Verruciform xanthoma of the oral mucosa. Report of a case.

Verruciform xanthoma is a rare benign lesion of unknown etiology and pathogenesis, although an inflammatory process seems to be implicated in its origin. It usually shows a slow-growing small lesion which can be sessile or pedunculated and has a typical rough and granular surface. A clinical case of an asymptomatic verruciform xanthoma of the ventral surface of the tongue in a 24-year-old male is reported. The lesion was noticed for the first time during a routine dental examination and it appeared as a sessile whitish verrucous lump hard in texture. An incisional biopsy followed by the excision of the whole lesion was performed. The histological and immunohistochemistry examinations were carried out using antibodies CD68-KP1, CD68-PGM1, alpha-1-antitrypsin and vimentin, desmin, cytokeratins, NSE and S-100. Histology showed epithelial degeneration. The connective tissue papillae were entirely occupied by foamy cells that were positive for CD68-KP1, CD68-PGM1, alpha-1-antitrypsin and vimentin and negative for desmin, cytokeratins, NSE and S-100. The foamy cells were characterized by a large granulous cytoplasm and small picnotic nuclei. In accordance with the literature, the immunohistochemistry analysis confirmed that foamy cells are likely to have a macrophagic origin and that epithelial degeneration could be correlated with the pathogenesis of this lesion.

808-nm laser with exogenous chromophores for the treatment of benign oral lesions.

OBJECTIVE: The aim of this study was to verify the effectiveness and safety of the 808-nm wavelength for use on benign lesions of the oral cavity that are stained with toluidine blue solution. MATERIALS AND METHODS: The toluidine blue solution according to Mashberg is used in stomatology for the detection of leuko-erythroplasic lesions. In our experience, we have used it to stain even serous cysts, angiomas, and fibromas. We chose a 808-nm wavelength emitted from a power diode laser, because it is well absorbed by the blue color and barely by the healthy mucosa. The non-contact photocoagulation kept the surrounding borders intact when we used the pulsed-emission, 50 ms 7 W, without anesthesia. No sutures were needed. The leukoplasic borders of the lesions were histologically examined before and after the treatment. RESULTS: The vaporized lesions healed completely in about 5-7 days without any kind of treatment, leaving some slight elastic white scars. A mild edema-erythema followed the treatment for 5-7 days. CONCLUSIONS: The selective results confirm the effectiveness of this therapeutic procedure on pigmented benign lesions, pre-treated with exogenous chromophores and photocoagulated without bleeding, with a minimum energy 808-nm laser.

Inaccuracy of death certificate diagnoses in malignancy: an analysis of 1,405 autopsied cases.

In 1,405 patients who died at the General Hospital of Trieste in 1974 and 1978, malignant neoplasm was revealed at autopsy. Clinical diagnosis was accurate in 54 per cent of these patients. The tumor was clinically suspected in 19 per cent and was undiagnosed in 27 per cent. The accuracy of the clinical diagnoses varied significantly according to the primary site and type of tumor; accuracy was inversely related to the age of the patient and varied also according to the department of the hospital to which the patient had been admitted. This latter variation is age-dependent, too. In the past decades clinical diagnosis of malignancy has not greatly improved, although the autopsy rate has almost everywhere strongly decreased, representing a heavy handicap in the epidemiologic research on cancer as a cause of death.

The lectin-binding sites for peanut agglutinin in invasive breast ductal carcinomas and their role as a prognostic factor.

The present study was designed to analyze the expression of lectin-binding sites for peanut agglutinin (PNA) in paraffin sections of primary invasive ductal carcinoma not otherwise specified and to consider PNA lectin histochemistry as a further aid in the prognostic evaluation of breast cancer. The expression of lectin-binding sites was studied using the avidin-biotin complex/ immunoperoxidase technique, and analyzed in relation to the different clinical, pathological, and biological parameters of the primary disease, i.e. the presence or absence of nodal metastases, pre- or post-menopausal age, size of the tumor, mitotic activity index, morphometric prognostic index, DNA content, S-phase fraction, and steroid receptor status. The results show significant differences in PNA binding patterns among malignant epithelial breast cells. There was no expression of PNA-binding sites in 14 out of 157 tumors, while 64 showed mostly apical (membrane) staining and 124 non-apical (membrane and/or cytoplasmic) staining. Apical staining was mostly observed in patients without lymph node metastasis, with positive steroid receptor status, and those who were postmenopausal diagnosis; non-apical staining was mostly observed in lymph-node-positive premenopausal patients negative for steroid receptors and with aneuploid tumor cells. Our results indicate that, in malignant breast cells, there is an alteration of cell-surface glycoconjugates, shown by heterogeneity within a histopathologically defined group, which is related to different properties of tumor cells. The apical PNA binding pattern indicates a better differentiation of tumor cells while non-apical PNA binding suggests a higher metastatic potential. Specific PNA lectin binding patterns should be considered as a further reliable prognostic factor in breast cancer.

Masson's pseudoangiosarcoma, alias intravascular papillary endothelial hyperplasia, in dissecting aortic aneurysm caused by cystic medionecrosis.

This report describes a 25-year-old man who died due to extensive cystic medionecrosis of the aortic wall complicated by both an acute and an ancient dissection. The very unusual finding of an intravascular papillary endothelial hyperplasia, also known as Masson's pseudoangiosarcoma, in the dissected wall is reported given its resemblance to a hemangiosarcoma.

The histopathology of non-steroidal anti-inflammatory drug induced gastroduodenal damage: correlation with Helicobacter pylori, ulcers, and haemorrhagic events.

AIMS: The spectrum of microscopic lesions resulting from the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), known as chemical gastritis, remains unclear, and the variable prevalence reported in different studies makes this issue a matter of lively debate. The aim of this study was to evaluate the prevalence and importance of chemical gastritis in patients regularly taking NSAIDs. Owing to the high prevalence of Helicobacter pylori infection, particularly in subjects over 60 years of age, and in view of a possible association with damage, the presence of H pylori infection in the same tissue sample was also determined in all patients. METHODS: One hundred and ninety seven subjects were enrolled, 118 of whom were receiving chronic treatment with NSAIDs and 79 of whom were controls, pair matched for age, sex, and clinical symptoms (ulcer-like dyspepsia or upper digestive tract haemorrhage). Antral biopsies taken during upper gastroduodenal endoscopy were assessed for chemical gastritis according to a modified version of Dixon's score, and for Helicobacter correlated chronic active gastritis, according to the updated Sydney system. RESULTS: Chemical gastritis was identified in 11 patients taking NSAIDs (9%) and in four controls (5%) (p < 0.05). Helicobacter pylori was detected in 53 patients taking NSAIDs (45%) and in 34 controls (43%). Patients taking NSAIDs had a significantly higher number of erosions and ulcers and worse endoscores than controls. The presence of H pylori did not appear to increase histological damage, ulcer prevalence, or haemorrhagic events. CONCLUSIONS: Chemical gastritis is present in a limited number of patients regularly taking NSAIDs, and is not strongly correlated with NSAID induced damage. In many cases of peptic ulcer or upper gastrointestinal bleeding in patients taking NSAIDs, the presence of chemical gastritis or H pylori infection cannot solely account for the development of mucosal damage.

Oral and intraperitoneal acute toxicity studies of yessotoxin and homoyessotoxins in mice.

The acute toxicity of yessotoxin (YTX), homoyessotoxin (homoYTX) and 45-hydroxy-homoyessotoxin (45-OH-homoYTX) has been studied in comparison to that of okadaic acid (OA), the main diarrhogenic toxin, both after intraperitoneal (i.p.) and oral administration. After i.p. administration, homoYTX and YTX showed similar lethality (LD(50)=444 microg/kg and 512 microg/kg), higher than that of OA (LD(50)=225 microg/kg), while 750 microg/kg of 45-OH-homoYTX did not cause death. OA induced the already known toxic signs: before death, mice were motionless and cyanotic; small intestine and liver damage were shown at post-mortem. Mice treated with YTX and homoYTX were restless and jumped before death; necroscopy did not show major changes. After oral treatment, 2 mg/kg of OA induced diarrhoea and body weight loss, causing 4/5 deaths; necroscopy and/or histology revealed degenerative lesions to small intestine, forestomach and liver (confirmed by increased plasma transaminase), but no myocardium alterations. On the contrary, the oral treatment with YTX (1 and 2 mg/kg) and its derivatives (1 mg/kg) did not cause any death or signs of toxicity, except some ultrastructural myocardiocyte alterations, adjacent to capillaries, such as cytoplasmic protrusions (YTX, 1 and 2 mg/kg), fibrillar alteration (YTX, 1 mg/kg) or mitochondria assemblage (45-OH-homoYTX). Altogether, our data show that YTX and its derivatives are less toxic than OA after acute oral and i.p. treatments, at doses which may represent up to 100 times of the possible human daily intake.

Cutaneous pseudolymphoma of the breast with late homozonal relapse.

Cutaneous pseudolymphomas refer to a group of lymphoproliferative disorders of difficult classification and diagnosis. Considered as very low-grade lymphomas by some authors, they are actually able to progress to overt cutaneous lymphomas in a minority of cases. We report a case of cutaneous pseudolymphoma of the breast in a 21-year old woman which relapsed locally ten years later. The case is of interest for the unusual localisation of the lesion, for its recurrence after such a long period of time, and for the homozonal site of recurrence. The reported features support both the long course and the lymphomatous nature of such lymphocytic proliferations.

Primary non-Hodgkin's lymphoma of the head of the pancreas: a case report and review of literature.

Among malignant neoplasms of the pancreas, lymphomas have a very low incidence. Nevertheless, the dramatic difference in prognosis and treatment between pancreatic carcinoma and lymphoma stresses the importance of a correct diagnosis, especially because most lymphomas of the biliopancreatic region are low-grade B-cell type. The case observed by us shares clinical and pathological features with the few previously reported in literature, and focuses clinicians' attention on the diagnosis of this unusual neoplasm whose clinical behaviour is characterized by obstructive jaundice and overlaps with that of epithelial tumours.

Gastric cancer and flow cytometry: the beginning of a promising match.

Gastric cancer (GC) is still a diffuse and aggressive disease in many countries where its frequency has not drastically decreased as in the USA. Furthermore, except in Japan and few other countries where the health care system has implemented effective strategies to diagnose the disease very early, GC therapy is unsatisfactory because of the advanced stage at which it is disclosed. Recent advances in the understanding of GC, resulting from identification of Helicobacter pylori as a critical factor in its development, seem not to have changed the situation. Studies on GC have often adopted flow-cytometry to investigate many parameters mostly related to prognosis. Unfortunately, the results obtained with this important technique have been disappointing and diverse, which has caused a fair amount of skepticism as to its role. Starting from a critical review of the vast Literature on the topic, this paper discusses a re-evaluation of the role of flow-cytometry in the fight against GC.

Non-Hodgkin's lymphoma (NHL) of the oral cavity.

BACKGROUND: The treatment of NHL in the head and neck region is complex because of the numerous variables that are involved. Reports in the recent literature on NHL of the oral region have dealt with one or two individual cases and routine treatment guidelines do not exist. Local lesions are responsive to radiotherapy as well as to chemotherapy, but the cure rates are discouragingly low. PATIENTS AND METHODS: We report a case of a painful swelling of the lower left gingiva. Local biopsy and a systemic work-up (labs, x-rays, eco scan, CT, bone marrow aspiration and biopsy) was performed. RESULTS: The biopsy of the oral lesion disclosed a malignant NHL; other examinations failed to find other foci of the lymphomatous process. CONCLUSIONS: This case of primitive NHL of the oral cavity summarises the main characteristics of this rather uncommon pathology: a) difficult diagnosis at presentation, often misdiagnosed for other more common oral diseases b) the importance of a local biopsy; c) rapid evolution; d) a good response to chemotherapy; e) poor prognosis.

Malignant pleural mesothelioma following chemotherapy for breast cancer.

Although the induction of malignant mesothelioma by radiotherapy, used alone or in combination with chemotherapy, has been previously reported in the literature, the number of documented cases is extremely small. We report a case of malignant pleural mesothelioma arising four years after chemotherapy for breast cancer in a 42-year-old woman without a history of exposure to asbestos. To our knowledge, this is the f rst reported case of malignant pleural mesothelioma following treatment with chemotherapy alone. It is of interest not only for the patient's young age and the absence of exposure to asbestos, but also for the very short latency period, if compared with asbestos-related mesothelioma.

Hemangiopericytoma of the nose: a case for both internal and external localization.

BACKGROUND: Nasal and paranasal cavities are sites of predilection for hemangiopericytoma (HPC), a rare vascular tumor described for the first time in 1942. Because of their characteristics, i.e. clinical presentation, age distribution and biological behavior, nasal HPCs are frequently reported as "hemangioperycitoma-like intranasal tumors" although such a distinction from other HPCs is debated. PATIENTS, METHODS AND RESULTS: out of nearly 64,000 autopsies and 336,000 surgical and endoscopic biopsies performed at the University of Trieste over 30 years, only three cases of HPC have been found, two of them affecting the external nose; for both there was a good agreement between histology--supported by immunohistochemistry and flow cytometry--and biological behavior. CONCLUSIONS: On the basis of the sparse literature on skin HPC and of our two cases, we suggest that not only the internal, but also the external nose should be considered a predilection site for HPC.

A new "anonymous" type of haemangioendothelioma.

BACKGROUND: Our report may contribute to a better understanding of the different possible presentations of endothelial tumors. METHODS AND RESULTS: We report a new type of haemangioendotheliomatous tumor of uncertain aggressiveness arisen in a benign haemangioma of the scalp and represented by a proliferation of small- and medium-sized arborescent vessels whose walls were totally replaced by endothelial-like, atypical cells. CONCLUSIONS: The features of our case do not fit those of the many types previously reported in the literature. As regards the name, we prefer to consider this new variety as an anonymous type in order to avoid further confusion on a topic deserving a drastic review.

Proliferating cell nuclear antigen (PCNA) as a prognostic factor for colorectal cancer.

PCNA (proliferating cell nuclear antigen) is a cell cycle related protein that is maximally elevated in late G1 and S-phase of proliferating cells. 114 biopsy specimens of colorectal cancer were immunolabeled with PC 10 which specifically recognizes PCNA; Dukes' staging and histological grading were estimated for each case. All patients were followed-up for at least 60 months or to death. All data were analysed by the computer program NCSS (Number Cruncher Statistical System). According to the results, PCNA-index may be considered an independent prognostic factor for colorectal cancer; it may also be helpful in supporting the therapeutic strategies based only on Dukes' stage.

Epidermal growth factor-receptor expression correlates with tumor cell proliferation and prognosis in gastric cancer.

Currently, the most accurate prognostic indicator in gastric cancer is stage. Studies on proliferating cell nuclear antigen (PCNA) in gastric cancer have demonstrated that the PCNA labeling index correlates with depth of invasion, organ metastasis, vascular invasion, and tumor stage, suggesting that this marker may be a valuable prognostic factor. Epidermal growth factor (EGF) promotes the growth of cells of both ectodermal and mesodermal origin, and plays an important role in cellular proliferation and differentiation. Furthermore, there has been increasing evidence that growth factors and their receptors are involved in carcinogenesis. The aim of this study was to investigate the correlation between expression of the EGF-receptor (EGF-r) and proliferative activity (PCNA labeling index) in gastric cancer by immunohistochemical analysis. Our preliminary results on 56 gastric cancers indicate that the PCNA labeling index correlates with EGF-r immunoreactivity. Furthermore, survival was significantly lower in patients with EGF-r positive tumors and a high PCNA labeling index. These in situ observations suggest that EGF-r may play an important role in the growth regulation of human gastric carcinomas.

Gastric epithelium proliferation in early Hp+ and Hp- gastritis: a flow cytometry study.

BACKGROUND: Helicobacter pylori increases cellular turn-over causing hyperproliferation and possible assumption of neoplastic characteristics by the gastric epithelial cells. To verify whether patients at risk of cancer can be identified at the very first stages of gastric disease, we studied a sample of patients affected by early Hp+ and Hp- gastritis by flow cytometry and assessed the methods commonly adopted to study gastric cell proliferation. METHODS: 48 fresh biopsies taken from the gastric antrum and body of 24 patients who had undergone endoscopy for dyspepsia, and 48 paraffin-embedded antrum and body biopsies taken from the files of our Department were studied by flow-cytometry. The following markers and parameters were considered: S-phase, proliferation index, PCNA and ploidy. RESULTS: No correlation was found between Hp+ or Hp- gastritis and gastric cell proliferation and no cases of aneuploidy were observed. Gastric proliferation was found to vary depending on the methods, markers and type of biopsy employed. Furthermore, proliferation expressed by PCNA was significantly different in antrum and body. CONCLUSIONS: The commonly studied proliferation markers do not allow the early detection of patients at risk of gastric cancer by flow cytometry. Proliferation differences between body and antrum must be taken into account in the investigation of gastric diseases.

Cytofluorimetric analysis of a renal tubular cell line and its resistant counterpart.

P-glycoprotein (P-gp) and multidrug resistance related protein (MRP) overexpression is often responsible of the development of multidrug resistance in cancer therapy. These proteins are also expressed in normal tissues, where their physiological role is related to the extrusion of endogenous toxins or to secretory function in liver and kidney. The LLC-PK1 cell line is derived from normal pig proximal renal tubule and physiologically expresses low levels of P-gp and MRP. A resistant cell line (LLC-PK1/ADR) has been established in our laboratory by chronic exposure to increasing doses of doxorubicin. Cytofluorimetric analysis of P-gp and MRP expression performed by C219 and MRPm6 immunofluorescence detection showed that these cells overexpress P-gp but not MRP. The uptake of doxorubicin and rhodamine 123 has been quantified in LLC-PK1 and LLC-PK1/ADR cells and compared with data obtained using other tumor cell lines commonly used as reference for studying P-gp or MRP overexpression. P388 sensitive cells and its resistant counterpart P388/ADR cells, which overexpress P-gp and PANC-1 cells, which express high levels of MRP were used. A lower fluorescence intensity was evident with both doxorubicin and rhodamine 123 in LLC-PK1/ADR as well as in P388/ADR cells, that overexpresses P-gp, in comparison with the parental lines. The uptake was increased by a pretreatment with verapamil. Verapamil was completely ineffective on PANC-1 cells, confirming a selective effect of this inhibitor on P-gp. Propidium iodide staining, performed after doxorubicin treatment, confirmed a higher cytotoxicity of the antineoplastic drug in the LLC-PK1 cells compared with the resistant counterpart.

Carcinosarcoma and separate neuroendocrine malignant tumor of a malignancy promoter, the gastric stump.

We report a case of carcinosarcoma and separate neuroendocrine malignant tumor of the gastric stump. The case is interesting because of its unique pathological features and it confirms the role of the gastric stump as a very important "malignancy promoter".