocarcinoma/inmunología , Adulto , Anciano , Femenino , Humanos , Inmunohistoquímica , Inmunofenotipificación , Masculino , Persona de Mediana Edad , Pronóstico , Tiroglobulina/inmunología , Neoplasias de la Tiroides/inmunologíaRESUMEN
Identification of sensitive techniques for breast cancer cell detection might be relevant for high-dose chemotherapy programs with autologous stem cell transplantation. We investigated the feasibility of Maspin, Mammaglobin and c-ErbB-2 amplification by real-time quantitative polymerase chain reaction (RQ-PCR) for the detection of breast cancer cells in leukaphereses. Expression of the three markers was determined in primary breast cancers and cell lines. Peripheral blood (PB), bone marrow (BM), and leukapheresis samples from patients with malignancies other than breast cancer were used as controls. Sensitivity was evaluated by dilution of primary tumors and cell lines with mononuclear blood cells. We found expression of the three markers in all primary tumors and most cell lines. No blood specimen from control patients had the Maspin transcript, while only one was positive for Mammaglobin. Weak c-ErbB-2 expression was detectable in most PB, all BM and all leukapheresis samples from controls. We observed a low sensitivity of Maspin RQ-PCR and a sensitivity of Mammaglobin RQ-PCR up to one tumor cell in 10(6) mononuclear cells. One out of 18 leukaphereses from breast cancer patients screened for the presence of Mammaglobin mRNA was positive. We conclude that Mammaglobin RQ-PCR might be a useful tool for detection of leukapheresis contamination.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Leucaféresis/normas , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/normas , Sangre , Médula Ósea , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Femenino , Secciones por Congelación , Genes Supresores de Tumor , Genes erbB-2 , Humanos , Mamoglobina A , Proteínas de Neoplasias/genética , Proteínas/genética , ARN Mensajero/análisis , Sensibilidad y Especificidad , Inhibidores de Serina Proteinasa/genética , Serpinas/genética , Células Tumorales Cultivadas , Uteroglobina/genéticaRESUMEN
This is a case of spontaneous regression of a tumour. Only the French Authors speak about this type of seminoma called them "seminome cicatrice". Probably the immunological defences are fundamental for the complete or partial spontaneous resolution of this type of tumour. Here we describe our clinical and surgical approach. The last control was normal with a relapse-free patient.
Asunto(s)
Disgerminoma/patología , Neoplasias Testiculares/patología , Adulto , Disgerminoma/diagnóstico por imagen , Disgerminoma/cirugía , Humanos , Metástasis Linfática/patología , Masculino , Orquiectomía , Neoplasias Testiculares/radioterapia , Neoplasias Testiculares/cirugía , Tomografía Computarizada por Rayos XRESUMEN
The author describe a rare case of pancreatic beta-cell hyperplasia. The patient was referred to us because of serious hypoglycemic crises. During hospitalization, endogenous hyperinsulinism was confirmed by hematochemical and instrumental tests. AngioCT of the pancreas evidenced a small lesion of the corpus, suspected of insulinoma. The patient underwent a corpus caudalis pancreatectomy: a small nodule with histologic neuroendocrine traits was ablated. A few days after the operation, new symptomatic hypoglycemia appeared. The hormonal tests confirmed a recurrence of endogenous hyperinsulinism. The patient underwent a new operation for pancreaticoduodenectomy: histological examination confirmed a pancreatic beta-cells hyperplasia. This condition has to be taken into account in the differential diagnosis of post prandial hypoglycemia. Besides, the observation of an insulinoma doesn't exclude the presence of a diffused disorder of islet cells as in the case above described.
Asunto(s)
Hiperinsulinismo/etiología , Hipoglucemia/etiología , Islotes Pancreáticos/patología , Péptido C/análisis , Diagnóstico Diferencial , Femenino , Humanos , Hiperinsulinismo/cirugía , Hiperplasia , Hipoglucemia/cirugía , Insulinoma/diagnóstico , Islotes Pancreáticos/cirugía , Persona de Mediana Edad , Pancreatectomía , Neoplasias Pancreáticas/diagnóstico , PancreaticoduodenectomíaRESUMEN
A rare case of bilateral granulomatous orchitis is presented and the problems of diagnosis and treatment are discussed. There are no relationships between echography and granulomatous orchitis. At present, granulomatous orchitis remains a disease with a difficult etiology treatment.
Asunto(s)
Granuloma/diagnóstico , Orquitis/diagnóstico , Neoplasias Testiculares/diagnóstico , Diagnóstico Diferencial , Granuloma/patología , Granuloma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Orquiectomía , Orquitis/patología , Orquitis/cirugía , Lesiones Precancerosas/diagnósticoRESUMEN
The case of a multiple kidney cyst in an adult patient is described. The cyst had caused parenchymal atrophy by blocking the excretory ways. The pathological anatomy of the lesion is described and the aetiopathogenic hypotheses found in the literature are reported.
Asunto(s)
Neoplasias Renales/patología , Enfermedades Renales Poliquísticas/patología , Tumor de Wilms/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The paper describes a case of light-cell carcinoma of the kidney in a patient affected by hairy-cell leukemia. The immunological status is assessed revealing a severe deficit of NK phenotype lymphocytes. Therapy with alpha interferon was proposed in order to stimulate killing and recruitment processes of new NK cells.
Asunto(s)
Adenocarcinoma/inmunología , Neoplasias Renales/inmunología , Leucemia de Células Pilosas/inmunología , Neoplasias Primarias Múltiples , Adenocarcinoma/epidemiología , Adenocarcinoma/terapia , Terapia Combinada , Humanos , Factores Inmunológicos/uso terapéutico , Interferón Tipo I/uso terapéutico , Neoplasias Renales/epidemiología , Neoplasias Renales/terapia , Células Asesinas Naturales/patología , Leucemia de Células Pilosas/terapia , Masculino , Persona de Mediana EdadRESUMEN
Renal damage is not uncommon in rheumatoid arthritis, but the causative role of the disease per se is not well defined yet. In this paper the updated literature data are reported and our own experience as well. In particular, we describe renal syndromes associated with non-steroidal antiinflammatory drugs, remission-inducing agents (gold and penicillamine) and cytotoxic drugs, secondary amyloidosis, systemic rheumatoid vasculitis, glomerular and tubulo-interstitial nephritis not related to drug therapy.
Asunto(s)
Artritis Reumatoide/complicaciones , Enfermedades Renales/etiología , Adulto , Amiloidosis/etiología , Antiinflamatorios no Esteroideos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Ciclosporina/efectos adversos , Femenino , Glomerulonefritis/etiología , Oro/efectos adversos , Humanos , Enfermedades Renales/inducido químicamente , Fallo Renal Crónico/inducido químicamente , Masculino , Metotrexato/efectos adversos , Persona de Mediana Edad , Penicilamina/efectos adversos , Vasculitis/etiologíaRESUMEN
Wegener's granulomatosis (WG) is a rare small vessels necrotizing and granulomatous systemic vasculitis which usually affects the respiratory-tract and the kidneys. Diagnosis is often difficult, but has become easier with antineutrophil cytoplasmic antibodies (ANCA) detection that may justify a more aggressive biopsy policy also in the elderly. Classic treatment with steroids and oral cyclophosphamide (CY) has proven to be of benefit, but side-effects are severe and frequent and the search for less toxic therapeutic schemes should be encouraged. We treated with intravenous pulses of CY (1 g/m2 monthly for 6 months, every two months for the following 6 and quarterly for another year) 5 of 7 patients with WG recently admitted to our institution. We obtained a quick, complete response in 4 of these patients, with no side effects, nor relapses, after a mean follow-up of 17 months. The only patient who did not respond was identified soon after the beginning of the treatment because of a poor reduction of ESR and could be shifted to oral administration of CY successfully. From our still limited experience CY intravenous pulses have proven to be safe and effective enough to advice its use as the first-choice treatment for WG.
Asunto(s)
Granulomatosis con Poliangitis/diagnóstico , Adulto , Anciano , Anticuerpos Anticitoplasma de Neutrófilos , Autoanticuerpos/sangre , Biomarcadores , Ciclofosfamida/uso terapéutico , Femenino , Estudios de Seguimiento , Granulomatosis con Poliangitis/sangre , Granulomatosis con Poliangitis/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana EdadRESUMEN
The cases of two patients with radio-opaque residues of contrast medium (Thorotrast) in the abdomen, at the level of the liver, the spleen and certain lymph node groups of the hepatic hilum and the pancreas are reported. In one of the two patients (both of whom had undergone examination with this contrast medium in the '40s) necropsy showed the existence of cholangiocarcinoma. It is therefore considered useful to recall the X-ray signs typical of this pathology, which is dying out after the abandonment of thorium dioxide as an X-ray contrast medium.
Asunto(s)
Adenoma de los Conductos Biliares/inducido químicamente , Neoplasias de los Conductos Biliares/inducido químicamente , Enfermedad Hepática Inducida por Sustancias y Drogas , Enfermedades del Bazo/inducido químicamente , Dióxido de Torio/efectos adversos , Anciano , Angiografía/efectos adversos , Atrofia , Medios de Contraste/efectos adversos , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Masculino , Neoplasias Pancreáticas/secundario , Urografía/efectos adversosRESUMEN
The paper describes two cases of cutaneous endometriosis in correspondence with the surgical scar following cesarean section. The cases formed part of a series of 500 abdominal operations performed during the period 1988-89, of which about 200 were cesarean sections, with a 1% frequency. In line with the hypothesis regarding the spread of endometrial tissue during surgery and with that concerning peritoneal metaplasia, the authors recommend paying special attention during the technical procedure of extracting the fetus, and performing an introflexed suture of the uterine incision and of the parietal peritoneum.
Asunto(s)
Cesárea/efectos adversos , Endometriosis/etiología , Neoplasias Cutáneas/etiología , Músculos Abdominales/patología , Músculos Abdominales/cirugía , Adulto , Cicatriz/patología , Cicatriz/cirugía , Endometriosis/patología , Endometriosis/cirugía , Femenino , Granuloma de Cuerpo Extraño/patología , Granuloma de Cuerpo Extraño/cirugía , Humanos , Complicaciones Posoperatorias , Embarazo , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Suturas/efectos adversosRESUMEN
A case of ectopic hepatic parenchyma in the wall of the gall bladder, independent of the remaining hepatic parenchyma, is reported. The node presented fairly advanced differentiation features in grossly lobular structures and biliary architecture.
Asunto(s)
Coristoma , Neoplasias de la Vesícula Biliar , Hígado , Femenino , Humanos , Persona de Mediana EdadRESUMEN
The aim of our retrospective study was to verify the results of surgical treatment of rectal cancer in a homogeneous case series, evaluating the various factors that can influence the prognosis and long-term results. The prognostic factors taken into consideration were: Duke's stage; grading; colloid component; location of tumour; type of surgical intervention; age; sex; duration of the symptoms; length of normal rectum below the lower border of the tumour correlated to stage and grading. One hundred and sixty-five patients were operated with a radical approach: 50 abdominoperineal resections (APR) and 115 sphincter-saving resections (SSR) were performed. There were 90 males and 75 females. The mean age was 63 years. Total survival was 61.7% after 5 years and 50% after 10 years. In our study neither the age nor the sex, duration of symptoms or location of the tumours proved to have an influence on survival; while Duke's state turned out to be decisive for survival; also the colloid tumour component proved to have a worse prognosis. The 5-10-year survival rate was respectively 53.6% and 49% in the APR and 65.7% and 50.9% in the SSR (p = n.s.). The data we have collected show that APR and SSR operations have analogous efficiency.
Asunto(s)
Neoplasias del Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Estudios Retrospectivos , Tasa de Supervivencia , Factores de TiempoRESUMEN
The development of lymphoproliferative disorders in association with a chronic liver disease, although uncommon has been documented in several reports and a review of the available literature yielded a total of 34 cases. It has been suggested that this association is probably not a fortuitous coincidence and several mechanisms explaining the development of lymphoproliferative diseases in the course of liver disease have been offered. We have evaluated the annual cumulative incidence of such an association in the specific population of patients with liver cirrhosis (N.:344) admitted to our Department of Gastroenterology, Mauriziano Hospital, in Turin, within 3.5 years, from January 1987 to June 1990: it resulted to be 9.56/1,000 subjects per year. This figure is much higher than the annual incidence registered in Turin within the years 1985-87 for the same lymphoproliferative disease, 39.6/100,000 inhabitants. Our data add value to the hypothesis that this association is not incidental and suggest that chronic liver disease should be added to the list of the pathological conditions with immunological disturbances associated with lymphoproliferative disorders.