Cellular fibroma in the Douglas cavity, mimicking a malignant neoplasia: fibroma, fibrosarcoma or mitotically active cellular fibroma?

INTRODUCTION: Ovarian fibroma is a benign stromal tumour composed of spindle/ovoid fibroblastic cells producing collagen. Approximally 10% of fibromas are densely cellular with small amount of collagen. In these cases, if mild nuclear atypia is present, they are best addressed as cellular fibroma. However cellular fibroma may show a greater mitotic activity and therefore they should be referred as mitotically active cellular fibromas. Mostly benign, it is necessary to differentiate them from malignant tumours such as fibrosarcomas. METHODS: We report a case of an unusual presentation of mitotically active cellular fibroma, detected in the Douglas cavity of a young woman, with normal appearing ovaries and uterus, mimicking a malignant neoplasia clinically and on imaging. In fact abdominal mass may be associated with acute pain, resulting in clinical emergency, really difficult to distinguish from a frank malignancy, before surgical procedure. RESULTS: We described the clinical, radiological and pathological characteristics of our case and we make a comparison of what previously described in literature. DISCUSSION: The differential diagnosis among those entities is based on the microscopic features such as atypia and the number of mitoses. However, according to their dimensions, it may be necessary to generously sample these tumours and sometimes, to perform a panel of immunohistochemical markers, in order to make a correct diagnosis, establish the best treatment and the right follow-up. In fact, the prognosis is not certain, due to the possible recurrence, especially if not completely excised.

Solitary plasmacytoma of the tonsillar site associated with actinomyces infection: the possible role of IL-6.

ExtraMedullary Plasmacytoma (EMP) is a rare plasma cell tumor. It can occur in the upper aerodigestive tract and presents as a large nodule causing local compressive symptoms. A 79-year old woman presented to Otorhinolaryngology Department with progressive hearing loss and no other symptoms. Following PET/TC examination due to the suspicion of a lymphoproliferative disease, the patient underwent tonsillectomy and the diagnosis of solitary EMP was formulated. In addition to that, the histological examination of the tonsillar tissue revealed large colonies of filamentous bacteria, showing abundant sulphur granules and Splendore-Hoeppli phenomenon; these evidences indicating the presence of a chronic Actinomyces infection. Immunohistochemical analysis demonstrated a marked IL-6 immunoreactivity of the neoplastic plasma cells. Interestingly, a marked IL-6 immunoreactivity was also found in the tissue surrounding the Actinomyces colonies. In the present study we report for the first time a solitary EMP associated with Actinomycosis. It is tempting to speculate that the unsuspected and untreated Actinomyces infection, through chronic IL-6 production, could contribute to the neoplastic transformation of plasma cells.

Poly-L-lactic acid beta-tricalcium phosphate screws: a preliminary in vivo biocompatibility study.

The aim of this study is to assess the biocompatibility of two types of Poly-L-lactic acid (PLLA) screws (with either hydroxyapatite (HA) or beta-tricalcium phosphate (beta-TCP)) implanted in the left femur of four sheep euthanized at 42, 50, 57 and 84 days after surgery. Titanium screws were also implanted for comparison purposes. No signs of inflammation were seen in the 240 specimens. A rating of "+/-" for macrophages and "-" for neutrophils was assigned to all specimens. All specimens were assigned a rating which ranged from "+/-" to "+++" for fibroblasts and osteoblasts. The presence of macrophages, neutrophils and fibroblasts/osteoblasts was not statistically different for the four implantation periods. PLLA implants with beta-TCP have a biocompatibility comparable to PLLA implants with HA.

Transforming growth factor beta 1, interleukin-8 and interleukin-1, in non-small-cell lung tumors.

A role in tumor progression has been proposed for transforming growth factor-beta 1 (TGF beta 1) and interleukin (IL)-8 as well as for IL-1, which itself induces the production of TGF beta 1 and IL-8 in many cell types. TGF beta 1 and IL-8 production and their regulation by IL-1 in five non-small-cell (NSC) lung tumor cell lines were evaluated. Moreover, their levels were evaluated in 29 NSC lung tumors. All cell lines constitutively produced TGF beta 1, and three produced IL-8. After IL-1 beta treatment, TGF beta 1 production was upregulated in two cell lines, whereas IL-8 production was markedly upregulated in two, induced in one, and unmodified in two. In tumors, the levels of TGF beta 1, IL-8, and IL-1 beta were higher than in normal counterparts (p < 0.001), and a positive correlation between IL-8 and IL-1 beta levels (p < 0.001) was found. TGF beta 1, IL-8, and IL-1 beta mRNA expression was examined in 12 tumors. TGF beta 1 mRNA was detected in all cases, IL-8 mRNA in 7, and IL-1 beta MRNA was undetectable. TGF beta 1, IL-8, and IL-1 beta immunoreactivity was then studied by immunohistochemistry. TGF beta 1 and IL-8 immunoreactivity was observed in neoplastic cells; IL-1 beta immunoreactivity was observed in mononuclear cells. In conclusion, in tumors IL-1 beta levels positively correlated with those of IL-8, and IL-1 beta as well as TGF beta 1 and IL-8 levels were significantly higher than in normal tissues.

Defective development of pristane-oil-induced plasmacytomas in interleukin-6-deficient BALB/c mice.

Interleukin (IL)-6 is known to be an essential growth factor for myeloma cells, both in vitro and in vivo. In mice, IL-6 is required for development of B cell tumors upon infection with a retrovirus expressing the myc/raf oncogenes. In the present study, we used the pristane-oil-induced plasmacytoma model, which more closely mimics tumor transformation and progression in human multiple myeloma. Also using this system, we found that IL-6-deficient BALB/c mice are protected against tumor development. Although the pristane-induced inflammatory reaction was less pronounced in IL-6-deficient mice versus their wild-type littermates, both B cell differentiation and plasma cell formation took place, and even morphological evidence of plasma cell transformation was detected, albeit at a low frequency. However, in the absence of IL-6, there were never signs of uncontrolled proliferation of either normal B lymphocytes or tumor cells, suggesting that the role of IL-6 in murine plasmacytoma and possibly also in human multiple myeloma is to ensure abnormal survival and proliferation of previously transformed tumor cells and therefore tumor development and progression.

[Primary non-Hodgkin's lymphoma of the mandible: a description of a clinical case and review of literature]. / Linfoma non Hodgkin primitivo della mandibola: descrizione di un caso clinico e revisione della letteratura.

The authors present a rare case of primary non-Hodgkin lymphoma (NHL) of the mandible in an 81-year old woman. The location of this NHL caused problems in making a differential diagnosis between periodontal and tumoral disease as they have similar symptoms (i.e. dental pain, swelling, ulceration and radiologically detected rarefaction). The present work emphasizes how important correct diagnosis and staging of the primary NHL are to good therapy. The patient was treated with a combination of chemotherapy and radiotherapy and is alive and disease-free 12 months after treatment.

Depletion of stromal and intraepithelial antigen-presenting cells in cervical neoplasia in human immunodeficiency virus infection.

Human immunodeficiency virus-positive (HIV+) women have an increased risk of lower genital tract dysplasia and neoplasia, and studies of the central lymphoid system suggest that impaired immunosurveillance plays a role in the development of their cervical tumors. Intraepithelial and stromal immunocompetent cell counts were compared in cervical specimens from 50 HIV+ and 50 appropriately matched HIV-women (controls) with low and high grade squamous intraepithelial lesions (SIL), or carcinoma. Each histological class of HIV+ women displayed fewer intraepithelial Langerhans' (S100+) cells (LC) (as already known), and also fewer stromal LC and both intraepithelial and stromal (CD68+) macrophages. LC and macrophages were reduced in all HIV+ patients, whereas reduction of cervical T lymphocytes was found in only immunocompromised subjects (peripheral blood CD4+ T-cell count < 500/microL). A mucosal quantitative deficiency of antigen-presenting cells (APC) thus precedes that of T cells. HIV infection appears to lead to early impairment of mucosal immunoreactivity mainly because of defective antigen presentation. This impairment may be one mechanism underlying the increased frequency of cervical dysplasia/neoplasia, and the enhanced aggressiveness of invasive cancers in HIV+ women.

Lymphoproliferative disorder and imbalanced T-helper response in C/EBP beta-deficient mice.

C/EBP beta is considered a key element of interleukin-6 (IL-6) signalling as well as an important transcriptional regulator of the IL-6 gene itself. We describe here how mice lacking C/EBP beta develop a pathology similar to mice overexpressing IL-6 and nearly identical to multicentric Castleman's disease in human patients, with marked splenomegaly, peripheral lymphadenopathy and enhanced haemopoiesis. Humoral, innate and cellular immunity are also profoundly distorted, as shown by the defective activation of splenic macrophages, the strong impairement of IL-12 production, the increased susceptibility to Candida albicans infection and the altered T-helper function. Our data show that C/EBP beta is crucial for the correct functional regulation and homeostatic control of haemopoietic and lymphoid compartments.

[Simultaneous laryngeal carcinomas: a case report and review of literature]. / Carcinomi laringei simultanei. Presentazione di un caso e revisione della letteratura.

The high incidence of second primary malignant neoplasms in patients under treatment for head and neck tumors has been well documented in literature. In these cases the second primary reappears still in the upper aero-digestive tract or in distant organs (lung, esophagus, stomach, skin,....). The Authors report a case of a male, 64 year old patient, a moderate drinker and smoker, with two distinct simultaneous laryngeal malignant neoplasms. One tumor, which arose on the laryngeal face of the epiglottis, was a verrucous carcinoma (Ackerman's tumor); the other neoplasm, on the right vocal cord, was a well differentiated squamous cell carcinoma. Microlaryngeal examinations and TC-scans revealed a normal, uninvolved right false vocal cord and the Morgagni's ventricle. After surgical therapy, serial laryngeal samples were removed and underwent immunohistochemical studies. Microscopic examination revealed that the anterior commissure, the pre-epiglottic and paraglottic spaces were intact, furthermore, monoclonal antibody studies proved that the two simultaneous laryngeal cancers were independent. In the discussion the Authors report some clinical considerations, a review of literature concerning multiple simultaneous laryngeal tumours and emphasize the concept of "field cancerization", first described with regard to the oral cavity by Slaughter.

[Peritoneal mesothelioma as a rare case of acute abdomen. Review of the literature]. / Il mesotelioma peritoneale come raro caso di addome acuto. Revisione della letteratura.

Peritoneal mesothelioma is a rare neoplasm with generic and non-specific symptoms. In some cases it is associated with various and particular clinical syndromes. These findings make it so insidious that the diagnosis is rarely make the preoperative course. Usually, there has been previous exposure to asbestos, during even if other causes are reported. Rarely, a peritoneal mesothelioma appears with signs and symptoms suggestive of acute abdomen, such as the present case. On admission the patient presented clinical features apparently requiring emergency surgery. In fact, at laparotomy, the tumour, arising from the mesenterium, had perforated the peritoneal cavity and communicated with the digiunal lumen, causing a septic hemoperitoneum. A radical resection was performed and the continuity of the intestinal tract was restored through an end-to-end entero-anastomosis. The patient, with a history of exposure to asbestos, was alive four years later. But over the last twelve months diffuse metastasis has occurred in the lung and liver, and there was no response to systemic chemotherapy. This case may be considered singular of the clinical syndrome, the long-term survival and the circumscribed aspect of the tumour. Through a review of the literature, the features of the present diagnostic procedure are underlined and the importance of multidisciplinary treatment as the best approach to peritoneal mesothelioma is emphasized.

Severe pruritus should be a B-symptom in Hodgkin's disease.

Pruritus was evaluated with respect to frequency, intensity, and prognostic significance in 360 patients with Hodgkin's disease. In order to discriminate severe from mild pruritus, the following criteria was used: (1) multiple excoriations; (2) ineffectiveness of local and systemic antipruritics; and (3) improvement with either radiotherapy or chemotherapy. Ninety of 360 patients had mild itching on admission and showed the same survival as the 249 nonitching cases; 21 patients presented with severe pruritus, which was also generalized, and showed a statistically shorter survival than that of mild and non-itching cases. This comparison was carried out between patients homologous with respect to sex, age, stage, A or B category, and histotype. Analysis of the data pointed out that the third requirement, i.e., improvement with antineoplastic therapy, is not substantial; moreover, for staging purposes, it is preferably replaced by the requisite of generalized pruritus. The intrinsically poor prognosis related to severe pruritus may be important for treatment, when this symptom occurs in early stages or without other systemic symptoms. The inclusion of severe pruritus among the Ann Arbor criteria for definition of the B-clinical category is proposed.