Primary parotid liposarcoma.

INTRODUCTION: Primary liposarcoma is very rare in the parotid gland. To date, only 8 cases of primary parotid liposarcoma have been reported. The aim of this study is to report on a case of primary parotid liposarcoma highlighting the complexity of its treatment and analyze treatment outcomes of other reported cases. CASE SUMMARY: We report a case of parotid liposarcoma arising in the left parotid gland of a 66 year-old man, causing local morbidity, recurrence, repeated surgical treatment and death 5 months after initial treatment. DISCUSSION: Parotid liposarcoma is marked by a high probability of local recurrence of up to 70% and is prone to distant metastatic spread, as was the case in our patient. Based on limited experience from published literature, optimal treatment entails radical surgery with negative margins. Postoperative radiotherapy is an option for patients with large high-grade tumors, positive margins and involvement of complex anatomic subsites. High-grade tumors have a worse outcome despite the addition of surgery and postoperative radiotherapy.

Malignant melanoma of the urethra: a rare histologic subdivision of vulvar cancer with a poor prognosis.

Malignant melanoma of the urethra is a rare tumour that is difficult to diagnose and treat, resulting in a poor prognosis. In this paper, we present the case of a 65-year-old woman who was referred to a gynaecologist because of a urethral mass that mimicked a caruncle. The tumour was removed by local excision, and a pathological analysis revealed a malignant melanoma. Distal urethrectomy was performed after three months with no evidence of residual tumour. There was no evidence of disease at a six-year followup. In this paper, we compare the epidemiology, treatment, staging, and prognosis of vulvar cancer in general to malignant melanoma of the vulva in particular.

Tissue extract from Eisenia foetida as a wound-healing agent.

BACKGROUND AND OBJECTIVES: This study was aimed at demonstrating the influence of Eisenia foetida earthworm extract (G-90) on wound healing in an animal model. Medicinal properties of earthworms have been long known, especially in Eastern countries. MATERIALS AND METHODS: Four groups of Wister rats (36 in each group) were wounded under anaesthesia; the skin was surgically incised in a circular manner (the circular incision in reference measuring 2 cm in diameter) and afterwards daily treated for 24 days in a following manner: Group 0--the control group deprived from any treatment whatsoever; Group 1--treated with physiological saline solution; Group 2--treated with Panthenol D and serving as a positive control, and Group 3--treated with G-90 (10 ng/ml). The animals were sacrificed on days 3, 6, 9, 12, 18 and 24 post wounding and the diameter of wound was measured by virtue of photometric method. The excised wounds were routinely fixed and embedded into paraffin section and dully stained for histopathological analysis. The presence of microorganisms on the wounds was assessed as well. RESULTS: The best antibacterial wound shielding was achieved with G-90 treatment. Besides antibacterial shielding, the wounds treated with G-90 were also protected from inflammation. G-90 was shown to shorten the inflammatory, and accelerate the proliferative and the maturation phase, stimulating thereby the regeneration of an injured epidermis. Statistical analysis revealed G-90 (p=0.018) to be superior over other treatments. CONCLUSIONS: Thus, Eisenia foetida earthworm extract (G90) might be considered as a new wound-healing agent suitable for use in both veterinary and human medicine practice.

Correlation between Bcl-2 and Bax in atrophic and hypertrophic type of actinic keratosis.

BACKGROUND: Recent investigations consider actinic keratosis (AK) as an earliest visible pattern of squamous cell carcinoma (SCC). We have analysed the expression of apoptosis-related proteins TP53, Bcl-2 and Bax in 30 atrophic and 30 hypertrophic AK cases. MATERIAL AND METHODS: Immunohistochemical analysis was performed following microwave streptavidin immunoperoxidase protocol on DAKO TechMate Horizon automated immunostainer (DAKO, Copenhagen, Denmark). Monoclonal antibody for TP53 and Bcl-2 and polyclonal antibody for Bax (DAKO, Copenhagen, Denmark) were used. RESULTS: Expression of TP53 showed no significant differences between two analysed groups (chi2-test, P = 0.35636) whereas expression of Bcl-2 and Bax protein was significantly higher in atrophic compared to hypertrophic AK (chi2-test, P = 0.01458 and P = 0.00358, respectively). Comparison of Bcl-2 : Bax ratio in two analysed AK showed significantly higher value in hypertrophic compared to atrophic AK (Mann-Whitney U test, P = 0.02272). Statistical analysis did not show any correlation between patient's sex and age, localization and size of the lesion with expression of investigated oncoproteins (anova, P > 0.05). CONCLUSIONS: Our results may indicate higher resistance of keratinocytes on apoptotic stimuli in hypertrophic compared to atrophic AK. Thus, we suppose that keratinocytes in hypertrophic AK live longer and probably have higher propensity for additional mutations and conversion to overt SCC.

Benign epithelial gastric polyps--frequency, location, and age and sex distribution.

Prospective investigation has been undertaken with the aim to study the frequency, location and age and sex distribution of various histological types of benign gastric epithelial polyps. Histological type--adenomatous, hyperplastic and fundic gland polyps--was diagnosed on the basis of at least three histological samples taken from the polyp. Biopsy samples were also taken from the antrum and the body of the stomach so that gastritis could be graded and classified, and the presence of H. pylori could be determined by histology. All 6,700 patients, who had undergone upper gastrointestinal endoscopy in a one-year period, participated in this study. Among them 42 benign gastric epithelial polyp were found in 31 patients: adenomatous gastric polyps in 7 patients, hyperplastic gastric polyp in 21 and fundic gland polyp in 3 patients. All patients with hyperplastic polyps had chronic active superficial gastritis, whereas most of the patients with adenomatous polyps had a chronic atrophic gastritis with high prevalence of intestinal metaplasia. Among 21 patients with hyperplastic gastric polyps, 16 (76%) patients were positive for H. pylori infection in contrast to only 2 patients (29%) with adenomatous gastric polyps and 1 patient (33%) with fundic gland polyp. Presented data indicates that hyperplastic gastric polyps are the most common and they are associated with the presence of chronic active superficial gastritis and concomitant H. pylori infection. Adenomatous polyps are rarer and they tend to be associated with chronic atrophic gastritis and intestinal metaplasia. Fundic gland polyp is the rarest type of gastric polyps.

Helicobacter pylori infection in patients with Brunner's gland adenoma.

Histopathologic and clinical data strongly suggest a causal relation between Helicobacter pylori infection and gastritis, peptic ulcer disease, or both. However, little has been written about the potential association between H. pylori infection and Brunner's gland adenoma. Therefore, we carried out a prospective study to determine the presence of H. pylori infection among patients with Brunner's gland adenoma. From November 1996 till October 1999, 19100 patients who had undergone upper gastrointestinal endoscopy at two clinical centers in Zagreb, Croatia, were candidates for participation in the study. Brunner's gland adenoma was diagnosed on the basis of histologic samples taken from the polyp (four patients) or after the entire polyp was made available upon endoscopic removal (three patients). When all endoscopic examinations had been performed, biopsy samples were taken from the antrum and body of the stomach, so that gastritis could be classified and H. pylori determined by histology. Biopsy samples were also taken from the duodenal bulb to verify duodenitis. Two other samples were taken from the antrum for rapid urease test. The patients were considered positive for H. pylori when both histology and rapid urease test were positive. Brunner's gland adenoma was diagnosed in seven patients (five women and two men; median age, 49 yrs). Five (71%) patients with diagnosed Brunner's gland adenoma had concurrent H. pylori infection. Duodenitis associated with gastric metaplasia was observed in six patients. Complete eradication of H. pylori was achieved in only two patients. Symptoms disappeared or markedly diminished in all patients with significant improvement during therapy or immediately upon endoscopic removal of the polyp. Although limited by a very small number of patients, our results suggest that concurrent H. pylori infection is very common in patients with Brunner's gland adenoma. However, the role of H. pylori infection in the pathogenesis and development of Brunner's gland hyperplasia remains unclear.

[Carcinoma of the urinary bladder resembling lymphoepithelioma]. / Karcinom mokracnog mjehura slican limfoepiteliomu.

Lymphoepithelioma-like carcinoma of the bladder is rare and has only recently been described at this site. We report a case of lymphoepithelioma-like carcinoma of the urinary bladder in a 70-years old male patient who presented with painless hematuria lasting for one month. The patient underwent transurethral resection two times. Histopathologic diagnosis was transitional cell carcinoma. Histopathologic examination of the third biopsy showed tumor tissue with typical syncitial growth pattern of atypical, large, epitheloid cells with ill-defined cytoplasmic borders, prominent nucleoli and numerous mitoses. A prominent lymphocytic infiltrate was found as a component of the tumor. Immunohistochemistry showed positive reaction for cytokeratin and epithelial membrane antigen, and negative results for leukocyte common antigen, CD3, CD20, CD30, CD68 and PSA. The lymphoid infiltrate was an admixture of T and B cells. The tumor invaded the muscle wall. After last surgery the patient underwent chemotherapy by local application of Adriablastine. At present the patient is without recurrence 10 months after the last surgery.

Effect of cromolyn pre-treatment on capsaicin-induced rhinitis in rats.

The effect of cromolyn sodium local pre-treatment on capsaicin-induced rhinitis in rats was studied by analyzing tissue changes due to edema, inflammatory cell infiltration and IgA upregulation. Nasal mucosa samples were stained with hematoxylin-eosin and examined immunohistochemically with monoclonal IgA antibodies. Changes were analyzed at 6, 12 and 72 h after capsaicin treatment and were scored semiquantitatively. Results showed that local cromolyn pre-treatment modified all parameters observed in the nasal mucosa following capsaicin-induced rhinitis in the rats.

Basaloid squamous cell carcinoma of the larynx: report of two cases.

AIM: To present two patients with basaloid squamous cell carcinoma of the larynx, a rare, highly aggressive variant of the squamous cell carcinoma. METHODS: Surgical excision of the polypoid tumor of the anterior comissure of the larynx was performed in a 62 year-old male, and in the second case, total laryngectomy with radical dissection of the neck was performed in a 66 year-old male with supraglottic tumor of the larynx and enlarged lymph nodes of the neck. Histopathological analysis of biopsy specimens was performed on routine hematoxylin-eosin stained sections and on sections stained with antibodies to cytokeratin, epithelial membrane antigen, S-100 protein, neuron-specific enolase, and chromogranin. RESULTS: In both cases, the tumors were composed of moderately pleomorphic basaloid cells forming nests, cords, and cribriform patterns with foci of necrosis, squamous differentiation, and small cystic spaces containing mucin-like material. Surface mucosa showed squamous dysplasia. Cytokeratin and epithelial membrane antigen were positive. After surgery, both patients recieved radiotherapy and had no signs of tumor recurrence or metastases 12 and 15 months later, respectively. CONCLUSION: Basaloid squamous cell carcinoma has a potential for diagnostic confusion because of its basaloid and squamous component. It should be distinguished from adenoid cystic carcinoma that is much less aggressive.

Epithelial hyperplastic lesions of the larynx in biopsy specimens.

Surgical biopsy files for the period 1991-92 were reviewed to determine the relative proportion and types of epithelial hyperplastic lesions of the larynx as well as sex and age distribution and correlation between clinical and histopathological diagnoses. In this period 203 laryngeal biopsies from 187 patients were analyzed. Epithelial hyperplastic lesions were found in 42 males and 9 females. There were 39 cases with keratosis and 12 cases showing keratosis with atypia. Correlation between clinical diagnoses and pathohistological findings was established in only 5 cases (9.8%), clinically diagnosed as leukoplakia; an additional 5 cases (9.8%) were clinically diagnosed as chronic laryngitis. The majority of clinical diagnoses in cases with epithelial hyperplastic lesions were laryngeal neoplasm (29, 56.9%) followed by laryngeal polyp in 9 cases (17.6%). We conclude that for correct diagnosis the biopsy should be performed in all patients with clinical symptoms showing laryngoscopic alterations that suggest a potentially malignant lesion.