[Stromal tumors of the small intestine (GIST). Prognostic differences based on clinical, morphological and immunophenotypic features]. / I tumori stromali del piccolo intestino (GIST). Differenze prognostiche sulla base delle caratteristiche cliniche, morfologiche e immunofenotipiche.

Gastro Intestinal Stromal Tumors (GIST) are rare malignant non-epithelial tumors arising from gastro-intestinal tract. They represent the 0.2% of all malignancy of this site. Three cases, treated in our Department, are an example of the anatomo-clinical features of these tumors. In two cases the clinical features on admission were similar to those of acute abdominal pain; in the third one a palpable mass rapidly growing was observed. All three patients had surgical treatment but survival were quite different. The size of tumor mass in the first two cases was 5 cm; one patient was alive after ten years without relapse, the second one died five years after with liver metastasis. The third one, with a mass larger more than ten centimeters, developed 8 months after surgical resection a diffuse local relapse of the disease. The microscopic pattern and the lack of epithelial markers allowed to classify them as GIST. All cases were tested with S100 protein, smooth muscle actine, and CD-34 antigen. Two cases had both smooth muscle and nervous markers, the third resembled a malignant schwannoma. Prognosis was correlated with the size of tumor at the time of surgery and immunophenotype pattern. The tumors with high expression of nervous antigens had a worse prognosis.

Effusion cytology of hepatocellular carcinoma.

OBJECTIVE: To evaluate effusion cytology on routine smears in patients with hepatocellular carcinoma. STUDY DESIGN: Filed smears from 106 patients with autopsy-proven hepatocellular carcinoma were retrospectively reviewed for the presence of malignant cells. Morphologic patterns, as well as immunochemical reactivity for a panel of antibodies, were analyzed when feasible. RESULTS: Malignant cells were identified in 10 cases of ascites and 1 of pleural fluid. Positive smears were variably cellular, with paucicellular, round or linear aggregates of polygonal cells. The cytoplasm was usually evident and very stainable. The nuclei were hyperchromatic or vesicular, with inconspicuous nucleoli. Reactive changes were frequent. Malignant cells were positive for keratins (7/8) and erythropoietin (4/8) and negative for carcinoembryonic antigen (0/8). Concomitant cirrhosis was present in 103 cases (97.1%); all the noncirrhotic cases had malignant cells identifiable in the effusion. Antemortem clinical diagnosis of malignancy was made in 59 cases (55.7%); cytology was the only source of the morphologic diagnosis in most of them. CONCLUSION: These results indicate that although the yield of hepatocellular carcinoma in effusion cytology is limited, it may be important in the initial assessment of the disease, given the ineligibility of most patients for invasive procedures and the equivocal features of instrumental investigations. Immunocytochemistry may further assist in differentiating doubtful cases.

Multicentric papillomavirus infection of the female genital tract. A study of morphologic pattern, possible risk factors and viral prevalence.

We have investigated 103 biopsy specimens obtained from 50 women (average 28.1 years, range 16-66) with multicentric condylomatosis of the genital tract, including the uterine cervix (48 samples), the vagina (23), and the vulva (32). Each patient had at least 2 biopsies. A positive in situ hybridization for a Human Papilloma Virus (HPV) cocktail was observed in samples from 38 patients: in these multiplicity of lesions regarded the cervix and vulva (22 cases), cervix and vagina (12), vulva and vagina (1), cervix, vulva and vagina (3). Viral types 6,11 were more prevalent in simple condylomata. Both low- and high grade lesions of cervix, vagina, and vulva showed prevalence of types 16, 18 and 31, 33, 35. Signaling for more than one probe cocktail was detected in 14 (13.6%) samples. Partner's condylomatosis was referred to by a sizeable minority of patients. It is concluded that the spectrum of HPV infection in the female genital tract reflects a multiplicity of factors, including involved viral type and site, immunitary reaction of the host, perpetration or reactivation of latent infections.

Association of breast cancer and meningioma. Report of 12 new cases and review of the literature.

We report 12 new cases of female breast cancer associated with intracranial meningiomas, inclusive of autopsy study. At the time of death the patients' age ranged from 52 to 95 years (average 70.6 years). Breast carcinomas were documented ante mortem in 11 cases and at autopsy in 1. Meningiomas were diagnosed at autopsy (10 cases) or in vivo (2 cases). The diagnosis of meningioma antedated that of mammary carcinoma in only one patient. Histologically, the cancers were of ductal (11 cases) and lobular infiltrating (1 case) types and showed a variable malignancy grade. Widespread extracranial metastases were present at autopsy in 7 cases. Brain metastases were seen in 1 case. Neurologic signs were referred in 4 subjects. Four breast cancers and one meningioma showed immunoreactivity for progesterone receptors, whereas all the cases were negative for estrogen receptors. In one case, metastatic breast carcinoma tissue was present within a psammomatous meningioma. A brief review of the literature, which includes 14 similar observations, is reported. Although the association of breast cancer and meningioma is still difficult to explain, its clinical implications are important and deserve proper attention. A proper work up in patients with suspected intracranial metastases is recommended so that resectable meningiomas are not mistaken for metastases.

Cytopathology of malignant mesothelioma: a study of its patterns and histological bases.

We have reviewed the effusion cytology of 51 cases of histologically proven malignant mesothelioma of the pleura (49 cases) and the peritoneum (2 cases). The patient group included 45 males and 6 females, aged 45-83 yr. A cytological diagnosis of malignancy had been rendered on 43 cases, and in 30 of them it was consistent with, or at least suggestive of, a mesothelioma. Diagnostic clues, especially evident in epithelial and biphasic tumors were hypercellularity and/or morular aggregates of malignant cells showing scalloped borders and nuclei with dense chromatin and evident nucleoli. Cytomegaly with multinucleation was also frequently observed. Reactive mesothelial cells were often present along with other non specific features such as red blood cells, fibrin, necrotic debris. In 13 cases, a diagnosis of malignancy was entertained but mesothelioma, although considered, was not reported out because of scantiness of material. In four cases, adenocarcinoma was erroneously diagnosed for the presence of deceptive cell vacuoles. In eight cases, no diagnostic cells were recovered in repeated effusions. The first diagnosis was a cytologic one in 37 patients, Tissue study was performed on autopsy (35 patients) and surgical material. The latter was the only source of histology in six cases. Immunocytochemical investigation was negative for carcinoembryonic antigen in all but one tested cases (1/21) and positive for human milk fat globulin in about one-half of the epithelial and biphasic tumors. In 18 of 21 cases, positivity for combined high- and low-molecular-weight keratins was detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracranial metastases from malignant pleural mesothelioma. Report of three autopsy cases and review of the literature.

We report three cases of brain metastases from malignant pleural mesothelioma that were seen at autopsy. We present a summarized review of 15 similar reports that were previously published. Our study included three aged male patients with a long occupational history of heavy asbestos exposure. In two patients, the metastases were discovered incidentally at autopsy, and there were no neurologic symptoms referred to before death. In the other patient, who had clinically occult mesothelioma, the intracranial tumor was discovered ante mortem: in this patient, the clinical features, as well as a computed tomographic scan, suggested a primary tumor of the brain. Interestingly, the histologic features of the latter case that were seen at autopsy depicted a spindle cell tumor that focally exhibited pseudopalisading, necrosis, vascular buds, which deceptively recalled a glioblastoma. All the three cases shared a basic sarcomatous pattern of malignant pleural mesothelioma in both primary and metastatic tumors. The immunohistochemical profile was consistent with such interpretation. It was concluded that metastases to the brain from malignant pleural mesothelioma, although rare, are not exceptional even if their clinical relevance is not prominent. They are seen concomitantly with high-grade tumors, and by mimicking a primary tumor on a clinical, instrumental, and histologic ground, they may occasionally represent a potential source of diagnostic pitfall.

Amyloidosis of the pancreas: histochemical differentiation between insular and extrainsular deposits.

The results of a study of eighty-two human pancreases affected by deposits of amyloid in the islets of Langerhans are presented. Two different types of amyloid deposits were observed, one affecting the exocrine tissue and the other affecting the islets. These deposits were found to be histochemically different and appeared to indicate two different aetiopathogenetic processes. The deposit found in the exocrine tissue is essentially perivascular and might be considered an extension to the pancreas of a systemic amyloidosis of the "senile type"; the islet deposits appear to be a completely different phenomenon that could become part of the biology and pathology peculiar to the so called APUD system. The coexistence of the two types of amyloid in the human pancreas would seem, therefore, to represent a casual event.