[Pelvic lymphadenectomy as an alternative to adjuvant radiotherapy in early stage endometrial cancer at high risk of recurrent lymphatic metastases (stage I)]. / Linfoadenectomia pelvica come alternativa alla radioterapia adiuvante nel carcinoma endometriale ad alto rischio di metastasi linfonodali in fase precoce (stadio I).

AIM: The aim of this study was to evaluate if the surgical approach without pelvic lymphadenectomy and with adjuvant radiotherapy in the patients suffering from endometrioid adenocarcinoma type at high risk (of lymphatic metastasis) in early stage can be substituted by only surgery with pelvic lymphadenectomy (with or without para-aortic lymphadenectomy). METHODS: A retrospective study was carried out on 56 patients who underwent surgery with eventual adjuvant radiotherapy and were attended during the follow-up in the Operative Unit of Gynecology and Obstetrics from 1997 to 2004. The patients were divided into two groups: the low risk group and the high risk group. The cancer grading (G) was defined before the surgery with an hystological exam on endometrial biopsies. The follow-up had a medium duration of 30 months (range: 9-44 months) and consisted of the evaluation of: cancer related survival (CRS); recurrence free survival (RFS). Both were evaluated according to age, risk type, and therapy adopted. RESULTS: Four patients (7.1%) showed relapse during the period of study in a medium time of 24 months (range: 12-36): 2 of these patients (C and D cases; 36%) had a relapse both locally (pelvic wall) and distantly; the other two (A and B cases; 36%) had only a distant relapse. None of the patients at the stage IA had a relapse, but it occurred in the 8.7% of the cases (N.=2) IB and in the 10.5 % of the patients IC (N.=2). One patient of the low risk group (3.8%) (case A) had a distant relapse (lungs) 12 months after the surgery and died 6 months after the appearance of the relapse without any additional treatment, because of age and of concomitant pathologies which suggested another illness. Three patients of the high risk group (10%) had a local and /or distant relapse (one only distant, two both distant and local). One of them with distant relapse (36 months after the primary treatment) (case B) is still alive, even though she has got a controlled cancer, 8 months after the rescue treatment (chemotherapy), whereas two of them died in a medium time of 14 months (range 13-15 months) from the rescue treatment (C and D cases). One of the three patients of the high risk group underwent the standard surgical treatment with lympho-adenectomy (case B) whereas the other two underwent the standard surgical treatment with aiding radiotherapy (C and D cases). The CRS and the RFS were 96.2% and 96.2% in the low risk group, 93.3% and 90% in the high risk group, respectively. CONCLUSIONS: The standard surgery offers a good prognosis to the low risk group patients. To the high risk group the CRS and the RFS were better with standard surgery with lymphadenectomy than with standard surgery with adjuvant radiotherapy. The degree of differentiation of the cancer is the most important prognostic factor in relation to the survival free from relapse (RFS).

[Placental insufficiency and intrauterine growth retardation]. / Insufficienza placentare e ritardo di crescita fetale.

AIM: Placental insufficiency is a pathological condition consisting of a placental functional deficit with multifactorial etiology; it can cause maternal complications such as edema, proteinuria, hypertension, etc. Our study aims to establish if placenta analysis after birth can lead to the identification of basic morphological alterations which can be easily documented and useful for the diagnosis of feto-neonatal pathologies. METHODS: We examined 60 pregnant women (45 primipara, 15 multipara). They were hospitalized in the period from March 1998 to March 2004 in different pregnancy periods because of fetus growth delay. After birth, a careful examination of the placenta has been carried out soon after spontaneous birth (weight, thickness, possible morphological alterations which could be macroscopically observed) and it was followed by an anatomo-pathological examination carried out at the Anatomopathology Unit of Ospedali Riuniti in Foggia. RESULTS: Macroscopic examination, in the group of women at the first pregnancy, showed that there were no morphological alterations in the placenta in all the cases, but the weight was normal (400- 500 g) in 8 cases and it was less than 400 g in the other 37 cases. In the group of multipara, placenta did not shown morphological alterations in all the cases, but the weight was normal in only 3 cases and it was lower in the remaining 12 cases. The placental microscopic examination pointed out: infarct focus in 34 cases (60%), 12 (35%) of which were recent and 22 (65%) were old infarct focuses; immaturity of chorionic villus in 15 (30%) of the examined placentas; increase in the cytotrophoblast mitotic index in 49 cases (90%) and placenta with normal histological appearance in 11 cases (10%). CONCLUSION: Placental examination, both with macroscopic and microscopic techniques, can lead to the identification of basic morphological alterations which can be easily documented and useful for the diagnosis of feto-neonatal pathologies. A good placental functionality influences both fetal life and postnatal life. Thus, a greater attention to the placental examination in obstetric practice is suggested, especially for maternal and fetal pathologies.

[Recurrent spontaneous miscarriages and hyperhomocysteinemia]. / Aborti spontanei ricorrenti e iperomocisteinemia.

AIM: Recurrent fetal loss is defined as the number of consecutive miscarriages which is not less than 2 occurred within the 16th week of gestation and it is a very interesting pathology of pregnancy. Further to thrombophilia, very important causes have been identified, since the damage of the vascular system supporting the placenta may cause a deficiency of placenta functions and development, leading to a loss of the conception product, also in a condition of hyperhomocystinemia, causing a damage to the vascular endothelium. Hyperhomocystinemia seems to be a risk factor for artero-venous thrombotic diseases, even not in pregnancy. METHODS: We have examined 40 patients referred to our Institute for unexplained fetal loss (at least 2 consecutive miscarriages within the 16th week of gestation) and the same number of patients who had at least 1 spontaneous delivery with a healthy and alive newborn and none abortion nor fetal death nor abruptio placentae. RESULTS: The mean levels of homocystinemia observed were significantly different in the 2 groups (p = or < 0.05). In the control group the values of plasmatic homocysteine were 10+/-4 micromol/L, corresponding to normal range, while in the other group the values of plasmatic homocysteine were 21+/-6 micromol/L, values certainly elevated, also because during the 1st trimester of pregnancy the levels of homocysteine decrease, reaching the lowest value during the 2nd trimester of pregnancy. In particular, high levels of homocysteine have been found in 25% (10) of women with unexplained early fetal loss. CONCLUSION: Hypercystinemia, as a consequence of an interaction between a primary genetic defect and a nutrition condition (folate deficiency), may be a cause of recurrent miscarriages. Therefore, in these cases, a possible hypercystinemia should be searched and an association of folic acid and vitamin B6, a non teratogenic treatment, should be useful to restore the metabolic picture and to favour the pregnancy outcome.

Prospective evaluation of the role of fine-needle aspiration biopsy in the diagnosis and management of patients with palpable solid breast lesions.

To evaluate the role of fine-needle aspiration biopsy (FNAB) in the diagnosis and management of patients with palpable, solid and suspicious breast lesions, a total of 107 FNABs were performed on 98 patients under the prospective FNAB protocol. Eight-four FNABs were positive for breast carcinomas; of these 84 positive FNABs, 80 underwent mastectomy without open biopsy or frozen section. Our data showed a sensitivity of 95 per cent and a specificity of 100 per cent for diagnosis of breast malignancies on these patients. We concluded that FNAB is a simple, reliable, and cost-effective diagnostic procedure for patients with palpable breast carcinomas.

Primary malignant fibrous histiocytoma of the lung. Fine needle aspiration cytologic features.

A case of primary malignant fibrous histiocytoma of the lung occurring in a 71-year-old woman is presented. The preoperative aspiration cytology showed a large-cell, undifferentiated, malignant neoplasm suggestive of carcinoma. Subsequent histologic examination revealed a primary malignant fibrous histiocytoma. The diagnosis was confirmed by electron microscopic and immunohistochemical studies. Cytologic features of this rare primary pulmonary sarcoma are discussed.

Gastric anisakiasis: report of a case with clinical, endoscopic, and histological findings.

A case of gastric anisakiasis in a 45-yr-old Oriental woman who had eaten fresh, raw salmon is reported. This is the second case of gastric anisakiasis reported in the United States. The clinical course, endoscopic features, and histological findings are described. With the increased popularity of Japanese restaurants and sushi bars in the United States, the incidence of anisakiasis can be expected to increase. Clinicians and pathologists should be aware of this unusual parasitic infestation in this country.

Malignant melanoma presenting as a unilateral ovarian neoplasm.

A 45-year-old female with a unilateral ovarian melanoma without residual ovarian teratoma or clinical evidence of primary lesion is described. The clinical and pathological differential diagnosis is discussed.

Primary amyloidosis presenting as a unilateral hilar mass. Report of a case diagnosed by fine needle aspiration biopsy.

A case of unilateral hilar amyloidosis in a 69-year-old man was diagnosed by fine needle aspiration (FNA) biopsy and confirmed by ultrastructural studies. The roentgenographic presentation of amyloidosis solely as a unilateral hilar enlargement is extremely rare, with only one case previously reported in the English literature; this appears to be the first case of hilar amyloidosis diagnosed by FNA biopsy.

Papillary mucinous cystadenoma of probable renal pelvic origin in a horseshoe kidney.

A 59-year-old woman underwent a partial nephrectomy to remove a 7-cm cystic mass involving the left portion of a horseshoe kidney. Microscopically, the cyst was lined by tall columnar mucosecretory cells resembling endocervical cells. The lesion is believed to represent the benign counterpart of mucinous adenocarcinoma of the renal pelvis.

Malignant islet-cell tumor of the pancreas diagnosed by fine needle aspiration biopsy. A case report.

A case of malignant islet-cell tumor of the pancreas diagnosed by preoperative percutaneous fine needle aspiration biopsy and confirmed by tissue examination is reported. The cytologic presentation of this neoplasm is described, and the differential diagnosis is discussed.

Method for screening urinary steroids by gas chromatography.

Numerous methods are available for measuring urinary steroids in evaluating endocrine dysfunctions. Measurements of these particular steroids, or groups of them, usually involve tedious isolation methods, corrections for interferences and losses of the steroid, and (or) expensive reagents. We show how gas-liquid chromatography provides a rapid, sensitive, and direct method for several steroid metabolites in urine. Androstanol, androsterone, etiocholanolone, dehydroisoandrosterone, pregnanediol, pregnanetriol, 11-keto-17-ketosteroids, and the 11beta-hydroxy-17-ketosteroids can be identified and quantified.