Carcinosarcoma of the parotid gland: cytological, clinicopathological and immunohistochemical study of a case.

Manifesting a putative origin from a pleomorphic adenoma, carcinosarcoma of the salivary gland is a heterologous neoplasm in which a sarcomatous and a carcinomatous component coexist. We present a parotid gland carcinosarcoma in a 77-year-old man with peculiar morphological findings. Fine-needle aspiration cytology allowed a preoperative diagnosis of poorly differentiated carcinoma. At histologic examination, the tumor showed biphasic differentiation with an epithelial component made up of well-differentiated keratinizing squamous carcinoma and ductal-type adenocarcinoma, and a mesenchymal component, revealing focal areas of osteosarcoma and myoepithelial malignant proliferation. Carcinosarcoma is a very rare malignant neoplasm, accounting for 0.16% of malignant salivary gland tumors: only 60 cases have been reported, some of which arose "de novo", i.e., without clinico-pathologic evidence of a pre- or co-existing pleomorphic adenoma.

Gastrointestinal autonomic nerve tumor (plexosarcoma): report of a case with fine needle aspiration biopsy and histologic, immunocytochemical and ultrastructural study.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) encompass a large group of mesenchymal neoplasms that display common cytologic spindle-shaped morphology on light microscopy. Immunocytochemical and ultrastructural studies can demonstrate several patterns of differentiation. CASE: A 70-year-old male presented with two intraabdominal small bowel masses. The cytopathologic features of a fine needle aspiration biopsy (FNAB) included plump spindle cells in densely populated aggregates or in a fasciculated pattern, without significant pleomorphism. An epithelioid component in a lobular arrangement with abundant, eosinophilic cytoplasm was also noted. The nuclei were vesicular, with a very evident, eosinophilic nucleolus and finely distributed chromatin. Groups of loosely cohesive cells with slender, dendritic-like cytoplasm were evident. Immunocytochemical study of the embedded, fine needle aspirated fragments of the neoplasm demonstrated immunoreactivity for vimentin and neuron-specific enolase. Cytokeratin immunoreactivity or muscular, vascular, neuroendocrine or nerve sheath differentiation failed to be demonstrated. The cytologic and immunocytochemical findings correlated well with the histologic features of the neoplasm. The morphologic diagnosis was confirmed by ultrastructural study. CONCLUSION: FNAB and immunocytochemistry can be valuable in making the correct diagnosis between gastrointestinal stromal tumors.

[Prevention of immunodeficiency and postoperative infective complications in patients undergoing surgical resection for carcinoma of the colon-rectum. Clinical study on 50 cases, using thymus hormones and thymopentin in particular]. / La prevenzione dell'immunodeficit e delle complicanze infettive postoperatorie in pazienti sottoposti ad intervento di resezione per carcinoma del colon-retto. Studio clinico su 50 casi, mediante l'impiego degli ormoni timici e della timopentina in particolare.

As well as being related to the spread of the tumour, cancer patients present a state of immunodeficiency which is linked to age, malnutrition which is often present, particular in cases of cancer of the gastroenteric tract, surgery and the possibility of associated chemo- or radiotherapy. The authors studied two groups of 25 patients with colorectal cancer. In addition to antibiotic prophylaxis, group A received immunostimulating therapy with thymopentin-TP5. Group B was treated with antibiotic therapy alone. Cell-mediated immunity was checked preoperatively and after 15 days on the basis of skin reaction to 7 booster antigens (Multitest-IMC). Strictly surgical infective complications were more frequent in group B patients (28.1%) receiving antibiotic treatment alone compared to subjects in group A (21.6%). Infections in a non-surgical site were more than double in the absence of perioperative immune therapy. Of the 25 patients examined in group A, 3-4 postoperative infections and as many long-distance infections were reported, all of which resolved without sequelae within a few days. There was a greater and faster recovery of body weight in those subjects receiving thymopentin treatment in addition to antibiotic therapy. In colorectal cancer surgery antibiotic prophylaxis alone is without doubt a valid surgical antisepsis but, above all in hypoergic patients, it is significantly enhanced by perioperative treatment with thymopentin. This association reduces both postoperative infectious complications, in particular postoperative abdominal abscess, and infections in other areas, such as respiratory complications.

[Intramuscular beta-interferon therapy of patients with genital HPV infection]. / Trattamento con beta-interferone per via intramuscolare in pazienti con patologia genitale da virus HPV.

From May 1990 to April 1992 we used intramuscular beta-interferon to treat 17 patients with CIN associated with HPV virus (9 cases CIN1 and 8 cases CIN2) and 10 patients with genital condylomas without CIN. The dosage employed was 3.000.000 IU/daily/7 days and every other day for a further 14 days. All patients were followed up at 1,3 and 6 months and some for longer. Complete cyto histological resolution of CIN was achieved in 58% of patients: however the HPV remain cytologically present in 64% of cases. The data presented are encouraging though they confirm that it is difficult to completely eradicated the genital HPV. In patients with genital condyloma the condition persisted in 66% of patients receiving only medical treatment, whereas in those treated with beta-interferon and dyatermocoagulation the recurrence rate was 28%.

[Ogilvie's syndrome: clinical reality or nosographic error?]. / La sindrome di Ogilvie: realtà clinica o errore nosografico?

The authors report their experience in the management of Ogilvie's syndrome, a rare form of large bowel acute pseudo-obstruction. The study includes fifteen cases of the disease. There were ten males and five female, with a mean age of sixty-two years (range 45-92). Three patients were only treated with medical and conservative measures, one with unsuccessful colonoscopy and twelve (two with colonic perforation) underwent laparotomy. The surgical procedures performed were tube cecostomy (40%), colonic resection with primary anastomosis (27%) and exploratory laparotomy with decompression (13%). The overall morbidity and mortality rate were respectively 0 and 13%. Our epidemiological, clinical and therapeutic results are similar to those reported in the international literature. The pathophysiology of the syndrome is still unknown. It can be "idiopathic" or can complicate other diseases or surgical procedures (urological and gynaecological procedures mostly). Plain abdominal roentgenogram is the most useful diagnostic test, but colonoscopy may be an alternative diagnostic (and therapeutic) weapon. Conservative treatment is the method of choice but when the cecal diameter is more than 12 cm. (impending perforation), when the colon is perforated or when medical measures are unsuccessful, surgical procedure is compulsory. The age of the patient, cecal size, delay in colonic decompression are the most important prognostic factors. Even with a proper management, the prognosis is severe and the mortality rate is high (3-50%).

Monolateral sarcoidosis of parotid gland associated with hemolytic anemia: description of a case diagnosed by cyto-histology.

In this paper the authors describe an uncommon case of a young woman affected by sarcoidosis with a unique localization in the right parotid gland, who, later on, developed a clinical picture of hemolytic anemia due to warm antibodies. The case is described and comments are made based on existing literature.

Problems in fine-needle aspiration biopsy cytology of clinically or mammographically uncertain breast tumors.

From June 1978 to December 1980 at the Istituto Nazionale Tumori of Milano, a fine-needle aspiration biopsy was performed on each of 4834 cases of palpable mammary nodules, the large majority of which were clinically and mammographically suspicious for cancer and only a small part clinically definitely positive. Of these, 1173 underwent surgery at this institution, and 534 (45.5%) had a histologically proven carcinoma. The aspirations were performed by individuals different from those who read the cytologic smears. The aspirations were never repeated, and methods for the retrieval of cells were never applied. Under the circumstances, sensitivity was 0.67, specificity 0.98, and the predictive value for positive results 0.97. The high percentage of inadequate samples (25.5%) influenced the low sensitivity. The few false-positive results occurred exclusively during the first year. Frozen sections can be avoided in those cases (about 50%) with definitely positive cytologic diagnosis by the application of strict criteria. The intrinsic incapability of cytology to yield any information on the extent and the invasiveness of a malignant lesion does not seem to effect its preoperatory conclusiveness.