Segmental infarction of the testis: can frozen sections avoid orchidectomy?

Segmental infarction (SI) of the testis is a rare condition that can masquerade as a mass lesion, thus requiring exclusion of tumour. If clinical exams do not exclude a neoplastic lesion with certainty, orchidectomy is usually performed. A case of SI of the testis is presented; the use of frozen section of the enucleated mass demonstrated the ischaemic nature of the lesion, so avoiding orchidectomy. The 8 year follow-up was uneventful. The use of frozen section in SI could permit the selection of cases in which testicular-sparing surgery should be considered.

Synchronous occurrence of pulmonary adenocarcinoma and pleural diffuse malignant mesothelioma.

We report a rare case of diffuse malignant pleural mesothelioma synchronous with a localized adenocarcinoma of lung in a 68-year old man with a suspicious history of asbestos exposure. Computed tomography revealed a sub-pleural mass in the lower lobe and an irregular dense area of medium lobe of right lung with thickening of pleura encasing the lung parenchyma and homolateral pleural effusion 1 cm thick. The patient underwent surgery and a right medium and lower lobectomy was performed. Upon frozen sections, intraoperative diagnosis was adenocarcinoma with a poorly differentiated component of lung infiltrating the pleura. The postoperative histological definitive diagnosis with an important contribution of immunostaining was synchronous pulmonary adenocarcinoma and pleural diffuse malignant epithelioid mesothelioma.

[Use of cellulose acetate millipore filters for the correct orientation of endoscopic biopsies in digestive diseases]. / Utilizzo dei filtri millipore di acetato di cellulosa per un corretto orientamento delle biopsie endoscopiche in patologia digestiva.

INTRODUCTION: Properly oriented endoscopic biopsies allow an effective assessment of some diagnostic features in non neoplastic gastrointestinal diseases. MATERIALS AND METHODS: We used cellulose acetate millipore filters (Endofilter, Bio-Optica, Milan, Italy) in order to improve the orientation of biopsies during processing. Forty biopsies were placed on filter after endoscopic sampling whereas no orientation attempt was done for other 40 filter-free biopsies (20 from esophagus and 20 from gastric antrum in each group). Both groups were compared in terms of orientation and assessability of the following morphological features: thickness of basal layer in the esophageal squamous epithelium, length of esophageal papillae, interstitial space dilatations in the esophageal squamous epithelium and gland atrophy in the gastric antrum. Both orientation and assessability of individual morphological features were graded with a score ranging from 1 (good) to 3 (poor). The impact of this procedure on costs was analysed, both in terms of material and technical workload. RESULTS: All 20 esophageal and 20 antral biopsies on filter showed acceptable (score 1 or 2) orientation. In contrast, 14/20 filter-free esophageal and 13/20 antral biopsies showed poor (score 3) orientation (p = 0.0001 for both groups). Basal layer thickness was assessable (score 1 or 2) in 20/20 esophageal biopsies on filter vs 14/20 filter-free ones (p = 0.0001) and length of papillae in 15/20 biopsies on filter vs 4/20 filter-free ones (p = 0.0002). Interstitial space dilatation assessability was not affected by orientation procedures. Gland atrophy in the antrum was assessable (score 1 or 2) in 20/20 gastric biopsies on filter vs 8/20 filter-free ones (p = 0.0001). The use of endofilters permitted the process of numerous (up to 8 for each block) samples from different biopsy sites together and produced a significant reduction in costs (18.35 in the case of 8 biopsies from 4 different biopsy sites). CONCLUSIONS: The use of millipore filters allows orientation of biopsy samples, improves the assessment of several diagnostic features in esophageal and gastric pathology and yields a significant reduction in costs when biopsies from different sites are processed together.

[Parosteal ossifying lipoma of the femur. Description of a case]. / Lipoma parosteo ossificante del femore. Descrizione di un caso.

A case of parosteal ossifyng lipoma of femour in 67 years-old female patient is described. Review of literature (1966-1999) about parosteal lipoma reveals less then 70 referred cases; much less common is the ossifyng type; in our knowledge five cases of this very rare subtype are referred in last thirty years.

Absence of histological malignancy in a patient cohort with follicular lesions on fine-needle aspiration.

Follicular lesions account for 4-6% of all thyroid fine-needle aspiration (FNA) cytologies. To date, no cytological criteria exist to distinguish follicular adenoma from carcinoma. For this purpose, histological evaluation after surgical exeresis is required. From 1993 to 2000 we performed 1,238 US-assisted FNA biopsies in patients admitted to our unit for uni- or multi-nodular goiters. In the latter goiters, FNA was performed in the dominant nodule. Cytological examination revealed a follicular lesion in 71 patients (5.7%). All patients came from regions of Northern Italy with moderate iodine deficiency. In 48%, the lesion presented as a solitary nodule, while in the other 52% it occurred in the context of a multinodular goiter. Surgical exeresis of the neoplasm was recommended in all cases. Sixty-three patients (89%) underwent surgery (Group 1) while the other 8 patients (11%) opted for follow-up (Group 2). In Group 2, the mean nodule volume (3.2 +/- 0.5 ml) at baseline was slightly smaller (p = 0.08) than that found in Group 1 (5.4 +/- 0.7 ml). In Group 1, histological examination after surgery showed a follicular adenoma in 52 patients (83%) and a colloid goiter in the others (17%). No malignancy was detected. Group 2 underwent a median follow-up of 46 months (range 24-96 months) on L-thyroxine suppressive regimen (dose range 75-125 pg/day), with TSH levels ranging from 0.1 to 0.3 mlU/l. Throughout the follow-up, no patient developed clinical or ultrasonographic features that could be considered worrisome for malignancy; thus, no further biopsy was performed. However, an overall slight increase (median +5.2%) in nodular volume in respect to baseline was observed. Although institutional and cytological bias cannot be ruled out, our data do not confirm the reported incidence of malignancy in histological specimens of follicular lesions diagnosed on FNA cytology, and prompt us to suggest a less aggressive first-step approach (i.e. careful clinical and instrumental evaluation, and suppressive L-T4 therapy) for these lesions, unless anamnestic reports or clinical and ultrasonographic features of the nodules suggest malignancy.

Cabergoline modulation of alpha-subunits and FSH secretion in a gonadotroph adenoma.

Most non-functioning pituitary adenomas respond poorly to medical therapy. We describe the case of a 62-year-old man who presented with clinical features of an invasive macroadenoma. Baseline hormonal evaluation revealed increased FSH and alpha-subunit (alpha-SU) levels. Transsphenoidal exeresis followed by radiotherapy (RT) was performed. Almost all neoplastic cells were intensely immunoreactive for alpha-SU. On PCR analysis, specific amplification products were observed for somatostatin 2, 3 and 5 receptors as well as for both short and long isoforms of the dopamine D2 receptor. In vitro, alpha-SU and FSH were released into the medium by adenoma cells and increased after TRH stimulation. After surgery, alpha-SU and FSH levels were still elevated. Short-term slow-release lanreotide treatment did not modify either alpha-SU or FSH levels. Cabergoline was started and a fast and long-lasting decrease in alpha-SU and, to a lesser extent, in FSH was observed. The tumor remnant was unmodified on magnetic resonance imaging 3 years after surgery and RT. This case report shows that the in vitro expression of somatostatin receptors may not be directly associated to the in vivo response of alpha-SU and FSH to lanreotide, probably because of a functional uncoupling of the receptors. Cabergoline should be considered as an effective therapy for hormonal, and perhaps proliferative, control of gonadotroph adenoma remnants before the effects of RT are fully effective.