Utero-placental apoplexy during induction of therapeutic abortion in a 18-week pregnancy.

Utero-Placental Apoplexy, or Couvelaire Uterus, is a third-trimester major obstetrical complication, occurring especially during labor. It consists of placental abruption followed by an acute intradecidual hemorrhage produced by the rupture of the uterus-placental spiral arterioles leading to a retroplacental hematoma. This hemorrhage infiltrates the uterine wall up to intra- and retro-peritoneal areas. We provide a case report, on which no previous literature is available, of a utero-placental apoplexy during induction of therapeutic abortion.

Metastatic hepatocellular carcinoma of the parotid region without lung metastasis: a case report.

Parotid gland metastatic tumours are rare, usually arising from a primary mucosal or cutaneous cancer located in the ipsilateral head and neck region, although metastases from a primary cancer outside the head and neck region are possible. Hepatocellular carcinoma (HCC) rarely metastasizes to the head and neck region and the parotid glands are an even more unusual site. The authors describe the case of an 82-year-old male who presented with a right parotid mass. Percutaneous incisional biopsy with histological and immunohistochemical studies suggested metastatic HCC. Radiological investigations excluded other metastatic lesions. This case illustrates the difficulties that may be encountered when seeking a definitive diagnosis of parotid gland masses and underlines the need for collaboration between clinicians and pathologists when diagnosing a parotid enlargement.

Malignant vulvar melanoma: colposcopic evaluation and review of the literature. A case report.

Because of the rarity of this kind of vulvar neoplasia, the diagnostic difficulties (clinical and histopathological) conditioning the therapeutic approach and the missing iconographical material, we report a case of vulvar melanoma seen at the Department of Obstetrics and Gynecology of the University of L'Aquila in April 2001, together with a review of the literature. Owing to radical vulvectomy and bilateral inguinal lymphadenectomy with the Byron three-incision approach the histological report was: epithelioid cell apigmented melanoma radially spreading (MMSS), a tumor-free margin of at least 1.7 cm with sufficient lympholitic infiltration.

Local chemotherapy with interferon-alpha for conjunctival mucosa-associated lymphoid tissue lymphoma: a preliminary report.

OBJECTIVE: To evaluate the efficacy of subconjunctival interferon-alpha for the treatment of conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma. DESIGN: Small, noncomparative, interventional case series. PARTICIPANTS: Five patients with histologically proven conjunctival MALT lymphoma were studied prospectively. METHODS: Patients were given 1,500,000 international units (IU) of interferon-alpha (IFN-alpha) (Roferon-A) subconjunctivally inside the lesion, three times a week for four weeks. If there was even a minimal response, a further cycle of 1,000,000 IU three times a week for four weeks was administered. Patients received a maintenance dose of 1 million IU, every 15 days for 4 times, after clinical resolution of the lesion. MAIN OUTCOME MEASURES: Patients were followed clinically, with slit lamp examination, for evidence of tumor disappearance or recurrence. RESULTS: Complete response was obtained in all patients. The lesion resolved completely by the eighth week. Four patients did not show any local recurrence with a median follow-up of 21 months (12-36 months). One patient presented with a recurrence after 11 months, in association with systemic lymphoma progression. CONCLUSIONS: Local chemotherapy with IFN-alpha seems to be an effective treatment modality, alternative to radiotherapy, for conjunctival MALT lymphomas.

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.

N-Nitroso compounds, bacteria, and carcinoembryonic antigen in the gastric stump.

Analyses of biochemical and microbiological parameters such as pH, N-nitroso compound (NOC) concentration, carcinoembryonic antigen (CEA) level, and total viable counts (TVCs), and identification of microorganisms were carried out on 65 fasting gastric juice samples obtained at endoscopy from 45 patients previously submitted to partial gastrectomy for benign peptic ulcer disease (23 Billroth I, 22 Billroth II/Reichel-Polya) and 20 normal controls. Biopsy specimens were taken to determine histology, the Helicobacter pylori status, and both tissue CEA immunoreactivity and level. Significantly higher mean pH values, NOC and CEA concentrations, and TVCs were found in partial gastrectomies compared with normal controls. In relation to surgical methods, higher mean pH values, NOC concentrations, TVCs, and anaerobic bacterial counts were observed in the juice of patients with Billroth II compared with Billroth I gastrectomies. Mild CEA immunoreactivity and apical CEA localization were found significantly more often in Billroth II than in Billroth I stumps. Intensive CEA immunoreactivity and cytoplasmatic localization were found significantly more often in Billroth I than in Billroth II stumps. Independent of the type of surgical reconstruction, higher mean NOC levels were recorded in patients with more severe histological changes and H. pylori infection. Higher mean CEA levels in gastric juice and tissue were detected in the gastric stumps with more severe histological changes. All these data suggest that high levels of NOCs in the gastric juice could be a cofactor in gastric stump carcinogenesis and determination of CEA level in gastric juice and tissue could be included as a very useful marker in quantifying this process.

An immunohistochemical analysis of nm23 gene product expression in uveal melanoma.

Uveal melanoma is characterized by an unpredictable clinical course, during which metastatic disease may occur after a prolonged and, at present, undefinable disease-free interval. Because of its relative rarity and the dispersion of cases, the possible genetic alterations implicated in the invasive and metastatic behaviour of this ocular neoplasm have not yet been characterized. The aim of this immunohistochemical retrospective study was to assess the expression of nm23 gene product, proposed to be a metastasis-suppressor gene, in uveal melanoma and to analyse its prognostic significance in relation to the various conventional histopathological parameters, currently considered the major prognostic indicators in this intra-ocular neoplasm. We analysed formalin-fixed paraffin-embedded samples excised from 33 patients with uveal melanoma. Of these, 22 (67%) were positive for monoclonal antibody nm23. This nm23 positivity was inversely associated with scleral invasion level (P = 0.001) and largest tumour diameter (P = 0.02), which represent the two most significant prognostic factors for metastasis. On the other hand, there was no correlation between nm23 expression and other prognostic markers such as cell type, intraocular location or clinical characteristics. These results may suggest a close relationship between nm23 gene expression and metastatic potential of uveal melanomas. In addition, analysis of nm23 gene expression on bioptic tissue may represent an extreme useful prognostic tool for metastatic progression of uveal melanomas.

Epididymal lymphoma. A case report.

Primary epididymal lymphoma is an unusual observation. Only 2 cases of non-Hodgkin's lymphoma of the epididymis have been previously reported. We describe the clinical and pathologic features and management of a primary high-grade malignant lymphoma of the epididymis in which a tentative diagnosis of lymphoma was made on the basis of cytologic examination and immunochemical staining of the material obtained from an aspiration needle biopsy.

[Ménétrier's disease associated with a gastric ulcer: a clinical case report and review of the literature]. / Malattia di Ménétrier associata ad ulcera gastrica: presentazione di un caso clinico e review della letteratura.

The authors report on a case of Ménétrier's disease, associated with antral gastric ulcer. The patient came at our observation after a severe high digestive bleeding. On the basis of the endoscopic diagnosis of gastric ulcer and because of the failure of medical treatment with continuous bleeding, the patient underwent subtotal gastrectomy. The histological examination of the specimen confirmed the benign nature of the gastric ulcer but revealed also the presence of Ménétrier's disease. After three years, an endoscopic control excluded the presence of the disease in the remaining stomach. The association between gastric ulcer and Ménétrier's disease is of difficult pathophysiological explanation in the literature. The presence of the ulcer, however, does not seem to influence the clinical evolution of the disease or the treatment, which, moreover, has not been codified as yet. In fact, cases of Ménétrier's disease are reported to have been cured with cortisol, anticholinergic, anti-H2 receptor and antifibrinolytic preparations or by surgery (subtotal gastrectomy, total gastrectomy). However, as in our patient, spontaneous remission of the disease with no treatment have been reported. The Ménétrier's disease, the treatment of which has yet to be codified, is still a difficult situation, in particular when associated to gastric ulcer.

[Magnetic resonance in the diagnosis of thyroid diseases]. / La Risonanza Magnetica nella diagnostica delle malattie della tiroide.

Previous clinical experience in the study of the soft tissues of the neck region has pointed out the accuracy of MRI in terms of high definition and contrast resolution. Seventy-seven patients with thyroid diseases were examined to define the possible role of MRI in the diagnosis of these conditions. In the patients affected with thyroiditis, MR findings were not specific, showing increased glandular volume and signal inhomogeneity. MR examinations of struma allowed an accurate evaluation of glandular size; furthermore, more information was obtained than with other imaging modalities in the cases with mediastinal involvement. On T2-weighted images, adenomas were always hyperintense, whereas variable signal intensity was seen on T1-weighted scans, with the exception of Hürthle cell adenomas, which were hyperintense on both T1- and T2-weighted sequences. MRI proved to be reliable in the depiction of tumor spread at both glandular and extraglandular levels. The distinction between scar fibrosis and relapse was also possible, in the cases undergoing postoperative follow-up. In conclusion, MRI emerges as a diagnostic tool complementary to other imaging techniques. However, in selected conditions--e.g., mediastinal struma and tumors--and in the postoperative follow-up, MRI can be considered the method of choice.

[Identification of growth hormone in human embryos and fetuses]. / Individuazione del growth hormone in embrioni e feti umani.

The authors report a study on 10 human fetuses aged between 9 and 16 weeks of gestation. A PAP technique (peroxidase-anti-peroxidase) was used to identify the time and place of growth hormone appearance. Data obtained show intense positivity for chondrocytes, obleoblasts and perichrondrium. Hepatocytes were also found to be positive. These results suggest that GH plays an important role in a number of tissues in which it conditions maturation and development.

Isolated atrial myocardial infarction: pathological and clinical features in 10 cases.

Isolated myocardial infarction of the atria is a relatively understudied and underestimated entity, rarely diagnosed in life. The pathological and clinical features in 10 cases of acute isolated atrial myocardial infarction are reported. They represent 3.5% of all myocardial necrosis out of a series of 2,704 consecutive autopsies in adults. The right atrium is more frequently involved than the left atrium (9:1). Pulmonary hypertension, with or without coronary arterial narrowing, is the major condition leading to isolated atrial infarction. Congestive heart failure, thromboembolic phenomena, and supraventricular arrhythmias are the most frequent complications of atrial infarction. The electrocardiographic findings are often non-specific and elusive and are not useful to a correct diagnosis. These observations suggest that isolated atrial myocardial infarction is a well-distinct entity with respect to ventricular myocardial infarction, since there are several differences between the 2 diseases in pathogenesis, diagnosis, clinical picture, and prognosis.