Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy.

Percutaneous core biopsy (CB) has been introduced to increase the ability of accurately diagnosing breast malignancies without the need of resorting to surgery. Compared to conventional automated 14 gauge needle core biopsy (NCB), vacuum-assisted needle core biopsy (VANCB) allows obtaining larger specimens and has recognized advantages particularly when the radiological pattern is represented by microcalcifications. Regardless of technical improvements, a small percentage of percutaneous CBs performed to detect breast lesions are still classified, according to European and UK guidelines, in the borderline B3 category, including a group of heterogeneous lesions with uncertain malignant potential. We aimed to assess the prevalence and positive predictive values (PPV) on surgical excision (SE) of B3 category (overall and by sub-categories) in a large series of non-palpable breast lesions assessed through VANCB, also comparison with published data on CB. Overall, 26,165 consecutive stereotactic VANCB were identified in 22 Italian centres: 3107 (11.9%) were classified as B3, of which 1644 (54.2%) proceeded to SE to establish a definitive histological diagnosis of breast pathology. Due to a high proportion of microcalcifications as main radiological pattern, the overall PPV was 21.2% (range 10.6%-27.3% for different B3 subtypes), somewhat lower than the average value (24.5%) from published studies (range 9.9%-35.1%). Our study, to date the largest series of B3 with definitive histological assessment on SE, suggests that B3 lesions should be referred for SE even if VANCB is more accurate than NCB in the diagnostic process of non-palpable, sonographically invisible breast lesions.

Contrast-enhanced breast MR imaging of claustrophobic or oversized patients using an open low-field magnet.

PURPOSE: A number of women who should undergo magnetic resonance (MR) imaging of the breast cannot use this diagnostic tool due to claustrophobia or excessive body size for the restricted confines of standard closed MR systems. Our aim was to evaluate the performance of open low-field magnet breast MR imaging in such patients using a high-relaxivity contrast agent. MATERIALS AND METHODS: Of 397 consecutive patients undergoing breast MR imaging, 379 (95.5%) were studied at 1.5 T. Due to claustrophobia (n=15) or large body size (n=3), 18 patients (4.5%) were studied on a 0.2-T open magnet using a body coil. A 3D dynamic T1-weighted gradient-echo 94-s sequence was acquired with intravenous injection of gadobenate dimeglumine (0.1 mmol/kg). The standard of reference was pathological examination for 16 lesions classified with a maximal Breast Imaging Reporting and Data System (BI-RADS) score from 3 to 5, fine-needle aspiration cytology and >or=2-year follow-up for two lesions classified as BI-RADS 3, and >or=2-years follow-up for five lesions classified as BI-RADS 2. RESULTS: Diagnostic MR image quality was achieved for 20/23 lesions in 15/18 patients. Three lesions (two invasive cancers and a cyst) were not assessed due to patient movement and considered as two false negatives and one false positive. Thus, an 86% sensitivity [13/15; 95% confidence interval (CI): 70%-100%], an 87% specificity (7/8; 95% CI: 65%-100%) and an 87% accuracy (20/23; 95% CI: 73%-100%) were obtained. The intraclass correlation coefficient between MR and pathologic lesion size was 0.845. CONCLUSION: In claustrophobic or oversized patients, open low-field breast MR with gadobenate dimeglumine yields good diagnostic performance.

Complete spontaneous remission of non-small-cell lung cancer: a case report.

Spontaneous remission (SR) of cancer is a rare event, particularly in lung cancer. We report the case of a 68-year-old man, who came to our attention with a diagnosis of poorly differentiated pulmonary adenocarcinoma and, in absence of any active therapy, underwent a durable complete SR. Our case supports the rare occurrence of SR in non-small-cell lung cancer (NSCLC).

Primary peripheral adenoid cystic carcinoma of the lung. A case report.

We report a rare case of peripheral adenoid cystic carcinoma of the lung, showing unusual pathological and clinical features, namely rapid growth, local aggressive behaviour, huge tumour size, no endobronchial component or submucosal infiltration, and a rapidly progressive clinical course. Extensive surgery resulted in considerable palliation of symptoms, but not in prolonged survival. The reported case emphasizes the malignant potential of peripheral adenoid cystic carcinoma of the lung.

Prognostic significance of K-ras, p53, bcl-2, PCNA, CD34 in radically resected non-small cell lung cancers.

The aim of this study was to investigate the prognostic significance of a panel of biological parameters in patients with radically resected non-small cell lung cancers (NSCLC). 269 cases with pathological stage I-IIIA NSCLC were retrospectively analysed. Immunohistochemistry was performed to detect protein expression of p53, bcl-2, proliferating cell nuclear antigen (PCNA) and CD34. Polymerase chain reaction (PCR)/direct nucleotide sequencing method was used to detect mutations in K-ras (codons 12, 13, 61, exons 1-2). The Kaplan-Meier estimates of survival were calculated for clinical and biological variables using the Cox model for multivariate analysis. Histological subtype and the pathologic tumour extension (pT) were the most powerful clinical-pathological prognostic factors for survival (P=0.030 and P=0.031, respectively), whereas among the biological parameters, p53 overexpression (P=0.032) and K-ras mutation (P=0.078) had a negative prognostic role, as demonstrated by multivariate analysis. Conversely, bcl-2, PCNA and CD34 expression were not correlated with survival. Statistically significant associations between p53 expression and the squamous cell carcinoma (SCC) subtype, bcl-2 expression and SCC subtype, K-ras mutation and p53 negative expression, p53 and bcl-2, bcl-2 and PCNA overexpression were observed. In conclusion, some biological characteristics such as the K-ras and p53 status may provide useful prognostic information in resected NSCLC patients, in addition to the classical clinico-pathological parameters. However, further studies are needed to clarify the value of adopting biological prognostic factor into clinical practice.

Possible malignant transformation of benign lymphoepithelial parotid lesions in human immunodeficiency virus-infected patients: report of three cases.

Benign lymphoepithelial parotid lesions (BLL) are intraparotid pathological changes that are commonly thought to be an early manifestation of human immunodeficiency virus (HIV) infection. It is not well known whether BLL may undergo malignant transformation into B cell lymphoma and may therefore be a sort of precancerous lesion. We report 3 cases of possible malignant transformation of BLL in HIV-infected patients.

Benign lymphoepithelial parotid lesions in HIV-positive patients: spectrum of findings at gray-scale and Doppler sonography.

OBJECTIVE: Benign lymphoepithelial lesions are intraparotid nodules that develop as an early manifestation of HIV infection. The purpose of this study was to describe the spectrum of sonographic and Doppler findings of benign lymphoepithelial lesions in HIV-positive patients and to assess whether these findings are specific for the diagnosis of such lesions. SUBJECTS AND METHODS: Nine HIV-positive patients with swelling of the parotid gland caused by single or multiple parotid nodules were evaluated. Fourteen nodules were identified sonographically and proved to be benign lymphoepithelial lesions at cytologic examination. They were assessed with gray-scale, duplex, color Doppler, and power Doppler sonography. For each nodule, the echogenicity, grade and pattern of vascularity, and spectral tracings were evaluated. RESULTS: Benign lymphoepithelial lesions manifested as parotid nodules with a wide spectrum of sonographic appearances, ranging from simple cysts to mixed masses with predominantly solid components. Cystic lesions (10/14) were not purely anechoic; they had an internal network of thin septa supplied by vessel pedicles and, in four of 10 cases, a solid mural nodule. On the other hand, mixed nodules (4/14) had a higher conspicuity of solid tissue and thicker stromal septa, thus resembling a parotid neoplasm more than a cyst. The overall grade of vascularity of benign lymphoepithelial lesions varied from avascular to intensely hypervascular. Generally, mixed nodules were more hypervascular than were the cystlike ones. Spectral analysis showed slow velocity (peak systolic velocity range, 8-28 cm/sec; mean, 20 20 cm/sec) and low impedance (resistive index range, 0.36-0.70; mean, 0.57) arterial flows. CONCLUSION: The spectrum of sonographic and Doppler features of benign lymphoepithelial lesions in HIV-positive patients is broad. Sonographic findings are non-specific for the diagnosis of such lesions, especially in cases of mixed solid-cystic isolated nodules.

Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons.

PURPOSE: To correlate the histologic structure and echotexture of peripheral nerves and verify if ultrasound (US) findings can be used to differentiate nerve from tendon. MATERIALS AND METHODS: In an in vitro study, the echotexture of normal peripheral nerves was correlated with the histologic findings. In an in vivo study, US was used to differentiate median nerve from flexor pollicis longus tendon in healthy volunteers (12 male and eight female subjects 7-68 years of age; mean age, 35 years). RESULTS: US examination of the peripheral nerve specimens showed hypoechoic areas separated by hyperechoic bands. The hypoechoic areas corresponded to neuronal fascicles at histologic examination. This fascicular pattern was clear in all median and ulnar nerves, 15 of 20 vagus nerves, and 19 of 20 sciatic nerves in the volunteers but not in recurrent laryngeal nerves. CONCLUSION: Peripheral nerves have a typical US pattern that correlates with histologic structure and facilitates differentiation between nerves and tendons.

[Anatomo-pathologic diagnostic interpretation of nodular hepatic lesions]. / Interpretazione diagnostica anatomo-patologica delle lesioni nodulari epatiche.

Thirty cases of primary hepatic carcinomas and twenty hepatic metastatic localizations with equivocal histopathological features were investigated using morphologic criteria and immunohistochemical methods. The study was performed on formalin-fixed, paraffin-embedded tissue sections from surgical removed specimens. On the basis of our experience (in according with literature data) we have shown that most of hepatocellular carcinomas express a specific morphologic pattern (i.e. contemporary cholangiocellular differentiation) and phenotypic characters (particularly CEA positivity with bile canalicular pattern). Nevertheless in some cases it is impossible to make a differential diagnosis; the evaluation of new biological parameters like proliferative index will be useful.

Increased numbers of mast cells in bronchial mucosa after the late-phase asthmatic response to allergen.

We examined the characteristics of allergen-induced inflammation of the bronchial mucosa in asthmatic patients. Studies were carried out 4 h (eight patients) and 24 h (nine patients) after allergen inhalation challenge; 10 patients were not challenged and served as control subjects. We found that in the control group the ratio of degranulating to granulated mast cells was higher in patients with than in patients without late-phase response. In patients studied 4 h after allergen challenge the total number of mast cells was not significantly different from that in control subjects; the ratio of degranulating to granulated mast cells was increased similarly in patients with and without late-phase response. Among patients studied 24 h after allergen challenge, those who had developed the late-phase response had an increased (p less than 0.05) number of mast cells as compared with patients who had not developed the late-phase response, the number of mast cells was significantly correlated with the severity of the late-phase response (r = 0.80; p less than 0.001). The numbers of eosinophils and mononuclear cells and the morphologic abnormalities of bronchial structure (altered ratio of cylindrical to goblet cells, thickening of the basement membrane, and edema and angiectasis of lamina propria) were similar in the different groups of patients. We conclude that the inflammatory events leading to the development of the late-phase asthmatic response to allergen represent a stimulus for an increase in the number of mast cells in the bronchial mucosa.

Different effects of intraperitoneal or subcutaneous administration of H2-antagonists on pancreatic response to chronic administration of caerulein in rats.

This study deals with the effect of H2-receptor antagonists on pancreatic response to chronic administration of caerulein. Caerulein was administered alone or combined with cimetidine, ranitidine or famotidine twice a day in various regimes. At the end of treatment, pure pancreatic juice was collected after hormonal stimulation. Then, the rats were killed, and growth and composition of the pancreatic tissue were determined. Caerulein increased pancreatic weight and enzyme content as well as volume and enzyme activity of pancreatic juice. When given alone the three H2-receptor antagonists were totally ineffective. Both ranitidine and famotidine, but not cimetidine, significantly reduced pancreatic response to chronic administration of caerulein only when given intraperitoneally together with caerulein. On the contrary, separate applications of caerulein and ranitidine (or famotidine) did not influence caerulein-stimulated pancreatic growth or enzyme secretion. Moreover, in rats treated both intraperitoneally and subcutaneously with caerulein, the H2-antagonists reduced the pancreatic response only partially and in proportion to the intraperitoneal dose of caerulein. The responsiveness of pancreatic tissue to subcutaneous caerulein was not modified. The results suggest that H2-receptor antagonists induce (1) impaired uptake of caerulein when given together with peptide, but (2) have no specific inhibitory effect on pancreatic response to caerulein.

[Anatomicopathological findings relating to fungal infections: considerations on their increase and microbiological findings]. / Rilievi anatomopatologici sulle infezioni da miceti. Considerazioni sul loro incremento e rilievi microbiologici.

2,366 consecutive autopsies carried out at the Institute of Anatomy and Histopathology of the University of Genova over the last 10 years are re-examined. 33 cases of visceral mycosis were found (a frequency of 1.4%). The following factors were considered: number and location of fungal infection, morphological characteristics of mycetes responsible, host tissue reaction, relationship with any other disease manifestation or predisposing factors. It is emphasized that these infections are increasing in frequency and severity. Clinics should therefore always consider possible fungal causes in the differential diagnosis of infections.

Pathogenesis of pseudomembranous colitis.

This work is concerned with new morphologic data pointing to an immune component in the pathogenesis of pseudomembranous colitis. The focal distribution of the pseudomembranes suggests selective damage induced by Clostridium difficile toxins. The sites of attachment to the mucosa correspond anatomically to the intestinal structures specialized for immune information and response. Furthermore, viable IgA production supports the view that toxins are carried to lymphoid aggregates where plasma cell proliferation takes place. A sharp increase in the mast cell population of the colon is also reported. Mast cells, whose role in the pathogenesis of intestinal diseases is still obscure, are diffusely distributed, irrespective of the focal lesions of pseudomembranous colitis.