Partial nodal involvement by marginal zone lymphoma. Use of IGK gene rearrangement analysis in diagnostic work-up.

Nodal marginal zone lymphoma (NMZL) is an indolent B-cell lymphoma that originates from the marginal zone of B-cell follicles. The tumour is rather uncommon, and shares some morphologic and immunophenotypic similarities with the extranodal form of marginal zone lymphomas. However, diagnosis of NMZL implies the exclusion of lymphoplasmacytic lymphoma, follicular lymphoma, and lymph node involvement by extra nodal or splenic marginal zone B-cell lymphoma In addition, its distinction from reactive conditions, including T-zone hyperplasia, are sometimes problematic based on morphologic grounds. We describe a patient who presented with cervical and inguinal lymphadenopathies and high inflammation indexes. Bone marrow and lymph node biopsies were performed for definitive diagnosis. Bone marrow histological and immunophenotypic examinations were normal and excluded haematological disease. In contrast, lymph node evaluation showed some features compatible with a possible lymphoproliferative disorder, even though no definite diagnosis could be made based on morphologic and immunohistochemical investigation. In particular, the problem of a differential diagnosis between NMZL and a florid hyperplasia of monocytoid B-elements was posed. Thus, in order to assess the nature (neoplastic vs. reactive) of the lesion, molecular analysis of the immunoglobulin genes was performed by PCR. Notably, although no clonal rearrangements were revealed by IGHV@ analysis, further evaluation of the immunoglobulin light chain (IGKV@) confirmed the presence of a clonal B-cell population. Accordingly, a final diagnosis of NMZL was made. In conclusion, this case is a good example of the crucial role of complete molecular analysis in the diagnostic work up of lymphoproliferative disorders.

[Fluorescence endoscopy in the diagnosis and treatment of superficial bladder neoplasms]. / L'indagine fotodinamica nella diagnosi e nel trattamento della neoplasia vseicale superficiale.

AIM: The results of a clinical investigation on neoplasm and bladder dysplasia detection by 5-aminolaevulinic acid (5-ALA)-induced fluorescence are reported. In this paper the authors report their experience with 5-ALA in the diagnosis, treatment and follow-up of bladder neoplasms after chemotherapy and endocavitary immunotherapy. METHODS: The 5-ALA was instilled in the bladder 2 h before bladder transurethral resection. This method has been used since December 2000 on 163 patients and a total of 266 biopsies were histologically examined. RESULTS: One-hundred and four benign and 92 malignant/dysplastic areas were biopsied; 46 malignant/dysplastic lesions were not detected during routine white-light cystoscopy but were identified with fluorescence cystoscopy. Sensitivity was 99% but specificity was low (20%). CONCLUSIONS: ALA-based fluorescence cystoscopy is a safe and simple technique that enhances the detection of flat and papillary urothelial neoplasms.

[Role of intraprostatic stents in benign prostatic hypertrophy]. / Il ruolo degli stents endoprostatici nell'ipertrofia prostatica benigna.

We report our indications and experience in the use of intraprostatic endoprosthesis. We report also our preliminary experience in the use of a new intraprostatic endoprosthesis which has been developed at our institute. This prosthesis can be easily positioned, shows little invasiveness and does not require ultrasonic, radiological or endoscopical guidance.

[Structure, physiology and physiopathology of the ureter]. / Struttura, fisiologia e fisiopatologia dell'uretere.

The function of the ureter is to transport urine from the renal pelvis toward the bladder and to protect the renal parenchyma from distally generated backflow and back pressure. The ureter manifests peristaltic activity and can adapt its mechanical characteristics to diuresis amount. The changes in ureteral function resulting from obstruction are dependent on the degree and duration of obstruction. Even the rate of urine flow, the mechanical and anatomic properties of the ureter, the nature of disease process and the age of the patient influence the response of the ureter to obstruction. It is the purpose of this report to correlate the anatomic and physiologic properties of the ureter with normal and pathologic clinical situations.

[Primary ureteral neoplasia]. / Neoplasie ureterali primitive.

From 1983 to 1992, 29 patients with primitive ureteral tumors have been recovered in our department. All the tumors were urothelial. Urography, spontaneous and selective urinary cytology, retrograde ureteropyelography permitted a correct diagnosis in 86% of them. Ureteroscopy is not performed routinely but only when conventional radiology is doubtful or a conservative treatment can be proposed. Controlled trials on endoscopic therapy of ureteral tumours are very few and even if our results are encouraging we believe that this therapeutic option is effective and safe only in selected case and nephroureterectomy is the treatment of choice.

[Ureteral complications in the treatment of gynecologic diseases]. / Complicanze ureterali nel trattamento delle affezioni ginecologiche.

Ureteral injuries are an uncommon complication after gynecological procedures. The Authors consider separately direct lesions during surgery and those following radiotherapy. For both these situations preventive criteria, which permit a lower incidence in ureteral injuries, are considered. Early diagnosis and intraoperative repair are the most important tool for surgical lesions while the exact stage of neoplasm and N.E.D. status are fundamental for lesions resulting from radiation therapy. In our opinion, best treatment of stable lesions is surgery, while endourology is not usually a definitive treatment and has only a temporary and palliative role.

[The ureter in urinary diversion]. / L'uretere derivato.

Ureteral pathology is reviewed in 297 urinary diversions, which were performed consecutively in our Department, in the last 9 years. Either cutaneous or intestinal anastomosis stricture was the most common complication. Our attempts to cure definitely this problem by endourological techniques were unsatisfactory. So the Authors conclude that surgery is usually the best option.

[Idiopathic retroperitoneal fibrosis]. / Fibrosi retroperitoneale primitiva.

Idiopathic retroperitoneal fibrosis is generally held to be uncommon. Its etiology is unknown. The disease continues to present with early bilateral ureteric involvement. Nowadays imaging techniques permit so a timely diagnosis to preserve and reduce renal damage. The optimum method of management is still controversial. Controversies on pharmacological, endourological and surgical treatment are debated. The advantages of various types of surgery are reviewed. In the urological department of the Civic Hospital in Brescia from February 1984 to June 1992, 87 patients (6 females and 2 males) with IRP were observed. Surgical treatment was combined with corticosteroids in 6 patients. Ureterolysis was performed with omental wrapping in 5 patients, with ureteric intraperitonealisation in 2 other ones. In the last case an ileal loop replacement was performed. In 5 out of 8 patients the ureteral stricture was resected and a termino-terminal anastomosis was necessary. Long-term follow-up is satisfactory. The authors conclude that omental wrapping is the safest method of choice.

[Controversies concerning the treatment of ureteral complications following kidney transplantation]. / Controversie nel trattamento della patologia dell'uretere trapiantato.

The ureteral complications after renal transplantation are urine leakage, stenosis and vesicoureteral reflux. The treatment is influenced by immunosuppression and difficult surgery (for bleeding and fibrosis). We report 8 cases with ureteral complication after renal transplantation. Stenosis were present in 5 cases: we performed ureterocystoneostomy by Politano-Leadbetter technique in 4 and pyelocystoanastomosis in 1. Vesicoureteral reflux were present in 3 cases: we preformed ureterocystoneostomy by Politano-Leadbetter technique in 2 and endoscopic infiltration with teflon of ureterovesical junction in 1. At present all patients have a normal renal function and absence of urinary tract infection.

[Comparison of prostatic biopsy guided or not guided by echography]. / Comparaison entre biopsie prostatique aveugle et sous échographie.

We studied 151 patients aged from 49 to 85 years (mean 71) with a clinical suspect of prostatic cancer. 104 underwent a transrectal digitally directed prostatic biopsy, while 47 an ultrasonically perineal guided prostatic biopsy. Transrectal fine needle aspiration was performed in the whole group. Both techniques showed a high cyto-histologic concordance: 83.6% with transrectal digitally directed biopsy, 78.7% with perineal ultrasonically guided biopsy. The ultrasound guided biopsy has been able to downset the rate of cytologic false negatives in comparison to the digitally guided biopsy. In case of pathological rectal examination, digitally directed prostatic biopsy is still available and those who haven't an ultrasound apparatus, can equally perform a traditional biopsy with a limited possibility of mistake.