The solitary fibrous malignant tumour of the kidney: clinical and pathological considerations on a case revisiting the literature.

The solitary fibrous tumours (SFT) are rare spindle cell neoplasms which generally originate from the pleura; also described are cases of SFT in other locations, included the genital-urinary tract. Described in the ambit the kidney are 19 cases of SFT and such rarity of localisation makes rather unknown the histogenesis and the prognosis of the lesion. We report the case of a 72 year old lady who attended our Unit for a mass which was clinically palpable at the level of the left hemiabdomen. Following an abdominal ultrasound scan a neoformation was highlighted which a successive tomodensitographic test indicated as being of likely pertinence of the middle third of the left kidney; the mass had a diameter of approximately 19 cm. A radical nephrectomy has been conducted. The histological examen highlighted a solitary fibrous tumour: the presence of hypercellularity, of cellular pleiomorphism and of a high number of mitosis has led to a histopathological diagnosis of malignancy of the neoplasm under examination. Departing from this case a review of the literature is carried out. The SFT of the kidney can have an aggressive character and more the present has hystopathological characters and clinical results are still rather unknown.

[Solitary fibrous tumor of the kidney. A propos of a case].

Solitary Fibrous Tumors (SFT) are rare spindle cell neoplasm that typically originate from the pleura. However, cases of the SFT are described with origin in other organs, including the urinary and genital apparatus. Within the kidney, except from the renal pelvis, only 19 cases of SFT are described and such rarity of localization makes the histogenesis and the prognosis of the tumor rather unknown. We report the case of a 72-year-old lady who attended our Unit for a mass that was clinically palpable at the level of the left hemiabdomen. The tomodensitographic test indicated a 19cm-diameter mass of likely pertinence of the middle bystender of the left kidney. She had undergone left radical nephrectomy. The histological examination highlighted a solitary fibrous tumor (SFT): the presence of hypercellularity, of cellular pleiomorphism and of a high number of mitosis has led to a histological diagnosis of malignancy for the neoplasm analyzed. The SFT are of rare clinical comparison: this does not allow for a deep knowledge of the lesion histogenesis and prognosis; moreover, the clinical behavior should be more precisely defined.

Integration of TBNA and TCNA in the diagnosis of peripheral lung nodules. Influence on staging.

Although transbronchial and percutaneous approaches to peripheral pulmonary lesions (PPL) are widely diffused, effective and safe diagnostic techniques, no standardised strategy yet exists that defines the specific role of each in this clinical setting. With the aim of defining the role of each approach and of verifying if the two techniques are alternative or may be integrated in a logical diagnostic sequence based on the advantages and the limits of each biopsy method, the authors analysed their experience with the integrated use of transbronchial and percutaneous approach to PPL performed on 1,680 consecutive patients affected by PPL. The procedure used was as follows: 1) bronchoscopy with exploration of the bronchial tree and transbronchial needle aspiration (TBNA) of hilar/mediastinal lympho nodes for staging N factor followed by TBNA and transbronchial pulmonary biopsy (TBPB) of the PPL under fluoroscopic guidance and immediate cytological assessment (ICA); 2) if TBNA was diagnostic, the procedure was stopped; if not, a second pass with the needle was performed and then the bronchoscope removed; 3) if the second TBNA was not diagnostic, percutaneous approach (PCNA) with ICA was performed up to a maximum of three needle passes. Diagnostic sensitivity for malignant lesions was: 50.0% for TBPB, 70.1% for TBNA, 76.0% for TBPB and TBNA together, 92.8% for PCNA, and 95.0% overall. The percentage of benign nodules correctly defined was 43.0% for TBPB, 16.7% for TBNA, 47.8% for PCNA. Examination of the upper airways and bronchial tree was positive for lesions endoscopically visible in 11.4% of cases. TBNA of hilar/mediastinal lympho nodes was positive for metastatic involvement in 43.9%. The authors' experience demonstrates that transbronchial and percutaneous approaches must be considered complementary and that their integrated use not only increases diagnostic yield but also permits important information to be obtained for the staging of lung cancer. The creation of teams able to utilise both approaches with the cytopathologist present for ICA should be encouraged in order to optimise the diagnostic management of PPL.

Primary pulmonary hypertension: a continuing diagnostic and therapeutic challenge.

Primary pulmonary hypertension (PPH) continues to present both diagnostic and therapeutic challenges to the physician, reflecting the lack of understanding about the basic mechanism of the disease. The onset of the condition is usually insidious, the main symptoms of dyspnoea, syncope and angina often being ascribed to functional or emotional causes. As a result, delay in diagnosis is the norm, with an interval from onset of symptoms to diagnosis of up 2 yrs. The ability of the vasodilator drugs that are now available to produce sustained improvement in patients with PPH is limited by a number of factors. The prognosis is generally severe; however, despite the overall dismal prognosis, duration of survival ranges up to 10 years or more. It is important to consider the possibility of an early stage, when functional changes are prevalent in a substantial number of patients with primary pulmonary hypertension. At this stage, an optimized therapy would be expected to interrupt the course of pulmonary hypertension or, at the very least, retard its progression.

[Mandibular fibromyxoma]. / Fibromixoma della mandibola.

Fibromyxoma of the jaw is a rare neoplasm that may have the radiologic pattern of an aggressive lytic process despite its benign biological behaviour. The lesion is most common between the ages of 10 and 50. We report a case of fibromyxoma of the jaw in a 56 years old woman, with histologic and histochemical study. The case has clinical and statistical relevance for its unusual age of occurrence.