Usefulness of human papilloma virus testing in the screening of cervical cancer precursor lesions: a retrospective study in 314 cases.

OBJECTIVE: To assess the usefulness of human papilloma virus (HPV) typing for predicting pre-malignant and malignant cervical lesions. STUDY DESIGN: 314 women, who underwent colposcopy, biopsies and high and low-risk HPV typing after a confirmed abnormal routine Pap test were studied. HPV-DNAs were typed by using PCR technique. RESULTS: We found a significant increasing rate of high-risk-HPV by the increasing severity of histology, ranging from 40% in negative cases to 86.9% in those with CIN3 lesions. The positive predictive value of high-risk-HPV ranged from 13.3% in patients with atypical squamous cells of undetermined significance (ASCUS) to 29.4% in those with HSIL. By contrast, negative predictive value was 96% in patients with ASCUS, 97.2% in low-grade squamous intraepithelial lesions (LSIL), and 71.4% in high-grade squamous intraepithelial lesions (HSIL). Sensitivity and specificity for detecting CIN2 or CIN3 was 86.0% and 41.3%, respectively. CONCLUSIONS: The high negative predictive value of high-risk HPV testing suggests that HPV negativity could be used for predicting the absence of important cervical lesions, and therefore avoiding unnecessary colposcopy in ASCUS and LSIL cases.

TTV infection in patients with acute hepatitis of defined aetiology and in acute non-A-E hepatitis.

BACKGROUND/AIMS: Recently, the presence of a novel nonenveloped single-stranded DNA virus (TTV) has been associated with either acute or chronic hepatitis of unknown aetiology, suggesting a possible aetiological role. The aim of this study was to evaluate the prevalence, the significance and the clinical impact of TTV infection in patients with acute viral hepatitis of defined aetiology and in patients with non-A-E acute hepatitis. METHODS: TTV-DNA was tested by hemi-nested PCR in serum samples collected from 121 patients during and after acute hepatitis (103 with acute viral hepatitis of defined aetiology and 18 with acute non-A-E hepatitis) and in 30 healthy controls. RESULTS: Overall, the rate of TTV infection was 12.6% (13/103) in patients with acute hepatitis of defined aetiology, 16.6% (3/18) in patients with non-A-E acute hepatitis and 6.6% (2/30) in the healthy control group, (p=n.s). TTV-DNA was detected in the following proportions: hepatitis B, 13.2% (7/53); hepatitis C, 16.6% (4/24); hepatitis A, 4.7% (1/21); hepatitis E 20% (1/5). Moreover, acute hepatitis with and without TTV infection/coinfection were comparable in terms of both liver biochemistry and chronicity rate. The results of TTV re-testing after serial dilutions of six TTV-DNA positive serum samples during and after the peak of liver transaminases failed to demonstrate a correlation between liver damage and viral titre. CONCLUSIONS: The prevalence of TTV infection appeared to be comparable in patients with non-A-E hepatitis, in acute hepatitis of defined aetiology and in the control group. Hence, an aetiological role of TTV for acute hepatitis of unknown aetiology seems questionable. Moreover, TTV infection does not modify the natural history of acute hepatitis of defined aetiology.

High prevalence of HCV-RNA in the saliva cell fraction of patients with chronic hepatitis C but no evidence of HCV transmission among sexual partners.

The aims of this study were to evaluate the prevalence of HCV-RNA in different fractions of saliva taken from patients with chronic hepatitis C, to establish whether virologic parameters or disease severity exert any influence on the detectability of HCV-RNA in saliva, and to evaluate the prevalence of HCV infection in partners of HCV-infected subjects with respect to the presence of HCV-RNA in saliva. Sera samples and different fractions of saliva (whole saliva, surnatant, and cell fraction) from 48 subjects (45 with chronic hepatitis C and three healthy anti-HCV+ carriers) were examined for HCV-RNA by RT nested PCR and DEIA hybridization. HCV-RNA-positive sera were also tested for genotype and viral titer (bDNA2 method). Twenty-seven stable sexual partners (25 females and 2 males) were screened for anti-HCV antibodies at least twice over a minimum of 12 months. HCV-RNA was detected in the sera of 39/45 patients and of 22/39 viremic patients. In all of the latter, the presence of HCV-RNA was restricted to the cell fraction. Viral titer was significantly higher in patients with HCV-RNA in saliva than in those without (12.3 x 10(6) versus 4.6 x 10(6) eq/ml, P < 0.01). HCV-RNA positivity was unrelated to genotype, duration of disease, Hepatitis Activity Index scores or transaminase levels. Anti-HCV was positive in one of 13 sexual partners of patients with HCV-RNA in saliva and in 1/14 of those without (P = NS). In conclusion, HCV-RNA is detectable in the cell fraction of saliva in a high proportion of highly viremic patients with chronic hepatitis C, but its presence does not seem to be associated with an increased risk of HCV transmission among sexual partners.

Filamentous inclusions in nonneoplastic and neoplastic pancreas: an ultrastructural and immunogold labeling study.

Filamentous inclusions (FI) are unusual, irregularly shaped cytoplasmic inclusions, which are mostly found in acinar cell carcinomas of the pancreas and are consequently thought to be an abnormal zymogen granule type. This study describes identical inclusions in acinar, centroacinar, and small duct epithelial cells from nonneoplastic pancreas, as well as those found in tumor cells from a mixed acinar-endocrine pancreatic carcinoma. An ultrastructural and immunogold labeling demonstration indicates that these inclusions are aggregates of intermediate filaments immunoreacting with the anti-cytokeratin AE1/AE3 mixture and with V9 clone anti-vimentin monoclonal antibodies. Their pleomorphic appearance, variable immunoreactivity, and frequent association with lipid droplets and secondary lysosomes, mostly of the angulate type, led to the hypothesis that the FI undergo a degenerative remodeling pathway similar to that proposed for hepatic Mallory bodies. A survey of the literature on FI and human tumors suggests that they are a variably expressed ultrastructural feature of tumor cells originating from exocrine cell-containing tissues, namely the pancreas and gastrointestinal tract.

Benign myxoid hepatocellular tumor: a variant of liver cell adenoma.

A case of myxoid hepatocellular adenoma in the non-cirrhotic liver of a 26-year-old man is described. Grossly, the tumor was well circumscribed, rounded and measured 16 cm in diameter. Histologically, the tumor was characterized by nests and strands of polygonal cells embedded in a myxoid extracellular matrix. Electron microscopy confirmed the hepatocellular nature of the neoplastic cells. The patient is alive and well, without evidence of disease, 2 years after a local excision.

A case of virus associated hemophagocytic syndrome and malignant histiocytosis: sometimes a difficult distinction.

The differential diagnosis among hemophagocytic syndromes and particularly between the virus-associated hemophagocytic syndrome (VAHS) and the malignant histiocytosis (HM) is quite easy in typical cases. Difficulties of interpretation may sometimes ensue when viral-bacteriologic work-ups indicative of VAHS are negative and/or morphologic histiocytic aberrations indicative of HM are missing. The authors present a case of hemophagocytic syndrome with the latter characteristics and discuss the differential diagnosis.

Malignant melanoma of the gallbladder. Case report and review of the literature.

The authors are presenting a new case of malignant melanoma of the gallbladder to be added to those described in the literature. The tumour appeared as a polypoid mass of the gallbladder and had metastasized to the jejunum and the brain. Review of the literature and analysis of this case require a thorough discussion of the real existence of tumours in this unusual primary site.

[Necrotizing lymphadenitis without granulocytic infiltration or Kikuchi disease. Description of 5 cases]. / Linfoadenite necrotizzante senza infiltrazione granulocitaria o malattia di Kikuchi. Descrizione di cinque casi.

The authors describe five cases of necrotizing lymphadenitis without granulocyte infiltration or Kikuchi's disease. Of the patients, all young, four were females and one of male sex. In one case serological positivity was found for the anti Toxoplasma antibodies. Histologically they are noted in the lymph node infiltration areas constituted by histiocytes, immunoblasts, lymphocytes and plasmacytoid cells with phenomena of variable degree necrosis. Granulocytes were absent in all. Cytochemistry and immunohistochemistry studies with specific antiserums for the k and lambda chains, the S100 protein and the MB1, MB2 and MT1 antigens, the Lisozyme and the alpha 1 antichymotrypsin, show a prevalent histiocyte population, associated with a modest polyclonal B component and with a T population of variable entity. The plasmacytoid component did not appear reactive to the same antibodies.

[Variability in immunologic aspects of Whipple's disease. Is a unitary interpretation possible?]. / Variabilità degli aspetti immunologici nella malattia di Whipple. E possibile una interpretazione unitaria?

A case of Whipple's disease with histological and ultrastructural studies, characterized by unusual bacteriological and immunologic findings, is reported. Alpha hemolytic Streptococcus and Candida tropicalis were isolated from the culture of the intestinal biopsy specimens. The immunological function study showed a global defect both of humoral and cellular immunity. On the basis of the literature review, the Authors debate a unitary interpretation of the various immunological dysfunctions reported in this disease.

[Early gastric cancer: a retrospective study of our cases (1974-1979)]. / Early gastric cancer: studio retrospettivo sulla nostra casistica (1974-1979).

A retrospective analysis of 3052 gastroscopies made by our Digestive Endoscopy Department from 1974 to 1979 was carried out. 14 Early Gastric Cancers out of a total of 157 gastric carcinomas were diagnosed (8.9%), with an EGC: Gastroscopies ratio = 1:218. From the macroscopic point of view 8 were found to belong to type III, 5 to type II, and 1 to type I. The main location was the lesser curvature (angulus-antrum). With regard to the degree of infiltration, 2 were found to belong to stage 0a, 8 to stage 0b, and 5 to stage I. The endoscopic observation gave reason to suspect the presence of a malignant lesion in 6 of the 14 cases. The bioptic examination proved positive in 10 cases, while in 4 the diagnosis was made on the operatory piece. The importance of multiple bioptic samples is again confirmed. Cytology performed by brushing showed malignant tumoral cells in 4 cases, and again in 4 cases the radiological examination led to suspicion of degenerated gastric ulcer. 13 patients were subjected to surgery during which no metastases to the locoregional lymphonodes were found; the patients are all alive. We started gastric carcinoma screening by selecting the patients on the basis of a worksheet covering epidemiological, clinical, biohumoural and instrumental parameters, since the prognosis for the disease is directly proportional to the earliness of its diagnosis.