Impact of Helicobacter pylori on multiple sclerosis-related clinically isolated syndrome.

OBJECTIVES: There are no data regarding the relationship between Helicobacter pylori infection (Hp-I) and clinically isolated syndrome (CIS) suggestive of multiple sclerosis. The purpose of this pilot study was to investigate the association between active Hp-I, confirmed by histology, and CIS and to evaluate the impact of Hp eradication on the CIS clinical course. MATERIAL AND METHODS: We conducted a study on 48 patients with CIS and 20 matched controls. At baseline, apart from histology, serum anti-Hp-specific IgG titer, inflammatory mediators, and HLA-A, HLA-B, HLA-DR genetic polymorphisms were estimated. Hp-positive patients received standard triple eradication regimen, and all patients were followed up for 2 years. RESULTS: The prevalence of Hp-I was significantly higher in patients with CIS (43/48, 89.6%) than in control (10/20, 50%) (P < 0.001, OR: 8.6, 95% CI: 2.4-30.8). When compared with controls, patients with CIS also showed significantly higher serum anti-Hp IgG titer and HLA-A26, HLA-A30, and HLA-B57 frequencies. Hp-positive patients also showed higher serum concentrations of inflammatory cytokines and homocysteine. At 2-year clinical endpoint, in the subgroup of CIS patients with successful Hp eradication, the number of patients who presented with a second episode was significantly lower accompanied by significant improvement in mean Expanded Disability Status Scale score. CONCLUSIONS: Hp-I seems more frequent in a Greek CIS cohort and its eradication might delay CIS progression, suggesting a possible link between Hp-I and CIS.

Postoperative adhesion prevention using a statin-containing cellulose film in an experimental model.

BACKGROUND: Intraperitoneal adhesions are a common problem in abdominal surgery. The aim of this study was to compare the effectiveness of Statofilm, a novel antiadhesive film based on cross-linked carboxymethylcellulose and atorvastatin, with that of sodium hyaluronate-carboxymethylcellulose (Seprafilm(®)) in the prevention of postoperative intraperitoneal adhesions in rats. METHODS: One hundred male Wistar rats underwent a laparotomy and adhesions were induced by caecal abrasion. The animals were allocated to five groups: a control group with no adhesion barrier, Seprafilm(®) group, placebo group with a film containing carboxymethylcellulose without atorvastatin, and low- and high-dose groups with films containing carboxymethylcellulose and atorvastatin 0·125 and 1 mg per kg bodyweight respectively. Adhesions were classified by two independent surgeons 2 weeks after surgery. Caecal biopsies were obtained for histological evaluation of fibrosis, inflammation and vascular proliferation. RESULTS: All antiadhesive film groups (Seprafilm(®), placebo, low-dose and high-dose) had statistically significant adhesion reduction compared with the control group (P < 0·001, P = 0·015, P < 0·001 and P < 0·001 respectively). The low-dose Statofilm was superior to Seprafilm(®) in terms of adhesion prevention (P = 0·001). Adhesions were present in three-quarters of rats in the Seprafilm(®) group, but only one-quarter in the low-dose Statofilm group. CONCLUSION: The data suggest that the newly developed adhesion barrier Statofilm has better results than Seprafilm(®) in preventing postoperative adhesions in rats. A low-dose atorvastatin-containing film, such as Statofilm, could be evaluated for future clinical application.

Epithelial splenic cysts and life-threatening splenic rupture.

BACKGROUND/AIM: Primary splenic cysts are relatively uncommon and in the majority of cases are classified as epithelial cysts which are more frequent in young patients. Most of them are asymptomatic, and they are found incidentally during imaging techniques or laparotomy. We report two rare cases of patients with epithelial splenic cysts as an incidental finding during emergency laparotomy for splenic rupture. MATERIALS AND METHOD: The first patient was a 70-year-old man who presented with symptoms of acute abdomen after intensive cough during an episode of asthma. Emergency laparotomy findings were splenic rupture and intraperitoneal haemorrhage. A splenectomy was performed and the histological examination showed a ruptured spleen with an epithelial cyst. The second patient was a 19-year-old man who was transferred to the Emergency Department in hypovolemic shock due to intraperitoneal bleeding after a blunt abdominal injury. During laparotomy a splenic rupture was found, and an epithelial cyst. CONCLUSION: Epithelial splenic cysts are a rare entity and they can be an incidental finding during the surgical treatment of a spleen rupture and haemoperitoneum. These cysts may be a predisposing factor to splenic rupture in cases of increased intraabdominal pressure or blunt abdominal trauma.

An immunohistochemical study of mechanoreceptors in lumbar spine intervertebral discs.

There are limited data concerning mechanoreceptors in normal human lumbar intervertebral discs. The aim of our study was to determine the types of mechanoreceptors in the two lower intervertebral discs in normal adult cadaveric donors and to review the literature. Twenty-five lumbar (L4-5 and L5-S1) intervertebral discs were retrieved from 15 fresh cadavers. We utilized immunoreactivity against the S-100 protein to localize specialized nerve endings. Immunoreactivity showed receptors in 92% of discs. The most frequent type had morphology resembling the Ruffini type receptor (88%), followed by the Golgi type. Free nerve fibers were frequently present. All neural structures were found in the superficial layers of the annulus fibrosus, in longitudinal ligaments, or between these two. The anterior part of the L5-S1 disc had a greater frequency of encapsulated receptors than the other parts (p=0.022), which may be correlated with the high shear forces to which the lumbosacral junction is subjected.

Long-term follow-up of a non-infantile desmoplastic ganglioglioma.

Desmoplastic gangliogliomas are mixed cerebral tumors traditionally reported in infants. However, a few non-infantile cases have been documented. A case of a desmoplastic ganglioglioma in a 16-year male is presented. The patient reported severe headaches. Radiological examination revealed a large mass occupying the right frontal lobe. The lesion was totally excised. Histopathological examination confirmed the diagnosis of a desmoplastic ganglioglioma. The postoperative course was excellent. At the 10(1/2) year follow-up there was no evidence of tumor recurrence. Although desmoplastic gangliogliomas have aggressive features, complete surgical removal is the treatment of choice obviating the need for adjuvant therapy.

ERBB2 (HER2) protein expression in uterine sarcomas.

PURPOSE: Multiple clinical trials in recent years have shown that breast cancer patients with primary tumors overexpressing ERBB2 can be effectively treated with specific forms of modern anti-ERBB2-targeted therapy. The aim of the present study was to analyze the expression of the ERBB2 (HER2) protein in uterine sarcomas, in order to investigate the possibility of applying this treatment modality in uterine sarcomas. METHODS: The expression of ERBB2 has been analyzed immunohistochemically in formalin-fixed paraffin-embedded primary uterine sarcomas (n = 11). RESULTS: Using a semi-quantitative immunohistochemical score, we found that ERBB2 expression was very weak in the majority of tumors, with only three sarcomas showing moderate ERBB2 expression. Published studies evaluating the same issue in small numbers of uterine sarcomas reached similar findings. CONCLUSION: Overall, ERBB2 expression appears to be weak in uterine sarcomas. However, targeted treatment might still be feasible in a subgroup of patients with uterine sarcomas overexpressing ERBB2.

Virilizing ovarian hilus (Leydig) cell tumor with concurrent contralateral hilus cell hyperplasia: a rare diagnosis.

Ovarian hilus or Leydig cell tumor and ovarian hilus cell hyperplasia are rare clinical entities, causing virilization in both pre- and postmenopausal women. Differentiation between these two conditions is not always straightforward; the former is usually unilateral appearing as a single, grossly visible, circumscribed mass of hilus cells, while the latter is usually bilateral, appearing as diffuse microscopic aggregates of hilus cells. We report herein an extremely rare case of ovarian hilus or Leydig cell tumor, presenting concurrently with contralateral ovarian hilus cell hyperplasia in a postmenopausal woman with virilization. To the best of our knowledge, only four such cases have been previously reported in the literature. Ovarian hilus cell tumors and hilus hyperplasia almost always have benign biological behavior, thus making bilateral salpingo-oophorectomy an appropriate and sufficient therapeutic approach.

A rare case of renal cell carcinoma metastasizing to the uterine cervix.

Metastatic tumors to the uterine cervix originating from malignancies in other organs are very rare. A case of a 45-year-old white woman presenting with vaginal bleeding, due to renal cell carcinoma metastasizing to the cervix, is reported. The patient had been treated four years and five months earlier due to two primary malignancies: colon adenocarcinoma and renal cell carcinoma. After D&C, microscopic examination and immunohistochemical staining showed that the tumor was metastatic, originating from the renal cell carcinoma. Radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node resection followed, and postoperatively the patient received targeted therapy with sutinib malate. The possibility of metastasis from another primary should be considered in the differential diagnosis of tumors of the uterine cervix in order to plan optimal management.

A breast fibroadenoma mimicking an extranodal deposit of Hodgkin's lymphoma in 67Ga imaging.

We present the case of a young woman with classical nodular sclerosing Hodgkin's lymphoma (clinical stage IIB). During staging work-up, intense gallium-67 ((67)Ga) accumulation in a left breast lump raised the suspicion of an extranodal deposit, but biopsy favoured a benign histology. A post-treatment (67)Ga scan showed complete remission of the disease with normal tracer uptake in the left breast. However, a few months after treatment, a faint left mammary concentration of (67)Ga was observed. The breast mass was excised and histopathology was consistent with fibroadenoma. This unusual presentation is a new addition to the literature on false-positive (67)Ga findings and chemotherapy-associated tracer changes.

Primary cutaneous T-cell-rich B-cell lymphoma: a case report and literature review.

T-cell-rich B-cell lymphoma (TCRBCL) is a recently recognized B-cell lymphoma variant, characterized by a minor population of neoplastic B-cells existing in a background of predominant reactive T-lymphocytes. It is a rare entity, accounting for approximately 1 to 2% of all non-Hodgkin's lymphomas. It has both nodal and extranodal presentation. Primary cutaneous TCRBCL is an extremely rare lymphoma and only 16 cases have been documented thus far in the medical literature. We report the case of a 46- year-old man that presented with a slowly-growing, painless skin nodule on the left temporofrontal region of the scalp. A complete surgical excision was performed and histological examination revealed diffuse infiltration of the dermis by TCRBCL. A complete surgical excision of the skin lesion and systemic chemotherapy seems to have been effective because the patient is disease-free 2 years after the initial diagnosis was made. This study reports a very rare case of TCRBCL presented primarily in the skin. Because of its rarity, it is especially important to make the correct diagnosis using the appropriate immunohistochemical stains and apply the proper therapy.

Primary adrenal lymphoma presenting as Addison's disease. Case report and review of the literature.

Primary Adrenal Lymphoma (PAL) is a very rare clinical entity. Adrenal insufficiency is a common complication of this pathology. Most patients present with clinical and laboratory findings of adrenal insufficiency and bilateral enlargement of the adrenal glands. We present a 78-year-old woman admitted to our institution with typical clinical and laboratory findings of adrenal insufficiency. Computerized tomography (CT) of the abdomen revealed bilateral enlargement of the adrenal glands. The patient was eventually diagnosed with a diffuse large B-cell lymphoma after a CT-guided needle adrenal biopsy and treated with combined immuno-chemotherapy (R-LPD-COP). Twenty months after the initial evaluation, she is in good condition, with no signs of adrenal insufficiency.

KIT protein expression in uterine sarcomas: an immunohistochemical study and review of the literature.

PURPOSE: The aim of the present study was to investigate the possibility of treating uterine sarcomas with imatinib mesylate. Imatinib mesylate, a selective tyrosine kinase inhibitor, is very efficient against mesenchymal tumors of the gastrointestinal tract, known as GISTs. Imatinib mesylate acts against a tyrosine kinase encoded by the KIT gene in GISTs, and is more effective in tumors expressing this protein. METHODS: Expression of KIT was analyzed immunohistochemically (n = 12) in formalin-fixed paraffin-embedded primary uterine sarcomas. RESULTS: Using a semi-quantitative immunohistochemical score we found that KIT expression was very weak in the majority of tumors, while none of the uterine sarcomas tested showed strong expression. Overall, published studies addressing this issue in small series of uterine sarcomas yielded similar results. CONCLUSION: Current data suggest that it is unlikely that imatinib mesylate could be used effectively as a single agent in patients with uterine sarcomas.

Normal development of fetal hepatic haematopoiesis during the second trimester of gestation is upregulated by fibronectin expression in the stromal cells of the portal triads.

OBJECTIVE: in midtrimester fetuses the principal site of hematopoiesis is the liver. In hematopoietic organs, stromal cells such as fibroblasts, epithelial cells, and macrophage-like cells develop networks to maintain hematopoiesis, i.e. hematopoietic stem cell self-renewal, proliferation, and growth, by interaction with hematopoietic progenitor cells. ECM glycoproteins produced by the stromal cells are known to play a critical role in the regulation of cell growth and differentiation. Numerous soluble and membrane-bound factors directly regulating haematopoiesis have been documented, but little is known about fetal hepatic stromal cell activity and stromal extracellular matrix protein-fibronectin, on fetal hepatic haematopoiesis. The binding of late stage erythroid cells to fibronectin has been well characterized and is believed to be critical for the terminal stages of erythroid differentiation. The intention of this article is to determine the role of fibronectin in fetal hepatic hematopoietic proliferation and differentiation in different stages of development. MATERIAL AND METHOD: we examined and compared the immunohistochemical expression of fibronectin in the hepatic stromal portal fields in the 1st, 2nd, and 3rd trimester of gestation respectively, in relation to the appearance of CD34 progenitor hematopoietic, stromal progenitor and vascular endothelial positive cells. RESULTS: our results demonstrated a quantitative difference in the second trimester of gestation concerning the expression of fibronectin in the connective tissue stroma of the hepatic portal fields over the equivalent expression of the protein in the first (p < 0.0001, t-test) and third trimester (p < 0.0001, t-test). Similar changes in the above period were found concerning the expression of CD34 during the second trimester of gestation, over the first (p < 0.0001, t-test) and third trimesters (p < 0.0001, t-test), suggesting a direct involvement of fibronectin in the sustaining of hematopoietic activity. CONCLUSIONS: our data provide evidence that an ECM glycoprotein component, fibronectin, plays a relevant role in hematopoiesis through interaction between stromal cells and hematopoietic progenitor cells.

Induction of hepatic haematopoiesis with fibronectin expression by EMT stromal cells during the second trimester of development.

In an initial period of vertebrate phylogeny (bone marrow-less vertebrates), lymphohaematopoiesis takes place in numerous organs containing a suitable microenvironment. Among other organs (i.e., gonads, kidney and spleen), the liver is apparently the most appropriate site for homing and differentiation of haematopoietic cell precursors. Interaction between haematopoietic cells and stromal cells is important for regulation of haematopoiesis. Numerous soluble and membrane-bound factors directly regulating haematopoiesis have been documented, but little is known about the effect of the foetal hepatic epithelial-to-mesenchymal transition (EMT) stromal cells' activity and their product-fibronectin, on foetal hepatic haematopoiesis. The binding of late-stage erythroid cells to FN has been well characterised and is believed to be critical for the terminal stages of erythroid differentiation. The intention of this article is to provide a quantitative overview of FN, produced by hepatic EMT stromal cells, in foetal hepatic haematopoiesis during the first and second trimester of development. Paraffin-embedded specimens from the liver of 30 human embryos in the first and second trimesters of gestation were investigated by conventional histology and immunohistology for the presence of FN and specific haematopoietic cell types. The staining intensity, and localisation of FN and haematopoietic markers in sequential sections were examined. Furthermore, double immunohistochemical staining was performed to assess simultaneous detection of FN and haematopoietic markers. FN was expressed in the EMT stromal cells of the hepatic portal triads more strongly during the second trimester than the first. Furthermore, an intense immunostaining for haematopoietic lineages, and especially for erythropoiesis, was observed in the second trimester compared to the first. The results of the double immunostaining disclosed an intimate co-expression of the FN and CD haematopoietic markers. Foetal hepatic EMT stromal cells provide a unique microenvironment that supports the emergence, expansion and maintenance of human foetal haematopoietic development during the mid-gestational stage. FN produced by the EMT stromal cells follows a time course parallel to that of haematopoiesis. We suggest that in foetal liver, phenotypic modifications of EMT stromal cells expressing FN concerning the cell adhesion capacity of the protein are associated with proliferation and differentiation of specific haematopoietic cell lineages during the second trimester of gestation, probably reflecting the increasing demand of the growing foetus for mature erythroid and myeloid cells.

High grade primary adrenal intravascular large B-cell lymphoma manifesting as Addison disease.

We report a rare case of a 68 aged male who presented with adrenal failure and was diagnosed of high grade large B-cell lymphoma primarily arising in the adrenal glands. The patient was administrated with additional chemotherapy but he passed away 7 months later due to infection in the lungs. Intravascular lymphoma should be suspected in patients with bilateral adrenal masses who present with rapidly progressive adrenal insufficiency.

Epidermoid splenic cyst presented as huge splenic abscess: a case report.

Epidermoid splenic cysts are very rare. Symptoms emerge because of enlargement, infection, haemorrhage or rupture. Although splenectomy is indicated for large cysts, minimally invasive and preservation procedures, such as partial splenectomy or total cystectomy with splenorrhaphy, have been increasingly used during the last decade. We report herein the case of a 16-year old female presented with left upper abdominal quadrant pain, fever and abdominal distention treated in our department.

Oral complaints caused from metastases to the mandible and maxilla.

Jaw bone disorders causing oral complaints are common in primary care settings. Most of these conditions are of a chronic and benign nature. However they also may be the symptoms of a primary or secondary malignant process in the bone. The most common malignant bone tumor is metastatic carcinoma, and tumors arising in the breast, prostate, thyroid, lung and kidney have a special propensity to spread to bone. Yet metastases to the bones are rare; less than one per cent of all neoplasms metastases to the maxillofacial area. We describe four cases of metastatic tumours to the jaws. Two cases originated from the thyroid gland while the rest were from the oesophagus and the liver respectively. Three lesions occurred in the mandible and one in the maxilla. Patients presented with oral discomforts disregarding the primary tumor. Physicians who frequently advise patients with oral complaints should keep in mind that whereas these symptoms are mostly of a chronic and benign nature, metastases from a malignant tumor must be included in the differential diagnosis.

Normal development of fetal hepatic haematopoiesis during the second trimester of gestation is upregulated by fibronectin expression in the stromal cells of the portal triads

Objetivo: en el segundo trimestre de la gestación, el principalfoco de hematopoyesis del feto es el hígado. En los órganoshematopoyéticos, las células del estroma, como fibroblastos,células epiteliales y células de tipo macrófago, desarrollan redespara mantener la hematopoyesis, es decir, la auto-renovación,la proliferación y el crecimiento de las células madre hematopoyéticas,al interactuar con las células progenitoras hematopoyéticas.Se sabe que las glucoproteínas de la MEC producidaspor las células del estroma desempeñan un papel crítico enla regulación del crecimiento y la diferenciación celulares. Sehan documentado numerosos factores solubles y de membranaque regulan directamente la hematopoyesis, pero se sabe pocode la actividad de las células del estroma hepático y de laproteína (fibronectina) de la matriz extracelular en el feto en relacióncon la hematopoyesis hepática. La unión de las célulaseritroides tardías a la fibronectina está bien tipificada y se creeque es crítica para las etapas terminales de la diferenciación eritroide.La intención de este artículo es determinar el papel dela fibronectina en la proliferación y diferenciación hematopoyéticadel hígado fetal en las distintas etapas del desarrollo.Material y método: examinamos y comparamos la expresióninmunohistoquímica de fibronectina en los campos portalesdel estroma hepático durante los trimestres primero, segundoy tercero del embarazo en relación con la aparición decélulas progenitoras hematopoyéticas CD34, progenitoras delestroma y endoteliales vasculares, respectivamente.Resultados: nuestros resultados mostraron una diferenciacuantitativa en cuanto a expresión de fibronectina en el estromadel tejido conjuntivo de los campos portales en el segundotrimestre de embarazo respecto al primero (p < 0,0001, pruebade la t) y respecto al tercero (p < 0,0001, prueba de la t). Sehallaron también cambios similares en cuanto a la expresión deCD34 respecto al primer (p < 0,0001, prueba de la t) y el tercertrimestres (p < 0,0001, prueba de la t), lo que indica la participacióndirecta de la fibronectina en el mantenimiento de laactividad hematopoyética

Objective: in midtrimester fetuses the principal site ofhematopoiesis is the liver. In hematopoietic organs, stromal cellssuch as fibroblasts, epithelial cells, and macrophage-like cells developnetworks to maintain hematopoiesis, i.e. hematopoietic stemcell self-renewal, proliferation, and growth, by interaction withhematopoietic progenitor cells. ECM glycoproteins produced by thestromal cells are known to play a critical role in the regulation of cellgrowth and differentiation. Numerous soluble and membraneboundfactors directly regulating haematopoiesis have been documented,but little is known about fetal hepatic stromal cell activityand stromal extracellular matrix protein-fibronectin, on fetal hepatichaematopoiesis. The binding of late stage erythroid cells to fibronectinhas been well characterized and is believed to be criticalfor the terminal stages of erythroid differentiation. The intention ofthis article is to determine the role of fibronectin in fetal hepatichematopoietic proliferation and differentiation in different stages ofdevelopment.Material and method: we examined and compared the immunohistochemicalexpression of fibronectin in the hepatic stromalportal fields in the 1st, 2nd, and 3rd trimester of gestation respectively,in relation to the appearance of CD34 progenitor hematopoietic,stromal progenitor and vascular endothelial positive cells.Results: our results demonstrated a quantitative difference inthe second trimester of gestation concerning the expression of fibronectinin the connective tissue stroma of the hepatic portalfields over the equivalent expression of the protein in the first (p <0.0001, t-test) and third trimester (p < 0.0001, t-test). Similarchanges in the above period were found concerning the expressionof CD34 during the second trimester of gestation, over thefirst (p < 0.0001, t-test) and third trimesters (p < 0.0001, t-test),suggesting a direct involvement of fibronectin in the sustaining ofhematopoietic activity