Histological changes in odontogenic parakeratinized keratocysts treated with marsupialization followed by enucleation.

BACKGROUND: The purpose of this study was to evaluate whether marsupialization treatment induces changes in the histology of odontogenic keratocyst epithelium and to compare our experience with the literature. MATERIAL AND METHODS: A retrospective revision of histological samples was performed. 5 patients with odontogenic keratocyst treated with marsupialization follow by enucleation were selected. Histologic evaluation analyzed the changes in the keratocyst epithelium after marsupialization in terms of type of keratinization, thickness of the epithelium and connective tissue, the presence of acanthosis, the presence and grade of fibrosis, the type and grade of inflammation and the presence and number of mitotic figures and daughter cysts. RESULTS: In our case series, a variation of para-keratinized into ortho-keratinized keratocyst was found in one case, and no significant increases were observed in the epithelium and capsule thickness, or even in the level of inflammation. However, we observed an increase in fibrosis and qualitative changes in inflammation type. CONCLUSIONS: Minor and major histological changes were associated with reduction in cyst volume, which resulted in a simpler and less invasive cystic enucleation after marsupialization.

An outbreak of cutaneous leishmaniasis in Modena province (Northern Italy): report of 35 cases.

Canine Leishmaniasis is a disease endemic in many parts of Europe, carried by insects of phlebotomous species. Humans are occasional hosts of the parasites. Cases of human leishmaniasis have been registered in Italy, particularly in the southern and coastal regions. In the period 1997-2016, we collected a series of 35 patients affected by cutaneous leishmaniasis, uncovered by skin biopsy and histological examination, 21 of them found in last 3 years. The patients, 28 males and 7 female, aged between 19 and 91, resided in a restricted area of Northern Italy, and none, but two, had travelled abroad. Lesions presented clinically mostly as single nodule or plaque, often ulcerated, and involved predominantly head-neck and upper extremities. Histology showed a diffuse, granulomatous inflammation including numerous plasma cells. Variable numbers of amastigotes were visible, usually in the superficial part of the dermis, in all cases but two. In these two cases, highly suspicious by clinico-pathologic features, PCR analysis allowed to achieve the correct diagnosis. Our attention was then focused on the geographical residence of the patients, that turned out to be mostly in the piedmont area, whereas only one lived in the alluvial area corresponding to Padana plain. These data underline the diffusion of phlebotomus in northern areas of Italy, and particularly on the hills, characterized by a type of soil more favorable to vector survival; also, they indicate the adaptation of leishmania to hosts other than dogs, such as foxes and small rodents. Histology alone resulted sufficient to make diagnosis in most cases, but PCR analysis is recommended in those cases showing a suspicious background, in absence of amastigotes.

The impact of field cancerization on the extent of duct carcinoma in situ (DCIS) in breast tissue after conservative excision.

AIM: Aim of the present study is to evaluate the risk of residual neoplastic foci, in patients treated with breast conservative surgery, based on duct carcinoma in situ (DCIS) grading. MATERIALS AND METHODS: The study is based on a retrospective analysis of 419 resection specimens relative to 161 patients. All these patients underwent surgical re-excision when the first specimen had shown one or more margins involved by DCIS. Margins were oriented and the side of margin involved was recorded. Clonal analysis, using the mitochondrial DNA (mtDNA) technique, was obtained in selected cases. RESULTS: Residual neoplastic foci were found in 145 out of 419 (34.6%) re-excised specimens. Specifically, residual foci of DCIS grade 2 and 3 were found more frequently in the margin facing the nipple (33.3% and 51.6%, respectively). On the contrary foci of DCIS grade 1 did not show any specific distribution. Clonal mt DNA analysis evidenced that DCIS grade 3 foci present in the re-excision specimens were genetically similar to the tumor removed in the first specimen, while DCIS grade 1 foci were not clonally related each other. CONCLUSIONS: The present data further confirm that DCIS grade 3 is characterized by a circumscribed neoplastic process extending along the large ducts probably of a single mammary lobe. On the contrary DCIS grade 1 is characterized by multiple independent neoplastic foci, dispersed through several lobes indicating a field where multiple independent foci of cancer harbor.