Amniotic band syndrome: a case report.

Amniotic band syndrome is an uncommon congenital pathological condition that may lead to malformations and foetal-infant death. We report an autoptic case. The patient was a male preterm infant. At 14 weeks of gestation, a routine ultrasonography showed severe craniofacial anomalies and a close contiguity of the foetal head with the amnios. The neonate survived three days, after which an autopsy was carried out. The infant had a frontoparietal meningoencephalocele; a fibrous band was attached to the skin, close to the meningoencephalocele base. Cleft lip and palate, nose deformation and agenesis of the right eye were also present. At the opening of the cranial cavity, occipital hyperostosis was observed. The herniated brain showed anatomical abnormalities that made identification of normal structures difficult. Microscopically, the nervous parenchyma had architectural disorganization and immaturity, and the fibrous band consisted of amniotic membranes. As evident from this case report, amniotic band syndrome may cause severe malformations and foetal-infant death.

Gestational diabetes insipidus: a morphological study of the placenta.

Gestational diabetes insipidus (GDI) refers to the state of excessive water intake and hypotonic polyuria. Those cases manifesting in pregnancy and referred to as GDI may persist thereafter or may be a transient latent form that resolves after delivery. Microscopic examination of affected subjects has not been previously reported. In the literature, there are various case reports and case series on diabetes insipidus in pregnancy. In this study, we present a case that had transient diabetes insipidus during pregnancy in which the placenta was examined.

O6-Methylguanine-DNA-methyltransferase in recurring anaplastic ependymomas: PCR and immunohistochemistry.

Ependymomas are the third most common brain tumor in children. The post surgical management is controversial. There are no convincing data on an effective role for chemotherapy. O(6)-Methylguanine-DNA-Methyltransferase (MGMT) is a DNA repair protein considered to be a chemosensitivity predictor. Hypermethylation of the MGMT gene promoter is an important cause of MGMT inactivation. We evaluated the MGMT gene promoter methylation and the immunohistochemical MGMT protein expression in 12 recurrent anaplastic ependymomas affecting children. Our purpose was to investigate the molecular rationale of the administration of alkylating agents to children affected by recurrent anaplastic ependymomas. All ependymomas lacked MGMT promoter hypermethylation and 9 (75%) showed high MGMT protein expression (>50% tumoral cells). Differences between different recurrences in the same patient were not observed. These results may indicate MGMT as a factor of chemoresistance to alkylating drugs in anaplastic ependymomas and support the uncertainties regarding the actual benefit of chemotherapy for patients with anaplastic ependymomas.

Placental findings in pregnancy-associated haemolytic uremic syndrome: clinicomorphological study of three cases.

Acute renal failure occurring in pregnancy or postpartum is often associated with preeclampsia, HELLP syndrome or haemolytic uremic syndrome: differential diagnosis may be difficult due to the overlapping symptoms of these syndromes. We report our experience on diagnosis, management and outcome of women with pregnancy associated haemolytic uremic syndrome, focusing on placental features.

Occipital pilomyxoid astrocytoma in a 14-year-old girl--case report.

Pilomyxoid astrocytoma is a recently described tumor. Its most typical morphological characteristics are an angiocentric astrocytic proliferation embedded in a myxoid background. The behavior seems to be unfavorable due to the reported high rate of local recurrence. The earlier studies indicated that pilomyxoid astrocytoma typically affects young children and arises in the hypothalamic/chiasmatic region. We report a case of a 14-year-old patient with a 6-year history of absence seizure. Magnetic resonance imaging showed a right occipital lesion of approximately 3 cm in diameter. The patient underwent the surgical procedure with gross total excision. Histologically, the tumor was mainly composed of a monomorphous population of bipolar elongated piloid cells radially arranged around thin-walled blood vessels in a prominent myxoid background. There were focal hemorrhagic foci but no bona fide evidence of tumor necrosis or mitoses. Rosenthal fibers and eosinophilic granular bodies were not observed. The postoperative course was uneventful. No adjuvant therapy was administered. The patient is alive and well at 18-month follow-up. The case presented provides evidence that pilomyxoid astrocytoma can occur at a later age and can arise in regions different from hypothalamic/chiasmatic.

[Metastatic brain tumors]. / I tumori cerebrali metastatici.

211 patients operated on for brain metastases have been selected through a review of specimens from the Department of Pathology of the University of Florence covering the period between 1980 to 1995. 140 patients (66%) are males and 71 (34%) are females. Average age is 59 years ranging from 33 to 79 years of age. Lung tumours (47%) and breast cancer (9%) are most frequently responsible for brain metastases. In 17% of the patients, the primary lesion was unknown. The average survival was 14 months and in 8 patients (4%) it was more 5 years. In 36 cases (17%) recurrence appeared 8 months after the first operation. Survival in these patients averaged 20 months from the diagnosis of brain metastases and 11 months after the discovery of the relapses. It is not significantly different from that of patients without evidence of relapsed metastases in the brain (13 months). Prognostically renal carcinoma behaves more favourably, average survival (27 months); on the contrary prognosis of metastatic melanoma is ominous (7 months). Metastases from unknown primaries do not have a significant different prognosis from all the other lesions.

Human endometrial cancers contain follicle-stimulating hormone receptors: a preliminary study.

In order to investigate whether human endometrial cancers contain follicle-stimulating hormone (FSH) receptors, cancer fragments were collected at hysterectomy in six post-menopausal women affected by histologically confirmed endometrial malignancy. Cryostat sections were prepared for in situ binding investigation. Positive endometrial glandular cells were registered in all cancers; 125I-FSH binding sites seemed to increase with the increasing tumor grade. Our data demonstrated for the first time that human endometrial cancers contain specific FSH receptors.

Precancerous lesions of the endometrium and medical treatment.

Endometrial hyperplasias, which occur in the premenopausal age and are often induced by anovulatory cycles, are kept under control by progestin therapy. The good results with natural and synthetic progestins suggest that this treatment can be used both in premenopause and postmenopause hyperplasia. The progestin effect on the endometrium appears through a marked pseudodecidual reaction of the stroma and functional atrophy of the glands. These events are reported in the literature as inactive or suppressed endometrium and there is no physiological equivalent.

Hormonal patterns, steroid receptors and morphological pictures of endometrium in hyperstimulated IVF cycles.

OBJECTIVE: The purpose of this contribution is to investigate the pathophysiology of the abnormal endometrial development in hyperstimulated IVF cycles. STUDY DESIGN: In 12 IVF-patients who did not have embryo transfer because of failure of oocyte fertilization, serum values of 17 beta-estradiol, progesterone, FSH, LH, total and free testosterone, and androstenedione were measured on the pick-up day and were evaluated with respect to the values normally expressed in the day of ovulation; in the endometrial specimens collected 2 days later, at the time of embryo replacement, estrogen and progesterone receptors were immunohistochemically determined and dating by the Noyes method was performed. RESULTS: 17 beta-Estradiol values are constantly higher, and progesterone levels are, only in four cases, higher than expected for the day of ovulation in a natural cycle. These hormonal patterns can only partially explain the pattern of steroid receptors: progesterone receptors are expressed sparsely both in glands and stroma, while estrogen receptors are abundant in the glands and absent in the stroma. In 11 of 12 patients an abnormal endometrial development with stromal advancement was observed: this morphological picture of the endometrium could partially be explained only in the four cases presenting high progesterone levels by serum values and endometrial receptor content of estrogen and progesterone. CONCLUSIONS: The abnormal endometrial development in hyperstimulated IVF cycles could only in part be explained by estrogen and progesterone, and other factors have to be considered.

Morphological and functional aspects of the endometrium of asymptomatic post-menopausal women: does the endometrium really age?

The morphological and functional aspects of the endometrium were investigated in 28 asymptomatic post-menopausal women to evaluate the ageing phenomenon of this tissue. Haematoxylin-eosin staining showed an atrophic endometrium in 12 cases and a hyperplastic endometrium in the other 16 cases. Masson's trichrome identified moderate fibrosis in all post-menopausal endometrial stroma. Immunohistochemical analyses were performed on the endometrial specimens to evaluate the distribution of the capillary system, the cellular proliferation index and the presence of oestrogen and progesterone receptors. Our data showed a discrepancy between the morphological pictures and the functional aspects of the post-menopausal endometrium. In fact, the morphological pictures suggested an involution of this tissue according to the increase in collagen fibres, the decrease in vascular distribution and the frequent atrophic patterns. On the other hand, data from steroid receptors and the cell proliferation index suggest that post-menopausal endometrium is an active structure. So, endometria from normal post-menopausal women appear to be in a more quiescent state than in a really atrophic condition. This leads to the question: does the endometrium really age?

Sugar residues content and distribution in atrophic and hyperplastic postmenopausal human endometrium: lectin histochemistry.

A lectin histochemical study was performed to investigate the glycoconjugate saccharidic moieties of the human postmenopausal endometrium (14 atrophic and 15 hyperplastic). For this purpose a battery of seven horseradish peroxidase-conjugated lectins (PNA, SBA, DBA, WGA, ConA, LTA and UEA I) was used. No differences in lectin binding between atrophic and hyperplastic endometria were observed. This investigation allowed us to provide a basic picture of the oligosaccharidic distribution in postmenopausal endometria. The data on the saccharidic distribution at the postmenopausal endometria showed a large amount of sugar residues at all the investigated sites, i.e. the lining and glandular epithelium, the stroma and the vessels (capillary and large vessels). Furthermore, at the endometrial lining epithelium, at the glands and at the wall of the blood vessels of some postmenopausal women the presence of alpha-L-fucosyl residues which bind via alpha (1-6) linkage to penultimate glucosaminyl residues and/or difucosylated oligosaccharides was demonstrated for the first time.

Clinical stage IIb carcinoma of the uterine cervix: results in 122 patients.

122 patients affected by clinical stage IIb cervical carcinoma were referred to the Radiation Therapy Department and Obstetrics and Gynaecology Department of the University of Florence between 1977 and 1986 for either radiation therapy only (42 patients) or preoperative treatment followed by surgical resection (80 patients). Among the 42 patients receiving radiation therapy only 23 were treated with external beam therapy only (total dose ranging between 50 Gy and 70 Gy at the mid-plane of the pelvis) while 19 received an additional intracavitary boost (total dose ranging between 68 Gy and 98 Gy at Manchester point A). Higher doses of irradiation to point A were correlated with significantly improved survival (65% vs. 18.5%, p = 0.001) and lower incidence of pelvic failure (33% vs 78%). Following preoperative radiation therapy 80 patients underwent radical surgery. Reassessment of the pathologic specimens was possible in all the cases. Disease free survival was not influenced by involvement of parametria, type of surgery or dose to Manchester point A, but rather to nodal status and thickness of the residual tumour in the cervix.

Aging of the human endometrium: peri-implantation phase endometrium does not show any age-dependent variation in lectin binding.

OBJECTIVE: To evaluate if the peri-implantation endometrium shows age variations in lectin patterns, which suggest possible age variations in embryo-maternal recognition. STUDY DESIGN: Peri-implantation endometria of younger ( < 30 years of age: n = 13) and older ( > 40 years of age: n = 17) normally menstruating women was studied. Endometrial specimens were routinely fixed in buffered formaline and embedded in paraffin. Sections (5 microns) were studied using seven lectins: DBA (Dolicus biflorus, binding specificity alpha-D-GalNAc), PNA (Arachis hypogea, binding specificity D-Gal (beta 1 --> 3)-D-GalNAc), SBA (Glycine max binding specificity alpha/beta-D-GalNAc > D-Gal), WGA (Triticum vulgare binding specificity (alpha-D-GlcNAc)n and sialic acid), ConA (Canavalia ensiformis binding specificity alpha-D-Man > alpha-D-Glc), LTA (Lotus tetragonolobus binding specificity alpha-L-fucose) and UEA 1 (Ulex europaeus binding specificity alpha-L-fucose). RESULTS: No significant differences were found in the glycoconjugates sugar residue content and distribution between the endometria of women < 30 years of age and those of women > 40. CONCLUSIONS: Our results suggest that human endometrium does not age, at least while cyclic hormonal stimulation and menstruation are present.

Chorion villosum does not express progesterone and estrogen receptors during the first trimester of pregnancy.

First-trimester chorion villosum plays the key role in the development of human placenta and secretes a large number of hormones and hormone-related substances. To test whether progesterone and estrogen could have regulatory effects on first-trimester chorion villosum functions, we investigated the presence of progesterone receptor (PR) and estrogen receptor (ER) in 47 chorion villosum samples from patients who underwent abortion during the first trimester of pregnancy. The study was carried out using immunohistochemical methods. No ER and PR positivity was evidenced in the 47 chorion villosum samples examined. The possibility that progesterone and estrogen play a role in the regulation of chorion villosum functions should therefore be excluded.

I. Aging of the human endometrium: a basic morphological and immunohistochemical study.

OBJECTIVE: To evaluate if human endometrium presents morphological variations suggestive of an age-related decline in endometrial receptivity. STUDY DESIGN: Peri-implantation endometrium of younger (<30 years of age: n = 13) and older (>40 years of age: n = 17) normally menstruating women was studied. Endometrial specimens were routinely fixed in buffered formalin and embedded in paraffin. Sections (5 mu m) were stained with hematoxylin-eosin, periodic acid-Schiff (PAS) and Trichrome conforming to Masson according to conventional histologic examination. Several consecutive sections were used for the following immunohistochemical study: vascular localization (CD34), cellular proliferation index (PCNA), progesterone and estrogen receptors. RESULTS: Using both the traditional morphological evaluation and monoclonal antibodies, no significant differences were found between the endometria of women <30 years of age and those of women >40. CONCLUSIONS: Our results suggest that human endometrium does not age, at least while cyclic hormonal stimulation and menstruation are present.

Can hysteroscopic evaluation of endometrial carcinoma influence therapeutic treatment?

235 cases of primary endometrial adenocarcinoma (AC) (age range, 37-94; mean age, 61 years) were collected during the period 1980-1992. Hysteroscopic examination of both the endometrial cavity and the cervical canal was performed in every patient prior to hysterectomy, and evaluations of cancer extension in the endometrium (focal: 97 pts; partial: 82 pts; massive: 47 pts; unevaluable: 9 pts) and of endocervical involvement (positive: 45 pts) were compared to the histological findings and survival rates. The chi 2 test was used for statistical analysis, and statistical significance was considered where the p value was < 0.05. Endometrial extension was poorly related to the depth of myometrial invasion (M1 = depth of invasion to < 1/2 myometrium, M2 = invasion to > 1/2 myometrium): focal AC: M1 57.8%, M2 42.2%; partial AC: M1 40.2%, M2 59.8%; massive AC: M1 51.1%, M2 48.9%; (p = 0.5). Endocervical involvement was unrelated to endometrial extension. No correlation was found between AC histological grade (G1-G3) and entity of endometrial extension, whereas grade showed a significant correlation with myometrial invasion (G1 M1: 69.1%; G3 M1: 41.0%; p = 0.002) and survival rates (G1 90.4%, G2 88.5%, G3 69.4%; p = 0.01). Five-year survival figures showed no evident correlation with cancer extension (focal AC: 86.5%; partial AC: 87.8%; massive AC: 86.3%; p = 0.9) whereas myometrial invasion showed a statistical significance (M1: 91.4%, M2: 79.7%; p = 0.03). Three patterns of invasion were defined: pushing (P), infiltrative (I) and diffuse (D) isolated cells. There were significant differences between the various growth patterns and survival rates (P 90.7%; I 84.3%; D 45.4%; p = 0.0001). False negative rate of the hysteroscopic diagnosis of cervical involvement was 7.9% (18 cases); however, in 6 of these cases only deep cervical invasion was found.

[Extra-mammary Paget's disease. An HPV-correlated neoplasia?]. / La malattia di Paget extramammaria. Neoplasia HPV correlata?

Eight cases of Paget's disease of the vulva and anogenital region are presented. Seven cases presented intraepithelial lesions and only one showed superficial intraepidermal diffusion. The average age of the patients in our series was 58.8 years. In all cases histochemical and immunohistochemical reactions were positive, except for the CEA reaction (only one case was positive). Specimens from our series were tested for presence of HPV 6, 11, 16, 18, 31, 33, 35 by in situ DNA hybridization. All cases were negative. Paget's disease, at the moment, is the only tumor of the low female genital tract non HPV-associated. Recurrences are very frequent even many years after radical surgery treatment.

[Evaluation of the efficacy and tolerability of quinapril monotherapy in mild and moderate arterial hypertension]. / Valutazione dell'efficacia e della tollerabilità del trattamento con quinapril in monoterapia nell'ipertensione arteriosa di grado lieve o moderato.

The aim of this single blind, placebo controlled study is to evaluate the efficacy and safety of quinapril in mild to moderate hypertension. Thirty-six patients (from 32 to 64 years old, mean 54.8 +/- 8.84) with diastolic blood pressure (DP) greater than or equal to 96 mmHg and less than or equal to 114 mmHg were enrolled. After a two week wash-out, a placebo was administered for two weeks and than for 12 weeks 20 mg of quinapril u.i.d. At the eighth week if DP was not less than less than or equal to 94 mmHg 40 mg of quinapril was administered. Blood pressure was evaluated at the onset of the study, at the beginning of every step and every 4 weeks. Mean DP and systolic pressure were respectively 159.17 +/- 11.43 and 101.14 +/- 4.39 at the enrolling time, 159.72 +/- 9.41 and 101.86 +/- 3.45 after the wash-out period, 152.78 +/- 9.22 and 98.33 +/- 2.9 after the placebo period, 150 +/- 9.34 and 95.28 +/- 3.52, 144.72 +/- 8.89 and 92.22 +/- 4.32, 140.25 +/- 8.21 and 88.24 +/- 5.27 after 4, 8, 12 weeks of treatment.