Requirement for leptin in the induction and progression of autoimmune encephalomyelitis.

Recent evidence indicates that leptin modifies T cell immunity, and may provide a key link between nutritional deficiency and immune dysfunction. To study the influence of leptin on autoimmunity, susceptibility to experimental autoimmune encephalomyelitis induced by immunization with a myelin-derived peptide was examined in leptin-deficient, C57BL/6J-ob/ob mice, with or without leptin replacement, and in wild-type controls. Leptin replacement converted disease resistance to susceptibility in the C57BL/6J-ob/ob mice; this was accompanied by a switch from a Th2 to Th1 pattern of cytokine release and consequent reversal of Ig subclass production. Our findings suggest that leptin is required for the induction and maintenance of an effective proinflammatory immune response in the CNS.

Papillary cystic tumor of the pancreas. A clinicopathologic study of 20 cases with cytologic, immunohistochemical, ultrastructural, and flow cytometric observations, and a review of the literature.

Twenty cases of papillary cystic tumor of the pancreas were studied (19 female patients, one male patient; median age, 19.5 years). Most tumors developed in the head or body of the pancreas as well-circumscribed, large masses. Gross examination showed that they were solid, cystic, and hemorrhagic. Preoperative fine-needle aspiration biopsy anticipated the diagnosis in four cases. Histologic examination showed that uniform cells formed solid sheets, and loss of cohesion produced pseudopapillae. Hemorrhage, foam cells, cholesterol granulomas, and entrapped nests of pancreatic parenchyma were often found. Fifteen cases studied immunohistochemically were reactive for vimentin and alpha-1-antitrypsin, 13 expressed neuron-specific enolase, 2 expressed cytokeratin, and 1 expressed S-100 protein. None were reactive for pancreatic hormones, opioid peptides, hormonal receptors, or neuroendocrine markers. Electron microscopic examination in five cases showed oval nuclei, moderate amounts of rough endoplasmic reticulum, and many mitochondria; it also showed that annulate lamellae were common. No diagnostic secretory granules were found. DNA study in nine cases revealed a diploid GO/1 peak in eight and hyperdiploid (diploid index = 1.1) DNA content in one case. Fourteen patients with follow-up were free of disease (mean, 2.6 years). Papillary cystic tumor of the pancreas possibly originates from primordial pancreatic cells and lacks definite evidence of endocrine or exocrine differentiation.

Malignant lymphoma of the ovary: report on two cases and review of the literature.

Two cases of malignant lymphoma of the ovary observed at the Division of Medical Oncology of the II Medical School of Naples, are described. One patient had a diffuse immunoblastic lymphoma confined to the ovaries, after accurate clinical-pathological staging. She received aggressive chemotherapy after surgery, and is disease free over one year after diagnosis. The second patient had a low grade lymphoma of the ovary that had spread throughout the abdomen. This patient failed to respond to first line chemotherapy. The literature on ovarian involvement by lymphoma is also reviewed, and prognosis according to different stages of the disease is explained.

Congenital giant diverticulum of the posterior urethra in a 4-year-old boy.

A congenital giant diverticulum of the posterior urethra in a 4-year-old boy is reported. The theories on development of congenital urethral diverticula are considered and the importance of the clinical, radiological, endoscopical and histological examination for the differential diagnosis of the acquired diverticula and enlarged utricle is emphasised. In the majority of diverticula transurethral unroofing is most appropriate. The larger and symptomatic diverticula require open excision and eventually urethral reconstruction. Small asymptomatic diverticula may not require any treatment.

[Prognostic, clinical and anatomo-pathological aspects of gastric lymphoma]. / Aspetti prognostici, clinici ed anatomopatologici del linfoma gastrico.

The authors refer about the results of a study made on 15 cases of gastric lymphoma with a mean follow-up of 6 years. Among the examined features they underlie the clinical appearance of each case according to histologic cell-type, stage of disease and performed treatment with relation to the survival rate. According to the Rappaport classification, diffuse histiocytic lymphoma was the most frequent histologic type of disease: the prognosis turned out to be significantly favorable in case of stage I, while no correlation was observed between different surgical procedures and cell-type. The overall 5 years survival rate was 33.3% with a strong suggestion of better survival in case of early diagnosis.

[Congenital cystic adenomatoid malformation of the lung]. / La malformation adénomateuse kystique congénitale du poumon.

Congenital cystic adenomatoid malformation of the lung (CCAM) has been reported with increasing frequency since it was first described in 1949. In a review of the literature by Halloran and co-workers in 1972, 61 cases were reported. After ten years, we collected from the literature 279 cases. The malformation is characterized by a multicystic mass of lung tissue with bronchiolar proliferation and alveolar impairment. The clinical picture of this pulmonary malformation varies with the age at presentation. In the neonatal period the respiratory distress syndrome is often very serious and may require an urgent treatment. In the older infant, the unrecognized disease has more often a chronic course characterized by recurrent respiratory infections and failure to thrive. Sometime, the malformation may be completely silent and be disclosed during a routine examination of the thorax for others reasons. Both types of presentations of the cystic adenomatoid malformation require a surgical therapy and the lobectomy is the treatment of choice. The prognosis following resection in the older patients is generally good, while in the neonatal period the remaining hypoplastic pulmonary tissue may represent a problem in the postoperative ventilatory management. Two cases of congenital cystic adenomatoid malformation observed in a 5 months old and in a 10 months old infants are reported. The clinical, pathologic and radiologic features of this pulmonary malformation are discussed. The hypothesis of a future "in utero" correction of the most severe cases, in order to prevent the pulmonary hypoplasia of the healthy parenchyma, is also suggested.

[Angioma of the parotid gland in children. Considerations on 3 cases]. / L'angioma della parotide nel bambino. Considerazioni a proposito di 3 osservazioni.

Three cases of haemangioma of the parotid observed in infants are presented and their aetiopathogenetic and anatomopathological aspects are stressed. An examination of the pros and cons of conservative, surgical, radiation, and pharmacological management leads to the conclusion that surgery is the treatment of choice, provided a suitable technique is employed.