[Renal liposarcoma clinical and pathological aspects. Case report and literature review]. / Liposarcoma renale aspetti clinici ed anatomo-patologici. Case report e revisione della letteratura.

Sarcomas of the retroperitoneum represent 0.2% of tumors and 15% of soft tissue sarcomas. Retro-peritoneal differentiated liposarcoma must be distinguished from the connective neoplasm of kidney. The main features of these tumors are: the rapid growth, infiltration of surrounding tissue, the tendency to local relapse and very fast metastasis (60-80%). Authors report a clinical case of a patient 61 old years with occasional reflected ultrasound is performed for lumbar pain a retro peritoneal mass. CT described a retro peritoneal mass that raised medially and displaced the left kidney. The patient was subjected to removal of the mass now to his kidney capsule, which was nevertheless preserved.The histological examination showed a picture of well-differentiated liposarcoma with areas of high-grade sarcoma with malignant morphology fibrohistiocytoma-like aspects and fibromyxomatosis. The well-differentiated liposarcoma has biological behavior similar to other sarcomas with high degree of adults with high local recurrence and distant metastases in 15-20% with overall mortality at 5 years about 30%. The most significant prognostic factor is the location of the cancer and the extent and degree of differentiation did not impact on the clinical prognosis is conditioned by the difficulty of obtaining a radical surgery in spite linfoadenectomia a retro peritoneal accurate.

Diagnostic value of micro-histology in endometrial brushing.

INTRODUCTION: The efficacy of direct endometrial sampling by brushing in the collection of adequate and representative material is evaluated. METHODS: From January 1 2008 to October 31 2009, 195 women (age 29-82, mean 56, 113 postmenopausal), underwent endometrial brushing with Endoflower. All samplings were performed in an outpatient setting. 137 patients had abnormal uterine bleeding (70 postmenopausal), 25 had asymptomatic endometrial thickening (> 4 mm), 6 had atypical endometrial cells on pap-smear, 9 patients needed preoperative controls for uterine prolapse, 11 were treated with tamoxifen and 7 had other problems. The samples were fixed in a solution containing alcohol, water, EDTA and KCO3, and centrifuged. The supernatant was filtered and the pellet embedded in paraffin. RESULTS: All patients reported that the technique was painless. Three cases suffered from shock. In 29 cases (15%), the sampling procedure was difficult due to cervical stenosis. A cellular sample large enough to prepare a cell-block was obtained in all cases. In 27 cases (14%), the sample was non-diagnostic. Cases were categorized as non-pathologic (negative) or pathologic (atypical and carcinoma). The correlation between cyto-histology on samples obtained with brushing and histology on biopsy or surgical specimen was possible in 46 cases (24%), with a diagnostic concordance of 93%. The rate of inadequate biopsies was 27% (8/30). 13 of 15 malignant neoplasias (2 carcinosarcomas, 13 endometrioid adenocarcinomas) were correctly diagnosed in samples collected with Endoflower. The sensitivity was 87% and specificity was 96%, with a positive predictive value of 92% and a negative predictive value of 90%. CONCLUSIONS: Endometrial direct sampling with the Endoflower device in an outpatient setting is well tolerated and well accepted by the gynaecologist. This sampling procedure allows preparation of cell-blocks. Endometrial cyto-histology is less expensive and invasive than other procedures and it could therefore be used in association with transvaginal sonography, even in institutions where liquid-based cytology is not in use.

Correlation between pS2 protein positivity, steroid receptor status and other prognostic factors in breast cancer.

The cytosolic levels of pS2, an estrogen-regulated protein, were measured in 100 cases of primary breast cancer and related to several conventional histological and biochemical prognostic factors. The data were statistically analyzed on the basis of two different cutoff point for pS2: 4 and 11 ng/mg of cytosolic proteins. pS2 positivity (cutoff 11 ng/mg) was shown to be associated with small tumor size (p = 0.05), a higher differentiation grade (p = 0.007) and a smaller number of mitoses (p = 0.004), but not with menopausal status, lymph node involvement, cathepsin D levels, or proliferative activity determined by the monoclonal antibody Ki67. With the cutoff of 4 ng/mg, the statistical significance was confirmed only for the number of mitoses (p = 0.03), which was also the most closely related covariate in multivariate analysis (p = 0.008). As regards steroid receptor status, a significant difference was observed between pS2+ and pS2- cases (Chi-square = 8.9; p = 0.04, cutoff 4 ng/mg). in conclusion, pS2 positivity, being preferentially expressed in hormone-dependent cells and related to other well-known positive markers, may either indicate a good prognosis or predict responsiveness to endocrine treatment.

B-cell chronic lymphocytic leukaemia stage 0. An immunophenotypic study of 66 cases and comparison with B small cell lymphomas.

The cells of 66 B-CLL stage 0 patients were analyzed using a large panel of monoclonal antibodies in order to better define the immunophenotype of B-CLL. The data were compared with the immunophenotypes of lymph node cells from 51 patients with diffuse B small cell lymphoma or leukaemia with lymph node enlargement. The most frequent immunophenotype of B-CLL stage 0 was SIgM(D)+ EmR+ CD5+ CD9+ CD21+ CD23+ CD35- CD38-. Among the lymphomas, EmR-positive and EmR-negative cases were identified. The vast majority of the EmR-positive cases usually showed the leukaemic pattern, immunophenotype and lymph node histology of B-CLL. The EmR-negative cases usually had immunophenotypes quite different from those of B-CLL and the histology of indented cell lymphoma (centrocytic or intermediate) or features of lymphoplasmacytoid/cytic lymphoma. More than 20% of EmR-positive cells proved to be the most important marker to distinguish B-CLL from other lymphocytic lymphomas. Indeed this was a sign of better prognosis. Lymphoplasmacytoid/cytic lymphomas were EmR-positive with the immunophenotype of B-CLL or EmR-negative with a definitely different immunological profile. This suggests two morphologically similar but biologically different subgroups of these diseases.

Ketanserin and captopril interaction in the treatment of essential hypertensives.

The aim of the study was to evaluate whether the combination of ketanserin with captopril exerts an additive antihypertensive effect, as compared with single drug treatment. Twelve patients with uncomplicated moderate essential hypertension received, according to a randomized, double-blind, crossover design, ketanserin (40 mg twice daily), captopril (50 mg twice daily), the combination of the two drugs at these dosages, and the corresponding placebo, each treatment being given for 1 month. Both ketanserin and captopril as monotherapy similarly and significantly reduced blood pressure as compared with placebo (p less than 0.001). The combination treatment of ketanserin plus captopril further and significantly reduced blood pressure when compared with single drug treatment (p less than 0.001). Moreover, the percentage of responders and patients whose blood pressure was normalized were significantly greater under the combined treatment than under ketanserin or captopril monotherapy (p less than 0.001). These data indicate that the combination of ketanserin plus captopril exerts a clear additive antihypertensive effect when compared with each treatment as monotherapy, a finding that suggests this combination can be usefully employed in the treatment of hypertensive patients.

Relationship between structure and T-lymphocyte maturation in human thymomas. Enzyme histochemical and immunohistological studies.

Twenty-six human thymomas were studied in an attempt to correlate their morphological appearance with the type and degree of T-lymphocyte maturation, as determined by acid alpha-naphthyl-acetate esterase (ANAE) activity and immunological analysis. Four normal human thymuses were used for purposes of comparison. Two morphological patterns were identified in the thymomas. The distinction was based largely on similarities between the neoplastic epithelial cells and normal cortical and medullary epithelial cells, and on the relative proportions of epithelial cells and lymphocytes. By these criteria "medullary" and "cortical" patterns were identified. In several thymomas both patterns were present in the same tumor ("mixed-type pattern"), producing alternating dark cortical-like areas and lighter foci of medullary differentiation. A good correlation was found between the two patterns and the phenotype of the T-associated lymphoid component. ANAE activity, which was completely lacking in normal cortical thymocytes, was almost absent in the phenotypically immature T-cells of cortical-type thymomas. By contrast, in the medullary-type thymomas, T-cells showed immunological features in common with medullary thymocytes. This was characterized by strong ANAE activity in the majority of cells with a staining pattern corresponding to that of peripheral T-lymphocytes. In addition, most of the proliferating epithelial cells in medullary-type thymomas stained strongly with anti-cytokeratin and anti-epidermal-type keratin antisera. In the mixed-type thymomas the epithelial cell morphology and the immunohistochemical and enzymic features of the T-cells were found to be closely related to the respective cortical--or medullary-like areas. It was concluded that the various characteristics of normal thymic cortex and medulla studied are also present in thymomas. In particular, in medullar-type thymomas the presence of many of the features of normal thymic medulla, such as a squamous cell component, macrophages and interdigitating reticulum cells, may constitute a microenvironment which operates actively in T-cell education. This may account for the functional activities, characteristic of peripheral T-lymphocytes, which T-lymphocytes attain in these thymomas.

Distribution of two tumor-associated antigens in gastric lesions as detected by two monoclonal antibodies on tissue sections.

Two monoclonal antibodies antitumor-associated antigens, B1.1 and B72.3, have been used with the immunoperoxidase technique on tissue sections to study gastric carcinomas, dysplasia, intestinal metaplasia, and adenomas. B1.1 reacts with carcinoembryonic antigen (CEA); B72.3 reacts with a 220-400 kd glycoprotein present in colon, breast, and other carcinomas. CEA was found in 89% (34 of 38) and B72.3 antigen in 92% (35 of 38) of carcinomas. In half of these more than 50% of tumor cells were positive. The normal epithelium was usually negative or sporadically positive in a few cells. In dysplastic areas and adenomas the number of cells that were positive for the two antigens was greater than in normal epithelium and smaller than in carcinomas. In intestinal metaplasia B72.3 antigen was almost always present, whereas CEA was sometimes undetectable. Both the antigens proved to be good markers of neoplastic versus normal cells. The presence of B72.3 antigen in addition to CEA in dysplasia, adenomas, and intestinal metaplasia adds further evidence of their close relationship with gastric cancer.

Signet ring cell lymphoma in salivary gland. An immunohistochemical and ultrastructural study.

A case of recurrent signet ring cell lymphoma involving a salivary gland is reported. The tumour was centroblastic-centrocytic nodular and diffuse. The cells were vacuolated, oil red, Sudan III, PAS and Alcian blue negative. They displayed the Ia-like antigen but were negative for SIg. Ultrastructurally the vacuoles appeared empty or containing residual membrane and/or myelinoid bodies. Sometimes microvesicles were found in them. The vacuoles were mainly located in the Golgi area but they were also found in mitochondria. Cytoplasmic bodies containing microvesicles were also seen. The case is compared with those of the literature and the significance of the vacuoles is discussed.

Differential reactivity of monoclonal antibodies with human colon adenocarcinomas and adenomas.

Monoclonal antibodies have been generated using membrane-enriched extracts of human metastatic mammary carcinoma lesions (Colcher et al., 1981), some of which demonstrated binding to the surface of human colon carcinoma cell lines. We report here an analysis of the reactivity of three of these monoclonal antibodies with formalin fixed tissue sections of human colon adenocarcinomas and adenomas. The three monoclonals employed were B72.3, which is reactive with a 220-400 kdal high molecular weight glycoprotein complex; B6.2, reactive with a 90 kdal glycoprotein, and B1.1, which is reactive with the 180 kdal glycoprotein CEA. B1.1 was least selective in its reactivity to colon carcinoma versus adenoma lesions. When 10 micrograms/ml of purified B1.1 IgG were used per slide, 94% (15 of 16) of carcinomas and 83% (15 of 18) adenomas showed reactivity. Monoclonal B72.3 demonstrated the most selective reactivity for carcinomas. Eighty-two percent (14 of 17) of carcinomas were positive while none of 18 adenomas examined showed reactivity with more than a few percent of adenoma cells positive. When a low concentration of purified B72.3 immunoglobulin was used per slide, 8 of 16 carcinomas and none of 46 adenomas or normal colon epithelium samples scored positive. Monoclonal B72.3 also reacted with cells in areas of "atypia" within adenomas. The reactivity of monoclonal B6.2 was intermediate as compared to B1.1 and B72.3 in its selectivity of reactivity for carcinoma cells. A heterogeneity in the populations of tumor cells showing reactivity with the three monoclonals was observed within many of the tumor masses. Both colon adenocarcinomas and adenomas can now be placed in several distinct groups based on their expression of antigens reactive with the three monoclonal antibodies employed.