Assisted reproductive technologies in Italy, 2005-2007: results from the Italian Assisted Reproductive Technologies Register.

AIM: The aim of this study was to assess the quantitative and qualitative outcomes of assisted reproductive technologies in Italy, from 2005 to 2007, collected by the Italian Assisted Reproductive Technologies Register (IARTR). METHODS: We analyzed, retrospectively, 121,708 ART treatments performed by Italian assisted reproductive technologies (ART) centres from 2005 to 2007. RESULTS: In the study period ART Italian centers were reporting data to the IARTR. Number of total cycles (all homologous) reported was 121,708 including 110,074 fresh (FRESH), 8682 frozen/thawed oocytes (FO) and 2952 frozen embryo (FER). Pregnancy rates per cycle with respect to FRESH, FO and FER treatments were 19.1%, 10.2% and 15%, respectively. Delivery rate per cycle with at least one live birth was 10.8%, 5.8% and 8.4%, respectively, per type of procedure. Twin and "triplet or more" birth rate per delivery was 21% and 2.8%; 12% and 0.4%; 14.9% and 0.8%, respectively. During the study period 15923 ART infants were born (0.95% of all newborn in Italy). CONCLUSION: From 2005 to 2007 we registered a strong increase in ART procedures concomitantly with a qualitative improvement leading to increased pregnancy and live birth rates per cycles. Remarkably, pregnancy loss to follow-up decreased drastically during the three years study-period.

FNAC: its role, limitations and perspective in the preoperative diagnosis of breast cancer.

Fine-needle aspiration cytology (FNAC) was first described and performed in 1930. Thirty years later, it gained acceptance first in Europe and about a decade later in North America. The method is generally considered as a rapid, reliable, safe diagnostic tool to distinguish non-neoplastic from neoplastic breast lesions. In developed countries, in the last 20 years, mammographic screening programmes, which have been used extensively, are designed to detect the earliest possible breast cancer. The FNAC report is extremely important because it gives the necessary information for the management of patients, in order to proceed with more invasive diagnostic methods or surgical treatment, and to decide what kind of operation to perform. In the preoperative phase, FNAC has taken a fundamental role of both palpable and nonpalpable lesions, using ultrasound or stereotactic guidance. New developed techniques, breast biopsy instrumentation (ABBI) and mammotome have the advantage of complete removal of breast lesions, but this is not possible in all the examined cases. In developing countries, economical restrictions, low budget for health care and screening programmes put the patients at a disadvantage because of the high cost of sophisticated diagnostic methods, thus we recommend that FNAC be used as a routine diagnostic method because of its low cost compared with the others and this policy maximizes the availability of health care to women with breast cancer. We conclude that FNAC plays an important and essential role in the management of patients with breast lesions and also offers a great potential for prediction of patient outcome, disease response to therapy and assessment of risk of developing breast cancer. The reliability and efficiency of the method depends on the quality of the samples and the experience of the medical staff that performs the aspiration.

Reproducibility of histological diagnoses and diagnostic accuracy of non palpable breast lesions.

Twelve pathologists independently examined and classified a set of 25 cases of non palpable breast lesions selected from the archival files of the Pathology Department in Florence. A final consensus diagnosis was reached for all cases at a slide seminar. Individual diagnoses were first combined in 3 broad categories (benign lesion, in situ and invasive carcinoma), then compared to each other and then to the "consensus". Results show that among these 12 pathologists there was complete agreement in 14 cases. Discrepancies for the other 11 cases varied in the number of pathologists and diagnostic categories involved. Overall agreement was excellent (median kappa 0.86) but cases of potentially harmful errors were evident. The authors discuss these findings in the frame of a breast cancer screening program planning.

Fine-needle aspiration cytologic findings in a case of lymph node tumor of plasmacytoid monocytes.

We present a unique case of fine-needle aspiration (FNA) from a lymph node with subsequent histologic diagnosis of tumor of plasmacytoid monocytes (PMs). The patient had an associated myeloproliferative disease which terminated into an acute myelomonocytic leukemia. In a 95% ethanol-fixed, hematoxylin-eosin (H&E)-stained smear, the tumor cells appeared monomorphic, medium size, with oval to indented nuclei, finely stippled chromatin, and small nucleoli; the cytoplasm was scanty and slightly eccentric. The cytologic picture suggested some subtypes of small-cell non-Hodgkin's lymphomas or a leukemic infiltration. In the FNA specimen, the cells appeared immunocytochemically negative for some B- and T-cell markers (MB2, L26, LN1, and UCHL1) and strongly positive to KP1, a known histyocyte-macrophage and myeloid marker. The FNA differentiated diagnoses are discussed.

Fine needle aspiration cytology in two cases of well-differentiated acinic-cell carcinoma of the parotid gland. Discussion of diagnostic criteria.

Two cases of well-differentiated acinic-cell carcinoma of the parotid gland with diverse histology (one compact variant and one rare tubular-acinic type with an important lymphoid component) underwent fine needle aspiration. Both were clinically thought to be benign neoplasms but were correctly diagnosed preoperatively by aspiration cytology. Cytohistologic correlation in these cases showed that the decisive diagnostic criteria for well-differentiated acinic-cell carcinoma were the presence of atypical acinous structures and of cytoplasmic granules that were acid alcian blue negative and period acid-Schiff positive after diastase digestion.

Cytology of indeterminate cases (C3). Can this diagnostic class be improved?

The aim of this brief report is to emphasize the need for a stronger effort from Pathologists, to reduce the incidence of the "C3", Indeterminate, diagnostic class. The experience derived from immunohistochemistry could be useful also when applied to cytological samples. In this study, based on immunostaining for HMW Cytokeratin 5 (normally present in normal breast cells and absent in malignant cells) on conventional breast nodules aspirates, 21 out of 30 evaluated cases diagnosed as "C3" and with histological control, have been reclassified as "C2", Benign or "C4", Suspicious of malignancy. The Authors conclude that this immunocytochemical algorithm could emprove the diagnosis di "C2" and "C4", avoiding in many cases other presurgical, more invasive diagnostic procedures, with a positive cost/ benefit ratio.

Bronchogenic cysts of the neck: a rare localization and review of the literature.

Personal experience in the diagnosis and management of two patients, one adult and one child, with pathologically proven bronchogenic cysts is described. Both patients presented with a solitary neck mass that proved to be bronchogenic cysts on histological examination. Aim of the review is to define the cytology, histopathological and clinical characteristics of bronchogenic cysts and discuss the features that distinguish them from other cervical cysts. Definitive treatment requires surgical excision.

Endometrial pathological changes after Fallopian ring tubal ligation.

Endometrial biopsy was used to study the luteal phase in patients with Fallopian ring (Yoon ring) tubal ligation. Luteal phase insufficiency was found in 9.3% of patients in the study group and in 3.4% of patients in the control group. THe differences are statistically not significant (p = 0.5). The patients with histological evidence of poor luteal phase after tubal ligation presented with oligomenorrhea and dysfunctional uterine bleeding. These results exclude the possibility of some interference with the utero-ovarian circulatory system caused by Fallopian rings.

PIP: A study of the luteal phase of patients with tubal sterilizations in which the Fallopian rings 2 incision technique was used was conducted to determine the extent of luteal phase insufficiency caused by the procedure. Corpus luteum activity of 32 patients who had tubal sterilizations for a period of 12-15 months and of 29 patients awaiting the procedure was studied using endometrial biopsy. Increased frequency of luteal phase insufficiency after tubal sterilization was not statistically present. The condition was found in 3 patients in the study group (9.3%) and 1 patient in the control group (3.4%). The patients with luteal phase insufficiency after tubal ligation presented with oligomenorrhea of dysfunctional uterine bleeding. The results do not support the hypothesis that Fallopian ring tubal ligation interferes with the utero-ovarian circulatory system as suggested by other research. To avoid disturbance of the corpus luteum or enhance the success of future reanastomosis, the use of Hulka clips or Yoon rings is advised.

Fine needle aspiration of myofibroblastoma of the breast. Case report.

The cytologic and histologic findings of myofibroblastoma of a man's breast are reported. Cytologic specimens showed many scarcely cohesive clusters of bipolar or stellate cells. The cytoplasm was moderately eosinophilic and had clearly-defined edges. The nucleus was characterized by round or coffee-bean shape, regular chromatin and small nucleolus. Atypical features were absent. Immunocytochemical tests confirmed the mesenchymal nature of the lesion showing negativity for CAM 5.2 and positivity for vimentin. We stress the value of fine-needle aspiration biopsy in association with clinical- examination, mammography and/or echography in establishing the preoperative diagnosis of this benign tumor.

A distinctive cutaneous malignant neoplasm expressing the Langerhans cell phenotype. Synchronous occurrence with B-chronic lymphocytic leukemia.

The authors describe a 63-year-old woman who developed a histologically distinctive malignant cutaneous neoplasm composed of large pleomorphic cells with abundant cytoplasm and multilobate, often clefted nuclei that occasionally contained small nucleoli. This neoplastic cell population metastasized to a regional lymph node already involved by a B-cell derived chronic lymphocytic leukemia expressing surface IgMk, BA-1, and OKT1. The large metastatic tumor cells lacked surface immunoglobulin, B-lymphocyte associated antigen BA-1, T-lymphocyte associated antigens OKT1 and OKT3, and the monocyte/macrophage markers lysozyme and alpha 1-antichymotrypsin. These tumor cells expressed HLA-DR antigens, adenosine triphosphatase (ATPase), OKT6, and contained S-100 protein, i.e., they expressed the phenotype peculiar to epidermal Langerhans cells. The typical clinical and histologic features of Histiocytosis X were absent. Thus, this case appears to represent a distinctive cutaneous neoplasm composed entirely of malignant cells of dendritic cell origin which, by immunophenotypic and histochemical analysis, appear to be related to epidermal Langerhans cells.