[Qualitative and quantitative parameters for prognosis in renal carcinoma in early and advanced stages]. / Parametri qualitativi e quantitativi per la prognosi del carcinoma renale in stadio precoce ed avanzato.

AIM OF THE STUDY: A minority of stage I renal cell cancers have a bad prognosis, a minority of those in stage II-IV may behave favorably. Are there parameters which characterize such cases? In this study, a number of qualitative and quantitative parameters are used to detect differences between cases with at least 9 years of survival and those with a survival of less than 9 years. MATERIAL AND METHODS: 133 cases of renal cell cancer were subdivided into stage subgroups: Robson's I; Robson's II-IV. The following data and parameters were registered and/or measured: sex, stage, tumor size, histological type, mean nuclear profile area (mA) and pleomorphism (standard deviation of mean nuclear profile area--SDA) nuclear grade (NG) and combined nuclear grade (CNG), DNA index, cell proliferation, as determined by mitotic index (MI), per cent of PCNA positive cells (PCNA + cells %), per cent of S-phase cells (SP cells %), p53 and EGFR expression, intratumoral T lymphocytes. RESULTS: Older patients have a worse prognosis independently of the stage. Stage is the most discriminant qualitative parameter; tumor dimensions and both nuclear and combined nuclear grade are important too. Mean nuclear profile area and pleomorphism are also discriminant, while no prognostic value of histological type is shown and histology is not related to other parameters. Higher DNA index characterizes cases with worse prognosis, as well as MI, SP cells %, PCNA + cells %, and EGFR expression. No significant differences are detected for p53 expression and lymphoid infiltrates. A minority of patients with stage I tumors die within 9 years of diagnosis. They are older than survivors with the same stage, their tumors have larger nuclear area and greater pleomorphism, and are more frequently aneuploid with higher DNA index. A minority of patients with stage II-IV tumors survive at least 9 years from the time of diagnosis. They are younger than non-survivors in the same stages and have lower MI and PCNA positivity in the tumors, while other parameters are not discriminant.

[Video laparoscopic cholecystectomy in a case of biliary lithiasis associated with gallbladder tuberculosis. Considerations and review of the literature]. / Videolaparocolecistectomia in un caso di litiasi biliare associata a tubercolosi della colecisti. Considerazioni e revisione della letteratura.

The authors report a case of gallbladder stones with tuberculosis of gallbladder, operated for laparoscopic cholecystectomy. From the review of the literature two basic data stand out: the exceptionality of gallbladder's tuberculosis with stones at the same time and the opportunity to make the diagnosis of tuberculosis of the gallbladder only by the histological examination after cholecystectomy.

Incidence rates of leukemias, lymphomas and myelomas in Italy: geographic distribution and NHL histotypes.

The annual incidence of non-Hodgkin's lymphomas is increasing by 3 to 4% in different parts of the developed world, while rates for Hodgkin's disease, myelomas and leukemias are more stable. In the case of this group of malignancies, hypothesis generation on risk factors has been limited by the use of the ICD classification in mortality and incidence statistics. We have computed incidence rates in different Italian areas after careful re-classification of diagnoses, and considering specific histotypes (Working Formulation for NHL, Rye's classification for HD). While no particularly interesting pattern is suggested for Hodgkin's disease (even after considering specific Rye subgroups), multiple myeloma and leukemias, for non-Hodgkin's lymphomas the high rate in one agricultural area (Forli) was mainly due to the A sub-group in the Working Formulation (low-grade). In a heavily industrialized area (Varese), the high incidence rate was at least partly explained by a higher proportion of cases classified in the G sub-group (intermediate grade). Excesses of non-Hodgkin's lymphomas have been observed in populations exposed to phenoxy-acetic-acid herbicides, to insecticides and to organic solvents. One can hypothesize that different risk factors act on different stem cells and induce lymphoid malignancies belonging to different histologic sub-types.

[Cerebrotendinous xanthomatosis. A case report]. / Xantomatosi cerebrotendinea. Presentatazione di un caso.

We describe a patient with cerebrotendinous xanthomatosis (CTX) who saw a Rheumatologist because of joint and muscle pain in the lower limbs. Clinical examination did not reveal any classic joint disease; however, tendon lesions and clumsy gait were noted. The patient presented with a swollen Achilles tendon bilaterally and a parapareto-spastic gait; Babinski sign was positive on the right side, and hyperreflexia of both lower limbs could be demonstrated. As bilateral cataracts were present, we have interpreted the aforementioned signs as CTX with spinal involvement; mean plasma cholesterol was increased, thus confirming the diagnosis. The primary biochemical abnormality of this disease is a defect in the synthesis of bile acids; therefore, chenodeoxycholic acid (CDCA) has been tried, and beneficial effects following CDCA treatment, especially in the early stages of CTX, have been reported in the literature. We report this case because of the severity and the rarity of this disease, and also because of its hereditary transmission. Our aim is to underline the need of a precocious diagnosis, in order to prevent a further progression of the disease; this therapeutic goal can now be achieved, thanks to the therapeutic regimens recently developed.

Epstein-Barr virus infection in sinonasal non-Hodgkin's lymphomas.

Sinonasal non-Hodgkin's lymphomas (SNHLs) of B- or T-cell immunophenotype have been associated with Epstein-Barr virus (EBV) infection of neoplastic lymphoid tissue. Nine SNHLs were investigated using immunohistochemistry, the polymerase chain reaction (PCR) for EBV genome and in situ hybridization (ISH) for EBV encoded RNAs (EBER), immunoglobulin (CI-gHR) and clonal T-cell receptor (CTC beta R) gene rearrangements. Eight cases were diagnosed as peripheral pleomorphic T-cell lymphomas (pPTCL). PCR showed the presence of EBV genome in eight cases; ISH for EBER led to the detection of positive cells in five cases. Late membrane protein (LMP) immunostaining was observed in three cases. No EBV positivity has been detected in control cases. The frequent association with EBV infection in the cases illustrated confirms the previous suggestions that EBV may have a role in the genesis of lymphomas of the sinonasal region.

Primary branchiogenic carcinoma - immunohistochemical and ultrastructural features - a case-report and review of the literature.

A case with histological evidence of malignancy developed in a branchial cleft cyst (BCC), which conforms with the criteria for primary branchiogenic carcinoma (PBC) was analyzed by electron microscopy and immunchistochemistry; our findings reveal peculiar analogies between PBC and BBC, further supporting the primitive nature of the lesion.

Epstein-Barr virus and gastric cancer: data and unanswered questions.

Sixty-five unselected cases of gastric cancer have been analysed for EBV DNA by polymerase chain reaction, in situ hybridization and immunohistochemistry for CD21 antigen expression. Four cases were found EBV-positive by PCR, while ISH yielded positive results in 3 of these cases, demonstrating EBV in the nuclei of cancerous cells. CD21 antigen was expressed in cancerous cells in all 3 ISH-positive cases. All the EBV-positive cancers of the present series were poorly to moderately differentiated adenocarcinomas with prominent lymphoid infiltration. These results are discussed also on the basis of the literature.

Identification of monoclonal B-cell populations in lymphoid infiltrates of lacrimal gland by rapid cycle polymerase chain-reaction.

Lymphoid hyperplasia of lacrimal gland may be difficult to be differentiated from lymphomas on the basis of morphology and immunohistochemistry. The results of this study indicate that polymerase chain reaction should be employed for confirming the diagnosis of lymphoma in cases with histological and immunophenotypical characteristics of lymphomas, and for detecting monoclonal lymphoid cells in an otherwise non-lymphomatous but dubious or borderline morphological context.