Faecal occult blood test-based screening programme with high compliance for colonoscopy has a strong clinical impact on colorectal cancer.

BACKGROUND: The results of a pilot colorectal cancer screening programme by biennial immunochemical faecal occult blood test (FOBT) are reported. METHODS: All residents aged between 50 and 69 years in the Italian province of Lecco were invited to have a FOBT. Those with a positive result were offered colonoscopy. FOBT uptake and compliance with colonoscopy were assessed. Detection rate and positive predictive value (PPV) for cancer and adenoma were calculated. Tumour stages were compared between screen-detected cancers and other colorectal cancers diagnosed within the target age group. RESULTS: Some 38,693 (49.6 per cent) of 78,083 individuals had a FOBT and 2392 (6.2 per cent) had a positive result. Colorectal cancer was diagnosed in 4.6 per cent and advanced adenoma in 32.7 per cent. PPVs were 4.0 per cent for cancer, 28.1 per cent for advanced adenoma and 36.6 per cent for any adenoma. There was a significant difference in incidence of stage III/IV disease between screened and non-screened cohorts. Compliance for colonoscopy was 92.0 per cent. Major determinants of compliance were age less than 59 years, female sex, high education level and non-manual work. CONCLUSION: These results justify extension of colorectal cancer screening to other regions of Italy.

Extracellular matrix globules in renal oncocytoma.

Extracellular hyaline globules resulting from abnormal accumulation of matrix components have been described in several pathological conditions, including renal tumors. We studied 16 renal oncocytomas and observed these bodies in 11 of them. In these tumors, they showed a homogeneous texture as well as roundish, smooth contours, and were easily detected in hematoxylin-eosin sections in five cases. PAS staining greatly facilitated the identification of globules in the remaining six cases, where they were fewer in number. Immunohistochemically, they appeared to be composed primarily of basement membrane material, being strongly reactive to antibodies for type IV collagen, laminin, and heparan sulphate proteoglycan. In addition, a weak immunoreactivity for type I and type III collagen, and fibronectin was observed in some cases, whereas no globule stained for tenascin. We also analyzed 89 renal cell carcinomas, and found somewhat similar bodies in 10 of them. However, they were more scanty in the latter tumors, and displayed a more irregular configuration with granular or smudged contours. We conclude that, although the mere presence of extracellular hyaline globules does not justify a distinction between renal oncocytoma and renal cell carcinoma, the detection of a large number of well-demarcated, roundish extracellular bodies with smooth contours suggests renal oncocytoma.

Morphologic-cytogenetic analysis of dedifferentiated liposarcomas with an extensive misleading leiomyosarcomatous component.

This report describes two cases of recurrent retroperitoneal dedifferentiated liposarcoma characterized by an extensive leiomyomatous component that prevented the correct diagnosis before the last recurrence. Strong immunoreactivity with smooth muscle and desmin antibodies and ultrastructural features consistent with leiomyosarcoma were observed in the spindle-cell and/or myxoid-like components in all four recurrences in case 1, and in the spindle-cell component of the primary tumor and the first recurrence in case 2. In case 1, the correct diagnosis was suggested by the cytogenetic evidence of ring markers, a hallmark of well-differentiated/dedifferentiated liposarcoma. In case 2, tumor type was yielded mainly by the morphology of the second recurrence, which consisted entirely of a well-differentiated liposarcoma, a sclerosing inflammatory variant, as confirmed by the karyotype. Reevaluation of the first two surgical specimens of each case revealed small areas consistent with well-differentiated liposarcoma that had been previously overlooked. Despite the smooth-muscle antigen profile, both cases retained an mdm2+/p53+/cdk4+ immunophenotype consistent with the genotype.

Malignant mixed müllerian tumor of the uterus. Features favoring its origin from a common cell clone and an epithelial-to-mesenchymal transformation mechanism of histogenesis.

AIMS AND BACKGROUND: Various histogenetic mechanisms have been postulated to explain the biphasic carcinomatous-sarcomatous appearance of malignant mixed mullerian tumors (MMMTs), but the nature of these uncommon neoplasms is still unclear. Some evidence would suggest that MMMT displays similarities with sarcomatoid carcinoma, a tumor arising in extragenital sites that also features a mixed appearance. To gain further insight into the histogenesis of this tumor, we have studied by immunohistochemistry a case of uterine MMMT showing an extensive rhabdomyosarcomatous component. METHODS: A panel of antibodies including reactivity for p53, cytokeratin, vimentin, desmin, muscle actin, epithelial membrane antigen (EMA), myoglobin, type IV collagen, laminin, and tenascin was applied to paraffin tumor sections by means of the avidin-biotin complex technique. RESULTS: p53 immunoreactivity was observed in approximately the same number of cells in carcinomatous and sarcomatous tissue. The former stained for vimentin, cytokeratin and EMA, while the latter, in addition to expressing vimentin, desmin, muscle actin and myoglobin, also exhibited immunoreactivity for epithelial markers such as cytokeratin and EMA. At the borders between carcinoma and sarcoma the basement membrane pattern, as seen by staining for type IV collagen and laminin, showed interruptions in correspondence with areas of transition between the two tissues. Antibody to tenascin strongly labeled the sarcomatous tissue immediately around carcinomatous elements. CONCLUSIONS: A similar immunoreactivity for p53 in both carcinomatous and sarcomatous components, expression of epithelial markers in the sarcomatous cells, and disruption of the basement membrane profile in areas of transition between carcinomatous and sarcomatous tissue, would all suggest, as has been postulated for extragenital sarcomatoid carcinomas, an origin from a common epithelial clone and an epithelial-to-mesenchymal transformation-based mechanism of development for this MMMT. In addition, these findings provide further analogies between these categories of tumors, supporting a unifying nosological concept for MMMTs and sarcomatoid carcinomas of non-genital tract origin.

[Incidence of lymphoproliferative diseases in Northern Italy]. / Incidenza delle malattie linfoproliferative nell'area lariana.

INTRODUCTION: In the last 6 years we have observed an increasing number of cases of lymphoma, extranodal cases being the majority over nodal ones. This fact induced us to investigate the incidence of NHL and HD in the population served by the Lecco Hospital, Department of Pathology, as well as the temporal trend from 1990 to 1995. MATERIALS AND METHODS AND DATA: All hospitals and dispensaries located in the surrounding areas of Lecco including the district of Menaggio and Morbegno are dependent on the Department of Pathology of Lecco Hospital. In fact, the surgical pathology of this area with its 272144 inhabitants converges in our department. We investigated the incidence of nodal and extranodal lymphomas in this population in the period between january 1990 and december 1995 while isolating the number of new cases reported in our files. The incidence per age, population over three-years period has been epressed as the number of cases per million population per year (cases per pmp/y). RESULTS: 285 patients aged 20 to 90 years old (mean 62.5) were selected (51% males, 49% females): they presented 141 nodal lymphomas (36 HD and 105 NHL) and 144 extranodal lymphomas of which 57 primary gastric lesions (22 males and 35 females, mean-age 63.5 in the male group (range 38-85) and 59.0 in the female group (range 31-91)). In nodal as in extranodal lymphomas the diffuse large B-cell lymphomas were the most frequent entity diagnosed, furthermore we noted an increase of incidence in all age groups in the last six years for NHL, mostly NHL HG, in contrast to decrease for HD. About gastric lymphomas, 2/3 were diffuse large B-cell lymphoma with or without low grade component, while the remaining were low grade B-cell lymphoma and only three cases were gastric peripheral T-cell lymphoma. Gastric lymphomas show a higher incidence than in other countries. CONCLUSION: These results show an increase of the incidence of non-Hodgkin lymphomas, mainly of high grade, during six years and in all age groups. On the contrary we observe a tendency in reduction for Hodgkin Disease. Primary gastric lymphomas show a greater increase and their incidence has been estimated in 17.5 cases per 100,000 per 5 years.

Sarcomatoid carcinomas: pathological and histopathogenetic considerations.

Malignant tumors with a mixed phenotype are a controversial field of pathology. In this article the morphological aspects and the immunohistological characterization of sarcomatoid carcinomas are presented. These uncommon neoplasms show both carcinomatous and sarcomatous features, and have been described in the past under a variety of different names causing great uncertainty about their classification and histogenesis. They can occur in various anatomical sites and exhibit a wide range of microscopic appearances, but some features are quite characteristic and are found in many cases. Morphological "transition" between carcinomatous and sarcomatous tissue, and detection of epithelial characteristics by electron microscopy or immunohistochemistry in the sarcomatous component, are very peculiar features of these neoplasms, providing both helpful clues for pathological diagnosis and important insights into histogenesis. Here a unifying histopathogenetic mechanism based on the phenotypic conversion of carcinoma into sarcomatoid tissue is proposed and supporting literature data from both experimental systems and clinicopathological observations are reviewed and discussed.

[Audit of histopathology activities at the pathology departments of 7 general hospitals. 2. Response time]. / Audit dell'attività istopatologica nei servizi di sette ospedali generali. 2. Tempi di risposta.

A retrospective analysis of 1,000 consecutive cases was conducted in each histopathology lab of seven general hospitals. The collected information included the date of specimen withdrawal (six labs only), receipt in the laboratory, and reporting. Time intervals between withdrawal and receipt. Two labs, received 3/4 of cases the same day, while the others had a very low prevalence of receipt. All labs but one, received 80-90% of cases within 48 hours. In one lab, 17% of cases arrived five days after from the withdrawal. Time intervals between receipt and reporting. The mean observed in the seven labs ranged from 3.1 to 6.1 days. Two labs were able to report within 24 hours, but this occurred only in 6% of their cases. The reporting prevalence within three days ranged between 5 and 64%, with a mean for the seven labs of 37%. The reporting prevalence within 6 days was about 95% (four labs), 60-70% (two labs) and 20% (one lab). All labs but one reported 95-100% of cases within ten days. Time intervals between withdrawal and reporting. Our labs were not able to report within 24 hours from the withdrawal (frozen sections excluded). The reporting prevalence within 2-3 days was about 35-40% (three labs), 16% (one lab), 2% (two labs), and within six days it was about 90% (three labs), and 61%, 38% and 14% (the remaining). These latter reported 95% of their cases within twenty days. The turnaround times we found are unsatisfactory. Probably, there are many sources of delay, and these are multifactorial. However, a major factor involved in these delays seems to be related to poor arrangements in the allocation and managing of human resources.

[Audit of histopathological activities in the laboratories of 7 general hospitals. 1. Types of resources and quantitative aspects of the workload]. / Audit dell'attività istopatologica nei servizi di sette ospedali generali. 1. Tipi di risorse e aspetti quantitativi delle prestazioni.

Following a major reorganization of the National Health Service, competition for resources will depend to a great extent on the quality of the service offered, and audit will be of increasing importance. The present investigation deals with the quantitative aspects of the histopathology workload. A retrospective analysis of the biopsy handling of 1,000 consecutive cases was conducted in each histopathology lab of seven general hospitals. The data collected included information on specimen type, diagnosis, block/section/stain details for each specimen, as well as information about human resources, total workload and technical equipment. Among the seven labs, the histopathology workload ranged between 6,600 and 15,600 cases/year. The workload per person/year ranged between 1,400 and 2,600 (mean 1,900) for pathologists, between 800 and 3,000 (mean 1,500) for technicians, and between 2,200 and 8,300 (mean 4,400) for secretarial staff. The prevalence of biopsy fragments (endoscopic, endometrial curettage , etc.), "small" surgery (skin, appendix, gallbladder, etc.) and surgery was, respectively, between 42 and 50%, 34 and 47%, 9 and 21%. In all labs but one, 80% of cases were within 1-3 blocks; the seven labs had a mean of blocks/case ranging from 1.8 to 4.0 (total mean = 2.8). Differences in performing special stains were astonishing: one lab performed special stains in about 40%, and another in only 0.6% of cases (mean of the seven labs = 15%). Finally, the labs performed immunohistochemical stains within a range of 2.7-8% of cases (mean of the seven labs = 4.6%). The data we have collected provided baseline information on the laboratory running, and this is likely to be an integral part of laboratory administration in the near future.

Collagenous spherulosis of the breast with atypical epithelial hyperplasia.

Collagenous spherulosis of the breast is a recently described lesion that was previously been seen only in a setting of benign, typical epitheliosis. We report that unusual case of a collagenous spherulosis of the breast in association with severely atypical epithelial hyperplasia in a 45-year-old woman. The patient presented an asymptomatic right lump and underwent a wide breast tissue resection. After a postoperative follow-up of twelve months, the patient remained well with no breast symptoms. Since atypical hyperplasia in the breast is considered predictive of relatively high risk of later carcinoma development, the finding of collagenous spherulosis with atypical hyperplasia should suggest a long-term follow-up. although at present the biological and prognostic significance of this association is unknown.

Xanthogranulomatous gastritis: association with xanthogranulomatous cholecystitis.

A case of xanthogranulomatous inflammation of the gastric wall is reported. The lesion was associated with adherent xanthogranulomatous cholecystitis and simulated, clinically, a malignant neoplasm. Histologically, foamy histiocytes, multi-nucleated giant cells, other inflammatory cells, fibrous reaction with spindle cells and cholesterol clefts were found.

Smooth muscle contraction bands in intestinal infarction.

We studied microscopic sections of 24 cases of intestinal infarction looking for contraction bands (CB) in the muscularis propria of the bowel wall. Controls were 11 surgical and 11 autopsy cases from patients who did not suffer any form of ischaemic disease. The difference of CB frequency was significant (P less than 0.001) in infarction versus the surgical control group. Moreover, within the study group the CB frequency was also related to the severity of the ischaemic lesion (P less than 0.01). With immunostaining, CB were not reactive with antibodies against vimentin, desmin, actin or myosin. We propose that CB genesis in intestinal smooth muscle is related to hypoxia, possibly through altered homeostasis of calcium and catecholamine metabolism.

Liposarcoma in a child: a case report.

Liposarcoma is a soft tissue tumor usually observed in adults. Although occasional cases have been reported in childhood, it is virtually unknown in infants and small children. Our experience documents a case of liposarcoma in a 6-year-old girl, an extremely rare occurrence in this age-group. The patient underwent wide local excision followed by chemotherapy. Histologically, the tumor was a myxoid type. Differential diagnosis and problems concerning prognosis and therapy of this tumor in children are discussed.

[Hypothyroid neuropathy. Description 2 cases]. / In tema di neuropatia ipotiroidea. Descrizione di due casi.

Although neurological complications of hypothyroidism are well recognized, scanty data, to the best of our knowledge, are available about peripheral neuropathies in this condition. The electrographic studies so far performed are nearly all devoted to the well known association myxoedema-carpal tunnel syndrome. Our data concern two patients affected by neuropathy in hypothyroidism, presenting diffuse anomalies of electrographic parameters (motor and sensitive nerve conduction velocity, F-wave, H-reflex, H-index); and, in one of these cases, a marked segmental demyelination and axonal degenerations were disclosed by pathological examination of sural nerve (according to Dyck and Lambert, 1970; Shirabe and coll., 1975).