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.

[In situ ductal carcinoma of the breast: current status and our experience]. / Il carcinoma duttale in situ della mammella: situazione attuale e nostra esperienza.

INTRODUCTION: Selecting the appropriate treatment strategy for the individual patient with DCIS represents a major challenge to the surgeon treating breast cancer in the 1990's. CASES AND METHODS: In this study 48 "pure" DCIS patients, treated at Surgical Department of Genoa University, have been selected and divided into Van Nuys prognostic groups. New prognostic classification (Van Nuys) defines three distinct and easily recognizable groups, each of which has a different likelihood of local recurrence if treated with breast conservation. RESULTS: Our results confirm that the risk of local recurrence increases in close relation with prognostic classification groups and suggests that different forms of DCIS may require different treatments.

[Renal hemangiopericytoma. Anatomo-pathologic and clinico-therapeutic considerations. A case report]. / L'emangiopericitoma renale. Considerazioni anatomo-patologiche e clinico-terapeutiche. Descrizione di un caso.

The Authors report a case of renal hemangiopericytoma, whose interest is related to the extreme rarity (24 cases reported until today), its insidious growth, the late in diagnosis, its uncertain clinical-biological evolution, not always predictable. Considering chemotherapy and radiotherapy ineffectiveness, an adequate treatment for such a neoplasm requires the surgical therapy, which must be followed by a careful follow-up.

[Case report of a double ano-rectal neoplasia (adenocarcinoma and melanoma)]. / Segnalazione di un caso di doppia neoplasia ano-rettale (adenocarcinoma e melanoma).

The association in a single organ of two neoplasms with different, histogenensis is uncommon. A dual ano-rectal neoplasms, pigmented malignant melanoma in collision with adenocarcinoma is reported, along with a discussion concerning the problems related with primary origin of the melanocytic component.

[Intrahepatic dilation of the bile ducts. Particularity of a clinical case]. / Dilatazione intraepatica delle vie biliari. Particolarità su un caso clinico.

We report the case of a 71 years old male patient with a "simple" form of Caroli's syndrome. The "simple" form is less common than the form associated with congenital hepatic fibrosis. In this case the intrahepatic bile duct dilatation was confined to the segments V and VI, and intrahepatic lithiasis and cholelithiasis were associated. Usually, Caroli's syndrome remains asymptomatic for the first 20 years of the patient's life, sometimes longer, and in few cases for the patient's whole life. "Simple" asymptomatic Caroli's syndrome is generally unrecognized and in our own case it was an intraoperative finding. Patient's age, the presence of a hepatitis C and the absence of malignant changes discouraged us from performing a right hepatectomy and then a Roux-en-Y intrahepatic bile duct jejunal anastomosis was done. One year after the operation the patient is leading a normal life, and he is symptom-free.

Pharmacological control of intimal hyperplasia in small diameter polytetrafluoroethylene grafts. An experimental study.

OBJECTIVE: The efficacy of a postoperative treatment with Low molecular weight heparin (LMWH) vs Ticlopidine in controlling early thrombosis, intimal hyperplasia and growth of true endothelial cells in small prosthetic expanded polytetrafluoroethylene (ePTFE) grafts (4 mm) interposed in the carotid artery of sheep has been evaluated. EXPERIMENTAL DESIGN: Thirty animals were randomized into three different groups: control group (CTRL); ticlopidine hydrochloride (TICL) 250 mg/b.d. by month for 4 weeks from day 1; LMWH 3,085 IU AXa s.c. preoperatively and once a day for the same period. RESULTS: Complete thrombosis of the graft occurred in 7 sheep in the CTRL group and 5 in the TICL group while 2 partial thrombosis were observed in the LMWH group (n.s.). In all the evaluable cases, hyperplasia was observed in both anastomotic areas and did not involve the middle portion of the graft. The mean +/- SD intimal thickness was 603 +/- 20 micron in the CTRL group, 356 +/- 10 in the TICL group and 152 +/- 17 in the LMWH group (p < 0.001) compared to the 60 +/- 12 of the normal intima. True endothlial cells were found mainly in the LMWH group close to the arterial anastomosis. CONCLUSIONS: The postoperative use of LMWH seems to inhibit intimal hyperplasia, with interesting results also on patency and cellular coverage. Further studies are necessary to support this promising trend.

Understanding regional metabolism for a sustainable development of urban systems.

Cities are the most complex forms of settlements which man has built in the course of his cultural development. Their "metabolism" is connected with the world economy and is run mainly by fossil energy carriers. Up to now there are no validated models for the evaluation of a sustainable development of urban regions.The guidelines for a "sustainable development" suggest the reduction of resource consumption. The article is concerned with the problem of how the "sustainable-development concept" can be transformed from a global to a regional scale. In urban settlements the strategy of final storage should be applied. By this, the subsystem waste management can be transformed within 10 to 15 years to a "sustainable status".With regard to the system "agronomy", the article concludes that agriculture in urban systems should focus on food production instead of promoting reduction of food production in favour of energy plants, which is not a suitable strategy.The main problems are the energy carriers. Transformation to a "sustainble status" is only possible by a reconstruction of the urban system, i.e. of buildings and the transportation network. The rate determining step in achieving such a status is the change in the fabric of buildings and in the type of transportation networks. The reconstruction of an urban system needs, mainly for economical reasons, a time period of two generations.

[Prevention of vascular intimal hyperplasia in small caliber prostheses. Preliminary results]. / Controllo dell'iperplasia intimale in protesi di piccolo calibro. Risultati preliminari.

Intimal hyperplasia is one of the main risk factors for the patency of small diameter bypass grafts. The standard unfractioned heparin (UH) is able to control this phenomenon but the clinical use is not fit for long term treatment; on the other hand the antiplatelet drugs have an anti-thrombotic effect but they seem to be unable to control intimal hyperplasia. Low molecular weight heparins (LMWH) have an anti-thrombotic effect superimposable to that of UH with minimal side-effects and might inhibit intimal hyperplasia too. Based on these criteria, we carried out an experimental study on sheep with the aim of evaluating the efficacy of postoperative treatment with LMWH versus an anti-platelet drug in controlling intimal hyperplasia and growth of true endothelial cells in small prosthetic ePTFE grafts (4 mm) interposed in the carotid artery. At the operation, 30 sheep were randomly located in 3 groups: A = control group, no treatment; B = Ticlopidine hydrochloride 250 mg/bid by mouth for 4 weeks; C = LMWH 3.075 IU AXa (0.3 ml) sc preoperatively and then once a day for the same period. Complete thrombosis of the graft occurred in 7 sheep of group A, 5 in B and 2 partial in group C. The intimal hyperplasia was moderate-severe in group A, mild-moderate in group B and no-mild in group C. True endothelial cells were found mainly in the LMWH group; in the other groups and in other portions of the grafts the cellular coverage was accomplished almost completely by fibroblasts. The study is still in progress with 6 further sheep treated with LMWH.

[Inflammatory pseudotumor of the liver: report of a case with cytological and histological findings]. / Pseudotumore infiammatorio del fegato: segnalazione di un caso con rilievi citologici ed istologici.

The AA. report a case concerning a 58 years old woman with a large hepatic mass involving the segments V-VI-VII-VIII of the liver. The clinical and radiological findings were suggestive for primary malignant lesion. On the contrary, the cytological and histological findings allowed to diagnosis of inflammatory pseudotumor of the liver.

[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.