[Malignant fibrous histiocytoma of the penis]. / Malignes fibröses Histiozytom des Penis.

According to the most recent World Health Organization (WHO) guidelines a diagnosis of malignant fibrous histiocytoma (MFH) should be made only for lesions composed of tumor cells without evidence of a specific line of differentiation. This is therefore a diagnosis by exclusion which is why the name of undifferentiated high-grade pleomorphic sarcoma (UPS) should be preferred. Soft tissue sarcomas currently have an incidence in all body regions of approximately 20 cases per 1 million inhabitants per year. Soft tissue tumors of the penis represent approximately 5 % of all penile tumors and the incidence of penile sarcomas is estimated to be approximately 0.6-1 case per 100,000 patients. Only seven cases have so far been reported in the literature. This article describes the case of a 61-year-old Caucasian male who presented with a painless mass sited in the upper part of the corpus cavernosa. An incisional biopsy with a subsequent investigation using an extensive immunohistochemical panel were performed and a high-grade undifferentiated pleomorphic sarcoma or pleomorphic storiform MFH was diagnosed. In addition to the case report a literature review is presented to elaborate the discussion on the differential diagnoses of these kinds of lesions.

Lack of prognostic significance in Goseki grading of gastric carcinoma.

The Goseki grading system, based on intracellular mucin content and tubular differentiation, was originally created to study the influence of histologic type on the mode of extension of gastric carcinoma. The prognostic value of this grading system was subsequently proposed and even recently supported, but controversies still remain about this topic. We applied the Goseki system on 114 cases of node-negative primary gastric cancer and compared Goseki groups with the other clinicopathologic features of the patients. Statistical analysis showed a significant correlation between Goseki grading and Laurèn classification, but failed to reveal any prognostic significance for this grading system. We believe that Goseki classification should not be routinely used for prognostic purposes.

[Gastric carcinoma: a histopathological study of 705 cases]. / Carcinoma gastrico: studio istopatologico di 705 casi.

We examined 705 surgical specimens of total and subtotal gastrectomy for gastric cancer, from the Surgical Pathology Department of L'Aquila, Atri and Avezzano, during the period from January 1972 to December 1991. For each case at least 15 samplings were taken, from the tumor itself and from the mucosa which appeared macroscopically normal. The cases were then classified according to the criteria proposed by Lauren and by Ming and the staging of the disease using the UICC's pTNM. Applying Ming's classification, it was evident a clear prevalence of the infiltrative (78.6%), rather than the expansive type (21.4%). Lauren's classification showed a slight prevalence of the diffuse type (56.5%), compared with the intestinal type. Intestinal metaplasia, chronic atrophic gastritis and dysplasia were found more frequently in the intestinal and expansive histotypes. These are the forms having a better prognosis and which in our results represent a minority of cases, therefore identifying the geographic area as a low risk area. With regards to the pTNM staging, T3's resulted the most numerous; T1's, or early gastric cancers (EGC), represented instead 15.7% of the total. Such a percentage is rather high in comparison with the mean percentage in western countries with low risk of disease. In reference to the macroscopic variants, a clear prevalence of the ulcerated forms (66.5%) was noted, in contrast with Ming and other Authors, that declare a slight prevalence of the fungating type. Also considering the histotypes there is a certain discrepancy between the data of Ming and ours; in fact, in our study the infiltrative type prevails, representing 78.6% against 33.6% found by Ming. Such a result can be usefully correlated to the high percentage of the ulcerated forms observed in our study and to the relative scarcity of fungating forms; these variants themselves, according to Ming, are usually related to the expansive type of gastric carcinoma. We also noted, in EGC, a remarkable age difference in regards to the diffuse type; the mean age of the 57 patients with this type classified as T1 was 52.2 years against the 63.0 years of the 341 patients with T > 1. The patients with T1 diffuse type carcinoma were not only 10.8 years younger than the patients with advanced gastric cancer of corresponding histotype, but were also 10 years younger than patients with EGC of intestinal type. Such data could support the hypothesis that EGC, diffuse type, has a peculiar biologic behavior.

Histopathological study of 110 cystectomy specimens for bladder cancer by an original mapping method.

The management of cystectomy specimens represents the first and most important step in the study of bladder cancer and related lesions. We carried out a study on 110 patients, applying an original mapping protocol which allowed to determine the exact topography of lesions, recognizing even the smallest ones and putting in evidence some rare histotype. A prevalence of high-grade, high-stage tumors was noted, as well as a remarkable frequency of precancerous lesions, mostly found in Brunn's nests. This latter finding could mean that in many cases a flat carcinoma becomes invasive within a Brunn's nest rather than in surface urothelium. We were also able to accurately evaluate prostatic pathology, finding incidental malignant lesions of this gland in 24.2% of the cystectomized males. The apparently worst prognosis of the patients who underwent chemotherapy depends on the fact that they had grades and stages higher than the untreated subjects. In conclusion, we believe that a more extensive sampling of cystectomy specimens gives highly reliable prognostic data and represents an unreplaceable tool in understanding bladder neoplasms.

Interferon-beta, retinoids, and tamoxifen in the treatment of metastatic breast cancer: a phase II study.

Based on the additive or synergistic antiproliferative effect of interferon and tamoxifen on breast cancer cell lines and on preclinical and clinical data on retinoids alone and in combination with antiestrogen or interferon, we designed a pilot phase II study to test the toxicity of simultaneous administration of interferon-beta (IFN-beta), retinoids (R), and tamoxifen (TAM) and the efficacy of this combination as salvage therapy in a group of patients with metastatic breast cancer (MBC). A total of 49 stage IV breast cancer patients, 11 pretreated with hormones, 26 with chemotherapy, and 12 with both, received 30 mg TAM and two dose levels of IFN-beta and retinyl palmitate. Among 49 evaluable patients, 27 achieved a clinical response (55%; 95% CI 41-69%), 10 had stable disease (20%), and in 12 (25%) the disease progressed. Toxicity with both dose levels was moderate and mainly hepatic. Median response duration, not statistically different in estrogen receptor-positive and negative patients, was 31.4 months (range 4.9-67). Median overall survival was 19.2 months (range 2-69). We have shown that long-term administration of TAM, IFN-beta, and retinyl palmitate is feasible with moderate toxicity. We have also demonstrated that this regimen is active in pretreated MBC patients and that responses are not influenced by receptor status.

Pericentric inversion of chromosome 19 in three families.

Pericentric inversion of chromosome 19 has been found in several members of three unrelated families from a restricted geographical region. In one of the families, an additional pericentric inversion of chromosome 9 was observed. Reproductive problems, multiple abortions in two families and a neonatal death in the third, were present. A review of previously described cases is included, and the genetic risk connected with this type of rearrangement is also discussed.

Light microscopic, immunocytochemical and ultrastructural study of a case of Sertoli cell tumor of the testis.

A case of testicular specialized gonadal stroma tumor was evaluated by histologic, ultrastructural and immunohistochemical techniques in a young adult male patient. The neoplastic cells were organized in cords or tubular structures delimited by a basement membrane. The ultrastructural findings suggested a diagnosis of a partially differentiated Sertoli cell tumor. This was also supported by the presence of a vimentin rich cytoskeleton, which is normally present in Sertoli and Leydig cells. The tumor cells did not secrete steroid hormones, as suggested by clinical findings, as well as by hormonal, immunohistochemical, and ultrastructural observations.

[Adenomyosis: histological remarks about 1500 hysterectomies]. / Adenomiosi: rilievi istologici su 1500 isterectomie.

1500 surgical bits had been histologically examined. There were 556 total hysterectomies and 994 total hysterectomies with bilateral salpingo-oophorectomy. In all we have found 310 cases of adenomyosis (20,6%); 60,3% of them had a submucosal location. A clear correlation between adenomyosis and pregnancy resulted, expecially, between submucosal adenomyosis and number of pregnancies.

[Squamous metaplasia of the cervical canal: histologic observations concerning 1500 hysterectomies]. / La metaplasia squamosa del canale cervicale: rilievi istologici su 1.500 isterectomie.

1.500 cases of total hysterectomies were examined for the sake of point out the incidence and distribution of squamous metaplasia of the endocervix. It was found in 12,6% of cases with a prevalently focal distribution; the prevalent hystological type was hyperplasia of reserve-cells (78,4%). Essential variations in women over 50 years were not noted. S.M. was associated in 33,7% of cases with adenomyosis and in 37,3% of cases with myomas.

[Evaluation of gestational age by comparing ecographic results with amniotic cell morphology]. / Valutazione dell'epoca gestazionale mediante il raffronto dell'immagine ecografica e la morfologia delle cellule amniotiche.

The Authors compared the foetal growth, evaluated by using echographic technique, and the study of amniotic cells morphology, following the Philippe's classification. The results obtained show a good correlation between the two methods.

The lipoma of tuber cinereum.

Two cases of lipoma of the tuber cinereum, unexpectedly discovered in the course of autopsy examination, are reported. Each case was thoroughly investigated by serial sectioning of both the diencephalic floor and the tumor. Some peculiar findings observed and a complete survey of the literature revealed that such a growth may be considered an incomplete benign mesenchymoma, i.e., a mixed tumor of mesenchymal derivates, according to Stout (14). The error in development, consisting in the inclusion of embryonal germs of primitive meninx into the nervous system, may occur early during the third month of intrauterine life, at the time of the formation of the primitive septa.

Biometric analysis of splanchnic and somatic weight in infancy.

During 712 consecutive autopsies on liveborn infants, body weight and the weight of single organs were systematically recorded. These data have provided the material for a statistical investigation. Tables and graphs have been prepared to allow a statistical estimate of the normal value of the weight of organs in the first year of life, as a function of body weight and/or the subject's age. It has been shown that in this period, the weight of an organ varies as a linear function of these two independent variables, whose action is sometimes synergic and, more rarely, in conflict in determing the weight of the organ.