[Adhesion the vaccination against HPV in ASL of L'Aquila]. / Adesione alla vaccinazione contro l'HPV nella ASL dell'Aquila.

Sexually transmitted human papillomaviruses (HPVs) are responsible for anogenital infections and tumours. Types 16 and 18 cause 70% of cervical carcinomas, the incidence of which is higher among young women. The aim of this study was to evaluate the propensity of mothers to have their 12-year-old daughters vaccinated against HPV and identify the variables that may influence their agreement, such as their kowledge of HPV and its relationship with cervical cancer. A 17-item questionnaire was anonymously administered to 312 mothers of girls born in 1997 who were invited to undergo vaccination by their local health authority. The results were analysed using the chi-squared test and STATA 9 statistical software. The analysis showed that 69% of the mothers had had their daughters vaccinated, that most of them know about HPV but only 20% clearly understood the relationship between HPV and cancer Acceptance of the vaccination seems to be associated more with a general predisposition to vaccinate than with a knowledge of HPV and its causal relationship with cervical carcinoma. This indicates a need for educational/ information programmes before and during the vaccination cycle.

Congenital mesoblastic nephroma: report of a Case with review of the most significant literature.

AIMS AND BACKGROUND: Congenital mesoblastic nephroma (CMN) is a rare pediatric tumor of the kidney with the highest peak of incidence during the first 3 postnatal months. It has previously been confused with Wilms' tumor (which, on the contrary, is rare during the first six months of age and is still considered a histogenetic congener). CMN almost always has a favourable prognosis. Therefore, CMN needs to be correctly diagnosed and differentiated from other pediatric renal neoplasms. Two morphological subtypes are currently distinguished histologically: the classical or leiomyomatous type and the atypical or cellular type. Mixed forms with a combination of the two patterns are also on record. Recurrence and even tumor-related death have been described in the literature and always related to the atypical form or to the mixed form, particularly in patients aged more than 3 months and in those cases in which the surgical removal was not complete. Opinions concerning post-surgical clinical management, especially in regard to adjuvant therapy, are not unanimous. METHODS: A case of CMN, predominantly of the classical histological subtype diagnosed in a baby with a follow-up of 6 years, is herein presented. The tumor was discovered at birth and surgically removed after one month. Since the tumor showed a high mitotic index (one of the characteristics of the cellular subtype) and the perirenal fat was focally involved with the tumor, the possibility of giving adjuvant chemotherapy was considered. Flow cytometric analysis was also performed which showed a diploid DNA content of neoplastic cells. RESULTS: The tumor was completely removed, surgical margins were free histologically, and no clear-cut histological features of the atypical subtype were noted. Flow cytometrically, it showed the euploid DNA content. Consequently no additional therapy was given. Six years after surgery the patient is developing well and is free of disease. He has regular follow-up examinations. CONCLUSIONS: CMN almost always pursues a benign clinical course if diagnosed under three months of age and if totally surgically excised independent of histological type. Criteria for management of atypical cases are not unanimous in regard to the benefit of additional therapy after surgery.

[Clear cell sarcoma of soft tissues. Clinico-pathological and ultrastructural analysis of a case in the head-neck region and a literature review]. / Il "sarcoma a cellule chiare delle parti molli". Analisi clinico-patologica e ultrastrutturale di un caso a localizzazione nella regione testa-collo e revisione della letteratura.

BACKGROUND: Clear cell sarcoma of soft tissues (CCSST), even synonymically termed malignant melanoma of soft tissues, is a peculiar malignant tumor with both a prolonged clinical course and a final poor prognosis. Whilst its neuroectodermal histogenesis is most likely, its nosological position is still a matter of debate. Light microscopy (LM), immunocytochemistry (ICC), and electron microscopy (EM) investigations have shown both a melanocytic and schwannian differentiation. Recent findings from cytogenetic analysis documenting a reciprocal translocation between the long arms of chromosomes 12 and 22 [t(12:22)(q13;q12.2)] not seen in cutaneous melanomas nor in other neurogenic sarcomas support CCSST as a distinct entity. MATERIALS AND METHODS: A case of CCSST arising in the preparotid region of a young man with a clinical history of two previous surgical interventions was admitted in 1994 and is herein reported. This patient was previously cured twice in different institutions: the first time he was diagnosed with a "melanoma, NOS" of the face and surgically treated 10 years earlier. The second time--meaning one year earlier the admission--this patient was again surgically treated for a local recurrence which was interpreted as a myoepithelioma (clear cell type) of salivary gland origin. A morphological, immunocytochemical, and ultrastructural analysis performed on the last recurrence is herein presented. RESULTS: On LM the tumor exhibited the classic morphological appearance comprised both of clear and eosinophilic cells with prominent nucleoli, focally containing cytoplasmic granules of melanin pigment. At ICC expression of vimentin and S-100 protein was diffusely demonstrated as well as the melanoma associated antigen HMB-45 was even albeit focally documented.

[Multiple Fordyce-type angiokeratomas of the scrotum. An iatrogenic case]. / Angiocheratomi multipli dello scroto, "tipo Fordyce". Su un caso ad insorgenza iatrogena.

BACKGROUND: Angiokeratoma is a wart-like vascular lesion of the skin. There are five types of angiokeratoma: the Mibelli-type, the Fordyce-type, the solitary and multiple (papular) types, the angiokeratoma circumscriptum, and the angiokeratoma corporis diffusum. The "Mibelli-type" occurs on the acral sites, mainly digits, of young people affected by repeated attacks of chilblain, which result in a deleterious effects on vessel walls. The "Fordyce-type" occurs on the scrotal skin of young and adults as a secondary effect to an increased blood pressure in scrotal veins. An equivalent form affecting adult females and occurring analogously on the skin of the vulva is also on record. The "solitary and multiple papular types" of young individuals affect the lower extremities and is considered a consequence of a congenital deficiency of elastic tissue in regional veins. We suggest the term "acquired angiokeratomas" for these three above mentioned clinical forms of angiokeratomas, leaving apart the other two types which are essentially congenital. In fact the "angiokeratoma circumscriptum" is a nevoid hamartomatous lesion arising early in life during infancy or childhood, sometimes in association with other congenital malformation of other sites, while the "angiokeratoma corporis diffusum" almost always occurs in association with enzyme disorders, usually alpha-galactosidase A enzyme deficiency (Anderson-Fabry disease), an X-linked recessive disorder affecting homozigous male patients in their adulthood. CASE REPORT: A case of multiple angiokeratomas of the scrotum (Fordyce-type) arisen in a 62-year old male patient following surgical amputation of the penis and bilateral inguino-crural lymphadenectomy for carcinoma of the penis is reported on. RESULTS AND CONCLUSION: Although they are well on record cases of angiokeratomas of the scrotum arising after surgical injuries to the outer vein pudenda (mainly following inguinocrural hernioplasty), based on a computerized search of the literature on theme this case represents the first iatrogenic example of such an occurrence. The pathogenetic mechanism leading to the the rise of angiokeratomas mediated by the increase of the blood pressure in the superficial scrotal veins is discussed. This example represents an additional case report of inevitable and sometimes unsuspected iatrogenic pathology in medicine.

[Radio-surgical-histological procedure in the diagnosis and management of non-palpable breast lesions, suspected from mammography: experience of "Casa Sollievo della Sofferenza" Hospital in San Giovanni Rotondo]. / La procedura radio-chirurgico-istologica nella individuazione e diagnosi delle lesioni impalpabili della mammella, sospette alla mammografia: l'esperienza dell'Ospedale "Casa Sollievo della Sofferenza" di San Giovanni Rotondo.

The almost 4-year long experience of the IRCCS--"Casa Sollievo della Sofferenza" hospital (FG, Italy) dealing with 165 nonpalpable breast lesions mammographically detected is herein presented. According to a protocol based on the previously as well as relatively recent described guidelines for the clinico-pathological management of such lesions, the authors underline the necessity of a strict cooperation between the radiologist, the surgeon and the pathologist. They also emphasize the perspectives derived from such a new impact, among which the most impressive is the handling and sampling of this relatively new type of material with lesions which only rarely are grossly palpable ("pseudononpalpable lesions"), whilst often they are truly non palpable being of minute sizes ("microlesions") and even grossly "invisible" ("quasi-normal fibrofatty tissue"). Of note as consequences derived from the strict adherence to this type of protocol which anyone should adhere to there are also a decrease of frozen section diagnoses, a global increase in the surgical pathology lab workload, the ban for taking away any tissue from the lesion or from the area of concern for special studies, the technical approach to the identification of microcalcifications when they are present, the new questions & answers concerning with the completeness and the adequacy of excision, the state of surgical margins of the excised specimens, and the possible existence of residual in situ or infiltrating disease. The results herein presented area in consonance with those from other institutions so confirming the high incidence both of borderline lesions and in situ malignancies (overall incidence around 28%) and of the early and minute invasive cancers (44%) usually of favourable histological types, among truly nonpalpable breast lesions.

[Nevus of Ota. Presentation of a case associated with a cellular blue nevus with suspected malignant degeneration and review of the literature]. / Il nevo di Ota. Presentazione di un caso con associato nevo blu cellulare in sospetta degenerazione maligna e revisione della letteratura.

BACKGROUND: Nevus of Ota is a melanotic pigmentary disorder ("dermal melanocytosis"), mostly congenital or acquired, involving the skin innervated by the first and the second branch of the trigeminal nerve, hence its descriptive label of "nevus fuscus coerulaeus ophthalmic and maxillaris". In more than half of patients this condition is associated with "ocular melanocytosis" ("melanosis oculi") involving the conjunctiva, the sclera, the uveal tract and possibly the optic nerve. In some cases a condition of "orbital melanocytosis" with involvement of orbital fat and periosteum by dendritic melanocytes is on record as well as in some other patients an analogous condition of "leptomeningeal melanocytosis" is present. At histology tissues from the above sites are seen infiltrated by dendritic melanocytes which can vary in number from so scarce up to so numerous that a diagnosis of a blue nevus of the common type is warranted. Sometimes the finding of a variously pigmented typical cellular blue nevus in the skin and alternatively that of heavily pigmented melanocytoma in the eye ("nevus magnocellularis") or in the meninges (so-called "melanotic meningioma") are respectively observed. MATERIALS AND METHODS: A case of cellular blue nevus with histologically uncertain malignant potential in a nevus of Ota of 30 years duration in a white female patient aged 59 is described. The lesion which was surgically totally removed grossly appeared nodular shaped and 2 cm sized. Histologically it consisted of a fairly well-circumscribed proliferation of melanocytic spindle-shaped cells growing in a vaguely fascicular pattern. On the basis of random nuclear atypicalities and pleomorphism and additionally by virtue of the presence of a few scattered mitoses (one of which was atypical) but in absence of frank necrosis a diagnosis of unpredictable biologic behaviour seemed to be warranted. The patient was closely followed-up but no adjunctive therapy given. Four years after the excision and diagnosis no local recurrence or distant metastasis has been discovered. A computerized search of previously recorded cases of melanomas in nevus of Ota was made. CONCLUSIONS: Forty-eight cases of malignant melanomas complicating this clinico-pathological setting are on record, mostly in the uveal tract, followed by locations in central nervous system, skin, and retro-orbital fatty tissue. Melanomas arising in nevus of Ota tend to be low grade lesions that do infiltrate locally but rarely metastasize. The importance of a closely dermatological and ophthalmic surveillance of patients with nevus of Ota is emphasized.

[Primary amyloid tumor of the breast. Case report and review of the literature]. / Tumore amiloideo primitivo della mammella. Osservazione di un caso e revisione della letteratura.

Along with an introductory summary concerning practically with all types of amyloidoses the authors report on a case of a primary amyloid tumor in a female patient, which resulted the eight after a computer-assisted literature search. Amyloid deposits in the breast represent an extremely rare event, which has been described in three clinical settings, in patients with reactive or secondary amyloidosis, in patients with immunocytic amyloidosis (this term including both the so-called primary form and the myeloma-associated form), and finally even in patients who are well and otherwise asymptomatic. Amyloid deposits in the breast can occur in the course of a systemic involvement as well as in form of a localized or organ-limited disease ("amyloid tumor"). Further the latter form is qualified as a "secondary amyloid tumor" (in those patients affected by certain neoplastic diseases, plasmacellular or non plasmacellular, or by a chronic infectious-inflammatory-dysreactive process) or as a " primary amyloid tumor" in those who are found free of any disease and of any other amyloid deposits. The case the authors report on deals with a lady who was admitted due to a breast lump which mammographically was thought suspicious for malignancy by virtue of a cluster of variously sized microcalcifications. At histology the lesion was diagnosed as an amyloid deposit on special stains and disclosed of the AL type with Congo red stain on sections previously treated with KMn04, according to standard methods.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tumor and tumor-like benign mesenchymal lesions of the breast]. / Lesioni mesenchimali benigne tumorali e simil-tumorali della mammella.

All the spectrum is encompassed of those miscellaneous pathologic entities occurring in the mammary stroma which are on record up to date other than "mixed fibroepithelial" tumors (fibroadenomas and phyllodes tumors) and tumors both "pure" and "mixed" originating from myoepithelium (adenomyoepitheliomas and pleomorphic adenomas). Also they were excluded those dysreactive-autoimmune diseases (sarcoidosis, sclerosing lymphocytic lobulitis, lobular granulomatous mastitis) and those inflammatory-infectious conditions (tuberculosis, actinomycosis, foreign body reactions, Mondor's disease) which can mimick breast tumors clinically or on image analysis, but on the contrary not evoking the idea of a tumor on histology. Specifically, inflammatory pseudotumor, myofibroblastoma, leiomyoma, neurinoma/neurofibroma, benign fibrous histiocytoma, hemangiopericytoma, fibromatosis, nodular fascitis, variants of lipoma, mesenchymoma, amartoma and its variants, hemangiomas, pseudoangiomatous hyperplasia of stroma, amyloid tumor, granular cell tumor, are consecutively described and discussed, with a large list of references enclosed to each rubric. Most of the pictures are taken from personally observed lesions of the breast. Only few pictures referred to are from their analogue lesions which occurred in soft parts of other locations, with specific mention of that when it was the case. Of note after reviewing the literature the fact that no glomus tumor, nor Kaposi's sarcoma either sporadic or in the context of any immunodeficiency, nor myelolipoma has been recorded yet.