Revisiting Pulmonary Sclerosing Pneumocytoma.

Pulmonary sclerosing pneumocytoma (PSP) is a quite rare tumor outside Eastern countries. This rarity, together with a wide histological appearance, makes its correct identification a diagnostic challenge for pathologists under the microscope. Historically, PSP was considered a vascular-derived neoplasm (sclerosing hemangioma), but its immunohistochemical profile clearly supports its epithelial origin. No specific molecular fingerprint has been detected so far. This short narrative revisits the clinical, histological, immunohistochemical, and molecular aspects of this tumor, paying special attention to some controversial points still not well clarified, i.e., clinical aggressiveness and metastatic spread, multifocality, the supposed development of sarcomatoid change in a subset of cases, and tumor associations with lung adenocarcinoma and/or well-differentiated neuroendocrine hyperplasia/tumors. The specific diagnostic difficulties on fine-needle aspiration cytology/biopsy and perioperative frozen sections are also highlighted. Finally, a teaching case of tumor concurrence of lung adenocarcinoma, neuroendocrine lesions, and PSP, paradigmatic of tumor association in this context, is also presented.

Classification of different patterns of pulmonary adenocarcinomas.

The epidemic increase of adenocarcinoma histology accounting for more than 50% of primary lung malignancies and the advent of effective molecular targeted-therapies against specific gene alterations characterizing this tumor type have led to the reconsideration of the pathologic classification of lung cancer. The new 2015 WHO classification provided the basis for a multidisciplinary approach emphasizing the close correlation among clinical, radiologic and molecular characteristics and histopathologic pattern of lung adenocarcinoma. The terms 'bronchioloalveolar carcinoma' and 'mixed adenocarcinoma' have been eliminated, introducing the concepts of 'adenocarcinoma in situ', 'minimally invasive adenocarcinoma' and the use of descriptive predominant patterns in invasive adenocarcinomas (lepidic, acinar, papillary, solid and micropapillary patterns). 'Invasive mucinous adenocarcinoma' is the new definition for mucinous bronchioloalveolar carcinoma, and some variants of invasive adenocarcinoma have been included, namely colloid, enteric and fetal-type adenocarcinomas. A concise update of the immunomorphologic, radiological and molecular characteristics of the different histologic patterns of lung adenocarcinoma is reported here.

Insomnia among hospitalized elderly patients: prevalence, clinical characteristics and risk factors.

Insomnia can determine an increase in falls and accidents, hospitalization and nursing home placement. The aims of our study are to evaluate prevalence, clinical characteristics and predictors of sleep disorders in elderly inpatients admitted to a Geriatric Acute Care Ward. This longitudinal observational study consecutively recruited patients aged 65 and older admitted to a Geriatric Acute Care Unit between January the 1st 2007 and June 31st 2007. During the 3rd day of length of stay (LOS), patients were asked if they suffered with sleep disorders. Patients reporting sleep disturbances during the first 3 days of LOS were included in the study. Patients were evaluated for insomnia, comorbidity, self-rated health, functional status, cognitive impairment and pain. Of the 280 subjects investigated, 80 referred sleep disorders during LOS with a prevalence of 36.7%. Patients with sleep problems scored significantly worse on the cumulative index rating scale (CIRS) severity index (p=0.007), on the numeric rating scale (NRS) (p=0.01) and on the activities of daily living (ADL) scale (p<0.001). The CIRS severity index resulted the best predictor for insomnia related to hospitalization (OR 7.9, SE 0.85, p=0.01). The knowledge of insomnia predictors might help in planning preventive strategies to improve patients' global health status and quality of life.